305 Ill. Comp. Stat. § 5/5-16. Managed Care: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1990
he Illinois Department may develop and implement a Primary Care Sponsor System consistent with the provisions of this Section. The purpose of this managed care delivery system shall be to contain the costs of providing …
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305 Ill. Comp. Stat. § 5/5-2. Class of persons eligible: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1967
Statute provides classes of persons to which medical assistance shall be available, which includes persons eligible pursuant to a waiver.
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305 Ill. Comp. Stat. § 5/5-2.01. Medicaid accountability through transparency program: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2010
There is a Medicaid accountability though transparency program through which the department shall publish de-identified information about claims.
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305 Ill. Comp. Stat. § 5/5-30. Care coordination: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2011
At least 50% of eligible patients shall be enrolled in the coordinated care program. Payments can be based on the coordination of care. There is a specific program for patients with chronic illnesses, and the …
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305 Ill. Comp. Stat. § 5/5-30.1. Managed care protections: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2014
An MCO shall pay any provider of emergency services that does not have in effect a contract with the contracted Medicaid MCO. The default rate of reimbursement shall be the rate paid under Illinois Medicaid …
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305 Ill. Comp. Stat. § 5/5-30.2. Monthly reports; managed care enrollment: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2015
The department must publish monthly enrollment reports on the website. The Department must annually publish on its website each Medicaid Managed Care Entity’s quality metrics outcomes and must make public an independent annual quality review …
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305 Ill. Comp. Stat. § 5/5-30.3. Empowering meaningful patient choice in Medicaid Managed Care: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2016
Each medicaid managed care entity shall have an updated provider directory. Medicaid Managed Care Entities shall publish on their respective websites a formulary for each plan offered and make the formularies easily understandable and publicly …
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305 Ill. Comp. Stat. § 5/5-30.5. Managed care; automatic assignment: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2017
Medicaid enrollees shall be automatically enrolled in plans thought an algorithm which is designed to preserveexisting provider-beneficiary relationships that takes into account quality scores and other operational proficiency criteria developed, defined, and adopted by the …
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305 Ill. Comp. Stat. § 5/5-30.7. Encounter data guidelines; provider fee schedule: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2018
The Department shall publish on its website provider fee schedules on both a portable document format (PDF) and EXCEL format. The portable document format shall serve as the ultimate source if there is a discrepancy.
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305 Ill. Comp. Stat. § 5/5-30.8. Managed care organization rate transparency: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2018
Department of Healthcare and Family Services shall implement a capitation base rate setting process beginning on the effective date of this amendatory Act of the 100th General Assembly which shall include all of the following …
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305 Ill. Comp. Stat. § 5/5-32. Medicaid research and education enhancement payments: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2013
The Department shall make Medicaid enhancement payments to Tier I and Tier II academic medical centers as defined in Section 5-5e.2 of this Code identified as primary affiliates by any university or college that makes …
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305 Ill. Comp. Stat. § 5/5-4.1. Co-payments: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1981
Co-payments are permissible for most health care services, but not for chronic illness treatment. There is a $2 co-pay for generic drugs.
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305 Ill. Comp. Stat. § 5/5-4.2. Ambulance services payments: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1992
Ambulance cost reimbursement rate calculations are based on the type of trasportation required, mileage, actual costs, and other variables as described.
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305 Ill. Comp. Stat. § 5/5-5.02. Hospital reimbursements: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1989
Hospital reimbursement rates are calculated in accordance with this section.
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305 Ill. Comp. Stat. § 5/5-5.10. Value-based purchasing: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2019
Statute Department of Healthcare and Family Services and divisions within the Department of Human Services to discuss development of alternative value-based payment models that move away from fee-for-service and reward health outcomes ad=nd reward health …
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305 Ill. Comp. Stat. § 5/5-5.12. Pharmacy payments: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1984
Pharmacies providing prescription drugs under this Article shall be reimbursed at a rate which shall include a professional dispensing fee as determined by the Illinois Department, plus the current acquisition cost of the prescription drug …
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