Full Text of HB5909 97th General Assembly
HB5909ham001 97TH GENERAL ASSEMBLY | Rep. Patricia R. Bellock Filed: 3/6/2012
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| 1 | | AMENDMENT TO HOUSE BILL 5909
| 2 | | AMENDMENT NO. ______. Amend House Bill 5909 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 50% of recipients eligible for comprehensive | 9 | | medical benefits in all medical assistance programs or other | 10 | | health benefit programs administered by the Department, | 11 | | including the Children's Health Insurance Program Act and the | 12 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | 13 | | care coordination program by no later than January 1, 2014 | 14 | | 2015 . For purposes of this Section, "coordinated care" or "care | 15 | | coordination" means delivery systems where recipients will | 16 | | receive their care from providers who participate under |
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| 1 | | contract in integrated delivery systems that are responsible | 2 | | for providing or arranging the majority of care, including | 3 | | primary care physician services, referrals from primary care | 4 | | physicians, diagnostic and treatment services, behavioral | 5 | | health services, in-patient and outpatient hospital services, | 6 | | dental services, and rehabilitation and long-term care | 7 | | services. The Department shall designate or contract for such | 8 | | integrated delivery systems (i) to ensure enrollees have a | 9 | | choice of systems and of primary care providers within such | 10 | | systems; (ii) to ensure that enrollees receive quality care in | 11 | | a culturally and linguistically appropriate manner; and (iii) | 12 | | to ensure that coordinated care programs meet the diverse needs | 13 | | of enrollees with developmental, mental health, physical, and | 14 | | age-related disabilities. | 15 | | (b) Payment for such coordinated care shall be based on | 16 | | arrangements where the State pays for performance related to | 17 | | health care outcomes, the use of evidence-based practices, the | 18 | | use of primary care delivered through comprehensive medical | 19 | | homes, the use of electronic medical records, and the | 20 | | appropriate exchange of health information electronically made | 21 | | either on a capitated basis in which a fixed monthly premium | 22 | | per recipient is paid and full financial risk is assumed for | 23 | | the delivery of services, or through other risk-based payment | 24 | | arrangements. | 25 | | (c) To qualify for compliance with this Section, the 50% | 26 | | goal shall be achieved by enrolling medical assistance |
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| 1 | | enrollees from each medical assistance enrollment category, | 2 | | including parents, children, seniors, and people with | 3 | | disabilities to the extent that current State Medicaid payment | 4 | | laws would not limit federal matching funds for recipients in | 5 | | care coordination programs. In addition, services must be more | 6 | | comprehensively defined and more risk shall be assumed than in | 7 | | the Department's primary care case management program as of the | 8 | | effective date of this amendatory Act of the 96th General | 9 | | Assembly. | 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 10. The Covering ALL KIDS Health Insurance Act is | 24 | | amended by changing Section 56 as follows: |
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| 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 comprehensive | 5 | | medical benefits in all medical assistance programs or other | 6 | | health benefit programs administered by the Department, | 7 | | including the Children's Health Insurance Program Act and the | 8 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | 9 | | care coordination program by no later than January 1, 2014 | 10 | | 2015 . For purposes of this Section, "coordinated care" or "care | 11 | | coordination" means delivery systems where recipients will | 12 | | receive their care from providers who participate under | 13 | | contract in integrated delivery systems that are responsible | 14 | | for providing or arranging the majority of care, including | 15 | | primary care physician services, referrals from primary care | 16 | | physicians, diagnostic and treatment services, behavioral | 17 | | health services, in-patient and outpatient hospital services, | 18 | | dental services, and rehabilitation and long-term care | 19 | | services. The Department shall designate or contract for such | 20 | | integrated delivery systems (i) to ensure enrollees have a | 21 | | choice of systems and of primary care providers within such | 22 | | systems; (ii) to ensure that enrollees receive quality care in | 23 | | a culturally and linguistically appropriate manner; and (iii) | 24 | | to ensure that coordinated care programs meet the diverse needs | 25 | | of enrollees with developmental, mental health, physical, and | 26 | | age-related 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 50% | 12 | | 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 | | (d) The Department shall report to the General Assembly in | 23 | | a separate part of its annual medical assistance program | 24 | | report, beginning April, 2012 until April, 2016, on the | 25 | | progress and implementation of the care coordination program | 26 | | initiatives established by the provisions of this amendatory |
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| 1 | | Act of the 96th General Assembly. The Department shall include | 2 | | in its April 2011 report a full analysis of federal laws or | 3 | | regulations regarding upper payment limitations to providers | 4 | | and the necessary revisions or adjustments in rate | 5 | | methodologies and payments to providers under this Code that | 6 | | would be necessary to implement coordinated care with full | 7 | | financial risk by a party other than the Department.
