MEDICAID ACCESS MONITORING

Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning managed care organizations (MCOs) contracted with the Department of Healthcare and Family Services to provide health services, requires the Department to develop a procedure no later than January 1, 2017 to directly test the provider network directories submitted to the State by each MCO. Provides that the procedure must directly test the accuracy of the information contained in the provider directories, the ability of prospective patients to obtain an appointment, and the timeliness of appointments offered to prospective patients. Requires the Department to develop the procedure in consultation with MCOs, providers, consumer advocacy organizations, and other relevant stakeholders and to contract with a third party with experience developing or evaluating procedures to directly test Medicaid provider availability and access in Illinois and other states. Sets forth certain provider types the Department is required to test for each MCO and mandatory managed care region, including: (i) primary care; (ii) mental health treatment; (iii) adult specialty; (iv) child specialty; and (v) any additional provider types the Department has reason to believe may not exist in sufficient numbers in one or more mandatory managed care regions. Requires the Department to annually publish the data collected in its External Quality Review Technical Report. Permits the Department to adopt any rules necessary to implement these responsibilities. Effective immediately.