97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5909

 

Introduced 2/16/2012, by Rep. Patricia R. Bellock

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 106/23
215 ILCS 170/56
305 ILCS 5/5-30

    Amends the Children's Health Insurance Program Act, the Covering ALL KIDS Health Insurance Act, and the Medical Assistance Article of the Illinois Public Aid Code. Provides that prior to the Department of Healthcare and Family Services enrolling individuals under the expanded coverage provisions mandated by the federal Patient Protection and Affordable Care Act of 2010 which require a minimum eligibility level of 133% of the federal poverty level for legal residents, the Department shall first meet the care coordination enrolling requirements mandated by Public Act 96-1501. Effective immediately.


LRB097 17029 KTG 62225 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5909LRB097 17029 KTG 62225 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 Children's Health Insurance Program Act is
5amended by changing Section 23 as follows:
 
6    (215 ILCS 106/23)
7    Sec. 23. 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.
14This requirement shall be met prior to enrolling individuals
15under the expanded coverage provisions mandated by the federal
16Patient Protection and Affordable Care Act of 2010 which
17require a minimum eligibility level of 133% of the federal
18poverty level for legal residents. For purposes of this
19Section, "coordinated care" or "care coordination" means
20delivery systems where recipients will receive their care from
21providers who participate under contract in integrated
22delivery systems that are responsible for providing or
23arranging the majority of care, including primary care

 

 

HB5909- 2 -LRB097 17029 KTG 62225 b

1physician services, referrals from primary care physicians,
2diagnostic and treatment services, behavioral health services,
3in-patient and outpatient hospital services, dental services,
4and rehabilitation and long-term care services. The Department
5shall designate or contract for such integrated delivery
6systems (i) to ensure enrollees have a choice of systems and of
7primary care providers within such systems; (ii) to ensure that
8enrollees receive quality care in a culturally and
9linguistically appropriate manner; and (iii) to ensure that
10coordinated care programs meet the diverse needs of enrollees
11with developmental, mental health, physical, and age-related
12disabilities.
13    (b) Payment for such coordinated care shall be based on
14arrangements where the State pays for performance related to
15health care outcomes, the use of evidence-based practices, the
16use of primary care delivered through comprehensive medical
17homes, the use of electronic medical records, and the
18appropriate exchange of health information electronically made
19either on a capitated basis in which a fixed monthly premium
20per recipient is paid and full financial risk is assumed for
21the delivery of services, or through other risk-based payment
22arrangements.
23    (c) To qualify for compliance with this Section, the 50%
24goal shall be achieved by enrolling medical assistance
25enrollees from each medical assistance enrollment category,
26including parents, children, seniors, and people with

 

 

HB5909- 3 -LRB097 17029 KTG 62225 b

1disabilities to the extent that current State Medicaid payment
2laws would not limit federal matching funds for recipients in
3care coordination programs. In addition, services must be more
4comprehensively defined and more risk shall be assumed than in
5the Department's primary care case management program as of the
6effective date of this amendatory Act of the 96th General
7Assembly.
8    (d) The Department shall report to the General Assembly in
9a separate part of its annual medical assistance program
10report, beginning April, 2012 until April, 2016, on the
11progress and implementation of the care coordination program
12initiatives established by the provisions of this amendatory
13Act of the 96th General Assembly. The Department shall include
14in its April 2011 report a full analysis of federal laws or
15regulations regarding upper payment limitations to providers
16and the necessary revisions or adjustments in rate
17methodologies and payments to providers under this Code that
18would be necessary to implement coordinated care with full
19financial risk by a party other than the Department.
20(Source: P.A. 96-1501, eff. 1-25-11.)
 
21    Section 10. The Covering ALL KIDS Health Insurance Act is
22amended by changing Section 56 as follows:
 
23    (215 ILCS 170/56)
24    (Section scheduled to be repealed on July 1, 2016)

 

 

HB5909- 4 -LRB097 17029 KTG 62225 b

1    Sec. 56. Care coordination.
2    (a) At least 50% of recipients eligible for comprehensive
3medical benefits in all medical assistance programs or other
4health benefit programs administered by the Department,
5including the Children's Health Insurance Program Act and the
6Covering ALL KIDS Health Insurance Act, shall be enrolled in a
7care coordination program by no later than January 1, 2015.
8This requirement shall be met prior to enrolling individuals
9under the expanded coverage provisions mandated by the federal
10Patient Protection and Affordable Care Act of 2010 which
11require a minimum eligibility level of 133% of the federal
12poverty level for legal residents. For purposes of this
13Section, "coordinated care" or "care coordination" means
14delivery systems where recipients will receive their care from
15providers who participate under contract in integrated
16delivery systems that are responsible for providing or
17arranging the majority of care, including primary care
18physician services, referrals from primary care physicians,
19diagnostic and treatment services, behavioral health services,
20in-patient and outpatient hospital services, dental services,
21and rehabilitation and long-term care services. The Department
22shall designate or contract for such integrated delivery
23systems (i) to ensure enrollees have a choice of systems and of
24primary care providers within such systems; (ii) to ensure that
25enrollees receive quality care in a culturally and
26linguistically appropriate manner; and (iii) to ensure that

