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92_SB0873enr SB873 Enrolled LRB9201523DJgc 1 AN ACT in relation to public aid. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The University of Illinois Act is amended by 5 changing Section 7 as follows: 6 (110 ILCS 305/7) (from Ch. 144, par. 28) 7 Sec. 7. Powers of trustees. 8 (a) The trustees shall have power to provide for the 9 requisite buildings, apparatus, and conveniences; to fix the 10 rates for tuition; to appoint such professors and 11 instructors, and to establish and provide for the management 12 of such model farms, model art, and other departments and 13 professorships, as may be required to teach, in the most 14 thorough manner, such branches of learning as are related to 15 agriculture and the mechanic arts, and military tactics, 16 without excluding other scientific and classical studies. The 17 trustees shall, upon the written request of an employee 18 withhold from the compensation of that employee any dues, 19 payments or contributions payable by such employee to any 20 labor organization as defined in the Illinois Educational 21 Labor Relations Act. Under such arrangement, an amount shall 22 be withheld from each regular payroll period which is equal 23 to the pro rata share of the annual dues plus any payments or 24 contributions, and the trustees shall transmit such 25 withholdings to the specified labor organization within 10 26 working days from the time of the withholding. They may 27 accept the endowments and voluntary professorships or 28 departments in the University, from any person or persons or 29 corporations who may offer the same, and, at any regular 30 meeting of the board, may prescribe rules and regulations in 31 relation to such endowments and declare on what general SB873 Enrolled -2- LRB9201523DJgc 1 principles they may be admitted: Provided, that such special 2 voluntary endowments or professorships shall not be 3 incompatible with the true design and scope of the act of 4 congress, or of this Act: Provided, that no student shall at 5 any time be allowed to remain in or about the University in 6 idleness, or without full mental or industrial occupation: 7 And provided further, that the trustees, in the exercise of 8 any of the powers conferred by this Act, shall not create any 9 liability or indebtedness in excess of the funds in the hands 10 of the treasurer of the University at the time of creating 11 such liability or indebtedness, and which may be specially 12 and properly applied to the payment of the same. Any lease to 13 the trustees of lands, buildings or facilities which will 14 support scientific research and development in such areas as 15 high technology, super computing, microelectronics, 16 biotechnology, robotics, physics and engineering shall be for 17 a term not to exceed 18 years, and may grant to the trustees 18 the option to purchase the lands, buildings or facilities. 19 The lease shall recite that it is subject to termination and 20 cancellation in any year for which the General Assembly fails 21 to make an appropriation to pay the rent payable under the 22 terms of the lease. 23 Leases for the purposes described herein exceeding 5 24 years shall have the approval of the Illinois Board of Higher 25 Education. 26 The Board of Trustees may, directly or in cooperation 27 with other institutions of higher education, acquire by 28 purchase or lease or otherwise, and construct, enlarge, 29 improve, equip, complete, operate, control and manage medical 30 research and high technology parks, together with the 31 necessary lands, buildings, facilities, equipment and 32 personal property therefor, to encourage and facilitate (a) 33 the location and development of business and industry in the 34 State of Illinois, and (b) the increased application and SB873 Enrolled -3- LRB9201523DJgc 1 development of technology and (c) the improvement and 2 development of the State's economy. The Board of Trustees may 3 lease to nonprofit corporations all or any part of the land, 4 buildings, facilities, equipment or other property included 5 in a medical research and high technology park upon such 6 terms and conditions as the University of Illinois may deem 7 advisable and enter into any contract or agreement with such 8 nonprofit corporations as may be necessary or suitable for 9 the construction, financing, operation and maintenance and 10 management of any such park; and may lease to any person, 11 firm, partnership or corporation, either public or private, 12 any part or all of the land, building, facilities, equipment 13 or other property of such park for such purposes and upon 14 such rentals, terms and conditions as the University may deem 15 advisable; and may finance all or part of the cost of any 16 such park, including the purchase, lease, construction, 17 reconstruction, improvement, remodeling, addition to, and 18 extension and maintenance of all or part of such high 19 technology park, and all equipment and furnishings, by 20 legislative appropriations, government grants, contracts, 21 private gifts, loans, receipts from the operation of such 22 high technology park, rentals and similar receipts; and may 23 make its other facilities and services available to tenants 24 or other occupants of any such park at rates which are 25 reasonable and appropriate. 26 The Trustees shall have power (a) to purchase real 27 property and easements, and (b) to acquire real property and 28 easements in the manner provided by law for the exercise of 29 the right of eminent domain, and in the event negotiations 30 for the acquisition of real property or easements for making 31 any improvement which the Trustees are authorized to make 32 shall have proven unsuccessful and the Trustees shall have by 33 resolution adopted a schedule or plan of operation for the 34 execution of the project and therein made a finding that it SB873 Enrolled -4- LRB9201523DJgc 1 is necessary to take such property or easements immediately 2 or at some specified later date in order to comply with the 3 schedule, the Trustees may acquire such property or easements 4 in the same manner provided in Sections 7-103 through 7-112 5 of the Code of Civil Procedure. 