103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3372

 

Introduced 2/7/2024, by Sen. Ann Gillespie

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-30.1

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Makes changes to provisions requiring Medicaid managed care organizations (MCO) to make payments for emergency services. Requires an MCO to pay any provider of emergency services, including inpatient stabilization services provided during the inpatient stabilization period, that does not have in effect a contract with the MCO. Defines "inpatient stabilization period" to mean the initial 72 hours of inpatient stabilization services, beginning from the date and time of the order for inpatient admission to the hospital. Provides that when determining payment for all emergency services, including inpatient stabilization services provided during the inpatient stabilization period, the MCO shall: (i) not impose any service authorization requirements, including, but not limited to, prior authorization, prior approval, pre-certification, concurrent review, or certification of admission; (ii) have no obligation to cover emergency services provided on an emergency basis that are not covered services under the MCO's contract with the Department of Healthcare and Family Services; and (iii) not condition coverage for emergency services on the treating provider notifying the MCO of the enrollee's emergency medical screening examination and treatment within 10 days after presentation for emergency services. Provides that the determination of the attending emergency physician, or the practitioner responsible for the enrollee's care at the hospital, of whether an enrollee requires inpatient stabilization services, can be stabilized in the outpatient setting, or is sufficiently stabilized for discharge or transfer to another facility, shall be binding on the MCO. Provides that an MCO shall not reimburse inpatient stabilization services billed on an inpatient institutional claim under the outpatient reimbursement methodology and shall not reimburse providers for emergency services in cases of fraud. Requires the Department to impose sanctions on a MCO for noncompliance, including, but not limited to, financial penalties, suspension of enrollment of new enrollees, and termination of the MCO's contract with the Department. Effective immediately.


LRB103 37676 KTG 67803 b

 

 

A BILL FOR

 

SB3372LRB103 37676 KTG 67803 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-30.1 as follows:
 
6    (305 ILCS 5/5-30.1)
7    Sec. 5-30.1. Managed care protections.
8    (a) As used in this Section:
9    "Managed care organization" or "MCO" means any entity
10which contracts with the Department to provide services where
11payment for medical services is made on a capitated basis.
12    "Emergency services" means health care items and services,
13including inpatient and outpatient hospital services,
14furnished or required to evaluate and stabilize an emergency
15medical condition. "Emergency services" include inpatient
16stabilization services furnished during the inpatient
17stabilization period. "Emergency services" do not include
18post-stabilization medical services. include:
19        (1) emergency services, as defined by Section 10 of
20    the Managed Care Reform and Patient Rights Act;
21        (2) emergency medical screening examinations, as
22    defined by Section 10 of the Managed Care Reform and
23    Patient Rights Act;

 

 

SB3372- 2 -LRB103 37676 KTG 67803 b

1        (3) post-stabilization medical services, as defined by
2    Section 10 of the Managed Care Reform and Patient Rights
3    Act; and
4        (4) emergency medical conditions, as defined by
5    Section 10 of the Managed Care Reform and Patient Rights
6    Act.
7    "Emergency medical condition" means a medical condition
8manifesting itself by acute symptoms of sufficient severity,
9regardless of the final diagnosis given, such that a prudent
10layperson, who possesses an average knowledge of health and
11medicine, could reasonably expect the absence of immediate
12medical attention to result in:
13        (1) placing the health of the individual (or, with
14    respect to a pregnant woman, the health of the woman or her
15    unborn child) in serious jeopardy;
16        (2) serious impairment to bodily functions;
17        (3) serious dysfunction of any bodily organ or part;
18        (4) inadequately controlled pain; or
19        (5) with respect to a pregnant woman who is having
20    contractions:
21            (A) inadequate time to complete a safe transfer to
22        another hospital before delivery; or
23            (B) a transfer to another hospital may pose a
24        threat to the health or safety of the woman or unborn
25        child.
26    "Emergency medical screening examination" means a medical

 

 

SB3372- 3 -LRB103 37676 KTG 67803 b

1screening examination and evaluation by a physician licensed
2to practice medicine in all its branches or, to the extent
3permitted by applicable laws, by other appropriately licensed
4personnel under the supervision of or in collaboration with a
5physician licensed to practice medicine in all its branches to
6determine whether the need for emergency services exists.
7    "Inpatient stabilization period" means the initial 72
8hours of inpatient stabilization services, beginning from the
9date and time of the order for inpatient admission to the
10hospital.
11    "Inpatient stabilization services" mean emergency services
12furnished in the inpatient setting at a licensed hospital
13pursuant to an order for inpatient admission by a physician or
14other qualified practitioner who has admitting privileges at
15the hospital, as permitted by State law, to stabilize an
16emergency medical condition following an emergency medical
17screening examination.
18    "Post-stabilization medical services" means health care
19services provided to an enrollee that are furnished in a
20licensed hospital by a provider that is qualified to furnish
21such services and determined to be medically necessary and
22directly related to the emergency medical condition following
23stabilization.
24    (b) As provided by Section 5-16.12, managed care
25organizations are subject to the provisions of the Managed
26Care Reform and Patient Rights Act.

