Provider Notice issued 10/02/14

Rate Increases and Claim Processing Issues

Effective July 1, 2014, as a result of PA 098-0651(pdf), rates paid to Home Health Agencies for all-inclusive intermittent visits, and for In-Home shift hourly nursing services rendered by a Certified Nursing Assistant (CNA) were increased. The rate paid to Home Health Agencies will be increased to $72 per visit for the all-inclusive intermittent visit; the rate for in-home shift nursing services rendered by CNAs will be increased to $20 per hour. The new rates are no longer subject to the 2.7% SMART Act rate reduction. Please see the updated fee schedule located at FY2015 Home Health Fee Schedule (pdf).

The rates for In-Home Shift nursing services rendered by a LPN or RN have not been increased and will remain subject to the 2.7% SMART Act rate reduction. Please see the updated fee schedule. Effective with dates of service July 1, 2014, the 2.7% rate reduction will be reflected on the Prior Approval authorization. Providers will receive updated copies of prior approvals reflecting these decreases. Providers should use the decreased hourly rate to calculate the Provider Charge Amount when submitting weekly claims. The 2.7% rate reduction will no longer be applied after the claim processes.

For intermittent visits, if the approval period spans across state fiscal years 2014 and 2015 (example 6/15/14 to 07/15/14), the dates of service during fiscal year 2014 are currently paying at the fiscal year 2015 rate. Providers should monitor the department’s Claims Processing System Issues page for information regarding the department’s resolution of this issue.

In-Home shift nursing providers who billed charges for the RN/LPN services at the higher rate for dates of services 7/1/14 and after, must complete a replacement claim using the lower rate upon receipt of the corrected Prior Approval notice. For replacement claims, providers must submit bill type ‘7’ via 837P file or by using the ‘Provider Invoice’ link on MEDI. Instructions for submitting replacement claims may be found beginning on page 16 at the 837P link of the Chapter 300 Companion Guide at http://www.illinois.gov/hfs/SiteCollectionDocuments/837p.pdf.

Special Information Regarding Care Coordination Billing and Eligibility

The billing instructions in this notice apply to patients enrolled in traditional fee-for-service, Accountable Care Entities (ACEs) and Care Coordination Entities (CCEs) but do not apply to patients enrolled in Managed Care Organizations (MCOs) and Managed Care Community Networks (MCCNs).

It is imperative that providers check HFS electronic eligibility systems regularly to determine a beneficiaries’ enrollment in a plan. The Recipient Eligibility Verification (REV) System, the Automated Voice Response System (AVRS) at 1-800-842-1461, and the Medical Electronic Data Interchange (MEDI) system will identify any care coordination plan in which a beneficiary is enrolled. Plan contact information for questions related to coverage and billing requirements as well as information regarding the way each plan is displayed in the department’s electronic eligibility systems is contained in the June 24, 2014 informational notice titled, Revised - Care Coordination Enrollment for Children, Families and ACA Adults.

Please Note: Prior approval requests for participants in an MCO or MCCN should be directed to the individual plan.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at (877)782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs