Full Text of HB4880 101st General Assembly
HB4880ham001 101ST GENERAL ASSEMBLY | Rep. Stephanie A. Kifowit Filed: 3/4/2020
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| 1 | | AMENDMENT TO HOUSE BILL 4880
| 2 | | AMENDMENT NO. ______. Amend House Bill 4880 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Children and Family Services Act is amended | 5 | | by changing Section 5.45 as follows: | 6 | | (20 ILCS 505/5.45) | 7 | | Sec. 5.45. Managed care plan services. | 8 | | (a) As used in this Section: | 9 | | "Caregiver" means an individual or entity directly | 10 | | providing the day-to-day care of a child ensuring the child's | 11 | | safety and well-being. | 12 | | "Child" means a child placed in the care of the Department | 13 | | pursuant to the Juvenile Court Act of 1987. | 14 | | "Department" means the Department of Children and Family | 15 | | Services, or any successor State agency. | 16 | | "Director" means the Director of Children and Family |
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| 1 | | Services. | 2 | | "Managed care organization" has the meaning ascribed to | 3 | | that term in Section 5-30.1 of the Illinois Public Aid Code. | 4 | | "Medicaid managed care plan" means a health care plan | 5 | | operated by a managed care organization under the Medical | 6 | | Assistance Program established in Article V of the Illinois | 7 | | Public Aid Code. | 8 | | "Workgroup" means the Child Welfare Medicaid Managed Care | 9 | | Implementation Advisory Workgroup. | 10 | | (b) Every child who is in the care of the Department | 11 | | pursuant to the Juvenile Court Act of 1987 shall receive the | 12 | | necessary services required by this Act and the Juvenile Court | 13 | | Act of 1987, including any child enrolled in a Medicaid managed | 14 | | care plan. | 15 | | (c) The Department shall not relinquish its authority or | 16 | | diminish its responsibility to determine and provide necessary | 17 | | services that are in the best interest of a child even if those | 18 | | services are directly or indirectly: | 19 | | (1) provided by a managed care organization, another | 20 | | State agency, or other third parties; | 21 | | (2) coordinated through a managed care organization, | 22 | | another State agency, or other third parties; or | 23 | | (3) paid for by a managed care organization, another | 24 | | State agency, or other third parties. | 25 | | (d) The Department shall: | 26 | | (1) implement and enforce measures to ensure that a |
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| 1 | | child's enrollment in Medicaid managed care supports | 2 | | continuity of treatment and does not hinder service | 3 | | delivery; | 4 | | (2) establish a single point of contact for health care | 5 | | coverage inquiries and dispute resolution systemwide | 6 | | without transferring this responsibility to a third party | 7 | | such as a managed care coordinator; | 8 | | (3) not require any child to participate in Medicaid | 9 | | managed care if the child would otherwise be exempt from | 10 | | enrolling in a Medicaid managed care plan under any rule or | 11 | | statute of this State; and | 12 | | (4) make recommendations regarding managed care | 13 | | contract measures, quality assurance activities, and | 14 | | performance delivery evaluations in consultation with the | 15 | | Workgroup; 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 notification process and timeframe | 23 | | requirements used to inform managed care plan | 24 | | enrollees, enrollees' caregivers, and enrollees' legal | 25 | | representation of any changes in health care coverage | 26 | | or change in a child's managed care provider; |
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| 1 | | (D) defined prior authorization requirements for | 2 | | prescriptions, goods, and services in emergency and | 3 | | non-emergency situations; | 4 | | (E) the State's current Health Care Oversight and | 5 | | Coordination Plan developed in accordance with federal | 6 | | requirements; and | 7 | | (F) the transition plan required under subsection | 8 | | (f), including: | 9 | | (i) the public comments submitted to the | 10 | | Department, the Department of Healthcare and | 11 | | Family Services, and the Workgroup for | 12 | | consideration in development of the transition | 13 | | plan; | 14 | | (ii) a list and summary of recommendations of | 15 | | the Workgroup that the Director or Director of | 16 | | Healthcare and Family Services declined to adopt | 17 | | or implement; and | 18 | | (iii) the Department's attestation that the | 19 | | transition plan will not impede the Department's | 20 | | ability to timely identify the service needs of | 21 | | youth in care and the timely and appropriate | 22 | | provision of services to address those identified | 23 | | needs ; and . | 24 | | (6) review and automatically appeal all claim denials | 25 | | for youth in care and former youth in care who are enrolled | 26 | | in or received services provided by a Medicaid managed care |
