Human Services Committee

Filed: 3/12/2008

 

 


 

 


 
09500HB5331ham001 LRB095 17540 DRJ 48138 a

1
AMENDMENT TO HOUSE BILL 5331

2     AMENDMENT NO. ______. Amend House Bill 5331 by replacing
3 everything after the enacting clause with the following:
 
4     "Section 5. The Covering ALL KIDS Health Insurance Act is
5 amended by adding Section 52.5 as follows:
 
6     (215 ILCS 170/52.5 new)
7     Sec. 52.5. Specialty physician care; fee schedule.
8     (a) Beginning January 1, 2009, the physician fee schedule
9 for the Covering ALL KIDS Insurance Program must increase to
10 become competitive with those of non-governmental, third party
11 health insurance programs. By January 1, 2011, the payment for
12 a pediatric specialty physician service must not be lower than
13 Medicare reimbursement in accordance with the Medicare payment
14 localities for Illinois. Reimbursement rules and policies
15 shall not be more restrictive than Medicare physician payment
16 rules and policies except as specifically required by federal

 

 

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1 Medicaid and SCHIP laws. Payment for services must be made
2 within 30 days after receipt of a bill or claim for payment in
3 accordance with Section 368a of the Illinois Insurance Code.
4     (b) Transition period. For payments made or authorized by
5 the Department of Healthcare and Family Services, the
6 Department shall annually increase pediatric specialty
7 physician payments under subsection (a) by an amount
8 approximately equal to one third of the difference between the
9 actual rates available for such purposes on January 1, 2008 and
10 the Medicare reimbursement rates effective on January 1, 2007.
11 If the General Assembly determines that resources are not
12 available to fully fund the fee schedule for pediatric
13 specialty physician care required by this subsection, then,
14 until such time as the General Assembly determines that such
15 funding is available, the Department shall increase any payment
16 for physicians who provide pediatric specialty care services
17 under the Covering ALL KIDS Health Insurance Program by an
18 amount proportionately equivalent to any other increases for
19 physicians, federally qualified health centers, rural health
20 centers, or other non-institutional providers providing
21 services to children for any services provided under this Act.
22     (c) Notwithstanding any other rulemaking authority that
23 may exist, neither the Governor nor any agency or agency head
24 under the jurisdiction of the Governor has any authority to
25 make or promulgate rules to implement or enforce the provisions
26 of this amendatory Act of the 95th General Assembly. If,

 

 

09500HB5331ham001 - 3 - LRB095 17540 DRJ 48138 a

1 however, the Governor believes that rules are necessary to
2 implement or enforce the provisions of this amendatory Act of
3 the 95th General Assembly, the Governor may suggest rules to
4 the General Assembly by filing them with the Clerk of the House
5 and Secretary of the Senate and by requesting that the General
6 Assembly authorize such rulemaking by law, enact those
7 suggested rules into law, or take any other appropriate action
8 in the General Assembly's discretion. Nothing contained in this
9 amendatory Act of the 95th General Assembly shall be
10 interpreted to grant rulemaking authority under any other
11 Illinois statute where such authority is not otherwise
12 explicitly given. For the purposes of this amendatory Act of
13 the 95th General Assembly, "rules" is given the meaning
14 contained in Section 1-70 of the Illinois Administrative
15 Procedure Act, and "agency" and "agency head" are given the
16 meanings contained in Sections 1-20 and 1-25 of the Illinois
17 Administrative Procedure Act to the extent that such
18 definitions apply to agencies or agency heads under the
19 jurisdiction of the Governor.
20     
 
21     Section 10. The Illinois Public Aid Code is amended by
22 adding Section 5-5.05 as follows:
 
23     (305 ILCS 5/5-5.05 new)
24     Sec. 5-5.05. Physician payments; pediatric specialty

 

 

09500HB5331ham001 - 4 - LRB095 17540 DRJ 48138 a

1 physician services.
2     (a) Notwithstanding any other provision of this Article,
3 beginning January 1, 2009, the physician fee schedule for
4 pediatric physician specialists must increase to become
5 competitive with those of non-governmental, third party health
6 insurance programs. By January 1, 2011, the payment for a
7 pediatric specialty physician service must not be lower than
8 Medicare reimbursement in accordance with the Medicare payment
9 localities for Illinois. Reimbursement rules and policies
10 shall not be more restrictive than Medicare physician payment
11 rules and policies except as specifically required by federal
12 Medicaid and SCHIP laws. Payment for services must be made
13 within 30 days after receipt of a bill or claim for payment in
14 accordance with Section 368a of the Illinois Insurance Code.
15     (b) Transition period. For payments made or authorized by
16 the Department of Healthcare and Family Services, the
17 Department shall annually increase pediatric specialty
18 physician payments under subsection (a) by an amount
19 approximately equal to one third of the difference between the
20 actual rates available for such purposes on January 1, 2008 and
21 the Medicare reimbursement rates effective on January 1, 2007.
22 If the General Assembly determines that resources are not
23 available to fully fund the fee schedule for pediatric
24 specialty physician care required by this subsection, then,
25 until such time as the General Assembly determines that such
26 funding is available, the Department shall increase any payment

 

 

09500HB5331ham001 - 5 - LRB095 17540 DRJ 48138 a

1 for physicians who provide pediatric specialty care services
2 under the medical assistance program by an amount
3 proportionately equivalent to any other increases for
4 physicians, federally qualified health centers, rural health
5 centers, or other non-institutional providers providing
6 services to children for any services provided under this Act.
7     (c) Notwithstanding any other rulemaking authority that
8 may exist, neither the Governor nor any agency or agency head
9 under the jurisdiction of the Governor has any authority to
10 make or promulgate rules to implement or enforce the provisions
11 of this amendatory Act of the 95th General Assembly. If,
12 however, the Governor believes that rules are necessary to
13 implement or enforce the provisions of this amendatory Act of
14 the 95th General Assembly, the Governor may suggest rules to
15 the General Assembly by filing them with the Clerk of the House
16 and Secretary of the Senate and by requesting that the General
17 Assembly authorize such rulemaking by law, enact those
18 suggested rules into law, or take any other appropriate action
19 in the General Assembly's discretion. Nothing contained in this
20 amendatory Act of the 95th General Assembly shall be
21 interpreted to grant rulemaking authority under any other
22 Illinois statute where such authority is not otherwise
23 explicitly given. For the purposes of this amendatory Act of
24 the 95th General Assembly, "rules" is given the meaning
25 contained in Section 1-70 of the Illinois Administrative
26 Procedure Act, and "agency" and "agency head" are given the

 

 

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1 meanings contained in Sections 1-20 and 1-25 of the Illinois
2 Administrative Procedure Act to the extent that such
3 definitions apply to agencies or agency heads under the
4 jurisdiction of the Governor.".