Illinois 2023-2024 Regular Session

Illinois House Bill HB1202 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1202 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-47 new Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that it is the intent of the General Assembly to ensure that all youth in the care of the Department of Children and Family Services have increased access to health care under the YouthCare Program. Provides that in order to maximize the accessibility of health care services for youth in care and former youth in care enrolled in the YouthCare Program, the Department of Healthcare and Family Services shall amend its managed care contracts such that a managed care organization (MCO) that manages health care for youth in care and former youth in care must pay for services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the rate paid under the Illinois Medicaid fee-for-service program methodology for such services, including all policy adjusters, including, but not limited to, Medicaid High Volume Adjustments, Medicaid Percentage Adjustments, Outpatient High Volume Adjustments, and all outlier add-on adjustments to the extent such adjustments are incorporated in the development of the applicable MCO capitated rates, unless a different rate was agreed upon by the health plan and the non-affiliated provider. Provides that the payment requirement under the amendatory Act shall not apply if: (i) the services provided by the non-affiliated provider were not emergency services; (ii) the non-affiliated provider has, within the 12 months preceding the date of service, rejected a contract that was offered in good faith by the health plan as determined by the Department; and (iii) the health plan has terminated a contract with the non-affiliated provider for cause, and the Department has not deemed the termination to have been without merit. Effective immediately. LRB103 24930 KTG 51264 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1202 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-47 new 305 ILCS 5/5-47 new Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that it is the intent of the General Assembly to ensure that all youth in the care of the Department of Children and Family Services have increased access to health care under the YouthCare Program. Provides that in order to maximize the accessibility of health care services for youth in care and former youth in care enrolled in the YouthCare Program, the Department of Healthcare and Family Services shall amend its managed care contracts such that a managed care organization (MCO) that manages health care for youth in care and former youth in care must pay for services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the rate paid under the Illinois Medicaid fee-for-service program methodology for such services, including all policy adjusters, including, but not limited to, Medicaid High Volume Adjustments, Medicaid Percentage Adjustments, Outpatient High Volume Adjustments, and all outlier add-on adjustments to the extent such adjustments are incorporated in the development of the applicable MCO capitated rates, unless a different rate was agreed upon by the health plan and the non-affiliated provider. Provides that the payment requirement under the amendatory Act shall not apply if: (i) the services provided by the non-affiliated provider were not emergency services; (ii) the non-affiliated provider has, within the 12 months preceding the date of service, rejected a contract that was offered in good faith by the health plan as determined by the Department; and (iii) the health plan has terminated a contract with the non-affiliated provider for cause, and the Department has not deemed the termination to have been without merit. Effective immediately. LRB103 24930 KTG 51264 b LRB103 24930 KTG 51264 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1202 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-47 new 305 ILCS 5/5-47 new
4	4	305 ILCS 5/5-47 new
5	5	Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that it is the intent of the General Assembly to ensure that all youth in the care of the Department of Children and Family Services have increased access to health care under the YouthCare Program. Provides that in order to maximize the accessibility of health care services for youth in care and former youth in care enrolled in the YouthCare Program, the Department of Healthcare and Family Services shall amend its managed care contracts such that a managed care organization (MCO) that manages health care for youth in care and former youth in care must pay for services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the rate paid under the Illinois Medicaid fee-for-service program methodology for such services, including all policy adjusters, including, but not limited to, Medicaid High Volume Adjustments, Medicaid Percentage Adjustments, Outpatient High Volume Adjustments, and all outlier add-on adjustments to the extent such adjustments are incorporated in the development of the applicable MCO capitated rates, unless a different rate was agreed upon by the health plan and the non-affiliated provider. Provides that the payment requirement under the amendatory Act shall not apply if: (i) the services provided by the non-affiliated provider were not emergency services; (ii) the non-affiliated provider has, within the 12 months preceding the date of service, rejected a contract that was offered in good faith by the health plan as determined by the Department; and (iii) the health plan has terminated a contract with the non-affiliated provider for cause, and the Department has not deemed the termination to have been without merit. Effective immediately.
6	6	LRB103 24930 KTG 51264 b LRB103 24930 KTG 51264 b
7	7	LRB103 24930 KTG 51264 b
8	8	A BILL FOR
9	9	HB1202LRB103 24930 KTG 51264 b HB1202 LRB103 24930 KTG 51264 b
10	10	HB1202 LRB103 24930 KTG 51264 b
11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Public Aid Code is amended by
15	15	5 adding Section 5-47 as follows:
16	16	6 (305 ILCS 5/5-47 new)
17	17	7 Sec. 5-47. Managed care services for youth in care;
18	18	8 payments to non-affiliated providers.
