Illinois General Assembly - Full Text of HB0207
Illinois General Assembly

Previous General Assemblies

Full Text of HB0207  101st General Assembly




State of Illinois
2019 and 2020


Introduced , by Rep. Mary E. Flowers


New Act

    Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health care providers. Sets forth the specific standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the program. Requires the State to establish the Illinois Health Services Trust to provide financing for the program. Sets forth the specific requirements for claims billed under the program. Provides that the program shall include funding for long-term care services and mental health services. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Provides that patients in the program shall have the same rights and privacy as they are entitled to under current State and federal law. Provides that the Commissioner, the Chief Medical Officer, the public State board members, and employees of the program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective July 1, 2019.

LRB101 04728 CPF 49737 b






HB0207LRB101 04728 CPF 49737 b

1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the Health
5Care for All Illinois Act.
6    Section 5. Purposes. It is the purpose of this Act to
7provide universal access to health care for all individuals
8within the State, to promote and improve the health of all its
9citizens, to stress the importance of good public health
10through treatment and prevention of diseases, and to contain
11costs to make the delivery of this care affordable. Should
12legislation of this kind be enacted on a federal level, it is
13the intent of this Act to become a part of a nationwide system.
14    Section 10. Definitions. In this Act:
15    "Board" means the Illinois Health Services Governing
17    "Program" means the Illinois Health Services Program.
18    Section 15. Eligibility; registration. All individuals
19residing in this State are covered under the Illinois Health
20Services Program for health insurance and shall receive a card
21with a unique number in the mail. An individual's social



HB0207- 2 -LRB101 04728 CPF 49737 b

1security number shall not be used for purposes of registration
2under this Section. Individuals and families shall receive an
3Illinois Health Services Insurance Card in the mail after
4filling out a program application form at a health care
5provider. Such application form shall be no more than 2 pages
6long. Individuals who present themselves for covered services
7from a participating provider shall be presumed to be eligible
8for benefits under this Act, but shall complete an application
9for benefits in order to receive an Illinois Health Services
10Insurance Card and have payment made for such benefits.
11    Section 20. Benefits and portability.
12    (a) The health coverage benefits under this Act cover all
13medically necessary services, including:
14        (1) primary care and prevention;
15        (2) specialty care (other than what is deemed elective
16    cosmetic);
17        (3) inpatient care;
18        (4) outpatient care;
19        (5) emergency care;
20        (6) prescription drugs;
21        (7) durable medical equipment;
22        (8) long-term care;
23        (9) mental health services;
24        (10) the full scope of dental services (other than
25    elective cosmetic dentistry);



HB0207- 3 -LRB101 04728 CPF 49737 b

1        (11) substance abuse treatment services;
2        (12) chiropractic services; and
3        (13) basic vision care and vision correction.
4    (b) Health coverage benefits under this Act are available
5through any licensed health care provider anywhere in the State
6that is legally qualified to provide such benefits and for
7emergency care anywhere in the United States.
8    (c) No deductibles, copayments, coinsurance, or other cost
9sharing shall be imposed with respect to covered benefits
10except for those goods or services that exceed basic covered
11benefits, as defined by the Board.
12    Section 25. Qualification of participating providers.
13    (a) Health care delivery facilities must meet regional and
14State quality and licensing guidelines as a condition of
15participation under the program, including guidelines
16regarding safe staffing and quality of care.
17    (b) A participating health care provider must be licensed
18by the State. No health care provider whose license is under
19suspension or has been revoked may participate in the program.
20    (c) Only nonprofit health maintenance organizations that
21actually deliver care in their own facilities and directly
22employ clinicians may participate in the program.
23    (d) Patients shall have free choice of participating
24eligible providers, hospitals, and inpatient care facilities.



HB0207- 4 -LRB101 04728 CPF 49737 b

1    Section 30. Provider reimbursement.
2    (a) The program shall pay all health care providers
3according to the following standards:
4        (1) Physicians and other practitioners can choose to be
5    paid fee-for-service, salaried by institutions receiving
6    global budgets, or salaried by group practices or health
7    maintenance organizations receiving capitation payments.
8    Investor-owned health maintenance organizations and group
9    practices shall be converted to not-for-profit status.
10    Only institutions that deliver care shall be eligible for
11    program payments.
12        (2) The program will pay each hospital and providing
13    institution a monthly lump sum (global budget) to cover all
14    operating expenses. The hospital and program will
15    negotiate the amount of this payment annually based on past
16    budgets, clinical performance, projected changes in demand
17    for services and input costs, and proposed new programs.
18    Hospitals shall not bill patients for services covered by
19    the program, and cannot use any of their operating budgets
20    for expansion, profit, excessive executive income,
21    marketing, or major capital purchases or leases.
22        (3) The program budget will fund major capital
23    expenditures, including the construction of new health
24    facilities and the purchase of expensive equipment. The
25    regional health planning districts shall allocate these
26    capital funds and oversee capital projects funded from