 

 

SB3372- 4 -LRB103 37676 KTG 67803 b

1    (c) An MCO shall pay any provider of emergency services,
2including inpatient stabilization services provided during the
3inpatient stabilization period, that does not have in effect a
4contract with the contracted Medicaid MCO. The default rate of
5reimbursement shall be the rate paid under Illinois Medicaid
6fee-for-service program methodology, including all policy
7adjusters, including but not limited to Medicaid High Volume
8Adjustments, Medicaid Percentage Adjustments, Outpatient High
9Volume Adjustments, and all outlier add-on adjustments to the
10extent such adjustments are incorporated in the development of
11the applicable MCO capitated rates.
12    (d) An MCO shall pay for all post-stabilization services
13as a covered service in any of the following situations:
14        (1) the MCO authorized such services;
15        (2) such services were administered to maintain the
16    enrollee's stabilized condition within one hour after a
17    request to the MCO for authorization of further
18    post-stabilization services;
19        (3) the MCO did not respond to a request to authorize
20    such services within one hour;
21        (4) the MCO could not be contacted; or
22        (5) the MCO and the treating provider, if the treating
23    provider is a non-affiliated provider, could not reach an
24    agreement concerning the enrollee's care and an affiliated
25    provider was unavailable for a consultation, in which case
26    the MCO must pay for such services rendered by the

 

 

SB3372- 5 -LRB103 37676 KTG 67803 b

1    treating non-affiliated provider until an affiliated
2    provider was reached and either concurred with the
3    treating non-affiliated provider's plan of care or assumed
4    responsibility for the enrollee's care. Such payment shall
5    be made at the default rate of reimbursement paid under
6    Illinois Medicaid fee-for-service program methodology,
7    including all policy adjusters, including but not limited
8    to Medicaid High Volume Adjustments, Medicaid Percentage
9    Adjustments, Outpatient High Volume Adjustments and all
10    outlier add-on adjustments to the extent that such
11    adjustments are incorporated in the development of the
12    applicable MCO capitated rates.
13    (d) Notwithstanding any other provision of law, the (e)
14The following requirements apply to MCOs in determining
15payment for all emergency services, including inpatient
16stabilization services provided during the inpatient
17stabilization period:
18        (1) The MCO MCOs shall not impose any service
19    authorization requirements for prior approval of emergency
20    services, including, but not limited to, prior
21    authorization, prior approval, pre-certification,
22    concurrent review, or certification of admission.
23        (2) The MCO shall cover emergency services provided to
24    enrollees who are temporarily away from their residence
25    and outside the contracting area to the extent that the
26    enrollees would be entitled to the emergency services if

 

 

SB3372- 6 -LRB103 37676 KTG 67803 b

1    they still were within the contracting area.
2        (3) The MCO shall have no obligation to cover
3    emergency medical services provided on an emergency basis
4    that are not covered services under the contract.
5        (4) The MCO shall not condition coverage for emergency
6    services on the treating provider notifying the MCO of the
7    enrollee's emergency medical screening examination and
8    treatment within 10 days after presentation for emergency
9    services.
10        (5) The determination of the attending emergency
11    physician, or the practitioner responsible for the
12    enrollee's care at the hospital, the provider actually
13    treating the enrollee, of whether an enrollee requires
14    inpatient stabilization services, can be stabilized in the
15    outpatient setting, or is sufficiently stabilized for
16    discharge or transfer to another facility, shall be
17    binding on the MCO. The MCO shall cover and reimburse
18    providers for emergency services as billed by the provider
19    for all enrollees whether the emergency services are
20    provided by an affiliated or non-affiliated provider,
21    except in cases of fraud. The MCO shall not reimburse
22    inpatient stabilization services provided during the
23    inpatient stabilization period and billed on an inpatient
24    institutional claim under the outpatient reimbursement
25    methodology.
26        (6) The MCO's financial responsibility for

 

 

