Date: January 8, 2020
To: All Medical Assistance Program Providers
Re: Special Needs Children Continuity of Care Beyond Transition to Managed Care February 1, 2020
The informational notice dated October 29, 2019, notified providers of the Special Needs Children populations who will be transitioning to managed care as of February 1, 2020. Children under the legal custody or guardianship of the Illinois Department of Children and Family Services will enroll in a specialty health plan (YouthCare) administered by IlliniCare Health. Former Youth in Care will be auto-assigned to IlliniCare Health, with the option to select from other health plans serving under the existing HealthChoice Illinois managed care program. All other Special Needs Children populations will be auto-assigned to a HealthChoice Illinois managed care health plan with the option to select from other available health plans.
Providers should not cancel or postpone upcoming procedures and appointments or stop providing services. The managed care plans will allow these new enrollees an initial 180-day transition period, during which the enrollees may maintain a current course of treatment with a provider who is not part of the health plan’s provider network. This policy applies to all providers, including those providing behavioral health services and long term services and supports.
Providers who are not in a health plan’s network will be paid the same rate the Department would pay for those services under current fee-for-service rates. After February 1, 2020, providers should check the child’s eligibility in MEDI for the health plan responsible for care and contact the plan to coordinate care and verify payment. Providers must adhere to the health plan’s policies and procedures regarding referrals and obtaining any preauthorization for treatment. Providers serving these Special Needs Children populations who are currently not in a health plan’s network are encouraged to enter contract discussions with the managed care plans.
The MCOs, in collaboration with the IAMHP, have developed a Comprehensive Billing Guide for Medical Assistance Program providers. This billing guide is designed to help providers who are contracted with the MCOs understand the general MCO billing requirements and is a single source of information for all claims regardless of provider type. Providers are encouraged to utilize this manual housed on the IAMHP website. The Department continues to update providers via a provider notice as new sections are published.
Questions regarding this notice may be directed to the Bureau of Managed Care at