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April 2014 


Greetings from HFS Director Julie Hamos

Welcome to another periodic edition of HFS e-news to keep you updated on program changes. To register for future editions, please visit HFS E-News Online Registration or download for others who might be interested by visiting: If you are a Medicaid client, this newsletter is not the official notification of any changes that may impact you, and you do not have to respond in any way. This is general information for the public.

Thank you,

Julie Hamos

Accountable Care Entity (ACE) Entities Being Developed

Nine applicants have received conditional approval letters and are working to become Accountable Care Entities, on or after July 1, 2014. This is contingent on addressing outstanding issues identified during the proposal evaluation, meeting the requirements of the readiness review process and negotiating the final contract. The readiness review tool is posted on the HFS website. We also have listed a contact for each ACE on the HFS website Accountable Care Entities in Development – Primary Contact Information sheet (pdf), as we encourage collaboration and the formation of robust networks for Medicaid clients.

1115 Waiver Application Still Under Development

Thank you to everyone who submitted comments on the 1115 Waiver application. More than 650 comments were received by the March 10, 2014 deadline. Based on comments received, the Governor's Office of Health Innovation and Transformation (GOHIT) has developed a Frequently Asked Questions resource, which has been posted and can be accessed on the HFS 1115 Waiver Frequently Asked Questions resource (pdf) page. GOHIT is finalizing responses to all comments received and will post those on the website as well.

While nearly all comments supported the waiver, many wanted more detail about how the strategies described in the waiver would be implemented. The workgroup structure on implementation issues has been announced and workgroups will be convened shortly. For more information on the workgroups, see the Health Care Reform in Illinois 1115 Waiver webpage. In response to the comments heard, GOHIT has also re-posted the most updated draft of the waiver application, The Path to Transformation: Illinois 1115 Waiver Proposal, and extended public review for an additional 30 days while these groups get organized and begin their work. We look forward to your continued engagement in the implementation process.

Strong Enrollment under Affordable Care Act

There has been a significant response to the Affordable Care Act in Illinois. As of mid-April 2014, 267,000 adults who would not have been eligible before the ACA have been enrolled into Medicaid. (This includes those enrolled in CountyCare throughout 2013 under the special waiver for early enrollment.) We expect that 350,000 or more newly eligible adults will be enrolled by the end of this fiscal year in June 2014. To ensure the program integrity of Illinois Medicaid, we conduct a rigorous screening process that relies on electronic data matching to confirm information that is provided by applicants regarding their income and residence. Thus, there is currently a backlog of cases being processed. For anyone who is eligible for Medicaid, reimbursement for services up to three months prior to the date of application may be available. Anyone with an immediate need for urgent medical care who is waiting for an application to be processed should call 866-311-1119 or visit the GetCovered Illinois Get Help webpage to contact a Navigator and ask for the application to be expedited.

Medicaid Transparency

Under Public Act 96-0941, Illinois Medicaid has released three years of data on physician payment and program enrollment. (In contrast, this month, for the first time, Medicare released data concerning Medicare payments made to physicians.) The data can be found on the HFS Transparency webpage and also on the State of Illinois Data Portal. The physician payment data allows users to quickly see what individual providers have been paid by category of service. In addition, the providers can be grouped by characteristics such as type of provider, county and zip code. The enrollment data allows users to examine our enrollment over time by such categories as age, county, zip code, race, ethnicity and program enrollment status.

Summit for Healthcare Providers: Strategies for Pediatric Obesity Prevention and Control

Illinois Medicaid is supportive of initiatives that tackle pediatric obesity prevention and control. For the first time ever, we have recently implemented a policy which formalizes coverage for evaluation and management services provided to children and adults with a diagnosis of obesity only, without any co-existing medical conditions. Three visits are covered over a period of six months, after which evidence of improvement must be provided for additional visits. A detailed policy is available at the HFS website.

In keeping with our commitment to improve pediatric obesity rates in the population we serve, we are inviting newsletter readers to a pediatric obesity healthcare summit. Presentations will cover communicating more effectively based on the patient's culture, ethnicity and socioeconomic status; taking a multidisciplinary approach to address patient overweight or obesity; and becoming an advocate for widespread change in the overweight/obese pediatric population. Local clinical and community resource providers for pediatric overweight or obese patients will be present. The intended audience includes physicians, physician assistants, nurse practitioners, nurses, school nurses, registered dietitians, medical assistants, social workers, physical therapists, office managers, administrative staff and other interested healthcare professionals.

Date: Wednesday, May 14, 2014
Time: 7 a.m. - 11 a.m. (Presentations are 7:30 – 10:30 a.m.)
Location: Medinah Shriners, 550 Shriners Drive, Addison, IL 60101 (near I-355 and Army Trail Rd)
Free CME, Breakfast Provided

Register for this free CME event on the Dupage Health Summit for Healthcare Providers: Strategies for Pediatric Obesity Prevention and Control webpage. For more information, contact FORWARD at or 630-221-7146.

Please feel free to ask questions or share comments by e-mailing: