HB3285 99TH GENERAL ASSEMBLY

  
  

 


 
99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB3285

 

Introduced , by Rep. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5F-25
305 ILCS 5/5F-30

    Amends the Illinois Public Aid Code. In a provision concerning certain requirements care coordination services must conform to when such services are provided to enrollees participating in the Medicare-Medicaid Alignment Initiative Demonstration Project, adds the requirement that all rights guaranteed an enrollee under federal and State law be protected, including the right of an enrollee to select his or her own physician. In a provision concerning continuity of care for nursing home residents transitioning to a managed care organization, provides that the managed care organization shall, within 24 hours of receiving a request, change an enrollee's primary care provider and notify the enrollee in writing. Provides that if the enrollee states that a medical emergency exists, the managed care organization shall make the necessary changes immediately and notify by phone all involved parties followed by a written confirmation. Effective immediately.


LRB099 10146 KTG 30369 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3285LRB099 10146 KTG 30369 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5F-25 and 5F-30 as follows:
 
6    (305 ILCS 5/5F-25)
7    Sec. 5F-25. Care coordination. Care coordination provided
8to all enrollees in the Demonstration Project shall conform to
9the following requirements:
10        (1) care coordination services shall be
11    enrollee-driven and person-centered;
12        (2) all enrollees in the Demonstration Project shall
13    have the right to receive health care services in the care
14    setting of their choice, except as permitted by Part 4 of
15    Article III of the Nursing Home Care Act with respect to
16    involuntary transfers and discharges; and
17        (3) decisions shall be based on the enrollee's best
18    interests; and .
19        (4) all rights guaranteed an enrollee under federal and
20    State law shall be protected, including the right of an
21    enrollee to select his or her own physician.
22(Source: P.A. 98-651, eff. 6-16-14.)
 

 

 

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1    (305 ILCS 5/5F-30)
2    Sec. 5F-30. Continuity of care. When a nursing home
3resident first transitions to a managed care organization from
4the fee-for-service system or from another managed care
5organization, the managed care organization shall honor the
6existing care plan and any necessary changes to that care plan
7until the MCO has completed a comprehensive assessment and new
8care plan, to the extent such services are covered benefits
9under the contract, which shall be consistent with the
10requirements of the RAI Manual.
11    When an enrollee of a managed care organization is moving
12from a community setting to a nursing home, and the MCO is
13properly notified of the proposed admission by a network
14nursing home, and the managed care organization fails to
15participate in developing a care plan within the time frames
16required by nursing home regulations, the MCO must honor a care
17plan developed by the nursing home until the MCO has completed
18a comprehensive assessment and a new care plan to the extent
19such services are covered benefits under the contract,
20consistent with the requirements of the RAI Manual.
21    A managed care organization shall, within 24 hours of
22receiving a request, change an enrollee's primary care provider
23and notify the enrollee in writing. If the enrollee states that
24a medical emergency exists, the managed care organization shall
25make the necessary changes immediately and notify by phone all
26involved parties followed by a written confirmation.

 

 

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1    A nursing home shall have the ability to refuse admission
2of an enrollee for whom care is required that the nursing home
3determines is outside the scope of its license and healthcare
4capabilities.
5(Source: P.A. 98-651, eff. 6-16-14.)
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.