HB5424 98TH GENERAL ASSEMBLY

LRB098 18649 KTG 53792 b

98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB5424

Introduced , by Rep. Elaine Nekritz

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-33 new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to establish a Health Homes for Chronic Conditions Pilot Program with licensed or certified community-based developmental disability service providers and behavioral health service providers (including mental health providers and substance use disorder prevention and treatment providers) as designated providers. Provides that consistent with Section 2703 of the Patient Protection and Affordable Care Act these health homes shall provide certain services to program enrollees including (i) comprehensive care management; (ii) care coordination; and (iii) health promotion. Requires the Department to submit, by no later than January 1, 2015, the necessary application to the federal Centers for Medicare and Medicaid Services for a State Plan amendment to implement the Pilot Program. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

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

Section 5. The Illinois Public Aid Code is amended by adding Section 5-33 as follows:

(305 ILCS 5/5-33 new)

Sec. 5-33. Health Homes for Chronic Conditions Pilot Program.

(a) Findings. Section 2703 of the Patient Protection and Affordable Care Act, and as contemplated in the Illinois Alliance for Health Innovation Plan, provides states with a Medicaid State Plan Option to establish Health Homes for Enrollees with Chronic Conditions. A health home provides states with an opportunity to build person-centered systems of care that achieve improved outcomes for beneficiaries and better services and value for Medicaid programs. States receiving approval for a Section 2703 Health Home will receive a 90% enhanced Federal Matching Assistance Percentage (FMAP) for the specific services outlined for the first 8 quarters in which the health home program is effective.

Public Act 96-1501 established a long-term care rebalancing initiative aimed at removing the barriers to community living for individuals of all ages with disabilities and long-term illnesses. In addition, Public Act 96-1501 established the Care Coordination mandate to ensure that by January 1, 2015 at least 50% of eligible medical assistance recipients would be enrolled in integrated delivery systems.

On December 30, 2013 the State of Illinois published its Alliance for Health Innovation Plan, which outlines a series of recommended innovations, with initial focus on the State's Medical Assistance program, aimed at achieving the "triple aim" of improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita costs of health care. This Innovation Plan, in describing Medicaid Innovation Models with consumer choice at its core, references both "Medical homes" for specific populations as well as potentially placing primary care responsibilities with providers other than a medical Primary Care Provider (PCP), such as a behavioral health provider, an ID/DD provider, or a specialist. Furthermore, this plan makes specific reference to Section 2703 Health Homes as a potential avenue for such policy changes, indicating support for implementing these models in Illinois.

The General Assembly finds that in the spirit of system rebalancing, advancing person-centered services and supports, and furthering care coordination implementation it is appropriate to explore models of care in which individuals with intellectual and developmental disabilities, mental illness, or substance use disorders receive coordinated medical and long-term care through health homes.

(b) Health Homes for Chronic Conditions Pilot Program. The Department shall establish a Health Homes for Chronic Conditions Pilot Program with licensed or certified community-based developmental disability service providers and behavioral health service providers (including mental health providers and substance use disorder prevention and treatment providers) as designated providers. Consistent with Section 2703 of the Patient Protection and Affordable Care Act, these health homes shall provide the following minimum services to program enrollees:

(1) comprehensive care management;

(2) care coordination;

(3) health promotion;

(4) comprehensive transitional care/follow-up;

(5) patient and family support; and

(6) referral to community and social support services.

State Plan Amendment. By no later than January 1, 2015, the Department shall submit the necessary application to the federal Centers for Medicare and Medicaid Services for a State Plan amendment to implement the Pilot Program described in this Section.

Section 99. Effective date. This Act takes effect upon becoming law.