Full Text of SB2561 94th General Assembly
SB2561sam001 94TH GENERAL ASSEMBLY
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Sen. Debbie DeFrancesco Halvorson
Filed: 2/9/2006
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| AMENDMENT TO SENATE BILL 2561
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| AMENDMENT NO. ______. Amend Senate Bill 2561 by replacing | 3 |
| everything after the enacting clause with the following:
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| "ARTICLE 1. GENERAL PROVISIONS | 5 |
| Section 1-1. Short title. This Act may be cited as the | 6 |
| Healthy Illinois Act. | 7 |
| Section 1-5. Purpose. Health care costs are rising rapidly | 8 |
| and challenging Illinois' capacity to provide accessible, | 9 |
| high-quality health care. Small businesses and individuals do | 10 |
| not have adequate access to affordable health insurance in this | 11 |
| State. This legislation creates Healthy Illinois, a 3-part | 12 |
| program that will provide access to affordable coverage for | 13 |
| small businesses and individuals through the Healthy Illinois | 14 |
| Plan, initiate new strategies for health care quality | 15 |
| improvement and cost containment through the Healthy Illinois | 16 |
| Quality Forum, and gather and disseminate through the Health | 17 |
| Resource Plan the information needed to ensure that all | 18 |
| Illinoisans have access to quality, affordable health care. | 19 |
| Section 1-10. Definitions. As used in this Act: | 20 |
| "Authority" means the Healthy Illinois Authority | 21 |
| established in Article 5 of this Act. | 22 |
| "Eligible business" means a business that employs at least |
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| 2 but not more than 50 employees, at least two-thirds of whom | 2 |
| are employed in the State, including a not-for-profit | 3 |
| corporation or a municipality or other public sector entity | 4 |
| that has at least 2 but not more than 50 employees. Beginning | 5 |
| one year after the Authority begins providing health insurance | 6 |
| benefits, the Authority may, by rule, define "eligible | 7 |
| business" to include larger public or private employers. | 8 |
| "Eligible employee" means an employee of an eligible | 9 |
| business who works at least 20 hours per week for that eligible | 10 |
| business. "Eligible employee" does not include an employee who | 11 |
| works on a temporary or substitute basis or who does not work | 12 |
| at least 26 weeks annually. New employees meet the 26-week | 13 |
| requirement if they are expected to work at least 26 weeks in | 14 |
| their first year of employment. | 15 |
| "Eligible individual" means any Illinois resident, | 16 |
| including any dependents thereof. | 17 |
| "Health insurance carrier" means any entity that provides | 18 |
| health insurance in this State. For the purposes of this Act, | 19 |
| "health insurance carrier" includes a licensed insurance | 20 |
| company, a prepaid hospital or medical service plan, a health | 21 |
| maintenance organization, or any other entity providing a plan | 22 |
| of health insurance or health benefits subject to State | 23 |
| insurance regulation. | 24 |
| "Healthy Illinois Plan" means the health insurance plan | 25 |
| established by the Healthy Illinois Authority. | 26 |
| "Quality improvement organization" means an organization | 27 |
| whose mission includes the creation, endorsement, or | 28 |
| implementation of healthcare quality performance measures. | 29 |
| "Quality improvement organization" includes, but is not | 30 |
| limited to, the National Quality Forum, the Illinois Foundation | 31 |
| for Health Care Quality, the Agency for Healthcare Research and | 32 |
| Quality, the Joint Commission on Accreditation of Healthcare | 33 |
| Organizations, and the National Committee for Quality | 34 |
| Assurance.
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| "Resident" means an individual (i) who is in the State for | 2 |
| other than a temporary or transitory purpose during the taxable | 3 |
| year or (ii) who is domiciled in this State but is absent from | 4 |
| the State for a temporary or transitory purpose during the | 5 |
| taxable year. | 6 |
| ARTICLE 5. THE HEALTHY ILLINOIS AUTHORITY | 7 |
| Section 5-5. Healthy Illinois Authority Established. The | 8 |
| Healthy Illinois Authority is established as an agency in the | 9 |
| executive branch of State government to arrange for the | 10 |
| provision of comprehensive, affordable health care coverage to | 11 |
| eligible businesses, including employees and their dependents, | 12 |
| the self-employed and their dependents, and eligible | 13 |
| individuals on a voluntary basis through the Healthy Illinois | 14 |
| Plan. The Authority shall also monitor and improve the quality | 15 |
| of health care in this State through administration of the | 16 |
| Healthy Illinois Quality Forum. The Authority shall also | 17 |
| develop the Health Resource Plan, focused on gathering and | 18 |
| disseminating the information and plans needed to ensure the | 19 |
| provision of quality, affordable health care in Illinois. | 20 |
| Section 5-10. Powers and duties of the Authority.
