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Provider Notice Issued 08/30/2022

Date:   August 30, 2022

To:       Enrolled Physicians; Advanced Practice Registered Nurses; Physician Assistants; Hospitals; Ambulance Providers, Independent Laboratories; and Pharmacies

Re:      Sexual Assault Treatment Program Private Insurance Opt-Out Alternative Per Public Act 102-1097

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This notice informs providers that certain sexual assault survivors can elect not to bill their private insurance policy and instead receive coverage under the Department of Healthcare and Family Services' (HFS) Sexual Assault Emergency Treatment Program.

Pursuant to Public Act 102-1097, a sexual assault survivor who is not the subscriber or primary policyholder of the sexual assault survivor's private insurance policy may opt out of billing their private insurance provider and request medical forensic services be billed through the HFS  Sexual Assault Emergency Treatment Program.

A hospital, an approved pediatric health care facility, a health care professional, an ambulance provider, a laboratory, or a pharmacy must submit a request for reimbursement to the Illinois Sexual Assault Emergency Treatment Program administered by HFS in accordance with 89 Ill. Adm. Code 148.510. Services will be reimbursed at HFS' allowable Medicaid rates under the Illinois Public Aid Code. The claim submittal address is:

Illinois HFS Sexual Assault Emergency Treatment Program
PO Box 19129
Springfield, IL  62794-9129

 
If the survivor has elected not to have their private insurance policy billed, no third-party liability (TPL) should be listed on a claim submitted to the Sexual Assault Emergency Treatment Program. This applies to all follow-up services.

If a TPL is identified on a claim, HFS, as the agency authorizing payment through the Sexual Assault Emergency Treatment Program, will adjudicate the claim and deduct any TPL payment shown from the Sexual Assault Emergency Treatment Program payment.

Questions regarding this notice may be directed to HFS at the Bureau of Professional and Ancillary Services at 217-782-3303.

 
Kelly Cunningham, Administrator
Division of Medical Programs



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