Illinois Governor Signs Landmark Medicaid Reform Legislation

Last week Illinois Governor Pat Quinn signed into law major reforms to the State’s Medicaid program. Public Act 96-1501 authorizes the Illinois Department of Healthcare and Family Services (HFS) to expand HMO-style “coordinated care” to cover at least 50% of all recipients by the year 2015. The law also changes the Illinois Medicaid eligibility process by requiring certain income verifications and annual re-determinations.

On the provider side, the law empowers HFS to impose significant Medicaid fraud penalties. HFS may now impose civil monetary penalties up to $2,000 for each fraudulent claim submitted to the Illinois Medicaid program. Providers will be able to appeal the assessment of these civil monetary penalties through an administrative process before HFS and through the Circuit Court. Pharmacy providers, meanwhile, may now promote 90-day maintenance prescriptions to Medicaid beneficiaries. The law also reduces the interest rate the State must pay to pharmacies from 2% to 1% for late reimbursement payments.

For additional information about this new law, Illinois State health care, or other issues involving Medicare or Medicaid fraud, please contact Randall Fearnow or Mark Bina in the Firm’s Chicago office at 312-423-9300.