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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/01/14

Restoration of Previously Discontinued/Reduced Medical Services

To:​ All Long Term Care Facilities (Nursing Facilities, Supportive Living Facilities, Specialized Mental Health Rehabilitation Facilities, Intermediate Care Facilities for Individuals with Intellectual disabilities)​
​Date: ​July 1, 2014
​Re: Restoration of Previously Discontinued/Reduced Medical Services​

This Notice informs facilities that Public Act 098-0651 (pdf) restores some of the medical services that were previously discontinued/reduced as a result of the SMART Act.

Restored services for all long term care settings include:

  • Dental – Effective 7/1/2014 adult dental services are restored to the levels in effect prior to their July 1, 2012 discontinuance. A list of covered dental services may be found at Dental Office Reference Manual (pdf) (Pages 106 through 110). In addition, pregnant women are also eligible for some preventive dental services.

  • Podiatry - Effective October 1, 2014 services will be available for those with no diagnosis of diabetes. Until this date a diagnosis of diabetes is required for coverage of podiatric care.

  • Pharmaceuticals – Elimination of the prior approval requirement for anti-psychotic drugs.

Applicable to Supportive Living Facility residents only:

Speech, hearing, language, occupational and physical therapy services are covered as part of a Nursing Facility Medicaid per diem and are not payable fee-for-service. Participants in the Home and Community Services Waiver for Supportive Living are allowed to receive therapy services fee-for-service. The maximum therapy coverage of 20 visits per month will be lifted, however prior approval will be required.

All services provided during the time of reduced or discontinued coverage are subject to the limitations in place during that time.

An overview of changes related to Public Act 098-0651 (pdf) is located on the HFS website.

If you have questions, contact HFS’ Bureau of Long Term Care at 217-782-0545.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs