Full Text of SB2169 96th General Assembly
SB2169sam001 96TH GENERAL ASSEMBLY
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Sen. Dale A. Righter
Filed: 5/27/2009
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| AMENDMENT TO SENATE BILL 2169
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| AMENDMENT NO. ______. Amend Senate Bill 2169 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 1. Short title. This Act may be cited as the | 5 |
| Medicaid Program Rescue Act. | 6 |
| Section 5. Legislative findings and intent. The General | 7 |
| Assembly finds that, for the economic and social benefit of all | 8 |
| residents of the State, it is important to ensure that all | 9 |
| eligible Medicaid recipients have access to quality medical | 10 |
| care. It is vital to the financial health of the State and to | 11 |
| the State's Medicaid program that the dramatically increasing | 12 |
| liabilities of the State-funded healthcare system be brought | 13 |
| under control.
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| The legislature finds that the state of the current | 15 |
| Medicaid program is unacceptable. Program liabilities are | 16 |
| growing at an unsustainable rate, providers are forced to wait |
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| months for chronically late reimbursements, reimbursement | 2 |
| levels in some areas are inadequate, hospital emergency rooms | 3 |
| are utilized too often for non-emergency treatment, and | 4 |
| Medicaid patients in many areas suffer from a lack of adequate | 5 |
| access to services.
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| Costs associated with the Illinois Medicaid program have | 7 |
| grown by over 50% in the last 7 years. The State's taxpayers | 8 |
| cannot sustain 7% annual growth to a program that is reaching | 9 |
| $10,000,000,000 in costs annually. This dramatic increase has | 10 |
| led to unprecedented delays in bill payments, causing much | 11 |
| hardship to medical service providers and those they serve. As | 12 |
| a result, access to quality healthcare has been compromised for | 13 |
| low-income individuals and families, making it increasingly | 14 |
| difficult in many areas of the State for patients to access | 15 |
| Medicaid services.
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| This Act requires the Department of Healthcare and Family | 17 |
| Services to implement reforms and practices designed to make | 18 |
| the program more efficient, improve the quality of care | 19 |
| provided to enrollees, mandate that providers are paid in a | 20 |
| timely fashion, and generate significant savings to ensure the | 21 |
| program is affordable to the taxpayers of Illinois.
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| To achieve savings, it is directed that the Medicaid | 23 |
| program shall experience no growth in gross liabilities for | 24 |
| fiscal year 2010, and no more than 3% annual gross liability | 25 |
| growth in fiscal year 2011 or 2012. This growth rate is | 26 |
| approximately equal to the average growth in gross liability |
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| for the 10-year period prior to fiscal year 2004. | 2 |
| The Department is directed to begin implementation of cost | 3 |
| saving reforms as soon as possible upon implementation of this | 4 |
| Act. However, no reforms that will cause the loss of federal | 5 |
| stimulus funding under the American Recovery and Reinvestment | 6 |
| Act of 2009 shall be implemented prior to January 1, 2011.
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| The legislature finds that the current administration of | 8 |
| the Department has focused primarily on expansion of programs, | 9 |
| with less emphasis on managing the Medicaid program to keep | 10 |
| costs down and to prevent payment delays to providers. Further, | 11 |
| the Department has clearly shown a disregard in certain | 12 |
| instances in the past for the will of the legislature, namely, | 13 |
| in expanding the FamilyCare program without legislative | 14 |
| approval. For that reason, the administration of the Department | 15 |
| is viewed as a potential impediment to the successful | 16 |
| implementation of this Act.
