MEDICAID-MCO-PAYOUT RATIOS

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to calculate the payout ratios reported by managed care organizations no less frequently than annually and to post these calculations on its website. Provides that the minimum payout ratio shall be 85% and that a managed care organization not meeting the 85% threshold must refund to the State, for each coverage year, an amount equal to the difference between the calculated payout ratio and 85% multiplied by coverage year revenue for that managed care organization. Requires the Department to exclusively use paid claims data submitted by managed care organizations in establishing managed care capitation rates. Provides that managed care organizations shall not be reimbursed by the State for any costs associated with health insurance fees. Provides that beginning July 1, 2019, in addition to any other payments made for inpatient Medicaid inpatient services, the Department must make the following add-on enhancement payments for each covered inpatient day for any patient covered by any medical assistance program administered by the Department: (i) for each general acute care hospital with a rate year 2017 Medicaid inpatient utilization rate equal to or greater than 47%, an additional $172 per inpatient day; (ii) for each hospital defined as a children's hospital under the Code with a rate year 2017 Medicaid inpatient utilization rate equal to or greater than 59%, an additional $200 per inpatient day; and (iii) for each critical access hospital, an additional $600 per inpatient day. Provides that the Department must require managed care organizations to make the same inpatient high-volume add-on enhancements for inpatient days of care. Effective July 1, 2019.