Lightford030519SPRINGFIELD – Fed up with delayed and denied state payments that are compromising quality health care for the most vulnerable, state legislators joined safety-net hospitals today to call for landmark reform of managed care companies under Illinois’ Medicaid program.

Senate Bill 1807 and House Bill 2814, also known as the Safety Net Hospital MCO Reform Act, provide a path to rein in repeated abuses by managed care organizations (MCOs) in their oversight of hundreds of millions of dollars of care each year provided by hospitals who treat Medicaid low-income patients. Advocates and lawmakers called for immediate reform Tuesday at a Statehouse news conference.

The bills, backed by Senate Majority Leader Kimberly A. Lightford and Rep. Camille Lilly, 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

Advocates and lawmakers said these provisions have become major problems for safety-net hospitals with high percentages of Medicaid patients. 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.

They say without these reforms, MCOs will continue to stall and stop payments and put Medicaid-dominant hospitals in an untenable position of providing care for people who need it, even though they cannot afford to pay for it, and then wait months for reimbursement – if they ever receive it at all. They are encouraged there will be strong support for MCO restraints from the Pritzker Administration and Democratic supermajorities in the Legislature.

“MCOs were authorized by the General Assembly to help manage care in the Medicaid program. But the reality is they are managing costs: doing everything possible to avoid paying hospitals for the care they are providing, and putting the very future of our hospitals at stake in the process,” said George Miller of Loretto Hospital on Chicago’s west side, on behalf of the Association of Safety-Net Community Hospitals.

“We thank Rep. Lilly and Majority Leader Lightford for standing with us to demand MCO reform and restore sanity to our Medicaid program again.”

“Our hospitals are already under tremendous pressure to meet the needs of the most vulnerable people in our communities while receiving reimbursements that fall far short of covering their costs,” Lightford said. “It’s unconscionable to have these out-of-state MCOs taking hundreds of millions of dollars in taxpayer dollars and rejecting claim after claim, putting dollars ahead of care. Our legislation will right the ship and send a strong message: managed care will be accountable in Illinois for caring for patients first, not protecting shareholders.”

“The people I represent need quality, reliable health care in their neighborhoods. When they’re sick or hurt, they need to know they can get better right away, and that they won’t go bankrupt to protect their health,” Lilly said. “These MCO reforms are commonsense ways to restore balance. We need to be mindful of managing taxpayer investment in Medicaid, but not at the expense of hospitals and patients who have nowhere else to turn. We will work hard with the Pritzker Administration and our colleagues to put hospital care first again in Illinois, not Wall Street returns.”

Sen. Andy Manar, joined at the news conference Tuesday by Ken Reid, CEO of Carlinville Area Hospital in his central Illinois district, emphasized the MCO delays and denials hurt all hospitals statewide – especially those with limited resources.

“This is not a Chicago issue, or a Downstate issue. 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,” said Manar, D-Bunker Hill. “I am proud to stand with Leader Lightford, Rep. Lilly and many other lawmakers and health care providers to demand MCO reform now. Our constituents deserve to know their hospital will be there to serve them. These bills take an important step forward in providing that assurance.”