99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB1729

 

Introduced 2/20/2015, by Sen. Heather A. Steans

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Illinois Public Aid Code. Provides that beginning July 1, 2015, the Department of Healthcare and Family Services shall publish monthly reports on its website on the enrollment of persons in the State's medical assistance program, and the enrollment of recipients of medical assistance into a Medicaid Managed Care Entity contracted by the Department. Provides that the monthly reports shall include certain information for the medical assistance program generally and, separately, for each Medicaid Managed Care Entity contracted by the Department, including: (i) total enrollment and (ii) the number of persons enrolled in the medical assistance program pursuant to the Patient Protection and Affordable Care Act. Requires the Department to annually publish on its website every Medicaid Managed Care Entity's quality metrics outcomes and to make public an independent annual quality review report on the State's Medicaid managed care delivery system. Requires the Department to compile on a monthly basis data on eligibility redeterminations of beneficiaries of medical assistance. Requires the data to be posted on the Department's website and to include certain information, including: (a) the total number of redetermination decisions made in a month and, of that total number, the number of decisions to continue benefits, the number of decisions to change benefits, and the number of decisions to cancel benefits; and (b) if a vendor is procured to assist the Department in the redetermination process, the total number of redetermination decisions made in a month with the involvement of the vendor and without the involvement of the vendor. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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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 Section 11-5.1 and by adding Section 5-30.2 as
6follows:
 
7    (305 ILCS 5/5-30.2 new)
8    Sec. 5-30.2. Monthly reports; managed care enrollment.
9    (a) As used in this section, "Medicaid Managed Care Entity"
10means a Managed Care Organization (MCO), a Managed Care
11Community Network (MCCN), an Accountable Care Entity (ACE), or
12a Care Coordination Entity (CCE) contracted by the Department.
13    (b) Beginning July 1, 2015, the Department shall publish
14monthly reports on its website on the enrollment of persons in
15the State's medical assistance program. In addition, beginning
16July 1, 2015, the Department shall publish monthly reports on
17its website on the enrollment of recipients of medical
18assistance into a Medicaid Managed Care Entity contracted by
19the Department. The monthly reports shall include all of the
20following information for the medical assistance program
21generally and, separately, for each Medicaid Managed Care
22Entity contracted by the Department:
23        (1) Total enrollment.

 

 

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1        (2) The number of persons enrolled in the medical
2    assistance program pursuant to the Patient Protection and
3    Affordable Care Act (Public Law 111-148).
4        (3) The number of children enrolled.
5        (4) The number of parents and caretakers of minor
6    children enrolled.
7        (5) The number of pregnant women enrolled.
8        (6) The number of seniors enrolled.
9        (7) The number of persons with disabilities enrolled.
10    (c) Beginning July 1, 2015, the Department shall publish
11monthly reports on its website detailing the percentage of
12persons enrolled in each Medicaid Managed Care Entity that was
13assigned using an auto-assignment algorithm. This percentage
14should also report the type of enrollee who was assigned using
15an auto-assignment algorithm, including, but not limited to,
16persons enrolled in the medical assistance program pursuant to
17the Patient Protection and Affordable Care Act (Public Law
18111-148), children, parents and caretakers of minor children,
19pregnant women, seniors, and persons with disabilities.
20    (d) Monthly enrollment reports for each Medicaid Managed
21Care Entity shall include data on the 2 most recent months and
22data comparing the current month to that month in the prior
23year.
24    (e) Monthly enrollment reports for each Medicaid Managed
25Care Entity shall include a breakdown of language preference
26for enrollees.

 

 

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1    (f) The Department must annually publish on its website
2each Medicaid Managed Care Entity's quality metrics outcomes
3and must make public an independent annual quality review
4report on the State's Medicaid managed care delivery system.
 
5    (305 ILCS 5/11-5.1)
6    Sec. 11-5.1. Eligibility verification. Notwithstanding any
7other provision of this Code, with respect to applications for
8medical assistance provided under Article V of this Code,
9eligibility shall be determined in a manner that ensures
10program integrity and complies with federal laws and
11regulations while minimizing unnecessary barriers to
12enrollment. To this end, as soon as practicable, and unless the
13Department receives written denial from the federal
14government, this Section shall be implemented:
15    (a) The Department of Healthcare and Family Services or its
16designees shall:
17        (1) By no later than July 1, 2011, require verification
18    of, at a minimum, one month's income from all sources
19    required for determining the eligibility of applicants for
20    medical assistance under this Code. Such verification
21    shall take the form of pay stubs, business or income and
22    expense records for self-employed persons, letters from
23    employers, and any other valid documentation of income
24    including data obtained electronically by the Department
25    or its designees from other sources as described in

 

 

