February 2021

Childhood and adolescence are critical stages of life for mental health.  This is a time when rapid growth and development take place in the brain.  Children and adolescents acquire cognitive and social-emotional skills that shape their future mental health and are important for assuming adult roles in society.

This is why the Illinois Association of Medicaid Health Plans (IAMHP) partnered with the Medicaid Managed Care Organization Aetna Better Health of Illinois (ABHIL) to discuss their approach to holistic care management for children with behavioral health care needs through partnership with families and providers to ensure children have access to the care they need, when they need it. 

“Member’s needs were not being met under the traditional model.  I want to applaud Aetna Better Health of Illinois for thinking outside the box and for partnering with providers, like us, to provide for member’s needs in a more holistic fashion”

 - Bernadette May, Executive Director of Family Service Association of Elgin

To view the presentation on Children’s Behavioral Health: Connected through Care, visit the IAMHP Video Library or check out our question & answers to catch the highlights from the webinar. 

Q:  Quickly summarize Aetna Better Health of Illinois’ approach to care management for children’s behavioral health.

A:  Given the needs of children it is important to be flexible and adaptable.  This includes having families, community organizations and Health Plans at the table working through the continuum of care to ensure care is delivered at the right time by the right people.  That is why ABHIL created a dedicated children’s care management team specialized in the integration of care that ultimately wraps care around the children, the families, and the community so they have the supports they need to flourish.  ABHIL also wanted to align ourselves with crisis providers to ensure a seamless experience for the members, which is why we partnered with providers such as, Family Service Association of Elgin. 

Q:  What changes and improvements have you seen since increased partnership between FSA and ABHIL?  What lessons can you share from this partnership that attendees could benefit from? 

A:  We have seen increased communication and shared clinical information that is important for continuity of care.  Things to take away would be that partnership among the provider, health plan, and member allow for a holistic treatment plan to be put into place.

Q:  What changes have you seen in mobile crisis response in the past year given COVID? 

A:  We have seen the MCR providers make effective and timely transitions to providing telehealth services.  This has increased satisfaction from both the providers and the members.

Q:  What questions do you think the health care community needs to be asking itself in order to improve quality and care within Illinois?

A:  How do we keep the ancillary members of a child or member’s life at the table and contributing to the member’s holistic well being?  For children specifically, how do we ensure continuity of support at school and in the community?  How can we prevent fragmentation of services to support the person, the family and the community?

Q:  As attendees ruminate on this presentation what would you say is the most crucial item for them to contemplate or consider? 

A:  The most crucial item to consider is the support for a child.  Support will mean something different to every individual, but that’s what makes it so crucial.  Is something as simple as a journal enough to help the child feel more at peace, is ensuring that the child’s coach attends IEP meetings what makes their interests feel validated, or is it that the mother needs a ride to the grocery store so the family can eat?  Children don’t exist in a vacuum, especially in a behavioral health crisis, so we wrap them in support (providers, people, places and things/resources) that are beneficial and member centered.

Learn about the latest news & insights on Illinois Medicaid for healthcare providers and healthcare advocacy groups by visiting our website IAMHP.net. 

And like and follow us on Facebook, LinkedIn and Twitter. 

As the COVID-19 vaccination rollout continues, IAMHP wants to ensure Medicaid members stay up-to-date with the most current information and access to resources. Lack of access is still an issue for many so IAMHP, along with its member plans, are committed to partnering with community organizations to provide increased access to care and resources throughout the COVID-19 vaccination process.

 

What you need to know

There are two COVID-19 vaccines currently authorized and recommended for use in the United States, and three other vaccines are currently in large-scale clinical trials. Visit the CDC website to learn more about the different vaccines for COVID-19 and how vaccines work.

The process for who gets vaccinated and when is based on a phased strategy as vaccine supply is available using guidance from local, state and national public health authorities.

Vaccination phases include:

Phase 1A: Healthcare personnel and long term care facility residents

Phase 1B: Individuals age 65 and older and front-line essential workers.

Phase 1C: Individuals aged 16-64 with high risk conditions and essential workers not recommended in Phase 1B.