Subject | 21 |
| to any limitation contained in this Act or in any other law, | 22 |
| the Authority shall have and exercise all powers necessary or | 23 |
| convenient to effectuate the purposes for which the Authority | 24 |
| is organized or to further the activities in which the | 25 |
| Authority may lawfully be engaged, including the establishment | 26 |
| of the Healthy Illinois Plan, the administration of the Healthy | 27 |
| Illinois Quality Forum, and the development and promulgation of | 28 |
| the Health Resource Plan. | 29 |
| Section 5-15. The Healthy Illinois Authority Fund. The | 30 |
| Healthy Illinois Authority Fund is created as a special fund in |
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| the State treasury for the deposit of any funds advanced for | 2 |
| initial operating expenses, payments made by participating | 3 |
| businesses and individuals, any windfall profit assessments | 4 |
| paid pursuant to Section 10-20 of this Act, and any funds | 5 |
| received from any public or private source. The Fund is exempt | 6 |
| from the provisions of subsection (c) of Section 5 of the State | 7 |
| Finance Act and shall not lapse, but must be carried forward to | 8 |
| carry out the purposes of this Act. | 9 |
| ARTICLE 10. HEALTHY ILLINOIS PLAN | 10 |
| Section 10-5. Healthy Illinois Plan. The Authority shall | 11 |
| begin to provide health benefit coverage through the Healthy | 12 |
| Illinois Plan not later than 12 months after entering into | 13 |
| contracts with one or more qualified bidders to administer | 14 |
| Healthy Illinois Plan benefits. The Healthy Illinois Plan must | 15 |
| comply with all relevant requirements of this Article. The | 16 |
| Authority shall select one or more entities to administer the | 17 |
| Healthy Illinois Plan through a competitive request for | 18 |
| proposal process to identify those that most fully meet | 19 |
| qualifications set by the Authority. | 20 |
| Section 10-10. Healthy Illinois Plan administration. | 21 |
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(a) The Healthy Illinois Plan must provide a comprehensive | 22 |
| package of benefits that is at least as comprehensive as the | 23 |
| outline of benefits provided in the Comprehensive Health | 24 |
| Insurance Plan Act. Preventive health care services, | 25 |
| including, but not limited to, routine doctor visits, disease | 26 |
| screenings, and contraception must be fully covered with no | 27 |
| co-pays and no deductibles. | 28 |
| (b) The Healthy Illinois Plan must also provide any | 29 |
| supplemental benefits the Authority makes available. The | 30 |
| Healthy Illinois Plan may, at the discretion of the Authority, | 31 |
| meet the requirements for mandated coverage for specific health |
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| services and specific diseases and for certain providers of | 2 |
| health services under the Illinois Insurance Code. | 3 |
| (c) The Authority shall establish the minimum required | 4 |
| contribution levels, not to exceed 60% of the cost of coverage | 5 |
| for eligible employees, to be paid by eligible businesses | 6 |
| toward the aggregate payment. The Authority may establish a | 7 |
| separate minimum contribution level to be paid by eligible | 8 |
| businesses toward coverage for dependents of the eligible | 9 |
| business's enrolled employees. Aggregate payments owed under | 10 |
| this subsection (c) shall be calculated in accordance with | 11 |
| subsection (a) of Section 10-15 of this Act. | 12 |
| (d) The Authority shall require participating businesses | 13 |
| to certify that at least 75% of their employees that work 20 | 14 |
| hours or more per week are either enrolled in the Healthy | 15 |
| Illinois Plan or have other creditable coverage. | 16 |
| (e) The Authority shall reduce the required payment amounts | 17 |
| for Healthy Illinois Plan enrollees eligible for a subsidy | 18 |
| under Section 10-15 of this Act in accordance with the | 19 |
| enrollee's subsidy amount. The Authority shall notify both the | 20 |
| Healthy Illinois Plan enrollee and the employer, if applicable, | 21 |
| of both the subsidy and the new required payment amount so that | 22 |
| the employer, where applicable, can reduce the amount deducted | 23 |
| or otherwise set aside for the enrollee's premium share. | 24 |
| (f) A participating business shall make payments on behalf | 25 |
| of both itself and its enrolled employees. | 26 |
| Section 10-15. Subsidies. | 27 |
| (a) The Authority shall pay 50% of a participating | 28 |
| business's premium using funds generated by the windfall profit | 29 |
| assessment established pursuant to Section 10-20. The | 30 |
| participating business's aggregate payment will be calculated | 31 |
| on the basis of the remaining 50%. | 32 |
| (b)
The Authority shall establish sliding-scale subsidies | 33 |
| for the purchase of the Healthy Illinois Plan by eligible |
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| employees and eligible individuals whose household income is | 2 |
| under 300% of the federal poverty level and who are not | 3 |
| eligible for Medicaid. | 4 |
| Section 10-20. Windfall profit assessment. | 5 |
| (a) For the purpose of providing the funds necessary to | 6 |
| provide subsidies pursuant to Section 10-15 of this Act and to | 7 |
| support the Healthy Illinois Quality Forum, health insurance | 8 |
| carriers shall pay to the Authority 4% of annual health | 9 |
| insurance premiums on policies issued pursuant to the laws of | 10 |
| this State that insure residents of this State. | 11 |
| (b) A carrier may petition the Secretary of the Department | 12 |
| of Financial and Professional Regulation for an abatement or | 13 |
| deferment of all or part of an assessment imposed by the | 14 |
| Authority. The Secretary may abate or defer, in whole or in | 15 |
| part, the assessment if, in the opinion of the Secretary, | 16 |
| payment of the assessment would endanger the ability of the | 17 |
| carrier to fulfill its contractual obligations. | 18 |
| ARTICLE 15. HEALTH CARE QUALITY | 19 |
| Section 15-5. Healthy Illinois Quality Forum. The Healthy | 20 |
| Illinois Quality Forum, referred to in this Article as the | 21 |
