Agencies
Services
Provider Notice issued 05/15/13
You are providing continuity of care for the most at-risk Medicaid clients; and
MCOs payments may come sooner than HFS payments
Care Coordination Expansion
| To: | All Medical Assistance Providers |
| Date: | May 15, 2013 |
| Re: | Care Coordination Expansion |
This notice is to update you on the Department’s continued roll-out of care coordination initiatives, including both provider-based models (Managed Care Community Networks and Care Coordination Entities) and traditional managed care models (Health Maintenance Organizations).
The Medicaid reform law [PA 96-1501], requires that by January 1, 2015, at least 50 percent of the individuals covered under Medicaid be enrolled in a risk-based care coordination program. The Department of Healthcare and Family Services (HFS) took the first step in implementing this law by starting the Integrated Care Program (ICP) in May 2011. ICP serves approximately 36,000 seniors and persons with disabilities in the counties of DuPage, Kane, Kankakee, Lake, Will and Suburban Cook who are eligible for Medicaid but are not eligible for Medicare.
ICP is expanding in 2013 to the Rockford Region, Central Illinois Region, Quad Cities Region and Metro East Region.
Also in 2013, HFS, in partnering with the Centers for Medicare & Medicaid Services (CMS) will introduce the Medicare-Medicaid Alignment Initiative (MMAI) in Greater Chicago and Central Illinois. HFS and CMS will contract with health plans to coordinate the delivery of services for individuals who have both Medicare and Medicaid.
There are different health plans in each region that will be responsible for managing and paying for the services for both ICP and MMAI clients.
HFS encourages providers serving the target population to contract with the health plans. If you are a provider outside the counties listed in this notice but you provide care to individuals residing in the counties which will soon be served by a Managed Care Organization (MCO), you are still encouraged to join the MCO networks.
Joining their networks ensures your patients can continue to receive the healthcare services you are providing and reassures clients they will not have to change providers.
Being a provider within these networks means:
The only way to ensure payment for patients enrolled in these programs is to contract with the health plans.
In addition to ICP and MMAI, in 2013 the Department is implementing another initiative under Medicaid reform - the Innovations Project for Seniors and Adults with Disabilities. Under this initiative, the Department has already selected six (6) initial Care Coordination Entities (CCEs) to provide care coordination services to seniors and adults with disabilities who have the most complex health and behavioral health conditions. The CCEs will operate in many of the same counties as ICP and MMAI and will be a health plan option for eligible enrollees. The State requires that these CCEs include participation from hospitals, primary care providers and mental health and substance abuse providers in order to facilitate the delivery of appropriate health care and other services, and to manage needed transitions in care among providers and community agencies for these vulnerable populations.
Currently, the Illinois Health Connect (IHC) Program will continue to operate as a statewide mandatory health plan choice for those individuals that are not required to participate in ICP, MMAI or a CCE. In some counties, individuals that are required to participate in IHC can opt out of IHC and select a Voluntary Managed Care Organization. As the expansion of these new health plans progresses, the counties where Illinois Health Connect operates will change. To learn more about Illinois Health Connect, Integrated Care and the Voluntary Managed Care Organizations, please visit the HFS Managed Care webpage.
HFS thanks you for your continued service to our most vulnerable population and urges you to participate in the ICP, MMAI and CCE Programs.
For a list of MCOs and CCEs participating in Care Coordination Expansion and the geographic areas they are serving, please refer to the attachment of this notice.
If you have questions, contact the Department’s Bureau of Managed Care at 217-524-7478.
Theresa A. Eagleson, Administrator
Division of Medical Programs
Contact information for each health plan and the geographic areas they are serving for ICP is:
Integrated Care Program Expansion |
|
Rockford Region – includes Winnebago, Boone and McHenry Counties |
|
Aetna Better Health |
Community Care Alliance of Illinois * |
IlliniCare Health Plan |
|
Integrated Care Program Expansion |
|
Central Illinois Region – includes McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermilion, Ford, Menard Counties |
|
Health Alliance Medical Plans |
Molina Healthcare of Illinois |
Integrated Care Program Expansion |
|
Central Illinois Region – includes Tazewell, Knox, Peoria and Stark Counties |
|
Health Alliance Medical Plans |
Meridian Health Plan |
Molina Healthcare of Illinois |
|
Integrated Care Program Expansion |
|
Quad Cities Region – includes Rock Island, Mercer and Henry Counties |
|
HealthSpring of Illinois |
IlliniCare Health Plan |
Integrated Care Program Expansion |
|
Metro East Region – includes Madison, Clinton and St. Clair Counties |
|
Meridian Health Plan |
Molina Healthcare of Illinois |
Contact information for each CCE and the geographic areas they are serving for the Innovations
Project is:
Innovations Project – Seniors and Persons with Disabilities |
Central Illinois Region – includes DeWitt, Logan, Macon, Moultrie, Piatt and Shelby Counties |
Macon County Care Coordination Entity |
Quad Cities Region – includes Bureau, Carroll, La Salle, Lee, Mercer, Ogle, Putnam, Rock Island, Stark, and Whiteside Counties |
Precedence Care Coordination Entity, LLC |
Innovations Project – Seniors and Persons with Disabilities |
|
Cook County |
|
Be Well Partners in Health |
Healthcare Consortium of Illinois |
Together4Health |
|
Contact information for each health plan and the geographic areas they are serving for MMAI is:
Medicare-Medicaid Alignment Initiative |
|
Greater Chicago Region – includes Cook, DuPage, Lake Kane, Kankakee & Will Counties |
|
Aetna Better Health |
Healthcare Service Company (also known as Blue Cross/Blue Shield of Illinois) |
HealthSpring of Illinois |
Humana Health Plan |
IlliniCare Health Plan |
Meridian Health Plan |
Medicare-Medicaid Alignment Initiative |
|
Central Illinois Region – includes McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermilion, Ford, Menard, Tazewell, Knox, Peoria and Stark Counties |
|
Health Alliance Medical Plans |
Molina Healthcare of Illinois |