MEDICAID-MANAGED CARE-CONTRACT

Amends the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services' contracts with Managed Care Organizations and other entities reimbursed by risk based capitation shall (i) have a minimum medical loss ratio of 85% prior to December 31, 2014 and a minimum medical loss ratio of 90% thereafter; (ii) require the MCO or other entity to pay claims within 30 days of receiving a bill that contains all the essential information needed to adjudicate the bill; (iii) require the MCO or other entity to pay a penalty that is at least equal to the penalty imposed under the Illinois Insurance Code for any claims not timely paid; (iv) require the MCO or other entity to notify the billing party within 30 days of receiving a bill of any essential information needed to adjudicate the bill; (v) require payments for hospital services in an amount not less than the Department would pay on a fee-for-service basis; (vi) contain a warranty by the MCO or other entity that its network is in place at the time the contract is in effect; (vii) provide for shared savings requirements between the MCO or other entity and its hospital providers; (viii) require that the MCO or other entity post a bond to cover the risk of failure to pay any pass-through payments; and (ix) contain dispute resolution protocols and utilization review or denial management standards consistent with the standards required pursuant to the Medicare Advantage program (rather than shall have a minimum medical loss ratio of 85%, shall require the MCO or other entity to pay claims within 30 days of receiving a bill that contains all the essential information needed to adjudicate the bill, and shall require the entity to pay a penalty that is at least equal to the penalty imposed under the Illinois Insurance Code for any claims not paid within this time period). Effective immediately.