| "Forum", is established within the Authority. The Forum shall | 22 |
| be funded, at least in part, through the windfall profit | 23 |
| assessments paid pursuant to Section 10-20 of this Act. | 24 |
| Information obtained by the Forum is a public record within the | 25 |
| meaning in Section 2 of the Freedom of Information Act. All | 26 |
| data collection required by the Forum shall be done in a manner | 27 |
| consistent with and not in duplication of the data collection | 28 |
| requirements of federal and State law. | 29 |
| Section 15-10. Duties. The Forum shall perform the | 30 |
| following duties: |
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| (1) Gathering and disseminating information on health care | 2 |
| quality and patient safety. | 3 |
| (2) Research on best practice in Illinois, including, but | 4 |
| not limited to, the following: | 5 |
| (A) Collecting information from Illinois health care | 6 |
| providers, insurers, third party administrators, and | 7 |
| others to identify practices designed to increase health | 8 |
| care quality and patient safety, focusing on those | 9 |
| practices where a positive impact has been documented and | 10 |
| where the information needed for others to replicate the | 11 |
| practice is available. The Forum shall include examples of | 12 |
| effective uses of electronic technology for such things as | 13 |
| medical records and physical order entry. | 14 |
| (B) Dissemination of information on effective | 15 |
| practices in Illinois through public reports, conferences, | 16 |
| and other appropriate vehicles. The Authority, with | 17 |
| guidance from the Forum, shall provide technical | 18 |
| assistance to health care providers, insurers, and other | 19 |
| entities that plan to implement proven practices that have | 20 |
| been demonstrated to have a material positive impact on | 21 |
| health care quality and patient safety in Illinois. | 22 |
| (3) Evaluation and comparison of health care quality and | 23 |
| provider performance, including, but not limited to, the | 24 |
| following: | 25 |
| (A) The Forum shall identify existing valid and | 26 |
| reliable measures of health care quality and provider | 27 |
| performance that have been adopted by existing quality | 28 |
| improvement organizations. | 29 |
| (B) In coordination with existing quality improvement | 30 |
| organizations, the Forum shall facilitate the | 31 |
| dissemination of information on the measures identified in | 32 |
| item (A) of this paragraph (3) to Illinois health care | 33 |
| providers, insurers, and others. | 34 |
| (C) By the third year of operation, the Forum shall |
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| recommend an initial set of measures that all Illinois | 2 |
| providers, insurers, and others, as appropriate, should | 3 |
| adopt. The Forum shall develop incentives to encourage the | 4 |
| adoption of those measures, such as the development of a | 5 |
| pay-for-performance system whereby providers are | 6 |
| financially rewarded for compliance with the established | 7 |
| measures. The Forum shall provide guidance on data | 8 |
| collection and submission protocols with the minimum | 9 |
| possible burden for the providers of data. | 10 |
| ARTICLE 20. HEALTH RESOURCE PLAN | 11 |
| Section 20-5. Duties of the Authority related to the Health | 12 |
| Resource Plan. | 13 |
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(a) The Authority shall do all of the following: | 14 |
| (1) develop and issue the biennial Health Resource | 15 |
| Plan, referred to in this Article as the "plan". The first | 16 |
| plan shall be issued by May 31 of the year following the | 17 |
| effective date of this Act of the 94th General Assembly; | 18 |
| (2) make an annual report to the public assessing the | 19 |
| progress toward meeting goals of the plan and provide any | 20 |
| needed updates to the plan; and | 21 |
| (3) issue an annual statewide health expenditure | 22 |
| budget report that shall serve as the basis for | 23 |
| establishing priorities within the plan. | 24 |
| (b) The Authority shall provide the reports specified in | 25 |
| paragraphs (2) and (3) of subsection (a) of this Section to the | 26 |
| General Assembly. | 27 |
| Section 20-10. Health Resource Plan. The plan, issued | 28 |
| pursuant to Section 20-5 of this Act, must set forth a | 29 |
| comprehensive, coordinated approach to the development of | 30 |
| health care facilities and resources in the State based on | 31 |
| statewide cost, quality, and access goals and strategies to |
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| ensure access to affordable health care, maintain a rational | 2 |
| system of health care, and promote the development of the | 3 |
| health care workforce. | 4 |
| ARTICLE 25. COST CONTAINMENT | 5 |
| Section 25-5. Public reporting. | 6 |
| (a) Each health care practitioner licensed under the | 7 |
| Medical Practice Act of 1987 shall, beginning on August 1, | 8 |
| 2007, submit an annual report to the Authority listing the | 9 |
| percentage by which its net revenue for the fiscal year | 10 |
| exceeded its net revenue for the preceding fiscal year. | 11 |
| (b) Each hospital licensed under the Hospital Licensing Act | 12 |
| shall, beginning August 1, 2007, submit an annual report to the | 13 |
| Authority listing cost increases, as measured as expenses for | 14 |
| case mix adjusted discharge, for the fiscal year as compared to | 15 |
| cost increases for the preceding fiscal year. Each hospital | 16 |
| licensed under the Hospital Licensing Act shall, beginning on | 17 |
| August 1, 2007, submit an annual report to the Authority | 18 |
| listing its operating margin for the fiscal year. | 19 |
| (c) Each health insurance carrier licensed in this State | 20 |
| shall, beginning on August 1, 2007, submit an annual report to | 21 |
| the Authority listing its overall underwriting gain, less | 22 |
| federal taxes, on health insurance for the fiscal year. | 23 |
| (d) For the purposes of this Section, "fiscal year" means | 24 |
| the fiscal year ending immediately prior to the deadline for | 25 |
| the submission of a report required under this Section.
