Family Planning and Reproductive Health Services (From HFS)

06/26/14

 
Informational Notice

To: Participating Physicians, Advanced Practice Nurses, Physician Assistants, Local Health Departments, Enrolled Encounter Rate Clinics, Federally Qualified Health Centers, Rural Health Clinics, Enrolled Hospitals, and Managed Care Entities 

Re: Family Planning and Reproductive Health Services
The purpose of this notice is to provide further guidance regarding family planning and reproductive health services. Consistent with requirements of the Affordable Care Act, all Healthcare and Family Services (HFS) enrolled providers shall ensure that the full spectrum of family planning options and reproductive health services are appropriately provided with no cost sharing. Family planning and reproductive health services are defined as those services offered, arranged or furnished for the purpose of preventing an unintended pregnancy, and to improve health and birth outcomes. Family planning and reproductive health services shall be provided by, or administered under the supervision/collaboration of a physician (MD or DO), advanced practice nurse or physician assistant, and must follow the most current nationally recognized evidence-based standards of care and guidelines for sexual and reproductive health, such as those established by the Centers for Disease Control and Prevention (CDC) (pdf)  or the American Congress of Obstetricians and Gynecologists.

Medicaid’s free choice of provider’s statute (pdf) allows clients to see any Medicaid provider of their choice when seeking family planning and reproductive healthcare services.  Thus, clients can access contraceptive services and supplies without managed care network restrictions.  Additionally, provider policies/protocols shall not present barriers that delay or prevent access, such as prior authorizations or step-therapy failure requirements. Clients should receive education and counseling on all FDA-approved birth control methods (pdf) from most effective to least effective, and have the option to choose the preferred birth control method that is most appropriate for them – CDC Guidance (pdf).

The following services are covered under HFS’ comprehensive medical programs* and, at a minimum, must be offered to patients through direct services or timely referral:

• A reproductive life plan (pdf) which may include a preconception care risk assessment (pdf) and preconception and interconception care discussions.
• Education and counseling on all contraceptive methods with emphasis on presenting the most effective methods first, specifically long acting reversible contraceptives (LARC) such as intrauterine devices (IUD) (pdf)  and the implantable rod.
• Contraceptive methods must also include over-the-counter and prescription emergency contraception, including the provision of the copper IUD for emergency contraception.
• Permanent methods of birth control: tubal ligation, transcervical sterilization and vasectomy
• Basic infertility counseling, consisting of medical/sexual history review and fertility awareness education. Infertility medications and procedures are NOT covered.
• Reproductive health exam, with pelvic exam decoupled from the provision of contraception
• Age and risk appropriate Sexually Transmitted Infection (STI) screening and treatment (pdf)
• Universal HIV testing and counseling

• Testing and treatment for genital and related infections and other pathological conditions
• Lab test or screening necessary for family planning and reproductive health services 
• Cervical cancer screening, management, and  early treatment
• Vaccines for preventable reproductive health related conditions (i.e., HPV, Hepatitis B)
• Mammography referral and BRCA genetic counseling and testing

*Note, not all services are covered by Illinois Healthy Woman, please refer to http://www.illinoishealthywomen.com/covered.html

Please refer to the Handbook for Practitioners Rendering Medical Services (pdf) for policy and procedures for medical services.

Theresa A. Eagleson, Administrator, Division of Medical Programs

Update in Adult Dental Program Services (From HFS)

06/27/14

Informational Notice

To: All Enrolled Medical Assistance Program Providers

Re: Update in Adult Dental Program Services

This informational notice covers important changes to adult dental services in the Healthcare and Family Services (HFS) Dental Program. Adult dental services are being restored as a result of Public Act 98-0651. In addition, this notice provides billing instructions for services covered exclusively for pregnant women.

Effective July 1, 2014, adult dental benefits will be restored to the 2011 levels. For a list of 2011 covered services and rates, go to: DentaQuest Dental Office Reference Manual (pdf) (page 106). A new 2014 Dental Office Reference Manual with complete listing of benefits and limitations will be published soon and sent to all HFS-enrolled dental providers.

