IL SB0788

Department of Public Aid must develop and implement an algorithm by January 1, 2017 to automatically assign Medicaid enrollees to managed care entities based on quality scores and operational proficiency criteria.

Algorithm applies to enrollees in the Family Health Plan, Integrated Care Program, and those eligible under the Affordable Care Act, assigning them to Accountable Care Entities, Managed Care Community Networks, or Managed Care Organizations.

Algorithm shall only assign enrollees who have not voluntarily selected a primary care physician and managed care entity.

Assigned enrollees have 90 calendar days to select a different managed care entity if they choose.

Quality metrics used must be measurable across all entities, and the algorithm must prioritize assignment to entities with the highest quality scores and operational proficiency compliance.