97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB4620

 

Introduced 2/1/2012, by Rep. Robyn Gabel

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 106/23
215 ILCS 170/56
305 ILCS 5/5-30

    Amends the Children's Health Insurance Program Act, the Covering ALL KIDS Health Insurance Act, and the Medical Assistance Article of the Illinois Public Aid Code. Provides that at least 70% (rather than 50%) of recipients eligible for comprehensive medical benefits in all medical assistance programs or other health benefit programs administered by the Department of Healthcare and Family Services, including the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act, shall be enrolled in a care coordination program by no later than January 1, 2015. Provides that the Department of Healthcare and Family Services' primary care case management program shall be considered a care coordination program. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB4620LRB097 17852 KTG 63074 b

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 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
17participate under contract in integrated delivery systems that
18are responsible for providing or arranging the majority of
19care, including primary care physician services, referrals
20from primary care physicians, diagnostic and treatment
21services, behavioral health services, in-patient and
22outpatient hospital services, dental services, and
23rehabilitation and long-term care services. The Department

 

 

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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. For purposes of this Section, the
26Department's primary care case management program shall be

 

 

HB4620- 3 -LRB097 17852 KTG 63074 b

1considered a care coordination program. In addition, services
2must be more comprehensively defined and more risk shall be
3assumed than in the Department's primary care case management
4program as of the effective date of this amendatory Act of the
596th General Assembly.
6    (d) The Department shall report to the General Assembly in
7a separate part of its annual medical assistance program
8report, beginning April, 2012 until April, 2016, on the
9progress and implementation of the care coordination program
10initiatives established by the provisions of this amendatory
11Act of the 96th General Assembly. The Department shall include
12in its April 2011 report a full analysis of federal laws or
13regulations regarding upper payment limitations to providers
14and the necessary revisions or adjustments in rate
15methodologies and payments to providers under this Code that
16would be necessary to implement coordinated care with full
17financial risk by a party other than the Department.
18(Source: P.A. 96-1501, eff. 1-25-11.)
 
19    Section 10. The Covering ALL KIDS Health Insurance Act is
20amended by changing Section 56 as follows:
 
21    (215 ILCS 170/56)
22    (Section scheduled to be repealed on July 1, 2016)
23    Sec. 56. Care coordination.
24    (a) At least 70% 50% of recipients eligible for

 

 

HB4620- 4 -LRB097 17852 KTG 63074 b

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

 

 

HB4620- 5 -LRB097 17852 KTG 63074 b

1use of primary care delivered through comprehensive medical
2homes, the use of electronic medical records, and the
3appropriate exchange of health information electronically made
4either on a capitated basis in which a fixed monthly premium
5per recipient is paid and full financial risk is assumed for
6the delivery of services, or through other risk-based payment
7arrangements.
8    (c) To qualify for compliance with this Section, the 70%
950% goal shall be achieved by enrolling medical assistance
10enrollees from each medical assistance enrollment category,
11including parents, children, seniors, and people with
12disabilities to the extent that current State Medicaid payment
13laws would not limit federal matching funds for recipients in
14care coordination programs. For purposes of this Section, the
15Department's primary care case management program shall be
16considered a care coordination program. In addition, services
17must be more comprehensively defined and more risk shall be
18assumed than in the Department's primary care case management
19program as of the effective date of this amendatory Act of the
2096th General Assembly.
21    (d) The Department shall report to the General Assembly in
22a separate part of its annual medical assistance program
23report, beginning April, 2012 until April, 2016, on the
24progress and implementation of the care coordination program
25initiatives established by the provisions of this amendatory
26Act of the 96th General Assembly. The Department shall include

 

 

HB4620- 6 -LRB097 17852 KTG 63074 b

1in its April 2011 report a full analysis of federal laws or
2regulations regarding upper payment limitations to providers
3and the necessary revisions or adjustments in rate
4methodologies and payments to providers under this Code that
5would be necessary to implement coordinated care with full
6financial risk by a party other than the Department.
7(Source: P.A. 96-1501, eff. 1-25-11.)
 
8    Section 15. The Illinois Public Aid Code is amended by
9changing Section 5-30 as follows:
 
10    (305 ILCS 5/5-30)
11    Sec. 5-30. Care coordination.
12    (a) At least 70% 50% of recipients eligible for
13comprehensive medical benefits in all medical assistance
14programs or other health benefit programs administered by the
15Department, including the Children's Health Insurance Program
16Act and the Covering ALL KIDS Health Insurance Act, shall be
17enrolled in a care coordination program by no later than
18January 1, 2015. For purposes of this Section, "coordinated
19care" or "care coordination" means delivery systems where
20recipients will receive their care from providers who
21participate under contract in integrated delivery systems that
22are responsible for providing or arranging the majority of
23care, including primary care physician services, referrals
24from primary care physicians, diagnostic and treatment

 

 

HB4620- 7 -LRB097 17852 KTG 63074 b

1services, behavioral health services, in-patient and
2outpatient hospital services, dental services, and
3rehabilitation and long-term care services. The Department
4shall designate or contract for such integrated delivery
5systems (i) to ensure enrollees have a choice of systems and of
6primary care providers within such systems; (ii) to ensure that
7enrollees receive quality care in a culturally and
8linguistically appropriate manner; and (iii) to ensure that
9coordinated care programs meet the diverse needs of enrollees
10with developmental, mental health, physical, and age-related
11disabilities.
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 70%
2350% goal 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

 

 

HB4620- 8 -LRB097 17852 KTG 63074 b

1laws would not limit federal matching funds for recipients in
2care coordination programs. For purposes of this Section, the
3Department's primary care case management program shall be
4considered a care coordination program. In addition, services
5must be more comprehensively defined and more risk shall be
6assumed than in the Department's primary care case management
7program as of the effective date of this amendatory Act of the
896th General Assembly.
9    (d) The Department shall report to the General Assembly in
10a separate part of its annual medical assistance program
11report, beginning April, 2012 until April, 2016, on the
12progress and implementation of the care coordination program
13initiatives established by the provisions of this amendatory
14Act of the 96th General Assembly. The Department shall include
15in its April 2011 report a full analysis of federal laws or
16regulations regarding upper payment limitations to providers
17and the necessary revisions or adjustments in rate
18methodologies and payments to providers under this Code that
19would be necessary to implement coordinated care with full
20financial risk by a party other than the Department.
21(Source: P.A. 96-1501, eff. 1-25-11.)
 
22    Section 99. Effective date. This Act takes effect upon
23becoming law.