Full Text of HR1216 100th General Assembly
HR1216 100TH GENERAL ASSEMBLY |
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| 1 | | HOUSE RESOLUTION
| 2 | | WHEREAS, In 2011, the Illinois General Assembly decided to | 3 | | begin to transition the Illinois Medicaid program from | 4 | | fee-for-service to a managed care program; and
| 5 | | WHEREAS, The purpose of the transition to Medicaid managed | 6 | | care was to save the State money as well as coordinate care for | 7 | | Medicaid recipients; and
| 8 | | WHEREAS, Unfortunately, neither of those things have | 9 | | occurred; instead, the managed care organizations (MCOs) have | 10 | | instituted a "claims management program" rather than a "care | 11 | | management program", where the MCOs deny incredible amounts of | 12 | | Medicaid claims, resulting in significant harm to Medicaid | 13 | | providers throughout the State and billions of state funds | 14 | | being pocketed by the MCOs; and | 15 | | WHEREAS, In 2018, the Auditor General published an audit as | 16 | | a result of HR 100 of the 100th General Assembly that showed | 17 | | billions of state funds being paid to the MCOs which were not | 18 | | passed along to providers; and | 19 | | WHEREAS, The harm being caused by the MCOs is particularly | 20 | | damaging to providers who rely heavily on the Medicaid program, | 21 | | such as Roseland Community Hospital; and |
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| 1 | | WHEREAS, The average MCO denial rate for safety-net | 2 | | hospitals is 20%, which has resulted in significant layoffs in | 3 | | areas with the highest unemployment in the State and puts | 4 | | future health care services at-risk in the State's most | 5 | | vulnerable communities; and
| 6 | | WHEREAS, This incredible MCO denial rate is not unique to | 7 | | geography, affects communities throughout downstate Illinois | 8 | | as well as Chicago, and results in diminished patient care and | 9 | | lost revenues for local communities throughout Illinois; and
| 10 | | WHEREAS, Under the Rauner Administration, the Department | 11 | | of Healthcare and Family Services has not provided adequate | 12 | | oversight to prevent the abuse of the MCOs, resulting in | 13 | | billions of dollars being shipped to out-of-state for-profit | 14 | | corporations at the expense of Illinois providers and the | 15 | | Illinois residents who rely on healthcare services; and
| 16 | | WHEREAS, The MCO crisis has caused disproportionate harm to | 17 | | minority communities that rely on safety-net hospitals to | 18 | | provide quality healthcare services to vulnerable communities; | 19 | | therefore, be it
| 20 | | RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE | 21 | | HUNDREDTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that the |
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| 1 | | Auditor General is directed to conduct an audit of the average | 2 | | denial rate of hospitals throughout Illinois in both the | 3 | | fee-for-service and managed care programs, with at least 50% of | 4 | | the audit consisting of safety-net and critical access | 5 | | hospitals; the Department of Healthcare and Family Services and | 6 | | all managed care entities shall be required to participate | 7 | | fully, at the Auditor General's request; and be it further | 8 | | RESOLVED, That the Illinois Department of Healthcare and | 9 | | Family Services and any other State agency having information | 10 | | relevant to this audit cooperate fully and promptly with the | 11 | | Auditor General's Office; and be it further | 12 | | RESOLVED, That the Auditor General commence this audit as | 13 | | soon as possible and report his findings and recommendations to | 14 | | the General Assembly; and be it further | 15 | | RESOLVED, That if the Auditor General's findings conclude | 16 | | that the average MCO denial rate for hospitals in the managed | 17 | | care program is 10% or more higher than the average denial rate | 18 | | of the fee-for-service program, then the General Assembly | 19 | | should consider sun-setting the managed care program; and be it | 20 | | further
| 21 | | RESOLVED, That suitable copies of this resolution shall be | 22 | | delivered to the Governor, the Director of Healthcare and |
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| 1 | | Family Services, and each of the four legislative leaders.
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