94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
SB3021

 

Introduced 1/20/2006, by Sen. J. Bradley Burzynski - Dale A. Righter - Kirk W. Dillard - Dave Syverson - Wendell E. Jones, et al.

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 170/20
215 ILCS 170/30
215 ILCS 170/35
215 ILCS 170/37 new
215 ILCS 170/40
215 ILCS 170/42 new
215 ILCS 170/70 new
215 ILCS 170/75 new

    Amends the Covering ALL KIDS Health Insurance Act. Provides that a person must be a citizen of the United States, have an annual household income of less than $80,001, and have household assets of less than $10,000 to be eligible for the Program. Provides that the Department of Financial and Professional Regulation shall not incur an annual outreach and marketing expense of greater than $1,000,000 and that products, publications, and advertisements shall not contain the name or title of any elected official. Specifies health benefits that may be included in benefit packages. Sets forth premium, co-payment, and out-of-pocket cost requirements. Establishes the Covering ALL KIDS Health Insurance Program Review Committee and sets forth duties of the Committee. Limits State funding for the Covering ALL KIDS Health Insurance Program. Effective July 1, 2006.


LRB094 18923 LJB 54370 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB3021 LRB094 18923 LJB 54370 b

1     AN ACT concerning insurance.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Covering ALL KIDS Health Insurance Act is
5 amended by changing Sections 20, 30, 35, and 40 and by adding
6 Sections 37, 42, 70, and 75 as follows:
 
7     (215 ILCS 170/20)
8     (Section scheduled to be repealed on July 1, 2011)
9     (This Section may contain text from a Public Act with a
10 delayed effective date)
11     Sec. 20. Eligibility.
12     (a) To be eligible for the Program, a person must be a
13 child:
14         (1) who is a citizen of the United States and a
15     resident of the State of Illinois; and
16         (2) who is ineligible for medical assistance under the
17     Illinois Public Aid Code or benefits under the Children's
18     Health Insurance Program Act; and
19         (3) either (i) who is verified by the Department to
20     have has been without health insurance coverage for a
21     period set forth by the Department in rules, but not less
22     than 6 months during the first month of operation of the
23     Program, 7 months during the second month of operation, 8
24     months during the third month of operation, 9 months during
25     the fourth month of operation, 10 months during the fifth
26     month of operation, 11 months during the sixth month of
27     operation, and 12 months thereafter, (ii) whose parent has
28     lost employment that made available affordable dependent
29     health insurance coverage, until such time as affordable
30     employer-sponsored dependent health insurance coverage is
31     again available for the child as set forth by the
32     Department in rules, (iii) who is a newborn whose

 

 

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1     responsible relative does not have available affordable
2     private or employer-sponsored health insurance, or (iv)
3     who, within one year of applying for coverage under this
4     Act, lost medical benefits under the Illinois Public Aid
5     Code or the Children's Health Insurance Program Act; and .
6         (4) whose annual household income, as determined and
7     verified by the Department, is less than $80,001; and
8         (5) whose household assets do not exceed $10,000,
9     excluding (i) the value of the residence in which the child
10     lives and (ii) the value of a vehicle used by the household
11     for transportation purposes; for purposes of this
12     subdivision (5), "vehicle" does not include a recreational
13     vehicle as defined in the Campground Licensing and
14     Recreational Area Act.
15     An entity that provides health insurance coverage (as
16 defined in Section 2 of the Comprehensive Health Insurance Plan
17 Act) to Illinois residents shall provide health insurance data
18 match to the Department of Healthcare and Family Services for
19 the purpose of determining eligibility for the Program under
20 this Act.
21     The Department of Healthcare and Family Services, in
22 collaboration with the Department of Financial and
23 Professional Regulation, Division of Insurance, shall adopt
24 rules governing the exchange of information under this Section.
25 The rules shall be consistent with all laws relating to the
26 confidentiality or privacy of personal information or medical
27 records, including provisions under the Federal Health
28 Insurance Portability and Accountability Act (HIPAA).
29     (b) The Department shall monitor the availability and
30 retention of employer-sponsored dependent health insurance
31 coverage and shall modify the period described in subdivision
32 (a)(3) if necessary to promote retention of private or
33 employer-sponsored health insurance and timely access to
34 healthcare services, but at no time shall the period described
35 in subdivision (a)(3) be less than 6 months.
36     (c) The Department, at its discretion, may take into

