Illinois Resources

The links on this page represent a collection of executive orders, regulations, waivers and other guidance issued by Governor Pritzker, the Illinois Department of Public Health and other Illinois state agencies affecting health care providers in response to the coronavirus pandemic.

This link encompasses all information, including applications, related to the distribution of CARES Act funds as appropriated by the Illinois General Assembly and enacted by the governor for the fiscal year beginning July 1, 2020.

Vaccination Resources

4.08.21 | COVID-19 Vaccine Administration – Performed in Hospital-Based Outpatient Settings

3.15.21 | COVID-19 Vaccine Administration – Free to Medical Assistance Program Participants and the Uninsured

3.01.21 | Guidance for Vaccination Scope of Practice

2.08.21 | Provider Notice: COVID-19 Vaccine Administration Billing for the Illinois Medicaid Pharmacy Benefits Manager System and the Federal HRSA COVID-19 Reimbursement Program for the Uninsured

2.02.21 | Guidance for Physician Delegation to an Unlicensed Person

1.07.21 | Provider Notice: COVID-19 Vaccine and Vaccination Administration Billing Information for Practitioners: This notice provides information to practitioners on current coding and rates, as well as billing guidance for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Encounter Rate Clinics (ERCs) related to the COVID-19 vaccine and its administration. Practitioners may bill at the time the vaccine becomes available. This billing guidance applies to claims for participants covered under both traditional Medicaid fee-for-service and the HealthChoice Illinois Medicaid managed care plans.

1.06.21 | Provider Notice: COVID-19 Vaccination Administration Billing for Pharmacies: This notice informs providers that the Illinois Department of Healthcare and Family Services will reimburse Medicaid participating pharmacies an administration fee through NCPDP claim submission for federally allocated COVID-19 vaccines. These specific instructions apply to Medicaid fee-for-service claims, but the Medicaid managed care plans will also reimburse these claims through NCPDP claim submission.

Illinois Department of Public Health General Resources

Guidance for Non-Discrimination in Medical Treatment

4.08.20 | Healthcare Personnel Return to Work Guidance

3.30.20 | Recommended Guidance for the Care of Pregnant Women and Newborns During the COVID-19 Pandemic

3.23.20 | Letter to Hospitals: Development of COVID-19 Hospital Triage Mechanisms

3.20.20 | General Recommendations for Healthcare Settings (for Healthcare Personnel)

3.20.20 | Long-Term Facility Guidance

3.18.20 | General Clinical and Public Health Guidance for Managing COVID-19

Waiver

2.04.21 | Updated Appendix K: Emergency Preparedness and Response and COVID-19 Addendum

8.31.20 | Appendix K (here and here): Emergency Preparedness and Response and COVID-19 Addendum: This standalone appendix may be utilized by the state during emergency situations to request amendments to its approved waiver, to multiple approved waivers in the state, and/or to all approved waivers in the state.

3.23.20 | CMS’ Response to IL’s Section 1135 Waiver Request, including CMS approval of requests for EMTALA, physical environment, verbal orders waived, medical records timing, medical staff, discharge planning for hospitals, reporting requirements, sterile compounding, patient rights, detailing information sharing for discharge planning for hospitals and CAHs, and flexibility in Patient Self Determination Act Requirements)

Personal Protective Equipment

4.06.20 | Provider Notice for Temporary Prior Authorization Requirement Changes

3.26.20 | Memo: PPE Burn Rate Calculator

3.25.20 | Recommended Guidance for Extended Use of N-95 Masks, Regular Masks, and PAPRs

3.18.20 | Guidance for Requesting PPE During COVID-19

Licensure Resources

4.21.20 | Guidance on Where Out-of-State Health Care Providers Can Work

4.16.20 | Executive Order Number 26: Hospital Capacity: IDPH shall exercise discretion enforcing certain regulations. Suspends specific provisions in the Hospital Licensing Act, the Hospital Report Card Act, the Department of Public Health Powers and Duties Law, the Illinois Adverse Health Care Events Reporting Law of 2005, and the Emergency Medical Services (EMS) Systems Act. Hospitals licensed by IDPH or the State of Illinois may establish an ACF to provide room and board, nursing, and diagnosis or treatment to patients to increase regional hospital capacity.

3.25.20 | Home Health, Home Services, and Home Nursing Agency Emergency Order: Suspending the requirement that a registered nurse conduct a supervisory visit to a patient’s home, and instead permitting telehealth.

3.25.20 | Hospital Licensing Requirements Rule: Allowing hospitals to increase bed capacity between clinical services to accommodate COVID-19 pandemic without prior authorization from the Department.

3.25.20 | Long-Term Care Assistants and Aide Training Programs Code Rule: Allowing for military personnel with medic training to serve as CNAs and allows CNAs who have been certified or licensed in another state to work in Illinois.