Phase 2: All people aged 16 years and older not in Phase 1.

How to sign up:

If you are an eligible individual as outlined in Phase 1A or 1B, such as health care workers, first responders, essential workers, or anyone 65 years of age and older, or if you are outside of Cook County or the City of Chicago and are 16 years of age and older with a high risk medical condition, find your nearest vaccination site.

For those living or working in Cook County, more information can be found at vaccine.cookcountyil.gov.

January 2021

Molina Healthcare Responds to Community Needs Amid a Pandemic

With the COVID-19 pandemic and heightened social unrest in 2020, health care has increasingly become a vital part of our communities’ lives. Molina Healthcare of Illinois and other providers play a pivotal role in meeting the needs of members, providers, and communities.

Recognizing The Need 

The pandemic has exacerbated the impact of social determinants of health. Black and Latinx populations, people living in under-resourced communities, and lower-income individuals have been disproportionately impacted. Mandatory school closures have adversely affected nutrition and educational outcomes, and food insecurity has tripled among households with children. Massive layoffs have caused financial instability and limited access to quality health care services. Further, COVID-19 mitigation strategies have compounded mental health issues, grief, and bereavement in vulnerable populations at the intersections of age, income, employment, race, and ethnicity.

The Response

Molina recently established The MolinaCares Accord, an initiative created to improve the health and well-being of disadvantaged populations. The vision of MolinaCares is to change life and health for the better by identifying and reducing racial, social, and financial barriers to the access and delivery of quality health care.

Molina has also established employee resource groups (ERGs) throughout the enterprise. Molina CEO Joseph Zubretsky signed on to the CEO Action for Diversity and Inclusion, the largest CEO-driven commitment to advance diversity and inclusion in the workplace. Additionally, Molina is fostering an equitable work environment with a Diversity and Inclusion strategist to further implement inclusion strategies, programs, and initiatives.

Helping Communities 

Even before the pandemic, Molina had been addressing social determinants of health including the health care system, educational access, economic stability, and food insecurity. In 2020, Molina Healthcare of Illinois partnered with community organizations to host a variety of events that followed social distancing guidelines. These included drive-through baby showers, flu clinics, winter coat drives, food drives, laundry service programs, and job fairs. Molina in Illinois hosted over 80 events across the state, distributed more than 40,000 pounds of food, 6000 hygiene kits, 3,000 COVID prep kits, and donated to over 52 community organizations.  

Helping Providers 

Molina has supported our providers during this time by expanding health programs—including telemedicine—distributing personal protective equipment (PPE) and addressing the unique needs in rural areas. Behavioral health provider fee schedules were increased by 20 percent from March 9 -June 30, resulting in over $1 million in additional funds to affected behavioral providers, and much more.  

Moving Forward

Molina strives to remove barriers to care and address social determinants of health. Molina will continue to partner with providers and organizations to offer needed resources that help further support and serve communities most in need.

To learn more about how Molina is working to address the fundamental impact of the COVID-19 pandemic and heightened social unrest on vulnerable communities visit IAMHP’s Video Library. 

For the latest news & insights on Illinois Medicaid visit www.IAMHP.net.

References

1.        “Social Determinants of Health-Related Needs During COVID-19 Among Low-Income Households With Children” https://www.cdc.gov/pcd/issues/2020/20_0322.htm
2.        “COVID-19 and African Americans” https://jamanetwork.com/journals/jama/article-abstract/2764789
3.        “Filling the school meal gap” https://www.chicagobusiness.com/crains-forum-education/filling-school-meal-gap
4.        “Food Insecurity Remains Elevated Across All 50 States” https://www.ipr.northwestern.edu/news/2020/schanzenbach-household-pulse-survey-analysis-report-2.html
5.        “Unintended Consequences of COVID-19 Mitigation Strategies” https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-impact.html

January Lunch & Learn Blog

The new year is such an important time for us to invest in ourselves, and that includes taking time to invest in our work skills and knowledge. We here at the Illinois Association of Medicaid Health Plans (IAMHP) want to help you start your year strong so we can all achieve better health care outcomes for Illinois residents this year.

