Full Text of HB4076 103rd General Assembly
HB4076ham001 103RD GENERAL ASSEMBLY | Rep. Camille Y. Lilly Filed: 4/12/2024 | | 10300HB4076ham001 | | LRB103 32309 KTG 71748 a |
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| 1 | | AMENDMENT TO HOUSE BILL 4076
| 2 | | AMENDMENT NO. ______. Amend House Bill 4076 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | adding Section 11-5.3a as follows: | 6 | | (305 ILCS 5/11-5.3a new) | 7 | | Sec. 11-5.3a. Vendor assistance with redeterminations. | 8 | | (a) Each managed care organization, as defined in Section | 9 | | 5-30.1, may enter into one or more contracts with eligible | 10 | | vendors to assist in the redetermination of eligibility of | 11 | | medical assistance enrollees, other than enrollees for whom an | 12 | | ex parte renewal is determined by the Department in accordance | 13 | | with a federal waiver provided under Section 1902(e)(14)(A) of | 14 | | the Social Security Act. Eligible vendors must be certified by | 15 | | the Business Enterprise Program and have no less than 60% of | 16 | | its owners with established residency in Illinois as of the |
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| 1 | | effective date of this amendatory Act of the 103rd General | 2 | | Assembly. | 3 | | (b) Selected vendors shall assist in the redetermination | 4 | | of eligibility for medical assistance by utilizing a system | 5 | | that meets the following requirements: | 6 | | (1) The system must be hosted on a platform that is | 7 | | secure and compliant with standards under the federal | 8 | | Health Insurance Portability and Accountability Act of | 9 | | 1996. Such platform must be scalable and may be | 10 | | cloud-based or on premises. | 11 | | (2) The system must use a communication platform to | 12 | | programmatically perform calls, text messages, and other | 13 | | communication functions using web services or application | 14 | | programming interface services. | 15 | | (3) The system must be able to make contact with a | 16 | | medical assistance enrollee in an automated fashion, | 17 | | continuing until contact is made and confirmed and contact | 18 | | information is updated. | 19 | | (4) The system must allow medical assistance enrollees | 20 | | to enter, update, and transmit their required information | 21 | | through use of a voice virtual agent or text virtual agent | 22 | | to an online web form and back to a human assistant without | 23 | | losing any data input. | 24 | | (5) The system must allow a medical assistance | 25 | | enrollee to switch between the voice virtual agent, the | 26 | | text virtual agent, and an online web form. |
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| 1 | | (6) The system must be designed to be compliant with | 2 | | the Americans with Disabilities Act (ADA). ADA compliance | 3 | | must be found regardless of which of the different ways a | 4 | | medical assistance enrollee enters the data, and then, any | 5 | | of the other means to which the medical assistance | 6 | | enrollee can switch, must continue to be ADA compliant | 7 | | regardless of the stage of the redetermination process | 8 | | that the enrollee is in and regardless of the number of | 9 | | transitions from one data entry means to another. | 10 | | (7) The system must provide an analytics dashboard | 11 | | that is tethered to the communication platform with no | 12 | | additional software installation on the user's computer or | 13 | | mobile devices. | 14 | | (8) The system must include a data processing platform | 15 | | to accumulate enrollee data to begin the process in an | 16 | | automated fashion. This includes data validation, | 17 | | rejection, and preparation for communication such as call | 18 | | or text. | 19 | | (9) The system must be capable of contacting each | 20 | | medical assistance enrollee not less than 3 times per year | 21 | | utilizing skip tracing and bi-directional texting | 22 | | processes to locate up-to-date contact information for | 23 | | members. | 24 | | (10) The system must include a data processing | 25 | | platform to provide data submitted by medical assistance | 26 | | enrollees to managed care organizations at a predefined |
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| 1 | | frequency, such as daily, weekly, or monthly and for | 2 | | measures identified within the Healthcare Effectiveness | 3 | | Data and Information Set guidelines. | 4 | | (c) The Department shall establish a process to accept | 5 | | information provided by managed care organizations or their | 6 | | contracted vendors under this Section no later than 60 days | 7 | | after the effective date of this amendatory Act of the 103rd | 8 | | General Assembly. Nothing in this amendatory Act of the 103rd | 9 | | General Assembly shall be construed to contravene any federal | 10 | | regulation, policy, or requirement of the Centers for Medicare | 11 | | and Medicaid Services. If any provision of this Section or its | 12 | | application is found to be in violation of any federal | 13 | | regulation, policy, or requirement of the Centers for Medicare | 14 | | and Medicaid Services, that provision is declared invalid. | 15 | | (d) Beginning no later than the 30th day of each fiscal | 16 | | year, the Department shall issue monthly payments to each | 17 | | managed care organization, which shall be used to issue | 18 | | payments to its contracted vendors in accordance with this | 19 | | Section. Each managed care organization shall receive a | 20 | | payment in an amount equal to $10 per medical assistance | 21 | | enrollee scheduled for a redetermination of eligibility during | 22 | | the monthly payment period, other than enrollees for whom an | 23 | | ex parte renewal is determined by the Department in accordance | 24 | | with a federal waiver provided under Section 1902(e)(14)(A) of | 25 | | the Social Security Act. | 26 | | (e) Each managed care organization shall report, in a |
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| 1 | | format prescribed by the Department, on at least a quarterly | 2 | | basis the status of its activity or that of its vendors | 3 | | regarding assistance with redeterminations. The Department | 4 | | shall, in turn, report quarterly on its utilization of the | 5 | | information provided by the managed care organizations or | 6 | | their contracted vendors in accordance with this Section. | 7 | | Section 99. Effective date. This Act takes effect July 1, | 8 | | 2024.". |
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