MANAGED CARE-PEDIATRIC NETWORK

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a health plan, including an Accountable Care Entity (ACE), a Care Coordination Entity (CCE), a Managed Care Community Network (MCCN), or a Managed Care Organization (MCO), that has met the Department of Healthcare and Family Services' requirements to provide services to Medicaid managed care enrollees must meet minimum specialty pediatric network adequacy requirements. Provides that to meet those requirements (i) a network must include at least one Pediatric Essential Community Provider; (ii) as determined by the Department, the health plan must show that its network has access to the full range of primary, specialty, and ancillary pediatric providers, and must ensure coordination and continuity of care among all providers; and (iii) the health plan must provide annual reports to the Department that demonstrate its assessment of pediatric provider networks and whether gaps in access to care have been identified, accompanied by a plan to remedy those gaps and monitor access to care in those specifically identified areas. Provides that a health plan must demonstrate to the Department that it meets certain minimum pediatric network adequacy requirements and that the Department may only contract with health plans serving children that meet the pediatric network adequacy requirements. Contains a provision concerning certain annual reports submitted by the Office of Health Innovation and Transformation created by Executive Order 14-01. Effective immediately.