MEDICAID MANAGED CARE AND IES GO LIVE UPDATES

MEDICAID MANAGED CARE AND IES GO LIVE UPDATES PRESENTED BY HFS HOSTED BY EVERTHRIVE NOVEMBER 2, 2017 1

ILLINOIS’ NEW STATEWIDE MEDICAID MANAGED CARE PROGRAM

AGENDA FOR CALL 1. Health. Choice Illinois – Medicaid Managed Care “Reboot” 2. Update on IES Phase 2 Go Live - what you need to know 3. Time for Questions 3

TRANSFORMING AND EXPANDING THE CURRENT PROGRAM The goal of Illinois’ new Statewide Medicaid Managed Care Program is to transition to a streamlined, accountable and integrated managed care program that delivers: - Member-centric care Enhanced quality Improved outcomes Sustainable costs 4

HEALTHCHOICE ILLINOIS’ IMPROVED MANAGED CARE PROGRAM Through an improved managed care program, the Department seeks to improve health and experience of care, and lower cost by: - Paying plans for value, quality, and outcomes Effective care coordination Renewed focus on prevention Deeper integration of behavioral and physical health Reduction in unnecessary emergency room visits and repeat hospitalizations - Continued emphasis on moving members from institutional to community care - Use of new data integration and predictive analytic tools - Education and self-sufficiency 5

IMPACTED POPULATIONS Illinois’ New Statewide Medicaid Managed Care Contract covers: • Family Health Plan (FHP) • Affordable Care Act (ACA) Adults • Integrated Care Program (ICP) • Managed Long Term Services and Supports (MLTSS) It does NOT Include: • Medicare-Medicaid Alignment Initiative (MMAI) Populations Excluded from Managed Care: • AK Premium Level 2; spenddown; refugees; Individuals with high level third party liability insurance (TPL); partial/limited benefit programs; those eligible through presumptive eligibility, and more. 6

Managed Care Proposed Timeline Three Phases Effective date, Phase 1 January 1, 2018 for current mandatory and voluntary managed care membership Effective date, Phase 2 April 1, 2018 for new geographies and newly eligible managed care members Tentative Effective date, Phase 3 July 1, 2018 for Special Needs Children 7

HFS AWARDED CONTRACTS TO THESE MANAGED CARE ORGANIZATIONS (MCOS) State-Wide • Blue Cross Blue Shield of Illinois • Harmony Health Plan • Illini. Care Health Plan • Meridian Health Plan • Molina Healthcare of Illinois Cook County • Blue Cross Blue Shield of Illinois • Harmony Health Plan • Illini. Care Health Plan • Meridian Health Plan • Molina Healthcare of Illinois • County. Care • Next. Level Health 8

CURRENT MCO MEMBERS PHASE 1 • Transition includes all individuals currently enrolled with an MCO in a mandatory or voluntary county. • Effective Date of Transition – January 1, 2018 • All transition members will have a 90 -day period to switch MCOs starting January 1, 2018. This resets their annual Open Enrollment Periods. • No individuals new to managed care and no new geographies in this group. • There is no phase-in enrollment period. Description Transition Notice Mail Start Week Transition Notice Mail End Week Transition Effective Enrollment Date Members whose current plan was awarded new contract October 30, 2017 November 30, 2017 January 1, 2018 Members whose current plan was NOT awarded new contract (Aim to keep PCP/member connections) November 6, 2017 November 30, 2017 January 1, 2018 9

EXPANSION PHASE 2 STATE-WIDE, ALL COUNTIES – APRIL 1 • Newly Eligible populations in new geographic areas and previous Illinois Health Connect Members. • Will be required to enroll in an MCO • Earliest effective enrollment date - April 1, 2018 • New geographic areas are any Illinois county outside the five current mandatory managed care regions, including current voluntary counties. • Includes newly eligible clients in current mandatory counties too! • Illinois Health Connect will close down December 31, 2017. Members will be in Fee-For-Service (FFS) between January 1, 2018 and April 1, 2018. • Will select an MCO and PCP for April 1, 2018 enrollment effective date. • Starting January 1, 2018, individuals in FFS and/or not yet enrolled with an MCO in the Statewide managed care program, can get help finding a doctor from the HFS Health Benefits Hotline at 1 -800 -226 -0768 (TTY: 1 -877 -204 -1012) 10

