DHFS-INPATIENT STABILIZATION Senate SponsorsSen. Don Harmon-Adriane Johnson 1/7/2025SenateSession Sine Die 305 ILCS 5/5-30.1Amends the Medical Assistance Article of the Illinois Public Aid Code. Makes changes to provisions requiring Medicaid managed care organizations (MCO) to make payments for emergency services. Requires an MCO to pay any provider of emergency services, including inpatient stabilization services provided during the inpatient stabilization period, that does not have in effect a contract with the MCO. Defines "inpatient stabilization period" to mean the initial 72 hours of inpatient stabilization services, beginning from the date and time of the order for inpatient admission to the hospital. Provides that when determining payment for all emergency services, including inpatient stabilization services provided during the inpatient stabilization period, the MCO shall: (i) not impose any service authorization requirements, including, but not limited to, prior authorization, prior approval, pre-certification, concurrent review, or certification of admission; (ii) have no obligation to cover emergency services provided on an emergency basis that are not covered services under the MCO's contract with the Department of Healthcare and Family Services; and (iii) not condition coverage for emergency services on the treating provider notifying the MCO of the enrollee's emergency medical screening examination and treatment within 10 days after presentation for emergency services. Provides that the determination of the attending emergency physician, or the practitioner responsible for the enrollee's care at the hospital, of whether an enrollee requires inpatient stabilization services, can be stabilized in the outpatient setting, or is sufficiently stabilized for discharge or transfer to another facility, shall be binding on the MCO. Provides that an MCO shall not reimburse inpatient stabilization services billed on an inpatient institutional claim under the outpatient reimbursement methodology and shall not reimburse providers for emergency services in cases of fraud. Requires the Department to impose sanctions on an MCO for noncompliance, including, but not limited to, financial penalties, suspension of enrollment of new enrollees, and termination of the MCO's contract with the Department. Effective immediately. 2/7/2024SenateFiled with Secretary by Sen. Ann Gillespie 2/7/2024SenateFirst Reading 2/7/2024SenateReferred to Assignments 2/20/2024SenateAssigned to Health and Human Services 2/20/2024SenateAdded as Chief Co-Sponsor Sen. Adriane Johnson 3/6/2024SenatePostponed - Health and Human Services 3/13/2024SenateDo Pass Health and Human Services; 009-000-000 3/13/2024SenatePlaced on Calendar Order of 2nd Reading March 14, 2024 3/21/2024SenateSecond Reading 3/21/2024SenatePlaced on Calendar Order of 3rd Reading March 22, 2024 4/12/2024SenateRule 2-10 Third Reading Deadline Established As April 19, 2024 4/15/2024SenateChief Sponsor Changed to Sen. Don Harmon 4/19/2024SenateRule 2-10 Third Reading Deadline Established As May 3, 2024 5/3/2024SenateRule 3-9(a) / Re-referred to Assignments 1/7/2025SenateSession Sine Die