That is why we brought you our latest Lunch & Learn training!

IAMHP hopes our January 2021 Lunch & Learn on the Illinois Medicaid Program Advanced Cloud Technology (IMPACT), our Comprehensive Billing Guide, and IAMHP Resources give you some new information that can help you this year.

This webinar was designed to provide guidance to contracted Medicaid providers who are responsible for billing services but is open to anyone who wants to learn more about the Medicaid program in Illinois or who want to learn more about MCOs and IAMHP.

To view our January Lunch & Learn visit the IAMHP video library or check out our question & answers to catch the highlights from the webinar!

Question: Approximately how long does it take the Department of Healthcare and Family Services (HFS) to review IMPACT information once it has been submitted?

Answer: As of January 20, 2021, if it is not a COVID-19 related application it takes approximately 30 to 45 days.

Q: Does HFS notify an MCO once a provider has been enrolled in IMPACT?

A: MCO can become aware or notified that a provider been approved and enrolled in IMPACT on a weekly extract file that is sent directly to an MCO. Weekly extract files are typically sent to health plans on Wednesday afternoon. Please note, there are a couple of technical processes that happen on the HFS side that can potentially create a little lag time between when a provider may get approved on IMPACT and when that information flows over to the health plans. Generally, HFS hopes to minimize that lag to a weeks’ time.

Q: Once a provider has been enrolled in IMPACT does the provider receive a notification?

A: Yes, once a provider is approved, they will receive a notification. Generally, a provider will receive a series of systematically generated emails once they start the application process. First, a provider will a generated email after they apply which will have basic information such as their application ID. Second, a provider will receive an email informing them that their application was approved. Third, a provider will receive an email 14 to 30 days after the IMPACT application has been approved with a generated provider information sheet.

Q: How should a health care facility remove a provider that is no longer associated with the health care facility?

A: The preferred and recommended course of action is to send an email to impact.help@illinois.gov requesting for that provider to be end dated. This ensures HFS is updating records accordingly. It should be noted, that a provider can also do this through the modification process.

Q: Can providers check in IMPACT to ensure they are enrolled before prescribing medication to a Medicaid member?

A: HFS implemented a provider directory on the HFS website specifically for the ordering referring and prescribing providers.

The information contained in this directory is made available to the public by HFS to assist Medical providers in verifying an actively enrolled ordering/referring/prescribing Medicaid provider. This directory is provided for informational purposes solely regarding a provider's enrollment and is not intended to guarantee payment for any service by any provider.

Q: Where there any complications with IMPACT during the third quarter of 2020? What measures are being taken to minimize complications moving forward?

A: The beginning of September of last year (2020), HFS was notified of some issues with their licenser interface. As a result of, providers who became inactive due to expiration of licenser were no longer enrolled in IMPACT. Once aware of the issue, HFS worked with their vendor to ensure that those interfaces are working.

There was a bit of an alarm again in the end of November and beginning of December when thousands of providers again became inactive due to licensure. It should be noted that many providers who licensure became inactive is because some providers licenses were extended due to the COVID pandemic.

HFS worked with IDFPR to try to get an extension for those licenses but the extension was not granted. IDFPR has to manually review every license application again and make that license active, due to short staffing this process can take time. HFS believes the last round of applications have been corrected. 

HFS has tested the licensure interface and believes this process is now working. Nevertheless, these are interfaces we collectively rely on. When glitches to arise and HFS is made aware of these, HFS commits to working collaboratively with the vendor to ensuring those get resolved.

Collaboration with partners like IDFPR and feedback from providers and the MCOs are crucial when complications arise, or system/interface breakdowns potentially occur. HFS encourages providers and provider associations reach out to HFS so they can be made aware when those system issues might arise.

HFS has taken steps to ensure they stay on top of the feedback and stay on top of their processes. There are internal workgroups at HFS and workgroups between HFS and the MCOs specifically dedicated on provider enrollment. The workgroups plan on continuing to meet regularly.

