Human Services Committee
Filed: 3/12/2008
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1 | AMENDMENT TO HOUSE BILL 5331
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2 | AMENDMENT NO. ______. Amend House Bill 5331 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Covering ALL KIDS Health Insurance Act is | ||||||
5 | amended by adding Section 52.5 as follows: | ||||||
6 | (215 ILCS 170/52.5 new) | ||||||
7 | Sec. 52.5. Specialty physician care; fee schedule. | ||||||
8 | (a) Beginning January 1, 2009, the physician fee schedule | ||||||
9 | for the Covering ALL KIDS Insurance Program must increase to | ||||||
10 | become competitive with those of non-governmental, third party | ||||||
11 | health insurance programs. By January 1, 2011, the payment for | ||||||
12 | a pediatric specialty physician service must not be lower than | ||||||
13 | Medicare reimbursement in accordance with the Medicare payment | ||||||
14 | localities for Illinois. Reimbursement rules and policies | ||||||
15 | shall not be more restrictive than Medicare physician payment | ||||||
16 | rules and policies except as specifically required by federal |
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1 | Medicaid and SCHIP laws. Payment for services must be made | ||||||
2 | within 30 days after receipt of a bill or claim for payment in | ||||||
3 | accordance with Section 368a of the Illinois Insurance Code. | ||||||
4 | (b) Transition period. For payments made or authorized by | ||||||
5 | the Department of Healthcare and Family Services, the | ||||||
6 | Department shall annually increase pediatric specialty | ||||||
7 | physician payments under subsection (a) by an amount | ||||||
8 | approximately equal to one third of the difference between the | ||||||
9 | actual rates available for such purposes on January 1, 2008 and | ||||||
10 | the Medicare reimbursement rates effective on January 1, 2007. | ||||||
11 | If the General Assembly determines that resources are not | ||||||
12 | available to fully fund the fee schedule for pediatric | ||||||
13 | specialty physician care required by this subsection, then, | ||||||
14 | until such time as the General Assembly determines that such | ||||||
15 | funding is available, the Department shall
increase any payment | ||||||
16 | for physicians who provide pediatric specialty care
services | ||||||
17 | under the Covering ALL KIDS Health Insurance Program
by an | ||||||
18 | amount proportionately equivalent to any other increases
for | ||||||
19 | physicians, federally qualified health centers, rural
health | ||||||
20 | centers, or other non-institutional providers providing
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21 | services to children for any services provided under this Act. | ||||||
22 | (c) Notwithstanding any other rulemaking authority that | ||||||
23 | may exist, neither the Governor nor any agency or agency head | ||||||
24 | under the jurisdiction of the Governor has any authority to | ||||||
25 | make or promulgate rules to implement or enforce the provisions | ||||||
26 | of this amendatory Act of the 95th General Assembly. If, |
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1 | however, the Governor believes that rules are necessary to | ||||||
2 | implement or enforce the provisions of this amendatory Act of | ||||||
3 | the 95th General Assembly, the Governor may suggest rules to | ||||||
4 | the General Assembly by filing them with the Clerk of the House | ||||||
5 | and Secretary of the Senate and by requesting that the General | ||||||
6 | Assembly authorize such rulemaking by law, enact those | ||||||
7 | suggested rules into law, or take any other appropriate action | ||||||
8 | in the General Assembly's discretion. Nothing contained in this | ||||||
9 | amendatory Act of the 95th General Assembly shall be | ||||||
10 | interpreted to grant rulemaking authority under any other | ||||||
11 | Illinois statute where such authority is not otherwise | ||||||
12 | explicitly given. For the purposes of this amendatory Act of | ||||||
13 | the 95th General Assembly, "rules" is given the meaning | ||||||
14 | contained in Section 1-70 of the Illinois Administrative | ||||||
15 | Procedure Act, and "agency" and "agency head" are given the | ||||||
16 | meanings contained in Sections 1-20 and 1-25 of the Illinois | ||||||
17 | Administrative Procedure Act to the extent that such | ||||||
18 | definitions apply to agencies or agency heads under the | ||||||
