Managed Care Organization Resources

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.

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.

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. 

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.

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.

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.

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 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.

MCO Administrative Performance Survey Results: 2nd Quarter 2018

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

MCO Administrative Performance Survey Results: 1st Quarter 2018

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

Medicaid MCOs Transition to New, Universal Provider Roster Template

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

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.

HFS Consulting and Audit Contract

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

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.

Medicaid MCO Contract Awards

Medicaid MCO Testimony

March 9, 2017

Testimony: State of Illinois Medicaid MCO Request for Proposals

• IHA
• Ann & Robert H. Lurie Children's Hospital of Chicago
• Hospital Sisters Health System
• Swedish Covenant Hospital

Senate Bill 3080 Update

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.