SB1515sam001 96TH GENERAL ASSEMBLY

Sen. Heather Steans

Filed: 3/4/2009

09600SB1515sam001 LRB096 10924 RPM 22400 a

AMENDMENT TO SENATE BILL 1515

AMENDMENT NO. ______. Amend Senate Bill 1515 by replacing everything after the enacting clause with the following:

"Section 5. The Covering ALL KIDS Health Insurance Act is amended by adding Section 52.5 as follows:

(215 ILCS 170/52.5 new)

Sec. 52.5. Specialty physician services; fee schedule.

(a) Beginning January 1, 2010, the physician fee schedule for the Covering ALL KIDS Health Insurance Program must increase to become competitive with those of non-governmental, third-party health insurance programs. By January 1, 2012, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Payment for services must be made within 30 days after receipt of a bill or claim meeting the requirements of the Department of Healthcare and Family Services.

(b) For payments made or authorized by the Department of Healthcare and Family Services, the Department shall annually increase pediatric specialty physician payments under subsection (a) by an amount approximately equal to one-third of the difference between the actual rates available for such purposes on January 1, 2009 and the Medicare reimbursement rates effective on January 1, 2007. If the General Assembly determines that resources are not available to fully fund the fee schedule for pediatric specialty physician care required by this subsection (b), then, until such time as the General Assembly determines that such funding is available, the Department shall increase any payment for physicians who provide pediatric specialty care services under the Covering ALL KIDS Health Insurance Program by an amount proportionately equivalent to any other increases for physicians, federally qualified health centers, rural health centers, or other non-institutional providers providing services to children for any services provided under this Act.

Section 10. The Illinois Public Aid Code is amended by adding Section 5-5.06 as follows:

(305 ILCS 5/5-5.06 new)

Sec. 5-5.06. Specialty physician services; fee schedule.

(a) Notwithstanding any other provisions of this Article, beginning January 1, 2010, the physician fee schedule for pediatric physician specialists must increase to become competitive with those of non-governmental, third-party health insurance programs. By January 1, 2012, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Payment for services must be made within 30 days after receipt of a bill or claim meeting the requirements of the Department of Healthcare and Family Services.

(b) For payments made or authorized by the Department of Healthcare and Family Services, the Department shall annually increase pediatric specialty physician payments under subsection (a) by an amount approximately equal to one-third of the difference between the actual rates available for such purposes on January 1, 2009 and the Medicare reimbursement rates effective on January 1, 2007. If the General Assembly determines that resources are not available to fully fund the fee schedule for pediatric specialty physician care required by this subsection (b), then, until such time as the General Assembly determines that such funding is available, the Department shall increase any payment for physicians who provide pediatric specialty care services under the medical assistance program by an amount proportionately equivalent to any other increases for physicians, federally qualified health centers, rural health centers, or other non-institutional providers providing services to children for any services provided under this Article.".