Full Text of HB5331 95th General Assembly
HB5331ham001 95TH GENERAL ASSEMBLY
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Human Services Committee
Filed: 3/12/2008
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09500HB5331ham001 |
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LRB095 17540 DRJ 48138 a |
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| AMENDMENT TO HOUSE BILL 5331
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| AMENDMENT NO. ______. Amend House Bill 5331 by replacing | 3 |
| everything after the enacting clause with the following:
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| "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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LRB095 17540 DRJ 48138 a |
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| 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
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| 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, |
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LRB095 17540 DRJ 48138 a |
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| 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 |
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| 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 |
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LRB095 17540 DRJ 48138 a |
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| 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 |
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|
09500HB5331ham001 |
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LRB095 17540 DRJ 48138 a |
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| 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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09500HB5331ham001 |
- 6 - |
LRB095 17540 DRJ 48138 a |
|
| 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. ".
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