PAYOR OF LAST RESORT
Organizations must first ensure that third-party payment benefits, including Medicaid, are identified and applied before using grant funding.
ADMISSIONS
Organizations should screen each patient for entitlement benefits, including Medicaid. To improve health outcomes, patients who qualify for public healthcare benefits should receive assistance registering for these entitlements.
MEDICAID MANAGED
CARE CONTRACTS
Providers are responsible for contracting with all possible Medicaid Managed Care Organizations (MCO). To identify the current MCOs, visit: https://hfs.illinois.gov/medicalclients/managedcare
PATIENT REFERRALS
Organizations refer patients to other appropriately licensed organizations for medically or clinically necessary services the organization does not deliver or when the organization does not contract with the patient's MCO.
OPIOID TREATMENT
PROGRAMS / MEDICARE
Medicare will reimburse OTPs for a package of methadone services. Organizations must enroll with and bill Medicare directly for qualifying patients.
COVERED SERVICES
Grant funds will cover services for income eligible patients who do not have insurance (Medicaid, Medicaid Managed-Care, Medicare (OTP only), or private insurance). Services not authorized by a patient's insurance cannot be covered with grant funds.
FOR MORE INFORMATION:
Review SUPR's Contractual Policy Manual (https://www.dhs.state.il.us/page.aspx?item=149483) for how funds can be used and our current reimbursement rate.
