Full Text of SB0464 99th General Assembly
SB0464sam001 99TH GENERAL ASSEMBLY | Sen. David Koehler Filed: 4/14/2016
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| 1 | | AMENDMENT TO SENATE BILL 464
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 464 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, 2015. | 14 | | However, mandatory assignments into managed care organizations | 15 | | shall not occur when 50% of persons eligible for selecting a | 16 | | managed care service are covered through an integrated care |
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| 1 | | program until the Department demonstrates that the net | 2 | | per-recipient cost paid by non-federal, State revenue sources | 3 | | in those contracts, adjusted for age and gender, is less than | 4 | | the non-federal, net State per-recipient cost in | 5 | | fee-for-service for fiscal year 2014 and the health outcome | 6 | | goals required in those contracts have been achieved. All | 7 | | per-recipient cost calculations shall be performed between | 8 | | like eligibility categories. Hospital Assessment Program | 9 | | payments are excluded from these calculations. For purposes of | 10 | | this Section, "coordinated care" or "care coordination" means | 11 | | delivery systems where recipients will receive their care from | 12 | | providers who participate under contract in integrated | 13 | | delivery systems that are responsible for providing or | 14 | | arranging the majority of care, including primary care | 15 | | physician services, referrals from primary care physicians, | 16 | | diagnostic and treatment services, behavioral health services, | 17 | | in-patient and outpatient hospital services, dental services, | 18 | | and rehabilitation and long-term care services. The Department | 19 | | shall designate or contract for such integrated delivery | 20 | | systems (i) to ensure enrollees have a choice of systems and of | 21 | | primary care providers within such systems; (ii) to ensure that | 22 | | enrollees receive quality care in a culturally and | 23 | | linguistically appropriate manner; and (iii) to ensure that | 24 | | coordinated care programs meet the diverse needs of enrollees | 25 | | with developmental, mental health, physical, and age-related | 26 | | 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.)".
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