98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB2965

 

Introduced 2/4/2014, by Sen. Heather A. Steans

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-33 new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to establish a Health Homes for Chronic Conditions Pilot Program with licensed or certified community-based developmental disability service providers and behavioral health service providers (including mental health providers and substance use disorder prevention and treatment providers) as designated providers. Provides that consistent with Section 2703 of the Patient Protection and Affordable Care Act these health homes shall provide certain services to program enrollees including (i) comprehensive care management; (ii) care coordination; and (iii) health promotion. Requires the Department to submit, by no later than January 1, 2015, the necessary application to the federal Centers for Medicare and Medicaid Services for a State Plan amendment to implement the Pilot Program. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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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
5adding Section 5-33 as follows:
 
6    (305 ILCS 5/5-33 new)
7    Sec. 5-33. Health Homes for Chronic Conditions Pilot
8Program.
9    (a) Findings. Section 2703 of the Patient Protection and
10Affordable Care Act, and as contemplated in the Illinois
11Alliance for Health Innovation Plan, provides states with a
12Medicaid State Plan Option to establish Health Homes for
13Enrollees with Chronic Conditions. A health home provides
14states with an opportunity to build person-centered systems of
15care that achieve improved outcomes for beneficiaries and
16better services and value for Medicaid programs. States
17receiving approval for a Section 2703 Health Home will receive
18a 90% enhanced Federal Matching Assistance Percentage (FMAP)
19for the specific services outlined for the first 8 quarters in
20which the health home program is effective.
21    Public Act 96-1501 established a long-term care
22rebalancing initiative aimed at removing the barriers to
23community living for individuals of all ages with disabilities

 

 

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1and long-term illnesses. In addition, Public Act 96-1501
2established the Care Coordination mandate to ensure that by
3January 1, 2015 at least 50% of eligible medical assistance
4recipients would be enrolled in integrated delivery systems.
5    On December 30, 2013 the State of Illinois published its
6Alliance for Health Innovation Plan, which outlines a series of
7recommended innovations, with initial focus on the State's
8Medical Assistance program, aimed at achieving the "triple aim"
9of improving the patient experience of care (including quality
10and satisfaction), improving the health of populations, and
11reducing the per capita costs of health care. This Innovation
12Plan, in describing Medicaid Innovation Models with consumer
13choice at its core, references both "Medical homes" for
14specific populations as well as potentially placing primary
15care responsibilities with providers other than a medical
16Primary Care Provider (PCP), such as a behavioral health
17provider, an ID/DD provider, or a specialist. Furthermore, this
18plan makes specific reference to Section 2703 Health Homes as a
19potential avenue for such policy changes, indicating support
20for implementing these models in Illinois.
21    The General Assembly finds that in the spirit of system
22rebalancing, advancing person-centered services and supports,
23and furthering care coordination implementation it is
24appropriate to explore models of care in which individuals with
25intellectual and developmental disabilities, mental illness,
26or substance use disorders receive coordinated medical and

 

 

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1long-term care through health homes.
2    (b) Health Homes for Chronic Conditions Pilot Program. The
3Department shall establish a Health Homes for Chronic
4Conditions Pilot Program with licensed or certified
5community-based developmental disability service providers and
6behavioral health service providers (including mental health
7providers and substance use disorder prevention and treatment
8providers) as designated providers. Consistent with Section
92703 of the Patient Protection and Affordable Care Act, these
10health homes shall provide the following minimum services to
11program enrollees:
12        (1) comprehensive care management;
13        (2) care coordination;
14        (3) health promotion;
15        (4) comprehensive transitional care/follow-up;
16        (5) patient and family support; and
17        (6) referral to community and social support services.
18    State Plan Amendment. By no later than January 1, 2015, the
19Department shall submit the necessary application to the
20federal Centers for Medicare and Medicaid Services for a State
21Plan amendment to implement the Pilot Program described in this
22Section.
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.