Illinois General Assembly - Full Text of SR1916
Illinois General Assembly

Previous General Assemblies

Full Text of SR1916  99th General Assembly




SR1916LRB099 21997 KTG 49101 r


2    WHEREAS, The Medicaid program in Illinois has a substantial
3and growing impact both in terms of taxpayer dollars and in
4terms of the effect it has on citizens across the State; and
5    WHEREAS, State resources for healthcare services are
6currently so scarce that many healthcare providers are
7discontinuing services leading to a profoundly detrimental
8impact on our communities; and
9    WHEREAS, Enrollment under the Department of Healthcare and
10Family Services' Medical Programs (Medicaid) exceeds 3
11million; and
12    WHEREAS, Over 60% of the Medicaid population is currently
13enrolled in Managed Care Organizations (MCOs), making outlays
14to MCOs one of the largest resource uses in the State; and
15    WHEREAS, Heretofore there has been inadequate information
16disseminated to the General Assembly in terms of how State
17resources are being spent on MCOs and on the overall healthcare
18outcomes for individuals enrolled in these MCOs; and
19    WHEREAS, In an environment of limited funding for education
20and other critical needs, the Senate must stay engaged in



SR1916- 2 -LRB099 21997 KTG 49101 r

1Medicaid funding and corresponding healthcare outcome issues
2and be prepared to make legislative decisions and
3administrative recommendations; and
4    WHEREAS, Having per-recipient MCO costs from each State
5fiscal year for each eligibility category as a basis for
6comparison to the Fee-For-Service baseline per-recipient costs
7will help this institution determine how effectively Medicaid
8resources are being managed; therefore, be it
10ASSEMBLY OF THE STATE OF ILLINOIS, that we request from the
11Department of Healthcare and Family Services the following
13        (1) Calculating a Fee-For-Service baseline.
14            (a) For Fiscal Year 2012, provide the following:
15                (i) The total Fiscal Year 2012 Fee-For-Service
16            Medical liability for the Family Health Plan
17            population divided by the total Fiscal Year 2012
18            Family Health Plan Fee-For-Service recipient
19            member days. This quotient multiplied by 365
20            becomes the Fiscal Year 2012 per-recipient
21            Fee-For-Service cost for the Family Health Plan.
22                (ii) The total Fiscal Year 2012
23            Fee-For-Service Medical liability for the
24            Integrated Care Program population divided by the



SR1916- 3 -LRB099 21997 KTG 49101 r

1            total Fiscal Year 2012 Integrated Care Program
2            Fee-For-Service recipient member days. This
3            quotient multiplied by 365 becomes the Fiscal Year
4            2012 per-recipient Fee-For-Service cost for the
5            Integrated Care Program.
6                (iii) The total Fiscal Year 2012
7            Fee-For-Service Medical liability for the
8            Medicare-Medicaid Alignment Initiative population
9            divided by the total Fiscal Year 2012
10            Medicare-Medicaid Alignment Initiative
11            Fee-For-Service recipient member days. This
12            quotient multiplied by 365 becomes the Fiscal Year
13            2012 per-recipient Fee-For-Service cost for
14            Medicare-Medicaid Alignment Initiative.
15            For these calculations, "Medical liability" is
16        defined as payments billed by providers to any State
17        agency for healthcare services provided to eligible
18        Medicaid enrollees during dates of service between
19        July 1 and June 30 of each fiscal year (commonly
20        referred to by the Department of Healthcare and Family
21        Services as DCN liability).
22            (b) For Fiscal Year 2013: replicate all steps in
23        (1)(a) using Fiscal Year 2013 Fee-For-Service data.
24            (c) For Fiscal Year 2014: replicate all steps in
25        (1)(a) using Fiscal Year 2014 Fee-For-Service data.
26            (d) For each category (Family Health Plan,



SR1916- 4 -LRB099 21997 KTG 49101 r

1        Integrated Care Program, and Medicare-Medicaid
2        Alignment Initiative), the Fee-For-Service annual
3        per-recipient cost baseline shall be the sum of the
4        Fiscal Year 2012, Fiscal Year 2013, and Fiscal Year
5        2014 per-recipient cost divided by 3.
6            (e) Provide the Department of Healthcare and
7        Family Services total computable administrative cost
8        for Fiscal Year 2012, Fiscal Year 2013, and Fiscal Year
9        2014. Also, for each of these years, provide the
10        MCO-comparable administrative cost which is calculated
11        by taking the total computable administrative cost
12        less all administrative costs associated with:
13        eligibility screenings, schools, other agencies,
14        federal Electronic Health Records incentives and
15        planning, eligibility system design, and county/local
16        administration.
17        (2) MCO per-recipient costs for Fiscal Year 2015.
18            (a) Sum all MCO capitation payments made on behalf
19        of Family Health Plan recipients during Fiscal Year
20        2015 and divide this sum by the corresponding number of
21        MCO member months for these same recipients during the
22        fiscal year. This becomes the Fiscal Year 2015
23        per-recipient MCO cost for the Family Health Plan.
24            (b) Sum all MCO capitation payments made on behalf
25        of Integrated Care Program recipients during Fiscal
26        Year 2015 and divide this sum by the corresponding



SR1916- 5 -LRB099 21997 KTG 49101 r

1        number of MCO member months for these same recipients
2        during the fiscal year. This becomes the Fiscal Year
3        2015 per-recipient MCO cost for the Integrated Care
4        Program.
5            (c) Sum all MCO capitation payments made on behalf
6        of Medicare-Medicaid Alignment Initiative recipients
7        during Fiscal Year 2015 and divide this sum by the
8        corresponding number of MCO member months for these
9        same recipients during the fiscal year. This becomes
10        the Fiscal Year 2015 per-recipient MCO cost for the
11        Medicare-Medicaid Alignment Initiative.
12            For (a), (b), and (c), legislatively-mandated
13        changes related to Medicaid reimbursement occurring on
14        or after July 1, 2014 can be excluded from summary
15        totals, although please list and detail these specific
16        items including the actuary's calculations for
17        inclusion into the MCO rates. Also, please exclude (and
18        detail separately) any payments associated with the
19        Hospital Assessment program or the Hospital ACA
20        program.
21            (d) Provide the Department of Healthcare and
22        Family Services total computable administrative cost
23        for Fiscal Year 2015. Additionally provide the Fiscal
24        Year 2015 MCO-comparable administrative cost which is
25        calculated by taking the total computable
26        administrative cost less all administrative costs



SR1916- 6 -LRB099 21997 KTG 49101 r

1        associated with: eligibility screenings, schools,
2        other agencies, federal Electronic Health Records
3        incentives and planning, eligibility system design,
4        and county/local administration.
5            (e) Provide the aggregate sum total of all MCO
6        payments for Fiscal Year 2015 as well as the aggregate
7        MCO member months for Fiscal Year 2015.
8            (f) Provide the sum total of all encounter data
9        received from MCOs in Fiscal Year 2015.
10        Provide to the Senate Human Services Committee all data
11    requested in (1) and (2) above no later than August 1,
12    2016.
13        (3) MCO per-recipient costs for Fiscal Year 2016.
14    Replicate all steps in (2) above, only substituting in
15    Fiscal Year 2016 data. Provide this data to the Senate
16    Human Services committee by August 31, 2016; and be it
17    further
18    RESOLVED, That a copy of this resolution be presented to
19the Director of the Department of Healthcare and Family