Thursday, December 29, 2016

Fee-For-Service Reimbursement for Licensed Clinical Psychologist (LCP) or a Licensed Clinical Social Worker (LCSW)

                  
 
To:
Enrolled Medical Assistance Providers
​Date:
​December 28, 2016
​Re:
Fee-For-Service Reimbursement for Licensed Clinical Psychologist (LCP) or a Licensed Clinical Social Worker (LCSW)
This notice informs providers that the Department of Healthcare and Family Services (HFS) will begin fee-for-service (FFS) reimbursement for certain services provided by Licensed Clinical Psychologists (LCPs) and Licensed Clinical Social Workers (LCSWs) enrolled for participation in the Department’s Medical Programs beginning with dates of service on or after January 1, 2017. Enrolled providers are not required to make changes in IMPACT in order to bill the Department FFS. 
Fee-for-service reimbursement is eligible for services billed and rendered by an LCP or LCSW. This change applies to services rendered by individual LCPs and LCSWs practicing outside a Community Mental Health Center, Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) setting. Reimbursement is not eligible for services identified in 89 Ill. Adm. Code 140.6, self-administered and self-scored tests of cognitive function or biofeedback therapy. 
Billing instructions and the LCP/LCSW fee schedule will be published in January 2017. 

Licensed Clinical Psychologist Services

The Department will reimburse LCPs for psychological and neuropsychological testing including diagnostic evaluation and therapeutic services provided in the office, home or community setting for individual psychotherapy and family or group psychotherapy for which the purpose is the treatment of the patient. Group psychotherapy services must meet guidelines set forth in 89 Ill. Adm. Code 140.462 (c)(2) and (d)(2). 
LCPs who hold a current prescribing psychologist license or have and maintain a current written collaborative agreement with a collaborating physician as defined in the Clinical Psychologist Licensing Act (225 ILCS 15/) may prescribe medications. All prescriptions must meet the requirements set forth in 89 Ill. Adm. Code 140.414 
The collaborating physician is not required to be enrolled with the Department, however, may not be terminated, suspended or barred by the Department from participating in the Medical Assistance Program. The LCP must notify the Department within 10 business days if an agreement is dissolved or if a change occurs in the collaborating agreement. Collaborative agreements must be updated and maintained on file at each practice location, and be available to the Department upon request. 

Licensed Clinical Social Worker Services 


The Department will reimburse LCSWs for diagnostic evaluation and therapeutic services provided in the office, home or community setting for individual psychotherapy and family or group psychotherapy for which the purpose is the treatment of the patient. Group psychotherapy services must meet the guidelines set forth in 89 Ill. Adm. Code 140.462 (c)(2) and (d)(2). 
Questions regarding this notice should be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
 
Felicia F. Norwood
Director

Thursday, December 22, 2016

​Pharmacy Benefit Management System (PBMS) Updates – New Payor Sheet and Prescriber Enrollment Requirement







Provider Notice Issued 12/21/2016
                 
To:
Participating Pharmacies, Physicians, Dentists, Podiatrists, Optometrists, Hospitals, Advanced Practice Nurses, and Physician Assistants
​Date:​December 21, 2016
​Re:Pharmacy Benefit Management System (PBMS) Updates – New Payor Sheet and Prescriber Enrollment Requirement

The purpose of this notice is to inform providers that effective with the implementation of the Department’s new Pharmacy Benefit Management System (PBMS) any prescriber wishing to prescribe medications for an Illinois Medicaid participant must be enrolled through the IMPACT system. Implementation of the PBMS is tentatively scheduled for March 27, 2017.  
Additional information regarding the IMPACT system including frequently asked questions, webinars and other training guides are available on the IMPACT webpage. Providers are encouraged to subscribe to receive e-mail notification when new Provider Notices are posted to the Healthcare and Family Services (HFS) website.     
For additional questions or assistance, please contact the IMPACT Help Desk by email at IMPACT.HELP@illinois.gov or by phone at 877-782-5565, option #1. 
In addition, the Department has posted the updated draft payor sheet for the new PBMS on the ILLINOIS Rx Portal Home Page and it can be accessed by clicking on the “Payor Sheet” hyperlink on the right side of the page.  
Providers are encouraged to pay particular attention to the Coordination of Benefits/Other Payments Segment Questions section of the payor sheet.  
For additional questions or assistance regarding the payor sheet, please contact a Bureau of Professional and Ancillary Services Pharmacy Billing Consultant at 877-782-5565.
  
