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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/18/10

Clarification for Submittal of Ventilator Notification
 

To:​

Providers of Nursing Facility Services​
Date:​ February 18, 2010​
Re:​ Clarification for Submittal of Ventilator Notification​

 

This notice serves as providing clarification when submitting Form HFS 106 (pdf), Nursing Facility Ventilator Notification, to the department.

The effective date for discontinuing ventilator coverage should reflect the last day of coverage.  For example, if a resident goes off a ventilator on January 30, the date entered on the HFS 106 (pdf) should be January 30 regardless of the time of day the ventilator was discontinued.  Do not enter the day, after ventilator coverage ended, as the discontinued date.  If a resident is discharged or dies, the discontinued date would be the date of discharge or death.

The HFS 106 (pdf) should not be submitted to discontinue ventilator services for a hospital admission, and it should not be resubmitted for a readmission from a hospitalization.  This is assuming the facility is submitting Form HFS 2234 (pdf), Bed Reserve and Temporary Absence Form, to identify the absence.  Only if a resident is literally discharged and readmitted through the Recipient Eligibility Verification (REV) system, or the Department of Human Services (DHS) caseworker, should an HFS 106 be submitted again.

Do not submit HFS 106 (pdf) if eligibility for medical assistance has not been determined.  However, eligible cases not yet entered on the department’s Recipient Data Base and Medicaid-eligible residents admitted on a Medicare stay may be submitted.

The “Provider Number” is the 12-digit number assigned by the department when a facility is enrolled.  It is not the facility phone number. 

The “Recipient Identification Number” is the nine-digit number assigned by DHS to a resident.  Do not enter the Case Identification Number or Social Security number.

The form referenced in this notice is available on the department's Web site at: http://www.hfs.illinois.gov/medicalforms/

Questions can be directed to the Bureau of Long Term Care at 217-524-0372.

/s/

Theresa A. Eagleson, Administrator

Division of Medical Programs