19	19	9 (a) Statement of purpose. It is the intent of the General
20	20	10 Assembly to ensure that all youth in the care of the Department
21	21	11 of Children and Family Services have increased access to
22	22	12 health care under the YouthCare Program.
23	23	13 (b) Definitions. As used in this Section, "youth in care"
24	24	14 has the meaning ascribed to that term in Section 4d of the
25	25	15 Children and Family Services Act.
26	26	16 (c) In order to maximize the accessibility of health care
27	27	17 services for youth in care and former youth in care enrolled in
28	28	18 the YouthCare Program, the Department of Healthcare and Family
29	29	19 Services shall amend its managed care contracts such that a
30	30	20 managed care organization (MCO) that manages health care for
31	31	21 youth in care and former youth in care must pay for services
32	32	22 rendered by a non-affiliated provider, for which the health
33	33	23 plan would pay if rendered by an affiliated provider, at the
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1202 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/5-47 new 305 ILCS 5/5-47 new
39	39	305 ILCS 5/5-47 new
40	40	Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that it is the intent of the General Assembly to ensure that all youth in the care of the Department of Children and Family Services have increased access to health care under the YouthCare Program. Provides that in order to maximize the accessibility of health care services for youth in care and former youth in care enrolled in the YouthCare Program, the Department of Healthcare and Family Services shall amend its managed care contracts such that a managed care organization (MCO) that manages health care for youth in care and former youth in care must pay for services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the rate paid under the Illinois Medicaid fee-for-service program methodology for such services, including all policy adjusters, including, but not limited to, Medicaid High Volume Adjustments, Medicaid Percentage Adjustments, Outpatient High Volume Adjustments, and all outlier add-on adjustments to the extent such adjustments are incorporated in the development of the applicable MCO capitated rates, unless a different rate was agreed upon by the health plan and the non-affiliated provider. Provides that the payment requirement under the amendatory Act shall not apply if: (i) the services provided by the non-affiliated provider were not emergency services; (ii) the non-affiliated provider has, within the 12 months preceding the date of service, rejected a contract that was offered in good faith by the health plan as determined by the Department; and (iii) the health plan has terminated a contract with the non-affiliated provider for cause, and the Department has not deemed the termination to have been without merit. Effective immediately.
41	41	LRB103 24930 KTG 51264 b LRB103 24930 KTG 51264 b
42	42	LRB103 24930 KTG 51264 b
43	43	A BILL FOR
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49	49	305 ILCS 5/5-47 new
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53	53	LRB103 24930 KTG 51264 b
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68	68	1 rate paid under the Illinois Medicaid fee-for-service program
69	69	2 methodology for such services, including all policy adjusters,
70	70	3 including, but not limited to, Medicaid High Volume
71	71	4 Adjustments, Medicaid Percentage Adjustments, Outpatient High
72	72	5 Volume Adjustments, and all outlier add-on adjustments to the
73	73	6 extent such adjustments are incorporated in the development of
74	74	7 the applicable MCO capitated rates, unless a different rate
75	75	8 was agreed upon by the health plan and the non-affiliated
76	76	9 provider.
77	77	10 (d) In cases where a MCO must pay for services rendered by
78	78	11 a non-affiliated provider, the requirements under subsection
79	79	12 (c) shall not apply if the services were not emergency
80	80	13 services, as defined in Section 5-30.1, and:
81	81	14 (1) the non-affiliated provider has, within the 12
82	82	15 months preceding the date of service, rejected a contract
83	83	16 that was offered in good faith by the health plan as
84	84	17 determined by the Department; or
85	85	18 (2) the health plan has terminated a contract with the
86	86	19 non-affiliated provider for cause, and the Department has
87	87	20 not deemed the termination to have been without merit. The
88	88	21 Department may deem that a determination for cause has
89	89	22 merit if:
90	90	23 (A) an institutional provider has repeatedly
91	91	24 failed to conduct discharge planning; or
92	92	25 (B) the provider's conduct adversely and
93	93	26 substantially impacts the health of Medicaid patients;
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104	104	1 or
105	105	2 (C) the provider's conduct constitutes fraud,
106	106	3 waste, or abuse; or
107	107	4 (D) the provider's conduct violates the code of
108	108	5 ethics governing his or her profession.
109	109	6 Section 99. Effective date. This Act takes effect upon
110	110	7 becoming law.
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116	116	HB1202 - 3 - LRB103 24930 KTG 51264 b