State of Illinois
2021 and 2022


Introduced 2/26/2021, by Sen. David Koehler


305 ILCS 5/5-2.01
305 ILCS 5/5-30.1

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that no later than 90 days after the effective date of the amendatory Act, the Department of Healthcare and Family Services shall post on its official website: (i) a copy of all current, executed, or adopted contracts with each managed care organization (MCO), including all amendments, attachments, and exhibits, that are in effect as of January 1, 2021; (ii) all changes made to each MCO contract that are in effect on or after January 1, 2021; (iii) all operational policy changes issued to MCOs; and (iv) a copy of all contracts and operational policy changes for a period of not less than 24 months after the termination or expiration of any MCO contract. Provides that the Department shall prohibit each MCO from operating, implementing, or modifying any program or policy that concerns, but it not limited to, reducing potentially preventable hospital readmissions (PPR) until after the Department has adopted an updated PPR policy for services provided to individuals not covered under managed care. Contains provisions concerning prohibited PPR policy measures. Provides that if the Department elects to implement a comprehensive PPR policy that applies to both the fee-for-service and managed care medical assistance programs, then no MCO may operate a similar PPR policy. Provides that an MCO shall not make a material change unless the material change has been approved by the Department or agreed upon in writing by the MCO and the health care provider. Requires the Department to publish on its website a process through which an MCO may submit a written proposed material change request. Effective immediately.

LRB102 15657 KTG 21020 b






SB2006LRB102 15657 KTG 21020 b

1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-2.01 and 5-30.1 as follows:
6    (305 ILCS 5/5-2.01)
7    Sec. 5-2.01. Medicaid accountability through transparency
9    (a) Internet-based transparency program. The Director of
10the Department of Healthcare and Family Services shall be
11authorized to implement a program under which the Director
12shall make available through the Department's public Internet
13website information on medical claims reimbursed under the
14State's medical assistance program insofar as such information
15has been de-identified in accordance with regulations
16promulgated pursuant to the Illinois Health Insurance
17Portability and Accountability Act. In implementing the
18program, the Director shall ensure the following:
19        (1) The information made so available shall be in a
20    format that is easily accessible, useable, and
21    understandable to the public, including individuals
22    interested in improving the quality of care provided to
23    individuals eligible for items and services under this



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1    Article, researchers, health care providers, and
2    individuals interested in reducing the prevalence of waste
3    and fraud under this Article.
4        (2) The information made so available shall be as
5    current as deemed practical by the Director and shall be
6    updated at least once per calendar quarter.
7        (3) The information made so available shall be
8    aggregated to a level to ensure patient confidentiality,
9    but shall, to the extent feasible, allow for posting of
10    information by provider or vendor name and county, number
11    of individuals served, total patient visits, payment for
12    bills submitted, average cost for bills submitted,
13    adjustments to payments, and total amounts paid.
14        (4) The Director periodically solicits comments from a
15    sampling of individuals who access the information through
16    the program on how to best improve the utility of the
17    program.
18    (b) Use of contractor. For purposes of implementing the
19program under subsection (a) of this Section and ensuring the
20information made available through the program is periodically
21updated, the Director may select and enter into a contract
22with a public or private entity meeting the criteria and
23qualifications the Director determines appropriate.
24    (c) Annual Reports. Not later than 12 months after the
25effective date of this amendatory Act of the 96th General
26Assembly and annually thereafter, the Director shall submit to



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1the General Assembly a report on the status of the program
2authorized under subsection (a). The report shall include
3details including, but not limited to, the estimated or actual
4costs of developing and maintaining the reporting system, the
5actual or potential benefit or adverse consequences associated
6with the system, and, if applicable, the extent to which
7information made available through the program is accessed and
8the extent to which comments received under paragraph (4) of
9subsection (a) of this Section were used to improve the
10utility of the program.
11    (d) Managed care contracts and operational policy changes.
12        (1) No later than 90 days after the effective date of
13    this amendatory Act of the 102nd General Assembly, the
14    Department shall post on its official website a copy of
15    all current, executed, or adopted contracts with each
16    managed care organization (MCO), including all amendments,
17    attachments, and exhibits, that are in effect as of
18    January 1, 2021. The Department shall post on its official
19    website, within 60 days of execution or adoption, all
20    changes made to each MCO contract, including all
21    amendments, attachments, and exhibits, that are in effect
22    on or after January 1, 2021.
23        (2) The Department shall post to its official website
24    all operational policy changes, as defined in paragraph
25    (1) of subsection (c) of Section 5-30.8, issued to MCOs no
26    later than 60 days prior to the effective date of the



