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94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 HB2898
Introduced 2/22/2005, by Rep. Tom Cross SYNOPSIS AS INTRODUCED: |
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305 ILCS 5/5-16 |
from Ch. 23, par. 5-16 |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care.
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A BILL FOR
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HB2898 |
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LRB094 08628 DRJ 38836 b |
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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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.
The Illinois Department may |
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| develop and
and implement
a Primary Care Sponsor System |
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| consistent with the provisions of this Section.
The purpose of |
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| this managed care delivery system shall be to contain the costs
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| of providing medical care to Medicaid recipients by having one |
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| provider
responsible for managing all aspects of a recipient's |
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| medical care. This
managed care system shall have the following |
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| 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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HB2898 |
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LRB094 08628 DRJ 38836 b |
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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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HB2898 |
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LRB094 08628 DRJ 38836 b |
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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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| (Source: P.A. 87-14; 88-490.)
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