Provider Notice issued 02/23/06

To: Enrolled Physicians, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics, Hospitals, Advanced Practice Nurses, Chiropractors, Podiatrists, Physical Therapists, Occupational Therapists, Speech Therapists, Audiologists, Home Health Agencies and Durable Medical Equipment Providers

Date: February 23, 2006

Re: Primary Care Case Management Request for Proposals

The Department of Healthcare and Family Services (HFS) is pleased to announce the release of a Request for Proposals (RFP) for the administration and operation of a Primary Care Case Management (PCCM) program. The purpose of this notice is to advise providers of this new managed care program.

On July 1, 2006, the State of Illinois will begin to implement a statewide PCCM program for eligible enrollees. Through this PCCM program, enrollees will have a medical home through a Primary Care Provider (PCP). This is a model based on the American Academy of Pediatricians’ initiative to create medical homes as a way to ensure that preventive health care is provided in the most appropriate setting, i.e., a provider’s office rather than an emergency room. Through the establishment of the medical home, the state expects to generate cost savings, which, in turn, will allow the state to expand health care coverage through the unprecedented All Kids program.

Potential enrollees will choose a single PCP who will manage their care by ensuring that they get immunizations and other primary and preventive health care services and that they avoid unnecessary emergency room visits and hospitalizations.  Patients with chronic conditions like asthma or diabetes will have a single PCP to ensure they are getting the treatment and ongoing care they need to avoid acute care.  PCPs will make referrals to specialists for additional care or tests as needed.

Through the RFP, released January 31, 2006, HFS is seeking the services of a qualified, experienced and financially sound entity(ies) to administer the PCCM program and to perform outreach, education and enrollment functions to potential enrollees into the PCCM or voluntary managed care program.

The RFP for PCCM Program Administration and Client Enrollment Broker Services may be viewed through the state’s Central Management Services’ Web site at:

                                                        http://www.purchase.state.il.us

In order to view the RFP, users must first complete the online form under “Registration.” Once registered, select the “IllinoisBID” option, followed by the “Primary Care Case Management,” reference number 22009649, option. The file attachment options are located at the bottom of the page. The description of the program and the vendor contract requirements are contained in Section 4 of the document.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs