Full Text of HB2435 99th General Assembly
HB2435ham002 99TH GENERAL ASSEMBLY | Rep. Dwight Kay Filed: 4/20/2015
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| 1 | | AMENDMENT TO HOUSE BILL 2435
| 2 | | AMENDMENT NO. ______. Amend House Bill 2435, AS AMENDED, by | 3 | | replacing everything after the enacting clause with the | 4 | | following:
| 5 | | "Section 5. The Illinois Public Aid Code is amended by | 6 | | changing Section 5-11a as follows: | 7 | | (305 ILCS 5/5-11a) | 8 | | Sec. 5-11a. Health Benefit Information Systems. | 9 | | (a) It is the intent of the General Assembly to support | 10 | | unified electronic systems initiatives that will improve | 11 | | management of information related to medical assistance | 12 | | programs. This will include improved management capabilities | 13 | | and new systems for Eligibility, Verification, and Enrollment | 14 | | (EVE) that will simplify and increase efficiencies in and | 15 | | access to the medical assistance programs and ensure program | 16 | | integrity. The Department of Healthcare and Family Services, in |
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| 1 | | coordination with the Department of Human Services and other | 2 | | appropriate state agencies, shall develop a plan by July 1, | 3 | | 2011, that will: | 4 | | (1) Subject to federal and State privacy and | 5 | | confidentiality laws and regulations, meet standards for | 6 | | timely eligibility verification and enrollment, and annual | 7 | | redetermination of eligibility, of applicants for and | 8 | | recipients of means-tested health benefits sponsored by | 9 | | the State, including medical assistance under this Code. | 10 | | (2) Receive and update data electronically from the | 11 | | Social Security Administration, the U.S. Postal Service, | 12 | | the Illinois Secretary of State, the Department of Revenue, | 13 | | the Department of Employment Security, and other | 14 | | governmental entities, as appropriate and to the extent | 15 | | allowed by law, for verification of any factor of | 16 | | eligibility for medical assistance and for updating | 17 | | addresses of applicants and recipients of medical | 18 | | assistance and other health benefit programs administered | 19 | | by the Department. Data relevant to eligibility shall be | 20 | | provided for no other purpose than to verify the | 21 | | eligibility of new applicants or current recipients of | 22 | | health benefits provided by the State. Data shall be | 23 | | requested or provided for any individual only insofar as | 24 | | that new applicant or current recipient's circumstances | 25 | | are relevant to that individual's or another individual's | 26 | | eligibility for State-sponsored health benefits. |
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| 1 | | (3) Meet federal requirements for timely installation | 2 | | by January 1, 2014 to provide integration with a Health | 3 | | Benefits Exchange pursuant to the requirements of the | 4 | | federal Affordable Care Act and the Reconciliation Act and | 5 | | any subsequent amendments thereto and to ensure capture of | 6 | | the maximum available federal financial
participation | 7 | | (FFP). | 8 | | (4) Meet federal requirements for compliance with | 9 | | architectural standards, including, but not limited to, | 10 | | (i) the use of a module development as outlined by the | 11 | | Medicaid Information Technology Architecture standards, | 12 | | (ii) the use of federally approved open-interfaces where | 13 | | they exist, (iii) the use or the creation of | 14 | | open-interfaces where necessary, and (iv) the use of rules | 15 | | technology that can dynamically accept and modify rules in | 16 | | standard formats. | 17 | | (5) Include plans to ensure coordination with the State | 18 | | of Illinois Framework Project that will (i) expedite and | 19 | | simplify access to services provided by Illinois human | 20 | | services programs; (ii) streamline administration and data | 21 | | sharing; (iii) enhance planning capacity, program | 22 | | evaluation, and fraud detection or prevention with access | 23 | | to cross-agency data; and (iv) simplify service reporting | 24 | | for contracted providers. | 25 | | (b) The Department of Healthcare and Family Services shall | 26 | | continue to plan for and implement a new Medicaid Management |
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| 1 | | Information System (MMIS) and upgrade the capabilities of the | 2 | | MMIS data warehouse. Upgrades shall include, among other | 3 | | things, enhanced capabilities in data analysis including the | 4 | | ability to identify risk factors that could impact the | 5 | | treatment and resulting quality of care, and tools that perform | 6 | | predictive analytics on data applying to newborns, women with | 7 | | high risk pregnancies, and other populations served by the | 8 | | Department. | 9 | | (c) The Department of Healthcare and Family Services shall | 10 | | report in its annual Medical Assistance program report each | 11 | | April through April, 2015 on the progress and implementation of | 12 | | this plan.
| 13 | | (d) The Department of Healthcare and Family Services shall | 14 | | not use a virtual provider network to contract with any entity | 15 | | located outside the United States or with any entity that | 16 | | subcontracts with another entity located outside the United | 17 | | States for the purpose of processing claims under the medical | 18 | | assistance program where the personal or confidential | 19 | | information of medical assistance recipients is used or | 20 | | transmitted by employees working for the entity directly or | 21 | | through subcontract. | 22 | | For the purposes of this subsection: | 23 | | "Entity" means a proprietorship,
partnership, association, | 24 | | trust, estate, business trust, group, or
corporation, whether | 25 | | or not operated for profit, or a governmental agency,
unit, or | 26 | | subdivision. |
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| 1 | | "Personal or confidential information" includes, but is | 2 | | not limited to, social security numbers, healthcare | 3 | | information, and medical records. | 4 | | "Subcontract" means a contract or contractual action | 5 | | entered into by
a prime contractor or subcontractor for the | 6 | | purpose of obtaining goods or
services of any kind under a | 7 | | prime contract. | 8 | | (Source: P.A. 96-1501, eff. 1-25-11.)".
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