96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
SB1893

 

Introduced 2/20/2009, by Sen. William R. Haine

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Sets forth the purpose of the Act. Creates the Health Insurance Choice Law. Sets forth requirements concerning policy offerings, choice, renewability, notice, disclosure, and rates. Creates the Illinois Healthcare Policy Task Force Law. Provides that the Task Force shall make recommendations regarding legislation. Amends the Illinois Income Tax Act to provide for certain contribution credits. Creates the Illinois Innovative Insurance Solutions Law as a new Article in the Illinois Insurance Code. Provides that health insurance carriers may submit plans that may not otherwise meet existing requirements. Creates the Illinois Health Insurance Premium Assistance Program as a new Article in the Illinois Insurance Code. Provides that the Department of Healthcare and Family Services shall administer the Program and issue rebates. Amends the Illinois Insurance Code. Provides assistance to small employers with certain provisions of the Code. Amends the Comprehensive Health Insurance Plan Act to set forth provisions concerning eligibility and small employer participation. Amends the Children's Health Insurance Program Act to set forth provisions concerning eligibility and health benefits for children. Amends the Managed Care Reform and Patients Rights Act to set forth requirements concerning the Office of Consumer Health Insurance. Amends the Covering ALL KIDS Health Insurance Act to set forth requirements concerning eligibility and enrollment. Amends the Illinois Public Aid Code. Sets forth provisions concerning eligibility, reporting, incentives, model programs, and enforcement. Makes other changes. Effective immediately.


LRB096 10117 RPM 20283 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1893 LRB096 10117 RPM 20283 b

1     AN ACT concerning insurance.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4
ARTICLE 5. PURPOSE

 
5     Section 5-5. Purpose. Increasing health care benefit and
6 health insurance costs threaten our citizens from being able to
7 afford and access quality healthcare services. To address these
8 threats, the State of Illinois must establish a State policy on
9 healthcare that relies on flexibility and innovativeness,
10 focuses on quality, and reduces the number of uninsured.
11     It is the intent of this legislation to strategically
12 address these issues by encouraging collaboration with
13 consumers, private purchasers of insurance benefits, providers
14 of medical services, insurance carriers, and State government
15 to implement the following:
16         (1) Increased measurement, transparency, and
17     disclosure of hospital and clinician performance.
18         (2) Information, tools, and, incentives for patients
19     and other consumers to enable them to make informed health
20     care decisions.
21         (3) Timely payment of hospitals and clinicians based on
22     their performance.
23         (4) Enhanced health information technology, including

 

 

SB1893 - 2 - LRB096 10117 RPM 20283 b

1     an electronic health record for each of Illinois' citizens.
2         (5) Preventive and wellness initiatives.
3         (6) Creation of health insurance plans that provide
4     flexibility, affordability, and innovativeness.
5         (7) Review of current private and public health plan
6     designs and requirements identifying elements of the plans
7     that need elimination and implementation of new programs
8     that are consistent with guidelines and protocols
9     established by organizations representing medical
10     professions and best practices of public and private payers
11     of healthcare benefits; changes or expansion of current
12     public programs must meet State budget plans.
13         (8) Prioritizing of State provided healthcare programs
14     assuring that such programs are being accessed and meeting
15     the needs of low-income individuals and families before
16     State program eligibility for these programs are expanded
17     to higher income levels.
 
18
ARTICLE 10. MAKING HEALTHCARE MORE
19
ACCESSIBLE AND AFFORDABLE BY EXPANDING
20
HEALTHCARE INSURANCE CHOICES TO CONSUMERS

 
21     Section 10-1. Short title. This Law may be cited as the
22 Health Insurance Choice Law.
 
23     Section 10-5. Purpose. The General Assembly recognizes the

 

 

SB1893 - 3 - LRB096 10117 RPM 20283 b

1 need for individuals and small employers in this State to have
2 access to health insurance policies that are more affordable
3 and flexible than those currently available in the small group
4 market. The General Assembly, therefore, seeks to increase the
5 availability of health insurance coverage by requiring small
6 employer carriers in this State to issue policies that are more
7 affordable for employees of eligible employers.
 
8     Section 10-10. Definitions. For purposes of this Act:
9     "Department" means the Department of Financial and
10 Professional Regulation.
11     "Director" means the Director of the Division of Insurance
12 of the Department of Financial and Professional Regulation.
13     "Eligible employer" means a small employer (1) that has not
14 offered group health plans to its employees for at least 12
15 months before the employee applies for such coverage under a
16 health insurance choice policy; and (2) whose average annual
17 compensation paid to employees is less than 250% of the Federal
18 poverty level.
19     "Employee" means an employee who is scheduled to work not
20 less than 20 hours per week on a regular basis.
21     "Enrollee" means an individual covered under a health
22 insurance choice policy, including both an employee and his or
23 her dependents.
24     "Federal poverty level" means the federal poverty level
25 guidelines published annually by the United States Department

 

 

SB1893 - 4 - LRB096 10117 RPM 20283 b

1 of Health and Human Services.
2     "Group health plan" has the meaning given to such term in
3 the Illinois Health Insurance Portability and Accountability
4 Act.
5     "Health insurance choice policy" or "policy" means a policy
6 of accident and health insurance that provides standard
7 required benefits as described in Section 10-20 of this Law and
8 satisfies the additional requirements set forth in Section
9 10-25 of this Law.
10     "Insurer" means a small employer carrier as such term is
11 defined in the Small Employer Health Insurer Rating Act.
12     "Secretary" means the Secretary of the Department of
13 Financial and Professional Regulation.
14     "Small employer" has the meaning given that term in the
15 Illinois Health Insurance Portability and Accountability Act.
16     "State-mandated health benefits" means coverage required
17 under the laws of this State to be provided in a group major
18 medical policy for accident and health insurance or a contract
19 for a health-related condition that: (1) includes coverage for
20 specific health care services or benefits; (2) places
21 limitations or restrictions on deductibles, coinsurance,
22 co-payments, or any annual or lifetime maximum benefit amounts;
23 or (3) includes coverage for a specific category of licensed
24 health practitioner from whom an insured is entitled to receive
25 care.
 

 

 

SB1893 - 5 - LRB096 10117 RPM 20283 b

1     Section 10-15. Authorization of health insurance choice
2 policies.
3     (a) All insurers, as defined in Section 10-10 of this Law,
4 shall offer one or more health insurance choice policies to
5 employees of eligible employers in this State.
6     (b) An insurer that offers one or more health insurance
7 choice policies under this Law to the employees of an eligible
8 employer must also offer to all employees of such eligible
9 employer at least one accident and health insurance policy that
10 has been filed with and approved by the Department and includes
11 coverage for the state-mandated health benefits required of
12 such policy.
13     (c) Each employee may elect whether he or she wants to
14 apply for coverage.
15     (d) All eligible employers in the State shall also offer to
16 their employees at least one insured group health plan under a
17 policy that has been filed with and approved by the Department
18 and includes coverage for the state-mandated health benefits
19 required of such policy.
20     (e) An eligible employer whose employees elect coverage
21 under a health insurance choice policy or group health plan
22 under subsections (c) or (d) of this Section for themselves or
23 their dependents is not required to make contributions to the
24 cost of any policy or group health plan on behalf of its
25 employees or their dependents.
26     (f) An insurer is not required to issue or renew coverage

 

 

SB1893 - 6 - LRB096 10117 RPM 20283 b

1 to the employees of an eligible employer under a health
2 insurance choice policy or group health plan unless (i) 75% of
3 the eligible employer's employees, excluding employees covered
4 by a group health plan of another employer, elect coverage
5 under a health insurance choice policy or a group health plan
6 of the small employer offered by the insurer and (ii) 50% of
7 the eligible employer's total employees elect coverage under a
8 health insurance choice policy or group health plan of the
9 eligible employer offered by the insurer.
10     (g) This Law shall not be interpreted to restrict the
11 ability of any insurer or small employer to offer any health
12 insurance coverage permitted by law.
 
