IL HB4977

Requires MCOs to pay any emergency services provider, including those without contracts, at Illinois Medicaid fee-for-service rates plus applicable adjustments for emergency services and inpatient stabilization services during the initial 72 hours of inpatient admission.

Prohibits MCOs from imposing service authorization requirements (prior authorization, pre-certification, concurrent review, certification of admission) for emergency services and inpatient stabilization services.

Makes the attending emergency physician's or hospital practitioner's determination regarding whether an enrollee requires inpatient stabilization, can be stabilized outpatient, or is ready for discharge binding on the MCO.

Establishes that MCOs shall not reimburse inpatient stabilization services billed on inpatient claims under outpatient reimbursement methodology and shall not reimburse for emergency services in cases of fraud.

Authorizes the Department to impose sanctions on MCOs for noncompliance, including financial penalties, suspension of new enrollee enrollment, and contract termination, effective immediately.