3.24.20 | Executive Order Number 12: Suspending background checks for healthcare workers. Individuals who are certified as a nurse assistant, but are currently inactive on the Health Care Worker Registry, may be hired under certain provisions, such as the inactive status being no more than five years and limiting conditional employment to three months pending the result of a more extensive background check.

3.20.20 | IDFPR has waived the requirement for permanent licensure of physicians, nurses, physician assistants, and respiratory care therapists who are licensed in another state. Out-of-state licensees working in Illinois pursuant to this Order must hold a license from another U.S. jurisdiction and must be in good standing. Licensees are limited to working under the direction of IEMA and IDPH pursuant to a declared disaster or in a state licensed long-term care facility, state regulated hospital, or federally qualified health center (FQHC). Applications for temporary licenses are available on IDFPR’s website.

1.01.18 | The Respiratory Care Practice Act allows out of state, licensed respiratory care practitioners to work in Illinois without an Illinois license in the case of a declared emergency.

2.25.21 | Provider Notice: Repricing Hospital Outpatient Claims Billed with COVID-19 Diagnosis and Procedure Codes

2.08.21 | Provider Notice: Lab Testing and Claims Submittal Related to COVID-19 – Launch of HFS COVID Portal

1.15.21 | Provider Notice: HFS CARES Program Reporting Deadline Extension

9.15.20 | Provider Notice: First Round Distribution of Coronavirus Aid, Relief, and Economic Security (CARES) Act Funds Appropriated by the Illinois General Assembly

8.04.20 | Provider Notice: Deadline Extension – Federal Provider Relief Fund Payment Update for Medicaid and CHIP Providers

7.08.20 | Provider Notice: This notice informs providers that the Department will resume editing to ensure that ordering/referring/prescribing (ORP) provider National Provider Identifiers (NPIs) are valid and the providers are enrolled with the Department. This will be effective with claims received starting August 1, 2020, regardless of service date, and applies to claims for both managed care and traditional fee-for-service participants. As a result of the current COVID-19 public health emergency, the Department had requested a waiver through the federal Centers for Medicare & Medicaid Services (CMS) to temporarily cease the requirement that providers who order, refer, or prescribe to Medicaid beneficiaries be enrolled with Illinois Medicaid. This waiver request was ultimately not approved by CMS. Therefore, the Department is resuming normal editing effective with claims received starting August 1, 2020.

6.12.20 | Provider Notice: The Illinois Department of Healthcare and Family Services advised that on Tuesday, June 9, 2020, federal Centers for Medicare and Medicaid Services (CMS) announced a new provider portal available on their website that will allow Medicaid and CHIP providers that did not receive federal CARES Act funding from the Provider Relief Fund General Allocation to submit a request.

5.01.20 | Executive Order 35: This order suspends provisions in the Assisted Living and Shared Housing Act, the Nursing Home Care Act and the Community Care Act. For example, the order suspends IDPH conducting an on-site review at each facility annually. IDPH will continue to conduct on-site reviews to the extent feasible.

4.27.20 | Provider Notice: Physician Certification Statement (PCS) Not Required for Hospital-to-Hospital Non-Emergency Transports (applies to participants covered under fee-for-service HealthChoice Illinois managed care plans and the Medicare/Medicaid Alignment Initiative (MMAI) plans).

4.20.20 | The Department of Insurance (IDOI) adopted a new Part by emergency rulemaking titled, "Temporary Health Coverage Requirements During an Epidemic or Public Health Emergency.” This new Part provides for 30 or 60-day extensions of premium payment deadlines; prohibits an issuer of group HMO coverage from interfering with an employer that wants to keep their employees on the existing health coverage despite a reduction in hours or a temporary lay-off; restricts the ability of an issuer of group HMO coverage to prevent a person whose employment-based coverage was terminated from electing COBRA or state continuation coverage; allows people who qualify for a special enrollment period due to loss of employment to have their new coverage retroactively begin the day after their loss of previous coverage; requires coverage of off-formulary prescriptions if there is a shortage of a covered formulary drug; and requires coverage of a 90-day supply of covered maintenance medications, other than those prone to misuse.

4.17.20 | Guidelines for Medical Students and Residents, Nursing Students, and Physician Assistants to Assist in Healthcare Settings During the COVID-19 Pandemic

4.16.20 | Prescriber Guidelines During COVID-19 Emergency Declaration

4.06.20 | Guidance for APRNs and CRNAs

4.06.20 | Guidance for Illinois-Licensed Physician Assistants

4.07.20 | Executive Order 22: In the Health Care Worker Background Check Act, suspends the time period for designated students, applicants, and employees to have their fingerprints collected electronically.

4.01.20 | Executive Order 19: a broad order to cancel all elective procedures, requires assistance in responding to the COVID-19 pandemic, and shields providers and volunteers from liability.

SIREN

SIREN Hospitals and physicians are urged to sign up for SIREN, the State of Illinois Rapid Electronic Notification System, which IDPH uses to send COVID-19 alerts and guidance. To register for SIREN, go to https://siren.illinois.gov/agreement.php or send an email to [email protected].

