12/10/14
Policy Memo
Summary
- Effective July 1, 2014, 'CountyCare' changed from being a federal demonstration waiver program to a Managed Care Community Network (MCCN) health plan operated by Cook County Health and Hospitals System;
- Customers who had been enrolled in CountyCare waiver cases prior to July 1, 2014 are now considered ACA Adult cases under the Affordable Care Act (ACA) who are participating in the CountyCare MCCN Medicaid health plan;
- ACA Adult, Family Health Plans and AABD (seniors and persons with disabilities) customers who are living in Cook County may now choose CountyCare MCCN as their managed care health plan; and
- Procedures are clarified for Family Community Resource Centers (FCRCs) including Stroger FCRC #197 when dealing with CountyCare cases in Office 197.
On July 1, 2014, CountyCare changed from being a federal demonstration waiver program to a Managed Care Community Network (MCCN) for Cook County residents. HFS received federal approval to automatically transition this population into the new ACA Adult group.
Active CountyCare customers continue to receive their medical services through the CountyCare MCCN.
'CountyCare 197 waiver cases' will be used throughout this memorandum to describe cases that were formerly known as CountyCare waiver cases. These cases are active in office 197 and contain a code W in Item 25. As of July 1, 2014, all CountyCare 197 waiver cases are equivalent to ACA Adult cases. A central conversion will update Item 25 code from W to K. Until then, continue to use code W for cases that were created as CountyCare 197 waiver cases.
Clarification of Procedures
There is no change in procedure regarding an applicant who is requesting medical benefits and is currently active in a medical case. Before processing an application in IES, check the clearances in PACIS to determine if the applicant is active in another case. If the applicant is active in a case with CountyCare coding, treat the application the same as for customers with other active medical benefits. Deny the request for duplicate medical benefits.
CountyCare Changes: CountyCare 197 Waiver Cases
Applications processed by the Stroger Family Community Resource Center (FCRC) office #197 with application dates prior to July 1, 2014 are CountyCare 197 waiver cases. Applications received by the Stroger FCRC with application dates on or after July 1, 2014 are applications for Medicaid that may include ACA Adult or other Medicaid eligibility categories including Family Health Plans and AABD. When a customer is already active in more than one case and one of the cases is a CountyCare 197 waiver case, follow the instructions below.
Duplicate Cases
There are a number of customers who are active in both a CountyCare 197 waiver case and another medical case. Many of these duplicate cases are discovered by HFS staff in the Bureau of Technical Support (HFS central office staff). When HFS finds that a customer appears in more than one medical case, HFS central office staff advise Stroger FCRC to take the appropriate action to keep the customer in CountyCare MCCN while canceling the duplicate case.
When canceling the duplicate case, use TA/TAR 22-G6. TAR G6 does not generate a central notice.
Note: When caseworkers in any FCRC find a customer active in more than one case that includes a CountyCare 197 waiver case, contact Stroger FCRC management for direction. Special procedures are required until the system is updated to handle actions centrally. Stroger FCRC management will work with HFS central office staff and other FCRCs to ensure the proper action is taken.
CountyCare 197/W Case was Opened Prior to the Duplicate Case
HFS central office staff will manually code the CountyCare MCCN on the duplicate case. There should be no interruption of the CountyCare MCCN enrollment.
CountyCare 197/W Case was Opened After the Duplicate Case
HFS central office staff will not manually code the CountyCare MCCN on the duplicate case. Refer the customer to the Client Enrollment Broker to select a managed care provider.
Reinstatements of Medical Cases Enrolled in CountyCare MCCN
When CountyCare 197 waiver or other medical cases enrolled in CountyCare are canceled, the managed care enrollment ends effective with the month of cancelation. If the case was canceled for noncooperation and the customer cooperates within the time allowed for reinstatement, reinstate the original case using TA 12/TAR 98. The case will be reenrolled in the CountyCare MCCN prospectively but a gap will be created in the managed care enrollment for the effective month of the reinstatement and the prospective month for which the action is taken.
To eliminate this gap, caseworkers in any FCRC can notify the Stroger FCRC managers to contact the HFS central office staff who will manually update the managed care enrollment to cover the gap period.
If reinstating a CountyCare 197 waiver case using TA 12/TAR 93, enter code W in Item 25 until further notice. Contact Stroger FCRC management who will contact HFS central office staff to manually update the CountyCare MCCN enrollment.
Example 1: Mr. G's CountyCare 197 waiver case is canceled effective November 2014. The Stroger office discovers Mr. G is eligible to be reinstated and processes a TA 12/TAR 98 effective December 2014. Medical coverage is reinstated for November 2014, however, the managed care enrollment starts December 2014. Stroger staff contact HFS central office staff to request a manual update to the managed care enrollment to cover November 2014.
Pending Applications
Request for Cash Assistance in Another FCRC
When a customer who has a CountyCare 197 waiver case applies for cash assistance in another FCRC, the FCRC staff must alert Stroger FCRC who will cancel the CountyCare 197 waiver case. Coordinate the cancelation of the CountyCare 197 waiver case with the approval of the pending application to ensure there is no gap in medical coverage. Remind the applicant to choose a managed care plan once they receive their client enrollment packet in the mail.
