Illinois HB 4893: FINANCE-TECH

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 Full Text of HB4893

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 HB4893 - 104th General Assembly 

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104TH GENERAL ASSEMBLY 
State of Illinois 
2025 and 2026
HB4893

Introduced , by Rep. Lindsey LaPointe 

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-30.19 new

 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.

LRB104 18033 KTG 31472 b

A BILL FOR

HB4893LRB104 18033 KTG 31472 b

1 AN ACT concerning public aid.

2 Be i