Felicia F. Norwood
Director
 
 

Friday, December 16, 2016

Preferred Drug List for 2017


Illinois Medicaid:  Changes have been made to the Committee on Drugs and Therapeutics webpage and the  Medicaid Preferred Drug List (pdf) has been updated.

Wednesday, December 14, 2016

ICAPP- Lets Update 12-14-16


This message was sent to tagin@automated-health.com
 
December 14, 2016


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 TOP NEWS


 
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ICAAP
The Autism, Behavior, and Complex Medical Needs-Downstate (ABC-D) planning committee is seeking presentation proposals for the 2017 3rd ABCD Conference, "Zip Code vs. Genetic Code: The Social Determinants of Caring for Children and Families with Special Needs," scheduled for Friday, April 28, 2017, at the Regency Conference Center in O'Fallon, IL. The conference theme has been determined based on current AAP priorities and past participant feedback. The recent 7th Annual ABC Conference held in Northern Illinois of the same format and theme was very successful and received overwhelming positive response.

The deadline for submission of proposals is Monday, January 9, 2017 at 5pm. The planning committee will review submissions and send notifications of acceptance by Friday, January 23rd.

ABC Conference participants learn about the broad landscape of services and programs that are available to support children with special needs from birth through adolescence, and develop skills to make effective referrals and partner with other agencies and systems. Each track features sessions that converge with different systems, developmental services, medical interventions, and innovative partnerships that benefit children served across interprofessional groups.
More information about past ABC Conferences can be found here.



 
 
 NEWS PROVIDED BY ICAAP


 
Twitter
ICAAP
ICAAP is looking for member physicians, especially those in central/southern Illinois, to serve on the planning committee for the 3rd Annual ABCD (Autism, Behavior, and Complex Medical Needs – Downstate) Conference, "Zip Code vs. Genetic Code: The Social Determinants of Health in Caring for Children and Families with Special Needs," to be held on Friday, April 28, 2017, at the Regency Conference Center in O’Fallon, IL.

The role of planning committee members is to:
  • Attend (via conference call) the planning meetings
  • Review Requests for Proposals (RFPs) and provide recommendations for speakers
  • Provide recommendations for exhibitors
  • Utilize networks to help promote the event
  • Be present at the conference on April 28 and available at the conference to serve as a session moderator
The first planning committee meeting will take place by conference call on Wednesday, December 14, 2016 at 12:00 pm. If you would like to participate, please RSVP to Tom Bradach to request the call-in information. More information about ABC Conferences can be found here.

ICAAP
Body mass index reduction in children with overweight and obesity can be challenging. Psychosocial stressors, such as adverse childhood experiences, unmet social needs, and psychiatric disorders, may represent an important reason why pediatric obesity is so difficult to treat. Learn how to address these issues in your practice with ICAAP's upcoming MOC activity Identification and Management of Psychosocial Stressors in Children with Overweight and Obesity. Participants will learn about the connection between psychosocial stressors and obesity as well as practical tips on how to screen, counsel, and refer for one focused psychosocial stressor of their choice. The collaborative project is slated to begin in mid-January 2017 and run for approximately three months. The deadline for registration is Monday, January 16, 2017. To register or for more information, please contact Anna Carvlin, Manager, Obesity Prevention Initiatives, at 312/733-1026, ext 214 or acarvlin@illinoisaap.com or Mary Elsner, Director of Obesity Prevention Initiatives, melsner@illinoisaap.com or 312/733-1026, ext 237. This activity is funded by a grant from the Illinois Department of Healthcare and Family Services and the Otho S. A. Sprague Memorial Institute.


