Bill Text: IL HB3352 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a managed care organization that contracts with a safety-net hospitals shall: (i) be liable for 50% of the amount due on any unadjudicated claims properly submitted by the safety-net hospital; (ii) if pre-admission certification is required by the managed care organization prior to authorizing inpatient care, pay the full admission rate to any contracted safety-net hospital that does not receive such authorization within 24 hours after the safety-net hospital first made its request for authorization; (iii) update its provider roster within 48 hours of contracting with a safety-net hospital and pay the full amount on any claim properly submitted by a contracted safety-net hospital even if the managed care organization fails to update its provider roster as required; and (iv) equally share those costs incurred by a contracted safety-net hospital for services provided to a Medicaid enrollee beyond the enrollee's scheduled date of discharge or transfer to another facility, if the managed care organization fails to facilitate the enrollee's discharge or transfer by the scheduled date.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2019-03-29 - Rule 19(a) / Re-referred to Rules Committee [HB3352 Detail]

Download: Illinois-2019-HB3352-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 HB3352 Introduced , by Rep. Marcus C. Evans, Jr. SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-36 new
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a managed care organization that contracts with a safety-net hospitals shall: (i) be liable for 50% of the amount due on any unadjudicated claims properly submitted by the safety-net hospital; (ii) if pre-admission certification is required by the managed care organization prior to authorizing inpatient care, pay the full admission rate to any contracted safety-net hospital that does not receive such authorization within 24 hours after the safety-net hospital first made its request for authorization; (iii) update its provider roster within 48 hours of contracting with a safety-net hospital and pay the full amount on any claim properly submitted by a contracted safety-net hospital even if the managed care organization fails to update its provider roster as required; and (iv) equally share those costs incurred by a contracted safety-net hospital for services provided to a Medicaid enrollee beyond the enrollee's scheduled date of discharge or transfer to another facility, if the managed care organization fails to facilitate the enrollee's discharge or transfer by the scheduled date.
LRB101 08927 KTG 54017 b
A BILL FOR
HB3352 LRB101 08927 KTG 54017 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
adding Section 5-36 as follows:
(305 ILCS 5/5-36 new)
Sec. 5-36. Payment requirements; MCOs; safety-net
hospital.
(a) As used in this Section, "safety-net hospital" means a
hospital as defined in Section 5-5e.1 of this Code.
(b) The following requirements apply to all managed care
organizations under contract with the Department:
(1) A managed care organization shall be liable for 50%
of the amount due on any unadjudicated claims properly
submitted by a safety-net hospital.
(2) Any managed care organization that requires
pre-admission certification prior to authorizing inpatient
care shall pay the full admission rate to any contracted
safety-net hospital that does not receive authorization to
provide inpatient care within 24 hours after the safety-net
hospital first made its request for authorization.
(3) A managed care organization shall update its
provider roster within 48 hours of contracting with a

HB3352 - 2 - LRB101 08927 KTG 54017 b
safety-net hospital. Any managed care organization that
fails to update its provider roster as required under this
paragraph shall still be liable for and must pay the full
amount on any claim for a reimbursable service properly
submitted by a contracted safety-net hospital.
(4) A managed care organization shall equally share
those costs incurred by a contracted safety-net hospital
for services provided to a Medicaid enrollee beyond the
enrollee's scheduled date of discharge or transfer to
another facility for proper post-acute care, if the managed
care organization fails to facilitate the enrollee's
discharge or transfer by the scheduled discharge or
transfer date.