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1    subsection (b) of this Section.
2        (2) By no later than October 1, 2011, require
3    verification of, at a minimum, one month's income from all
4    sources required for determining the continued eligibility
5    of recipients at their annual review of eligibility for
6    medical assistance under this Code. Such verification
7    shall take the form of pay stubs, business or income and
8    expense records for self-employed persons, letters from
9    employers, and any other valid documentation of income
10    including data obtained electronically by the Department
11    or its designees from other sources as described in
12    subsection (b) of this Section. The Department shall send a
13    notice to recipients at least 60 days prior to the end of
14    their period of eligibility that informs them of the
15    requirements for continued eligibility. If a recipient
16    does not fulfill the requirements for continued
17    eligibility by the deadline established in the notice a
18    notice of cancellation shall be issued to the recipient and
19    coverage shall end on the last day of the eligibility
20    period. A recipient's eligibility may be reinstated
21    without requiring a new application if the recipient
22    fulfills the requirements for continued eligibility prior
23    to the end of the third month following the last date of
24    coverage (or longer period if required by federal
25    regulations). Nothing in this Section shall prevent an
26    individual whose coverage has been cancelled from

 

 

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1    reapplying for health benefits at any time.
2        (3) By no later than July 1, 2011, require verification
3    of Illinois residency.
4    (b) The Department shall establish or continue cooperative
5arrangements with the Social Security Administration, the
6Illinois Secretary of State, the Department of Human Services,
7the Department of Revenue, the Department of Employment
8Security, and any other appropriate entity to gain electronic
9access, to the extent allowed by law, to information available
10to those entities that may be appropriate for electronically
11verifying any factor of eligibility for benefits under the
12Program. Data relevant to eligibility shall be provided for no
13other purpose than to verify the eligibility of new applicants
14or current recipients of health benefits under the Program.
15Data shall be requested or provided for any new applicant or
16current recipient only insofar as that individual's
17circumstances are relevant to that individual's or another
18individual's eligibility.
19    (c) Within 90 days of the effective date of this amendatory
20Act of the 96th General Assembly, the Department of Healthcare
21and Family Services shall send notice to current recipients
22informing them of the changes regarding their eligibility
23verification.
24    (d) The Department shall compile on a monthly basis data on
25eligibility redeterminations of beneficiaries of medical
26assistance provided under Article V of this Code. This data

 

 

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1shall be posted on the Department's website, and data from
2prior months shall be retained and available on the
3Department's website. The data compiled and reported shall
4include the following:
5        (1) The total number of redetermination decisions made
6    in a month and, of that total number, the number of
7    decisions to continue benefits, the number of decisions to
8    change benefits, and the number of decisions to cancel
9    benefits.
10        (2) A breakdown of enrollee language preference for the
11    total number of redetermination decisions made in a month
12    and, of that total number, a breakdown of enrollee language
13    preference for the number of decisions to continue
14    benefits, a breakdown of enrollee language preference for
15    the number of decisions to change benefits, and a breakdown
16    of enrollee language preference for the number of decisions
17    to cancel benefits.
18        (3) The percentage of cancellation decisions made in a
19    month due to each of the following:
20            (A) The beneficiary's ineligibility due to excess
21        income.
22            (B) The beneficiary's ineligibility due to not
23        being an Illinois resident.
24            (C) The beneficiary's ineligibility due to being
25        deceased.
26            (D) The beneficiary's request to cancel benefits

 

 

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1        due to having other insurance.
2            (E) The beneficiary's lack of response after
3        notices mailed to the beneficiary are returned to the
4        Department as undeliverable by the United States
5        Postal Service.
6            (F) The beneficiary's lack of response to a request
7        for additional information when reliable information
8        in the beneficiary's account, or other more current
9        information, is unavailable to the Department to make a
10        decision on whether to continue benefits.
11            (G) Other reasons tracked by the Department for the
12        purpose of ensuring program integrity.
13        (4) If a vendor is procured to assist the Department in
14    the redetermination process, the total number of
15    redetermination decisions made in a month and, of that
16    total number, the number of decisions to continue benefits,
17    the number of decisions to change benefits, and the number
18    of decisions to cancel benefits (i) with the involvement of
19    the vendor and (ii) without the involvement of the vendor.
20        (5) Of the total number of benefit cancellations in a
21    month, the number of beneficiaries who return from
22    cancellation within one month, the number of beneficiaries
23    who return from cancellation within 2 months, and the
24    number of beneficiaries who return from cancellation
25    within 3 months. Of the number of beneficiaries who return
26    from cancellation within 3 months, the percentage of those

 

 

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1    cancellations due to each of the reasons listed under
2    paragraph (3) of this subsection.
3(Source: P.A. 98-651, eff. 6-16-14.)
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    305 ILCS 5/5-30.2 new
4    305 ILCS 5/11-5.1