Fw: Arc Integrated Care Pilot Update

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Ellen

Ellen Garber Bronfeld

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Arc Integrated Care Pilot Update

The Arc of Illinois

April 8, 2011

Leaders in The Arc:

This has been an extremely busy but productive week. There is a lot happening in

Springfield, Washington D.C. is about to implode and we are kicking off our LIFE

Funding Critical Services for People with Disabilities Campaign!

Yesterday, advocates met with Health Care & Family Services Director

Hamos, Deputy Administrator Jim and representatives from both Aetna and

IlliniCare.

Tony auski

The Arc of Illinois

815-464-1832

INTEGRATED CARE PILOT UPDATE

On March 17th enrollment forms for the Integrated Care Pilot were mailed out to

Medicaid recipients in the collar counties. HFSs plan is to mail out 3,000

enrollment forms each week until all 40,000 recipients receive their enrollment

forms. The enrollment packages are being mailed to in Suburban Cook County first

and will end with Lake County.

Enrollment can be done online or by calling the toll free number.

Persons in the Pilot will have to make a choice between the two Managed Care

Organizations, Aetna and IlliniCare. If they do not make a decision, they will

be automatically enrolled into one of the two medical plans. People do not have

the choice to opt out of the Pilot unless they want to drop their medical care.

As you decide on the network you want, you should visit the Aetna and IlliniCare

websites which are posting new additions to their provider networks. You

certainly will want to see if your health care providers are in at least one of

the networks to make an informed choice.

Before you go to the websites of either Manage Care Organizations, call them, or

call Illinois Client Enrollment Broker, you should make a list of the names and

contact information for each doctor, hospital and medical center that you now

use.

You will need to check carefully to see if your doctors and/or hospitals are

enrolled with either (or both) of the plans.

Here are the websites:

IlliniCare Health Plan (Centene): http://www.illinicare.com/

Aetna Better Health: http://www.aetnabetterhealth.com/Illinois/default.aspx

Illinois Client Enrollment Broker (program of Illinois Health Connect):

http://illinoiscebicp.com/

If your doctor or other health care providers are not in the network, you can

initiate a Single Case Agreement between your health care provider and the

insurance company. Of course, that is dependent upon the health care providers

choice to do a Single Case Agreement.

If they are not enrolled, and you do not request a single case agreement, you

will only be allowed to continue to see them for 90 days.

After that, you will be assigned to new doctors and hospitals, based upon what

is available from the MCOs.

The Arc is in the process in developing a fact sheet on Single Case Agreements.

The priority for Aetna and IlliniCare is to build their networks. Needless to

say there is a lot of speculation by doctors, medical groups and hospitals about

becoming a part of this Medicaid managed care network. The real challenge is

getting the hospitals into the networks. The state is providing incentives for

the hospitals to join the networks, and it is important to note that the

proposed 6% Medicaid rate cut will NOT apply to providers that join Aetna or

IlliniCare networks.

You will still apply for Medicaid in the same way, and go through the same

annual redetermination process as before.

Here is link to DHS website for more information about applying for Medicaid:

http://www.dhs.state.il.us/page.aspx?item=30359

Here is how to apply information from the Illinois Department of Healthcare and

Family Services: http://www.hfs.illinois.gov/medical/apply.html

Here is link to the online application system:

http://fspp.dhs.state.il.us/register/wb/wbHomePre.do

Some important information on the Integrated Care Pilot;

a.. The state, Etna and IlliniCare have not signed contracts but are very

close to agreement. The contracts cover Phase One, Phase Two and Phase Three but

additional amendments for Phases Two & Three will be worked out as they are

about to be implemented.

b.. Integrated Care will NOT change the way you apply for Medicaid.

c.. Medical Necessity will determine the supports and services individuals

will receive.

d.. The Integrated Care Pilot is expected to be expanded statewide.

Faye Manaster, Director of The Arcs Family to Family Health Education Center,

and I will be doing a session on the Integrated Care Pilot at The Arc TAP

Convention in Lisle at the end of the month.

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The Arc of Illinois

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fort, IL 60423