IL HB4980

Establishes a single, uniform service authorization program administered by the Department's contracted utilization review organization (URO) for all managed care organizations (MCOs), with URO determinations binding upon MCOs, effective for contracts issued or renewed on or after January 1, 2025.

Prohibits MCOs from denying, reducing, or recouping payment for health care services approved by the URO except in cases of fraud, and prohibits MCOs from imposing their own separate service authorization programs.

Requires MCOs to pay emergency services without prior approval requirements and establishes payment obligations for post-stabilization services, with default reimbursement rates based on Illinois Medicaid fee-for-service methodology.

Mandates MCOs pay claims within 30 days of receiving complete information, pay timely payment interest penalties for late claims consistent with Illinois Insurance Code Section 368a, and process provider disputes through internal MCO dispute resolution and Department-level review processes.

Authorizes the Department to impose sanctions on MCOs for non-compliance, including financial penalties, suspension of new enrollee enrollment, and contract termination.