Managed Care Organization Resources
IHA is working to ensure Managed Care Organizations (MCOs) perform well for patients. Our policy experts monitor MCO activities and issues for opportunities for greater accountability and efficiency.
MCOs are tasked with improving performance, quality and patient outcomes. Oversight, transparency and accountability for these goals are top priorities for IHA and our members, as Illinois seeks to move most Medicaid enrollees into MCOs.
IHA Summary: Medicaid Managed Care and Prior Authorization Reform Bills
This memo summarizes recent state legislation to reform clinical and reimbursement policies implemented by commercial health insurance issuers and Medicaid MCOs.
HFS Guidance on MCOs’ Potentially Preventable Readmissions Policies
Pursuant to 89 Ill. Adm. Code 152.300, related to Adjustment for Potentially Preventable Readmissions, HFS is requiring MCOs to update their current hospital readmission policies.
MCO Administrative Performance Survey Results (3Q-4Q 2020)
IHA continues to conduct a quarterly MCO Administrative Performance Survey as part of ongoing efforts to demonstrate the significant burden of MCO claim denials on member hospitals, health systems.
Medicare-Medicaid Alignment Initiative (MMAI) Statewide Expansion New Effective Date: July 1, 2021
HFS issued a Provider Notice to advise providers that the previously delayed statewide expansion of the Medicare-Medicaid Alignment Initiative (MMAI) is now scheduled to begin July 1, 2021.
Medicare-Medicaid Alignment Initiative (MMAI) Statewide Expansion New Effective Date: July 1, 2021
HFS issued a Provider Notice to advise providers that the previously delayed statewide expansion of the Medicare-Medicaid Alignment Initiative (MMAI) is now scheduled to begin July 1, 2021.
Medicaid Claim Submission Pipeline Implementation
HFS began the initial launch of its new claim rejection and denial management system.
MCO Administrative Performance Survey Results (2Q 2019)
IHA continues to hold a quarterly MCO Administrative Performance Survey as part of ongoing efforts to demonstrate the significant burden of MCO claim denials on member hospitals and health systems.
Medicaid MCO Dispute Resolution Process Begins Feb. 28
The Dept. of Healthcare and Family Services is implementing a new Medicaid Managed Care Organization Dispute Resolution Process as of Feb. 28.
Implementation of Medicaid Managed Care Reform Legislation
This memo provides an overview of IHA’s key priorities for the implementation of legislation (SB1321/PA101-0209) to fix Illinois’ broken Medicaid managed care program.
IHA Update: Governor Signs Medicaid Managed Care Reform Bill
On Monday (Aug. 5) Governor Pritzker signed Senate Bill 1321 / PA101-0209, comprehensive Medicaid managed care reform legislation strongly backed by IHA.
Technical Summary of Senate Bill 1321
On May 30, 2019, the General Assembly passed a Medicaid Omnibus Bill (SB1321) designed to stabilize Illinois’ Medicaid managed care program.
Agreement on Medicaid Managed Care Reform Legislation (SB1321)
IHA is pleased to announce that an agreement has been reached on a comprehensive Medicaid managed care reform package.
Medicaid Managed Care: Common Sense Business Practices
Enhancing oversight of MCO operational performance and requiring the MCOs to implement common sense business practices will lead to improved outcomes for patients and providers.
Support Medicaid Managed Care Organization Fairness and Accountability
Senate Bill 1697/House Bill 2715 is a comprehensive approach to needed managed care reforms for fairness and accountability.
Support Safety Net and Critical Access Hospital MCO Reforms
Senate Bill 1807/House Bill 2814 is a comprehensive approach to needed Safety Net and Critical Access Hospital managed care reforms.
Support the Right to a Fair Review of Improper Medicaid MCO Denials
Senate Bill 1703/House Bill 2730 will help assure access to care for Medicaid beneficiaries by providing a fair process to review and correct improper Medicaid MCO payment denials.
MCO Administrative Performance Survey Results: 2nd Quarter 2018
Results of IHA's most recent member survey on MCO performance in 2nd quarter 2018.
Medicaid MCO Discharge Planning - Key Contacts and Escalation Points
IAMHP, in conjunction with MCOs, has developed a Discharge Planning Resource Guide to help hospitals make initial contact with MCOs for discharge planning assistance.
MCO Administrative Performance Survey Results: 1st Quarter 2018
Results of IHA's most recent member survey on MCO performance in 1st quarter 2018.
Medicaid FFS, State PPO and Medicaid MCO Aging Accounts Receivable Balances
IHA is asking for your participation in completing the second quarter surveys for 2018.
Medicaid MCOs Transition to New, Universal Provider Roster Template
IHA worked with HFS and IAMHP to develop a new, universal provider roster.
MCO Administrative Performance Survey Results
Results of IHA's most recent member survey on MCO performance in 4th quarter 2017.
Medicaid Operational and Financial Performance Surveys
At the direction of IHA’s Board of Trustees, IHA continues to conduct quarterly Medicaid MCO operational performance surveys during 2018.
MCO Administrative Performance Survey Results
Results of IHA's most recent member survey on MCO performance in 3rd quarter 2017.
HFS Consulting and Audit Contract
Update on the Dept. of Healthcare and Family Services audit of open Medicaid MCO payables.
Medicaid MCO Update: HFS Consulting and Audit Contract
Update on HFS activities with independent consulting and audit firm Myers & Stauffer, LLC and its ongoing audit.
IHA Update: Managed Care Expansion/Jan. 24 Webinar
IHA's is offering a series of educational activities to help hospitals prepare for the state's new Medicaid managed care program, launched on Jan. 1.