Illinois General Assembly - Full Text of HB0311
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Full Text of HB0311  97th General Assembly




State of Illinois
2011 and 2012


Introduced 01/31/11, by Rep. Mary E. Flowers


New Act

    Creates the Illinois Universal Health Care Act. Provides that all individuals residing in the State are covered under the Illinois Health Services Program for health insurance. Sets forth the health coverage benefits that participants are entitled to under the Program. Sets forth the qualification requirements for participating health providers. Sets forth standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the Program. Provides that investor-ownership of health delivery facilities is unlawful. Provides that the State shall establish the Illinois Health Services Trust to provide financing for the Program. Sets forth the requirements for claims billing under the Program. Provides that the Program shall include funding for long-term care services and mental health services. Provides that the Program shall establish a single prescription drug formulary and list of approved durable medical goods and supplies. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Sets forth provisions concerning patients' rights. Provides that the employees of the Program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly.

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1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the
5Illinois Universal Health Care Act.
6    Section 5. Purposes. It is the purpose of this Act to
7provide universal access to health care for all individuals
8within the State, to promote and improve the health of all its
9citizens, to stress the importance of good public health
10through treatment and prevention of diseases, and to contain
11costs to make the delivery of this care affordable. Should
12legislation of this kind be enacted on a federal level, it is
13the intent of this Act to become a part of a nationwide system.
14    Section 10. Definitions. In this Act:
15    "Board" means the Illinois Health Services Governing
17    "Program" means the Illinois Health Services Program.
18    Section 15. Eligibility; registration. All individuals
19residing in this State are covered under the Illinois Health
20Services Program for health insurance and shall receive a card
21with a unique number in the mail. An individual's social



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1security number shall not be used for purposes of registration
2under this Section. Individuals and families shall receive an
3Illinois Health Services Insurance Card in the mail after
4filling out a Program application form at a health care
5provider. Such application form shall be no more than 2 pages
6long. Individuals who present themselves for covered services
7from a participating provider shall be presumed to be eligible
8for benefits under this Act, but shall complete an application
9for benefits in order to receive an Illinois Health Services
10Insurance Card and have payment made for such benefits.
11    Section 20. Benefits and portability.
12    (a) The health coverage benefits under this Act cover all
13medically necessary services, including:
14        (1) primary care and prevention;
15        (2) specialty care (other than what is deemed elective
16    cosmetic);
17        (3) inpatient care;
18        (4) outpatient care;
19        (5) emergency care;
20        (6) prescription drugs;
21        (7) durable medical equipment;
22        (8) long-term care;
23        (9) mental health services;
24        (10) the full scope of dental services (other than
25    elective cosmetic dentistry);



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1        (11) substance abuse treatment services;
2        (12) chiropractic services; and
3        (13) basic vision care and vision correction.
4    (b) Health coverage benefits under this Act are available
5through any licensed health care provider anywhere in the State
6that is legally qualified to provide such benefits and for
7emergency care anywhere in the United States.
8    (c) No deductibles, copayments, coinsurance, or other cost
9sharing shall be imposed with respect to covered benefits
10except for those goods or services that exceed basic covered
11benefits, as defined by the Board.
12    Section 25. Qualification of participating providers.
13    (a) Health care delivery facilities must meet regional and
14State quality and licensing guidelines as a condition of
15participation under the Program, including guidelines
16regarding safe staffing and quality of care.
17    (b) A participating health care provider must be licensed
18by the State. No health care provider whose license is under
19suspension or has been revoked may participate in the Program
20    (c) Only non-profit health maintenance organizations that
21actually deliver care in their own facilities and directly
22employ clinicians may participate in the Program.
23    (d) Patients shall have free choice of participating
24eligible providers, hospitals, and inpatient care facilities.