19 | jurisdiction of the Governor. | ||||||
20 | | ||||||
21 | Section 10. The Illinois Public Aid Code is amended by | ||||||
22 | adding Section 5-5.05 as follows: | ||||||
23 | (305 ILCS 5/5-5.05 new) | ||||||
24 | Sec. 5-5.05. Physician payments; pediatric specialty |
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1 | physician services. | ||||||
2 | (a) Notwithstanding any other provision of this Article, | ||||||
3 | beginning January 1, 2009, the physician fee schedule for | ||||||
4 | pediatric physician specialists must increase to become | ||||||
5 | competitive with those of non-governmental, third party health | ||||||
6 | insurance programs. By January 1, 2011, the payment for a | ||||||
7 | pediatric specialty physician service must not be lower than | ||||||
8 | Medicare reimbursement in accordance with the Medicare payment | ||||||
9 | localities for Illinois. Reimbursement rules and policies | ||||||
10 | shall not be more restrictive than Medicare physician payment | ||||||
11 | rules and policies except as specifically required by federal | ||||||
12 | Medicaid and SCHIP laws. Payment for services must be made | ||||||
13 | within 30 days after receipt of a bill or claim for payment in | ||||||
14 | accordance with Section 368a of the Illinois Insurance Code. | ||||||
15 | (b)
Transition period. For payments made or authorized by | ||||||
16 | the Department of Healthcare and Family Services, the | ||||||
17 | Department shall annually increase pediatric specialty | ||||||
18 | physician payments under subsection (a) by an amount | ||||||
19 | approximately equal to one third of the difference between the | ||||||
20 | actual rates available for such purposes on January 1, 2008 and | ||||||
21 | the Medicare reimbursement rates effective on January 1, 2007. | ||||||
22 | If the General Assembly determines that resources are not | ||||||
23 | available to fully fund the fee schedule for pediatric | ||||||
24 | specialty physician care required by this subsection, then, | ||||||
25 | until such time as the General Assembly determines that such | ||||||
26 | funding is available, the Department shall
increase any payment |
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1 | for physicians who provide pediatric specialty care
services | ||||||
2 | under the medical assistance program
by an amount | ||||||
3 | proportionately equivalent to any other increases
for | ||||||
4 | physicians, federally qualified health centers, rural
health | ||||||
5 | centers, or other non-institutional providers providing
| ||||||
6 | services to children for any services provided under this Act. | ||||||
7 | (c) Notwithstanding any other rulemaking authority that | ||||||
8 | may exist, neither the Governor nor any agency or agency head | ||||||
9 | under the jurisdiction of the Governor has any authority to | ||||||
10 | make or promulgate rules to implement or enforce the provisions | ||||||
11 | of this amendatory Act of the 95th General Assembly. If, | ||||||
12 | however, the Governor believes that rules are necessary to | ||||||
13 | implement or enforce the provisions of this amendatory Act of | ||||||
14 | the 95th General Assembly, the Governor may suggest rules to | ||||||
15 | the General Assembly by filing them with the Clerk of the House | ||||||
16 | and Secretary of the Senate and by requesting that the General | ||||||
17 | Assembly authorize such rulemaking by law, enact those | ||||||
18 | suggested rules into law, or take any other appropriate action | ||||||
19 | in the General Assembly's discretion. Nothing contained in this | ||||||
20 | amendatory Act of the 95th General Assembly shall be | ||||||
21 | interpreted to grant rulemaking authority under any other | ||||||
22 | Illinois statute where such authority is not otherwise | ||||||
23 | explicitly given. For the purposes of this amendatory Act of | ||||||
24 | the 95th General Assembly, "rules" is given the meaning | ||||||
25 | contained in Section 1-70 of the Illinois Administrative | ||||||
26 | Procedure Act, and "agency" and "agency head" are given the |
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| |||||||
1 | meanings contained in Sections 1-20 and 1-25 of the Illinois | ||||||
2 | Administrative Procedure Act to the extent that such | ||||||
3 | definitions apply to agencies or agency heads under the | ||||||
4 | jurisdiction of the Governor. ".
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