Co-sponsors measure to reform Illinois’ managed care program

03052019 MCO news conference 650

SPRINGFIELD – Fed up with delayed and denied state payments that compromise quality health care in rural areas of Illinois, State Senator Andy Manar joined rural and safety net hospitals to call for landmark reform of managed care companies under Illinois’ Medicaid program.

Manar is co-sponsoring Senate Bill 1807, also known as the Safety Net Hospital MCO Reform Act. The measure aims to correct repeated abuses by managed care organizations – or MCOs – that oversee hundreds of millions of dollars of care each year provided by hospitals that treat Medicaid low-income patients.

“The long payment delays are costing downstate hospitals millions of dollars when they’re already struggling to survive day to day,” Manar (D-Bunker Hill) said during a news conference at the Capitol. He was joined by Ken Reid, CEO of Carlinville Area Hospital.

Carlinville Area Hospital is one of six critical access hospitals in the 48th Senate District that Manar represents. All of these rural hospitals, which are vital health care centers and economic engines in rural communities of central Illinois, are being adversely affected by the state’s MCO program. More than 43 percent of Illinois’ critical access hospitals are operating in the red, or are close to doing so.

Rather than provide needed clinical care to patients, critical access hospitals find they are being forced spend more time jumping through bureaucratic hoops so they can be reimbursed for services they already provided, Reid said.

“Critical access hospitals simply do not have the capacity or the ability to take on huge insurance companies and MCOs. The unfair claim denials and payment delays must stop now,” he said.

Advocates and lawmakers said rural and safety net hospitals with high percentages of Medicaid patients have encountered major problems under the state’s MCO program. MCOs delay and deny payments for care already given, change provider coverage without proper notice, delay patient release from hospitals without reimbursement and refuse to let hospitals fix paperwork errors on claims.

SB1807, which is sponsored by State Senator Kimberly Lightford (D-Maywood), would require MCOs to:

  • Treat hospitals as expedited providers who regularly need quicker payments, similar to the state’s fee-for-service system
  • Discharge patients more quickly upon a doctor’s release, or pay for keeping the patient hospitalized
  • Update health care provider rosters weekly and to reimburse providers who have contracts with MCO for medically necessary services regardless if the provider is on the updated MCO roster
  • Provide reasonable time to fix errors on non-electronic health care claims

“This is about the fundamental right people have around our state to get the health care they need, at a price we all can afford,” Manar said. “Our constituents deserve to know their hospital will be there to serve them. This bill takes an important step forward in providing that assurance.”

Pictured (left to right): State Rep. Camille Lilly (D-Chicago); Ken Reid, CEO, Carlinville Area Hospital; State Sen. Kimberly Lightford (D-Maywood); and State Sen. Andy Manar (D-Bunker Hill).

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