Health Care Availability and Access Committee
Filed: 5/30/2007
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1 | AMENDMENT TO HOUSE BILL 311
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2 | AMENDMENT NO. ______. Amend House Bill 311 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 1. Short title. This Act may be cited as the | ||||||
5 | Health Care for All Illinois Act. | ||||||
6 | Section 5. Purposes. It is the purpose of this Act to | ||||||
7 | provide universal access to health care for all
individuals | ||||||
8 | within the State, to promote and improve the health of all
its | ||||||
9 | citizens, to stress the importance of good public health | ||||||
10 | through treatment and prevention of diseases, and to contain | ||||||
11 | costs to make the delivery of this care affordable. Should | ||||||
12 | legislation of this kind be enacted on a federal level, it is | ||||||
13 | the intent of this Act to become a part of a nationwide system. | ||||||
14 | Section 10. Definitions. In this Act: | ||||||
15 | "Board" means the Illinois Health Services Governing |
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1 | Board.
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2 | "Program" means the Illinois Health Services Program.
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3 | Section 15. Eligibility; registration. All individuals | ||||||
4 | residing in this State are covered
under the Illinois Health | ||||||
5 | Services Program for health insurance and shall receive a card | ||||||
6 | with a unique number in the
mail. An individual's social | ||||||
7 | security number shall not be used for purposes of
registration | ||||||
8 | under this Section. Individuals and families shall receive an | ||||||
9 | Illinois Health Services Insurance Card
in the mail after | ||||||
10 | filling out a Program application form at a health care | ||||||
11 | provider.
Such application form shall be no more than 2 pages | ||||||
12 | long. Individuals who present themselves for covered services
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13 | from a participating provider shall be presumed to be eligible | ||||||
14 | for benefits under
this Act, but shall complete an application | ||||||
15 | for benefits in order to receive an Illinois Health Services
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16 | Insurance Card and have payment made for such benefits. | ||||||
17 | Section 20. Benefits and portability.
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18 | (a) The health coverage benefits under this Act cover all | ||||||
19 | medically
necessary services, including: | ||||||
20 | (1) primary care and prevention; | ||||||
21 | (2) specialty care (other than what is deemed elective | ||||||
22 | cosmetic); | ||||||
23 | (3) inpatient care; | ||||||
24 | (4) outpatient care; |
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1 | (5) emergency care; | ||||||
2 | (6) prescription drugs; | ||||||
3 | (7) durable medical equipment; | ||||||
4 | (8) long-term care; | ||||||
5 | (9) mental health services; | ||||||
6 | (10) the full scope of dental services (other than | ||||||
7 | elective cosmetic dentistry);
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8 | (11) substance abuse treatment services; | ||||||
9 | (12) chiropractic services; and | ||||||
10 | (13) basic vision care and vision correction. | ||||||
11 | (b) Health coverage benefits under this Act are available | ||||||
12 | through any licensed health care provider anywhere in the State | ||||||
13 | that is legally qualified to provide such benefits and for | ||||||
14 | emergency care anywhere in the United States. | ||||||
15 | (c) No deductibles, co-payments, coinsurance, or other | ||||||
16 | cost sharing shall be imposed with respect to covered benefits | ||||||
17 | except for those goods or services that exceed basic covered | ||||||
18 | benefits, as defined by the Board. | ||||||
19 | Section 25. Qualification of participating providers. | ||||||
20 | (a) Health care delivery facilities must meet regional and | ||||||
21 | State
quality and licensing guidelines as a condition of | ||||||
22 | participation under the
Program, including guidelines | ||||||
23 | regarding safe staffing and quality of care. | ||||||
24 | (b) A participating health care provider must be
licensed | ||||||
25 | by the State. No health care provider whose license
is under |
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1 | suspension or has been revoked may participate in the Program | ||||||
2 | (c)
Only non-profit health maintenance organizations that | ||||||
3 | actually deliver care in their own facilities and directly | ||||||
4 | employ clinicians may participate in the Program. | ||||||
5 | (d) Patients shall have free choice of participating
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6 | eligible providers, hospitals, and inpatient care facilities. | ||||||
7 | Section 30. Provider reimbursement. | ||||||
