Full Text of SB2382 100th General Assembly
SB2382sam002 100TH GENERAL ASSEMBLY | Sen. Heather A. Steans Filed: 5/2/2018
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| 1 | | AMENDMENT TO SENATE BILL 2382
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2382 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Findings; intent. According to the | 5 | | Congressional Research Service reporting, approximately 35% to | 6 | | 60% of children placed in foster care have at least one chronic | 7 | | or acute physical health condition that requires treatment, | 8 | | including growth failure, asthma, obesity, vision impairment, | 9 | | hearing loss, neurological problems, and complex chronic | 10 | | illnesses; as many as 50% to 75% show behavioral or social | 11 | | competency issues that may warrant mental health services; many | 12 | | of these physical and mental health care issues persist and, | 13 | | relative to their peers in the general population, children who | 14 | | leave foster care for adoption and those who age out of care | 15 | | continue to have greater health needs. | 16 | | Federal child welfare policy requires states to develop | 17 | | strategies to address the health care needs of each child in |
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| 1 | | foster care and mandates coordination of state child welfare | 2 | | and Medicaid agencies to ensure that the health care needs of | 3 | | children in foster care are properly identified and treated. | 4 | | The Department of Children and Family Services is | 5 | | responsible for ensuring safety, family permanence, and | 6 | | well-being for the children placed in its custody and | 7 | | protecting these children from further trauma by ensuring | 8 | | timely access to appropriate placements and services, | 9 | | especially those children with complex emotional and | 10 | | behavioral needs who are at much greater risk for not achieving | 11 | | the fundamental child welfare goals of safety, permanence, and | 12 | | well-being. | 13 | | The Department remains under federal court oversight | 14 | | pursuant to the B.H. Consent Decree, in part, for failure to | 15 | | provide constitutionally sufficient services and placements | 16 | | for children with psychological, behavioral, or emotional | 17 | | challenges; the 2015 court-appointed Expert Panel found too | 18 | | many children in the class experience multiple disruptions of | 19 | | placement, services, and relationships; these children and | 20 | | their families endure indeterminate waits, month upon month, | 21 | | for services the child and family need, without a concrete plan | 22 | | or timeframe; these disruptions and delays and the inaction of | 23 | | Department officials exacerbate children's already serious and | 24 | | chronic mental health problems; the Department's approach to | 25 | | treatment and its system of practice has been one shaped by | 26 | | crises, practitioner preferences, tradition, and system |
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| 1 | | expediency. | 2 | | The American Academy of Pediatrics cautions that the | 3 | | effects of managed care on children's access to services and | 4 | | actual health outcomes are not yet clear; it outlines design | 5 | | and implementation principles if managed care is to be | 6 | | implemented for children. | 7 | | It is the intent of the General Assembly to ensure that | 8 | | children are provided a system of health care with full and | 9 | | inclusive access to physical and behavioral health services | 10 | | necessary for them to thrive. | 11 | | The General Assembly finds it necessary to protect youth in | 12 | | care by requiring the Department to plan the use of managed | 13 | | care services transparently, collaboratively, and deliberately | 14 | | to ensure quality outcomes and accountable oversight. | 15 | | Section 5. The Children and Family Services Act is amended | 16 | | by adding Section 5.45 as follows: | 17 | | (20 ILCS 505/5.45 new) | 18 | | Sec. 5.45. Managed care plan services. | 19 | | (a) As used in this Section: | 20 | | "Caregiver" means an individual or entity directly | 21 | | providing the day-to-day care of a child ensuring the child's | 22 | | safety and well-being. | 23 | | "Child" means a child placed in the care of the Department | 24 | | pursuant to the Juvenile Court Act of 1987. |