Example 2: Mr. A has a CountyCare 197 waiver case. Mr. A's wife and their 10 year old son move in with him. Mr. A applies for TANF on 08/25/14 in another FCRC. The following actions are taken on 09/24/14:
- (The FCRC) Reviews the clearances and finds the active CountyCare 197 waiver case;
- (The FCRC) Contacts the Stroger FCRC (office # 197) to alert them that Mr. A and his family will be approved for TANF effective November 2014; and
- (Stroger Office #197) Cancels the CountyCare 197 waiver case effective November 2014 after assuring that the TANF will be approved for the same month.
- (Client Enrollment Broker) Sends a managed care enrollment packet to the family to choose a health plan for each family member approved for TANF and medical benefits.
Stroger FCRC Receives Request for Medical Benefits for Additional Household Members
When a customer with an active CountyCare 197 waiver case reports their child moved in with them, the Stroger FCRC can make the appropriate change to the case. Refer to the memorandum The New ACA Adult Group dated 05/07/14 for information on changing a case from ACA Adult to a Family Health Plans case. Contact Stroger FCRC who will contact the HFS central office to manually update the CountyCare MCCN enrollment for Ms. B on the Family Health Plans case.
Example 3: Ms. B has a CountyCare 197 waiver case. She reports that her daughter, age 4 moved in with her. The Stroger FCRC obtains a signed Form 243C Request to Add Another Household Member. The Stroger office adds the child to the case and removes Code W from Item 25 and removes Code W from Item 28. The case is now a Family Health Plans case.
- (Stroger FCRC #197) updates the CountyCare 197 waiver case to a Family Health Plans case and adds the child;
- (Stroger FCRC #197) contacts HFS Central office to manaully update the CountyCare MCCN enrollment for Ms. B; and
- (Client Enrollment Broker) Sends a managed care enrollment packet to Ms. B to choose a health plan for her daughter. Ms. B remains enrolled in CountyCare MCCN.
SNAP Benefits
The Stroger FCRC does not handle SNAP benefits. When a customer who has a CountyCare 197 case applies for SNAP in another office, the FCRC opens a separate SNAP case.
Participation in CountyCare MCCN
Most ACA Adult, Family Health Plans and AABD customers in Cook County now have the option to choose CountyCare MCCN as their managed care plan. Customers who are currently enrolled in CountyCare MCCN and wish to stay in CountyCare MCCN do not have to do anything at this time. However, CountyCare 197 waiver customers may choose to receive their medical care through another managed care plan.
To change managed care plans, refer customers to the Client Enrollment Broker at 1-877-912-8880 (TTY: 1-866-565-8576).
For more information on managed care plans available to Cook County residents, see memorandum dated 02/27/2014 Integrated Care Program Enrollment Expands-Chicago Area.
If customers choose to enroll in a different managed care plan, the Client Enrollment Broker will make the change prospectively. Depending on the managed care plan chosen, customers will get medical services through CountyCare MCCN until the effective date of the change in plans.
IMPORTANT NOTE: do not transfer the CountyCare 197 waiver case to another FCRC because of the change in the managed care plan. Do not change Item 25 from W to K in an attempt to disenroll a customer from CountyCare MCCN. Refer customers who want to change their managed care enrollment to the Client Enrollment Broker.
A client's managed care enrollment including the CountyCare MCCN can be found in the ACID screen 6 in PACIS in the HMO field.
Example 4: George is enrolled in CountyCare (HMO: 560012) beginning 11/01/13.
|
RIN: 123456789 |
George |
03/25/1960 |
| HIB: |
-- |
SMIB: |
QMB: |
| CM: |
-- |
Enroll: |
Begin: |
| HMO: |
560012 |
Enroll: A |
Begin: 11/01/13 |
ACID Screen 6 HMO Codes
The HMO codes appearing on ACID screen 6 are entered centrally. The new codes effective 07/01/14 will be updated in the CDB over the next few months.
| ACID Screen 6 |
CountyCare MCCN Enrollment |
HMO Codes |
| Prior to 07/01/14 |
CountyCare demonstration waiver |
560012 |
| Effective 07/01/14 |
CountyCare health plan (customers in ACA Adult without SSI/SSDI income and Family Health Plans) |
560015 |
| Effective 07/01/14 |
CountyCare health plan (customers in AABD and ACA Adult with SSI/SSDI income) |
560017 |
System
Form 552 Item 25 codes are redefined as shown below.
| Form 552 Coding |
Program |
| Item 25=W |
ACA Adult (formerly CountyCare 197 waiver) |
| Item 25=K |
ACA Adult |
Central Conversion
A central conversion is planned to update the MMIS system and ACID screen 6 to show CountyCare as an MCCN. No action is required of FCRC staff.
Covered Services through CountyCare MCCN
CountyCare MCCN now includes prenatal care as well as long term care benefits for eligible individuals. A CountyCare individual who needs prenatal care or long term services and supports (LTSS) should arrange this care through their CountyCare MCCN provider.
[signed copy on file]
Michelle R.B. Saddler
Secretary, Illinois Department of Human Services
Julie Hamos
Director, Illinois Department of HealthCare and Family Services
Forms Referenced
243C
