HB1876 Summary

• The Illinois Department of Healthcare and Family Services must establish procedures by July 1, 2016 to allow skilled nursing facilities to submit monthly billing claims for reimbursement, with testing and implementation of necessary information technology changes to accept and pay nursing home claims directly.

• The Department must establish procedures within 365 days after August 15, 2014 for ID/DD facilities to submit monthly billing claims, with an additional 365-day period for system testing and implementation of required technology platform changes.

• Vendors enrolling in the medical assistance program are subject to a one-year conditional enrollment period during which the Department may terminate or disenroll them without cause, with enhanced oversight, screening, and review procedures based on fraud and abuse risk.

• Payment claims must be received by the Department within 180 days after service delivery, with specified exceptions for providers whose enrollment is pending, errors by the Department or intermediaries, monthly billing arrangements, and certain local government providers.

• The Department shall establish policies and procedures for acquiring, repairing, and replacing orthotic and prosthetic devices and durable medical equipment in a cost-effective manner based on recipient medical prognosis and needs.