HR0100 Summary

• Direct the Auditor General to conduct an audit of Illinois Medicaid Managed Care Organizations (MCOs) for fiscal year 2016, including comparison with the Medicaid fee-for-service program

• Examine MCO capitation rate setting and reimbursement practices, including comparison of encounter data submitted to the Department of Healthcare and Family Services versus actual claims payments made

• Analyze administrative costs, payout ratios, denial rates, and supplemental provider payments included in MCO capitation rates

• Investigate state payments to for-profit MCOs for the ACA Health Insurance Fee (HIF) and related "gross-up" payments, and determine if federal CMS mandates such reimbursement

• Require the Department of Healthcare and Family Services to cooperate fully with the Auditor General and report findings and recommendations upon completion