MI Health Link Information for Providers

MI Health Link is a new health care option for Michigan adults, age 21 or older, who are enrolled in both Medicare and Medicaid. Currently, these individuals navigate multiple sets of rules, benefits, insurance cards, and providers in accessing services covered by Medicare Parts A and B, Part D, and Medicaid.  Many also have multiple or chronic conditions and will benefit from better care coordination, person-centered planning, and management of health and long term supports and services. 

The goal of MI Health Link is to provide seamless access to high quality care through coordination of services currently covered separately by Medicare and Medicaid. MI Health Link offers a broad range of medical and behavioral health services, nursing home care, pharmacy and home and community based services through new managed care entities called Integrated Care Organizations (ICO) and Medicaid’s existing Pre-paid Inpatient Health Plans (PIHP). ICOs, PIHPs and providers will be connected through the Care Bridge, a web-based platform for information exchange that is used to coordinate supports and services.

Provider Resources Toolkit

ICO Contact List for Providers

ICO CHAMPS IDs and TPL Contract Numbers
 

Frequently Asked Questions for Providers

Who is eligible for MI Health Link?

People may be eligible for MI Health Link if they: 

  • Live in the counties of Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Macomb, St. Joseph, Van Buren, Wayne, or any county in the Upper Peninsula
  • Are age 21 or older
  • Have full Medicare and full Medicaid
  • Are not enrolled in hospice              


What are the benefits of MI Health Link for providers?

We recognize the challenges providers face in coordinating care for persons eligible for both Medicare and Medicaid. MI Health Link aims to reduce the administrative burden for providers and simplify the navigation of benefits and services for this population.

  • Services will be delivered through one integrated system to enhance communication and care delivery.
  • Each enrollee will have access to an ICO Care Coordinator who will provide coordination and follow-up.
  • Each ICO will offer a single formulary for all Medicare and Medicaid covered drugs.
  • The billing process will be simpler—all billing is processed by the ICO. You will no longer need to wait for a Medicare denial to bill Medicaid. Simplified billing will reduce the delay and duplication from working with multiple payment systems.


What are the benefits of MI Health Link for enrollees?

  • They will have one plan for all Medicare and Medicaid services.
  • They will not pay a deductible or copayment when they receive services from an ICO in-network provider.
  • They will have their own Care Coordinators who will ask them about their health care needs and choices and will work with them to create a personal care plan based on their goals.
  • A Care Coordinator will help them access services they need, when they need them. This person will answer questions and make sure that each health care issue is addressed.
  • Those who qualify will have access to home and community based supports and services to help them live independently.


How will care coordination work with MI Health Link?

Integrated Care Organizations (ICOs) will give providers information and resources to support care coordination through timely communication across care team members and through the use of an interoperable electronic platform called the Care Bridge.

  • Assessments: ICOs will conduct an initial assessment to identify enrollees’ needs and make referrals to specialized service providers.
  • Integrated Care Teams (ICTs): An ICT, led by the ICO Care Coordinator, will be offered to the enrollee. The team will help manage and coordinate care by participating in the person-center planning process. Membership will include the enrollee and the enrollee’s chosen allies, primary care physician and, as applicable, LTSS Supports Coordinator and PIHP Supports Coordinator. The enrollee and team may also include other providers who are needed.
  • Integrated Individualized Care and Supports Plan (IICSP): Through the assessment and the person-centered planning process, the IICSP will be developed with the enrollees and the ICT to identify the supports and services that will best help enrollees meet their needs and care goals. ICT members will provide timely access to care and services identified in the plan and communicate plan facilitation through the Care Bridge.
  • ICO Care Coordinators: Each enrollee with have Care Coordinators to facilitate communication among the enrollee’s providers, including physicians, long term supports and services providers and behavioral health providers.  They will also help connect enrollees to other community-based social services to help them live as independently as possible.


If I decide not to join a provider network, will I still be able to see my current patients? Will I still be paid?

If you choose to not participate with an Integrated Care Organization (ICO), you may continue to see your patients who are enrolled once they have joined MI Health Link for a limited period of time – depending on the type of care or service provided. For more information, please read Integrated Care Organization Transition Requirements at Enrollment. If you see a patient during this transition period, the ICO is to reimburse you at no less than the current fee-for-service rate.


How does MI Health Link protect continuity of care for enrollees?

  • MI Health Link seeks to ensure continuity of care for enrollees in the program. The Integrated Care Organization (ICO) will work with you and your patients to make sure they get all the care they need.
  • Continuity of care protections are different for the various services and providers under MI Health Link.  Enrollees have the right to continue to receive needed services from their current providers, but eventually they receive most covered services from ICO providers as detailed in Integrated Care Organization Transition Requirements at Enrollment.


How do I join a provider network? How will I get paid?