13     Section 10-20. Standard required benefits. A health
14 insurance choice policy must include an annual maximum
15 aggregate benefit for each enrollee and the policy must contain
16 the following standard required benefits:
17         (1) physician services, including, primary care,
18     consultation, referral, surgical, anesthesia, or other
19     services as needed by the enrollee in any level of service
20     delivery; such services need not include organ transplants
21     unless specifically authorized by a physician;
22         (2) outpatient diagnostic, imaging, and pathology
23     services and radiation therapy;
24         (3) 120 days of non-mental-health inpatient services
25     per year, including all professional services,

 

 

SB1893 - 7 - LRB096 10117 RPM 20283 b

1     medications, surgically implanted devices, and supplies
2     used by the enrollee while an inpatient;
3         (4) 45 days of inpatient serious mental illness
4     treatment services per year and 60 office visits per year
5     for outpatient serious mental illness treatment services,
6     with the copayment to apply to the cost of treatment if the
7     treatment occurs during the office visit;
8         (5) 30 days of other inpatient mental health and
9     chemical dependency treatment services per year and 30 days
10     of other outpatient mental health and chemical dependency
11     treatment services per year, with a lifetime maximum of 100
12     visits;
13         (6) emergency services for accidental injury or
14     emergency illness 24 hours per day and 7 days per week;
15     such emergency treatment shall include outpatient visits
16     and referrals for emergency mental health problems;
17         (7) maternity care, including prenatal and post-natal
18     care, care for complications of pregnancy of the mother,
19     and care with respect to a newborn child from the moment of
20     birth, which shall include the necessary care and treatment
21     of an illness, an injury, congenital defects, birth
22     abnormalities, and a premature birth; this coverage shall
23     be included at the option of the enrollee;
24         (8) blood transfusion services, processing, and the
25     administration of whole blood and blood components and
26     derivatives;

 

 

SB1893 - 8 - LRB096 10117 RPM 20283 b

1         (9) preventive health services as appropriate for the
2     patient population, including a health evaluation program
3     and immunizations to prevent or arrest the further
4     manifestation of human illness or injury, including, but
5     not limited to, allergy infections and allergy serum; such
6     health evaluation program shall include at least periodic
7     physical examinations and medical history, hearing and
8     vision testing or screening, routine laboratory testing or
9     screening, blood pressure testing, uterine
10     cervical-cytological testing, and low-dose mammography
11     testing as required by Section 356g of the Illinois
12     Insurance Code; and
13         (10) outpatient rehabilitative therapy, including, but
14     not limited to, speech therapy, physical therapy, and
15     occupational therapy directed at improving physical
16     functioning of the member, up to 60 treatments per year for
17     conditions that are expected to result in significant
18     improvement within 2 months, as determined by the primary
19     care physician.
20     The benefits under a health insurance choice policy may
21 contain reasonable deductibles and co-payments subject to such
22 limitations as the Department may prescribe pursuant to rule.
 
23     Section 10-25. Health insurance choice policy
24 requirements.
25     (a) Any insurer, as defined in Section 10-10 of this Law,

 

 

SB1893 - 9 - LRB096 10117 RPM 20283 b

1 shall have the power to issue health insurance choice policies.
2 No such policy may be issued or delivered in this State unless
3 a copy of the form thereof has been filed with the Department
4 and approved by it in accordance with Section 355 of the
5 Illinois Insurance Code, unless it contains in substance those
6 provisions contained in Sections 357.1 through 357.30 of the
7 Illinois Insurance Code as may be applicable to this Act and
8 the provisions set forth in this Section.
9     (b) The policy must provide that the policy and the
10 individual applications of the employees of the eligible
11 employer shall constitute the entire contract between the
12 parties, that all statements made by the employer or by the
13 individual employees shall (in the absence of fraud) be deemed
14 representations and not warranties, and that none of those
15 statements may be used in defense to a claim under the policy
16 unless it is contained in a written application.
17     (c) The policy must provide that the insurer will issue to
18 the eligible employer, for delivery to the employee who is
19 insured under the policy, an individual certificate setting
20 forth a statement as to the insurance protection to which the
21 employee is entitled and to whom payable.
22     (d) The policy must provide that all new employees of the
23 eligible employer shall be eligible to apply for coverage under
24 any health insurance choice policies offered by such employer
25 or the group health plan of the employer.
26     (e) Whenever the Department of Public Health finds that it

 

 

SB1893 - 10 - LRB096 10117 RPM 20283 b

1 has paid all or part of any hospital or medical expenses that
2 an insurer is obligated to pay under a policy issued under this
3 Law, the Department of Public Health shall be entitled to
4 receive reimbursement for its payments from the insurer,
5 provided that the Department of Public Health has notified the
6 insurer of its claim before the carrier has paid the benefits
7 to its insureds or the insureds' assignees.
8     (f) No group hospital, medical, or surgical expense policy
9 under this Law may contain any provision whereby benefits
10 otherwise payable there under are subject to reduction solely
11 on account of the existence of similar benefits provided under
12 other group or group-type accident and sickness insurance
13 policies if the reduction would operate to reduce total
14 benefits payable under the policies below an amount equal to
15 100% of total allowable expenses provided under the policies.
16     (g) If dependents of insureds are covered under 2 policies,
17 both of which contain coordination of benefit provisions, then
18 benefits of the policy of the insured whose birthday falls
19 earlier in the year are determined before those of the policy
20 of the insured whose birthday falls later in the year.
21 "Birthday", as used in this subsection (g), refers only to the
22 month and day in a calendar year, not the year in which the
23 person was born. The Department shall promulgate rules defining
24 the order of benefit determination under this subsection (g).
25     (h) Discrimination between individuals of the same class of
26 risk in the issuance of policies, in the amount of premiums or

 

 

SB1893 - 11 - LRB096 10117 RPM 20283 b

1 rates charged for any insurance covered by this Law, in
2 benefits payable thereon, in any of the terms or conditions of
3 the policy, or in any other manner whatsoever is prohibited.
4 Nothing in this subsection (h) prohibits an insurer from
5 providing incentives for insureds to utilize the services of a
6 particular hospital or person.
7     (i) No insurer may make or permit any distinction or
8 discrimination against individuals solely because of handicaps
9 or disabilities in (1) the amount of payment of premiums or
10 rates charged for policies of insurance, (2) the amount of any
11 dividends or other benefits payable thereon, or (3) any other
12 terms and conditions of the contract it makes, except if the
13 distinction or discrimination is based on sound actuarial
14 principles or is related to actual or reasonably anticipated
15 experience.
16     (j) No insurer may refuse to insure or refuse to continue
17 to insure, limit the amount, extent, or kind of coverage
18 available to an individual, or charge an individual a different
19 rate for the same coverage solely because of blindness or
20 partial blindness. With respect to all other conditions,
21 including the underlying cause of the blindness or partial
22 blindness, persons who are blind or partially blind shall be
23 subject to the same standards of sound actuarial principles or
24 actual or reasonably anticipated experience as are sighted
25 persons. Refusal to insure includes denial by an insurer of
26 disability insurance coverage on the grounds that the policy

 

 

SB1893 - 12 - LRB096 10117 RPM 20283 b

1 defines "disability" as being presumed in the event that the
2 insured loses his or her eyesight. However, an insurer may
3 exclude from coverage disability consisting solely of
4 blindness or partial blindness when the condition existed at
5 the time the policy was issued.
 
6     Section 10-30. Applicability of other Insurance Code
7 provisions. All health insurance choice policies issued under
8 this Law shall be subject to the provisions of Sections 356c,
9 356d, 356g, 356h, 356n, 367.2, 367.2-5, 367c, 367d, 367e,
10 367e.1, 367i, 368a, 370, 370a, and 370e of the Illinois
11 Insurance Code even though such policies do not constitute
12 group health plans.
 