SB3372- 7 -LRB103 37676 KTG 67803 b

1    post-stabilization medical care services it has not
2    pre-approved ends when:
3            (A) a plan physician with privileges at the
4        treating hospital assumes responsibility for the
5        enrollee's care;
6            (B) a plan physician assumes responsibility for
7        the enrollee's care through transfer;
8            (C) a contracting entity representative and the
9        treating physician reach an agreement concerning the
10        enrollee's care; or
11            (D) the enrollee is discharged.
12    (e) An MCO shall pay for all post-stabilization medical
13services as a covered service in any of the following
14situations:
15        (1) the MCO authorized such services;
16        (2) such services were administered to maintain the
17    enrollee's stabilized condition within one hour after a
18    request to the MCO for authorization of further
19    post-stabilization services;
20        (3) the MCO did not respond to a request to authorize
21    such services within one hour;
22        (4) the MCO could not be contacted; or
23        (5) the MCO and the treating provider, if the treating
24    provider is a non-affiliated provider, could not reach an
25    agreement concerning the enrollee's care and an affiliated
26    provider was unavailable for a consultation, in which case

 

 

SB3372- 8 -LRB103 37676 KTG 67803 b

1    the MCO must pay for such services rendered by the
2    treating non-affiliated provider until an affiliated
3    provider was reached and either concurred with the
4    treating non-affiliated provider's plan of care or assumed
5    responsibility for the enrollee's care. Such payment shall
6    be made at the default rate of reimbursement paid under
7    the State's Medicaid fee-for-service program methodology,
8    including all policy adjusters, including, but not limited
9    to, Medicaid High Volume Adjustments, Medicaid Percentage
10    Adjustments, Outpatient High Volume Adjustments, and all
11    outlier add-on adjustments to the extent that such
12    adjustments are incorporated in the development of the
13    applicable MCO capitated rates.
14    (f) Network adequacy and transparency.
15        (1) The Department shall:
16            (A) ensure that an adequate provider network is in
17        place, taking into consideration health professional
18        shortage areas and medically underserved areas;
19            (B) publicly release an explanation of its process
20        for analyzing network adequacy;
21            (C) periodically ensure that an MCO continues to
22        have an adequate network in place;
23            (D) require MCOs, including Medicaid Managed Care
24        Entities as defined in Section 5-30.2, to meet
25        provider directory requirements under Section 5-30.3;
26            (E) require MCOs to ensure that any

 

 

SB3372- 9 -LRB103 37676 KTG 67803 b

1        Medicaid-certified provider under contract with an MCO
2        and previously submitted on a roster on the date of
3        service is paid for any medically necessary,
4        Medicaid-covered, and authorized service rendered to
5        any of the MCO's enrollees, regardless of inclusion on
6        the MCO's published and publicly available directory
7        of available providers; and
8            (F) require MCOs, including Medicaid Managed Care
9        Entities as defined in Section 5-30.2, to meet each of
10        the requirements under subsection (d-5) of Section 10
11        of the Network Adequacy and Transparency Act; with
12        necessary exceptions to the MCO's network to ensure
13        that admission and treatment with a provider or at a
14        treatment facility in accordance with the network
15        adequacy standards in paragraph (3) of subsection
16        (d-5) of Section 10 of the Network Adequacy and
17        Transparency Act is limited to providers or facilities
18        that are Medicaid certified.
19        (2) Each MCO shall confirm its receipt of information
20    submitted specific to physician or dentist additions or
21    physician or dentist deletions from the MCO's provider
22    network within 3 days after receiving all required
23    information from contracted physicians or dentists, and
24    electronic physician and dental directories must be
25    updated consistent with current rules as published by the
26    Centers for Medicare and Medicaid Services or its

 

 

SB3372- 10 -LRB103 37676 KTG 67803 b

1    successor agency.
2    (g) Timely payment of claims.
3        (1) The MCO shall pay a claim within 30 days of
4    receiving a claim that contains all the essential
5    information needed to adjudicate the claim.
6        (2) The MCO shall notify the billing party of its
7    inability to adjudicate a claim within 30 days of
8    receiving that claim.
9        (3) The MCO shall pay a penalty that is at least equal
10    to the timely payment interest penalty imposed under
11    Section 368a of the Illinois Insurance Code for any claims
12    not timely paid.
13            (A) When an MCO is required to pay a timely payment
14        interest penalty to a provider, the MCO must calculate
15        and pay the timely payment interest penalty that is
16        due to the provider within 30 days after the payment of
17        the claim. In no event shall a provider be required to
18        request or apply for payment of any owed timely
19        payment interest penalties.
20            (B) Such payments shall be reported separately
21        from the claim payment for services rendered to the
22        MCO's enrollee and clearly identified as interest
23        payments.
24        (4)(A) The Department shall require MCOs to expedite
25    payments to providers identified on the Department's
26    expedited provider list, determined in accordance with 89

