I was pleased to give a Keynote Address at the Transition Conference sponsored by the AERO Special Education Cooperative this past Saturday. My topic was “State of the State in Illinois,” in that presentation I covered the importance of your special education entitlement, real work through the IEP and the Ligas Settlement. Here is a picture of Tony with Jim Gunnel Executive Director of Special Education at AERO. They had about 100 families come to their transtion conference.
In Springfield, we held a demonstration against institutions at the Capitol. Here we are and check out the video!
Here is an update in the Integrated Care Pilot from Shirley Perez, Executive Director of the Family Support Network.
Integrated Care stakeholder Videoconference Meeting
The meeting was facilitated byJim Parker, Deputy Administrator of Medical Programs, Illinois Department of Healthcare and Family Services. A total of 70 people participated. There were no formal introductions nor did Chicagohave sign-in sheets, but they had about 30 people attend. Per Jim Parker, Springfield’s sign-in sheet had 8 participants. And 40 people registered for the dial-in number.
Organizations represented were: Access Living, Illinois Council on Developmental Disabilities, Family Support Network, Arc of Illinois, University of Illinois at Chicago and others.Sherry Husa, CEO and President of IlliniCare was in attendance. Robert Mendonsa, Chief Executive Officer, Aetna Better Health, Illinois, Sandra Redmond, Care Coordination Manager, Aetna and Sue Strange, Behavior Health Coordinator, Aetna was also in attendance.
Mr. Mendonsa, CEO, Aetna provided the following update:
Loyola University Medical Center, flat out refused contract, is accepting “single case agreements.’
Joliet, in discussion with Silver Cross and St. Joseph Medical Center
Northwestern Memorial Hospital, in discussion with but have not joined
Ingles Hospital, Harvey, IL is reviewing contract
Rush Presbyterian in discussion, “transplants,” but will pursue other areas
Northwest Community Hospital, Arlington Heights is in discussion.
Aetna in some cases has extended the 90 day transition of care for some individualsbeyond the member’s initial enrollment until December 31, 2011. During this period a member continues to receive care from an out-of-network provider or hospital. They will not deny any claims for failure to prior authorize services. They are still trying to recruit these patient’s doctors. However, beginning next year, if the individual’s doctor has not joined the network the patient will have to be moved to a doctor within the network.
Aetna conducts health risk assessment through outreach. This will help flag any complex issues before they become future problems. Aetna is committed to training their staff and now has week-end/after-care where supervisor can authorize 72 hours overrides in prescription cases that require immediate attention.
Problems or Concerns contact:
Aetna Better Health
Sherry Husa CEO and President of IlliniCare provided the following update:
IlliniCare is diligently pursing two hospitals in Joliet: Silver Cross and St Joseph. Illinicare went through 5 weeks of training with over 200 of their providers and will continue educating their staff. This training was provided by Progress Center. In addition they provide 1-3 hours of training to their new employees.
Illinicare provides transportation and does not use first-transit. Individuals must provide at least 72 hours lead time if they require this service. They are looking into options for emergency travel but are not able to provide it at this time .Individuals or family member with issues/concerns should contact customer services at:
How do consumers go about obtaining disposable gloves from service provider agencies if they are Medicaid waiver participants when the provider states “we don’t do that”?
The response by Jim Parker, and both provider was, “that is a quality issue,” providers should be providing gloves. If you have a complaint like this you can contact both Aetna and Illinicare and provide specifics and it will be addressed.
Can HFS issue a letter to all providers reference Universal Precautions? This question was not answered.
What is an appropriate wait time for scheduling an appointment as a new enrollee?
Both Aetna and Illinicare stated that the contract list this information. Routine: 30 days, Urgent, 48-72 hours and emergency, immediately.
Who tracks to see if this standard is being followed?
It is based on the number of complaints that are provided by patients. If you don’t report it no one knows.
How many people are enrolled in ICP and what percent is auto enrolled? Per Jim Parker, there are about 33,000 individuals enrolled in ICP and about 70% of these individuals were auto enrolled!
When will Phase 2 begin? It is targeted for late summer 2012 it will focus on Long term care, Institutions and Community based excluding developmental disabilities.
Jim Parker wrapped up the meeting by stating that HFS has begun to talk internally about Phase 2 and 3. They would like to know what our concern/hopes are and what would we like to see included? What type of flexibilities would we like to see? What type of protections needs to be in place? What are our concerns about self-directed care? He encouraged feedback.
Next Meeting: within 6 weeks tentatively the 1st Thursday in December 1st, 2011, location and time to be determined.
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423