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1    change.
2        (3) No later than 180 days after the effective date of
3    this amendatory Act of the 102nd General Assembly, the
4    Department shall post all operational policy changes
5    issued during the 12 months preceding the effective date
6    of this amendatory Act of the 102nd General Assembly.
7        (4) The Department shall maintain a copy of all
8    contracts and operational policy changes required under
9    this subsection on its official website for a period of
10    not less than 24 months after the termination or
11    expiration of any MCO contract.
12(Source: P.A. 96-941, eff. 6-25-10.)
13    (305 ILCS 5/5-30.1)
14    Sec. 5-30.1. Managed care protections.
15    (a) As used in this Section:
16    "Managed care organization" or "MCO" means any entity
17which contracts with the Department to provide services where
18payment for medical services is made on a capitated basis.
19    "Emergency services" include:
20        (1) emergency services, as defined by Section 10 of
21    the Managed Care Reform and Patient Rights Act;
22        (2) emergency medical screening examinations, as
23    defined by Section 10 of the Managed Care Reform and
24    Patient Rights Act;
25        (3) post-stabilization medical services, as defined by



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1    Section 10 of the Managed Care Reform and Patient Rights
2    Act; and
3        (4) emergency medical conditions, as defined by
4    Section 10 of the Managed Care Reform and Patient Rights
5    Act.
6    (b) As provided by Section 5-16.12, managed care
7organizations are subject to the provisions of the Managed
8Care Reform and Patient Rights Act.
9    (c) An MCO shall pay any provider of emergency services
10that does not have in effect a contract with the contracted
11Medicaid MCO. The default rate of reimbursement shall be the
12rate paid under Illinois Medicaid fee-for-service program
13methodology, including all policy adjusters, including but not
14limited to Medicaid High Volume Adjustments, Medicaid
15Percentage Adjustments, Outpatient High Volume Adjustments,
16and all outlier add-on adjustments to the extent such
17adjustments are incorporated in the development of the
18applicable MCO capitated rates.
19    (d) An MCO shall pay for all post-stabilization services
20as a covered service in any of the following situations:
21        (1) the MCO authorized such services;
22        (2) such services were administered to maintain the
23    enrollee's stabilized condition within one hour after a
24    request to the MCO for authorization of further
25    post-stabilization services;
26        (3) the MCO did not respond to a request to authorize



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1    such services within one hour;
2        (4) the MCO could not be contacted; or
3        (5) the MCO and the treating provider, if the treating
4    provider is a non-affiliated provider, could not reach an
5    agreement concerning the enrollee's care and an affiliated
6    provider was unavailable for a consultation, in which case
7    the MCO must pay for such services rendered by the
8    treating non-affiliated provider until an affiliated
9    provider was reached and either concurred with the
10    treating non-affiliated provider's plan of care or assumed
11    responsibility for the enrollee's care. Such payment shall
12    be made at the default rate of reimbursement paid under
13    Illinois Medicaid fee-for-service program methodology,
14    including all policy adjusters, including but not limited
15    to Medicaid High Volume Adjustments, Medicaid Percentage
16    Adjustments, Outpatient High Volume Adjustments and all
17    outlier add-on adjustments to the extent that such
18    adjustments are incorporated in the development of the
19    applicable MCO capitated rates.
20    (e) The following requirements apply to MCOs in
21determining payment for all emergency services:
22        (1) MCOs shall not impose any requirements for prior
23    approval of emergency services.
24        (2) The MCO shall cover emergency services provided to
25    enrollees who are temporarily away from their residence
26    and outside the contracting area to the extent that the



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1    enrollees would be entitled to the emergency services if
2    they still were within the contracting area.
3        (3) The MCO shall have no obligation to cover medical
4    services provided on an emergency basis that are not
5    covered services under the contract.
6        (4) The MCO shall not condition coverage for emergency
7    services on the treating provider notifying the MCO of the
8    enrollee's screening and treatment within 10 days after
9    presentation for emergency services.
10        (5) The determination of the attending emergency
11    physician, or the provider actually treating the enrollee,
12    of whether an enrollee is sufficiently stabilized for
13    discharge or transfer to another facility, shall be
14    binding on the MCO. The MCO shall cover emergency services
15    for all enrollees whether the emergency services are
16    provided by an affiliated or non-affiliated provider.
17        (6) The MCO's financial responsibility for
18    post-stabilization care services it has not pre-approved
19    ends when:
20            (A) a plan physician with privileges at the
21        treating hospital assumes responsibility for the
22        enrollee's care;
23            (B) a plan physician assumes responsibility for
24        the enrollee's care through transfer;
25            (C) a contracting entity representative and the
26        treating physician reach an agreement concerning the



