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90_HB0775
305 ILCS 5/5-16.8 new
Amends the Illinois Public Aid Code. Provides that in
adopting rules implementing a managed care Medicaid program,
the Department of Public Aid shall establish guidelines for
and require managed care organizations to provide education
programs for providers and clients. Details the requirements
for the contents of provider and client education programs.
Creates a bill of rights and responsibilities for those
enrolled in the Medicaid program. Provides that the
Department shall provide support and information services to
a person enrolled in the program or applying for Medicaid
coverage who experiences barriers to receiving health care
services, listing services to be provided. Effective
immediately.
LRB9000954SMdv
LRB9000954SMdv
1 AN ACT to amend the Illinois Public Aid Code by adding
2 Section 5-16.8.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 adding Section 5-16.8 as follows:
7 (305 ILCS 5/5-16.8 new)
8 Sec. 5-16.8. Administration of managed care program.
9 (a) In adopting rules implementing a managed care
10 Medicaid program, the Department shall establish guidelines
11 for and require managed care organizations to provide
12 education programs for providers and clients using a variety
13 of techniques and mediums.
14 (b) A provider education program must include
15 information on:
16 (1) Medicaid policies, procedures, eligibility
17 standards, and benefits;
18 (2) the specific problems and needs of Medicaid
19 clients; and
20 (3) the rights and responsibilities of Medicaid
21 clients under the bill of rights and the bill of
22 responsibilities prescribed by this Section.
23 (c) A client education program must present information
24 in a manner that is easy to understand. A program must
25 include information on:
26 (1) a client's rights and responsibilities under
27 the bill of rights and the bill of responsibilities
28 prescribed by this Section;
29 (2) how to access health care services;
30 (3) how to access complaint procedures and the
31 client's rights to bypass the managed care organization's
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1 internal complaint system and use the notice and appeal
2 procedures otherwise required by the Medicaid program;
3 (4) Medicaid policies, procedures, eligibility
4 standards, and benefits;
5 (5) the policies and procedures of the managed care
6 organization; and
7 (6) the importance of prevention, early
8 intervention, and appropriate use of services.
9 (d) The Department by rule shall adopt a bill of rights
10 and a bill of responsibilities for each person enrolled in
11 the Medicaid program. The bill of rights must address a
12 client's right to:
13 (1) respect, dignity, privacy, confidentiality, and
14 nondiscrimination;
15 (2) a reasonable opportunity to choose a health
16 care plan and primary care provider and to change to
17 another plan or provider in a reasonable manner;
18 (3) consent to or refuse treatment and actively
19 participate in treatment decisions;
20 (4) ask questions and receive complete information
21 relating to the client's medical condition and treatment
22 options, including specialty care;
23 (5) access each available complaint process,
24 receive a timely response to a complaint, and receive a
25 fair hearing; and
26 (6) timely access to care that does not have any
27 communication or physical access barriers.
28 (e) The bill of responsibilities must address a client's
29 responsibility to:
30 (1) learn and understand each right the client has
31 under the Medicaid program;
32 (2) abide by the health plan and Medicaid policies
33 and procedures;
34 (3) share information relating to the client's
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1 health status with the primary care provider and become
2 fully informed about service and treatment options; and
3 (4) actively participate in decisions relating to
4 service and treatment options, make personal choices and
5 take action to maintain the client's health.
6 (f) The Department shall provide support and information
7 services to a person enrolled in the program or applying for
8 Medicaid coverage who experiences barriers to receiving
9 health care services. The Department shall give emphasis to
10 assisting a person with an urgent or immediate medical or
11 support need. The Department may provide support and
12 information services by contracting with a nonprofit
13 organization that is not involved in providing health care,
14 health insurance, or health benefits. As a part of the
15 support and information services required by this subsection,
16 the Department or nonprofit organization shall:
17 (1) operate a statewide toll-free assistance
18 telephone number that includes TDD lines and assistance
19 for persons who speak Spanish;
20 (2) intervene promptly with the managed care
21 organizations and providers and any other appropriate
22 entity on behalf of a person who has an urgent need for
23 medical services;
24 (3) assist a person who is experiencing barriers in
25 the Medicaid application and enrollment process and refer
26 the person for further assistance if appropriate;
27 (4) educate persons so that they:
28 (A) understand the concept of managed care;
29 (B) understand their rights under the Medicaid
30 program, including grievance and appeal procedures;
31 and
32 (C) are able to advocate for themselves;
33 (5) collect and maintain statistical information on
34 a regional basis regarding calls received by the
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1 assistance lines and publish quarterly reports that:
2 (A) list the number of calls received by
3 region;
4 (B) identify trends in delivery and access
5 problems;
6 (C) identify recurring barriers in the
7 Medicaid system; and
8 (D) indicate other problems identified with
9 Medicaid managed care; and
10 (6) assist the managed care organizations and
11 providers in identifying and correcting problems,
12 including site visits to affected regions if necessary.
13 Section 99. Effective date. This Act takes effect upon
14 becoming law.