97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB2878

 

Introduced 2/1/2012, by Sen. William Delgado

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 106/23

    Amends the Children's Health Insurance Program Act. Deletes dental services from the definition of "coordinated care" and "care coordination". Effective immediately.


LRB097 13783 RPM 58342 b

 

 

A BILL FOR

 

SB2878LRB097 13783 RPM 58342 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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 comprehensive
9medical benefits in all medical assistance programs or other
10health benefit programs administered by the Department,
11including the Children's Health Insurance Program Act and the
12Covering ALL KIDS Health Insurance Act, shall be enrolled in a
13care coordination program by no later than January 1, 2015. For
14purposes of this Section, "coordinated care" or "care
15coordination" means delivery systems where recipients will
16receive their care from providers who participate under
17contract in integrated delivery systems that are responsible
18for providing or arranging the majority of care, including
19primary care physician services, referrals from primary care
20physicians, diagnostic and treatment services, behavioral
21health services, in-patient and outpatient hospital services,
22dental services, and rehabilitation and long-term care
23services. The Department shall designate or contract for such

 

 

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1integrated delivery systems (i) to ensure enrollees have a
2choice of systems and of primary care providers within such
3systems; (ii) to ensure that enrollees receive quality care in
4a culturally and linguistically appropriate manner; and (iii)
5to ensure that coordinated care programs meet the diverse needs
6of enrollees with developmental, mental health, physical, and
7age-related disabilities.
8    (b) Payment for such coordinated care shall be based on
9arrangements where the State pays for performance related to
10health care outcomes, the use of evidence-based practices, the
11use of primary care delivered through comprehensive medical
12homes, the use of electronic medical records, and the
13appropriate exchange of health information electronically made
14either on a capitated basis in which a fixed monthly premium
15per recipient is paid and full financial risk is assumed for
16the delivery of services, or through other risk-based payment
17arrangements.
18    (c) To qualify for compliance with this Section, the 50%
19goal shall be achieved by enrolling medical assistance
20enrollees from each medical assistance enrollment category,
21including parents, children, seniors, and people with
22disabilities to the extent that current State Medicaid payment
23laws would not limit federal matching funds for recipients in
24care coordination programs. In addition, services must be more
25comprehensively defined and more risk shall be assumed than in
26the Department's primary care case management program as of the

 

 

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1effective date of this amendatory Act of the 96th General
2Assembly.
3    (d) The Department shall report to the General Assembly in
4a separate part of its annual medical assistance program
5report, beginning April, 2012 until April, 2016, on the
6progress and implementation of the care coordination program
7initiatives established by the provisions of this amendatory
8Act of the 96th General Assembly. The Department shall include
9in its April 2011 report a full analysis of federal laws or
10regulations regarding upper payment limitations to providers
11and the necessary revisions or adjustments in rate
12methodologies and payments to providers under this Code that
13would be necessary to implement coordinated care with full
14financial risk by a party other than the Department.
15(Source: P.A. 96-1501, eff. 1-25-11.)
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.