DHFS-MCO ENROLLMENT-ALGORITHM

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall, within a reasonable period of time, develop and implement within each enrollment region an algorithm that preserves existing provider-beneficiary relationships and that takes into account previous relationships with managed care entities in order 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 into managed care entities, including accountable care entities, managed care community networks, and managed care organizations. Provides that 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. Provides that clients shall have one opportunity within 90 calendar days after auto-assignment by algorithm to select a different managed care entity. Requires the Department to seek input from stakeholders, including, but not limited to, Medicaid health plans and consumer advocacy organizations, prior to changing the automatic assignment algorithm. Requires the Department to publish the automatic assignment algorithm's components and on a quarterly basis publish auto-assignment enrollment numbers as well as the corresponding logic for those enrollment numbers.