Provider Notice issued 04/05/04

Illinois Healthy Women

The Illinois Department of Public Aid will expand access to women’s healthcare services, including family planning, that enable women to choose the number and spacing of their pregnancies and to plan a healthy birth. This program, named Illinois Healthy Women, will begin April 19, 2004, will be in effect for at least five years, and will provide family planning and other related women’s healthcare services to women who would otherwise lose their medical coverage.

Women aged 19 through age 44 who leave the department’s medical programs will be offered enrollment in Illinois Healthy Women. The program will make it possible for such a woman to continue to obtain family planning and reproductive health care services from her regular physician. She may also choose to receive these services from any other Medicaid-enrolled provider of family planning services.

Eligible women will receive an initial pink identification card that will be valid for three months. To be eligible for this voluntary program for more than three months, the woman must sign and return an enrollment form indicating her desire to continue under Illinois Healthy Women. If she does this, a new pink identification card will be issued for an additional nine months of coverage under the program. A facsimile of the Illinois Healthy Women medical card is attached. After the first year of coverage, an annual re-enrollment will be required.

E-mail: dpawebmaster@mail.idpa.state.il.us Internet: http://www.dpaillinois.com/

Illinois Healthy Women will cover the following services (when billed with a family planning diagnosis code in the V25 series):

•  Physical examination and health history for family planning purposes.

•  Office visits related to family planning.

•  Pap smears, at least annually, or as medically indicated.

•  Necessary family planning or women’s health related lab and diagnostic tests.

•  Birth control drugs and supplies.

•  The inserting, implanting and removal of birth control devices, as well as the injecting of birth control drugs.

•  Sterilization services, pursuant to Section 140.483.

•  Testing for sexually transmitted infections (STIs), including HIV, identified during a family planning visit.

•  Treatment for STIs diagnosed during a family planning visit (excluding treatment for HIV, see below).

•  Mammograms, when ordered by the doctor during a family planning visit.

•  Generic prenatal vitamins or generic multivitamins with folic acid.

Please note, the department’s coverage and billing requirements applicable to these services for other coverage groups also apply to Illinois Healthy Women. Co-payments do not apply to family planning services, or generic prenatal vitamins or generic multivitamins with folic acid. Co-payments may apply to other prescription drugs, such as those prescribed for the treatment of STI’s. Generic medications do not have a co-pay.

Prescriptions written for medications used to treat STI's will require prior approval. Prior approval is also required for multivitamins but is not required for prenatal vitamins. Either the physician's office or the pharmacy may request the prior approval by calling 1-800-252-8942 and supplying the following information:

•  Recipient ID number

•  Physician ID, name & phone number

•  Pharmacy ID, name & phone number if known

•  Name of medication or NDC number of medication

•  Diagnosis or ICD-9-CM

Physicians are urged to include the ICD-9-CM on a written prescription given to the patient, as it is required for the pharmacy to make the request.

Under this special program, coverage is not available for:

•  Treatment for Human Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS). For assistance in locating HIV/AIDS treatment resources, call the AIDS/HIV & STD Hotline, operated by the Illinois Department of Public Health, at 1-800-243-2437 (TTY: 1-800-782-0423).

•  All other primary care services and medications for acute and chronic conditions. Program participants should be appropriately referred to low-cost primary health care services, as needed. To locate health care resources for referrals, the provider or

• individual may call:

•  The Health and Human Services Helpline, operated by the Illinois Department of Human Services, at 1-800-323-4769 (TTY: 1-800-323-4769).

•  The Health Benefits and KidCare Hotline, operated by the Illinois Department of Public Aid, at 1-800-226-0768 (TTY: 1-877-204-1012).

• The Women's Health-Line, operated by the Illinois Department of Public Health, Office of Women's Health, 1-888-522-1282 (TTY: 1-800-547-0466), when a patient enrolled in Illinois Healthy Women is suspected of having breast or cervical cancer or a precancerous condition.

Questions regarding this notice may be directed to the Bureau of Contract Management at

217-524-7478.

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs