SR1916 99TH GENERAL ASSEMBLY

SR1916 LRB099 21997 KTG 49101 r

SENATE RESOLUTION

WHEREAS, The Medicaid program in Illinois has a substantial and growing impact both in terms of taxpayer dollars and in terms of the effect it has on citizens across the State; and

WHEREAS, State resources for healthcare services are currently so scarce that many healthcare providers are discontinuing services leading to a profoundly detrimental impact on our communities; and

WHEREAS, Enrollment under the Department of Healthcare and Family Services' Medical Programs (Medicaid) exceeds 3 million; and

WHEREAS, Over 60% of the Medicaid population is currently enrolled in Managed Care Organizations (MCOs), making outlays to MCOs one of the largest resource uses in the State; and

WHEREAS, Heretofore there has been inadequate information disseminated to the General Assembly in terms of how State resources are being spent on MCOs and on the overall healthcare outcomes for individuals enrolled in these MCOs; and

WHEREAS, In an environment of limited funding for education and other critical needs, the Senate must stay engaged in Medicaid funding and corresponding healthcare outcome issues and be prepared to make legislative decisions and administrative recommendations; and

WHEREAS, Having per-recipient MCO costs from each State fiscal year for each eligibility category as a basis for comparison to the Fee-For-Service baseline per-recipient costs will help this institution determine how effectively Medicaid resources are being managed; therefore, be it

RESOLVED, BY THE SENATE OF THE NINETY-NINTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that we request from the Department of Healthcare and Family Services the following information:

(1) Calculating a Fee-For-Service baseline.

(a) For Fiscal Year 2012, provide the following:

(i) The total Fiscal Year 2012 Fee-For-Service Medical liability for the Family Health Plan population divided by the total Fiscal Year 2012 Family Health Plan Fee-For-Service recipient member days. This quotient multiplied by 365 becomes the Fiscal Year 2012 per-recipient Fee-For-Service cost for the Family Health Plan.

(ii) The total Fiscal Year 2012 Fee-For-Service Medical liability for the Integrated Care Program population divided by the total Fiscal Year 2012 Integrated Care Program Fee-For-Service recipient member days. This quotient multiplied by 365 becomes the Fiscal Year 2012 per-recipient Fee-For-Service cost for the Integrated Care Program.

(iii) The total Fiscal Year 2012 Fee-For-Service Medical liability for the Medicare-Medicaid Alignment Initiative population divided by the total Fiscal Year 2012 Medicare-Medicaid Alignment Initiative Fee-For-Service recipient member days. This quotient multiplied by 365 becomes the Fiscal Year 2012 per-recipient Fee-For-Service cost for Medicare-Medicaid Alignment Initiative.

For these calculations, "Medical liability" is defined as payments billed by providers to any State agency for healthcare services provided to eligible Medicaid enrollees during dates of service between July 1 and June 30 of each fiscal year (commonly referred to by the Department of Healthcare and Family Services as DCN liability).

(b) For Fiscal Year 2013: replicate all steps in (1)(a) using Fiscal Year 2013 Fee-For-Service data.

(c) For Fiscal Year 2014: replicate all steps in (1)(a) using Fiscal Year 2014 Fee-For-Service data.

(d) For each category (Family Health Plan, Integrated Care Program, and Medicare-Medicaid Alignment Initiative), the Fee-For-Service annual per-recipient cost baseline shall be the sum of the Fiscal Year 2012, Fiscal Year 2013, and Fiscal Year 2014 per-recipient cost divided by 3.

(e) Provide the Department of Healthcare and Family Services total computable administrative cost for Fiscal Year 2012, Fiscal Year 2013, and Fiscal Year 2014. Also, for each of these years, provide the MCO-comparable administrative cost which is calculated by taking the total computable administrative cost less all administrative costs associated with: eligibility screenings, schools, other agencies, federal Electronic Health Records incentives and planning, eligibility system design, and county/local administration.

(2) MCO per-recipient costs for Fiscal Year 2015.

(a) Sum all MCO capitation payments made on behalf of Family Health Plan recipients during Fiscal Year 2015 and divide this sum by the corresponding number of MCO member months for these same recipients during the fiscal year. This becomes the Fiscal Year 2015 per-recipient MCO cost for the Family Health Plan.

(b) Sum all MCO capitation payments made on behalf of Integrated Care Program recipients during Fiscal Year 2015 and divide this sum by the corresponding number of MCO member months for these same recipients during the fiscal year. This becomes the Fiscal Year 2015 per-recipient MCO cost for the Integrated Care Program.

(c) Sum all MCO capitation payments made on behalf of Medicare-Medicaid Alignment Initiative recipients during Fiscal Year 2015 and divide this sum by the corresponding number of MCO member months for these same recipients during the fiscal year. This becomes the Fiscal Year 2015 per-recipient MCO cost for the Medicare-Medicaid Alignment Initiative.

For (a), (b), and (c), legislatively-mandated changes related to Medicaid reimbursement occurring on or after July 1, 2014 can be excluded from summary totals, although please list and detail these specific items including the actuary's calculations for inclusion into the MCO rates. Also, please exclude (and detail separately) any payments associated with the Hospital Assessment program or the Hospital ACA program.

(d) Provide the Department of Healthcare and Family Services total computable administrative cost for Fiscal Year 2015. Additionally provide the Fiscal Year 2015 MCO-comparable administrative cost which is calculated by taking the total computable administrative cost less all administrative costs associated with: eligibility screenings, schools, other agencies, federal Electronic Health Records incentives and planning, eligibility system design, and county/local administration.

(e) Provide the aggregate sum total of all MCO payments for Fiscal Year 2015 as well as the aggregate MCO member months for Fiscal Year 2015.

(f) Provide the sum total of all encounter data received from MCOs in Fiscal Year 2015.

Provide to the Senate Human Services Committee all data requested in (1) and (2) above no later than August 1, 2016.

(3) MCO per-recipient costs for Fiscal Year 2016. Replicate all steps in (2) above, only substituting in Fiscal Year 2016 data. Provide this data to the Senate Human Services committee by August 31, 2016; and be it further

RESOLVED, That a copy of this resolution be presented to the Director of the Department of Healthcare and Family Services.