Bill Status of SB1703  101st General Assembly

Short Description:  MEDICAID-MANAGED CARE APPEALS

Senate Sponsors
Sen. Don Harmon - Iris Y. Martinez - Kimberly A. Lightford - Andy Manar and Elgie R. Sims, Jr.

Last Action
DateChamber Action
  1/13/2021SenateSession Sine Die

Statutes Amended In Order of Appearance
305 ILCS 5/5-30.1


Synopsis As Introduced
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a provider who has exhausted the written internal appeals process of a managed care organization (MCO) shall be entitled to an external independent third-party review of the MCO's final decision that denies, in whole or in part, a health care service to an enrollee or a claim for reimbursement to a provider for a health care service rendered to an enrollee of the Medicaid managed care organization. Requires an MCO's final decision letter to a provider to include: (i) a statement that the provider's internal appeal rights within the MCO have been exhausted; (ii) a statement that the provider is entitled to an external independent third-party review; (iii) the time period granted to request an external independent third-party review; and (iv) the mailing address to initiate an external independent third-party review. Provides that a party shall be entitled to appeal a final decision of the external independent third-party review within 30 days after the date upon which the appealing party receives the external independent third-party review. Provides that a final decision by the Director of Healthcare and Family Services shall be final and reviewable under the Administrative Review Law. Contains provisions concerning fees to help defray the cost of the administrative hearings; the specific claims of services that are appealable; and the Department's rulemaking authority. Effective immediately.

Senate Committee Amendment No. 1
Deletes reference to:
305 ILCS 5/5-30.1
Adds reference to:
305 ILCS 5/1-5from Ch. 23, par. 1-5

Replaces everything after the enacting clause. Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning construction of the Code.

Actions 
DateChamber Action
  2/15/2019SenateFiled with Secretary by Sen. Don Harmon
  2/15/2019SenateFirst Reading
  2/15/2019SenateReferred to Assignments
  2/22/2019SenateAdded as Chief Co-Sponsor Sen. Iris Y. Martinez
  2/27/2019SenateAssigned to Special Committee on Oversight of Medicaid Managed Care
  2/27/2019SenateAdded as Chief Co-Sponsor Sen. Kimberly A. Lightford
  3/4/2019SenateAdded as Chief Co-Sponsor Sen. Andy Manar
  3/22/2019SenateRule 3-9(a) / Re-referred to Assignments
  3/25/2019SenateAdded as Co-Sponsor Sen. Elgie R. Sims, Jr.
  2/25/2020SenateRe-referred to Executive
  2/25/2020SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Don Harmon
  2/25/2020SenateSenate Committee Amendment No. 1 Referred to Assignments
  2/26/2020SenateSenate Committee Amendment No. 1 Assignments Refers to Executive
  3/4/2020SenateSenate Committee Amendment No. 1 Adopted
  3/4/2020SenateDo Pass as Amended Executive; 016-000-000
  3/4/2020SenatePlaced on Calendar Order of 2nd Reading March 5, 2020
  3/25/2020SenateRule 2-10 Third Reading Deadline Established As May 7, 2020
  4/12/2020SenatePursuant to Senate Rule 3-9(b) / Referred to Assignments
  4/23/2020SenateRule 2-10 Third Reading Deadline Established As May 15, 2020
  4/30/2020SenateRule 2-10 Third Reading Deadline Established As May 22, 2020
  5/7/2020SenateRule 2-10 Third Reading Deadline Established As May 29, 2020
  5/15/2020SenateRule 2-10 Third Reading/Passage Deadline Established As May 31, 2020
  1/13/2021SenateSession Sine Die