April 8, 2020

ENSURING THE SAFETY AND ACCESS TO MEDICAID FOR ILLINOIS RESIDENTS

With over 12,000 cases and more than 300 deaths, Illinois has been hit hard by the COVID-19 pandemic.  As federal and state officials work feverishly to flatten the curve of this disease, Illinois’s Department of Healthcare and Family Services (HFS) along with the Illinois Association of Medicaid Health Plans (IAMHP) and its member plans have increased coordination efforts to combat this public health emergency. 

Technical experts from IAMHP and Medicaid Health plans have been working with HFS to find solutions to some of the many issues facing Illinois residents.  As a result, the following changes have been enacted to mitigate the impact and spread of the COVID-19, streamline process for new applications and preserve access for current Medicaid members. 

MITIGATING THE IMPACT AND SPREAD OF COVID-19:

As the state reinforces shelter-in-place and social distancing guidelines, measures have been taken to halt the acceleration of COVID-19 while meeting the needs of Illinois residents including: 

      • Expanding telehealth services to allow people to continue medical services from home and free up hospital space.
      • Coordinating temporary housing as a Medicaid benefit for people experiencing homelessness for the 14-day quarantine period.
      • Covering home delivered meals for Medicaid members who do not have access to meal during the directed social distancing period.
      • Encouraging all Medicaid members to apply for or manage their coverage online at www.ABE.Illinois.gov to protect staff and members working in facilities.

NEW MEDICAID APPLICATIONS

In the last week of March, more than 178,000 Illinois residents applied for unemployment, a 50% increase from the week before.  For those without health insurance, Illinois’ Medicaid Managed Care program has implemented new policies to simplify the application process:

      • Expanding staff to process applications to manage the influx of new Medicaid applications so people have quicker access to medical benefits.
      • Reduced documentation required for Medicaid applications.  Applicants can submit an application without waiting for verification documents that are not immediately available.
      • For uninsured patients who need COVID-19 testing or treatment, hospitals, physicians, and other primary care providers can assist in submitting applications for expedited processing.

For more information or to apply for Medicaid, visit the State of Illinois’ Application for Benefits Eligibility (ABE) website.

CURRENT MEDICAID MEMBERS

If you are a current Medicaid member do not worry about losing coverage, the following steps have been taken to preserve access to benefits:

      • Delay action that would end or reduce eligibility of medical services. Medical eligibility known as “redetermination” has been extended 12 months before next renewal.
      • Ensuring access to prescription benefits. Allowing early refill overrides and authorization extensions for maintenance medications.
      • Removing prior authorizations for physical, occupational, speech therapies, home health and certain durable medical equipment/supplies. Any prior authorizations obtained with an expiration date will be extended for any service that has been rescheduled.


April 8, 2020

SUPPORT FOR MEDICAID PROVIDERS

IAMHP, along with its member plans are committed to ensuring Medicaid members continue to receive the services and care they need during this public health crisis.

With over 12,000 cases of COVID-19 in Illinois, Managed Care Organizations (MCOs) are working to ease the burden for Medicaid Providers as much as possible.  Hospitals are at capacity and Health Plans are seeing steep declines in enrollments as more people become unemployed.

To date, we have taken the following steps to help members and providers:

  • Covering COVID-19 testing for all Medicaid members. 

  • Expanding telehealth services to ensure members are served and help healthcare providers have alternative revenue streams.

  • Allowing early refill overrides and extending authorization for maintenance medications to ensure members have the medications they need.

  • Partnering with health centers to meet the needs of Medicaid members with underlying health conditions and those experiencing homelessness. 

  • Covering certain non-elective care services that are medically necessary. 

  • Extending previously issued prior authorizations for elective procedures and treatments that had to be delayed.

  • Created additional guidance for providers on caring for vulnerable seniors in a home setting.

  • Advising on ways to ensure timely billing payments for providers receiving payments via check, we recommend signing up for EFT payments. 

  • Exploring transitioning health centers to monthly or alternative payments to allow for more predictable funding.

  • Providing complimentary education and resources.  IAMHP is conducting multiple COVID-19 webinars on relevant topics like Telehealth billing and Small Business Loans for Providers.  Visit IAMHP’s events page for details.

These are unparalleled and unpredictable times that require all of us to come together for the greater good. Medicaid Health Plans are committed to this state, their members, and their provider partners and are prepared to help solve the unprecedented challenges before us all.



April 8, 2020

ILLINOIS MEDICAID TELEHEALTH EXPANSION

In an effort to free up hospital space for COVID-19 patients and adhere to social distancing orders in place, health plans are covering telehealth services to allow people to continue regular medical and behavioral health needs.  Now Medicaid members can receive services in a wider range of facilities, including their place of residence or other temporary location within or outside the state of Illinois.

Under this expansion, there are three types of appointments – telehealth, virtual check-ins and portal visits:

  • Telehealth visits are virtual appointments via telephone or video conferencing that typically last for 30 minutes to 1 hour.
  • Virtual check-ins are brief 5- to 10-minute discussions for patients with an established relationship with the medical professional.
  • Portal visits may be conducted through a provider’s patient portal or secure chat messaging with a qualifying medical professional who has an established relationship with the patient.

Telehealth appointments are conducted in real time via telephone or video conferencing by a qualified Medicaid provider. 

HFS will reimburse medically necessary virtual care services on or after March 9, 2020 until the public health crisis no longer exists.

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