Provider Notice issued 05/26/2023

This notice serves as a reminder of the service planning requirements for Supportive Living Program residents enrolled in Medicaid managed care.

Effective 07/01/20, Managed Care Organization (MCO) case managers became responsible for assisting Supportive Living Program (SLP) residents enrolled in Medicaid managed care with the development of their service plan, including SLP services. This includes residents enrolled in HealthChoice Illinois and the Medicare Medicaid Alignment Initiative (MMAI) Plans. 

Service Planning Process:

For residents enrolled in Medicaid managed care, the SLP provider’s Registered Nurse (RN) is responsible for the completion of the Resident Assessment Instrument (RAI) and Informational Service Summary (ISS). The ISS is due within 7 days of the RAI. A copy of the RAI and ISS must be sent together to the MCO case manager no later than the day the ISS is completed. These documents are used to assist with the  development of the resident’s service plan. SLP staff involvement in the development of the service plan, created by the MCO case manager, is very important in meeting the resident’s needs.

The SLP provider’s RN is also responsible for completing the RAI and Individual Support Plan (ISP) for residents not enrolled in Medicaid managed care; otherwise known as fee-for-service (FFS). If the FFS resident later enrolls in Medicaid managed care, the SLP provider must send the MCO case manager a copy of the individual’s current RAI and ISP. When the next annual RAI is due, an ISS should be completed, and the RAI and ISS forms will be sent to the MCO case manager. The ISP should not be completed after a resident is enrolled in Medicaid managed care.  

Submission of the RAI and ISS to the case manager is based on the SLP provider’s timeline for the initial and annual completion, not the MCO’s annual service plan due date. The MCO case manager will share a copy of the service plan with the SLP provider’s RN for review and

input. A final copy of the service plan will be supplied to the SLP provider. Quarterly assessments are not required for residents enrolled in managed care.

MCO case managers must also be notified of incidents and changes of condition for their member. Reporting requirements for MCO enrolled residents include:

1.    SLP Provider Preliminary Incident Report form

·   Allegations of abuse, neglect, and exploitation

·  Crime involving a resident

2.    SLP Medication Error Report form

3.    SLP Significant Change in Condition Notification for MCO Enrollees form must be used

4.    SLP Notice of Involuntary Discharge

5.    Specific for SLP dementia care setting residents:

·    Elopement Risk Assessment

·   St. Louis University Mental Status exam (SLUMS) or Montreal Cognitive Assessment (MoCA)

·   Sink and appliance assessments

Communication:

The SLP provider’s communication to the MCO case manager will assist with the timely updating of the resident’s service plan and coordination of additional services, if necessary.

Below is contact information for each MCO.  In the body of the email or on the fax coversheet, include the resident’s name, Medicaid Recipient Identification Number (RIN) and the SLP staff contact information, in case the MCO has questions.  The standardized subject line should state, “RAI and ISS for your Managed Care Member,” or whichever document(s) if applicable. 

Accessing Medicaid Managed Care Enrollment Information:

SLP providers can view resident eligibility information, including MCO enrollment, by completing an individual eligibility inquiry for each resident in the Medical Electronic Data Interchange (MEDI) through the Internet Electronic Claims (IEC) System inquiry or via a batch eligibility inquiry, which is called a 270/271. There is more info regarding the 270/271 at 270271cgupdatestatehealthbenefits.pdf (illinois.gov). SLP providers may access their Long Term Care (LTC) Patient Roster via a download through MEDI, monthly. The links below provide more information regarding the roster. Please note the Exclusion Code will identify if a resident is enrolled in HealthChoice Illinois (code 6) or MMAI (code 8).

resident-roster-report-specifications.pdf (illinois.gov)

patientrosterreportinstructions.pdf (illinois.gov)

If you have questions regarding this notice, contact the Bureau of Long Term Care toll free at 844-528-8444.

Kelly Cunningham, Administrator

Division of Medical Programs