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1        enrollee's care; or
2            (D) the enrollee is discharged.
3    (f) Network adequacy and transparency.
4        (1) The Department shall:
5            (A) ensure that an adequate provider network is in
6        place, taking into consideration health professional
7        shortage areas and medically underserved areas;
8            (B) publicly release an explanation of its process
9        for analyzing network adequacy;
10            (C) periodically ensure that an MCO continues to
11        have an adequate network in place; and
12            (D) require MCOs, including Medicaid Managed Care
13        Entities as defined in Section 5-30.2, to meet
14        provider directory requirements under Section 5-30.3.
15        (2) Each MCO shall confirm its receipt of information
16    submitted specific to physician or dentist additions or
17    physician or dentist deletions from the MCO's provider
18    network within 3 days after receiving all required
19    information from contracted physicians or dentists, and
20    electronic physician and dental directories must be
21    updated consistent with current rules as published by the
22    Centers for Medicare and Medicaid Services or its
23    successor agency.
24    (g) Timely payment of claims.
25        (1) The MCO shall pay a claim within 30 days of
26    receiving a claim that contains all the essential



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1    information needed to adjudicate the claim.
2        (2) The MCO shall notify the billing party of its
3    inability to adjudicate a claim within 30 days of
4    receiving that claim.
5        (3) The MCO shall pay a penalty that is at least equal
6    to the timely payment interest penalty imposed under
7    Section 368a of the Illinois Insurance Code for any claims
8    not timely paid.
9            (A) When an MCO is required to pay a timely payment
10        interest penalty to a provider, the MCO must calculate
11        and pay the timely payment interest penalty that is
12        due to the provider within 30 days after the payment of
13        the claim. In no event shall a provider be required to
14        request or apply for payment of any owed timely
15        payment interest penalties.
16            (B) Such payments shall be reported separately
17        from the claim payment for services rendered to the
18        MCO's enrollee and clearly identified as interest
19        payments.
20        (4)(A) The Department shall require MCOs to expedite
21    payments to providers identified on the Department's
22    expedited provider list, determined in accordance with 89
23    Ill. Adm. Code 140.71(b), on a schedule at least as
24    frequently as the providers are paid under the
25    Department's fee-for-service expedited provider schedule.
26        (B) Compliance with the expedited provider requirement



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1    may be satisfied by an MCO through the use of a Periodic
2    Interim Payment (PIP) program that has been mutually
3    agreed to and documented between the MCO and the provider,
4    and the PIP program ensures that any expedited provider
5    receives regular and periodic payments based on prior
6    period payment experience from that MCO. Total payments
7    under the PIP program may be reconciled against future PIP
8    payments on a schedule mutually agreed to between the MCO
9    and the provider.
10        (C) The Department shall share at least monthly its
11    expedited provider list and the frequency with which it
12    pays providers on the expedited list.
13    (g-5) Recognizing that the rapid transformation of the
14Illinois Medicaid program may have unintended operational
15challenges for both payers and providers:
16        (1) in no instance shall a medically necessary covered
17    service rendered in good faith, based upon eligibility
18    information documented by the provider, be denied coverage
19    or diminished in payment amount if the eligibility or
20    coverage information available at the time the service was
21    rendered is later found to be inaccurate in the assignment
22    of coverage responsibility between MCOs or the
23    fee-for-service system, except for instances when an
24    individual is deemed to have not been eligible for
25    coverage under the Illinois Medicaid program; and
26        (2) the Department shall, by December 31, 2016, adopt



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1    rules establishing policies that shall be included in the
2    Medicaid managed care policy and procedures manual
3    addressing payment resolutions in situations in which a
4    provider renders services based upon information obtained
5    after verifying a patient's eligibility and coverage plan
6    through either the Department's current enrollment system
7    or a system operated by the coverage plan identified by
8    the patient presenting for services:
9            (A) such medically necessary covered services
10        shall be considered rendered in good faith;
11            (B) such policies and procedures shall be
12        developed in consultation with industry
13        representatives of the Medicaid managed care health
14        plans and representatives of provider associations
15        representing the majority of providers within the
16        identified provider industry; and
17            (C) such rules shall be published for a review and
18        comment period of no less than 30 days on the
19        Department's website with final rules remaining
20        available on the Department's website.
21    The rules on payment resolutions shall include, but not be
22limited to:
23        (A) the extension of the timely filing period;
24        (B) retroactive prior authorizations; and
25        (C) guaranteed minimum payment rate of no less than
26    the current, as of the date of service, fee-for-service