HB0207- 5 -LRB101 04728 CPF 49737 b

1    private donations.
2    (b) The program shall reimburse physicians choosing to be
3paid fee-for-service according to a fee schedule negotiated
4between physician representatives and the program on at least
5an annual basis.
6    (c) Hospitals, nursing homes, community health centers,
7nonprofit staff model health maintenance organizations, and
8home health care agencies will receive a global budget to cover
9operating expenses, negotiated annually with the program based
10on past expenditures, past budgets, clinical performance,
11projected changes in demand for services and input costs, and
12proposed new programs. Expansions and other substantive
13capital investments will be funded separately.
14    (d) All covered prescription drugs and durable medical
15supplies will be paid for according to a fee schedule
16negotiated between manufacturers and the program on at least an
17annual basis. Price reductions shall be achieved by bulk
18purchasing whenever possible. Where therapeutically equivalent
19drugs are available, the formulary shall specify the use of the
20lowest-cost medication, with exceptions available in the case
21of medical necessity.
22    Section 35. Prohibition against duplicating coverage;
23investor-ownership of health delivery facilities.
24    (a) It is unlawful for a private health insurer to sell
25health insurance coverage that duplicates the benefits



HB0207- 6 -LRB101 04728 CPF 49737 b

1provided under this Act. Nothing in this Act shall be construed
2as prohibiting the sale of health insurance coverage for any
3additional benefits not covered by this Act.
4    (b) Investor-ownership of health delivery facilities,
5including hospitals, health maintenance organizations, nursing
6homes, and clinics, is unlawful. Investor-owners of health
7delivery facilities at the time of the effective date of this
8Act shall be compensated for the loss of their facilities, but
9not for loss of business opportunities or for administrative
10capacity not used by the program.
11    Section 40. Illinois Health Services Trust.
12    (a) The State shall establish the Illinois Health Services
13Trust (IHST), the sole purpose of which shall be to provide the
14financing reserve for the purposes outlined in this Act.
15Specifically, the IHST shall provide all of the following:
16        (1) The funds for the general operating budget of the
17    program.
18        (2) Reimbursement for those benefits outlined in
19    Section 20 of this Act.
20        (3) Public health services.
21        (4) Capital expenditures for construction or
22    renovation of health care facilities or major equipment
23    purchases deemed necessary throughout the State and
24    approved by the Board.
25        (5) Re-education and job placement of persons who have



HB0207- 7 -LRB101 04728 CPF 49737 b

1    lost their jobs as a result of this transition, limited to
2    the first 5 years.
3    (b) The General Assembly or the Governor may provide funds
4to the IHST, but may not remove or borrow funds from the IHST.
5    (c) The IHST shall be administered by the Board, under the
6oversight of the General Assembly.
7    (d) Funding of the IHST shall include, but is not limited
8to, all of the following:
9        (1) Funds appropriated as outlined by the General
10    Assembly on a yearly basis.
11        (2) A progressive set of graduated income
12    contributions; 20% paid by individuals, 20% paid by
13    businesses, and 60% paid by the government.
14        (3) All federal moneys that are designated for health
15    care, including, but not limited to, all moneys designated
16    for Medicaid. The Secretary of Human Services shall be
17    authorized to negotiate with the federal government for
18    funding of Medicare recipients.
19        (4) Grants and contributions, both public and private.
20        (5) Any other tax revenues designated by the General
21    Assembly.
22        (6) Any other funds specifically earmarked for health
23    care or health care education, such as settlements from
24    litigation.
25    (e) The total overhead and administrative portion of the
26program budget may not exceed 12% of the total operating budget



