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90_HB1857
305 ILCS 5/5-16 from Ch. 23, par. 5-16
Amends the Illinois Public Aid Code. Makes a reference
in the Section concerning managed care gender neutral.
LRB9004601LDbd
LRB9004601LDbd
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 5-16.
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 changing Section 5-16 as follows:
7 (305 ILCS 5/5-16) (from Ch. 23, par. 5-16)
8 Sec. 5-16. Managed care. The Illinois Department may
9 develop and implement a Primary Care Sponsor System
10 consistent with the provisions of this Section. The purpose
11 of this managed care delivery system shall be to contain the
12 costs of providing medical care to Medicaid recipients by
13 having one provider responsible for managing all aspects of a
14 recipient's medical care. This managed care system shall
15 have the following characteristics:
16 (a) The Department, by rule, shall establish
17 criteria to determine which clients must participate in
18 this program;
19 (b) Providers participating in the program may be
20 paid an amount per patient per month, to be set by the
21 Illinois Department, for managing each recipient's
22 medical care;
23 (c) Providers eligible to participate in the
24 program shall be physicians licensed to practice medicine
25 in all its branches, and the Illinois Department may
26 terminate a provider's participation if the provider is
27 determined to have failed to comply with any applicable
28 program standard or procedure established by the Illinois
29 Department;
30 (d) Each recipient required to participate in the
31 program must select from a panel of primary care
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1 providers or networks established by the Department in
2 their communities;
3 (e) A recipient may change his or her designated
4 primary care provider:
5 (1) when the designated source becomes
6 unavailable, as the Illinois Department shall
7 determine by rule; or
8 (2) when the designated primary care provider
9 notifies the Illinois Department that it wishes to
10 withdraw from any obligation as primary care
11 provider; or
12 (3) in other situations, as the Illinois
13 Department shall provide by rule;
14 (f) The Illinois Department shall, by rule,
15 establish procedures for providing medical services when
16 the designated source becomes unavailable or wishes to
17 withdraw from any obligation as primary care provider
18 taking into consideration the need for emergency or
19 temporary medical assistance and ensuring that the
20 recipient has continuous and unrestricted access to
21 medical care from the date on which such unavailability
22 or withdrawal becomes effective until such time as the
23 recipient designates a primary care source;
24 (g) Only medical care services authorized by a
25 recipient's designated provider, except for emergency
26 services, services performed by a provider that is owned
27 or operated by a county and that provides non-emergency
28 services without regard to ability to pay and such other
29 services as provided by the Illinois Department, shall be
30 subject to payment by the Illinois Department. The
31 Illinois Department shall enter into an intergovernmental
32 agreement with each county that owns or operates such a
33 provider to develop and implement policies to minimize
34 the provision of medical care services provided by county
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1 owned or operated providers pursuant to the foregoing
2 exception.
3 The Illinois Department shall seek and obtain necessary
4 authorization provided under federal law to implement such a
5 program including the waiver of any federal regulations.
6 The Illinois Department may implement the amendatory
7 changes to this Section made by this amendatory Act of 1991
8 through the use of emergency rules in accordance with the
9 provisions of Section 5.02 of the Illinois Administrative
10 Procedure Act. For purposes of the Illinois Administrative
11 Procedure Act, the adoption of rules to implement the
12 amendatory changes to this Section made by this amendatory
13 Act of 1991 shall be deemed an emergency and necessary for
14 the public interest, safety and welfare.
15 The Illinois Department may establish a managed care
16 system demonstration program, on a limited basis, as
17 described in this Section. The demonstration program shall
18 terminate on June 30, 1997. Within 30 days after the end of
19 each year of the demonstration program's operation, the
20 Illinois Department shall report to the Governor and the
21 General Assembly concerning the operation of the
22 demonstration program.
23 (Source: P.A. 87-14; 88-490.)