HB3055 Summary

• Caps non-participant reimbursement rates at 90% of established State rates when managed care organizations (MCOs) and medical providers or hospitals cannot agree to contract terms for non-emergency services.

• Applies the 90% reimbursement cap to contracts between MCOs and medical providers, including hospitals, located in neighboring states that serve Illinois Medicaid beneficiaries.

• Requires MCOs to pay emergency services at full Illinois Medicaid fee-for-service rates with all applicable policy adjusters and add-ons.

• Mandates MCOs pay claims within 30 days of receipt and establish timely notification procedures for claims that cannot be adjudicated.

• Requires the Department to publish quarterly MCO performance metrics reports covering claims payment, prior authorizations, grievances, appeals, and provider customer service, accessible online to providers by January 1, 2017.