DHFS-MCO PERFORMANCE METRICS Senate SponsorsSen. Donne E. Trotter-Mattie Hunter-Jacqueline Y. Collins-William Delgado House Sponsors(Rep. Gregory Harris-Patricia R. Bellock-Eddie Lee Jackson, Sr.) 8/5/2016SenatePublic Act . . . . . . . . . 99-0751 305 ILCS 5/5-30.1Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning network adequacy for managed care organizations (MCO) contracted with the Department of Healthcare and Family Services, provides that each MCO shall (i) on a monthly basis, jointly validate with contracted providers any changes in provider information, including, but not limited to, changes concerning new providers, terminated providers, updated address information, hours of operation, or other information that is material to a Medicaid beneficiary in the enrollment and provider selection process; and (ii) be required to produce system reports that validate that all MCO systems reflect updated provider information. Provides that in situations in which an enrolled Medicaid provider renders services based on information obtained after verifying a patient's eligibility and coverage plan through either the Department's current enrollment system or the coverage plan identified by the patient presenting for services, such services shall be considered rendered in good faith. Requires the Department to create and maintain a MCO Performance Metrics Comparison Tool that provides periodic reporting, on at least a quarterly basis, of each MCO's performance in various administrative measures. Requires the tool to be accessible in both a print and online format, with the online format allowing for Medicaid beneficiaries and providers to access additional detailed MCO performance information. Effective immediately.Senate Floor Amendment No. 1 Replaces everything after the enacting clause. Amends the Illinois Public Aid Code. In a provision concerning network adequacy for managed care organizations (MCO) contracted with the Department of Healthcare and Family Services, provides that each MCO shall confirm its receipt of information submitted specific to physician additions or physician deletions from the MCO's provider network within 3 days after receiving all required information from contracted physicians, and electronic physician directories must be updated consistent with current rules as published by the Centers for Medicare and Medicaid Services or its successor agency. Provides that (i) in no instance shall a medically necessary covered service rendered in good faith, based upon eligibility information documented by the provider, be denied coverage or diminished in payment amount if the eligibility or coverage information available at the time the service was rendered is later found to be inaccurate; and (ii) the Department shall, by December 31, 2016, adopt rules establishing policies that shall be included in the Medicaid managed care policy and procedures manual addressing payment resolutions in situations in which a provider renders services based upon information obtained after verifying a patient's eligibility and coverage plan through either the Department's current enrollment system or a system operated by the coverage plan identified by the patient presenting for certain services. Requires the Department to publish on at least a quarterly basis, each MCO's operational performance, including, but not limited to, certain categories of metrics. Requires the Department to ensure that (1) the metrics report is accessible to providers online by January 1, 2017; (2) the metrics are developed in consultation with industry representatives of the Medicaid managed care health plans and representatives of associations representing the majority of providers within the identified industry; and (3) the metrics are defined and incorporated into the applicable Managed Care Policy Manual issued by the Department. Effective immediately. 2/19/2016SenateFiled with Secretary by Sen. Donne E. Trotter 2/19/2016SenateFirst Reading 2/19/2016SenateReferred to Assignments 3/8/2016SenateAssigned to Special Committee on Oversight of Medicaid Managed Care 4/8/2016SenateRule 2-10 Committee Deadline Established As April 22, 2016 4/13/2016SenateAdded as Chief Co-Sponsor Sen. Mattie Hunter 4/13/2016SenateAdded as Chief Co-Sponsor Sen. Jacqueline Y. Collins 4/14/2016SenateDo Pass Special Committee on Oversight of Medicaid Managed Care; 009-000-000 4/14/2016SenatePlaced on Calendar Order of 2nd Reading April 18, 2016 4/14/2016SenateAdded as Chief Co-Sponsor Sen. William Delgado 4/20/2016SenateSecond Reading 4/20/2016SenatePlaced on Calendar Order of 3rd Reading April 21, 2016 4/28/2016SenateRule 2-10 Committee/3rd Reading Deadline Established As May 13, 2016 5/11/2016SenateSenate Floor Amendment No. 1 Filed with Secretary by Sen. Donne E. Trotter 5/11/2016SenateSenate Floor Amendment No. 1 Referred to Assignments 5/11/2016SenateSenate Floor Amendment No. 1 Assignments Refers to Human Services 5/12/2016SenateSenate Floor Amendment No. 1 Recommend Do Adopt Human Services; 007-000-000 5/12/2016SenateRecalled to Second Reading 5/12/2016SenateSenate Floor Amendment No. 1 Adopted; Trotter 5/12/2016SenatePlaced on Calendar Order of 3rd Reading 5/12/2016SenateThird Reading - Passed; 055-000-000 5/13/2016HouseArrived in House 5/13/2016HouseChief House Sponsor Rep. Barbara Flynn Currie 5/16/2016HouseFirst Reading 5/16/2016HouseReferred to Rules Committee 5/17/2016HouseAlternate Chief Sponsor Changed to Rep. Gregory Harris 5/17/2016HouseAssigned to Human Services Committee 5/17/2016HouseFinal Action Deadline Extended-9(b) May 27, 2016 5/24/2016HouseAdded Alternate Chief Co-Sponsor Rep. Patricia R. Bellock 5/24/2016HouseDo Pass / Short Debate Human Services Committee; 013-000-000 5/25/2016HousePlaced on Calendar 2nd Reading - Short Debate 5/25/2016HouseSecond Reading - Short Debate 5/25/2016HousePlaced on Calendar Order of 3rd Reading - Short Debate 5/27/2016HouseThird Reading - Short Debate - Passed 107-001-000 5/27/2016HouseAdded Alternate Chief Co-Sponsor Rep. Eddie Lee Jackson, Sr. 5/27/2016SenatePassed Both Houses 6/27/2016SenateSent to the Governor 8/5/2016SenateGovernor Approved 8/5/2016SenateEffective Date August 5, 2016 8/5/2016SenatePublic Act . . . . . . . . . 99-0751