There are also monthly HFS / IAMHP / MCO and Provider Association Meetings to discuss billing conversations and technical issues that arise.

The collective encourages you to utilize the tools available to you!

Learn about the latest news & insights on Illinois Medicaid for healthcare providers and healthcare advocacy groups by visiting our website IAMHP.net.

And like and follow us on Facebook, LinkedIn and Twitter.

If you are interested in becoming a Trusted Partner, I encourage you reach out to Alaina Kennedy at alaina@iamhpteam.net or visit our website at IAMHP.net.

As part of being a Trusted Partner you actually have the opportunity to attend all of our Lunch & Learns for complimentary, among many more benefits.

The impact of COVID-19 on Illinois’ communities and health care system cannot be understated resulting in Illinois, including Medicaid Managed Care Organizations, having to rapidly mobilize and adapt. 

Technical experts from the Illinois Association of Medicaid Health Plans (IAMHP) and Medicaid Health plans have been working with Illinois’ Department of Healthcare and Family Services (HFS) to find solutions to some of the many issues facing Illinois residents. But as we move into autumn and winter, the United States’ now faces the possibility of a “twindemic” with COVID-19 and the upcoming flu season happening simultaneously.

Many questions remain about how flu season might affect the pandemic, and vice versa. Especially since the flu and COVID-19 are both respiratory illnesses, individuals already at risk for developing complications from COVID-19 could be at an even greater risk by contracting the flu.

Could coinfection with influenza worsen the course of COVID-19? 

Fortunately, the influenza season in the Southern Hemisphere, which the United States uses to predict our own flu season, had a record low number of cases. This is attributed to travel restrictions, school closures, social distancing and masking from COVID-19, along with strong flu vaccination compliance.

If we continue to follow these recommendations for slowing the spread of COVID-19 -- social distancing, wearing masks and washing hands -- and  getting  flu vaccinations, we, too, can reduce the impact that the flu will have on our communities.

This is where we need our partners and the public to encourage everyone to do what they can to reduce the number of flu cases. 

The easiest way to do that is to get the flu shot. 

Experts recommended that you plan now to ensure you are covered when the peak of the flu season happens which is usually mid-to-late winter. Although, it is never too late to get vaccinated. 

Just as we came together earlier this year to “flatten the curve” of COVID-19, we need everyone to do their part in reducing the impact of this year’s influenza season by getting vaccinated.

To learn more about addressing concerns of vaccine hesitancy, how to catch-up on immunizations due to COVID-19 and how to address gaps in vaccinations visit IAMHP’s video library.

To learn about the latest news and  insights on Illinois Medicaid for healthcare providers, healthcare advocacy groups and Medicaid members visit IAMHP’s insights page. 

As summer comes to a close, Illinoisans are preparing for the transition into fall and winter. For many this might mean pulling out the jackets from storage, trying fun fall recipes and sending the kids back to school. While the transition can be exciting, it means shorter and darker months in Illinois are looming. 

If you have been living in Illinois for a while you might know what to expect from the weather. However, you might not know that these darker days predispose you to having a vitamin D deficiency which actually leads to many people feeling even more lackluster during these upcoming dreary days. 

Each vitamin and mineral have a unique and specific role in ensuring your body stays healthy. For example, vitamin A supports vision, the B vitamins keep up your energy and vitamin C helps your body heal. 

Vitamin D helps boost immune function, reduce inflammation, aid neuromuscular function and help absorb calcium. It is a fat soluble vitamin found in food and manufactured in the body from exposure to ultraviolet rays from the sun. That is why in northern latitudes, like Illinois, it is very common to have a deficiency. 

Even with a healthy, balanced diet with the appropriate casual exposure to the sun some people still experience deficiencies. 

Don’t worry though, deficiencies can be diagnosed by a simple blood test during a wellness check with your primary care provider (PCP). 

Wellness checks are a great time to talk to your PCP about your health, discuss changes or problems you have noticed and get ready for those long winter days. 

You don’t have to be sick to request an exam; PCPs actually recommend a wellness check at least once a year, especially in people over the age of 50. 

