Provider Notice issued 11/21/2025

Home Visiting Organization Enrollment and Billing per Public Act 102-0665

The Department of Healthcare and Family Services (HFS) received approval from the Federal Centers for Medicare & Medicaid Services (CMS) to provide coverage for home visiting services required under Public Act 102-0665. Providers may enroll and bill for home visiting services under the Medical Assistance Program as of November 21, 2025. This coverage applies to the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois managed care organizations (MCOs).  

Home visiting services offer informational support, facilitate screening, and provide care coordination to pregnant and parenting individuals as needed to support health outcomes through pregnancy and beyond. Home visiting services are covered when delivered in accordance with one of the HFS-recognized evidence-based and research-informed home visiting models listed below:   

• Nurse Models:

• Family Connects

• Nurse Family Partnership

• Non-Nurse Models:

• Healthy Families America (HFA) 

• Parents as Teachers

• Early Head Start Home Based

• Home Instruction for Parents of Preschool Youngsters (HIPPY) 

• Baby TALK

• Healthy Start

The following details provide the necessary information for organizations interested in enrolling in the Medical Assistance Program as a provider of home visiting services.

Medicaid Provider Educational Materials and Webinars for Home Visiting Organizations

The Medicaid Technical Assistance Center (MTAC), in partnership with HFS, has prepared enhanced Medicaid onboarding educational materials and support to aid home visiting organizations in the enrollment process. This includes a Medicaid provider overview specifically for home visiting programs, how to obtain a National Provider Identifier (NPI), and how to enroll in IMPACT.

It is highly recommended that attending this training should be the first step in this process. Please visit the MTAC Calendar of Events for training dates, times, and registration links. Home visiting organizations may also reach MTAC for technical assistance support at mtac.maternalhealth@uillinois.edu.

Covered Home Visiting Activities

Home visiting services may include the following activities, as appropriate based on the training of the home visitor and the components of the home visiting model being provided:

1) Prenatal home visits:

• Education on key topics related to perinatal health, including prenatal health warning signs, diet and nutrition, and sexually transmitted disease (STD) prevention;
• Monitoring for high blood pressure or other complications of pregnancy;
• Stress management; 
• Behavioral health screening, brief counseling, and education, including for depression, tobacco use and cessation, and alcohol and other substance misuse;  
• Domestic and intimate partner violence screening and education; and, 
• Linkage and referral to services, healthcare providers, public benefits, and community or other resources that can improve birth-related outcomes.  

2) Postpartum home visits:

• Education on key topics related to perinatal health, including postpartum health warning signs and symptoms, diet and nutrition, and sexually transmitted disease (STD) prevention;

• Monitoring for high blood pressure or other complications of pregnancy;

• Stress management;

• Behavioral health screening, brief counseling, and education, including for depression, tobacco use and cessation, and alcohol and other substance misuse; 

• Domestic and intimate partner violence screening and education; and,

• Guidance and education to obtain recommended preventive services, including well visits;

• Medical assessment of the postpartum person and infant, within the scope of the model or provider’s license or certification;

• Child development education;

• Maternal-infant safety assessment and education;

• Counseling regarding postpartum recovery, family planning, and needs of a newborn;

• Assistance for the family in establishing a primary source of care and a primary care provider;

• Parenting skills, parent-child relationship building, and confidence building; and

• Linkage and referral to services, healthcare providers, public benefits, and community or other resources that can improve birth-related outcomes.

3) Child Home Visits:

• Education about infant health warning signs and symptoms;

• Child developmental screening at major developmental milestones;

• Parenting skills, parent-child relationship building, and confidence building;

• Providing resources for breastfeeding support and education, including referrals to lactation consultant services; and,

• Linkage and referral to services, healthcare providers, public benefits, and community or other resources that can improve birth-related outcomes. 

Certification

Providers seeking to enroll as a home visiting organization must be certified by the appropriate national governing body to deliver services by one of the HFS-recognized home visiting models listed above. Home visiting organizations must upload their certificate as part of the HFS provider enrollment process. 

The uploaded certificate must contain a certification number unique to the home visiting organization, an effective date, and an expiration date. Providers will also be required to show that they are certified at the site for which they are seeking enrollment. If the certificate does not include an address, providers should upload additional documentation from the certifying organization that includes the address for the location they are enrolling.

Grant Funded Home Visiting Organization Guidance

Illinois Department of Human Services (IDHS), Illinois State Board of Education (ISBE), and (future) home visiting grantees: Cannot use Medicaid Funds for existing and/or future programs. More guidance on billing and enrollment into Medicaid will be provided by the Grantors at a later date. 

Early Head Start/Head Start programs: Please consult the Federal Office of Head Start before enrolling and billing Medicaid for home visiting services. 

Organizations that do not receive state or federal funding from the above agencies are not subject to this guidance. 

Provider Enrollment

Home visiting services are reimbursable to certified home visiting organizations enrolled in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) provider enrollment system. Home visiting organizations should review the IMPACT Account Activation Instructions for New External IMPACT Users.

Home visiting organizations must use a unique Type 2 Organizational National Provider Identifier (NPI) to enroll. An agency may have more than one Type 2 NPI; however, each NPI may only be tied to one provider type in IMPACT. Information about obtaining an NPI is located on the CMS website.

In IMPACT, a home visiting organization must select an enrollment type of: Facility, Agency, Organization (FAO). Home visiting organizations must select the appropriate IMPACT provider type, specialty, and subspecialty based on the home visiting model the organization is certified to provide, using the table below as a guide: 

Billable Procedure Codes and Modifiers

Standing Recommendation

The State of Illinois has issued a standing recommendation for home visiting services. When home visitors document the services they deliver, they must note in their documentation that they either (1) used the standing recommendation or (2) used a recommendation from a specific licensed physician, physician assistant (PA), or advanced practice registered nurse (APRN). 

This documentation is for audit purposes and to meet the federal requirement that preventive services provided by home visiting organizations be recommended by a licensed provider. This will not go on the claim submitted for reimbursement. 

Claim Submission

Claim Format

• Home visiting services are billed electronically on the 837 Professional transaction. Information regarding electronic 837P transactions may be found in the Chapter 300 Companion Guide. Claims may also be submitted via direct data entry within the MEDI system.  
• Home visiting services must be billed under the birthing person’s recipient identification number (RIN), or the child’s RIN if the birthing person is not Medicaid eligible.

Taxonomy Code

• Taxonomy code for home visiting services: 174H00000X 

Telehealth

• The use of telehealth to deliver home visiting services is only allowed via video modality (modifier GT) and only in the customer’s home setting (place of service code 10). 

Fee schedule

• More detail regarding the billable procedures is contained in the Home Visiting Fee Schedule on the Reimbursements page of the HFS website.

Questions regarding this notice, fee-for-service (FFS) claims assistance, or requests to schedule a MEDI training for FFS billing, may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.  Providers should contact the applicable MCO plan for questions, claims assistance, or billing guidance for customers enrolled in managed care.

Laura Phelan, Administrator
Division of Medical Programs