Rep. Camille Y. Lilly
Filed: 5/20/2024
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1 | AMENDMENT TO HOUSE BILL 4076 | ||||||
2 | AMENDMENT NO. ______. Amend House Bill 4076 by replacing | ||||||
3 | everything after the enacting clause with the following: | ||||||
4 | "Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | adding Section 11-5.3a as follows: | ||||||
6 | (305 ILCS 5/11-5.3a new) | ||||||
7 | Sec. 11-5.3a. Vendor assistance to managed care | ||||||
8 | organizations. | ||||||
9 | (a) Each managed care organization, as defined in Section | ||||||
10 | 5-30.1, may enter into one or more contracts with eligible | ||||||
11 | vendors to assist in the collection of updated contact | ||||||
12 | information of existing medical assistance enrollees, other | ||||||
13 | than enrollees for whom an ex parte renewal is determined by | ||||||
14 | the Department in accordance with a federal waiver provided | ||||||
15 | under Section 1902(e)(14)(A) of the Social Security Act and | ||||||
16 | enrollees who have responded to the Department within 30 days |
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1 | after contact is initiated. Eligible vendors must be certified | ||||||
2 | by the Business Enterprise Program and have no less than 60% of | ||||||
3 | its owners with established residency in Illinois as of the | ||||||
4 | effective date of this amendatory Act of the 103rd General | ||||||
5 | Assembly. | ||||||
6 | (b) Selected vendors shall assist in the identification | ||||||
7 | and collection of updated contact information for medical | ||||||
8 | assistance enrollees of the managed care organization by | ||||||
9 | utilizing a system that meets the following requirements: | ||||||
10 | (1) The system must be hosted on a platform that is | ||||||
11 | secure and compliant with standards under the federal | ||||||
12 | Health Insurance Portability and Accountability Act of | ||||||
13 | 1996. Such platform must be scalable and may be | ||||||
14 | cloud-based or on premises. | ||||||
15 | (2) The system must use a communication platform to | ||||||
16 | programmatically perform calls, text messages, and other | ||||||
17 | communication functions using web services or application | ||||||
18 | programming interface services. | ||||||
19 | (3) The system must be able to make contact with a | ||||||
20 | medical assistance enrollee in an automated fashion, | ||||||
21 | continuing until contact is made and confirmed and contact | ||||||
22 | information is updated. | ||||||
23 | (4) The system must allow medical assistance enrollees | ||||||
24 | to enter, update, and transmit their updated contact | ||||||
25 | information through use of a voice virtual agent or text | ||||||
26 | virtual agent to an online web form and back to a human |
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1 | assistant without losing any data input. | ||||||
2 | (5) The system must allow a medical assistance | ||||||
3 | enrollee to switch between the voice virtual agent, the | ||||||
4 | text virtual agent, and an online web form. | ||||||
5 | (6) The system must be designed to be compliant with | ||||||
6 | the Americans with Disabilities Act (ADA). ADA compliance | ||||||
7 | must be found regardless of which of the different ways a | ||||||
8 | medical assistance enrollee enters the data, and then, any | ||||||
9 | of the other means to which the medical assistance | ||||||
10 | enrollee can switch, must continue to be ADA compliant | ||||||
11 | regardless of the stage of the redetermination process | ||||||
12 | that the enrollee is in and regardless of the number of | ||||||
13 | transitions from one data entry means to another. | ||||||
14 | (7) The system must provide an analytics dashboard | ||||||
15 | that is tethered to the communication platform with no | ||||||
16 | additional software installation on the user's computer or | ||||||
17 | mobile devices. | ||||||
18 | (8) The system must include a data processing platform | ||||||
19 | to accumulate enrollee data to begin the process in an | ||||||
20 | automated fashion. This includes data validation, | ||||||
21 | rejection, and preparation for communication such as call | ||||||
22 | or text. | ||||||
23 | (9) The system must be capable of contacting each | ||||||
24 | medical assistance enrollee not less than 3 times per year | ||||||
25 | utilizing skip tracing and bi-directional texting | ||||||
26 | processes to locate up-to-date contact information for |
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1 | members. | ||||||
2 | (10) The system must include a data processing | ||||||
3 | platform to provide data submitted by medical assistance | ||||||
4 | enrollees to managed care organizations at a predefined | ||||||
5 | frequency, such as daily, weekly, or monthly and for | ||||||
6 | measures identified within the Healthcare Effectiveness | ||||||
7 | Data and Information Set guidelines. | ||||||
8 | (c) The Department shall establish a process to accept | ||||||
9 | updated contact information provided by managed care | ||||||
10 | organizations or their contracted vendors under this Section | ||||||
11 | no later than 60 days after the effective date of this | ||||||
12 | amendatory Act of the 103rd General Assembly. Nothing in this | ||||||
13 | amendatory Act of the 103rd General Assembly shall be | ||||||
14 | construed to contravene any federal regulation, policy, or | ||||||
15 | requirement of the Centers for Medicare and Medicaid Services. | ||||||
16 | If any provision of this Section or its application is found to | ||||||
17 | be in violation of any federal regulation, policy, or | ||||||
18 | requirement of the Centers for Medicare and Medicaid Services, | ||||||
19 | that provision is declared invalid. | ||||||
20 | (d) Beginning no later than the 30th day of each fiscal | ||||||
21 | year, the Department shall issue monthly payments to each | ||||||
22 | managed care organization, which shall be used to issue | ||||||
23 | payments to its contracted vendors in accordance with this | ||||||
24 | Section. Each managed care organization shall receive a | ||||||
25 | payment in an amount equal to $6 per medical assistance | ||||||
26 | enrollee for which updated contact information is being |
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1 | sought, limited to no more than $6 per medical assistance | ||||||
2 | enrollee in any 12-month period. | ||||||
3 | (e) Each managed care organization shall report, in a | ||||||
4 | format prescribed by the Department, on at least a quarterly | ||||||
5 | basis the status of its activity or that of its vendors | ||||||
6 | regarding assistance with collecting updated contact | ||||||
7 | information. The Department shall, in turn, report quarterly | ||||||
8 | on its utilization of the information provided by the managed | ||||||
9 | care organizations or their contracted vendors in accordance | ||||||
10 | with this Section. | ||||||
11 | (f) Nothing in this amendatory Act of the 103rd General | ||||||
12 | Assembly shall be construed to permit the Department or any | ||||||
13 | county operating a managed care organization to transfer | ||||||
14 | functions being performed by its employees to eligible vendors | ||||||
15 | under this Section, including standard procedures to secure | ||||||
16 | updated contact information for medical assistance enrollees. | ||||||
17 | Section 99. Effective date. This Act takes effect July 1, | ||||||
18 | 2024.". |