MEDICAID-MCO BEHAVIORIAL HLTH House SponsorsRep. Lindsey LaPointe, Rita Mayfield, Laura Faver Dias, Nabeela Syed, Diane Blair-Sherlock, Lisa Davis, Dagmara Avelar, Barbara Hernandez, Theresa Mah, Carol Ammons and Anne Stava 3/27/2026HouseRule 19(a) / Re-referred to Rules Committee 305 ILCS 5/5-30.19 new Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services must incorporate minimum standards governing behavioral health pre-payment and post-payment reviews into MCO contracts effective for all services covered on and after January 1, 2027. Requires the Department to develop or adopt behavioral health-specific pre-payment and post-payment review guidelines and incorporate such guidelines by reference into MCO contracts. Provides that the Department-issued guidelines must: (1) define the documentation and clearly specify the discrete data elements that may be requested prior to and during a pre-payment or post-payment review, and applicable response timeframes, ensuring that all requests are specific, reasonable, and directly tied to the review objectives; (2) identify regulatory, statutory, and contractual standards applicable to behavioral health services; (3) establish uniform evaluation criteria and checklists; and (4) be publicly available and updated as necessary. Contains provisions on MCO contracts and required contract terms; pre-payment and post-payment review processes and notice requirements; timeframes for providers to respond to a documentation request; communication protocols; contract transparency and extrapolation from a statistical sampling of claims; the timeliness and closure of claims reviews; submission methods; reviewer qualifications; and enforcement. Effective immediately. 2/3/2026HouseFiled with the Clerk by Rep. Lindsey LaPointe 2/6/2026HouseFirst Reading 2/6/2026HouseReferred to Rules Committee 3/4/2026HouseAssigned to Appropriations-Health and Human Services Committee 3/9/2026HouseAdded Co-Sponsor Rep. Rita Mayfield 3/9/2026HouseAdded Co-Sponsor Rep. Laura Faver Dias 3/10/2026HouseAdded Co-Sponsor Rep. Nabeela Syed 3/13/2026HouseAdded Co-Sponsor Rep. Diane Blair-Sherlock 3/13/2026HouseAdded Co-Sponsor Rep. Lisa Davis 3/16/2026HouseAdded Co-Sponsor Rep. Dagmara Avelar 3/19/2026HouseAdded Co-Sponsor Rep. Barbara Hernandez 3/19/2026HouseAdded Co-Sponsor Rep. Theresa Mah 3/20/2026HouseTo Appropriations-Medicaid Subcommittee 3/24/2026HouseAdded Co-Sponsor Rep. Carol Ammons 3/27/2026HouseRule 19(a) / Re-referred to Rules Committee 4/6/2026HouseAdded Co-Sponsor Rep. Anne Stava