(305 ILCS 5/5-30.10) Sec. 5-30.10. Electronic report submission. To preserve the quality of data and ensure productive oversight of Medicaid managed care organizations, all regular reports required, either by contract or statute, to be collected by the Department from managed care organizations shall be collected through a secure electronic format and medium as designated by the Department. The Department shall consider concerns raised by the contractor about potential burdens associated with producing the report. Ad hoc reports may be collected in alternative manners.
(Source: P.A. 100-1105, eff. 8-27-18; 101-81, eff. 7-12-19.) |
(305 ILCS 5/5-30.11) Sec. 5-30.11. Treatment of autism spectrum disorder. Treatment of autism spectrum disorder through applied behavior analysis shall be covered under the medical assistance program under this Article for children with a diagnosis of autism spectrum disorder when (1) ordered by a physician licensed to practice medicine in all its branches or a psychologist licensed by the Department of Financial and Professional Regulation and (2) evaluated by a behavior analyst as recognized by the Department or licensed by the Department of Financial and Professional Regulation to practice applied behavior analysis in this State. Such coverage may be limited to age ranges based on evidence-based best practices. Appropriate State plan amendments as well as rules regarding provision of services and providers will be submitted by September 1, 2019. Pursuant to the flexibilities allowed by the federal Centers for Medicare and Medicaid Services to Illinois under the Medical Assistance Program, the Department shall enroll and reimburse qualified staff to perform applied behavior analysis services in advance of Illinois licensure activities performed by the Department of Financial and Professional Regulation. These services shall be covered if they are provided in a home or community setting or in an office-based setting. The Department may conduct annual on-site reviews of the services authorized under this Section. Provider enrollment shall occur no later than September 1, 2023.
(Source: P.A. 102-558, eff. 8-20-21; 102-953, eff. 5-27-22; 103-102, eff. 7-1-23.) |
(305 ILCS 5/5-30.12) Sec. 5-30.12. Managed care claim rejection and denial management. (a) In order to provide greater transparency to managed care organizations (MCOs) and providers, the Department shall explore the availability of and, if reasonably available, procure technology that, for all electronic claims, with the exception of direct data entry claims, meets the following needs: (1) The technology shall allow the Department to | ||
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(2) The technology shall create a single electronic | ||
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(3) The technology shall cause all HIPAA-compliant | ||
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(4) The technology shall give the Department the | ||
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(5) The technology shall allow the Department to | ||
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(6) The technology shall send copies of all claims | ||
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(b) If the Department chooses to implement front end edits or customized responses to claims submissions, the MCOs and other stakeholders shall be consulted prior to implementation and providers shall be notified of edits at least 30 days prior to their effective date. (c) Neither the technology nor MCO policy shall require providers to submit claims through a process other than the pipeline. MCOs may request supplemental information needed for adjudication which cannot be contained in the claim file to be submitted separately to the MCOs. (d) The technology shall allow the Department to fully analyze and report on MCO claims processing and payment performance by provider type.
(Source: P.A. 101-209, eff. 8-5-19.) |
(305 ILCS 5/5-30.13)
Sec. 5-30.13. Managed care reports; minority-owned and women-owned businesses. Each Medicaid managed care health plan shall submit a report to the Department by March 1, 2020, and every March 1 thereafter, that includes the following information: (1) The administrative expenses paid to the Medicaid | ||
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(2) The amount of money the Medicaid managed care | ||
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(3) The amount of money the Medicaid managed care | ||
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(4) The amount of money the Medicaid managed care | ||
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(5) The proportion of minorities, people with | ||
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(6) Recommendations for increasing expenditures with | ||
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(7) A list of the types of services to which the | ||
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(8) The certifications the Medicaid managed care | ||
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(9) The point of contact for potential vendors | ||
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The Department shall publish the reports on its website and shall maintain each report on its website for 5 years. In May of 2020 and every May thereafter, the Department shall hold 2 annual public workshops, one in Chicago and one in Springfield. The workshops shall include each Medicaid managed care health plan and shall be open to vendor communities to discuss the submitted plans and to seek to connect vendors with the Medicaid managed care health plans.
(Source: P.A. 101-209, eff. 8-5-19; 102-558, eff. 8-20-21.)
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