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1    rate, plus all applicable add-ons, when the resulting
2    service relationship is out of network.
3    The rules shall be applicable for both MCO coverage and
4fee-for-service coverage.
5    If the fee-for-service system is ultimately determined to
6have been responsible for coverage on the date of service, the
7Department shall provide for an extended period for claims
8submission outside the standard timely filing requirements.
9    (g-6) MCO Performance Metrics Report.
10        (1) The Department shall publish, on at least a
11    quarterly basis, each MCO's operational performance,
12    including, but not limited to, the following categories of
13    metrics:
14            (A) claims payment, including timeliness and
15        accuracy;
16            (B) prior authorizations;
17            (C) grievance and appeals;
18            (D) utilization statistics;
19            (E) provider disputes;
20            (F) provider credentialing; and
21            (G) member and provider customer service.
22        (2) The Department shall ensure that the metrics
23    report is accessible to providers online by January 1,
24    2017.
25        (3) The metrics shall be developed in consultation
26    with industry representatives of the Medicaid managed care



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1    health plans and representatives of associations
2    representing the majority of providers within the
3    identified industry.
4        (4) Metrics shall be defined and incorporated into the
5    applicable Managed Care Policy Manual issued by the
6    Department.
7    (g-7) MCO claims processing and performance analysis. In
8order to monitor MCO payments to hospital providers, pursuant
9to this amendatory Act of the 100th General Assembly, the
10Department shall post an analysis of MCO claims processing and
11payment performance on its website every 6 months. Such
12analysis shall include a review and evaluation of a
13representative sample of hospital claims that are rejected and
14denied for clean and unclean claims and the top 5 reasons for
15such actions and timeliness of claims adjudication, which
16identifies the percentage of claims adjudicated within 30, 60,
1790, and over 90 days, and the dollar amounts associated with
18those claims. The Department shall post the contracted claims
19report required by HealthChoice Illinois on its website every
203 months.
21    (g-8) Dispute resolution process. The Department shall
22maintain a provider complaint portal through which a provider
23can submit to the Department unresolved disputes with an MCO.
24An unresolved dispute means an MCO's decision that denies in
25whole or in part a claim for reimbursement to a provider for
26health care services rendered by the provider to an enrollee



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1of the MCO with which the provider disagrees. Disputes shall
2not be submitted to the portal until the provider has availed
3itself of the MCO's internal dispute resolution process.
4Disputes that are submitted to the MCO internal dispute
5resolution process may be submitted to the Department of
6Healthcare and Family Services' complaint portal no sooner
7than 30 days after submitting to the MCO's internal process
8and not later than 30 days after the unsatisfactory resolution
9of the internal MCO process or 60 days after submitting the
10dispute to the MCO internal process. Multiple claim disputes
11involving the same MCO may be submitted in one complaint,
12regardless of whether the claims are for different enrollees,
13when the specific reason for non-payment of the claims
14involves a common question of fact or policy. Within 10
15business days of receipt of a complaint, the Department shall
16present such disputes to the appropriate MCO, which shall then
17have 30 days to issue its written proposal to resolve the
18dispute. The Department may grant one 30-day extension of this
19time frame to one of the parties to resolve the dispute. If the
20dispute remains unresolved at the end of this time frame or the
21provider is not satisfied with the MCO's written proposal to
22resolve the dispute, the provider may, within 30 days, request
23the Department to review the dispute and make a final
24determination. Within 30 days of the request for Department
25review of the dispute, both the provider and the MCO shall
26present all relevant information to the Department for