13     Section 10-35. Means testing; authorized. For purposes of
14 this Law, an employer shall perform means testing to determine
15 eligibility requirements for the health insurance choice
16 policy and shall provide a certification to the insurer
17 respecting the results of the means testing. A health insurance
18 choice policy based on those eligibility requirements shall not
19 be in violation of Section 364 of the Illinois Insurance Code
20 or subsection (i) or (j) of Section 10-25 of this Law.
 
21     Section 10-40. Guaranteed renewability and availability.
22     (a) Subject to subsection (f) of Section 10-15 of this Law
23 and subsections (b) and (c) of this Section, an insurer (1)

 

 

SB1893 - 13 - LRB096 10117 RPM 20283 b

1 must accept the application of every employee of an eligible
2 employer that applies for coverage under subsections (c) or (d)
3 of Section 10-15 of this Law and (2) must renew or continue in
4 force such coverage at the option of the covered employee as
5 long as the employee continues as an employee of the eligible
6 employer.
7     (b) An insurer is not obligated to renew or continue in
8 force coverage under subsection (a) of this Section (1) if the
9 coverage requirements of subsection (f) of Section 10-15 of
10 this Law are not satisfied, (2) if the insurer would not be
11 obligated to renew or continue in force such coverage had
12 subdivision (2), (4), or (5) of subsection (B) of Section 30 of
13 the Illinois Health Insurance Portability and Accountability
14 Act applied to such policies, or (3) with respect to an
15 employee who has failed to pay premiums in accordance with the
16 applicable policy or the insurer has not received timely
17 premium payments from the employee.
18     (c) An insurer may modify the coverage offered under this
19 Law only at the time of coverage renewal and only if the
20 modification is consistent with State law and effective on a
21 uniform basis with respect to all employees of eligible
22 employers.
23     (d) Subsection (a) of Section 10-15 of this Law and this
24 Section shall apply with respect to an insurer as long as the
25 insurer offers any health benefit plan to small employers in
26 this State that is subject to the Small Employer Health

 

 

SB1893 - 14 - LRB096 10117 RPM 20283 b

1 Insurance Rating Act.
 
2     Section 10-45. Notice to policyholders and enrollees.
3     (a) Each written application for enrollment under a health
4 insurance choice policy must contain the following language at
5 the beginning of the application in bold type:
6     "You have the option to choose this health insurance choice
7     policy that, either in whole or in part, does not provide
8     state-mandated health insurance benefits normally required
9     in accident and health insurance policies in Illinois. This
10     health insurance choice policy may provide a more
11     affordable health insurance policy for you, although, at
12     the same time, it may provide you with fewer health
13     insurance benefits than those normally included as
14     state-mandated health insurance benefits in policies in
15     Illinois."
16     (b) Each health insurance choice policy must contain the
17 following language at or near the beginning of the policy in
18 bold type:
19     "This health insurance choice policy, either in whole or in
20     part, does not provide state-mandated health benefits
21     normally required in accident and health insurance
22     policies in Illinois. This health insurance choice policy
23     may provide a more affordable health insurance policy for
24     you, although, at the same time, it may provide you with
25     fewer health insurance benefits than those normally

 

 

SB1893 - 15 - LRB096 10117 RPM 20283 b

1     included as State-mandated health insurance benefits in
2     policies in Illinois."
 
3     Section 10-50. Disclosure statement.
4     (a) When a health insurance choice policy is issued, the
5 insurer providing such policy must provide an applicant with a
6 written disclosure statement that does the following:
7         (1) acknowledges that the health insurance choice
8     policy being purchased does not provide some or all
9     state-mandated health benefits;
10         (2) lists those State-mandated health benefits not
11     included under the health insurance choice policy; and
12         (3) includes a Section that allows for a signature by
13     the applicant attesting to the fact that the applicant has
14     read and understands the disclosure statement and
15     attesting to the fact that the applicant has in fact been
16     given a choice between the health insurance choice policy
17     that he or she has chosen and a health insurance policy
18     that includes all State-mandated health benefits.
19     (b) Each applicant for initial coverage must sign the
20 disclosure statement provided by the insurer under subsection
21 (a) of this Section and return the statement to the insurer.
22     (c) An insurer must:
23         (1) retain the signed disclosure statement in the
24     insurer's records; and
25         (2) provide the signed disclosure statement to the

 

 

SB1893 - 16 - LRB096 10117 RPM 20283 b

1     Department upon request from the Secretary.
 
2     Section 10-55. Rates.
3     (a) Except as expressly provided in paragraphs (b) and (c)
4 of this Section, the Small Employer Health Insurance Rating Act
5 shall apply to each health insurance choice policy that is
6 delivered, issued for delivery, renewed, or continued in this
7 State.
8     (b) An insurer may establish one or more separate classes
9 of business for purposes of the Small Employer Health Insurance
10 Rating Act for health insurance choice policies delivered,
11 issued for delivery, renewed, or continued in this State, and
12 any such separate classes of business so established and
13 including only health insurance choice policies shall not
14 reduce the number of classes of business that an insurer may
15 otherwise establish under the Small Employer Health Insurance
16 Rating Act.
17     (c) Premium rates for health insurance choice policies
18 included in a separate class of business shall not be subject
19 to subdivision (1) of subsection (a) of Section 25 of the Small
20 Employer Health Insurance Rating Act.
 
21     Section 10-60. Department and Director authority. The
22 Director shall adopt rules as necessary to implement this Law.
23 Rulemaking authority to implement this Law, if any, is
24 conditioned on the rules being adopted in accordance with all

 

 

SB1893 - 17 - LRB096 10117 RPM 20283 b

1 provisions of the Illinois Administrative Procedure Act and all
2 rules and procedures of the Joint Committee on Administrative
3 Rules; any purported rule not so adopted, for whatever reason,
4 is unauthorized.
5     It shall be the duty of the Director to withhold approval
6 of any such policy, certificate, endorsement, rider, bylaw or
7 other matter incorporated by reference or application blank
8 filed with the Director under this Law if it contains
9 provisions which encourage misrepresentation or are unjust,
10 unfair, inequitable, ambiguous, misleading, inconsistent,
11 deceptive, contrary to law or to the public policy of this
12 State, or contains exceptions and conditions that unreasonably
13 or deceptively affect the risk purported to be assumed in the
14 general coverage of the policy.
 
15
ARTICLE 15. HELPING IMPROVE ILLINOIS
16
HEALTHCARE POLICY BY CREATING THE
17
ILLINOIS HEALTHCARE POLICY TASK FORCE LAW

 
18     Section 15-1. Short title. This Law may be cited as the
19 Illinois Healthcare Policy Task Force Law.
 
20     Section 15-5. Illinois Healthcare Policy Task Force.
21     (a) The purpose of the Task Force is to annually review and
22 make recommendations to the General Assembly and the Governor
23 regarding legislative changes needed to meet and implement the

 

 

SB1893 - 18 - LRB096 10117 RPM 20283 b

1 following healthcare policies and objectives:
2         (1) increased measurement, transparency, and
3     disclosure of hospital and clinician performance;
4         (2) information, tools, and incentives for patients
5     and other consumers to enable them to make informed
6     healthcare decisions;
7         (3) payment of hospitals and clinicians based on their
8     performance;
9         (4) health information technology, including an
10     electronic health record for all Illinois citizens;
11         (5) preventative and wellness initiatives; and
12         (6) review of current health plan design and
13     requirements, identifying elements of the plans that need
14     elimination, and implementation of new provisions that are
15     consistent with guidelines and protocols established by
16     organizations representing medical professions and
17     organizations with affordable budget guidelines.
18     The task force must report by January 1, 2010 to the
19 Governor and the General Assembly and by January 1 of each year
20 thereafter.
21     (b) The Task Force shall consist of 14 voting members, as
22 follows: 6 persons, who are not currently employed by a State
23 agency, appointed by the Director of Public Health, 3 of whom
24 shall be persons with knowledge and experience in the delivery
25 of health care services, including at least one person
26 representing organized health service workers, 2 of whom shall

 

 

