Illinois General Assembly - Full Text of SB2382
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Full Text of SB2382  100th General Assembly

SB2382sam002 100TH GENERAL ASSEMBLY

Sen. Heather A. Steans

Filed: 5/2/2018

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 2382

2    AMENDMENT NO. ______. Amend Senate Bill 2382 by replacing
3everything after the enacting clause with the following:
 
4    "Section 1. Findings; intent. According to the
5Congressional Research Service reporting, approximately 35% to
660% of children placed in foster care have at least one chronic
7or acute physical health condition that requires treatment,
8including growth failure, asthma, obesity, vision impairment,
9hearing loss, neurological problems, and complex chronic
10illnesses; as many as 50% to 75% show behavioral or social
11competency issues that may warrant mental health services; many
12of these physical and mental health care issues persist and,
13relative to their peers in the general population, children who
14leave foster care for adoption and those who age out of care
15continue to have greater health needs.
16    Federal child welfare policy requires states to develop
17strategies to address the health care needs of each child in

 

 

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1foster care and mandates coordination of state child welfare
2and Medicaid agencies to ensure that the health care needs of
3children in foster care are properly identified and treated.
4    The Department of Children and Family Services is
5responsible for ensuring safety, family permanence, and
6well-being for the children placed in its custody and
7protecting these children from further trauma by ensuring
8timely access to appropriate placements and services,
9especially those children with complex emotional and
10behavioral needs who are at much greater risk for not achieving
11the fundamental child welfare goals of safety, permanence, and
12well-being.
13    The Department remains under federal court oversight
14pursuant to the B.H. Consent Decree, in part, for failure to
15provide constitutionally sufficient services and placements
16for children with psychological, behavioral, or emotional
17challenges; the 2015 court-appointed Expert Panel found too
18many children in the class experience multiple disruptions of
19placement, services, and relationships; these children and
20their families endure indeterminate waits, month upon month,
21for services the child and family need, without a concrete plan
22or timeframe; these disruptions and delays and the inaction of
23Department officials exacerbate children's already serious and
24chronic mental health problems; the Department's approach to
25treatment and its system of practice has been one shaped by
26crises, practitioner preferences, tradition, and system

 

 

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1expediency.
2    The American Academy of Pediatrics cautions that the
3effects of managed care on children's access to services and
4actual health outcomes are not yet clear; it outlines design
5and implementation principles if managed care is to be
6implemented for children.
7    It is the intent of the General Assembly to ensure that
8children are provided a system of health care with full and
9inclusive access to physical and behavioral health services
10necessary for them to thrive.
11    The General Assembly finds it necessary to protect youth in
12care by requiring the Department to plan the use of managed
13care services transparently, collaboratively, and deliberately
14to ensure quality outcomes and accountable oversight.
 
15    Section 5. The Children and Family Services Act is amended
16by adding Section 5.45 as follows:
 
17    (20 ILCS 505/5.45 new)
18    Sec. 5.45. Managed care plan services.
19    (a) As used in this Section:
20    "Caregiver" means an individual or entity directly
21providing the day-to-day care of a child ensuring the child's
22safety and well-being.
23    "Child" means a child placed in the care of the Department
24pursuant to the Juvenile Court Act of 1987.

 

 

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1    "Council" means the Child Welfare Medicaid Managed Care
2Steering and Implementation Oversight Council.
3    "Department" means the Department of Children and Family
4Services, or any successor State agency.
5    "Director" means the Director of Children and Family
6Services.
7    "Managed care organization" has the meaning ascribed to
8that term in Section 5-30.1 of the Illinois Public Aid Code.
9    "Medicaid managed care plan" means a health care plan
10operated by a managed care organization under the Medical
11Assistance Program established in Article V of the Illinois
12Public Aid Code.
13    (b) Every child who is in the care of the Department
14pursuant to the Juvenile Court Act of 1987 shall receive the
15necessary services required by this Act and the Juvenile Court
16Act of 1987, including any child enrolled in a Medicaid managed
17care plan.
18    (c) The Department shall not relinquish its authority or
19diminish its responsibility to determine, provide, or
20authorize necessary services that are in the best interest of a
21child even if those services are directly or indirectly:
22        (1) provided by a managed care organization, another
23    State agency, or other third parties;
24        (2) coordinated through a managed care organization,
25    another State agency, or other third parties; or
26        (3) paid for by a managed care organization, another

 

 

