Illinois General Assembly - Bill Status for HB6213

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires each Medicaid Managed Care Entity (MMCE) contracted by the Department of Healthcare and Family Services to: (i) make available on the entity's website a provider directory in a machine readable file and format; (ii) make provider directories publicly accessible without the necessity of providing a password, a username, or personally identifiable information; (iii) make available through an electronic provider directory, for each Medicaid Managed Care Entity Plan offered by the entity, certain information in an easily understandable and searchable format, including the contact information and website URLs, if applicable, of all health care professionals, hospitals, pharmacies, and facilities that provide services to Medicaid recipients under the Medicaid Managed Care Entity Plan. Requires each MMCE to ensure that all information included in a print version of the provider directory is updated at least monthly and that the electronic provider directory is updated no later than 3 business days after the MMCE receives updated provider information. Provides that non-compliance with these and other specified requirements may subject the MMCE to certain sanctions. Requires the Department's client enrollment services broker to post certain information on the broker's website, including, information explaining the circumstances under which a Medicaid enrollee can file a grievance or request a hearing to appeal an adverse action by the Department or the MMCE; information on the Medicaid eligibility redetermination process; and information on Medicaid care coordination. Requires the Department to create a consumer quality comparison tool to assist enrollees with Medicaid Managed Care Entity Plan selection. Effective immediately.

Replaces everything after the enacting clause. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires each Medicaid Managed Care Entity contracted by the Department of Healthcare and Family Services to: (i) make available on the entity's website a provider directory in a machine readable file and format; (ii) make provider directories publicly accessible without the necessity of providing a password, a username, or personally identifiable information; (iii) comply with all federal and State statutes and regulations pertaining to provider directories within Medicaid Managed Care; and (iv) request, at least annually, provider office hours for certain provider types, including hospitals and facilities, pharmacies, and durable medical equipment suppliers that are not hospitals. Contains provisions requiring the print and online version of the consumer quality comparison tool to use a quality rating system developed by the Department to reflect Medicaid Managed Care Entities' individual Plan performance. Requires the Department to make the consumer quality comparison tool available for consumer use no later than January 1, 2018. Effective immediately.

Replaces everything after the enacting clause. Reinserts the provisions of the engrossed bill, with the following changes: Removes the term "clinical interest" and its definition. Makes changes to the definition of "composite domains". Defines "facilities" (instead of "facility type") and "hospitals" (instead of "hospital type"). Requires each Medicaid Managed Care Entity to comply with certain federal regulations pertaining to provider directories within Medicaid Managed Care. Requires the client enrollment services broker to have certain information available and searchable through the integrated provider directory on its website as soon as possible but no later than January 1, 2017. Provides that if the Department of Healthcare and Family Services (rather than the client enrollment services broker) receives a report that identifies an inaccuracy in the integrated provider directory, the Department (rather than the client enrollment services broker) shall provide the information about the reported inaccuracy to the appropriate Medicaid Managed Care Entity within 3 business days after the reported inaccuracy is received. Requires a Medicaid Managed Care Entity that receives a report that certain formulary information is inaccurate to investigate the report and correct any inaccurate information displayed in the electronic formulary (rather than requiring the Medicaid Managed Care Entity to investigate and report any incorrect information, as necessary, no later than the third business day after the date the report is received). Provides that if a Medicaid enrollee calls the client enrollment services broker with questions regarding formularies, the client enrollment services broker shall offer a brief description of what a formulary is and shall refer the Medicaid enrollee to the appropriate Medicaid Managed Care Entity regarding his or her questions about a specific entity's formulary. Makes changes concerning a printed version of the consumer quality comparison tool and a quality rating system developed by the Department to reflect each Medicaid Managed Care Entities' individual Plan performance. Effective immediately.

Requires the client enrollment services broker to use the Medicaid provider number for all providers with a Medicaid Provider number to populate the provider information in the integrated provider directory (rather than requiring the client enrollment services broker to use the Medicaid provider number to populate the provider information in the integrated provider directory). In a provision concerning grievances and appeals, requires the Department to display prominently on its website consumer-oriented information describing how a Medicaid enrollee can file a complaint or grievance, request a fair hearing for any adverse action taken by the Department or a Medicaid Managed Care Entity, and access free legal assistance or other assistance made available by the State for Medicaid enrollees to pursue an action (rather than requiring the Department to require the client enrollment services broker to display prominently on the client enrollment services broker's website a description of where a Medicaid enrollee can access information on how to file a complaint or grievance or request a fair hearing for any adverse action taken by the Department or the Medicaid Managed Care Entity).

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