Full Text of SR1916 99th General Assembly
SR1916 99TH GENERAL ASSEMBLY |
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| 1 | | SENATE RESOLUTION
| 2 | | WHEREAS, The Medicaid program in Illinois has a substantial | 3 | | and
growing impact both in terms of taxpayer dollars and in | 4 | | terms of the
effect it has on citizens across the State; and
| 5 | | WHEREAS, State resources for healthcare services are | 6 | | currently so
scarce that many healthcare providers are | 7 | | discontinuing services leading to
a profoundly detrimental | 8 | | impact on our communities; and
| 9 | | WHEREAS, Enrollment under the Department of Healthcare and
| 10 | | Family Services' Medical Programs (Medicaid) exceeds 3 | 11 | | million; and
| 12 | | WHEREAS, Over 60% of the Medicaid population is currently | 13 | | enrolled
in Managed Care Organizations (MCOs), making outlays | 14 | | to MCOs one of
the largest resource uses in the State; and
| 15 | | WHEREAS, Heretofore there has been inadequate information
| 16 | | disseminated to the General Assembly in terms of how State | 17 | | resources are
being spent on MCOs and on the overall healthcare | 18 | | outcomes for
individuals enrolled in these MCOs; and
| 19 | | WHEREAS, In an environment of limited funding for education | 20 | | and
other critical needs, the Senate must stay engaged in |
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| 1 | | Medicaid funding and
corresponding healthcare outcome issues | 2 | | and be prepared to make
legislative decisions and | 3 | | administrative recommendations; and
| 4 | | WHEREAS, Having per-recipient MCO costs from each State | 5 | | fiscal year
for each eligibility category as a basis for | 6 | | comparison to the Fee-For-Service baseline
per-recipient costs | 7 | | will help this institution determine how effectively
Medicaid | 8 | | resources are being managed; therefore, be it
| 9 | | RESOLVED, BY THE SENATE OF THE NINETY-NINTH GENERAL | 10 | | ASSEMBLY OF THE STATE OF ILLINOIS, that we
request from the | 11 | | Department of Healthcare and Family Services
the following | 12 | | information: | 13 | | (1) Calculating a Fee-For-Service baseline. | 14 | | (a) For Fiscal Year 2012, provide the following: | 15 | | (i) The total Fiscal Year 2012 Fee-For-Service | 16 | | Medical liability for the Family Health
Plan | 17 | | population divided by the total Fiscal Year 2012 | 18 | | Family Health Plan Fee-For-Service
recipient | 19 | | member days. This quotient multiplied by 365
| 20 | | becomes the Fiscal Year 2012 per-recipient | 21 | | Fee-For-Service cost for the Family Health Plan. | 22 | | (ii) The total Fiscal Year 2012 | 23 | | Fee-For-Service Medical liability for the | 24 | | Integrated Care Program population divided by the |
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| 1 | | total Fiscal Year 2012 Integrated Care Program | 2 | | Fee-For-Service recipient
member days. This | 3 | | quotient multiplied by 365 becomes the
Fiscal Year | 4 | | 2012 per-recipient Fee-For-Service cost for the | 5 | | Integrated Care Program. | 6 | | (iii) The total Fiscal Year 2012 | 7 | | Fee-For-Service Medical liability for the | 8 | | Medicare-Medicaid Alignment Initiative population | 9 | | divided
by the total Fiscal Year 2012 | 10 | | Medicare-Medicaid Alignment Initiative | 11 | | Fee-For-Service recipient member days. This
| 12 | | quotient multiplied by 365 becomes the Fiscal Year | 13 | | 2012 per-recipient
Fee-For-Service cost for | 14 | | Medicare-Medicaid Alignment Initiative. | 15 | | For these calculations, "Medical liability" is | 16 | | defined as payments
billed by providers to any State | 17 | | agency for healthcare services
provided to eligible | 18 | | Medicaid enrollees during dates of service
between | 19 | | July 1 and June 30 of each fiscal year (commonly | 20 | | referred
to by the Department of Healthcare and Family | 21 | | Services as DCN liability). | 22 | | (b) For Fiscal Year 2013: replicate all steps in | 23 | | (1)(a) using Fiscal Year 2013 Fee-For-Service data. | 24 | | (c) For Fiscal Year 2014: replicate all steps in | 25 | | (1)(a) using Fiscal Year 2014 Fee-For-Service data. | 26 | | (d) For each category (Family Health Plan, |