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1resolution and make individuals with knowledge of the issues
2available to the Department for further inquiry if needed.
3Within 30 days of receiving the relevant information on the
4dispute, or the lapse of the period for submitting such
5information, the Department shall issue a written decision on
6the dispute based on contractual terms between the provider
7and the MCO, contractual terms between the MCO and the
8Department of Healthcare and Family Services and applicable
9Medicaid policy. The decision of the Department shall be
10final. By January 1, 2020, the Department shall establish by
11rule further details of this dispute resolution process.
12Disputes between MCOs and providers presented to the
13Department for resolution are not contested cases, as defined
14in Section 1-30 of the Illinois Administrative Procedure Act,
15conferring any right to an administrative hearing.
16    (g-9)(1) The Department shall publish annually on its
17website a report on the calculation of each managed care
18organization's medical loss ratio showing the following:
19        (A) Premium revenue, with appropriate adjustments.
20        (B) Benefit expense, setting forth the aggregate
21    amount spent for the following:
22            (i) Direct paid claims.
23            (ii) Subcapitation payments.
24            (iii) Other claim payments.
25            (iv) Direct reserves.
26            (v) Gross recoveries.



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1            (vi) Expenses for activities that improve health
2        care quality as allowed by the Department.
3    (2) The medical loss ratio shall be calculated consistent
4with federal law and regulation following a claims runout
5period determined by the Department.
6    (g-10)(1) "Liability effective date" means the date on
7which an MCO becomes responsible for payment for medically
8necessary and covered services rendered by a provider to one
9of its enrollees in accordance with the contract terms between
10the MCO and the provider. The liability effective date shall
11be the later of:
12        (A) The execution date of a network participation
13    contract agreement.
14        (B) The date the provider or its representative
15    submits to the MCO the complete and accurate standardized
16    roster form for the provider in the format approved by the
17    Department.
18        (C) The provider effective date contained within the
19    Department's provider enrollment subsystem within the
20    Illinois Medicaid Program Advanced Cloud Technology
21    (IMPACT) System.
22    (2) The standardized roster form may be submitted to the
23MCO at the same time that the provider submits an enrollment
24application to the Department through IMPACT.
25    (3) By October 1, 2019, the Department shall require all
26MCOs to update their provider directory with information for



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1new practitioners of existing contracted providers within 30
2days of receipt of a complete and accurate standardized roster
3template in the format approved by the Department provided
4that the provider is effective in the Department's provider
5enrollment subsystem within the IMPACT system. Such provider
6directory shall be readily accessible for purposes of
7selecting an approved health care provider and comply with all
8other federal and State requirements.
9    (g-11) The Department shall work with relevant
10stakeholders on the development of operational guidelines to
11enhance and improve operational performance of Illinois'
12Medicaid managed care program, including, but not limited to,
13improving provider billing practices, reducing claim
14rejections and inappropriate payment denials, and
15standardizing processes, procedures, definitions, and response
16timelines, with the goal of reducing provider and MCO
17administrative burdens and conflict. The Department shall
18include a report on the progress of these program improvements
19and other topics in its Fiscal Year 2020 annual report to the
20General Assembly.
21    (g-12)(1) The Department shall prohibit each MCO from
22operating, implementing, or modifying any program or policy
23similar to subsection (d) of Section 5-5f, including, but not
24limited to, hospital potentially preventable readmissions
25(PPR), until after:
26        (A) the Department has adopted, by rule, an updated



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1    PPR policy for services provided to individuals not
2    covered by the capitated managed care program, and has
3    published on its website guidelines for an approvable MCO
4    PPR policy that is consistent with and aligned with the
5    adopted fee-for-service PPR policy;
6        (B) the MCO has published its proposed PPR policy for
7    public comment on its public website for a period of no
8    fewer than 60 days and has publicly responded to comments;
9    and
10        (C) the Department has approved the MCO's proposed
11    policy and posted such approval on its official website,
12    after considering all public comments received by the MCO.
13    (2) No PPR policy, whether adopted by the Department or an
14MCO, may result in the denial of payment for a hospital stay
15that may be considered a PPR that is the result of a previous
16discharge from another hospital.
17    (3) No PPR policy, whether adopted by the Department or an
18MCO, may apply to behavioral health care services, including
19mental health and substance use disorder treatment.
20    (4) No PPR policy, whether adopted by the Department or an
21MCO, may be effective any sooner than 60 days after the
22Department has published its approval of an MCO's policy.
23    (5) If the Department elects to implement a comprehensive
24PPR policy which encompasses both individuals covered under
25the fee-for-service and capitated managed care programs, then
26no MCO may operate a similar PPR policy.



