Bill Text: IL HB2690 | 2019-2020 | 101st General Assembly | Introduced
Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires each managed care organization contracted with the Department of Healthcare and Family Services to file an annual cost report in a form and manner prescribed by the Department. Provides that the Department must make all cost reports available to the public, including, but not limited to, posting the cost reports on the Department's website.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-29 - Rule 19(a) / Re-referred to Rules Committee [HB2690 Detail]
Download: Illinois-2019-HB2690-Introduced.html
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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||||||||||||||||||||
5 | changing Section 5-30.8 as follows:
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6 | (305 ILCS 5/5-30.8) | ||||||||||||||||||||||||
7 | Sec. 5-30.8. Managed care organization rate transparency. | ||||||||||||||||||||||||
8 | (a) For the establishment of managed care
organization | ||||||||||||||||||||||||
9 | (MCO) capitation base rate payments from the State,
including, | ||||||||||||||||||||||||
10 | but not limited to: (i) hospital fee schedule
reforms and | ||||||||||||||||||||||||
11 | updates, (ii) rates related to a single
State-mandated | ||||||||||||||||||||||||
12 | preferred drug list, (iii) rate updates related
to the State's | ||||||||||||||||||||||||
13 | preferred drug list, (iv) inclusion of coverage
for children | ||||||||||||||||||||||||
14 | with special needs, (v) inclusion of coverage for
children | ||||||||||||||||||||||||
15 | within the child welfare system, (vi) annual MCO
capitation | ||||||||||||||||||||||||
16 | rates, and (vii) any retroactive provider fee
schedule | ||||||||||||||||||||||||
17 | adjustments or other changes required by legislation
or other | ||||||||||||||||||||||||
18 | actions, the Department of Healthcare and Family
Services shall | ||||||||||||||||||||||||
19 | implement a capitation base rate setting process beginning
on | ||||||||||||||||||||||||
20 | July 27, 2018 ( the effective date of Public Act 100-646) this | ||||||||||||||||||||||||
21 | amendatory Act of the 100th
General Assembly which shall | ||||||||||||||||||||||||
22 | include all of the following
elements of transparency: | ||||||||||||||||||||||||
23 | (1) The Department shall include participating MCOs |
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1 | and a statewide trade association representing a majority | ||||||
2 | of participating MCOs in meetings to discuss the impact to | ||||||
3 | base capitation rates as a result of any new or updated | ||||||
4 | hospital fee schedules or
other provider fee schedules. | ||||||
5 | Additionally, the Department
shall share any data or | ||||||
6 | reports used to develop MCO capitation rates
with | ||||||
7 | participating MCOs. This data shall be comprehensive
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8 | enough for MCO actuaries to recreate and verify the
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9 | accuracy of the capitation base rate build-up. | ||||||
10 | (2) The Department shall not limit the number of
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11 | experts that each MCO is allowed to bring to the draft | ||||||
12 | capitation base rate
meeting or the final capitation base | ||||||
13 | rate review meeting. Draft and final capitation base rate | ||||||
14 | review meetings shall be held in at least 2 locations. | ||||||
15 | (3) The Department and its contracted actuary shall
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16 | meet with all participating MCOs simultaneously and
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17 | together along with consulting actuaries contracted with
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18 | statewide trade association representing a majority of | ||||||
19 | Medicaid health plans at the request of the plans.
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20 | Participating MCOs shall additionally, at their request,
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21 | be granted individual capitation rate development meetings | ||||||
22 | with the
Department. | ||||||
23 | (4) Any quality incentive or other incentive
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24 | withholding of any portion of the actuarially certified
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25 | capitation rates must be budget-neutral. The entirety of | ||||||
26 | any aggregate
withheld amounts must be returned to the MCOs |
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1 | in proportion
to their performance on the relevant | ||||||
2 | performance metric. No
amounts shall be returned to the | ||||||
3 | Department if
all performance measures are not achieved to | ||||||
4 | the extent allowable by federal law and regulations. | ||||||
5 | (5) Upon request, the Department shall provide written | ||||||
6 | responses to
questions regarding MCO capitation base | ||||||
7 | rates, the capitation base development
methodology, and | ||||||
8 | MCO capitation rate data, and all other requests regarding
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9 | capitation rates from MCOs. Upon request, the Department | ||||||
10 | shall also provide to the MCOs materials used in | ||||||
11 | incorporating provider fee schedules into base capitation | ||||||
12 | rates. | ||||||
13 | (b) For the development of capitation base rates for new | ||||||
14 | capitation rate years: | ||||||
15 | (1) The Department shall take into account emerging
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16 | experience in the development of the annual MCO capitation | ||||||
17 | base rates,
including, but not limited to, current-year | ||||||
18 | cost and
utilization trends observed by MCOs in an | ||||||
19 | actuarially sound manner and in accordance with federal law | ||||||
20 | and regulations. | ||||||
21 | (2) No later than January 1 of each year, the | ||||||
22 | Department shall release an agreed upon annual calendar | ||||||
23 | that outlines dates for capitation rate setting meetings | ||||||
24 | for that year. The calendar shall include at least the | ||||||
25 | following meetings and deadlines: | ||||||
26 | (A) An initial meeting for the Department to review |
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1 | MCO data and draft rate assumptions to be used in the | ||||||
2 | development of capitation base rates for the following | ||||||
3 | year. | ||||||
4 | (B) A draft rate meeting after the Department | ||||||
5 | provides the MCOs with the
draft capitation base
rates
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6 | to discuss, review, and seek feedback regarding the | ||||||
7 | draft capitation base
rates. | ||||||
8 | (3) Prior to the submission of final capitation rates | ||||||
9 | to the federal Centers for
Medicare and Medicaid Services, | ||||||
10 | the Department shall
provide the MCOs with a final | ||||||
11 | actuarial report including
the final capitation base rates | ||||||
12 | for the following year and
subsequently conduct a final | ||||||
13 | capitation base review meeting.