SB1893 - 19 - LRB096 10117 RPM 20283 b

1 be persons with professional experience in the administration
2 or management of health care facilities, and one of whom shall
3 be a person with experience in health planning; 6 persons, who
4 are not currently employed by a State agency, appointed by the
5 Director of Insurance, one of whom shall be an employer of less
6 than 50 employees, one of whom shall be an employer of more
7 than 50 employees, 2 of whom shall be health care insurers, 1
8 of whom shall be a licensed health insurance agent, 1 of whom
9 shall be a consumer of an individual health insurance plan; the
10 Director of Insurance shall appoint a representative from the
11 Illinois Comprehensive Health Insurance Plan; and a
12 representative of the Department of Healthcare and Family
13 Services responsible for programs under Medicaid and the
14 children's health insurance programs.
15     (c) The Directors of Public Health and the Division of
16 Insurance shall serve as co-chairpersons of the Task Force.
17     (d) The Department may accept gifts and grants from any
18 party, including a health benefit plan issuer or a foundation
19 associated with a health benefit plan issuer, to assist with
20 funding the programs established in Section 90 of the Managed
21 Care Reform and Patients Rights Act. The Department of
22 Financial and Professional Regulation, Division of Insurance
23 shall adopt rules governing acceptance of donations that are
24 consistent with the Illinois Governmental Ethics Act. Before
25 adopting rules under this subsection (d), the Department shall:
26         (1) submit the proposed rules to the Illinois Board of

 

 

SB1893 - 20 - LRB096 10117 RPM 20283 b

1     Ethics for review; and
2         (2) consider the Board's recommendations regarding the
3     regulations.
4     Rulemaking authority to implement this Law, is conditioned
5 on the rules being adopted in accordance with all provisions of
6 the Illinois Administrative Procedure Act and all rules and
7 procedures of the Joint Committee on Administrative Rules; any
8 purported rule not so adopted, for whatever reason, is
9 unauthorized.
 
10     Section 15-10. Repeal of Task Force. The Task Force is
11 abolished on July 1, 2014.
 
12
ARTICLE 90. AMENDATORY PROVISIONS

 
13     Section 90-5. The Illinois Income Tax Act is amended by
14 adding Section 218 as follows:
 
15     (35 ILCS 5/218 new)
16     Sec. 218. Health insurance contribution credit.
17     (a) For those taxable years ending on or after December 31,
18 2007 and ending on or before December 30, 2012, each taxpayer
19 that is an employer with 10 or fewer employees and whose
20 average annual compensation paid to employees is less than 250%
21 of the Federal poverty level is entitled to a credit against
22 the tax imposed by subsections (a) and (b) of Section 201 in an

 

 

SB1893 - 21 - LRB096 10117 RPM 20283 b

1 amount equal to 33% of the amount of any contribution made by
2 the taxpayer during the taxable year towards the premium of a
3 health insurance policy authorized for sale in the State by the
4 Department of Financial and Professional Regulation.
5     (b) For partners, shareholders of Subchapter S
6 corporations, and owners of limited liability companies, if the
7 liability company is treated as a partnership for purposes of
8 federal and State income taxation, there shall be allowed a
9 credit under this Section to be determined in accordance with
10 the determination of income and distributive share of income
11 under Sections 702 and 704 and Subchapter S of the Internal
12 Revenue Code.
13     (c) The credit under this Section may not be carried
14 forward or back and may not reduce the taxpayer's liability to
15 less than zero.
 
16     Section 90-10. The Illinois Insurance Code is amended by
17 adding Articles XLV and XLVI and Section 352b and by changing
18 Section 352 as follows:
 
19     (215 ILCS 5/Art. XLV heading new)
20
ARTICLE XLV. ILLINOIS INNOVATIVE INSURANCE SOLUTIONS

 
21     (215 ILCS 5/10-1500 new)
22     Sec. 10-1500. Short title. This Article may be cited as the
23 Illinois Innovative Insurance Solutions Law.
 

 

 

SB1893 - 22 - LRB096 10117 RPM 20283 b

1     (215 ILCS 5/10-1505 new)
2     Sec. 10-1505. Purpose. It is hereby determined and declared
3 that the purpose of this Article is to establish a program,
4 called the Illinois Innovative Insurance Solutions Program,
5 whereby authorized health insurance carriers may develop and
6 submit to the Director of the Division of Insurance for
7 consideration and approval, policies or plans of individual
8 major medical, blanket, or group major medical accident and
9 health insurance having the potential to increase Illinois
10 residents' access to health care coverage, but which may not
11 otherwise meet existing regulatory requirements. The Director
12 of the Division of Insurance is authorized by this Section to
13 grant approval of such innovative health insurance products on
14 a limited, pilot program basis in order that any overriding
15 potential to increase access to health care may be assessed on
16 a limited trial basis. The purpose of this program is to
17 encourage private health insurance market innovation and
18 creativity in order to arrive at viable solutions for providing
19 health insurance coverage and access to previously uninsured
20 Illinois residents.
 
21     (215 ILCS 5/10-1510 new)
22     Sec. 10-1510. Duties of Director. It shall be the duty of
23 the Director to withhold approval of any such policy,
24 certificate, endorsement, rider, bylaw, or other matter

 

 

SB1893 - 23 - LRB096 10117 RPM 20283 b

1 incorporated by reference or application blank filed with the
2 Director under this Law if it contains provisions which
3 encourage misrepresentation or are unjust, unfair,
4 inequitable, ambiguous, misleading, inconsistent, deceptive,
5 contrary to law or to the public policy of this State, or
6 contains exceptions and conditions that unreasonably or
7 deceptively affect the risk purported to be assumed in the
8 general coverage of the policy.
9     Rulemaking authority to implement this Law, if any, is
10 conditioned on the rules being adopted in accordance with all
11 provisions of the Illinois Administrative Procedure Act and all
12 rules and procedures of the Joint Committee on Administrative
13 Rules; any purported rule not so adopted, for whatever reason,
14 is unauthorized.
 
15     (215 ILCS 5/Art. XLVI heading new)
16
ARTICLE XLVI. ILLINOIS HEALTH INSURANCE
17
PREMIUM ASSISTANCE PROGRAM

 
18     (215 ILCS 5/10-1600 new)
19     Sec. 10-1600. Short title. This Article may be cited as the
20 Illinois Health Insurance Premium Assistance Program.
 
21     (215 ILCS 5/10-1605 new)
22     Sec. 10-1605. Legislative intent. The General Assembly
23 finds that, for the economic and social benefit of all

 

 

SB1893 - 24 - LRB096 10117 RPM 20283 b

1 residents of this State, it is important to enable all State
2 residents to access affordable health insurance coverage.
 
3     (215 ILCS 5/10-1610 new)
4     Sec. 10-1610. Definitions. In this Law:
5     "Carrier" has the same meaning as defined in the Small
6 Employer Health Insurance Rating Act.
7     "Department" means the Department of Healthcare and Family
8 Services.
9     "Employee" has the same meaning as provided in the Illinois
10 Health Insurance Portability and Accountability Act.
11     "Eligible individual" means an individual who:
12         (1) is a resident of the State of Illinois;
13         (2) is not eligible for Medicare;
14         (3) except as otherwise provided by the Department, has
15     family income less than 200% of the federal poverty level
16     or, if the individual is not married, has income less than
17     100% of the federal poverty level;
18         (4) has investments, savings, or other assets less than
19     the limit established by the Department; and
20         (5) Meets other eligibility criteria established by
21     the Department.
22     "Family" means:
23         (1) a single individual;
24         (2) an adult and the adult's spouse;
25         (3) an adult and the adult's spouse, all unmarried,

 

 

