Bill Text: IL HB4545 | 2021-2022 | 102nd General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that by October 1, 2023 the Department of Healthcare and Family Services shall ensure the Illinois Medicaid Program Advanced Cloud Technology system is updated daily with eligibility coverage information from the integrated eligibility system. Provides that notwithstanding any other provision of the Code, in order to recover an overpayment by recoupment or offset of future payments, a managed care organization's post-payment audit of any claim submitted by a provider must be completed no later than one year after the claim's payment date. Provides that the one-year time limit does not apply to claims that are (i) submitted fraudulently, (ii) known, or should have been known, by the provider to be a pattern of inappropriate billing according to standard provider billing practices, or (iii) subject to any federal law or regulation that permits post-payment audits beyond one year. Effective immediately.

Spectrum: Moderate Partisan Bill (Republican 4-1)

Status: (Engrossed - Dead) 2022-03-16 - Referred to Assignments [HB4545 Detail]

Download: Illinois-2021-HB4545-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB4545 Introduced , by Rep. Jackie Haas SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-30.12a new
305 ILCS 5/5-45 new
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to explore, by July 1, 2023, the availability of and, if reasonably available, procure technology that: (i) allows the Department's Medical Electronic Data Interchange (MEDI) system to update recipient eligibility and coverage information for providers in real time; and (ii) allows the Department to transmit updated recipient eligibility and coverage information to managed care organizations under contract with the Department to ensure the information contained in the MEDI system corresponds with the information maintained by managed care organizations in their web-based provider portals. Provides that notwithstanding any provision of this Code to the contrary, in order to recover an overpayment by recoupment or offset of future payments, a managed care organization's post-payment audit of any claim submitted by a provider must be completed no later than 2 years after the claim's payment date. Provides that the 2-year time limit does not apply to claims that are (i) submitted fraudulently, (ii) known, or should have been known, by the provider to be a pattern of inappropriate billing according to standard provider billing practices, or (iii) subject to any federal law or regulation that permits post-payment audits beyond 2 years. Effective immediately.
LRB102 22906 KTG 32059 b
A BILL FOR
HB4545 LRB102 22906 KTG 32059 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 Sections 5-30.12a and 5-45 as follows:
(305 ILCS 5/5-30.12a new)
Sec. 5-30.12a. Medical Electronic Data Interchange system
upgrade. By July 1, 2023, the Department of Healthcare and
Family Services shall explore the availability of and, if
reasonably available, procure technology that: (i) allows the
Department's Medical Electronic Data Interchange (MEDI) system
to update recipient eligibility and coverage information for
providers in real time; and (ii) allows the Department to
transmit updated recipient eligibility and coverage
information to managed care organizations under contract with
the Department to ensure the information contained in the MEDI
system corresponds with the information maintained by managed
care organizations in their web-based provider portals.
(305 ILCS 5/5-45 new)
Sec. 5-45. MCO post-payment audit; time period limitation.
Notwithstanding any provision of this Code to the contrary, in
order to recover an overpayment by recoupment or offset of

HB4545 - 2 - LRB102 22906 KTG 32059 b
future payments, a managed care organization's post-payment
audit of any claim submitted by a provider must be completed no
later than 2 years after the claim's payment date. The 2-year
time limit does not apply to claims that are (i) submitted
fraudulently, (ii) known, or should have been known, by the
provider to be a pattern of inappropriate billing according to
standard provider billing practices, or (iii) subject to any
federal law or regulation that permits post-payment audits
beyond 2 years.
Section 99. Effective date. This Act takes effect upon
becoming law.