HFS Overview on MCO Transition - Question and Answer

Transcription

1 1 Q: can you please repeat the answer for Plans with selected MCO? A: See slide 6 of the presentation for the listing. 2 Q: For the non-award plans, when we will be able to see the new MCO eff 1/1/18 in Medi? A: The MEDI system will show the new HealthChoice Illinois plan assignment for January 1, 2018 once an individual has been transitioned by HFS to the HealthChoice Illinois plan. The transition of current MCO members is currently in process and will continue through November 30, Q: Will those enrolled in an MCO whose plan WILL still be available get an open enrollment to switch plans? A: Yes, all individuals that are transitioned to HealthChoice Illinois plans for January 1, 2018 will have a 90-day switch period - January 1, 2018 to March 31, Q: can people whose plans are leaving IL, select a new plan A:Individuals who are currently enrolled with a non-award plan will be assigned to prior to 1/1/18 or will they just be auto-assigned and then can a participating HealthChoice Illinois plan through either an MCO partnership or the make that change after 1/1/18? auto-assignment process. In all cases, the individual will be mailed a HealthChoice Illinois transition notice advising the individual of their current plans closure December 31, 2017, the new plan assignment in HealthChoice Illinois beginning January 1, 2018, information on other plan choices, timeframe for making a plan switch and how to get more information. All individuals being transitioned to the HealthChoice Illinois program (from both non-award and award plans) will be provided with a 90-day period to switch plans. This switch period is between January 1, 2018 and March 31, However, an individual may certainly contact the Client Enrollment Broker (CEB) and switch plans in advance of the January 1, 2018 date. The CEB will not require an individual that would like to switch their HealthChoice Illinois plan in advance of January 1, 2018 to call back to initiate the plan switch on or after January 1, The CEB will educate the client on their plan choices for January 1, 2018 and process the requested plan switch at the time of the call. In these instances, the earliest effective date of the health plan switch is January 1, No plan switches for HealthChoice Illinois will be effective any earlier than January 1, As such, a client may elect to switch plans one time in advance of January 1, 2018 and again during their formal 90-day switch period between January 1, 2018 and March 31, Q: There will still be a Medicaid only population correct? If so, what will be % of the population remaining with Medicaid only benefits? A: Correct. Approximately 20% of the Medicaid population will remain with Medicaid only benefits after all of the Statewide transition and expansion rollouts. 6 Q: Do patients who update redetermination must select a new MCO? or this does not impact at all. A: No, A rede is not the same as MCO enrollment. Those dates many times are not the same. 7 Q: Will those in voluntary managed care areas that are NOT currently enrolled in a managed care plan receive notice now or in January A: The Illinois Health Connect Program is currently mailing plan closure notices to their members in the non-mandatory counties. Samples of the plan closure notice can be found at the following link: Notice pdf Eligible individuals in the non-mandatory counties, currently not enrolled with an MCO, will begin to receive HealthChoice Illinois enrollment packets the week of January 8, 2018 through February 16, 2018 for an enrollment effective date of April 1, 2018.

2 8 Q: Has HFS already completed the non-award plan PCP reassignment? A: No, the transition of members in both non-award and award plans will continue through November 30, Most non-award plan members will be transitioned to partner MCOs for the January 1, 2018 HealthChoice Illinois program effective date. At this time, the only non-award plan whose members will be transitioned via the auto-assignment algorithm are Humana's members and that transition process is expected to begin the week of November 6, Q: regardless of the time they change... the member will only be effective with the new picked plan , correct? 10 Q: Not sure if this is too fast to ask but will Beacon be administering Behavioral Health for Humana Health Plan MMAI? 11 Q: When auto assigning; were families kept together on the same plan? 12 Q: Do you have any information on Family health network members transitioning to CountyCare? A: Members previously enrolled in FHN and CCAI in Cook County have been transitioned to CountyCare's current programs for a November 1, 2017 enrollment effective date. The HealthChoice Illinois Program is effective January 1, 2018, and as such, all membership for plans in this program will be effective January 1, 2018 or after. Yes A: Yes, the updated auto-assignment algorithm will attempt to keep families in the same plans; however, assignment will attempt to maintain intact Provider/Member relationships first. A: FHN and CCAI members in Cook County were transitioned to CountyCare's current programs for a November 1, 2017 enrollment effective date. Sample Member notices can be found at the following links: untyfhnandccaimemberhealthchoiceiltransitionnotice pdf and, onnoticetocountycare pdf and, onnoticetocountycare pdf 13 Q: How will people that are currently with Health Connect be covered between January and April? 14 Q: Will that list of companies be provided that are no longer participating as of December 31st? A: Clients will remain in traditional FFS Medicaid coverage, continue to use their HFS Medical Card to access services and providers will continue to bill HFS in accordance with the FFS guidelines. Please see the sample IHC Plan Closure Member notice at: Notice pdf A: Family Health Network (FHN), Community Care Alliance (CCAI), Aetna Better Health Network, Cigna-HealthSpring, Humana. Please note that this statewide expansion does not impact the MMAI program. As such, Aetna and Humana will continue as participating health plans in the MMAI program as of January 1, Q: I had a patient who came in that had received a letter from Family Health Network letting her know that her and her children will be automatically assigned under County Care, will they be able to switch to another plan? If so, will it be until January 1st? A: An individual may contact the CEB to request a plan switch between now and December 31, 2017, and again during their 90-day HealthChoice Illinois switch period of January 1, 2018 and March 31, Most switches initiated prior to January 1, 2018 will be effective for January 1, Switches initiated on or after January 1, 2018 will be effective for the first of the following month, or the first of the next month - depends on the date of the requested plan change and cut-off for plan switches.