Billing Resources

5.07.21 | Updated COVID-19 Fee Schedule

12.18.20 | Provider Notice: This notice reminds providers of COVID-19 testing and treatment billing instructions issued in a May 18, 2020 provider notice, including provider billing guidance for submitting claims to the appropriate COVID-19 reimbursement program for uninsured patients. As a reminder, providers should not bill uninsured patients for COVID-19 testing, COVID-19 testing-related services, or COVID-19 treatment.

12.08.20 | Provider Notice: This notice informs providers of the HFS procedures for rate determination and claims processing of new COVID-19 laboratory test codes. This information is applicable for the Department’s fee-for-service population. The Department’s Managed Care Organizations (MCOs) will follow the same lab test code coverage and rate policies; however, the MCOs will not put them in place until guidance is received from the Centers for Medicare and Medicaid Services.

9.25.20 | Provider Notice: This notice provides updated information to that communicated in the July 17, 2020 provider notice regarding the Department’s upcoming deployment of an online portal that will allow providers to bill for COVID-19 testing services for patients.

8.11.20 | Provider Notice: The notice informs hospitals that some outpatient claims with COVID-19 coding will be reprocessed.

7.17.20 | Provider Notice: Intended to provide guidance to Federally Qualified Health Centers (FQHCs) for testing and encounter claims related to COVID-19. This billing guidance is effective with dates of service beginning March 18, 2020 and applies to claims for participants covered under both traditional Medicaid fee-for-service and Medicaid managed care plans.

7.13.20 | Provider Notice: States the Department’s position regarding providers charging Medicaid participants for personal protective equipment (PPE).

6.15.20 | Provider Notice: Informs dental providers of a temporary change in prior authorization requirements due to the current public health emergency.

5.29.20 | Provider Notice: Informs community mental health centers, behavioral health clinics, and Substance Use Disorder providers of rate increases prompted by COVID-19. The rate increases apply to claims only for participants covered under a HealthChoice Illinois managed care plan.

5.22.20 | Provider Notice: Instructs providers to use Condition Code DR – Disaster Related, for tracking of claims potentially related to treatment of COVID-19. These instructions apply to claims for participants covered under the fee-for-service program as well as a HealthChoice Illinois managed care plan or Medicare/Medicaid Alignment Initiative (MMAI) plan.

5.21.20 | Update to Illinois Medicaid COVID-19 Fee Schedule for Virtual Healthcare/Telehealth Expansion

5.20.20 | Provider Notice. This notice provides clarification of billing instructions to Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Encounter Rate Clinics (ERCs) for fee-for-service (FFS) reimbursement of Long-Acting Reversible Contraceptives (LARCs), FFS reimbursement of virtual check-in and e-visit services billable during the COVID-19 public health emergency, and telehealth services.

3.30.20 | Provider Notice - Temporary Rate Increase during COVID-19 Pandemic and Day Services Billing

3.30.20 | Provider Notice - Pharmacy - Temporary COVID-19 Billing Policies

3.20.20 | Illinois HFS issued guidance on Provider Enrollment, Billing, and Payment Changes Prompted by COVID-19

Elective surgeries

5.13.20 | Executive Order 37: Defines and renders assistance in support of the State’s response to hospitals, health care facilities, health care professionals, and health care volunteers. Those that continue to cancel or postpone all elective surgeries or procedures, or begin elective surgeries on or after May 11th, in order to respond to the COVID-19 outbreak shall be immune from civil liability for any alleged injury or death relating to COVID-19.

4.01.20 | IDPH has issued guidance on elective surgeries, specifically this PDF and these FAQ’s.

Ethical Medical Decision-Making: Responding to an inquiry from IHA, IDPH has confirmed that it will be releasing guidance soon to assist medical decision-making with resource allocation. An extensive and experienced team has been convened that was tasked with creating guidelines and developing an objective scoring tool to be used for care prioritization. When complete, initial guidance will be released, with updates thereafter.

Pharmacy Resources

6.04.20 | Executive Order: Scope of practice for pharmacists expanded to screen patients, order, administer, read, and report the findings of federally-approved tests for COVID-19.

5.20.20 | Provider Notice: This notice informs providers that medications in specified drug classes and certain over-the-counter (OTC) medications are temporarily covered, due to the COVID-19 public health emergency.

5.20.20 | List of Drugs Covered in 90-Day Supplies During COVID-19 Emergency

5.06.20 | Compounding Guidance

4.23.20 | Prescribing and Dispensing of Controlled Substances

4.06.20 | Guidance for Use of PPE by Compounding Pharmacies

4.06.20 | Dispensing Guidance for Pharmacists

4.06.20 | Guidance for Pharmacies for Remote Processing

4.06.20 | Pharmacy Delivery Guidance

3.30.20 | Provider Notice for Temporary COVID-19 Billing Policies (relevant amendment begins on page 20 of the PDF)