Full Text of HJR0041 98th General Assembly
HJ0041 98TH GENERAL ASSEMBLY |
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| 1 | | HOUSE JOINT RESOLUTION
| 2 | | WHEREAS, The General Assembly passed legislation and the | 3 | | Governor signed into law major reforms of Illinois' Medical | 4 | | Assistance Programs, including Senate Bill 2840, The Save | 5 | | Medicaid Access and Resources Together (SMART) Act (Public Act | 6 | | 97-0689) and House Bill 5429 (Public Act 96-1501) and these new | 7 | | laws intend to "address the significant spending and liability | 8 | | deficit in the medical assistance program budget of the | 9 | | Department of Healthcare and Family Services by implementing | 10 | | changes, improvements, and efficiencies"; and
| 11 | | WHEREAS, The reforms require the Illinois Department of | 12 | | Healthcare and Family Services to enroll at least 50% of | 13 | | recipients eligible for comprehensive medical benefits in a | 14 | | care coordination program by January 1, 2015; and
| 15 | | WHEREAS, Care coordination programs may be | 16 | | provider-sponsored programs that contract directly with the | 17 | | State or traditional managed care programs; they must operate | 18 | | integrated delivery systems where recipients will receive | 19 | | their care from providers who are responsible for providing or | 20 | | arranging the majority of care, including primary care | 21 | | physician services, referrals from primary care physicians, | 22 | | diagnostic and treatment services, behavioral health services, | 23 | | in-patient and outpatient hospital services, dental services, |
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| 1 | | and rehabilitation and long-term care services; and
| 2 | | WHEREAS, The Department must designate or contract for | 3 | | integrated delivery systems that ensure enrollees have a choice | 4 | | of systems and of primary care providers within the systems; | 5 | | and
| 6 | | WHEREAS, Payment for coordinated care must be based on | 7 | | arrangements where the State pays for performance related to | 8 | | health care outcomes, the use of evidence-based practices, the | 9 | | use of primary care delivered through comprehensive medical | 10 | | homes, the use of electronic medical records, and the | 11 | | appropriate exchange of health information electronically made | 12 | | either on a capitated basis in which a fixed monthly premium | 13 | | per recipient is paid and full financial risk is assumed for | 14 | | the delivery of services, or through other risk-based payment | 15 | | arrangements; and
| 16 | | WHEREAS, Health care providers, including hospitals, | 17 | | physicians and nurses, federally qualified health centers | 18 | | (FQHCs), nursing homes, home health agencies, social service | 19 | | organizations, and pharmacies can assume responsibility for | 20 | | coordinating the care of Medicaid recipients under a direct | 21 | | arrangement with the State that requires the providers to | 22 | | assume increasing risk over a short period of time; and
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| 1 | | WHEREAS, In order to achieve significant savings needed to | 2 | | cover administrative expenses and generate profits for | 3 | | shareholders, HMOs often prevent beneficiaries from getting | 4 | | the services they need; Medicaid HMOs in Illinois have | 5 | | previously placed barriers to care, and in some instances, | 6 | | either reduced rates to providers or made it very difficult for | 7 | | providers to get approvals to provide the care that people | 8 | | need; major policy reviews of various studies on Medicaid HMO | 9 | | managed care have found little savings from HMOs and that such | 10 | | an approach is unlikely to significantly lower costs; and
| 11 | | WHEREAS, HMOs in Illinois have a checkered track record in | 12 | | "managing" Medicaid patients; Illinois failed in its first | 13 | | major attempt to enroll a large number of children into a | 14 | | managed care program, the Healthy Moms/Kids program, which was | 15 | | scrapped in 1995 after having failed to meet performance | 16 | | standards and spending millions in failed computer systems; the | 17 | | State also scrapped the ambitious MediPlan Plus program; and
| 18 | | WHEREAS, Even more concern should be given to the 2004 | 19 | | federal court ruling in Memisovski v. Maram that HMOs provided | 20 | | less preventive and primary care and poorer quality care to | 21 | | children in the Medicaid program in Cook County than non-HMO, | 22 | | fee-for-service programs; and in 2008, an HMO in Illinois paid | 23 | | $225 million - the largest jury verdict in a false claims case | 24 | | in U.S. history - to settle charges that it deliberately |
