95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
HB0596


 
Introduced 2/5/2007, by Rep. Patricia R. Bellock
 
SYNOPSIS AS INTRODUCED:
 		













215 ILCS 106/27 new






305 ILCS 5/5-16.14 new










    Amends the Children's Health Insurance Program Act and the Illinois Public Aid Code. Under the Children's Health Insurance Program Act, provides that on and after July 1, 2007, the Department of Healthcare and Family Services shall implement the following: (1) a capitated managed care system for selected populations of persons in certain counties surrounding Cook County and in certain counties in southern Illinois, under which the State pays a fixed amount per individual per month to a third-party entity to manage the program of health care benefits and assume the risk associated with the payment of medical bills without regard to the actual medical claims incurred; (2) a primary care case management (PCCM) system for selected populations of persons in the remaining counties of the State other than Cook County, under which each participant has one health care provider who is responsible for managing all aspects of the participant's medical care; and (3) a PCCM system for selected populations of persons in Cook County. Requires the Department to file a report describing a mechanism for achieving a transition to a capitated managed care system for persons in Cook County by July 1, 2008. Requires that the populations selected for participation in the various systems must include, at a minimum, all persons eligible for benefits under the Children's Health Insurance Program Act. Provides that the Department may implement similar capitated managed care systems and primary care case management systems for Medicaid recipients under the Illinois Public Aid Code. Effective immediately.
















LRB095 04333 DRJ 24376 b

















FISCAL NOTE ACT MAY APPLY
















 


 


A BILL FOR









 











HB0596

LRB095 04333 DRJ 24376 b






1
    AN ACT concerning health.

 
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 is 
5
amended  by adding Section 27 as follows:
 
6
    (215 ILCS 106/27 new)

7
    Sec. 27. Transition to capitated managed care or primary 
8
care case management systems.
9
    (a) Designated counties. On and after July 1, 2007, in 
10
counties determined by the Department of Healthcare and Family 
11
Services by rule, the Department shall implement a capitated 
12
managed care system for selected populations of persons. Under 
13
the capitated managed care system, the State shall pay a fixed 
14
amount per individual per month to a third-party entity to 
15
manage the program of health care benefits and assume the risk 
16
associated with the payment of medical bills without regard to 
17
the actual medical claims incurred. At a minimum, the counties 
18
in which the Department implements the capitated managed care 
19
system must include the following:
20
        (1) The counties of Winnebago, Boone, McHenry, Lake, 
21
    DeKalb, Kane, DuPage, Kendall, Grundy, Will, and Kankakee.
22
        (2) The counties of Madison, St. Clair, Monroe, 
23
    Randolph, Perry, Franklin, Jackson, and Williamson.
 


 






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    In counties of the State in which the Department implements 
2
the capitated managed care system under this subsection, the 
3
Department may provide for the payment of capitated payments 
4
within a time period that is consistent with the time period 
5
within which payments are made to fee-for-service providers in 
6
counties in which the Department uses a primary care case 
7
management system.
8
    The Department shall adopt rules establishing the 
9
populations in the designated counties that must participate in 
10
the capitated managed care system. At a minimum, those 
11
populations must include all persons eligible for benefits 
12
under Sections 25 and 40. The Department shall adopt rules 
13
providing for the implementation and continued oversight of the 
14
capitated managed care system.
15
    (b) Remaining counties, other than Cook. On and after July 
16
1, 2007, in the counties of the State other than Cook County 
17
and other than the counties designated under subsection (a), 
18
the Department of Healthcare and Family Services shall 
19
implement a primary care case management system for selected 
20
populations of persons. Under the primary care case management 
21
system, each individual enrolled in the system shall have one 
22
health care provider who is responsible for managing all 
23
aspects of the individual's medical care.
24
    An individual who is required to participate in the primary 
25
care case management system must select a primary care provider 
26
from a panel of primary care physicians designated by the 
 


 






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1
Department. An individual may change his or her primary care 
2
provider when the provider selected by the individual becomes 
3
unavailable, as provided by the Department in rules, or in 
4
other situations as provided by the Department in rules. At a 
5
minimum, an individual must be given an opportunity to change 
6
his or her primary care provider at least once during each 
7
State fiscal year.
8
    The Department shall adopt rules establishing the 
9
populations in these counties that must participate in the 
10
primary care case management system. At a minimum, those 
11
populations must include all persons eligible for benefits 
12
under Sections 25 and 40.
13
    A health care provider serving as a primary care physician 
14
in the primary care case management system is entitled to a 
15
care coordination fee, as determined by the Department, for 
16
managing each patient's medical care. The fee may be contingent 
17
on performance measures as determined by the Department in 
18
rules. In addition, a health care provider is entitled to 
19
reimbursement for specific services rendered to a patient.
20
    The Department shall adopt rules providing for the 
21
implementation and continued oversight of the primary care case 
22
management system.
23
    (c) Cook County. On and after July 1, 2008, in Cook County, 
24
the Department of Healthcare and Family Services shall 
25
implement a primary care case management system for selected 
26
populations of persons. The Department shall implement the 
 


 






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1
primary care case management system in Cook County in a manner 
2
consistent with the implementation of a primary care case 
3
management system in other counties under subsection (b).
4
    The Department shall adopt rules establishing the 
5
populations in Cook County that must participate in the primary 
6
care case management system. At a minimum, those populations 
7
must include all persons eligible for benefits under Sections 
8
25 and 40.
9
    The Department shall adopt rules providing for the 
10
implementation and continued oversight of the primary care case 
11
management system.
12
    No later than January 1, 2008, the Department shall file 
13
with the General Assembly a report setting forth a proposed 
14
means of transferring the individuals participating in the 
15
primary care case management system to a capitated managed care 
16
system by July 1, 2008.
17
    (d) Waivers. The Department of Healthcare and Family 
18
Services shall promptly apply for all waivers of federal law 
19
and regulations that are necessary to allow the full 
20
implementation of this Section.


