DHFS-MANAGED CARE PROTECTIONS
Sponsored By: Dagmara Avelar (Democratic)
In Committee
Summary
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to adopt rules that require managed care organizations (MCOs) to utilize a universal provider application developed by a council for affordable quality healthcare, as defined, for the purpose of credentialing a health care professional or a health care provider who seeks to participate in an MCO's provider network. Provides that the rules shall also require the use of a CAQH application for the renewal of credentials; and that the Department may revise the CAQH universal provider application or the application for renewal of credentials to conform to industry or national standards for credentialing health care professionals or health care providers. Provides that within 180 days after the adoption of rules, health and dental plan carriers must accept the universal provider application and the application for the renewal of credentials approved by the Department. Requires all MCOs to provide a provider network consultant to act as a liaison between a health care provider and the MCO. Require the Department to employ provider enrollment consultants to assist health care providers with enrollment in the Illinois Medicaid Program Advanced Cloud Technology system, help navigate the enrollment and provider credentialing process by serving as the liaison between health care providers and MCOs, and other matters. Amends the Illinois Insurance Code. In provisions concerning recoupments, requires a health care professional or health care provider to be provided a remittance advice that includes an explanation of a recoupment or offset taken by a managed care organization. Removes provisions permitting insurers contracted with the Department of Healthcare and Family Services to recoup or offset payments due to a federal Medicaid requirement. Provides that no contract between an MCO and health care professional or provider may provide for recoupments in violation of the Code. Effective January 1, 2027.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
No Economic Impacts Identified for this Bill
Sponsors & Cosponsors
Sponsor
Dagmara Avelar
Democratic • House
Cosponsors
Tracy Katz Muhl
Democratic • House
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
Added Co-Sponsor Rep. Tracy Katz Muhl
4/22/2026HouseRule 19(a) / Re-referred to Rules Committee
3/27/2026HouseTo Appropriations-Medicaid Subcommittee
3/20/2026HouseAssigned to Appropriations-Health and Human Services Committee
2/24/2026HouseReferred to Rules Committee
1/14/2026HouseFirst Reading
1/14/2026HouseFiled with the Clerk by Rep. Dagmara Avelar
1/12/2026House
Bill Text
Introduced
Related Bills
HB4154 — PHARMACIST APPLICATION/EXAM
HB4890 — UNACCOMPANIED CHILDREN
Creates the Dependency Determinations for Unaccompanied Children Act. Creates a process for an unaccompanied child in the custody of the federal Office of Refugee Resettlement housed in Illinois who is alleged to have been abused, neglected, or abandoned by one or both parents to file a petition seeking a finding of dependency under the Act. Provides that a child declared dependent is eligible for oversight and services as ordered by the court and may be referred for psychological, educational, medical, or social services deemed necessary as a result of parental abuse, abandonment, or neglect or for protection against trafficking or domestic violence. Defines terms. Makes legislative findings. Effective immediately.
HB0598 — GOVERNMENT-TECH
Amends the Salaries Act. Makes a technical change in a Section concerning the short title.
SB0314 — BUSINESS-TECH
Amends the Business Corporation Act of 1983. Makes a technical change in a Section concerning the short title.
HB3428 — LONG-TERM CARE JOINT TRAINING
Amends the Nursing Home Care Act and the Assisted Living and Shared Housing Act. Requires the Department of Public Health to hold semiannual joint training sessions for surveyors, nursing home providers, and assisted living establishment providers. Provides that the Department shall include the State long-term care ombudsman, or the State long-term care ombudsman's designee, and representatives of each nursing home provider association and assisted living provider association in the State in the planning process to create the topics and content of the joint training sessions as well as the coordination and presentations for the joint training sessions. Provides that, at least annually, a joint training session shall include, but not be limited to, regional citation patterns relating to complaints, standards, and outcomes in the nursing home and assisted living survey process. Requires the Department to develop standardized training for establishments to prevent common citations in the assisted living survey process.
SB1265 — ENVTL BARRIER-ENFORCEMENT DATA
Amends the Environmental Barriers Act. Requires the Attorney General to provide, by January 31, 2026 and every January 31 thereafter (rather than by July 31, 2020 and every July 31 thereafter), data on the Attorney General's website about annual enforcement efforts performed under the Act. Effective immediately.