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| Section 10. Definitions. In this Act: | 18 |
| "Department" means the Department of Healthcare and Family | 19 |
| Services. | 20 |
| "Medicaid program" or "Medicaid" means the program of | 21 |
| medical assistance under Article V of the Illinois Public Aid | 22 |
| Code. | 23 |
| Section 15. Savings achievement. In order to achieve | 24 |
| savings and reduce the growth in the Medicaid program, the |
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| Department, among other measures: | 2 |
| (1) May implement a broad risk-based managed care | 3 |
| program. | 4 |
| (2) May employ other strategies to reduce the frequency | 5 |
| of costly emergency room visits, especially for minor | 6 |
| health issues. | 7 |
| (3) May reevaluate the policy of providing | 8 |
| "presumptive eligibility" to Medicaid applicants whose | 9 |
| eligibility status has not been verified. | 10 |
| (4) May utilize income verification processes designed | 11 |
| to more accurately identify annual income in order to | 12 |
| ensure that those recipients receiving Medicaid benefits | 13 |
| are qualified to receive those benefits under the | 14 |
| eligibility guidelines. | 15 |
| (5) May apply asset tests to any Medicaid programs to | 16 |
| which asset tests do not currently apply. | 17 |
| (6) May increase the frequency of the process of | 18 |
| re-determining eligibility status for program participants | 19 |
| and may contract with a private entity for this purpose. | 20 |
| (7) May increase cost-sharing requirements of | 21 |
| participants. | 22 |
| (8) May pursue a comprehensive drug purchasing | 23 |
| agreement with all other State, county, and local agencies. | 24 |
| (9) May pursue a global federal waiver. | 25 |
| (10) May enhance efforts to reduce fraud and abuse | 26 |
| through the Office of the Inspector General. |
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| (11) May reduce benefits for any participants in any | 2 |
| Medicaid program not covered by federal matching dollars. | 3 |
| Reducing benefits for any participants in the program | 4 |
| should be considered as a last resort after other savings | 5 |
| options have been implemented.
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| Section 20. Liability growth. Savings measures, including | 7 |
| some measures from Section 10 of this Act, shall be taken to | 8 |
| achieve no growth in gross Medicaid liabilities for fiscal year | 9 |
| 2010 and a maximum gross Medicaid liability growth of 3% | 10 |
| annually for fiscal years 2011 and 2012. | 11 |
| Section 25. Appropriations limitations. Appropriations for | 12 |
| the fiscal year 2010 Medicaid program shall be limited to no | 13 |
| increase over the enacted FY09 appropriation as included in | 14 |
| Public Act 95-734, Article 10, Section 10. Any FY09 | 15 |
| supplemental appropriations shall be excluded in calculating | 16 |
| the FY2010 appropriation. Appropriations for the fiscal year | 17 |
| 2011 Medicaid program shall be limited to a maximum increase of | 18 |
| 3% over the fiscal year 2010 enacted appropriation for the | 19 |
| Medicaid program. Appropriations for the fiscal year 2012 | 20 |
| Medicaid program shall be limited to a maximum increase of 3% | 21 |
| over the fiscal year 2011 enacted appropriation for the | 22 |
| Medicaid Program. | 23 |
| Section 30. Liability cap. The amount of Medicaid |
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| liabilities carried from one fiscal year to the next under | 2 |
| Section 25 of the State Finance Act is capped at $650,000,000. | 3 |
| The Department shall not exceed a maximum $650,000,000 in | 4 |
| Medicaid liabilities under Section 25 of the State Finance Act | 5 |
| at the end of any fiscal year beginning June 30, 2009. | 6 |
| Section 35. Prohibitions. The Department is expressly | 7 |
| prohibited from implementing rate reductions for long term care | 8 |
| facilities to achieve savings. The Department is prohibited, | 9 |
| until January 1, 2011, from implementing measures that would | 10 |
| result in the loss of federal stimulus funding. | 11 |
| Section 40. Expansion moratorium. From the effective date | 12 |
| of this Act until June 30, 2012, the Department is prohibited | 13 |
| (i) from expanding eligibility for any existing Medicaid | 14 |
| program, including FamilyCare, or from creating any new | 15 |
| Medicaid program and (ii) from expanding eligibility for the | 16 |
| Covering ALL KIDS Health Insurance Program. | 17 |
| Section 45. Director termination. The Director of | 18 |
| Healthcare and Family Services holding that position on May 14, | 19 |
| 2009 is terminated on July 1, 2009, by operation of law, and | 20 |
| shall thereafter no longer hold that position or any other | 21 |
| employment position with the State of Illinois. The Governor is | 22 |
| directed to take whatever action is necessary to effectuate | 23 |
| this termination. |
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| Section 50. Rulemaking. Rules to implement this Act in its | 2 |
| entirety shall be promulgated and adopted by the Department. | 3 |
| This rulemaking authority is conditioned on the rules being | 4 |
| promulgated and adopted in accordance with all provisions of | 5 |
| the Illinois Administrative Procedure Act and all rules and | 6 |
| procedures of the Joint Committee on Administrative Rules; any | 7 |
| purported rule not so promulgated or adopted, for whatever | 8 |
| reason, is unauthorized. | 9 |
| Section 55. Reports to General Assembly. On June 30, 2009 | 10 |
| or 30 days after the effective date of this Act, whichever is | 11 |
| later, and on every April 15th thereafter, the Department shall | 12 |
| provide the General Assembly with a report on liability | 13 |
| projections for the next fiscal year. The Department shall | 14 |
| report to the General Assembly by July 31 of each calendar year | 15 |
| on the measures implemented and the savings achieved from each | 16 |
| measure in the fiscal year just concluded. | 17 |
| Section 60. Federal funding. No reforms implemented by the | 18 |
| Department shall be enacted if those reforms cause a loss in | 19 |
| funding under the federal American Recovery and Reinvestment | 20 |
| Act of 2009. Any cost saving measures delayed as a result of | 21 |
| the federal Act may be enacted upon expiration of that Act. | 22 |
| Section 90. The State Finance Act is amended by changing |
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| Section 25 as follows:
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| (30 ILCS 105/25) (from Ch. 127, par. 161)
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| Sec. 25. Fiscal year limitations.