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| 1 | | excluded pregnant women and sick people from its program; and
| 2 | | WHEREAS, The 50% goal must be achieved by enrolling medical | 3 | | assistance enrollees from each medical assistance enrollment | 4 | | category, including parents, children, seniors, and people | 5 | | with disabilities only to the extent that current State | 6 | | Medicaid payment laws would not limit federal matching funds | 7 | | for the State; and
| 8 | | WHEREAS, Moving most or all recipients to full-capitation | 9 | | HMOs will contravene federal rules, cause the State to exceed | 10 | | the federal upper payment limit and thus jeopardize up to $1 | 11 | | billion in federal funding under the Hospital Assessment | 12 | | Program; and
| 13 | | WHEREAS, The Illinois Department of Healthcare and Family | 14 | | Services has selected only a limited number of | 15 | | provider-sponsored Care Coordination Entities while giving | 16 | | preference to health maintenance organizations; another | 17 | | solicitation of interest could ensure further expansion of care | 18 | | coordination beyond mandatory HMO enrollment; and
| 19 | | WHEREAS, The State should thoroughly evaluate its | 20 | | experience with HMOs before substantially increasing mandatory | 21 | | enrollment in these types of plans; hastily moving large | 22 | | portions of the Medicaid population into HMOs (i.e., 1.5 |
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| 1 | | million to 2 million) is inherently risky; and
| 2 | | WHEREAS, Given that the Department is planning more | 3 | | aggressive use of HMOs, all policymakers should know that there | 4 | | is little evidence to date that the initiatives will contain | 5 | | program costs; Illinois needs to be far more cautious and | 6 | | conservative in estimates of the likely benefits of HMO | 7 | | Medicaid managed care; the State should work with providers to | 8 | | develop innovative partnerships that share risk, rather than | 9 | | abdicate responsibilities to HMOs, which often achieve savings | 10 | | by denying services or reducing payment; and
| 11 | | WHEREAS, Hastily moving large numbers of Medicaid | 12 | | recipients to full-capitation HMOs will jeopardize up to $1 | 13 | | billion in federal funding under the Hospital Assessment | 14 | | Program; care coordination must be carefully designed so that | 15 | | the State does not jeopardize the funding provided by the | 16 | | Hospital Assessment Program; therefore, be it
| 17 | | RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE | 18 | | NINETY-EIGHTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, THE | 19 | | SENATE CONCURRING HEREIN, that we urge the Department of | 20 | | Healthcare and Family Services to carefully evaluate and | 21 | | reconsider its actions to quickly move larger numbers of | 22 | | Medicaid beneficiaries into HMOs; and urge that the agency | 23 | | refocus its current preferences and give more favorable |
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| 1 | | consideration to innovative, provider-based care coordination | 2 | | strategies; Accountable Care Entities should be utilized as | 3 | | important and valued alternatives to traditional HMOs; these | 4 | | models bring together a wide variety of entities such as | 5 | | hospitals, physician-led groups, Federally Qualified Health | 6 | | Centers, social service organizations, pharmacies, and | 7 | | behavioral health providers and closely resemble the | 8 | | Accountable Care Organizations (ACOs) that participate in the | 9 | | Medicare Shared Savings Program, under which these entities | 10 | | provide care coordination services to seniors and adults with | 11 | | disabilities who have the most complex physical health and | 12 | | behavioral health conditions by facilitating the delivery of | 13 | | appropriate health care and other services and managing needed | 14 | | transitions in care among providers and community agencies; and | 15 | | be it further
| 16 | | RESOLVED, That the General Assembly recommends that the | 17 | | Department of Healthcare and Family Services should more | 18 | | actively pursue provider-sponsored care coordination in the | 19 | | Medicaid program, including application for relevant federal | 20 | | grants and Medicaid waivers; and give provider-sponsored | 21 | | entities a more meaningful and substantive opportunity to | 22 | | succeed, because provider-sponsored care coordination, done at | 23 | | the local level, is best for patients.
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