8 | (a) The Program shall pay all health care providers | ||||||
9 | according to the following standards: | ||||||
10 | (1) Physicians and other practitioners can choose to be | ||||||
11 | paid fee-for-service, salaried by institutions receiving | ||||||
12 | global budgets, or salaried by group practices or HMOs | ||||||
13 | receiving capitation payments. Investor-owned HMOs and | ||||||
14 | group practices shall be converted to not-for-profit | ||||||
15 | status. Only institutions that deliver care shall be | ||||||
16 | eligible for Program payments. | ||||||
17 | (2) The Program will pay each hospital and providing | ||||||
18 | institution a monthly lump sum (global budget) to cover all | ||||||
19 | operating expenses. The hospital and Program will | ||||||
20 | negotiate the amount of this payment annually based on past | ||||||
21 | budgets, clinical performance, projected changes in demand | ||||||
22 | for services and input costs, and proposed new programs. | ||||||
23 | Hospitals shall not bill patients for services covered by | ||||||
24 | the Program, and cannot use any of their operating budgets | ||||||
25 | for expansion, profit, excessive executive income, |
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1 | marketing, or major capital purchases or leases. | ||||||
2 | (3) The Program budget will fund major capital | ||||||
3 | expenditures, including the construction of new health | ||||||
4 | facilities and the purchase of expensive equipment. The | ||||||
5 | regional health planning districts shall allocate these | ||||||
6 | capital funds and oversee capital projects funded from | ||||||
7 | private donations.
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8 | (b) The Program shall reimburse physicians choosing to be | ||||||
9 | paid fee-for-service according to a fee schedule negotiated | ||||||
10 | between physician representatives and the Program on at least | ||||||
11 | an annual basis. | ||||||
12 | (c) Hospitals, nursing homes, community health centers, | ||||||
13 | non-profit staff model HMOs, and home health care agencies will | ||||||
14 | receive a global budget to cover operating expenses, negotiated | ||||||
15 | annually with the Program based on past expenditures, past | ||||||
16 | budgets, clinical performance, projected changes in demand for | ||||||
17 | services and input costs, and proposed new programs. Expansions | ||||||
18 | and other substantive capital investments will be funded | ||||||
19 | separately. | ||||||
20 | (d) All covered prescription drugs and durable medical | ||||||
21 | supplies will be paid for according to a fee schedule | ||||||
22 | negotiated between manufacturers and the Program on at least an | ||||||
23 | annual basis. Price reductions shall be achieved by bulk | ||||||
24 | purchasing whenever possible. Where therapeutically equivalent | ||||||
25 | drugs are available, the formulary shall specify the use of the | ||||||
26 | lowest-cost medication, with exceptions available in the case |
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1 | of medical necessity.
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2 | Section 35. Prohibition against duplicating coverage; | ||||||
3 | investor-ownership of health delivery facilities. | ||||||
4 | (a) It is unlawful for a private health insurer to sell | ||||||
5 | health insurance coverage that duplicates the benefits | ||||||
6 | provided under this Act. Nothing in this Act shall be construed | ||||||
7 | as prohibiting the
sale of health insurance coverage for any | ||||||
8 | additional benefits not covered by this Act. | ||||||
9 | (b) Investor-ownership of health delivery facilities, | ||||||
10 | including hospitals, health maintenance organizations, nursing | ||||||
11 | homes, and clinics, is unlawful. Investor-owners of health | ||||||
12 | delivery facilities at the time of the effective date of this | ||||||
13 | Act shall be compensated for the loss of their facilities, but | ||||||
14 | not for loss of business opportunities or for administrative | ||||||
15 | capacity not used by the Program. | ||||||
16 | Section 40. Illinois Health Services Trust. | ||||||
17 | (a) The State shall
establish the Illinois Health Services | ||||||
18 | Trust (IHST), the sole purpose of which shall be to provide the
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19 | financing reserve for the purposes outlined in this Act. | ||||||
20 | Specifically, the IHST
shall provide all of the following: | ||||||
21 | (1) The funds for the general operating budget of the | ||||||
22 | Program. | ||||||
23 | (2) Reimbursement for those benefits outlined in | ||||||
24 | Section 20 of this Act. |
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1 | (3) Public health services. | ||||||
2 | (4) Capital expenditures for construction or | ||||||
3 | renovation of health care facilities or major equipment | ||||||
4 | purchases deemed necessary throughout the State and | ||||||
5 | approved by the Board.