To participate as a MI Health Link Provider, you will need to join one or more of the ICO provider networks

MI Health Link providers will be paid directly by the ICOs in which they elect to participate. Provider contracts with the ICOs will define specific payment structures and procedures.


Will there be training for providers who participate in MI Health Link?

ICOs are required to train their network providers on policies and procedures pertaining to the MI Health Link demonstration in order to best serve enrollees and meet the program’s goals. These topics include, but are not limited to, care coordination, service delivery, complaints and grievances, and person-centered planning.


What information can I give my patients?

It is important that people have all the information they need about MI Health Link so they can make informed choices based on their needs and understand their options.

The MI Health Link Beneficiary web page has information designed to help patients understand the program and their choices.

 

 Integrated Care Organization (ICO) Transition Requirements at Enrollment

Transition Requirements1

Habilitation Supports Waiver

Enrollees and Enrollees Receiving Specialty Services and Supports Program through the PIHP

All Other Enrollees

Physician/Other Practitioners

Maintain current provider at the time of enrollment for 180 days. (ICO must honor existing plans of care and prior authorizations (PAs) until the authorization ends or 180 days from enrollment, whichever is sooner)

Maintain current provider at the time of enrollment for 90 days. (ICO must honor existing plans of care and prior authorizations (PAs) until the authorization ends or 180 days from enrollment, whichever is sooner)

DME

Must honor PAs when item has not been delivered and must review ongoing PAs for medical necessity

Must honor PAs when item has not been delivered and must review ongoing PAs for medical necessity

Scheduled Surgeries

Must honor specified provider and PAs for surgeries scheduled within 180 days of enrollment

Must honor specified provider and PAs for surgeries scheduled within 180 days of enrollment

Chemotherapy/Radiation

Treatment initiated prior to enrollment must be authorized through the course of treatment with the specified provider

Treatment initiated prior to enrollment must be authorized through the course of treatment with the specified provider

Organ, Bone Marrow, Hematopoietic Stem Cell Transplant

Must honor specified provider, PAs and plans of care

Must honor specified provider, PAs and plans of care

Dialysis Treatment

Maintain current level of service and same provider at the time of enrollment for 180 days

Maintain current level of service and same provider at the time of enrollment for 180 days

Vision and Dental

Must honor PAs when anitem has not been delivered

Must honor PAs when anitem has not been delivered

Home Health

Maintain current level of service and same provider at the time of enrollment for 180 days

Maintain current level of service and same provider at the time of enrollment for 90 days

Medicaid Nursing Facility Services2

N/A

Enrollee may remain at the facility through contract with the ICO or via single case agreements or on an out-of-network basis for the duration of the Demonstration or until the enrollee chooses to relocate

Waiver Services

N/A– Enrollment in MI Health Link does not impact Habilitation Supports Waiver services. Current providers and level of services will remain unchanged unless changed during the person-centered planning process.

For enrollees transitioning from the MIChoice HCBS waiver, the ICO will maintain current providers and level of services at the time of enrollment for 90 days unless changed during the person-centered planning process

State Plan Personal Care

Maintain current provider and level of services at the time of enrollment for 180 days. The IICSP must be reviewed and updated and providers secured within 180 days of enrollment.

 

Maintain current provider and level of services at the time of enrollment for 90 days. The IICSP must be reviewed and updated and providers secured within 90 days of enrollment. 

*Not applicable for enrollees transitioning from the MIChoice HCBS waiver. 

1Requirements for all Medicare and Medicaid pharmacy transition will adhere to Medicare Part D pharmacy transition requirements.

During the first 180 calendar days of coverage, the ICO will provide the following:

  • A temporary supply of drugs when the enrollee requests a refill of a non-formulary drug that otherwise meets the definition of a Part D drug; and
  • A 90-day supply of drugs when an enrollee requests a refill of a non-Part D drug that is covered by Medicaid.

Additional requirements may apply.

The ICO must provide an appropriate transition process for enrollees who are prescribed Part D drugs that are not on its formulary (including drugs that are on the ICO’s formulary but require prior authorization or step therapy under the ICO’s utilization management rules). This transition process must be consistent with the requirements at 42 C.F.R. § 423.120(b)(3).

With some exceptions, all prior approvals for non-Part D drugs, therapies, or other services existing in Medicare or Medicaid at the time of enrollment will be honored for 180 calendar days after enrollment and will not be terminated at the end of 180 calendar days without advance notice to the enrollee and transition to other services, if needed. 

2 Out-of-network nursing facilities must be offered single case agreements to continue to care for the enrollee through the life of the demonstration if the nursing facility does not participate in the ICO’s network and the enrollee:

  • Resides in the nursing facility at the time of enrollment;
  • Has a family member or spouse that resides in the nursing facility; or
  • Requires nursing facility care and resides in a retirement community that includes a nursing facility.