Medicaid MCO Discharge Planning - Key Contacts and Escalation Points


For several months, IHA, the Illinois Association of Medicaid Health Plans (IAMHP), and Medicaid Managed Care Organizations (MCOs) have been participating in a Discharge Planning Workgroup convened by the Illinois Department of Healthcare and Family Services (HFS) to address ongoing challenges with discharge planning for post-acute placement of Medicaid managed care members. Through this workgroup, IHA’s Patient Financial Services (PFS) program staff and representatives of the PFS Subcommittee on Utilization Review and Case Management have raised members’ collective concerns regarding the ability to identify key MCO contacts for assistance in executing the discharge planning process. PFS member hospitals have also reported ongoing challenges in obtaining a response from the MCOs after an initial contact is made. As a result, IHA requested that the MCOs provide a comprehensive resource document identifying key discharge planning contacts and escalation points for hospitals.

IHA is pleased to report that IAMHP, in conjunction with the MCOs, has developed a Discharge Planning Resource Guide to help hospitals make initial contact with the MCOs for discharge planning assistance and to identify the appropriate escalation hierarchy if no response is received to the initial request. Please click here to access this resource via IAMHP’s website. IAMHP has assured IHA that it will continue to regularly update this document.

This information was shared with hospitals that participate in the fee-based PFS program earlier this month. For additional information on the PFS program, and its member groups, or for questions regarding this memorandum, please contact Stephanie Volante, manager, PFS.