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September 2016

Behavioral Health Section 1115 Waiver Proposal from HFS

The Illinois Department of Healthcare and Family Services has released an 1115 waiver draft that details a proposed overhaul of the behavioral health delivery system. Interesting expanded Medicaid benefits included in the draft waiver extend from care coordination in health homes to pre-tenancy services for supportive housing.

As with all endeavors, there is no one size fits all solution to Illinois’ behavioral health system. Be sure to review the waiver documents for yourself, and send comments by October 2nd to ensure that the behavioral health system works best for you and your community.

Hearings will be held Sept. 8 in Springfield and Sept. 9 in Chicago. Details.

'Miss Obamacare' Has a Mission for Illinois’ Troubled Marketplace

“There is no greater service than helping individuals gain access to health care,” says Graciela Guzman, a leader of the Chicago Affordable Care Act Consortium. A tireless recruiter, she’s made it her mission to enroll the remaining 35% of the roughly 2 million Hispanics residents in the Chicago area who do not yet have coverage.

Her work is especially critical now: the choices available to consumers are in disarray with the closing of Land of Lincoln Health, and the news that Aetna is leaving the ACA market. And when it comes to the ACA, "you have a large group of working-poor Hispanics who just do not believe this was meant for them," observed HDA CEO Barbara Otto. "Information about the Affordable Care Act just isn't getting to them." Read more about Graciela’s work in Progress Illinois.

Medicare’s Hospital Readmission Penalties Show Multi-Year Patterns

Of the 123 Illinois hospitals that have been penalized by Medicare for excessive readmissions, 93 have been received penalties in all five years since the program started. The penalties, for higher than expected re-hospitalization rates for patients with six common conditions, were mandated by the Affordable Care Act.

Currently more than half the nation’s hospitals are experiencing penalties – which take the form of reductions in Medicare case reimbursement with the average nationally equating to 0.73% of its Medicare payments; penalties are capped by law at 3%, In Illinois, FY 2103 penalties ranged from 0.01% to the full 3%. See our interactive map, or read more at Kaiser Health News.

In case you missed it

Sepsis screening protocols
Illinois hospitals are now required to adopt and implement evidence based screening protocols and protocols for early recognition and treatment of patients with sepsis. The new law, an amendment to the Illinois Hospital Licensing Act, was signed by Gov. Rauner on August 18. The legislation, SB 2403 known as "Gabby’s Law," had been overwhelmingly approved by the General Assembly.

New payment models
In July, HHS proposed new models that aim to create further incentives for hospitals to deliver better care to patients at a lower cost. The agency proposed bundled payments for cardiac care and cardiac rehabilitation, and a new model to increase cardiac rehabilitation utilization, as well as extension of the existing bundled payment model for hip replacements to other hip surgeries.

Elder abuse "common, fatal and costly"
XinQi Dong, MD, professor of geriatric medicine at Rush University Medical Center, calling upon regulators and the medical profession to develop better programs for preventing, screening, monitoring and managing elder abuse in nursing homes." Writing in an editorial in the June 14 online issue of Annals of Internal Medicine, Dr. Dong called for elder abuse to be named an urgent public health issue. The editorial is summarized in Rush News.

Our MOON watching continues
The long-awaited Medicare Outpatient Observation Notice to inform Medicare patients about their observation status is supposed to go into effect this fall; it’s already been delayed once. Stay on top of this issue at and the Center for Medicare Advocacy.

Still no real budget
Illinois’ stopgap measure measure leaves social service providers stranded and essential services at risk, and calls for close monitoring of potential harms. Moody’s Investors Service has now warned that the backlog of unpaid bills could grow to as much as $14 billion this fiscal year.

And now, Aetna
The largest insurer to turn its back on the ACA Marketplace, Aetna is leaving 11 of the 15 states where it sells Obamacare plans, including Illinois, following similar moves by rivals Human and United Healthcare. All cited heavy losses on the exchanges, a claim that has been called into question by some, such as this columnist in MarketWatch. For 2017, the move would leave Illinois’ Marketplace with six insurers, dominated by Blue Cross Blue Shield of Illinois.

From our social media

On Twitter
@ILHealthMatters: Finally, a serious attempt to exam the barriers to Medicaid redetermination in Illinois

On Twitter
@ILHealthMatters: A new study says that emergency room visits in Illinois have increased after Obamacare... is this good or bad?

On Facebook
Despite GOP opposition, new research proves that #Medicaid improves health

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