Full Text of HB0108 099th General Assembly
HB0108eng 99TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning health.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. Short title. This Act may be cited as the | 5 | | Illinois Universal Health Care Act. | 6 | | Section 5. Purposes. It is the purpose of this Act to | 7 | | provide universal access to health care for all
individuals | 8 | | within the State, to promote and improve the health of all
its | 9 | | citizens, to stress the importance of good public health | 10 | | through treatment and prevention of diseases, and to contain | 11 | | costs to make the delivery of this care affordable. Should | 12 | | legislation of this kind be enacted on a federal level, it is | 13 | | the intent of this Act to become a part of a nationwide system. | 14 | | Section 10. Definitions. In this Act: | 15 | | "Board" means the Illinois Health Services Governing | 16 | | Board.
| 17 | | "Program" means the Illinois Health Services Program.
| 18 | | Section 15. Eligibility; registration. All individuals | 19 | | residing in this State are covered
under the Illinois Health | 20 | | Services Program for health insurance and shall receive a card | 21 | | with a unique number in the
mail. An individual's social |
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| 1 | | security number shall not be used for purposes of
registration | 2 | | under this Section. Individuals and families shall receive an | 3 | | Illinois Health Services Insurance Card
in the mail after | 4 | | filling out a Program application form at a health care | 5 | | provider.
Such application form shall be no more than 2 pages | 6 | | long. Individuals who present themselves for covered services
| 7 | | from a participating provider shall be presumed to be eligible | 8 | | for benefits under
this Act, but shall complete an application | 9 | | for benefits in order to receive an Illinois Health Services
| 10 | | Insurance Card and have payment made for such benefits. | 11 | | Section 20. Benefits and portability. | 12 | | (a) The health coverage benefits under this Act cover all | 13 | | medically
necessary services, including: | 14 | | (1) primary care and prevention; | 15 | | (2) specialty care (other than what is deemed elective | 16 | | cosmetic); | 17 | | (3) inpatient care; | 18 | | (4) outpatient care; | 19 | | (5) emergency care; | 20 | | (6) prescription drugs; | 21 | | (7) durable medical equipment; | 22 | | (8) long-term care; | 23 | | (9) mental health services; | 24 | | (10) the full scope of dental services (other than | 25 | | elective cosmetic dentistry);
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| 1 | | (11) substance abuse treatment services; | 2 | | (12) chiropractic services; and | 3 | | (13) basic vision care and vision correction. | 4 | | (b) Health coverage benefits under this Act are available | 5 | | through any licensed health care provider anywhere in the State | 6 | | that is legally qualified to provide such benefits and for | 7 | | emergency care anywhere in the United States. | 8 | | (c) No deductibles, copayments, coinsurance, or other cost | 9 | | sharing shall be imposed with respect to covered benefits | 10 | | except for those goods or services that exceed basic covered | 11 | | benefits, as defined by the Board. | 12 | | Section 25. Qualification of participating providers. | 13 | | (a) Health care delivery facilities must meet regional and | 14 | | State
quality and licensing guidelines as a condition of | 15 | | participation under the
Program, including guidelines | 16 | | regarding safe staffing and quality of care. | 17 | | (b) A participating health care provider must be
licensed | 18 | | by the State. No health care provider whose license
is under | 19 | | suspension or has been revoked may participate in the Program. | 20 | | (c)
Only non-profit health maintenance organizations that | 21 | | actually deliver care in their own facilities and directly | 22 | | employ clinicians may participate in the Program. | 23 | | (d) Patients shall have free choice of participating
| 24 | | eligible providers, hospitals, and inpatient care facilities. |
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| 1 | | Section 30. Provider reimbursement. | 2 | | (a) The Program shall pay all health care providers | 3 | | according to the following standards: | 4 | | (1) Physicians and other practitioners can choose to be | 5 | | paid fee-for-service, salaried by institutions receiving | 6 | | global budgets, or salaried by group practices or HMOs | 7 | | receiving capitation payments. Investor-owned HMOs and | 8 | | group practices shall be converted to not-for-profit | 9 | | status. Only institutions that deliver care shall be | 10 | | eligible for Program payments. | 11 | | (2) The Program shall pay each hospital and providing | 12 | | institution a monthly lump sum (global budget) to cover all | 13 | | operating expenses. The hospital and Program shall | 14 | | negotiate the amount of this payment annually based on past | 15 | | budgets, clinical performance, projected changes in demand | 16 | | for services and input costs, and proposed new programs. | 17 | | Hospitals shall not bill patients for services covered by | 18 | | the Program, and cannot use any of their operating budgets | 19 | | for expansion, profit, excessive executive income, | 20 | | marketing, or major capital purchases or leases. | 21 | | (3) The Program budget shall fund major capital | 22 | | expenditures, including the construction of new health | 23 | | facilities and the purchase of expensive equipment. The | 24 | | regional health planning districts shall allocate these | 25 | | capital funds and oversee capital projects funded from | 26 | | private donations.
