Full Text of HB2731 99th General Assembly
HB2731 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 HB2731 Introduced , by Rep. Elizabeth Hernandez SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Public Aid Code. Provides that beginning July 1, 2015, the Department of Healthcare and Family Services shall publish monthly reports on its website on the enrollment of persons in the State's medical assistance program, and the enrollment of recipients of medical assistance into a Medicaid Managed Care Entity contracted by the Department. Provides that the monthly reports shall include certain information for the medical assistance program generally and, separately, for each Medicaid Managed Care Entity contracted by the Department, including: (i) total enrollment and (ii) the number of persons enrolled in the medical assistance program pursuant to the Patient Protection and Affordable Care Act. Requires the Department to annually publish on its website every Medicaid Managed Care Entity's quality metrics outcomes and to make public an independent annual quality review report on the State's Medicaid managed care delivery system. Requires the Department to compile on a monthly basis data on eligibility redeterminations of beneficiaries of medical assistance. Requires the data to be posted on the Department's website and to include certain information, including: (a) the total number of redetermination decisions made in a month and, of that total number, the number of decisions to continue benefits, the number of decisions to change benefits, and the number of decisions to cancel benefits; and (b) if a vendor is procured to assist the Department in the redetermination process, the total number of redetermination decisions made in a month with the involvement of the vendor and without the involvement of the vendor. Effective immediately.
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| | A BILL FOR |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 11-5.1 and by adding Section 5-30.2 as | 6 | | follows: | 7 | | (305 ILCS 5/5-30.2 new) | 8 | | Sec. 5-30.2. Monthly reports; managed care enrollment. | 9 | | (a) As used in this section, "Medicaid Managed Care Entity" | 10 | | means a Managed Care Organization (MCO), a Managed Care | 11 | | Community Network (MCCN), an Accountable Care Entity (ACE), or | 12 | | a Care Coordination Entity (CCE) contracted by the Department. | 13 | | (b) Beginning July 1, 2015, the Department shall publish | 14 | | monthly reports on its website on the enrollment of persons in | 15 | | the State's medical assistance program. In addition, beginning | 16 | | July 1, 2015, the Department shall publish monthly reports on | 17 | | its website on the enrollment of recipients of medical | 18 | | assistance into a Medicaid Managed Care Entity contracted by | 19 | | the Department. The monthly reports shall include all of the | 20 | | following information for the medical assistance program | 21 | | generally and, separately, for each Medicaid Managed Care | 22 | | Entity contracted by the Department: | 23 | | (1) Total enrollment. |
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| 1 | | (2) The number of persons enrolled in the medical | 2 | | assistance program pursuant to the Patient Protection and | 3 | | Affordable Care Act (Public Law 111-148). | 4 | | (3) The number of children enrolled. | 5 | | (4) The number of parents and caretakers of minor | 6 | | children enrolled. | 7 | | (5) The number of pregnant women enrolled. | 8 | | (6) The number of seniors enrolled. | 9 | | (7) The number of persons with disabilities enrolled. | 10 | | (c) Beginning July 1, 2015, the Department shall publish | 11 | | monthly reports on its website detailing the percentage of | 12 | | persons enrolled in each Medicaid Managed Care Entity that was | 13 | | assigned using an auto-assignment algorithm. This percentage | 14 | | should also report the type of enrollee who was assigned using | 15 | | an auto-assignment algorithm, including, but not limited to, | 16 | | persons enrolled in the medical assistance program pursuant to | 17 | | the Patient Protection and Affordable Care Act (Public Law | 18 | | 111-148), children, parents and caretakers of minor children, | 19 | | pregnant women, seniors, and persons with disabilities. | 20 | | (d) Monthly enrollment reports for each Medicaid Managed | 21 | | Care Entity shall include data on the 2 most recent months and | 22 | | data comparing the current month to that month in the prior | 23 | | year. | 24 | | (e) Monthly enrollment reports for each Medicaid Managed | 25 | | Care Entity shall include a breakdown of language preference | 26 | | for enrollees. |
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| 1 | | (f) The Department must annually publish on its website | 2 | | each Medicaid Managed Care Entity's quality metrics outcomes | 3 | | and must make public an independent annual quality review | 4 | | report on the State's Medicaid managed care delivery system. | 5 | | (305 ILCS 5/11-5.1) | 6 | | Sec. 11-5.1. Eligibility verification. Notwithstanding any | 7 | | other provision of this Code, with respect to applications for | 8 | | medical assistance provided under Article V of this Code, | 9 | | eligibility shall be determined in a manner that ensures | 10 | | program integrity and complies with federal laws and | 11 | | regulations while minimizing unnecessary barriers to | 12 | | enrollment. To this end, as soon as practicable, and unless the | 13 | | Department receives written denial from the federal | 14 | | government, this Section shall be implemented: | 15 | | (a) The Department of Healthcare and Family Services or its | 16 | | designees shall: | 17 | | (1) By no later than July 1, 2011, require verification | 18 | | of, at a minimum, one month's income from all sources | 19 | | required for determining the eligibility of applicants for | 20 | | medical assistance under this Code. Such verification | 21 | | shall take the form of pay stubs, business or income and | 22 | | expense records for self-employed persons, letters from | 23 | | employers, and any other valid documentation of income | 24 | | including data obtained electronically by the Department | 25 | | or its designees from other sources as described in |
