FY22 Health & Human Services Virtual Budget Briefing Q & A

1. As a solution to gaps in care and safety nets, are there any discussions on establishing a per diem rate for crisis stabilization units for non SMHRF and non hospital based units?

​​​A: HFS will be launching the Crisis Intervention Services Pilot described in the 1115 waiver later in calendar year 2021. This pilot will allow short-term crisis intervention services to be provided for individuals who are experiencing a mental health crisis and who can be safely stabilized in a community based setting that is less intensive than a psychiatric hospital. HFS will be providing additional information regarding individuals who are eligible and provider requirements for participation in this pilot as that information becomes available closer to the time that the pilot will be launched.

2. Does the State anticipate that Medicaid payments will be slowed next FY due to state's financial status?

​A:  The Governor is proposing a balanced budget so therefore we are not forecasting lengthy delays in FY 22 beyond the current average payment cycles in place now. Managed Care Organizations help with payment cycles by keeping their payments around 30 days during periods when the State experiences uneven cash-flow throughout the year.

3. Will there be a public process for providers to apply for the HFS equity-centric healthcare transformation pilots announced on November 13, 2020? If so, is there an estimated time-frame for this and where will it be posted?

A: We are so excited to have just gotten approval from the Illinois General Assembly during the lame duck session to move forward on the Healthcare Transformation Proposal. We are in the process right now of creating all the materials for interested parties to review the opportunity, apply now or seek consulting assistance to potentially apply down the road. This is a multi-year effort which is targeting real, community-driven, transformation changes to the health care delivery system in the most distressed communities in Illinois. We have some preliminary information about our initial proposal and the research behind it on our website. From the main page there is a blue box on the right titled Healthcare Transformation. That will be the landing page for the materials we will be publishing in the weeks ahead.

4. Last year in his 2020 budget address, Governor Pritzker committed to providing general revenue funding for family planning service providers that were harmed by the federal Title X changes. EverThrive IL is writing to ask if HFS has concrete plans to submit a family planning state plan amendment to the Medicaid program to leverage potential federal dollars that could help Illinois fill the remaining Title X funding gap.

A: Same answer as below 1 of 3

5. Does the fiscal year 2022 budget proposed by Governor Pritzker allow for the enactment and implementation of a Family Planning State Plan Amendment? The fiscal year 2021 budget included allowances for enactment of the FP SPA but submission to CMS was delayed due to COVID and related priorities. The FP SPA is urgent and necessary to address the state's state priorities of reducing disparities in maternal mortality and morbidity. Further, the FP SPA is fiscally prudent given the 90/10 federal match for family planning services and the abundance of research on realized cost savings to Medicaid programs following investments in family planning coverage (including from the previous Illinois Healthy Women Program.) The FP SPA is urgent and needed in addition to any potential expansion and/or changes to the federal Title X program that might be coming with the new federal administration. Title X dollars cover only a small portion of the uninsured population at select sites across the state leaving many of our most low-resource Illinoisans behind.

A:  Same answer as below 2 of 3

6. As a FQHC nurse midwife, I hope the state will see the ROI for preventive services especially focused on contraceptive equity. There is no reason anyone in Illinois should have financial barriers to unbiased education and tools to decide if/when and under what circumstances to parent/be pregnant (includes male vasectomy). Budgeting in a family planning SPA will cover thousands more families which will also help insure continued healthcare coverage that can alleviate coverage concerns related to the maternal health crisis amongst black postpartum women. Research has shown, a dollar used in family planning saves $7 dollars. Also, the often referenced TX dollars available under this current administration will not impact the disparate perinatal outcomes as TX dollars are mired in administrative burdens and the FP SPA is needed to provide increase access to thousands of more people. Plus with a 90/10 FMAP, this is the definition of fiscal prudence. 

A: Answer 3 of 3

While we very much support Family Planning and have done a lot to enhance rates for and access to Family Planning services, we also have several additional priorities at this time. Continued Covid-19 response is among them, as well as numerous programs and changes that address racial and other health disparities, such as the 65+ program, vaccines, health care transformation, emphasis on contracting with minority vendors, reviewing roll out of enhanced care coordination for certain populations (esp. behavioral health), overall emphasis on re-evaluating our programs and policies for Diversity, Equity, and Inclusion impact.

H​​​igh on the priority list is getting our postpartum coverage waiver through the new federal administration and implemented. That said, we will continue to evaluate the changes from DC under the new administration around Family Planning and evaluate what that might mean for a Family Planning SPA and the timing of such.

6. What is the process for interested providers to apply to be involved in the HFS 1915c Supported Employment and Housing Waiver pilots? What provider types will be permitted to participate? Will CMHCs be included? Will DASASUPR providers be included? 

A: The Department is currently negotiating its recently submitted 1915 I State Plan Amendment with federal CMS. (These are not 1915 c services.) Subject to federal approval, the Department is proposing that Community Mental Health Centers and Behavioral Health Clinics will be eligible to offer these services, which are scheduled to begin on July 1, 2022.

