Illinois General Assembly - Bill Status for SB1321

Replaces everything after the enacting clause. Amends the Illinois Public Aid Code. Permits the Department of Healthcare and Family Services to require medical assistance recipients to pay a federally approved co-payment for services (rather than prohibiting co-payments for medical assistance services and generic drugs). Removes a provision requiring the Department to authorize nutritionists and certified diabetes educators to counsel senior diabetes patients at the patient's home. Requires the Department to confer with stakeholders to discuss the development of alternative value-based payment models that move away from fee-for-service and reward health outcomes and improved quality and provide flexibility in how providers meet the needs of the individuals they serve. Requires the Department to meet with mental health providers and other specified persons no later than July 1, 2019 to discuss the development of value-based payment models. Contains provisions concerning an extended period for claims submissions outside the standard filing requirements; a dispute resolution process; annual publications on the Department's website of each Medicaid managed care organization's (MCO's) calculated medical loss ratios; a MCO's liability effective date; updated provider directories from MCOs; operational guidelines to enhance and improve operation performance of the State's Medicaid managed care program; and health care information released to managed care organizations. Contains provisions concerning managed care claim rejection and denial management; pay stub information to verify eligibility for medical assistance; other acceptable information to verify continued eligibility for medical assistance; a review of the Medicaid redetermination process in order to identify changes that can increase the use of ex parte redetermination processing; reporting requirements; and audits for the State's Integrated Eligibility System; provisional eligibility for Medicaid long-term care services. Removes a provision concerning third party liability recoveries. Requires the Department of Healthcare and Family Services to implement, by October 1, 2019, a methodology effective for dates of service July 1, 2019 and later to reimburse hospitals for inpatient stays extended beyond medical necessity. Makes other changes. Amends the Department of Healthcare and Family Services Law of the Civil Administrative Code of Illinois. Extends the completion date for a study the Department of Healthcare and Family Services must complete on long-term care trends and other matters. Amends the Illinois Procurement Code. Requires the Chief Procurement Officer to work with the Department of Healthcare and Family Services to identify an appropriate method of source selection to execute a contract for technology that will analyze claim denials in the Medicaid managed care program. Amends the Illinois Banking Act and the Illinois Credit Union Act. Makes changes to provisions concerning the furnishing of financial records by a bank or credit union to determine a person's eligibility or continued eligibility for Medicaid long-term care benefits. Amends the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act. Adds provisions concerning pay stubs and other acceptable information to determine a person's eligibility for the benefits provided under those Acts. Effective immediately.

Removes changes made to the Illinois Banking Act, the Savings Bank Act, and the Illinois Credit Union Act. Further amends the Medical Assistance Article of the Illinois Public Aid Code. Requires each Medicaid managed care health plan to submit a report to the Department of Healthcare and Family Services by March 1, 2020, and every March 1 thereafter, that includes certain information, including: (i) the amount of money the Medicaid managed care health plan has spent with Business Enterprise Program certified businesses; (ii) the amount of money the Medicaid managed care health plan has spent with minority-owned and women-owned businesses that are certified by other agencies or private organizations; and (iii) the point of contact for potential vendors seeking to do business with the Medicaid managed care health plan. Requires the Department to publish and maintain each report on its website for 5 years. Requires the Department to conduct 2 annual public workshops in May 2020 and every May thereafter to discuss the submitted Medicaid managed care health plans and to seek to connect vendors with the Medicaid managed care health plans. Provides that each Medicaid managed care health plan shall participate in the workshops and that the workshops shall be open to vendor communities.

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