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| 1 | | "Council" means the Child Welfare Medicaid Managed Care | 2 | | Steering and Implementation Oversight Council. | 3 | | "Department" means the Department of Children and Family | 4 | | Services, or any successor State agency. | 5 | | "Director" means the Director of Children and Family | 6 | | Services. | 7 | | "Managed care organization" has the meaning ascribed to | 8 | | that term in Section 5-30.1 of the Illinois Public Aid Code. | 9 | | "Medicaid managed care plan" means a health care plan | 10 | | operated by a managed care organization under the Medical | 11 | | Assistance Program established in Article V of the Illinois | 12 | | Public Aid Code. | 13 | | (b) Every child who is in the care of the Department | 14 | | pursuant to the Juvenile Court Act of 1987 shall receive the | 15 | | necessary services required by this Act and the Juvenile Court | 16 | | Act of 1987, including any child enrolled in a Medicaid managed | 17 | | care plan. | 18 | | (c) The Department shall not relinquish its authority or | 19 | | diminish its responsibility to determine, provide, or | 20 | | authorize necessary services that are in the best interest of a | 21 | | child even if those services are directly or indirectly: | 22 | | (1) provided by a managed care organization, another | 23 | | State agency, or other third parties; | 24 | | (2) coordinated through a managed care organization, | 25 | | another State agency, or other third parties; or | 26 | | (3) paid for by a managed care organization, another |
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| 1 | | State agency, or other third parties. | 2 | | (d) The Department shall: | 3 | | (1) implement and enforce measures to prevent | 4 | | enrollment in Medicaid managed care plans from disrupting | 5 | | service delivery or hindering continuity of treatment for | 6 | | any child; | 7 | | (2) establish a single point of contact for health care | 8 | | coverage inquiries and dispute resolution systemwide | 9 | | without transferring this responsibility to a third party | 10 | | such as a managed care coordinator; | 11 | | (3) not require participation in Medicaid managed care | 12 | | plans for any child; and | 13 | | (4) develop and review managed care contract measures, | 14 | | quality assurance activities, and performance delivery | 15 | | evaluations in consultation with the Council; and | 16 | | (5) post on its website: | 17 | | (A) a link to any rule adopted or procedures | 18 | | changed to address the provisions of this Section, if | 19 | | applicable; | 20 | | (B) each managed care organization's contract, | 21 | | enrollee handbook, and directory; | 22 | | (C) the State's current Health Care Oversight and | 23 | | Coordination Plan developed in accordance with federal | 24 | | requirements; and | 25 | | (D) the transition plan required under subsection | 26 | | (f), including: |
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| 1 | | (i) the public comments submitted to the | 2 | | Department or the Council for consideration in | 3 | | development of the transition plan; | 4 | | (ii) a list and explanation of any | 5 | | recommendations of the Council that the Director | 6 | | or Director of Healthcare and Family Services | 7 | | declined to adopt or implement; and | 8 | | (iii) the Department's attestation that | 9 | | implementation of the transition plan will not | 10 | | impact its ability to comply with current class | 11 | | action litigation. | 12 | | (e) The Child Welfare Medicaid Managed Care Steering and | 13 | | Implementation Oversight Council is established to advise the | 14 | | Department on the transition and implementation of managed care | 15 | | for children. The Director of Children and Family Services and | 16 | | the Director of Healthcare and Family Services shall serve as | 17 | | co-chairpersons of the Council. The Directors shall jointly | 18 | | appoint members to the Council who are stakeholders from the | 19 | | child welfare community, including: | 20 | | (1) 3 non-voting members who are employees of the | 21 | | Department of Children and Family Services who have | 22 | | responsibility in the areas of (i) managed care services, | 23 | | (ii) performance monitoring and oversight, (iii) placement | 24 | | operations, and (iv) budget revenue maximization; | 25 | | (2) 3 non-voting members who are employees of the | 26 | | Department of Healthcare and Family Services who have |
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| 1 | | responsibility in the areas of (i) managed care | 2 | | contracting, (ii) performance monitoring and oversight, | 3 | | (iii) children's behavioral health, and (iv) budget | 4 | | revenue maximization; | 5 | | (3) at least one representative of youth in care; | 6 | | (4) at least one representative of managed care | 7 | | organizations; | 8 | | (5) at least one representative of child welfare | 9 | | providers; | 10 | | (6) at least one representative of a trade association | 11 | | with expertise in child welfare; | 12 | | (7) at least one representative of parents of children | 13 | | in out-of-home care; | 14 | | (8) at least one representative of universities or | 15 | | research institutions; | 16 | | (9) at least one pediatric expert; | 17 | | (10) at least one court stakeholder; | 18 | | (11) at least one representative of caregivers of youth | 19 | | in care; | 20 | | (12) at least one child and adolescent psychiatrist or | 21 | | psychologist; | 22 | | (13) at least one representative of substance abuse and | 23 | | mental health providers with expertise in serving children | 24 | | involved in child welfare and their families; | 25 | | (14) at least one representative of trade associations | 26 | | with expertise in substance abuse and mental health; |
