Illinois 103rd Regular Session Status: Died 6 D cosponsors

SB 1965 — MEDICAID-MCO RATE TRANSPARENCY

Last action — Chief Sponsor Changed to Sen. Don Harmon

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Senate
  4. Died in session

This bill died with 103rd Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions requiring the Department of Healthcare and Family Services to implement a capitation base rate setting process for payments to managed care organizations (MCOs), removes the following requirements: (i) that any quality incentive or other incentive withholding of any portion of the actuarially certified capitation rates must be budget-neutral; (ii) that the entirety of any aggregate withheld amounts must be returned to the MCOs in proportion to their performance on the relevant performance metric; and (iii) that no amounts shall be returned to the Department if all performance measures are not achieved to the extent allowable by federal law and regulations.

Bill Text

What changed in the latest version

7 added · 28 removed

Plain-language change summary

The recent changes to SB 1965 remove specific requirements related to the payment system for managed care organizations (MCOs) in Illinois. Previously, the bill mandated that any financial incentives or penalties for MCOs must be budget-neutral, must be based on their performance, and that any withheld funds needed to be redistributed based on that performance. By eliminating these requirements, the bill allows for more flexibility in how payments are structured, which could impact how MCOs are incentivized to improve healthcare quality. This matters because it could lead to different outcomes in the quality of care provided to patients enrolled in Medicaid.

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*LRB10324848KTG51181b* SB1965 103RD GENERAL ASSEMBLY State of Illinois and 2024 SB1965 Introduced 2/9/2023, by Sen.
SB1965 Engrossed LRB103 24848 KTG 51181 b AN ACT concerning public aid.
Ann Gillespie SYNOPSIS AS INTRODUCED:
ILCS 5/5-30.8 Amends the Medical Assistance Article of the Illinois Public Aid Code.
In provisions requiring the Department of Healthcare and Family Services to implement a capitation base rate setting process for payments to managed care organizations (MCOs), removes the following requirements:
(i) that any quality incentive or other incentive withholding of any portion of the actuarially certified capitation rates must be budget-neutral;
(ii) that the entirety of any aggregate withheld amounts must be returned to the MCOs in proportion to their performance on the relevant performance metric;
and (iii) that no amounts shall be returned extent allowable by federal law and regulations.e not achieved to the LRB103 24848 KTG 51181 b A BILL FOR SB1965 LRB103 24848 KTG 51181 b AN ACT concerning public aid.
(1) The Department shall include participating MCOs SB1965 - 2 - LRB103 24848 KTG 51181 b and a statewide trade association representing a majority of participating MCOs in meetings to discuss the impact to base capitation rates as a result of any new or updated hospital fee schedules or other provider fee schedules.
(1) The Department shall include participating MCOs SB1965 Engrossed - 2 - LRB103 24848 KTG 51181 b and a statewide trade association representing a majority of participating MCOs in meetings to discuss the impact to base capitation rates as a result of any new or updated hospital fee schedules or other provider fee schedules.
The entirety of any aggregate withheld amounts must be returned to the SB1965 - 3 - LRB103 24848 KTG 51181 b MCOs in proportion to their performance on the relevant performance metric.
The entirety of any aggregate withheld amounts must be returned to the SB1965 Engrossed - 3 - LRB103 24848 KTG 51181 b MCOs in proportion to their performance on the relevant performance metric.
(A) An initial meeting for the Department to SB1965 - 4 - LRB103 24848 KTG 51181 b review MCO data and draft rate assumptions to be used in the development of capitation base rates for the following year.
(A) An initial meeting for the Department to SB1965 Engrossed - 4 - LRB103 24848 KTG 51181 b review MCO data and draft rate assumptions to be used in the development of capitation base rates for the following year.
"Operational policy change" means a change to operational requirements such as reporting formats, encounter submission definitional changes, or required provider SB1965 - 5 - LRB103 24848 KTG 51181 b interfaces made at the sole discretion of the Department and not required by legislation with a retroactive effective date.
"Operational policy change" means a change to operational requirements such as reporting formats, encounter submission definitional changes, or required provider SB1965 Engrossed - 5 - LRB103 24848 KTG 51181 b interfaces made at the sole discretion of the Department and not required by legislation with a retroactive effective date.
(4) No later than 60 days after the effective date of the policy change or program implementation, the Department shall provide the MCOs with draft capitation base rates and shall also conduct a draft capitation base SB1965 - 6 - LRB103 24848 KTG 51181 b rate meeting with MCOs to discuss, review, and seek feedback regarding the draft capitation base rates.
(4) No later than 60 days after the effective date of the policy change or program implementation, the Department shall provide the MCOs with draft capitation base rates and shall also conduct a draft capitation base SB1965 Engrossed - 6 - LRB103 24848 KTG 51181 b rate meeting with MCOs to discuss, review, and seek feedback regarding the draft capitation base rates.
SB1965 - 7 - LRB103 24848 KTG 51181 b Records and information produced by the group established to discuss Medicaid capitation rates under this Section shall be confidential and not subject to the Freedom of Information Act.
SB1965 Engrossed - 7 - LRB103 24848 KTG 51181 b Records and information produced by the group established to discuss Medicaid capitation rates under this Section shall be confidential and not subject to the Freedom of Information Act.
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Amendments

