IL SB3080

Amends Illinois Public Aid Code to establish managed care organization (MCO) protections including emergency services coverage without prior approval and payment at Illinois Medicaid fee-for-service rates for non-contracted providers.

Requires MCOs to pay claims within 30 days of receipt and impose penalties equal to those under the Illinois Insurance Code for late payments; MCOs must notify billing parties within 30 days if unable to adjudicate a claim.

Mandates Department establish network adequacy standards considering health professional shortage areas, publicly release network analysis processes, and require MCOs to maintain updated public provider directories with confirmation of physician additions/deletions within 3 days.

Requires Department to adopt rules by December 31, 2016 ensuring medically necessary covered services rendered in good faith based on verified eligibility information are not denied or reduced if eligibility information is later found inaccurate, including extended filing periods and retroactive prior authorizations.

Directs Department to publish MCO operational performance metrics on at least a quarterly basis covering claims payment, prior authorizations, grievances, utilization, provider disputes, credentialing, and customer service, accessible to providers online by January 1, 2017.