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1    (g-13) MCO provider agreement material changes. As used in
2this subsection:
3    "Adverse effect" means a change to a provision of a
4contract between an MCO and a health care provider that
5results in a reduction to reimbursement received by a health
6care provider or an increase in administrative
7responsibilities or expenses incurred by a health care
9    "Material change" means any action taken by an MCO to
10implement, amend, add, expand, or otherwise alter a provision
11of a contract with a health care provider, including by
12amending a manual, policy, procedure document, or other
13document referenced in the contract, that has an adverse
14effect on the provider.
15        (1) An MCO shall not impose obligations, duties, or
16    other requirements on a provider that are inconsistent
17    with federal or State laws, regulations, or policies, or
18    the contract between the Department and the MCO.
19        (2) An MCO shall not make a material change unless the
20    material change has been approved by the Department, in
21    accordance with paragraph (6), or the material change has
22    been mutually agreed upon in writing by the MCO and the
23    health care provider.
24        (3) No provider shall be required to accept any
25    material change that has not been approved by the
26    Department consistent with the approval process outlined



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1    in this subsection.
2        (4) A material change that is necessary to comply with
3    federal or State laws, regulations, or policies shall not
4    require prior approval by the Department. The Department
5    and the MCO shall provide written and electronic
6    notification of the material change to the health care
7    provider no less than 90 business days prior to
8    implementation.
9        (5) Within 120 days after the effective date of this
10    amendatory Act of the 102nd General Assembly, the
11    Department shall establish, and publish on its website, a
12    process through which an MCO may submit a written proposed
13    material change request for prior approval to the
14    Department.
15        (6) Prior to issuing a determination on any proposed
16    material change request, the Department shall:
17            (A) publish on its website a public notice that
18        includes a comprehensive description of the proposed
19        material change request;
20            (B) accept, consider, and provide responses to all
21        public comments submitted within 45 business days of
22        publication of the public notice; and
23            (C) review the proposed material change request
24        for compliance with federal and State laws,
25        regulations, and policies and the Department's
26        contract with the MCO.



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1        (7) The Department shall issue a written determination
2    to deny or approve the proposed material change request
3    within 60 days of the close of the 45-day public notice
4    period. The Department's determination shall be made
5    readily accessible to the public on its website and shall
6    include a mechanism for providers to report MCO
7    noncompliance with the determination.
8        (8) A material change request that has been approved
9    by the Department shall take effect no earlier than 90
10    business days from the date the Department has made the
11    written determination of approval publicly available on
12    its website and the MCO has met the following criteria:
13            (A) offered providers and their employees, agents,
14        subcontractors, and others acting on their behalf
15        comprehensive training and education on the material
16        change; and
17            (B) notified providers of the material change, in
18        written and electronic form, at least 90 business days
19        prior to the effective date of the material change.
20        The notice shall be published on the MCO's public
21        website and shall include the following information:
22                (i) the effective date of the material change;
23                (ii) a comprehensive description of the
24            material change and references to any related
25            policies; and
26                (iii) contact information to discuss the



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1            material change or to request individual
2            education.
3        (9) A provider retains the right to terminate, with
4    proper notification, its agreement with an MCO prior to
5    implementation of a material change approved by the
6    Department.
7        (10) Any provision of a provider agreement with an MCO
8    that violates this subsection shall be void, unlawful, and
9    unenforceable.
10        (11) The requirements of this subsection apply to and
11    must be described in any provider agreement with an MCO
12    issued, amended, or renewed on or after the effective date
13    of this amendatory Act of the 102nd General Assembly.
14    (h) The Department shall not expand mandatory MCO
15enrollment into new counties beyond those counties already
16designated by the Department as of June 1, 2014 for the
17individuals whose eligibility for medical assistance is not
18the seniors or people with disabilities population until the
19Department provides an opportunity for accountable care
20entities and MCOs to participate in such newly designated
22    (i) The requirements of this Section apply to contracts
23with accountable care entities and MCOs entered into, amended,
24or renewed after June 16, 2014 (the effective date of Public
25Act 98-651).
26    (j) Health care information released to managed care



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1organizations. A health care provider shall release to a
2Medicaid managed care organization, upon request, and subject
3to the Health Insurance Portability and Accountability Act of
41996 and any other law applicable to the release of health
5information, the health care information of the MCO's
6enrollee, if the enrollee has completed and signed a general
7release form that grants to the health care provider
8permission to release the recipient's health care information
9to the recipient's insurance carrier.
10(Source: P.A. 100-201, eff. 8-18-17; 100-580, eff. 3-12-18;
11100-587, eff. 6-4-18; 101-209, eff. 8-5-19.)
12    Section 99. Effective date. This Act takes effect upon
13becoming law.