Illinois Medicare-Medicaid Alignment Initiative

Illinois Medicare-Medicaid Alignment – Managed Care in the State of Ilinois

The Centers for Medicare & Medicaid Services (CMS) and State of Illinois are establishing a Federal-State partnership to implement the Medicare-Medicaid Alignment Demonstration to serve individuals eligible for both Medicare and Medicaid. This Federal/State partnership includes contracting with “Demonstration Plans” from Managed Care organizations that will provide integrated benefits to Medicare-Medicaid Enrollees in targeted geographic areas. Contract management will focus on performance measurement and continuous quality improvement, and CMS and the State of Illinois expect these Demonstration Plans to achieve savings through better integrated and coordinated care.

Michael Scavotto and Scott Gima from Management Performance Associates presented several training sessions throughout Illinois that reviewed some of the known elements of the Initiative, including the heightened emphasis on quality as reimbursement will depend on achieving measurable quality goals.

Counties involved include:

Currently there are 6 delegated Chicago Health Plans and 2 Central Illinois Health Plans. Many providers in these counties have been contacted by the Managed Care companies and are in the process of negotiating terms. Because beneficiaries have a choice of insurance plans, facilities will likely have to contract with more than one company.

The Demonstration is scheduled to begin on October 1, 2013 and will continue until December 31, 2016, but it appears that start date may be pushed back to allow time to consider the many complexities of the Demonstration Plans. To learn more about the Illinois Medicare-Medicaid Alignment Initiative and how it will effect your healthcare facility, feel free to contact Joan McCarthy, ProviNET’s Medicaid and Reimbursement Specialist, for more information and an opportunity to review your contracts.