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92_SB0885sam002
LRB9202681JSpcam02
1 AMENDMENT TO SENATE BILL 885
2 AMENDMENT NO. . Amend Senate Bill 885, AS AMENDED,
3 by replacing everything after the enacting clause with the
4 following:
5 "Section 5. The Children's Health Insurance Program Act
6 is amended by changing Sections 25 and 40 as follows:
7 (215 ILCS 106/25)
8 (Section scheduled to be repealed on July 1, 2002)
9 Sec. 25. Health benefits for children.
10 (a) The Department shall, subject to appropriation,
11 provide health benefits coverage to eligible children by:
12 (1) Subsidizing the cost of privately sponsored
13 health insurance, including employer based health
14 insurance, to assist families to take advantage of
15 available privately sponsored health insurance for their
16 eligible children; and
17 (2) Purchasing or providing health care benefits
18 for eligible children. The health benefits provided
19 under this subdivision (a)(2) shall, subject to
20 appropriation and without regard to any applicable cost
21 sharing under Section 30, be identical to the benefits
22 provided for children under the State's approved plan
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1 under Title XIX of the Social Security Act. Providers
2 under this subdivision (a)(2) shall be subject to
3 approval by the Department to provide health care under
4 the Illinois Public Aid Code and shall be reimbursed at
5 the same rate as providers under the State's approved
6 plan under Title XIX of the Social Security Act. In
7 addition, providers may retain co-payments when
8 determined appropriate by the Department.
9 (b) The subsidization provided pursuant to subdivision
10 (a)(1) shall be credited to the family of the eligible child.
11 The Department shall make the subsidization pursuant to
12 subdivision (a)(1) available to children whose annual
13 household income is at or below 133% of the federal poverty
14 level.
15 (c) The Department is prohibited from denying coverage
16 to a child who is enrolled in a privately sponsored health
17 insurance plan pursuant to subdivision (a)(1) because the
18 plan does not meet federal benchmarking standards or cost
19 sharing and contribution requirements. To be eligible for
20 inclusion in the Program, the plan shall contain
21 comprehensive major medical coverage which shall consist of
22 physician and hospital inpatient services. The Department is
23 prohibited from denying coverage to a child who is enrolled
24 in a privately sponsored health insurance plan pursuant to
25 subdivision (a)(1) because the plan offers benefits in
26 addition to physician and hospital inpatient services.
27 (d) The total dollar amount of subsidizing coverage per
28 child per month pursuant to subdivision (a)(1) shall be equal
29 to the average dollar payments, less premiums incurred, per
30 child per month pursuant to subdivision (a)(2). The
31 Department shall set this amount prospectively based upon the
32 prior fiscal year's experience adjusted for incurred but not
33 reported claims and estimated increases or decreases in the
34 cost of medical care. Payments obligated before July 1,
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1 1999, will be computed using State Fiscal Year 1996 payments
2 for children eligible for Medical Assistance and income
3 assistance under the Aid to Families with Dependent Children
4 Program, with appropriate adjustments for cost and
5 utilization changes through January 1, 1999. The Department
6 is prohibited from providing a subsidy pursuant to
7 subdivision (a)(1) that is more than the individual's monthly
8 portion of the premium.
9 (e) An eligible child may obtain immediate coverage
10 under this Program only once during a medical visit. If
11 coverage lapses, re-enrollment shall be completed in advance
12 of the next covered medical visit and the first month's
13 required premium shall be paid in advance of any covered
14 medical visit.
15 (f) In order to accelerate and facilitate the
16 development of networks to deliver services to children in
17 areas outside counties with populations in excess of
18 3,000,000, in the event less than 25% of the eligible
19 children in a county or contiguous counties has enrolled with
20 a Health Maintenance Organization pursuant to Section 5-11 of
21 the Illinois Public Aid Code, the Department may develop and
22 implement demonstration projects to create alternative
23 networks designed to enhance enrollment and participation in
24 the program. The Department shall prescribe by rule the
25 criteria, standards, and procedures for effecting
26 demonstration projects under this Section.
27 (Source: P.A. 90-736, eff. 8-12-98.)
28 (215 ILCS 106/40)
29 (Section scheduled to be repealed on July 1, 2002)
30 Sec. 40. Waivers.
31 (a) The Department shall request any necessary waivers
32 of federal requirements in order to allow receipt of federal
33 funding for:
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1 (1) the coverage of families with eligible children
2 under this Act; and
3 (2) for the coverage of children who would
4 otherwise be eligible under this Act, but who have health
5 insurance; and.
6 (3) the coverage of children that are eligible
7 under subsection (b) of Section 25.
8 (b) The failure of the responsible federal agency to
9 approve a waiver for children who would otherwise be eligible
10 under this Act but who have health insurance shall not
11 prevent the implementation of any Section of this Act
12 provided that there are sufficient appropriated funds.
13 (Source: P.A. 90-736, eff. 8-12-98.)
14 Section 99. Effective date. This Act takes effect upon
15 becoming law.".