MEDICAID-YOUTHCARE PROGRAM

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that it is the intent of the General Assembly to ensure that all youth in the care of the Department of Children and Family Services have increased access to health care under the YouthCare Program. Provides that in order to maximize the accessibility of health care services for youth in care and former youth in care enrolled in the YouthCare Program, the Department of Healthcare and Family Services shall amend its managed care contracts such that a managed care organization (MCO) that manages health care for youth in care and former youth in care must pay for services rendered by a non-affiliated provider, for which the health plan would pay if rendered by an affiliated provider, at the rate paid under the Illinois Medicaid fee-for-service program methodology for such services, including all policy adjusters, including, but not limited to, Medicaid High Volume Adjustments, Medicaid Percentage Adjustments, Outpatient High Volume Adjustments, and all outlier add-on adjustments to the extent such adjustments are incorporated in the development of the applicable MCO capitated rates, unless a different rate was agreed upon by the health plan and the non-affiliated provider. Provides that the payment requirement under the amendatory Act shall not apply if: (i) the services provided by the non-affiliated provider were not emergency services; (ii) the non-affiliated provider has, within the 12 months preceding the date of service, rejected a contract that was offered in good faith by the health plan as determined by the Department; and (iii) the health plan has terminated a contract with the non-affiliated provider for cause, and the Department has not deemed the termination to have been without merit. Effective immediately.

• Carol AmmonsD