Full Text of SB2382 100th General Assembly
SB2382sam001 100TH GENERAL ASSEMBLY | Sen. Heather A. Steans Filed: 4/20/2018
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| 1 | | AMENDMENT TO SENATE BILL 2382
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2382 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Findings; intent. According to the | 5 | | Congressional Research Service reporting, approximately 35% to | 6 | | 60% of children placed in foster care have at least one chronic | 7 | | or acute physical health condition that requires treatment, | 8 | | including growth failure, asthma, obesity, vision impairment, | 9 | | hearing loss, neurological problems, and complex chronic | 10 | | illnesses; as many as 50% to 75% show behavioral or social | 11 | | competency issues that may warrant mental health services; many | 12 | | of these physical and mental health care issues persist and, | 13 | | relative to their peers in the general population, children who | 14 | | leave foster care for adoption and those who age out of care | 15 | | continue to have greater health needs. | 16 | | Federal child welfare policy requires states to develop | 17 | | strategies to address the health care needs of each child in |
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| 1 | | foster care and mandates coordination of state child welfare | 2 | | and Medicaid agencies to ensure that the health care needs of | 3 | | children in foster care are properly identified and treated. | 4 | | The Department of Children and Family Services is | 5 | | responsible for ensuring safety, family permanence, and | 6 | | well-being for the children placed in its custody and | 7 | | protecting these children from further trauma by ensuring | 8 | | timely access to appropriate placements and services, | 9 | | especially those children with complex emotional and | 10 | | behavioral needs who are at much greater risk for not achieving | 11 | | the fundamental child welfare goals of safety, permanence, and | 12 | | well-being. | 13 | | The Department remains under federal court oversight | 14 | | pursuant to the B.H. Consent Decree, in part, for failure to | 15 | | provide constitutionally sufficient services and placements | 16 | | for children with psychological, behavioral, or emotional | 17 | | challenges; the 2015 court-appointed Expert Panel found too | 18 | | many children in the class experience multiple disruptions of | 19 | | placement, services, and relationships; these children and | 20 | | their families endure indeterminate waits, month upon month, | 21 | | for services the child and family need, without a concrete plan | 22 | | or timeframe; these disruptions and delays and the inaction of | 23 | | Department officials exacerbate children's already serious and | 24 | | chronic mental health problems; the Department's approach to | 25 | | treatment and its system of practice has been one shaped by | 26 | | crises, practitioner preferences, tradition, and system |
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| 1 | | expediency. | 2 | | The American Academy of Pediatrics cautions that the | 3 | | effects of managed care on children's access to services and | 4 | | actual health outcomes are not yet clear; it outlines design | 5 | | and implementation principles if managed care is to be | 6 | | implemented for children. | 7 | | It is the intent of the General Assembly to ensure that | 8 | | children are provided a system of health care with full and | 9 | | inclusive access to physical and behavioral health services | 10 | | necessary for them to thrive. | 11 | | The General Assembly finds it necessary to protect youth in | 12 | | care by requiring the Department to plan the use of managed | 13 | | care services transparently, collaboratively, and deliberately | 14 | | to ensure quality outcomes and accountable oversight. | 15 | | Section 5. The Children and Family Services Act is amended | 16 | | by adding Section 5.45 as follows: | 17 | | (20 ILCS 505/5.45 new) | 18 | | Sec. 5.45. Managed care plan services. | 19 | | (a) As used in this Section: | 20 | | "Caregiver" means an individual or entity directly | 21 | | providing the day-to-day care of a child ensuring the child's | 22 | | safety and well-being. | 23 | | "Child" or "youth" means a child placed in the care of the | 24 | | Department pursuant to the Juvenile Court Act of 1987. |