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| 1 | | (b) The Program shall reimburse physicians choosing to be | 2 | | paid fee-for-service according to a fee schedule negotiated | 3 | | between physician representatives and the Program on at least | 4 | | an annual basis. | 5 | | (c) Hospitals, nursing homes, community health centers, | 6 | | non-profit staff model HMOs, and home health care agencies | 7 | | shall receive a global budget to cover operating expenses, | 8 | | negotiated annually with the Program based on past | 9 | | expenditures, past budgets, clinical performance, projected | 10 | | changes in demand for services and input costs, and proposed | 11 | | new programs. Expansions and other substantive capital | 12 | | investments shall be funded separately. | 13 | | (d) All covered prescription drugs and durable medical | 14 | | supplies shall be paid for according to a fee schedule | 15 | | negotiated between manufacturers and the Program on at least an | 16 | | annual basis. Price reductions shall be achieved by bulk | 17 | | purchasing whenever possible. Where therapeutically equivalent | 18 | | drugs are available, the formulary shall specify the use of the | 19 | | lowest-cost medication, with exceptions available in the case | 20 | | of medical necessity.
| 21 | | Section 35. Prohibition against duplicating coverage; | 22 | | investor-ownership of health delivery facilities. | 23 | | (a) It is unlawful for a private health insurer to sell | 24 | | health insurance coverage that duplicates the benefits | 25 | | provided under this Act. Nothing in this Act shall be construed |
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| 1 | | as prohibiting the
sale of health insurance coverage for any | 2 | | additional benefits not covered by this Act. | 3 | | (b) Investor-ownership of health delivery facilities, | 4 | | including hospitals, health maintenance organizations, nursing | 5 | | homes, and clinics, is unlawful. Investor-owners of health | 6 | | delivery facilities at the time of the effective date of this | 7 | | Act shall be compensated for the loss of their facilities, but | 8 | | not for loss of business opportunities or for administrative | 9 | | capacity not used by the Program. | 10 | | Section 40. Illinois Health Services Trust. | 11 | | (a) The State shall
establish the Illinois Health Services | 12 | | Trust (IHST), the sole purpose of which shall be to provide the
| 13 | | financing reserve for the purposes outlined in this Act. | 14 | | Specifically, the IHST
shall provide all of the following: | 15 | | (1) The funds for the general operating budget of the | 16 | | Program. | 17 | | (2) Reimbursement for those benefits outlined in | 18 | | Section 20 of this Act. | 19 | | (3) Public health services. | 20 | | (4) Capital expenditures for construction or | 21 | | renovation of health care facilities or major equipment | 22 | | purchases deemed necessary throughout the State and | 23 | | approved by the Board.
| 24 | | (5) Re-education and job placement of persons who have | 25 | | lost their jobs as a
result of this transition, limited to |
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| 1 | | the first 5 years. | 2 | | (b) The General Assembly or the Governor may provide funds | 3 | | to the IHST, but may not remove or borrow funds from the IHST. | 4 | | (c) The IHST shall be administered by the Board, under the | 5 | | oversight of the General Assembly.
| 6 | | (d) Funding of the IHST shall include, but is not limited | 7 | | to, all of the following: | 8 | | (1) Funds appropriated as outlined by the General | 9 | | Assembly on a yearly basis. | 10 | | (2) A progressive set of graduated income | 11 | | contributions: 20% paid by individuals, 20% paid by a | 12 | | business, and 60% paid by the government. | 13 | | (3) All federal moneys that are designated for health | 14 | | care, including, but not limited to, all moneys designated | 15 | | for Medicaid. The Secretary shall be authorized to | 16 | | negotiate with the federal
government for funding of | 17 | | Medicare recipients.
| 18 | | (4) Grants and contributions, both public and private.
| 19 | | (5) Any other tax revenues designated by the General | 20 | | Assembly. | 21 | | (6) Any other funds specifically ear-marked for health | 22 | | care or health care
education, such as settlements from | 23 | | litigation.
| 24 | | (e) The total overhead and administrative portion of the | 25 | | Program budget may not exceed 12% of the total operating budget | 26 | | of the Program for the first 2 years that the Program is in |
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| 1 | | operation; 8% for the following 2 years; and 5% for each year | 2 | | thereafter. | 3 | | (f) The Program may be divided into
regional districts for | 4 | | the purposes of local administration and oversight of programs | 5 | | that are specific to each
region's needs. | 6 | | (g) Claims billing from all providers must be submitted | 7 | | electronically and in compliance with current State and federal | 8 | | privacy laws within 5 years after the effective date of this | 9 | | Act. Electronic claims and billing must be uniform across the | 10 | | State. The Board shall create and implement a statewide uniform | 11 | | system of electronic medical records that is in compliance with | 12 | | current State and federal privacy laws within 7 years after the | 13 | | effective date of this Act. Payments to providers must be made | 14 | | in a timely fashion as outlined under current State and federal | 15 | | law. Providers who accept payment from the Program for services | 16 | | rendered may not bill any patient for covered services. | 17 | | Providers may elect either to participate fully, or not at all, | 18 | | in the Program.
