Illinois Care Coordination Initiatives Pre-Conference Intensive
Oak Brook Hills Resort, Rooms A-E
Sandy Leith, Facilitator
INTR INTRODUCTION TO CARE COORDINATION IN ILLINOIS BY MICHELLE ECKHOFF/HFS
Overview of the Care Coordination efforts in Illinois
Differences between Care Coordination Programs in Illinois
Differences between Managed Care Organizations(MCOs), Managed Care
Community Care Entity (MCCEs), and Accountability Care Entities (ACEs)
Outreach efforts – Getting the word out and Stakeholder Engagement – Feedback
Loop
INTRODUCTION TO THE ILLINOIS MMAI BY YOLANDA BURGE/CMS
Key Players (HFS, CMS, Plans, Providers, Ombudsman Programs)
Overview of the CMS Financial Alignment Initiative
Overview of the Illinois MMAI, as well as eligible and excluded populations
Brief overview of available MMAI Plans (more detailed information in separate session)
Highlight critical requirements in the MOU. Three-way contracts. State/Federal guidance
(i.e., access to records for complaint investigation and resolution, referral protocols) that
necessitates a collaborative effort by the different groups attending the meeting
MEDICARE AND MEDICAID INTEGRATION BY SANDY LEITH/IDOA/SHIP
Overview of Medicare/Medicaid, the traditional Program
How Medicare/Medicaid will intersect and provide integrated coverage under Managed
Care and a Continuity of Care
MANAGED CARE PLAN INFORMATION BY MICHELLE ECKHOFF/HFS
Overview of the range of available Plans in each region and the range of services they
cover and Provider Networks
ENROLLMENT STRATEGIES BY MICHELLE ECKHOFF/HFS
Enrollment/disenrollment related transactions, including all aspects of voluntary and
passive enrollment, effect dates of coverage, enrollment notices and processing of optout requests
Roles of the different entities in handling enrollment and disenrollment transactions –
Client enrollment services in the MMAI, DHFS, CMS, Plans, Ombudsman Programs, etc.
CARE MANAGEMENT BY SAMANTHA OLDS/MANAGED CARE ORGANIZATION REP.
Overview of care management in MMAI environment as well as the roles and responsibilities of care
managers/coordinators and the Interdisciplinary Team in bolstering care coordination to ensure swift
delivery of care and services to MMAI enrollees
MEDICARE/MEDICAID APPEALS BY RYAN LIPINSKI/HFS
Overview of Medicare/Medicaid appeals process
If applicable, changes to Medicare and Medicaid appeals process under Managed Care
OMBUDSMAN ROLE IN THE MANAGED CARE ENVIRONMENT BY LYLE VANDEVENTER/
IDOA/SLTCOP
Roles and responsibilities of the Ombudsman Program in educating consumers and stakeholders,
advocating and investigating complaints on behalf of enrollees, collecting complaint data and outcomes,
identifying and reporting systematic problems, and making policy recommendations to improve delivery
of integrated care to enrollees.