Illinois · House Bill 4893 · 104th General Assembly

MEDICAID-MCO BEHAVIORAL HLTH

HB 4893 Sponsored by Lindsey LaPointe In committee

  1. Introduced Feb 3, 2026
  2. In committee Feb 6, 2026
  3. Passed the House Next
  4. Passed the Senate  
  5. To the governor  
  6. Became law  

What it does

The legislature's own summary of the bill, or its official long title.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services must incorporate minimum standards governing behavioral health pre-payment and post-payment reviews into MCO contracts effective for all services covered on and after January 1, 2027. Requires the Department to develop or adopt behavioral health-specific pre-payment and post-payment…

Read the full title (197 words)

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services must incorporate minimum standards governing behavioral health pre-payment and post-payment reviews into MCO contracts effective for all services covered on and after January 1, 2027. Requires the Department to develop or adopt behavioral health-specific pre-payment and post-payment review guidelines and incorporate such guidelines by reference into MCO contracts. Provides that the Department-issued guidelines must: (1) define the documentation and clearly specify the discrete data elements that may be requested prior to and during a pre-payment or post-payment review, and applicable response timeframes, ensuring that all requests are specific, reasonable, and directly tied to the review objectives; (2) identify regulatory, statutory, and contractual standards applicable to behavioral health services; (3) establish uniform evaluation criteria and checklists; and (4) be publicly available and updated as necessary. Contains provisions on MCO contracts and required contract terms; pre-payment and post-payment review processes and notice requirements; timeframes for providers to respond to a documentation request; communication protocols; contract transparency and extrapolation from a statistical sampling of claims; the timeliness and closure of claims reviews; submission methods; reviewer qualifications; and enforcement. Effective immediately.

Every action

19 steps, oldest first, as the legislature records them.

Show the 11 earlier steps
  1. HouseFiled with the Clerk by Rep. Lindsey LaPointe
  2. HouseFirst Reading
  3. CommitteeReferred to Rules Committee · House Rules
  4. CommitteeAssigned to Appropriations-Health and Human Services Committee · House Approp-Health and Human Services
  5. HouseAdded Co-Sponsor Rep. Rita Mayfield
  6. HouseAdded Co-Sponsor Rep. Laura Faver Dias
  7. HouseAdded Co-Sponsor Rep. Nabeela Syed
  8. HouseAdded Co-Sponsor Rep. Diane Blair-Sherlock
  9. HouseAdded Co-Sponsor Rep. Lisa Davis
  10. HouseAdded Co-Sponsor Rep. Dagmara Avelar
  11. HouseAdded Co-Sponsor Rep. Barbara Hernandez
  1. HouseAdded Co-Sponsor Rep. Theresa Mah
  2. CommitteeTo Appropriations-Medicaid Subcommittee · House Approp-Medicaid Sub
  3. HouseAdded Co-Sponsor Rep. Carol Ammons
  4. CommitteeRule 19(a) / Re-referred to Rules Committee · House Rules
  5. HouseAdded Co-Sponsor Rep. Anne Stava
  6. HouseAdded Co-Sponsor Rep. Joyce Mason
  7. HouseAdded Co-Sponsor Rep. Debbie Meyers-Martin
  8. HouseAdded Co-Sponsor Rep. Kevin John Olickal

Roll calls

No recorded votes on this bill yet.

Sponsors

The member who introduced it, joined by 13 cosponsors: 13 Democrats.

All 13 cosponsors

From Illinois's official records (www.ilga.gov), checked Nov 13, 2026. Text links go to the official versions; LegiList does not copy bill text.