HB5331eng 95TH GENERAL ASSEMBLY

HB5331 Engrossed LRB095 17540 DRJ 43614 b

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Covering ALL KIDS Health Insurance Act is amended by adding Section 52.5 as follows:

(215 ILCS 170/52.5 new)

Sec. 52.5. Specialty physician care; fee schedule.

(a) Beginning January 1, 2009, the physician fee schedule for the Covering ALL KIDS Insurance Program must increase to become competitive with those of non-governmental, third party health insurance programs. By January 1, 2011, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Reimbursement rules and policies shall not be more restrictive than Medicare physician payment rules and policies except as specifically required by federal Medicaid and SCHIP laws. Payment for services must be made within 30 days after receipt of a bill or claim for payment in accordance with Section 368a of the Illinois Insurance Code.

(b) Transition period. For payments made or authorized by the Department of Healthcare and Family Services, the Department shall annually increase pediatric specialty physician payments under subsection (a) by an amount approximately equal to one third of the difference between the actual rates available for such purposes on January 1, 2008 and the Medicare reimbursement rates effective on January 1, 2007. If the General Assembly determines that resources are not available to fully fund the fee schedule for pediatric specialty physician care required by this subsection, then, until such time as the General Assembly determines that such funding is available, the Department shall increase any payment for physicians who provide pediatric specialty care services under the Covering ALL KIDS Health Insurance Program by an amount proportionately equivalent to any other increases for physicians, federally qualified health centers, rural health centers, or other non-institutional providers providing services to children for any services provided under this Act.

(c) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly. If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly's discretion. Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given. For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.

Section 10. The Illinois Public Aid Code is amended by adding Section 5-5.05 as follows:

(305 ILCS 5/5-5.05 new)

Sec. 5-5.05. Physician payments; pediatric specialty physician services.

(a) Notwithstanding any other provision of this Article, beginning January 1, 2009, the physician fee schedule for pediatric physician specialists must increase to become competitive with those of non-governmental, third party health insurance programs. By January 1, 2011, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Reimbursement rules and policies shall not be more restrictive than Medicare physician payment rules and policies except as specifically required by federal Medicaid and SCHIP laws. Payment for services must be made within 30 days after receipt of a bill or claim for payment in accordance with Section 368a of the Illinois Insurance Code.

(b) Transition period. For payments made or authorized by the Department of Healthcare and Family Services, the Department shall annually increase pediatric specialty physician payments under subsection (a) by an amount approximately equal to one third of the difference between the actual rates available for such purposes on January 1, 2008 and the Medicare reimbursement rates effective on January 1, 2007. If the General Assembly determines that resources are not available to fully fund the fee schedule for pediatric specialty physician care required by this subsection, then, until such time as the General Assembly determines that such funding is available, the Department shall increase any payment for physicians who provide pediatric specialty care services under the medical assistance program by an amount proportionately equivalent to any other increases for physicians, federally qualified health centers, rural health centers, or other non-institutional providers providing services to children for any services provided under this Act.

(c) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly. If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly's discretion. Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given. For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.