Sen. Heather A. Steans
Filed: 4/15/2016
 
 

 

 

 
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1
AMENDMENT TO SENATE BILL 2306 




2    AMENDMENT NO. ______. Amend Senate Bill 2306, AS AMENDED, 
3by replacing everything after the enacting clause with the 
4following:

 
5    "Section 5. The Illinois Public Aid Code is amended  by 
6adding Section 5-30.3 as follows:
 
7    (305 ILCS 5/5-30.3 new)
8    Sec. 5-30.3. Managed care; automatic assignment. The

9Department shall, within a reasonable period of time after

10relevant data from managed care entities has been collected and

11analyzed, but no earlier than January 1, 2017, develop and

12implement within each enrollment region an algorithm 
13preserving existing provider-beneficiary relationships that 
14takes
into account quality scores and other operational 
15proficiency
criteria developed, defined, and adopted by the 
16Department, to
automatically assign Medicaid enrollees served 
 
 
09900SB2306sam002- 2 -LRB099 19419 KTG 47399 a

1under the
Family Health Plan and the Integrated Care Program 
2and those
Medicaid enrollees eligible for medical assistance 
3pursuant to
the Patient Protection and Affordable Care Act 
4(Public Law  111-148) into managed care entities, including 
5Accountable
Care Entities, Managed Care Community Networks, 
6and Managed
Care Organizations. The quality metrics used shall 
7be
measurable for all entities. The algorithm shall not use the

8quality and proficiency metrics to reassign enrollees out of

9any plan in which they are enrolled at the time and shall only

10be used if the client has not voluntarily selected a primary

11care physician and a managed care entity or care coordination

12entity. Clients shall have one opportunity within 90 calendar

13days after auto-assignment by algorithm to select a different

14managed care entity. The algorithm developed and implemented

15shall favor assignment into managed care entities with the

16highest quality scores and levels of compliance with the

17operational proficiency criteria established, taking into 
18consideration existing provider-beneficiary relationship as 
19defined by 42 CFR 438.50(f)(3) if one exists.".