Accountable Care Entity (ACEs) and Care Coordination Entities (CCEs)

Accountable Care Entities (ACEs) and Care Coordination Entities (CCEs) are new approaches to meeting the triple aim (increasing quality of care, lowering costs, and improving population health outcomes) for the Medicaid population. This page is the central resource for information on ACEs and CCEs.

Please check back here shortly for FAQs on additional topics.

• FAQ on Marketing, Outreach, and Member Materials (pdf)

• FAQ on Connectivity and Data Use (pdf)

• FAQ on Providers and Clients (pdf)

• FAQ on Monthly Reporting Requirements and Templates for ACEs and CCEs (pdf)

• FAQ Tips for Helping Medicaid Clients Change Their Address (pdf)

The following link provides an overview of the total number of enrollees in various health plans throughout the state of Illinois. Check back here for updates regularly.

• Care Coordination Enrollment

The following documents provide primary contacts for ACEs and CCEs.

• Primary Contact Information for Accountable Care Entities (pdf)
• Primary Contact Information for Care Coordination Entities (pdf)

Care coordination relies on ACEs and CCEs sharing data with HFS, a client enrollment broker, and Illinois Health Connect. These documents describe this process.

• Overview and Flowchart of Connectivity and Data Use (pdf)

Care coordination partners must establish connectivity to HFS for the purposes of downloading Care Coordination Claims Data (CCCD) and a HFS Provider Extract file. Claims data is necessary for risk stratification and ongoing monitoring of their enrollees. The HFS Provider Extract provides a directory of all Medicaid-eligible providers.

• For data dictionaries and test files, see the CCCD webpage

• Data Connectivity Process Document

• CCCD Distribution Dates (pdf)

• Provider Extract File example/layout (xls)

• Troubleshooting FTP Connectivity

• Monthly Payment Enrollment Roster (pdf)

MEDI registration permits plans to access a daily panel roster, detailing new, continuing, and terminated enrollments..

• MEDI Overview
• HFS MEDI website
• MEDI FAQ
• Step by step instructions on MEDI registration (at IHC website)

Illinois Health Connect (IHC) connects ICEB with an ACE or CCE to manage and share data on enrollment. To complete connectivity procedures, contact IHC directly. For an example of the panel roster that IHC will make available to ACEs/CCEs, see below.

• Panel Roster example (IHC website)

An ACE/CCE must establish connectivity to client enrollment broker (Maximus) to receive a monthly Health Needs Assessment file. This file contains surveys completed by clients at the time of enrollment. To complete connectivity procedures, work with Maximus directly. For an example of the survey data that Maximus will make available to ACEs/CCEs, see below.

• Client Enrollment website
• Health Needs Assessment File Layout (xls)
• Auto-Assignment algorithm details

HFS must preapprove all outreach activities to potential and current enrollees to ensure compliance with federal regulations. Please use this section to clarify outreach for ACEs and CCEs.

• Health Plan Outreach Guidelines (pdf)
• Federal Regulation 42 CFR 438.104
• Process for Mass Mailings (pdf)
• Flier template and letter template (pdf)
• Mail Schedule (pdf)
• Envelope Proof 1 (pdf)
• Envelope Proof 2 (pdf)
• Tips to Help You Enroll (pdf)

After enrollment, ACEs and CCEs must provide members with certain materials including, at a minimum, a member handbook and welcome letter (with PCPs). Below please find resources to help you develop these materials.

• Checklist for ACE and CCE Member Marketing Materials (pdf)
• Grievance and Appeals Language for Care Coordination Member Handbooks (pdf)

HFS is further developing this section. Please check back for updates here.

• ACE Quality Measures (pdf)
• Healthcare and Quality of Life Performance Specifications for ACEs (pdf)

ACEs and CCEs are required to submit a variety of reports on a regular basis. We will be updating this section regularly in upcoming weeks.

• Sharepoint overview (pdf)
• CCE Annual Report Outline (pdf)
• CCE Annual Report Template (xls)
• ACE and CCE Care Coordination Report Template (xls)
• ACE and CCE Care Coordination Template Instructions (pdf)
• ACE and CCE Monthly Report Utilization Template (xls)
• ACE and CCE Utilization Report Instructions (pdf)
• ACE and CCE Care Coordination and Utilization Report Due Dates (pdf)
• ACEs Reporting Requirements Dates (pdf)
• CCEs Reporting Requirements Dates (pdf)

• ACE-CCE Member Services Toolkit, Installment 5 (pdf) (html)
• ACE-CCE Member Services Toolkit, Installment 4 (pdf) (html)
• ACE-CCE Member Services Toolkit, Installment 3 (pdf) (html)
• ACE-CCE Member Services Toolkit, Installment 2 (pdf) (html)
• ACE-CCE Member Services Toolkit, Installment 1 (pdf) (html)

On July 23, 2014, an educational phone call was offered on the topics of dental, transportation, optical and pharmacy benefits. The following documents were provided to participants.

• Optical Benefits Overview for ACEs and CCEs (pdf)
• Pharmacy Information for ACEs and CCEs (pdf)
• Dental Benefits Overview for ACEs and CCEs (pdf)
• Transportation Overview for ACEs and CCEs (pdf)
• First Transit flier in English (pdf)
• First Transit flier in Spanish (pdf)

Prior to approval as fully operational organizations, ACEs and CCEs are required to complete Readiness Reviews, in addition to addressing issues identified during the proposal evaluation and negotiation of a final contract. Please see details in the following documents.

• Accountable Care Entities Pre-Assessment Information Form (pdf)
• Care Model (pdf)
• Complaints and Grievances (pdf)
• Enrollment Information (pdf)
• Health Information Technology (pdf)
• IT Inventory (xls)
• Network (pdf)
• Organization and Governance (pdf)
• Subcontractual Relationships and Delegation (pdf)

• Proposals Received (pdf)
• Business Enterprise Program (BEP) Contact and Service Area Information (pdf)
• Business Enterprise Program (BEP) List of BEP Subcontractor Services (pdf)
• ACE Letters of Intent Received
• List and Contacts for ACE Letters of Intent (pdf)
• ACE Solicitation Questions and Answers - Addendum 3 (pdf)
• ACE Solicitation Questions and Answers – Addendum 2 (pdf)
• ACE Solicitation Questions and Answers – Addendum 1 (pdf)

• Accountable Care Entity (ACE) Webinar August 28, 2013
• Accountable Care Entity (ACE) Webinar with Open Caption August 28, 2013
• Background and Overview on Accountable Care Entities (pdf)
• Solicitation for Accountable Care Entities (pdf) (.doc)

• HFS Program Enrollment:  Potential ACEs wishing to have a better understanding of HFS’s program enrollment and therefore potential ACE enrollment by geographical area and demographic characteristics can refer to the 2012 Program Enrollment and Demographics Data on the HFS website. More detailed data will be available to ACEs that file a Letter of Intent as described in the Solicitation and further information is found through this ACE Data Webpage.

Please see the Care Coordination Innovation Project page for further information on CCE development.

• Innovations Project, Seniors and Persons with Disabilities
• Innovations Project, Children with Complex Medical Needs

Please email any questions or comments to HFS.ACE.CCE@illinois.gov.