Seniors and Persons with Disabilities Service Package II: Long Term Services & Supports. Revised January 2014. Company Overview. Parent Company Established 1995 Serving TANF Population 85,000+ enrollees Non for Profit. Wholly Owned Subsidiary of FHN
Seniors and Persons with Disabilities
Service Package II: Long Term Services & Supports
Revised January 2014
Not-for-profit created in 1995 by five safety-net hospitals
Only not-for-profit Managed Care Community Network in the State of Illinois
Medicaid: TANF Population
Member Value-Added Benefits
Seeking a better alternative for Medicaid health care and financing, Family Health Network took a grassroots approach and joined with the following allies to develop CCAI:
• Access Living of Metropolitan Chicago, a nationally recognized advocacy group for people with disabilities
• Health & Medicine Policy Research Group, an independent policy center that conducts research, educates and collaborates with other groups to advocate policies and impact health systems to improve the health status of all people
• Sinai Health System and Schwab Rehabilitation Hospitalrecognized as national models for urban health care delivery
The Community Care Alliance of Illinois is a health plan dedicated to consumer-directed, community-based innovative health services specializing in the care of Seniors & Persons with Disabilities.
To be the leader in Choice, Access, and Quality of Health Services for the people we serve.
Integrated Care Program Expansion
Medicare Advantage – New! Effective 01/01/2014
SPD Populations Excluded from ICP
Person Centered with Six Domains
Disability Competent Primary Care
Fully accessible and user-friendly environment for people with disabilities and complex needs. Anchor Health Homes will provide the following:
All mental health and substance abuse (MHSA) services are sub-contracted to PsycHealth. PsycHealth manages both inpatient and outpatient services, as well as all UM processes related to MHSA.
1121 Florence Ave., 2nd Floor
Evanston, Illinois 60202
CCAI has chosen CVS Caremark as its Pharmacy Benefits Manager.
Enrollees may contact the Customer Care Line at (855)248-3446 or visit the CCAI website and click the CVS Caremark button on our Home Page to find a participating pharmacy nearby.
Mail Order Option
Prescriptions will be filled for up to a 30-day supply in the pharmacy. Enrollees who need long-term medication can send their prescriptions to CVS Caremark’s mail-order pharmacy:
PO Box 94467
Palatine, IL 60094-4467
Formulary, Prior Authorization and Step Therapy
CCAI utilizes a Preferred Drug List, which can be found on the CCAI website. There are medications that require Prior Authorization or are only accessible through Step Therapy. These, along with instructions for obtaining authorization, can be found by calling the CVS Caremark Customer Care Line at (855)248-3446.
Home & Community-Based Services (Waiver Programs) serving the following populations:
Long Term Care Facilities
Long Term Supports and Services
The State completes Determination of Eligibility (DOE) for home/community ‘waiver’ services; eligibility shared with CCAI
CCAI develops and implements a Waiver Service Plan for Enrollees who are LTSS waiver-eligible. The Waiver Services Plan
CCAI contracts with CCUs and Centers for Independent Living (CILs) to ensure that Enrollees’ LTSS needs are met in the home/community setting
All Long Term & Support Services require Prior Authorization
Services Requiring Authorization
Authorizations may be obtained one of the following ways
Supportive Living Program Waiver
Persons with Brain Injury Waiver
People with HIV or AIDS Waiver
Persons with Disabilities Waiver
The Enrollee’s ID number is the same as their Medicaid Recipient ID number
Providers are able to verify Enrollee eligibility via:
Timely Filing Guidelines
CCAI follows CMS guidelines for clean claims
Submission of Corrected Claims
Claim Appeals or Disputes
Community Care Alliance
C/0 Appeals Dept.
322 S. Green St., Suite 400
Chicago, Illinois 60607
These forms are available on the website at www.cccaillinois.com
The following items will cause a claim to be rejected prior to processing
**Rejected claims will be returned to the provider with an applicable explanation
Mail paper claims to:
Community Care Alliance of Illinois
4044 N. Lincoln, #294
Chicago, IL 60618
Claim inquiries may be made to:
Enrollee and Provider Services at (866)871-2305
Timely and accurate claims payment
Online Resources on CCAI Website
Access to the CCAI Secure Web Portal for Contracted Providers
Please visit us at www.ccaillinois.com and register today!
CCAI works to
What is Abuse?
-Emotional or Mental Abuse
What are the Reporting Requirements?
(866)800-1409, (800)544-5304 (TTY)
When Should You Report to the Hotline Number?
Whenever you believe that an individual with disabilities or an older adult has been abused or neglected. Some examples of abuse or neglect are
Where should you report Abuse or Neglect?
Adult Protective Services Hotline at 1-866-800-1409, 1-888-206-1327 (TTY)
Adults 18 years and older with Disabilities and Adults 60 years of age and older
Illinois Department of Public Health Hotline at 1-800-252-4343
Abuse, neglect, exploitation of an adult 60 years of age older in a Nursing Home
Supportive Living Facility (SLF): 1-800-226-0768
Enrollees residing in SLFs
Community Care Alliance of Illinois at 1-866-871-2305