Illinois House Bill 4977

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Spectrum: Partisan Bill (Democrat 2-0)
Status: Introduced on February 7 2024 - 25% progression
Action: 2024-04-05 - Committee/3rd Reading Deadline Extended-Rule May 24, 2024
Pending: House Medicaid & Managed Care Committee
Text: Latest bill text (Introduced) [HTML]

Amends the Medical Assistance Article of the Illinois Public Aid Code. Makes changes to provisions requiring Medicaid managed care organizations (MCO) to make payments for emergency services. Requires an MCO to pay any provider of emergency services, including inpatient stabilization services provided during the inpatient stabilization period, that does not have in effect a contract with the MCO. Defines "inpatient stabilization period" to mean the initial 72 hours of inpatient stabilization services, beginning from the date and time of the order for inpatient admission to the hospital. Provides that when determining payment for all emergency services, including inpatient stabilization services provided during the inpatient stabilization period, the MCO shall: (i) not impose any service authorization requirements, including, but not limited to, prior authorization, prior approval, pre-certification, concurrent review, or certification of admission; (ii) have no obligation to cover emergency services provided on an emergency basis that are not covered services under the MCO's contract with the Department of Healthcare and Family Services; and (iii) not condition coverage for emergency services on the treating provider notifying the MCO of the enrollee's emergency medical screening examination and treatment within 10 days after presentation for emergency services. Provides that the determination of the attending emergency physician, or the practitioner responsible for the enrollee's care at the hospital, of whether an enrollee requires inpatient stabilization services, can be stabilized in the outpatient setting, or is sufficiently stabilized for discharge or transfer to another facility, shall be binding on the MCO. Provides that an MCO shall not reimburse inpatient stabilization services billed on an inpatient institutional claim under the outpatient reimbursement methodology and shall not reimburse providers for emergency services in cases of fraud. Requires the Department to impose sanctions on an MCO for noncompliance, including, but not limited to, financial penalties, suspension of enrollment of new enrollees, and termination of the MCO's contract with the Department. Effective immediately.

DHFS-INPATIENT STABILIZATION

Rep. Robyn Gabel [D]

Rep. Dagmara Avelar [D]

Date	Chamber	Action
2024-04-05	House	Committee/3rd Reading Deadline Extended-Rule May 24, 2024
2024-04-04	House	To Medicaid & Managed Care Subcommittee
2024-03-06	House	Added Co-Sponsor Rep. Dagmara Avelar
2024-02-28	House	Assigned to Appropriations-Health & Human Services Committee
2024-02-08	House	Referred to Rules Committee
2024-02-08	House	First Reading
2024-02-07	House	Filed with the Clerk by Rep. Robyn Gabel

Chapter	Article	Section	Citation Type	Statute Text
305	5	5-30.1	Amended Code	Citation Text

Type	Source
Summary	https://www.ilga.gov/legislation/BillStatus.asp?DocNum=4977&GAID=17&DocTypeID=HB&SessionID=112&GA=103
Text	https://www.ilga.gov/legislation/103/HB/10300HB4977.htm