State of Illinois
91st General Assembly
Legislation

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[ Engrossed ][ House Amendment 001 ]

91_HB2760

 
                                               LRB9104075SMdv

 1        AN  ACT to amend the Illinois Public Aid Code by changing
 2    Section 5-16 and adding Section 5-16.12.

 3        Be it enacted by the People of  the  State  of  Illinois,
 4    represented in the General Assembly:

 5        Section  5.   The  Illinois Public Aid Code is amended by
 6    changing Section 5-16 and adding Section 5-16.12 as follows:

 7        (305 ILCS 5/5-16) (from Ch. 23, par. 5-16)
 8        Sec. 5-16.  Managed Care.  The  Illinois  Department  may
 9    develop   and   implement   a  Primary  Care  Sponsor  System
10    consistent with the provisions of this Section.  The  purpose
11    of  this managed care delivery system shall be to contain the
12    costs of providing medical care  to  Medicaid  recipients  by
13    having one provider responsible for managing all aspects of a
14    recipient's  medical  care.   This  managed care system shall
15    have the following characteristics:
16             (a)  The  Department,  by  rule,   shall   establish
17        criteria  to  determine which clients must participate in
18        this program or any other managed care program except  as
19        limited by Section 5-16.12;
20             (b)  Providers  participating  in the program may be
21        paid an amount per patient per month, to be  set  by  the
22        Illinois   Department,   for  managing  each  recipient's
23        medical care;
24             (c)  Providers  eligible  to  participate   in   the
25        program shall be physicians licensed to practice medicine
26        in  all  its  branches,  and  the Illinois Department may
27        terminate a provider's participation if the  provider  is
28        determined  to  have failed to comply with any applicable
29        program standard or procedure established by the Illinois
30        Department;
31             (d)  Each recipient required to participate  in  the
 
                            -2-                LRB9104075SMdv
 1        program   must  select  from  a  panel  of  primary  care
 2        providers or networks established by  the  Department  in
 3        their communities;
 4             (e)  A  recipient  may change his designated primary
 5        care provider:
 6                  (1)  when   the   designated   source   becomes
 7             unavailable,  as  the  Illinois   Department   shall
 8             determine by rule; or
 9                  (2)  when  the designated primary care provider
10             notifies the Illinois Department that it  wishes  to
11             withdraw   from   any  obligation  as  primary  care
12             provider; or
13                  (3)  in  other  situations,  as  the   Illinois
14             Department shall provide by rule;
15             (f)  The   Illinois   Department   shall,  by  rule,
16        establish procedures for providing medical services  when
17        the  designated  source  becomes unavailable or wishes to
18        withdraw from any obligation  as  primary  care  provider
19        taking  into  consideration  the  need  for  emergency or
20        temporary  medical  assistance  and  ensuring  that   the
21        recipient  has  continuous  and  unrestricted  access  to
22        medical  care  from the date on which such unavailability
23        or withdrawal becomes effective until such  time  as  the
24        recipient designates a primary care source;
25             (g)  Only  medical  care  services  authorized  by a
26        recipient's designated  provider,  except  for  emergency
27        services,  services performed by a provider that is owned
28        or operated by a county and that  provides  non-emergency
29        services  without regard to ability to pay and such other
30        services as provided by the Illinois Department, shall be
31        subject to  payment  by  the  Illinois  Department.   The
32        Illinois Department shall enter into an intergovernmental
33        agreement  with  each county that owns or operates such a
34        provider to develop and implement  policies  to  minimize
 
                            -3-                LRB9104075SMdv
 1        the provision of medical care services provided by county
 2        owned  or  operated  providers  pursuant to the foregoing
 3        exception.
 4        The Illinois Department shall seek and  obtain  necessary
 5    authorization  provided under federal law to implement such a
 6    program including the waiver of any federal regulations.
 7        The Illinois  Department  may  implement  the  amendatory
 8    changes  to  this Section made by this amendatory Act of 1991
 9    through the use of emergency rules  in  accordance  with  the
10    provisions  of  Section  5.02  of the Illinois Administrative
11    Procedure Act. For purposes of  the  Illinois  Administrative
12    Procedure  Act,  the  adoption  of  rules  to  implement  the
13    amendatory  changes  to  this Section made by this amendatory
14    Act of 1991 shall be deemed an emergency  and  necessary  for
15    the public interest, safety and welfare.
16        The  Illinois  Department  may  establish  a managed care
17    system  demonstration  program,  on  a  limited   basis,   as
18    described  in  this Section.  The demonstration program shall
19    terminate on June 30, 1997.  Within 30 days after the end  of
20    each  year  of  the  demonstration  program's  operation, the
21    Illinois Department shall report  to  the  Governor  and  the
22    General    Assembly   concerning   the   operation   of   the
23    demonstration program.
24    (Source: P.A. 87-14; 88-490.)

25        (305 ILCS 5/5-16.12 new)
26        Sec. 5-16.12.  Exemption  from  mandatory  enrollment  in
27    managed  care  programs  and  eligibility for wards of court.
28    The Department may not require any individual under 19  years
29    of age to enroll in any managed care program who is in foster
30    care  or  otherwise  in  an  out-of-home placement, including
31    children who are wards of the court or mandated by a court to
32    foster care, detention,  substance  abuse  treatment,  mental
33    health  services, or group living facilities.  As required by
 
                            -4-                LRB9104075SMdv
 1    Section 1932(a)(2)(A) of the  federal  Social  Security  Act,
 2    such  children  shall  be exempt from mandatory enrollment in
 3    managed care programs. A person under age  18  who  has  been
 4    removed  from  his  or  her  home by a circuit court shall be
 5    Medicaid eligible if he or she satisfies Department  criteria
 6    for  citizen/Immigration  and  Naturalization Service status,
 7    residence,  Supplemental  Security   Income   (SSI),   social
 8    security   number,   and   client   cooperation.    Financial
 9    eligibility factors shall not apply to wards of the court nor
10    affect   a   ward's   Medicaid  eligibility.    However,  the
11    Department may seek reimbursement for  services  rendered  to
12    the  ward  from the ward's parents pursuant to Section 6-9 of
13    the Juvenile Court Act of 1987.

14        Section 99.  Effective date.  This Act takes effect  upon
15    becoming law.

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