IllinoisHB4893104th General Assembly (2025–2026)House

MEDICAID-MCO BEHAVIORAL HLTH

Sponsored By: Lindsey LaPointe

In Committee

Summary

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.

appropriations-health and human services

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Bill Overview

No Economic Impacts Identified for this Bill

Sponsors & Cosponsors

Sponsor

  • Lindsey LaPointe

    Affiliation unavailable

Cosponsors

  • Anne Stava

    Affiliation unavailable

  • Barbara Hernandez

    Affiliation unavailable

  • Carol Ammons

    Affiliation unavailable

  • Dagmara Avelar

    Affiliation unavailable

  • Debbie Meyers-Martin

    Affiliation unavailable

  • Diane Blair-Sherlock

    Affiliation unavailable

  • Joyce Mason

    Affiliation unavailable

  • Kevin John Olickal

    Affiliation unavailable

  • Laura Faver Dias

    Affiliation unavailable

  • Lisa Davis

    Affiliation unavailable

  • Nabeela Syed

    Affiliation unavailable

  • Rita Mayfield

    Affiliation unavailable

  • Theresa Mah

    Affiliation unavailable

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. Added Co-Sponsor Rep. Kevin John Olickal

    5/13/2026House
  2. Added Co-Sponsor Rep. Debbie Meyers-Martin

    4/28/2026House
  3. Added Co-Sponsor Rep. Joyce Mason

    4/13/2026House
  4. Added Co-Sponsor Rep. Anne Stava

    4/6/2026House
  5. Rule 19(a) / Re-referred to Rules Committee

    3/27/2026House
  6. Added Co-Sponsor Rep. Carol Ammons

    3/24/2026House
  7. To Appropriations-Medicaid Subcommittee

    3/20/2026House
  8. Added Co-Sponsor Rep. Theresa Mah

    3/19/2026House
  9. Added Co-Sponsor Rep. Barbara Hernandez

    3/19/2026House
  10. Added Co-Sponsor Rep. Dagmara Avelar

    3/16/2026House
  11. Added Co-Sponsor Rep. Lisa Davis

    3/13/2026House
  12. Added Co-Sponsor Rep. Diane Blair-Sherlock

    3/13/2026House
  13. Added Co-Sponsor Rep. Nabeela Syed

    3/10/2026House
  14. Added Co-Sponsor Rep. Laura Faver Dias

    3/9/2026House
  15. Added Co-Sponsor Rep. Rita Mayfield

    3/9/2026House
  16. Assigned to Appropriations-Health and Human Services Committee

    3/4/2026House
  17. Referred to Rules Committee

    2/6/2026House
  18. First Reading

    2/6/2026House
  19. Filed with the Clerk by Rep. Lindsey LaPointe

    2/3/2026House

Bill Text

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