Full Text of SB2830 103rd General Assembly
SB2830sam002 103RD GENERAL ASSEMBLY | Sen. David Koehler Filed: 5/1/2024 | | 10300SB2830sam002 | | LRB103 36606 KTG 72870 a |
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| 1 | | AMENDMENT TO SENATE BILL 2830
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2830 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Sections 5-30.1 and 5F-35 as follows: | 6 | | (305 ILCS 5/5-30.1) | 7 | | Sec. 5-30.1. Managed care protections. | 8 | | (a) As used in this Section: | 9 | | "Managed care organization" or "MCO" means any entity | 10 | | which contracts with the Department to provide services where | 11 | | payment for medical services is made on a capitated basis. | 12 | | "Emergency services" include: | 13 | | (1) emergency services, as defined by Section 10 of | 14 | | the Managed Care Reform and Patient Rights Act; | 15 | | (2) emergency medical screening examinations, as | 16 | | defined by Section 10 of the Managed Care Reform and |
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| 1 | | Patient Rights Act; | 2 | | (3) post-stabilization medical services, as defined by | 3 | | Section 10 of the Managed Care Reform and Patient Rights | 4 | | Act; and | 5 | | (4) emergency medical conditions, as defined by | 6 | | Section 10 of the Managed Care Reform and Patient Rights | 7 | | Act. | 8 | | (b) As provided by Section 5-16.12, managed care | 9 | | organizations are subject to the provisions of the Managed | 10 | | Care Reform and Patient Rights Act. | 11 | | (c) An MCO shall pay any provider of emergency services | 12 | | that does not have in effect a contract with the contracted | 13 | | Medicaid MCO. The default rate of reimbursement shall be the | 14 | | rate paid under Illinois Medicaid fee-for-service program | 15 | | methodology, including all policy adjusters, including but not | 16 | | limited to Medicaid High Volume Adjustments, Medicaid | 17 | | Percentage Adjustments, Outpatient High Volume Adjustments, | 18 | | and all outlier add-on adjustments to the extent such | 19 | | adjustments are incorporated in the development of the | 20 | | applicable MCO capitated rates. | 21 | | (d) An MCO shall pay for all post-stabilization services | 22 | | as a covered service in any of the following situations: | 23 | | (1) the MCO authorized such services; | 24 | | (2) such services were administered to maintain the | 25 | | enrollee's stabilized condition within one hour after a | 26 | | request to the MCO for authorization of further |
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| 1 | | post-stabilization services; | 2 | | (3) the MCO did not respond to a request to authorize | 3 | | such services within one hour; | 4 | | (4) the MCO could not be contacted; or | 5 | | (5) the MCO and the treating provider, if the treating | 6 | | provider is a non-affiliated provider, could not reach an | 7 | | agreement concerning the enrollee's care and an affiliated | 8 | | provider was unavailable for a consultation, in which case | 9 | | the MCO must pay for such services rendered by the | 10 | | treating non-affiliated provider until an affiliated | 11 | | provider was reached and either concurred with the | 12 | | treating non-affiliated provider's plan of care or assumed | 13 | | responsibility for the enrollee's care. Such payment shall | 14 | | be made at the default rate of reimbursement paid under | 15 | | Illinois Medicaid fee-for-service program methodology, | 16 | | including all policy adjusters, including but not limited | 17 | | to Medicaid High Volume Adjustments, Medicaid Percentage | 18 | | Adjustments, Outpatient High Volume Adjustments and all | 19 | | outlier add-on adjustments to the extent that such | 20 | | adjustments are incorporated in the development of the | 21 | | applicable MCO capitated rates. | 22 | | (e) The following requirements apply to MCOs in | 23 | | determining payment for all emergency services: | 24 | | (1) MCOs shall not impose any requirements for prior | 25 | | approval of emergency services. | 26 | | (2) The MCO shall cover emergency services provided to |
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| 1 | | enrollees who are temporarily away from their residence | 2 | | and outside the contracting area to the extent that the | 3 | | enrollees would be entitled to the emergency services if | 4 | | they still were within the contracting area. | 5 | | (3) The MCO shall have no obligation to cover medical | 6 | | services provided on an emergency basis that are not | 7 | | covered services under the contract. | 8 | | (4) The MCO shall not condition coverage for emergency | 9 | | services on the treating provider notifying the MCO of the | 10 | | enrollee's screening and treatment within 10 days after | 11 | | presentation for emergency services. | 12 | | (5) The determination of the attending emergency | 13 | | physician, or the provider actually treating the enrollee, | 14 | | of whether an enrollee is sufficiently stabilized for | 15 | | discharge or transfer to another facility, shall be | 16 | | binding on the MCO. The MCO shall cover emergency services | 17 | | for all enrollees whether the emergency services are | 18 | | provided by an affiliated or non-affiliated provider. | 19 | | (6) The MCO's financial responsibility for | 20 | | post-stabilization care services it has not pre-approved | 21 | | ends when: | 22 | | (A) a plan physician with privileges at the | 23 | | treating hospital assumes responsibility for the | 24 | | enrollee's care; | 25 | | (B) a plan physician assumes responsibility for | 26 | | the enrollee's care through transfer; |
