Sen. Heather A. Steans

Filed: 3/11/2015





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2    AMENDMENT NO. ______. Amend Senate Bill 788 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-30.2 as follows:
6    (305 ILCS 5/5-30.2 new)
7    Sec. 5-30.2. Managed care; automatic assignment. The
8Department shall, within a reasonable period of time after
9relevant data from managed care entities has been collected and
10analyzed, but no earlier than January 1, 2017, develop and
11implement within each enrollment region an algorithm that takes
12into account quality scores and other operational proficiency
13criteria developed, defined, and adopted by the Department, to
14automatically assign Medicaid enrollees served under the
15Family Health Plan and the Integrated Care Program and those
16Medicaid enrollees eligible for medical assistance pursuant to



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1the Patient Protection and Affordable Care Act (Public Law
2111-148) into managed care entities, including Accountable
3Care Entities, Managed Care Community Networks, and Managed
4Care Organizations. The quality metrics used shall be
5measurable for all entities. The algorithm shall not use the
6quality and proficiency metrics to reassign enrollees out of
7any plan that they are enrolled with at the time and shall only
8be used if the client has not voluntarily selected a primary
9care physician and a managed care entity. Clients shall have
10one opportunity within 90 calendar days after auto assignment
11by algorithm to select a different managed care entity. The
12algorithm developed and implemented shall favor assignment
13into managed care entities with the highest quality scores and
14levels of compliance with the operational proficiency criteria