Integrated Health Homes & Managed Care

Illinois Association of Medicaid Health Plans Nine MCO Members (2018): CountyCare – HealthChoice Illinois, Cook County Only NextLevel Health – HealthChoice Illinois, Cook County Only Harmony WellCare – HealthChoice Illinois BCBSIL – HealthChoice Illinois, MMAI Molina Healthcare – HealthChoice Illinois, MMAI Meridian Health – HealthChoice Illinois, MMAI IlliniCare – HealthChoice Illinois, DCFS, MMAI Aetna Better Health – MMAI Humana – MMAI

HealthChoice Illinois Enrollment Process: Phase I Transition Assignment in Current MCO Regions Letters mailed October & November 2017 with effective date of January 1, 2018 Clients assigned to current MCO with 90-day option to change to another MCO Locked in for 12 months

HealthChoice Illinois Enrollment Process: Phase II Full Enrollment Packet in Expansion Regions Enrollment Packets mailed beginning January 2018 with effective date beginning April 1, 2018 Clients given 30-day option to voluntarily enroll with one of five statewide MCOs by calling Client Enrollment Broker (Maximus) If no choice is made, client will be auto assigned to an MCO based on an algorithm 90-day option period to change to another MCO Locked in for 12 months

HealthChoice Illinois Enrollment Process: Phase III Enrollment of Special Needs Children Enrollment anticipated Oct 1, 2018 Children with Special Needs: Under age 21 are eligible for supplemental security income (SSI) under Title XVI; receive services under the Specialized Care for Children Act via the Division of Specialized Care for Children (DSCC); qualify as disabled; or, are under the legal custody or guardianship of the Illinois Department of Children and Family Services (DCFS).

Specific Population Delays According to an HFS Provider Notice published on 3/29/18, “the HealthChoice Illinois program for dual-eligible individuals receiving long term care and who are not enrolled in the Medicare-Medicaid Alignment Initiative (MMAI) or individuals receiving waiver services in the expansion counties has been postponed. This change effects only individuals receiving services in one of the following programs and who recently selected or were assigned to a health plan in the HealthChoice Illinois program in the expansion counties for an April 1, 2018 or later effective date. Community Care Program (Elderly Waiver) Home Services Program (Division of Rehabilitation Services Waivers) Supportive Living Program (SLP Waiver) Nursing home or long term care facility (non-MMAI dual eligible)

IHH Specifics

Where to ensure you have all the facts:

Required Professionals Physician Psychiatrist/Psychologist/MH Specialist SUD Specialist Social Worker/Social Service Specialist Nurse Care Manager Clinical Care Coordinator

Billing Codes

PMPM rates

Quality Metrics

Quality Bonus Payments

MCOs and IHHs partnering

Contracting with an MCO All providers, including IHHs, must be registered in IMPACT in order to contract with an MCO. Please ensure your contracting NPI matches the NPI used to register in IMPACT Contracting and loading providers takes time, especially if there is a rush of providers at the same time. Begin working with plans and providers proactively

Clean Claims & Quality Outcomes Quality Scores are driven by clean claims and encounters by both the IHH and direct service providers. Timely claim filing will be imperative for IHH success given the quarterly reporting. Developing a relationship with Provider Relations teams at MCOs will be beneficial in identifying challenges early on. Health Plan staff may be able to assist on the identification of claims and quality improvement.

IHH providers partnering with MCOs Engagement on hard to reach members assigned to an IHH. Sharing of successful projects and dialog on unsuccessful efforts. Health Plans have a more global understanding of individuals medical history. Sharing information on provider outcomes and opportunities for improvement. Potential for regular “rounds” with health plan clinical and care coordination staff. Alerts to IHHs when certain prior authorizations are requested or claims are filed. Strong partnership between care monitors at MCOs and care managers at IHHs

Non-IHH providers partnering with MCOs Health Plans are still your point of contact for prior authorizations, billing concerns, and overall care management. Non-IHH providers may interact with the IHH on care coordination efforts regarding the needs of the Medicaid member. Given appropriate data/information sharing agreements are in place. Non-IHH providers will still have a provider relations representative at health plans. The IHH can serve as a tool to increase appointment attendance, medication adherence, and patient wellbeing.

PCPs and IHHs A PCP is not an IHH. An IHH is a collaborative of providers coordinating care for a panel of at least 500 patients. A PCP is a direct service provider caring for individual patients. A PCP can specialize in the patients they serve (children, those with a chronic disease, seniors, etc.) Health homes must be able to serve the entire family. A member can still see a contracted PCP that is not affiliated with an IHH. It is not envisioned that IHHs will steer patients away from PCP’s members already have a relationship with.

Contacting MCOs Blue Cross Blue Shield: CountyCare: Harmony: Joanne O’Brien, Contracting: Joanne_obrien@bcbsil.com, 312.653.2413 Kimberly Dean, Project Manager: Kimberly_J_Dean@bcbsil.com, CountyCare: Crissy Turino: cristina.turino@cookcountyhhs.org Andrea McGlynn: amcglynn@cookcountyhhs.org Harmony: Nancy Byrne:  Nancy.Byrne@wellcare.com IlliniCare:  Hector Hernandez:  HHERNANDEZ@illinicare.com Meridian: Gregory A. Lee, LCSW: gregory.lee@mhplan.com, d. 312-665-0065 p. 313-324- 3700 x22187 f. 312-508-7273 Molina: Natalie Kasper:  Natalie.Kasper@molinahealthcare.com Matt Wolf:  Matthew.Wolf@molinahealthcare.com NextLevel Health: Garfield Collins:  Garfield.Collins@nlhpartners.com Theodore Dixon:  Theodore.Dixon@nlhpartners.com

Additional Resources

IAMHP Website – Info for Providers In addition to the Key Contacts and Billing Guides, the Info for Providers section also includes links to Provider Manuals and Prior Authorization links Regular updates to reflect any URL changes, document updates, etc. IAMHP always welcomes suggestions, so please don’t hesitate to share what additional information we can collect from the health plans and post to our site.

IAMHP Billing Guides

IAMHP Key Contacts

IAMHP Contact Information Samantha Olds Frey, Executive Director samantha@iamhpteam.org Alaina Kennedy, Associate Director alaina@iamhpteam.org