IL SB1965

Department of Healthcare and Family Services must implement a transparent capitation base rate-setting process for managed care organizations (MCOs) beginning July 27, 2018, covering hospital fee schedules, drug lists, special needs coverage, and annual rate updates.

Department shall share comprehensive data and reports with MCOs sufficient for actuaries to verify rate accuracy, include MCOs and trade associations in meetings to discuss fee schedule impacts, and allow unlimited experts at draft and final rate review meetings held in at least 2 locations.

Department must release an annual calendar by January 1 outlining capitation rate-setting meetings and deadlines, including initial meetings to review data and assumptions, draft rate meetings, and final actuarial reports and review meetings before federal submission.

Department shall provide 60 days' notice to MCOs before significant operational policy changes take effect and meet with MCOs within 60 days of implementation to discuss data collection, assumptions, and draft rates for policy-related rate adjustments.

Meetings and records regarding Medicaid capitation rates are closed to the public and exempt from the Open Meetings Act and Freedom of Information Act.