Final capitation rates | ||||||
14 | shall be marked final. | ||||||
15 | (c) For the development of capitation base rates reflecting | ||||||
16 | policy changes: | ||||||
17 | (1) Unless contrary to federal law and regulation,
the | ||||||
18 | Department must provide notice to MCOs
of any significant | ||||||
19 | operational policy change no later than 60 days
prior to | ||||||
20 | the effective date of an operational policy change in order | ||||||
21 | to give MCOs time to prepare for and implement the | ||||||
22 | operational policy change and to ensure that the quality | ||||||
23 | and delivery of enrollee health care is not disrupted. | ||||||
24 | "Operational policy change" means a change to operational | ||||||
25 | requirements such as reporting formats, encounter | ||||||
26 | submission definitional changes, or required provider |
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1 | interfaces
made at the sole discretion of the Department
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2 | and not required by legislation with a retroactive
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3 | effective date. Nothing in this Section shall be construed | ||||||
4 | as a requirement to delay or prohibit implementation of | ||||||
5 | policy changes that impact enrollee benefits as determined | ||||||
6 | in the sole discretion of the Department. | ||||||
7 | (2) No later than 60 days after the effective date of | ||||||
8 | the policy change or
program implementation, the | ||||||
9 | Department shall meet with the
MCOs regarding the initial | ||||||
10 | data collection needed to
establish capitation base rates | ||||||
11 | for the policy change. Additionally,
the Department shall | ||||||
12 | share with the participating MCOs what
other data is needed | ||||||
13 | to estimate the change and the processes for collection of | ||||||
14 | that data that shall be
utilized to develop capitation base | ||||||
15 | rates. | ||||||
16 | (3) No later than 60 days after the effective date of | ||||||
17 | the policy change or
program implementation, the | ||||||
18 | Department shall meet with
MCOs to review data and the | ||||||
19 | Department's written draft
assumptions to be used in | ||||||
20 | development of capitation base rates for the
policy change, | ||||||
21 | and shall provide opportunities for
questions to be asked | ||||||
22 | and answered. | ||||||
23 | (4) No later than 60 days after the effective date of | ||||||
24 | the policy change or
program implementation, the | ||||||
25 | Department shall provide the
MCOs with draft capitation | ||||||
26 | base rates and shall also conduct
a draft capitation base |
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1 | rate meeting with MCOs to discuss, review, and seek
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2 | feedback regarding the draft capitation base rates. | ||||||
3 | (d) For the development of capitation base rates for | ||||||
4 | retroactive policy or
fee schedule changes: | ||||||
5 | (1) The Department shall meet with the MCOs regarding
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6 | the initial data collection needed to establish capitation | ||||||
7 | base rates for
the policy change. Additionally, the | ||||||
8 | Department shall
share with the participating MCOs what | ||||||
9 | other data is needed to estimate the change and the
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10 | processes for collection of the data that shall be utilized | ||||||
11 | to develop capitation base
rates. | ||||||
12 | (2) The Department shall meet with MCOs to review data
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13 | and the Department's written draft assumptions to be used
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14 | in development of capitation base rates for the policy | ||||||
15 | change. The Department shall
provide opportunities for | ||||||
16 | questions to be asked and
answered. | ||||||
17 | (3) The Department shall provide the MCOs with draft
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18 | capitation rates and shall also conduct a draft rate | ||||||
19 | meeting
with MCOs to discuss, review, and seek feedback | ||||||
20 | regarding
the draft capitation base rates. | ||||||
21 | (4) The Department shall inform MCOs no less than | ||||||
22 | quarterly of upcoming benefit and policy changes to the | ||||||
23 | Medicaid program. | ||||||
24 | (e) Meetings of the group established to discuss Medicaid | ||||||
25 | capitation rates under this Section shall be closed to the | ||||||
26 | public and shall not be subject to the Open Meetings Act. |
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1 | Records and information produced by the group established to | ||||||
2 | discuss Medicaid capitation rates under this Section shall be | ||||||
3 | confidential and not subject to the Freedom of Information Act.
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4 | (f) Each MCO contracted with the Department must file an | ||||||
5 | annual cost report in a form and manner prescribed by the | ||||||
6 | Department. The Department must make all cost reports available | ||||||
7 | to the public, including, but not limited to, posting the cost | ||||||
8 | reports on the Department's website. | ||||||
9 | (Source: P.A. 100-646, eff. 7-27-18; revised 10-22-18.)
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