HR1216 100TH GENERAL ASSEMBLY

HR1216 LRB100 23414 MST 42440 r

HOUSE RESOLUTION

WHEREAS, In 2011, the Illinois General Assembly decided to begin to transition the Illinois Medicaid program from fee-for-service to a managed care program; and

WHEREAS, The purpose of the transition to Medicaid managed care was to save the State money as well as coordinate care for Medicaid recipients; and

WHEREAS, Unfortunately, neither of those things have occurred; instead, the managed care organizations (MCOs) have instituted a "claims management program" rather than a "care management program", where the MCOs deny incredible amounts of Medicaid claims, resulting in significant harm to Medicaid providers throughout the State and billions of state funds being pocketed by the MCOs; and

WHEREAS, In 2018, the Auditor General published an audit as a result of HR 100 of the 100th General Assembly that showed billions of state funds being paid to the MCOs which were not passed along to providers; and

WHEREAS, The harm being caused by the MCOs is particularly damaging to providers who rely heavily on the Medicaid program, such as Roseland Community Hospital; and

WHEREAS, The average MCO denial rate for safety-net hospitals is 20%, which has resulted in significant layoffs in areas with the highest unemployment in the State and puts future health care services at-risk in the State's most vulnerable communities; and

WHEREAS, This incredible MCO denial rate is not unique to geography, affects communities throughout downstate Illinois as well as Chicago, and results in diminished patient care and lost revenues for local communities throughout Illinois; and

WHEREAS, Under the Rauner Administration, the Department of Healthcare and Family Services has not provided adequate oversight to prevent the abuse of the MCOs, resulting in billions of dollars being shipped to out-of-state for-profit corporations at the expense of Illinois providers and the Illinois residents who rely on healthcare services; and

WHEREAS, The MCO crisis has caused disproportionate harm to minority communities that rely on safety-net hospitals to provide quality healthcare services to vulnerable communities; therefore, be it

RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE HUNDREDTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that the Auditor General is directed to conduct an audit of the average denial rate of hospitals throughout Illinois in both the fee-for-service and managed care programs, with at least 50% of the audit consisting of safety-net and critical access hospitals; the Department of Healthcare and Family Services and all managed care entities shall be required to participate fully, at the Auditor General's request; and be it further

RESOLVED, That the Illinois Department of Healthcare and Family Services and any other State agency having information relevant to this audit cooperate fully and promptly with the Auditor General's Office; and be it further

RESOLVED, That the Auditor General commence this audit as soon as possible and report his findings and recommendations to the General Assembly; and be it further

RESOLVED, That if the Auditor General's findings conclude that the average MCO denial rate for hospitals in the managed care program is 10% or more higher than the average denial rate of the fee-for-service program, then the General Assembly should consider sun-setting the managed care program; and be it further

RESOLVED, That suitable copies of this resolution shall be delivered to the Governor, the Director of Healthcare and Family Services, and each of the four legislative leaders.