Illinois Compiled Statutes 305 Public Aid: Article V-F - Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home Residents' Managed Care Rights Law

• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-1
  Short title. This Article may be referred to as the Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home Residents' Managed Care Rights Law. (Source: P.A. 98-651, eff.
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-5
  Findings. The General Assembly finds that elderly Illinoisans residing in a nursing home have the right to: (1) quality health care regardless of the payer;...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-10
  Scope. This Article applies to policies and contracts amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-15
  Definitions. As used in this Article: "Appeal" means any of the procedures that deal with the review of adverse organization determinations on the health care...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-20
  Network adequacy. (a) Every managed care organization shall allow every nursing home in its service area an opportunity to be a network contracted facility at...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-25
  Care coordination. Care coordination provided to all enrollees in the Demonstration Project shall conform to the following requirements: (1) care coordination services shall be enrollee-driven...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-30
  Continuity of care. When a nursing home resident first transitions to a managed care organization from the fee-for-service system or from another managed care organization,...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-32
  Non-emergency prior approval and appeal. (a) MCOs must have a method of receiving prior approval requests 24 hours a day, 7 days a week, 365...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-35
  Reimbursement. The Department shall provide each managed care organization with the quarterly facility-specific RUG-IV nursing component per diem along with any add-ons for enhanced care...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-40
  Contractual requirements. (a) Every contract shall contain a clause for termination consistent with the Managed Care Reform and Patient Rights Act providing nursing homes the...
• Illinois Public Aid Code. - 305 ILCS 5, Section 5F-45
  Prohibition. No managed care organization or contract shall contain any provision, policy, or procedure that limits, restricts, or waives any rights set forth in this...

Last modified: February 18, 2015