Full Text of SB2578 97th General Assembly
SB2578sam001 97TH GENERAL ASSEMBLY | Sen. M. Maggie Crotty Filed: 3/1/2012
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| 1 | | AMENDMENT TO SENATE BILL 2578
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2578 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 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 50% |
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| 1 | | 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 | | (d) The Department shall report to the General Assembly in | 12 | | a separate part of its annual medical assistance program | 13 | | report, beginning April, 2012 until April, 2016, on the | 14 | | progress and implementation of the care coordination program | 15 | | initiatives established by the provisions of this amendatory | 16 | | Act of the 96th General Assembly. The Department shall include | 17 | | in its April 2011 report a full analysis of federal laws or | 18 | | regulations regarding upper payment limitations to providers | 19 | | and the necessary revisions or adjustments in rate | 20 | | methodologies and payments to providers under this Code that | 21 | | would be necessary to implement coordinated care with full | 22 | | financial risk by a party other than the Department.
| 23 | | (Source: P.A. 96-1501, eff. 1-25-11.) | 24 | | Section 10. The Covering ALL KIDS Health Insurance Act is | 25 | | 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 for | 5 | | comprehensive medical benefits in all medical assistance | 6 | | programs or other health benefit programs administered by the | 7 | | Department, including the Children's Health Insurance Program | 8 | | Act and the Covering ALL KIDS Health Insurance Act, shall be | 9 | | enrolled in a care coordination program by no later than | 10 | | January 1, 2015. For purposes of this Section, "coordinated | 11 | | care" or "care coordination" means delivery systems where | 12 | | recipients will receive their care from providers who | 13 | | participate under contract in integrated delivery systems that | 14 | | are responsible for providing or arranging the majority of | 15 | | care, including primary care physician services, referrals | 16 | | from primary care physicians, diagnostic and treatment | 17 | | services, behavioral health services, in-patient and | 18 | | outpatient hospital services, dental services, and | 19 | | rehabilitation and long-term care services. The Department | 20 | | shall designate or contract for such integrated delivery | 21 | | systems (i) to ensure enrollees have a choice of systems and of | 22 | | primary care providers within such systems; (ii) to ensure that | 23 | | enrollees receive quality care in a culturally and | 24 | | linguistically appropriate manner; and (iii) to ensure that | 25 | | coordinated care programs meet the diverse needs of enrollees |
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| 1 | | with developmental, mental health, physical, and age-related | 2 | | disabilities. | 3 | | (b) Payment for such coordinated care shall be based on | 4 | | arrangements where the State pays for performance related to | 5 | | health care outcomes, the use of evidence-based practices, the | 6 | | use of primary care delivered through comprehensive medical | 7 | | homes, the use of electronic medical records, and the | 8 | | appropriate exchange of health information electronically made | 9 | | either on a capitated basis in which a fixed monthly premium | 10 | | per recipient is paid and full financial risk is assumed for | 11 | | the delivery of services, or through other risk-based payment | 12 | | arrangements. | 13 | | (c) To qualify for compliance with this Section, the 50% | 14 | | goal shall be achieved by enrolling medical assistance | 15 | | enrollees from each medical assistance enrollment category, | 16 | | including parents, children, seniors, and people with | 17 | | disabilities to the extent that current State Medicaid payment | 18 | | laws would not limit federal matching funds for recipients in | 19 | | care coordination programs. In addition, services must be more | 20 | | comprehensively defined and more risk shall be assumed than in | 21 | | the Department's primary care case management program as of the | 22 | | effective date of this amendatory Act of the 96th General | 23 | | Assembly. | 24 | | (d) The Department shall report to the General Assembly in | 25 | | a separate part of its annual medical assistance program | 26 | | report, beginning April, 2012 until April, 2016, on the |
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| 1 | | progress and implementation of the care coordination program | 2 | | initiatives established by the provisions of this amendatory | 3 | | Act of the 96th General Assembly. The Department shall include | 4 | | in its April 2011 report a full analysis of federal laws or | 5 | | regulations regarding upper payment limitations to providers | 6 | | and the necessary revisions or adjustments in rate | 7 | | methodologies and payments to providers under this Code that | 8 | | would be necessary to implement coordinated care with full | 9 | | financial risk by a party other than the Department.
| 10 | | (Source: P.A. 96-1501, eff. 1-25-11.) | 11 | | Section 15. The Illinois Public Aid Code is amended by | 12 | | changing Section 5-30 as follows: | 13 | | (305 ILCS 5/5-30) | 14 | | Sec. 5-30. Care coordination. | 15 | | (a) At least 50% of recipients eligible for for | 16 | | comprehensive medical benefits in all medical assistance | 17 | | programs or other health benefit programs administered by the | 18 | | Department, including the Children's Health Insurance Program | 19 | | Act and the Covering ALL KIDS Health Insurance Act, shall be | 20 | | enrolled in a care coordination program by no later than | 21 | | January 1, 2015. For purposes of this Section, "coordinated | 22 | | care" or "care coordination" means delivery systems where | 23 | | recipients will receive their care from providers who | 24 | | participate under contract in integrated delivery systems that |
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| 1 | | are responsible for providing or arranging the majority of | 2 | | care, including primary care physician services, referrals | 3 | | from primary care physicians, diagnostic and treatment | 4 | | services, behavioral health services, in-patient and | 5 | | outpatient hospital services, dental services, and | 6 | | rehabilitation and long-term care services. The Department | 7 | | shall designate or contract for such integrated delivery | 8 | | systems (i) to ensure enrollees have a choice of systems and of | 9 | | primary care providers within such systems; (ii) to ensure that | 10 | | enrollees receive quality care in a culturally and | 11 | | linguistically appropriate manner; and (iii) to ensure that | 12 | | coordinated care programs meet the diverse needs of enrollees | 13 | | with developmental, mental health, physical, and age-related | 14 | | 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.)".
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