305 ILCS 5/ Illinois Public Aid Code.

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305 ILCS 5/5-30.17

    (305 ILCS 5/5-30.17)
    Sec. 5-30.17. Medicaid Managed Care Oversight Commission.

(a)   The Medicaid Managed Care Oversight Commission is created within the Department of Healthcare and Family Services to evaluate the effectiveness of Illinois' managed care program.

(b) The Commission shall consist of the following members:
(1) One member of the Senate, appointed by the

Senate President, who shall serve as co-chair.

(2) One member of the House of Representatives,

appointed by the Speaker of the House of Representatives, who shall serve as co-chair.

(3) One member of the House of Representatives,

appointed by the Minority Leader of the House of Representatives.

(4) One member of the Senate, appointed by the

Senate Minority Leader.

(5) One member representing the Department of

Healthcare and Family Services, appointed by the Governor.

(6) One member representing the Department of

Public Health, appointed by the Governor.

(7) One member representing the Department of Human

Services, appointed by the Governor.

(8) One member representing the Department of

Children and Family Services, appointed by the Governor.

(9) One member of a statewide association

representing Medicaid managed care plans, appointed by the Governor.

(10) One member of a statewide association

representing a majority of hospitals, appointed by the Governor.

(11) Two academic experts on Medicaid managed care

programs, appointed by the Governor.

(12) One member of a statewide association

representing primary care providers, appointed by the Governor.

(13) One member of a statewide association

representing behavioral health providers, appointed by the Governor.

(14) Members representing Federally Qualified Health

Centers, a long-term care association, a dental association, pharmacies, pharmacists, a developmental disability association, a Medicaid consumer advocate, a Medicaid consumer, an association representing physicians, a behavioral health association, and an association representing pediatricians, appointed by the Governor.

(15) A member of a statewide association representing

only safety-net hospitals, appointed by the Governor.

(c)   The Director of Healthcare and Family Services and chief of staff, or their designees, shall serve as the Commission's executive administrators in providing administrative support, research support, and other administrative tasks requested by the Commission's co-chairs. Any expenses, including, but not limited to, travel and housing, shall be paid for by the Department's existing budget.

(d) The members of the Commission shall receive no compensation for their services as members of the Commission.

(e)   The Commission shall meet quarterly beginning as soon as is practicable after the effective date of this amendatory Act of the 102nd General Assembly.

(f) The Commission shall:
(1) review data on health outcomes of Medicaid

managed care members;

(2) review current care coordination and case

management efforts and make recommendations on expanding care coordination to additional populations with a focus on the social determinants of health;

(3) review and assess the appropriateness of

metrics used in the Pay-for-Performance programs;

(4) review the Department's prior authorization and

utilization management requirements and recommend adaptations for the Medicaid population;

(5) review managed care performance in meeting

diversity contracting goals and the use of funds dedicated to meeting such goals, including, but not limited to, contracting requirements set forth in the Business Enterprise for Minorities, Women, and Persons with Disabilities Act; recommend strategies to increase compliance with diversity contracting goals in collaboration with the Chief Procurement Officer for General Services and the Business Enterprise Council for Minorities, Women, and Persons with Disabilities; and recoup any misappropriated funds for diversity contracting;

(6) review data on the effectiveness of

processing to medical providers;

(7) review member access to health care services in

the Medicaid Program, including specialty care services;

(8) review value-based and other alternative

payment methodologies to make recommendations to enhance program efficiency and improve health outcomes;

(9) review the compliance of all managed care

entities in State contracts and recommend reasonable financial penalties for any noncompliance;

(10) produce an annual report detailing the

Commission's findings based upon its review of research conducted under this Section, including specific recommendations, if any, and any other information the Commission may deem proper in furtherance of its duties under this Section;

(11) review provider availability and make

recommendations to increase providers where needed, including reviewing the regulatory environment and making recommendations for reforms;

(12) review capacity for culturally competent

services, including translation services among providers; and

(13) review and recommend changes to the safety-net

hospital definition to create different classifications of safety-net hospitals.

(f-5) The Department shall make available upon request the analytics of Medicaid managed care clearinghouse data regarding  processing.

(g)     Beginning January 1, 2022, and for each year thereafter, the Commission shall submit a report of its findings and recommendations to the General Assembly. The report to the General Assembly shall be filed with the Clerk of the House of Representatives and the Secretary of the Senate in electronic form only, in the manner that the Clerk and the Secretary shall direct.

(Source: P.A. 102-4, eff. 4-27-21.)

305 ILCS 5/5-30a

(305 ILCS 5/5-30a)
Sec. 5-30a. Exemptions from managed care enrollment; children.

Notwithstanding any other provision of law, the Department shall not require any of the following children to enroll in or transition to the State's managed care medical assistance program:

(1) Children who are authorized by the Department to

receive in-home shift nursing services as required by the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions under 42 CFR 441.50 et seq.

(2) Children made eligible for medical assistance

through any home and community-based services waiver program for medically fragile and technology dependent children authorized under Section 1915(c) of the Social Security Act.

Any children who meet the criteria under paragraph (1) or (2) and who are enrolled in the State's managed care medical assistance program on or before the effective date of this amendatory Act of the 100th General Assembly shall be given the option to disenroll from the State's managed care medical assistance program and receive medical assistance coverage under the State's traditional fee-for-service program.

(Source: P.A. 100-990, eff. 1-1-19.)

305 ILCS 5/5-30b

(305 ILCS 5/5-30b)
Sec. 5-30b. Exemptions from managed care; ground ambulance services.

Notwithstanding any other provision of law, beginning on the effective date of this amendatory Act of the 102nd General Assembly, the Department shall exempt ground ambulance services as described in subsections (c-1) and (c-2) of Section 5-4.2. These services shall continue to be paid under the State's traditional fee-for-service program.

(Source: P.A. 102-661, eff. 1-1-22.)