HB2985 101ST GENERAL ASSEMBLY

LRB101 05267 KTG 50280 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB2985

Introduced , by Rep. Sonya M. Harper

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5F-31

Amends the Illinois Public Aid Code. Requires Medicaid managed care organizations to verify payer source using the Medical Electronic Data Interchange (MEDI) System, or its successor, prior to denying a claim for services provided to a nursing home resident not assigned to the managed care organization on the most recent patient credit file. Requires the Department of Healthcare and Family Services to grant Medicaid managed care organizations access to MEDI, or its successor, for the purpose of verifying payer source and resident liability. Effective immediately.

A BILL FOR

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 changing Section 5F-31 as follows:

(305 ILCS 5/5F-31)

Sec. 5F-31. Patient credit files; denials of claims.

(a) To reduce the number of claim denials resulting from coverage plan errors, the Department shall provide each nursing home enrolled in one or more Medicaid managed care networks with the corresponding patient credit file at the same time the Department provides the files to the managed care organization.

(b) Medicaid managed care organizations shall verify payer source using the Medical Electronic Data Interchange (MEDI) System, or its successor, prior to denying a claim for services provided to a nursing home resident not assigned to the managed care organization on the most recent patient credit file. The Department shall grant Medicaid managed care organizations access to MEDI, or its successor, for the purpose of verifying payer source and resident liability.

(Source: P.A. 100-1085, eff. 1-1-19.)

Section 99. Effective date. This Act takes effect upon becoming law.