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| (a) All appropriations shall be
available for expenditure | 5 |
| for the fiscal year or for a lesser period if the
Act making | 6 |
| that appropriation so specifies. A deficiency or emergency
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| appropriation shall be available for expenditure only through | 8 |
| June 30 of
the year when the Act making that appropriation is | 9 |
| enacted unless that Act
otherwise provides.
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| (b) Outstanding liabilities as of June 30, payable from | 11 |
| appropriations
which have otherwise expired, may be paid out of | 12 |
| the expiring
appropriations during the 2-month period ending at | 13 |
| the
close of business on August 31. Any service involving
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| professional or artistic skills or any personal services by an | 15 |
| employee whose
compensation is subject to income tax | 16 |
| withholding must be performed as of June
30 of the fiscal year | 17 |
| in order to be considered an "outstanding liability as of
June | 18 |
| 30" that is thereby eligible for payment out of the expiring
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| appropriation.
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| However, payment of tuition reimbursement claims under | 21 |
| Section 14-7.03 or
18-3 of the School Code may be made by the | 22 |
| State Board of Education from its
appropriations for those | 23 |
| respective purposes for any fiscal year, even though
the claims | 24 |
| reimbursed by the payment may be claims attributable to a prior
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| fiscal year, and payments may be made at the direction of the |
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| State
Superintendent of Education from the fund from which the | 2 |
| appropriation is made
without regard to any fiscal year | 3 |
| limitations.
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| Medical payments may be made by the Department of Veterans' | 5 |
| Affairs from
its
appropriations for those purposes for any | 6 |
| fiscal year, without regard to the
fact that the medical | 7 |
| services being compensated for by such payment may have
been | 8 |
| rendered in a prior fiscal year.
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| Medical payments may be made by the Department of | 10 |
| Healthcare and Family Services and medical payments and child | 11 |
| care
payments may be made by the Department of
Human Services | 12 |
| (as successor to the Department of Public Aid) from
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| appropriations for those purposes for any fiscal year,
without | 14 |
| regard to the fact that the medical or child care services | 15 |
| being
compensated for by such payment may have been rendered in | 16 |
| a prior fiscal
year; and payments may be made at the direction | 17 |
| of the Department of
Central Management Services from the | 18 |
| Health Insurance Reserve Fund and the
Local Government Health | 19 |
| Insurance Reserve Fund without regard to any fiscal
year | 20 |
| limitations. Notwithstanding any other provision of this | 21 |
| Section, the amount of liabilities for medical payments by the | 22 |
| Department of Healthcare and Family Services carried from one | 23 |
| fiscal year to the next under this Section may not exceed | 24 |
| $650,000,000. Beginning June 30, 2009, the amount of | 25 |
| liabilities for medical payments by the Department of | 26 |
| Healthcare and Family Services at the end of any fiscal year |
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| may not exceed $650,000,000.
