IARF WEBINAR: AN EXCLUSIVE HRST ORIENTATION FOR IARF MEMBERS
Although the online version of the HRST has been used by several providers in IL over the past few years, including some IARF members, all providers will be moving away from the paper version to the online version of the HRST in the upcoming weeks. HRS, Inc. has agreed to partner with IARF to offer an introductory webinar, to IARF members only, to help them get more acquainted with the online version. This webinar will allow IARF members to better understand the contractual steps that must be taken before January 1, 2020, as well as the ongoing implementation process.
Join us for this exclusive, members’ only webinar next Wednesday, December 18th at 10:00 am. This will be an orientation style webinar, with the opportunity at the end for IARF members to ask questions. Other, more-in-depth, webinar trainings will be offered in the coming months.
Topics for this webinar will include:
- How to get signed up to use HRST online
- Basic implementation steps (including options for data imports from existing systems)
- How to log in and navigate the HRST web-based application
- How to access support
A registration link has been emailed out to IARF members. If you did not receive the link, please contact us
here to be emailed the registration link. (Contact: Maggie Henley)
PROVIDER COST SURVEY DEADLINE PUSHED BACK TO JANUARY 8th
DHS-DDD released a notification today announcing the Navigant Provider Cost Survey deadline is being pushed back to close of business on January 8, 2020. Director Stark has indicated that the data obtained in this cost survey is vitally important to the rate methodology development process and believes this three-week extension would allow providers to complete all of the end-of-year reporting, as well as the cost survey.
The survey and related materials can be found on the
Navigant website. Any comments or questions can be sent to Beth Owens,
bowens@iarf.org. (Contact: Beth Owens)
CURRENT STATUS ON I/DD PROVIDER RATE INCREASES
The 3.5% rate increases have received approval. Federal CMS has approved the three waiver amendments and the State Plan amendment has been approved for ICF/DD providers. Providers should have begun seeing those back payments. The DHS-DDD is currently working on a Q&A document that will provide guidance on how the $13/ hour increase will be structured. The waiver amendments for this second-rate increase were submitted to federal CMS on November 30th and December 2
nd and will again be subject to a 90-day review window. Additional information about the submission of the second state plan amendment will be forthcoming. (Contact: Beth Owens)
ILLINOIS EXPANDING MEDICARE-MEDICAID ALIGNMENT INITIATIVE STATEWIDE
Illinois is
expanding a care coordination program for residents enrolled in Medicare and Medicaid statewide. Currently, the Medicare-Medicaid Alignment Initiative (MMAI) is only available in counties in the greater Chicago area and central Illinois. The program brings together Medicare, Medicaid and prescription drug benefits under a single plan. Most also cover additional dental care.
The expansion is set to begin January 1, 2021.
The move comes after the state made the
Managed Long Term Services and Supports program part of the HealthChoice Illinois program on July 1. Under the expansion, nearly 60,000 dual eligibles will be able to also choose a MMAI plan, according to the Department of Healthcare and Family Services. IARF will continue to keep you all abreast of any and all developments on this expansion as more information becomes available. (Contact Dan Frey)
PLEASE SIGN ON TO ESTABLISH MTAC FUNDING AT HFS
To obtain long-term sustainability for the Medicaid Technical Assistance Center (MTAC), IARF is requesting organizations' signatures on a letter urging Governor Pritzker to allocate $5 million in his FY 2021 budget proposal to establish Illinois' first MTAC at HFS' Office of Medicaid Innovation. This will help improve behavioral health providers' ability to bill managed care so that Illinois' residents can access the care they need in their communities. Join the 100 other organizations that have signed on by adding your signature by December 17.
See the letter
here.
Please sign on
here.
