DHFS-MCO-TRANSPORTATION CLAIMS

Amends the Illinois Public Aid Code. Requires managed care organizations (MCOs) to participate in the Non-Emergency Transportation Services Prior Approval Program (NETSPAP) established under the Code beginning 90 days after the effective date of the amendatory Act. Requires each MCO to submit through NETSPAP for adjudication every unpaid non-emergency transportation claim incurred since January 1, 2012; and requires a NETSPAP contractor to adjudicate such claims without regard to any deadlines for submission or processing that are otherwise applicable. Provides that all non-emergency ambulance service providers seeking reimbursement for prior claims must submit documentation of the transport no later than 150 days after the effective date of the amendatory Act. Provides that upon receipt of approval from the NETSPAP contractor, each MCO shall process and pay all approved claims within 30 days, without requiring any further action by the non-emergency transportation services provider; and that any denial of reimbursement by the NETSPAP contractor may be appealed. Provides that any costs incurred in connection with the review of claims by the NETSPAP contractor are the sole responsibility of the MCO. Provides that MCOs shall not unreasonably refuse to contract with ground ambulance services providers and medi-car services providers, shall not unreasonably restrict access to and the availability of ground ambulance services and medi-car services, and shall ensure that recipients of benefits provided under the Department of Healthcare and Family Services' programs are not liable for ground ambulance services and medi-car services expenses consistent with federal law and specified provisions of the Illinois Insurance Code and the Illinois Administrative Code. Effective immediately.