Proposed Changes In Methods And Standards

The Department of Healthcare and Family Services (HFS) proposes to change the methods and standards by which certain services are reimbursed under the Illinois Medical Assistance program. These changes are being made in order to assure that reimbursement for services rendered by these classes of providers are consistent with the State’s fiscal year 2006 budget while maintaining access to necessary medical services. Unless otherwise specified, the changes are effective January 1, 2006.

T he HFS will allow community mental health providers to provide and bill for (a) risk assessment screening for perinatal depression, for either the mother (prenatal or post-partum) or the infant, up to one year after delivery and (b) social emotional developmental screening of child under five years of age. These services, when delivered and billed by a community mental health provider will be reimbursed at the rate paid to a physician for the same procedure. It is estimated that these changes will result in an annual increase in Medicaid liability of $0.25 million during the current fiscal year.

The HFS, in coordination with the Department of Human Services, will increase, by 2.69%, the rate of reimbursement for services provided by intermediate care facilities for the developmentally disabled. These services are reimbursed through the Department of Human Services. The change affects long term care facilities licensed under the Nursing Home Care Act as intermediate care facilities for the developmentally disabled or long term care facilities for under age 22. It is estimated that these changes will result in an annual increase in Medicaid liability for these services of 3% ($4.75 million during the current fiscal year).

The HFS, in coordination with the Department of Human Services, will increase, by 3%, the rate of reimbursement for developmental training services. It is estimated that these changes will result in an increase in Medicaid liability for these services of $1.1 million during the current fiscal year.

Any interested party may submit comments, data, views, or arguments concerning these proposed. All comments must be in writing and should be addressed to:

Bureau of Program and Reimbursement Analysis

Division of Medical Programs

Healthcare and Family Services

201 South Grand Avenue East

Springfield, Illinois 62763-0001

E-mail address: bpra@idpa.state.il.us

Interested persons may review these proposed changes on the Internet HFS Public Notices. Local access to the Internet is available through any local public library. In addition, this material may be viewed at the DHS local offices (except in Cook County). In Cook County, the changes may be reviewed at the Office of the Director, Healthcare and Family Services, 100 West Randolph Street, Chicago, Illinois. The changes may be reviewed at all offices Monday through Friday from 8:30 a.m. until 5 p.m. This notice is being provided in accordance with federal requirements found at 42 CFR 447.205.