Bill Text: IL HR1123 | 2015-2016 | 99th General Assembly | Introduced

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Bill Title: Requests that the Auditor General conduct an audit of Medicaid MCO capitation payment development, State GRF expenditures on MCOs, and a review of healthcare outcomes for Medicaid individuals enrolled in MCOs.

Spectrum: Moderate Partisan Bill (Democrat 47-14)

Status: (Introduced - Dead) 2016-05-12 - Added Co-Sponsor Rep. Steven A. Andersson [HR1123 Detail]

Download: Illinois-2015-HR1123-Introduced.html

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HOUSE RESOLUTION
WHEREAS, The Medicaid program in Illinois has an immense
and growing impact both in terms of taxpayer dollars and in
terms of the effect it has on citizens across the State; and
WHEREAS, State resources for healthcare services are
currently so scarce that many healthcare providers are
discontinuing services, leading to a profoundly detrimental
impact on our communities; and
WHEREAS, Enrollment under the Department of Healthcare and
Family Services Medical Programs (Medicaid) exceeds 3 million;
and
WHEREAS, A sizable portion of the Medicaid population is
currently enrolled (often mandatorily) in Managed Care
Organizations (MCOs), making outlays to MCOs one of the largest
resource uses in the State; and
WHEREAS, There has been little information disseminated to
the General Assembly in terms of how State resources are being
spent on MCOs and on the overall healthcare outcomes for
individuals enrolled in these MCOs; and
WHEREAS, In this quickly evolving environment, the General

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Assembly must stay engaged in Medicaid funding and
corresponding healthcare outcome issues and be prepared to make
legislative and administrative recommendations; therefore, be
it
RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE
NINETY-NINTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that we
request that the Auditor General of the State of Illinois
conduct an audit of Medicaid MCO capitation payment
development, State GRF expenditures on MCOs, and a review of
healthcare outcomes for Medicaid individuals enrolled in MCOs;
and be it further
RESOLVED, That this audit shall examine capitation rate
setting and reimbursement issues for Medicaid MCOs while also
examining healthcare outcomes for the Medicaid MCO population
with respect to the following issues:
(1) whether the use of MCO encounter data for rate
setting purposes would provide Illinois taxpayers a more
accurate and value-based methodology as opposed to the
current practice of using historical fee-for-service (FFS)
data combined with various inflationary assumptions to
estimate an MCO capitation rate;
(2) whether it is the best use of State resources to
pay the ACA Health Insurance Fee for MCOs and an
examination of the "gross-up" (the additional monies paid

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MCOs to compensate for their tax hit) in the context of
whether this unusual benefit is a good value for Illinois
taxpayers;
(3) how the effective Administration rate Illinois
pays MCOs (14.74% effective rate) compares to rates paid in
other states and how this benefits the Illinois taxpayer;
and
(4) whether Emergency Room usage rates are lower or
higher within the Medicaid MCO population compared to rates
within the Medicaid FFS population; and be it further
RESOLVED, That legislative staff shall assist the Office of
the Auditor General in carrying out this audit should the
Auditor General require assistance; and be it further
RESOLVED, That suitable copies of this resolution be
delivered to the Auditor General and the Director of the
Department of Healthcare and Family Services.