Provider Notice issued 09/12/14

Integrated Care Program Update- City of Chicago

The Department of Healthcare and Family Services (HFS) is in the final stages of the Integrated Care Program (ICP) expansion. ICP is for seniors and persons with disabilities (SPDs) age 19 or older who are eligible for Medicaid but not eligible for Medicare. HFS has completed mailing enrollment material to all city of Chicago residents who are eligible for ICP. HFS expects those city of Chicago individuals will have enrolled in ICP by September 1, 2014.

ICP is now operating in all areas of the five mandatory managed care regions, including: the Greater Chicago Region, the Rockford Region, the Central Illinois Region, the Metro East Region and the Quad Cities Region.

SPDs in the city of Chicago will be enrolled with one of the following types of organizations: Managed Care Organizations (MCOs), Managed Care Community Networks (MCCNs), and Coordinated Care Entities (CCEs).

Managed Care Organizations (MCOs) are the traditional insurance-based Health Maintenance Organizations. They are paid on a full-risk capitated basis to cover almost all Medicaid services. Providers will need to bill these entities directly in order to get paid. Providers will also have to make sure they follow the MCOs’ utilization policies and procedures, including procedures for prior authorization and billing. Providers with enrollees in an MCO should work with the Integrated Care Team to coordinate care for these individuals. The Department electronic eligibility systems clearly identify under the ‘Managed Care Organization segment’ which MCO an individual is enrolled.

Managed Care Community Networks (MCCNs) are provider-owned and governed entities that operate like MCOs on a full-risk capitated basis. Just as with MCOs, providers will need to bill these entities directly in order to get paid. MCCN enrollment in the HFS eligibility systems will look identical to MCO enrollment. Providers will also have to make sure they follow the MCCNs’ utilization policies and procedures, including procedures for prior authorization and billing. Providers with enrollees in an MCCN should work with the Integrated Care Team to coordinate care for these individuals. The Department electronic eligibility systems clearly identify under the ‘Managed Care Organization segment’ which MCCN an individual is enrolled.

Care Coordination Entities (CCEs) are provider-based organizations that will be paid a fee by the Department to coordinate care for their enrollees. All Medicaid covered services will continue to be covered by the state. Providers will need to bill the state as they do today. If services require prior approval in the fee-for-service system today, they will continue to require it under CCEs. The process for obtaining prior approval from the state remains unchanged. Providers with enrollees in a CCE should work with the CCE Care Team to coordinate care for these individuals. The Department electronic eligibility systems will state “no MCO information for this inquiry” and will clearly identify the CCE in which an individual is enrolled under the ‘Care Coordination Entity segment.’

It is imperative that providers check Department electronic eligibility systems regularly to determine beneficiaries’ enrollment in a plan and to ensure your clients can continue care with you. The Recipient Eligibility Verification (REV) System, the Automated Voice Response System (AVRS), and the Medical Electronic Data Interchange (MEDI ) system will identify the care coordination plan in which the beneficiary is enrolled. It is also imperative that providers of all types join managed care networks in order to ensure timely payment.

Different regions will be served by different managed care entities. Please review the Department’s Care Coordination Expansion Map (pdf), which includes the ICP plans.

James Parker, Deputy Administrator

Division of Medical Programs

MCO, MCCN, and CCE CONTACT INFORMATION FOR CITY OF CHICAGO ICP MEMBERS

The contact information below lists the Provider Services Hotline Numbers for the Managed Care Organizations and Managed Care Community Networks that serve the Integrated Care Program members:

The information below provides the name and contact information of the CCEs: