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Policy Update
Action Required!! HFS Survey on Residents Impacted by May 2023 Asset Limit Increase
We encourage you to complete the survey sent by HFS!! Your help is needed. Please complete the survey by September 13th!
The federally approved 1915(c) Home and Community Based Services waiver for the Supportive Living Program (SLP) includes a cap each year for the number of unduplicated Medicaid residents served. With the asset limit change that became effective in May, it’s possible we will have more Medicaid residents than projected for this waiver year and the next.
HFS may need to submit a waiver amendment to federal CMS to revise our cap. To determine if a waiver amendment is necessary, HFS must collect information on:
· The residents who were recently approved for Medicaid as a result of the asset limit change effective May 19, 2023.
· Residents impacted by the asset limit change with pending Medicaid applications and anticipated applications within the next 6 months.
Again, HFS is only requesting information for residents whose recent Medicaid approval was impacted by the asset limit change or those with pending/future approvals that will be impacted. If an individual applied for Medicaid prior to 5/19/23 and their assets were <$2,000 for an individual or <$3,000 for a married couple, do not include them in the survey response. To learn more, click here.
*If you did not receive the password-protected survey, please contact: kara.helton@illinois.gov.
Maximus Dementia Reviews for Colbert Class Members began this Month
The Illinois Department of Healthcare and Family Services (HFS) has contracted with partner Maximus to conduct independent, conflict-free Dementia Reviews to facilitate HFS compliance with Colbert Consent Decree requirements. This new service launched on August 14, 2023, and will help to:
· Identify persons residing in Cook County Nursing Facilities who may no longer require community transition services due to severe dementia (i.e., major neurocognitive disorder) that is unlikely to improve.
· Support the long-term resolution of the Colbert Consent Decree through the implementation of this new process. To learn more, click here.
Medicaid Reinstatement Accountability Call with LTC Providers-August
To view slides, click here.
Updated SLP Cost Report & Instructions
All supportive living program providers certified by the Department of Healthcare and Family Services must file a cost report. SLP providers must submit cost reports to the Bureau of Health Finance at any time upon request from the Department, or, when a significant change occurs in the SLP provider's financial status/solvency, and, annually not later than 90 days after the end of the SLP provider’s fiscal year. Additional details regarding preparation and, filing requirements can be found in the cost reporting instructions, and in the Department’s rules at 89 Ill. Adm. Code 146.265(e)2. Click here to learn more.
Any questions concerning the filing of cost reports should be addressed to:
Illinois Department of Healthcare and Family Services
Bureau of Health Finance
201 S. Grand Ave. E.
Springfield, IL 62763
Telephone: 217-782-1630
Questions and Answer: Reinstatement Period
Members that do not submit their redetermination on time have a 90-day reinstatement period. If their redetermination is completed within the 90-day period, and if the member is determined eligible for coverage, the member’s Medicaid coverage will be reinstated back to the first date of lost coverage. If the reinstatement is processed within the 90-day period, the member will be reassigned to the same managed care organization (MCO) prospectively. Providers should bill HFS for any services performed for the period of reinstated coverage.
QUESTION #1: When an enrollee loses his/her eligibility during redetermination and enters the 90-day grace period, what entity will pay for services provided if the person is then reinstated (ie- the MCO or the State). I assumed it would be the person's original MCO with which he/she was previously enrolled that would pay, but I found the paragraph below on the BCBSIL website, which states that providers should bill HFS for any services performed for the period of reinstated coverage. Does this mean that that HFS would pay fee-for-service, or the MCOs will pay claims when directed by HFS?
ANSWER: The re-enrollment into the managed care is prospective, so the customer would be fee-for-service during the period of time that their Medicaid eligibility was reinstated prior to the prospective enrollment back into the managed care plan. Services provided during that period of time should be billed to fee-for-service Medicaid and would be paid fee-for-service.
QUESTION #2: If the resident is not reinstated during the 90-day period and determined ineligible, will there be any payment for continued services during the 90-day grace period?
ANSWER: No, there wouldn’t be any payments if the individual didn’t have coverage. The customer would have to reapply if they didn’t get the redetermination and necessary supporting documentation submitted within 90 days of the closure.
Do you have a question about the ongoing redetermination process? Ask AALC and we will track down the answers for you! Send questions to info@aalcillinois.org with subject line “Redetermination Question.”
CMS Extends Timeline for Appendix K Authorities
CMS is issuing this guidance in recognition of the number of section 1915(c) waiver actions already submitted and expected to be submitted by states to incorporate Appendix K flexibilities into the ongoing operations of their HCBS programs. The nature of these amendments, namely those to modify services, payment rates and provider qualifications, meets the definition of a “substantive change” defined at 42 CFR § 441.304(d), and therefore requires an effective date no earlier than the date of CMS approval, and requires public notice to be conducted prior to submission of the action to CMS, as defined in § 441.304(f). The ability for these waiver actions to be submitted, reviewed and approved by November 11, 2023, to prevent a lapse in authority, is highly uncertain. In the name of minimizing disruption to beneficiaries, providers and states, CMS is issuing this extension of the Appendix K expiration date. The applicable Appendix K will remain in effect until the effective date of the section 1915(c) waiver action (amendment or renewal). To learn more, click here.
HFS submitted a waiver amendment to federal CMS on August 1st seeking, among other things, to make permanent the $6.15 daily rate increased authorized by Appendix K.
Expanding Veterans’ Options for LTC
AALC has been working to educate and promote Expanding Veterans' Options for Long Term Care Act (SB 495/HB 1815). AALC has been meeting with other national trade associations as well as the Illinois Congressional Delegation to secure support for the Act. If enacted, the Act provides for selection of six Veterans Integrated Service Networks (VISNs) or regions to help pilot this veterans' initiative. With Illinois' national lead in affordable, Medicaid-supported assisted living and its location spanning 3 VISNs (VA Heartland Network, Great Lakes Health Care System, and the Midwest Health Care Network), Illinois could be instrumental in successfully implementing this pilot program. To learn more, click here.
New Application for Benefits Eligibility Access and Multi-Factor Authentication Process
All Long Term Care (LTC) providers that the State of Illinois will soon be introducing a new way for Application for Benefits Eligibility (ABE) users to log in to their accounts. The projected Go Live for this new process is Fall 2023. Users will then receive an email with instructions on how to complete registration on their Illinois Partner account.
This new login, which includes a Multi-Factor Authentication (MFA) security process, is called ILogin for customers and Illinois Partner for logging into the ABE Provider Portal. The goal is to improve protection of private information. The Illinois Partner application uses the latest security tools to protect information and reduce the chance that someone other than the Provider user is able to access data in ABE. To learn more, click here.
Illinois Among States Prompting Concern By Federal CMS
In letters sent this month to state Medicaid agencies, CMS raised concerns that long call center wait times and high abandonment rates “are impeding equitable access to assistance and the ability for people to apply for or renew Medicaid” and may run afoul of federal requirements. Similar warnings were sent to 16 states — Alaska, Arizona, Florida, Hawaii, Idaho, Illinois, Kansas, Maine, Missouri, Montana, Nevada, New Mexico, Oregon, Rhode Island, South Carolina and Utah. To read more, click here.
Biden-Harris Administration Announces $100 million to Grow the Nursing Workforce
The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, this month announced awards of more than $100 million to train more nurses and grow the nursing workforce. These investments will address the increasing demand for registered nurses, nurse practitioners, certified nurse midwives, and nurse faculty. To learn more, click here.
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