In addition to the dental benefits listed for all eligible adults, pregnant women (prior to the birth of their children) are eligible for the following five preventive dental services:

1. D0120 - Periodic Oral Evaluation
2. D1110 - Cleaning
3. D4341 - Periodontal Scaling and Root Planing-4 or more teeth per quadrant (deep cleaning)
4. D4342 - Periodontal Scaling and Root Planing-1-3 teeth per quadrant (deep cleaning)
5. D4355 - Full Mouth Debridement (gross removal of plaque and calculus)
   

In order to receive coverage for these additional services, providers must write “Pregnant” in the Remarks Field (Box 35) of the 2006 ADA claim form.

For more information, please contact your DentaQuest provider representative:

Timika Nunley at 855-333-8997
Jennifer Straub at 855-451-8814 or
DentaQuest Provider Relations Hotline at 888-281-2076
Theresa A. Eagleson, Administrator
Division of Medical Programs

Change in Coverage of Group Psychotherapy (From HFS)

06/26/14

Informational Notice

To: Encounter Rate Clinics, Federally Qualified Health Centers, Hospitals, Physicians and Rural Health Clinics

Re: Change in Coverage of Group Psychotherapy

The purpose of this notice is to advise providers of the requirements that must be met for group psychotherapy services rendered in a Federally Qualified Health Center (FQHC), or a Rural Health Clinic (RHC) setting. This notice supersedes the informational notice issued on January 30, 2013 (pdf).

Effective with dates of service February 1, 2013, and after, the department will pay for up to two group psychotherapy sessions for a participant in a rolling 7-day period, with a maximum of one session per day. Documentation shall be maintained in the patient's medical record and must indicate the person participating in the group session has been diagnosed with a mental illness as defined in the International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) or, upon implementation, International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), or the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

Beginning February 1, 2013, the entire group of psychotherapy services must be directly performed by one of the following practitioners:

• a physician licensed to practice medicine in all its branches who has completed an approved general psychiatry residency program or is providing the service as a resident or attending physician at an approved or accredited residency program;

• an Advanced Practice Nurse holding a current certification in Psychiatric and Mental Health Nursing as set forth in 68 Ill. Adm. Code 1305.Appendix A;

• one of the following providers in an FQHC or RHC:
  • Psychologist;
  • Licensed Clinical Social Worker;
  • Licensed Clinical Professional Counselor; or
  • Licensed Marriage and Family Therapist.

Group Session Requirements

The group must not exceed 12 patients, regardless of payment source and the minimum duration of the group session is 45 minutes.  Also, the group session must be documented in the patient's medical record by the rendering practitioner, including the session's primary focus, level of patient participation, and begin and end times of each session.

The group treatment model, methods and subject content must have been selected on evidence-based criteria for the target population of the group and shall follow recognized practice guidelines for psychiatric services.  In addition, the group session must be provided in accordance with a clear written description of goals, methods and referral criteria.

Group psychotherapy is not covered for recipients who are residents in a facility licensed under the Nursing Home Care Act [210 ILCS 45] or the Specialized Mental Health Rehabilitation Act [210 ILCS 48].

Enrollment

Physicians and Advanced Practice Nurses (APN) rendering group psychotherapy services at an FQHC or at an RHC must be enrolled as a provider in the Illinois Medicaid Program.  Physicians must complete a Form HFS 3882 (pdf) and APNs must complete a form HFS 3411C (pdf) to be eligible to render these services. Forms for enrollment may be accessed at the HFS Provider Enrollment website.

