State of Illinois
90th General Assembly
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90_HB0775

      305 ILCS 5/5-16.8 new
          Amends the Illinois Public Aid Code.   Provides  that  in
      adopting  rules implementing a managed care Medicaid program,
      the Department of Public Aid shall establish  guidelines  for
      and  require  managed care organizations to provide education
      programs for providers and clients.  Details the requirements
      for the contents of provider and client  education  programs.
      Creates  a  bill  of  rights  and  responsibilities for those
      enrolled  in  the  Medicaid  program.    Provides  that   the
      Department  shall provide support and information services to
      a person enrolled in the program  or  applying  for  Medicaid
      coverage  who  experiences  barriers to receiving health care
      services,  listing  services  to  be   provided.    Effective
      immediately.
                                                     LRB9000954SMdv
                                               LRB9000954SMdv
 1        AN  ACT  to  amend the Illinois Public Aid Code by adding
 2    Section 5-16.8.
 3        Be it enacted by the People of  the  State  of  Illinois,
 4    represented in the General Assembly:
 5        Section  5.   The  Illinois Public Aid Code is amended by
 6    adding Section 5-16.8 as follows:
 7        (305 ILCS 5/5-16.8 new)
 8        Sec. 5-16.8.  Administration of managed care program.
 9        (a)  In  adopting  rules  implementing  a  managed   care
10    Medicaid  program,  the Department shall establish guidelines
11    for  and  require  managed  care  organizations  to   provide
12    education  programs for providers and clients using a variety
13    of techniques and mediums.
14        (b)  A   provider   education   program   must    include
15    information on:
16             (1)  Medicaid   policies,   procedures,  eligibility
17        standards, and benefits;
18             (2)  the specific problems  and  needs  of  Medicaid
19        clients; and
20             (3)  the  rights  and  responsibilities  of Medicaid
21        clients  under  the  bill  of  rights  and  the  bill  of
22        responsibilities prescribed by this Section.
23        (c)  A client education program must present  information
24    in  a  manner  that  is  easy  to understand.  A program must
25    include information on:
26             (1)  a client's rights  and  responsibilities  under
27        the  bill  of  rights  and  the  bill of responsibilities
28        prescribed by this Section;
29             (2)  how to access health care services;
30             (3)  how to  access  complaint  procedures  and  the
31        client's rights to bypass the managed care organization's
                            -2-                LRB9000954SMdv
 1        internal  complaint  system and use the notice and appeal
 2        procedures otherwise required by the Medicaid program;
 3             (4)  Medicaid  policies,   procedures,   eligibility
 4        standards, and benefits;
 5             (5)  the policies and procedures of the managed care
 6        organization; and
 7             (6)  the    importance    of    prevention,    early
 8        intervention, and appropriate use of services.
 9        (d)  The  Department by rule shall adopt a bill of rights
10    and a bill of responsibilities for each  person  enrolled  in
11    the  Medicaid  program.   The  bill  of rights must address a
12    client's right to:
13             (1)  respect, dignity, privacy, confidentiality, and
14        nondiscrimination;
15             (2)  a reasonable opportunity  to  choose  a  health
16        care  plan  and  primary  care  provider and to change to
17        another plan or provider in a reasonable manner;
18             (3)  consent to or  refuse  treatment  and  actively
19        participate in treatment decisions;
20             (4)  ask  questions and receive complete information
21        relating to the client's medical condition and  treatment
22        options, including specialty care;
23             (5)  access   each   available   complaint  process,
24        receive a timely response to a complaint, and  receive  a
25        fair hearing; and
26             (6)  timely  access  to  care that does not have any
27        communication or physical access barriers.
28        (e)  The bill of responsibilities must address a client's
29    responsibility to:
30             (1)  learn and understand each right the client  has
31        under the Medicaid program;
32             (2)  abide  by the health plan and Medicaid policies
33        and procedures;
34             (3)  share  information  relating  to  the  client's
                            -3-                LRB9000954SMdv
 1        health status with the primary care provider  and  become
 2        fully informed about service and treatment options; and
 3             (4)  actively  participate  in decisions relating to
 4        service and treatment options, make personal choices  and
 5        take action to maintain the client's health.
 6        (f)  The Department shall provide support and information
 7    services  to a person enrolled in the program or applying for
 8    Medicaid  coverage  who  experiences  barriers  to  receiving
 9    health care services.  The Department shall give emphasis  to
10    assisting  a  person  with  an urgent or immediate medical or
11    support  need.   The  Department  may  provide  support   and
12    information   services   by   contracting  with  a  nonprofit
13    organization that is not involved in providing  health  care,
14    health  insurance,  or  health  benefits.   As  a part of the
15    support and information services required by this subsection,
16    the Department or nonprofit organization shall:
17             (1)  operate  a   statewide   toll-free   assistance
18        telephone  number  that includes TDD lines and assistance
19        for persons who speak Spanish;
20             (2)  intervene  promptly  with  the   managed   care
21        organizations  and  providers  and  any other appropriate
22        entity on behalf of a person who has an urgent  need  for
23        medical services;
24             (3)  assist a person who is experiencing barriers in
25        the Medicaid application and enrollment process and refer
26        the person for further assistance if appropriate;
27             (4)  educate persons so that they:
28                  (A)  understand the concept of managed care;
29                  (B)  understand their rights under the Medicaid
30             program,  including grievance and appeal procedures;
31             and
32                  (C)  are able to advocate for themselves;
33             (5)  collect and maintain statistical information on
34        a  regional  basis  regarding  calls  received   by   the
                            -4-                LRB9000954SMdv
 1        assistance lines and publish quarterly reports that:
 2                  (A)  list  the  number  of  calls  received  by
 3             region;
 4                  (B)  identify  trends  in  delivery  and access
 5             problems;
 6                  (C)  identify   recurring   barriers   in   the
 7             Medicaid system; and
 8                  (D)  indicate other  problems  identified  with
 9             Medicaid managed care; and
10             (6)  assist   the  managed  care  organizations  and
11        providers  in  identifying   and   correcting   problems,
12        including site visits to affected regions if necessary.
13        Section  99.  Effective date.  This Act takes effect upon
14    becoming law.

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