Full Text of HB4620 97th General Assembly
HB4620ham001 97TH GENERAL ASSEMBLY | Rep. Robyn Gabel Filed: 3/2/2012
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| 1 | | AMENDMENT TO HOUSE BILL 4620
| 2 | | AMENDMENT NO. ______. Amend House Bill 4620 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Children's Health Insurance Program Act is | 5 | | amended by changing Section 23 as follows: | 6 | | (215 ILCS 106/23) | 7 | | Sec. 23. Care coordination. | 8 | | (a) At least 70% 50% of recipients eligible for | 9 | | comprehensive medical benefits in all medical assistance | 10 | | programs or other health benefit programs administered by the | 11 | | Department, including the Children's Health Insurance Program | 12 | | Act and the Covering ALL KIDS Health Insurance Act, shall be | 13 | | enrolled in a care coordination program by no later than | 14 | | January 1, 2015. For purposes of this Section, "coordinated | 15 | | care" or "care coordination" means delivery systems where | 16 | | recipients will receive their care from providers who |
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| 1 | | participate under contract in integrated delivery systems that | 2 | | are responsible for providing or arranging the majority of | 3 | | care, including primary care physician services, referrals | 4 | | from primary care physicians, diagnostic and treatment | 5 | | services, behavioral health services, in-patient and | 6 | | outpatient hospital services, dental services, and | 7 | | rehabilitation and long-term care services. The Department | 8 | | shall designate or contract for such integrated delivery | 9 | | systems (i) to ensure enrollees have a choice of systems and of | 10 | | primary care providers within such systems; (ii) to ensure that | 11 | | enrollees receive quality care in a culturally and | 12 | | linguistically appropriate manner; and (iii) to ensure that | 13 | | coordinated care programs meet the diverse needs of enrollees | 14 | | with developmental, mental health, physical, and age-related | 15 | | disabilities. | 16 | | (b) Payment for such coordinated care shall be based on | 17 | | arrangements where the State pays for performance related to | 18 | | health care outcomes, the use of evidence-based practices, the | 19 | | use of primary care delivered through comprehensive medical | 20 | | homes, the use of electronic medical records, and the | 21 | | appropriate exchange of health information electronically made | 22 | | either on a capitated basis in which a fixed monthly premium | 23 | | per recipient is paid and full financial risk is assumed for | 24 | | the delivery of services, or through other risk-based payment | 25 | | arrangements. | 26 | | (c) To qualify for compliance with this Section, the 70% |
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| 1 | | 50% goal shall be achieved by enrolling medical assistance | 2 | | enrollees from each medical assistance enrollment category, | 3 | | including parents, children, seniors, and people with | 4 | | disabilities to the extent that current State Medicaid payment | 5 | | laws would not limit federal matching funds for recipients in | 6 | | care coordination programs. In addition, services must be more | 7 | | comprehensively defined and more risk shall be assumed than in | 8 | | the Department's primary care case management program as of the | 9 | | effective date of this amendatory Act of the 96th General | 10 | | Assembly. | 11 | | (c-5) An enhanced primary care case management program that | 12 | | includes collaboration between primary care providers, | 13 | | hospitals, and behavioral health providers with protocols for | 14 | | coordination, electronic exchange of health information, and | 15 | | fees at risk based on performance and outcomes qualifies as | 16 | | care coordination under this Section. | 17 | | (d) The Department shall report to the General Assembly in | 18 | | a separate part of its annual medical assistance program | 19 | | report, beginning April, 2012 until April, 2016, on the | 20 | | progress and implementation of the care coordination program | 21 | | initiatives established by the provisions of this amendatory | 22 | | Act of the 96th General Assembly. The Department shall include | 23 | | in its April 2011 report a full analysis of federal laws or | 24 | | regulations regarding upper payment limitations to providers | 25 | | and the necessary revisions or adjustments in rate | 26 | | methodologies and payments to providers under this Code that |
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| 1 | | would be necessary to implement coordinated care with full | 2 | | financial risk by a party other than the Department.
