103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB3855

 

Introduced 2/17/2023, by Rep. Hoan Huynh

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Illinois Medicare for All Health Care Act. Provides that all individuals residing in the State are covered under the Illinois Health Services Program for health insurance. Sets forth the health coverage benefits that participants are entitled to under the Program. Sets forth the qualification requirements for participating health providers. Sets forth standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the Program. Provides that investor-ownership of health delivery facilities is unlawful. Provides that the State shall establish the Illinois Health Services Trust to provide financing for the Program. Sets forth the requirements for claims billing under the Program. Provides that the Program shall include funding for long-term care services and mental health services. Provides that the Program shall establish a single prescription drug formulary and list of approved durable medical goods and supplies. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Sets forth provisions concerning patients' rights. Provides that the employees of the Program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective January 1, 2024.


LRB103 30205 CPF 56633 b

 

 

A BILL FOR

 

HB3855LRB103 30205 CPF 56633 b

1    AN ACT concerning health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the
5Illinois Medicare for All Health Care Act.
 
6    Section 5. Purposes. It is the purpose of this Act to
7provide universal access to health care for all individuals
8within the State, to promote and improve the health of all its
9citizens, to stress the importance of good public health
10through treatment and prevention of diseases, and to contain
11costs to make the delivery of this care affordable. Should
12legislation of this kind be enacted on a federal level, it is
13the 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
16Board.
17    "Program" means the Illinois Health Services Program.
 
18    Section 15. Eligibility; registration. All individuals
19residing in this State are covered under the Illinois Health
20Services Program for health insurance and shall receive a card
21with a unique number in the mail. An individual's social

 

 

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1security number shall not be used for purposes of registration
2under this Section. Individuals and families shall receive an
3Illinois Health Services Insurance Card in the mail after
4filling out a Program application form at a health care
5provider. Such application form shall be no more than 2 pages
6long. Individuals who present themselves for covered services
7from a participating provider shall be presumed to be eligible
8for benefits under this Act, but shall complete an application
9for benefits in order to receive an Illinois Health Services
10Insurance Card and have payment made for such benefits.
 
11    Section 20. Benefits and portability.
12    (a) The health coverage benefits under this Act cover all
13medically necessary services, including:
14        (1) primary care and prevention;
15        (2) specialty care (other than what is deemed elective
16    cosmetic);
17        (3) inpatient care;
18        (4) outpatient care;
19        (5) emergency care;
20        (6) prescription drugs;
21        (7) durable medical equipment;
22        (8) long-term care;
23        (9) mental health services;
24        (10) the full scope of dental services (other than
25    elective cosmetic dentistry);

 

 

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1        (11) substance abuse treatment services;
2        (12) chiropractic services; and
3        (13) basic vision care and vision correction.
4    (b) Health coverage benefits under this Act are available
5through any licensed health care provider anywhere in the
6State that is legally qualified to provide such benefits and
7for emergency care anywhere in the United States.
8    (c) No deductibles, copayments, coinsurance, or other cost
9sharing shall be imposed with respect to covered benefits
10except for those goods or services that exceed basic covered
11benefits, as defined by the Board.
 
12    Section 25. Qualification of participating providers.
13    (a) Health care delivery facilities must meet regional and
14State quality and licensing guidelines as a condition of
15participation under the Program, including guidelines
16regarding safe staffing and quality of care.
17    (b) A participating health care provider must be licensed
18by the State. No health care provider whose license is under
19suspension or has been revoked may participate in the Program
20    (c) Only non-profit health maintenance organizations that
21actually deliver care in their own facilities and directly
22employ clinicians may participate in the Program.
23    (d) Patients shall have free choice of participating
24eligible providers, hospitals, and inpatient care facilities.
 

