On May 15th, HFS released a notice 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:
• You are providing continuity of care for the most at-risk Medicaid clients; and
• MCOs payments may come sooner than HFS payments
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. http://www2.illinois.gov/hfs/ManagedCare/Pages/default.aspx
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.
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
One South Wacker, Suite 1200
Chicago, Illinois 60606
1-866-212-2851
Prompt for Providers – Press 2, then select 5 to speak to a Provider Services Representative
Community Care Alliance of Illinois
*Kili Chivers
322 S. Green St. Suite 400
Chicago IL 60607
Office: 312-491-1956 ext. 644
kchivers@fhnchicago.com *one of the initial six Innovation project plans
IlliniCare Health Plan
Humberto Torres, VP Network Development and Provider Relations
999 Oakmont Plaza Drive, Suite 400
Westmont, IL 60559
866-329-4701 x 47827
E-mail: htorres@centene.com
General request to join inquiries: ILContracting@centene.com
Integrated Care Program Expansion Central Illinois Region – includes McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermilion, Ford, Menard Counties
Health Alliance Medical Plans
Maxine Wallner
Director, Contracting & Provider Services
301 S. Vine Street
Urbana, Illinois 61801-3347
Direct: 217-337-8117
Toll-free: 1-800-851-3379, ext 8117
maxine.wallner@healthalliance.org
Molina Healthcare of Illinois
Nancy Wohlhart
1520 Kensington Dr., Suite 212
Oak Brook, IL 60523
E-mail: Nancy.Wohlhart@molinahealthcare.com
630-203-3905 (Office)
312-343-7940 (Cell)
Integrated Care Program Expansion Central Illinois Region – includes Tazewell, Knox, Peoria and Stark Counties
Health Alliance Medical Plans
Maxine Wallner
Director, Contracting & Provider Services
301 S. Vine Street
Urbana, Illinois 61801-3347
Direct: 217-337-8117
Toll-free: 1-800-851-3379, ext 8117
maxine.wallner@healthalliance.org
Molina Healthcare of Illinois
Nancy Wohlhart
1520 Kensington Dr., Suite 212
Oak Brook, IL 60523
E-mail: Nancy.Wohlhart@molinahealthcare.com
630-203-3905 (Office)
312-343-7940 (Cell)
Meridian Health Plan
Mari Jo Nissen
222 N. LaSalle Street, Suite 930
Chicago, IL 60601
312-705-2900 ext 2161
Marijo.nissen@mhplan.com
Integrated Care Program Expansion Quad Cities Region – includes Rock Island, Mercer and Henry Counties
HealthSpring of Illinois
Andrew Galbierz
Network Operations Administrator
9701 W. Higgins Rd, Suite 360
Rosemont, IL 60018
(847) 993-1966
Andrew.Galbierz@healthspring.com
IlliniCare Health Plan
Humberto Torres, VP Network Development and Provider Relations
999 Oakmont Plaza Drive, Suite 400
Westmont, IL 60559
866-329-4701 x 47827
E-mail: htorres@centene.com
General Request to Join Inquiries: ILContracting@centene.com
Integrated Care Program Expansion Metro East Region – includes Madison, Clinton and St. Clair Counties
Meridian Health Plan
Mari Jo Nissen
222 N. LaSalle Street, Suite 930
Chicago, IL 60601
312-705-2900 ext 2161
Marijo.nissen@mhplan.com
Molina Healthcare of Illinois
Nancy Wohlhart
1520 Kensington Dr., Suite 212
Oak Brook, IL 60523
Nancy.Wohlhart@molinahealthcare.com
630-203-3905 (Office)
312-343-7940 (Cell)
HFS CONTACT INFORMATION:
E-mail: hfs.webmaster@illinois.gov Internet: http://www.hfs.illinois.gov/
