95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
HB2870

 

Introduced 2/26/2007, by Rep. Tom Cross

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-16   from Ch. 23, par. 5-16

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care.


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A BILL FOR

 

HB2870 LRB095 07577 DRJ 27727 b

1     AN ACT concerning public aid.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Illinois Public Aid Code is amended by
5 changing Section 5-16 as follows:
 
6     (305 ILCS 5/5-16)  (from Ch. 23, par. 5-16)
7     Sec. 5-16. Managed Care. The The Illinois Department may
8 develop and implement a Primary Care Sponsor System consistent
9 with the provisions of this Section. The purpose of this
10 managed care delivery system shall be to contain the costs of
11 providing medical care to Medicaid recipients by having one
12 provider responsible for managing all aspects of a recipient's
13 medical care. This managed care system shall have the following
14 characteristics:
15         (a) The Department, by rule, shall establish criteria
16     to determine which clients must participate in this
17     program;
18         (b) Providers participating in the program may be paid
19     an amount per patient per month, to be set by the Illinois
20     Department, for managing each recipient's medical care;
21         (c) Providers eligible to participate in the program
22     shall be physicians licensed to practice medicine in all
23     its branches, and the Illinois Department may terminate a

 

 

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1     provider's participation if the provider is determined to
2     have failed to comply with any applicable program standard
3     or procedure established by the Illinois Department;
4         (d) Each recipient required to participate in the
5     program must select from a panel of primary care providers
6     or networks established by the Department in their
7     communities;
8         (e) A recipient may change his designated primary care
9     provider:
10             (1) when the designated source becomes
11         unavailable, as the Illinois Department shall
12         determine by rule; or
13             (2) when the designated primary care provider
14         notifies the Illinois Department that it wishes to
15         withdraw from any obligation as primary care provider;
16         or
17             (3) in other situations, as the Illinois
18         Department shall provide by rule;
19         (f) The Illinois Department shall, by rule, establish
20     procedures for providing medical services when the
21     designated source becomes unavailable or wishes to
22     withdraw from any obligation as primary care provider
23     taking into consideration the need for emergency or
24     temporary medical assistance and ensuring that the
25     recipient has continuous and unrestricted access to
26     medical care from the date on which such unavailability or

 

 

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1     withdrawal becomes effective until such time as the
2     recipient designates a primary care source;
3         (g) Only medical care services authorized by a
4     recipient's designated provider, except for emergency
5     services, services performed by a provider that is owned or
6     operated by a county and that provides non-emergency
7     services without regard to ability to pay and such other
8     services as provided by the Illinois Department, shall be
9     subject to payment by the Illinois Department. The Illinois
10     Department shall enter into an intergovernmental agreement
11     with each county that owns or operates such a provider to
12     develop and implement policies to minimize the provision of
13     medical care services provided by county owned or operated
14     providers pursuant to the foregoing exception.
15     The Illinois Department shall seek and obtain necessary
16 authorization provided under federal law to implement such a
17 program including the waiver of any federal regulations.
18     The Illinois Department may implement the amendatory
19 changes to this Section made by this amendatory Act of 1991
20 through the use of emergency rules in accordance with the
21 provisions of Section 5.02 of the Illinois Administrative
22 Procedure Act. For purposes of the Illinois Administrative
23 Procedure Act, the adoption of rules to implement the
24 amendatory changes to this Section made by this amendatory Act
25 of 1991 shall be deemed an emergency and necessary for the
26 public interest, safety and welfare.

 

 

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1     The Illinois Department may establish a managed care system
2 demonstration program, on a limited basis, as described in this
3 Section. The demonstration program shall terminate on June 30,
4 1997. Within 30 days after the end of each year of the
5 demonstration program's operation, the Illinois Department
6 shall report to the Governor and the General Assembly
7 concerning the operation of the demonstration program.
8 (Source: P.A. 87-14; 88-490.)