Illinois Health Connect Blog

Friday, October 14, 2016

Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines -Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Encounter Rate Clinics (ERCs)

Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines

To:	Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Encounter Rate Clinics (ERCs)
Date:	October 14, 2016
Re:	Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines

This notice provides information regarding the Vaccines for Children (VFC) program. In an effort to ensure Title XXI (21) and State-Funded All Kids eligible children have access to vaccines, the Illinois Department of Public Health (IDPH) is providing Illinois VFC providers the opportunity to order vaccines (317-funded vaccines) through November 26, 2016 or as long as federal funding remains available. Please see IDPH’s notice dated September 30, 2016 for details.

Billing instructions for the transition period are detailed below:

For vaccines obtained from IDPH through the limited 317 fund supply, clinics must bill the vaccine-specific procedure code as part of a billable encounter (T1015) or as part of a wellness encounter (S5190).
For private stock vaccines, clinics should bill in accordance with the Vaccination Billing Instructions for Encounter Rate Clinics Only posted on the Non-Institutional Providers webpage.

For participants enrolled in one of the Medicaid Managed Care Organizations, providers should contact the individual plan for billing policies and procedures, as well as reimbursement information.
Providers must maintain appropriate documentation in their records to be able to provide in the event of an audit.
Additional information specific to the VFC program changes are located on the Non-Institutional Providers webpage.
Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/default.aspx

Felicia F. Norwood
Director

Hepatitis C Treatment

To:	All Medical Assistance Providers
Date:	September 30, 2016
Re:	Hepatitis C Treatment

The purpose of this notice is to inform providers that the cost of newer, direct-acting antivirals (DAAs) for treatment of Hepatitis C for Medicaid beneficiaries will be covered in earlier stages of the condition (F3) effective with dates of service on or after October 1, 2016.

The Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force recommend a onetime Hepatitis C Virus antibody test for those born between 1945 and 1965 regardless of risk factors. CDC estimates that a significant majority of those living with Hepatitis C belong to this age group and approximately three-fourths of Hepatitis C related deaths occur in this population. The Illinois Medicaid program allows and pays for Hepatitis C antibody testing when ordered by a physician or other authorized practitioner.

The DAAs have resulted in a significant shift in the general approach to treatment of Hepatitis C. These new antivirals are considered to be much more effective in eradicating the virus than previously available therapy. In addition, the treatment is safer, of a shorter duration, and in many cases can be accomplished with oral therapy alone, without Interferon, which is known to have many side-effects. Effective with dates of service on or after October 1, 2016, the Department will begin providing prescription coverage for qualifying patients with a Metavir score of F3 down from F4 previously.

Hepatitis C drugs require prior authorization to be eligible for reimbursement by Medicaid. Additional information such as the criteria and the necessary prior authorization request forms can be found on the HFS Criteria and Forms webpage.

Questions regarding this notice should be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood

Director

MACRA - Quality Payment Program Begins Soon

MACRA - the Medicare Access & CHIP Reauthorization Act of 2015 - is set to transform the way the federal government delivers and pays for healthcare. MACRA replaces the sustainable growth rate (SGR) Medicare Part B reimbursement model with a value-based payment system designed to lower costs and improve healthcare quality. MACRA will replace PQRS, value-based modifier (VBM) and meaningful use with two payment tracks:

Merit Based Incentive Payment System (MIPS)

Alternative Payment Models (APMs)

To assist practices with these changes, Quality Payment Program (QPP) Resource Centers will be established as early as November 2016 to answer questions and provide direct technical assistance and support at no cost to practices with 15 or fewer clinicians. If you would like to be notified of the QPP Resource Center serving your practice, CLICK HERE. For additional information, visit ILHITREC's MACRA website or Telligen's MACRA website.

Service Definition and Reimbursement Guide (SDRG), Reissue

To:	All Enrolled Medical Assistance Providers
Date:	October 12, 2016
Re:	Service Definition and Reimbursement Guide (SDRG), Reissue

The Department is reissuing the Service Definition and Reimbursement Guide (SDRG).

Providers are encouraged to review the handbook in its entirety. This handbook provides information necessary for providers to receive payment from the Department.

Any questions may be directed to the Department at: HFS.CBH@illinois.gov, using the subject line “SDRG” or by calling 217-557-1000.

