Public Act 099-0898
 
SB2306 EnrolledLRB099 19419 KTG 43811 b



    AN ACT concerning public aid.

 
    Be it enacted by the People of the State of Illinois, 
represented in the General Assembly: 






 
    Section 5. The Illinois Public Aid Code is amended  by 
adding Section 5-30.3 as follows:
 
    (305 ILCS 5/5-30.3 new)
    Sec. 5-30.3. Managed care; automatic assignment. The

Department shall, within a reasonable period of time after

relevant data from managed care entities has been collected and

analyzed, but no earlier than January 1, 2017, seek input from 
the managed care entities and other stakeholders and develop 
and
implement within each enrollment region an algorithm 
preserving existing provider-beneficiary relationships that 
takes
into account quality scores and other operational 
proficiency
criteria developed, defined, and adopted by the 
Department, to
automatically assign Medicaid enrollees served 
under the
Family Health Plan and the Integrated Care Program 
and those
Medicaid enrollees eligible for medical assistance 
pursuant to
the Patient Protection and Affordable Care Act 
(Public Law  111-148) into managed care entities, including 
Accountable
Care Entities, Managed Care Community Networks, 
and Managed
Care Organizations. The quality metrics used shall 
be
measurable for all entities. The algorithm shall not use the

quality and proficiency metrics to reassign enrollees out of

any plan in which they are enrolled at the time and shall only

be used if the client has not voluntarily selected a primary

care physician and a managed care entity or care coordination

entity. Clients shall have one opportunity within 90 calendar

days after auto-assignment by algorithm to select a different

managed care entity. The algorithm developed and implemented

shall favor assignment into managed care entities with the

highest quality scores and levels of compliance with the

operational proficiency criteria established, taking into 
consideration existing provider-beneficiary relationship as 
defined by 42 CFR 438.50(f)(3) if one exists.