IL HB5485

Requires at least 50% of medical assistance recipients eligible for comprehensive medical benefits to be enrolled in a care coordination program by January 1, 2015.

Defines "care coordination" as integrated delivery systems where providers are responsible for primary care, referrals, diagnostic services, behavioral health, hospital services, dental services, and long-term care.

Mandates that health insurance companies contracting with the Department to provide managed care must obtain National Committee for Quality Assurance (NCQA) accreditation within 3 years of beginning service, or by January 1, 2015 if already providing services.

Requires payment for coordinated care to be based on performance metrics including health outcomes, evidence-based practices, comprehensive medical homes, electronic medical records, and health information exchange, either through capitated or risk-based arrangements.

Directs the Department to report to the General Assembly from April 2012 through April 2016 on care coordination program progress and implementation, including analysis of federal payment limitations and necessary rate adjustments.