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Transition Planfor Illinois Child Welfare Medicaid Managed Care ImplementationWorkgroup:HealthChoice Illinois YouthCarePrepared byDepartment of Children & Family ServicesDepartment of Healthcare & Family ServicesSeptember 25, 2019UPDATED INTERIM PLANFor review by Child Welfare Medicaid Managed CareImplementation Advisory WorkgroupPursuant to Public Act 100-0646, passed by the 100th General Assembly, the Department of Children & FamilyServices (DCFS) and the Department of Healthcare & Family Services (HFS) must develop and post publicly, atransition plan for the provision of health care services to children enrolled in Medicaid managed care plans.The final transition plan shall be posted at least 28 days before the Department’s implementation of managedcare.The Contract Addendum between HFS and IlliniCare Health Plan (IlliniCare) for DCFS youth managed carewas originally signed on November 2, 2018, and is currently being updated. The actions described belowshould be considered tentative and subject to change based on other factors impacting the implementationof managed care. The Departments have updated this interim plan as an effort to promote transparency andaccountability in the implementation of managed care for DCFS Youth in Care.Per Public Act 100-0646, the transition plan shall address, but is not limited to, the following initiatives, listed onthe left with the Departments’ actions described on the right:1 Pag eUpdated I n t e r i m T r a n s i t i o n P l a n
Initiative1) an assessment of existingnetwork adequacy, plansto address gaps innetwork, and ongoingnetwork evaluation;ActionIlliniCare is the Medicaid Managed Care Organization (MCO) that willcoordinate the physical and behavioral health of DCFS Youth, includingYouth in Care and Former Youth in Care. This initiative is calledHealthChoice Illinois YouthCare.The top priority of Illinicare, and the Departments of Healthcare andFamily Services and Children and Family Services is a smooth transitionof services for DCFS Youth. Therefore, Illinicare and the Departmentshave been working to identify all providers who are currently providingMedicaid services for DCFS Youth. Illinicare has contacted all of theidentified providers to begin the contracting process.In addition, Illinicare and the Departments are conducting Town Hall andWorkgroup meetings where additional providers are being identified sothat Illinicare can contact those providers as well. The goal will be tohave all of these providers in network by November 1.However, if any DCFS Youth is receiving Medicaid covered services, andtheir provider is not in network by November 1, Illinicare will continue topay that provider for up to six months while Illinicare and the providerare executing a contract for that provider to join the network.In addition, IlliniCare must ensure they have adequate physical,professional and provider network capacity to provide Medicaid coveredservices for all enrollees. IlliniCare Health Plan’s Medicaid network hasalready been assessed by the Health Services Advisory Group (HSAG),HFS’ External Quality Review Organization and was found to beadequate for their existing Medicaid enrollees.In August 2019, a Readiness Review for the YouthCare program wasconducted to assess the network development strategy and process forthe DCFS Youth specific network and involved the following activities:1) Receipt of a list of providers that have billed Medicaid for DCFSYouth in Care and Former Youth in Care during FY 2017 and 2018. IlliniCare reviewed this list of approximately 20,000 lineitems, assessed who was already in network and developeda strategy to address those not in network. Approx 1,700 providers required outreach and recruitment At this time, 100% of the providers who had Medicaidclaims for DCFS Youth in FY17 and FY18 have beencontacted by IlliniCare. Discussions are underway tofinalize provider contracts with these providers. Requesting input from DCFS Purchase of Service (POS)agencies regarding providers that they are currently usingwho might not yet be identified by Illinicare so thatIllinicare can contact the provider directly.2 Pag eUpdated I n t e r i m T r a n s i t i o n P l a n
