Bill Text: IL HB3245 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. Provides that on and after January 1, 2020 no recipient of medical assistance shall be required to enroll or transition to the State's managed care medical assistance program. Provides that any recipient enrolled in a managed care health plan on January 1, 2020 shall be given the option to disenroll from the State's managed care medical assistance program and receive coverage under the State's fee-for-service program. Provides that on and after January 1, 2020, the Department of Healthcare and Family Services shall not enter into any new contract or agreement with a managed care organization (MCO) to provide services where payment for medical services is made on a capitated basis. Provides that the Department shall not renew, renter, renegotiate, change orders, or amend any contract or agreement it entered with a MCO that was solicited under the State of Illinois Medicaid Managed Care Organization Request for Proposals (2018-24-001) (Request for Proposals (2018-24-001)). Provides that any recipient who is enrolled in a managed care health plan administered by a MCO that entered a contract with the Department under the Request for Proposals (2018-24-001) shall be transitioned to the State's fee-for-service program upon the expiration of the MCO's contract with the Department. Requires the Department to establish, by rule, an appeals and grievance process that includes: (i) an expedited internal review of an appeal involving an adverse determination; (ii) a final adverse determination; and (iii) a standard external review. Requires the Department to notify a recipient in writing of the recipient's right to request an external review. Repeals a provision concerning procurement requirements for MCO contracts.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2020-06-23 - Rule 19(b) / Re-referred to Rules Committee [HB3245 Detail]

Download: Illinois-2019-HB3245-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 HB3245 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
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Amends the Illinois Public Aid Code. Provides that on and after January 1, 2020 no recipient of medical assistance shall be required to enroll or transition to the State's managed care medical assistance program. Provides that any recipient enrolled in a managed care health plan on January 1, 2020 shall be given the option to disenroll from the State's managed care medical assistance program and receive coverage under the State's fee-for-service program. Provides that on and after January 1, 2020, the Department of Healthcare and Family Services shall not enter into any new contract or agreement with a managed care organization (MCO) to provide services where payment for medical services is made on a capitated basis. Provides that the Department shall not renew, renter, renegotiate, change orders, or amend any contract or agreement it entered with a MCO that was solicited under the State of Illinois Medicaid Managed Care Organization Request for Proposals (2018-24-001) (Request for Proposals (2018-24-001)). Provides that any recipient who is enrolled in a managed care health plan administered by a MCO that entered a contract with the Department under the Request for Proposals (2018-24-001) shall be transitioned to the State's fee-for-service program upon the expiration of the MCO's contract with the Department. Requires the Department to establish, by rule, an appeals and grievance process that includes: (i) an expedited internal review of an appeal involving an adverse determination; (ii) a final adverse determination; and (iii) a standard external review. Requires the Department to notify a recipient in writing of the recipient's right to request an external review. Repeals a provision concerning procurement requirements for MCO contracts.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
adding Sections 5-36 and 5-37 as follows:
(305 ILCS 5/5-36 new)
Sec. 5-36. Termination of managed care.
(a) On and after January 1, 2020, no recipient of medical
assistance shall be required to enroll or transition to the
State's managed care medical assistance program. Any recipient
of medical assistance who is enrolled in a managed care health
plan on January 1, 2020 shall be given the option to disenroll
from the State's managed care medical assistance program and
receive medical assistance coverage under the State's
fee-for-service medical assistance program.
(b) On and after January 1, 2020, the Department of
Healthcare and Family Services shall not enter into any new
contract or agreement with a managed care organization as
defined in Section 5-30.1 or with any other entity to provide
services where payment for medical services is made on a
capitated basis. The Department of Healthcare and Family
Services shall not renew, renter, renegotiate, change orders,
or amend any contract or agreement it entered with a managed

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care organization, as defined in Section 5-30.1, that was
solicited under the State of Illinois Medicaid Managed Care
Organization Request for Proposals (2018-24-001). Any
recipient of medical assistance who is enrolled in a managed
care health plan administered by a managed care organization
that entered a contract with the Department under the State of
Illinois Medicaid Managed Care Organization Request for
Proposals (2018-24-001) shall be transitioned to the State's
fee-for-service medical assistance program upon the expiration
of the managed care organization's contract with the
Department.
(305 ILCS 5/5-37 new)
Sec. 5-37. External review and appeal process.
(a) Notwithstanding any other provision of this Code, the
Department shall establish, by rule, an appeals and grievance
process that includes:
(1) an expedited internal review of an appeal involving
an adverse determination;
(2) a final adverse determination; and
(3) a standard external review.
(b) At the same time the Department sends written notice of
a recipient's right to appeal a coverage decision upon an
adverse determination or a final adverse determination, the
Department shall notify a recipient and the recipient's
authorized representative, if any, in writing of the

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recipient's right to request an external review as prescribed
by the Department.
(305 ILCS 5/5-30.6 rep.)
Section 10. Illinois Public Aid Code is amended by
repealing Section 5-30.6.
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INDEX
Statutes amended in order of appearance