To make an appointment with your PCP, call your PCP’s office. If you don’t know who your PCP is, please reach out to your health insurance. Medicaid Managed Care Organizations (MCOs) are happy to assist you and help coordinate your benefits. 

This year as you fall back into your fall and winter routine make sure to maintain a balanced diet, sneak in walks in the sun on those nice days and connect with your PCP as well as your health insurance to maximize your health and get the most out of your benefits. 

The pandemic has upended every aspect of life in the United States and continues to sow a deep uncertainty into life. 

This loss of control and predictability can understandably result in stress and anxiety. 

Adults have the ability to recognize and express anxiety, but children tend to not have the tools or language to understand or communicate anxiety. 

New school years, communicating with friends and changing your routine can be exciting but stressful during ideal conditions, let alone during a global pandemic.  In light of COVID-19, children are facing additional stress related to back-to-school, fall sports, or lack thereof, and many new routines.

Managing the stress and anxiety of so much change looks different for each child within each family. However, it is important to start conversations to ensure we are supporting children’s mental health during COVID-19.

Parents can actively help kids and adolescents manage stress by:

Paying attention

Being available

Listening actively

Responding thoughtfully

Modeling 

Call your child’s or adolescent’s health care provider if stress begins to interfere with their daily activities for several days in a row.

Find additional helpful information about kids and stress by visiting the Centers for Disease Control and Prevention’s Helping Children Cope webpage at https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/for-parents.html.

Black women in the United States are four times more likely to die of a pregnancy related death than white women and on average white men live four and half years longer than black men. Black people do not receive the same quality of care as their white counterparts even when insurance status, income, age and severity of conditions are comparable. 

So why do black people receive inferior care?  Implicit bias plays a huge role. According to the National Academy of Medicine, minority persons are less likely than white persons to be given appropriate cardiac care, to receive kidney dialysis or transplants, and to receive the best treatments for stroke, cancer, or AIDS. 

Regardless of background, ethnicity or socioeconomic status, we all have attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner. 

Experts say it’s our brain’s way of trying to find patterns and organize in a way that makes sense to us. But experts also say that when addressed, our brain becomes more aware of perceptions that can lead to implicit bias, or unequal treatment of people. So simply being aware of subconscious perceptions can help prevent them. 

This is key because implicit bias is especially harmful when it comes to providing quality healthcare to all. Populations most vulnerable to implicit bias in health care include racial and ethnic minorities, LGBTQ individuals, children, women, individuals who are overweight or disabled, and those experiencing behavioral health issues. 

Currently medical doctors, nurses and other healthcare workers are offered implicit bias training. The problem is that most people, including doctors and lawmakers, don’t believe they exhibit implicit bias at all, so the issue remains unaddressed. 

That is why the Illinois Association of Medicaid Health Plans (IAMHP) is once again lobbying for HB 5522 to be reconsidered at the fall session. IAMHP realizes that not only is implicit bias far from being a non-issue, it is a public health problem that’s been begging for our attention long before the current climate to support blacks in this country ensued. 

HB 5522, sponsored by House Representative Emanuel Chris Welch, amends the Medical Practice Act of 1987, the Nurse Practice Act, and the Physician Assistant Practice Act of 1987 to require persons licensed under the Acts take a licensed continuing education course that includes implicit bias training. To satisfy the requirements of this subsection, continuing education courses shall address at least one of the following: 

1. examples of how implicit bias affects perceptions and treatment decisions, leading to disparities in health outcomes; or
   
   
2. strategies to address how unintended biases in decision making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, physical, intellectual or developmental disabilities or other characteristics. 

At this time, IAMHP has lobbied and secured three chief co-sponsors, numerous legislative supporters from across the state of Illinois, and a diverse coalition of advocacy groups including, the American Cancer Society, Equality Illinois, Heartland Alliance, the Aids Foundation of Chicago, Access Living, 360 Youth Services, Ever Thrive Illinois, Healthy Illinois, Planned Parenthood of Illinois, Pride Action Tank, Sargent Shriver National Center on Poverty Law, and SEIU Healthcare. 

