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Illinois Compiled Statutes

Information maintained by the Legislative Reference Bureau
Updating the database of the Illinois Compiled Statutes (ILCS) is an ongoing process. Recent laws may not yet be included in the ILCS database, but they are found on this site as Public Acts soon after they become law. For information concerning the relationship between statutes and Public Acts, refer to the Guide.

Because the statute database is maintained primarily for legislative drafting purposes, statutory changes are sometimes included in the statute database before they take effect. If the source note at the end of a Section of the statutes includes a Public Act that has not yet taken effect, the version of the law that is currently in effect may have already been removed from the database and you should refer to that Public Act to see the changes made to the current law.

PUBLIC AID
(305 ILCS 5/) Illinois Public Aid Code.

305 ILCS 5/5-30.13

    (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
    
managed care health plan.
        (2) The amount of money the Medicaid managed care
    
health plan has spent with Business Enterprise Program certified businesses.
        (3) The amount of money the Medicaid managed care
    
health plan has spent with minority-owned and women-owned businesses that are certified by other agencies or private organizations.
        (4) The amount of money the Medicaid managed care
    
health plan has spent with not-for-profit community-based organizations serving predominantly minority communities, as defined by the Department.
        (5) The proportion of minorities, people with
    
disabilities, and women that make up the staff of the Medicaid managed care health plan.
        (6) Recommendations for increasing expenditures with
    
minority-owned and women-owned businesses.
        (7) A list of the types of services to which the
    
Medicaid managed care health plan is contemplating adding new vendors.
        (8) The certifications the Medicaid managed care
    
health plan accepts for minority-owned and women-owned businesses.
        (9) The point of contact for potential vendors
    
seeking to do business with the Medicaid managed care health plan.
    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.)

305 ILCS 5/5-30.14

    (305 ILCS 5/5-30.14)
    Sec. 5-30.14. Medicaid managed care organizations; preferred drug lists.
    (a) No later than January 1, 2020, the Illinois Department shall develop a standardized format for all Medicaid managed care organization preferred drug lists in collaboration with Medicaid managed care organizations and other stakeholders, including, but not limited to, organizations that serve individuals impacted by HIV/AIDS or epilepsy, and community-based organizations, providers, and entities with expertise in drug formulary development.
    (b) Following development of the standardized Preferred Drug List format, the Illinois Department shall allow Medicaid managed care organizations 6 months from the date of completion to comply with the new Preferred Drug List format. Each Medicaid managed care organization must post its preferred drug list on its website without restricting access and must update the preferred drug list posted on its website. Medicaid managed care organizations shall publish updates to their preferred drug lists no less than 30 days prior to the date upon which any update or change takes effect, including, but not limited to, any and all changes to requirements for prior approval requirements, step therapy, or other utilization controls.
    (c)(1) No later than January 1, 2020, the Illinois Department shall establish and maintain the Illinois Drug and Therapeutics Advisory Board. The Board shall have the authority and responsibility to provide recommendations to the Illinois Department regarding which drug products to list on the Illinois Department's preferred drug list. The Illinois Department shall provide administrative support to the Board and the Board shall:
        (A) convene and meet no less than once per calendar
    
quarter;
        (B) provide regular opportunities for public comment;
    
and
        (C) comply with the provisions of the Open Meetings
    
Act.
    All correspondence related to the Board, including correspondence to and from Board members, shall be subject to the Freedom of Information Act.
    (2) The Board shall consist of the following voting members, all of whom shall be appointed by the Governor and shall serve terms of 3 years without compensation:
        (A) one pharmacist licensed to practice pharmacy in
    
Illinois who is recommended by a statewide organization representing pharmacists;
        (B) 4 physicians, recommended by a statewide
    
organization representing physicians, who are licensed to practice medicine in all its branches in Illinois, have knowledge of and adhere to best practice standards, and have experience treating Illinois Medicaid beneficiaries;
        (C) at least one clinician who specializes in the
    
prevention and treatment of HIV, recommended by an HIV healthcare advocacy organization;
        (D) at least one clinician recommended by a
    
healthcare advocacy organization that serves individuals who are affected by chronic diseases that require significant pharmaceutical treatments;
        (E) one clinician representing the Illinois
    
Department; and
        (F) one licensed psychiatrist, recommended by a
    
statewide organization representing psychiatrists, who has experience treating Illinois Medicaid beneficiaries.
    One non-voting clinician recommended by an association of Medicaid managed care health plans shall serve a term of 3 years on the Board without compensation.
    Organizations interested in nominating non-voting clinicians to advise the Board may submit requests to participate to the Illinois Department.
    A licensed physician recommended by the Rare Disease Commission who is a rare disease specialist and possesses scientific knowledge and medical training with respect to rare diseases and is familiar with drug and biological products and treatment shall be notified in advance to attend an Illinois Drug and Therapeutics Advisory Board meeting when a drug or biological product is scheduled to be reviewed in order to advise and make recommendations on drugs or biological products.
    (d) The Illinois Department shall adopt rules, to be in place no later than January 1, 2020, for the purpose of establishing and maintaining the Board.
(Source: P.A. 101-62, eff. 7-12-19; 102-558, eff. 8-20-21.)

305 ILCS 5/5-30.16

    (305 ILCS 5/5-30.16)
    Sec. 5-30.16. Medicaid Business Opportunity Commission.
    (a) The Medicaid Business Opportunity Commission is created within the Department of Healthcare and Family Services to develop a program to support and grow minority, women, and persons with disability owned businesses.
    (b) The Commission shall consist of the following members:
        (1) Two members appointed by the Illinois Legislative
    
Black Caucus.
        (2) Two members appointed by the Illinois Legislative
    
Latino Caucus.
        (3) Two members appointed by the Conference of Women
    
Legislators of the Illinois General Assembly.
        (4) Two members representing a statewide Medicaid
    
health plan association, appointed by the Governor.
        (5) One member representing the Department of
    
Healthcare and Family Services, appointed by the Governor.
        (6) Three members representing businesses currently
    
registered with the Business Enterprise Program, appointed by the Governor.
        (7) One member representing the disability
    
community, appointed by the Governor.
        (8) One member representing the Business Enterprise
    
Council, 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 members of the Commission shall designate co-chairs of the Commission to lead their efforts at the first meeting of the Commission.
    (f) The Commission shall meet at least monthly beginning as soon as is practicable after the effective date of this amendatory Act of the 102nd General Assembly.
    (g) The Commission shall:
        (1) Develop a recommendation on a Medicaid Business
    
Opportunity Program for Minority, Women, and Persons with Disability Owned business contracting requirements to be included in the contracts between the Department of Healthcare and Family Services and the Managed Care entities for the provision of Medicaid Services.
        (2) Make recommendations on the process by which
    
vendors or providers would be certified as eligible to be included in the program and appropriate eligibility standards relative to the healthcare industry.
        (3) Make a recommendation on whether to include not
    
for profit organizations, diversity councils, or diversity chambers as eligible for certification.
        (4) Make a recommendation on whether diverse staff
    
shall be considered within the goals set for managed care entities.
        (5) Make a recommendation on whether a new platform
    
for certification is necessary to administer this program or if the existing platform for the Business Enterprise Program is capable of including recommended changes coming from this Commission.
        (6) Make a recommendation on the ongoing activity of
    
the Commission including structure, frequency of meetings, and agendas to ensure ongoing oversight of the program by the Commission.
    (h) The Commission shall provide recommendations to the Department and the General assembly by April 15, 2021 in order to ensure prompt implementation of the Medicaid Business Opportunity Program.
    (i) 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 5/5-30.17

    (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.)