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| 1 | | (C) a contracting entity representative and the | 2 | | treating physician reach an agreement concerning the | 3 | | enrollee's care; or | 4 | | (D) the enrollee is discharged. | 5 | | (f) Network adequacy and transparency. | 6 | | (1) The Department shall: | 7 | | (A) ensure that an adequate provider network is in | 8 | | place, taking into consideration health professional | 9 | | shortage areas and medically underserved areas; | 10 | | (B) publicly release an explanation of its process | 11 | | for analyzing network adequacy; | 12 | | (C) periodically ensure that an MCO continues to | 13 | | have an adequate network in place; | 14 | | (D) require MCOs, including Medicaid Managed Care | 15 | | Entities as defined in Section 5-30.2, to meet | 16 | | provider directory requirements under Section 5-30.3; | 17 | | (E) require MCOs to ensure that any | 18 | | Medicaid-certified provider under contract with an MCO | 19 | | and previously submitted on a roster on the date of | 20 | | service is paid for any medically necessary, | 21 | | Medicaid-covered, and authorized service rendered to | 22 | | any of the MCO's enrollees, regardless of inclusion on | 23 | | the MCO's published and publicly available directory | 24 | | of available providers; and | 25 | | (F) require MCOs, including Medicaid Managed Care | 26 | | Entities as defined in Section 5-30.2, to meet each of |
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| 1 | | the requirements under subsection (d-5) of Section 10 | 2 | | of the Network Adequacy and Transparency Act; with | 3 | | necessary exceptions to the MCO's network to ensure | 4 | | that admission and treatment with a provider or at a | 5 | | treatment facility in accordance with the network | 6 | | adequacy standards in paragraph (3) of subsection | 7 | | (d-5) of Section 10 of the Network Adequacy and | 8 | | Transparency Act is limited to providers or facilities | 9 | | that are Medicaid certified. | 10 | | (2) Each MCO shall confirm its receipt of information | 11 | | submitted specific to physician or dentist additions or | 12 | | physician or dentist deletions from the MCO's provider | 13 | | network within 3 days after receiving all required | 14 | | information from contracted physicians or dentists, and | 15 | | electronic physician and dental directories must be | 16 | | updated consistent with current rules as published by the | 17 | | Centers for Medicare and Medicaid Services or its | 18 | | successor agency. | 19 | | (g) Timely payment of claims. | 20 | | (1) The MCO shall pay a claim within 30 days of | 21 | | receiving a claim that contains all the essential | 22 | | information needed to adjudicate the claim. | 23 | | (2) The MCO shall notify the billing party of its | 24 | | inability to adjudicate a claim within 30 days of | 25 | | receiving that claim. | 26 | | (3) The MCO shall pay a penalty that is at least equal |
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| 1 | | to the timely payment interest penalty imposed under | 2 | | Section 368a of the Illinois Insurance Code for any claims | 3 | | not timely paid. | 4 | | (A) When an MCO is required to pay a timely payment | 5 | | interest penalty to a provider, the MCO must calculate | 6 | | and pay the timely payment interest penalty that is | 7 | | due to the provider within 30 days after the payment of | 8 | | the claim. In no event shall a provider be required to | 9 | | request or apply for payment of any owed timely | 10 | | payment interest penalties. | 11 | | (B) Such payments shall be reported separately | 12 | | from the claim payment for services rendered to the | 13 | | MCO's enrollee and clearly identified as interest | 14 | | payments. | 15 | | (4)(A) The Department shall require MCOs to expedite | 16 | | payments to providers identified on the Department's | 17 | | expedited provider list, determined in accordance with 89 | 18 | | Ill. Adm. Code 140.71(b), on a schedule at least as | 19 | | frequently as the providers are paid under the | 20 | | Department's fee-for-service expedited provider schedule. | 21 | | (B) Compliance with the expedited provider requirement | 22 | | may be satisfied by an MCO through the use of a Periodic | 23 | | Interim Payment (PIP) program that has been mutually | 24 | | agreed to and documented between the MCO and the provider, | 25 | | if the PIP program ensures that any expedited provider | 26 | | receives regular and periodic payments based on prior |