 

 

SB3372- 11 -LRB103 37676 KTG 67803 b

1    Ill. Adm. Code 140.71(b), on a schedule at least as
2    frequently as the providers are paid under the
3    Department's fee-for-service expedited provider schedule.
4        (B) Compliance with the expedited provider requirement
5    may be satisfied by an MCO through the use of a Periodic
6    Interim Payment (PIP) program that has been mutually
7    agreed to and documented between the MCO and the provider,
8    if the PIP program ensures that any expedited provider
9    receives regular and periodic payments based on prior
10    period payment experience from that MCO. Total payments
11    under the PIP program may be reconciled against future PIP
12    payments on a schedule mutually agreed to between the MCO
13    and the provider.
14        (C) The Department shall share at least monthly its
15    expedited provider list and the frequency with which it
16    pays providers on the expedited list.
17    (g-5) Recognizing that the rapid transformation of the
18Illinois Medicaid program may have unintended operational
19challenges for both payers and providers:
20        (1) in no instance shall a medically necessary covered
21    service rendered in good faith, based upon eligibility
22    information documented by the provider, be denied coverage
23    or diminished in payment amount if the eligibility or
24    coverage information available at the time the service was
25    rendered is later found to be inaccurate in the assignment
26    of coverage responsibility between MCOs or the

 

 

SB3372- 12 -LRB103 37676 KTG 67803 b

1    fee-for-service system, except for instances when an
2    individual is deemed to have not been eligible for
3    coverage under the Illinois Medicaid program; and
4        (2) the Department shall, by December 31, 2016, adopt
5    rules establishing policies that shall be included in the
6    Medicaid managed care policy and procedures manual
7    addressing payment resolutions in situations in which a
8    provider renders services based upon information obtained
9    after verifying a patient's eligibility and coverage plan
10    through either the Department's current enrollment system
11    or a system operated by the coverage plan identified by
12    the patient presenting for services:
13            (A) such medically necessary covered services
14        shall be considered rendered in good faith;
15            (B) such policies and procedures shall be
16        developed in consultation with industry
17        representatives of the Medicaid managed care health
18        plans and representatives of provider associations
19        representing the majority of providers within the
20        identified provider industry; and
21            (C) such rules shall be published for a review and
22        comment period of no less than 30 days on the
23        Department's website with final rules remaining
24        available on the Department's website.
25        The rules on payment resolutions shall include, but
26    not be limited to:

 

 

SB3372- 13 -LRB103 37676 KTG 67803 b

1            (A) the extension of the timely filing period;
2            (B) retroactive prior authorizations; and
3            (C) guaranteed minimum payment rate of no less
4        than the current, as of the date of service,
5        fee-for-service rate, plus all applicable add-ons,
6        when the resulting service relationship is out of
7        network.
8        The rules shall be applicable for both MCO coverage
9    and fee-for-service coverage.
10    If the fee-for-service system is ultimately determined to
11have been responsible for coverage on the date of service, the
12Department shall provide for an extended period for claims
13submission outside the standard timely filing requirements.
14    (g-6) MCO Performance Metrics Report.
15        (1) The Department shall publish, on at least a
16    quarterly basis, each MCO's operational performance,
17    including, but not limited to, the following categories of
18    metrics:
19            (A) claims payment, including timeliness and
20        accuracy;
21            (B) prior authorizations;
22            (C) grievance and appeals;
23            (D) utilization statistics;
24            (E) provider disputes;
25            (F) provider credentialing; and
26            (G) member and provider customer service.

