AFC Contracting Seminar

1. AFC Contracting Seminar July 19, 2013

2. Implementation Timeline • October 2012-notification of 1115 waiver approval • November 2012-starting taking applications • January 2013-first member approved • February 2013-service delivery begins

3. CountyCare Eligibility • Live in Cook County • Be 19-64 years old • Have income at or below 133% of the Federal Poverty Level ($15,282 individual, $20,628 couple - annually) • Not be eligible for “state Plan” Medicaid (parent, pregnant, blind or receiving disability income) • Not be eligible for Medicare • Be a legal immigrant for five years or more or a US citizen • Have a Social Security number or have applied for one Note:  No asset test. Note:  Although most persons who have been adjudicated as disabled for SSI, SSDI purposes are ineligible, those with income above Medicaid levels (100-133% FPL) and those with assets above Medicaid levels can enroll in CountyCare

4. CountyCare Screening - 1 1. Do you live in Cook County? If yes –Go to question #2. If no–Not eligible for CountyCare. 2. Are you a US citizen or an eligible immigrant (a legal immigrant for 5 years or more)? If yes – Go to question #3. If no – Not eligible for CountyCare. 3. How old are you? If under 19 – “You may be eligible for traditional Medicaid.” If 65 or older– “You may be eligible for traditional Medicaid.” If 19-64– Go to question #4.

5. CountyCare Screening - 2 4. Are you raising related children under 19?” If living with and raising your own children – May be eligible for traditional Medicaid. If living with and raising related children and the children’s parents are not in the home – May be eligible for traditional Medicaid. 5. Are you pregnant? If yes – May be eligible for traditional Medicaid. • Are you blind or do you receive Medicare, SSI or SSDI benefits? If yes – May be eligible for traditional Medicaid. If no – May be eligible for CountyCare.

6. CountyCare – How to Apply • Apply with Application Assistors only – by phone or in person • Call 312-864-8200 or toll free 855-444-1661 M-F 8am-8pm, Sat 9am-2pm • To apply by phone • To find a CCHHS location to apply in person • To find a CountyCare FQHC site or Organization to apply in person • Two steps to apply • Provide verbal answers to application questions • Submit verification documents

7. Provider Network • CCHHS PCMH sites General Medicine Clinic-Fantus Dr. Jorge Prieto Health Center Austin Health Center Logan Square Health Center Cicero Health Center Vista Health Center John Sengstacke Health Center Woodlawn Health Center Near South Health Center Englewood Health Center Oak Forest Health Center Cottage Grove Medical Center Robbins Health Center Woody Winston Health Center   CORE Center • FQHCs Asian Human Services Lawndale Christian Health Center ACCESS Friend Family Health Center Beloved Community Wellness PCC Community Wellness Center Community Nurse Health Center Erie Family Health Center Salud de Esperanza PrimeCare Community Health Howard Brown Chicago Family Health Center Heartland Health Outreach Heartland International Health Center Alivio Medical Center Christian Community Health Center Aunt Martha’s Near North Health Center Circle Family HealthCare Network Mercy Family Health Center

8. Participating Hospitals Advocate Christ Medical Center Advocate Illinois Masonic Medical Center Advocate Lutheran General Advocate South Suburban Advocate Trinity Hospital Holy Family Medical Center Long Term Acute Care Mercy Hospital & Medical Center Metro South Medical Center Mount Sinai Hospital Norwegian American Hospital Our Lady Of The Resurrection Medical Center Resurrection Medical Center RML Long Term Acute Care Hospital Roseland Community Hospital Schwab Rehabilitation Hospital South Shore Hospital St. Anthony Hospital St. Bernard Hospital St. Francis Hospital St. James Hospital and Health System St. Joseph Hospital Sts. Mary and Elizabeth Medical Center Swedish Covenant Hospital University of Chicago Medical Center Vanguard – MacNeal Hospital Vanguard – West Suburban Medical Center Vanguard – Weiss Memorial Hospital Vanguard – Westlake Hospital

9. Participating Other Providers Others • Behavioral Health: PsycHealth • Durable Medical Equipment: Doctor’s Choice, Premier Home Care Supplies, Orsini, Premier Home Care Supplies, Prism Healthcare Services, /Resurrection Home Medical Equipment • Home Health: Doctor’s Choice Home Care, Resurrection Home Health • Hospice: Horizon’s Hospice, Vitas Healthcare, and Rainbow Health

10. Needed Services • Primary care • Specialty Care • Hospitals • Third Party Administrator • Behavioral Health • Pharmacy management • Ancillary services e.g., home health; DME

11. Contracting Strategy • Request for Information (RFI) • Request for Proposal (RFP) • Developing evaluation criteria • Compliance with Cook County Procurement Code • Develop agreement • Securing needed signatures to fully execute • Develop Provider Manual • Site visits

12. Vendor On-Boarding • Review workflow and processes • Claim information for payment • Provider credentialing • Compliance with access standards • Providing contact information for utilization review, registration, admissions • Staff orientation • Technology assessment

13. Challenges • Know market rates • Consider short-term as well as full agreements • Contracting with a medical facility may involve several different agreements • Be responsive • Know population needs • Managed Care lingo • Navigating legal, clinical, financial, political • Evolving healthcare landscape

14. Questions and Answers • www.Countycare.com