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| 1 | | (15) a member of the Medicaid Advisory Committee; | 2 | | (16) a private sector member of the Child Welfare | 3 | | Advisory Committee; and | 4 | | (17) other child advocates. | 5 | | To the greatest extent possible, the co-chairpersons shall | 6 | | appoint members who reflect the geographic diversity of the | 7 | | State and include members who represent rural service areas. | 8 | | Members shall serve 2-year terms. If a vacancy occurs in the | 9 | | Council membership, the vacancy shall be filled in the same | 10 | | manner as the original appointment for the remainder of the | 11 | | unexpired term. The Council shall hold meetings, as it deems | 12 | | appropriate, in the northern, central, and southern regions of | 13 | | the State to solicit public comments to develop its | 14 | | recommendations. The Department of Children and Family | 15 | | Services shall provide administrative support to the Council. | 16 | | Council members shall serve without compensation. | 17 | | (f) Prior to placing any child in managed care, the | 18 | | Department of Children and Family Services and the Department | 19 | | of Healthcare and Family Services, in consultation with the | 20 | | Council, must develop, adopt, and submit to the General | 21 | | Assembly a comprehensive transition plan for the provision of | 22 | | health care services to children enrolled in Medicaid managed | 23 | | care plans. The transition plan shall address, but is not | 24 | | limited to, the following: | 25 | | (1) an assessment of existing network adequacy, plans | 26 | | to address gaps in network before transition to managed |
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| 1 | | care, and ongoing network evaluation; | 2 | | (2) an assessment of child welfare provider | 3 | | capacity-building needs, system infrastructure gaps, and | 4 | | steps to be taken to prepare and train organizations, | 5 | | caregivers, frontline staff, and managed care | 6 | | organizations; | 7 | | (3) the identification of administrative changes | 8 | | necessary for successful transition to managed care, and | 9 | | the timeframes to make changes; | 10 | | (4) defined roles, responsibilities, and lines of | 11 | | authority for care coordination, placement providers, | 12 | | service providers, and each State agency involved in | 13 | | management and oversight of managed care services; | 14 | | (5) data used to establish baseline performance and | 15 | | quality of care, which shall be used to evaluate outcomes | 16 | | and identify ongoing areas for improvement; | 17 | | (6) a process and timeline for stakeholder input into | 18 | | managed care contract development; | 19 | | (7) a dispute resolution process, including the rights | 20 | | of enrollees and representatives of enrollees under the | 21 | | dispute process and timeframes for dispute resolution | 22 | | determinations and remedies; | 23 | | (8) the relationship of the dispute resolution process | 24 | | described in paragraph (7) to the administrative review | 25 | | process under the Administrative Review Law; | 26 | | (9) an initial enrollment process and enrollment |
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| 1 | | process for those children entering or exiting the | 2 | | Department's care after the implementation of managed | 3 | | care; | 4 | | (10) protections to ensure the continued provision of | 5 | | health care services if a child's residence or legal | 6 | | guardian changes; | 7 | | (11) a method that the Department shall use to ensure a | 8 | | reasonable rate is utilized for Medicaid managed care plans | 9 | | to meet the specialized needs of children in the | 10 | | Department's care; | 11 | | (12) the notification process and timeframes to inform | 12 | | managed care plan enrollees, enrollees' caregivers, and | 13 | | enrollees' legal representation of any changes in health | 14 | | care coverage or a change in a child's managed care | 15 | | provider; | 16 | | (13) defined pre-clearance requirements for | 17 | | prescriptions, goods, and services in emergency and | 18 | | non-emergency situations, if applicable; | 19 | | (14) the Department's role and responsibility to | 20 | | ensure implementation of a robust, responsive beneficiary | 21 | | support system that has the capacity to provide assistance | 22 | | in navigating the Medicaid managed care system to all | 23 | | current and prospective beneficiaries and their | 24 | | representatives, including, but not limited to: | 25 | | (A) establishing a single point of contact | 26 | | systemwide; |
