Sen. Heather A. Steans

Filed: 4/15/2016

 

 


 

 


 
09900SB2306sam002LRB099 19419 KTG 47399 a

1
AMENDMENT TO SENATE BILL 2306

2    AMENDMENT NO. ______. Amend Senate Bill 2306, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The Illinois Public Aid Code is amended by
6adding Section 5-30.3 as follows:
 
7    (305 ILCS 5/5-30.3 new)
8    Sec. 5-30.3. Managed care; automatic assignment. The
9Department shall, within a reasonable period of time after
10relevant data from managed care entities has been collected and
11analyzed, but no earlier than January 1, 2017, develop and
12implement 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

 

 

09900SB2306sam002- 2 -LRB099 19419 KTG 47399 a

1under the Family Health Plan and the Integrated Care Program
2and those Medicaid enrollees eligible for medical assistance
3pursuant to the Patient Protection and Affordable Care Act
4(Public Law 111-148) into managed care entities, including
5Accountable Care Entities, Managed Care Community Networks,
6and Managed Care Organizations. The quality metrics used shall
7be measurable for all entities. The algorithm shall not use the
8quality and proficiency metrics to reassign enrollees out of
9any plan in which they are enrolled at the time and shall only
10be used if the client has not voluntarily selected a primary
11care physician and a managed care entity or care coordination
12entity. Clients shall have one opportunity within 90 calendar
13days after auto-assignment by algorithm to select a different
14managed care entity. The algorithm developed and implemented
15shall favor assignment into managed care entities with the
16highest quality scores and levels of compliance with the
17operational proficiency criteria established, taking into
18consideration existing provider-beneficiary relationship as
19defined by 42 CFR 438.50(f)(3) if one exists.".