3 16 Q: For those currently on Fee-For-Service, specifically Illinois Health Connect, that need to switch providers before December 31st, will they be able to do so without enrolling in an MCO? A: Yes, individuals in FFS can continue to utilize the Illinois Health Connect member services line to get help with finding providers through the end of this year - December 31, As of January 1, 2018, individuals in FFS will need to call the HFS health benefits hotline for assistance in finding providers. 17 Q: For patients who change their MCO plans before Jan 1st will they continue in Jan 1st with the same plan? 18 Q: perhaps this will be covered later, but what is the effect of dental MCO coverage A: Yes, unless they choose to switch during the 90 day period. Plans will still be required to provide the same services as HFS FFS and may offer additional dental services. Each MCO will have their own dental administrator. 19 Q: Please Discuss credentialing with new companies how this will be managed and apply to FQHC's A: Medicaid only plans will be credentialed through HFS IMPACT system with 2 new questions as detailed in IMAIL - October 16. Although providers will be credentialed through IMPACT, they should continue to provide specific information requested by MCOs that is not included in the credentialing process but is needed for MCO Operations, such as provider office hours. 20 Q: Who are the correlated dental MCOs with each medical MCO A: Please see attached for most recent list. 21 Q: For the Auto Assignment Algorithm, we are an FQHC facility, are patients assigned under the FQHC NPI or are they assigned under the Providers at the FQHC? (hope that makes sense) A: The MCO files of patient PCP relationship will be used where available. Since MCOs assign PCP at either the FQHC site or clinician level and FQHCs also bill at both the clinician and site level the algorithm will look at either site or clinician HFS Provider ID. Where there is not an MCO relationship available for 6 months the algorithm will look back at claims for 6 months. If the billing/mco shows an individual clinician/site the client will be assigned to the clinician/site as PCP with an exception; the clinician/site must be an open and assignable PCP within an active MCO Provider Network in order for the assignment to take place. 22 Q: If the hospitals in our area are not planning to participate with any new MCO's, will those MCO's be assigned any patients in our area? A: HFS is doing an intensive readiness review to make sure MCOs are compliant with provider network requirements noted in the HFS-MCO model contract Sections 5.7 and Q: How many times can they switch? FHN patients? A: Potentially twice, between Nov 1, 2017 and Dec 31, 2017, for a January 1, 2018 plan switch effective date, and during the HealthChoice Illinois 90-day switch period of January 1, 2018 and March 31, Q: I understand 5 months period to change, however how many times can they switch A: Please see the response for the question above. 25 Q: Please elaborate on Utilization Management language. A: HFS request more specific information to provide an answer. 26 Q: Can HFS facilitate with all the MCO's that they use a standardize excel spreadsheet to collect add'l info they need (ie office hours, ADA compliance...) instead of each MCO having their own unique spreadsheet we need to complete/maintain 27 Q: Now that IMPACT will be used by all MCOs, will they be held to any specific timeline when loading provider credentials? A: At this time, there are no contractual requirements for the plans to use a standardized excel spreadsheet. A: The timeline pertaining to loading provider credentials is not a contractual requirement. HFS does strongly encourage plans to load within days.

