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Illinois Democratic senators advance bills improving managed care organizations

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SPRINGFIELD, Ill.- The Senate Managed Care Organizations Subcommittee advanced a bill that could offer better access to healthcare for nursing home residents.

MCOs are currently able to deny patients access to care based on the services they need. However, Illinois senators hope to change that policy. Sen. Linda Holmes (D-Aurora) said her bill could prohibit the Department of Healthcare and Family Services from entering into MCO contracts that include any incentive for denying care.

Nate Harris, Legislative Director for the Health Care Council of Illinois, also emphasized that patients shouldn’t be denied care. He said they should always have a voice in the matter.

“Basically, if an individual qualifies for nursing home care, we think that should be up to the individual’s choice about where they want to be,” said Harris. “It shouldn’t come down to whether or not the MCO denies prior authorization for that.”

Harris said his organization supports incentives for MCOs. Still, he stressed that incentivizing denial of care shouldn’t be part of any policies in Illinois.

The proposal advanced out of the subcommittee and now moves up to the Senate Health Committee for final approval.

Prescription drug costs

Lawmakers passed another bill out of the subcommittee that could help with prescription drug costs.

Currently, most patients across the country have fees covered by medicaid or private insurance. However, medicaid only reimburses dispensing fees of $4.50 per prescription.

A new proposal could require all medicaid MCOs to reimburse pharmacy provider dispensing fees between $8-$10. Sen. Napoleon Harris (D-Flossmoor) emphasized this legislation would apply to all pharmacies in the state of Illinois.

“So, we want to even the playing field so that the CVS and Walgreens of the world are not benefitting while the smaller ones are getting driven out of business,” said Harris.

The Illinois Association of Long-Term Care Pharmacy Providers were in support of the bill. Many locally owned pharmacies struggle to make a profit, as they have no control over the reimbursements right now.

The measure also passed out of the managed care subcommittee and now moves to the Senate Health Committee.

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Ali Rasper

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