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.
Jul 06, 2021

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.

May 01, 2021

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.

Mar 11, 2021

IHA Alert: Urge Senators to Co-Sponsor Medicaid Managed Care/Prior Authorization Reform Legislation

IHA is strongly supporting legislation to reform the unfair policies and practices of the Medicaid Managed Care Organizations and state-regulated commercial health plans (Senate Bills 2006 and 177).

Mar 10, 2021

IHA Fact Sheet: Support Medicaid Managed Care Reforms – Senate Bill 2006

IHA urges the General Assembly to enact the practical reforms in Senate Bill 2006, grounded by three key principles—transparency, standardization, and accountability.

Mar 10, 2021

IHA Position Paper: Support Medicaid Managed Care Reforms – SB2006

IHA urges the General Assembly to exercise its critical oversight authority by supporting initiatives in SB 2006 to improve transparency, standardization and accountability in the state’s MCOs.

Jan 27, 2021

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.

Dec 16, 2020

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. 

Dec 16, 2020

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. 

Sep 10, 2020

Medicaid Claim Submission Pipeline Implementation

HFS began the initial launch of its new claim rejection and denial management system.

Mar 02, 2020

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.

Feb 26, 2020

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.

Sep 19, 2019

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.

Aug 05, 2019

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.

Jun 03, 2019

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.

May 29, 2019

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.

May 01, 2019

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.

Feb 15, 2019

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.

Feb 15, 2019

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.

Feb 15, 2019

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.

Dec 21, 2018

MCO Administrative Performance Survey Results: 2nd Quarter 2018

Results of IHA's most recent member survey on MCO performance in 2nd quarter 2018.

Nov 29, 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.

Sep 10, 2018

MCO Administrative Performance Survey Results: 1st Quarter 2018

Results of IHA's most recent member survey on MCO performance in 1st quarter 2018.

Jul 18, 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.

Jul 18, 2018

Medicaid MCOs Transition to New, Universal Provider Roster Template

IHA worked with HFS and IAMHP to develop a new, universal provider roster.

Jul 17, 2018

MCO Administrative Performance Survey Results

Results of IHA's most recent member survey on MCO performance in 4th quarter 2017.

May 08, 2018

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.

Apr 30, 2018

MCO Administrative Performance Survey Results

Results of IHA's most recent member survey on MCO performance in 3rd quarter 2017.

Apr 25, 2018

HFS Consulting and Audit Contract

Update on the Dept. of Healthcare and Family Services audit of open Medicaid MCO payables.

Feb 23, 2018

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.

Jan 02, 2018

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.

Oct 12, 2017

MCO Update

Updates on the final Managed Care Organization awards and the closeout of the current MCO contracts.
Aug 23, 2017

Medicaid MCO Contract Awards

On Friday, August 11, 2017, HFS announced plans to award contracts to six MCOs to provide covered services to certain Medicaid-eligible populations.
Jul 11, 2017

Medicaid Model Contract Recommendations

IHA provided recommendations to the Department of Healthcare and Family Services designed to strengthen the MCO Model Contract between the state and the MCOs. 
Jan 09, 2017

Senate Bill 3080 Summary

Proposed rule addressing Medicaid eligibility discrepancies; IHA comment letter
Dec 14, 2016

Senate Bill 3080 Update

Senate Bill 3080 addresses key oversight and transparency issues that IHA members raised about Medicaid Managed Care Organizations.
Dec 13, 2016

HFS MCO Dashboard

HFS MCO Performance Dashboard