MAIL SCHEDULE – PHASES 1 & 2 ONLY Effective Enrollment Auto-Assignment Date* Description Mailing Dates Transition of members currently enrolled with a managed care health plan that was awarded a new contract for January 1, 2018. Members will stay enrolled with their current health plan. Each member will receive a Health. Choice Illinois transition notice. Transition of members currently enrolled with a managed care health plan that was not awarded a new contract for January 1, 2018. Members will be transitioned to a new health plan via the auto-assignment algorithm. Each member will receive a Health. Choice Illinois transition notice. Enrollment of newly eligible potential enrollees, previous Illinois Health Connect members, and no-longer excluded populations (does not include special needs children). Each individual will be provided with a 30 -day enrollment choice period to select a health plan and PCP. ** October 30, 2017 -November 30, 2017 January 1, 2018 N/A Current mandatory and voluntary counties with MCO members will be included in the daily mailings. Only individuals currently enrolled in an MCO are included in these mailings. November 6, 2017 – November 30, 2017 January 1, 2018 Current mandatory and voluntary counties with MCO members will be included in the daily mailings. Only individuals currently enrolled in an MCO are included in these mailings. January 8, 2018 – February 16, 2018 Earliest effective Choice Earliest Auto. All counties statewide will be enrollment date is April Assignment date is April included in the daily mailings. 1, 2018 Enrollment of Special Needs Children. Each individual will be mailed a Health. Choice Illinois enrollment packet. Each individual will have a 30 -day enrollment choice period to select a health plan and PCP. ** May 7, 2018 – May 16, 2018 TENTATIVE Earliest choice enrollment date is July 1, 2018 TENTATIVE Earliest Auto. Assignment date is July 1, 2018 Counties included in mailing All counties statewide will be included in the daily mailings. *All individuals will have a 90 -day switch period to select a different plan. Sample transition and enrollment materials are available on the Illinois Client Enrollment Broker Program web site at www. enrollhfs. illinois. gov. **The enrollment packet will identify the MCO and PCP assignment if no enrollment choice is made during the 30 -day enrollment choice 11 period.

TRANSITION OF MEMBERS IN EXITING PLANS • MCOs exiting the program are required to provide to each member’s “new” MCO with: • All open prior authorizations, including prescription drugs and DME • Current care plans • ETI forms for waiver members • MCOs receiving members from exiting plans are expected to honor all open prior authorizations for 90 days. • MCOs continue to be required to provide a 90 day continuity of care period for individuals by paying all current providers even if not innetwork with the new MCO. 12

THE NEW CONTRACT KEY DIFFERENCES • Most populations will fall under one contract (FHP, ACA, ICP, and MLTSS). • MMAI continues under a separate contract. • Single source provider credentialing – Registration in IMPACT will suffice for credentialing. Starting January 1, 2018, MCOs are not permitted to credential for Medicaid, but can still collect certain information required by law for posting (hours and affiliation, etc). • Effective July 1, 2018, single preferred drug list (PDL) – All plans must use HFS’ preferred drug list • Can continue to waive co-pays • Can impose own utilization management controls unless otherwise prohibited by law • Plans will be required to expedite provider payments for providers on HFS expedite list. 13

HFS WORKING WITH PROVIDERS Engaging Providers through provider notices on topics such as: 1. How to work with MCOs that did not receive a contract for the new program 2. Details on the new program how it will mean less work for providers, for example • Single provider credentialing by the State 3. How HFS and the MCOs will communicate transition and plan switch details to members. 4. How to work with MCOs serving individuals eligible for full Medicare and Medicaid benefits (dual eligibles) All Provider notices are posted to the HFS. Illinois. gov website 14