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| ARTICLE 95. AMENDATORY PROVISIONS | 27 |
| Section 95-5. The Illinois Health Facilities Planning Act | 28 |
| is amended by changing Sections 3 and 12 as follows:
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| (20 ILCS 3960/3) (from Ch. 111 1/2, par. 1153)
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| (Section scheduled to be repealed on July 1, 2006)
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| Sec. 3. Definitions. As used in this Act:
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| "Health care facilities" means and includes
the following | 4 |
| facilities and organizations:
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| 1. An ambulatory surgical treatment center required to | 6 |
| be licensed
pursuant to the Ambulatory Surgical Treatment | 7 |
| Center Act;
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| 2. An institution, place, building, or agency required | 9 |
| to be licensed
pursuant to the Hospital Licensing Act;
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| 3. Skilled and intermediate long term care facilities | 11 |
| licensed under the
Nursing
Home Care Act;
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| 3. Skilled and intermediate long term care facilities | 13 |
| licensed under the
Nursing
Home Care Act;
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| 4. Hospitals, nursing homes, ambulatory surgical | 15 |
| treatment centers, or
kidney disease treatment centers
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| maintained by the State or any department or agency | 17 |
| thereof;
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| 5. Kidney disease treatment centers, including a | 19 |
| free-standing
hemodialysis unit required to be licensed | 20 |
| under the End Stage Renal Disease Facility Act; and
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| 6. An institution, place, building, or room used for | 22 |
| the performance of
outpatient surgical procedures that is | 23 |
| leased, owned, or operated by or on
behalf of an | 24 |
| out-of-state facility.
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| No federally owned facility shall be subject to the | 26 |
| provisions of this
Act, nor facilities used solely for healing | 27 |
| by prayer or spiritual means.
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| No facility licensed under the Supportive Residences | 29 |
| Licensing Act or the
Assisted Living and Shared Housing Act
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| shall be subject to the provisions of this Act.
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| A facility designated as a supportive living facility that | 32 |
| is in good
standing with the program
established under Section | 33 |
| 5-5.01a of
the Illinois Public Aid Code shall not be subject to | 34 |
| the provisions of this
Act.
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| This Act does not apply to facilities granted waivers under | 2 |
| Section 3-102.2
of the Nursing Home Care Act. However, if a | 3 |
| demonstration project under that
Act applies for a certificate
| 4 |
| of need to convert to a nursing facility, it shall meet the | 5 |
| licensure and
certificate of need requirements in effect as of | 6 |
| the date of application. | 7 |
| This Act does not apply to a dialysis facility that | 8 |
| provides only dialysis training, support, and related services | 9 |
| to individuals with end stage renal disease who have elected to | 10 |
| receive home dialysis. This Act does not apply to a dialysis | 11 |
| unit located in a licensed nursing home that offers or provides | 12 |
| dialysis-related services to residents with end stage renal | 13 |
| disease who have elected to receive home dialysis within the | 14 |
| nursing home. The Board, however, may require these dialysis | 15 |
| facilities and licensed nursing homes to report statistical | 16 |
| information on a quarterly basis to the Board to be used by the | 17 |
| Board to conduct analyses on the need for proposed kidney | 18 |
| disease treatment centers.
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| This Act shall not apply to the closure of an entity or a | 20 |
| portion of an
entity licensed under the Nursing Home Care Act | 21 |
| that elects to convert, in
whole or in part, to an assisted | 22 |
| living or shared housing establishment
licensed under the | 23 |
| Assisted Living and Shared Housing Act.
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| With the exception of those health care facilities | 25 |
| specifically
included in this Section, nothing in this Act | 26 |
| shall be intended to
include facilities operated as a part of | 27 |
| the practice of a physician or
other licensed health care | 28 |
| professional, whether practicing in his
individual capacity or | 29 |
| within the legal structure of any partnership,
medical or | 30 |
| professional corporation, or unincorporated medical or
| 31 |
| professional group. Further, this Act shall not apply to | 32 |
| physicians or
other licensed health care professional's | 33 |
| practices where such practices
are carried out in a portion of | 34 |
| a health care facility under contract
with such health care |
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| facility by a physician or by other licensed
health care | 2 |
| professionals, whether practicing in his individual capacity
| 3 |
| or within the legal structure of any partnership, medical or
| 4 |
| professional corporation, or unincorporated medical or | 5 |
| professional
groups. This Act shall apply to construction or
| 6 |
| modification and to establishment by such health care facility | 7 |
| of such
contracted portion which is subject to facility | 8 |
| licensing requirements,
irrespective of the party responsible | 9 |
| for such action or attendant
financial obligation.
| 10 |
| "Person" means any one or more natural persons, legal | 11 |
| entities,
governmental bodies other than federal, or any | 12 |
| combination thereof.
| 13 |
| "Consumer" means any person other than a person (a) whose | 14 |
| major
occupation currently involves or whose official capacity | 15 |
| within the last
12 months has involved the providing, | 16 |
| administering or financing of any
type of health care facility, | 17 |
| (b) who is engaged in health research or
the teaching of | 18 |
| health, (c) who has a material financial interest in any
| 19 |
| activity which involves the providing, administering or | 20 |
| financing of any
type of health care facility, or (d) who is or | 21 |
| ever has been a member of
the immediate family of the person | 22 |
| defined by (a), (b), or (c).
| 23 |
| "State Board" means the Health Facilities Planning Board.
| 24 |
| "Construction or modification" means the establishment, | 25 |
| erection,
building, alteration, reconstruction, modernization, | 26 |
| improvement,
extension, discontinuation, change of ownership, | 27 |
| of or by a health care
facility, or the purchase or acquisition | 28 |
| by or through a health care facility
of
equipment or service | 29 |
| for diagnostic or therapeutic purposes or for
facility | 30 |
| administration or operation, or any capital expenditure made by
| 31 |
| or on behalf of a health care facility which
exceeds the | 32 |
| capital expenditure minimum; however, any capital expenditure
| 33 |
| made by or on behalf of a health care facility for (i) the | 34 |
| construction or
modification of a facility licensed under the |
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| Assisted Living and Shared
Housing Act or (ii) a conversion | 2 |
| project undertaken in accordance with Section 30 of the Older | 3 |
| Adult Services Act shall be excluded from any obligations under | 4 |
| this Act.
