Bill Amendment: IL SB2830 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: MEDICAID-MCO PROMPT PAYMENT
Status: 2024-05-03 - Senate Committee Amendment No. 2 Rule 3-9(a) / Re-referred to Assignments [SB2830 Detail]
Download: Illinois-2023-SB2830-Senate_Amendment_001.html
Bill Title: MEDICAID-MCO PROMPT PAYMENT
Status: 2024-05-03 - Senate Committee Amendment No. 2 Rule 3-9(a) / Re-referred to Assignments [SB2830 Detail]
Download: Illinois-2023-SB2830-Senate_Amendment_001.html
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1 | AMENDMENT TO SENATE BILL 2830 | ||||||
2 | AMENDMENT NO. ______. Amend Senate Bill 2830 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 5F-35 and by adding Section 5-16.14 as | ||||||
6 | follows:
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7 | (305 ILCS 5/5-16.14 new) | ||||||
8 | Sec. 5-16.14. Managed care prompt payment to providers. | ||||||
9 | (a) The Department shall adopt rules and policies within | ||||||
10 | 90 days after the effective date of this amendatory Act of the | ||||||
11 | 103rd General Assembly for interest penalties to be imposed on | ||||||
12 | managed care organizations for all delayed payments to medical | ||||||
13 | providers. As used in this Section, "delayed payment" means a | ||||||
14 | payment owed by a managed care organization to a medical | ||||||
15 | provider when the State has provided the managed care | ||||||
16 | organization with the funds for the payment, but the payment |
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1 | to the medical provider has taken over 30 days from submission | ||||||
2 | of a claim by a medical provider or a posting of quarterly | ||||||
3 | incentive payments by the Department. | ||||||
4 | (b) If payment is not issued from the managed care | ||||||
5 | organization to the medical provider within 30 days of | ||||||
6 | receiving the funds from the State, it shall be considered a | ||||||
7 | delayed payment and an interest penalty of 1.0% of any amount | ||||||
8 | unpaid shall be added for each month or fraction thereof after | ||||||
9 | the end of this 30-day period, until final payment is made. If | ||||||
10 | payment is not issued from the managed care organization to | ||||||
11 | the medical provider within 60 days of receiving the funds | ||||||
12 | from the State, the interest penalty shall increase to 2.5% of | ||||||
13 | any amount unpaid, until final payment is made. If payment is | ||||||
14 | not issued from the managed care organization to the medical | ||||||
15 | provider within 90 days of receiving the funds from the State, | ||||||
16 | the interest penalty shall increase to 5% of any amount | ||||||
17 | unpaid, until final payment is made. | ||||||
18 | (c) Managed care organizations shall review in a timely | ||||||
19 | manner each claim made to it and provide the Department with a | ||||||
20 | quarterly report indicating: | ||||||
21 | (1) the number of claims and dollar amount received by | ||||||
22 | the managed care organization from providers for that | ||||||
23 | quarter; | ||||||
24 | (2) the number of claims and dollar amount paid by the | ||||||
25 | managed care organization to providers for that quarter; | ||||||
26 | (3) the total number of claims and dollar amount of |
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1 | outstanding payments owed from the managed care | ||||||
2 | organization to providers, broken down by provider; | ||||||
3 | (4) the average length of time for that quarter it | ||||||
4 | took the managed care organization to pay a provider claim | ||||||
5 | from when it was first submitted; | ||||||
6 | (5) the average length of time for that quarter it | ||||||
7 | took the managed care organization to pay a provider claim | ||||||
8 | from when the funds were transferred from the State to | ||||||
9 | cover that claim; and | ||||||
10 | (6) the total number and dollar amount of interest | ||||||
11 | penalty payments incurred for that quarter. | ||||||
12 | (d) The Department shall annually review managed care | ||||||
13 | payment times and provide details of delays in the | ||||||
14 | Department's annual report.
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15 | (305 ILCS 5/5F-35) | ||||||
16 | Sec. 5F-35. Reimbursement. The Department shall provide | ||||||
17 | each managed care organization with the quarterly | ||||||
18 | fee-for-service facility-specific RUG-IV nursing component per | ||||||
19 | diem along with any add-ons for enhanced care services, | ||||||
20 | support component per diem, and capital component per diem | ||||||
21 | effective for each nursing home under contract with the | ||||||
22 | managed care organization. No managed care contract shall | ||||||
23 | provide for a level of reimbursement lower than the | ||||||
24 | fee-for-service rate in effect for the facility at the time | ||||||
25 | service is rendered. |
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