Rep. Esther Golar

Filed: 3/1/2012

 

 


 

 


 
09700HB3893ham001LRB097 14519 KTG 66964 a

1
AMENDMENT TO HOUSE BILL 3893

2    AMENDMENT NO. ______. Amend House Bill 3893 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Children's Health Insurance Program Act is
5amended by changing Section 23 as follows:
 
6    (215 ILCS 106/23)
7    Sec. 23. Care coordination.
8    (a) At least 50% of recipients eligible for for
9comprehensive medical benefits in all medical assistance
10programs or other health benefit programs administered by the
11Department, including the Children's Health Insurance Program
12Act and the Covering ALL KIDS Health Insurance Act, shall be
13enrolled in a care coordination program by no later than
14January 1, 2015. For purposes of this Section, "coordinated
15care" or "care coordination" means delivery systems where
16recipients will receive their care from providers who

 

 

09700HB3893ham001- 2 -LRB097 14519 KTG 66964 a

1participate under contract in integrated delivery systems that
2are responsible for providing or arranging the majority of
3care, including primary care physician services, referrals
4from primary care physicians, diagnostic and treatment
5services, behavioral health services, in-patient and
6outpatient hospital services, dental services, and
7rehabilitation and long-term care services. The Department
8shall designate or contract for such integrated delivery
9systems (i) to ensure enrollees have a choice of systems and of
10primary care providers within such systems; (ii) to ensure that
11enrollees receive quality care in a culturally and
12linguistically appropriate manner; and (iii) to ensure that
13coordinated care programs meet the diverse needs of enrollees
14with developmental, mental health, physical, and age-related
15disabilities.
16    (b) Payment for such coordinated care shall be based on
17arrangements where the State pays for performance related to
18health care outcomes, the use of evidence-based practices, the
19use of primary care delivered through comprehensive medical
20homes, the use of electronic medical records, and the
21appropriate exchange of health information electronically made
22either on a capitated basis in which a fixed monthly premium
23per recipient is paid and full financial risk is assumed for
24the delivery of services, or through other risk-based payment
25arrangements.
26    (c) To qualify for compliance with this Section, the 50%

 

 

09700HB3893ham001- 3 -LRB097 14519 KTG 66964 a

1goal shall be achieved by enrolling medical assistance
2enrollees from each medical assistance enrollment category,
3including parents, children, seniors, and people with
4disabilities to the extent that current State Medicaid payment
5laws would not limit federal matching funds for recipients in
6care coordination programs. In addition, services must be more
7comprehensively defined and more risk shall be assumed than in
8the Department's primary care case management program as of the
9effective date of this amendatory Act of the 96th General
10Assembly.
11    (d) The Department shall report to the General Assembly in
12a separate part of its annual medical assistance program
13report, beginning April, 2012 until April, 2016, on the
14progress and implementation of the care coordination program
15initiatives established by the provisions of this amendatory
16Act of the 96th General Assembly. The Department shall include
17in its April 2011 report a full analysis of federal laws or
18regulations regarding upper payment limitations to providers
19and the necessary revisions or adjustments in rate
20methodologies and payments to providers under this Code that
21would be necessary to implement coordinated care with full
22financial risk by a party other than the Department.
23(Source: P.A. 96-1501, eff. 1-25-11.)
 
24    Section 10. The Covering ALL KIDS Health Insurance Act is
25amended by changing Section 56 as follows:
 

 

 

09700HB3893ham001- 4 -LRB097 14519 KTG 66964 a

1    (215 ILCS 170/56)
2    (Section scheduled to be repealed on July 1, 2016)
3    Sec. 56. Care coordination.
4    (a) At least 50% of recipients eligible for for
5comprehensive medical benefits in all medical assistance
6programs or other health benefit programs administered by the
7Department, including the Children's Health Insurance Program
8Act and the Covering ALL KIDS Health Insurance Act, shall be
9enrolled in a care coordination program by no later than
10January 1, 2015. For purposes of this Section, "coordinated
11care" or "care coordination" means delivery systems where
12recipients will receive their care from providers who
13participate under contract in integrated delivery systems that
14are responsible for providing or arranging the majority of
15care, including primary care physician services, referrals
16from primary care physicians, diagnostic and treatment
17services, behavioral health services, in-patient and
18outpatient hospital services, dental services, and
19rehabilitation and long-term care services. The Department
20shall designate or contract for such integrated delivery
21systems (i) to ensure enrollees have a choice of systems and of
22primary care providers within such systems; (ii) to ensure that
23enrollees receive quality care in a culturally and
24linguistically appropriate manner; and (iii) to ensure that
25coordinated care programs meet the diverse needs of enrollees

 

 

