After more than two years, Illinois adopted a budget and has begun to make up for back payments due to their vendors. All told, health care providers and managed care organizations have a backlog of more than $4 billion of the $16 billion the state is in arrears.
BJC Government Relations has supported the budget compromise plan which included authority to issue bonds to make up for some of the back payments. The bonds would save the state millions in interest (state law requires the state to pay vendors an interest penalty for any debt owed - this penalty exceeds the interest rate on bonds) and expedite payments to care providers.
Of course, the state's overall fiscal condition remains a concern with more than $100 billion in pension obligations and a credit rating only slightly above "junk" status. BJC Government Relations will continue to work with partners like the Illinois Health and Hospital Association to ensure that our hospitals receive the reimbursement they are due when providing care for Illinoisans covered by Medicaid or the state’s employee health plan.
Illinois is undergoing a required update to their Medicaid rates. The State Plan Amendment (SPA) is due to be submitted to the federal government by mid-2018. Mark Turner (Memorial Hospital - Belleville and Memorial Hospital - East) is on the Illinois Hospital Association board and both he and David Braasch (Alton Memorial Hospital) have been directly involved in rate reform.
At the same time, BJC HealthCare is a bi-state asset. Our two academic medical centers (Barnes-Jewish Hospital and St. Louis Children's Hospital), which treat patients who tend to be sicker and poorer than the average community hospital, derive 30% of their in-patients from Illinois. The same is true for our Rehabilitation Institute of St. Louis. Christian Hospital and Barnes-Jewish West County Hospital also have large proportions of their volume that are attributable to Illinois.
If our Missouri-based facilities are penalized simply on the grounds that they are domiciled outside of the state, Illinoisans who rely on us for care will be inadvertently harmed. We are encouraging policymakers to ensure that we are treated equitably in any new reimbursement scheme that is authorized by the Legislature.
Managed Care Reform
With the expansion of managed care in Illinois to a significant percentage of the total Medicaid population, the need to ensure that Medicaid-eligibles receive adequate coverage and providers have necessary protections has increased. In 2016, several of the protections we have advocated for were signed into law and have become effective. These include:
- Required reporting of new MCO quality metrics
- Required accuracy of the MCO’s electronic provider directories
- Hold harmless provisions for providers that act in good faith on documented coverage information
This was a strong first step in correcting many of the pitfalls providers and patients have come across in dealing with the numerous plans that have contracts in Illinois to provide managed care. We will continue to work towards a managed care regulatory environment that standardizes administrative burdens, emphasizes quality, and ensures patients have access to strong networks of care when and where they need it most. We are also closely monitoring the shift to statewide managed care which is set to go live on January 1, 2018.
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Page updated 11/1/17