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1    State agency, or other third parties.
2    (d) The Department shall:
3        (1) implement and enforce measures to prevent
4    enrollment in Medicaid managed care plans from disrupting
5    service delivery or hindering continuity of treatment for
6    any child;
7        (2) establish a single point of contact for health care
8    coverage inquiries and dispute resolution systemwide
9    without transferring this responsibility to a third party
10    such as a managed care coordinator;
11        (3) not require participation in Medicaid managed care
12    plans for any child; and
13        (4) develop and review managed care contract measures,
14    quality assurance activities, and performance delivery
15    evaluations in consultation with the Council; and
16        (5) post on its website:
17            (A) a link to any rule adopted or procedures
18        changed to address the provisions of this Section, if
19        applicable;
20            (B) each managed care organization's contract,
21        enrollee handbook, and directory;
22            (C) the State's current Health Care Oversight and
23        Coordination Plan developed in accordance with federal
24        requirements; and
25            (D) the transition plan required under subsection
26        (f), including:

 

 

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1                (i) the public comments submitted to the
2            Department or the Council for consideration in
3            development of the transition plan;
4                (ii) a list and explanation of any
5            recommendations of the Council that the Director
6            or Director of Healthcare and Family Services
7            declined to adopt or implement; and
8                (iii) the Department's attestation that
9            implementation of the transition plan will not
10            impact its ability to comply with current class
11            action litigation.
12    (e) The Child Welfare Medicaid Managed Care Steering and
13Implementation Oversight Council is established to advise the
14Department on the transition and implementation of managed care
15for children. The Director of Children and Family Services and
16the Director of Healthcare and Family Services shall serve as
17co-chairpersons of the Council. The Directors shall jointly
18appoint members to the Council who are stakeholders from the
19child welfare community, including:
20        (1) 3 non-voting members who are employees of the
21    Department of Children and Family Services who have
22    responsibility in the areas of (i) managed care services,
23    (ii) performance monitoring and oversight, (iii) placement
24    operations, and (iv) budget revenue maximization;
25        (2) 3 non-voting members who are employees of the
26    Department of Healthcare and Family Services who have

 

 

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1    responsibility in the areas of (i) managed care
2    contracting, (ii) performance monitoring and oversight,
3    (iii) children's behavioral health, and (iv) budget
4    revenue maximization;
5        (3) at least one representative of youth in care;
6        (4) at least one representative of managed care
7    organizations;
8        (5) at least one representative of child welfare
9    providers;
10        (6) at least one representative of a trade association
11    with expertise in child welfare;
12        (7) at least one representative of parents of children
13    in out-of-home care;
14        (8) at least one representative of universities or
15    research institutions;
16        (9) at least one pediatric expert;
17        (10) at least one court stakeholder;
18        (11) at least one representative of caregivers of youth
19    in care;
20        (12) at least one child and adolescent psychiatrist or
21    psychologist;
22        (13) at least one representative of substance abuse and
23    mental health providers with expertise in serving children
24    involved in child welfare and their families;
25        (14) at least one representative of trade associations
26    with expertise in substance abuse and mental health;

 

 

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1        (15) a member of the Medicaid Advisory Committee;
2        (16) a private sector member of the Child Welfare
3    Advisory Committee; and
4        (17) other child advocates.
5    To the greatest extent possible, the co-chairpersons shall
6appoint members who reflect the geographic diversity of the
7State and include members who represent rural service areas.
8Members shall serve 2-year terms. If a vacancy occurs in the
9Council membership, the vacancy shall be filled in the same
10manner as the original appointment for the remainder of the
11unexpired term. The Council shall hold meetings, as it deems
12appropriate, in the northern, central, and southern regions of
13the State to solicit public comments to develop its
14recommendations. The Department of Children and Family
15Services shall provide administrative support to the Council.
16Council members shall serve without compensation.
17    (f) Prior to placing any child in managed care, the
18Department of Children and Family Services and the Department
19of Healthcare and Family Services, in consultation with the
20Council, must develop, adopt, and submit to the General
21Assembly a comprehensive transition plan for the provision of
22health care services to children enrolled in Medicaid managed
23care plans. The transition plan shall address, but is not
24limited to, the following:
25        (1) an assessment of existing network adequacy, plans
26    to address gaps in network before transition to managed

 

 

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1    care, and ongoing network evaluation;
2        (2) an assessment of child welfare provider
3    capacity-building needs, system infrastructure gaps, and
4    steps to be taken to prepare and train organizations,
5    caregivers, frontline staff, and managed care
6    organizations;
7        (3) the identification of administrative changes
8    necessary for successful transition to managed care, and
9    the timeframes to make changes;
10        (4) defined roles, responsibilities, and lines of
11    authority for care coordination, placement providers,
12    service providers, and each State agency involved in
13    management and oversight of managed care services;
14        (5) data used to establish baseline performance and
15    quality of care, which shall be used to evaluate outcomes
16    and identify ongoing areas for improvement;
17        (6) a process and timeline for stakeholder input into
18    managed care contract development;
19        (7) a dispute resolution process, including the rights
20    of enrollees and representatives of enrollees under the
21    dispute process and timeframes for dispute resolution
22    determinations and remedies;
23        (8) the relationship of the dispute resolution process
24    described in paragraph (7) to the administrative review
25    process under the Administrative Review Law;
26        (9) an initial enrollment process and enrollment

