SB2830sam001 103RD GENERAL ASSEMBLY

Sen. David Koehler

Filed: 3/7/2024

10300SB2830sam001 LRB103 36606 KTG 70652 a

AMENDMENT TO SENATE BILL 2830

AMENDMENT NO. ______. Amend Senate Bill 2830 by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Public Aid Code is amended by changing Section 5F-35 and by adding Section 5-16.14 as follows:

(305 ILCS 5/5-16.14 new)

Sec. 5-16.14. Managed care prompt payment to providers.

(a) The Department shall adopt rules and policies within 90 days after the effective date of this amendatory Act of the 103rd General Assembly for interest penalties to be imposed on managed care organizations for all delayed payments to medical providers. As used in this Section, "delayed payment" means a payment owed by a managed care organization to a medical provider when the State has provided the managed care organization with the funds for the payment, but the payment to the medical provider has taken over 30 days from submission of a claim by a medical provider or a posting of quarterly incentive payments by the Department.

(b) If payment is not issued from the managed care organization to the medical provider within 30 days of receiving the funds from the State, it shall be considered a delayed payment and an interest penalty of 1.0% of any amount unpaid shall be added for each month or fraction thereof after the end of this 30-day period, until final payment is made. If payment is not issued from the managed care organization to the medical provider within 60 days of receiving the funds from the State, the interest penalty shall increase to 2.5% of any amount unpaid, until final payment is made. If payment is not issued from the managed care organization to the medical provider within 90 days of receiving the funds from the State, the interest penalty shall increase to 5% of any amount unpaid, until final payment is made.

(c) Managed care organizations shall review in a timely manner each claim made to it and provide the Department with a quarterly report indicating:

(1) the number of claims and dollar amount received by the managed care organization from providers for that quarter;

(2) the number of claims and dollar amount paid by the managed care organization to providers for that quarter;

(3) the total number of claims and dollar amount of outstanding payments owed from the managed care organization to providers, broken down by provider;

(4) the average length of time for that quarter it took the managed care organization to pay a provider claim from when it was first submitted;

(5) the average length of time for that quarter it took the managed care organization to pay a provider claim from when the funds were transferred from the State to cover that claim; and

(6) the total number and dollar amount of interest penalty payments incurred for that quarter.

(d) The Department shall annually review managed care payment times and provide details of delays in the Department's annual report.

(305 ILCS 5/5F-35)

Sec. 5F-35. Reimbursement. The Department shall provide each managed care organization with the quarterly fee-for-service facility-specific RUG-IV nursing component per diem along with any add-ons for enhanced care services, support component per diem, and capital component per diem effective for each nursing home under contract with the managed care organization. No managed care contract shall provide for a level of reimbursement lower than the fee-for-service rate in effect for the facility at the time service is rendered.

(Source: P.A. 98-651, eff. 6-16-14.)".