HB4893 - 104th General Assembly (2025-2026)
MEDICAID-MCO BEHAVIORIAL HLTH
Last Action
3/27/2026 - House: Rule 19(a) / Re-referred to Rules Committee
Statutes Amended In Order of Appearance
Synopsis As Introduced
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services must incorporate minimum standards governing behavioral health pre-payment and post-payment reviews into MCO contracts effective for all services covered on and after January 1, 2027. Requires the Department to develop or adopt behavioral health-specific pre-payment and post-payment review guidelines and incorporate such guidelines by reference into MCO contracts. Provides that the Department-issued guidelines must: (1) define the documentation and clearly specify the discrete data elements that may be requested prior to and during a pre-payment or post-payment review, and applicable response timeframes, ensuring that all requests are specific, reasonable, and directly tied to the review objectives; (2) identify regulatory, statutory, and contractual standards applicable to behavioral health services; (3) establish uniform evaluation criteria and checklists; and (4) be publicly available and updated as necessary. Contains provisions on MCO contracts and required contract terms; pre-payment and post-payment review processes and notice requirements; timeframes for providers to respond to a documentation request; communication protocols; contract transparency and extrapolation from a statistical sampling of claims; the timeliness and closure of claims reviews; submission methods; reviewer qualifications; and enforcement. Effective immediately.
Actions
| Date | Chamber | Action |
|---|---|---|
| 2/03/2026 | House | Filed with the Clerk by Rep. Lindsey LaPointe |
| 2/06/2026 | House | First Reading |
| 2/06/2026 | House | Referred to Rules Committee |
| 3/04/2026 | House | Assigned to Appropriations-Health and Human Services Committee |
| 3/09/2026 | House | Added Co-Sponsor Rep. Rita Mayfield |
| 3/09/2026 | House | Added Co-Sponsor Rep. Laura Faver Dias |
| 3/10/2026 | House | Added Co-Sponsor Rep. Nabeela Syed |
| 3/13/2026 | House | Added Co-Sponsor Rep. Diane Blair-Sherlock |
| 3/13/2026 | House | Added Co-Sponsor Rep. Lisa Davis |
| 3/16/2026 | House | Added Co-Sponsor Rep. Dagmara Avelar |
| 3/19/2026 | House | Added Co-Sponsor Rep. Barbara Hernandez |
| 3/19/2026 | House | Added Co-Sponsor Rep. Theresa Mah |
| 3/20/2026 | House | To Appropriations-Medicaid Subcommittee |
| 3/24/2026 | House | Added Co-Sponsor Rep. Carol Ammons |
| 3/27/2026 | House | Rule 19(a) / Re-referred to Rules Committee |