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  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 11/27/2023

 

Date: November 27, 2023
​To: Enrolled Transportation Providers 
​Re: Long Term Care (LTC) Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP), Medically Complex for the Developmentally Disabled Facilities (MC/DD) and Specialized Mental Health Rehabilitation Facilities (SMHRF)

In 2018, the Department of Healthcare and Family Services (HFS) implemented the Provisional Eligibility process for pending Medicaid applications and pending long term care (LTC) admission transactions that exceed the timely processing timeframes. A monthly process was established to identify eligible individuals and enter their Medicaid eligibility and approve the pending LTC admission transaction into Medicaid Management Information System (MMIS), which allowed LTC providers to submit claims for Medicaid reimbursement more quickly. Information on the Provisional Eligibility process can be found on the HFS Long Term Services and Supports | HFS (illinois.gov) webpage at the following links:

Provisional Eligibility Process - July 30, 2018

Provisional Eligibility Webinar - November 1, 2018

Provisional Eligibility Process - Questions and Answers

Since that time, HFS has established policies and made adjustments to procedures to help streamline the approval process for long term care services. For example, the Provider Notice Issued 05/08/2020 (illinois.gov) describes the process for processing LTC admission transactions for cases that already have active community Medicaid. In addition, approval processing changes mandated during the COVID Public Health Emergency (PHE) allowed the State to become current on LTC admission processing so that the processing of  admission transactions were not exceeding 45 days.

HFS has continued to monitor application processing timelines and has identified increases in processing delays since the end of the COVID PHE. Due to the increased length in time to complete the application processing, HFS has reimplemented the assignment of Provisional Eligibility for LTC applications which meet the criteria requirements. The Provisional Eligibility process will occur monthly as long as eligibility determinations exceed the 45 day threshold.

In October 2023, HFS completed the Provisional Eligibility process and loaded applications and admissions that qualified, as of October 18, 2023. In November 2023,

HFS completed the Provisional Eligibility process and loaded applications and admissions that qualified, as of November 13, 2023.

Pursuant to 305 ILCS 5/11-5.4(i), individuals given Provisional Eligibility are entitled to receive the same services as individuals with regular Medicaid eligibility regardless of fee-for-service or Managed Care Organization (MCO) plan enrollment.

Questions regarding this process should be directed via email to: hfs.ltc.mediadmissions@illinois.gov.

 

Kelly Cunningham, Administrator
Division of Medical Programs