MEDICAID-MCO BEHAVIORAL HLTH
Sponsored By: Lindsey LaPointe (Democratic)
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.
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Bill Overview
No Economic Impacts Identified for this Bill
Sponsors & Cosponsors
Sponsor
Lindsey LaPointe
Democratic • House
Cosponsors
Anne Stava
Democratic • House
Barbara Hernandez
Democratic • House
Carol Ammons
Democratic • House
Dagmara Avelar
Democratic • House
Debbie Meyers-Martin
Democratic • House
Diane Blair-Sherlock
Democratic • House
Joyce Mason
Democratic • House
Kevin John Olickal
Democratic • House
Laura Faver Dias
Democratic • House
Lisa Davis
Democratic • House
Nabeela Syed
Democratic • House
Rita Mayfield
Democratic • House
Theresa Mah
Democratic • House
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
Added Co-Sponsor Rep. Kevin John Olickal
5/13/2026HouseAdded Co-Sponsor Rep. Debbie Meyers-Martin
4/28/2026HouseAdded Co-Sponsor Rep. Joyce Mason
4/13/2026HouseAdded Co-Sponsor Rep. Anne Stava
4/6/2026HouseRule 19(a) / Re-referred to Rules Committee
3/27/2026HouseAdded Co-Sponsor Rep. Carol Ammons
3/24/2026HouseTo Appropriations-Medicaid Subcommittee
3/20/2026HouseAdded Co-Sponsor Rep. Theresa Mah
3/19/2026HouseAdded Co-Sponsor Rep. Barbara Hernandez
3/19/2026HouseAdded Co-Sponsor Rep. Dagmara Avelar
3/16/2026HouseAdded Co-Sponsor Rep. Lisa Davis
3/13/2026HouseAdded Co-Sponsor Rep. Diane Blair-Sherlock
3/13/2026HouseAdded Co-Sponsor Rep. Nabeela Syed
3/10/2026HouseAdded Co-Sponsor Rep. Laura Faver Dias
3/9/2026HouseAdded Co-Sponsor Rep. Rita Mayfield
3/9/2026HouseAssigned to Appropriations-Health and Human Services Committee
3/4/2026HouseReferred to Rules Committee
2/6/2026HouseFirst Reading
2/6/2026HouseFiled with the Clerk by Rep. Lindsey LaPointe
2/3/2026House
Bill Text
Introduced
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