Section 240.1955  Fixed Unit Rates of Reimbursement for Emergency Home Response Service

EHRS providers executing a contractual agreement with the Department pursuant to Section 240.1600 shall be uniformly reimbursed for the provision of EHRS at fixed unit rates of reimbursement established by the Department. The reimbursable units of EHRS shall be as follows:

a)         Installation and Removal

The Department shall pay a 1-time installation fee at a fixed unit reimbursement rate established by the Department for the installation of the base unit in the participant's home.  The Department shall not pay any fee for expenses incurred by the EHRS provider if service could not be provided due to either the participant's absence or the participant's refusal to admit the EHRS provider's employee into the home.  The Department shall not pay any fee for removal of the base unit. 

b)         Monthly Service

The Department shall pay a monthly service fee per participant at a fixed unit reimbursement rate established by the Department for providing EHRS to participants.  The Department shall not pay for the cost of maintaining telephone service for the participants or any associated charges or fees.

c)            The rates will be reviewed annually, at a minimum. Adjustments  may be made to conform to the appropriation, service requirements and/or changes in federal and State laws, regulations and/or rules affecting the service.

d)         In establishing the rates of reimbursement, the Department will comply with federal requirements for Medicaid waivers, which are described in the State Medicaid Plan maintained by HFS and posted on the HFS website.  The Department will use a Request for Information process to obtain rate information from providers and then consider whether the resulting average is supported by the appropriation level for the program in light of trend analyses on use of the service and current market conditions.  The goal is to ensure adequate provider participation and participant choice.  The specific amount that the service provider will be reimbursed for a unit of service is reflected in the provider contract and is listed on the Department's website.

e)         Upon written notification from the Department of a change in the rates of reimbursement, an AMD provider may exercise its 60 calendar day termination rights if the EHRS provider no longer wishes to provide services thereafter at the new rates of reimbursement.

(Source:  Amended at 42 Ill. Reg. 20653, effective January 1, 2019)