October 28, 2022
You may have participated in the recent Illinois Medicaid webinars, facilitated by the Illinois Department of Healthcare and Family Services (HFS), regarding the rollout of the new Pathways to Success initiative. Blue Cross and Blue Shield of Illinois (BCBSIL) will implement Pathways to Success for our Blue Cross Community Health PlansSM (BCCHPSM) members beginning Jan. 1, 2023.
As described on the HFS website, Pathways to Success is a program for Medicaid-enrolled children under the age of 21 in Illinois, who have significant and complex behavioral health needs. The program provides access to an evidence-informed model of intensive care coordination and additional home and community-based services.
The goal of the program is to improve family functioning and reduce caregiver stress. It involves increased use of evidence-based practices by expanding access to services provided in home and community settings. The program promotes more stable living situations, improved school attendance and performance, increased family and youth involvement, and reduced contacts with law enforcement and child welfare officials. Pathways to Success is designed to address many of the state’s commitments under the HFS N.B. Consent Decree.
A BCCHP member is eligible to participate in Pathways to Success if they meet the following criteria:
- A Medicaid recipient
- Under age 21
- Have been diagnosed with a Serious Emotional Disturbance (SED) or Serious Mental Illness (SMI)
- Demonstrates a need for intensive services pursuant to the Illinois Medicaid Comprehensive Assessment of Needs and Strengths IM+CANS decision support criteria
What’s the role of the provider?
Pathways to Success involves participation of Care Coordination and Support Organizations (CCSOs).
- The role of the CCSO is to provide Care Coordination and Support Services to children enrolled in Pathways to Success.
- As the local hub, the CCSO is accountable to serve as the care coordination entity for children enrolled in the Family Support Program (FSP) and the Specialized Family Support Program (SFSP).
- The CCSO will also operate as the fiscal agent for individual Support Services (ISS) and Therapeutic Support Services (TSS).
- In addition, the CCSO will serve as the designated Mobile Crisis Response (MCR) Provider for the newly reconstructed Designated Service Area (DSA), on a no-decline basis, to all eligible individuals within the DSA. Only CCSOs will receive calls from Crisis and Referral Entry Services (CARES) as the DSA MCR Provider.
- Existing DSAs have been redrawn, reducing the total number of DSAs statewide to 32; this redesign allows for streamlined management of the statewide CCSO and MCR system and ensures that each CCSO will have a referral base robust enough to sustain operations.
Pathways to Success Program Rollout
The timeline for implementation is as follows:
- Nov. 1, 2022 – MCR transition to new DSA and new Providers
- Jan. 1, 2023 – Pathways to Success Program goes live
If you missed the recent webinars or need a refresher, the recorded sessions and presentation slides are available on the HFS site on the Pathways to Success Town Hall Webinars and Other Resources page. This page also includes answers to frequently asked questions and links to helpful education and reference materials.