Medicaid Managed Care
Over the course of the next legislative session, our Illinois Medicaid Managed Care priorities include transparency and standardized preventable readmissions policies. With regard to transparency, any changes the Department of Healthcare and Family Services (HFS) have made to MCO master contracts have not been made widely public. We believe they should be required to post contract changes annually with guidance given 30 days before those changes go into effect. HFS should also be required to take public comment on unilateral contract changes. The current MCO preventable readmissions policies do not account for homelessness or chronic conditions. BJC would like to see a moratorium on MCOs implementing preventable readmission policies until HFS creates a standardized readmissions policy.
Emergency waivers due to the pandemic have allowed hospitals to rapidly increase access to virtual services by investing in new technology, adjusting clinical workflows, and educating staff and patients. These waivers will eventually come to an end. Absent changes in statute and regulation, providers do not have the certainty needed to continue to invest in and utilize new care delivery tools, and patients could lose the telehealth services they have relied on during the pandemic. Policies that provide sustainable reimbursement framework for telehealth are needed, including lifting restrictions on the location of the patient, aligning payment with in-person services, expanding the types of facilities eligible to serve as distant sites, and expanding the types of practitioners eligible to provide and bill for virtual services.
To begin to eliminate health disparities and achieve health equity, Illinois must invest in systemic health care transformation. The result will be a more integrated and coordinated system of care, especially for the most vulnerable communities. To achieve this vision, the Illinois General Assembly must adopt legislation for hospital and health care transformation that promotes systemic change. The proposed funding mix would begin with an annual pool of $150 million to start a realignment of state resources. The plan recommends coordinating projects with other sources of funding from other state agencies, the business community, and the philanthropic community to spur broad investment in community projects that have a coordinated, comprehensive approach to improving community health. Illinois hospitals are uniquely situated to lead the effort in southern Illinois.
Health care transformation in Illinois is important to eliminate health disparities; however, it is only one piece of the puzzle for tangible and lasting changes. We will work with state partners to enact policies that ensure essential, high-quality health care services are available to all individuals and communities. Policies that invest resources in underserved communities, to enhance access to primary and specialty care, address Social Determinants of Health, and reduce maternal mortality will also be a primary focus. Health equity is a priority for the Black Caucus in Illinois, and we expect to see this as a centralized topic for the 102nd Illinois General Assembly
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Page updated 02/23/2021