| 5 |
| "Establish" means the construction of a health care | 6 |
| facility or the
replacement of an existing facility on another | 7 |
| site.
| 8 |
| "Major medical equipment" means medical equipment which is | 9 |
| used for the
provision of medical and other health services and | 10 |
| which costs in excess
of the capital expenditure minimum, | 11 |
| except that such term does not include
medical equipment | 12 |
| acquired
by or on behalf of a clinical laboratory to provide | 13 |
| clinical laboratory
services if the clinical laboratory is | 14 |
| independent of a physician's office
and a hospital and it has | 15 |
| been determined under Title XVIII of the Social
Security Act to | 16 |
| meet the requirements of paragraphs (10) and (11) of Section
| 17 |
| 1861(s) of such Act. In determining whether medical equipment | 18 |
| has a value
in excess of the capital expenditure minimum, the | 19 |
| value of studies, surveys,
designs, plans, working drawings, | 20 |
| specifications, and other activities
essential to the | 21 |
| acquisition of such equipment shall be included.
| 22 |
| "Capital Expenditure" means an expenditure: (A) made by or | 23 |
| on behalf of
a health care facility (as such a facility is | 24 |
| defined in this Act); and
(B) which under generally accepted | 25 |
| accounting principles is not properly
chargeable as an expense | 26 |
| of operation and maintenance, or is made to obtain
by lease or | 27 |
| comparable arrangement any facility or part thereof or any
| 28 |
| equipment for a facility or part; and which exceeds the capital | 29 |
| expenditure
minimum.
| 30 |
| For the purpose of this paragraph, the cost of any studies, | 31 |
| surveys, designs,
plans, working drawings, specifications, and | 32 |
| other activities essential
to the acquisition, improvement, | 33 |
| expansion, or replacement of any plant
or equipment with | 34 |
| respect to which an expenditure is made shall be included
in |
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| determining if such expenditure exceeds the capital | 2 |
| expenditures minimum.
Donations of equipment
or facilities to a | 3 |
| health care facility which if acquired directly by such
| 4 |
| facility would be subject to review under this Act shall be | 5 |
| considered capital
expenditures, and a transfer of equipment or | 6 |
| facilities for less than fair
market value shall be considered | 7 |
| a capital expenditure for purposes of this
Act if a transfer of | 8 |
| the equipment or facilities at fair market value would
be | 9 |
| subject to review.
| 10 |
| "Capital expenditure minimum" means $6,000,000, which | 11 |
| shall be annually
adjusted to reflect the increase in | 12 |
| construction costs due to inflation, for major medical | 13 |
| equipment and for all other
capital expenditures; provided, | 14 |
| however, that when a capital expenditure is
for the | 15 |
| construction or modification of a health and fitness center, | 16 |
| "capital
expenditure minimum" means the capital expenditure | 17 |
| minimum for all other
capital expenditures in effect on March | 18 |
| 1, 2000, which shall be annually
adjusted to reflect the | 19 |
| increase in construction costs due to inflation.
| 20 |
| "Non-clinical service area" means an area (i) for the | 21 |
| benefit of the
patients, visitors, staff, or employees of a | 22 |
| health care facility and (ii) not
directly related to the | 23 |
| diagnosis, treatment, or rehabilitation of persons
receiving | 24 |
| services from the health care facility. "Non-clinical service | 25 |
| areas"
include, but are not limited to, chapels; gift shops; | 26 |
| news stands; computer
systems; tunnels, walkways, and | 27 |
| elevators; telephone systems; projects to
comply with life | 28 |
| safety codes; educational facilities; student housing;
| 29 |
| patient, employee, staff, and visitor dining areas; | 30 |
| administration and
volunteer offices; modernization of | 31 |
| structural components (such as roof
replacement and masonry | 32 |
| work); boiler repair or replacement; vehicle
maintenance and | 33 |
| storage facilities; parking facilities; mechanical systems for
| 34 |
| heating, ventilation, and air conditioning; loading docks; and |
|
|
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| 1 |
| repair or
replacement of carpeting, tile, wall coverings, | 2 |
| window coverings or treatments,
or furniture. Solely for the | 3 |
| purpose of this definition, "non-clinical service
area" does | 4 |
| not include health and fitness centers.
| 5 |
| "Areawide" means a major area of the State delineated on a
| 6 |
| geographic, demographic, and functional basis for health | 7 |
| planning and
for health service and having within it one or | 8 |
| more local areas for
health planning and health service. The | 9 |
| term "region", as contrasted
with the term "subregion", and the | 10 |
| word "area" may be used synonymously
with the term "areawide".
| 11 |
| "Local" means a subarea of a delineated major area that on | 12 |
| a
geographic, demographic, and functional basis may be | 13 |
| considered to be
part of such major area. The term "subregion" | 14 |
| may be used synonymously
with the term "local".
| 15 |
| "Areawide health planning organization" or "Comprehensive | 16 |
| health
planning organization" means the health systems agency | 17 |
| designated by the
Secretary, Department of Health and Human | 18 |
| Services or any successor agency.
| 19 |
| "Local health planning organization" means those local | 20 |
| health
planning organizations that are designated as such by | 21 |
| the areawide
health planning organization of the appropriate | 22 |
| area.
| 23 |
| "Physician" means a person licensed to practice in | 24 |
| accordance with
the Medical Practice Act of 1987, as amended.
