Bill Status of HB5433 100th General Assembly
Short Description: MEDICAID-MCO-PAYOUT RATIOS
Rep. Fred Crespo - Emanuel Chris Welch
| 1/8/2019||House||Session Sine Die|
Statutes Amended In Order of Appearance
Synopsis As Introduced
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to calculate the payout ratios reported by managed care organizations no less frequently than annually and to post these calculations on its website. Provides that the minimum payout ratio shall be 85% and that a managed care organization not meeting the 85% threshold must refund to the State, for each coverage year, an amount equal to the difference between the calculated payout ratio and 85% multiplied by coverage year revenue for that managed care organization. Defines "payment ratio". Requires the Department to exclusively use paid claims data submitted by managed care organizations in establishing managed care capitation rates. Provides that managed care organizations shall not be reimbursed by the State for any costs associated with health insurance fees.