IL SB2331

Requires at least 50% of Illinois Medicaid recipients to be enrolled in care coordination programs by January 1, 2015, covering medical assistance, CHIP, and ALL KIDS programs.

Establishes payment models for coordinated care based on performance metrics, evidence-based practices, and either capitated or risk-based arrangements, with integrated delivery systems responsible for providing primary care, specialty care, behavioral health, and hospital services.

Mandates Accountable Care Entities (ACEs) to serve children and parents/caretakers in specified regions (40,000+ in Cook County, 20,000+ in collar counties, 10,000+ elsewhere) with phased payment progression from care coordination fees to full capitation over 36 months.

Requires Medicaid Managed Care Entities to maintain 85% minimum medical loss ratios, establish appeals and grievances processes, undergo national accreditation, and implement language access policies including translation and qualified interpreter services.

Prohibits disclosure of sensitive health services information (mental health, substance abuse, reproductive health, sexual health) to third parties without enrollee authorization, except to covered entities and business associates permitted under federal law.