SB1893 - 25 - LRB096 10117 RPM 20283 b

1     dependent children less than 23 years of age, including
2     adopted children, children placed for adoption, and
3     children under the legal guardianship of the adult or the
4     adult's spouse;
5         (4) an adult and the adult's unmarried, dependent
6     children less than 23 years of age, including adopted
7     children, children placed for adoption, and children under
8     the legal guardianship of the adult; or
9         (5) a dependent elderly relative or a dependent adult
10     disabled child who meets criteria established by the
11     Department and who lives in the home of the adult described
12     in items (1) through (4) of this definition of "family".
13     "Federal poverty level" means the federal poverty level
14 guidelines published annually by the United States Department
15 of Health and Human Services.
16     "Family member" means an employee's spouse, any unmarried
17 child, stepchild or dependent within age limits and other
18 conditions under the terms of the health benefit plan selected
19 by the employee or the employee's employer.
20     "Health benefit plan" has the same meaning as provided in
21 the Small Employer Health Insurance Rating Act.
22     "Health benefit plan" includes the Illinois Comprehensive
23 Health Insurance Plan and any plan provided by a less than
24 fully insured multiple employer welfare arrangement or by
25 another benefit arrangement defined in the federal Employee
26 Retirement Income Security Act of 1974, as amended. Health

 

 

SB1893 - 26 - LRB096 10117 RPM 20283 b

1 benefit plan does not include coverage for accident only,
2 specific disease or condition only, credit, disability income,
3 coverage of Medicare services pursuant to contracts with the
4 federal government, Medicare supplement insurance, student
5 accident and health insurance, long term care insurance,
6 hospital indemnity only, dental only, vision only, coverage
7 issued as a supplement to liability insurance, insurance
8 arising out of a workers' compensation or similar law,
9 automobile medical payment insurance, insurance under which
10 the benefits are payable with or without regard to fault and
11 that is legally required to be contained in any liability
12 insurance policy or equivalent self-insurance or coverage
13 obtained or provided in another state but not available in
14 Illinois.
15     "Income" means gross income in cash or kind available to
16 the applicant or the applicant's family. "Income" does not
17 include earned income of the applicant's children or income
18 earned by a spouse if there is a legal separation.
19     "Premium" means the monthly or other periodic charge for a
20 health benefit plan.
21     "Program" means the Illinois Health Insurance Premium
22 Assistance Program.
23     "Rebate" means payment or reimbursement to an eligible
24 individual toward the eligible individual's purchase or
25 contribution of premium towards a health benefit plan for the
26 eligible individual and the eligible individual's family and

 

 

SB1893 - 27 - LRB096 10117 RPM 20283 b

1 may include co-payments or deductible expenses that are the
2 responsibility of the eligible individual.
3     "Small employer" has the same meaning as provided in the
4 Illinois Health Insurance Portability and Accountability Act.
5     "Third-party administrator" means any insurance company or
6 other entity licensed under the Illinois Insurance Code to
7 administer health insurance benefit programs.
 
8     (215 ILCS 5/10-1615 new)
9     Sec. 10-1615. Program operation. The Illinois Health
10 Insurance Premium Assistance Program is created. The Program
11 shall be administered by the Department of Healthcare and
12 Family Services. The Department shall have the same powers and
13 authority to administer the Program as are provided to the
14 Department in connection with the Department's administration
15 of the Illinois Public Aid Code, the Children's Health
16 Insurance Program Act, and the Covering ALL KIDS Health
17 Insurance Program.
 
18     (215 ILCS 5/10-1620 new)
19     Sec. 10-1620. Additional duties of Department; rules.
20     (a) In carrying out its duties under this Program, the
21 Department may:
22         (1) enter into contracts for administration of this Law
23     that include, but are not limited to:
24             (a) distribution of rebate payments;

 

 

SB1893 - 28 - LRB096 10117 RPM 20283 b

1             (b) eligibility determination;
2             (c) data collection;
3             (d) financial tracking and reporting; and
4             (e) such other services as the Department may deem
5         necessary for the administration of the Program; and
6         (2) retain consultants and employ staff.
7     (b) The Department shall adopt rules reasonably necessary
8 to carry out the purposes of this Law. If the Department
9 decides to enter into any contract pursuant to this subsection
10 (b), the Department shall engage in competitive bidding.
11 Rulemaking authority to implement this Law, if any, is
12 conditioned on the rules being adopted in accordance with all
13 provisions of the Illinois Administrative Procedure Act and all
14 rules and procedures of the Joint Committee on Administrative
15 Rules; any purported rule not so adopted, for whatever reason,
16 is unauthorized.
 
17     (215 ILCS 5/10-1625 new)
18     Sec. 10-1625. Application to participate in the Program;
19 issuance of rebates; restrictions; health benefit plan
20 enrollment.
21     (a) To enroll in the Program, an applicant shall submit a
22 written application to the Department in the form and manner
23 prescribed by the Department. If the applicant qualifies as an
24 eligible individual, the applicant shall either be enrolled in
25 the Program or placed on a waiting list for enrollment.

 

 

SB1893 - 29 - LRB096 10117 RPM 20283 b

1     (b) After an eligible individual has enrolled in the
2 Program, the individual shall remain eligible for enrollment
3 for the period of time established by the Department.
4     (c) After an eligible individual has enrolled in the
5 Program, the Department shall issue rebates as provided in
6 accordance with the restrictions in Section 25 of the
7 Children's Health Insurance Program Act and available
8 appropriations.
9     (d) Rebates may not be issued to an eligible individual
10 unless all eligible children, if any, in the eligible
11 individual's family are covered under a health benefit plan,
12 Medicaid, or the Covering ALL KIDS Health Insurance Act.
13     (e) Rebates may not be used to subsidize premiums on a
14 health benefit plan whose premiums are wholly paid by the
15 eligible individual's employer. However, rebates may be used to
16 pay for any copayments or deductibles required under the policy
17 for the eligible individual or a covered family member and paid
18 by the eligible individual.
19     (f) The Department may issue rebates to an eligible
20 individual in advance of a purchase of a health benefit plan.
21     (g) An eligible individual must enroll in a health benefit
22 plan if such a plan is available to the eligible individual
23 through the individual's employment.
24     (h) Notwithstanding Section 1610, if an eligible
25 individual is enrolled in a group health benefit plan available
26 to the eligible individual through the individual's

 

 

SB1893 - 30 - LRB096 10117 RPM 20283 b

1 employment, and the employer requires enrollment in both a
2 health benefit plan and a dental plan, the individual is
3 eligible for a rebate for both the health benefit plan and the
4 dental plan.
 
5     (215 ILCS 5/10-1630 new)
6     Sec. 10-1630. Level of assistance determinations.
7     (a) The Department shall determine the level of assistance
8 to be granted under Section 1625 based on a sliding scale that
9 considers:
10         (1) family size;
11         (2) family income;
12         (3) the number of members of a family who will receive
13     health benefit plan coverage subsidized through the
14     Program; and
15         (4) such other factors as the Department may establish.
16     (b) Notwithstanding the sliding scale established in
17 subsection (a) of this Section, the Department may establish
18 different assistance levels for otherwise similarly situated
19 eligible individuals based on factors including but not limited
20 to whether the individual is enrolled in an employer-sponsored
21 group health benefit plan or an individual health benefit plan.
 
22     (215 ILCS 5/10-1635 new)
23     Sec. 10-1635. Rebates limited to funds appropriated;
24 enrollment restrictions.

 

 

SB1893 - 31 - LRB096 10117 RPM 20283 b

1     (a) Notwithstanding eligibility criteria and rebate
2 amounts established in this Law, rebates shall be provided only
3 to the extent the General Assembly specifically appropriates
4 funds to provide such assistance.
5     (b) The Department may prohibit or limit enrollment in the
6 Program to ensure that Program expenditures are within
7 legislatively appropriated amounts. Prohibitions or
8 limitations allowed under this Section may include but are not
9 limited to:
10         (1) lowering the allowable income level necessary to
11     qualify as an eligible individual; and
12         (2) establishing a waiting list of eligible
13     individuals who shall receive rebates only when sufficient
14     funds are available.
 
15     (215 ILCS 5/10-1640 new)
16     Sec. 10-1640. Repeal. This Article is repealed on December
17 31, 2019.
 