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| Medical payments may be made by the Department of Human | 3 |
| Services from its appropriations relating to substance abuse | 4 |
| treatment services for any fiscal year, without regard to the | 5 |
| fact that the medical services being compensated for by such | 6 |
| payment may have been rendered in a prior fiscal year, provided | 7 |
| the payments are made on a fee-for-service basis consistent | 8 |
| with requirements established for Medicaid reimbursement by | 9 |
| the Department of Healthcare and Family Services. | 10 |
| Additionally, payments may be made by the Department of | 11 |
| Human Services from
its appropriations, or any other State | 12 |
| agency from its appropriations with
the approval of the | 13 |
| Department of Human Services, from the Immigration Reform
and | 14 |
| Control Fund for purposes authorized pursuant to the | 15 |
| Immigration Reform
and Control Act of 1986, without regard to | 16 |
| any fiscal year limitations.
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| Further, with respect to costs incurred in fiscal years | 18 |
| 2002 and 2003 only,
payments may be made by the State Treasurer | 19 |
| from its
appropriations
from the Capital Litigation Trust Fund | 20 |
| without regard to any fiscal year
limitations.
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| Lease payments may be made by the Department of Central | 22 |
| Management
Services under the sale and leaseback provisions of
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| Section 7.4 of
the State Property Control Act with respect to | 24 |
| the James R. Thompson Center and
the
Elgin Mental Health Center | 25 |
| and surrounding land from appropriations for that
purpose | 26 |
| without regard to any fiscal year
limitations.
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| Lease payments may be made under the sale and leaseback | 2 |
| provisions of
Section 7.5 of the State Property Control Act | 3 |
| with
respect to the
Illinois State Toll Highway Authority | 4 |
| headquarters building and surrounding
land
without regard to | 5 |
| any fiscal year
limitations.
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| (c) Further, payments may be made by the Department of | 7 |
| Public Health and the
Department of Human Services (acting as | 8 |
| successor to the Department of Public
Health under the | 9 |
| Department of Human Services Act)
from their respective | 10 |
| appropriations for grants for medical care to or on
behalf of | 11 |
| persons
suffering from chronic renal disease, persons | 12 |
| suffering from hemophilia, rape
victims, and premature and | 13 |
| high-mortality risk infants and their mothers and
for grants | 14 |
| for supplemental food supplies provided under the United States
| 15 |
| Department of Agriculture Women, Infants and Children | 16 |
| Nutrition Program,
for any fiscal year without regard to the | 17 |
| fact that the services being
compensated for by such payment | 18 |
| may have been rendered in a prior fiscal year.
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| (d) The Department of Public Health and the Department of | 20 |
| Human Services
(acting as successor to the Department of Public | 21 |
| Health under the Department of
Human Services Act) shall each | 22 |
| annually submit to the State Comptroller, Senate
President, | 23 |
| Senate
Minority Leader, Speaker of the House, House Minority | 24 |
| Leader, and the
respective Chairmen and Minority Spokesmen of | 25 |
| the
Appropriations Committees of the Senate and the House, on | 26 |
| or before
December 31, a report of fiscal year funds used to |
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| pay for services
provided in any prior fiscal year. This report | 2 |
| shall document by program or
service category those | 3 |
| expenditures from the most recently completed fiscal
year used | 4 |
| to pay for services provided in prior fiscal years.
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| (e) The Department of Healthcare and Family Services, the | 6 |
| Department of Human Services
(acting as successor to the | 7 |
| Department of Public Aid), and the Department of Human Services | 8 |
| making fee-for-service payments relating to substance abuse | 9 |
| treatment services provided during a previous fiscal year shall | 10 |
| each annually
submit to the State
Comptroller, Senate | 11 |
| President, Senate Minority Leader, Speaker of the House,
House | 12 |
| Minority Leader, the respective Chairmen and Minority | 13 |
| Spokesmen of the
Appropriations Committees of the Senate and | 14 |
| the House, on or before November
30, a report that shall | 15 |
| document by program or service category those
expenditures from | 16 |
| the most recently completed fiscal year used to pay for (i)
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| services provided in prior fiscal years and (ii) services for | 18 |
| which claims were
received in prior fiscal years.
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| (f) The Department of Human Services (as successor to the | 20 |
| Department of
Public Aid) shall annually submit to the State
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| Comptroller, Senate President, Senate Minority Leader, Speaker | 22 |
| of the House,
House Minority Leader, and the respective | 23 |
| Chairmen and Minority Spokesmen of
the Appropriations | 24 |
| Committees of the Senate and the House, on or before
December | 25 |
| 31, a report
of fiscal year funds used to pay for services | 26 |
| (other than medical care)
provided in any prior fiscal year. |
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| This report shall document by program or
service category those | 2 |
| expenditures from the most recently completed fiscal
year used | 3 |
| to pay for services provided in prior fiscal years.
