Provider Notice issued 01/02/13

(SMART) Act Changes and its Effect on DCFS Children

As a result of Public Act 097-0689(pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, effective July 1, 2012, HFS has implemented several changes to services, including but not limited to reimbursement reductions, limitations on services, reductions in services, and prior approval changes. The purpose of this notice is to provide clarification on certain changes for services covered as a "98" Medicaid case. This includes DCFS children in foster care, youth in independent living and transitional living programs, children in adoptions and subsidized guardianships, and the children of parenting wards. 

• The following identifies certain changes and the impact on DCFS children.

• No elimination of Medicaid services for DCFS children.

• No service reductions for dental services for DCFS children, including youth ages 18 to 21.

• No co-payments for any Medicaid services for DCFS children.

• There are utilization controls for in-home nursing services: initial and periodic evaluations based on the child's medical necessity for nursing services; limits on the number of approved nursing hours per day; and implementation of standard payment rates for nursing services.

• There are utilization controls and prior approval review procedures for durable medical equipment (e.g., wheelchair repairs, oxygen supplies, nebulizers, etc.).

• There is a limit to coverage for incontinence supplies: no more than 200 units per month, reduced from 300 units per month; and no coverage for children under the age of four.

• As part of the plan to phase in the four prescription policy, currently, there is no limit on the number of prescriptions for all children, including DCFS children.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs