HB1900 102ND GENERAL ASSEMBLY

LRB102 13746 KTG 19096 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB1900

Introduced 2/17/2021, by Rep. Deanne M. Mazzochi

SYNOPSIS AS INTRODUCED:

New Act

Creates the Community Hospital Access, Relationship, and Equity (CARE) Act. Requires the Department of Healthcare and Family Services to establish a community hospital pilot program to expand access to health care options through the use of prepayment plans to secure improved access to health care navigators, physician networks, prescription drugs at reduced prices, and transparent health care pricing. Provides that no later than December 1, 2021, the Director of Healthcare and Family Services shall identify a community hospital in (i) the Cook County region; (ii) a suburban region; and (iii) a rural region of the State that is eligible to participate in the pilot program. Provides that the hospitals must provide pediatric services, diagnostic services, emergency room services, standard chronic care treatments, and obstetrics services. Provides that for a period of 3 years after selection, each community hospital may craft hospital community access plans that achieve the following for underinsured or uninsured patients: (1) charge patients capped annual fees in exchange for an assigned patient navigator; (2) for patients who have contracted for administrative services, grant access to all health care professional services with capped billing amounts; provide a list of medical services offered by the community hospital or in-network providers; and allow prescription fills at federal pricing levels; (3) identify out-of-network providers and associated costs for services not available at the community hospital; and (4) assist patients with referrals to appropriate federal and State agencies when they have a grievance, complaint, or question regarding their health plan or coverage. Contains provisions concerning reporting requirements. Provides that the Act is repealed on June 30, 2025. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning health care.

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

Section 1. Short title. This Act may be cited as the Community Hospital Access, Relationship, and Equity (CARE) Act.

Section 3. Purpose. The purpose of this Act is to establish a community hospital pilot program with the goal of expanding access to health care options through the use of prepayment plans to secure improved access to health care navigators, physician networks, prescription drugs at reduced prices, and transparent health care pricing.

Section 5. Definitions. As used in this Act:

"Administrative services" means services provided to schedule appointments, to review bills and charges, and to identify network providers.

"Community hospital" means a non-federal hospital, a short-term general hospital, or any other hospital licensed under Section 3 of the Hospital Licensing Act that is intended to serve a local community and where a significant percentage of patients qualify for Medicaid or Medicare services.

"Director" means the Director of Healthcare and Family Services or his or her designee.

"Medicaid rates" means the practitioner rates or other fee schedules published by the Department of Healthcare and Family Services.

Section 10. Pilot program.

(a) The Department of Healthcare and Family Services shall establish a community hospital pilot program to expand access to health care options through the use of prepayment plans to secure improved access to health care navigators, physician networks, prescription drugs at reduced prices, and transparent health care pricing. No later than December 1, 2021, the Director shall identify a community hospital in (i) the Cook County region; (ii) a suburban region; and (iii) a rural region of the State eligible to participate in the pilot program. Such hospitals must provide pediatric services, diagnostic services, emergency room services, standard chronic care treatments, and obstetrics services.

(b) For a period of 3 years after selection, each community hospital may craft hospital community access plans that achieve the following for patients, in particular patients who may be underinsured, on high deductible or catastrophic plans, or uninsured and not enrolled in Medicaid or Medicare:

(1) Charge prospective patients an annual fee (which can be billed in monthly installments) for administrative services, in an amount not to exceed $6,000 per year or 5% of gross income, whichever is less, but in no event less than $1,200 per year. In exchange for the administrative services, patients shall be assigned a patient navigator certified under the Navigator Certification Act who will:

(A) help identify for a patient a primary care physician;

(B) work with the patient and physician to schedule needed health care and wellness visits and vaccinations;

(C) advise on specialty services offered by the hospital or in-network providers, including obstetrics and gynecology and diagnostic screenings; and

(D) grant access for up to 2 emergency room visits per year at the community hospital, under the pricing conditions set forth in this Act.

(2) Patients who have contracted for administrative services with the community hospital shall be provided with the following:

(A) Access to all health care professional services offered by the community hospital, with billing amounts not to exceed:

(i) the Medicaid rates, if the patient's annual income levels are $40,000 or less, or the patient's household income levels are $75,000 or less;

(ii) the Medicaid rates plus 10%, if annual income levels are $40,000, or if household income levels are $75,000 or more; or

(iii) the Medicaid rates plus 25%, if annual income levels are $100,000, or if household income levels are $125,000 or more.

(B) A list of medical services (either in paper or electronic form) offered by the community hospital or in-network providers.

(C) The ability to fill prescriptions at a pricing level set under Section 340B of the Public Health Service Act, 42 U.S.C. 256(b), plus an additional charge of either $5 per prescription or 10% of the prescription cost, whichever is less.

(3) For services that are needed by a patient that cannot be fulfilled by the community hospital or its network of existing care providers, the certified patient navigator may also, in consultation with the patient's physician, identify out-of-network providers and the proposed costs associated with such services.

(4) Assist patients with referrals to appropriate federal and State agencies when they have a grievance, complaint, or question regarding their health plan or coverage or a determination under such plan or coverage, where applicable.

Section 15. Analysis and review.

(a) No later than June 1, 2022 and June 1, 2023, the Director shall provide interim reports to the General Assembly identifying patient satisfaction, access to care, physician satisfaction, hospital profit or loss associated with administering the pilot program, and areas for improvement to the pilot program.

(b) Subject to appropriation, the Director may also issue grants in amounts not to exceed $100,000 per year to facilitate continued participation and study in the pilot program.

(c) No later than June 1, 2024, the Director shall provide a report to the General Assembly with recommendations on health care metrics, outcomes, and whether expanded access to health care was achieved using the patient model under the pilot program.

Section 20. Repeal. This Act is repealed on June 30, 2025.

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