HB6213 Summary

• Requires managed care organizations (MCOs) to pay emergency service providers at Illinois Medicaid fee-for-service rates, including all applicable adjustments, even if the provider is not contracted with the MCO.

• Mandates MCOs cover post-stabilization services in specified situations including when services are provided within one hour of authorization request, when MCO cannot be contacted, or when non-affiliated and affiliated providers cannot reach agreement on care.

• Prohibits MCOs from imposing prior approval requirements for emergency services and makes the attending physician's determination of patient stabilization binding on the MCO.

• Requires MCOs to maintain publicly accessible provider directories in machine-readable format without password requirements, including provider office hours and mechanisms to report and correct inaccuracies.

• Mandates Department create a consumer quality comparison tool (online and print) displaying standardized performance measures across multiple domains to help Medicaid enrollees select plans, available by January 1, 2018.