Provider Notice Issued 05/18/2020

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Date:    May 18, 2020

To:       Durable Medical Equipment and Supplies Providers and Home Health Agencies

Re:      Additional Detail Regarding Temporary Prior Approval Requirement Changes Related to the COVID-19 Public Health Emergency

The Illinois Department of Healthcare and Family Services is exercising regulatory flexibilities to help durable medical equipment (DME) providers and home health agencies combat and contain the spread of COVID-19. This notice is a follow-up to the informational notice dated April 6, 2020, and specifies prior approval changes for DME and home health providers effective March 1, 2020, until the termination date of the public health emergency, including any extensions. The information applies to prior approval requests for participants covered under fee-for-service as well as HealthChoice Illinois or MMAI plans.

The Department will implement the following changes:

·         Prior approval authorizations for all billing procedure codes ending prior to June 1, 2020 will be automatically extended for an additional six (6) months. Providers should use the same prior approval authorization number for claims submission. Additional supporting documentation for the prior approval extension is not required.

·         Signed and dated practitioner orders and/or Certificate of Medical Necessity with an expiration date on or after March 1, 2020, for procedure codes which do not require prior approval, will be automatically extended until the end of the public health emergency period.

·         The Women, Infants, and Children (WIC) denial requirement for enteral requests will be waived until the end of the public health emergency.    

·         To facilitate prompt discharge, HFS is waiving the clinical and prior approval requirements for Continuous Positive Airway Pressure (CPAP), Respiratory Assist Devices (Bi-Level), Non-Invasive/Invasive Ventilation and Oxygen. Providers are strongly encouraged to document the reasons the clinical indications were not available.

·         Renewal requests after the end of the public health emergency will require clinical justification, in addition to the practitioner’s order.

The following items are not included under the automatic 6-month prior approval extension:

·         Enteral Nutrition

·         DME rentals beyond their purchase date

·         Overlaps with managed care plan eligibility

·         Overlaps with Medicare Part B coverage

·         Supplies ordered for acute care needs, such as wound care supplies

·         Equipment ordered for acute care needs, such as a wheelchair for fracture management

The Department’s goal in implementing these changes is to allow flexibility and accommodate all requests in a timely manner so that a participant’s access to care is not impacted, to reduce participant visits to providers, promote social distancing, reduce barriers to supplies and equipment, and ease the burden on DME providers and ordering providers during the COVID-19 public health emergency.

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

Kelly Cunningham

Interim Medicaid Administrator