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Elizabeth M. Whitehorn, Director

Provider Notice issued 01/23/12

Integrated Care Program

To:​ ​Participating Nursing Facilities
​Date: ​January 23, 2012
​Re: Integrated Care Program​

This notice is to provide clarification to nursing facilities, with residents participating in the Integrated Care Program (ICP), of the importance of enrolling with Aetna Better Health and/or IlliniCare Health Plan for long term care services covered under Service Package I. ICP operates in suburban Cook (excluding zip codes that begin with 606), DuPage, Kane, Kankakee, Lake and Will Counties.

Service Package I began May 1, 2011, for all eligible enrollees. ALL ICP members receive medical services, in Service Package I, through Aetna Better Health or IlliniCare Health Plan – this includes residents in long term care facilities.

In addition to covering all of the standard Medicaid covered medical services, such as physician services and specialist care, emergency care, laboratory and X-rays, behavioral health, pharmacy, etc., Aetna Better Health and IlliniCare Health Plan are also responsible for the first 90 days of nursing facility services for residents admitted after being enrolled with an ICP provider. Nursing facilities in the aforementioned locations must contract with Aetna Better Health and/or IlliniCare Health Plan in order to assure payment for the first 90 days of Nursing Facility care provided to eligible residents under Service Package I.

The processing of a facility admission has not changed. The admission date remains as the day the resident is admitted into the facility. This serves as a reminder to not hold onto the admission, but to process the admission as soon as possible. The 90 day coverage period is identified on the HFS 3402, LTC Pre-Payment Report by bed reserve type 50.

Service Package II, which will begin in 2012, will expand ICP coverage to include all nursing facility services, not just the first 90 days, for residents eligible under the program.

The department issued a May 13, 2011 informational notice regarding ICP that included a list of Frequently Asked Questions. Facilities should continue to refer to the May 13, 2011, Notice, Integrated Care Program into LTC Facilities.

If you have questions, contact the department's Bureau of Managed Care at 217-524-7478 or the Bureau of Long Term Care at 217-524-7245.

Theresa A. Eagleson, Administrator

Division of Medical Programs