MEMORANDUM

Date: June 19, 2013

To: Child and Family Connection Offices

Assistive Technology Vendors

From: Amy S. Tarr, Chief

Bureau of Early Intervention

The Bureau of Early Intervention (EI) is required to meet the requirements of the SMART ACT (Save Medicaid Access and Resources Together) and the Department of Healthcare and Family Services (HFS) rules and regulations. The SMART Act requires vendors of assistive technology (AT) equipment to provide durable medical equipment (DME) acquisition manufacturer’s pricing for all requested AT equipment.

Effective July 15, 2013, all AT requests received at the Bureau must comply with the new process. Make accommodations to ensure all new requests submitted follow the new policy and that any existing requests are submitted with sufficient time to ensure the received deadline of July 15, 2013.

The CFC Procedure Manual will incorporate the revised policies and procedures attached when released after July 1, 2013. This is the first of three updates to AT procedures.

This is for AT equipment requests, regardless of the child’s eligibility status for HFS/Medicaid.

If you have any questions, you may contact Colleen Cunningham of the Bureau at or 217/782-1981, option 4.

New Procedures for AT Request Submission:

The following pricing methodology will be used:

1.  If a requested item has an existing HCPCS code within the HFS system that has a pre-approved price, the HFS pricing will be utilized. This is the current practice with EI AT approvals. HCPCS codes and pricing may be found at www.hfs.illinois.gov/reimbursement/dme.html.

If the vendor currently provides HFS equipment for populations other than EI, this is the same process as HFS currently uses.

NOTE: Neither EI nor HFS pay for extra charges for color upgrades, specialty trays, toy bars, soft fabric upgrades, canopies, etc.

2.  If the requested item has an existing HCPCS code within the HFS system that is HFS hand priced (meaning no pre-approved price is listed with HFS), then the vendor is required to provide the true acquisition. The vendor must submit a price quote showing all primary and secondary discounts provided to the vendor by the manufacturer. The acquisition cost plus 50% will be approved to the vendor. Pricing methodology is substantiated in 89 Illinois Admin. Code 140.481.

If the vendor does not have primary or secondary discounts then the vendor is required to submit manufacturer’s pricing (catalog page, price sheet, etc) for the item from three different sources (catalogs, websites, etc) to ensure EI is obtaining the equipment at the most reasonable cost. EI will allow 25% above the most reasonable retail pricing.

3.  If the equipment is not a listed DME item through HFS or if the vendor cannot provide true acquisition pricing (primary and secondary discounts), the vendor is required to submit manufacturer’s pricing (catalog page, price sheet, etc.) for the item from three sources (catalogs, websites, etc.) to ensure EI is obtaining the equipment at the most reasonable cost. EI will then allow 25% above the most reasonable retail pricing.

cc: CFC Managers, CFC AT Coordinators