From: Theodora Binion, Director
Division of Alcoholism and Substance Abuse
DEMOGRAPHIC INFORMATION MEDICAID MCO PATIENTS
In May of 2011, Managed Care Organizations (MCOs) began contracting with DASA Medicaid enrolled substance abuse treatment providers for the delivery of services to Medicaid eligible patients. Since that time, the number of patients receiving substance abuse services in this manner has increased and we expect this trend to continue. MCOs are part of the system of care coordination for Medicaid-eligible clients that is expected to achieve the "triple aim" of improving the quality of care, improving the health of populations and reducing the growth in health care costs. While coordinated care may achieve these benefits, the drawback is that it is now more difficult for DASA to obtain information about the patients and the types of services that are reimbursed to our providers by the MCO, since these services are not reported through the Department's Automated Reporting and Tracking Software (DARTS).
Collection of this information is critical to DASA as it helps to accurately demonstrate need for state and Federal funding initiatives and, supports the Maintenance of Effort (MOE) requirement for our SAPT Block Grant application.
Therefore, effective July 1, 2015, demographic information should be entered into DARTS for any patient with Medicaid MCO coverage opened on or after this date or for any existing patient whose services, on or after this date, will be reimbursed by a Medicaid MCO.
This required demographic information should also include discharge information and closing, when applicable, so that we can more accurately collect National Outcome Measures (NOMS).
New fields have been added to the demographic screen in DARTS that will allow entry of "Medicaid Managed Care (MCO)" as the insurance type and a selection of the name of the MCO. These fields should also be updated if the insurance type for any patient changes during the course of treatment.
We know that you share DASA's desire to protect and enhance funding for substance abuse treatment and your compliance with entry of Medicaid MCO patient demographics into DARTS will support those efforts. In the near future, we plan to also use the demographic data to seek specific information about billed services directly from each MCO. This information, along with the patient demographics, will provide a much clearer picture of substance abuse service delivery in Illinois.
Thank you in advance for your cooperation and assistance. As always, contact DASA Help at DHS.DASAHELP@ILLINOIS.GOV with questions.