Department of Public Aid MediPlan Plus (Springfield, IL)

The Pacific Health Policy Group (PHPG) provided assistance to Illinois in the re-design of its Medicaid program to managed care, by developing caseload and cost estimates and participating in the negotiation of Section 1115 Waiver terms and conditions with Centers for Medicare and Medicaid Services (CMS). PHPG also assisted in the drafting of an RFP to procure the services of an organization to process referrals and claims related to behavioral health services provided outside the managed care benefit package.

Specific activities included:

• Developing caseload and cost estimates for the state's Section 1115 Demonstration Waiver program

• Conducting budget neutrality studies and analyses

• Negotiating program financing and operational terms and conditions with CMS on behalf of the state

• Drafting separate RFPs for referral (utilization management) and claims processing contractors to administer behavioral health services provided outside of the health plan benefit package

• Assisting in the design of an evaluation process for both procurements