97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB4332

 

Introduced 1/30/2012, by Rep. Michael J. Madigan

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-16  from Ch. 23, par. 5-16

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care.


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A BILL FOR

 

HB4332LRB097 15326 KTG 60426 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-16 as follows:
 
6    (305 ILCS 5/5-16)  (from Ch. 23, par. 5-16)
7    Sec. 5-16. Managed Care. The The Illinois Department may
8develop and implement a Primary Care Sponsor System consistent
9with the provisions of this Section. The purpose of this
10managed care delivery system shall be to contain the costs of
11providing medical care to Medicaid recipients by having one
12provider responsible for managing all aspects of a recipient's
13medical care. This managed care system shall have the following
14characteristics:
15        (a) The Department, by rule, shall establish criteria
16    to determine which clients must participate in this
17    program;
18        (b) Providers participating in the program may be paid
19    an amount per patient per month, to be set by the Illinois
20    Department, for managing each recipient's medical care;
21        (c) Providers eligible to participate in the program
22    shall be physicians licensed to practice medicine in all
23    its branches, and the Illinois Department may terminate a

 

 

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1    provider's participation if the provider is determined to
2    have failed to comply with any applicable program standard
3    or procedure established by the Illinois Department;
4        (d) Each recipient required to participate in the
5    program must select from a panel of primary care providers
6    or networks established by the Department in their
7    communities;
8        (e) A recipient may change his designated primary care
9    provider:
10            (1) when the designated source becomes
11        unavailable, as the Illinois Department shall
12        determine by rule; or
13            (2) when the designated primary care provider
14        notifies the Illinois Department that it wishes to
15        withdraw from any obligation as primary care provider;
16        or
17            (3) in other situations, as the Illinois
18        Department shall provide by rule;
19        (f) The Illinois Department shall, by rule, establish
20    procedures for providing medical services when the
21    designated source becomes unavailable or wishes to
22    withdraw from any obligation as primary care provider
23    taking into consideration the need for emergency or
24    temporary medical assistance and ensuring that the
25    recipient has continuous and unrestricted access to
26    medical care from the date on which such unavailability or

 

 

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1    withdrawal becomes effective until such time as the
2    recipient designates a primary care source;
3        (g) Only medical care services authorized by a
4    recipient's designated provider, except for emergency
5    services, services performed by a provider that is owned or
6    operated by a county and that provides non-emergency
7    services without regard to ability to pay and such other
8    services as provided by the Illinois Department, shall be
9    subject to payment by the Illinois Department. The Illinois
10    Department shall enter into an intergovernmental agreement
11    with each county that owns or operates such a provider to
12    develop and implement policies to minimize the provision of
13    medical care services provided by county owned or operated
14    providers pursuant to the foregoing exception.
15    The Illinois Department shall seek and obtain necessary
16authorization provided under federal law to implement such a
17program including the waiver of any federal regulations.
18    The Illinois Department may implement the amendatory
19changes to this Section made by this amendatory Act of 1991
20through the use of emergency rules in accordance with the
21provisions of Section 5.02 of the Illinois Administrative
22Procedure Act. For purposes of the Illinois Administrative
23Procedure Act, the adoption of rules to implement the
24amendatory changes to this Section made by this amendatory Act
25of 1991 shall be deemed an emergency and necessary for the
26public interest, safety and welfare.

 

 

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1    The Illinois Department may establish a managed care system
2demonstration program, on a limited basis, as described in this
3Section. The demonstration program shall terminate on June 30,
41997. Within 30 days after the end of each year of the
5demonstration program's operation, the Illinois Department
6shall report to the Governor and the General Assembly
7concerning the operation of the demonstration program.
8(Source: P.A. 87-14; 88-490.)