| 25 |
| "Licensed health care professional" means a person | 26 |
| licensed to
practice a health profession under pertinent | 27 |
| licensing statutes of the
State of Illinois.
| 28 |
| "Director" means the Director of the Illinois Department of | 29 |
| Public Health.
| 30 |
| "Agency" means the Illinois Department of Public Health.
| 31 |
| "Comprehensive health planning" means health planning | 32 |
| concerned with
the total population and all health and | 33 |
| associated problems that affect
the well-being of people and | 34 |
| that encompasses health services, health
manpower, and health |
|
|
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| 1 |
| facilities; and the coordination among these and
with those | 2 |
| social, economic, and environmental factors that affect | 3 |
| health.
| 4 |
| "Alternative health care model" means a facility or program | 5 |
| authorized
under the Alternative Health Care Delivery Act.
| 6 |
| "Out-of-state facility" means a person that is both (i) | 7 |
| licensed as a
hospital or as an ambulatory surgery center under | 8 |
| the laws of another state
or that
qualifies as a hospital or an | 9 |
| ambulatory surgery center under regulations
adopted pursuant | 10 |
| to the Social Security Act and (ii) not licensed under the
| 11 |
| Ambulatory Surgical Treatment Center Act, the Hospital | 12 |
| Licensing Act, or the
Nursing Home Care Act. Affiliates of | 13 |
| out-of-state facilities shall be
considered out-of-state | 14 |
| facilities. Affiliates of Illinois licensed health
care | 15 |
| facilities 100% owned by an Illinois licensed health care | 16 |
| facility, its
parent, or Illinois physicians licensed to | 17 |
| practice medicine in all its
branches shall not be considered | 18 |
| out-of-state facilities. Nothing in
this definition shall be
| 19 |
| construed to include an office or any part of an office of a | 20 |
| physician licensed
to practice medicine in all its branches in | 21 |
| Illinois that is not required to be
licensed under the | 22 |
| Ambulatory Surgical Treatment Center Act.
| 23 |
| "Change of ownership of a health care facility" means a | 24 |
| change in the
person
who has ownership or
control of a health | 25 |
| care facility's physical plant and capital assets. A change
in | 26 |
| ownership is indicated by
the following transactions: sale, | 27 |
| transfer, acquisition, lease, change of
sponsorship, or other | 28 |
| means of
transferring control.
| 29 |
| "Related person" means any person that: (i) is at least 50% | 30 |
| owned, directly
or indirectly, by
either the health care | 31 |
| facility or a person owning, directly or indirectly, at
least | 32 |
| 50% of the health
care facility; or (ii) owns, directly or | 33 |
| indirectly, at least 50% of the
health care facility.
| 34 |
| "Charity care" means care provided by a health care |
|
|
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| facility for which the provider does not expect to receive | 2 |
| payment from the patient or a third-party payer. | 3 |
| "Health Resource Plan" means the biennial Health Resource | 4 |
| Plan developed under Article 20 of the Healthy Illinois Act.
| 5 |
| (Source: P.A. 93-41, eff. 6-27-03; 93-766, eff. 7-20-04; | 6 |
| 93-935, eff. 1-1-05; 93-1031, eff. 8-27-04; 94-342, eff. | 7 |
| 7-26-05; revised 10-19-05.)
| 8 |
| (20 ILCS 3960/12) (from Ch. 111 1/2, par. 1162)
| 9 |
| (Section scheduled to be repealed on July 1, 2006)
| 10 |
| Sec. 12. Powers and duties of State Board. For purposes of | 11 |
| this Act,
the State Board
shall
exercise the following powers | 12 |
| and duties:
| 13 |
| (1) Prescribe rules,
regulations, standards, criteria, | 14 |
| procedures or reviews which may vary
according to the purpose | 15 |
| for which a particular review is being conducted
or the type of | 16 |
| project reviewed and which are required to carry out the
| 17 |
| provisions and purposes of this Act.
| 18 |
| (2) Adopt procedures for public
notice and hearing on all | 19 |
| proposed rules, regulations, standards,
criteria, and plans | 20 |
| required to carry out the provisions of this Act.
| 21 |
| (3) Prescribe criteria for
recognition for areawide health | 22 |
| planning organizations, including, but
not limited to, | 23 |
| standards for evaluating the scientific bases for
judgments on | 24 |
| need and procedure for making these determinations.
| 25 |
| (4) Develop criteria and standards for health care | 26 |
| facilities planning,
conduct statewide inventories of health | 27 |
| care facilities, maintain an updated
inventory on the | 28 |
| Department's web site reflecting the
most recent bed and | 29 |
| service
changes and updated need determinations when new census | 30 |
| data become available
or new need formulae
are adopted,
and
| 31 |
| develop health care facility plans which shall be utilized in | 32 |
| the review of
applications for permit under
this Act. Such | 33 |
| health facility plans shall be coordinated by the Agency
with |
|
|
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| the health care facility plans areawide health planning
| 2 |
| organizations and with other pertinent State Plans.
| 3 |
| In developing health care facility plans, the State Board | 4 |
| shall consider,
but shall not be limited to, the following:
| 5 |
| (a) The size, composition and growth of the population | 6 |
| of the area
to be served;
| 7 |
| (b) The number of existing and planned facilities | 8 |
| offering similar
programs;
| 9 |
| (c) The extent of utilization of existing facilities;
| 10 |
| (d) The availability of facilities which may serve as | 11 |
| alternatives
or substitutes;
| 12 |
| (e) The availability of personnel necessary to the | 13 |
| operation of the
facility;
| 14 |
| (f) Multi-institutional planning and the establishment | 15 |
| of
multi-institutional systems where feasible;
| 16 |
| (g) The financial and economic feasibility of proposed | 17 |
| construction
or modification; and
| 18 |
| (h) In the case of health care facilities established | 19 |
| by a religious
body or denomination, the needs of the | 20 |
| members of such religious body or
denomination may be | 21 |
| considered to be public need ; and . | 22 |
| (i) The Health Resource Plan adopted by the Healthy | 23 |
| Illinois Authority.