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| 1 | | subsection (b) of this Section. | 2 | | (2) By no later than October 1, 2011, require | 3 | | verification of, at a minimum, one month's income from all | 4 | | sources required for determining the continued eligibility | 5 | | of recipients at their annual review of eligibility for | 6 | | medical assistance under this Code. Such verification | 7 | | shall take the form of pay stubs, business or income and | 8 | | expense records for self-employed persons, letters from | 9 | | employers, and any other valid documentation of income | 10 | | including data obtained electronically by the Department | 11 | | or its designees from other sources as described in | 12 | | subsection (b) of this Section. The
Department shall send a | 13 | | notice to
recipients at least 60 days prior to the end of | 14 | | their period
of eligibility that informs them of the
| 15 | | requirements for continued eligibility. If a recipient
| 16 | | does not fulfill the requirements for continued | 17 | | eligibility by the
deadline established in the notice a | 18 | | notice of cancellation shall be issued to the recipient and | 19 | | coverage shall end on the last day of the eligibility | 20 | | period. A recipient's eligibility may be reinstated | 21 | | without requiring a new application if the recipient | 22 | | fulfills the requirements for continued eligibility prior | 23 | | to the end of the third month following the last date of | 24 | | coverage (or longer period if required by federal | 25 | | regulations). Nothing in this Section shall prevent an | 26 | | individual whose coverage has been cancelled from |
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| 1 | | reapplying for health benefits at any time. | 2 | | (3) By no later than July 1, 2011, require verification | 3 | | of Illinois residency. | 4 | | (b) The Department shall establish or continue cooperative
| 5 | | arrangements with the Social Security Administration, the
| 6 | | Illinois Secretary of State, the Department of Human Services,
| 7 | | the Department of Revenue, the Department of Employment
| 8 | | Security, and any other appropriate entity to gain electronic
| 9 | | access, to the extent allowed by law, to information available
| 10 | | to those entities that may be appropriate for electronically
| 11 | | verifying any factor of eligibility for benefits under the
| 12 | | Program. Data relevant to eligibility shall be provided for no
| 13 | | other purpose than to verify the eligibility of new applicants | 14 | | or current recipients of health benefits under the Program. | 15 | | Data shall be requested or provided for any new applicant or | 16 | | current recipient only insofar as that individual's | 17 | | circumstances are relevant to that individual's or another | 18 | | individual's eligibility. | 19 | | (c) Within 90 days of the effective date of this amendatory | 20 | | Act of the 96th General Assembly, the Department of Healthcare | 21 | | and Family Services shall send notice to current recipients | 22 | | informing them of the changes regarding their eligibility | 23 | | verification.
| 24 | | (d) The Department shall compile on a monthly basis data on | 25 | | eligibility redeterminations of beneficiaries of medical | 26 | | assistance provided under Article V of this Code. This data |
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| 1 | | shall be posted on the Department's website, and data from | 2 | | prior months shall be retained and available on the | 3 | | Department's website. The data compiled and reported shall | 4 | | include the following: | 5 | | (1) The total number of redetermination decisions made | 6 | | in a month and, of that total number, the number of | 7 | | decisions to continue benefits, the number of decisions to | 8 | | change benefits, and the number of decisions to cancel | 9 | | benefits. | 10 | | (2) A breakdown of enrollee language preference for the | 11 | | total number of redetermination decisions made in a month | 12 | | and, of that total number, a breakdown of enrollee language | 13 | | preference for the number of decisions to continue | 14 | | benefits, a breakdown of enrollee language preference for | 15 | | the number of decisions to change benefits, and a breakdown | 16 | | of enrollee language preference for the number of decisions | 17 | | to cancel benefits. | 18 | | (3) The percentage of cancellation decisions made in a | 19 | | month due to each of the following: | 20 | | (A) The beneficiary's ineligibility due to excess | 21 | | income. | 22 | | (B) The beneficiary's ineligibility due to not | 23 | | being an Illinois resident. | 24 | | (C) The beneficiary's ineligibility due to being | 25 | | deceased. | 26 | | (D) The beneficiary's request to cancel benefits |
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| 1 | | due to having other insurance. | 2 | | (E) The beneficiary's lack of response after | 3 | | notices mailed to the beneficiary are returned to the | 4 | | Department as undeliverable by the United States | 5 | | Postal Service. | 6 | | (F) The beneficiary's lack of response to a request | 7 | | for additional information when reliable information | 8 | | in the beneficiary's account, or other more current | 9 | | information, is unavailable to the Department to make a | 10 | | decision on whether to continue benefits. | 11 | | (G) Other reasons tracked by the Department for the | 12 | | purpose of ensuring program integrity. | 13 | | (4) If a vendor is procured to assist the Department in | 14 | | the redetermination process, the total number of | 15 | | redetermination decisions made in a month and, of that | 16 | | total number, the number of decisions to continue benefits, | 17 | | the number of decisions to change benefits, and the number | 18 | | of decisions to cancel benefits (i) with the involvement of | 19 | | the vendor and (ii) without the involvement of the vendor. | 20 | | (5) Of the total number of benefit cancellations in a | 21 | | month, the number of beneficiaries who return from | 22 | | cancellation within one month, the number of beneficiaries | 23 | | who return from cancellation within 2 months, and the | 24 | | number of beneficiaries who return from cancellation | 25 | | within 3 months. Of the number of beneficiaries who return | 26 | | from cancellation within 3 months, the percentage of those |
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| 1 | | cancellations due to each of the reasons listed under | 2 | | paragraph (3) of this subsection. | 3 | | (Source: P.A. 98-651, eff. 6-16-14.)
| 4 | | Section 99. Effective date. This Act takes effect upon | 5 | | becoming law.
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INDEX
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Statutes amended in order of appearance
| | 3 | | 305 ILCS 5/5-30.2 new | | | 4 | | 305 ILCS 5/11-5.1 | |
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