Provider Notice Issued 06/13/2018

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Date:  June 13, 2018                                                

To:     Long Term Care Facilities - Skilled Nursing Facilities (SNF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Specialized Mental Health Rehabilitation Facilities (SMHRF) and Supportive Living Program (SLP) Providers

Re:     Updated Timelines for Reporting Admissions and Resident Status Changes

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This Notice is to inform Long Term Care (LTC) providers of the change in reporting requirements regarding a resident’s admission and status.

Admissions

Pursuant to Public Act 100-0449 (pdf), effective for resident admissions on or after January 1, 2018, all admissions must be reported within 45 calendar days through the MEDI system or an EDI vendor as outlined in 89 Ill. Adm. Code 140.513. 

In order for the submission to be considered “timely”, day one of the 45 calendar day period commences on the latter of either:

• the date the long term care provider receives the required pre-admission screening results from the “Interagency Certification of Screening Results” form HFS 2536 (pdf) or “Screening Verification” form HFS 3864 (pdf), (or successor form) documenting the level of care screening determination results from the screening agent; or
• the admission date entered by the provider for which the provider is requesting Medicaid reimbursement.

Changes in Resident Status

Effective January 1, 2018, changes in the resident’s status including, death, discharge, change in patient credit and third party liability (TPL) must be reported within the timeframes listed below:

·       Death of a resident – 15 calendar days;

·       Discharge of a resident – 15 calendar days;

·       Change in patient credit – 45 calendar days;

·       Third Party Liability (TPL) – 45 calendar days; and

·       Request for enhanced care rate – 45 calendar days from the effective date of the enhanced rate.  

All transactions completed through the MEDI system or EDI vendor are assigned a confirmation number also known as the Transaction Audit Number (TAN). This number shall be retained by the LTC provider to verify timely submittal of transactions and for future reference, including audit purposes.

LTC providers must continue to electronically submit admissions, discharges, deaths, TPL changes and income changes using the Department’s Medical Electronic Data Interchange (MEDI) system or an Electronic Data Interchange (EDI) (formerly referred to as REV) vendor. 

The Department has filed proposed rulemaking changes to 89 Ill. Adm. Code 140.513 to reflect these updates.  The proposed rule can be viewed in Illinois Register Volume 42 Issue 23, June 8, 2018.

Questions regarding this notice may be directed to the Bureau of Long Term Care at 217-782-0545 or 1-844-528-8444 toll free.

Felicia F Norwood

Director