IllinoisSB3163104th General Assembly (2025–2026)Senate

DHFS-MANAGED CARE PROTECTIONS

Sponsored By: David Koehler (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 may 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.

assignmentsappropriations- health and human services

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Bill Overview

No Economic Impacts Identified for this Bill

Sponsors & Cosponsors

Sponsor

  • David Koehler

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. Rule 3-9(a) / Re-referred to Assignments

    5/22/2026Senate
  2. Rule 2-10 Committee/3rd Reading Deadline Established As May 22, 2026

    5/15/2026Senate
  3. Rule 2-10 Committee/3rd Reading Deadline Established As May 15, 2026

    4/24/2026Senate
  4. Rule 2-10 Committee Deadline Established As April 24, 2026

    3/13/2026Senate
  5. Assigned to Appropriations- Health and Human Services

    2/10/2026Senate
  6. Referred to Assignments

    2/2/2026Senate
  7. First Reading

    2/2/2026Senate
  8. Filed with Secretary by Sen. David Koehler

    2/2/2026Senate

Bill Text

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