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| 1 | | period payment experience from that MCO. Total payments | 2 | | under the PIP program may be reconciled against future PIP | 3 | | payments on a schedule mutually agreed to between the MCO | 4 | | and the provider. | 5 | | (C) The Department shall share at least monthly its | 6 | | expedited provider list and the frequency with which it | 7 | | pays providers on the expedited list. | 8 | | (g-1) Timely provider payments other than clean claims. | 9 | | (1) The MCO shall pay to providers all incentive | 10 | | payments, add-on payments, directed payments, and any | 11 | | other Medicaid payment other than clean claims, within 30 | 12 | | days of the posting from the Department. | 13 | | (2) The MCO shall notify the billing party of its | 14 | | inability to pay the payment within 30 days of the posting | 15 | | by the Department. | 16 | | (3) The MCO shall pay a penalty that is at least equal | 17 | | to the timely payment interest penalty imposed under | 18 | | Section 368a of the Illinois Insurance Code for any | 19 | | payments not timely paid. | 20 | | (A) When an MCO is required to pay a timely payment | 21 | | interest penalty to a provider, the MCO must calculate | 22 | | and pay the timely payment interest penalty that is | 23 | | due to the provider within 30 days after the payment of | 24 | | the claim. In no event shall a provider be required to | 25 | | request or apply for payment of any owed timely | 26 | | payment interest penalties. |
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| 1 | | (B) Such payments shall be reported separately | 2 | | from the claim payment for services rendered to the | 3 | | MCO's enrollee and clearly identified as interest | 4 | | payments. | 5 | | (4)(A) The Department shall require MCOs to expedite | 6 | | payments to providers identified on the Department's | 7 | | expedited provider list, determined in accordance with 89 | 8 | | Ill. Adm. Code 140.71(b), on a schedule at least as | 9 | | frequently as the providers are paid under the | 10 | | Department's fee-for-service expedited provider schedule. | 11 | | (B) Compliance with the expedited provider requirement | 12 | | may be satisfied by an MCO through the use of a Periodic | 13 | | Interim Payment (PIP) program that has been mutually | 14 | | agreed to and documented between the MCO and the provider, | 15 | | if the PIP program ensures that any expedited provider | 16 | | receives regular and periodic payments based on prior | 17 | | periodic payment experience from that MCO. Total payments | 18 | | under the PIP program may be reconciled against future PIP | 19 | | payments on a schedule mutually agreed to between the MCO | 20 | | and the provider. | 21 | | (C) The Department shall share at least monthly its | 22 | | expedited provider list and the frequency with which it | 23 | | pays providers on the expedited list. | 24 | | (g-5) Recognizing that the rapid transformation of the | 25 | | Illinois Medicaid program may have unintended operational | 26 | | challenges for both payers and providers: |
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| 1 | | (1) in no instance shall a medically necessary covered | 2 | | service rendered in good faith, based upon eligibility | 3 | | information documented by the provider, be denied coverage | 4 | | or diminished in payment amount if the eligibility or | 5 | | coverage information available at the time the service was | 6 | | rendered is later found to be inaccurate in the assignment | 7 | | of coverage responsibility between MCOs or the | 8 | | fee-for-service system, except for instances when an | 9 | | individual is deemed to have not been eligible for | 10 | | coverage under the Illinois Medicaid program; and | 11 | | (2) the Department shall, by December 31, 2016, adopt | 12 | | rules establishing policies that shall be included in the | 13 | | Medicaid managed care policy and procedures manual | 14 | | addressing payment resolutions in situations in which a | 15 | | provider renders services based upon information obtained | 16 | | after verifying a patient's eligibility and coverage plan | 17 | | through either the Department's current enrollment system | 18 | | or a system operated by the coverage plan identified by | 19 | | the patient presenting for services: | 20 | | (A) such medically necessary covered services | 21 | | shall be considered rendered in good faith; | 22 | | (B) such policies and procedures shall be | 23 | | developed in consultation with industry | 24 | | representatives of the Medicaid managed care health | 25 | | plans and representatives of provider associations | 26 | | representing the majority of providers within the |