 
21
    Section 10. The Illinois Public Aid Code is amended  by 
22
adding Section 5-16.14 as follows:
 
23
    (305 ILCS 5/5-16.14  new)
24
    Sec. 5-16.14. Transition to capitated managed care or 
 


 






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1
primary care case management systems.
2
    (a) Designated counties. On and after July 1, 2007, in 
3
counties determined by the Department of Healthcare and Family 
4
Services by rule, the Department may implement a capitated 
5
managed care system for selected populations of recipients of 
6
medical assistance under this Article. Under the capitated 
7
system, the State shall pay a fixed amount per member per month 
8
to a third-party entity to manage the program of medical 
9
assistance benefits and assume the risk associated with the 
10
payment of medical bills without regard to the actual medical 
11
claims incurred. If the Department implements a capitated 
12
managed care system as provided in this subsection, the 
13
counties in which the Department implements the system must be 
14
the same as the counties in which the Department implements a 
15
capitated managed care system under subsection (a) of Section 
16
27 of the Children's Health Insurance Program Act and must 
17
include, at a minimum, the following:
18
        (1) The counties of Winnebago, Boone, McHenry, Lake, 
19
    DeKalb, Kane, DuPage, Kendall, Grundy, Will, and Kankakee.
20
        (2) The counties of Madison, St. Clair, Monroe, 
21
    Randolph, Perry, Franklin, Jackson, and Williamson.
22
    In the counties in which the Department implements a 
23
capitated managed care system under this subsection, the 
24
Department may provide for the payment of capitated payments 
25
within a time period that is consistent with the time period 
26
within which payments are made to fee-for-service providers in 
 


 






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1
areas where the Department uses a primary care case management 
2
system.
3
    The Department shall adopt rules establishing the medical 
4
assistance recipient populations in the designated counties 
5
that must participate in the capitated managed care system. The 
6
Department shall adopt rules providing for the implementation 
7
and continued oversight of the capitated managed care system. 
8
The rules shall provide for the implementation of the system in 
9
a manner consistent with the Department's implementation of a 
10
capitated managed care system under subsection (a) of Section 
11
27 of the Children's Health Insurance Program Act.
12
    (b) Remaining counties, other than Cook. On and after July 
13
1, 2007, in the counties of the State other than Cook County 
14
and other than the counties designated under subsection (a), 
15
the Department of Healthcare and Family Services may implement 
16
a primary care case management system for selected populations 
17
of recipients of medical assistance under this Article. Under 
18
the primary care case management system, each individual 
19
enrolled in the system shall have one health care provider who 
20
is responsible for managing all aspects of the individual's 
21
medical care.
22
    An individual who is required to participate in the primary 
23
care case management system must select a primary care provider 
24
from a panel of primary care physicians designated by the 
25
Department. An individual may change his or her primary care 
26
provider when the provider selected by the individual becomes 
 


 






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1
unavailable, as provided by the Department in rules, or in 
2
other situations as provided by the Department in rules. At a 
3
minimum, an individual must be given an opportunity to change 
4
his or her primary care provider at least once during each 
5
State fiscal year.
6
    The Department shall adopt rules establishing the medical 
7
assistance recipient populations in these counties that must 
8
participate in the primary care case management system.
9
    A health care provider serving as a primary care physician 
10
in the primary care case management system is entitled to a 
11
care coordination fee, as determined by the Department, for 
12
managing each patient's medical care. The fee may be contingent 
13
on performance measures as determined by the Department in 
14
rules. In addition, a health care provider is entitled to 
15
reimbursement for specific services rendered to a patient.
16
    The Department shall adopt rules providing for the 
17
implementation and continued oversight of the primary care case 
18
management system. The rules shall provide for the 
19
implementation of the system in a manner consistent with the 
20
Department's implementation of a primary care casse management 
21
system under subsection (b) of Section 27 of the Children's 
22
Health Insurance Program Act.
23
    (c) Cook County. On and after July 1, 2008, in Cook County, 
24
the Department of Healthcare and Family Services may implement 
25
a primary care case management system for selected populations 
26
of recipients of medical assistance under this Article. The 
 


 






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1
Department shall implement the primary care case management 
2
system in Cook County in a manner consistent with (i) the 
3
implementation of a primary care case management system in 
4
other counties under subsection (b) and (ii) the implementation 
5
of a primary care case management system in under subsection 
6
(c) of Section 27 of the Children's Health Insurance Program 
7
Act.
8
    The Department shall adopt rules establishing the 
9
populations in Cook County that must participate in the primary 
10
care case management system.
11
    The Department shall adopt rules providing for the 
12
implementation and continued oversight of the primary care case 
13
management system. The rules shall provide for the 
14
implementation of the system in a manner consistent with the 
15
Department's implementation of a primary care case management 
16
system under subsection (c) of Section 27 of the Children's 
17
Health Insurance Program Act.
18
    (d) Waivers. If the Department of Healthcare and Family 
19
Services implements any of the health care benefit systems 
20
authorized under this Section for recipients of medical 
21
assistance, the Department shall promptly apply for all waivers 
22
of federal law and regulations that are necessary to allow the 
23
full implementation of those provisions.

 

24
    Section 99. Effective date. This Act takes effect upon 
25
becoming law.