| 8 | | (Source: P.A. 96-1501, eff. 1-25-11.) | 9 | | Section 15. The Illinois Public Aid Code is amended by | 10 | | changing Section 5-30 as follows: | 11 | | (305 ILCS 5/5-30) | 12 | | Sec. 5-30. Care coordination. | 13 | | (a) At least 50% of recipients eligible for comprehensive | 14 | | medical benefits in all medical assistance programs or other | 15 | | health benefit programs administered by the Department, | 16 | | including the Children's Health Insurance Program Act and the | 17 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | 18 | | care coordination program by no later than January 1, 2014 | 19 | | 2015 . For purposes of this Section, "coordinated care" or "care | 20 | | coordination" means delivery systems where recipients will | 21 | | receive their care from providers who participate under | 22 | | contract in integrated delivery systems that are responsible | 23 | | for providing or arranging the majority of care, including | 24 | | primary care physician services, referrals from primary care |
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| 1 | | physicians, diagnostic and treatment services, behavioral | 2 | | health services, in-patient and outpatient hospital services, | 3 | | dental services, and rehabilitation and long-term care | 4 | | services. The Department shall designate or contract for such | 5 | | integrated delivery systems (i) to ensure enrollees have a | 6 | | choice of systems and of primary care providers within such | 7 | | systems; (ii) to ensure that enrollees receive quality care in | 8 | | a culturally and linguistically appropriate manner; and (iii) | 9 | | to ensure that coordinated care programs meet the diverse needs | 10 | | of enrollees with developmental, mental health, physical, and | 11 | | age-related disabilities. | 12 | | (b) Payment for such coordinated care shall be based on | 13 | | arrangements where the State pays for performance related to | 14 | | health care outcomes, the use of evidence-based practices, the | 15 | | use of primary care delivered through comprehensive medical | 16 | | homes, the use of electronic medical records, and the | 17 | | appropriate exchange of health information electronically made | 18 | | either on a capitated basis in which a fixed monthly premium | 19 | | per recipient is paid and full financial risk is assumed for | 20 | | the delivery of services, or through other risk-based payment | 21 | | arrangements. | 22 | | (c) To qualify for compliance with this Section, the 50% | 23 | | goal shall be achieved by enrolling medical assistance | 24 | | enrollees from each medical assistance enrollment category, | 25 | | including parents, children, seniors, and people with | 26 | | disabilities to the extent that current State Medicaid payment |
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| 1 | | laws would not limit federal matching funds for recipients in | 2 | | care coordination programs. In addition, services must be more | 3 | | comprehensively defined and more risk shall be assumed than in | 4 | | the Department's primary care case management program as of the | 5 | | effective date of this amendatory Act of the 96th General | 6 | | Assembly. | 7 | | (d) The Department shall report to the General Assembly in | 8 | | a separate part of its annual medical assistance program | 9 | | report, beginning April, 2012 until April, 2016, on the | 10 | | progress and implementation of the care coordination program | 11 | | initiatives established by the provisions of this amendatory | 12 | | Act of the 96th General Assembly. The Department shall include | 13 | | in its April 2011 report a full analysis of federal laws or | 14 | | regulations regarding upper payment limitations to providers | 15 | | and the necessary revisions or adjustments in rate | 16 | | methodologies and payments to providers under this Code that | 17 | | would be necessary to implement coordinated care with full | 18 | | financial risk by a party other than the Department.
| 19 | | (Source: P.A. 96-1501, eff. 1-25-11.)
| 20 | | Section 99. Effective date. This Act takes effect upon | 21 | | becoming law.".
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