HFS NOTICE: Recoupment of Some Enhanced Payments Made to PCPs under Affordable Care Act (ACA)

Informational Notice

Date:     April 14, 2014

To:         Participating Primary Care Physicians (PCPs)

 Re:         Recoupment of Some Enhanced Payments Made to PCPs under Affordable Care Act (ACA)

Many Primary Care Physicians (PCPs) in the specialties of Internal Medicine, Family Medicine and Pediatrics have received enhanced payments for several services they have provided to Medicaid patients since January 1, 2013 following their required attestation. These additional payments over and above the Medicaid Fee Schedule, provided with 100% funding by the Federal Centers for Medicare and Medicaid Services (CMS), were prescribed by the Affordable Care Act (ACA) for 2 years and are slated to expire December 31, 2014. This department has acted as an intermediary for collection of those funds from the CMS and distribution for qualifying PCP services in accordance with the federal guidance.

The purpose of this notice is to inform participating Primary Care Physicians that the federal guidance, now clarified, limits additional payments for specified services only to those patients who receive Medicaid benefits under Title XIX. A smaller number of patients on Title XXI and some state funded programs are not eligible for enhanced payments under the ACA. Those additional payments made in error on claims received between January 1, 2013 and November 17, 2013 (the date that error was corrected) to patients in Title XXI and state funded programs will therefore need to be recouped according to federal rules. That take-back, although inconvenient and an unfortunate necessity, will only affect 3%-4% of the total enhanced payments made under the program and will be applied only on future vouchers for enhanced ACA payments, until recouped. The department will not recoup against any other type of payment.

On March 10, 2014, the department began issuing remittance advices identifying the erroneous payments with an Adjustment Reason Code 3317, (ACA Pmt Recoup/Client Category Ineligible).

Unfortunately, there is no such reliable system currently available which will allow the participating PCPs to definitively determine in advance whether a patient about to be seen or billed is Title XIX, Title XXI, or State-Funded. However, the participating PCPs will continue to receive enhanced payments for qualified services to a vast majority of patients they see.

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

American Academy of Pediatrics is conducting an assessment of the strengths and gaps for early childhood service providers who access trauma-informed resources such as training and coaching

PLEASE PROVIDE INPUT ON TRAUMA-INFORMED TRAINING

Throughout Illinois, there are strong commitments to providing trauma-informed support and quality services for children and families at risk in many service sectors, including health care, mental and behavioral health, family support, home visiting, education, and legal. However, the likelihood is very remote that from one community to another or from one system to another, every early childhood service provider a) has access to training and other resources on trauma and toxic stress; b) is supported to implement best practices; and c) coordinates services with other systems interacting with the child and caregivers.

 

Promoting Resiliency of Trauma Exposed Communities Together (PROTECT) is the Illinois initiative to mitigate toxic stress and trauma in early childhood.  PROTECT will expand access to trauma-informed resources systemically and statewide, coordinate efforts among systems, and engage and work with families and communities exposed to trauma to build resilience.

 

As part of the PROTECT initiative, the Illinois Chapter, American Academy of Pediatrics is conducting an assessment of the strengths and gaps for early childhood service providers who access trauma-informed resources such as training and coaching.  To this end, we request that you complete a survey located at https://www.surveymonkey.com/s/KTL7N6L.  This survey will be available until April 4, 2014.  Your responses will aid PROTECT leadership  in creating  a picture of  existing professional development, policy and systems integration, and standards and protocols for becoming and maintaining trauma-informed practices.  Thank you.  For more information on PROTECT contact jbrewster@illinoisaap.com or 312/733-1026, ext 203.

Oracle update from HFS

Oracle is introducing a new version of JAVA on March 18, 2014. This version will be called Java 8 GA (8 update 0). DO NOT UPGRADE to this new version. Java 8 GA is not compatible with MEDI. The update will not allow any transactions to occur from the MEDI login page.

 

We have been told that this upgrade will not be forced out to users. If you do upgrade, you will need to uninstall the new version 8 and reinstall version 7, update 51.