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| 1 | | Integrated Care Program, and Medicare-Medicaid | 2 | | Alignment Initiative), the Fee-For-Service annual | 3 | | per-recipient
cost baseline shall be the sum of the | 4 | | Fiscal Year 2012, Fiscal Year 2013, and
Fiscal Year | 5 | | 2014 per-recipient cost divided by 3. | 6 | | (e) Provide the Department of Healthcare and | 7 | | Family Services total computable administrative cost | 8 | | for Fiscal Year 2012,
Fiscal Year 2013, and Fiscal Year | 9 | | 2014. Also, for each of these years, provide the | 10 | | MCO-comparable
administrative cost which is calculated | 11 | | by taking the
total computable administrative cost | 12 | | less all administrative costs
associated with: | 13 | | eligibility screenings, schools, other agencies,
| 14 | | federal Electronic Health Records incentives and | 15 | | planning, eligibility system design, and
county/local | 16 | | administration. | 17 | | (2) MCO per-recipient costs for Fiscal Year 2015. | 18 | | (a) Sum all MCO capitation payments made on behalf | 19 | | of Family Health Plan
recipients during Fiscal Year | 20 | | 2015 and divide this sum by the
corresponding number of | 21 | | MCO member months for these same
recipients during the | 22 | | fiscal year. This becomes the Fiscal Year 2015 | 23 | | per-recipient
MCO cost for the Family Health Plan. | 24 | | (b) Sum all MCO capitation payments made on behalf | 25 | | of Integrated Care Program
recipients during Fiscal | 26 | | Year 2015 and divide this sum by the
corresponding |
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| 1 | | number of MCO member months for these same
recipients | 2 | | during the fiscal year. This becomes the Fiscal Year | 3 | | 2015 per-recipient
MCO cost for the Integrated Care | 4 | | Program. | 5 | | (c) Sum all MCO capitation payments made on behalf | 6 | | of Medicare-Medicaid Alignment Initiative
recipients | 7 | | during Fiscal Year 2015 and divide this sum by the
| 8 | | corresponding number of MCO member months for these | 9 | | same recipients during the fiscal year. This becomes | 10 | | the Fiscal Year 2015 per-recipient
MCO cost for the | 11 | | Medicare-Medicaid Alignment Initiative. | 12 | | For (a), (b), and (c), legislatively-mandated | 13 | | changes related to
Medicaid reimbursement occurring on | 14 | | or after July 1, 2014 can
be excluded from summary | 15 | | totals, although please list and
detail these specific | 16 | | items including the actuary's calculations
for | 17 | | inclusion into the MCO rates. Also, please exclude (and
| 18 | | detail separately) any payments associated with the | 19 | | Hospital
Assessment program or the Hospital ACA | 20 | | program. | 21 | | (d) Provide the Department of Healthcare and | 22 | | Family Services total computable administrative cost | 23 | | for Fiscal Year 2015.
Additionally provide the Fiscal | 24 | | Year 2015 MCO-comparable administrative
cost which is | 25 | | calculated by taking the total computable
| 26 | | administrative cost less all administrative costs |
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| 1 | | associated with:
eligibility screenings, schools, | 2 | | other agencies, federal Electronic Health Records
| 3 | | incentives and planning, eligibility system design, | 4 | | and county/local
administration. | 5 | | (e) Provide the aggregate sum total of all MCO | 6 | | payments for Fiscal Year 2015 as
well as the aggregate | 7 | | MCO member months for Fiscal Year 2015.
| 8 | | (f) Provide the sum total of all encounter data | 9 | | received from MCOs in
Fiscal Year 2015. | 10 | | Provide to the Senate Human Services Committee all data
| 11 | | requested in (1) and (2) above no later than August 1, | 12 | | 2016. | 13 | | (3) MCO per-recipient costs for Fiscal Year 2016. | 14 | | Replicate all steps in (2) above, only substituting in | 15 | | Fiscal Year 2016 data.
Provide this data to the Senate | 16 | | Human Services committee by
August 31, 2016; and be it | 17 | | further
| 18 | | RESOLVED, That a copy of this resolution be presented
to | 19 | | the Director of the Department of Healthcare and Family | 20 | | Services.
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