 

 

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1    Section 30. Provider reimbursement.
2    (a) The Program shall pay all health care providers
3according to the following standards:
4        (1) Physicians and other practitioners can choose to
5    be paid fee-for-service, salaried by institutions
6    receiving global budgets, or salaried by group practices
7    or HMOs receiving capitation payments. Investor-owned HMOs
8    and group practices shall be converted to not-for-profit
9    status. Only institutions that deliver care shall be
10    eligible for Program payments.
11        (2) The Program shall pay each hospital and providing
12    institution a monthly lump sum (global budget) to cover
13    all operating expenses. The hospital and Program shall
14    negotiate the amount of this payment annually based on
15    past budgets, clinical performance, projected changes in
16    demand for services and input costs, and proposed new
17    programs. Hospitals shall not bill patients for services
18    covered by the Program, and cannot use any of their
19    operating budgets for expansion, profit, excessive
20    executive income, marketing, or major capital purchases or
21    leases.
22        (3) The Program budget shall fund major capital
23    expenditures, including the construction of new health
24    facilities and the purchase of expensive equipment. The
25    regional health planning districts shall allocate these
26    capital funds and oversee capital projects funded from

 

 

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1    private donations.
2    (b) The Program shall reimburse physicians choosing to be
3paid fee-for-service according to a fee schedule negotiated
4between physician representatives and the Program on at least
5an annual basis.
6    (c) Hospitals, nursing homes, community health centers,
7non-profit staff model HMOs, and home health care agencies
8shall receive a global budget to cover operating expenses,
9negotiated annually with the Program based on past
10expenditures, past budgets, clinical performance, projected
11changes in demand for services and input costs, and proposed
12new programs. Expansions and other substantive capital
13investments shall be funded separately.
14    (d) All covered prescription drugs and durable medical
15supplies shall be paid for according to a fee schedule
16negotiated between manufacturers and the Program on at least
17an annual basis. Price reductions shall be achieved by bulk
18purchasing whenever possible. Where therapeutically equivalent
19drugs are available, the formulary shall specify the use of
20the lowest-cost medication, with exceptions available in the
21case of medical necessity.
 
22    Section 35. Prohibition against duplicating coverage;
23investor-ownership of health delivery facilities.
24    (a) It is unlawful for a private health insurer to sell
25health insurance coverage that duplicates the benefits

 

 

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1provided under this Act. Nothing in this Act shall be
2construed as prohibiting the sale of health insurance coverage
3for any additional benefits not covered by this Act.
4    (b) Investor-ownership of health delivery facilities,
5including hospitals, health maintenance organizations, nursing
6homes, and clinics, is unlawful. Investor-owners of health
7delivery facilities at the time of the effective date of this
8Act shall be compensated for the loss of their facilities, but
9not for loss of business opportunities or for administrative
10capacity not used by the Program.
 
11    Section 40. Illinois Health Services Trust.
12    (a) The State shall establish the Illinois Health Services
13Trust (IHST), the sole purpose of which shall be to provide the
14financing reserve for the purposes outlined in this Act.
15Specifically, the IHST shall provide all of the following:
16        (1) The funds for the general operating budget of the
17    Program.
18        (2) Reimbursement for those benefits outlined in
19    Section 20 of this Act.
20        (3) Public health services.
21        (4) Capital expenditures for construction or
22    renovation of health care facilities or major equipment
23    purchases deemed necessary throughout the State and
24    approved by the Board.
25        (5) Re-education and job placement of persons who have

 

 

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1    lost their jobs as a result of this transition, limited to
2    the first 5 years.
3    (b) The General Assembly or the Governor may provide funds
4to the IHST, but may not remove or borrow funds from the IHST.
5    (c) The IHST shall be administered by the Board, under the
6oversight of the General Assembly.
7    (d) Funding of the IHST shall include, but is not limited
8to, all of the following:
9        (1) Funds appropriated as outlined by the General
10    Assembly on a yearly basis.
11        (2) A progressive set of graduated income
12    contributions: 20% paid by individuals, 20% paid by a
13    business, and 60% paid by the government.
14        (3) All federal moneys that are designated for health
15    care, including, but not limited to, all moneys designated
16    for Medicaid. The Secretary shall be authorized to
17    negotiate with the federal government for funding of
18    Medicare recipients.
19        (4) Grants and contributions, both public and private.
20        (5) Any other tax revenues designated by the General
21    Assembly.
22        (6) Any other funds specifically ear-marked for health
23    care or health care education, such as settlements from
24    litigation.
25    (e) The total overhead and administrative portion of the
26Program budget may not exceed 12% of the total operating

 

 

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1budget of the Program for the first 2 years that the Program is
2in operation; 8% for the following 2 years; and 5% for each
3year thereafter.
4    (f) The Program may be divided into regional districts for
5the purposes of local administration and oversight of programs
6that are specific to each region's needs.
7    (g) Claims billing from all providers must be submitted
8electronically and in compliance with current State and
9federal privacy laws within 5 years after the effective date
10of this Act. Electronic claims and billing must be uniform
11across the State. The Board shall create and implement a
12statewide uniform system of electronic medical records that is
13in compliance with current State and federal privacy laws
14within 7 years after the effective date of this Act. Payments
15to providers must be made in a timely fashion as outlined under
16current State and federal law. Providers who accept payment
17from the Program for services rendered may not bill any
18patient for covered services. Providers may elect either to
19participate fully, or not at all, in the Program.
 
