305 Ill. Comp. Stat. § 5/5-11. Co-operative arrangements; contracts with other State agencies, health care and rehabilitation organizations, and fiscal intermediaries: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1967
The Illinois Department may enter into co-operative arrangements with State agencies responsible for administering or supervising the administration of health services and vocational rehabilitation services to the end that there may be maximum utilization of …
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305 Ill. Comp. Stat. § 5/5-15. Contracts with community based organizations; preventative health programs; disclosure of information; annual report: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1984
Statute authorizes the Department to contract with community based organizations serving low income communities for a three year period to demonstrate how and the extent to which preventative health programs can decrease utilization of medical …
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305 Ill. Comp. Stat. § 5/5-15.5. Preventative physical examinations; demonstration program: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1994
Statute created a demonstration program of preventative physical examinations subject to receipt of all necessary federal waivers.
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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. § 5/5-30. 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. § 5/5-30.7. 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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305 Ill. Comp. Stat. § 5/5-5.18. Diagnosis accompanying request for reimbursement: Medical Assistance – Illinois
Status: Enacted Year Enacted: 1994
Physicians must submit a diagnosis of the recipient’s illness or other condition requiring services when submitting requests for repayment.
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305 Ill. Comp. Stat. § 5/5-5.25. Access to behavioral health and medical services: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2007
In order to increase access to mental health providers, telehealth providers may be reimbursed via medicaid.
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