An FQHC or a RHC that will be providing group psychotherapy services rendered by Licensed Clinical Professional Counselors (LCPC) or rendered by LMFT or rendered by both will be assigned Category of Service (COS) 088 on the Centers/Clinics provider file.  In order to receive COS 088, the FQHC and the RHC must submit the professional license of the LCPC and/or the LMFT to the Provider Participation Unit along with a letter stating that group psychotherapy services will be provided with the date of the initiation of these services.  This letter must be dated and signed by the authorized representative of the FQHC or the RHC.

If the FQHC or the RHC has an LCPC on staff and previously has submitted to the Provider Participation Unit the professional license of the LCPC, then COS 088 has already been assigned to the Centers/Clinics provider file.  If this same FQHC or RHC will now be employing an LMFT to render group psychotherapy services as well, then the Center/Clinic must comply with letter and professional license submission as outlined above with the letter being dated and signed by the authorized representative of the FQHC or the RHC.

It is the responsibility of the FQHC and the RHC to submit to the Provider Participation Unit copies of all renewed professional licenses.  It is also the responsibility of the FQHC and the RHC to advise the Provider Participation Unit in writing if group psychotherapy services will be terminated with the effective date of such termination being indicated in the letter.  This letter must be dated and signed by the authorized representative of the FQHC or the RHC.

Questions regarding the completion of enrollment forms or letters should be directed to the Provider Participation Unit at (217) 782-0538.  Mail applications or letters/licenses to:

Illinois Department of Healthcare and Family Services
Provider Participation Unit
P. O. Box 19114
Springfield, Illinois 62794-9114

Billing Information

To receive reimbursement for services rendered by a physician or APN, providers must bill procedure code T1015. To receive reimbursement for services rendered by a psychologist, LCSW, LCPC or LMFT, providers must bill procedure code T1015 and the appropriate modifier listed below: 

Licensed Clinical Social Worker - T1015 with AJ modifier
Licensed Clinical Psychologist - T1015 with AH modifier
Licensed Clinical Professional Counselor - T1015 with HO modifier
Licensed Marriage and Family Therapists – T1015 with HO modifier

Timely Filing Override Information

Claims for any dates of service past the 180 day timely filing must be submitted to HFS on a paper claim form (HFS 2360) and provide a cover letter stating the reason they are requesting a time override to the following address. The instructions for preparation of the HFS 2360 can be found in the Handbook for Providers of Encounter Clinic Services, Chapter D-200, Appendix 1 (pdf). Please note that the information on the instructions for HFS 2360, Box 30 is incorrect. Box 30 must contain the 10-digit Provider’s NPI not the 12-digit Provider Identification Number.

Healthcare and Family Services
Bureau of Professional and Ancillary Services
Attn: Practitioner Billing Consultant
P.O. Box 19115
Springfield, Illinois 62794-9115

Any questions regarding this notice may be directed to a medical assistance consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565, option 3, option 1.

Theresa A. Eagleson, Administrator
Division of Medical Programs

HFS Webinar on Care Coordination Roll-Out

You are invited to a webinar on Care Coordination Roll-Out from 2 to 3:30 p.m. Monday, June 30, 2014. 

Pursuant to state law, the Department of Healthcare and Family Services (HFS) is in the process of enrolling Illinois Medicaid and All Kids clients into care coordination in five mandatory managed care regions: Rockford, Central Illinois, Metro East, Quad Cities, and Cook and Collar Counties. The Care Coordination Expansion can be reviewed on the HFS Care Coordination Expansion map (pdf). The week-by-week schedule for mailing enrollment packets to our clients will be posted on or before June 30, 2014 on the HFS website under “Care Coordination.” 

The subject of the webinar will be the timetable and Procedures for Enrollment of Medicaid Clients into Care Coordination, which can be viewed on the HFS Care Coordination Procedures for Enrollment of Medicaid Clients into Care Coordination page (pdf).  The timetable will be posted on the HFS website on or before June 30, 2014.  We encourage you to read these procedures before the webinar and email your questions in advance to HFS.HLTHPlnOutreach@illinois.gov. Questions received in advance will be addressed first.

