100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB3380

 

Introduced , by Rep. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-30.6 new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall, within a reasonable period of time, develop and implement within each enrollment region an algorithm that preserves existing provider-beneficiary relationships and that takes into account previous relationships with managed care entities in order to automatically assign Medicaid enrollees served under the Family Health Plan and the Integrated Care Program and those Medicaid enrollees eligible for medical assistance pursuant to the Patient Protection and Affordable Care Act into managed care entities, including accountable care entities, managed care community networks, and managed care organizations. Provides that the algorithm shall not use the quality and proficiency metrics to reassign enrollees out of any plan in which they are enrolled at the time and shall only be used if the client has not voluntarily selected a primary care physician and a managed care entity or care coordination entity. Provides that clients shall have one opportunity within 90 calendar days after auto-assignment by algorithm to select a different managed care entity. Requires the Department to seek input from stakeholders, including, but not limited to, Medicaid health plans and consumer advocacy organizations, prior to changing the automatic assignment algorithm. Requires the Department to publish the automatic assignment algorithm's components and on a quarterly basis publish auto-assignment enrollment numbers as well as the corresponding logic for those enrollment numbers.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3380LRB100 10906 KTG 21142 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
5adding Section 5-30.6 as follows:
 
6    (305 ILCS 5/5-30.6 new)
7    Sec. 5-30.6. Managed care; automatic assignment. The
8Department shall, within a reasonable period of time, develop
9and implement within each enrollment region an algorithm that
10preserves existing provider-beneficiary relationships and that
11takes into account previous relationships with managed care
12entities in order to automatically assign Medicaid enrollees
13served under the Family Health Plan and the Integrated Care
14Program and those Medicaid enrollees eligible for medical
15assistance pursuant to the Patient Protection and Affordable
16Care Act (Public Law 111-148) into managed care entities,
17including accountable care entities, managed care community
18networks, and managed care organizations. The algorithm shall
19not use the quality and proficiency metrics to reassign
20enrollees out of any plan in which they are enrolled at the
21time and shall only be used if the client has not voluntarily
22selected a primary care physician and a managed care entity or
23care coordination entity. Clients shall have one opportunity

 

 

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1within 90 calendar days after auto-assignment by algorithm to
2select a different managed care entity. The algorithm developed
3and implemented shall favor assignment into managed care
4entities with the highest quality scores and levels of
5compliance with the operational proficiency criteria
6established, taking into consideration existing
7provider-beneficiary relationship as defined by 42 CFR
8438.50(f)(3), if one exists.
9    The Department shall seek input from stakeholders,
10including, but not limited to, Medicaid health plans and
11consumer advocacy organizations, prior to changing the
12automatic assignment algorithm.
13    The Department shall publish the automatic assignment
14algorithm's components and on a quarterly basis publish
15auto-assignment enrollment numbers as well as the
16corresponding logic for those enrollment numbers.