PROVIDER NOTICES ON HFS WEBSITE 15

IDENTIFYING MLTSS MEMBERS IN MEDI AFTER 1/1/18 • Beginning January 1, 2018, the MLTSS program will be part of Health. Choice Illinois. • In MEDI, Health. Choice Illinois MLTSS enrollees will no longer be identified within the Site Name and Organization Name fields in the Managed Care Organization section. • Instead, Health. Choice Illinois MLTSS enrollees will be identified by having an Exclusion Code of “ 6” and a “Special Information” message underneath that says: 16

PREPARING/POSTING MEMBER INFORMATION • Transition material for January 1, 2018 effective dates was reviewed by internal and external stakeholders. ** • MCO letters being sent to members are being posted on the HFS. Illinois. gov website under Medical Providers, Care Coordination. • Education and Enrollment Packet Materials for April 1, 2018 effective dates will be shared for review by internal and external stakeholders. Enrollment Packet Materials will include: • • • Enrollment letter with plan and PCP assignment Tips sheet Brochure Comparison Chart Report Card/Star Report **Sample member materials are available on the Client Enrollment Broker website at www. enrollhfs. illinois. gov/ 17

KEY INFORMATION FOR MEMBERS • All members will receive ID cards from their MCO to use when accessing services even if the member stays with the same plan. • Once a member is enrolled, the MCO will also send each individual a welcome packet that includes a member handbook and additional information. • A member may switch their PCPs within the MCO according to the MCO policy. Members should contact their MCO member services directly to request a PCP change. • MCOs are required by contract to assign care coordinators to certain highrisk members and all waiver members; however, any member may request a care coordinator by calling the MCO’s member services. • MCOs are required to provide a 90 day continuity of care period for individuals by paying all current providers even if not in-network with the new MCO. This applies to any member changing plans. 18

THE CLIENT ENROLLMENT SERVICES ROLE • The role of Illinois Client Enrollment Services remains the same. • The ICES will provide unbiased education for all individuals’ managed care and PCP choices and will assist each individual with the enrollment process. • Clients should be directed to the ICES call center for more information about their Plan choices and for enrollment assistance: 1 -877 -912 -8880 (TTY: 1 -866 -565 -8576) or online at http: //enrollhfs. illinois. gov 19

Questions can be sent to: HFS. carecoord@illinois. gov

UPDATE ON IES PHASE 2 GO LIVE

CHANGES THE CLIENT CAN EXPECT WITH IES PHASE 2 • Benefit correspondence will have a standard “look and feel”, language has been simplified and some similar notices have been consolidated; there is a new “Notice of Decision” which consolidates several types of case action notices. • When customers are mailed a request form or verifications, a Document Cover Sheet with a barcode will be included. Customers should include the cover sheet with any forms or verifications. • There will be a new Central Scanning Unit (CSU) in Springfield where the customers will mail forms and verifications. The CSU address will be printed on forms to return, cover sheets, and return envelopes. The CSU will scan verifications received for AKU and all local offices (with the exception of the 3 LTC hubs) to the appropriate electronic case file. Customers can still bring documents to the local office. • Electronic interfaces will detect changing customer circumstances (e. g. new sources of income, Social Security determination, Medicare). Customers may receive notices of case changes – even if they have not reported a change. • Customers can check benefit information using the ABE Manage My Case (MMC) portal and can file and manage appeals online in the ABE Appeals portal. Among other things, the head of household on the case will be able to check the status of applications, report changes, add newborns to a case, upload documents, check for and change appointments (SNAP and TANF), complete redeterminations, view and print Notices.