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| 1 | | identified provider industry; and | 2 | | (C) such rules shall be published for a review and | 3 | | comment period of no less than 30 days on the | 4 | | Department's website with final rules remaining | 5 | | available on the Department's website. | 6 | | The rules on payment resolutions shall include, but | 7 | | not be limited to: | 8 | | (A) the extension of the timely filing period; | 9 | | (B) retroactive prior authorizations; and | 10 | | (C) guaranteed minimum payment rate of no less | 11 | | than the current, as of the date of service, | 12 | | fee-for-service rate, plus all applicable add-ons, | 13 | | when the resulting service relationship is out of | 14 | | network. | 15 | | The rules shall be applicable for both MCO coverage | 16 | | and fee-for-service coverage. | 17 | | If the fee-for-service system is ultimately determined to | 18 | | have been responsible for coverage on the date of service, the | 19 | | Department shall provide for an extended period for claims | 20 | | submission outside the standard timely filing requirements. | 21 | | (g-6) MCO Performance Metrics Report. | 22 | | (1) The Department shall publish, on at least a | 23 | | quarterly basis, each MCO's operational performance, | 24 | | including, but not limited to, the following categories of | 25 | | metrics: | 26 | | (A) claims payment, including timeliness and |
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| 1 | | accuracy; | 2 | | (B) prior authorizations; | 3 | | (C) grievance and appeals; | 4 | | (D) utilization statistics; | 5 | | (E) provider disputes; | 6 | | (F) provider credentialing; and | 7 | | (G) member and provider customer service. | 8 | | (2) The Department shall ensure that the metrics | 9 | | report is accessible to providers online by January 1, | 10 | | 2017. | 11 | | (3) The metrics shall be developed in consultation | 12 | | with industry representatives of the Medicaid managed care | 13 | | health plans and representatives of associations | 14 | | representing the majority of providers within the | 15 | | identified industry. | 16 | | (4) Metrics shall be defined and incorporated into the | 17 | | applicable Managed Care Policy Manual issued by the | 18 | | Department. | 19 | | (g-7) MCO claims processing and performance analysis. In | 20 | | order to monitor MCO payments to hospital providers, pursuant | 21 | | to Public Act 100-580, the Department shall post an analysis | 22 | | of MCO claims processing and payment performance on its | 23 | | website every 6 months. Such analysis shall include a review | 24 | | and evaluation of a representative sample of hospital claims | 25 | | that are rejected and denied for clean and unclean claims and | 26 | | the top 5 reasons for such actions and timeliness of claims |
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| 1 | | adjudication, which identifies the percentage of claims | 2 | | adjudicated within 30, 60, 90, and over 90 days, and the dollar | 3 | | amounts associated with those claims. | 4 | | (g-8) Dispute resolution process. The Department shall | 5 | | maintain a provider complaint portal through which a provider | 6 | | can submit to the Department unresolved disputes with an MCO. | 7 | | An unresolved dispute means an MCO's decision that denies in | 8 | | whole or in part a claim for reimbursement to a provider for | 9 | | health care services rendered by the provider to an enrollee | 10 | | of the MCO with which the provider disagrees. Disputes shall | 11 | | not be submitted to the portal until the provider has availed | 12 | | itself of the MCO's internal dispute resolution process. | 13 | | Disputes that are submitted to the MCO internal dispute | 14 | | resolution process may be submitted to the Department of | 15 | | Healthcare and Family Services' complaint portal no sooner | 16 | | than 30 days after submitting to the MCO's internal process | 17 | | and not later than 30 days after the unsatisfactory resolution | 18 | | of the internal MCO process or 60 days after submitting the | 19 | | dispute to the MCO internal process. Multiple claim disputes | 20 | | involving the same MCO may be submitted in one complaint, | 21 | | regardless of whether the claims are for different enrollees, | 22 | | when the specific reason for non-payment of the claims | 23 | | involves a common question of fact or policy. Within 10 | 24 | | business days of receipt of a complaint, the Department shall | 25 | | present such disputes to the appropriate MCO, which shall then | 26 | | have 30 days to issue its written proposal to resolve the |
