Illinois Tobacco Quitline (ITQL)

Overview of service

The Illinois Tobacco Quitline (ITQL) is funded by the Illinois Department of Public in partnership with the American Lung Association.  They ITQL serves both reactive and proactive call schedules. This ITQL gathers demographic and minimal data set tobacco questions on all callers. Content of sessions is based on the callers’ readiness and stage of quitting. Education on FDA approved interventions and recommendations for use are discussed. FDA approved tobacco cessation interventions are arranged currently through sources approved. The ITQL staff have been trained in risk assessment questioning, counseling tobacco users with mental illness and in communicating to those with a diverse ethnic background. The ITQL currently provides individual tobacco cessation counseling along with mailed or electronic versions of educational and support material.

Background and relevant experience with tobacco cessation services.

Established in 2001, the ITQL is the only lung health information and smoking cessation program offered by ‘Lung Health Experts’ due to the partnership with the American Lung Association. The ITQL provides barrier-free access to tobacco-cessation services through ease of accessibility to tobacco cessation education, counseling and support when callers are motivated to quit.

Staffing

The ITQL staff are Certified Tobacco Treatment Specialists, RN’s and or RRT’s and are trained in education of cessation and tobacco cessation interventions. Staff has attended training at the Mayo Clinic, New Jersey Medical and Dental School or Florida State University programs. Training has included addressing stages of change, motivational interviewing and recommended treatment for nicotine dependence. Many staff are also ancillary medical professionals and have backgrounds in previous counseling and health education with multiple years of clinical experience.

Intake

The ITQL intake and enrollment utilizes the Minimal Data Set Assessment recommended by North American Quitline Consortium. Caller and household disease status is also tracked. We currently evaluate a callers tobacco history, use, past use of products,  flying, PRP, PSP status, deployment status, rank, branch of service, medication and risk assessment questionnaire for making recommendations about each cessation product and appropriate use. The ITQL offers live answer reactive and counselor initiated proactive calls. Calls in queue transfer to live answer Intake Specialists.

Counseling

Our staff provides cessation counseling and relapse prevention to eligible clients. A tobacco cessation counselor works with each individual to develop a detailed tobacco cessation plan best suited to that person's tobacco habits and lifestyle. Each caller will receive individualized counseling and subsequent information outlining the tobacco cessation process.

Evaluation

During the National Conference on Tobacco or Health and the National Quitline Consortium meetings July 2012, details were presented on “industry standards” for follow- ups.  The recommendation is as follows:

Conduct follow-up seven months following enrollment.  This recommendation builds upon the existing MDS (minimal data set) system and has the advantage that a majority of cessation programs already conduct follow-up at this time.  This recommendation corresponds well to the six month time point recommended by the Society for Research on Nicotine and Tobacco (SRNT) workgroup while also allowing an initial one month grace period to initiate both treatment and a quit attempt. 

Over the past few years, we had been promoting and implemented follow up calls at 3, 6 and 12 months post a self-reported quit date. We now make a 7 month follow up call to all callers enrolled in the program regardless of quit status during calls to the Helpline. This now aligns with the industry standard. Our follow up data set mirrors the recommendation set forth by Department of HHS/CDC in the Quit line Resource Guide.

Hours of Operation

The Illinois Tobacco Quitline operates 24 hours with live voice answer. Counseling is available 7 a.m. – 11 p.m. CST, seven days a week. Current phone technology provides multiple call routing to available staff, call queue monitoring, queued call back, on hold messaging and voice mail capabilities.

2013 EHR Attestation Deadline Reminder!

2013 EHR Attestation Deadline Reminder!

The deadline for Eligible Professionals to attest for program year 2013 for the Electronic Health Record Incentive Program is March 31, 2014.    There will be a system outage from 6:00 PM to Midnight on the March 28, 2014, so don’t wait until the end of the month to submit your 2013 attestation.

Attestations can be submitted at: https://medicaid.illinois.gov.

EHR Provider Incentive Payment program questions and concerns can be submitted by email to hfs.ehrincentive@illinois.gov , or by contacting one of the Regional Extension Centers listed below. 

To resolve eMIPP or Illinois Medicaid Enrollment issues, contact the EHR Team at (877)782-5565 (select option 8)

The Regional Extension Centers are designed to help providers receive subsidized or free services to achieve Meaningful Use of electronic health records (EHRs).

