Full Text of SB3020 94th General Assembly
SB3020 94TH GENERAL ASSEMBLY
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94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 SB3020
Introduced 1/20/2006, by Sen. Dale A. Righter - Christine Radogno - Larry K. Bomke - Gary G. Dahl - Cheryl Axley, et al. 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. Provides that in State fiscal year 2007, the Department of Healthcare and Family Services shall implement a pilot mandatory managed care program requiring recipients to enroll with a managed care organization under contract with the Department. Provides that the program shall be implemented in at least 4 contiguous counties determined suitable for a managed care organization-based managed care system using objective criteria. Sets forth features that the program must include, including criteria for evaluating potential managed care organization contractors. Effective immediately.
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A BILL FOR
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SB3020 |
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LRB094 18935 DRJ 54383 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 | 5 |
| 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 | 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:
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| (a) The Department, by rule, shall establish criteria | 16 |
| to determine
which clients must participate in this | 17 |
| program;
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| (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;
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| (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 | 24 |
| provider's participation if the
provider is determined to | 25 |
| have failed to comply with any applicable program
standard | 26 |
| or procedure established by the Illinois Department;
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| (d) Each recipient required to participate in the | 28 |
| program must select
from a panel of primary care providers | 29 |
| or networks established by the
Department in their | 30 |
| communities;
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| (e) A recipient may change his designated primary care | 32 |
| provider:
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SB3020 |
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LRB094 18935 DRJ 54383 b |
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| (1) when the designated source becomes | 2 |
| unavailable, as the Illinois
Department shall | 3 |
| determine by rule; or
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| (2) when the designated primary care provider | 5 |
| notifies the Illinois
Department that it wishes to | 6 |
| withdraw from any obligation as primary care
provider; | 7 |
| or
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| (3) in other situations, as the Illinois | 9 |
| Department shall provide by
rule;
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| (f) The Illinois Department shall, by rule, establish | 11 |
| procedures for
providing medical services when the | 12 |
| designated source becomes unavailable or
wishes to | 13 |
| withdraw from any obligation as primary care provider | 14 |
| taking into
consideration the need for emergency or | 15 |
| temporary medical assistance and
ensuring that the | 16 |
| recipient has continuous and unrestricted access to | 17 |
| medical
care from the date on which such unavailability or | 18 |
| withdrawal becomes effective
until such time as the | 19 |
| recipient designates a primary care source;
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| (g) Only medical care services authorized by a | 21 |
| recipient's designated
provider, except for emergency | 22 |
| services, services performed by a provider
that is owned or | 23 |
| operated by a county and that provides non-emergency
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| services without regard to ability to pay and such other | 25 |
| services as provided
by the Illinois Department, shall be | 26 |
| subject to payment by the Illinois
Department. The Illinois | 27 |
| Department shall enter into an
intergovernmental agreement | 28 |
| with each county that owns or operates such a
provider to | 29 |
| develop and implement policies to minimize the provision of
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| medical care services provided by county owned or operated | 31 |
| providers
pursuant to the foregoing exception.
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| The Illinois Department shall seek and obtain necessary | 33 |
| authorization
provided under federal law to implement such a | 34 |
| program including the waiver of
any federal regulations.
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| The Illinois Department may implement the amendatory | 36 |
| changes to
this Section made by this amendatory Act of 1991 |
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SB3020 |
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LRB094 18935 DRJ 54383 b |
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| through the use of emergency
rules in accordance with the | 2 |
| provisions of Section 5.02 of the Illinois
Administrative | 3 |
| Procedure Act. For purposes of the Illinois Administrative
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| Procedure Act, the adoption of rules to implement the | 5 |
| amendatory changes to
this Section made by this amendatory Act | 6 |
| of 1991 shall be deemed an emergency
and necessary for the | 7 |
| public interest, safety and welfare.
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| The Illinois Department may establish a managed care system | 9 |
| demonstration
program, on a limited basis, as described in this | 10 |
| Section. The demonstration
program shall terminate on June 30, | 11 |
| 1997. Within 30 days after the end of each
year of the | 12 |
| demonstration program's operation, the Illinois Department | 13 |
| shall
report to the Governor and the General Assembly | 14 |
| concerning the operation of the
demonstration program.
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| In order to determine the potential for savings and | 16 |
| improved quality of care in the Medicaid program, in State | 17 |
| fiscal year 2007, the Department shall implement a pilot | 18 |
| mandatory managed care program requiring recipients to enroll | 19 |
| with a managed care organization under contract with the | 20 |
| Department. The program shall be implemented in at least 4 | 21 |
| contiguous counties determined suitable for a managed care | 22 |
| organization-based managed care system using objective | 23 |
| criteria. The program shall have the following features: | 24 |
| (A) All recipients in the selected counties who do not | 25 |
| have eligibility through the spend-down program and who are | 26 |
| not excluded from State-plan-based mandatory managed care | 27 |
| by the federal Balanced Budget Act of 1997 shall be | 28 |
| enrolled in the program. | 29 |
| (B) Only the following services shall be excluded from | 30 |
| the program and shall be delivered to eligible recipients | 31 |
| through the fee-for-service system: nursing home and | 32 |
| assisted living long-term care services and services | 33 |
| provided through waivers granted pursuant to Sections 1115 | 34 |
| and 1915 of the Social Security Act. | 35 |
| (C) Three managed care organizations shall be selected | 36 |
| for the program following a competitive procurement. The |
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LRB094 18935 DRJ 54383 b |
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| competitive procurement shall evaluate potential managed | 2 |
| care organization contractors on the following criteria: | 3 |
| (i) network adequacy ensuring availability and access to | 4 |
| care, (ii) provider payment levels, (iii) quality | 5 |
| assurance plans, (iv) past performance on quality outcome | 6 |
| measures (for example, HEDIS), (v) plan for care | 7 |
| management, (vi) data system adequacy for member | 8 |
| enrollment and communication, and (vii) any other criteria | 9 |
| that the Department determines to be appropriate. | 10 |
| (D) The Department shall competitively procure the | 11 |
| services of an enrollment broker to facilitate enrollment | 12 |
| in the selected plans in a manner that maximizes consumer | 13 |
| choice and continuity of care. The Department shall develop | 14 |
| a default assignment algorithm for recipients in the | 15 |
| selected counties who do not choose a managed care | 16 |
| organization.
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| (Source: P.A. 87-14; 88-490.)
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| Section 99. Effective date. This Act takes effect upon | 19 |
| becoming law.
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