 

 

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1 account the affordability of dependent health insurance when
2 determining whether employer-sponsored dependent health
3 insurance coverage is available upon reemployment of a child's
4 parent as provided in subdivision (a)(3).
5     (d) A child who is determined to be eligible for the
6 Program shall remain eligible for 12 months, provided that the
7 child maintains his or her residence in this State, has not yet
8 attained 19 years of age, and is not excluded under subsection
9 (e).
10     (e) A child is not eligible for coverage under the Program
11 if:
12         (1) the premium required under Section 40 has not been
13     timely paid; if the required premiums are not paid, the
14     liability of the Program shall be limited to benefits
15     incurred under the Program for the time period for which
16     premiums have been paid; if the required monthly premium is
17     not paid, the child is ineligible for re-enrollment for a
18     minimum period of 3 months; re-enrollment shall be
19     completed before the next covered medical visit, and the
20     first month's required premium shall be paid in advance of
21     the next covered medical visit; or
22         (2) the child is an inmate of a public institution or
23     an institution for mental diseases.
24     (f) The Department shall adopt eligibility rules,
25 including, but not limited to: rules regarding annual renewals
26 of eligibility for the Program; rules providing for
27 re-enrollment, grace periods, notice requirements, and hearing
28 procedures under subdivision (e)(1) of this Section; and rules
29 regarding what constitutes availability and affordability of
30 private or employer-sponsored health insurance, with
31 consideration of such factors as the percentage of income
32 needed to purchase children or family health insurance, the
33 availability of employer subsidies, and other relevant
34 factors.
35 (Source: P.A. 94-693, eff. 7-1-06.)
 

 

 

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1     (215 ILCS 170/30)
2     (Section scheduled to be repealed on July 1, 2011)
3     (This Section may contain text from a Public Act with a
4 delayed effective date)
5     Sec. 30. Program outreach and marketing.
6     (a) The Department may provide grants to application agents
7 and other community-based organizations to educate the public
8 about the availability of the Program. The Department shall
9 adopt rules regarding performance standards and outcomes
10 measures expected of organizations that are awarded grants
11 under this Section, including penalties for nonperformance of
12 contract standards.
13     (b) The Department shall not incur an annual outreach and
14 marketing expense greater than $1,000,000 in any given fiscal
15 year.
16     (c) Any product, publication, or advertisement used to
17 market or provide outreach for the Program may contain the name
18 and contact information of the Department but shall not contain
19 the name or title of any elected official in the State of
20 Illinois.
21 (Source: P.A. 94-693, eff. 7-1-06.)
 
22     (215 ILCS 170/35)
23     (Section scheduled to be repealed on July 1, 2011)
24     (This Section may contain text from a Public Act with a
25 delayed effective date)
26     Sec. 35. Health care benefits for children.
27     (a) The Department shall purchase or provide at least 3
28 different health care benefit packages benefits for eligible
29 children that may include all or any combination of the
30 following: are identical to the benefits provided for children
31 under the Illinois Children's Health Insurance Program Act,
32 except for non-emergency transportation.
33         (1) inpatient hospital care;
34         (2) outpatient hospital care;
35         (3) physician services;

 

 

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1         (4) laboratory and x-ray services;
2         (5) immunizations and other early and periodic
3     screening, diagnostic, and treatment services;
4         (6) Federally Qualified Health Center and rural health
5     clinic services;
6         (7) prescription drugs;
7         (8) dental care; or
8         (9) vision care.
9     (b) As an alternative to the benefits set forth in
10 subsection (a), and when cost-effective, the Department may
11 offer families subsidies toward the cost of privately sponsored
12 health insurance, including employer-sponsored health
13 insurance.
14     (c) Notwithstanding clause (i) of subdivision (a)(3) of
15 Section 20, the Department may consider offering, as an
16 alternative to the benefits set forth in subsection (a),
17 partial coverage to children who are enrolled in a
18 high-deductible private health insurance plan.
19     (d) Notwithstanding clause (i) of subdivision (a)(3) of
20 Section 20, the Department may consider offering, as an
21 alternative to the benefits set forth in subsection (a), a
22 limited package of benefits to children in families who have
23 private or employer-sponsored health insurance that does not
24 cover certain benefits such as dental or vision benefits.
25     (e) The content and availability of benefits described in
26 subsections (b), (c), and (d), and the terms of eligibility for
27 those benefits, shall be at the Department's discretion and the
28 Department's determination of efficacy and cost-effectiveness
29 as a means of promoting retention of private or
30 employer-sponsored health insurance.
31 (Source: P.A. 94-693, eff. 7-1-06.)
 
