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Proposed Changes In Methods And Standards 

 

State of Illinois
Healthcare and Family Services

Proposed Changes In Methods And Standards For Establishing Medical Assistance Payment Rates for Certain Non-institutional Services

The Department of Healthcare and Family Services (HFS) proposes to change the methods and standards by which certain services are reimbursed under the Illinois Medical Assistance program. These changes are being made in order to assure that reimbursement for services rendered by these classes of providers are consistent with the State’s fiscal year 2007 budget while maintaining access to necessary medical services.

Transportation

HFS provides reimbursement for transportation to and from a source of medical service. Effective October 1, 2006, HFS proposes to increase both the mileage and attendant rates paid for transport provided by s ervice car to match the rates paid for transport by Medicar.

It is estimated that these changes will result in an annual increase in Medicaid liability of $0.6 million.

Primary care case management (PCCM)

HFS is implementing a PCCM program. The program is a managed care model in which certain persons eligible to receive benefits under the Illinois Medical Assistance program will have a primary care provider (PCP) to help ensure delivery of appropriate preventive and coordinated healthcare, prevent duplication of services, ensure provision of the most appropriate level of care, provide specialty referrals where appropriate, and improve the quality of care.

Medical providers eligible to become PCPs include physicians, federally qualified health centers, rural health clinics, school-based/-linked clinics, certified local health departments, hospital clinics as defined at 89 Ill. Adm. Code 140.461(f), and encounter rate clinics as defined at 89 Ill. Adm. Code 140.461(b).

PCPs will receive the following monthly care management fees: (a) $2.00 for children (under age 21 years of age); (b) $3.00 for adults younger than 65 years of age who do not have a disability; and (c) $4.00 for adults 65 years of age and older and persons with disabilities. A description implementing these procedures, including an implementation schedule, has been defined at 89 Ill. Adm. Code 140.990 through 140.993.

It is estimated that the direct costs associated with the PCCM payment will result in an annual increase in liability of $40 million. However, these additional expenditures should be more than offset by the savings realized through managing the care of clients.

Time, place and manner in which interested persons may comment on the proposed changes

Any interested party may submit comments, data, views, or arguments concerning these proposed. All comments must be in writing and should be addressed to:

Bureau of Program and Reimbursement Analysis
Division of Medical Programs
Healthcare and Family Services
201 South Grand Avenue East
Springfield, Illinois 62763-0001
E-mail address: hfs.webmaster@illinois.gov

Interested persons may review these proposed changes on the Internet at HFS Public Notices. Local access to the Internet is available through any local public library. In addition, this material may be viewed at the local offices (except in Cook County) operated by the Department of Human Services. In Cook County, the changes may be reviewed at the Office of the Director, Healthcare and Family Services, 100 West Randolph Street, Chicago, Illinois. The changes may be reviewed at all offices Monday through Friday from 8:30 a.m. until 5 p.m. This notice is being provided in accordance with federal requirements found at 42 CFR 447.205.