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Rep. Dwight Kay
Filed: 4/20/2015
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1 | | AMENDMENT TO HOUSE BILL 2435
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2 | | AMENDMENT NO. ______. Amend House Bill 2435, AS AMENDED, by |
3 | | replacing everything after the enacting clause with the |
4 | | following:
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5 | | "Section 5. The Illinois Public Aid Code is amended by |
6 | | changing Section 5-11a as follows: |
7 | | (305 ILCS 5/5-11a) |
8 | | Sec. 5-11a. Health Benefit Information Systems. |
9 | | (a) It is the intent of the General Assembly to support |
10 | | unified electronic systems initiatives that will improve |
11 | | management of information related to medical assistance |
12 | | programs. This will include improved management capabilities |
13 | | and new systems for Eligibility, Verification, and Enrollment |
14 | | (EVE) that will simplify and increase efficiencies in and |
15 | | access to the medical assistance programs and ensure program |
16 | | integrity. The Department of Healthcare and Family Services, in |
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1 | | coordination with the Department of Human Services and other |
2 | | appropriate state agencies, shall develop a plan by July 1, |
3 | | 2011, that will: |
4 | | (1) Subject to federal and State privacy and |
5 | | confidentiality laws and regulations, meet standards for |
6 | | timely eligibility verification and enrollment, and annual |
7 | | redetermination of eligibility, of applicants for and |
8 | | recipients of means-tested health benefits sponsored by |
9 | | the State, including medical assistance under this Code. |
10 | | (2) Receive and update data electronically from the |
11 | | Social Security Administration, the U.S. Postal Service, |
12 | | the Illinois Secretary of State, the Department of Revenue, |
13 | | the Department of Employment Security, and other |
14 | | governmental entities, as appropriate and to the extent |
15 | | allowed by law, for verification of any factor of |
16 | | eligibility for medical assistance and for updating |
17 | | addresses of applicants and recipients of medical |
18 | | assistance and other health benefit programs administered |
19 | | by the Department. Data relevant to eligibility shall be |
20 | | provided for no other purpose than to verify the |
21 | | eligibility of new applicants or current recipients of |
22 | | health benefits provided by the State. Data shall be |
23 | | requested or provided for any individual only insofar as |
24 | | that new applicant or current recipient's circumstances |
25 | | are relevant to that individual's or another individual's |
26 | | eligibility for State-sponsored health benefits. |
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1 | | (3) Meet federal requirements for timely installation |
2 | | by January 1, 2014 to provide integration with a Health |
3 | | Benefits Exchange pursuant to the requirements of the |
4 | | federal Affordable Care Act and the Reconciliation Act and |
5 | | any subsequent amendments thereto and to ensure capture of |
6 | | the maximum available federal financial
participation |
7 | | (FFP). |
8 | | (4) Meet federal requirements for compliance with |
9 | | architectural standards, including, but not limited to, |
10 | | (i) the use of a module development as outlined by the |
11 | | Medicaid Information Technology Architecture standards, |
12 | | (ii) the use of federally approved open-interfaces where |
13 | | they exist, (iii) the use or the creation of |
14 | | open-interfaces where necessary, and (iv) the use of rules |
15 | | technology that can dynamically accept and modify rules in |
16 | | standard formats. |
17 | | (5) Include plans to ensure coordination with the State |
18 | | of Illinois Framework Project that will (i) expedite and |
19 | | simplify access to services provided by Illinois human |
20 | | services programs; (ii) streamline administration and data |
21 | | sharing; (iii) enhance planning capacity, program |
22 | | evaluation, and fraud detection or prevention with access |
23 | | to cross-agency data; and (iv) simplify service reporting |
24 | | for contracted providers. |
25 | | (b) The Department of Healthcare and Family Services shall |
26 | | continue to plan for and implement a new Medicaid Management |
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1 | | Information System (MMIS) and upgrade the capabilities of the |
2 | | MMIS data warehouse. Upgrades shall include, among other |
3 | | things, enhanced capabilities in data analysis including the |
4 | | ability to identify risk factors that could impact the |
5 | | treatment and resulting quality of care, and tools that perform |
6 | | predictive analytics on data applying to newborns, women with |
7 | | high risk pregnancies, and other populations served by the |
8 | | Department. |
9 | | (c) The Department of Healthcare and Family Services shall |
10 | | report in its annual Medical Assistance program report each |
11 | | April through April, 2015 on the progress and implementation of |
12 | | this plan.
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13 | | (d) The Department of Healthcare and Family Services shall |
14 | | not use a virtual provider network to contract with any entity |
15 | | located outside the United States or with any entity that |
16 | | subcontracts with another entity located outside the United |
17 | | States for the purpose of processing claims under the medical |
18 | | assistance program where the personal or confidential |
19 | | information of medical assistance recipients is used or |
20 | | transmitted by employees working for the entity directly or |
21 | | through subcontract. |
22 | | For the purposes of this subsection: |
23 | | "Entity" means a proprietorship,
partnership, association, |
24 | | trust, estate, business trust, group, or
corporation, whether |
25 | | or not operated for profit, or a governmental agency,
unit, or |
26 | | subdivision. |
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1 | | "Personal or confidential information" includes, but is |
2 | | not limited to, social security numbers, healthcare |
3 | | information, and medical records. |
4 | | "Subcontract" means a contract or contractual action |
5 | | entered into by
a prime contractor or subcontractor for the |
6 | | purpose of obtaining goods or
services of any kind under a |
7 | | prime contract. |
8 | | (Source: P.A. 96-1501, eff. 1-25-11.)".
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