SB2306 EnrolledLRB099 19419 KTG 43811 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 5-30.3 as follows:
 
6    (305 ILCS 5/5-30.3 new)
7    Sec. 5-30.3. 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, seek input from
11the managed care entities and other stakeholders and develop
12and implement within each enrollment region an algorithm
13preserving existing provider-beneficiary relationships that
14takes into account quality scores and other operational
15proficiency criteria developed, defined, and adopted by the
16Department, to automatically assign Medicaid enrollees served
17under the Family Health Plan and the Integrated Care Program
18and those Medicaid enrollees eligible for medical assistance
19pursuant to the Patient Protection and Affordable Care Act
20(Public Law 111-148) into managed care entities, including
21Accountable Care Entities, Managed Care Community Networks,
22and Managed Care Organizations. The quality metrics used shall
23be measurable for all entities. The algorithm shall not use the

 

 

SB2306 Enrolled- 2 -LRB099 19419 KTG 43811 b

1quality and proficiency metrics to reassign enrollees out of
2any plan in which they are enrolled at the time and shall only
3be used if the client has not voluntarily selected a primary
4care physician and a managed care entity or care coordination
5entity. Clients shall have one opportunity within 90 calendar
6days after auto-assignment by algorithm to select a different
7managed care entity. The algorithm developed and implemented
8shall favor assignment into managed care entities with the
9highest quality scores and levels of compliance with the
10operational proficiency criteria established, taking into
11consideration existing provider-beneficiary relationship as
12defined by 42 CFR 438.50(f)(3) if one exists.