Provider Notice Issued 05/02/2019

Date:   May 2, 2019
 
To:       Local Education Agencies and School Based Health Services
 
Re:      Medicaid School-Based Health Services FY17 Final Calculated Rates
 
 
This notice informs providers that the Department of Healthcare and Family Services (HFS) has completed its review of the submitted cost information for Fiscal Year 2017 and has determined the final calculated rates for each school district.    
 
Local Education Agencies (LEAs), enrolled with HFS to provide Medicaid covered medical services to children with an Individualized Education Plan (IEP), are required to bill HFS the actual cost of providing a medical service. LEAs were notified in April 2018, to submit cost information for each school-based health service the LEA provided during the 2016-2017 school year. HFS used the submitted cost information to calculate the LEA’s payment rates based on a federally approved methodology.  
 
LEAs may access the Fairbanks website to review final calculated rates for each of the Medicaid school-based health service types submitted for the 2016-2017 school year. Also included are interim rates with which to claim current services until the next year’s rates are calculated. In order for LEAs to log-in and access the Fairbanks system, a username is required. For instructions on how to obtain a username and access the form, contact Fairbanks at 877-219-1343.
 
Please review computed rates for each service category posted on the Fairbanks website. LEAs may request a review of cost information used to calculate these final rates. HFS will process adjustments using these computed rates to re-price all claims with dates of service in the 2016-2017 school year. HFS will make these adjustments automatically. LEAs should not re-submit previously filed claims to receive their claim adjustments. 
 
Submit requests for review, with revised cost information, no later than June 7, 2019, to the following address:
 
Illinois Department of Healthcare and Family Services
Bureau of Program and Policy Coordination
201 South Grand Avenue East
Springfield, Illinois 62763
 
Questions regarding this notice may be directed to the Bureau of Program and Policy Coordination at 217-782-3953.
 
 
Doug Elwell
Medicaid Director

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