Rep. Stephanie A. Kifowit

Filed: 3/4/2020

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 4880

2    AMENDMENT NO. ______. Amend House Bill 4880 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Children and Family Services Act is amended
5by changing Section 5.45 as follows:
 
6    (20 ILCS 505/5.45)
7    Sec. 5.45. Managed care plan services.
8    (a) As used in this Section:
9    "Caregiver" means an individual or entity directly
10providing the day-to-day care of a child ensuring the child's
11safety and well-being.
12    "Child" means a child placed in the care of the Department
13pursuant to the Juvenile Court Act of 1987.
14    "Department" means the Department of Children and Family
15Services, or any successor State agency.
16    "Director" means the Director of Children and Family

 

 

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1Services.
2    "Managed care organization" has the meaning ascribed to
3that term in Section 5-30.1 of the Illinois Public Aid Code.
4    "Medicaid managed care plan" means a health care plan
5operated by a managed care organization under the Medical
6Assistance Program established in Article V of the Illinois
7Public Aid Code.
8    "Workgroup" means the Child Welfare Medicaid Managed Care
9Implementation Advisory Workgroup.
10    (b) Every child who is in the care of the Department
11pursuant to the Juvenile Court Act of 1987 shall receive the
12necessary services required by this Act and the Juvenile Court
13Act of 1987, including any child enrolled in a Medicaid managed
14care plan.
15    (c) The Department shall not relinquish its authority or
16diminish its responsibility to determine and provide necessary
17services that are in the best interest of a child even if those
18services are directly or indirectly:
19        (1) provided by a managed care organization, another
20    State agency, or other third parties;
21        (2) coordinated through a managed care organization,
22    another State agency, or other third parties; or
23        (3) paid for by a managed care organization, another
24    State agency, or other third parties.
25    (d) The Department shall:
26        (1) implement and enforce measures to ensure that a

 

 

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1    child's enrollment in Medicaid managed care supports
2    continuity of treatment and does not hinder service
3    delivery;
4        (2) establish a single point of contact for health care
5    coverage inquiries and dispute resolution systemwide
6    without transferring this responsibility to a third party
7    such as a managed care coordinator;
8        (3) not require any child to participate in Medicaid
9    managed care if the child would otherwise be exempt from
10    enrolling in a Medicaid managed care plan under any rule or
11    statute of this State; and
12        (4) make recommendations regarding managed care
13    contract measures, quality assurance activities, and
14    performance delivery evaluations in consultation with the
15    Workgroup; and
16        (5) post on its website:
17            (A) a link to any rule adopted or procedures
18        changed to address the provisions of this Section, if
19        applicable;
20            (B) each managed care organization's contract,
21        enrollee handbook, and directory;
22            (C) the notification process and timeframe
23        requirements used to inform managed care plan
24        enrollees, enrollees' caregivers, and enrollees' legal
25        representation of any changes in health care coverage
26        or change in a child's managed care provider;

 

 

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1            (D) defined prior authorization requirements for
2        prescriptions, goods, and services in emergency and
3        non-emergency situations;
4            (E) the State's current Health Care Oversight and
5        Coordination Plan developed in accordance with federal
6        requirements; and
7            (F) the transition plan required under subsection
8        (f), including:
9                (i) the public comments submitted to the
10            Department, the Department of Healthcare and
11            Family Services, and the Workgroup for
12            consideration in development of the transition
13            plan;
14                (ii) a list and summary of recommendations of
15            the Workgroup that the Director or Director of
16            Healthcare and Family Services declined to adopt
17            or implement; and
18                (iii) the Department's attestation that the
19            transition plan will not impede the Department's
20            ability to timely identify the service needs of
21            youth in care and the timely and appropriate
22            provision of services to address those identified
23            needs; and .
24        (6) review and automatically appeal all claim denials
25    for youth in care and former youth in care who are enrolled
26    in or received services provided by a Medicaid managed care

 

 

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1    plan. The Department shall cover all costs associated with
2    any appeal it files in accordance with this paragraph. The
3    Department shall cover all costs associated with any
4    medications or health care services provided to a youth in
5    care or a former youth in care during the appeal process if
6    the youth's claim is ultimately denied after appeal.
7    (e) The Child Welfare Medicaid Managed Care Implementation
8Advisory Workgroup is established to advise the Department on
9the transition and implementation of managed care for children.
10The Director of Children and Family Services and the Director
11of Healthcare and Family Services shall serve as
12co-chairpersons of the Workgroup. The Directors shall jointly
13appoint members to the Workgroup who are stakeholders from the
14child welfare community, including:
15        (1) employees of the Department of Children and Family
16    Services who have responsibility in the areas of (i)
17    managed care services, (ii) performance monitoring and
18    oversight, (iii) placement operations, and (iv) budget
19    revenue maximization;
20        (2) employees of the Department of Healthcare and
21    Family Services who have responsibility in the areas of (i)
22    managed care contracting, (ii) performance monitoring and
23    oversight, (iii) children's behavioral health, and (iv)
24    budget revenue maximization;
25        (3) 2 representatives of youth in care;
26        (4) one representative of managed care organizations

 

 