32     (215 ILCS 170/37 new)
33     Sec. 37. Premiums.
34     (a) Children who are enrolled in the Program under
35 subsection (a) of Section 35 and whose annual household income

 

 

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1 is less than $60,000 shall be subject to monthly premiums not
2 to exceed $40 per month per child for the most comprehensive
3 benefit package offered by the Department in the fiscal year
4 beginning July 1, 2006. The Department may reduce the monthly
5 premium requirement for any lesser benefit package offered by
6 the Department. Premiums will only be charged on a maximum of 2
7 children per family. All monthly premiums shall be adjusted
8 annually on July 1 of each fiscal year based on the percentage
9 increase in the Consumer Price Index for All Urban Consumers
10 for medical care for the preceding 12-month calendar year, as
11 published by the United States Department of Labor, Bureau of
12 Labor Statistics.
13     (b) Children who are enrolled in the Program under
14 subsection (a) of Section 35 and whose annual household income
15 is between $60,000 and $80,001 shall be subject to monthly
16 premiums not to exceed $70 per month per child for the most
17 comprehensive benefit package offered by the Department in the
18 fiscal year beginning July 1, 2006. The Department may reduce
19 the monthly premium requirement for any lesser benefit package
20 offered by the Department. Premiums will only be charged on a
21 maximum of 2 children per family. All monthly premiums shall be
22 adjusted annually on July 1 of each fiscal year based on the
23 percentage increase in the Consumer Price Index for All Urban
24 Consumers for medical care for the preceding 12-month calendar
25 year, as published by the United States Department of Labor,
26 Bureau of Labor Statistics.
 
27     (215 ILCS 170/40)
28     (Section scheduled to be repealed on July 1, 2011)
29     (This Section may contain text from a Public Act with a
30 delayed effective date)
31     Sec. 40. Cost-sharing.
32     (a) Children enrolled in the Program under subsection (a)
33 of Section 35 are subject to the following cost-sharing
34 requirements:
35         (1) For children with household incomes less than

 

 

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1     $60,000, children will be subject to a $10 co-payment for
2     physician visits, a $30 co-payment for emergency room
3     visits, a $100 co-payment for in-patient hospital
4     services, a co-payment on prescription drugs that is equal
5     to 5% of the amount paid by the Department for the
6     prescription, and a co-payment for outpatient hospital
7     services that is equal to 5% of the amount paid by the
8     Department for those services. The Department, by rule,
9     shall set forth requirements concerning co-payments and
10     coinsurance for health care services and monthly premiums.
11     This cost-sharing shall be on a sliding scale based on
12     family income. The Department may periodically modify such
13     cost-sharing.
14         (2) For children with household incomes between
15     $60,000 and $80,001, children will be subject to a $15
16     co-payment for physician visits, a $50 co-payment for
17     emergency room visits, a $150 co-payment for in-patient
18     hospital services, a co-payment on prescription drugs that
19     is equal to 10% of the amount paid by the Department for
20     the prescription, and a co-payment for outpatient hospital
21     services that is equal to 10% of the amount paid by the
22     Department for those services. The Department may
23     periodically modify such cost sharing.
24         (3) (2) Notwithstanding paragraphs paragraph (1) and
25     (2), there shall be no co-payment required for well-baby or
26     well-child health care, including, but not limited to,
27     age-appropriate immunizations as required under State or
28     federal law.
29     (b) Children enrolled in a privately sponsored health
30 insurance plan under subsection (b) of Section 35 are subject
31 to the cost-sharing provisions stated in the privately
32 sponsored health insurance plan.
33     (c) Notwithstanding any other provision of law, rates paid
34 by the Department shall not be used in any way to determine the
35 usual and customary or reasonable charge, which is the charge
36 for health care that is consistent with the average rate or

 

 

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1 charge for similar services furnished by similar providers in a
2 certain geographic area.
3 (Source: P.A. 94-693, eff. 7-1-06.)
 
