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Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
In July 2016, the Illinois Department of Healthcare and Family Services will have a new health care program called Medicaid Managed Long Term Services and Supports (MLTSS). One or more of your customers may get an MLTSS enrollment notice as early as June 2016.
No, all MLTSS health plan members who can manage an Individual Provider can keep their Individual Provider no matter which MLTSS health plan they choose.
Having a customer in a MLTSS health plan does not change how Individual Providers submit timesheets or how they are paid. Individual Providers will continue to submit their timesheets to the Illinois Department of Human Services (DHS) Division of Rehabilitation Services (DRS). Individual Providers will continue to be paid by DRS.
Your customer will be required to enroll in a MLTSS health plan if they receive full Medicaid and Medicare benefits, live in the Greater Chicago Region, do not enroll in MMAI, and live in a nursing home or receive Home and Community Based Services (HCBS) Waiver services.
MLTSS health plans cover nursing home care, supportive living, HCBS Waiver services for members who qualify, mental health services, substance abuse services, and non-emergency transportation to health care services. Also, all MLTSS health plan members get a care coordinator to help them navigate the health care system and manage their health care needs.
No, your customer will get all Medicare benefits and prescription drugs the way they do now. They will get Medicare coverage through Original Medicare, Part D, or Medicare Advantage.
If your customer is required to enroll in the MLTSS program, they will receive an enrollment letter in the mail from Illinois Client Enrollment Services. If your customer gets an MLTSS enrollment letter, they will have 60 days to choose an MLTSS health plan. They will be assigned to an MLTSS health plan if they do not choose one. They can change their MLTSS health plan one time during the first 90 days. After that, your customer cannot change their MLTSS health plan for one year, but they can choose to enroll in MMAI at any time.
Your customer can get help enrolling in an MLTSS or MMAI health plan by calling Illinois Client Enrollment Services at 1-877-912-8880 (TTY 1-866-565-8576) Monday through Friday from 8 a.m. to 7 p.m. The call and interpretation services are free.
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