| 24 |
| The health care facility plans which are developed and | 25 |
| adopted in
accordance with this Section shall form the basis | 26 |
| for the plan of the State
to deal most effectively with | 27 |
| statewide health needs in regard to health
care facilities.
| 28 |
| (5) Coordinate with other state agencies having | 29 |
| responsibilities
affecting health care facilities, including | 30 |
| those of licensure and cost
reporting.
| 31 |
| (6) Solicit, accept, hold and administer on behalf of the | 32 |
| State
any grants or bequests of money, securities or property | 33 |
| for
use by the State Board or recognized areawide health | 34 |
| planning
organizations in the administration of this Act; and |
|
|
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| enter into contracts
consistent with the appropriations for | 2 |
| purposes enumerated in this Act.
| 3 |
| (7) The State Board shall prescribe, in
consultation with | 4 |
| the recognized
areawide health planning organizations, | 5 |
| procedures for review, standards,
and criteria which shall be | 6 |
| utilized
to make periodic areawide reviews and determinations | 7 |
| of the appropriateness
of any existing health services being | 8 |
| rendered by health care facilities
subject to the Act. The | 9 |
| State Board shall consider recommendations of the
areawide | 10 |
| health planning organization and the Agency in making its
| 11 |
| determinations.
| 12 |
| (8) Prescribe, in consultation
with the recognized | 13 |
| areawide health planning organizations, rules, regulations,
| 14 |
| standards, and criteria for the conduct of an expeditious | 15 |
| review of
applications
for permits for projects of construction | 16 |
| or modification of a health care
facility, which projects are | 17 |
| non-substantive in nature. Such rules shall
not abridge the | 18 |
| right of areawide health planning organizations to make
| 19 |
| recommendations on the classification and approval of | 20 |
| projects, nor shall
such rules prevent the conduct of a public | 21 |
| hearing upon the timely request
of an interested party. Such | 22 |
| reviews shall not exceed 60 days from the
date the application | 23 |
| is declared to be complete by the Agency.
| 24 |
| (9) Prescribe rules, regulations,
standards, and criteria | 25 |
| pertaining to the granting of permits for
construction
and | 26 |
| modifications which are emergent in nature and must be | 27 |
| undertaken
immediately to prevent or correct structural | 28 |
| deficiencies or hazardous
conditions that may harm or injure | 29 |
| persons using the facility, as defined
in the rules and | 30 |
| regulations of the State Board. This procedure is exempt
from | 31 |
| public hearing requirements of this Act.
| 32 |
| (10) Prescribe rules,
regulations, standards and criteria | 33 |
| for the conduct of an expeditious
review, not exceeding 60 | 34 |
| days, of applications for permits for projects to
construct or |
|
|
|
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| modify health care facilities which are needed for the care
and | 2 |
| treatment of persons who have acquired immunodeficiency | 3 |
| syndrome (AIDS)
or related conditions.
| 4 |
| (Source: P.A. 93-41, eff. 6-27-03 .)
| 5 |
| Section 95-10. The State Finance Act is amended by adding | 6 |
| Section 5.663 as follows: | 7 |
| (30 ILCS 105/5.663 new) | 8 |
| Sec. 5.663. The Healthy Illinois Authority Fund. | 9 |
| Section 95-15. The Illinois Insurance Code is amended by | 10 |
| adding Section 144.3 as follows: | 11 |
| (215 ILCS 5/144.3 new)
| 12 |
| Sec. 144.3. Health insurance rates; filing; public | 13 |
| hearing. | 14 |
| (a) The purpose of this Section is to help control the rate | 15 |
| of growth of costs of health coverage and to make the State's | 16 |
| oversight of health insurance carriers consistent with its | 17 |
| oversight of medical liability insurance carriers, as provided | 18 |
| in Section 155.18 of this Act. | 19 |
| (b) Except at preempted by federal law, this Section shall | 20 |
| apply to any hospital or medical expense-incurred policy, | 21 |
| hospital or medical service plan contract, or health | 22 |
| maintenance organization subscriber contract, collectively | 23 |
| referred to herein as health insurance. Health insurance, as | 24 |
| used in this Section, does not include short-term, accident | 25 |
| only, disability income, hospital confinement or fixed | 26 |
| indemnity, dental only, vision only, limited benefit, or credit | 27 |
| insurance, coverage issued as a supplement to liability | 28 |
| insurance, insurance arising out of a workers' compensation or | 29 |
| similar law, automobile medical-payment insurance, or | 30 |
| insurance under which benefits are payable with or without |
|
|
|
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| 1 |
| regard to fault and which is statutorily required to be | 2 |
| contained in any liability insurance policy or equivalent | 3 |
| self-insurance. | 4 |
| (c) The following standards shall apply to the making and | 5 |
| use of rates pertaining to all classes of health insurance: | 6 |
| (1) Rates shall not be excessive, inadequate, or | 7 |
| unfairly discriminatory. | 8 |
| (2) Consideration shall be given, to the extent | 9 |
| applicable, (i) to past and prospective loss experience | 10 |
| within and outside this State, (ii) to a reasonable margin | 11 |
| for underwriting profit and contingencies, (iii) to past | 12 |
| and prospective expenses both countrywide and those | 13 |
| especially applicable to this State, and (iv) to all other | 14 |
| factors, including judgment factors, deemed relevant | 15 |
| within and outside this State. Consideration may also be | 16 |
| given in the making and use of rates to dividends, savings, | 17 |
| or unabsorbed premium deposits allowed or returned by | 18 |
