SB1729 99TH GENERAL ASSEMBLY

LRB099 10888 KTG 31211 b

99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB1729

Introduced 2/20/2015, by Sen. Heather A. Steans

SYNOPSIS AS INTRODUCED:

See Index

Amends the Illinois Public Aid Code. Provides that beginning July 1, 2015, the Department of Healthcare and Family Services shall publish monthly reports on its website on the enrollment of persons in the State's medical assistance program, and the enrollment of recipients of medical assistance into a Medicaid Managed Care Entity contracted by the Department. Provides that the monthly reports shall include certain information for the medical assistance program generally and, separately, for each Medicaid Managed Care Entity contracted by the Department, including: (i) total enrollment and (ii) the number of persons enrolled in the medical assistance program pursuant to the Patient Protection and Affordable Care Act. Requires the Department to annually publish on its website every Medicaid Managed Care Entity's quality metrics outcomes and to make public an independent annual quality review report on the State's Medicaid managed care delivery system. Requires the Department to compile on a monthly basis data on eligibility redeterminations of beneficiaries of medical assistance. Requires the data to be posted on the Department's website and to include certain information, including: (a) the total number of redetermination decisions made in a month and, of that total number, the number of decisions to continue benefits, the number of decisions to change benefits, and the number of decisions to cancel benefits; and (b) if a vendor is procured to assist the Department in the redetermination process, the total number of redetermination decisions made in a month with the involvement of the vendor and without the involvement of the vendor. Effective immediately.

FISCAL NOTE ACT MAY APPLY

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 11-5.1 and by adding Section 5-30.2 as follows:

(305 ILCS 5/5-30.2 new)

Sec. 5-30.2. Monthly reports; managed care enrollment.

(a) As used in this section, "Medicaid Managed Care Entity" means a Managed Care Organization (MCO), a Managed Care Community Network (MCCN), an Accountable Care Entity (ACE), or a Care Coordination Entity (CCE) contracted by the Department.

(b) Beginning July 1, 2015, the Department shall publish monthly reports on its website on the enrollment of persons in the State's medical assistance program. In addition, beginning July 1, 2015, the Department shall publish monthly reports on its website on the enrollment of recipients of medical assistance into a Medicaid Managed Care Entity contracted by the Department. The monthly reports shall include all of the following information for the medical assistance program generally and, separately, for each Medicaid Managed Care Entity contracted by the Department:

(1) Total enrollment.

(2) The number of persons enrolled in the medical assistance program pursuant to the Patient Protection and Affordable Care Act (Public Law 111-148).

(3) The number of children enrolled.

(4) The number of parents and caretakers of minor children enrolled.

(5) The number of pregnant women enrolled.

(6) The number of seniors enrolled.

(7) The number of persons with disabilities enrolled.

(c) Beginning July 1, 2015, the Department shall publish monthly reports on its website detailing the percentage of persons enrolled in each Medicaid Managed Care Entity that was assigned using an auto-assignment algorithm. This percentage should also report the type of enrollee who was assigned using an auto-assignment algorithm, including, but not limited to, persons enrolled in the medical assistance program pursuant to the Patient Protection and Affordable Care Act (Public Law 111-148), children, parents and caretakers of minor children, pregnant women, seniors, and persons with disabilities.

(d) Monthly enrollment reports for each Medicaid Managed Care Entity shall include data on the 2 most recent months and data comparing the current month to that month in the prior year.

(e) Monthly enrollment reports for each Medicaid Managed Care Entity shall include a breakdown of language preference for enrollees.

(f) The Department must annually publish on its website each Medicaid Managed Care Entity's quality metrics outcomes and must make public an independent annual quality review report on the State's Medicaid managed care delivery system.

(305 ILCS 5/11-5.1)

Sec. 11-5.1. Eligibility verification. Notwithstanding any other provision of this Code, with respect to applications for medical assistance provided under Article V of this Code, eligibility shall be determined in a manner that ensures program integrity and complies with federal laws and regulations while minimizing unnecessary barriers to enrollment. To this end, as soon as practicable, and unless the Department receives written denial from the federal government, this Section shall be implemented:

(a) The Department of Healthcare and Family Services or its designees shall:

(1) By no later than July 1, 2011, require verification of, at a minimum, one month's income from all sources required for determining the eligibility of applicants for medical assistance under this Code. Such verification shall take the form of pay stubs, business or income and expense records for self-employed persons, letters from employers, and any other valid documentation of income including data obtained electronically by the Department or its designees from other sources as described in subsection (b) of this Section.

