HB 5930

Abstract

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to establish, by rule, minimum quality standards for providers of medical supplies, equipment, and related services applicable to contracted managed care organizations for all services rendered to MCO enrollees. Requires the minimum quality standards to be based upon recognized national standards promulgated by national bodies and by the Centers for Medicare and Medicaid Services. Requires the Department to set a rate of reimbursement payable by contracted managed care organizations to contracted, in-network providers of medical supplies, equipment, and related services at the default rate of reimbursement paid under the Illinois Medicaid fee-for-service program methodology for such medical supplies, equipment, and related services in effect as of June 30, 2017. Requires contracted managed care organizations to offer a reimbursement rate to contracted, in-network providers of medical supplies, equipment, and related services at not less than 90% of the default rate of reimbursement paid under the Illinois Medicaid fee-for-service program methodology, including all policy adjusters, for such medical supplies, equipment, and related services of similar quality. Provides that these provisions shall not be construed to allow the Department or its contracted MCOs to enter into sole source contracts for the provision of durable medical equipment, supplies, or related services to Medicaid beneficiaries and Medicaid managed care enrollees. Effective immediately.