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| 1 | | "Department" means the Department of Children and Family | 2 | | Services, or any successor State agency. | 3 | | "Director" means the Director of Children and Family | 4 | | Services. | 5 | | "Managed care organization" has the meaning ascribed to | 6 | | that term in Section 5-30.1 of the Illinois Public Aid Code. | 7 | | "Medicaid managed care plan" means a health care plan | 8 | | operated by a managed care organization under the Medical | 9 | | Assistance Program established in Article V of the Illinois | 10 | | Public Aid Code. | 11 | | (b) Every child who is in the care of the Department | 12 | | pursuant to the Juvenile Court Act of 1987 shall receive the | 13 | | necessary services required by this Act and the Juvenile Court | 14 | | Act of 1987, including any child enrolled in a Medicaid managed | 15 | | care plan. The Department shall adopt rules as set forth in | 16 | | this subsection (e) before the Department is permitted to | 17 | | utilize Medicaid managed care services for children. | 18 | | (c) The Department shall not relinquish its authority or | 19 | | diminish its responsibility to determine, provide, or | 20 | | authorize necessary services that are in the best interest of a | 21 | | child even if those services are directly or indirectly: | 22 | | (1) provided by a managed care organization, another | 23 | | State agency, or other third parties; | 24 | | (2) coordinated through a managed care organization, | 25 | | another State agency, or other third parties; or | 26 | | (3) paid for by a managed care organization, another |
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| 1 | | State agency, or other third parties. | 2 | | (d) The Department shall: | 3 | | (1) implement and enforce measures to prevent | 4 | | enrollment in Medicaid managed care plans from disrupting | 5 | | service delivery or hindering continuity of treatment for | 6 | | any child; | 7 | | (2) establish a single point of contact at the | 8 | | Department for health care coverage inquiries and dispute | 9 | | resolution systemwide without transferring this | 10 | | responsibility to a third party such as a managed care | 11 | | coordinator; | 12 | | (3) prohibit mandatory participation in Medicaid | 13 | | managed care plans for any child; and | 14 | | (4) develop managed care contract measures, quality | 15 | | assurance activities, and performance delivery evaluations | 16 | | with input from health care providers, caregivers of youth | 17 | | in care, State agency personnel, representatives of youth | 18 | | in care, managed care organizations, child welfare | 19 | | providers and related trade associations, parents of | 20 | | children in out-of-home care, academic institutions, | 21 | | pediatric experts, court stakeholders, and other child | 22 | | advocates; and | 23 | | (5) post on its website: | 24 | | (A) a link to any rule adopted in accordance to | 25 | | subsection (e) of this Section; | 26 | | (B) each managed care organization's contract, |
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| 1 | | enrollee handbook, and directory; and | 2 | | (C) the State's current Health Care Oversight and | 3 | | Coordination Plan developed in accordance with federal | 4 | | requirements. | 5 | | (e) The Department shall adopt rules regarding the | 6 | | provision of health care services to children enrolled in | 7 | | Medicaid managed care plans. The proposed rules shall address, | 8 | | but not be limited to, the following: | 9 | | (1) an assessment of existing network adequacy, plans | 10 | | to address gaps in network before transition to managed | 11 | | care, and ongoing network evaluation; | 12 | | (2) preparation and training of organizations, | 13 | | caregivers, frontline staff, and managed care | 14 | | organizations; | 15 | | (3) the identification of administrative changes | 16 | | necessary for successful transition to managed care, and | 17 | | the timeframes to make changes; | 18 | | (4) defined roles, responsibilities, and lines of | 19 | | authority for care coordination, placement providers, | 20 | | service providers, and each State agency involved in | 21 | | management and oversight of managed care services; | 22 | | (5) data used to establish baseline performance and | 23 | | quality of care, which shall be used to evaluate outcomes | 24 | | and identify ongoing areas for improvement; | 25 | | (6) a process and timeline for stakeholder input into | 26 | | managed care contract development; |