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| 1 | | plan. The Department shall cover all costs associated with | 2 | | any appeal it files in accordance with this paragraph. The | 3 | | Department shall cover all costs associated with any | 4 | | medications or health care services provided to a youth in | 5 | | care or a former youth in care during the appeal process if | 6 | | the youth's claim is ultimately denied after appeal. | 7 | | (e) The Child Welfare Medicaid Managed Care Implementation | 8 | | Advisory Workgroup is established to advise the Department on | 9 | | the transition and implementation of managed care for children. | 10 | | The Director of Children and Family Services and the Director | 11 | | of Healthcare and Family Services shall serve as | 12 | | co-chairpersons of the Workgroup. The Directors shall jointly | 13 | | appoint members to the Workgroup who are stakeholders from the | 14 | | child welfare community, including: | 15 | | (1) employees of the Department of Children and Family | 16 | | Services who have responsibility in the areas of (i) | 17 | | managed care services, (ii) performance monitoring and | 18 | | oversight, (iii) placement operations, and (iv) budget | 19 | | revenue maximization; | 20 | | (2) employees of the Department of Healthcare and | 21 | | Family Services who have responsibility in the areas of (i) | 22 | | managed care contracting, (ii) performance monitoring and | 23 | | oversight, (iii) children's behavioral health, and (iv) | 24 | | budget revenue maximization; | 25 | | (3) 2 representatives of youth in care; | 26 | | (4) one representative of managed care organizations |
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| 1 | | serving youth in care; | 2 | | (5) 4 representatives of child welfare providers; | 3 | | (6) one representative of parents of children in | 4 | | out-of-home care; | 5 | | (7) one representative of universities or research | 6 | | institutions; | 7 | | (8) one representative of pediatric physicians; | 8 | | (9) one representative of the juvenile court; | 9 | | (10) one representative of caregivers of youth in care; | 10 | | (11) one practitioner with expertise in child and | 11 | | adolescent psychiatry; | 12 | | (12) one representative of substance abuse and
mental | 13 | | health providers with expertise in serving children | 14 | | involved in child welfare and their families; | 15 | | (13) at least one member of the Medicaid Advisory | 16 | | Committee; | 17 | | (14) one representative of a statewide organization | 18 | | representing hospitals; | 19 | | (15) one representative of a statewide organization | 20 | | representing child welfare providers; | 21 | | (16) one representative of a statewide organization | 22 | | representing substance abuse and mental health providers; | 23 | | and | 24 | | (17) other child advocates as deemed appropriate by the | 25 | | Directors. | 26 | | To the greatest extent possible, the co-chairpersons shall |
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| 1 | | appoint members who reflect the geographic diversity of the | 2 | | State and include members who represent rural service areas. | 3 | | Members shall serve 2-year terms or until the Workgroup | 4 | | dissolves. If a vacancy occurs in the Workgroup membership, the | 5 | | vacancy shall be filled in the same manner as the original | 6 | | appointment for the remainder of the unexpired term. The | 7 | | Workgroup shall hold meetings, as it deems appropriate, in the | 8 | | northern, central, and southern regions of the State to solicit | 9 | | public comments to develop its recommendations. To ensure the | 10 | | Department of Children and Family Services and the Department | 11 | | of Healthcare and Family Services are provided time to confer | 12 | | and determine their use of pertinent Workgroup recommendations | 13 | | in the transition plan required under subsection (f), the | 14 | | co-chairpersons shall convene at least 3 meetings. The | 15 | | Department of Children and Family Services and the Department | 16 | | of Healthcare and Family Services shall provide administrative | 17 | | support to the Workgroup. Workgroup members shall serve without | 18 | | compensation. The Workgroup shall dissolve 5 years after the | 19 | | Department of Children and Family Services' implementation of | 20 | | managed care. | 21 | | (f) Prior to transitioning any child to managed care, the | 22 | | Department of Children and Family Services and the Department | 23 | | of Healthcare and Family Services, in consultation with the | 24 | | Workgroup, must develop and post publicly, a transition plan | 25 | | for the provision of health care services to children enrolled | 26 | | in Medicaid managed care plans. Interim transition plans must |
