MedicaidPrior AuthHigh impact
Resumption of Prior Approval Requirements at Public Health Emergency End
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Speech Therapy·Provider Notice
Effective date
May 12, 2023
We identified it
Jun 20, 2026
Summary
Prior authorization requirements that were temporarily waived during COVID-19 will resume on May 12, 2023, for therapy services, home health services, and durable medical equipment in Illinois Medicaid programs. All prior approval requests will again require clinical justification and valid practitioner orders.
Action Required
By May 12, 2023: Billing team must update systems to require prior authorization for all listed therapy, home health, and DME services for Illinois Medicaid patients. Update encounter forms and EMR templates to prompt providers to obtain prior approval with clinical justification before service delivery. Contact 877-782-5565 for FFS prior approvals or applicable managed care plan. Claims submitted without required prior authorization will be denied.