Illinois General Assembly - Full Text of HR1123
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Full Text of HR1123  99th General Assembly

HR1123 99TH GENERAL ASSEMBLY


  

 


 
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1
HOUSE RESOLUTION

 
2    WHEREAS, The Medicaid program in Illinois has an immense
3and growing impact both in terms of taxpayer dollars and in
4terms of the effect it has on citizens across the State; and
 
5    WHEREAS, State resources for healthcare services are
6currently so scarce that many healthcare providers are
7discontinuing services, leading to a profoundly detrimental
8impact on our communities; and
 
9    WHEREAS, Enrollment under the Department of Healthcare and
10Family Services Medical Programs (Medicaid) exceeds 3 million;
11and
 
12    WHEREAS, A sizable portion of the Medicaid population is
13currently enrolled (often mandatorily) in Managed Care
14Organizations (MCOs), making outlays to MCOs one of the largest
15resource uses in the State; and
 
16    WHEREAS, There has been little information disseminated to
17the General Assembly in terms of how State resources are being
18spent on MCOs and on the overall healthcare outcomes for
19individuals enrolled in these MCOs; and
 
20    WHEREAS, In this quickly evolving environment, the General

 

 

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1Assembly must stay engaged in Medicaid funding and
2corresponding healthcare outcome issues and be prepared to make
3legislative and administrative recommendations; therefore, be
4it
 
5    RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE
6NINETY-NINTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that we
7request that the Auditor General of the State of Illinois
8conduct an audit of Medicaid MCO capitation payment
9development, State GRF expenditures on MCOs, and a review of
10healthcare outcomes for Medicaid individuals enrolled in MCOs;
11and be it further
 
12    RESOLVED, That this audit shall examine capitation rate
13setting and reimbursement issues for Medicaid MCOs while also
14examining healthcare outcomes for the Medicaid MCO population
15with respect to the following issues:
16        (1) whether the use of MCO encounter data for rate
17    setting purposes would provide Illinois taxpayers a more
18    accurate and value-based methodology as opposed to the
19    current practice of using historical fee-for-service (FFS)
20    data combined with various inflationary assumptions to
21    estimate an MCO capitation rate;
22        (2) whether it is the best use of State resources to
23    pay the ACA Health Insurance Fee for MCOs and an
24    examination of the "gross-up" (the additional monies paid

 

 

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1    MCOs to compensate for their tax hit) in the context of
2    whether this unusual benefit is a good value for Illinois
3    taxpayers;
4        (3) how the effective Administration rate Illinois
5    pays MCOs (14.74% effective rate) compares to rates paid in
6    other states and how this benefits the Illinois taxpayer;
7    and
8        (4) whether Emergency Room usage rates are lower or
9    higher within the Medicaid MCO population compared to rates
10    within the Medicaid FFS population; and be it further
 
11    RESOLVED, That legislative staff shall assist the Office of
12the Auditor General in carrying out this audit should the
13Auditor General require assistance; and be it further
 
14    RESOLVED, That suitable copies of this resolution be
15delivered to the Auditor General and the Director of the
16Department of Healthcare and Family Services.