NEW NOTICES: 360 C NOTICE OF DECISION New Notice of Decision combines other notices. Mailed out of IES and includes: • Information on all benefits anyone is receiving in the household, by individual. • Includes how benefits were determined for each person • Individually identifies each person, RIN, benefits and effective dates. • Medical card is always last page of notice • Notices/medical card won’t be available in MMC until mailed by IES. Old notices not in there.

CASE INFORMATION AT GO LIVE q At Go Live – IES brought from the Legacy System, all cases active within the last 150 days. q Case information from the Legacy systems was loaded into IES. Cases brought over got a NEW, 9 digit IES case numbers. All legacy case numbers are retired. New case numbers have no “codes” within them. Just randomly assigned numeric numbers. • Pending applications remained in IES at Go Live keep their current tracking/case number. q For most cases, the Legacy System didn’t have all of the data IES needs. Caseworkers will look at each case when they process the redetermination or a change request to make sure the case has all of the data moving forward. q When processing the redetermination or a change request, workers who are not able to get the needed information electronically from a data hub or from a saved case record, will send a Request for Verification Notice to the client. Documents should be returned to the Central Scanning Unit • • • Clients can use MMC to respond to that request for verifications or report a change Clients should NOT add missing information into MMC unless it is in response to a request for information; If returning the requested information by mail – include the bar-coded cover sheet q No client will lose benefits because of the conversion of data to IES. Benefit changes will only occur as part of a redetermination or case change request if appropriate based on up to date information. When caseworkers process a redetermination or a case change, they will look for and merge multiple cases with the same Head of Household (HOH), clean up the data, and re-run clearances and eligibility. 24

REQUEST FOR VERIFICATION COVER PAGE 25

REDETERMINATION DATES AT GO LIVE q IES generates redetermination notices 60 days before the end of the benefit period. Generally, that’s when the “Time to Renew” button will appear in MMC. The “Time to Renew” button may already appear in MMC for redeterminations due in November and December. q The first set of “redesigned” redetermination notices that IES will send out will be in November 2017 for the benefit period ending on January 31, 2018. Note, these forms are to be returned to the central scanning unit – NOT the IMRP or the FCRC as per the instructions on the Notice. q NOTE: People with a redetermination due in November or December of 2017 should have received or will be receiving their redetermination notices as before. They should return documents as they did pre-Go Live. • Clients should return the redetermination forms for medical only cases as they do today: Upload, fax or mail in to the IMRP or take to the local office. • If the redetermination is for medical and SNAP, the forms need to go to the local office for redeterminations due in November and December ONLY. q If someone has a question about the dates their redetermination forms are due or where to send them, have them call 1 -855 -458 -4945. 26

CHANGE TO THE ABE APPLICATION With Phase 2, individuals filling out an application will have the option to go through Identity Proofing after answering the household questions for each person on the case. • Identity proofing is NOT required, the applicant can still submit an application by clicking the box that says “Verify Identity Later” at the bottom of the page. • Identify proofing is required for Manage My Case. • But if the identify proofing is successful, once the application is submitted, ABE will list what information could be verified electronically and what documents are still needed that can be uploaded with the application. Visit the ABE Customer Support Page (http: //dhs. state. il. us/ABE) for various resources including ABE Guides, FAQs, How To Set Up Manage My Case and more. 27

ID PROOFING • ID Proofing MUST be done by the Primary Applicant/Head of Household on the Case. • If someone is an Approved Representative, the client has to be on the phone or with them; the questions are for the client. • If you call Experian, the first thing they will do is make sure the person they are speaking to matches the head of household information they accessed from ABE. • If Experian successfully verifies identity over the phone, no PIN is needed, just click NEXT. (we are revising the screen) • If the head of household does not have a SS# or any credit history, they will not be able to successfully complete ID proofing through Experian, just click “verify identity later”. • ID proofing is NOT available for children under 18. • Currently there is no manual proofing process. 28

Questions or comments can be sent to: ABE. Questions@illinois. gov