Provider Notice issued 02/17/12

Solicitation for Phase I of the Care Coordination Innovations Project

Under the Medicaid reform law, Public Act 096-1501 (pdf), passed in 2011 by the Illinois General Assembly, 50 percent of all Illinois Medicaid participants must be in a coordinated care program by January 1, 2015. The law broadly defines care coordination to include both traditional managed care companies, as well as new alternative models of care organized and managed by entities such as hospitals, physician groups, Federally Qualified Health Centers (FQHC), or social service organizations. The purpose of this notice is to provide you with information on the department's efforts to meet the 50 percent requirement through its Care Coordination Innovations Project.

HFS, in collaboration with other state agencies and community partners, developed the Care Coordination Innovations Project. The Innovations Project is designed to meet the state's goal of creating a healthcare delivery system that is more patient-centered, with a focus on improved health outcomes, enhanced patient access, and patient safety, by testing community interest and capacity to provide alternative models of delivering care to children and families, special populations, seniors and persons with disabilities.

Under Phase I of the Innovations Project, the department will be contracting with multiple Care Coordination Entities (CCE) and Managed Care Community Networks (MCCN). A CCE is a collaboration of providers that develop and implement a Care Coordination Model meeting the state's guidelines. The CCE's provider collaborators must include primary care providers, hospital(s) and mental health/substance abuse providers, but can include a variety of other providers. CCEs will be reimbursed under a multi-layered structure, with a portion being a per member per month (PMPM) Care Coordination Fee and a portion being Shared Savings. This reimbursement structure will require federal approval and both parts will have a Pay-for-Performance component. Medical services provided through the CCE will remain fee-for-service, as the department works toward bundled payments, more capitation and other reimbursement models. A MCCN is a provider sponsored organization that contracts to provide Medicaid covered services through a risk-based capitation fee. MCCNs must be owned, operated, managed, or governed by providers, state funded medical schools, or county governments.

The solicitation for Phase I of the Innovations Project is now available and is posted on the Department of Central Management Services' Illinois Procurement Bulletin Web site, as well as on the HFS Care Coordination Web site. We believe the solicitation will allow providers to design and offer new service delivery models through which they will provide effective care coordination services that produce better health outcomes for Medicaid clients and render cost savings for the Medicaid program.

Although the solicitation identifies the minimum requirements that collaborations must meet, we encourage bidders to build models that take a holistic approach to serving our clients by attempting to coordinate services even beyond the traditional services covered by the Medicaid program.

We encourage you read the solicitation to determine if your organization would be interested in forming a CCE or MCCN. Many community partners have asked how they can identify other organizations in their area serving their populations of interest who may be interested in forming a collaboration in response to the solicitation. To assist in this effort, the department has created the Care Coordination Matchmaking Web page. This is an optional service being offered on the HFS Web site to help partners find each other, build relationships, offer their services and/or help develop Care Coordination Entities. HFS moderates this content for appropriateness, but takes no responsibility for content accuracy or completeness. Partners can submit information about their services on the HFS Matchmaking Web site. The HFS Matchmaking Search for Partners Web page allows partners to search the database by geographical area or organization type.

Under the solicitation, organizations interested in participating in Phase I of the Innovations Project must submit letters of intent by February 29, 2012. The due date for submitting proposals is May 25, 2012.

Any questions regarding the solicitation for Phase I of the Innovations Project should be directed to HFS.Carecoord@illinois.gov

Theresa A. Eagleson, Administrator

Division of Medical Programs