YouthCare HealthChoice Illinois Utilization and Administration of Medications in Multiple Settings
Date: 11/01/24
YouthCare covers the utilization and administration of medications in multiple settings, including the administration of oral and other methods of administration. Effective November 1,2024, both plans will review medications to determine the most appropriate benefit (pharmacy or medical) and will contact the requesting provider if a change in benefits is required.
Administration of medication settings include, but are not limited to,
- Hospital inpatient administration
- Non-hospital outpatient infusion
- Physician offices
- Ambulatory infusion suites
- Home infusion services
Our Medicaid plans support the utilization of medications for pharmacy and medical benefits with Healthcare Common Procedure Coding System established by the AMA and reviews medications for clinical appropriateness, regardless of benefit categorization.
Providers are encouraged to refer to the Billing and Payments web page for claim submissions. Medication prior authorization requirements are not being modified.