HB0207- 8 -LRB101 04728 CPF 49737 b

1of the program for the first 2 years that the program is in
2operation; 8% for the following 2 years; and 5% for each year
4    (f) The program may be divided into regional districts for
5the purposes of local administration and oversight of programs
6that are specific to each region's needs.
7    (g) Claims billing from all providers must be submitted
8electronically and in compliance with current State and federal
9privacy laws within 5 years after the effective date of this
10Act. Electronic claims and billing must be uniform across the
11State. The Board shall create and implement a statewide uniform
12system of electronic medical records that is in compliance with
13current State and federal privacy laws within 7 years after the
14effective date of this Act. Payments to providers must be made
15in a timely fashion as outlined under current State and federal
16law. Providers who accept payment from the program for services
17rendered may not bill any patient for covered services.
18Providers may elect either to participate fully, or not at all,
19in the program.
20    Section 45. Long-term care payment. The Board shall
21establish funding for long-term care services, including
22in-home, nursing home, and community-based care. A local public
23agency shall be established in each community to determine
24eligibility and coordinate home and nursing home long-term
25care. This agency may contract with long-term care providers



HB0207- 9 -LRB101 04728 CPF 49737 b

1for the full range of needed long-term care services.
2    Section 50. Mental health services. The program shall
3provide coverage for all medically necessary mental health care
4on the same basis as the coverage for other conditions. The
5program shall cover supportive residences, occupational
6therapy, and ongoing mental health and counseling services
7outside the hospital for patients with serious mental illness.
8In all cases the highest quality and most effective care shall
9be delivered, including institutional care.
10    Section 55. Payment for prescription medications, medical
11supplies, and medically necessary assistive equipment.
12    (a) The program shall establish a single prescription drug
13formulary and list of approved durable medical goods and
14supplies. The Board shall, by itself or by a committee of
15health professionals and related individuals appointed by the
16Board and called the Pharmaceutical and Durable Medical Goods
17Committee, meet on a quarterly basis to discuss, reverse, add
18to, or remove items from the formulary according to sound
19medical practice.
20    (b) The Pharmaceutical and Durable Medical Goods Committee
21shall negotiate the prices of pharmaceuticals and durable
22medical goods with suppliers or manufacturers on an open bid
23competitive basis. Prices shall be reviewed, negotiated, or
24renegotiated on no less than an annual basis. The



HB0207- 10 -LRB101 04728 CPF 49737 b

1Pharmaceutical and Durable Medical Goods Committee shall
2establish a process of open forum to the public for the
3purposes of grievance and petition from suppliers, provider
4groups, and the public regarding the formulary no less than 2
5times a year.
6    (c) All pharmacy and durable medical goods vendors must be
7licensed to distribute medical goods through the regulations
8outlined by the Board.
9    (d) All decisions and determinations of the Pharmaceutical
10and Durable Medical Goods Committee must be presented to and
11approved by the Board on an annual basis.
12    Section 60. Illinois Health Services Governing Board.
13    (a) The program shall be administered by an independent
14agency known as the Illinois Health Services Governing Board.
15The Board will consist of a Commissioner, a Chief Medical
16Officer, and public State board members. The Board is
17responsible for administration of the program, including:
18        (1) implementation of eligibility standards and
19    program enrollment;
20        (2) adoption of the benefits package;
21        (3) establishing formulas for setting health
22    expenditure budgets;
23        (4) administration of global budgets, capital
24    expenditure budgets, and prompt reimbursement of
25    providers;



HB0207- 11 -LRB101 04728 CPF 49737 b

1        (5) negotiations of service fee schedules and prices
2    for prescription drugs and durable medical supplies;
3        (6) recommending evidence-based changes to benefits;
4    and
5        (7) quality and planning functions, including criteria
6    for capital expansion and infrastructure development,
7    measurement and evaluation of health quality indicators,
8    and the establishment of regions for long-term care
9    integration.
10    (b) At least one-third of the members of the Board,
11including all committees dedicated to benefits design, health
12planning, quality, and long-term care, shall be consumer
14    Section 65. Patients' rights. The program shall protect the
15rights and privacy of the patients that it serves in accordance
16with all current State and federal statutes. With the
17development of the electronic medical records, patients shall
18be afforded the right and option of keeping any portion of
19their medical records separate from the electronic medical
20records. Patients have the right to access their medical
21records upon demand.
22    Section 70. Compensation. The Commissioner, the Chief
23Medical Officer, public State board members, and employees of
24the program shall be compensated in accordance with the current



HB0207- 12 -LRB101 04728 CPF 49737 b

1pay scale for State employees and as deemed professionally
2appropriate by the General Assembly and reviewed in accordance
3with all other State employees.
4    Section 99. Effective date. This Act takes effect July 1,