SB 1703

  • Illinois Senate Bill
  • 101st Regular Session
  • Introduced in Senate
  • Senate
  • House
  • Governor

Medicaid-Managed Care Appeals

Abstract

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a provider who has exhausted the written internal appeals process of a managed care organization (MCO) shall be entitled to an external independent third-party review of the MCO's final decision that denies, in whole or in part, a health care service to an enrollee or a claim for reimbursement to a provider for a health care service rendered to an enrollee of the Medicaid managed care organization. Requires an MCO's final decision letter to a provider to include: (i) a statement that the provider's internal appeal rights within the MCO have been exhausted; (ii) a statement that the provider is entitled to an external independent third-party review; (iii) the time period granted to request an external independent third-party review; and (iv) the mailing address to initiate an external independent third-party review. Provides that a party shall be entitled to appeal a final decision of the external independent third-party review within 30 days after the date upon which the appealing party receives the external independent third-party review. Provides that a final decision by the Director of Healthcare and Family Services shall be final and reviewable under the Administrative Review Law. Contains provisions concerning fees to help defray the cost of the administrative hearings; the specific claims of services that are appealable; and the Department's rulemaking authority. Effective immediately. Senate Committee Amendment No. 1 Deletes reference to: 305 ILCS 5/5-30.1 Adds reference to: 305 ILCS 5/1-5 from Ch. 23, par. 1-5 Replaces everything after the enacting clause. Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning construction of the Code.

Bill Sponsors (5)

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May 15, 2020

Senate

Rule 2-10 Third Reading/Passage Deadline Established As May 31, 2020

May 07, 2020

Senate

Rule 2-10 Third Reading Deadline Established As May 29, 2020

Apr 30, 2020

Senate

Rule 2-10 Third Reading Deadline Established As May 22, 2020

Apr 23, 2020

Senate

Rule 2-10 Third Reading Deadline Established As May 15, 2020

Apr 12, 2020

Senate

Pursuant to Senate Rule 3-9(b) / Referred to Assignments

Mar 25, 2020

Senate

Rule 2-10 Third Reading Deadline Established As May 7, 2020

Mar 04, 2020

Senate

Senate Committee Amendment No. 1 Adopted

Senate

Placed on Calendar Order of 2nd Reading March 5, 2020

Senate

Do Pass as Amended Executive; 016-000-000

Feb 26, 2020

Senate

Senate Committee Amendment No. 1 Assignments Refers to Executive

Feb 25, 2020

Senate

Senate Committee Amendment No. 1 Referred to Assignments

Senate

Re-referred to Executive

Senate

Senate Committee Amendment No. 1 Filed with Secretary by Sen. Don Harmon

Mar 25, 2019

Senate

Added as Co-Sponsor Sen. Elgie R. Sims, Jr.

Mar 22, 2019

Senate

Rule 3-9(a) / Re-referred to Assignments

Mar 04, 2019

Senate

Added as Chief Co-Sponsor Sen. Andy Manar

Feb 27, 2019

Senate

Added as Chief Co-Sponsor Sen. Kimberly A. Lightford

Senate

Assigned to Special Committee on Oversight of Medicaid Managed Care

Feb 22, 2019

Senate

Added as Chief Co-Sponsor Sen. Iris Y. Martinez

Feb 15, 2019

Senate

First Reading

Senate

Referred to Assignments

Senate

Filed with Secretary by Sen. Don Harmon

Bill Text

Bill Text Versions Format
Introduced HTML

Related Documents

Document Format
Senate Amendment 001

Sources

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