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1    Section 30. Provider reimbursement.
2    (a) The Program shall pay all health care providers
3according to the following standards:
4        (1) Physicians and other practitioners can choose to be
5    paid fee-for-service, salaried by institutions receiving
6    global budgets, or salaried by group practices or HMOs
7    receiving capitation payments. Investor-owned HMOs and
8    group practices shall be converted to not-for-profit
9    status. Only institutions that deliver care shall be
10    eligible for Program payments.
11        (2) The Program shall pay each hospital and providing
12    institution a monthly lump sum (global budget) to cover all
13    operating expenses. The hospital and Program shall
14    negotiate the amount of this payment annually based on past
15    budgets, clinical performance, projected changes in demand
16    for services and input costs, and proposed new programs.
17    Hospitals shall not bill patients for services covered by
18    the Program, and cannot use any of their operating budgets
19    for expansion, profit, excessive executive income,
20    marketing, or major capital purchases or leases.
21        (3) The Program budget shall fund major capital
22    expenditures, including the construction of new health
23    facilities and the purchase of expensive equipment. The
24    regional health planning districts shall allocate these
25    capital funds and oversee capital projects funded from
26    private donations.



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1    (b) The Program shall reimburse physicians choosing to be
2paid fee-for-service according to a fee schedule negotiated
3between physician representatives and the Program on at least
4an annual basis.
5    (c) Hospitals, nursing homes, community health centers,
6non-profit staff model HMOs, and home health care agencies
7shall receive a global budget to cover operating expenses,
8negotiated annually with the Program based on past
9expenditures, past budgets, clinical performance, projected
10changes in demand for services and input costs, and proposed
11new programs. Expansions and other substantive capital
12investments shall be funded separately.
13    (d) All covered prescription drugs and durable medical
14supplies shall be paid for according to a fee schedule
15negotiated between manufacturers and the Program on at least an
16annual basis. Price reductions shall be achieved by bulk
17purchasing whenever possible. Where therapeutically equivalent
18drugs are available, the formulary shall specify the use of the
19lowest-cost medication, with exceptions available in the case
20of medical necessity.
21    Section 35. Prohibition against duplicating coverage;
22investor-ownership of health delivery facilities.
23    (a) It is unlawful for a private health insurer to sell
24health insurance coverage that duplicates the benefits
25provided under this Act. Nothing in this Act shall be construed



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1as prohibiting the sale of health insurance coverage for any
2additional benefits not covered by this Act.
3    (b) Investor-ownership of health delivery facilities,
4including hospitals, health maintenance organizations, nursing
5homes, and clinics, is unlawful. Investor-owners of health
6delivery facilities at the time of the effective date of this
7Act shall be compensated for the loss of their facilities, but
8not for loss of business opportunities or for administrative
9capacity not used by the Program.
10    Section 40. Illinois Health Services Trust.
11    (a) The State shall establish the Illinois Health Services
12Trust (IHST), the sole purpose of which shall be to provide the
13financing reserve for the purposes outlined in this Act.
14Specifically, the IHST shall provide all of the following:
15        (1) The funds for the general operating budget of the
16    Program.
17        (2) Reimbursement for those benefits outlined in
18    Section 20 of this Act.
19        (3) Public health services.
20        (4) Capital expenditures for construction or
21    renovation of health care facilities or major equipment
22    purchases deemed necessary throughout the State and
23    approved by the Board.
24        (5) Re-education and job placement of persons who have
25    lost their jobs as a result of this transition, limited to



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1    the first 5 years.
2    (b) The General Assembly or the Governor may provide funds
3to the IHST, but may not remove or borrow funds from the IHST.
4    (c) The IHST shall be administered by the Board, under the
5oversight of the General Assembly.
6    (d) Funding of the IHST shall include, but is not limited
7to, all of the following:
8        (1) Funds appropriated as outlined by the General
9    Assembly on a yearly basis.
10        (2) A progressive set of graduated income
11    contributions: 20% paid by individuals, 20% paid by a
12    business, and 60% paid by the government.
13        (3) All federal moneys that are designated for health
14    care, including, but not limited to, all moneys designated
15    for Medicaid. The Secretary shall be authorized to
16    negotiate with the federal government for funding of
17    Medicare recipients.
18        (4) Grants and contributions, both public and private.
19        (5) Any other tax revenues designated by the General
20    Assembly.
21        (6) Any other funds specifically ear-marked for health
22    care or health care education, such as settlements from
23    litigation.
24    (e) The total overhead and administrative portion of the
25Program budget may not exceed 12% of the total operating budget
26of the Program for the first 2 years that the Program is in