09700HB3893ham001- 5 -LRB097 14519 KTG 66964 a

1with developmental, mental health, physical, and age-related
2disabilities.
3    (b) Payment for such coordinated care shall be based on
4arrangements where the State pays for performance related to
5health care outcomes, the use of evidence-based practices, the
6use of primary care delivered through comprehensive medical
7homes, the use of electronic medical records, and the
8appropriate exchange of health information electronically made
9either on a capitated basis in which a fixed monthly premium
10per recipient is paid and full financial risk is assumed for
11the delivery of services, or through other risk-based payment
12arrangements.
13    (c) To qualify for compliance with this Section, the 50%
14goal shall be achieved by enrolling medical assistance
15enrollees from each medical assistance enrollment category,
16including parents, children, seniors, and people with
17disabilities to the extent that current State Medicaid payment
18laws would not limit federal matching funds for recipients in
19care coordination programs. In addition, services must be more
20comprehensively defined and more risk shall be assumed than in
21the Department's primary care case management program as of the
22effective date of this amendatory Act of the 96th General
23Assembly.
24    (d) The Department shall report to the General Assembly in
25a separate part of its annual medical assistance program
26report, beginning April, 2012 until April, 2016, on the

 

 

09700HB3893ham001- 6 -LRB097 14519 KTG 66964 a

1progress and implementation of the care coordination program
2initiatives established by the provisions of this amendatory
3Act of the 96th General Assembly. The Department shall include
4in its April 2011 report a full analysis of federal laws or
5regulations regarding upper payment limitations to providers
6and the necessary revisions or adjustments in rate
7methodologies and payments to providers under this Code that
8would be necessary to implement coordinated care with full
9financial risk by a party other than the Department.
10(Source: P.A. 96-1501, eff. 1-25-11.)
 
11    Section 15. The Illinois Public Aid Code is amended by
12changing Section 5-30 as follows:
 
13    (305 ILCS 5/5-30)
14    Sec. 5-30. Care coordination.
15    (a) At least 50% of recipients eligible for for
16comprehensive medical benefits in all medical assistance
17programs or other health benefit programs administered by the
18Department, including the Children's Health Insurance Program
19Act and the Covering ALL KIDS Health Insurance Act, shall be
20enrolled in a care coordination program by no later than
21January 1, 2015. For purposes of this Section, "coordinated
22care" or "care coordination" means delivery systems where
23recipients will receive their care from providers who
24participate under contract in integrated delivery systems that

 

 

09700HB3893ham001- 7 -LRB097 14519 KTG 66964 a

1are responsible for providing or arranging the majority of
2care, including primary care physician services, referrals
3from primary care physicians, diagnostic and treatment
4services, behavioral health services, in-patient and
5outpatient hospital services, dental services, and
6rehabilitation and long-term care services. The Department
7shall designate or contract for such integrated delivery
8systems (i) to ensure enrollees have a choice of systems and of
9primary care providers within such systems; (ii) to ensure that
10enrollees receive quality care in a culturally and
11linguistically appropriate manner; and (iii) to ensure that
12coordinated care programs meet the diverse needs of enrollees
13with developmental, mental health, physical, and age-related
14disabilities.
15    (b) Payment for such coordinated care shall be based on
16arrangements where the State pays for performance related to
17health care outcomes, the use of evidence-based practices, the
18use of primary care delivered through comprehensive medical
19homes, the use of electronic medical records, and the
20appropriate exchange of health information electronically made
21either on a capitated basis in which a fixed monthly premium
22per recipient is paid and full financial risk is assumed for
23the delivery of services, or through other risk-based payment
24arrangements.
25    (c) To qualify for compliance with this Section, the 50%
26goal shall be achieved by enrolling medical assistance

 

 

09700HB3893ham001- 8 -LRB097 14519 KTG 66964 a

1enrollees from each medical assistance enrollment category,
2including parents, children, seniors, and people with
3disabilities to the extent that current State Medicaid payment
4laws would not limit federal matching funds for recipients in
5care coordination programs. In addition, services must be more
6comprehensively defined and more risk shall be assumed than in
7the Department's primary care case management program as of the
8effective date of this amendatory Act of the 96th General
9Assembly.
10    (d) The Department shall report to the General Assembly in
11a separate part of its annual medical assistance program
12report, beginning April, 2012 until April, 2016, on the
13progress and implementation of the care coordination program
14initiatives established by the provisions of this amendatory
15Act of the 96th General Assembly. The Department shall include
16in its April 2011 report a full analysis of federal laws or
17regulations regarding upper payment limitations to providers
18and the necessary revisions or adjustments in rate
19methodologies and payments to providers under this Code that
20would be necessary to implement coordinated care with full
21financial risk by a party other than the Department.
22(Source: P.A. 96-1501, eff. 1-25-11.)".