HB 5248

Abstract

Amends the Illinois Public Aid Code. In provisions concerning payment rates for nursing facilities, provides that a benchmark rate equal to the facility's fee-for-service rate shall be established for any facility receiving payment from a managed care entity for services. Provides that on and after July 1, 2020, no managed care entity shall pay a facility less than the established benchmark rate unless the managed care entity and the facility contractually agree upon a rate different than the established benchmark rate. Requires the benchmark rate to be updated quarterly by the Department of Healthcare and Family Services to recognize any rate adjustments to each facility's fee-for-service rate. Provides that until the State is in compliance with federal deadlines for Medicaid eligibility determinations, the Department must not expand the Medicare-Medicaid Alignment Initiative. Provides that beginning July 1, 2020, or upon federal approval, any enrollee who resides in a facility for more than 90 consecutive days shall no longer be required to enroll with a managed care organization and shall revert to having his or her services covered through a fee-for-service arrangement between the facility and the Department for any services received after 90 consecutive days of service. Effective immediately.