Full Text of HR0100 100th General Assembly
HR0100enr 100TH GENERAL ASSEMBLY |
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| 1 | | HOUSE RESOLUTION 100
| 2 | | WHEREAS, The Medicaid program in Illinois has an immense, | 3 | | and growing, impact,
both in terms of taxpayer dollars and the | 4 | | 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 Illinois Department of | 10 | | Healthcare and Family
Services' Medical Assistance Programs | 11 | | (Medicaid) exceeds three million; and | 12 | | WHEREAS, A sizable portion of the Medicaid population is | 13 | | currently enrolled, often
mandatorily, in Managed Care | 14 | | Organizations (MCOs), making outlays to MCOS, measured
in | 15 | | billions of dollars, one of the largest resource uses in the | 16 | | State; and | 17 | | WHEREAS, There has been little information disseminated to | 18 | | the General
Assembly in terms of how State resources are being | 19 | | spent on MCOs and on the overall
healthcare outcomes for | 20 | | individuals enrolled in these MCOs; and |
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| 1 | | WHEREAS, In this quickly evolving environment, the General | 2 | | Assembly must stay
engaged in Medicaid funding and | 3 | | corresponding healthcare outcome issues and must be prepared
to | 4 | | make legislative and administrative recommendations; | 5 | | therefore, be it | 6 | | RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE | 7 | | HUNDREDTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that the | 8 | | Auditor General is directed to conduct an audit of Medicaid | 9 | | MCOs, which includes a
comparison of State expenditures between | 10 | | MCOs and the Medicaid fee-for-service program; and be it | 11 | | further | 12 | | RESOLVED, That the audit shall examine capitation rate | 13 | | setting and reimbursement
issues for Medicaid MCOs for fiscal | 14 | | year 2016 with respect to the following issues: | 15 | | (1) Compare the total dollar amount of all reported MCO | 16 | | encounter data submitted to the
Illinois Department of | 17 | | Healthcare and Family Services (DHFS) during SFY 2016 to | 18 | | the total dollar
amount of reported claims payments made on | 19 | | behalf of Illinois Medicaid
individuals by MCOs as reported | 20 | | to DHFS during SFY 2016; | 21 | | (2) Whether MCO encounter data is used by the | 22 | | Department of Healthcare and Family
Services (DHFS) to set |
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| 1 | | capitation rates; | 2 | | (3) Calculate the aggregate amount of MCO capitation | 3 | | payments made by DHFS
during SFY2016 (exclude payments | 4 | | authorized under 305 ILCS Sections 5/5A-12.2, 5/5A-12.4, | 5 | | and 5/5A-12 from this
calculation); | 6 | | (4) Determine the amount of payments made by DHFS to | 7 | | reimburse for-profit MCOs for the
ACA Health Insurance Fee | 8 | | (HIF); determine if reimbursement by the State to | 9 | | for-profit MCOs for this HIF payment is mandated by
federal | 10 | | CMS; | 11 | | (5) Determine the amount of payments made by DHFS to | 12 | | reimburse for-profit MCOs for "gross-ups"
related to the | 13 | | HIF payment; determine the purpose of the "gross-up"
| 14 | | payments; | 15 | | (6) The incidence to which the MCO capitation rates | 16 | | contain supplemental, GRF-based
payments to providers; for | 17 | | these payments, determine the amount of the
supplemental, | 18 | | which providers received these payments, and whether these | 19 | | monies
were directly tied to services actually provided (do | 20 | | not include payments authorized under 305 ILCS Sections | 21 | | 5/5A-12.2, 5/5A-12.4, and 5/5A-12); |
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| 1 | | (7) What administrative costs are paid to MCOs in terms | 2 | | of total dollars and percent of
overall MCO medical | 3 | | based-payments; | 4 | | (8) What is the average payout ratio for all MCOs in | 5 | | aggregate
and for each MCO individually; for the purposes | 6 | | of this audit, payout ratio is defined as
all paid claims | 7 | | to Medicaid providers made by MCOs as reported to HFS for | 8 | | state fiscal year 2016 divided
by aggregate MCO capitation | 9 | | payments made by DHFS for State fiscal year 2016; and | 10 | | (9) What the denial rates are for MCOs and for | 11 | | fee-for-service providers billing the
DHFS; determine | 12 | | whether there is a higher denial rate for services paid by | 13 | | MCOs; and be it further | 14 | | RESOLVED, That the Illinois Department of Healthcare and | 15 | | Family Services and any
other State agency having information | 16 | | relevant to this audit cooperate fully and promptly
with the | 17 | | Auditor General's Office in its conduct; and be it further | 18 | | RESOLVED, That the Auditor General commence this audit as | 19 | | soon as possible and
report his findings and recommendations | 20 | | upon completion in accordance with the provisions
of Section | 21 | | 3-14 of the Illinois State Auditing Act.
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