Date: October 21, 2022
To: Enrolled Hospitals: Chief Operating Officers; Chief Financial Officers; Patient Accounts Managers; and Health Information Management Directors
Re: Hospital Utilization Review Policy Change Regarding Inpatient Detoxification Admissions within 60 Days of Previous Admission per Public Act 102-0043
This notice confirms that the Department of Healthcare and Family Services (HFS) has removed the prohibition for readmissions to a hospital for an inpatient alcohol or drug detoxification stay within 60 days of a previous detoxification stay. This change was required by Public Act 102-0043. The federal Centers for Medicare and Medicaid Services (CMS) has approved HFS' state plan amendment for this change.
The change impacts inpatient utilization review of both Medicaid FFS and HealthChoice Illinois (HCI) managed care organization (MCO) plan claims. For FFS claims, Utilization Review Attachment B has been updated to remove references to the 60-day detoxification readmission limit.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims or to the applicable HCI MCO plan.
Kelly Cunningham, Administrator
Division of Medical Programs