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| 1 | | dispute. The Department may grant one 30-day extension of this | 2 | | time frame to one of the parties to resolve the dispute. If the | 3 | | dispute remains unresolved at the end of this time frame or the | 4 | | provider is not satisfied with the MCO's written proposal to | 5 | | resolve the dispute, the provider may, within 30 days, request | 6 | | the Department to review the dispute and make a final | 7 | | determination. Within 30 days of the request for Department | 8 | | review of the dispute, both the provider and the MCO shall | 9 | | present all relevant information to the Department for | 10 | | resolution and make individuals with knowledge of the issues | 11 | | available to the Department for further inquiry if needed. | 12 | | Within 30 days of receiving the relevant information on the | 13 | | dispute, or the lapse of the period for submitting such | 14 | | information, the Department shall issue a written decision on | 15 | | the dispute based on contractual terms between the provider | 16 | | and the MCO, contractual terms between the MCO and the | 17 | | Department of Healthcare and Family Services and applicable | 18 | | Medicaid policy. The decision of the Department shall be | 19 | | final. By January 1, 2020, the Department shall establish by | 20 | | rule further details of this dispute resolution process. | 21 | | Disputes between MCOs and providers presented to the | 22 | | Department for resolution are not contested cases, as defined | 23 | | in Section 1-30 of the Illinois Administrative Procedure Act, | 24 | | conferring any right to an administrative hearing. | 25 | | (g-9)(1) The Department shall publish annually on its | 26 | | website a report on the calculation of each managed care |
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| 1 | | organization's medical loss ratio showing the following: | 2 | | (A) Premium revenue, with appropriate adjustments. | 3 | | (B) Benefit expense, setting forth the aggregate | 4 | | amount spent for the following: | 5 | | (i) Direct paid claims. | 6 | | (ii) Subcapitation payments. | 7 | | (iii) Other claim payments. | 8 | | (iv) Direct reserves. | 9 | | (v) Gross recoveries. | 10 | | (vi) Expenses for activities that improve health | 11 | | care quality as allowed by the Department. | 12 | | (2) The medical loss ratio shall be calculated consistent | 13 | | with federal law and regulation following a claims runout | 14 | | period determined by the Department. | 15 | | (g-10)(1) "Liability effective date" means the date on | 16 | | which an MCO becomes responsible for payment for medically | 17 | | necessary and covered services rendered by a provider to one | 18 | | of its enrollees in accordance with the contract terms between | 19 | | the MCO and the provider. The liability effective date shall | 20 | | be the later of: | 21 | | (A) The execution date of a network participation | 22 | | contract agreement. | 23 | | (B) The date the provider or its representative | 24 | | submits to the MCO the complete and accurate standardized | 25 | | roster form for the provider in the format approved by the | 26 | | Department. |
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| 1 | | (C) The provider effective date contained within the | 2 | | Department's provider enrollment subsystem within the | 3 | | Illinois Medicaid Program Advanced Cloud Technology | 4 | | (IMPACT) System. | 5 | | (2) The standardized roster form may be submitted to the | 6 | | MCO at the same time that the provider submits an enrollment | 7 | | application to the Department through IMPACT. | 8 | | (3) By October 1, 2019, the Department shall require all | 9 | | MCOs to update their provider directory with information for | 10 | | new practitioners of existing contracted providers within 30 | 11 | | days of receipt of a complete and accurate standardized roster | 12 | | template in the format approved by the Department provided | 13 | | that the provider is effective in the Department's provider | 14 | | enrollment subsystem within the IMPACT system. Such provider | 15 | | directory shall be readily accessible for purposes of | 16 | | selecting an approved health care provider and comply with all | 17 | | other federal and State requirements. | 18 | | (g-11) The Department shall work with relevant | 19 | | stakeholders on the development of operational guidelines to | 20 | | enhance and improve operational performance of Illinois' | 21 | | Medicaid managed care program, including, but not limited to, | 22 | | improving provider billing practices, reducing claim | 23 | | rejections and inappropriate payment denials, and | 24 | | standardizing processes, procedures, definitions, and response | 25 | | timelines, with the goal of reducing provider and MCO | 26 | | administrative burdens and conflict. The Department shall |