Felicia F. Norwood

Director

Psychiatric Services Provided Within Community Mental Health Centers (CMHCs)

To:	Participating Physicians, Participating Community Mental Health Centers
Date:	October 13, 2016
Re:	Psychiatric Services Provided Within Community Mental Health Centers (CMHCs)

The purpose of this notice is to inform participating physicians partnering with participating Community Mental Health Centers and billing the Department of Healthcare and Family Services (HFS) that the Department is adding an enhanced payment for certain fee-for-service psychiatric services.Physicians who render services in a community mental health setting are eligible to receive the enhanced payments for dates of service July 1, 2016 – June 30, 2017. In order to receive the enhanced payments, physicians must bill the applicable procedure code with the “UB” modifier and designate the community mental health center as the payee.Please note the community mental health center must be listed as a valid payee on the physician’s provider file.

The updated Practitioner fee schedule includes a tab with the enhanced payment to providers for fee-for-service psychiatric services provided between July 1, 2016 and June 30, 2017.

Resolution for claims with dates of service on or after July 1, 2016 that were submitted and paid, or are pending payment, prior to programming implementation for the add-on payments:

Providers may submit a void & rebill or a replacement claim. The Department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a payable or pending-payable claim if submitted within 12 months from the original paid voucher date.

Replacement Claims – To replace a single service line or entire claim, enter Claim Frequency “7.” Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide. This method is preferred as it requires no manual override.

Void & Re-bill – This process involves two steps. The void portion may be completed electronically or on paper. Please refer only to step #1 for a void with no re-bill.

1.) To electronically void a single service line or an entire claim, enter Claim Frequency “8”. Detailed instructions on how to void a claim electronically can be found in the Chapter 300, 837P Companion Guide. A paper void may be completed by submitting a NIPS Adjustment Form HFS 2292 (pdf), instructions for which may be found in Chapter 100, Appendix 6.

2.) Following completion of the void, a new original claim must be submitted within 90 days of the void DCN and may require manual override. If manual override is required, attach to a paper claim: a cover letter stating the reason for request for timely filing override.

Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood

Director

Communication Webinars for Public Health Leaders

To: Local Health Departments and Hospitals Statewide

From: Manjusha "Rani" Saxena, MPH

           Program Manager, MidAmerica Regional Public Health Leadership Institute

Subject: Communication Webinars for Public Health Leaders

The MidAmerica Center for Public Health Practice at UIC School of Public Health in Chicago is excited to launch three upcoming webinars on Communication Toolkit for Public Health Leaders. The webinars will be facilitated by Julie Swanson and will cover the following topics:

• Your Most Powerful Tool: Leverage the Power of Strategic Narrative

– Wednesday, November 2, 2016   11:00 am – 12:00 pm (CST)

• What You Say Matters: What Leaders Need to Know about Messaging

– Wednesday, November 16, 2016   11:00 am – 12:00 pm (CST)

• It’s Not Enough to be Right: Tips and Tools for Framing your Message

– Wednesday, November 30, 2016   11:00 am – 12:00 pm (CST)

Registration link - http://www.cvent.com/d/rvqqly

Please share the attached flyer to those that may be interested.

Thank you.

Rani

To:	Participating Community Mental Health Providers
Date:	October 13, 2016
Re:	Enhanced Payment for Psychiatric Services Provided Within Community Mental Health Centers (CMHCs)

The purpose of this notice is to inform participating Community Mental Health Centers of a change in reimbursement rates. The Department has increased reimbursement rates for specific psychiatric and behavioral health services rendered by a physician, advanced practice nurse or a licensed community mental health center. The rate change is for services provided between July 1, 2016 and June 30, 2017. Services qualifying for the enhanced payment are identified in the Community Mental Health Services Fee Schedule posted on the HFS website.

These services include but are not limited to mental health assessment, psychological evaluations, medication management, psychotherapy, and counseling.

The reimbursement changes will apply to mental health rehabilitative services provided in or by community mental health centers as well as the physician benefit categories.

Resolution for CMHC claims with dates of service on or after July 1, 2016 that were submitted and paid, or are pending payment, prior to programming implementation for the add-on payments:

The Department will adjust claims previously submitted and adjudicated for payment with dates of service after July 1, 2016 to reflect the enhanced payment on qualifying services.

Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood