Full Text of SB2878 97th General Assembly
SB2878 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 SB2878 Introduced 2/1/2012, by Sen. William Delgado SYNOPSIS AS INTRODUCED: |
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Amends the Children's Health Insurance Program Act. Deletes dental services from the definition of "coordinated care" and "care coordination". Effective immediately.
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| | A BILL FOR |
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| | | SB2878 | | LRB097 13783 RPM 58342 b |
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| 1 | | AN ACT concerning insurance.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Children's Health Insurance Program Act is | 5 | | amended by changing Section 23 as follows: | 6 | | (215 ILCS 106/23) | 7 | | Sec. 23. Care coordination. | 8 | | (a) At least 50% of recipients eligible for comprehensive | 9 | | medical benefits in all medical assistance programs or other | 10 | | health benefit programs administered by the Department, | 11 | | including the Children's Health Insurance Program Act and the | 12 | | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | 13 | | care coordination program by no later than January 1, 2015. For | 14 | | purposes of this Section, "coordinated care" or "care | 15 | | coordination" means delivery systems where recipients will | 16 | | receive their care from providers who participate under | 17 | | contract in integrated delivery systems that are responsible | 18 | | for providing or arranging the majority of care, including | 19 | | primary care physician services, referrals from primary care | 20 | | physicians, diagnostic and treatment services, behavioral | 21 | | health services, in-patient and outpatient hospital services, | 22 | | dental services, and rehabilitation and long-term care | 23 | | services. The Department shall designate or contract for such |
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| 1 | | integrated delivery systems (i) to ensure enrollees have a | 2 | | choice of systems and of primary care providers within such | 3 | | systems; (ii) to ensure that enrollees receive quality care in | 4 | | a culturally and linguistically appropriate manner; and (iii) | 5 | | to ensure that coordinated care programs meet the diverse needs | 6 | | of enrollees with developmental, mental health, physical, and | 7 | | age-related disabilities. | 8 | | (b) Payment for such coordinated care shall be based on | 9 | | arrangements where the State pays for performance related to | 10 | | health care outcomes, the use of evidence-based practices, the | 11 | | use of primary care delivered through comprehensive medical | 12 | | homes, the use of electronic medical records, and the | 13 | | appropriate exchange of health information electronically made | 14 | | either on a capitated basis in which a fixed monthly premium | 15 | | per recipient is paid and full financial risk is assumed for | 16 | | the delivery of services, or through other risk-based payment | 17 | | arrangements. | 18 | | (c) To qualify for compliance with this Section, the 50% | 19 | | goal shall be achieved by enrolling medical assistance | 20 | | enrollees from each medical assistance enrollment category, | 21 | | including parents, children, seniors, and people with | 22 | | disabilities to the extent that current State Medicaid payment | 23 | | laws would not limit federal matching funds for recipients in | 24 | | care coordination programs. In addition, services must be more | 25 | | comprehensively defined and more risk shall be assumed than in | 26 | | the Department's primary care case management program as of the |
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| 1 | | effective date of this amendatory Act of the 96th General | 2 | | Assembly. | 3 | | (d) The Department shall report to the General Assembly in | 4 | | a separate part of its annual medical assistance program | 5 | | report, beginning April, 2012 until April, 2016, on the | 6 | | progress and implementation of the care coordination program | 7 | | initiatives established by the provisions of this amendatory | 8 | | Act of the 96th General Assembly. The Department shall include | 9 | | in its April 2011 report a full analysis of federal laws or | 10 | | regulations regarding upper payment limitations to providers | 11 | | and the necessary revisions or adjustments in rate | 12 | | methodologies and payments to providers under this Code that | 13 | | would be necessary to implement coordinated care with full | 14 | | financial risk by a party other than the Department.
| 15 | | (Source: P.A. 96-1501, eff. 1-25-11.)
| 16 | | Section 99. Effective date. This Act takes effect upon | 17 | | becoming law.
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