IL SB1573

Requires new managed care organization contracts with the Department of Healthcare and Family Services to be procured under the Illinois Procurement Code, with exemptions for existing 2018-24-001 RFP agreements and Medicare-Medicaid Alignment Initiative contracts.

Establishes managed care organization performance requirements including 30-day claims payment deadlines, provider directory updates within 3 days, network adequacy standards, and quarterly public reporting of operational metrics on claims, prior authorizations, grievances, and provider credentialing.

Mandates the Department publish comprehensive encounter data submission guidance within 60 days and provider fee schedules in both PDF and Excel formats on its website, with quarterly updates.

Adds protections for Medicaid managed care plans under contract with the Department, exempting certain capitation revenue from risk-based capital calculations under the Illinois Insurance Code.

Establishes procedures for recouping disallowed or deferred federal matching funds from managed care organizations and hospitals, with limits on MCO losses to 1% of total Hospital Assessment Program distributions and Department good faith mitigation obligations.