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1    serving youth in care;
2        (5) 4 representatives of child welfare providers;
3        (6) one representative of parents of children in
4    out-of-home care;
5        (7) one representative of universities or research
6    institutions;
7        (8) one representative of pediatric physicians;
8        (9) one representative of the juvenile court;
9        (10) one representative of caregivers of youth in care;
10        (11) one practitioner with expertise in child and
11    adolescent psychiatry;
12        (12) one representative of substance abuse and mental
13    health providers with expertise in serving children
14    involved in child welfare and their families;
15        (13) at least one member of the Medicaid Advisory
16    Committee;
17        (14) one representative of a statewide organization
18    representing hospitals;
19        (15) one representative of a statewide organization
20    representing child welfare providers;
21        (16) one representative of a statewide organization
22    representing substance abuse and mental health providers;
23    and
24        (17) other child advocates as deemed appropriate by the
25    Directors.
26    To the greatest extent possible, the co-chairpersons shall

 

 

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1appoint members who reflect the geographic diversity of the
2State and include members who represent rural service areas.
3Members shall serve 2-year terms or until the Workgroup
4dissolves. If a vacancy occurs in the Workgroup membership, the
5vacancy shall be filled in the same manner as the original
6appointment for the remainder of the unexpired term. The
7Workgroup shall hold meetings, as it deems appropriate, in the
8northern, central, and southern regions of the State to solicit
9public comments to develop its recommendations. To ensure the
10Department of Children and Family Services and the Department
11of Healthcare and Family Services are provided time to confer
12and determine their use of pertinent Workgroup recommendations
13in the transition plan required under subsection (f), the
14co-chairpersons shall convene at least 3 meetings. The
15Department of Children and Family Services and the Department
16of Healthcare and Family Services shall provide administrative
17support to the Workgroup. Workgroup members shall serve without
18compensation. The Workgroup shall dissolve 5 years after the
19Department of Children and Family Services' implementation of
20managed care.
21    (f) Prior to transitioning any child to managed care, the
22Department of Children and Family Services and the Department
23of Healthcare and Family Services, in consultation with the
24Workgroup, must develop and post publicly, a transition plan
25for the provision of health care services to children enrolled
26in Medicaid managed care plans. Interim transition plans must

 

 

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1be posted to the Department's website by July 15, 2018. The
2transition plan shall be posted at least 28 days before the
3Department's implementation of managed care. The transition
4plan shall address, but is not limited to, the following:
5        (1) an assessment of existing network adequacy, plans
6    to address gaps in network, and ongoing network evaluation;
7        (2) a framework for preparing and training
8    organizations, caregivers, frontline staff, and managed
9    care organizations;
10        (3) the identification of administrative changes
11    necessary for successful transition to managed care, and
12    the timeframes to make changes;
13        (4) defined roles, responsibilities, and lines of
14    authority for care coordination, placement providers,
15    service providers, and each State agency involved in
16    management and oversight of managed care services;
17        (5) data used to establish baseline performance and
18    quality of care, which shall be utilized to assess quality
19    outcomes and identify ongoing areas for improvement;
20        (6) a process for stakeholder input into managed care
21    planning and implementation;
22        (7) a dispute resolution process, including the rights
23    of enrollees and representatives of enrollees under the
24    dispute process and timeframes for dispute resolution
25    determinations and remedies;
26        (8) the process for health care transition for youth

 

 

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1    exiting the Department's care through emancipation or
2    achieving permanency; and
3        (9) protections to ensure the continued provision of
4    health care services if a child's residence or legal
5    guardian changes.
6    (g) Reports.
7        (1) On or before February 1, 2019, and on or before
8    each February 1 thereafter, the Department shall submit a
9    report to the House and Senate Human Services Committees,
10    or to any successor committees, on measures of access to
11    and the quality of health care services for children
12    enrolled in Medicaid managed care plans, including, but not
13    limited to, data showing whether:
14            (A) children enrolled in Medicaid managed care
15        plans have continuity of care across placement types,
16        geographic regions, and specialty service needs;
17            (B) each child is receiving the early periodic
18        screening, diagnosis, and treatment services as
19        required by federal law, including, but not limited to,
20        regular preventative care and timely specialty care;
21            (C) children are assigned to health homes;
22            (D) each child has a health care oversight and
23        coordination plan as required by federal law;
24            (E) there exist complaints and grievances
25        indicating gaps or barriers in service delivery; and
26            (F) the Workgroup and other stakeholders have and

 

 

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1        continue to be engaged in quality improvement
2        initiatives.
3        The report shall be prepared in consultation with the
4    Workgroup and other agencies, organizations, or
5    individuals the Director deems appropriate in order to
6    obtain comprehensive and objective information about the
7    managed care plan operation.
8        (2) During each legislative session, the House and
9    Senate Human Services Committees shall hold hearings to
10    take public testimony about managed care implementation
11    for children in the care of, adopted from, or placed in
12    guardianship by the Department. The Department shall
13    present testimony, including information provided in the
14    report required under paragraph (1), the Department's
15    compliance with the provisions of this Section, and any
16    recommendations for statutory changes to improve health
17    care for children in the Department's care.
18    (h) If any provision of this Section or its application to
19any person or circumstance is held invalid, the invalidity of
20that provision or application does not affect other provisions
21or applications of this Section that can be given effect
22without the invalid provision or application.
23(Source: P.A. 100-646, eff. 7-27-18.)
 
24    Section 99. Effective date. This Act takes effect upon
25becoming law.".