4 28 Q: Regarding credentialing, can there be a session with the MCOs and the providers so all parties can be on the same page on expectations, etc. Thanks A: See additional IPHCA MCO meeting opportunities. 29 Q: Are providers allowed to educate patients on the various MCO plans after the letters are sent to the patients and enrollment begins? A: Use the 2014 outreach guide and templates available on the HFS website: emplates% pdf 30 Q: i don't recall if this was answered, there is not going to be a four prescription limit on any of the MCOs, correct? A: That policy applies to the Medicaid FFS coverage. MCOs can choose to offer additional benefits to their members and as such may choose to waive the 4 prescription policy. 31 Q: Will MCOs be required to go to a central location online to verify providers have being credentialed? A: HFS will provide weekly provider files to the MCOs identifying credentialed provider for use by the MCO in building their program provider networks. IPHCA: Since this is a new process be sure to notify your contracted MCOs as soon as you have provider additions or deletions as a backup during the new process implementation. 32 Q: There are some MCOs that are using different applications to verify if providers are credentialed but is different from IMPACT thus causing denials and lots of work behind the scenes to show MCOs providers are actually already credentialed 33 Q: When MCOs credential in IMPACT, does this include for dental services also? Just not medical and behavioral health. A: That may be the case currently under current MCO Contracts and current Medicaid Managed Care Programs. Under the HealthChoice Illinois program, Medicaid providers will be credentialed through HFS's IMPACT System. The HealthChoice Illinois program will be effective on January 1, A: All providers credential through IMPACT, including dental providers. 34 Q: If we feel that the MCO is asking for information that is not critical now that IMPACT is available (i.e. they want Provider License #s, etc., and not just office hours and ADA compliance data), is there somewhere we can go to inform the State to help police this? A: Although providers will be credentialed through HFS's IMPACT system, they should expect to continue to provide specific information requested by MCOs that is not included in the credentialing process but is needed for MCO Operations, such as provider office hours. 35 Q: How often can MCO enrollees switch PCPs? A: Each MCO enrollee handbook will convey information pertaining to any potential restriction on the number of times an enrollee can change their PCP. The plans are required by contract to process an enrollee s request to change PCP within 30 days of the day they receive the request. 36 Q: For the enrollment packets that will identify the MCO and A: Enrollment packets will begin to be mailed the week of January 8, MCOs PCP assignment if no enrollment choice is made during the 30- are encouraged to submit their most current provider network file to the CEB no day enrollment choice period will include only those providers later than the first week of January, However, enrollment packets will that are contracted with the assigned MCO by what specific continue to be mailed on a daily basis after January 8, 2018 and MCOs will be date? submitting weekly provider network updates to the CEB as provider networks expand or change. The enrollment process will only consider those providers that have been identified as open and assignable PCPs by each MCO at the time the algorithm is applied. Providers identified as specialist only, or closed, or missing from MCO provider networks will not be applied as part of the algorithm process.

5 37 Q: You mentioned that most exiting plans' members will be transitioning to the new pans, like FHN (cook county pts ) to CountyCare. Do we know anything about Aetna Better Health Patients? A: HFS announced that the Aetna Collar County/Rockford Region members will transition to Meridian. Please see the sample Aetna and Meridian member transition notices found at the following links: tiontomeridiannotice pdf and, emberhealthchoiceiltransitionletter pdf Aetna is working to contract with a partner MCO for their members in Cook County. Please continue to check the HFS Care Coordination web page for updates - sample member transition notices. 38 Q: SITE NPI A: The auto-enrollment algorithm will use the HFS Provider ID when identifying provider/member relationships in the algorithm process. 39 Q: does this mcos plan have interpreter services coverage A: Yes. 40 Q: are the "network adequacy" requirements available? Are they based on distance reasonable distances? Possibly using the Medicare requirements? 41 Q: Do the MCOs have a deadline for when their 2018 benefits need to be available on their websites? A: The provider network requirements are noted in the HFS-MCO model contract Sections 5.7 and 5.8. IPHCA: Urban versus rural designation are determined by IDPH criteria as noted in the contract definitions. A: HFS must review the benefits by December 1 st. It is up to the MCO to update their websites prior to implementation of the new program. 42 Q: Will this webinar be made available as a recording. A: Yes it will. 43 Q: There really needs to be one credentialing form that is utilized across all MCOs as we (FQHC) are having provider load issues. Can this be brought up and dealt with A: HFS will consider this recommendation as it works to implement the HealthChoice Illinois program and work with both MCOs and providers to ensure access to care for clients. 44 Q: You mentioned that a patient will be reassigned a new PCP if it is determined that the provider no longer participates in the plan. Will this patient be assigned to another provider in that provider group? (as in FQHC) A: The algorithm does not consider groups under the process. It attempts to maintain Provider/Member relationships based on previous provider assignments and claims data. If a provider is no longer an open and assignable provider the algorithm will look for another provider/member relationship and if none are found, it will assign the member to a PCP based on geomappping (geographic location of PCPs in the members area of service). 45 Q: Any notices so far from MCOs changing specific authorization requirements for Rule 132 services for 2018? A: No notices have been released at this time.