Provider Notice Issued 04/06/2020

Date:    April 6, 2020

To:       Durable Medical Equipment (DME) Providers, Home Health Agencies, Local Health Departments, Occupational Therapists, Speech Therapists, and Physical Therapists

Re:      Temporary Prior Authorization Requirement Changes Related to COVID-19 Public Health Emergency

This notice informs providers of temporary changes in prior authorization requirements. The Department’s goal in implementing these changes is to reduce participant visits to providers, promote social distancing, reduce barriers to participant access to supplies and equipment, and ease the burden on DME providers and ordering providers during the COVID-19 public health emergency. The information applies to prior authorization requests and claims for participants covered under fee-for-service, HealthChoice Illinois managed care plans and the Medicare/Medicaid Alignment Initiative (MMAI) plans.

Effective March 1, 2020, until the termination date of the public health emergency, including any extensions, the Department will implement the following changes. Codes affected are attached.

·         The Department will remove prior authorization for physical, occupational, and speech therapies.

·         The Department will remove prior authorization for home health.

·         Prior authorization for certain durable medical equipment and supplies will be removed.   

·         The Department will identify current prior authorizations for certain codes and extend the prior authorization timeframe. Providers whose prior authorizations are not extended should contact the prior authorization unit for assistance. The Department’s goal is to allow flexibility and accommodate all requests timely so that a participant’s access to care is not impacted.   

·         Face-to-face encounter requirements for ordering DME, Home Health, and therapy are waived.

·         Participant signature requirements for the delivery of supplies and equipment are waived.  Text, e-mail, photographic, or confirmed shipment receipt from third-party carrier as evidence to validate proof of delivery is acceptable.

·         Requests for prior authorization exceeding the quantity limits for items related to COVID-19 is still required; however, the process to receive a prior authorization is modified. Providers should reference the fee schedules for quantity limits for codes not listed in this notice. For participants with a diagnosis of COVID-19 who need quantities above the allowable amount, providers should submit a prior authorization request with an order documenting the diagnosis.  The prior authorization request will be expeditiously processed for approval. 

·         The ordering/referring provider is not required to be enrolled with the Department. Orders documenting medical necessity are required to be maintained by the provider for all medical supplies and equipment.

·         Providers delivering equipment may instruct participants through telecommunications methods; however, there is no additional payment for education since delivery and education is included in the reimbursement. More information is located in the Handbook for Medical Equipment and Supplies, M-202.1.

·         Prior authorization changes will not be made to bariatric surgery and gender affirming services.

·         Information regarding the Department’s telehealth policy during this emergency is in the Telehealth Expansion Billing Instructions Notice.  

·         Updates are posted on the Coronavirus (COVID-19) Updates page.

These changes are temporary to control issues that arise with our participant population due to the outbreak of COVID-19. Other potential changes may be implemented at the Administration’s directive. 

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

Kelly Cunningham

Interim Medicaid Administrator

Codes Affected by Prior Authorization Changes