18     (215 ILCS 5/352)  (from Ch. 73, par. 964)
19     Sec. 352. Scope of Article.
20     (a) Except as provided in subsections (b), (c), (d), and
21 (e), this Article shall apply to all companies transacting in
22 this State the kinds of business enumerated in clause (b) of
23 Class 1 and clause (a) of Class 2 of section 4. Nothing in this
24 Article shall apply to, or in any way affect policies or

 

 

SB1893 - 32 - LRB096 10117 RPM 20283 b

1 contracts described in clause (a) of Class 1 of Section 4;
2 however, this Article shall apply to policies and contracts
3 which contain benefits providing reimbursement for the
4 expenses of long term health care which are certified or
5 ordered by a physician including but not limited to
6 professional nursing care, custodial nursing care, and
7 non-nursing custodial care provided in a nursing home or at a
8 residence of the insured.
9     (b) This Article does not apply to policies of accident and
10 health insurance issued in compliance with Article XIXB of this
11 Code or the Health Insurance Choice Law.
12     (c) A policy issued and delivered in this State that
13 provides coverage under that policy for certificate holders who
14 are neither residents of nor employed in this State does not
15 need to provide to those nonresident certificate holders who
16 are not employed in this State the coverages or services
17 mandated by this Article.
18     (d) Stop-loss insurance is exempt from all Sections of this
19 Article, except this Section and Sections 353a, 354, 357.30,
20 and 370. For purposes of this exemption, stop-loss insurance is
21 further defined as follows:
22         (1) The policy must be issued to and insure an
23     employer, trustee, or other sponsor of the plan, or the
24     plan itself, but not employees, members, or participants.
25         (2) Payments by the insurer must be made to the
26     employer, trustee, or other sponsors of the plan, or the

 

 

SB1893 - 33 - LRB096 10117 RPM 20283 b

1     plan itself, but not to the employees, members,
2     participants, or health care providers.
3     (e) A policy issued or delivered in this State to the
4 Department of Healthcare and Family Services (formerly
5 Illinois Department of Public Aid) and providing coverage,
6 under clause (b) of Class 1 or clause (a) of Class 2 as
7 described in Section 4, to persons who are enrolled under
8 Article V of the Illinois Public Aid Code or under the
9 Children's Health Insurance Program Act is exempt from all
10 restrictions, limitations, standards, rules, or regulations
11 respecting benefits imposed by or under authority of this Code,
12 except those specified by subsection (1) of Section 143.
13 Nothing in this subsection, however, affects the total medical
14 services available to persons eligible for medical assistance
15 under the Illinois Public Aid Code.
16 (Source: P.A. 95-331, eff. 8-21-07.)
 
17     (215 ILCS 5/352b new)
18     Sec. 352b. Small employer assistance. The Director shall
19 assist employers with 25 or fewer employees with implementing
20 and administering plans under Section 125 of the Internal
21 Revenue Code, including medical expense reimbursement accounts
22 and dependent care accounts. The Director shall provide
23 information about the assistance available to small employers
24 on the Insurance Division's website.
 

 

 

SB1893 - 34 - LRB096 10117 RPM 20283 b

1     Section 90-15. The Comprehensive Health Insurance Plan Act
2 is amended by adding Sections 16 and 17 as follows:
 
3     (215 ILCS 105/16 new)
4     Sec. 16. No eligibility groups added or expanded.
5 Notwithstanding any other provision of this Act to the
6 contrary, no eligibility group may be added or expanded under
7 this Act without authorization by the General Assembly.
 
8     (215 ILCS 105/17 new)
9     Sec. 17. Small employer participation. Notwithstanding
10 Section 7 of this Act, an employer of 10 or less employees
11 contributing at least 50% of the cost of premiums for health
12 insurance coverage for its employees may enroll any covered
13 employee or covered dependent into the Plan, if: (i) the
14 employee or dependent meets a presumptive condition of the
15 Plan; (ii) the employer continues to contribute at least 50% of
16 the cost of the premium to the Plan on behalf of the employee
17 or dependent; (iii) the employer has experienced an average
18 increase in cost of its health insurance plan of 15% or more
19 over the previous consecutive three years; and (iv) maintains
20 coverage for its remaining employees and dependents.
 
21     Section 90-20. The Children's Health Insurance Program Act
22 is amended by adding Section 7 and by changing Section 25 as
23 follows:
 

 

 

SB1893 - 35 - LRB096 10117 RPM 20283 b

1     (215 ILCS 106/7 new)
2     Sec. 7. No eligibility groups added or expanded.
3 Notwithstanding any other provision of this Act to the
4 contrary, no eligibility group may be added or expanded under
5 this Act without authorization by the General Assembly.
 
6     (215 ILCS 106/25)
7     Sec. 25. Health benefits for children.
8     (a) The Department shall, subject to appropriation,
9 provide health benefits coverage to eligible children by:
10         (1) Subsidizing the cost of privately sponsored health
11     insurance, including employer based health insurance, to
12     assist families to take advantage of available privately
13     sponsored health insurance for their eligible children;
14     and
15         (2) Purchasing or providing health care benefits for
16     eligible children. The health benefits provided under this
17     subdivision (a)(2) shall, subject to appropriation and
18     without regard to any applicable cost sharing under Section
19     30, be identical to the benefits provided for children
20     under the State's approved plan under Title XIX of the
21     Social Security Act. Providers under this subdivision
22     (a)(2) shall be subject to approval by the Department to
23     provide health care under the Illinois Public Aid Code and
24     shall be reimbursed at the same rate as providers under the

 

 

SB1893 - 36 - LRB096 10117 RPM 20283 b

1     State's approved plan under Title XIX of the Social
2     Security Act. In addition, providers may retain
3     co-payments when determined appropriate by the Department.
4     (b) The subsidization provided pursuant to subdivision
5 (a)(1) shall be credited to the family of the eligible child.
6     (c) The Department is prohibited from denying coverage to a
7 child who is enrolled in a privately sponsored health insurance
8 plan pursuant to subdivision (a)(1) because the plan does not
9 meet federal benchmarking standards or cost sharing and
10 contribution requirements. To be eligible for inclusion in the
11 Program, the plan shall contain comprehensive major medical
12 coverage which shall consist of physician and hospital
13 inpatient services. The Department is prohibited from denying
14 coverage to a child who is enrolled in a privately sponsored
15 health insurance plan pursuant to subdivision (a)(1) because
16 the plan offers benefits in addition to physician and hospital
17 inpatient services.
18     (d) The total dollar amount of subsidizing coverage per
19 child per month pursuant to subdivision (a)(1) shall be equal
20 to the average dollar payments, less premiums incurred, per
21 child per month pursuant to subdivision (a)(2). The Department
22 shall set this amount prospectively based upon the prior fiscal
23 year's experience adjusted for incurred but not reported claims
24 and estimated increases or decreases in the cost of medical
25 care. Payments obligated before July 1, 1999, will be computed
26 using State Fiscal Year 1996 payments for children eligible for

 

 

SB1893 - 37 - LRB096 10117 RPM 20283 b

1 Medical Assistance and income assistance under the Aid to
2 Families with Dependent Children Program, with appropriate
3 adjustments for cost and utilization changes through January 1,
4 1999. The Department is prohibited from providing a subsidy
5 pursuant to subdivision (a)(1) that is more than the
6 individual's monthly portion of the premium.
7     (e) An eligible child may obtain immediate coverage under
8 this Program only once during a medical visit. If coverage
9 lapses, re-enrollment shall be completed in advance of the next
10 covered medical visit and the first month's required premium
11 shall be paid in advance of any covered medical visit.
12     (f) In order to accelerate and facilitate the development
13 of networks to deliver services to children in areas outside
14 counties with populations in excess of 3,000,000, in the event
15 less than 25% of the eligible children in a county or
16 contiguous counties has enrolled with a Health Maintenance
17 Organization pursuant to Section 5-11 of the Illinois Public
18 Aid Code, the Department may develop and implement
19 demonstration projects to create alternative networks designed
20 to enhance enrollment and participation in the program. The
21 Department shall prescribe by rule the criteria, standards, and
22 procedures for effecting demonstration projects under this
23 Section.
24     (g) The Department or any person acting on behalf of the
25 Department is prohibited from encouraging any individual to
26 drop or otherwise discontinue privately sponsored health

 

 

SB1893 - 38 - LRB096 10117 RPM 20283 b

1 insurance, including employer based health insurance that is
2 available to an eligible child. Any person violating this
3 Section shall be guilty of a petty offense.
4 (Source: P.A. 90-736, eff. 8-12-98.)
 