During the webinar, you will be able to ask questions on your computer by typing them in the question box. Your questions will be addressed during the question-and-answer period, as time permits. All questions and answers will be posted on the HFS website following the webinar.

If you would like to attend the webinar, register on the HFS Care Coordination Roll-Out Webinar registration page. You will receive additional information for the webinar before June 30, 2014. Captioning will be available.

If you do not have an opportunity to attend the webinar, the full audio of the meeting will be available on the HFS website by the following week.

If you have questions about this webinar, please email hfs.webmaster@illinois.gov.

HFS Notice: Illinois Healthy Women Program (Family Planning Waiver) Updates

06/04/14

 

Informational Notice

 

To: Participating Physicians, Advanced Practice Nurses, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics, School Based Clinics, Local Health Departments, Pharmacies, Hospitals and Hospital Clinics

 

Re: Illinois Healthy Women Program (Family Planning Waiver) Updates

The purpose of this notice is to provide updates regarding the Illinois Healthy Women (IHW) program to family planning providers.

• IHW is scheduled to end December 31, 2014. Since April 2004, the IHW program has provided a limited package of family planning (birth control) and related reproductive healthcare benefits to low-income women in Illinois who were not otherwise eligible for other Illinois Department of Healthcare and Family Services (HFS) medical benefits programs. New federal health reform laws, also known as the Affordable Care Act, require all individuals to have minimum essential healthcare coverage, which includes birth control services. Therefore, women enrolled in IHW will now have the opportunity to obtain comprehensive healthcare coverage through either Expanded Medicaid or the Health Insurance Marketplace.

To ensure a seamless transition into affordable health care plans, HFS will continue to provide coverage under IHW through December 31, 2014 to allow a period for IHW clients to obtain other healthcare coverage and have continued access to their birth control method. Any service claims for IHW coverage with dates of service on or after January 1, 2015 will not be accepted. Providers are encouraged to verify eligibility prior to providing care and should refer to Informational Notice issued on January 30, 2013 (pdf) for guidance.

Additionally, HFS is sending bi-monthly notices to IHW clients as a reminder that the program is ending and to give instructions on how to apply for full benefits. Individuals without comprehensive healthcare coverage are instructed to go to the GetCoveredIllinois.gov website to explore their healthcare options and to apply for full benefits coverage through Expanded Medicaid or through the Health Insurance Marketplace (during open enrollment periods). Individuals may also call 1-866-311-1119 to speak to a representative. To ensure access to birth control services for women who miss the open enrollment period, HFS will continue to process applications for enrollment in IHW until September 30, 2014.

• As previously mentioned, HFS will continue to provide coverage under IHW through December 31, 2014 to allow a period for IHW clients to obtain other healthcare coverage. However, due to a programming error, some IHW clients were erroneously determined ineligible during the period of January 1 - April 30, 2014. Before denying any services to IHW clients, providers should double check current eligibility through the Medical Electronic Data Interchange (MEDI) system to make sure family planning services are not discontinued inappropriately.

Any questions regarding this notice may be directed to a medical assistance consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs

Update to MEDI and IEC migrating to a new environment (IEC will be unavailable as of 10 p.m. on Monday, 6/2/2014, until 9 a.m. Tuesday, 6/3/2014)

IEC will be unavailable as of 10 p.m. on Monday, June 2, 2014, until 9 a.m. Tuesday, June 3, 2014.

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Healthcare and Family Services is in the process of migrating MEDI and IEC to a new environment and will have an outage June 3, 2014 from 7 a.m. to 9 a.m. After this outage the URLs will be changing for MEDI and IEC. If you are using a bookmark short cut you will need to update the login by using the new URL, which can be found on the main page http://www.myhfs.illinois.gov/. After the change, you may encounter a pop up asking you if you wish to run the Entrust, Inc. application. If you do select the “Do not show this again for apps from the publisher and location above” box and then select Run.

We apologize for the inconvenience this may cause, and we thank you for your patience.