94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB2887

 

Introduced 2/22/2005, by Rep. Tom Cross

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 106/25

    Amends the Children's Health Insurance Program Act. Makes a technical change in a Section concerning health benefits for children.


LRB094 10265 LJB 40533 b

 

 

A BILL FOR

 

HB2887 LRB094 10265 LJB 40533 b

1     AN ACT concerning regulation.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Children's Health Insurance Program Act is
5 amended by changing Section 25 as follows:
 
6     (215 ILCS 106/25)
7     Sec. 25. Health benefits for children.
8     (a) The The Department shall, subject to appropriation,
9 provide health benefits coverage to eligible children by:
10         (1) Subsidizing the cost of privately sponsored health
11     insurance, including employer based health insurance, to
12     assist families to take advantage of available privately
13     sponsored health insurance for their eligible children;
14     and
15         (2) Purchasing or providing health care benefits for
16     eligible children. The health benefits provided under this
17     subdivision (a)(2) shall, subject to appropriation and
18     without regard to any applicable cost sharing under Section
19     30, be identical to the benefits provided for children
20     under the State's approved plan under Title XIX of the
21     Social Security Act. Providers under this subdivision
22     (a)(2) shall be subject to approval by the Department to
23     provide health care under the Illinois Public Aid Code and
24     shall be reimbursed at the same rate as providers under the
25     State's approved plan under Title XIX of the Social
26     Security Act. In addition, providers may retain
27     co-payments when determined appropriate by the Department.
28     (b) The subsidization provided pursuant to subdivision
29 (a)(1) shall be credited to the family of the eligible child.
30     (c) The Department is prohibited from denying coverage to a
31 child who is enrolled in a privately sponsored health insurance
32 plan pursuant to subdivision (a)(1) because the plan does not

 

 

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1 meet federal benchmarking standards or cost sharing and
2 contribution requirements. To be eligible for inclusion in the
3 Program, the plan shall contain comprehensive major medical
4 coverage which shall consist of physician and hospital
5 inpatient services. The Department is prohibited from denying
6 coverage to a child who is enrolled in a privately sponsored
7 health insurance plan pursuant to subdivision (a)(1) because
8 the plan offers benefits in addition to physician and hospital
9 inpatient services.
10     (d) The total dollar amount of subsidizing coverage per
11 child per month pursuant to subdivision (a)(1) shall be equal
12 to the average dollar payments, less premiums incurred, per
13 child per month pursuant to subdivision (a)(2). The Department
14 shall set this amount prospectively based upon the prior fiscal
15 year's experience adjusted for incurred but not reported claims
16 and estimated increases or decreases in the cost of medical
17 care. Payments obligated before July 1, 1999, will be computed
18 using State Fiscal Year 1996 payments for children eligible for
19 Medical Assistance and income assistance under the Aid to
20 Families with Dependent Children Program, with appropriate
21 adjustments for cost and utilization changes through January 1,
22 1999. The Department is prohibited from providing a subsidy
23 pursuant to subdivision (a)(1) that is more than the
24 individual's monthly portion of the premium.
25     (e) An eligible child may obtain immediate coverage under
26 this Program only once during a medical visit. If coverage
27 lapses, re-enrollment shall be completed in advance of the next
28 covered medical visit and the first month's required premium
29 shall be paid in advance of any covered medical visit.
30     (f) In order to accelerate and facilitate the development
31 of networks to deliver services to children in areas outside
32 counties with populations in excess of 3,000,000, in the event
33 less than 25% of the eligible children in a county or
34 contiguous counties has enrolled with a Health Maintenance
35 Organization pursuant to Section 5-11 of the Illinois Public
36 Aid Code, the Department may develop and implement

 

 

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1 demonstration projects to create alternative networks designed
2 to enhance enrollment and participation in the program. The
3 Department shall prescribe by rule the criteria, standards, and
4 procedures for effecting demonstration projects under this
5 Section.
6 (Source: P.A. 90-736, eff. 8-12-98.)