Illinois General Assembly - Bill Status for SB2306

Replaces everything after the enacting clause. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to develop and implement an algorithm that is based on quality scores and other operational proficiency criteria developed, defined, and adopted by the Department, by rule, to automatically assign Medicaid enrollees served under the Family Health Plan and the Integrated Care Program and those Medicaid enrollees eligible for medical assistance pursuant to the Patient Protection and Affordable Care Act into managed care entities, including Accountable Care Entities, Care Coordination Entities, Children with Special Needs Care Coordination Entities, Managed Care Community Networks, and Managed Care Organizations. Provides that the algorithm developed and implemented shall favor assignment into managed care entities with the highest quality scores and levels of compliance with the operational proficiency criteria established.

Replaces everything after the enacting clause. Requires the Department of Healthcare and Family Services to, no earlier than January 1, 2017, develop and implement within each enrollment region an algorithm to automatically assign Medicaid enrollees served under the Family Health Plan and the Integrated Care Program and those Medicaid enrollees eligible for medical assistance pursuant to the Patient Protection and Affordable Care Act into managed care entities, including Accountable Care Entities, Managed Care Community Networks, and Managed Care Organizations. Provides that the algorithm shall not use the quality and proficiency metrics to reassign enrollees out of any plan in which they are enrolled at the time and shall only be used if the client has not voluntarily selected a primary care physician and a managed care entity or care coordination entity. Permits clients to select a different managed care entity within 90 calendar days after auto-assignment by algorithm and requires the algorithm to favor assignment into managed care entities with the highest quality scores and levels of compliance with the operational proficiency criteria established.

In a provision requiring the Department of Healthcare and Family Services to develop and implement an algorithm to automatically assign certain Medicaid enrollees into managed care entities, adds language requiring the Department to seek input from managed care entities and other stakeholders.

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