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| Public Act 095-0650 |
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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 | ||||
amended by changing Section 50 and by adding Sections 47, 52, | ||||
and 53 as follows: | ||||
(215 ILCS 170/47 new)
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Sec. 47. Program Information. The Department shall report | ||||
to the General Assembly no later than September 1 of each year | ||||
beginning in 2007, all of the following information: | ||||
(a) The number of professionals serving in the primary care | ||||
case management program, by licensed profession and by county, | ||||
and, for counties with a population of 100,000 or greater, by | ||||
geo zip code. | ||||
(b) The number of non-primary care providers accepting | ||||
referrals, by specialty designation, by licensed profession | ||||
and by county, and, for counties with a population of 100,000 | ||||
or greater, by geo zip code.
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(c) The number of individuals enrolled in the Covering ALL | ||||
KIDS Health Insurance Program by income or premium level and by | ||||
county, and, for counties with a population of 100,000 or | ||||
greater, by geo zip code. | ||||
(215 ILCS 170/50) | ||
(Section scheduled to be repealed on July 1, 2011)
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Sec. 50. Consultation with stakeholders. The Department | ||
shall present details regarding implementation of the Program | ||
to the Medicaid Advisory Committee, and the Committee shall | ||
serve as the forum for healthcare providers, advocates, | ||
consumers, and other interested parties to advise the | ||
Department with respect to the Program. The Department shall | ||
consult with stakeholders on the rules for healthcare | ||
professional participation in the Program pursuant to Sections | ||
52 and 53 of this Act.
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(Source: P.A. 94-693, eff. 7-1-06.) | ||
(215 ILCS 170/52 new) | ||
Sec. 52. Adequate access to specialty care. | ||
(a) The Department shall ensure adequate access to | ||
specialty physician care for Program participants by allowing | ||
referrals to be accomplished without undue delay. | ||
(b) The Department shall allow a primary care provider to | ||
make appropriate referrals to specialist physicians or other | ||
healthcare providers for an enrollee who has a condition that | ||
requires care from a specialist physician or other healthcare | ||
provider. The Department may specify the necessary criteria and | ||
conditions that must be met in order for an enrollee to obtain | ||
a standing referral. A referral shall be effective for the | ||
period necessary to provide the referred services or one year, | ||
whichever is less. A primary care provider may renew and | ||
re-renew a referral. | ||
(c) The enrollee's primary care provider shall remain | ||
responsible for coordinating the care of an enrollee who has | ||
received a standing referral to a specialist physician or other | ||
healthcare provider. If a secondary referral is necessary, the | ||
specialist physician or other healthcare provider shall advise | ||
the primary care physician. The primary care physician or | ||
specialist physician shall be responsible for making the | ||
secondary referral. In addition, the Department shall require | ||
the specialist physician or other healthcare provider to | ||
provide regular updates to the enrollee's primary care | ||
provider. | ||
(215 ILCS 170/53 new) | ||
Sec. 53. Program standards. | ||
(a) Any disease management program implemented by the | ||
Department must be or must have been developed in consultation | ||
with physician organizations, such as State, national, and | ||
specialty medical societies, and any available standards or | ||
guidelines of these organizations. These programs must be based | ||
on evidence-based, scientifically sound principles that are | ||
accepted by the medical community. An enrollee must be excused | ||
from participation in a disease management program if the | ||
enrollee's physician licensed to practice medicine in all its | ||
branches, in his or her professional judgment, determines that | ||
participation is not beneficial to the enrollee. | ||
(b) Any performance measures, such as primary care provider | ||
monitoring, implemented by the Department must be or must have | ||
been developed on consultation with physician organizations, | ||
such as State, national, and specialty medical societies, and | ||
any available standards or guidelines of these organizations. | ||
These measures must be based on evidence-based, scientifically | ||
sound principles that are accepted by the medical community. | ||
(c) The Department shall adopt variance procedures for the | ||
application of any disease management program or any | ||
performance measures to an individual enrollee.
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