Comptroller seeks more data from Illinois Medicaid MCO’s

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SPRINGFIELD – Illinois Comptroller Susana Mendoza is backing legislation that would require insurance companies that manage much of the state’s Medicaid program to publish more information about how promptly they are reimbursing claims.

The insurance companies, known as managed care organizations, or MCOs, contract with the state to manage the care of individuals enrolled in Medicaid. Among other things, that involves working with patients to make sure they receive routine exams and preventive care, and coordinating services provided by their primary physicians and other specialists.

The goal of a managed care system is to reduce costs and improve health outcomes by preventing the need for many emergency room visits and the complications that can result when patients don’t receive follow-up care.

Last year, Illinois greatly expanded the managed care system to make it available in all counties. But in a statement Wednesday, Mendoza said it is difficult for her office to know what happens to the roughly $63 billion a year the state now spends on managed care after the money is handed over to the MCOs.

“I frequently hear from providers whose Medicaid payments have been delayed. They often have no idea when their payments might come,” Mendoza said. “Providers, like nursing homes in rural and low-income communities, rely on reimbursements from MCOs to keep their doors open and serve vulnerable populations.”

Mendoza said she is urging lawmakers to pass legislation, already introduced in both chambers, that would require MCOs to report at least quarterly on their websites the total number of claims they receive for that quarter, the number and amounts of claims paid and information detailing how long it takes them to process claims.

The primary sponsors of the bills are Rep. David McSweeney (R-Barrington Hills) and Sen. Laura Fine (D-Glenview).

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via Cherokee Tribune Ledger News

February 6, 2019 at 10:25PM

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