Bill Title: 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.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Introduced - Dead) 2019-05-08 - Added Co-Sponsor Rep. Rita Mayfield [HB2730 Detail]

Text: Latest bill text (Introduced) [HTML]

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Sponsors

Name	Type	Sponsorship	District	Financial	Encyclopedia	Biography
Representative Bob Morgan [D]	Primary	Sponsored Bills	HD-058	FollowTheMoney	Ballotpedia	VoteSmart
Representative Kelly Cassidy [D]	Cosponsor	Sponsored Bills	HD-014	FollowTheMoney	Ballotpedia	VoteSmart
Senator Karina Villa [D]	Cosponsor	Sponsored Bills	SD-025	FollowTheMoney	Ballotpedia	VoteSmart
Representative Rita Mayfield [D]	Cosponsor	Sponsored Bills	HD-060	FollowTheMoney	Ballotpedia	VoteSmart

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