Illinois § 5F-20 Network adequacy

Illinois Statutes

§ 5F-20 — Network adequacy

Illinois § 5F-20

JurisdictionIllinois

TopicHUMAN NEEDS

Ch. 305PUBLIC AID

Act 305 ILCS 5/Illinois Public Aid Code.

Art.Article V-F - Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home Residents' Managed Care Rights Law

This text of Illinois § 5F-20 (Network adequacy) is published on Counsel Stack Legal Research, covering Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

305 Ill. Comp. Stat. 5F-20 (2026).

Text

(a)Every managed care organization shall allow every nursing home in its service area an opportunity to be a network contracted facility at the plan's standard terms, conditions, and rates. Either party may opt to limit the contract to existing residents only.

(b)With the exception of subsection (c) of this Section, a managed care organization shall only terminate or refuse to renew a contract with a nursing home if the nursing home fails to meet quality standards if the following conditions are met:

(1)the quality standards are made known to the nursing home;

(2)the quality standards can be objectively measured through data;

(3)the nursing home is measured on at least a year's worth of performance;

(4)a nursing home that the MCO has determined did not meet a quality standard has the

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(a) Every managed care organization shall allow every nursing home in its service area an opportunity to be a network contracted facility at the plan's standard terms, conditions, and rates. Either party may opt to limit the contract to existing residents only. (b) With the exception of subsection (c) of this Section, a managed care organization shall only terminate or refuse to renew a contract with a nursing home if the nursing home fails to meet quality standards if the following conditions are met: (1) the quality standards are made known to the nursing home; (2) the quality standards can be objectively measured through data; (3) the nursing home is measured on at least a year's worth of performance; (4) a nursing home that the MCO has determined did not meet a quality standard has the opportunity to contest that determination by challenging the accuracy or the measurement of the data through an arbitration process agreed to by contract; and (5) the Department may attempt to mediate a dispute prior to arbitration. (c) A managed care organization may terminate or refuse to renew a contract with a nursing home for a material breach of the contract, including, but not limited to, failure to grant reasonable and timely access to the MCO's care coordinators, SNFists and other providers, termination from the Medicare or Medicaid program, or revocation of license.