 

 

SB3372- 14 -LRB103 37676 KTG 67803 b

1        (2) The Department shall ensure that the metrics
2    report is accessible to providers online by January 1,
3    2017.
4        (3) The metrics shall be developed in consultation
5    with industry representatives of the Medicaid managed care
6    health plans and representatives of associations
7    representing the majority of providers within the
8    identified industry.
9        (4) Metrics shall be defined and incorporated into the
10    applicable Managed Care Policy Manual issued by the
11    Department.
12    (g-7) MCO claims processing and performance analysis. In
13order to monitor MCO payments to hospital providers, pursuant
14to Public Act 100-580, the Department shall post an analysis
15of MCO claims processing and payment performance on its
16website every 6 months. Such analysis shall include a review
17and evaluation of a representative sample of hospital claims
18that are rejected and denied for clean and unclean claims and
19the top 5 reasons for such actions and timeliness of claims
20adjudication, which identifies the percentage of claims
21adjudicated within 30, 60, 90, and over 90 days, and the dollar
22amounts associated with those claims.
23    (g-8) Dispute resolution process. The Department shall
24maintain a provider complaint portal through which a provider
25can submit to the Department unresolved disputes with an MCO.
26An unresolved dispute means an MCO's decision that denies in

 

 

SB3372- 15 -LRB103 37676 KTG 67803 b

1whole or in part a claim for reimbursement to a provider for
2health care services rendered by the provider to an enrollee
3of the MCO with which the provider disagrees. Disputes shall
4not be submitted to the portal until the provider has availed
5itself of the MCO's internal dispute resolution process.
6Disputes that are submitted to the MCO internal dispute
7resolution process may be submitted to the Department of
8Healthcare and Family Services' complaint portal no sooner
9than 30 days after submitting to the MCO's internal process
10and not later than 30 days after the unsatisfactory resolution
11of the internal MCO process or 60 days after submitting the
12dispute to the MCO internal process. Multiple claim disputes
13involving the same MCO may be submitted in one complaint,
14regardless of whether the claims are for different enrollees,
15when the specific reason for non-payment of the claims
16involves a common question of fact or policy. Within 10
17business days of receipt of a complaint, the Department shall
18present such disputes to the appropriate MCO, which shall then
19have 30 days to issue its written proposal to resolve the
20dispute. The Department may grant one 30-day extension of this
21time frame to one of the parties to resolve the dispute. If the
22dispute remains unresolved at the end of this time frame or the
23provider is not satisfied with the MCO's written proposal to
24resolve the dispute, the provider may, within 30 days, request
25the Department to review the dispute and make a final
26determination. Within 30 days of the request for Department

 

 

SB3372- 16 -LRB103 37676 KTG 67803 b

1review of the dispute, both the provider and the MCO shall
2present all relevant information to the Department for
3resolution and make individuals with knowledge of the issues
4available to the Department for further inquiry if needed.
5Within 30 days of receiving the relevant information on the
6dispute, or the lapse of the period for submitting such
7information, the Department shall issue a written decision on
8the dispute based on contractual terms between the provider
9and the MCO, contractual terms between the MCO and the
10Department of Healthcare and Family Services and applicable
11Medicaid policy. The decision of the Department shall be
12final. By January 1, 2020, the Department shall establish by
13rule further details of this dispute resolution process.
14Disputes between MCOs and providers presented to the
15Department for resolution are not contested cases, as defined
16in Section 1-30 of the Illinois Administrative Procedure Act,
17conferring any right to an administrative hearing.
18    (g-9)(1) The Department shall publish annually on its
19website a report on the calculation of each managed care
20organization's medical loss ratio showing the following:
21        (A) Premium revenue, with appropriate adjustments.
22        (B) Benefit expense, setting forth the aggregate
23    amount spent for the following:
24            (i) Direct paid claims.
25            (ii) Subcapitation payments.
26            (iii) Other claim payments.

 

 

SB3372- 17 -LRB103 37676 KTG 67803 b

1            (iv) Direct reserves.
2            (v) Gross recoveries.
3            (vi) Expenses for activities that improve health
4        care quality as allowed by the Department.
5    (2) The medical loss ratio shall be calculated consistent
6with federal law and regulation following a claims runout
7period determined by the Department.
8    (g-10)(1) "Liability effective date" means the date on
9which an MCO becomes responsible for payment for medically
10necessary and covered services rendered by a provider to one
11of its enrollees in accordance with the contract terms between
12the MCO and the provider. The liability effective date shall
13be the later of:
14        (A) The execution date of a network participation
15    contract agreement.
16        (B) The date the provider or its representative
17    submits to the MCO the complete and accurate standardized
18    roster form for the provider in the format approved by the
19    Department.
20        (C) The provider effective date contained within the
21    Department's provider enrollment subsystem within the
22    Illinois Medicaid Program Advanced Cloud Technology
23    (IMPACT) System.
24    (2) The standardized roster form may be submitted to the
25MCO at the same time that the provider submits an enrollment
26application to the Department through IMPACT.

