103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2830

 

Introduced 1/19/2024, by Sen. David Koehler

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-16.14 new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to adopt rules and policies within 90 days after the effective date of the amendatory Act for interest penalties to be imposed on managed care organizations for all delayed payments, as defined, to medical providers. Provides that if payment is not issued from the managed care organization to the medical provider within 30 days of receiving the funds from the State, it shall be considered a delayed payment and an interest penalty of 1.0% of any amount unpaid shall be added for each month or fraction thereof after the end of this 30-day period, until final payment is made. Provides that if payment is not issued from the managed care organization to the medical provider within 60 days of receiving the funds from the State, the interest penalty shall increase to 2.5% of any amount unpaid, until final payment is made. Provides that if payment is not issued from the managed care organization to the medical provider within 90 days of receiving the funds from the State, the interest penalty shall increase to 5% of any amount unpaid, until final payment is made. Requires managed care organizations to review in a timely manner each claim made to it and provide the Department with a quarterly report indicating certain information, including, but not limited to: (i) the number of claims and dollar amount received by the managed care organization from providers for that quarter; (ii) the average length of time for that quarter it took the managed care organization to pay a provider claim from when it was first submitted; and (iii) the total number and dollar amount of interest penalty payments incurred for that quarter. Requires the Department to annually review managed care payment times and provide details of delays in the Department's annual report.


LRB103 36606 KTG 66715 b

 

 

A BILL FOR

 

SB2830LRB103 36606 KTG 66715 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
5adding Section 5-16.14 as follows:
 
6    (305 ILCS 5/5-16.14 new)
7    Sec. 5-16.14. Managed care prompt payment to providers.
8    (a) The Department shall adopt rules and policies within
990 days after the effective date of this amendatory Act of the
10103rd General Assembly for interest penalties to be imposed on
11managed care organizations for all delayed payments to medical
12providers. As used in this Section, "delayed payment" means a
13payment owed by a managed care organization to a medical
14provider when the State has provided the managed care
15organization with the funds for the payment, but the payment
16to the medical provider has taken over 30 days from submission
17of a claim by a medical provider or a posting of quarterly
18incentive payments by the Department.
19    (b) If payment is not issued from the managed care
20organization to the medical provider within 30 days of
21receiving the funds from the State, it shall be considered a
22delayed payment and an interest penalty of 1.0% of any amount
23unpaid shall be added for each month or fraction thereof after

 

 

SB2830- 2 -LRB103 36606 KTG 66715 b

1the end of this 30-day period, until final payment is made. If
2payment is not issued from the managed care organization to
3the medical provider within 60 days of receiving the funds
4from the State, the interest penalty shall increase to 2.5% of
5any amount unpaid, until final payment is made. If payment is
6not issued from the managed care organization to the medical
7provider within 90 days of receiving the funds from the State,
8the interest penalty shall increase to 5% of any amount
9unpaid, until final payment is made.
10    (c) Managed care organizations shall review in a timely
11manner each claim made to it and provide the Department with a
12quarterly report indicating:
13        (1) the number of claims and dollar amount received by
14    the managed care organization from providers for that
15    quarter;
16        (2) the number of claims and dollar amount paid by the
17    managed care organization to providers for that quarter;
18        (3) the total number of claims and dollar amount of
19    outstanding payments owed from the managed care
20    organization to providers, broken down by provider;
21        (4) the average length of time for that quarter it
22    took the managed care organization to pay a provider claim
23    from when it was first submitted;
24        (5) the average length of time for that quarter it
25    took the managed care organization to pay a provider claim
26    from when the funds were transferred from the State to

 

 

SB2830- 3 -LRB103 36606 KTG 66715 b

1    cover that claim; and
2        (6) the total number and dollar amount of interest
3    penalty payments incurred for that quarter.
4    (d) The Department shall annually review managed care
5payment times and provide details of delays in the
6Department's annual report.