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| 1 | | (B) defining informational notice requirements; | 2 | | (C) explanation of enrollment and disenrollment | 3 | | rights; | 4 | | (D) education on grievance process and | 5 | | requirements for timely responses; and | 6 | | (E) key beneficiary protections; and | 7 | | (15) any limitations to the Department's ability to | 8 | | ensure implementation of the beneficiary support system | 9 | | described in paragraph (14). | 10 | | (g) Prior to implementing the transition plan described in | 11 | | subsection (f), the Department shall submit to the | 12 | | Chairpersons, Vice-Chairpersons, and Minority Spokespersons of | 13 | | the House and Senate Human Services Committees, or to any | 14 | | successor committees: | 15 | | (1) the transition plan; and | 16 | | (2) notice of any Council recommendations that the | 17 | | Director of Children and Family Services or the Director of | 18 | | Healthcare and Family Services declined to adopt or | 19 | | implement. This notice shall include: (i) the Council's | 20 | | recommendation that the Director of Children and Family | 21 | | Services or the Director of Healthcare and Family Services | 22 | | declined to adopt or implement; (ii) the justification for | 23 | | declining to adopt or implement the recommendation; and | 24 | | (iii) an attestation from the Director of Children and | 25 | | Family Services or the Director of Healthcare and Family | 26 | | Services that failure to adopt or implement the |
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| 1 | | recommendation does not contradict any court order or | 2 | | conflict with federal funding requirements. | 3 | | (h) Reports. | 4 | | (1) On or before February 1, 2019, and on or before | 5 | | each February 1 thereafter, the Department shall submit a | 6 | | report to the House and Senate Human Services Committees, | 7 | | or to any successor committees, on measures of access to | 8 | | and the quality of health care services for children | 9 | | enrolled in Medicaid managed care plans, including, but not | 10 | | limited to, data showing whether: | 11 | | (A) children enrolled in Medicaid managed care | 12 | | plans have continuity of care across placement types, | 13 | | geographic regions, and specialty service needs; | 14 | | (B) each child is receiving the early periodic | 15 | | screening, diagnosis, and treatment services as | 16 | | required by federal law, including, but not limited to, | 17 | | regular preventative care and timely specialty care; | 18 | | (C) children are assigned to health homes; | 19 | | (D) each child has a health care oversight and | 20 | | coordination plan as required by federal law; | 21 | | (E) there exist complaints and grievances | 22 | | indicating gaps or barriers in service delivery; | 23 | | (F) the Council and other stakeholders have and | 24 | | continue to be engaged in quality improvement | 25 | | initiatives; | 26 | | (G) there exist disenrollment trends and related |
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| 1 | | reasons such as poor quality of care, lack of access to | 2 | | services covered by the managed care organization, | 3 | | lack of access to providers experienced in addressing | 4 | | enrollees' needs, limitations of in-network and | 5 | | out-of-network coverage, or any other factors. | 6 | | The report shall be prepared in consultation with the | 7 | | Council and other agencies, organizations, or individuals | 8 | | the Director deems appropriate in order to obtain | 9 | | comprehensive and objective information about the managed | 10 | | care plan operation. | 11 | | (2) During each legislative session, the House and | 12 | | Senate Human Services Committees shall hold hearings to | 13 | | take public testimony about managed care implementation | 14 | | for children in the care of, adopted from, or placed in | 15 | | guardianship by the Department. The Department shall | 16 | | present testimony, including information provided in the | 17 | | report required under paragraph (1), the Department's | 18 | | compliance with the provisions of this Section, and any | 19 | | recommendations for statutory changes to improve health | 20 | | care for children in the Department's care. | 21 | | (i) If any provision of this Section or its application to | 22 | | any person or circumstance is held invalid, the invalidity of | 23 | | that provision or application does not affect other provisions | 24 | | or applications of this Section that can be given effect | 25 | | without the invalid provision or application.
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| 1 | | Section 99. Effective date. This Act takes effect upon | 2 | | becoming law.".
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