ICAAP and Illinois Alliance to Prevent Obesity
ICAAP is seeking pediatrician advocates living or working in Springfield, Champaign-Urbana, and Peoria for the state campaign to promote the Healthy Eating and Active Living (HEAL) proposal. The HEAL proposal would impose a state excise tax on sugary beverages and raise an estimated $600 million, with $500 million designated for Medicaid, including coverage of multi-disciplinary care for pediatric obesity, and $100 million designated for community prevention. If you are willing to become an advocate or need further information, please contact Mary Elsner, Director, Obesity Prevention Initiatives, melsner@illinoisaap.com or 312/733-1026, ext. 237, or Anna Carvlin, Manager, Obesity Prevention Initiatives, at 312/733-1026, ext. 214, or acarvlin@illinoisaap.com.

ICAAP
ICAAP's Obesity Prevention Initiatives offers an array of web-based education free of charge on ICAAP's new online learning platform in the course catalog under Obesity Prevention. Click here to access a flyer with more information about ICAAP’s obesity-related education offerings. The following courses are included:
  • Nutrition for Obesity Prevention and Treatment*
  • Physical Activity Guidelines and Counseling for Children and Adolescents**
  • Evaluation and Management of Hypertension in Children**
  • Evaluation and Management of Hyperlipidemia in Children**
  • Understanding and Assessing Psychosocial Factors Associated with Childhood Obesity**
  • Connecting Patients to Community Resources **
For more information, or for assistance navigating resources and finding resources for patients, please contact Anna Carvlin, Manager, Obesity Prevention Initiatives, at 312/733-1026 x214 or acarvlin@illinoisaap.com. ICAAP obesity-related education is funded by grants from the Otho S.A. Sprague Memorial Institute and the Illinois Department of Healthcare and Family Services.

*This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Pediatrics (AAP) and the Illinois Chapter of the American Academy of Pediatrics (ICAAP). The American Academy of Pediatrics is accredited by the ACCME to provide continuing medical education for physicians.

The AAP designates this enduring material activity for a maximum of 2.75 AMA PRA Category 1 Credit(s) TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity is acceptable for a maximum of 2.75 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.

The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit(s) TM from organizations accredited by ACCME. Physi¬cian assistants may receive a maximum of 2.75 hours of Category 1 credit for completing this program.

This program is accredited for 2.75 NAPNAP CE contact hours of which 0 contain pharmacology (Rx) content per the National Association of Pediatric Nurse Practitioners (NAPNAP) Continuing Education Guidelines.

**The Illinois Chapter, American Academy of Pediatrics is accredited by the Illinois State Medical Society (ISMS) to provide continuing medical education for physicians.

The Illinois Chapter, American Academy of Pediatrics designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s) TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ICAAP and Family-to-Family Health Information Center
Please read combined comments from ICAAP and our great partner the Family-to-Family Health Information Center (F2F) on the Illinois Statewide Transition Plan for new CMS Rules.

The Illinois Chapter of the American Academy of Pediatrics (ICAAP) and The Arc of Illinois Family-to-Family Health Information Center (F2F) support the comments on the Healthcare and Family Services Transition Plan for New CMS Rules on Home & Community Based Services (HCBS) submitted by the Arc of Illinois December 6, 2016. Below are additional comments related to the pediatric population for the revised Illinois Statewide Transition Plan.

ICAAP and F2F encourage the Illinois Department of Human Services (DHS), including the Division of Developmental Disabilities (DDD) and the Division of Rehabilitation Services (DRS), and the Illinois Department of Healthcare and Family Services (HFS) to come together and establish a pediatric focus for children (ages birth to 21 years) across all six of Illinois’ current nine Medicaid waivers which serve children with emphasis on coordinating services to support families to keep children living at home, in their own communities, whenever possible. This process should start with formalizing a “no wrong door” policy for all children and families currently receiving any type of services/supports from DHS (any division) and/or HFS (including children and families enrolled in Family Health Plans).

We recommend that HFS establish a pediatric specialist role within the HFS Bureau of Interagency Coordination as well as establish a Children’s Waiver Central Office in Springfield (analogous to the current arrangement established by HFS and DHS specific to the Medically Fragile and Technology Dependent (MFTD) waiver: Central Office (CO) 238, which is part of the Bureau of Local Office Transactions and Support Services (LOTS).

In this way, families of children and youth with special health care needs (CYSHCN) currently receiving any type of services/supports from DHS and HFS can be supported by direct linkage to potential HCBS waiver-specific programming designed to enable them to raise their children in their own communities.