5     Section 90-25. The Managed Care Reform and Patient Rights
6 Act is amended by changing Section 90 as follows:
 
7     (215 ILCS 134/90)
8     Sec. 90. Office of Consumer Health Insurance.
9     (a) The Director of Insurance shall establish the Office of
10 Consumer Health Insurance within the Department of Financial
11 and Professional Regulation, Division of Insurance to provide
12 assistance and information to all health care consumers within
13 the State. Within the appropriation allocated, the Office shall
14 provide information and assistance to all health care consumers
15 by:
16         (1) assisting consumers in understanding health
17     insurance marketing materials and the coverage provisions
18     of individual plans;
19         (2) educating enrollees about their rights within
20     individual plans;
21         (3) assisting enrollees with the process of filing
22     formal grievances and appeals;
23         (4) establishing and operating a toll-free "800"
24     telephone number line to handle consumer inquiries;

 

 

SB1893 - 39 - LRB096 10117 RPM 20283 b

1         (5) making related information available in languages
2     other than English that are spoken as a primary language by
3     a significant portion of the State's population, as
4     determined by the Department;
5         (6) analyzing, commenting on, monitoring, and making
6     publicly available reports on the development and
7     implementation of federal, State, and local laws,
8     regulations, and other governmental policies and actions
9     that pertain to the adequacy of health care plans,
10     facilities, and services in the State;
11         (7) filing an annual report with the Governor, the
12     Director, and the General Assembly, which shall contain
13     recommendations for improvement of the regulation of
14     health insurance plans, including recommendations on
15     improving health care consumer assistance and patterns,
16     abuses, and progress that it has identified from its
17     interaction with health care consumers; and
18         (8) performing all duties assigned to the Office by the
19     Director.
20     (b) The report required under subsection (a)(7) shall be
21 filed by January 31, 2001 and each January 31 thereafter.
22     (c) Nothing in this Section shall be interpreted to
23 authorize access to or disclosure of individual patient or
24 health care professional or provider records.
25     (d) The Office of Consumer Health Insurance shall:
26         (1) Develop and implement a health coverage public

 

 

SB1893 - 40 - LRB096 10117 RPM 20283 b

1     awareness and education program by:
2             (i) increasing public awareness of health coverage
3         options available in this State;
4             (ii) educating the public on the value of health
5         insurance coverage; and
6             (iii) providing information on health insurance
7         coverage options, including explanations of
8         deductibles and copayments and the differences between
9         health maintenance organizations, preferred provider
10         organizations, point of service plans, health savings
11         accounts and compatible high deductible health benefit
12         plans, and other forms of health insurance coverage.
13         (2) Provide information, including financial ratings
14     about specific health insurance coverage insurers, but the
15     Office may not favor or endorse one particular insurer over
16     another.
17         (3) Develop and release public service announcements
18     to educate consumers and employers about the types of
19     policies and availability of health coverage in this State.
20         (4) Develop an Internet website designed to educate the
21     public about the types of policies and availability of
22     health coverage in this State.
23         (5) Provide other appropriate education to the public
24     regarding the value of health insurance coverage.
25         (6) Consult the Illinois Healthcare Policy Task Force
26     regarding the content of the public service announcements,

 

 

SB1893 - 41 - LRB096 10117 RPM 20283 b

1     Internet website, and educational materials. The Director
2     has authority to make final decisions as to what the
3     Program's materials will contain.
4 (Source: P.A. 91-617, eff. 1-1-00.)
 
5     Section 90-30. The Covering ALL KIDS Health Insurance Act
6 is amended by adding Section 7 and by changing Section 25 as
7 follows:
 
8     (215 ILCS 170/7 new)
9     Sec. 7. No eligibility groups added or expanded.
10 Notwithstanding any other provision of this Act to the
11 contrary, no eligibility group may be added or expanded under
12 this Act without authorization by the General Assembly.
 
13     (215 ILCS 170/25)
14     (Section scheduled to be repealed on July 1, 2011)
15     Sec. 25. Enrollment in Program. The Department shall
16 develop procedures to allow application agents to assist in
17 enrolling children in the Program or other children's health
18 programs operated by the Department. At the Department's
19 discretion, technical assistance payments may be made
20 available for approved applications facilitated by an
21 application agent. The Department or any person acting on
22 behalf of the Department is prohibited from encouraging any
23 individual to drop or otherwise discontinue privately

 

 

SB1893 - 42 - LRB096 10117 RPM 20283 b

1 sponsored health insurance, including employer based health
2 insurance. Any person violating this Section shall be guilty of
3 a petty offense.
4 (Source: P.A. 94-693, eff. 7-1-06.)
 
5     Section 90-35. The Illinois Public Aid Code is amended by
6 adding Sections 1-12, 5-27, 5-28, 5-29, and 5-30 and by
7 changing Section 5A-7 as follows:
 
8     (305 ILCS 5/1-12 new)
9     Sec. 1-12. No programs or eligibility groups added or
10 expanded. Notwithstanding any other provision of this Code to
11 the contrary, no program or eligibility group may be added or
12 expanded under this Code without authorization by the General
13 Assembly.
 
14     (305 ILCS 5/5-27 new)
15     Sec. 5-27. Incentive payments to providers.
16     (a) Subject to appropriation, the Illinois Department
17 shall establish incentive payments to eligible providers based
18 on a quality reporting system using quality measures consistent
19 with criteria established by the Centers for Medicare and
20 Medicaid Services to implement the physician quality reporting
21 system established under the federal Tax Relief and Health Care
22 Act of 2006.
23     (b) Subject to appropriation, the Illinois Department

 

 

SB1893 - 43 - LRB096 10117 RPM 20283 b

1 shall establish incentive payments to eligible providers who
2 make health information technology investments that lead to
3 administrative and benefit delivery cost savings to the
4 Department in its administration and enforcement of the Act.
 
5     (305 ILCS 5/5-28 new)
6     Sec. 5-28. Incentive program for recipients.
7     (a) Subject to appropriation, the Illinois Department
8 shall establish a pilot program that allows recipients to
9 select a healthcare savings account option to meet their
10 coverage needs.
11     (b) The Department shall create a healthcare savings
12 account for each individual eligible for coverage under this
13 Act that volunteers to participate in the pilot program. The
14 Department shall contribute annually to each savings account
15 the maximum contribution provided under federal law for a
16 healthcare savings account.
17     (c) Any healthcare services provided to the recipient shall
18 be paid from the healthcare savings account until exhausted. If
19 the healthcare savings account is exhausted the Department
20 shall continue to pay benefits as provided under this Act. If
21 there is a balance at the end of the calendar year in the
22 savings account that amount shall be rolled over for future use
23 by the recipient.
24     (d) If the participating recipient is no longer eligible
25 for benefits under this Act due to income eligibility, the

 

 

SB1893 - 44 - LRB096 10117 RPM 20283 b

1 individual may retain the balance of the healthcare savings
2 account for the purpose of continuing the healthcare savings
3 account to pay for future healthcare expenses subject to any
4 and all federal and state tax law.
5     (e) The Department shall adopt rules to implement this
6 Section within 180 days of the effective date of these changes.
7     (f) The Department shall issue a report to the General
8 Assembly on the status and success of the pilot project by July
9 1, 2009.
 