4     (215 ILCS 170/42 new)
5     Sec. 42. Maximum out-of-pocket costs.
6     (a) Children who are enrolled in the Program under
7 subsection (a) of Section 35 and whose annual household income
8 is less than $60,000 shall be subject to a maximum
9 out-of-pocket limitation of $500 per year.
10     (b) Children who are enrolled in the Program under
11 subsection (a) of Section 35 and whose annual household income
12 is between $60,000 and $80,001 shall be subject to a maximum
13 out-of-pocket limitation of $750 per year.
 
14     (215 ILCS 170/70 new)
15     Sec. 70. Covering ALL KIDS Health Insurance Program Review
16 Committee.
17     (a) The Covering ALL KIDS Health Insurance Program Review
18 Committee is hereby created. The Committee shall consist of 15
19 members as follows:
20         (1) Twelve members appointed as follows: 2 members of
21     the General Assembly and 1 member of the general public
22     appointed by the President of the Senate; 2 members of the
23     General Assembly and 1 member of the general public
24     appointed by the Minority Leader of the Senate; 2 members
25     of the General Assembly and 1 member of the general public
26     appointed by the Speaker of the House of Representatives;
27     and 2 members of the General Assembly and 1 member of the
28     general public appointed by the Minority Leader of the
29     House of Representatives. These members shall serve at the
30     pleasure of the appointing authority.
31         (2) The Director of Healthcare and Family Services, or
32     his or her designee.
33         (3) The Director of the Division of Insurance of the
34     Department of Financial and Professional Regulation, or

 

 

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1     his or her designee.
2         (4) The Secretary of Human Services, or his or her
3     designee.
4     (b) Members appointed from the general public shall
5 represent the following associations, organizations, and
6 interests: statewide membership-based child advocacy
7 organizations, insurance companies or statewide member-based
8 organizations representing insurance companies, pharmacists or
9 statewide member-based organizations representing pharmacists,
10 physicians or statewide member-based organizations
11 representing physicians, pediatricians or statewide
12 member-based organizations representing pediatricians,
13 hospitals or statewide member-based organizations representing
14 hospitals, and providers of health care services to children.
15 No single organization may have more than one representative
16 appointed as a member from the general public.
17     (c) The President of the Senate and Speaker of the House of
18 Representatives shall each designate one member of the
19 Committee to serve as co-chairs.
20     (d) Committee members shall serve without compensation or
21 reimbursement for expenses.
22     (e) The Committee shall meet at the call of the co-chairs,
23 but at least quarterly.
24     (f) The Committee may conduct public hearings to gather
25 testimony from interested parties regarding the Program.
26     (g) The Committee may advise appropriate State agencies
27 regarding the establishment of proposed changes to the existing
28 Program. The State agencies shall take into consideration any
29 recommendations made by the Committee.
30     (h) The Department shall file an annual report with the
31 Committee detailing Program participation and costs.
 
32     (215 ILCS 170/75 new)
33     Sec. 75. Funding limitation. The State shall not expend
34 more than $72,600,000 for the Program in the fiscal year
35 beginning July 1, 2006. The State shall not expend more than

 

 

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1 $52,500,000 for the Program in the fiscal year beginning July
2 1, 2007. The State shall not expend more than $75,300,000 for
3 the Program in the fiscal year beginning July 1, 2008. The
4 State shall not expend more than $102,700,000 for the Program
5 in the fiscal year beginning July 1, 2009. The State shall not
6 expend more than $125,900,000 for the Program in the fiscal
7 year beginning July 1, 2010. For the purposes of this Section,
8 Program expenditures include, but are not limited to, the
9 following:
10         (1) providing health care benefits to eligible
11     children;
12         (2) expediting Medicaid payments to participating
13     physicians;
14         (3) Program administration; and
15         (4) Program marketing and outreach.
 
16     Section 99. Effective date. This Act takes effect July 1,
17 2006.