Full Text of HB4076 103rd General Assembly
HB4076ham002 103RD GENERAL ASSEMBLY | Rep. Camille Y. Lilly Filed: 5/20/2024 | | 10300HB4076ham002 | | LRB103 32309 KTG 73650 a |
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| 1 | | AMENDMENT TO HOUSE BILL 4076
| 2 | | AMENDMENT NO. ______. Amend House Bill 4076 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | adding Section 11-5.3a as follows: | 6 | | (305 ILCS 5/11-5.3a new) | 7 | | Sec. 11-5.3a. Vendor assistance to managed care | 8 | | organizations. | 9 | | (a) Each managed care organization, as defined in Section | 10 | | 5-30.1, may enter into one or more contracts with eligible | 11 | | vendors to assist in the collection of updated contact | 12 | | information of existing medical assistance enrollees, other | 13 | | than enrollees for whom an ex parte renewal is determined by | 14 | | the Department in accordance with a federal waiver provided | 15 | | under Section 1902(e)(14)(A) of the Social Security Act and | 16 | | enrollees who have responded to the Department within 30 days |
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| 1 | | after contact is initiated. Eligible vendors must be certified | 2 | | by the Business Enterprise Program and have no less than 60% of | 3 | | its owners with established residency in Illinois as of the | 4 | | effective date of this amendatory Act of the 103rd General | 5 | | Assembly. | 6 | | (b) Selected vendors shall assist in the identification | 7 | | and collection of updated contact information for medical | 8 | | assistance enrollees of the managed care organization by | 9 | | utilizing a system that meets the following requirements: | 10 | | (1) The system must be hosted on a platform that is | 11 | | secure and compliant with standards under the federal | 12 | | Health Insurance Portability and Accountability Act of | 13 | | 1996. Such platform must be scalable and may be | 14 | | cloud-based or on premises. | 15 | | (2) The system must use a communication platform to | 16 | | programmatically perform calls, text messages, and other | 17 | | communication functions using web services or application | 18 | | programming interface services. | 19 | | (3) The system must be able to make contact with a | 20 | | medical assistance enrollee in an automated fashion, | 21 | | continuing until contact is made and confirmed and contact | 22 | | information is updated. | 23 | | (4) The system must allow medical assistance enrollees | 24 | | to enter, update, and transmit their updated contact | 25 | | information through use of a voice virtual agent or text | 26 | | virtual agent to an online web form and back to a human |
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| 1 | | assistant without losing any data input. | 2 | | (5) The system must allow a medical assistance | 3 | | enrollee to switch between the voice virtual agent, the | 4 | | text virtual agent, and an online web form. | 5 | | (6) The system must be designed to be compliant with | 6 | | the Americans with Disabilities Act (ADA). ADA compliance | 7 | | must be found regardless of which of the different ways a | 8 | | medical assistance enrollee enters the data, and then, any | 9 | | of the other means to which the medical assistance | 10 | | enrollee can switch, must continue to be ADA compliant | 11 | | regardless of the stage of the redetermination process | 12 | | that the enrollee is in and regardless of the number of | 13 | | transitions from one data entry means to another. | 14 | | (7) The system must provide an analytics dashboard | 15 | | that is tethered to the communication platform with no | 16 | | additional software installation on the user's computer or | 17 | | mobile devices. | 18 | | (8) The system must include a data processing platform | 19 | | to accumulate enrollee data to begin the process in an | 20 | | automated fashion. This includes data validation, | 21 | | rejection, and preparation for communication such as call | 22 | | or text. | 23 | | (9) The system must be capable of contacting each | 24 | | medical assistance enrollee not less than 3 times per year | 25 | | utilizing skip tracing and bi-directional texting | 26 | | processes to locate up-to-date contact information for |
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| 1 | | members. | 2 | | (10) The system must include a data processing | 3 | | platform to provide data submitted by medical assistance | 4 | | enrollees to managed care organizations at a predefined | 5 | | frequency, such as daily, weekly, or monthly and for | 6 | | measures identified within the Healthcare Effectiveness | 7 | | Data and Information Set guidelines. | 8 | | (c) The Department shall establish a process to accept | 9 | | updated contact information provided by managed care | 10 | | organizations or their contracted vendors under this Section | 11 | | no later than 60 days after the effective date of this | 12 | | amendatory Act of the 103rd General Assembly. Nothing in this | 13 | | amendatory Act of the 103rd General Assembly shall be | 14 | | construed to contravene any federal regulation, policy, or | 15 | | requirement of the Centers for Medicare and Medicaid Services. | 16 | | If any provision of this Section or its application is found to | 17 | | be in violation of any federal regulation, policy, or | 18 | | requirement of the Centers for Medicare and Medicaid Services, | 19 | | that provision is declared invalid. | 20 | | (d) Beginning no later than the 30th day of each fiscal | 21 | | year, the Department shall issue monthly payments to each | 22 | | managed care organization, which shall be used to issue | 23 | | payments to its contracted vendors in accordance with this | 24 | | Section. Each managed care organization shall receive a | 25 | | payment in an amount equal to $6 per medical assistance | 26 | | enrollee for which updated contact information is being |
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| 1 | | sought, limited to no more than $6 per medical assistance | 2 | | enrollee in any 12-month period. | 3 | | (e) Each managed care organization shall report, in a | 4 | | format prescribed by the Department, on at least a quarterly | 5 | | basis the status of its activity or that of its vendors | 6 | | regarding assistance with collecting updated contact | 7 | | information. The Department shall, in turn, report quarterly | 8 | | on its utilization of the information provided by the managed | 9 | | care organizations or their contracted vendors in accordance | 10 | | with this Section. | 11 | | (f) Nothing in this amendatory Act of the 103rd General | 12 | | Assembly shall be construed to permit the Department or any | 13 | | county operating a managed care organization to transfer | 14 | | functions being performed by its employees to eligible vendors | 15 | | under this Section, including standard procedures to secure | 16 | | updated contact information for medical assistance enrollees. | 17 | | Section 99. Effective date. This Act takes effect July 1, | 18 | | 2024.". |
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