7. Will the Children Crisis unit ever be able to get full re-imbursement (at the higher rate) for crisis assessments via telehealth? Right now it has to be IN PERSON, which is a cause of much distress for the clinicians as they do no want to (necessarily ) go inside someone's home

A: There are several ways that a crisis assessment may be completed without requiring staff to enter a customer's home. The guidance provided by HFS in April 2020 is referenced below to outline the response options:

Initial Crisis Intervention via Phone or Video

After receiving a referral from CARES, the SASS/MCR provider will contact the individual in crisis, or the individual who reported the crisis to CARES, via phone or video to provide initial Crisis Intervention to attempt to stabilize the crisis. If the SASS/MCR provider is able to stabilize the individual, a Crisis Screening via the Illinois Medicaid - Crisis Assessment Tool (IM-CAT) will not be required. Staff should bill for their time completing telephonic or videoconference intervention as Crisis Intervention, on-site

Crisis Screening

If the initial Crisis Intervention via phone or video does not result in a stabilization of the crisis, a Crisis Screening will be conducted.

If the SASS/MCR staff are unable to have direct access to the individual (e.g., the individual is at a location that the staff is not allowed to access, the family does not want in-person contact by MCR staff), or the SASS/MCR provider assesses the situation as clinically unsafe for clients and themselves, the staff may, under these circumstances, conduct the Crisis Screening via telephone or video. Staff should bill for their time completing the telephonic or videoconference screening as Crisis Intervention, on-site. 

If the individual is accessible, is requesting an in-person screening and an in-person screening can be completed with reasonable safety precautions (e.g., use of PPE, CDC recommended social distancing, use of alternative safe locations, etc.) the SASS/MCR provider will complete, or will arrange for a partner provider to complete, a face-to-face crisis screening at the location of the crisis, or an alternative safe setting away from the home to ensure the safety of the individual and staff. Staff should bill for completing the in-person Crisis Screening as Mobile Crisis Response, off-site.

If the SASS/MCR provider reaches the location of the crisis and is only able to interact with the individual in crisis via phone or video, as a reasonable safety accommodation, that is allowable as part of the Mobile Crisis Response, off-site service event.

8. Can you say more about what the Director meant by transitioning telehealth expansion from emergency to permanent under the Medicaid program?

A: We filed both emergency (emergency rules expire after 150 days) and proposed rules. The proposed rules were adopted (89 Ill. Adm. Code 140.413(e) - Telehealth Requirements During a Public Health Emergency and are in effect for the duration of a public health emergency. HFS is looking at the possibility of changing our telehealth policies post PHE.

9. May we know why HFS gives contracts to for profit business and not to non profit community service organizations who have deep understanding of people in need in the community?

A: HFS contracts with a variety of vendors for programmatic and operational needs large and small. Along with our managed care and other provider partners, HFS does collaborate with and value community-based organizations with a deep understanding of the needs of the people they serve. The needs of our customers and the business needs of the Department cannot be met exclusively by non-profit organizations across the state.

10. HFS/DHS - As a solution to gaps in care and safety nets, are there any discussions on establishing a per diem rate for crisis stabilization units for non SMHRF and non hospital based units?

A: HFS will be launching the Crisis Intervention Services Pilot described in the 1115 waiver later in calendar year 2021. This pilot will allow short-term crisis intervention services to be provided for individuals who are experiencing a mental health crisis and who can be safely stabilized in a community-based setting that is less intensive than a psychiatric hospital. HFS will be providing additional information regarding individuals who are eligible and provider requirements for participation in this pilot as that information becomes available closer to the time that the pilot will be launched.

11. How families in the community could help increase HFS budget?

A: HFS is here to serve families in the community through our medical assistance program and our child support services. For more information about our services and how to access them, please go to our website at www.hfs.illinois.gov.

12. Director Eagleson, how do you comply with federally required monitoring of the $800 million in COVID grant funds?

A: HFS has contracted with Ernst & Young, a leading accounting and consulting firm, to provide assistance with program implementation and federal compliance guidance. In accordance with federal monitoring requirements in 2 CFR 200.332 for pass-through entities, HFS will review final reports from HFS CARES payment subrecipients as a closeout monitoring activity. Subrecipients are required to submit final reports and supporting documentation by March 29, 2021. HFS will analyze the expenditures reported against the HFS CARES Program requirements and the subrecipient's previously submitted budgets and/or applications, identifying expenditures which may not be allowable. HFS will follow-up with subrecipients to resolve any issues or findings identified, which per the subaward agreement may include the recoupment of misspent funds.

13. Does the HFS budget assumption of the enhanced FMAP include the assumption that the enhanced match will only go until CY 21 ends or for the entire FY 22?

A. HFS' Fiscal Year 2022 proposed budget assumes the COVID enhanced federal match will continue through December 2021.

14. Will the state pursue federal funding for Money Follows the Person?

A. HFS has no immediate plans to apply for the federal Money Follows the Person program but will be forming a subcommittee of the MAC during the next quarter to focus on issues around community integration and removing barriers to home and community-based services expansion.​