| 19 | | Section 45. Long-term care payment. The Board shall | 20 | | establish funding for long-term care services, including | 21 | | in-home, nursing home, and community-based care. A local public | 22 | | agency shall be established in each community to determine | 23 | | eligibility and coordinate home and nursing home long-term | 24 | | care. This agency may contract with long-term care providers | 25 | | for the full range of needed long-term care services. |
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| 1 | | Section 50. Mental health services. The Program shall | 2 | | provide coverage for all medically necessary
mental health care | 3 | | on the same basis as the coverage for other conditions. The | 4 | | Program shall cover
supportive residences, occupational | 5 | | therapy, and ongoing mental health and
counseling services | 6 | | outside the hospital for patients with serious mental illness.
| 7 | | In all cases the highest quality and most effective care shall | 8 | | be delivered, including institutional care. | 9 | | Section 55. Payment for prescription medications, medical | 10 | | supplies, and medically
necessary assistive equipment.
| 11 | | (a) The Program shall establish a single prescription drug
| 12 | | formulary and list of approved durable medical goods and | 13 | | supplies. The Board shall, by itself or by a committee of
| 14 | | health professionals and related individuals appointed by the | 15 | | Board and called the Pharmaceutical and Durable Medical Goods | 16 | | Committee,
meet on a quarterly basis to discuss, reverse, add | 17 | | to, or remove items from
the formulary according to sound | 18 | | medical practice. | 19 | | (b) The Pharmaceutical and Durable Medical Goods Committee | 20 | | shall negotiate the prices of pharmaceuticals and durable
| 21 | | medical goods with suppliers or manufacturers on an open bid | 22 | | competitive
basis. Prices shall be reviewed, negotiated, or | 23 | | re-negotiated on no less than
an annual basis.
The | 24 | | Pharmaceutical and Durable Medical Goods Committee shall |
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| 1 | | establish a process of open forum to the public for the | 2 | | purposes of grievance and petition from suppliers, provider | 3 | | groups, and the public regarding the formulary no less than 2 | 4 | | times a year. | 5 | | (c) All pharmacy and durable medical goods vendors must be | 6 | | licensed to
distribute medical goods through the regulations | 7 | | outlined by the Board. | 8 | | (d) All decisions and determinations of the Pharmacy and | 9 | | Durable Medical Goods Committee must be presented to and | 10 | | approved by the Board on an annual basis. | 11 | | Section 60. Illinois Health Services Governing Board. | 12 | | (a) The Program shall be administered by an independent | 13 | | agency known as the Illinois Health Services Governing Board. | 14 | | The Board will consist of a Commissioner, a Chief Medical | 15 | | Officer, and public State board members. The Board is | 16 | | responsible for administration of the Program, including:
| 17 | | (1) implementation of eligibility standards and | 18 | | Program enrollment; | 19 | | (2) adoption of the benefits package;
| 20 | | (3) establishing formulas for setting health | 21 | | expenditure budgets; | 22 | | (4) administration of global budgets, capital | 23 | | expenditure budgets, and prompt reimbursement of | 24 | | providers; | 25 | | (5) negotiations of service fee schedules and prices |
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| 1 | | for prescription drugs and durable medical supplies; | 2 | | (6) recommending evidenced-based changes to benefits; | 3 | | and | 4 | | (7) quality and planning functions including criteria | 5 | | for capital expansion and infrastructure development, | 6 | | measurement and evaluation of health quality indicators, | 7 | | and the establishment of regions for long-term care | 8 | | integration.
| 9 | | (b) At least one-third of the members of the Board, | 10 | | including all committees dedicated to benefits design, health | 11 | | planning, quality, and long-term care, shall be consumer | 12 | | representatives. | 13 | | Section 65. Patients' rights. The Program shall protect the | 14 | | rights and privacy of the patients that it serves in accordance | 15 | | with all current State and federal statutes. With the | 16 | | development of the electronic medical records, patients shall | 17 | | be afforded the right and option of keeping any portion of | 18 | | their medical records separate from the electronic medical | 19 | | records. Patients have the right to access their medical | 20 | | records upon demand. | 21 | | Section 70. Compensation. The Commissioner, the Chief | 22 | | Medical Officer, public State board members, and subsequent | 23 | | employees of the Program shall be compensated in accordance
| 24 | | with the current pay scale for State employees and as deemed |
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| 1 | | professionally appropriate by the General Assembly and | 2 | | reviewed in accordance with all other State employees.
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