Date: February 2, 2021
To: Enrolled Pharmacies
Re: Critical Access Pharmacy (CAP) Timely Attestation for Quarterly Payments for Managed Care Services
This notice serves to remind Critical Access Pharmacies (CAPs) of their attestation requirements so that they may receive quarterly payments from the Department.
Per Public Act 100-0587 and administrative rules at 89 Ill. Admin. Code Section 140.439, HFS is required to make quarterly payments to those pharmacies defined as Critical Access Pharmacies (CAPs). CAPs receive quarterly payments based on the total number of managed care encounter claims that have been accepted by the Department (CAP-eligible claims) from the Department’s contracted managed care plans. The payments are based on the lesser of:
1) the total number of a CAP’s CAP-eligible claims multiplied by the Department’s dispensing fee, or
2) the Individual Payment Amount, which is equal to one-quarter of the total amount appropriated for the CAP for a fiscal year, divided by the total number of CAP-eligible claims for the quarter for all CAP pharmacies.
To be eligible to receive payments, providers must self-attest to meeting the CAP criteria. Providers may attest using the Department’s MEDI site. Providers must attest within 30 days after the end of each quarter.
After the attestation period is closed, pharmacies are no longer able to attest that they meet the CAP payment requirements. The Department will not reimburse the quarterly payment to pharmacies that did not timely attest.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs