Provider Notice Issued 10/27/2017

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Date: October 26, 2017               

To: All Medical Assistance Providers

Re: Managed Care Program Update

This notice offers information to help providers understand the upcoming enhancement of the Managed Care Program at the Department of Healthcare and Family Services (HFS).

Featuring uniform credentialing and other upgrades for providers, the Department announces that with the final selection of seven managed care health plans, the new program is scheduled to begin launching on January 1, 2018.

The new Medicaid Managed Care Program is named “HealthChoice Illinois,” reflecting the goal of helping beneficiaries make smart healthcare decisions.

The following health plans are scheduled to begin operating as part of HealthChoice Illinois throughout Illinois starting next year:

·       Blue Cross Blue Shield of Illinois

·       CountyCare (available only in Cook County)

·       Harmony Health Plan

·       IlliniCare Health Plan

·       Meridian Health

·       Molina Healthcare of Illinois

·       NextLevel Health (available only in Cook County)

In the coming weeks, HFS will work closely with health plans, providers and clients to ensure a smooth transition to HealthChoice Illinois. HFS encourages providers to understand the benefits of this new program and to contract with available health plans.

For Patients Transitioning

Under HealthChoice Illinois, managed care will operate in every Illinois County. For Medicaid clients:

·       Individuals who are now enrolled with a FHP/ACA, ICP, or MLTSS managed care health plan will transition to the new program on January 1, 2018. If an individual is currently enrolled with one of the health plans selected and listed above, the individual will remain with that current plan in the new program. Managed care clients currently enrolled in a health plan that is not part of the new program will be transitioned to one of the newly awarded health plans. All clients will receive notice of the transition and their plan assignment for January 1, 2018. Regardless of which health plan a client is in on January 1, 2018, all clients will have 90 days with the option to switch to another plan.

·       Eligible Medicaid clients not currently participating in managed care will be provided with a 30-day enrollment choice period in early 2018 and will need to select a new health plan. These clients will begin receiving services in the newly selected health plan on April 1, 2018. Regardless of which health plan a client is in on April 1, 2018, all clients will have 90 days with the option to switch to another plan

A detailed client transition timeline will be provided prior to the transition along with a sample of the communications that will be mailed to affected clients.

Health plans are in the process of building their networks to ensure adequate coverage for clients. Providers that are not contacted by plans in the coming weeks are strongly encouraged to reach out to them and establish their relationships under HealthChoice Illinois. A provider notice with further details will be forthcoming.

In the coming weeks, HFS will be sending provider notices to discuss other specific aspects of the program reboot and answer questions. The Department believes that HealthChoice Illinois will significantly reduce administrative requirements, allowing providers to focus on client care.

Upcoming articles in the Department’s Succeeding in the New Managed Care series:

#1. What is my relationship with health plans that weren't awarded a contract for the new program?

#2. Four key ways the new managed care will mean less work for providers

#3. Simplified credentialing: Cutting back on your overhead costs

#4. How HFS and the health plans will communicate transition details to clients

#5. How you can help your patients understand what they need to know about this transition

Additional information regarding HealthChoice Illinois may be found on Department Website

Medicare-Medicaid Alignment Initiative (MMAI) Program

The MMAI program will continue to operate under a separate three-way contract between HFS, the federal Centers for Medicare & Medicaid Services, and health plans and will not be expanded to additional counties in 2018. The following health plans will continue operating in MMAI in 2018: Aetna Better Health, Blue Cross Blue Shield of Illinois, Humana Health Plan, IlliniCare Health Plan, Meridian Health, and Molina Healthcare of Illinois.

A separate provider notice is being issued and will further explain MMAI program details. The separate provider notice will also address the Managed Long Term Services and Supports (MLTSS) program, which will become part of HealthChoice Illinois.

Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at 217-524-7478.

Felicia F. Norwood
Director