 

 

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1    process for those children entering or exiting the
2    Department's care after the implementation of managed
3    care;
4        (10) protections to ensure the continued provision of
5    health care services if a child's residence or legal
6    guardian changes;
7        (11) a method that the Department shall use to ensure a
8    reasonable rate is utilized for Medicaid managed care plans
9    to meet the specialized needs of children in the
10    Department's care;
11        (12) the notification process and timeframes to inform
12    managed care plan enrollees, enrollees' caregivers, and
13    enrollees' legal representation of any changes in health
14    care coverage or a change in a child's managed care
15    provider;
16        (13) defined pre-clearance requirements for
17    prescriptions, goods, and services in emergency and
18    non-emergency situations, if applicable;
19        (14) the Department's role and responsibility to
20    ensure implementation of a robust, responsive beneficiary
21    support system that has the capacity to provide assistance
22    in navigating the Medicaid managed care system to all
23    current and prospective beneficiaries and their
24    representatives, including, but not limited to:
25            (A) establishing a single point of contact
26        systemwide;

 

 

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1            (B) defining informational notice requirements;
2            (C) explanation of enrollment and disenrollment
3        rights;
4            (D) education on grievance process and
5        requirements for timely responses; and
6            (E) key beneficiary protections; and
7        (15) any limitations to the Department's ability to
8    ensure implementation of the beneficiary support system
9    described in paragraph (14).
10    (g) Prior to implementing the transition plan described in
11subsection (f), the Department shall submit to the
12Chairpersons, Vice-Chairpersons, and Minority Spokespersons of
13the House and Senate Human Services Committees, or to any
14successor committees:
15        (1) the transition plan; and
16        (2) notice of any Council recommendations that the
17    Director of Children and Family Services or the Director of
18    Healthcare and Family Services declined to adopt or
19    implement. This notice shall include: (i) the Council's
20    recommendation that the Director of Children and Family
21    Services or the Director of Healthcare and Family Services
22    declined to adopt or implement; (ii) the justification for
23    declining to adopt or implement the recommendation; and
24    (iii) an attestation from the Director of Children and
25    Family Services or the Director of Healthcare and Family
26    Services that failure to adopt or implement the

 

 

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1    recommendation does not contradict any court order or
2    conflict with federal funding requirements.
3    (h) Reports.
4        (1) On or before February 1, 2019, and on or before
5    each February 1 thereafter, the Department shall submit a
6    report to the House and Senate Human Services Committees,
7    or to any successor committees, on measures of access to
8    and the quality of health care services for children
9    enrolled in Medicaid managed care plans, including, but not
10    limited to, data showing whether:
11            (A) children enrolled in Medicaid managed care
12        plans have continuity of care across placement types,
13        geographic regions, and specialty service needs;
14            (B) each child is receiving the early periodic
15        screening, diagnosis, and treatment services as
16        required by federal law, including, but not limited to,
17        regular preventative care and timely specialty care;
18            (C) children are assigned to health homes;
19            (D) each child has a health care oversight and
20        coordination plan as required by federal law;
21            (E) there exist complaints and grievances
22        indicating gaps or barriers in service delivery;
23            (F) the Council and other stakeholders have and
24        continue to be engaged in quality improvement
25        initiatives;
26            (G) there exist disenrollment trends and related

 

 

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1        reasons such as poor quality of care, lack of access to
2        services covered by the managed care organization,
3        lack of access to providers experienced in addressing
4        enrollees' needs, limitations of in-network and
5        out-of-network coverage, or any other factors.
6        The report shall be prepared in consultation with the
7    Council and other agencies, organizations, or individuals
8    the Director deems appropriate in order to obtain
9    comprehensive and objective information about the managed
10    care plan operation.
11        (2) During each legislative session, the House and
12    Senate Human Services Committees shall hold hearings to
13    take public testimony about managed care implementation
14    for children in the care of, adopted from, or placed in
15    guardianship by the Department. The Department shall
16    present testimony, including information provided in the
17    report required under paragraph (1), the Department's
18    compliance with the provisions of this Section, and any
19    recommendations for statutory changes to improve health
20    care for children in the Department's care.
21    (i) If any provision of this Section or its application to
22any person or circumstance is held invalid, the invalidity of
23that provision or application does not affect other provisions
24or applications of this Section that can be given effect
25without the invalid provision or application.
 

 

 

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1    Section 99. Effective date. This Act takes effect upon
2becoming law.".