Sen. Don Harmon

Filed: 3/23/2012

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 3326

2    AMENDMENT NO. ______. Amend Senate Bill 3326 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 70% 50% of recipients eligible for
9comprehensive medical benefits in all medical assistance
10programs or other health benefit programs administered by the
11Department, including the Children's Health Insurance Program
12Act and the Covering ALL KIDS Health Insurance Act, shall be
13enrolled in a care coordination program by no later than
14January 1, 2015. For purposes of this Section, "coordinated
15care" or "care coordination" means delivery systems where
16recipients will receive their care from providers who

 

 

09700SB3326sam001- 2 -LRB097 17848 KTG 67773 a

1participate under contract in integrated delivery systems that
2are responsible for providing or arranging the majority of
3care, including primary care physician services, referrals
4from primary care physicians, diagnostic and treatment
5services, behavioral health services, in-patient and
6outpatient hospital services, dental services, and
7rehabilitation and long-term care services. The Department
8shall designate or contract for such integrated delivery
9systems (i) to ensure enrollees have a choice of systems and of
10primary care providers within such systems; (ii) to ensure that
11enrollees receive quality care in a culturally and
12linguistically appropriate manner; and (iii) to ensure that
13coordinated care programs meet the diverse needs of enrollees
14with developmental, mental health, physical, and age-related
15disabilities.
16    (b) Payment for such coordinated care shall be based on
17arrangements where the State pays for performance related to
18health care outcomes, the use of evidence-based practices, the
19use of primary care delivered through comprehensive medical
20homes, the use of electronic medical records, and the
21appropriate exchange of health information electronically made
22either on a capitated basis in which a fixed monthly premium
23per recipient is paid and full financial risk is assumed for
24the delivery of services, or through other risk-based payment
25arrangements.
26    (c) To qualify for compliance with this Section, the 70%

 

 

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150% goal shall be achieved by enrolling medical assistance
2enrollees from each medical assistance enrollment category,
3including parents, children, seniors, and people with
4disabilities to the extent that current State Medicaid payment
5laws would not limit federal matching funds for recipients in
6care coordination programs. In addition, services must be more
7comprehensively defined and more risk shall be assumed than in
8the Department's primary care case management program as of the
9effective date of this amendatory Act of the 96th General
10Assembly.
11    (c-5) An enhanced primary care case management program that
12includes collaboration between primary care providers,
13hospitals, and behavioral health providers with protocols for
14coordination, electronic exchange of health information, and
15fees at risk based on performance and outcomes qualifies as
16care coordination under this Section.
17    (d) The Department shall report to the General Assembly in
18a separate part of its annual medical assistance program
19report, beginning April, 2012 until April, 2016, on the
20progress and implementation of the care coordination program
21initiatives established by the provisions of this amendatory
22Act of the 96th General Assembly. The Department shall include
23in its April 2011 report a full analysis of federal laws or
24regulations regarding upper payment limitations to providers
25and the necessary revisions or adjustments in rate
26methodologies and payments to providers under this Code that

 

 

09700SB3326sam001- 4 -LRB097 17848 KTG 67773 a

1would be necessary to implement coordinated care with full
2financial risk by a party other than the Department.
3(Source: P.A. 96-1501, eff. 1-25-11.)
 
4    Section 10. The Covering ALL KIDS Health Insurance Act is
5amended by changing Section 56 as follows:
 
6    (215 ILCS 170/56)
7    (Section scheduled to be repealed on July 1, 2016)
8    Sec. 56. Care coordination.
9    (a) At least 70% 50% of recipients eligible for
10comprehensive medical benefits in all medical assistance
11programs or other health benefit programs administered by the
12Department, including the Children's Health Insurance Program
13Act and the Covering ALL KIDS Health Insurance Act, shall be
14enrolled in a care coordination program by no later than
15January 1, 2015. For purposes of this Section, "coordinated
16care" or "care coordination" means delivery systems where
17recipients will receive their care from providers who
18participate under contract in integrated delivery systems that
19are responsible for providing or arranging the majority of
20care, including primary care physician services, referrals
21from primary care physicians, diagnostic and treatment
22services, behavioral health services, in-patient and
23outpatient hospital services, dental services, and
24rehabilitation and long-term care services. The Department

