Rep. Patricia R. Bellock

Filed: 3/6/2012

 

 


 

 


 
09700HB5909ham001LRB097 17029 KTG 67181 a

1
AMENDMENT TO HOUSE BILL 5909

2    AMENDMENT NO. ______. Amend House Bill 5909 by replacing
3everything after the enacting clause with the following:
 
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, 2014
142015. For purposes of this Section, "coordinated care" or "care
15coordination" means delivery systems where recipients will
16receive their care from providers who participate under

 

 

09700HB5909ham001- 2 -LRB097 17029 KTG 67181 a

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

 

 

09700HB5909ham001- 3 -LRB097 17029 KTG 67181 a

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

 

 

09700HB5909ham001- 4 -LRB097 17029 KTG 67181 a

1    (215 ILCS 170/56)
2    (Section scheduled to be repealed on July 1, 2016)
3    Sec. 56. Care coordination.
4    (a) At least 50% of recipients eligible for comprehensive
5medical benefits in all medical assistance programs or other
6health benefit programs administered by the Department,
7including the Children's Health Insurance Program Act and the
8Covering ALL KIDS Health Insurance Act, shall be enrolled in a
9care coordination program by no later than January 1, 2014
102015. For purposes of this Section, "coordinated care" or "care
11coordination" means delivery systems where recipients will
12receive their care from providers who participate under
13contract in integrated delivery systems that are responsible
14for providing or arranging the majority of care, including
15primary care physician services, referrals from primary care
16physicians, diagnostic and treatment services, behavioral
17health services, in-patient and outpatient hospital services,
18dental services, and rehabilitation and long-term care
19services. The Department shall designate or contract for such
20integrated delivery systems (i) to ensure enrollees have a
21choice of systems and of primary care providers within such
22systems; (ii) to ensure that enrollees receive quality care in
23a culturally and linguistically appropriate manner; and (iii)
24to ensure that coordinated care programs meet the diverse needs
25of enrollees with developmental, mental health, physical, and
26age-related disabilities.

 

 

09700HB5909ham001- 5 -LRB097 17029 KTG 67181 a

1    (b) Payment for such coordinated care shall be based on
2arrangements where the State pays for performance related to
3health care outcomes, the use of evidence-based practices, the
4use of primary care delivered through comprehensive medical
5homes, the use of electronic medical records, and the
6appropriate exchange of health information electronically made
7either on a capitated basis in which a fixed monthly premium
8per recipient is paid and full financial risk is assumed for
9the delivery of services, or through other risk-based payment
10arrangements.
11    (c) To qualify for compliance with this Section, the 50%
12goal shall be achieved by enrolling medical assistance
13enrollees from each medical assistance enrollment category,
14including parents, children, seniors, and people with
15disabilities to the extent that current State Medicaid payment
16laws would not limit federal matching funds for recipients in
17care coordination programs. In addition, services must be more
18comprehensively defined and more risk shall be assumed than in
19the Department's primary care case management program as of the
20effective date of this amendatory Act of the 96th General
21Assembly.
22    (d) The Department shall report to the General Assembly in
23a separate part of its annual medical assistance program
24report, beginning April, 2012 until April, 2016, on the
25progress and implementation of the care coordination program
26initiatives established by the provisions of this amendatory

 

 

09700HB5909ham001- 6 -LRB097 17029 KTG 67181 a

1Act of the 96th General Assembly. The Department shall include
2in its April 2011 report a full analysis of federal laws or
3regulations regarding upper payment limitations to providers
4and the necessary revisions or adjustments in rate
5methodologies and payments to providers under this Code that
6would be necessary to implement coordinated care with full
7financial risk by a party other than the Department.
8(Source: P.A. 96-1501, eff. 1-25-11.)
 
9    Section 15. The Illinois Public Aid Code is amended by
10changing Section 5-30 as follows:
 
11    (305 ILCS 5/5-30)
12    Sec. 5-30. Care coordination.
13    (a) At least 50% of recipients eligible for comprehensive
14medical benefits in all medical assistance programs or other
15health benefit programs administered by the Department,
16including the Children's Health Insurance Program Act and the
17Covering ALL KIDS Health Insurance Act, shall be enrolled in a
18care coordination program by no later than January 1, 2014
192015. For purposes of this Section, "coordinated care" or "care
20coordination" means delivery systems where recipients will
21receive their care from providers who participate under
22contract in integrated delivery systems that are responsible
23for providing or arranging the majority of care, including
24primary care physician services, referrals from primary care

 

 

09700HB5909ham001- 7 -LRB097 17029 KTG 67181 a

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

 

 

09700HB5909ham001- 8 -LRB097 17029 KTG 67181 a

1laws would not limit federal matching funds for recipients in
2care coordination programs. In addition, services must be more
3comprehensively defined and more risk shall be assumed than in
4the Department's primary care case management program as of the
5effective date of this amendatory Act of the 96th General
6Assembly.
7    (d) The Department shall report to the General Assembly in
8a separate part of its annual medical assistance program
9report, beginning April, 2012 until April, 2016, on the
10progress and implementation of the care coordination program
11initiatives established by the provisions of this amendatory
12Act of the 96th General Assembly. The Department shall include
13in its April 2011 report a full analysis of federal laws or
14regulations regarding upper payment limitations to providers
15and the necessary revisions or adjustments in rate
16methodologies and payments to providers under this Code that
17would be necessary to implement coordinated care with full
18financial risk by a party other than the Department.
19(Source: P.A. 96-1501, eff. 1-25-11.)
 
20    Section 99. Effective date. This Act takes effect upon
21becoming law.".