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.
…Adding… The article is in error. That $63 billion is the total number from the procurement. The annual spending is far lower.
…Adding… The comptroller’s office says current fiscal year is roughly $14 billion all funds for MCOs.
* From Mendoza’s press release…
“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.