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Transition Planfor Illinois Child WelfareMedicaid Managed Care ImplementationPrepared byDepartment of Children & Family ServicesDepartment of Healthcare & Family ServicesDecember 1, 2018INTERIM PLANPursuant in SB 1851, passed by the 100th General Assembly, the Department of Children & Family Services(DCFS) and the Department of Healthcare & Family Services (DHFS) 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 for DCFS youth managed care was signed onNovember 2, 2018. While the addendum has been signed, the actions described below should be consideredtentative and subject to change based on other factors impacting the implementation of managed care. TheDepartments are posting this interim plan as an effort to promote transparency and accountability in theimplementation of managed care for DCFS youth.1 PageInterim Transition Plan
Per SB 1851, the transition plan shall address, but is not limited to, the following initiatives, listed on the left.The Departments’ actions are described on the right.Initiative1) an assessment of existingnetwork adequacy, plans toaddress gaps in network, andongoing network evaluation;ActionIlliniCare Health Plan must ensure they have adequate physical,professional and provider network capacity to provide Medicaidcovered services for all DCFS Youth enrollees. These capabilities will beassessed by the Health Services Advisory Group (HSAG), HFS’ ExternalQuality Review Organization, under the 2018 readiness review. AReadiness Review is scheduled for December and will focus onrequirements that IlliniCare must meet for Medicaid-covered DCFSyouth.IlliniCare Health Plan’s network has already been approved by HSAG andthe Department of Healthcare and Family Services under theirHealthChoice Illinois statewide contract. The December ReadinessReview will assess IlliniCare’s recruitment of providers who havehistorically offered Medicaid-covered services to DCFS youth. IlliniCareis actively recruiting these providers now.IlliniCare’s current HealthChoice Illinois network is available for reviewthrough an online search function found at this ind-a-provider.html.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 for remedying such gaps.2) a framework for preparing andtraining organizations, caregivers,frontline staff, and managed careorganizations;DCFS is developing framework to inform and prepare all keystakeholders on the implementation of Medicaid Managed Care inIllinois. The framework will rely on a systematic approach to helpcommunicate, educate and promote Medicaid Managed Care to planparticipants and stakeholders.Preparation and training of stakeholders will leverage a phased plan toensure youth, families, caregivers and all other key stakeholders havethe information 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 know:2 PageInterim Transition Plan
Who’s affected, benefit, enrollment, carecoordination, transition, logisticsc) Important calendar dates and action neededd) Frequently asked questionse) Process flowsf) Where to get more information and/or additionalresources4. Establish DCFS, HFS and IlliniCare as the trusted sources ofinformation for implementation of Medicaid Managed Care5. Provide data links to DCFS, HFS, IlliniCare information6. Establish advocates in the child welfare communityPhase 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. ReviseTraining and preparation will be a coordinated effort across allstakeholder groups. DCFS will strive for at least four communicationtouch points (via email, in-person training, etc.) for stakeholders toaccess information.DCFS is also preparing to train IlliniCare staff on Illinois child welfaretopics, as well as DCFS processes. This training will be designed toprovide health plan staff with foundational-level knowledge to enable3 PageInterim Transition Plan
them to communicate effectively with enrollees, caregivers,caseworkers and providers.3) the identification ofadministrative changes necessaryfor successful transition tomanaged care, and thetimeframes to make changes;At this time, the following DCFS rules and procedures have beenidentified as requiring updates to align with managed careimplementation. As implementation planning develops, theDepartment may find that additional rules, procedures and policiesneed to change as well.Rule 301/Rule 301.90(b): Specialized Foster Care Anticipated revision start date: 2/1/19Rule 302/Rule 302.310: Adoption AssistanceRule 302/ Rule 302.410: Subsidized Guardianship Anticipated revision start date: 2/1/19Procedures 300.100: Medical Requirements for Reports of Child Abuseand Neglect Revision has startedProcedures 302.360: Health Care Services Anticipated revision start date: 2/1/19Procedures 315.95: Worker Assessments of the Child and Family Anticipated revision start date: 2/1/194) defined roles, responsibilities,and lines of authority for carecoordination, placementproviders, service providers, andeach state agency involved inmanagement and oversight ofmanaged care services;DCFS and HFS will continue to engage key stakeholders in their worktowards ensuring roles and responsibilities are defined and understoodby the departments, providers, IlliniCare, youth in DCFS care and theirfamilies.The contract and addendum will establish the basis for role clarificationamong individuals coordinating and managing the case, to promotemeaningful collaboration for youth and families. The departments andIlliniCare will continue meeting with stakeholder groups – including theChild Welfare Medicaid Managed Care Implementation AdvisoryWorkgroup and sub-committees of the Child Welfare AdvisoryCommittee – to identify and resolve problems related to roles andresponsibilities, and further develop a framework that meets the needsof children in DCFS care. Meetings will be scheduled as needed with thedepartments and IlliniCare to work through implementation challengesrelated to role clarity. This phase of engagement will feed thedevelopment of policies, procedures and training topics. The revisionand expansion of said policies, procedures and trainings will be ongoing.4 PageInterim Transition Plan
5) data used to establish baselineperformance and quality of care,which shall be utilized to assessquality outcomes and identifyongoing areas for improvement;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 DHFS has established to ensurefederal and state requirements are being met. Additional qualityoutcomes specific to DCFS Youth are included in the contract forIlliniCare.The contract and those attachments can be found at this cuments/2018MODELCONTRACTadministrationcopy.pdf6) a process for stake holderinput into managed care planningand implementation;For more than a year, DCFS has been engaging with various stakeholdergroups to share information and solicit feedback. Such engagementcontinues.SB 1851 also requires the DCFS and HFS to establish a Child WelfareMedicaid Managed Care Implementation Advisory Workgroup. TheWorkgroup will include representatives from the entire child welfaresystem, and is required to meet at least three times prior to thefinalization of this transition plan. This will be the official forum forstakeholders to provide input directly to DCFS and HFS directors andother leaders. Recommendations from the workgroup will be reflectedin the final version of this transition plan.Additionally, DCFS has established a feedback portal ages/YICHealthFBS.aspx.7) a dispute resolution process,including the rights of enrolleesand representatives of enrolleesunder the dispute process andtimeframes for dispute resolutiondeterminations and 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 providesinformation for their members regarding what grievances and appealsare, how to file a grievance or appeal, and what those timeframes are.IlliniCare’s current HealthChoice Illinois member handbook has thatinformation and can be found at this esources/handbooksforms.html5 PageInterim Transition Plan
Additionally, 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 800-232-37988) the process for health caretransition for youth exiting theDepartment’s care throughemancipations or achievingpermanency; andChildren 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 bemailed a new enrollment packet with education included on all 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.9) protections to ensure thecontinued provision of health careservice if a child’s residence orlegal guardian changes.Communication and data sharing among DCFS, HFS and IlliniCare will bekey to ensuring placement changes do not unduly disrupt a child’s care.Data solution: HFS, DCFS and IlliniCare are establishing a data file toensure Contractor is aware of placement, caregiver and other relatedchanges. This information will allow Contractor to contact enrolleeand/or caregiver to ensure a child is able to transition to new providers.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 casemanagement system. Caseworkers will also be trained to ensure newcaregivers are in receipt 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 nurseadvise linec) Provider directory.6 PageInterim Transition Plan
Review will assess IlliniCare’s recruitment of providers who have historically offered Medicaid-covered services to DCFS youth. IlliniCare is actively recruiting these providers now. IlliniCare’s current HealthChoice Illinois network is available for review through an on
