HB 5774: MEDICAID-PAYMENT RATES-FQHCS

Summary

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to seek a State Plan amendment from the Centers for Medicare and Medicaid Services regarding a prospective cost-reimbursement methodology for services provided by federally qualified health centers (FQHC) and FQHC Look-Alikes (LALs). Requires the State Plan amendment to include the following: (1) Prospective Payment System (PPS) rates for FQHCs; (2) a rate adjustment process; (3) a rate setting for new FQHCs; (4) payment in the event of Medicaid managed care; (5) payment in the event of dual enrollment in Medicare and Medicaid; and (6) appeal rights.

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May 13, 2026

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