10     (305 ILCS 5/5-29 new)
11     Sec. 5-29. Model program for enhanced primary care case
12 management.
13     (a) On or before January 1, 2010, the Department of
14 Healthcare and Family Services shall implement a model program
15 for enhanced primary care case management program for selected
16 populations of persons.
17     (b) In developing the enhanced primary care case management
18 program, the Department shall ensure that the program utilizes
19 managed care principles and strategies to ensure proper
20 utilization of acute care and long-term care services and
21 supports.
22     (c) The Department shall adopt rules establishing the
23 populations that must participate in the enhanced primary care
24 case management program. At a minimum, those populations must
25 include all persons eligible for benefits under Sections 20 and

 

 

SB1893 - 45 - LRB096 10117 RPM 20283 b

1 40. The Department shall adopt rules providing for the
2 implementation and continued oversight of the enhanced primary
3 care case management program.
4     (d) Every person eligible for or receiving assistance under
5 this Act may participate in the program authorized by this
6 Section. A recipient shall not be required to participate in,
7 and shall be permitted to withdraw from, the enhanced primary
8 care case management program upon showing that an individual
9 with a chronic medical condition being treated by a specialist
10 physician that is not associated with a provider in the
11 participant's service area may defer participation in the
12 enhanced primary care case management program until the course
13 of treatment is complete.
14     (e) The Department shall implement the model enhanced
15 primary care case management program in a manner that maximizes
16 all available State and federal funds, including those obtained
17 through intergovernmental transfers, supplemental Medicaid
18 payments, and the disproportionate share program.
19     (f) The Department of Healthcare and Family Services shall
20 promptly apply for all waivers of federal law and regulations
21 that are necessary to allow the full implementation of this
22 Section.
23     (g) On or before January 1, 2010 and every year thereafter,
24 the Department shall report to the General Assembly concerning
25 the effectiveness, the progress of implementation, and the
26 results of the primary care case management program.
 

 

 

SB1893 - 46 - LRB096 10117 RPM 20283 b

1     (305 ILCS 5/5-30 new)
2     Sec. 5-30. Model program for auto-assignment to quality
3 care. The Department shall work with the PCCM Administrator and
4 MCOs to develop a model program for an auto-assignment
5 algorithm following CMS regulations which equitably
6 distributes those recipients that do not choose an MCO or PCCM
7 during their enrollment process to a provider. Consistent with
8 current Medicaid enrollment procedure, recipients may opt out
9 of the plan to which they have been auto-assigned once a month.
 
10     (305 ILCS 5/5A-7)  (from Ch. 23, par. 5A-7)
11     Sec. 5A-7. Administration; enforcement provisions.
12     (a) The Illinois Department shall establish and maintain a
13 listing of all hospital providers appearing in the licensing
14 records of the Illinois Department of Public Health, which
15 shall show each provider's name and principal place of business
16 and the name and address of each hospital operated, conducted,
17 or maintained by the provider in this State. The Illinois
18 Department shall administer and enforce this Article and
19 collect the assessments and penalty assessments imposed under
20 this Article using procedures employed in its administration of
21 this Code generally. The Illinois Department, its Director, and
22 every hospital provider subject to assessment under this
23 Article shall have the following powers, duties, and rights:
24         (1) The Illinois Department may initiate either

 

 

SB1893 - 47 - LRB096 10117 RPM 20283 b

1     administrative or judicial proceedings, or both, to
2     enforce provisions of this Article. Administrative
3     enforcement proceedings initiated hereunder shall be
4     governed by the Illinois Department's administrative
5     rules. Judicial enforcement proceedings initiated
6     hereunder shall be governed by the rules of procedure
7     applicable in the courts of this State.
8         (2) No proceedings for collection, refund, credit, or
9     other adjustment of an assessment amount shall be issued
10     more than 3 years after the due date of the assessment,
11     except in the case of an extended period agreed to in
12     writing by the Illinois Department and the hospital
13     provider before the expiration of this limitation period.
14         (3) Any unpaid assessment under this Article shall
15     become a lien upon the assets of the hospital upon which it
16     was assessed. If any hospital provider, outside the usual
17     course of its business, sells or transfers the major part
18     of any one or more of (A) the real property and
19     improvements, (B) the machinery and equipment, or (C) the
20     furniture or fixtures, of any hospital that is subject to
21     the provisions of this Article, the seller or transferor
22     shall pay the Illinois Department the amount of any
23     assessment, assessment penalty, and interest (if any) due
24     from it under this Article up to the date of the sale or
25     transfer. If the seller or transferor fails to pay any
26     assessment, assessment penalty, and interest (if any) due,

 

 

SB1893 - 48 - LRB096 10117 RPM 20283 b

1     the purchaser or transferee of such asset shall be liable
2     for the amount of the assessment, penalties, and interest
3     (if any) up to the amount of the reasonable value of the
4     property acquired by the purchaser or transferee. The
5     purchaser or transferee shall continue to be liable until
6     the purchaser or transferee pays the full amount of the
7     assessment, penalties, and interest (if any) up to the
8     amount of the reasonable value of the property acquired by
9     the purchaser or transferee or until the purchaser or
10     transferee receives from the Illinois Department a
11     certificate showing that such assessment, penalty, and
12     interest have been paid or a certificate from the Illinois
13     Department showing that no assessment, penalty, or
14     interest is due from the seller or transferor under this
15     Article.
16         (4) Payments under this Article are not subject to the
17     Illinois Prompt Payment Act. The Department shall by rule
18     implement an expedited claims rejection process and within
19     30 days of the effective date of this Act shall provide
20     monthly reports to the General Assembly regarding payments
21     to providers under this Code including what policies,
22     procedures, schedules and actions undertaken by the
23     Department to make timely payments to providers.
24     Rulemaking authority to implement this amendatory Act of
25     the 96th General Assembly, if any, is conditioned on the
26     rules being adopted in accordance with all provisions of

 

 

SB1893 - 49 - LRB096 10117 RPM 20283 b

1     the Illinois Administrative Procedure Act and all rules and
2     procedures of the Joint Committee on Administrative Rules;
3     any purported rule not so adopted, for whatever reason, is
4     unauthorized Credits or refunds shall not bear interest.
5     (b) In addition to any other remedy provided for and
6 without sending a notice of assessment liability, the Illinois
7 Department may collect an unpaid assessment by withholding, as
8 payment of the assessment, reimbursements or other amounts
9 otherwise payable by the Illinois Department to the hospital
10 provider.
11 (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04;
12 94-242, eff. 7-18-05.)
 
13
ARTICLE 97. SEVERABILITY

 
14     Section 97-97. Severability. The provisions of this Act are
15 severable under Section 1.31 of the Statute on Statutes.
 
16
ARTICLE 99. EFFECTIVE DATE

 
17     Section 99-99. Effective date. This Act takes effect upon
18 becoming law.

 

 

SB1893 - 50 - LRB096 10117 RPM 20283 b

1 INDEX
2 Statutes amended in order of appearance
3     New Act
4     35 ILCS 5/218 new
5     215 ILCS 5/Art. XLV
6     heading new
7     215 ILCS 5/10-1500 new
8     215 ILCS 5/10-1505 new
9     215 ILCS 5/10-1510 new
10     215 ILCS 5/Art. XLVI
11     heading new
12     215 ILCS 5/10-1600 new
13     215 ILCS 5/10-1605 new
14     215 ILCS 5/10-1610 new
15     215 ILCS 5/10-1615 new
16     215 ILCS 5/10-1620 new
17     215 ILCS 5/10-1625 new
18     215 ILCS 5/10-1630 new
19     215 ILCS 5/10-1635 new
20     215 ILCS 5/10-1640 new
21     215 ILCS 5/352 from Ch. 73, par. 964
22     215 ILCS 5/352b new
23     215 ILCS 105/16 new
24     215 ILCS 105/17 new
25     215 ILCS 106/7 new

 

 

SB1893 - 51 - LRB096 10117 RPM 20283 b

1     215 ILCS 106/25
2     215 ILCS 134/90
3     215 ILCS 170/7 new
4     215 ILCS 170/25
5     305 ILCS 5/1-12 new
6     305 ILCS 5/5-27 new
7     305 ILCS 5/5-28 new
8     305 ILCS 5/5-29 new
9     305 ILCS 5/5-30 new
10     305 ILCS 5/5A-7 from Ch. 23, par. 5A-7