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Today’s must-read

Monday, Jun 17, 2019

* Dean Olsen has written a highly informative story about MCOs. Yes, it’s a complicated issue. Eyes tend to glaze over when you even mention Medicaid managed care. But try to take a little time to read his piece

Years of finger-pointing by Illinois hospitals and managed-care organizations about what the hospitals said were high denial rates for Medicaid claims ended last month with legislation that both sides hope will reduce friction between the two and benefit low-income patients.

“This is a really good step forward,” said Jay Roszhart, president of Memorial Health System’s ambulatory group. “I’m fairly optimistic that the intent of the bill will resolve these issues.”

Samantha Olds Frey, executive director of the Illinois Association of Medicaid Health Plans, said Senate Bill 1321, if signed into law by Gov. J.B. Pritzker as expected, would lead to hospitals sharing more information with companies hired by the state to carry out the state’s Medicaid managed-care program, HealthChoice Illinois.

The legislation, Olds Frey said, would make sure hospitals and the managed-care organizations, or MCOs, “are talking to one another instead of at one another … to ensure cohesive care-coordination and discharge planning with a focus on the Medicaid members.”

Illinois’ managed-care system covers 2.1 million Medicaid beneficiaries, or more than two-thirds of the state’s 3.1 million population in Medicaid.

The folks who put that truce together did an excellent job.

- Posted by Rich Miller        

8 Comments
  1. - GADawg - Monday, Jun 17, 19 @ 10:42 am:

    “Complicated” is right. But part of the problem also seems to be no consequences for the MCOs when they first issue denials that ultimately do get paid. The agencies and the hospitals have to spend additional time re-documenting services that have already been provided. And then still wait additional months to get paid. I know I am about to over-simplify, but it seems like every claim goes first to the office of “No”.


  2. - Annonin' - Monday, Jun 17, 19 @ 10:50 am:

    Majority Leader Greg Harris herded this collection of cats for many months.


  3. - Dan Johnson - Monday, Jun 17, 19 @ 10:55 am:

    I had a tiny role in this at the very end — it was one of the nicest legislative processes on a big bipartisan, bicameral agreed bill I’ve ever been involved in. Samantha Olds Frey was fantastic as were the legislator point people. Congratulations to everyone involved.


  4. - Klaus VonBulow - Monday, Jun 17, 19 @ 11:18 am:

    This issue is near and dear to me due to fatal loss of a loved one this year. The for profit managed care organizations that Rauner outsourced without proper bidding is devastating to the vulnerable. I’m disappointed Pritzker didn’t stop this. At least Pritzker didn’t use my loss for political gain as he did with the Quincy veterans.


  5. - walker - Monday, Jun 17, 19 @ 11:47 am:

    This is a big achievement . Thanks, Rich, for shining light on it.


  6. - Informed Mom - Monday, Jun 17, 19 @ 2:08 pm:

    I wouldn’t inflict an MCO on my worst enemy. As the parent of an adult with a developmental disability, I’m dreading “Phase III” of the LTSS waiver plan, which will put MCOs in charge of case management for people with intellectual and developmental disabilities. Why do we insist on shoving the sick, the poor, and the disabled aside? Despite our problems, Illinois is still the fifth wealthiest stare in the nation. We have the means to do better for “the least of these.”


  7. - Hoping for Rational Thought - Monday, Jun 17, 19 @ 3:35 pm:

    I’m very skeptical that this will solve many of the issues. Yes it could provide better information but HFS has not been known for making good procurement decisions involving technology which is what is involved here. The IES jointly done by DHS/HFS is still a mess in many ways.

    Fingers-crossed. Very little was done on MCO transparency other than publishing the MLR which is only a piece of the transparency problems.


  8. - DuPage - Monday, Jun 17, 19 @ 6:37 pm:

    MCOs, HMOs, are great-as long as you don’t get sick and really need good medical care. If that happens, your outcome can be very, very bad.


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