Illinois General Assembly - Bill Status for SB0788

Replaces everything after the enacting clause. 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 after relevant data from managed care entities has been collected and analyzed, but no earlier than January 1, 2017, develop and implement within each enrollment region an algorithm that takes into account quality scores and other operational proficiency criteria developed, defined, and adopted by the Department, 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 (Public Law 111-148) into managed care entities, including Accountable Care Entities, Managed Care Community Networks, and Managed Care Organizations. Provides that the quality metrics used shall be measurable for all entities; that the algorithm shall not use the quality and proficiency metrics to reassign enrollees out of any plan that they are enrolled with at the time and shall only be used if the client has not voluntarily selected a primary care physician and a managed care entity; that clients will have one opportunity within 90 calendar days after auto assignment by algorithm to select a different managed care entity; and that the algorithm developed and implemented shall favor assignment into managed care entities with the highest quality scores and levels of compliance with the operational proficiency criteria established.

Replaces everything after the enacting clause. Reinserts the provisions of the engrossed bill, but with the following changes: Amends the Emergency Medical Services (EMS) Systems Act. Requires the Department of Public Health to issue an annual Freestanding Emergency Center (FEC) license to a facility located within a municipality with a population in excess of 1,000,000 inhabitants if the facility has, by January 1, 2016, filed a letter of intent to establish a Freestanding Emergency Center and meets certain requirements. Adds provisions concerning transfer agreements; observation beds; and other matters. Further amends the Illinois Public Aid Code. Adds services delivered by facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 to the list of services covered under the Medical Assistance Program. Permits the Department to contract with a third-party vendor to supply durable medical equipment in a more cost effective manner. In provisions concerning kidney transplantation coverage for noncitizens with end-stage renal disease, restricts coverage to persons receiving emergency renal dialysis services covered by the Department for at least 2 years. In a provision concerning payments to nursing facilities, permits the Department to contract with a third-party auditor to perform auditing to determine the accuracy of resident assessment information transmitted in the MDS that is relevant to the determination of reimbursement rates. In a provision concerning care coordination, provides that for Accountable Care Entities (ACEs) with a contract with the Department as of January 1, 2015, their 18 month period of operation shall begin on January 1, 2015 and the Department shall pay a care coordination fee on a per member per month basis at a rate no less than the amount paid as of January 1, 2015. Requires the Department to evaluate the ACE readiness to accept capitation. Adds provisions concerning care coordination enrollment choices for children with complex medical needs; and care coordination fees for care coordination entities for seniors and persons with disabilities and for pediatric care coordination entities for children with complex medical needs. Provides that notwithstanding any other provision of the Code to the contrary, and subject to rescission if not federally approved, providers of certain services shall have their reimbursement rates or dispensing fees reduced for State fiscal year 2016 by an amount no greater than the equivalent to a 2.25% reduction in State fiscal year 2015 appropriations from the General Revenue Fund, with certain exceptions. Requires the Department to seek a waiver from the federal Centers for Medicare and Medicaid Services to allow wards of the Department of Children and Family Services access to mandatory Medicaid managed care. Provides that services delivered by facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 shall be a covered Medicaid service for eligible Medicaid enrollees; and that the Department shall ensure that all residents of facilities licensed under the Specialized Mental Health Rehabilitation Act of 2013 who are eligible for Medicaid are enrolled in Medicaid managed care. Requires the Department to, by January 1, 2016, make available on its website a managed care policy manual for providers that must be updated no less than annually. In a provision concerning certain annual assessments on inpatient services, provides that in lieu of a reduction in the reimbursement rates paid to hospitals, for State fiscal year 2016, the amount of $218.38 used to calculate a specified assessment shall, by emergency rule, be increased by a uniform percentage to generate $20,250,000 annually in the aggregate from all hospitals subject to the annual assessment. Makes other changes to provisions concerning hospital access payments; the aggregate amount of all increased capitation payments to managed care organizations (MCOs); adjustments to the capitation payments made to MCOs for adults eligible for medical assistance pursuant to the Affordable Care Act; and emergency rules. In a provision concerning an annual assessment imposed on supportive living facilities, provides that the Department must contest the interpretation of federal regulations on permissible provider taxes made by the federal Centers for Medicare and Medicaid Services as stated in correspondence dated January 20, 2015 and that the Department shall submit a report to the General Assembly no later than January 1, 2016 detailing all actions taken. In a provision concerning the Inspector General, provides that the Office of Inspector General must realign its resources toward activities with the greatest potential to reduce or avoid unnecessary, wasteful, or fraudulent expenditures. Changes a provision concerning the recoupment of advance payments made to nursing facilities with significant outstanding Medicaid liability. Adds a provision concerning temporary medical assistance coverage for long-term care services when an individual's application for such services is not timely processed under State and federal law and the individual did not cause the delay. Adds a provision requiring the Department to convene a working group in consultation with the Office of the Governor to discuss the development of a revised proposal for the research and demonstration project waiver proposal submitted to the U.S. Department of Health and Human Services on June 4, 2014. Makes changes to a provision concerning payments authorized under the Illinois Administrative Code and initially paid out to hospitals in State fiscal year 2015. Provides that the Governor's Office shall direct the Department of Healthcare and Family Services, in conjunction with other specified agencies, to initiate a review of all case management, care coordination programs, and public health programs for potential duplication of services; that each agency shall provide the Department with a copy of its internal review by October 1, 2015; that the Department shall provide the Governor and the General Assembly with a report of its findings by January 1, 2016; and that if duplicative services are identified, the Department shall work in conjunction with the agencies providing duplicative services to develop a policy or policies to ensure efficient expenditure of State resources, to be completed by December 31, 2016. Effective immediately.

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