MedicaidAdministrativeMedium impact
Hospice Nursing Home Room and Board Adjustments and Repayment
Illinois Medicaid - HFS·IL · Palliative Care·Provider Notice
Effective date
Aug 29, 2022
We identified it
Jun 20, 2026
Summary
Illinois HFS voided incorrect hospice nursing home room and board payments that were billed to the state instead of HealthChoice Illinois (HCI) managed care plans. Providers will receive remittance advices with 21C adjustment codes (incorrectly labeled as 5018 - EAPG Paid at Zero) and must work with appropriate HCI MCO plans for proper payment.
Action Required
Immediately: Hospice billing teams must review remittance advices for 21C adjustment codes related to nursing home room and board voids. Contact appropriate HealthChoice Illinois (HCI) MCO plans to resolve payments due from recoupments. Note that adjustment reason code 5018 (EAPG Paid at Zero) is incorrectly applied to these voids.