·         Illinois Health Information Technology Extension Center Collaborative Web site (Statewide Consortium)

·         Chicago Health Information Technology Regional Extension Center Web site (Chicago Consortium)

·         For EHR Incentive Program questions, the Regional Extension Centers can be contacted at (855) 684-3571.

Please share this information with the appropriate individuals in your organization who are responsible for the EHR Payment Incentive Program.

BMI Assessment and Obesity-related Weight Management Follow-up among Children and Adolescents: Documentation and Claims Coding Instructions

01/24/14

Informational Notice

BMI Assessment and Obesity-related Weight Management Follow-up among Children and Adolescents: Documentation and Claims Coding Instructions This notice is revised to clarify language in Section B. Body Mass Index Assessment Documentation in Claims related to claiming ICD-9-CM codes 278.00 – 278.02 with ICD-9-CM codes V85.51 – V85.54.
The purpose of this notice is two-fold. First, to advise providers to report assessment of Body Mass Index (BMI) percentile in claims submittals to HFS. Second, this notice is to clarify the conditions under which weight management Evaluation & Management (E&M) visits can be billed.
A. Clinical Guidelines
Providers are encouraged to follow recommended clinical guidelines for evaluation & management of overweight and obesity. In 2007, the American Medical Association (AMA) published clinical recommendations for the prevention and treatment of overweight and obesity (see Barlow SE; Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity; Summary report. In 2010, the U. S. Preventive Services Task Force released its recommendation on screening for obesity (see Barton M; U.S. Preventive Task Force).
Primary Care Physicians and other providers are encouraged to routinely assess and document children's weight status and weight trajectory and counsel parents about how to help their children achieve and maintain a healthy weight. The CDC's Research to Practice series, available through their Nutrition Resources for Health Professionals Web page, provides information regarding the use of therapeutic lifestyle changes, and guidance for encouraging modifications around nutrition and physical activity.
The American Academy of Pediatrics' Bright Futures Guidelines for Health Supervision for Infants, Children, and Adolescents, 3rd Edition, (2008) suggest that parents need information on how to encourage their children and adolescents to practice healthy eating behaviors, beginning in childhood. Bright Futures Guidelines and clinical recommendations provide a set of recommendations for healthcare professionals to assist families, which HFS subscribes to.
B. Body Mass Index Assessment Documentation in Claims
Annually, HFS reports performance on a core set of child health measures to the Centers for Medicare and Medicaid Services (CMS). One of these measures reports the prevalence of weight assessment of children and adolescents documented through claims. In accordance with expert committee recommendations as referred to above, providers are encouraged to assess and document BMI percentile at least one time per year for pediatric patients ages 2 through 20. BMI assessment may be done during any visit, sick child or preventive.
Claims for an episode or encounter where BMI is assessed must include the appropriate CPT or UB-04 revenue code, and ICD-9-CM codes V85.51 – V85.54. If ICD-9-CM codes V85.53 or V85.54 are used, then also include ICD-9-CM code 278.00 – 278.02, as appropriate. Providers should append a BMI-related diagnosis code for every episode or encounter of care during which BMI was assessed, documented, and addressed, if indicated.
Documentation must include a note in the patient's record indicating:

1. The date on which the BMI percentile was assessed
2. One of the following measurements:

• BMI percentile, or
• BMI percentile plotted on age-growth chart

3. If indicated, pertinent recommendation or plan of management consistent with the codes used.

C. Weight Management Visits: BMI >85th Percentile

1. Providers may bill for weight management visits for children with BMI >85th percentile; BMI percentile, as described above, must be measured and documented during that visit.
2. Visits addressing problem-focused care delivered by a physician or an advance practice nurse or physician's assistant billing under a physician, may be billed for care delivered and documented using evidence-based clinical guidelines as described above.
3. For those in the >85th percentile, payable weight management visits may include a maximum of 3 visits spread over a course of six months; follow-up visits after the initial one visit must include, in the patient's record, a note addressing the patient's/parent's readiness to change and outcomes of intervention to date.
   
4. An appropriate CPT code or UB-04 revenue code, an appropriate five-digit ICD-9 diagnosis code 278.00 through 278.02 and one of V85.53 or V85.54 codes must be included on the claim form for each visit.
5. Diagnosis codes for obesity related co-morbid conditions, if present and addressed at that visit, need to be listed on the claim form for each visit.
6. Each visit should include, in patient record, documentation of educational handouts given, care plan and outcomes based on specific treatment and behavior changes (e.g., nutrition, physical activity etc.) recommended and made, compliance with past recommendations, results of screening laboratory tests, reports of referrals and consultations if any, and time spent by provider with patient and family during that visit.
7. No further visits related to weight management will be payable after a maximum of 3 visits over a six month period, unless improvement in BMI percentile is evident based on the V85.5x codes submitted for that claim or documentation of favorable outcome is appended to the claim.

