§ 5H-1 — Definitions

As used in this Article: "Base year" means the 12-month period from January 1, 2023 to December 31, 2023. "Department" means the Department of Healthcare and Family Services. "Federal employee health benefit" means the program of health benefits plans, as defined in 5 U.S.C. 8901, available to federal employees under 5 U.S.C. 8901 to 8914. "Fund" means the Healthcare Provider Relief Fund. "Managed care organization" means an entity operating under a certificate of authority issued pursuant to the Health Maintenance Organization Act or as a Managed Care Community Network pursuant to Section 5-11 of this Code. "Medicaid managed care organization" means a managed care organization under contract with the Department to provide services to recipients of benefits in the medical assistance program pursuant to Article V of this Code, the Children's Health Insurance Program Act, or the Covering ALL KIDS Health Insurance Act. It does not include contracts the same entity or an affiliated entity has for other business. "Medicare" means the federal Medicare program established under Title XVIII of the federal Social Security Act. "Member months" means the aggregate total number of months all individuals are enrolled for coverage in a Managed Care Organization during the base year. Member months are determined by the Department for Medicaid Managed Care Organizations based on enrollment data in its Medicaid Management Information System and by the Department of Insurance for other Managed Care Organizations based on required filings with the Department of Insurance. Member months do not include months individuals are enrolled in a Limited Health Services Organization, including stand-alone dental or vision plans, a Medicare Advantage Plan, a Medicare Supplement Plan, or a Federal Employee Health Benefits Plan.

Legislative History

(Source: P.A. 103-593, eff. 6-7-24; 104-2, eff. 6-16-25.)