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| (g) In addition, each annual report required to be | 5 |
| submitted by the
Department of Healthcare and Family Services | 6 |
| under subsection (e) shall include the following
information | 7 |
| with respect to the State's Medicaid program:
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| (1) Explanations of the exact causes of the variance | 9 |
| between the previous
year's estimated and actual | 10 |
| liabilities.
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| (2) Factors affecting the Department of Healthcare and | 12 |
| Family Services' liabilities,
including but not limited to | 13 |
| numbers of aid recipients, levels of medical
service | 14 |
| utilization by aid recipients, and inflation in the cost of | 15 |
| medical
services.
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| (3) The results of the Department's efforts to combat | 17 |
| fraud and abuse.
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| (h) As provided in Section 4 of the General Assembly | 19 |
| Compensation Act,
any utility bill for service provided to a | 20 |
| General Assembly
member's district office for a period | 21 |
| including portions of 2 consecutive
fiscal years may be paid | 22 |
| from funds appropriated for such expenditure in
either fiscal | 23 |
| year.
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| (i) An agency which administers a fund classified by the | 25 |
| Comptroller as an
internal service fund may issue rules for:
| 26 |
| (1) billing user agencies in advance for payments or |
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| authorized inter-fund transfers
based on estimated charges | 2 |
| for goods or services;
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| (2) issuing credits, refunding through inter-fund | 4 |
| transfers, or reducing future inter-fund transfers
during
| 5 |
| the subsequent fiscal year for all user agency payments or | 6 |
| authorized inter-fund transfers received during the
prior | 7 |
| fiscal year which were in excess of the final amounts owed | 8 |
| by the user
agency for that period; and
| 9 |
| (3) issuing catch-up billings to user agencies
during | 10 |
| the subsequent fiscal year for amounts remaining due when | 11 |
| payments or authorized inter-fund transfers
received from | 12 |
| the user agency during the prior fiscal year were less than | 13 |
| the
total amount owed for that period.
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| User agencies are authorized to reimburse internal service | 15 |
| funds for catch-up
billings by vouchers drawn against their | 16 |
| respective appropriations for the
fiscal year in which the | 17 |
| catch-up billing was issued or by increasing an authorized | 18 |
| inter-fund transfer during the current fiscal year. For the | 19 |
| purposes of this Act, "inter-fund transfers" means transfers | 20 |
| without the use of the voucher-warrant process, as authorized | 21 |
| by Section 9.01 of the State Comptroller Act.
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| (Source: P.A. 95-331, eff. 8-21-07.)
| 23 |
| Section 92. The Covering ALL KIDS Health Insurance Act is | 24 |
| amended by changing Section 20 as follows: |
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| (215 ILCS 170/20) | 2 |
| (Section scheduled to be repealed on July 1, 2011)
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| Sec. 20. Eligibility. | 4 |
| (a) To be eligible for the Program, a person must be a | 5 |
| child:
| 6 |
| (1) who is a resident of the State of Illinois; and
| 7 |
| (2) who is ineligible for medical assistance under the | 8 |
| Illinois Public Aid Code or benefits under the Children's | 9 |
| Health Insurance Program Act; and
| 10 |
| (3) either (i) who has been without health insurance | 11 |
| coverage for a period set forth by the Department in rules, | 12 |
| but not less than 6 months during the first month of | 13 |
| operation of the Program, 7 months during the second month | 14 |
| of operation, 8 months during the third month of operation, | 15 |
| 9 months during the fourth month of operation, 10 months | 16 |
| during the fifth month of operation, 11 months during the | 17 |
| sixth month of operation, and 12 months thereafter, (ii) | 18 |
| whose parent has lost employment that made available | 19 |
| affordable dependent health insurance coverage, until such | 20 |
| time as affordable employer-sponsored dependent health | 21 |
| insurance coverage is again available for the child as set | 22 |
| forth by the Department in rules, (iii) who is a newborn | 23 |
| whose responsible relative does not have available | 24 |
