Provider Notice issued 06/29/12

Reimbursement Changes to the Sexual Assault Emergency Treatment Program

To: Participating Hospitals, Physicians, Pharmacies, Advanced Practice Nurses, FQHCs, RHCs, ERCs, Laboratories, Ambulance, Local Health Departments and Community Mental Health Providers ​
​Date: ​June 29, 2012
​Re: Reimbursement Changes to the Sexual Assault Emergency Treatment Program​

As a result of Public Act 097-0689 (pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, effective July 1, 2012, the Department of Healthcare and Family Services (HFS) will reimburse services provided to survivors of a sexual assault through the Sexual Assault Emergency Treatment Program at the department’s standard reimbursement rates.

Effective July 1, 2012, the department’s Outpatient Hospital Billing Form will no longer be required. Hospitals must submit a UB-04 billing form. The diagnosis on the claim must be sexual assault, sexual abuse or rape, or the claim will not be paid. Hospitals will be reimbursed at the Ambulatory Procedure Listing (APL) rate, as outpatient emergency room Medicaid claims are currently reimbursed. Physicians, ambulance providers and other miscellaneous medical providers rendering services in the hospital emergency department will be directly reimbursed by the department. Providers rendering follow-up care will continue to bill the department directly.

Hospitals must register all non-Medicaid sexual assault patients in the MEDI Early Registration of Sexual Assault Survivor’s System, and issue follow-up Authorization for Payment Vouchers to facilitate direct payment to other service providers. Note: All providers billing the program should include a copy of this Authorization for Payment Voucher with their claim.

Claims must be received by the department within 180 days from the date of service to be eligible for payment. The program remains the payer of last resort and all insurance must be billed as primary. Non-cooperation of a patient with billing their primary insurance carrier may render the patient ineligible for the Illinois Sexual Assault Program.

Questions regarding this notice may be directed to:

Attn: Program Coordinator

Sexual Assault Survivor Program

Healthcare and Family services

P.O. Box 19129

Springfield, Illinois 62794-9129

Telephone: 217-782-3303

E-Mail the HFS Webmaster

Theresa A. Eagleson, Administrator

Division of Medical Programs