HB5485 EngrossedLRB097 20051 KTG 65383 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 5-30 as follows:
 
6    (305 ILCS 5/5-30)
7    Sec. 5-30. Care coordination.
8    (a) At least 50% of recipients eligible for comprehensive
9medical benefits in all medical assistance programs or other
10health benefit programs administered by the Department,
11including the Children's Health Insurance Program Act and the
12Covering ALL KIDS Health Insurance Act, shall be enrolled in a
13care coordination program by no later than January 1, 2015. For
14purposes of this Section, "coordinated care" or "care
15coordination" means delivery systems where recipients will
16receive their care from providers who participate under
17contract in integrated delivery systems that are responsible
18for providing or arranging the majority of care, including
19primary care physician services, referrals from primary care
20physicians, diagnostic and treatment services, behavioral
21health services, in-patient and outpatient hospital services,
22dental services, and rehabilitation and long-term care
23services. The Department shall designate or contract for such

 

 

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1integrated delivery systems (i) to ensure enrollees have a
2choice of systems and of primary care providers within such
3systems; (ii) to ensure that enrollees receive quality care in
4a culturally and linguistically appropriate manner; and (iii)
5to ensure that coordinated care programs meet the diverse needs
6of enrollees with developmental, mental health, physical, and
7age-related disabilities.
8    (b) Payment for such coordinated care shall be based on
9arrangements where the State pays for performance related to
10health care outcomes, the use of evidence-based practices, the
11use of primary care delivered through comprehensive medical
12homes, the use of electronic medical records, and the
13appropriate exchange of health information electronically made
14either on a capitated basis in which a fixed monthly premium
15per recipient is paid and full financial risk is assumed for
16the delivery of services, or through other risk-based payment
17arrangements.
18    (b-5) Any health insurance company that contracts with the
19Department, its subsequent agency, or the State to provide
20managed care to individuals enrolled as clients,
21beneficiaries, or recipients, who receive medical benefits
22under the Illinois medical assistance program, must be National
23Committee for Quality Assurance (NCQA) accredited within 3
24years after beginning to provide services under the Illinois
25medical assistance program, and any such health insurance
26companies engaged in providing managed care or coordinated care

 

 

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1under the Illinois medical assistance program on the effective
2date of this amendatory Act of the 97th General Assembly must
3be NCQA accredited by January 1, 2015.
4    (c) To qualify for compliance with this Section, the 50%
5goal shall be achieved by enrolling medical assistance
6enrollees from each medical assistance enrollment category,
7including parents, children, seniors, and people with
8disabilities to the extent that current State Medicaid payment
9laws would not limit federal matching funds for recipients in
10care coordination programs. In addition, services must be more
11comprehensively defined and more risk shall be assumed than in
12the Department's primary care case management program as of the
13effective date of this amendatory Act of the 96th General
14Assembly.
15    (d) The Department shall report to the General Assembly in
16a separate part of its annual medical assistance program
17report, beginning April, 2012 until April, 2016, on the
18progress and implementation of the care coordination program
19initiatives established by the provisions of this amendatory
20Act of the 96th General Assembly. The Department shall include
21in its April 2011 report a full analysis of federal laws or
22regulations regarding upper payment limitations to providers
23and the necessary revisions or adjustments in rate
24methodologies and payments to providers under this Code that
25would be necessary to implement coordinated care with full
26financial risk by a party other than the Department.

 

 

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1(Source: P.A. 96-1501, eff. 1-25-11.)