Provider Notice issued 05/19/16

Participation in the Managed Long Term Services and Supports (MLTSS) Program

This notice provides information regarding the implementation of the Managed Long Term Services and Supports (MLTSS) Program and participation for both the Medicare-Medicaid Alignment Initiative (MMAI) and MLTSS.

MMAI Demonstration in Illinois

The Department of Healthcare and Family Services (HFS) and federal Centers for Medicare & Medicaid Services (CMS) implemented the MMAI demonstration in Illinois in 2014 for beneficiaries who are eligible for Medicare and full Medicaid benefits (also known as “dual eligibles”).  Beneficiaries enrolled in MMAI receive all Medicare and Medicaid services, including prescription drugs, from a Managed Care Organization (MCO).  MMAI also offers care coordination to assist enrollees in meeting their care plan goals.  Dual eligibles in the Greater Chicago (Lake, Kane, DuPage, Cook, Will, and Kankakee counties) and Central Illinois regions may enroll in or opt out of MMAI.

Mandatory MLTSS

Beginning July 1, 2016, the MLTSS program will be a mandatory program for dual eligibles receiving long term services and supports in the Greater Chicago Region who opt out of MMAI.  This includes individuals residing in a nursing facility and individuals on the following HCBS waivers: Supportive Living Program, Persons with Disabilities, Persons with HIV/AIDS, Persons with Traumatic Brain Injury, and Persons who are Elderly.  Individuals receiving HCBS on a Developmental Disability (DD) waiver or residing in a DD facility are excluded from the MMAI and MLTSS programs.

Individuals that opt out of MMAI will be able to choose an MLTSS plan or will be auto enrolled in the MLTSS plan that is administered by their MMAI plan if a choice is not made.  Enrollment information will be mailed in the Greater Chicago Region beginning in June 2016 to dual eligibles receiving LTSS.  Enrollment letters will explain the individual’s choices of MMAI or MLTSS.  The MLTSS Program will not be rolled out in the Central Illinois Region at this time.

An MCO cannot participate in MLTSS unless it participates in MMAI.  A list of all MMAI/MLTSS MCOs and their provider services phone numbers can found on the

HFS Medicaid Health Plan link.

HCBS Waiver Providers

HCBS waiver providers serving individuals who are required to join the MLTSS Program should take this opportunity to participate in MLTSS by contracting with health plans in their service area.

HCBS waiver providers may choose to contract with all MCOs or may limit their contracts to select MCOs. If an agreement cannot be reached or if a provider elects not to contract with an MCO and a beneficiary is residing in the facility, the MCO will make arrangements to move the beneficiary to a facility participating in their network.  Providers are encouraged to contract with all the MCOs in order to avoid any unnecessary limitations on current or future residents.  

Dual eligibles enrolled in MLTSS will receive some Medicaid-covered services from their MLTSS MCO, including long term care, waiver services, behavioral health services, non-emergency transportation, and care coordination.  Dual eligibles enrolled in MLTSS will receive their Medicare-covered services such as hospitalization, doctor visits, therapies, prescriptions, laboratory and x-ray services, medical supplies, etc. through Medicare fee-for-service, Medicare Part D, or Medicare Advantage.

Similar to MMAI, the MLTSS MCOs will honor a 180-day transition period for new enrollees and a 90-day transition period for enrollees switching from another health plan in which beneficiaries can continue receiving covered services with out-of-network providers.  MCOs are responsible to pay for those services.

Long Term Care questions or issues regarding MMAI or MLTSS may be sent to HFS.MMAI@illinois.gov .  HCBS Providers having MCO-specific issues should attempt to resolve those issues directly with the MCO first.

Robert Mendonsa, Deputy Administrator

Division of Medical Programs