103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB1202
 
Introduced 1/31/2023, by Rep. Mary E. Flowers
 
SYNOPSIS AS INTRODUCED:
 

 
305 ILCS 5/5-47 new

     Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that it is the intent of the General Assembly to ensure that all youth in the care of the Department of Children and Family Services have increased access to health care under the YouthCare Program. Provides that in order to maximize the accessibility of health care services for youth in care and former youth in care enrolled in the YouthCare Program, the Department of Healthcare and Family Services shall amend its managed care contracts such that a managed care organization (MCO) that manages health care for  youth in care and former youth in care must pay for services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the rate paid under the Illinois Medicaid fee-for-service program methodology for such services, including all policy adjusters, including, but not limited to, Medicaid High Volume Adjustments, Medicaid Percentage Adjustments, Outpatient High Volume Adjustments, and all outlier add-on adjustments to the extent such adjustments are incorporated in the development of the applicable MCO capitated rates, unless a different rate was agreed upon by the health plan and the non-affiliated provider. Provides that the payment requirement under the amendatory Act shall not apply if: (i) the services provided by the non-affiliated provider were not emergency services; (ii) the non-affiliated provider has, within the 12 months preceding the date of service, rejected a contract that was offered in good faith by the health plan as determined by the Department; and (iii) the health plan has terminated a contract with the non-affiliated provider for cause, and the Department has not deemed the termination to have been without merit. Effective immediately.
  


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A BILL FOR
 

  
HB1202LRB103 24930 KTG 51264 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 
5adding Section 5-47 as follows:
 
6    (305 ILCS 5/5-47 new)
7    Sec. 5-47. Managed care services for youth in care; 
8payments to non-affiliated providers.
9    (a) Statement of purpose. It is the intent of the General 
10Assembly to ensure that all youth in the care of the Department 
11of Children and Family Services have increased access to 
12health care under the YouthCare Program. 
13    (b) Definitions. As used in this Section, "youth in care" 
14has the meaning ascribed to that term in Section 4d of the  
15Children and Family Services Act. 
16    (c) In order to maximize the accessibility of health care 
17services for youth in care and former youth in care enrolled in 
18the YouthCare Program, the Department of Healthcare and Family 
19Services shall amend its managed care contracts such that a 
20managed care organization (MCO) that manages health care for  
21youth in care and former youth in care must pay for services 
22rendered by a non-affiliated provider, for which the health 
23plan would pay if rendered by an affiliated provider, at the 
 
 
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1rate paid under the Illinois Medicaid fee-for-service program 
2methodology for such services, including all policy adjusters, 
3including, but not limited to, Medicaid High Volume 
4Adjustments, Medicaid Percentage Adjustments, Outpatient High 
5Volume Adjustments, and all outlier add-on adjustments to the 
6extent such adjustments are incorporated in the development of 
7the applicable MCO capitated rates, unless a different rate 
8was agreed upon by the health plan and the non-affiliated 
9provider.
10    (d) In cases where a MCO must pay for services rendered by 
11a non-affiliated provider, the requirements under subsection  
12(c) shall not apply if the services were not emergency 
13services, as defined in Section 5-30.1, and:
14        (1) the non-affiliated provider has, within the 12 
15    months preceding the date of service, rejected a contract 
16    that was offered in good faith by the health plan as 
17    determined by the Department; or 
18        (2) the health plan has terminated a contract with the 
19    non-affiliated provider for cause, and the Department has 
20    not deemed the termination to have been without merit. The 
21    Department may deem that a determination for cause has 
22    merit if:
23            (A) an institutional provider has repeatedly 
24        failed to conduct discharge planning; or
25            (B) the provider's conduct adversely and 
26        substantially impacts the health of Medicaid patients; 
 
 
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1        or
2            (C) the provider's conduct constitutes fraud, 
3        waste, or abuse; or
4            (D) the provider's conduct violates the code of 
5        ethics governing his or her profession.
  
 
6    Section 99. Effective date. This Act takes effect upon 
7becoming law.