Provider Notice Issued 07/26/2018

Date:  July 26, 2018                                                 

To:     Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Medically Complex for the Developmentally Disabled Facilities (MC/DD), Supportive Living Program (SLP), and Specialized Mental Health Rehabilitation Facilities (SMHRF)

Re:     Notice of Informational Webinars on Provisional Eligibility – Implementation Process

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The Illinois Department of Healthcare and Family Services (HFS) will be offering an informational webinar to Long Term Care (LTC) providers relating to the implementation of “Provisional Eligibility”.

Pursuant to the Court's preliminary injunction order in Koss v. Norwood, HFS has been ordered to pay LTC and other Medicaid benefits to class members when their Medicaid application remains pending beyond the Medicaid Act’s deadline for an eligibility determination. HFS will implement this order through a Provisional Eligibility process.

Beginning August 1, 2018, and at the beginning of each month thereafter, HFS will identify those individuals that have a pending LTC Medicaid application over 45 days old due to delays by the State of Illinois. For those individuals identified, HFS will update the eligibility system with a Provisional Eligibility segment. This will allow providers to verify eligibility in the Medical Electronic Data Interchange (MEDI).

In addition, HFS will add a LTC admission segment to the claims processing system. This will allow providers to submit monthly claims for LTC covered services, which will be processed and sent to the Comptroller for reimbursement through standard processing procedures.

Individuals given Provisional Eligibility are entitled to receive the same services as individuals with regular Medicaid eligibility. Individuals with Provisional Eligibility who are currently enrolled in a Managed Care health plan will maintain their Managed Care enrollment. Individuals who are not currently enrolled with a Managed Care health plan will be required to enroll in a health plan if located in a mandatory managed care region or at the time the program is expanded statewide.

The Department will host an informational webinar regarding this process. There will be four (4) information sessions and capacity is limited for each session. If the selected session is full, it will be necessary to choose another day or time to attend. The same information will be presented in each session.

Click one of the links listed below to register for this event:

Session 1               July 30, 2018  10:00 a.m.  Event number: 800 056 880

Session 2               July 30, 2018  2:00 p.m.   Event number:  801 029 892

Session 3               July 31, 2018  10:00 a.m.  Event number:  807 129 631

Session 4               July 31, 2018  2:00 p.m.  Event number:  808 018 236

Webinar attendees will be able to submit questions using the “Q&A” feature. The webinar and a Question and Answer document will be posted after all sessions have been completed.

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

Teresa T. Hursey

Medicaid Director