103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3783

 

Introduced 2/9/2024, by Sen. Ann Gillespie

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5H-1
305 ILCS 5/5H-3

    Amends the Managed Care Organization Provider Assessment Article of the Illinois Public Aid Code. Changes the Tier 1 assessment amount for managed care organizations to $78.90 per member month (rather than $60.20 per member month). Changes the Tier 2 assessment amount for managed care organizations to $1.40 per member month (rather than $1.20 per member month). Provides that for State fiscal year 2020, and for each State fiscal year thereafter (rather than for State fiscal year 2020 through State fiscal year 2025), the Department of Healthcare and Family Services may adjust rates or tier parameters or both. Makes changes to the definition of "base year". Effective January 1, 2025.


LRB103 39515 KTG 69716 b

 

 

A BILL FOR

 

SB3783LRB103 39515 KTG 69716 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5H-1 and 5H-3 as follows:
 
6    (305 ILCS 5/5H-1)
7    Sec. 5H-1. Definitions. As used in this Article:
8    "Base year" means the 12-month period from January 1, 2023
92018 to December 31, 2023 2018.
10    "Department" means the Department of Healthcare and Family
11Services.
12    "Federal employee health benefit" means the program of
13health benefits plans, as defined in 5 U.S.C. 8901, available
14to federal employees under 5 U.S.C. 8901 to 8914.
15    "Fund" means the Healthcare Provider Relief Fund.
16    "Managed care organization" means an entity operating
17under a certificate of authority issued pursuant to the Health
18Maintenance Organization Act or as a Managed Care Community
19Network pursuant to Section 5-11 of this Code.
20    "Medicaid managed care organization" means a managed care
21organization under contract with the Department to provide
22services to recipients of benefits in the medical assistance
23program pursuant to Article V of this Code, the Children's

 

 

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1Health Insurance Program Act, or the Covering ALL KIDS Health
2Insurance Act. It does not include contracts the same entity
3or an affiliated entity has for other business.
4    "Medicare" means the federal Medicare program established
5under Title XVIII of the federal Social Security Act.
6    "Member months" means the aggregate total number of months
7all individuals are enrolled for coverage in a Managed Care
8Organization during the base year. Member months are
9determined by the Department for Medicaid Managed Care
10Organizations based on enrollment data in its Medicaid
11Management Information System and by the Department of
12Insurance for other Managed Care Organizations based on
13required filings with the Department of Insurance. Member
14months do not include months individuals are enrolled in a
15Limited Health Services Organization, including stand-alone
16dental or vision plans, a Medicare Advantage Plan, a Medicare
17Supplement Plan, a Medicaid Medicare Alignment Initiate Plan
18pursuant to a Memorandum of Understanding between the
19Department and the Federal Centers for Medicare and Medicaid
20Services or a Federal Employee Health Benefits Plan.
21(Source: P.A. 101-9, eff. 6-5-19; 102-558, eff. 8-20-21.)
 
22    (305 ILCS 5/5H-3)
23    Sec. 5H-3. Managed care assessment.
24    (a) There is For State Fiscal year 2020 through State
25Fiscal Year 2025, there is imposed upon managed care

 

 

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1organization member months an assessment, calculated on base
2year data, as set forth below for the appropriate tier:
3        (1) Tier 1: $78.90 $60.20 per member month.
4        (2) Tier 2: $1.40 $1.20 per member month.
5        (3) Tier 3: $2.40 per member month.
6    (b) The tiers are established as follows:
7        (1) Tier 1 includes the first 4,195,000 member months
8    in a Medicaid managed care organization for the base year;
9        (2) (ii) Tier 2 includes member months over 4,195,000
10    in a Medicaid managed care organization during the base
11    year; and
12        (3) (iv) Tier 3 includes member months during the base
13    year in a managed care organization that is not a Medicaid
14    managed care organization.
15    (c) For State fiscal year 2020, and for each State fiscal
16year thereafter, through State fiscal year 2025, the
17Department may by rule adjust rates or tier parameters or both
18in order to maximize the revenue generated by the assessment
19consistent with federal regulations and to meet federal
20statistical tests necessary for federal financial
21participation. Any upward adjustment to the Tier 3 rate shall
22be the minimum necessary to meet federal statistical tests.
23(Source: P.A. 101-9, eff. 6-5-19.)
 
24    Section 99. Effective date. This Act takes effect January
251, 2025.