COMPTROLLER'S BIPARTISAN LEGISLATIVE PROPOSAL WOULD BRING TRANSPARENCY TO BILLIONS IN MEDICAID PAYMENTS
Under the new, massive managed care expansion, health care providers are experiencing payment delays that put vulnerable populations at risk.
February 6, 2019
SPRINGFIELD, IL — Illinois Comptroller Susana A. Mendoza’s bipartisan MCO Transparency Act to shine light on the billions in state payments that go through Illinois’ Medicaid Managed Care program was filed today by sponsors Representative David McSweeney and Senator Laura Fine.
Last year, Illinois implemented a massive expansion of Medicaid Managed Care. The $63 billion procurement was the largest in state history. Although Illinois is relying on Managed Care Organizations (MCOs) to administer the bulk of the Medicaid program, providers and policymakers have relatively little information about when providers, like doctors and nursing homes, can expect payment from MCOs for the treatment they provide their patients.
“As the state’s chief fiscal officer, I cannot see what happens to billions of taxpayer dollars after my office releases them to the MCOs. I frequently hear from providers whose Medicaid payments have been delayed. They often have no idea when their payments might come,” said Comptroller Mendoza. “Providers, like nursing homes in rural and low-income communities, rely on reimbursements from MCOs to keep their doors open and serve vulnerable populations. They deserve transparency when it comes to how and when these payments are made — and so do taxpayers.”
Many of the state’s safety net hospitals, including South Shore Hospital in Chicago, are also struggling because of reimbursement delays.
“South Shore Hospital has been devastated by delayed and denied payments from the MCOs, and it threatens our ability to keep the doors open,” South Shore Hospital Chief Executive Officer Tim Caveney said. “South Shore cares for the state's most vulnerable patients. MCOs, as for-profit companies, deny and delay payments to maximize their profits. Today, we are still owed millions by the MCOs and seeing more than 20 percent of our cases denied by the MCOs, for no legitimate reasons. This cannot continue.”
Caveney said he commends Comptroller Mendoza and the sponsors of this legislation for working to bring transparency to the process. “It is only through the good work of Comptroller Mendoza and other policymakers that we can advocate for Illinois’ most vulnerable residents and protect the fragile health care safety net that is the only option for so many,” he said.
House Bill 2117 /Senate Bill 1238 would require MCOs to publish provider payment information on their websites every quarter. The information posted would include:
- Total number of claims received by the MCO for that quarter
- The number and amounts paid to providers
- When the payments were made
- When the claims for those payments were received
- When the service the payment is for was rendered
“The Medicaid program represents a massive area of state spending. This basic level of transparency is needed to protect taxpayer dollars and to ensure MCOs are paying what is owed to providers who serve Medicaid patients,” Representative McSweeney, R-Barrington Hills, said.
“Providers offering care to sick children and others in need are struggling because of payment delays, and they have no reliable way of knowing when their next payment is coming.” Senator Fine, D-Glenview, said. “As more and more state dollars are filtering through MCOs, it just makes sense to require transparency and give some predictability to our health care providers.”
The MCO Transparency Act is a natural outgrowth of Comptroller Mendoza’s Debt Transparency Act that opened the windows on unpaid bills held by state agencies and her other transparency reforms that shed light on the off-shoring of the Governor’s staff; the Vendor Payment Program and the state’s obligations to pay Late Payment Interest Penalties.
You can download a PDF of this release here.