| 3 | | (Source: P.A. 96-1501, eff. 1-25-11.) | 4 | | Section 10. The Covering ALL KIDS Health Insurance Act is | 5 | | amended by changing Section 56 as follows: | 6 | | (215 ILCS 170/56) | 7 | | (Section scheduled to be repealed on July 1, 2016) | 8 | | Sec. 56. Care coordination. | 9 | | (a) At least 70% 50% of recipients eligible for | 10 | | comprehensive medical benefits in all medical assistance | 11 | | programs or other health benefit programs administered by the | 12 | | Department, including the Children's Health Insurance Program | 13 | | Act and the Covering ALL KIDS Health Insurance Act, shall be | 14 | | enrolled in a care coordination program by no later than | 15 | | January 1, 2015. For purposes of this Section, "coordinated | 16 | | care" or "care coordination" means delivery systems where | 17 | | recipients will receive their care from providers who | 18 | | participate under contract in integrated delivery systems that | 19 | | are responsible for providing or arranging the majority of | 20 | | care, including primary care physician services, referrals | 21 | | from primary care physicians, diagnostic and treatment | 22 | | services, behavioral health services, in-patient and | 23 | | outpatient hospital services, dental services, and | 24 | | rehabilitation and long-term care services. The Department |
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| 1 | | shall designate or contract for such integrated delivery | 2 | | systems (i) to ensure enrollees have a choice of systems and of | 3 | | primary care providers within such systems; (ii) to ensure that | 4 | | enrollees receive quality care in a culturally and | 5 | | linguistically appropriate manner; and (iii) to ensure that | 6 | | coordinated care programs meet the diverse needs of enrollees | 7 | | with developmental, mental health, physical, and age-related | 8 | | disabilities. | 9 | | (b) Payment for such coordinated care shall be based on | 10 | | arrangements where the State pays for performance related to | 11 | | health care outcomes, the use of evidence-based practices, the | 12 | | use of primary care delivered through comprehensive medical | 13 | | homes, the use of electronic medical records, and the | 14 | | appropriate exchange of health information electronically made | 15 | | either on a capitated basis in which a fixed monthly premium | 16 | | per recipient is paid and full financial risk is assumed for | 17 | | the delivery of services, or through other risk-based payment | 18 | | arrangements. | 19 | | (c) To qualify for compliance with this Section, the 70% | 20 | | 50% goal shall be achieved by enrolling medical assistance | 21 | | enrollees from each medical assistance enrollment category, | 22 | | including parents, children, seniors, and people with | 23 | | disabilities to the extent that current State Medicaid payment | 24 | | laws would not limit federal matching funds for recipients in | 25 | | care coordination programs. In addition, services must be more | 26 | | comprehensively defined and more risk shall be assumed than in |
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| 1 | | the Department's primary care case management program as of the | 2 | | effective date of this amendatory Act of the 96th General | 3 | | Assembly. | 4 | | (c-5) An enhanced primary care case management program that | 5 | | includes collaboration between primary care providers, | 6 | | hospitals, and behavioral health providers with protocols for | 7 | | coordination, electronic exchange of health information, and | 8 | | fees at risk based on performance and outcomes qualifies as | 9 | | care coordination under this Section. | 10 | | (d) The Department shall report to the General Assembly in | 11 | | a separate part of its annual medical assistance program | 12 | | report, beginning April, 2012 until April, 2016, on the | 13 | | progress and implementation of the care coordination program | 14 | | initiatives established by the provisions of this amendatory | 15 | | Act of the 96th General Assembly. The Department shall include | 16 | | in its April 2011 report a full analysis of federal laws or | 17 | | regulations regarding upper payment limitations to providers | 18 | | and the necessary revisions or adjustments in rate | 19 | | methodologies and payments to providers under this Code that | 20 | | would be necessary to implement coordinated care with full | 21 | | financial risk by a party other than the Department.
