Provider Notice Issued 12/08/2017

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Date: December 8, 2017             

To:    All Medical Assistance Providers

Re:   Managed Care Programs for Full Dual Eligible Beneficiaries in 2018

This notice provides an update regarding the Managed Long Term Services and Supports (MLTSS) program, the Medicare Medicaid Alignment Initiative (MMAI) program, and Dual Eligible Special Need Plans (D-SNPs) for Calendar Year 2018.

MLTSS

Beginning January 1, 2018, the Managed Long Term Services and Supports (MLTSS) program will become part of HealthChoice Illinois. This means in every Illinois county, newly selected health plans will begin managing dual eligible beneficiaries who:

·       Have full Medicare and Medicaid benefits (“full dual eligible beneficiaries”);

·       Are not enrolled in the Medicare-Medicaid Alignment Initiative (MMAI) program; and

·       Reside in a nursing facility or are in the following Home and Community-based Services (HCBS) waivers: Supportive Living Facilities, Persons with Disabilities, Persons with HIV or AIDS, Persons with Brain Injury, and Persons who are Elderly.

Medicare will continue to be the primary payer for full dual eligible beneficiaries receiving MLTSS services through HealthChoice Illinois. Providers serving HealthChoice Illinois MLTSS enrollees will bill the HealthChoice Illinois plan, Medicare, or Medicaid Fee-for-Service depending on the service being provided.

Updated MEDI MLTSS provider notice

The following health plans will offer MLTSS benefits through HealthChoice Illinois in 2018:

·       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)

Aetna Better Health will not offer MLTSS coverage beginning January 1, 2018.    Current Aetna Better Health MLTSS enrollees will receive a letter from Illinois Client Enrollment Services with a HealthChoice Illinois MLTSS plan assignment effective January 1, 2018. Enrollees will have 90 days to switch HealthChoice Illinois MLTSS plans beginning January 1, 2018. Additionally, MLTSS enrollees may choose to enroll in MMAI at any time in counties with an MMAI health plan.

MMAI

The Medicare Medicaid Alignment Initiative (MMAI) program will not be part of HealthChoice Illinois in 2018. MMAI will continue to operate under a separate three-way contract between HFS, the federal Centers for Medicare & Medicaid Services (CMS), and health plans in the Greater Chicago and Central Illinois Regions.MMAI will not be offered statewide in 2018, but will continue to operate in limited counties. 

In 2018, the MMAI program will operate in the following counties:

·       Greater Chicago Region: Cook, DuPage, Kane, Kankakee, Lake, and Will Counties

·       Central Illinois Region: Champaign, DeWitt, Ford, Knox, McLean, Peoria, Stark, Tazewell, and Vermilion Counties. 

o   The MMAI program may return six additional Central Illinois counties in mid-2018: Christian, Logan, Macon, Menard, Piatt, and Sangamon Counties. 

Full dual eligible beneficiaries will not be eligible for Medicaid managed care in 2018 if the beneficiary is not eligible for HealthChoice Illinois MLTSS and lives in a county that does not have an MMAI health plan.

In 2018, the following health plans will participate in MMAI:

·       Greater Chicago Region:

o   Aetna Better Health

o   Blue Cross Blue Shield of Illinois

o   Humana Health Plan

o   IlliniCare Health Plan

o   Meridian Health

·       Central Illinois Region:

o   Molina Healthcare of Illinois

Cigna-HealthSpring will exit the MMAI program on December 31, 2017.  If eligible for MMAI passive enrollment, Cigna-HealthSpring MMAI enrollees received a letter from Illinois Client Enrollment Services with a new MMAI health plan assignment effective January 1, 2018.

Cigna-HealthSpring MMAI enrollees who previously opted-out of the MMAI program are not eligible to receive a passive enrollment notice for a different MMAI health plan. Enrollees may call Illinois Client Enrollment Services to enroll in a different MMAI health plan at any time. Cigna-HealthSpring MMAI enrollees, who do not enroll in a different MMAI health plan and are eligible for HealthChoice Illinois MLTSS, will receive a letter from Illinois Client Enrollment Services with a HealthChoice Illinois MLTSS plan assignment effective January 1, 2018. Cigna-HealthSpring MMAI enrollees who do not enroll in a different MMAI health plan or a Medicare Advantage plan will be enrolled in Original Medicare (Medicare Fee-for-Service) for Medicare benefits. Full dual eligible beneficiaries in counties with an MMAI health plan may enroll in MMAI, switch MMAI health plans, or opt-out of MMAI at any time.

D-SNPs

Dual Eligible Special Need Plans (D-SNPs) will end on December 31, 2017. 

If eligible for MMAI passive enrollment, Community Care Alliance of Illinois (CCAI), Cigna-HealthSpring, and WellCare D-SNP enrollees received a letter from Illinois Client Enrollment Services with a new MMAI health plan assignment effective January 1, 2018. D-SNP enrollees who do not enroll in a different Medicare Advantage plan or MMAI health plan will be enrolled in Original Medicare (Medicare Fee-for-Service) for Medicare benefits. 

Responsibilities Continue for Health Plans Ending December 31, 2017

MLTSS, MMAI, and D-SNP health plans ending on December 31, 2017 are required to ensure care for enrolled members through 11:59pm on December 31, 2017. The health plans also are required to meet all contractual and financial obligations and pay all verified claims, including any bills that remain outstanding after December 31, 2017.

Full Dual Eligible Beneficiaries Not Enrolled in Medicaid Managed Care

Full dual eligible beneficiaries who are not currently enrolled in a Medicaid managed care health plan will have a 30-day enrollment choice period in early Calendar Year 2018 if eligible to enroll in HealthChoice Illinois MLTSS. Enrollees will begin receiving MLTSS services through a HealthChoice Illinois health plan on April 1, 2018 and will have 90 days to switch HealthChoice Illinois plans beginning April 1, 2018. All HealthChoice Illinois MLTSS enrollees who live in a county with an MMAI health plan may choose to enroll in MMAI, switch MMAI health plans, or opt-out of MMAI at any time. 

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

Felicia F. Norwood
Director