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| 1 | | be posted to the Department's website by July 15, 2018. The | 2 | | transition plan shall be posted at least 28 days before the | 3 | | Department's implementation of managed care. The transition | 4 | | plan shall address, but is not limited to, the following: | 5 | | (1) an assessment of existing network adequacy, plans | 6 | | to address gaps in network, and ongoing network evaluation; | 7 | | (2) a framework for preparing and training | 8 | | organizations, caregivers, frontline staff, and managed | 9 | | care organizations; | 10 | | (3) the identification of administrative changes | 11 | | necessary for successful transition to managed care, and | 12 | | the timeframes to make changes; | 13 | | (4) defined roles, responsibilities, and lines of | 14 | | authority for care coordination, placement providers, | 15 | | service providers, and each State agency involved in | 16 | | management and oversight of managed care services; | 17 | | (5) data used to establish baseline performance and | 18 | | quality of care, which shall be utilized to assess quality | 19 | | outcomes and identify ongoing areas for improvement; | 20 | | (6) a process for stakeholder input into managed care | 21 | | planning and implementation; | 22 | | (7) a dispute resolution process, including the rights | 23 | | of enrollees and representatives of enrollees under the | 24 | | dispute process and timeframes for dispute resolution | 25 | | determinations and remedies; | 26 | | (8) the process for health care transition for youth |
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| 1 | | exiting the Department's care through emancipation or | 2 | | achieving permanency; and | 3 | | (9) protections to ensure the continued provision of | 4 | | health care services if a child's residence or legal | 5 | | guardian changes. | 6 | | (g) Reports. | 7 | | (1) On or before February 1, 2019, and on or before | 8 | | each February 1 thereafter, the Department shall submit a | 9 | | report to the House and Senate Human Services Committees, | 10 | | or to any successor committees, on measures of access to | 11 | | and the quality of health care services for children | 12 | | enrolled in Medicaid managed care plans, including, but not | 13 | | limited to, data showing whether: | 14 | | (A) children enrolled in Medicaid managed care | 15 | | plans have continuity of care across placement types, | 16 | | geographic regions, and specialty service needs; | 17 | | (B) each child is receiving the early periodic | 18 | | screening, diagnosis, and treatment services as | 19 | | required by federal law, including, but not limited to, | 20 | | regular preventative care and timely specialty care; | 21 | | (C) children are assigned to health homes; | 22 | | (D) each child has a health care oversight and | 23 | | coordination plan as required by federal law; | 24 | | (E) there exist complaints and grievances | 25 | | indicating gaps or barriers in service delivery; and | 26 | | (F) the Workgroup and other stakeholders have and |
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| 1 | | continue to be engaged in quality improvement | 2 | | initiatives. | 3 | | The report shall be prepared in consultation with the | 4 | | Workgroup and other agencies, organizations, or | 5 | | individuals the Director deems appropriate in order to | 6 | | obtain comprehensive and objective information about the | 7 | | managed care plan operation. | 8 | | (2) During each legislative session, the House and | 9 | | Senate Human Services Committees shall hold hearings to | 10 | | take public testimony about managed care implementation | 11 | | for children in the care of, adopted from, or placed in | 12 | | guardianship by the Department. The Department shall | 13 | | present testimony, including information provided in the | 14 | | report required under paragraph (1), the Department's | 15 | | compliance with the provisions of this Section, and any | 16 | | recommendations for statutory changes to improve health | 17 | | care for children in the Department's care. | 18 | | (h) If any provision of this Section or its application to | 19 | | any person or circumstance is held invalid, the invalidity of | 20 | | that provision or application does not affect other provisions | 21 | | or applications of this Section that can be given effect | 22 | | without the invalid provision or application.
| 23 | | (Source: P.A. 100-646, eff. 7-27-18.)
| 24 | | Section 99. Effective date. This Act takes effect upon | 25 | | becoming law.".
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