MedicaidPrior AuthMedium impact
Hospital Inpatient Payment for Long-Acting Injectable Antipsychotic Drugs per Public Act 102-0043
Illinois Medicaid - HFS·IL · Psychiatry·Provider Notice
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Illinois hospitals can now receive add-on payments for specific long-acting injectable antipsychotic drugs administered to psychiatric inpatients, separate from the per diem rate. Prior approval is required before administration, with retroactive approval available until December 18, 2023 for services back to January 1, 2022.
Action Required
By December 18, 2023: Hospitals must submit retroactive prior approval requests for LAI antipsychotic drugs administered since January 1, 2022 using Form HFS 1409X via hotline (1-800-252-8942), fax (1-217-524-7264), or mail. Going forward: Obtain prior approval before administering these drugs to psychiatric inpatients, ensure prescriber is board-certified/eligible psychiatrist, and document follow-up outpatient appointment coordination. Claims without prior approval will not receive add-on payment.