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| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 HB3285 Introduced , by Rep. Sara Feigenholtz SYNOPSIS AS INTRODUCED: |
| 305 ILCS 5/5F-25 | | 305 ILCS 5/5F-30 | |
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Amends the Illinois Public Aid Code. In a provision concerning certain requirements care coordination services must conform to when such services are provided to enrollees participating in the Medicare-Medicaid Alignment Initiative Demonstration Project, adds the requirement that all rights guaranteed an enrollee under federal and State law be protected, including the right of an enrollee to select his or her own physician. In a provision concerning continuity of care for nursing home residents transitioning to a managed care organization, provides that the managed care organization shall, within 24 hours of receiving a request, change an enrollee's primary care provider and notify the enrollee in writing. Provides that if the enrollee states that a medical emergency exists, the managed care organization shall make the necessary changes immediately and notify by phone all involved parties followed by a written confirmation. Effective immediately.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
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| | HB3285 | | LRB099 10146 KTG 30369 b |
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1 | | AN ACT concerning public aid.
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2 | | Be it enacted by the People of the State of Illinois,
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3 | | represented in the General Assembly:
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4 | | Section 5. The Illinois Public Aid Code is amended by |
5 | | changing Sections 5F-25 and 5F-30 as follows: |
6 | | (305 ILCS 5/5F-25) |
7 | | Sec. 5F-25. Care coordination. Care coordination provided |
8 | | to all enrollees in the Demonstration Project shall conform to |
9 | | the following requirements: |
10 | | (1) care coordination services shall be |
11 | | enrollee-driven and person-centered; |
12 | | (2) all enrollees in the Demonstration Project shall |
13 | | have the right to receive health care services in the care |
14 | | setting of their choice, except as permitted by Part 4 of |
15 | | Article III of the Nursing Home Care Act with respect to |
16 | | involuntary transfers and discharges; and |
17 | | (3) decisions shall be based on the enrollee's best |
18 | | interests ; and .
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19 | | (4) all rights guaranteed an enrollee under federal and |
20 | | State law shall be protected, including the right of an |
21 | | enrollee to select his or her own physician. |
22 | | (Source: P.A. 98-651, eff. 6-16-14.) |
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| | HB3285 | - 2 - | LRB099 10146 KTG 30369 b |
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1 | | (305 ILCS 5/5F-30) |
2 | | Sec. 5F-30. Continuity of care. When a nursing home |
3 | | resident first transitions to a managed care organization from |
4 | | the fee-for-service system or from another managed care |
5 | | organization, the managed care organization shall honor the |
6 | | existing care plan and any necessary changes to that care plan |
7 | | until the MCO has completed a comprehensive assessment and new |
8 | | care plan, to the extent such services are covered benefits |
9 | | under the contract, which shall be consistent with the |
10 | | requirements of the RAI Manual. |
11 | | When an enrollee of a managed care organization is moving |
12 | | from a community setting to a nursing home, and the MCO is |
13 | | properly notified of the proposed admission by a network |
14 | | nursing home, and the managed care organization fails to |
15 | | participate in developing a care plan within the time frames |
16 | | required by nursing home regulations, the MCO must honor a care |
17 | | plan developed by the nursing home until the MCO has completed |
18 | | a comprehensive assessment and a new care plan to the extent |
19 | | such services are covered benefits under the contract, |
20 | | consistent with the requirements of the RAI Manual. |
21 | | A managed care organization shall, within 24 hours of |
22 | | receiving a request, change an enrollee's primary care provider |
23 | | and notify the enrollee in writing. If the enrollee states that |
24 | | a medical emergency exists, the managed care organization shall |
25 | | make the necessary changes immediately and notify by phone all |
26 | | involved parties followed by a written confirmation. |