Provider Notice issued 7/24/19

REMINDER – Statewide HealthChoice Illinois Managed Long Term Services and Supports (MLTSS) Implementation

​To: ​All Medical Assistance Providers
​DATE: ​7/24/2019
​RE: REMINDER – Statewide HealthChoice Illinois Managed Long Term Services and Supports (MLTSS) Implementation
 
Effective July 1, 2019, the Managed Long Term Services and Supports (MLTSS) program is part of HealthChoice Illinois statewide. Beneficiaries are eligible for MLTSS if they have full Medicare (both Part A and Part B) and Medicaid benefits, are not enrolled in the Medicare-Medicaid Alignment Initiative (MMAI) program, and reside in a nursing facility or are in the following Home and Community-Based Services (HCBS) waivers: Supportive Living Program, Persons with Disabilities, Persons with HIV or AIDS, Persons with Brain Injury, and Persons who are Elderly.
 
MLTSS is a mandatory managed care program and eligible beneficiaries cannot opt-out.  All new MLTSS enrollees will have a 90-day continuity of care period during which the MLTSS health plan will pay for covered services provided by out-of-network providers at Medicaid Fee-for-Service (FFS) rates.
 
The Department strongly encourages nursing facilities and HCBS waiver providers to sign contracts with HealthChoice Illinois health plans as soon as possible in order to participate in the statewide HealthChoice Illinois MLTSS program as in-network providers. Contracting as an in-network provider is important for timely payment and continuity of care.  
 
Contracting with Participating HealthChoice Illinois Plans
Contact information for contracting with participating health plans is provided in Attachment A on the Department’s website.
 
The following health plans offer MLTSS benefits through HealthChoice Illinois:
 
·         Blue Cross Blue Shield of Illinois
·         CountyCare (available only in Cook County)
·         IlliniCare Health Plan
·         Meridian Health
·         Molina Healthcare of Illinois
·         NextLevel Health (available only in Cook County)
 
MLTSS Eligibility, Enrollment, and Billing
Medicare is the primary payer for dual eligible beneficiaries, including HealthChoice Illinois MLTSS enrollees. Providers serving HealthChoice Illinois MLTSS enrollees must bill the HealthChoice Illinois health plan, Medicare, or Medicaid FFS depending on the service being provided. Providers should review the May 14, 2019 MEDI/MLTSS Identifying Dual Eligible Beneficiaries provider notice for instructions on how to identify HealthChoice Illinois MLTSS enrollees in MEDI, and who to bill depending on the service being provided.
 
MLTSS enrollees have 90 days after their enrollment effective date to switch HealthChoice Illinois plans, and have an annual open enrollment period. All HealthChoice Illinois MLTSS enrollees who live in a county with a Medicare-Medicaid Alignment Initiative (MMAI) health plan may choose to enroll in MMAI instead of MLTSS at any time.
 
Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at
217-524-7478 or HFS.MMAI@illinois.gov.
 
 
Doug Elwell
Medicaid Director

Notices

 

 Need Assistance?