Bob Morgan illinois state representative

Hospitals seek reform of Medicaid managed care system

SPRINGFIELD — In response to concerns raised by hospitals and other health care providers in the Illinois Medicaid system, lawmakers have introduced three pairs of bills, with identical versions in both the House and Senate.

One pair of bills, Senate Bill 1697 and House Bill 2715, would require managed care organizations to use standardized processes for a number of different functions, such as determining whether a service is medically necessary. It would also put a time limit on how long MCOs have to request additional information, and it would further require them to update their rosters more promptly and to reimburse providers under contract, regardless of whether their roster has been updated. Those bills are sponsored by Sen. Heather Steans, D-Chicago, and Rep. Robyn Gabel, D-Evanston.

Another pair, Senate Bill 1703 and House Bill 2814, would allow providers to appeal claim denials to an independent, third-party reviewer. Those bills are sponsored by Sen. Don Harmon, D-Oak Park, and Rep. Bob Morgan, D-Deerfield. And a third pair, Senate Bill 1807 and House Bill 2814, would require, among other things, that MCOs reimburse critical access hospitals and safety net clinics on an expedited schedule, similar to the schedule the state uses for non-managed-care patients at those facilities. Those bills are sponsored by Sen. Kimberly Lightford, D-Maywood, and Rep. Camille Lilly, D-Chicago.

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