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| 1 | | (7) a dispute resolution process, including the rights | 2 | | of enrollees and representatives of enrollees under the | 3 | | dispute process and timeframes for dispute resolution | 4 | | determinations and remedies; | 5 | | (8) the relationship of the dispute resolution process | 6 | | described in paragraph (7) to the administrative review | 7 | | process under the Administrative Review Law; | 8 | | (9) an initial enrollment process and enrollment | 9 | | process for those children entering or exiting the | 10 | | Department's care after the implementation of managed | 11 | | care; | 12 | | (10) protections to ensure the continued provision of | 13 | | health care services if a child's residence or legal | 14 | | guardian changes; | 15 | | (11) a method, as informed by pediatric experts, that | 16 | | the Department shall use to ensure an appropriate rate is | 17 | | utilized for Medicaid managed care plans to meet the | 18 | | specialized needs of children in the Department's care; | 19 | | (12) the notification process and timeframes to inform | 20 | | managed care plan enrollees and enrollees' caregivers of | 21 | | any changes in health care coverage or a change in a | 22 | | child's managed care provider; | 23 | | (13) defined pre-clearance requirements for | 24 | | prescriptions, goods, and services in emergency and | 25 | | non-emergency situations, if applicable; | 26 | | (14) implementation of a robust, responsive |
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| 1 | | beneficiary support system that has the capacity to provide | 2 | | assistance in navigating the Medicaid managed care system | 3 | | to all current and prospective beneficiaries and their | 4 | | representatives, including, but not limited to: | 5 | | (A) establishing a single point of contact | 6 | | systemwide; | 7 | | (B) defining informational notice requirements; | 8 | | (C) explanation of enrollment and disenrollment | 9 | | rights; | 10 | | (D) education on grievance process and | 11 | | requirements for timely responses; and | 12 | | (E) key beneficiary protections. | 13 | | (f) Reports. | 14 | | (1) On or before February 1, 2019, and on or before | 15 | | each February 1 thereafter, the Department shall submit a | 16 | | report to the House and Senate Human Services Committees, | 17 | | or to any successor committees, on measures of access to | 18 | | and the quality of health care services for children | 19 | | enrolled in Medicaid managed care plans, including, but not | 20 | | limited to, data showing whether: | 21 | | (A) children enrolled in Medicaid managed care | 22 | | plans have continuity of care across placement types, | 23 | | geographic regions, and specialty service needs; | 24 | | (B) each child is receiving the early periodic | 25 | | screening, diagnosis, and treatment services as | 26 | | required by federal law, including, but not limited to, |
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| 1 | | regular preventative care and timely specialty care; | 2 | | (C) children are assigned to health homes; | 3 | | (D) each child has a health care oversight and | 4 | | coordination plan as required by federal law; | 5 | | (E) there exists complaints and grievances | 6 | | indicating gaps or barriers in service delivery; | 7 | | (F) stakeholders, including pediatric experts, | 8 | | have and continue to be engaged in quality improvement | 9 | | initiatives; | 10 | | (G) there exists disenrollment trends and related | 11 | | reasons such as poor quality of care, lack of access to | 12 | | services covered by the managed care organization, | 13 | | lack of access to providers experienced in addressing | 14 | | enrollees' needs, limitations of in-network and | 15 | | out-of-network coverage, or any other factors. | 16 | | The report shall be prepared in consultation with | 17 | | health care providers in the program, caregivers of youth | 18 | | in care, State agency personnel, personnel of the | 19 | | Department of Healthcare and Family Services, | 20 | | representatives of youth in care, managed care | 21 | | organizations, parents of children in out-of-home care, | 22 | | and other agencies, organizations, or individuals the | 23 | | Director deems appropriate in order to obtain | 24 | | comprehensive and objective information about the managed | 25 | | care plan operation. | 26 | | (2) During each legislative session, the House and |
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| 1 | | Senate Human Services Committees shall hold a hearing to | 2 | | take public testimony about managed care implementation | 3 | | for children in the care of, adopted from, or placed in | 4 | | guardianship by the Department. The Department shall | 5 | | present testimony, including information provided in the | 6 | | report required under paragraph (1), compliance with | 7 | | adopted rules, and any recommendations for statutory | 8 | | changes to improve health care for children in the | 9 | | Department's care.
| 10 | | Section 99. Effective date. This Act takes effect upon | 11 | | becoming law.".
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