Rep. Patricia R. Bellock
Filed: 3/23/2010
 
 

 




 

 		












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AMENDMENT TO HOUSE BILL 6277




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    AMENDMENT NO. ______. Amend House Bill 6277 by replacing 
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everything after the enacting clause with the following:

 
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    "Section 5. The Illinois Public Aid Code is amended  by 
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changing Section 5-16 as follows:
 
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    (305 ILCS 5/5-16)  (from Ch. 23, par. 5-16)
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    Sec. 5-16. Managed Care.  
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    (1) The Illinois Department may develop and implement
a 
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Primary Care Sponsor System consistent with the provisions of 
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this Section.
The purpose of this managed care delivery system 
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shall be to contain the costs
of providing medical care to 
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Medicaid recipients by having one provider
responsible for 
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managing all aspects of a recipient's medical care.  This

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managed care system shall have the following characteristics:
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        (a) The Department, by rule, shall establish criteria 
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    to determine
which clients must participate in this 
 


 






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    program;
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        (b) Providers participating in the program may be paid 
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    an
amount per patient per month, to be set by the Illinois 
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    Department, for
managing each recipient's medical care;
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        (c) Providers eligible to participate in the program 
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    shall be
physicians licensed to practice medicine in all 
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    its branches, and the
Illinois Department may terminate a 
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    provider's participation if the
provider is determined to 
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    have failed to comply with any applicable program
standard 
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    or procedure established by the Illinois Department;
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        (d) Each recipient required to participate in the 
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    program must select
from a panel of primary care providers 
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    or networks established by the
Department in their 
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    communities;
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        (e) A recipient may change his designated primary care 
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    provider:
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            (1) when the designated source becomes 
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        unavailable, as the Illinois
Department shall 
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        determine by rule; or
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            (2) when the designated primary care provider 
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        notifies the Illinois
Department that it wishes to 
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        withdraw from any obligation as primary care
provider; 
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        or
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            (3) in other situations, as the Illinois 
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        Department shall provide by
rule;
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        (f) The Illinois Department shall, by rule, establish 
 


 






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    procedures for
providing medical services when the 
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    designated source becomes unavailable or
wishes to 
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    withdraw from any obligation as primary care provider 
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    taking into
consideration the need for emergency or 
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    temporary medical assistance and
ensuring that the 
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    recipient has continuous and unrestricted access to 
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    medical
care from the date on which such unavailability or 
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    withdrawal becomes effective
until such time as the 
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    recipient designates a primary care source;
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        (g) Only medical care services authorized by a 
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    recipient's designated
provider, except for emergency 
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    services, services performed by a provider
that is owned or 
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    operated by a county and that provides non-emergency

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    services without regard to ability to pay and such other 
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    services as provided
by the Illinois Department, shall be 
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    subject to payment by the Illinois
Department.  The Illinois 
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    Department shall enter into an
intergovernmental agreement 
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    with each county that owns or operates such a
provider to 
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    develop and implement policies to minimize the provision of

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    medical care services provided by county owned or operated 
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    providers
pursuant to the foregoing exception. 
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    The Illinois Department shall seek and obtain necessary 
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authorization
provided under federal law to implement such a 
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program including the waiver of
any federal regulations. 
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    The Illinois Department may implement the amendatory 
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changes to
this Section made by this amendatory Act of 1991 
 


 






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through the use of emergency
rules in accordance with the 
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provisions of Section 5.02 of the Illinois
Administrative 
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Procedure Act. For purposes of the Illinois Administrative

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Procedure Act, the adoption of rules to implement the 
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amendatory changes to
this Section made by this amendatory Act 
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of 1991 shall be deemed an emergency
and necessary for the 
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public interest, safety and welfare.
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    The Illinois Department may establish a managed care system 
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demonstration
program, on a limited basis, as described in this 
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Section.  The demonstration
program shall terminate on June 30, 
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1997.  Within 30 days after the end of each
year of the 
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demonstration program's operation, the Illinois Department 
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shall
report to the Governor and the General Assembly 
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concerning the operation of the
demonstration program.
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    (2) The Department shall implement a mandatory, capitated 
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payment-based managed care pilot program covering at least 
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40,000 covered individuals. Enrollment in this program shall be 
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limited to individuals and eligible family caregivers eligible 
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for benefits under the Children's Health Insurance Program Act, 
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the Covering ALL KIDS Health Insurance Act, or this Article due 
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to eligibility for benefits under Article IV of this Code. 
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(Source: P.A. 87-14; 88-490.)
 

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