IAMHP is urging lawmakers in Springfield to recognize that implicit bias is a public health crisis that affects Medicaid members every day, putting their very lives at risk for something we can address and change. 

HB 5522 would be a huge step toward ensuring that quality healthcare will never again be subject to a person’s zip code, race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, physical, intellectual or developmental disabilities or other characteristics. We can no longer justify ignoring this public health crisis. 

As the country deals with the coronavirus pandemic there is another deadly disease that threatens to reverse our recovery gains – addiction.  For people struggling with addiction, services and treatments available to them have been disrupted by the COVID-19 epidemic.  Many community support groups are cancelled, and healthcare providers are diverted to treat COVID-19 patients making it harder for people with substance use disorders to seek help.

With in-person gatherings cancelled, people in recovery are now without a crucial lifeline and the fear is

that social isolation will increase the risk of addiction.  At the beginning on the pandemic, alcohol sales increased as anxiety and isolation rose and as more families sheltered in place they realized loved ones needed help for an addiction.  Additionally, studies show that as unemployment increases so does death from drugs, alcohol and suicide because of the psychological distress. 

Moreover, drug rehabs in Illinois and Indiana have experienced outbreaks of coronavirus or suffered COVID-related financial difficulties that have forced them to close or limit operations.  A treatment and sober living facility in Chicago recently had an outbreak of 55 coronavirus cases among clients and staff members.  The center was forced to go from double to single occupancy rooms, improve its air filtration system and change the way it serves food.  One drug rehab in Indiana which treated as many as 80 men at a time in its free, abstinence-based program is set to close its doors in September.  The next closest facility will be in Chicago, more than 30 miles away.

While addiction treatment centers have taken steps to protect their clients, they must avoid some safety strategies like keeping potentially intoxicating hand sanitizer on the premises.  Similar to nursing homes, drug rehabs have shared spaces, double occupancy rooms and group therapy which can also make social distancing difficult.  And while people struggling with addiction are generally younger, they are just as vulnerable as nursing home residents to suffer from other health conditions like diabetes and heart disease meaning they are at higher risk of succumbing to COVID-19.

Now is the time to reach out to those who are struggling with addiction and provide them with the resources and medications so that they are not alone and forgotten during this dual crisis of coronavirus and addiction.

If you need assistance locating the nearest organization providing Overdose Education and Naloxone Distribution  or Medication Assisted Recovery services in your area, contact the Illinois Helpline for Opioids and Other Substances by calling 833-2FINDHELP (234-6343), text "HELP" to 833234 or visit www.helplineil.org.

The Helpline is the only statewide, public resource for finding substance abuse treatment and recovery services in Illinois. They serve people using opioids and other substances, with or without insurance.

More information about overdose prevention and response can be found on the Drug Overdose Prevention Program (DOPP) homepage.

For Medicaid Members:  Managed Care Organization (MCOs) Care Coordinators also have special services and programs for members who need extra help managing a health program. If you are a Medicaid Member, please reach out to your Care Coordinator if you have specific questions or needs.

QUARTERLY NEWSLETTER
Texting to Improve 
Healthcare Communications
Spring 2020

COVID-19 may be having a devastating impact around the world, but it is also prompting Medicaid Health Plans in Illinois to find new ways to communicate with their members.  

During this time people need to know how to manage their health – finding testing sites, assistance with prescriptions, scheduling transportation etc.  One unique approach is a text campaign that can engage members to better manage their health while communicating important information with members. 

At a time when people can call, text or chat with their healthcare team, the value of text messaging to a person’s overall healthcare management is essential.   Texting can be used to engage and connect with member about everything from health management to billing.  It can notify Medicaid members of changes to their scheduled appointments and notify patients when they are due for routine exams, recommend specific preventive screenings, invite patients to attend community wellness events or share relevant wellness information. 

Illinois Medicaid Health Plans are constantly looking for ways to improve the overall health of their members and text messaging has seen a high engagement rate among respondents.