Illinois General Assembly - Full Text of HB0062
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Full Text of HB0062  102nd General Assembly

HB0062 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB0062

 

Introduced 1/14/2021, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health care providers. Sets forth the specific 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. Requires the State to establish the Illinois Health Services Trust to provide financing for the program. Sets forth the specific requirements for claims billed under the program. Provides that the program shall include funding for long-term care services and mental health services. 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. Provides that patients in the program shall have the same rights and privacy as they are entitled to under current State and federal law. Provides that the Commissioner, the Chief Medical Officer, the public State board members, and 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 July 1, 2021.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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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 Health
5Care for All Illinois 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 nonprofit 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 health maintenance organizations receiving capitation
8    payments. Investor-owned health maintenance organizations
9    and group practices shall be converted to not-for-profit
10    status. Only institutions that deliver care shall be
11    eligible for program payments.
12        (2) The program will pay each hospital and providing
13    institution a monthly lump sum (global budget) to cover
14    all operating expenses. The hospital and program will
15    negotiate the amount of this payment annually based on
16    past budgets, clinical performance, projected changes in
17    demand for services and input costs, and proposed new
18    programs. Hospitals shall not bill patients for services
19    covered by the program, and cannot use any of their
20    operating budgets for expansion, profit, excessive
21    executive income, marketing, or major capital purchases or
22    leases.
23        (3) The program budget will fund major capital
24    expenditures, including the construction of new health
25    facilities and the purchase of expensive equipment. The
26    regional health planning districts shall allocate these

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1Medical Officer, public State board members, and employees of
2the program shall be compensated in accordance with the
3current pay scale for State employees and as deemed
4professionally appropriate by the General Assembly and
5reviewed in accordance with all other State employees.
 
6    Section 99. Effective date. This Act takes effect July 1,
72021.