InitiativeActionAny interested provider should contact IlliniCare atILContracting@centene.com.IlliniCare’s current HealthChoice Illinois Medicaid network is availablefor review through an online search function found at this ind-a-provider.html. AllYouthCare providers will be listed on the IlliniCare website by November1, 2019. Network review will be ongoing.IlliniCare’s network will be reviewed on a quarterly basis for adequacyand/or gaps in care. If gaps in care are identified, IlliniCare will beprovided a timeframe by which they must remedy such gaps or penaltiesmay be assessed by HFS.2) a framework forpreparing and trainingorganizations, caregivers,frontline staff, andmanaged careorganizations;DCFS has developed a framework to inform and prepare all keystakeholders on the implementation of Medicaid Managed Care inIllinois. The framework relies on a systematic approach to helpcommunicate, educate and promote Medicaid Managed Care to planparticipants and stakeholders.As of December 1, 2018, when the Interim Transition Plan waspublished, the following three-part phased plan was included to ensureyouth, families, caregivers and all other key stakeholders had theinformation they need.Phase One1. Introduce concept and awareness of Medicaid Managed Care2. Gain (DCFS and private agency) leadership buy in andcommitment of support3. Engage all key stakeholders:a) What’s happening and whenb) What you need to knowc) Who’s affected, benefit, enrollment, carecoordination, transition, logisticsd) Important calendar dates and action needede) Frequently asked questionsf) Process flowsg) Where to get more information and/or additionalresourcesh) Establish DCFS, HFS and IlliniCare as the trustedsources of information for implementation of MedicaidManaged Carei) Provide data links to DCFS, HFS, IlliniCare informationj) Establish advocates in the child welfare community3 Pag eUpdated I n t e r i m T r a n s i t i o n P l a n
InitiativeActionPhase Two1. Educate and engage eligible Medicaid Managed Care planparticipants and key stakeholders2. Provide a better understanding of the implementation process3. Provide information on the latest updates, FAQs, best practices4. Reinforce DCFS, HFS and IlliniCare as the trusted sources ofinformation for implementation of Medicaid Managed Care5. Explain to youth and families the benefits of IlliniCare6. Empower advocates in the child welfare community7. Provide updated process flows as more information is availablePhase Three1. Encourage health plan engagement for older youth and formeryouth in care2. Reinforce key messaginga. Where to get informationb. Where and how to enroll in health plan, as applicablec. Anticipated transition dated. Feedback and FAQs3. Evaluate the preparation and training programa. Measure responseb. Monitor effectivenessc. Evaluated. ReviseAs of September 20, 2019, when this Updated Transition Plan is beingreviewed, the following activities have occurred or are being planned forpreparing and training organizations and frontline staff: Town Hall meetings were held during 2018 in Rockford, DesPlanes, Peoria, Harvey, Belleville and Chicago. Additional 14 Town Hall meetings are underway across thestate, in partnership with Illinois Collaboration on Youth. Presentations have been made to the Adoption Council and theStatewide Foster Care Council and ongoing communication willbe provided to both of these groups. A specific meeting is being scheduled for Residential Providersthe week of the 23rd. An email announcing YouthCare was sent to all DCFS providers. Presentations and webinars are being organized for DCFSregional administrators and area administrators, who will thenshare information with DCFS supervisors and caseworkers. Webinars are being organized for DCFS service providers.4 Pag eUpdated I n t e r i m T r a n s i t i o n P l a n
InitiativeActionIlliniCare is creating a unique internal structure for YouthCare. Thisprogram will have its own staff, with leadership reporting directly to theCEO. A local and regional approach has been employed in programdevelopment. Pods of staff members will work together asmultidisciplinary teams in regions that are aligned with DCFS regions.The pods will include clinical and non-clinical staff, representing the keyIlliniCare operations, in order to build local community relationships andto focus on local needs of Youth in Care. IlliniCare is currently in theprocess of staffing and training specialized staff for YouthCare: Eight (8) IlliniCare DCFS Liaisons are being hired to be placed atregional DCFS offices Over 100 IlliniCare care coordinators have been hiredspecifically for YouthCare Staff for two new initiatives are being hired: “a2A”(“adolescent to Adult”), a program designed for youthtransitioning from the system, and “Promoting AdoptionSuccess”, a program to support adoptive families to helpensure permanencyFour weeks of training have been developed for all YouthCare staff,including three (3) weeks of classroom