| 22 | | (Source: P.A. 96-1501, eff. 1-25-11.) | 23 | | Section 15. The Illinois Public Aid Code is amended by | 24 | | changing Section 5-30 as follows: |
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| 1 | | (305 ILCS 5/5-30) | 2 | | Sec. 5-30. Care coordination. | 3 | | (a) At least 70% 50% of recipients eligible for | 4 | | comprehensive medical benefits in all medical assistance | 5 | | programs or other health benefit programs administered by the | 6 | | Department, including the Children's Health Insurance Program | 7 | | Act and the Covering ALL KIDS Health Insurance Act, shall be | 8 | | enrolled in a care coordination program by no later than | 9 | | January 1, 2015. For purposes of this Section, "coordinated | 10 | | care" or "care coordination" means delivery systems where | 11 | | recipients will receive their care from providers who | 12 | | participate under contract in integrated delivery systems that | 13 | | are responsible for providing or arranging the majority of | 14 | | care, including primary care physician services, referrals | 15 | | from primary care physicians, diagnostic and treatment | 16 | | services, behavioral health services, in-patient and | 17 | | outpatient hospital services, dental services, and | 18 | | rehabilitation and long-term care services. The Department | 19 | | shall designate or contract for such integrated delivery | 20 | | systems (i) to ensure enrollees have a choice of systems and of | 21 | | primary care providers within such systems; (ii) to ensure that | 22 | | enrollees receive quality care in a culturally and | 23 | | linguistically appropriate manner; and (iii) to ensure that | 24 | | coordinated care programs meet the diverse needs of enrollees | 25 | | with developmental, mental health, physical, and age-related | 26 | | disabilities. |
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| 1 | | (b) Payment for such coordinated care shall be based on | 2 | | arrangements where the State pays for performance related to | 3 | | health care outcomes, the use of evidence-based practices, the | 4 | | use of primary care delivered through comprehensive medical | 5 | | homes, the use of electronic medical records, and the | 6 | | appropriate exchange of health information electronically made | 7 | | either on a capitated basis in which a fixed monthly premium | 8 | | per recipient is paid and full financial risk is assumed for | 9 | | the delivery of services, or through other risk-based payment | 10 | | arrangements. | 11 | | (c) To qualify for compliance with this Section, the 70% | 12 | | 50% goal shall be achieved by enrolling medical assistance | 13 | | enrollees from each medical assistance enrollment category, | 14 | | including parents, children, seniors, and people with | 15 | | disabilities to the extent that current State Medicaid payment | 16 | | laws would not limit federal matching funds for recipients in | 17 | | care coordination programs. In addition, services must be more | 18 | | comprehensively defined and more risk shall be assumed than in | 19 | | the Department's primary care case management program as of the | 20 | | effective date of this amendatory Act of the 96th General | 21 | | Assembly. | 22 | | (c-5) An enhanced primary care case management program that | 23 | | includes collaboration between primary care providers, | 24 | | hospitals, and behavioral health providers with protocols for | 25 | | coordination, electronic exchange of health information, and | 26 | | fees at risk based on performance and outcomes qualifies as |
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| 1 | | care coordination under this Section. | 2 | | (d) The Department shall report to the General Assembly in | 3 | | a separate part of its annual medical assistance program | 4 | | report, beginning April, 2012 until April, 2016, on the | 5 | | progress and implementation of the care coordination program | 6 | | initiatives established by the provisions of this amendatory | 7 | | Act of the 96th General Assembly. The Department shall include | 8 | | in its April 2011 report a full analysis of federal laws or | 9 | | regulations regarding upper payment limitations to providers | 10 | | and the necessary revisions or adjustments in rate | 11 | | methodologies and payments to providers under this Code that | 12 | | would be necessary to implement coordinated care with full | 13 | | financial risk by a party other than the Department.
| 14 | | (Source: P.A. 96-1501, eff. 1-25-11.)
| 15 | | Section 99. Effective date. This Act takes effect upon | 16 | | becoming law.".
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