HB3245 101ST GENERAL ASSEMBLY

LRB101 08838 KTG 53927 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3245

Introduced , by Rep. Mary E. Flowers

SYNOPSIS AS INTRODUCED:

See Index

Amends the Illinois Public Aid Code. Provides that on and after January 1, 2020 no recipient of medical assistance shall be required to enroll or transition to the State's managed care medical assistance program. Provides that any recipient enrolled in a managed care health plan on January 1, 2020 shall be given the option to disenroll from the State's managed care medical assistance program and receive coverage under the State's fee-for-service program. Provides that on and after January 1, 2020, the Department of Healthcare and Family Services shall not enter into any new contract or agreement with a managed care organization (MCO) to provide services where payment for medical services is made on a capitated basis. Provides that the Department shall not renew, renter, renegotiate, change orders, or amend any contract or agreement it entered with a MCO that was solicited under the State of Illinois Medicaid Managed Care Organization Request for Proposals (2018-24-001) (Request for Proposals (2018-24-001)). Provides that any recipient who is enrolled in a managed care health plan administered by a MCO that entered a contract with the Department under the Request for Proposals (2018-24-001) shall be transitioned to the State's fee-for-service program upon the expiration of the MCO's contract with the Department. Requires the Department to establish, by rule, an appeals and grievance process that includes: (i) an expedited internal review of an appeal involving an adverse determination; (ii) a final adverse determination; and (iii) a standard external review. Requires the Department to notify a recipient in writing of the recipient's right to request an external review. Repeals a provision concerning procurement requirements for MCO contracts.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by adding Sections 5-36 and 5-37 as follows:

(305 ILCS 5/5-36 new)

Sec. 5-36. Termination of managed care.

(a) On and after January 1, 2020, no recipient of medical assistance shall be required to enroll or transition to the State's managed care medical assistance program. Any recipient of medical assistance who is enrolled in a managed care health plan on January 1, 2020 shall be given the option to disenroll from the State's managed care medical assistance program and receive medical assistance coverage under the State's fee-for-service medical assistance program.

(b) On and after January 1, 2020, the Department of Healthcare and Family Services shall not enter into any new contract or agreement with a managed care organization as defined in Section 5-30.1 or with any other entity to provide services where payment for medical services is made on a capitated basis. The Department of Healthcare and Family Services shall not renew, renter, renegotiate, change orders, or amend any contract or agreement it entered with a managed care organization, as defined in Section 5-30.1, that was solicited under the State of Illinois Medicaid Managed Care Organization Request for Proposals (2018-24-001). Any recipient of medical assistance who is enrolled in a managed care health plan administered by a managed care organization that entered a contract with the Department under the State of Illinois Medicaid Managed Care Organization Request for Proposals (2018-24-001) shall be transitioned to the State's fee-for-service medical assistance program upon the expiration of the managed care organization's contract with the Department.

(305 ILCS 5/5-37 new)

Sec. 5-37. External review and appeal process.

(a) Notwithstanding any other provision of this Code, the Department shall establish, by rule, an appeals and grievance process that includes:

(1) an expedited internal review of an appeal involving an adverse determination;

(2) a final adverse determination; and

(3) a standard external review.

(b) At the same time the Department sends written notice of a recipient's right to appeal a coverage decision upon an adverse determination or a final adverse determination, the Department shall notify a recipient and the recipient's authorized representative, if any, in writing of the recipient's right to request an external review as prescribed by the Department.

(305 ILCS 5/5-30.6 rep.)

Section 10. Illinois Public Aid Code is amended by repealing Section 5-30.6.