MEDICAID-DHFS-MCO-PPR POLICY

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that no later than 90 days after the effective date of the amendatory Act, the Department of Healthcare and Family Services shall post on its official website: (i) a copy of all current, executed, or adopted contracts with each managed care organization (MCO), including all amendments, attachments, and exhibits, that are in effect as of January 1, 2021; (ii) all changes made to each MCO contract that are in effect on or after January 1, 2021; (iii) all operational policy changes issued to MCOs; and (iv) a copy of all contracts and operational policy changes for a period of not less than 24 months after the termination or expiration of any MCO contract. Provides that the Department shall prohibit each MCO from operating, implementing, or modifying any program or policy that concerns, but it not limited to, reducing potentially preventable hospital readmissions (PPR) until after the Department has adopted an updated PPR policy for services provided to individuals not covered under managed care. Contains provisions concerning prohibited PPR policy measures. Provides that if the Department elects to implement a comprehensive PPR policy that applies to both the fee-for-service and managed care medical assistance programs, then no MCO may operate a similar PPR policy. Provides that an MCO shall not make a material change unless the material change has been approved by the Department or agreed upon in writing by the MCO and the health care provider. Requires the Department to publish on its website a process through which an MCO may submit a written proposed material change request. Effective immediately.