Illinois behavioral health providers need help building capacity, as
sixty percent reported themselves not ready to bill managed care in 2018. Please consider showing your support for providers and the communities they serve by
signing the letter on behalf of your organization. (Contact Dan Frey)
UPDATE FEE SCHEDULE FOR 10/1/19 - 12/10/19 PUBLISHED FOR MULTIPLE PROVIDERS
HFS has published an updated fee schedule, effective from 10/1/19 - 12/10/19 for the following providers: Advanced Practice Nurses, Dentists providing medical services, Fee-For-Service Hospitals, Imaging Centers, Independent Diagnostic Testing Facilities (IDTFs), Independent Laboratories, Local Health Departments, Optometrists providing medical services, Physicians, and Portable X-ray Companies. Encounter Rate Clinics (ERCs), Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs).
You can find updated fee schedule here. (Contact Dan Frey)
ORP POLICY IMPLEMENTATION DENIAL GUIDANCE RELEASED BY IAMHP
Effective January 1, 2020 HFS is adopting and implementing a federal requirement on Ordering, Referring, and Prescribing (ORP). ORP is a federal requirement that any registered clinician (provider) that ordered, referred, or prescribed to a Medicaid member must be a registered clinician in IMPACT. If a member’s prescription is prescribed by a clinician not registered in IMPACT, the claim will deny.
The Illinois Association of Medicaid Health Plans estimate that this will impact over 40,000 Medicaid members. Under the Illinois’ Medicaid program, pharmacists may dispense a 72 hour supply of medications with a valid prescription as an emergency benefit for urgent/emergent medications that would otherwise require a prior authorization. Pharmacies may need to call the pharmacy benefit manager (PBM) for an override to allow the 72-hour supply to adjudicate.
Providers will see the following denial codes associated with ORP:
| Plan |
Denial Code(s) |
| BCBS |
R_71: Prescriber is not covered |
| County Care |
Prescriber not enrolled in State Medicaid Program. Inform Prescriber to contact IMPACT 877-782-5565. |
| Illinicare |
40: Pharmacy not contracted with plan on date of SVC 25: M/I Prescriber ID |
| Meridian |
889: Prescriber Not Enrolled in State Medicaid Program 890: Pharmacy Not Enrolled in State Medicaid Program |
| Molina |
889: Prescriber not enrolled in State Medicaid Program. For enrollment call 877-782-5565 |
| NextLevel Health |
56: Non-Matched Prescriber I.D. |
(Contact Dan Frey)
UNIVERSAL PDL DENIAL GUIDANCE RELEASED BY IAMHP
Effective January 1, 2020, HFS will be implementing the Uniform Preferred Drug List (PDL), also referred to as Single PDL will impact nearly 130,000 members. The Uniform PDL is an HFS requirement that all HealthChoice plans must follow the state’s preferred drug list. Plans may have quantity limits and safety edits that differ from HFS’ Fee-For-Service PDL.
Providers will see the following denial codes associated with the Uniform PDL:
| Plan |
Reject/Denial Code(s) |
| BCBS |
Various depending on the drug (non-formulary, PA required, quantity limits exceeded, etc) |
| County Care |
-60:Product/Service Not Covered For Patient Age
-70:Product/Service Not Covered – Plan/Benefit Exclusion
-75: Prior Authorization Required
-76: Plan Limitations Exceeded |
| Illinicare |
-75: PRIOR AUTHORIZATION REQUIRED
-70: NDC NOT COVERED
-AC: Product Not Covered Non-Participating Manufacturer
-AG: Days Supply Limitation For Product/Service
-AJ: GENERIC DRUG REQUIRED MR Product Not On Formulary |
| Meridian |
-70: Product/Service Not Covered
-75: Prior Authorization Required
-60: Product/Service Not Covered For Patient Age
-76: Plan Limitations Exceeded |
| Molina |
-75: Prior Authorization Required
-75: Non-preferred product/PA Required
-70/MR: Product/Service Not Covered. Product not on formulary |
| NextLevel Health |
Various depending on the drug (non-formulary, PA required, quantity limits exceeded, etc) |
If a pharmacist or other provider needs to contact a health plan they can utilize the provider services phone number. Providers can also use the key contact guide on IAMHP’s website https://iamhp.net/provider-contacts. (Contact Dan Frey)
STREATOR UNLIMITED AWARDED CENTRAL REGION EPILEPSY NOFO AWARD
Division of Developmental Disabilities (DDD) maintains a published list of all awardees for the FY20 NOFO process on their website. The list was recently updated to include the Epilepsy NOFO awardee for the central region, Streator Unlimited. The full list of Epilepsy Program Providers that have been awarded through the NOFO process is below.