| affordable private or employer-sponsored health insurance, | 25 |
| or (iv) who, within one year of applying for coverage under | 26 |
| this Act, lost medical benefits under the Illinois Public |
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| Aid Code or the Children's Health Insurance Program Act. | 2 |
| An entity that provides health insurance coverage (as | 3 |
| defined in Section 2 of the Comprehensive Health Insurance Plan | 4 |
| Act) to Illinois residents shall provide health insurance data | 5 |
| match to the Department of Healthcare and Family Services for | 6 |
| the purpose of determining eligibility for the Program under | 7 |
| this Act. | 8 |
| The Department of Healthcare and Family Services, in | 9 |
| collaboration with the Department of Financial and | 10 |
| Professional Regulation, Division of Insurance, shall adopt | 11 |
| rules governing the exchange of information under this Section. | 12 |
| The rules shall be consistent with all laws relating to the | 13 |
| confidentiality or privacy of personal information or medical | 14 |
| records, including provisions under the Federal Health | 15 |
| Insurance Portability and Accountability Act (HIPAA). | 16 |
| (b) The Department shall monitor the availability and | 17 |
| retention of employer-sponsored dependent health insurance | 18 |
| coverage and shall modify the period described in subdivision | 19 |
| (a)(3) if necessary to promote retention of private or | 20 |
| employer-sponsored health insurance and timely access to | 21 |
| healthcare services, but at no time shall the period described | 22 |
| in subdivision (a)(3) be less than 6 months.
| 23 |
| (c) The Department, at its discretion, may take into | 24 |
| account the affordability of dependent health insurance when | 25 |
| determining whether employer-sponsored dependent health | 26 |
| insurance coverage is available upon reemployment of a child's |
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| parent as provided in subdivision (a)(3). | 2 |
| (d) A child who is determined to be eligible for the | 3 |
| Program shall remain eligible for 12 months, provided that the | 4 |
| child maintains his or her residence in this State, has not yet | 5 |
| attained 19 years of age, and is not excluded under subsection | 6 |
| (e). | 7 |
| (e) A child is not eligible for coverage under the Program | 8 |
| if: | 9 |
| (1) the premium required under Section 40 has not been | 10 |
| timely paid; if the required premiums are not paid, the | 11 |
| liability of the Program shall be limited to benefits | 12 |
| incurred under the Program for the time period for which | 13 |
| premiums have been paid; if the required monthly premium is | 14 |
| not paid, the child is ineligible for re-enrollment for a | 15 |
| minimum period of 3 months; re-enrollment shall be | 16 |
| completed before the next covered medical visit, and the | 17 |
| first month's required premium shall be paid in advance of | 18 |
| the next covered medical visit; or | 19 |
| (2) the child is an inmate of a public institution or | 20 |
| an institution for mental diseases.
| 21 |
| (e-5) The Department may not expand eligibility for the | 22 |
| Program before July 1, 2012. | 23 |
| (f) The Department shall adopt eligibility rules, | 24 |
| including, but not limited to: rules regarding annual renewals | 25 |
| of eligibility for the Program; rules providing for | 26 |
| re-enrollment, grace periods, notice requirements, and hearing |
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| procedures under subdivision (e)(1) of this Section; and rules | 2 |
| regarding what constitutes availability and affordability of | 3 |
| private or employer-sponsored health insurance, with | 4 |
| consideration of such factors as the percentage of income | 5 |
| needed to purchase children or family health insurance, the | 6 |
| availability of employer subsidies, and other relevant | 7 |
| factors.
| 8 |
| (Source: P.A. 94-693, eff. 7-1-06 .) | 9 |
| Section 94. The Illinois Public Aid Code is amended by | 10 |
| adding Section 5-1.05 as follows: | 11 |
| (305 ILCS 5/5-1.05 new)
| 12 |
| Sec. 5-1.05. No expansion of eligibility or new programs. | 13 |
| The Department of Healthcare and Family Services may not expand | 14 |
| eligibility for medical assistance under this Article, | 15 |
| including eligibility for FamilyCare under paragraph 15 of | 16 |
| Section 5-2, before July 1, 2012, nor may the Department create | 17 |
| any new program of medical assistance under this Article before | 18 |
| that date.
| 19 |
| Section 99. Effective date. This Act takes effect upon | 20 |
| becoming law.".
|
|