HB1661 97TH GENERAL ASSEMBLY

LRB097 08698 RPM 48827 b

97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB1661

Introduced 2/15/2011, by Rep. Patricia R. Bellock

SYNOPSIS AS INTRODUCED:

215 ILCS 170/52.5 new
305 ILCS 5/5-5.06 new

Amends the Covering ALL KIDS Health Insurance Act and the Illinois Public Aid Code. Provides that beginning January 1, 2012, the physician fee schedule for the Covering ALL KIDS Health Insurance Program and for pediatric physician specialists under the medical assistance program must increase to become competitive with those of non-governmental, third-party health insurance programs. Provides that by January 1, 2015, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Provides that the Department shall annually increase pediatric specialty physician payments under the provisions of the Act by an amount approximately equal to one-third of the difference between the actual rates available for such purposes on January 1, 2011 and the Medicare reimbursement rates effective on January 1, 2011. Makes other changes.

A BILL FOR

AN ACT concerning insurance.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Covering ALL KIDS Health Insurance Act is amended by adding Section 52.5 as follows:

(215 ILCS 170/52.5 new)

Sec. 52.5. Specialty physician care; fee schedule.

(a) Beginning January 1, 2012, the physician fee schedule for the Covering ALL KIDS Insurance Program must increase to become competitive with those of non-governmental, third-party health insurance programs. By January 1, 2015, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Payment for services must be made within 30 days after receipt of a bill or claim meeting the requirements of the Department of Healthcare and Family Services.

(b) For payments made or authorized by the Department of Healthcare and Family Services, the Department shall annually increase pediatric specialty physician payments under subsection (a) by an amount approximately equal to one-third of the difference between the actual rates available for such purposes on January 1, 2011 and the Medicare reimbursement rates effective on January 1, 2011. If the General Assembly determines that resources are not available to fully fund the fee schedule for pediatric specialty physician care required by this subsection (b), then, until such time as the General Assembly determines that such funding is available, the Department shall increase any payment for physicians who provide pediatric specialty care services under the Covering ALL KIDS Health Insurance Program by an amount proportionately equivalent to any other increases for physicians, federally qualified health centers, rural health centers, or other non-institutional providers providing services to children for any services provided under this Act.

Section 10. The Illinois Public Aid Code is amended by adding Section 5-5.06 as follows:

(305 ILCS 5/5-5.06 new)

Sec. 5-5.06. Physician payments; pediatric specialty physician services.

(a) Notwithstanding any other provisions of this Article, beginning January 1, 2012, the physician fee schedule for pediatric physician specialists must increase to become competitive with those of non-governmental, third-party health insurance programs. By January 1, 2015, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Payment for services must be made within 30 days after receipt of a bill or claim meeting the requirements of the Department of Healthcare and Family Services.

(b) For payments made or authorized by the Department of Healthcare and Family Services, the Department shall annually increase pediatric specialty physician payments under subsection (a) by an amount approximately equal to one-third of the difference between the actual rates available for such purposes on January 1, 2011 and the Medicare reimbursement rates effective on January 1, 2011. If the General Assembly determines that resources are not available to fully fund the fee schedule for pediatric specialty physician care required by this subsection (b), then, until such time as the General Assembly determines that such funding is available, the Department shall increase any payment for physicians who provide pediatric specialty care services under the medical assistance program by an amount proportionately equivalent to any other increases for physicians, federally qualified health centers, rural health centers, or other non-institutional providers providing services to children for any services provided under this Act.