Northeastern Region
Epilepsy Foundation of Greater Chicago
University of Illinois - Chicago
Northwestern Region
Streator Unlimited
Southern Region
Epilepsy Foundation of Greater Southern Illinois
Epilepsy Foundation of Southern Illinois
Central Region
Streator Unlimited
(Contact: Beth Owens)
HFS STATES MEDICAID REDETERMINATION STUDY FOR PERSONS WITH I/DD WILL BE RELEASED BEFORE THE END OF THE YEAR
According to the Illinois Department of Healthcare and Family Services (HFS), a feasibility study of Automatic Medicaid Redeterminations for persons with I/DD will be released before the end of the year. As members will recall, Automatic Medicaid Redeterminations for persons with I/DD was a policy IARF pursued in the legislative spring 2019 session and the feasibility study was part of the Medicaid Omnibus bill that passed this past session. Once the study is released, IARF will send an update out to all members. (Contact: Luis Andrade)
GRETA THUNBERG NAMED TIME MAGAZINE PERSON OF THE YEAR
Greta Thunberg, the activist who has quickly become a leading voice on climate change, is Time's Person of the Year for 2019. At 16, she is the youngest person to earn the title in the magazine's 92-year history. It also makes her the first ever openly-autistic Person of the Year.
Thunberg burst onto the world stage in the past year, organizing school strikes and protest marches to call attention to a climate crisis that she says older generations are not taking seriously enough. She has famously called out world leaders for debating scientific facts and failing to stop a global warming trend that will affect the world's children more than it affects anyone who's currently in power.
The time magazine 2019 Person of the Year article can be found HERE. (Contact: Beth Owens)
ANCOR: MONEY FOLLOWS THE PERSON RENEWAL POSSIBLE WITH U.S. SENATE DRUG PRICING PROPOSAL
ANCOR was thrilled to announce on Friday that U.S. Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR), in their respective capacities as Chair and Ranking Member of the Senate Finance Committee, released a proposed drug pricing bill which includes permanent renewal of the Money Follows the Person (MFP) program. As ANCOR CEO Barbara Merrill said in our statement: "If this MFP measure passes, it could be one the decade's most significant legislative victories for community inclusion and the providers who make it possible. ANCOR is deeply grateful for the leadership of Senators Wyden and Grassley on the MFP program and the range of other ways they've supported community inclusion for people of all abilities." (Contact: Luis Andrade)
ONE WEEK LEFT TO APPLY FOR THE ANCOR FOUNDATIONS’ NEXT LEADERSHIP COHORT
The objectives of the ANCOR Foundation's Leadership Academy are to support mid-career professionals as they hone their expertise, build thought leadership, and raise their stature as leaders of a growing national community. Program participants will be expected to complete 50 units of learning activities that are completed over a 2-year period. Participants can earn the units through ANCOR- and ANCOR Foundation-sponsored events, or by completing external trainings (supporting documentation required). Accepted applicants will be notified in February 2020; the program starts in March 2020. Apply Here! (Contact: Luis Andrade)
U.S LAWMAKERS REACH A BIPARTISAN DEAL TO FUND THE FEDERAL GOVERNMENT
Top congressional appropriators announced on Thursday that they've reached a “deal in principle“ to fund the federal government and boost defense and domestic budgets by $49 billion in fiscal 2020, with plans for a House vote as early as Tuesday. S
The bipartisan agreement would avert a government shutdown that otherwise would kick in when a stopgap spending bill expires on Dec. 20, or yet another stopgap that would stretch into the new year. More Information can be found HERE. (Contact: Luis Andrade)
