State of Illinois
92nd General Assembly

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SB885 Engrossed                                LRB9202681JSpc

 1        AN ACT concerning children's health care.

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

 4        Section 5.  The Children's Health Insurance  Program  Act
 5    is amended by changing Sections 25 and 40 as follows:

 6        (215 ILCS 106/25)
 7        (Section scheduled to be repealed on July 1, 2002)
 8        Sec. 25.  Health benefits for children.
 9        (a)  The  Department  shall,  subject  to  appropriation,
10    provide health benefits coverage to eligible children by:
11             (1)  Subsidizing  the  cost  of  privately sponsored
12        health  insurance,  including   employer   based   health
13        insurance,  to  assist  families  to  take  advantage  of
14        available  privately sponsored health insurance for their
15        eligible children; and
16             (2)  Purchasing or providing  health  care  benefits
17        for  eligible  children.   The  health  benefits provided
18        under  this  subdivision   (a)(2)   shall,   subject   to
19        appropriation  and  without regard to any applicable cost
20        sharing under Section 30, be identical  to  the  benefits
21        provided  for  children  under  the State's approved plan
22        under Title XIX of the Social  Security  Act.   Providers
23        under   this  subdivision  (a)(2)  shall  be  subject  to
24        approval by the Department to provide health  care  under
25        the  Illinois  Public Aid Code and shall be reimbursed at
26        the same rate as providers  under  the  State's  approved
27        plan  under  Title  XIX  of  the  Social Security Act. In
28        addition,   providers   may   retain   co-payments   when
29        determined appropriate by the Department.
30        (b)  The subsidization provided pursuant  to  subdivision
31    (a)(1) shall be credited to the family of the eligible child.
SB885 Engrossed             -2-                LRB9202681JSpc
 1    The  Department  shall  make  the  subsidization  pursuant to
 2    subdivision  (a)(1)  available  to  children   whose   annual
 3    household  income  is at or below 133% of the federal poverty
 4    level.
 5        (c)  The Department is prohibited from  denying  coverage
 6    to  a  child  who is enrolled in a privately sponsored health
 7    insurance plan pursuant to  subdivision  (a)(1)  because  the
 8    plan  does  not  meet  federal benchmarking standards or cost
 9    sharing and contribution requirements.  To  be  eligible  for
10    inclusion   in   the   Program,   the   plan   shall  contain
11    comprehensive major medical coverage which shall  consist  of
12    physician  and hospital inpatient services. The Department is
13    prohibited from denying coverage to a child who  is  enrolled
14    in  a  privately  sponsored health insurance plan pursuant to
15    subdivision  (a)(1)  because  the  plan  offers  benefits  in
16    addition to physician and hospital inpatient services.
17        (d)  The total dollar amount of subsidizing coverage  per
18    child per month pursuant to subdivision (a)(1) shall be equal
19    to  the  average dollar payments, less premiums incurred, per
20    child  per  month  pursuant  to  subdivision  (a)(2).     The
21    Department shall set this amount prospectively based upon the
22    prior  fiscal year's experience adjusted for incurred but not
23    reported claims and estimated increases or decreases  in  the
24    cost  of  medical  care.   Payments  obligated before July 1,
25    1999, will be computed using State Fiscal Year 1996  payments
26    for  children  eligible  for  Medical  Assistance  and income
27    assistance under the Aid to Families with Dependent  Children
28    Program,   with   appropriate   adjustments   for   cost  and
29    utilization changes through January 1, 1999.  The  Department
30    is   prohibited   from   providing   a  subsidy  pursuant  to
31    subdivision (a)(1) that is more than the individual's monthly
32    portion of the premium.
33        (e)  An eligible  child  may  obtain  immediate  coverage
34    under  this  Program  only  once  during a medical visit.  If
SB885 Engrossed             -3-                LRB9202681JSpc
 1    coverage lapses, re-enrollment shall be completed in  advance
 2    of  the  next  covered  medical  visit  and the first month's
 3    required premium shall be paid  in  advance  of  any  covered
 4    medical visit.
 5        (f)  In   order   to   accelerate   and   facilitate  the
 6    development of networks to deliver services  to  children  in
 7    areas   outside   counties  with  populations  in  excess  of
 8    3,000,000, in  the  event  less  than  25%  of  the  eligible
 9    children in a county or contiguous counties has enrolled with
10    a Health Maintenance Organization pursuant to Section 5-11 of
11    the  Illinois Public Aid Code, the Department may develop and
12    implement  demonstration  projects  to   create   alternative
13    networks  designed to enhance enrollment and participation in
14    the program.  The Department  shall  prescribe  by  rule  the
15    criteria,    standards,    and   procedures   for   effecting
16    demonstration projects under this Section.
17    (Source: P.A. 90-736, eff. 8-12-98.)

18        (215 ILCS 106/40)
19        (Section scheduled to be repealed on July 1, 2002)
20        Sec. 40.  Waivers.
21        (a)  The Department shall request any  necessary  waivers
22    of  federal requirements in order to allow receipt of federal
23    funding for:
24             (1)  the coverage of families with eligible children
25        under this Act; and
26             (2)  for  the  coverage  of   children   who   would
27        otherwise be eligible under this Act, but who have health
28        insurance; and.
29             (3)  the  coverage  of  children  that  are eligible
30        under subsection (b) of Section 25.
31        (b)  The failure of the  responsible  federal  agency  to
32    approve a waiver for children who would otherwise be eligible
33    under  this  Act  but  who  have  health  insurance shall not
SB885 Engrossed             -4-                LRB9202681JSpc
 1    prevent  the  implementation  of  any  Section  of  this  Act
 2    provided that there are sufficient appropriated funds.
 3    (Source: P.A. 90-736, eff. 8-12-98.)

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

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