20    Section 45. Long-term care payment. The Board shall
21establish funding for long-term care services, including
22in-home, nursing home, and community-based care. A local
23public agency shall be established in each community to
24determine eligibility and coordinate home and nursing home
25long-term care. This agency may contract with long-term care

 

 

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1providers for the full range of needed long-term care
2services.
 
3    Section 50. Mental health services. The Program shall
4provide coverage for all medically necessary mental health
5care on the same basis as the coverage for other conditions.
6The Program shall cover supportive residences, occupational
7therapy, and ongoing mental health and counseling services
8outside the hospital for patients with serious mental illness.
9In all cases the highest quality and most effective care shall
10be delivered, including institutional care.
 
11    Section 55. Payment for prescription medications, medical
12supplies, and medically necessary assistive equipment.
13    (a) The Program shall establish a single prescription drug
14formulary and list of approved durable medical goods and
15supplies. The Board shall, by itself or by a committee of
16health professionals and related individuals appointed by the
17Board and called the Pharmaceutical and Durable Medical Goods
18Committee, meet on a quarterly basis to discuss, reverse, add
19to, or remove items from the formulary according to sound
20medical practice.
21    (b) The Pharmaceutical and Durable Medical Goods Committee
22shall negotiate the prices of pharmaceuticals and durable
23medical goods with suppliers or manufacturers on an open bid
24competitive basis. Prices shall be reviewed, negotiated, or

 

 

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1re-negotiated on no less than an annual basis. The
2Pharmaceutical and Durable Medical Goods Committee shall
3establish a process of open forum to the public for the
4purposes of grievance and petition from suppliers, provider
5groups, and the public regarding the formulary no less than 2
6times a year.
7    (c) All pharmacy and durable medical goods vendors must be
8licensed to distribute medical goods through the regulations
9outlined by the Board.
10    (d) All decisions and determinations of the Pharmacy and
11Durable Medical Goods Committee must be presented to and
12approved by the Board on an annual basis.
 
13    Section 60. Illinois Health Services Governing Board.
14    (a) The Program shall be administered by an independent
15agency known as the Illinois Health Services Governing Board.
16The Board will consist of a Commissioner, a Chief Medical
17Officer, and public State board members. The Board is
18responsible for administration of the Program, including:
19        (1) implementation of eligibility standards and
20    Program enrollment;
21        (2) adoption of the benefits package;
22        (3) establishing formulas for setting health
23    expenditure budgets;
24        (4) administration of global budgets, capital
25    expenditure budgets, and prompt reimbursement of

 

 

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1    providers;
2        (5) negotiations of service fee schedules and prices
3    for prescription drugs and durable medical supplies;
4        (6) recommending evidence-based changes to benefits;
5    and
6        (7) quality and planning functions including criteria
7    for capital expansion and infrastructure development,
8    measurement and evaluation of health quality indicators,
9    and the establishment of regions for long-term care
10    integration.
11    (b) At least one-third of the members of the Board,
12including all committees dedicated to benefits design, health
13planning, quality, and long-term care, shall be consumer
14representatives.
 
15    Section 65. Patients' rights. The Program shall protect
16the rights and privacy of the patients that it serves in
17accordance with all current State and federal statutes. With
18the development of the electronic medical records, patients
19shall be afforded the right and option of keeping any portion
20of their medical records separate from the electronic medical
21records. Patients have the right to access their medical
22records upon demand.
 
23    Section 70. Compensation. The Commissioner, the Chief
24Medical Officer, public State board members, and subsequent

 

 

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1employees of the Program shall be compensated in accordance
2with the current pay scale for State employees and as deemed
3professionally appropriate by the General Assembly and
4reviewed in accordance with all other State employees.
 
5    Section 99. Effective date. This Act takes effect January
61, 2024.