Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart B - MEDICAL PROVIDER PARTICIPATION › Section 140.71 - Reimbursement for Medical Services Through the Use of a C-13 Invoice Voucher Advance Payment and Expedited Payments

Current through Register Vol. 48, No. 28, July 12, 2024
a) C-13 Invoice Voucher Advance Payments
1) The C-13 invoice voucher, when used as an
				advanced payment, is an exception to the regular reimbursement process. It may
				be issued only under extraordinary circumstances to qualified providers of
				medical assistance services. C-13 advance payments will be made only to a
				hospital organized under the University of Illinois Hospital Act, subject to
				approval by the Director, or to qualified providers who meet the following
				requirements:
A) are enrolled with the
				Department;
B) have experienced an
				emergency which necessitates C-13 advance payments. Emergency in this instance
				is defined as a circumstance under which withholding of the advance payment
				would impose severe and irreparable harm to the clients served. Circumstances
				which may create such emergencies include, but are not limited to, the
				following:
i) agency system errors (either
				automated system or clerical) which have precluded payments, or which have
				caused erroneous payments such that the provider's ability to provide further
				services to clients is severely impaired; or
ii) cash flow problems encountered by a
				provider or group of providers which are unrelated to agency technical system
				problems. These situations include problems which are exclusively those of the
				providers or problems related to State cash flow which result in delayed
				payments and extensive financial problems to a provider, adversely impacting on
				the ability to promptly serve the clients;
C) serve a significant number of clients
				under the Medical Assistance Program. Significant in this instance means:
i) for long term care facilities, 80 percent
				or more of their residents must be eligible for public assistance;
ii) for long term care facilities enrolled in
				the Exceptional Care Program, four or more residents receiving exceptional
				care;
iii) for hospitals, the
				hospital must qualify as a disproportionate share hospital as described in 89
				Ill. Adm. Code
				148.120
				or receive Medicaid Percentage Adjustment payments as described in 89 Ill. Adm.
				Code
				148.122;
iv) for practitioners and other medical
				providers, 50 percent or more of their patient revenue must be generated
				through Medicaid reimbursement;
v)
				for sole source pharmacies in a community which are not within a 25-mile radius
				of another pharmacy, the provisions of this Section may be waived;
vi) for government-owned facilities, this
				subsection (a)(1)(C) may be waived if the cash flow criterion under subsection
				(a)(1)(B)(ii) is met; and
vii) for
				providers who have filed for Chapter 11 bankruptcy, this subsection (a)(1)(C)
				may be waived if the cash flow criterion under subsection (a)(1)(B)(ii) are
				met;
D) sign an
				agreement with the Department which specifies the terms of advance payment and
				subsequent repayment. The agreement will contain the following provisions:
i) specific reasons for advanced
				payments;
ii) specific amount
				agreed to be advanced;
iii)
				specific date to begin recoupment; and
iv) method of recoupment (percentage of
				payable amount of each Medicaid Management Information System (MMIS) voucher,
				specific amount per month, a warrant intercept, or a combination of the three
				recovery methods).