 

 

09700SB3326sam001- 5 -LRB097 17848 KTG 67773 a

1shall designate or contract for such integrated delivery
2systems (i) to ensure enrollees have a choice of systems and of
3primary care providers within such systems; (ii) to ensure that
4enrollees receive quality care in a culturally and
5linguistically appropriate manner; and (iii) to ensure that
6coordinated care programs meet the diverse needs of enrollees
7with developmental, mental health, physical, and age-related
8disabilities.
9    (b) Payment for such coordinated care shall be based on
10arrangements where the State pays for performance related to
11health care outcomes, the use of evidence-based practices, the
12use of primary care delivered through comprehensive medical
13homes, the use of electronic medical records, and the
14appropriate exchange of health information electronically made
15either on a capitated basis in which a fixed monthly premium
16per recipient is paid and full financial risk is assumed for
17the delivery of services, or through other risk-based payment
18arrangements.
19    (c) To qualify for compliance with this Section, the 70%
2050% goal shall be achieved by enrolling medical assistance
21enrollees from each medical assistance enrollment category,
22including parents, children, seniors, and people with
23disabilities to the extent that current State Medicaid payment
24laws would not limit federal matching funds for recipients in
25care coordination programs. In addition, services must be more
26comprehensively defined and more risk shall be assumed than in

 

 

09700SB3326sam001- 6 -LRB097 17848 KTG 67773 a

1the Department's primary care case management program as of the
2effective date of this amendatory Act of the 96th General
3Assembly.
4    (c-5) An enhanced primary care case management program that
5includes collaboration between primary care providers,
6hospitals, and behavioral health providers with protocols for
7coordination, electronic exchange of health information, and
8fees at risk based on performance and outcomes qualifies as
9care coordination under this Section.
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 15. The Illinois Public Aid Code is amended by
24changing Section 5-30 as follows:
 

 

 

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1    (305 ILCS 5/5-30)
2    Sec. 5-30. Care coordination.
3    (a) At least 70% 50% of recipients eligible for
4comprehensive medical benefits in all medical assistance
5programs or other health benefit programs administered by the
6Department, including the Children's Health Insurance Program
7Act and the Covering ALL KIDS Health Insurance Act, shall be
8enrolled in a care coordination program by no later than
9January 1, 2015. For purposes of this Section, "coordinated
10care" or "care coordination" means delivery systems where
11recipients will receive their care from providers who
12participate under contract in integrated delivery systems that
13are responsible for providing or arranging the majority of
14care, including primary care physician services, referrals
15from primary care physicians, diagnostic and treatment
16services, behavioral health services, in-patient and
17outpatient hospital services, dental services, and
18rehabilitation and long-term care services. The Department
19shall designate or contract for such integrated delivery
20systems (i) to ensure enrollees have a choice of systems and of
21primary care providers within such systems; (ii) to ensure that
22enrollees receive quality care in a culturally and
23linguistically appropriate manner; and (iii) to ensure that
24coordinated care programs meet the diverse needs of enrollees
25with developmental, mental health, physical, and age-related
26disabilities.

 

 

09700SB3326sam001- 8 -LRB097 17848 KTG 67773 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 70%
1250% goal 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    (c-5) An enhanced primary care case management program that
23includes collaboration between primary care providers,
24hospitals, and behavioral health providers with protocols for
25coordination, electronic exchange of health information, and
26fees at risk based on performance and outcomes qualifies as

 

 

09700SB3326sam001- 9 -LRB097 17848 KTG 67773 a

1care coordination under this Section.
2    (d) The Department shall report to the General Assembly in
3a separate part of its annual medical assistance program
4report, beginning April, 2012 until April, 2016, on the
5progress and implementation of the care coordination program
6initiatives established by the provisions of this amendatory
7Act of the 96th General Assembly. The Department shall include
8in its April 2011 report a full analysis of federal laws or
9regulations regarding upper payment limitations to providers
10and the necessary revisions or adjustments in rate
11methodologies and payments to providers under this Code that
12would be necessary to implement coordinated care with full
13financial risk by a party other than the Department.
14(Source: P.A. 96-1501, eff. 1-25-11.)
 
15    Section 99. Effective date. This Act takes effect upon
16becoming law.".