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6 | (5) Re-education and job placement of persons who have | ||||||
7 | lost their jobs as a
result of this transition, limited to | ||||||
8 | the first 5 years. | ||||||
9 | (b) The General Assembly or the Governor may provide funds | ||||||
10 | to the IHST, but may not remove or borrow funds from the IHST. | ||||||
11 | (c) The IHST shall be administered by the Board, under the | ||||||
12 | oversight of the General Assembly.
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13 | (d) Funding of the IHST shall include, but is not limited | ||||||
14 | to, all of the following: | ||||||
15 | (1) Funds appropriated as outlined by the General | ||||||
16 | Assembly on a yearly basis. | ||||||
17 | (2) A progressive set of graduated income | ||||||
18 | contributions: 20% paid by individuals, 20% paid by a | ||||||
19 | business, and 60% paid by the government. | ||||||
20 | (3) All federal moneys that are designated for health | ||||||
21 | care, including, but not limited to, all moneys designated | ||||||
22 | for Medicaid. The Secretary shall be authorized to | ||||||
23 | negotiate with the federal
government for funding of | ||||||
24 | Medicare recipients.
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25 | (4) Grants and contributions, both public and private.
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26 | (5) Any other tax revenues designated by the General |
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1 | Assembly. | ||||||
2 | (6) Any other funds specifically ear-marked for health | ||||||
3 | care or health care
education, such as settlements from | ||||||
4 | litigation.
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5 | (e) The total overhead and administrative portion of the | ||||||
6 | Program budget may not exceed 12% of the total operating budget | ||||||
7 | of the Program for the first 2 years that the Program is in | ||||||
8 | operation; 8% for the following 2 years; and 5% for each year | ||||||
9 | thereafter. | ||||||
10 | (f) The Program may be divided into
regional districts for | ||||||
11 | the purposes of local administration and oversight of programs | ||||||
12 | that are specific to each
region's needs. | ||||||
13 | (g) Claims billing from all providers must be submitted | ||||||
14 | electronically and in compliance with current State and federal | ||||||
15 | privacy laws within 5 years after the effective date of this | ||||||
16 | Act. Electronic claims and billing must be uniform across the | ||||||
17 | State. The Board shall create and implement a statewide uniform | ||||||
18 | system of electronic medical records that is in compliance with | ||||||
19 | current State and federal privacy laws within 7 years after the | ||||||
20 | effective date of this Act. Payments to providers must be made | ||||||
21 | in a timely fashion as outlined under current State and federal | ||||||
22 | law. Providers who accept payment from the Program for services | ||||||
23 | rendered may not bill any patient for covered services. | ||||||
24 | Providers may elect either to participate fully, or not at all, | ||||||
25 | in the Program.
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1 | Section 45. Long-term care payment. The Board shall | ||||||
2 | establish funding for long-term care services, including | ||||||
3 | in-home, nursing home, and community-based care. A local public | ||||||
4 | agency shall be established in each community to determine | ||||||
5 | eligibility and coordinate home and nursing home long-term | ||||||
6 | care. This agency may contract with long-term care providers | ||||||
7 | for the full range of needed long-term care services. | ||||||
8 | Section 50. Mental health services. The Program shall | ||||||
9 | provide coverage for all medically necessary
mental health care | ||||||
10 | on the same basis as the coverage for other conditions. The | ||||||
11 | Program shall cover
supportive residences, occupational | ||||||
12 | therapy, and ongoing mental health and
counseling services | ||||||
13 | outside the hospital for patients with serious mental illness.