training and one (1) week of onthe-job “preceptor”/mentoring. DCFS is also preparing to train IlliniCarestaff on Illinois child welfare topics, as well as DCFS processes. Thistraining will be designed to provide health plan staff with foundationallevel knowledge to enable them to communicate effectively withenrollees, caregivers, caseworkers and providers.IlliniCare is not authorized to contact or directly work with Youth in Careand their parents or caregivers until November 1, 2019, when theContract Addendum to the HFS Managed Care Contract takes effect.3) the identification ofadministrative changesnecessary for successfultransition to managed care,and the timeframes to makechanges;DCFS is currently evaluating administrative processes that may need tobe clarified as the transition to managed care is implemented. Identifiedso far are:- The referral processes between caseworkers and IlliniCare forphysical and behavioral health services,- Access to information for and from reports regarding Youth inCare’s physical health services, etc.- Amendment of Contracts- Modification of DCFS Procedures4) defined roles,responsibilities, and lines ofauthority for carecoordination, placementDCFS will continue to be responsible for Youth in Care, includingplacement, permanency planning and educational activities. DCFS willcontinue to contract with and pay placement providers.5 Pag eUpdated I n t e r i m T r a n s i t i o n P l a n
InitiativeActionproviders, service providers,and each state agencyinvolved in management andoversight of managed careservices;IlliniCare will be responsible for coordinating the overall physical,behavioral, dental and vision needs of Youth in Care. IlliniCare’s carecoordinators will work closely with DCFS caseworkers, HealthWorks leadagencies and Purchase of Service (POS) agencies across the state.The Contract and Contract Addendum will establish the basis for roleclarification among individuals coordinating and managing the case, topromote meaningful collaboration for youth and families. Thedepartments and IlliniCare will continue meeting with stakeholdergroups – including the Child Welfare Medicaid Managed CareImplementation Advisory Workgroup and sub-committees of the ChildWelfare Advisory Committee – to identify and resolve issues related toroles and responsibilities, and further develop a framework that meetsthe needs of Youth in Care.Meetings will be scheduled as needed with the Departments andIlliniCare to work through implementation challenges related to roleclarity. This phase of engagement will feed the development of policies,procedures and training topics. The revision and expansion of saidpolicies, procedures and trainings will be ongoing.5) data used to establishbaseline performance andquality of care, which shallbe utilized to assess qualityoutcomes and identifyongoing areas forimprovement;Information utilized to assess quality outcomes is identified in theHealthChoice Illinois contract. Attachments XI ‘Quality Assurance’ andAttachment XIII ‘Required Deliverables, Submissions and Reporting’ listdata collection requirements that HFS has established to ensure federaland state requirements are being met. Additional quality outcomesspecific to DCFS Youth are included in Attachment XI to the contract forIlliniCare:“1.2 Additional Outcomes for DCFS Youth in Care” include: Preventable inpatient hospitalizations for physical health will bereduced. Discharge planning and identification of Medicaid communitybased services available after discharge will be completed for 100% ofYouth in Care admitted to an inpatient psychiatric hospital For Youth in Care hospitalized Beyond Medical Necessity (BMN),specialized care conferences with the DCFS caseworker will be convenedwithin 20 days for BMN Youth in Care. HEDIS/CHIPRRA measures for Youth in Care will remainconsistent or will improve in relation to those measures reported byDCFS as of the Contract Addendum execution. Equal or increased percentage of Youth in Care with behavioralhealth issues will be engaged in behavioral health treatment. Equal or increased percentage of Youth in Care who receivescreening for trauma symptoms will be referred for further traumaassessment and trauma-oriented behavioral health services.6 Pag eUpdated I n t e r i m T r a n s i t i o n P l a n
