Bill Text: IL SB0192 | 2021-2022 | 102nd General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that if the Governor declares a statewide disaster due to a public health emergency and issues an executive order regarding the same disaster that orders hospitals and health care facilities to cancel or suspend elective or nonemergent surgeries or procedures, then the Department of Healthcare and Family Services must conduct an audit on each managed care organization under contract with the Department to determine if the managed care organization has maintained a minimum medical loss ratio of 85% during the disaster period established by the gubernatorial disaster proclamation. Requires the audit to be conducted no later than 90 days after the expiration of the proclaimed disaster. Requires each managed care organization, upon request, to submit to the Department all relevant data and other information in a form and manner prescribed by the Department to assist the Department in carrying out its duties concerning the audit. Provides that the Department shall recoup any overpayment made to a managed care organization during the disaster period established by a gubernatorial disaster proclamation if, upon completion of an audit, the Department determines that the managed care organization failed to maintain the minimum medical loss ratio of 85% during the disaster period established by the gubernatorial disaster proclamation. Provides that nothing under the amendatory Act shall be construed to alter the terms of any contract between the Department and a managed care organization.

Sponsorship: Partisan Bill (Democrat 1)

Status: (Introduced - Dead) 2021-04-16 - Rule 3-9(a) / Re-referred to Assignments [SB0192 Detail]

Download: Illinois-2021-SB0192-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 SB0192 Introduced 2/9/2021, by Sen. David Koehler SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-30.15 new
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that if the Governor declares a statewide disaster due to a public health emergency and issues an executive order regarding the same disaster that orders hospitals and health care facilities to cancel or suspend elective or nonemergent surgeries or procedures, then the Department of Healthcare and Family Services must conduct an audit on each managed care organization under contract with the Department to determine if the managed care organization has maintained a minimum medical loss ratio of 85% during the disaster period established by the gubernatorial disaster proclamation. Requires the audit to be conducted no later than 90 days after the expiration of the proclaimed disaster. Requires each managed care organization, upon request, to submit to the Department all relevant data and other information in a form and manner prescribed by the Department to assist the Department in carrying out its duties concerning the audit. Provides that the Department shall recoup any overpayment made to a managed care organization during the disaster period established by a gubernatorial disaster proclamation if, upon completion of an audit, the Department determines that the managed care organization failed to maintain the minimum medical loss ratio of 85% during the disaster period established by the gubernatorial disaster proclamation. Provides that nothing under the amendatory Act shall be construed to alter the terms of any contract between the Department and a managed care organization.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public health.
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 5-30.15 as follows:
(305 ILCS 5/5-30.15 new)
Sec. 5-30.15. Medical loss ratios during public health
emergency; audits.
(a) As used in this Section:
"Health care facility" means:
(1) every facility licensed, certified, or approved by
any State agency and subject to: (i) 77 Ill. Adm. Code
1130.215(a) and (c)-(f); (ii) the Alternative Health Care
Delivery Act; (iii) the Emergency Medical Services (EMS)
Systems Act; or (iv) the Department of Veterans' Affairs
Act;
(2) every State-operated developmental center
certified by the federal Centers for Medicare and Medicaid
Services; and every licensed State-operated facility
created in accordance with the Mental Health and
Developmental Disabilities Administrative Act;
(3) every licensed community-integrated living
arrangement as defined in the Community-Integrated Living

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Arrangements Licensure and Certification Act;
(4) every licensed community mental health facility as
described in the Community Services Act;
(5) every federally qualified health center as defined
in Section 1905(l)(2)(B) of the Social Security Act;
(6) every supportive living facility as described in
Section 5-5.01a; and
(7) every assisted living establishment and shared
housing establishment licensed under the Assisted Living
and Shared Housing Act.
"Managed care organization" has the meaning ascribed to
that term in Section 5-30.1.
"Hospital" means a hospital licensed under the Hospital
Licensing Act or any hospital organized under the University
of Illinois Hospital Act.
"Public health emergency" has the same meaning ascribed to
that term in the Illinois Emergency Management Agency Act.
(b) If the Governor declares a statewide disaster due to a
public health emergency in accordance with Section 7 of the
Illinois Emergency Management Agency Act and issues an
executive order regarding the same disaster that orders
hospitals and health care facilities to cancel or suspend
elective or nonemergent surgeries or procedures, then the
Department must conduct an audit on each managed care
organization to determine if the managed care organization has
maintained a minimum medical loss ratio of 85%, as required

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under subsection (h) of Section 5-30, during the disaster
period established by the gubernatorial disaster proclamation.
The audit required under this Section must be conducted no
later than 90 days after the expiration of the proclaimed
disaster. To assist the Department in carrying out its duties
under this Section, each managed care organization, upon
request, shall submit to the Department all relevant data and
other information in a form and manner prescribed by the
Department. The Department shall recoup any overpayment made
to a managed care organization during the disaster period
established by a gubernatorial disaster proclamation if, upon
completion of an audit required under this Section, the
Department determines that the managed care organization
failed to maintain a minimum medical loss ratio of 85% during
the disaster period established by the gubernatorial disaster
proclamation. Nothing in this Section shall be construed to
alter the terms of any contract between the Department and a
managed care organization.