 

 

SB3372- 18 -LRB103 37676 KTG 67803 b

1    (3) By October 1, 2019, the Department shall require all
2MCOs to update their provider directory with information for
3new practitioners of existing contracted providers within 30
4days of receipt of a complete and accurate standardized roster
5template in the format approved by the Department provided
6that the provider is effective in the Department's provider
7enrollment subsystem within the IMPACT system. Such provider
8directory shall be readily accessible for purposes of
9selecting an approved health care provider and comply with all
10other federal and State requirements.
11    (g-11) The Department shall work with relevant
12stakeholders on the development of operational guidelines to
13enhance and improve operational performance of Illinois'
14Medicaid managed care program, including, but not limited to,
15improving provider billing practices, reducing claim
16rejections and inappropriate payment denials, and
17standardizing processes, procedures, definitions, and response
18timelines, with the goal of reducing provider and MCO
19administrative burdens and conflict. The Department shall
20include a report on the progress of these program improvements
21and other topics in its Fiscal Year 2020 annual report to the
22General Assembly.
23    (g-12) Notwithstanding any other provision of law, if the
24Department or an MCO requires submission of a claim for
25payment in a non-electronic format, a provider shall always be
26afforded a period of no less than 90 business days, as a

 

 

SB3372- 19 -LRB103 37676 KTG 67803 b

1correction period, following any notification of rejection by
2either the Department or the MCO to correct errors or
3omissions in the original submission.
4    Under no circumstances, either by an MCO or under the
5State's fee-for-service system, shall a provider be denied
6payment for failure to comply with any timely submission
7requirements under this Code or under any existing contract,
8unless the non-electronic format claim submission occurs after
9the initial 180 days following the latest date of service on
10the claim, or after the 90 business days correction period
11following notification to the provider of rejection or denial
12of payment.
13    (h) The Department shall not expand mandatory MCO
14enrollment into new counties beyond those counties already
15designated by the Department as of June 1, 2014 for the
16individuals whose eligibility for medical assistance is not
17the seniors or people with disabilities population until the
18Department provides an opportunity for accountable care
19entities and MCOs to participate in such newly designated
20counties.
21    (h-5) Leading indicator data sharing. By January 1, 2024,
22the Department shall obtain input from the Department of Human
23Services, the Department of Juvenile Justice, the Department
24of Children and Family Services, the State Board of Education,
25managed care organizations, providers, and clinical experts to
26identify and analyze key indicators from assessments and data

 

 

SB3372- 20 -LRB103 37676 KTG 67803 b

1sets available to the Department that can be shared with
2managed care organizations and similar care coordination
3entities contracted with the Department as leading indicators
4for elevated behavioral health crisis risk for children. To
5the extent permitted by State and federal law, the identified
6leading indicators shall be shared with managed care
7organizations and similar care coordination entities
8contracted with the Department within 6 months of
9identification for the purpose of improving care coordination
10with the early detection of elevated risk. Leading indicators
11shall be reassessed annually with stakeholder input.
12    (i) The requirements of this Section apply to contracts
13with accountable care entities and MCOs entered into, amended,
14or renewed after June 16, 2014 (the effective date of Public
15Act 98-651).
16    (j) Health care information released to managed care
17organizations. A health care provider shall release to a
18Medicaid managed care organization, upon request, and subject
19to the Health Insurance Portability and Accountability Act of
201996 and any other law applicable to the release of health
21information, the health care information of the MCO's
22enrollee, if the enrollee has completed and signed a general
23release form that grants to the health care provider
24permission to release the recipient's health care information
25to the recipient's insurance carrier.
26    (k) The Department of Healthcare and Family Services,

 

 

SB3372- 21 -LRB103 37676 KTG 67803 b

1managed care organizations, a statewide organization
2representing hospitals, and a statewide organization
3representing safety-net hospitals shall explore ways to
4support billing departments in safety-net hospitals.
5    (l) The requirements of this Section added by Public Act
6102-4 shall apply to services provided on or after the first
7day of the month that begins 60 days after April 27, 2021 (the
8effective date of Public Act 102-4).
9    (m) The Department shall impose sanctions on a managed
10care organization for violating any provision under this
11Section, including, but not limited to, financial penalties,
12suspension of enrollment of new enrollees, and termination of
13the MCO's contract with the Department.
14(Source: P.A. 102-4, eff. 4-27-21; 102-43, eff. 7-6-21;
15102-144, eff. 1-1-22; 102-454, eff. 8-20-21; 102-813, eff.
165-13-22; 103-546, eff. 8-11-23.)
 
17    Section 99. Effective date. This Act takes effect upon
18becoming law.