1 amendment

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Action History

  1. Chief Sponsor Changed to Sen. Don Harmon

  2. Added as Chief Co-Sponsor Sen. Elgie R. Sims, Jr.

  3. House Committee Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee

  4. Rule 19(a) / Re-referred to Rules Committee

  5. House Committee Amendment No. 1 Rules Refers to Appropriations-Health & Human Services Committee

  6. House Committee Amendment No. 1 Referred to Rules Committee

  7. House Committee Amendment No. 1 Filed with Clerk by Rep. Anna Moeller

  8. Committee/Final Action Deadline Extended-9(b) May 19, 2023

  9. Assigned to Appropriations-Health & Human Services Committee

  10. Referred to Rules Committee

  11. First Reading

  12. Chief House Sponsor Rep. Anna Moeller

  13. Arrived in House

  14. Added as Co-Sponsor Sen. Napoleon Harris, III

  15. Third Reading - Passed; 056-000-000

  16. Placed on Calendar Order of 3rd Reading March 29, 2023

  17. Second Reading

  18. Added as Chief Co-Sponsor Sen. Sara Feigenholtz

  19. Placed on Calendar Order of 2nd Reading March 9, 2023

  20. Do Pass Health and Human Services; 013-000-000

  21. Added as Co-Sponsor Sen. Karina Villa

  22. Added as Chief Co-Sponsor Sen. David Koehler

  23. Assigned to Health and Human Services

  24. Referred to Assignments

  25. First Reading

  26. Filed with Secretary by Sen. Ann Gillespie

Sponsors

Sponsorship breakdown

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2 sponsors · 5 co-sponsors · 176 not signed on

Sponsors (2)

Co-sponsors (5)

Not signed on (176)

176 members have not signed on to this bill.

Show all 176 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Third Reading

Passed 56 Yea · 0 Nay · 3 Other
Party YeaNayPresentNot Voting
Democrat 32001
Republican 16001
Unaffiliated 8001
Total 56003
% of votes cast 95%0%0%5%
How each member voted (59)
Member Party Vote
Stoller — Yea
Gillespie — Yea
Bennett — Yea
Harris, N. — Yea
Pacione-Zayas — Yea
Simmons — Yea
Glowiak Hilton — Yea
Loughran Cappel — Yea
Van Pelt — Not Voting
Bill Cunningham Democrat Yea
Celina Villanueva Democrat Yea
Christopher Belt Democrat Yea
Cristina Castro Democrat Yea
David Koehler Democrat Yea
Don Harmon Democrat Yea
Doris Turner Democrat Yea
Elgie R. Sims, Jr. Democrat Yea
Emil Jones, III Democrat Not Voting
Gregg Johnson Democrat Yea
Javier L. Cervantes Democrat Yea
Julie A. Morrison Democrat Yea
Karina Villa Democrat Yea
Kimberly A. Lightford Democrat Yea
Laura Ellman Democrat Yea
Laura Fine Democrat Yea
Laura M. Murphy Democrat Yea
Linda Holmes Democrat Yea
Mary Edly-Allen Democrat Yea
Mattie Hunter Democrat Yea
Michael E. Hastings Democrat Yea
Michael W. Halpin Democrat Yea
Mike Porfirio Democrat Yea
Omar Aquino Democrat Yea
Patrick J. Joyce Democrat Yea
Paul Faraci Democrat Yea
Rachel Ventura Democrat Yea
Ram Villivalam Democrat Yea
Robert F. Martwick Democrat Yea
Robert Peters Democrat Yea
Sara Feigenholtz Democrat Yea
Steve Stadelman Democrat Yea
Willie Preston Democrat Yea
Andrew S. Chesney Republican Yea
Chapin Rose Republican Yea
Craig Wilcox Republican Yea
Dale Fowler Republican Yea
Dan McConchie Republican Yea
Dave Syverson Republican Yea
Donald P. DeWitte Republican Yea
Erica Harriss Republican Yea
Jason Plummer Republican Yea
Jil Tracy Republican Yea
John F. Curran Republican Yea
Neil Anderson Republican Yea
Sally J. Turner Republican Yea
Seth Lewis Republican Yea
Steve McClure Republican Not Voting
Sue Rezin Republican Yea
Terri Bryant Republican Yea

Health and Human Services

Passed 13 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Democrat 8000
Unaffiliated 2000
Republican 3001
Total 13001
% of votes cast 93%0%0%7%
How each member voted (14)
Member Party Vote
Pacione-Zayas, Cristina H — Yea
Stoller, Win — Yea
Doris Turner Democrat Yea
Julie A. Morrison Democrat Yea
Karina Villa Democrat Yea
Laura Fine Democrat Yea
Mary Edly-Allen Democrat Yea
Mattie Hunter Democrat Yea
Patrick J. Joyce Democrat Yea
Paul Faraci Democrat Yea
Dave Syverson Republican Yea
Jason Plummer Republican Yea
Neil Anderson Republican Not Voting
Sue Rezin Republican Yea

Subjects

healthcare health-insurance
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Frequently asked questions

What does SB 1965 do?
Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions requiring the Department of Healthcare and Family Services to implement a capitation base rate setting process for payments to managed care organizations (MCOs), removes the following requirements: (i) that any quality incentive or other incentive withholding of any portion of the actuarially certified capitation rates must be budget-neutral; (ii) that the entirety of any aggregate withheld amounts must be returned to the MCOs in proportion to their performance on the relevant performance metric; and (iii) that no amounts shall be returned to the Department if all performance measures are not achieved to the extent allowable by federal law and regulations.
Who sponsors SB 1965?
SB 1965 is sponsored by Don Harmon (Democrat), Elgie R. Sims, Jr. (Democrat), David Koehler (Democrat), Sara Feigenholtz (Democrat), Karina Villa (Democrat), Napoleon Harris and III, and Anna Moeller (Democrat).
What is the current status of SB 1965?
This bill died with 103rd Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 1965?
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