Fw: Arc and Managed Care Update

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Arc and Managed Care UpdateFYI

Ellen

Ellen Garber Bronfeld

egskb@...

Arc and Managed Care Update

Managed care implementation is experiencing problems of

getting physicians to sign on for the networks. The Home Services program is

scheduled to fall under the managed care pilot this summer. Is this email not

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Dear Ellen,

Yesterday, Dec 8th, The Arc and other advocates met with

Health and Family Services Director Hamos and Jim to discuss

implementation of Phase One of the Integrated Care Pilot. Representatives from

Aetna and Illini Care were also there to discuss issues with the advocates.

The biggest concern about the implementation of Phase

One of the Integrated Care Pilot remains the recruitment of physicians,

specialists and hospitals into the networks of Aetna and Illini Care. Both of

these Managed Care Organizations are currently engaged in aggressive recruitment

strategies with health care providers.

It appears that the main objection physicians have to

Integrated Care is that they will be overwhelmed with Medicaid patients if they

join either network. This is in fact untrue. Physicians can limit the number of

Medicaid patients they serve. They can also limit the Medicaid patients they

serve to current patients. If the physicians join the network, they are paid

promptly by Aetna and Illini Care and do not have to wait for months to be paid

by the state. It is unfortunate that groups like Loyola continue to oppose the

Integrated Care Pilot.

Jim stated that “out of network†services are

coming to an end unless your services are part of your continuity of care. After

the first of the new year, Aetna and Illini Care will begin redirecting Medicaid

patients into “network†only health care providers. So, it is in your best

interest to advocate with your physician to join the network,or you should be

seeking other physicians for your health care needs. There are, of course,

exceptions to this policy.

There has been considerable growth of the physician and

hospital network in the first year of operation. Here are some figures:

Aetna Network June, 2011

Nov, 2011

Primary Care Physicians 659

1,850

Specialists 758

3,227

Hospitals 29

50

Illini Care Network June, 2011

Nov, 2011

Primary Care Physicians 708

1,651

Specialists 1,063

3,600

Hospitals 37

47

Both MCO’s indicated that Provenia St. ph in

Joliet has joined the networks, and they, both expect Silver Cross in Joliet to

join shortly.

To date, about 35,000 Medicaid individuals have been

signed up into the networks. About 63% were automatically enrolled into a

network because they did not choose a specific network.

Once you have selected a network or have been

automatically enrolled into a network, you must wait one year to select another

network. You are only able to choose another network on your anniversary date of

enrollment.

Phase Two of the Integrated Care Pilot, which includes

all long term care, home services and other waiver services except developmental

disabilities, is scheduled to begin in the summer of 2012.

Phase Three of the Integrated Care Pilot, which includes

all developmental disability services, is scheduled to begin in the summer of

2013. The Arc of Illinois continues to oppose Phase Three of the Integrated Care

Pilot.

HFS will also be issuing another request for proposals

on Integrated Care for Dual Eligibles (persons eligible for both Medicare and

Medicaid), sometime after the beginning of the new year.

Our staff at Illinois Life Span and our Family to Family

Health Education Center will be there to provide you with additional information

on the Managed Care Pilot.

.

Tony auski

Executive Director

The Arc of Illinois

20901 S. LaGrange Rd. Suite 209

fort, IL 60423

815-464-1832 (OFFICE)

708-828-0188 (CELL)

Tony@...

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