Bill Text: IL SR1916 | 2015-2016 | 99th General Assembly | Introduced

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Bill Title: Requests the Department of Healthcare and Family Services to provide to the Senate Human Services Committee certain data concerning Medicaid fee-for service baseline calculations and the aggregate per-recipient costs for Medicaid managed care for State fiscal years 2012 through 2016.

Spectrum: Moderate Partisan Bill (Democrat 10-3)

Status: (Passed) 2016-05-31 - Resolution Adopted; 054-001-000 [SR1916 Detail]

Download: Illinois-2015-SR1916-Introduced.html

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SENATE RESOLUTION
WHEREAS, The Medicaid program in Illinois has a substantial
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, Over 60% of the Medicaid population is currently
enrolled in Managed Care Organizations (MCOs), making outlays
to MCOs one of the largest resource uses in the State; and
WHEREAS, Heretofore there has been inadequate 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 an environment of limited funding for education
and other critical needs, the Senate must stay engaged in

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Medicaid funding and corresponding healthcare outcome issues
and be prepared to make legislative decisions and
administrative recommendations; and
WHEREAS, Having per-recipient MCO costs from each State
fiscal year for each eligibility category as a basis for
comparison to the Fee-For-Service baseline per-recipient costs
will help this institution determine how effectively Medicaid
resources are being managed; therefore, be it
RESOLVED, BY THE SENATE OF THE NINETY-NINTH GENERAL
ASSEMBLY OF THE STATE OF ILLINOIS, that we request from the
Department of Healthcare and Family Services the following
information:
(1) Calculating a Fee-For-Service baseline.
(a) For Fiscal Year 2012, provide the following:
(i) The total Fiscal Year 2012 Fee-For-Service
Medical liability for the Family Health Plan
population divided by the total Fiscal Year 2012
Family Health Plan Fee-For-Service recipient
member days. This quotient multiplied by 365
becomes the Fiscal Year 2012 per-recipient
Fee-For-Service cost for the Family Health Plan.
(ii) The total Fiscal Year 2012
Fee-For-Service Medical liability for the
Integrated Care Program population divided by the

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total Fiscal Year 2012 Integrated Care Program
Fee-For-Service recipient member days. This
quotient multiplied by 365 becomes the Fiscal Year
2012 per-recipient Fee-For-Service cost for the
Integrated Care Program.
(iii) The total Fiscal Year 2012
Fee-For-Service Medical liability for the
Medicare-Medicaid Alignment Initiative population
divided by the total Fiscal Year 2012
Medicare-Medicaid Alignment Initiative
Fee-For-Service recipient member days. This
quotient multiplied by 365 becomes the Fiscal Year
2012 per-recipient Fee-For-Service cost for
Medicare-Medicaid Alignment Initiative.
For these calculations, "Medical liability" is
defined as payments billed by providers to any State
agency for healthcare services provided to eligible
Medicaid enrollees during dates of service between
July 1 and June 30 of each fiscal year (commonly
referred to by the Department of Healthcare and Family
Services as DCN liability).
(b) For Fiscal Year 2013: replicate all steps in
(1)(a) using Fiscal Year 2013 Fee-For-Service data.
(c) For Fiscal Year 2014: replicate all steps in
(1)(a) using Fiscal Year 2014 Fee-For-Service data.
(d) For each category (Family Health Plan,

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Integrated Care Program, and Medicare-Medicaid
Alignment Initiative), the Fee-For-Service annual
per-recipient cost baseline shall be the sum of the
Fiscal Year 2012, Fiscal Year 2013, and Fiscal Year
2014 per-recipient cost divided by 3.
(e) Provide the Department of Healthcare and
Family Services total computable administrative cost
for Fiscal Year 2012, Fiscal Year 2013, and Fiscal Year
2014. Also, for each of these years, provide the
MCO-comparable administrative cost which is calculated
by taking the total computable administrative cost
less all administrative costs associated with:
eligibility screenings, schools, other agencies,
federal Electronic Health Records incentives and
planning, eligibility system design, and county/local
administration.
(2) MCO per-recipient costs for Fiscal Year 2015.
(a) Sum all MCO capitation payments made on behalf
of Family Health Plan recipients during Fiscal Year
2015 and divide this sum by the corresponding number of
MCO member months for these same recipients during the
fiscal year. This becomes the Fiscal Year 2015
per-recipient MCO cost for the Family Health Plan.
(b) Sum all MCO capitation payments made on behalf
of Integrated Care Program recipients during Fiscal
Year 2015 and divide this sum by the corresponding

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number of MCO member months for these same recipients
during the fiscal year. This becomes the Fiscal Year
2015 per-recipient MCO cost for the Integrated Care
Program.
(c) Sum all MCO capitation payments made on behalf
of Medicare-Medicaid Alignment Initiative recipients
during Fiscal Year 2015 and divide this sum by the
corresponding number of MCO member months for these
same recipients during the fiscal year. This becomes
the Fiscal Year 2015 per-recipient MCO cost for the
Medicare-Medicaid Alignment Initiative.
For (a), (b), and (c), legislatively-mandated
changes related to Medicaid reimbursement occurring on
or after July 1, 2014 can be excluded from summary
totals, although please list and detail these specific
items including the actuary's calculations for
inclusion into the MCO rates. Also, please exclude (and
detail separately) any payments associated with the
Hospital Assessment program or the Hospital ACA
program.
(d) Provide the Department of Healthcare and
Family Services total computable administrative cost
for Fiscal Year 2015. Additionally provide the Fiscal
Year 2015 MCO-comparable administrative cost which is
calculated by taking the total computable
administrative cost less all administrative costs

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associated with: eligibility screenings, schools,
other agencies, federal Electronic Health Records
incentives and planning, eligibility system design,
and county/local administration.
(e) Provide the aggregate sum total of all MCO
payments for Fiscal Year 2015 as well as the aggregate
MCO member months for Fiscal Year 2015.
(f) Provide the sum total of all encounter data
received from MCOs in Fiscal Year 2015.
Provide to the Senate Human Services Committee all data
requested in (1) and (2) above no later than August 1,
2016.
(3) MCO per-recipient costs for Fiscal Year 2016.
Replicate all steps in (2) above, only substituting in
Fiscal Year 2016 data. Provide this data to the Senate
Human Services committee by August 31, 2016; and be it
further
RESOLVED, That a copy of this resolution be presented to
the Director of the Department of Healthcare and Family
Services.