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1operation; 8% for the following 2 years; and 5% for each year
3    (f) The Program may be divided into regional districts for
4the purposes of local administration and oversight of programs
5that are specific to each region's needs.
6    (g) Claims billing from all providers must be submitted
7electronically and in compliance with current State and federal
8privacy laws within 5 years after the effective date of this
9Act. Electronic claims and billing must be uniform across the
10State. The Board shall create and implement a statewide uniform
11system of electronic medical records that is in compliance with
12current State and federal privacy laws within 7 years after the
13effective date of this Act. Payments to providers must be made
14in a timely fashion as outlined under current State and federal
15law. Providers who accept payment from the Program for services
16rendered may not bill any patient for covered services.
17Providers may elect either to participate fully, or not at all,
18in the Program.
19    Section 45. Long-term care payment. The Board shall
20establish funding for long-term care services, including
21in-home, nursing home, and community-based care. A local public
22agency shall be established in each community to determine
23eligibility and coordinate home and nursing home long-term
24care. This agency may contract with long-term care providers
25for the full range of needed long-term care services.



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1    Section 50. Mental health services. The Program shall
2provide coverage for all medically necessary mental health care
3on the same basis as the coverage for other conditions. The
4Program shall cover supportive residences, occupational
5therapy, and ongoing mental health and counseling services
6outside the hospital for patients with serious mental illness.
7In all cases the highest quality and most effective care shall
8be delivered, including institutional care.
9    Section 55. Payment for prescription medications, medical
10supplies, and medically necessary assistive equipment.
11    (a) The Program shall establish a single prescription drug
12formulary and list of approved durable medical goods and
13supplies. The Board shall, by itself or by a committee of
14health professionals and related individuals appointed by the
15Board and called the Pharmaceutical and Durable Medical Goods
16Committee, meet on a quarterly basis to discuss, reverse, add
17to, or remove items from the formulary according to sound
18medical practice.
19    (b) The Pharmaceutical and Durable Medical Goods Committee
20shall negotiate the prices of pharmaceuticals and durable
21medical goods with suppliers or manufacturers on an open bid
22competitive basis. Prices shall be reviewed, negotiated, or
23re-negotiated on no less than an annual basis. The
24Pharmaceutical and Durable Medical Goods Committee shall



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1establish a process of open forum to the public for the
2purposes of grievance and petition from suppliers, provider
3groups, and the public regarding the formulary no less than 2
4times a year.
5    (c) All pharmacy and durable medical goods vendors must be
6licensed to distribute medical goods through the regulations
7outlined by the Board.
8    (d) All decisions and determinations of the Pharmacy and
9Durable Medical Goods Committee must be presented to and
10approved by the Board on an annual basis.
11    Section 60. Illinois Health Services Governing Board.
12    (a) The Program shall be administered by an independent
13agency known as the Illinois Health Services Governing Board.
14The Board will consist of a Commissioner, a Chief Medical
15Officer, and public State board members. The Board is
16responsible for administration of the Program, including:
17        (1) implementation of eligibility standards and
18    Program enrollment;
19        (2) adoption of the benefits package;
20        (3) establishing formulas for setting health
21    expenditure budgets;
22        (4) administration of global budgets, capital
23    expenditure budgets, and prompt reimbursement of
24    providers;
25        (5) negotiations of service fee schedules and prices



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1    for prescription drugs and durable medical supplies;
2        (6) recommending evidenced-based changes to benefits;
3    and
4        (7) quality and planning functions including criteria
5    for capital expansion and infrastructure development,
6    measurement and evaluation of health quality indicators,
7    and the establishment of regions for long-term care
8    integration.
9    (b) At least one-third of the members of the Board,
10including all committees dedicated to benefits design, health
11planning, quality, and long-term care, shall be consumer
13    Section 65. Patients' rights. The Program shall protect the
14rights and privacy of the patients that it serves in accordance
15with all current State and federal statutes. With the
16development of the electronic medical records, patients shall
17be afforded the right and option of keeping any portion of
18their medical records separate from the electronic medical
19records. Patients have the right to access their medical
20records upon demand.
21    Section 70. Compensation. The Commissioner, the Chief
22Medical Officer, public State board members, and subsequent
23employees of the Program shall be compensated in accordance
24with the current pay scale for State employees and as deemed



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1professionally appropriate by the General Assembly and
2reviewed in accordance with all other State employees.