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14 | In all cases the highest quality and most effective care shall | ||||||
15 | be delivered, including institutional care. | ||||||
16 | Section 55. Payment for prescription medications, medical | ||||||
17 | supplies, and medically
necessary assistive equipment.
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18 | (a) The Program shall establish a single prescription drug
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19 | formulary and list of approved durable medical goods and | ||||||
20 | supplies. The Board shall, by itself or by a committee of
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21 | health professionals and related individuals appointed by the | ||||||
22 | Board and called the Pharmaceutical and Durable Medical Goods | ||||||
23 | Committee,
meet on a quarterly basis to discuss, reverse, add | ||||||
24 | to, or remove items from
the formulary according to sound |
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1 | medical practice. | ||||||
2 | (b) The Pharmaceutical and Durable Medical Goods Committee | ||||||
3 | shall negotiate the prices of pharmaceuticals and durable
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4 | medical goods with suppliers or manufacturers on an open bid | ||||||
5 | competitive
basis. Prices shall be reviewed, negotiated, or | ||||||
6 | re-negotiated on no less than
an annual basis.
The | ||||||
7 | Pharmaceutical and Durable Medical Goods Committee shall | ||||||
8 | establish a process of open forum to the public for the | ||||||
9 | purposes of grievance and petition from suppliers, provider | ||||||
10 | groups, and the public regarding the formulary no less than 2 | ||||||
11 | times a year. | ||||||
12 | (c) All pharmacy and durable medical goods vendors must be | ||||||
13 | licensed to
distribute medical goods through the regulations | ||||||
14 | outlined by the Board. | ||||||
15 | (d) All decisions and determinations of the Pharmacy and | ||||||
16 | Durable Medical Goods Committee must be presented to and | ||||||
17 | approved by the Board on an annual basis. | ||||||
18 | Section 60. Illinois Health Services Governing Board. | ||||||
19 | (a) The Program shall be administered by an independent | ||||||
20 | agency known as the Illinois Health Services Governing Board. | ||||||
21 | The Board will consist of a Commissioner, a Chief Medical | ||||||
22 | Officer, and public State board members. The Board is | ||||||
23 | responsible for administration of the Program, including:
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24 | (1) implementation of eligibility standards and | ||||||
25 | Program enrollment; |
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1 | (2) adoption of the benefits package;
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2 | (3) establishing formulas for setting health | ||||||
3 | expenditure budgets; | ||||||
4 | (4) administration of global budgets, capital | ||||||
5 | expenditure budgets, and prompt reimbursement of | ||||||
6 | providers; | ||||||
7 | (5) negotiations of service fee schedules and prices | ||||||
8 | for prescription drugs and durable medical supplies; | ||||||
9 | (6) recommending evidenced-based changes to benefits; | ||||||
10 | and | ||||||
11 | (7) quality and planning functions including criteria | ||||||
12 | for capital expansion and infrastructure development, | ||||||
13 | measurement and evaluation of health quality indicators, | ||||||
14 | and the establishment of regions for long-term care | ||||||
15 | integration.
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16 | (b) At least one-third of the members of the Board, | ||||||
17 | including all committees dedicated to benefits design, health | ||||||
18 | planning, quality, and long-term care, shall be consumer | ||||||
19 | representatives. | ||||||
20 | Section 65. Patients rights. The Program shall protect the | ||||||
21 | rights and privacy of the patients that it serves in accordance | ||||||
22 | with all current State and federal statutes. With the | ||||||
23 | development of the electronic medical records, patients shall | ||||||
24 | be afforded the right and option of keeping any portion of | ||||||
25 | their medical records separate from the electronic medical |
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1 | records. Patients have the right to access their medical | ||||||
2 | records upon demand.
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3 | Section 70. Compensation. The Commissioner, the Chief | ||||||
4 | Medical Officer, public State board members, and subsequent | ||||||
5 | employees of the Program shall be compensated in accordance
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6 | with the current pay scale for State employees and as deemed | ||||||
7 | professionally appropriate by the General Assembly and | ||||||
8 | reviewed in accordance with all other State employees.
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9 | Section 99. Effective date. This Act takes effect July 1, | ||||||
10 | 2008.".
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