(a) For State Fiscal year 2020 through State Fiscal Year 2025, there is imposed upon managed care organization member months an assessment, calculated on base year data, as set forth below for the appropriate tier:
         (1) Tier 1: $60.20 per member month.
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Terms Used In Illinois Compiled Statutes 305 ILCS 5/5H-3

  • Base year: means the 12-month period from January 1, 2018 to December 31, 2018. See Illinois Compiled Statutes 305 ILCS 5/5H-1
  • Department: means the Department of Healthcare and Family Services. See Illinois Compiled Statutes 305 ILCS 5/5H-1
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • 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. See Illinois Compiled Statutes 305 ILCS 5/5H-1
  • 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. See Illinois Compiled Statutes 305 ILCS 5/5H-1
  • Member months: means the aggregate total number of months all individuals are enrolled for coverage in a Managed Care Organization during the base year. See Illinois Compiled Statutes 305 ILCS 5/5H-1
  • Month: means a calendar month, and the word "year" a calendar year unless otherwise expressed; and the word "year" alone, is equivalent to the expression "year of our Lord. See Illinois Compiled Statutes 5 ILCS 70/1.10
  • State: when applied to different parts of the United States, may be construed to include the District of Columbia and the several territories, and the words "United States" may be construed to include the said district and territories. See Illinois Compiled Statutes 5 ILCS 70/1.14

         (2) Tier 2: $1.20 per member month.
         (3) Tier 3: $2.40 per member month.
     (b) The tiers are established as follows:
         (1) Tier 1 includes the first 4,195,000 member months
    
in a Medicaid managed care organization for the base year;
        (ii) Tier 2 includes member months over 4,195,000 in
    
a Medicaid managed care organization during the base year; and
        (iv) Tier 3 includes member months during the base
    
year in a managed care organization that is not a Medicaid managed care organization.
    (c) For State fiscal year 2020 through State fiscal year 2025, the Department may by rule adjust rates or tier parameters or both in order to maximize the revenue generated by the assessment consistent with federal regulations and to meet federal statistical tests necessary for federal financial participation. Any upward adjustment to the Tier 3 rate shall be the minimum necessary to meet federal statistical tests.
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