| companies to their policyholders, members, or subscribers. | 19 |
| (3) The systems of expense provisions included in the | 20 |
| rates for use by any company or group of companies may | 21 |
| differ from those of other companies or groups of companies | 22 |
| to reflect the operating methods of any company or group of | 23 |
| companies with respect to any kind of insurance or with | 24 |
| respect to any subdivision or combination thereof. | 25 |
| (4) Risks may be grouped by classifications for the | 26 |
| establishment of rates and minimum premiums. | 27 |
| Classification rates may be modified to produce rates in | 28 |
| accordance with rating plans that establish standards for | 29 |
| measuring variations in hazards or expense provisions, or | 30 |
| both. The standards may measure any difference among risks | 31 |
| that have a probable effect upon losses or expenses. The | 32 |
| classifications or modifications of classifications of | 33 |
| risks may be established based upon size, expense, | 34 |
| management, experience, location, or dispersion of hazard |
|
|
|
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| 1 |
| or any other reasonable considerations and shall apply to | 2 |
| all risks under the same or substantially the same | 3 |
| circumstances or conditions. The rate for an established | 4 |
| classification should be related generally to the | 5 |
| anticipated loss and expense factors of the class. | 6 |
| (d) Every company writing health insurance shall file with | 7 |
| the Secretary the rates and rating schedules it uses for health | 8 |
| insurance. A rate shall go into effect upon filing, except as | 9 |
| otherwise provided in this Section. | 10 |
| A rate filing shall occur upon a company's commencement of | 11 |
| health insurance business in this State and thereafter as often | 12 |
| as the rates are changed or amended. The Secretary shall notify | 13 |
| the public of any application by an insurer for a rate increase | 14 |
| to which this Section applies. | 15 |
| For the purposes of this Section, any change in premium to | 16 |
| the company's insureds as a result of a change in the company's | 17 |
| base rates or a change in its increased limits factors shall | 18 |
| constitute a change in rates and shall require a filing with | 19 |
| the Secretary. | 20 |
| It shall be certified in the filing by an officer of the | 21 |
| company and a qualified actuary that the company's rates are | 22 |
| based on sound actuarial principles and are not inconsistent | 23 |
| with the company's experience. The Secretary may request any | 24 |
| additional statistical data and other pertinent information | 25 |
| necessary to determine how the company set the filed rates and | 26 |
| the reasonableness of those rates. This data and information | 27 |
| shall be made available, on a company by company basis, to the | 28 |
| general public. | 29 |
| (e) The Secretary may convene a public hearing at his or | 30 |
| her discretion for a violation of this Section or if a company | 31 |
| files for a rate increase pursuant to this Section. The | 32 |
| Secretary shall convene a public hearing if the percentage | 33 |
| increase in a company's index rate for any classification is | 34 |
| greater than 6%. |
|
|
|
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| 1 |
| A public hearing under this Section must be concluded | 2 |
| within 90 days after the decision or increase that gave rise to | 3 |
| the hearing. The burden is on the company to justify the rate | 4 |
| or proposed rate at the public hearing. The Secretary may, by | 5 |
| order, adjust a rate or take any other appropriate action at | 6 |
| the conclusion of the hearing. | 7 |
| (f) If, after a public hearing, the Secretary finds that | 8 |
| any rate, rating plan, or rating system violates the provisions | 9 |
| of this Section applicable to it, the Secretary shall issue an | 10 |
| order to the company that was the subject of the hearing | 11 |
| specifying the violation and may adjust the rate. | 12 |
| If, after a public hearing, the Secretary finds that the | 13 |
| violation of any of the provisions of this Section by any | 14 |
| company that was the subject of the hearing was willful or that | 15 |
| any company has repeatedly violated any provision of this | 16 |
| Section, the Secretary may take either or both of the following | 17 |
| actions: | 18 |
| (1) Suspend or revoke, in whole or in part, the | 19 |
| certificate of authority of the company with respect to the | 20 |
| class of insurance that was the subject of the hearing. | 21 |
| (2) Impose a fine of up to $1,000 against the company | 22 |
| for each violation. Each day during which a violation | 23 |
| occurs constitutes a separate violation. | 24 |
| (g) A company writing policies of health insurance in | 25 |
| Illinois must give 180 days' notice before the company | 26 |
| discontinues the writing of policies of health insurance in | 27 |
| Illinois. | 28 |
| (h) As used in this Section: | 29 |
| "Index rate" means, for each rate classification as to a | 30 |
| rating period, the arithmetic mean of the applicable base | 31 |
| premium rate and the corresponding highest premium rate. | 32 |
| "Base premium rate" means, for each rate classification as | 33 |
| to a rating period, the lowest premium rate charged or that | 34 |
| could be charged under a rating system for that classification.
|
|
|
|
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| 1 |
| ARTICLE 97. SEVERABILITY | 2 |
| Section 97-97. Severability. The provisions of this Act are | 3 |
| severable under Section 1.31 of the Statute on Statutes. | 4 |
| ARTICLE 99. EFFECTIVE DATE
| 5 |
| Section 99-99. Effective date. This Act takes effect upon | 6 |
| becoming law.".
|
|