Bill Text: IL HB3380 | 2017-2018 | 100th General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall, within a reasonable period of time, develop and implement within each enrollment region an algorithm that preserves existing provider-beneficiary relationships and that takes into account previous relationships with managed care entities in order to automatically assign Medicaid enrollees served under the Family Health Plan and the Integrated Care Program and those Medicaid enrollees eligible for medical assistance pursuant to the Patient Protection and Affordable Care Act into managed care entities, including accountable care entities, managed care community networks, and managed care organizations. Provides that the algorithm shall not use the quality and proficiency metrics to reassign enrollees out of any plan in which they are enrolled at the time and shall only be used if the client has not voluntarily selected a primary care physician and a managed care entity or care coordination entity. Provides that clients shall have one opportunity within 90 calendar days after auto-assignment by algorithm to select a different managed care entity. Requires the Department to seek input from stakeholders, including, but not limited to, Medicaid health plans and consumer advocacy organizations, prior to changing the automatic assignment algorithm. Requires the Department to publish the automatic assignment algorithm's components and on a quarterly basis publish auto-assignment enrollment numbers as well as the corresponding logic for those enrollment numbers.

Sponsorship: Partisan Bill (Democrat 1)

Status: (Failed) 2019-01-08 - Session Sine Die [HB3380 Detail]

Download: Illinois-2017-HB3380-Introduced.html

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100TH GENERAL ASSEMBLY State of Illinois 2017 and 2018 HB3380 Introduced , by Rep. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-30.6 new
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall, within a reasonable period of time, develop and implement within each enrollment region an algorithm that preserves existing provider-beneficiary relationships and that takes into account previous relationships with managed care entities in order to automatically assign Medicaid enrollees served under the Family Health Plan and the Integrated Care Program and those Medicaid enrollees eligible for medical assistance pursuant to the Patient Protection and Affordable Care Act into managed care entities, including accountable care entities, managed care community networks, and managed care organizations. Provides that the algorithm shall not use the quality and proficiency metrics to reassign enrollees out of any plan in which they are enrolled at the time and shall only be used if the client has not voluntarily selected a primary care physician and a managed care entity or care coordination entity. Provides that clients shall have one opportunity within 90 calendar days after auto-assignment by algorithm to select a different managed care entity. Requires the Department to seek input from stakeholders, including, but not limited to, Medicaid health plans and consumer advocacy organizations, prior to changing the automatic assignment algorithm. Requires the Department to publish the automatic assignment algorithm's components and on a quarterly basis publish auto-assignment enrollment numbers as well as the corresponding logic for those enrollment numbers.
LRB100 10906 KTG 21142 b
FISCAL NOTE ACT MAY APPLY
A BILL FOR
HB3380 LRB100 10906 KTG 21142 b
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 Section 5-30.6 as follows:
(305 ILCS 5/5-30.6 new)
Sec. 5-30.6. Managed care; automatic assignment. The
Department shall, within a reasonable period of time, develop
and implement within each enrollment region an algorithm that
preserves existing provider-beneficiary relationships and that
takes into account previous relationships with managed care
entities in order to automatically assign Medicaid enrollees
served under the Family Health Plan and the Integrated Care
Program and those Medicaid enrollees eligible for medical
assistance pursuant to the Patient Protection and Affordable
Care Act (Public Law 111-148) into managed care entities,
including accountable care entities, managed care community
networks, and managed care organizations. The algorithm shall
not use the quality and proficiency metrics to reassign
enrollees out of any plan in which they are enrolled at the
time and shall only be used if the client has not voluntarily
selected a primary care physician and a managed care entity or
care coordination entity. Clients shall have one opportunity

HB3380 - 2 - LRB100 10906 KTG 21142 b
within 90 calendar days after auto-assignment by algorithm to
select a different managed care entity. The algorithm developed
and implemented shall favor assignment into managed care
entities with the highest quality scores and levels of
compliance with the operational proficiency criteria
established, taking into consideration existing
provider-beneficiary relationship as defined by 42 CFR
438.50(f)(3), if one exists.
The Department shall seek input from stakeholders,
including, but not limited to, Medicaid health plans and
consumer advocacy organizations, prior to changing the
automatic assignment algorithm.
The Department shall publish the automatic assignment
algorithm's components and on a quarterly basis publish
auto-assignment enrollment numbers as well as the
corresponding logic for those enrollment numbers.