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| 1 | | include a report on the progress of these program improvements | 2 | | and other topics in its Fiscal Year 2020 annual report to the | 3 | | General Assembly. | 4 | | (g-12) Notwithstanding any other provision of law, if the | 5 | | Department or an MCO requires submission of a claim for | 6 | | payment in a non-electronic format, a provider shall always be | 7 | | afforded a period of no less than 90 business days, as a | 8 | | correction period, following any notification of rejection by | 9 | | either the Department or the MCO to correct errors or | 10 | | omissions in the original submission. | 11 | | Under no circumstances, either by an MCO or under the | 12 | | State's fee-for-service system, shall a provider be denied | 13 | | payment for failure to comply with any timely submission | 14 | | requirements under this Code or under any existing contract, | 15 | | unless the non-electronic format claim submission occurs after | 16 | | the initial 180 days following the latest date of service on | 17 | | the claim, or after the 90 business days correction period | 18 | | following notification to the provider of rejection or denial | 19 | | of payment. | 20 | | (h) The Department shall not expand mandatory MCO | 21 | | enrollment into new counties beyond those counties already | 22 | | designated by the Department as of June 1, 2014 for the | 23 | | individuals whose eligibility for medical assistance is not | 24 | | the seniors or people with disabilities population until the | 25 | | Department provides an opportunity for accountable care | 26 | | entities and MCOs to participate in such newly designated |
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| 1 | | counties. | 2 | | (h-5) Leading indicator data sharing. By January 1, 2024, | 3 | | the Department shall obtain input from the Department of Human | 4 | | Services, the Department of Juvenile Justice, the Department | 5 | | of Children and Family Services, the State Board of Education, | 6 | | managed care organizations, providers, and clinical experts to | 7 | | identify and analyze key indicators from assessments and data | 8 | | sets available to the Department that can be shared with | 9 | | managed care organizations and similar care coordination | 10 | | entities contracted with the Department as leading indicators | 11 | | for elevated behavioral health crisis risk for children. To | 12 | | the extent permitted by State and federal law, the identified | 13 | | leading indicators shall be shared with managed care | 14 | | organizations and similar care coordination entities | 15 | | contracted with the Department within 6 months of | 16 | | identification for the purpose of improving care coordination | 17 | | with the early detection of elevated risk. Leading indicators | 18 | | shall be reassessed annually with stakeholder input. | 19 | | (i) The requirements of this Section apply to contracts | 20 | | with accountable care entities and MCOs entered into, amended, | 21 | | or renewed after June 16, 2014 (the effective date of Public | 22 | | Act 98-651). | 23 | | (j) Health care information released to managed care | 24 | | organizations. A health care provider shall release to a | 25 | | Medicaid managed care organization, upon request, and subject | 26 | | to the Health Insurance Portability and Accountability Act of |
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| 1 | | 1996 and any other law applicable to the release of health | 2 | | information, the health care information of the MCO's | 3 | | enrollee, if the enrollee has completed and signed a general | 4 | | release form that grants to the health care provider | 5 | | permission to release the recipient's health care information | 6 | | to the recipient's insurance carrier. | 7 | | (k) The Department of Healthcare and Family Services, | 8 | | managed care organizations, a statewide organization | 9 | | representing hospitals, and a statewide organization | 10 | | representing safety-net hospitals shall explore ways to | 11 | | support billing departments in safety-net hospitals. | 12 | | (l) The requirements of this Section added by Public Act | 13 | | 102-4 shall apply to services provided on or after the first | 14 | | day of the month that begins 60 days after April 27, 2021 (the | 15 | | effective date of Public Act 102-4). | 16 | | (Source: P.A. 102-4, eff. 4-27-21; 102-43, eff. 7-6-21; | 17 | | 102-144, eff. 1-1-22; 102-454, eff. 8-20-21; 102-813, eff. | 18 | | 5-13-22; 103-546, eff. 8-11-23.) | 19 | | (305 ILCS 5/5F-35) | 20 | | Sec. 5F-35. Reimbursement. The Department shall provide | 21 | | each managed care organization with the quarterly | 22 | | fee-for-service facility-specific RUG-IV nursing component per | 23 | | diem along with any add-ons for enhanced care services, | 24 | | support component per diem, and capital component per diem | 25 | | effective for each nursing home under contract with the |
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| 1 | | managed care organization. No managed care contract shall | 2 | | provide for a level of reimbursement lower than the | 3 | | fee-for-service rate in effect for the facility at the time | 4 | | service is rendered. | 5 | | (Source: P.A. 98-651, eff. 6-16-14.)". |
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