Illinois General Assembly - Full Text of Public Act 099-0898
Illinois General Assembly

Previous General Assemblies

Public Act 099-0898




Public Act 099-0898
SB2306 EnrolledLRB099 19419 KTG 43811 b

    AN ACT concerning public aid.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Illinois Public Aid Code is amended by
adding Section 5-30.3 as follows:
    (305 ILCS 5/5-30.3 new)
    Sec. 5-30.3. Managed care; automatic assignment. The
Department shall, within a reasonable period of time after
relevant data from managed care entities has been collected and
analyzed, but no earlier than January 1, 2017, seek input from
the managed care entities and other stakeholders and develop
and implement within each enrollment region an algorithm
preserving existing provider-beneficiary relationships that
takes into account quality scores and other operational
proficiency criteria developed, defined, and adopted by the
Department, 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
(Public Law 111-148) into managed care entities, including
Accountable Care Entities, Managed Care Community Networks,
and Managed Care Organizations. The quality metrics used shall
be measurable for all entities. 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. Clients shall have one opportunity within 90 calendar
days after auto-assignment by algorithm to select a different
managed care entity. 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, taking into
consideration existing provider-beneficiary relationship as
defined by 42 CFR 438.50(f)(3) if one exists.

Effective Date: 1/1/2017