InitiativeActionThe contract and those attachments can be found at this cuments/2018MODELCONTRACTadministrationcopy.pdf6) a process for stake holderinput into managed careplanning andimplementation;For more than a year, DCFS has been engaging with various stakeholdergroups to share information and solicit feedback. Such engagement willcontinue through the Child Welfare Medicaid Managed CareImplementation Advisory Workgroup. The Workgroup includesrepresentatives from the entire child welfare system and will meet atleast three times prior to the finalization of this transition plan. This willbe the official forum for stakeholders to provide input directly to DCFSand HFS directors and other leaders. Recommendations from theworkgroup will be reflected in the final version of this transition plan.Additionally, DCFS has established a feedback portal ages/YICHealthFBS.aspx7) a dispute resolutionprocess, including the rightsof enrollees andrepresentatives of enrolleesunder the dispute processand timeframes for disputeresolution determinationsand remedies;IlliniCare is contractually required to have a procedure to accept andreview enrollees’ grievances and appeals. An enrollee’s authorizedrepresentative can also submit an appeal on behalf of the enrollee.Those grievances and/or appeals can be submitted orally or in writing atany time. IlliniCare must meet different timeframes for resolution basedon whether a grievance or appeal was submitted.IlliniCare is reviewing its current processes to identify modificationsneeded for this unique and high needs population. IlliniCare will work onthe front end with the case worker to develop a plan of service, allowingfor authorizations to occur at that time. Should a dispute occur, IlliniCareprovides information for their members regarding what grievances andappeals are, how to file a grievance or appeal, and what thosetimeframes are. IlliniCare’s current HealthChoice Illinois memberhandbook has that information and can be found at this esources/handbooksforms.htmlAdditionally, DCFS will utilize its Advocacy Office to respond tocomplaints, concerns, inquiries and suggestions about managed care.The Advocacy Office will provide connections to appropriate DCFS staffand suggestions to executive staff for improvements and changes formanaged care.The Advocacy Office toll-free number is 800-232-3798.8) the process for health caretransition for youth exitingthe Department’s careChildren that become former youth in care (reunification, adoption,subsidized guardianship, or cases where Juvenile Court closed the caseand the child is no longer under the legal custody of DCFS) will be mailed7 Pag eUpdated I n t e r i m T r a n s i t i o n P l a n
InitiativeActionthrough emancipations orachieving permanency; anda new enrollment packet with education included on all Medicaid healthplans available to them. The materials will explain their 30-daytimeframe to choose a health plan, along with the 90-day option tochange health plans after enrollment. IlliniCare care coordinators willalso work with older youth who are transitioning to adulthood to ensurethat they understand their healthcare coverage options and aretransitioned seamlessly to another plan, if they so choose.9) protections to ensure thecontinued provision ofhealth care service if a child’sresidence or legal guardianchanges.Communication and data sharing among DCFS, HFS and IlliniCare are keyto ensuring placement changes do not unduly disrupt a child’s care.HFS, DCFS and IlliniCare have established a data file to ensure Contractoris aware of placement, caregiver and other related changes to allowContractor to contact enrollee and/or caregiver to ensure a child is ableto transition to new providers, if necessary.Client service solution: Youth and/or caregivers will continue to haveaccess to IlliniCare’s toll-free 24-hour phone lines, which will be printedon IlliniCare insurance cards. Once IlliniCare receives updated caregiverinformation, its care coordinators can communicate health informationwith them and help identify health services for youth.Training solution: DCFS will educate caseworkers to ensure updatedcaregiver information is entered promptly in the DCFS case managementsystem. Caseworkers will also be trained to ensure new caregivers are inreceipt of or have easy access to:a)Youth’s insurance card, which includes IlliniCare contactinformationb)IlliniCare’s toll-free number(s), which will connectyouth/caregiver to IlliniCare care coordinators and/or nurse advise linec)Provider directory.8 Pag eUpdated I n t e r i m T r a n s i t i o n P l a n
that Illinicare can contact those providers as well. The goal will be to have all of these providers in network by November 1. However, if any DCFS Youth is receiving Medicaid covered services, and their provider is not in network by November 1, Illinicare will continue to pay that provider for up to six months while
