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Provider Notice Issued 11/07/2019

Date:    November 7, 2019
To:       Enrolled Transportation Providers; Hospitals; and Long-Term Care Facilities
Re:      HFS 2270 Physician Certification Statement and Transportation Provider Complaint Portal
This notice emphasizes the importance of proper completion of the HFS 2270, Physician Certification Statement (PCS) by hospitals and long term care (LTC) facilities, and informs transportation providers of a new complaint portal to report when a hospital or long term care facility has failed to submit a properly completed form. It further notifies hospitals and LTC facility providers of potential consequences for failure to provide transportation providers with a properly completed form.
Pursuant to Public Act 100-0646, the Hospital Licensing Act, the Nursing Home Care Act and the Illinois Public Aid Code were amended to require completion of the HFS 2270 Physician Certification Statement (PCS) form for all non-emergency transportation originating at a hospital or LTC facility, via ground ambulance, medicar/wheelchair van or service car transport. A PowerPoint presentation is posted to the Department’s website and should be used as a reference guide to complete the PCS form.
The Department has released the following notices related to the form completion by hospitals and long term care facilities and subsequent submission to the transportation provider:
November 21, 2018    Physician Certification Statement for Non-emergency Transportation
February 15, 2019      HFS 2270, Physician Certification Statement for Non-Emergency Transportation
April 26, 2019              Transportation PowerPoint Presentation for HFS 2270, Physician Certification Statement
July 25, 2019              Facility Compliance in Completing the HFS 2270, Physician Certification Statement for Non-Emergency Transportation
The Department recognizes the importance of transportation providers having a method for reporting issues they may have with hospital or LTC facility completion of the PCS form. An HFS Transportation Provider Complaint Portal has been created to allow transportation providers to report facilities that do not complete the PCS form, or do not complete it accurately or completely. The portal may be used to report issues for Medicaid fee-for-service participants as well as participants covered under a managed care plan. HFS will provide reporting to the Department’s Office of Inspector General (OIG) for further action.
Transportation providers may upload protected health information securely on this portal and should be prepared to provide specific detail, including the participant’s name, nine-digit Recipient Identification Number, and date of service. 
Continued failure by hospitals and long term care facilities to provide PCS forms may result in administrative action including, but not limited to: audit, recoupment, civil monetary penalties, payment suspension, and termination from Medicaid provider eligibility by the Office of the Inspector General.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service Medicaid participants, or to the applicable managed care plan.
Doug Elwell
Medicaid Director


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