 

 

HB5909- 5 -LRB097 17029 KTG 62225 b

1coordinated care programs meet the diverse needs of enrollees
2with developmental, mental health, physical, and age-related
3disabilities.
4    (b) Payment for such coordinated care shall be based on
5arrangements where the State pays for performance related to
6health care outcomes, the use of evidence-based practices, the
7use of primary care delivered through comprehensive medical
8homes, the use of electronic medical records, and the
9appropriate exchange of health information electronically made
10either on a capitated basis in which a fixed monthly premium
11per recipient is paid and full financial risk is assumed for
12the delivery of services, or through other risk-based payment
13arrangements.
14    (c) To qualify for compliance with this Section, the 50%
15goal shall be achieved by enrolling medical assistance
16enrollees from each medical assistance enrollment category,
17including parents, children, seniors, and people with
18disabilities to the extent that current State Medicaid payment
19laws would not limit federal matching funds for recipients in
20care coordination programs. In addition, services must be more
21comprehensively defined and more risk shall be assumed than in
22the Department's primary care case management program as of the
23effective date of this amendatory Act of the 96th General
24Assembly.
25    (d) The Department shall report to the General Assembly in
26a separate part of its annual medical assistance program

 

 

HB5909- 6 -LRB097 17029 KTG 62225 b

1report, beginning April, 2012 until April, 2016, on the
2progress and implementation of the care coordination program
3initiatives established by the provisions of this amendatory
4Act of the 96th General Assembly. The Department shall include
5in its April 2011 report a full analysis of federal laws or
6regulations regarding upper payment limitations to providers
7and the necessary revisions or adjustments in rate
8methodologies and payments to providers under this Code that
9would be necessary to implement coordinated care with full
10financial risk by a party other than the Department.
11(Source: P.A. 96-1501, eff. 1-25-11.)
 
12    Section 15. The Illinois Public Aid Code is amended by
13changing Section 5-30 as follows:
 
14    (305 ILCS 5/5-30)
15    Sec. 5-30. Care coordination.
16    (a) At least 50% of recipients eligible for comprehensive
17medical benefits in all medical assistance programs or other
18health benefit programs administered by the Department,
19including the Children's Health Insurance Program Act and the
20Covering ALL KIDS Health Insurance Act, shall be enrolled in a
21care coordination program by no later than January 1, 2015.
22This requirement shall be met prior to enrolling individuals
23under the expanded coverage provisions mandated by the federal
24Patient Protection and Affordable Care Act of 2010 which

 

 

HB5909- 7 -LRB097 17029 KTG 62225 b

1require a minimum eligibility level of 133% of the federal
2poverty level for legal residents. For purposes of this
3Section, "coordinated care" or "care coordination" means
4delivery systems where recipients will receive their care from
5providers who participate under contract in integrated
6delivery systems that are responsible for providing or
7arranging the majority of care, including primary care
8physician services, referrals from primary care physicians,
9diagnostic and treatment services, behavioral health services,
10in-patient and outpatient hospital services, dental services,
11and rehabilitation and long-term care services. The Department
12shall designate or contract for such integrated delivery
13systems (i) to ensure enrollees have a choice of systems and of
14primary care providers within such systems; (ii) to ensure that
15enrollees receive quality care in a culturally and
16linguistically appropriate manner; and (iii) to ensure that
17coordinated care programs meet the diverse needs of enrollees
18with developmental, mental health, physical, and age-related
19disabilities.
20    (b) Payment for such coordinated care shall be based on
21arrangements where the State pays for performance related to
22health care outcomes, the use of evidence-based practices, the
23use of primary care delivered through comprehensive medical
24homes, the use of electronic medical records, and the
25appropriate exchange of health information electronically made
26either on a capitated basis in which a fixed monthly premium

 

 

HB5909- 8 -LRB097 17029 KTG 62225 b

1per recipient is paid and full financial risk is assumed for
2the delivery of services, or through other risk-based payment
3arrangements.
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.

 

 

HB5909- 9 -LRB097 17029 KTG 62225 b

1(Source: P.A. 96-1501, eff. 1-25-11.)
 
2    Section 99. Effective date. This Act takes effect upon
3becoming law.