D. Additional Notes on Payment Policies Related to Weight Management

1. Weight management visits cannot be billed on the same day as a Preventive Medicine visit.
2. Weight management counseling services can be billed as part of a problem-focused E&M visit using CPT codes 99204-99205, if provided to a new patient, or 99214-99215 if provided during a follow-up visit to an established patient. CPT guidance on this topic allows for this provision when counseling and/or care coordination dominates (more than 50%) face-to-face encounter time with the patient and/or family. The extent of counseling and/or coordination of care (time as well as content of care, coordination and counseling) must be documented in the medical record.

Providers wishing to receive e-mail notification when new provider information is posted by the department may register by visiting the HFS Provider Releases and Bulletins E-mail Notification Request web page.
Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs

Illinois Expands Medicaid

Illinois Expands Medicaid

The Affordable Care Act (ACA) provided incentives for States to expand Medicaid to cover adults never before covered. Illinois responded by passing IL Public Act 98-104 (pdf).  Starting January 1, 2014, a new group Illinois residents, known as “ACA adults” are eligible for Medicaid.  To be eligible for this group, someone must:

·         Be between 19 and 64 years of age;

·         Be a U.S. citizens or have legal status,

·         Not be eligible under a previous Medicaid eligibility group (such as moms & babies, or parent/caretaker), and

·         Have a monthly income at or below 138% of the federal poverty level ($1,321.35 for an individual or $1,783.65 for a couple). 

In addition to expanding coverage, Illinois has made it easier for people to apply for coverage including online through www.ABE.Illinois.gov , over the phone at 1-800-843-6154 or with the help of Navigators trained through the Health Insurance Marketplace program.  A list of Navigators along with screening questions to help someone determine whether they should apply for health coverage through Medicaid or the Health Insurance Marketplace, can be found on the state’s www.GetCoveredIllinois.gov website.  If a consumer has questions about what coverage is right for them, please refer them to that website.

It’s important for someone to apply to the right program because under the ACA, individuals and families who are eligible for minimum essential coverage (MEC) such as Medicare, Medicaid or employer-sponsored coverage will not be eligible for Advanced Premium Tax Credits to buy coverage on the Marketplace.  As a result, it is important to understand that these new ACA adults are likely to be individuals who are young and not yet working in jobs that offer coverage, working adults in-between jobs, or older adults not yet eligible for Medicare, who took early retirement or are out of the workforce.

Currently, Illinois has enrolled 152,000 adults in the ACA adult category, 74,000 of them in Cook County’s CountyCare program.  Through the Medicaid expansion and the requirement that all individuals have health coverage in 2014, Illinois estimates an additional 509,000 individuals will enroll in Medicaid by 2017.

Public Notices regarding the Alternative Benefit Plan for newly eligible ACA adults can be found at the following link: http://www2.illinois.gov/hfs/PublicInvolvement/PublicNotices/Pages/2013.aspx

Changes to the IHC Quality Assurance Program

On January 1, 2014, Automated Health Systems (AHS) entered into a new contract term with the Department of Healthcare and Family Services as the administrator of the IHC program.  Under the new contract term, IHC Quality Assurance Nurses will be available to assist you and your office staff during the weeks following distribution of the Spring and Fall Provider Profiles and the annual Bonus Payment disbursement period.  While year-round access to QANs will change, the importance placed on quality within the IHC program will not.  IHC will continue to host quality webinars on the use of IHC’s Provider Portal and IHC Quality Assurance Tools.  In addition, the IHC Medical Director, Dr. Alvia Siddiqi, will continue to oversee IHC’s Quality Assurance Program and is available to assist with any questions pertaining to this notice.  You may contact her by email at asiddiqi@automated-health.com or call her at 877-912-1999 ext 3201.

 

Under this new contract IHC will also continue to conduct quarterly Provider & Quality Management and Behavioral Health subcommittee teleconferences with representatives from HFS.  You are highly encouraged to participate in these meetings as your schedule permits.  If you are interested in joining one of the IHC subcommittees listed, please contact Provider Services Manager Jonathan Jackson at jjackson@automated-health.com, and visit the IHC website for more information: http://www.illinoishealthconnect.com/stakeholders/ihcsubcommittees.aspx