(2) By no later than October 1, 2011, require verification of, at a minimum, one month's income from all sources required for determining the continued eligibility of recipients at their annual review of eligibility for medical assistance under this Code. Such verification shall take the form of pay stubs, business or income and expense records for self-employed persons, letters from employers, and any other valid documentation of income including data obtained electronically by the Department or its designees from other sources as described in subsection (b) of this Section. The Department shall send a notice to recipients at least 60 days prior to the end of their period of eligibility that informs them of the requirements for continued eligibility. If a recipient does not fulfill the requirements for continued eligibility by the deadline established in the notice a notice of cancellation shall be issued to the recipient and coverage shall end on the last day of the eligibility period. A recipient's eligibility may be reinstated without requiring a new application if the recipient fulfills the requirements for continued eligibility prior to the end of the third month following the last date of coverage (or longer period if required by federal regulations). Nothing in this Section shall prevent an individual whose coverage has been cancelled from reapplying for health benefits at any time.

(3) By no later than July 1, 2011, require verification of Illinois residency.

(b) The Department shall establish or continue cooperative arrangements with the Social Security Administration, the Illinois Secretary of State, the Department of Human Services, the Department of Revenue, the Department of Employment Security, and any other appropriate entity to gain electronic access, to the extent allowed by law, to information available to those entities that may be appropriate for electronically verifying any factor of eligibility for benefits under the Program. Data relevant to eligibility shall be provided for no other purpose than to verify the eligibility of new applicants or current recipients of health benefits under the Program. Data shall be requested or provided for any new applicant or current recipient only insofar as that individual's circumstances are relevant to that individual's or another individual's eligibility.

(c) Within 90 days of the effective date of this amendatory Act of the 96th General Assembly, the Department of Healthcare and Family Services shall send notice to current recipients informing them of the changes regarding their eligibility verification.

(d) The Department shall compile on a monthly basis data on eligibility redeterminations of beneficiaries of medical assistance provided under Article V of this Code. This data shall be posted on the Department's website, and data from prior months shall be retained and available on the Department's website. The data compiled and reported shall include the following:

(1) The total number of redetermination decisions made in a month and, of that total number, the number of decisions to continue benefits, the number of decisions to change benefits, and the number of decisions to cancel benefits.

(2) A breakdown of enrollee language preference for the total number of redetermination decisions made in a month and, of that total number, a breakdown of enrollee language preference for the number of decisions to continue benefits, a breakdown of enrollee language preference for the number of decisions to change benefits, and a breakdown of enrollee language preference for the number of decisions to cancel benefits.

(3) The percentage of cancellation decisions made in a month due to each of the following:

(A) The beneficiary's ineligibility due to excess income.

(B) The beneficiary's ineligibility due to not being an Illinois resident.

(C) The beneficiary's ineligibility due to being deceased.

(D) The beneficiary's request to cancel benefits due to having other insurance.

(E) The beneficiary's lack of response after notices mailed to the beneficiary are returned to the Department as undeliverable by the United States Postal Service.

(F) The beneficiary's lack of response to a request for additional information when reliable information in the beneficiary's account, or other more current information, is unavailable to the Department to make a decision on whether to continue benefits.

(G) Other reasons tracked by the Department for the purpose of ensuring program integrity.

(4) If a vendor is procured to assist the Department in the redetermination process, the total number of redetermination decisions made in a month and, of that total number, the number of decisions to continue benefits, the number of decisions to change benefits, and the number of decisions to cancel benefits (i) with the involvement of the vendor and (ii) without the involvement of the vendor.

(5) Of the total number of benefit cancellations in a month, the number of beneficiaries who return from cancellation within one month, the number of beneficiaries who return from cancellation within 2 months, and the number of beneficiaries who return from cancellation within 3 months. Of the number of beneficiaries who return from cancellation within 3 months, the percentage of those cancellations due to each of the reasons listed under paragraph (3) of this subsection.

(Source: P.A. 98-651, eff. 6-16-14.)

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