Full Text of HB1628 95th General Assembly
HB1628enr 95TH GENERAL ASSEMBLY
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HB1628 Enrolled |
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LRB095 09974 MJR 30187 b |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Covering ALL KIDS Health Insurance Act is | 5 |
| amended by changing Section 50 and by adding Sections 47, 52, | 6 |
| and 53 as follows: | 7 |
| (215 ILCS 170/47 new)
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| Sec. 47. Program Information. The Department shall report | 9 |
| to the General Assembly no later than September 1 of each year | 10 |
| beginning in 2007, all of the following information: | 11 |
| (a) The number of professionals serving in the primary care | 12 |
| case management program, by licensed profession and by county, | 13 |
| and, for counties with a population of 100,000 or greater, by | 14 |
| geo zip code. | 15 |
| (b) The number of non-primary care providers accepting | 16 |
| referrals, by specialty designation, by licensed profession | 17 |
| and by county, and, for counties with a population of 100,000 | 18 |
| or greater, by geo zip code.
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| (c) The number of individuals enrolled in the Covering ALL | 20 |
| KIDS Health Insurance Program by income or premium level and by | 21 |
| county, and, for counties with a population of 100,000 or | 22 |
| greater, by geo zip code. |
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LRB095 09974 MJR 30187 b |
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| (215 ILCS 170/50) | 2 |
| (Section scheduled to be repealed on July 1, 2011)
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| Sec. 50. Consultation with stakeholders. The Department | 4 |
| shall present details regarding implementation of the Program | 5 |
| to the Medicaid Advisory Committee, and the Committee shall | 6 |
| serve as the forum for healthcare providers, advocates, | 7 |
| consumers, and other interested parties to advise the | 8 |
| Department with respect to the Program. The Department shall | 9 |
| consult with stakeholders on the rules for healthcare | 10 |
| professional participation in the Program pursuant to Sections | 11 |
| 52 and 53 of this Act.
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| (Source: P.A. 94-693, eff. 7-1-06 .) | 13 |
| (215 ILCS 170/52 new) | 14 |
| Sec. 52. Adequate access to specialty care. | 15 |
| (a) The Department shall ensure adequate access to | 16 |
| specialty physician care for Program participants by allowing | 17 |
| referrals to be accomplished without undue delay. | 18 |
| (b) The Department shall allow a primary care provider to | 19 |
| make appropriate referrals to specialist physicians or other | 20 |
| healthcare providers for an enrollee who has a condition that | 21 |
| requires care from a specialist physician or other healthcare | 22 |
| provider. The Department may specify the necessary criteria and | 23 |
| conditions that must be met in order for an enrollee to obtain | 24 |
| a standing referral. A referral shall be effective for the | 25 |
| period necessary to provide the referred services or one year, |
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| whichever is less. A primary care provider may renew and | 2 |
| re-renew a referral. | 3 |
| (c) The enrollee's primary care provider shall remain | 4 |
| responsible for coordinating the care of an enrollee who has | 5 |
| received a standing referral to a specialist physician or other | 6 |
| healthcare provider. If a secondary referral is necessary, the | 7 |
| specialist physician or other healthcare provider shall advise | 8 |
| the primary care physician. The primary care physician or | 9 |
| specialist physician shall be responsible for making the | 10 |
| secondary referral. In addition, the Department shall require | 11 |
| the specialist physician or other healthcare provider to | 12 |
| provide regular updates to the enrollee's primary care | 13 |
| provider. | 14 |
| (215 ILCS 170/53 new) | 15 |
| Sec. 53. Program standards. | 16 |
| (a) Any disease management program implemented by the | 17 |
| Department must be or must have been developed in consultation | 18 |
| with physician organizations, such as State, national, and | 19 |
| specialty medical societies, and any available standards or | 20 |
| guidelines of these organizations. These programs must be based | 21 |
| on evidence-based, scientifically sound principles that are | 22 |
| accepted by the medical community. An enrollee must be excused | 23 |
| from participation in a disease management program if the | 24 |
| enrollee's physician licensed to practice medicine in all its | 25 |
| branches, in his or her professional judgment, determines that |
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| participation is not beneficial to the enrollee. | 2 |
| (b) Any performance measures, such as primary care provider | 3 |
| monitoring, implemented by the Department must be or must have | 4 |
| been developed on consultation with physician organizations, | 5 |
| such as State, national, and specialty medical societies, and | 6 |
| any available standards or guidelines of these organizations. | 7 |
| These measures must be based on evidence-based, scientifically | 8 |
| sound principles that are accepted by the medical community. | 9 |
| (c) The Department shall adopt variance procedures for the | 10 |
| application of any disease management program or any | 11 |
| performance measures to an individual enrollee.
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