Based on presently available information, our current system in Illinois appears to have some capacity to serve more children with disabilities and/or chronic illnesses with home-based services and supports, but accessing them can be a daunting task for many families, as well as for providers and service professionals. There is a paucity of current, definitive data that continues to be a barrier to both child-specific program and policy.
 READ MORE

The American Case Management Association
The American Case Management Association (ACMA) is dedicated including more pediatric focused topics at their future conferences. They are inviting ICAAP members and friends to participate in a 5-minute survey. All responses will be compiled together and analyzed to determine what sessions would be most beneficial. If you have any questions or concerns, please Susan Navarro, RN ACM, at snavarro@luriechildrens.org or 312-227-3276.

 
  ILLINOIS NEWS


 

Chicago Tribune
Cases of a dangerous superbug increased 27 percent last year in a region surrounding Chicago, a new survey shows, but incidents were down in the city, and officials say they are making strides in containing the contagion. The state survey counted medical patients who tested positive for a germ known as CRE, short for carbapenem-resistant Enterobacteriaceae, which withstands many of the strongest antibiotics. It generally strikes at health-care facilities, often among the elderly and people who have serious illnesses or have had invasive medical procedures.  READ MORE

Crain's Chicago Business
A Washington, D.C.-based nonprofit gave high marks to 10 Illinois hospitals on its 2016 Top Hospitals list. The Illinois hospitals recognized by Leapfrog Group include a children's hospital, a rural hospital, five general hospitals and three teaching hospitals. All of the highest-performing facilities in Leapfrog's survey must have received an A in the most recent round of scoring to be eligible.  READ MORE

 
 NATIONAL NEWS


 

HealthDay News
Infant vaccinations are no fun. But anesthetic cream can take away some of the sting, new research suggests. After testing several techniques, researchers determined the best recipe for minimizing babies' discomfort includes lidocaine cream at the site of the injection, a little sugar by mouth and parental soothing.  READ MORE

CNN
Fifteen-y
ear-old Savitri Yami Baker loves to belt a tune. "They can hear her from three houses away," Savitri's 26-year-old sister, Victoria Ajene, jokes. This comes as a surprise, as Savitri often has challenges breathing when she speaks. The Clovis, California, girl has the neurological disorder cerebral palsy. "She'll speak, and before she finishes her sentence, her breath will run out, and she'll just struggle to get the breath out. However, when she sings, there is no problem. She hits every tone, every note, loud, clear," said Beverly Baker-Ajene, Savitri's mother.  READ MORE

ScienceDaily

In children on the spectrum, anxiety is often masked by the symptoms of autism. But a new variant to a standard anxiety screening method has now proven effective in separating the two and it is leading to important diagnoses.  READ MORE


 
 MISSED AN ISSUE OF ICAAP-LETS UPDATE? VISIT AND SEARCH THE ARCHIVE TODAY.


 

Healthday News

Only about two out of five Americans had gotten this season's flu shot as of early November, the U.S. Centers for Disease Control and Prevention reports. About 37 percent of children between 6 months and 17 years old have gotten the flu vaccine this year. And approximately 41 percent of adults aged 18 and older have received the shot. The overall rate is similar to the vaccination rate at the same time last year, the CDC noted.  READ MORE

The New York Times
Increasing numbers of infants in rural areas in the U.S. are born dependent on drugs, largely as a consequence of their mothers’ use of opioids, researchers reported recently. From 2004 to 2013, the rate of newborns experiencing withdrawal increased sevenfold among infants born in hospitals in rural counties, to 7.5 per 1,000 from 1.2 per 1,000. By contrast, in that decade the uptick among urban infants was nearly fourfold, to 4.8 per 1,000 from 1.4 per 1,000.  READ MORE

EurekAlert!
A new minimally invasive technique for repairing the most common cardiac birth defect in extremely premature newborns can be performed safely with a high success rate in babies as small as 755 grams — about 1.6 pounds — only a few days after birth. The study, published in the Journal of the American College of Cardiology: Cardiovascular Interventions, details the results of a catheter-based approach to repairing patent ductus arteriosus, commonly referred to as "a hole in the heart."  READ MORE

 
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