6 The Board of Trustees also shall have power to agree with 7 the State's Attorney of the county in which any properties of 8 the Board are located to pay for services rendered by the 9 various taxing districts for the years 1944 through 1949 and 10 to pay annually for services rendered thereafter by such 11 district such sums as may be determined by the Board upon 12 properties used solely for income producing purposes, title 13 to which is held by said Board of Trustees, upon properties 14 leased to members of the staff of the University of Illinois, 15 title to which is held in trust for said Board of Trustees 16 and upon properties leased to for-profit entities the title 17 to which properties is held by the Board of Trustees. A 18 certified copy of any such agreement made with the State's 19 Attorney shall be filed with the County Clerk and such sums 20 shall be distributed to the respective taxing districts by 21 the County Collector in such proportions that each taxing 22 district will receive therefrom such proportion as the tax 23 rate of such taxing district bears to the total tax rate that 24 would be levied against such properties if they were not 25 exempt from taxation under the Property Tax Code. 26 The Board of Trustees of the University of Illinois, 27 subject to the applicable civil service law, may appoint 28 persons to be members of the University of Illinois Police 29 Department. Members of the Police Department shall be peace 30 officers and as such have all powers possessed by policemen 31 in cities, and sheriffs, including the power to make arrests 32 on view or warrants of violations of state statutes and city 33 or county ordinances, except that they may exercise such 34 powers only in counties wherein the University and any of its SB873 Enrolled -5- LRB9201523DJgc 1 branches or properties are located when such is required for 2 the protection of university properties and interests, and 3 its students and personnel, and otherwise, within such 4 counties, when requested by appropriate state or local law 5 enforcement officials; provided, however, that such officer 6 shall have no power to serve and execute civil processes. 7 The Board of Trustees must authorize to each member of 8 the University of Illinois Police Department and to any other 9 employee of the University of Illinois exercising the powers 10 of a peace officer a distinct badge that, on its face, (i) 11 clearly states that the badge is authorized by the University 12 of Illinois and (ii) contains a unique identifying number. No 13 other badge shall be authorized by the University of 14 Illinois. 15 The Board of Trustees may own, operate, or govern, by or 16 through the College of Medicine at Peoria, a managed care 17 community network established under subsection (b)(r)of 18 Section 5-115-16.3of the Illinois Public Aid Code. 19 The powers of the trustees as herein designated are 20 subject to the provisions of "An Act creating a Board of 21 Higher Education, defining its powers and duties, making an 22 appropriation therefor, and repealing an Act herein named", 23 approved August 22, 1961, as amended. 24 The Board of Trustees shall have the authority to adopt 25 all administrative rules which may be necessary for the 26 effective administration, enforcement and regulation of all 27 matters for which the Board has jurisdiction or 28 responsibility. 29 (b) To assist in the provision of buildings and 30 facilities beneficial to, useful for, or supportive of 31 University purposes, the Board of Trustees of the University 32 of Illinois may exercise the following powers with regard to 33 the area located on or adjacent to the University of Illinois 34 at Chicago campus and bounded as follows: on the West by SB873 Enrolled -6- LRB9201523DJgc 1 Morgan Street; on the North by Roosevelt Road; on the East by 2 Union Street; and on the South by 16th Street, in the City of 3 Chicago: 4 (1) Acquire any interests in land, buildings, or 5 facilities by purchase, including installments payable 6 over a period allowed by law, by lease over a term of 7 such duration as the Board of Trustees shall determine, 8 or by exercise of the power of eminent domain; 9 (2) Sub-lease or contract to purchase through 10 installments all or any portion of buildings or 11 facilities for such duration and on such terms as the 12 Board of Trustees shall determine, including a term that 13 exceeds 5 years, provided that each such lease or 14 purchase contract shall be and shall recite that it is 15 subject to termination and cancellation in any year for 16 which the General Assembly fails to make an appropriation 17 to pay the rent or purchase installments payable under 18 the terms of such lease or purchase contract; and 19 (3) Sell property without compliance with the State 20 Property Control Act and retain proceeds in the 21 University Treasury in a special, separate development 22 fund account which the Auditor General shall examine to 23 assure compliance with this Act. 24 Any buildings or facilities to be developed on the land shall 25 be buildings or facilities that, in the determination of the 26 Board of Trustees, in whole or in part: (i) are for use by 27 the University; or (ii) otherwise advance the interests of 28 the University, including, by way of example, residential 29 facilities for University staff and students and commercial 30 facilities which provide services needed by the University 31 community. Revenues from the development fund account may be 32 withdrawn by the University for the purpose of demolition and 33 the processes associated with demolition; routine land and 34 property acquisition; extension of utilities; streetscape SB873 Enrolled -7- LRB9201523DJgc 1 work; landscape work; surface and structure parking; 2 sidewalks, recreational paths, and street construction; and 3 lease and lease purchase arrangements and the professional 4 services associated with the planning and development of the 5 area. Moneys from the development fund account used for any 6 other purpose must be deposited into and appropriated from 7 the General Revenue Fund. Buildings or facilities leased to 8 an entity or person other than the University shall not be 9 subject to any limitations applicable to a State supported 10 college or university under any law. All development on the 11 land and all use of any buildings or facilities shall be 12 subject to the control and approval of the Board of Trustees. 13 (Source: P.A. 90-730, eff. 8-10-98; 91-883, eff. 1-1-01.) 14 Section 10. The Southern Illinois University Management 15 Act is amended by changing Section 8 as follows: 16 (110 ILCS 520/8) (from Ch. 144, par. 658) 17 Sec. 8. Powers and Duties of the Board. The Board shall 18 have power and it shall be its duty: 19 1. To make rules, regulations and by-laws, not 20 inconsistent with law, for the government and management 21 of Southern Illinois University and its branches; 22 2. To employ, and, for good cause, to remove a 23 president of Southern Illinois University, and all 24 necessary deans, professors, associate professors, 25 assistant professors, instructors, and other educational 26 and administrative assistants, and all other necessary 27 employees, and contract with them upon matters relating 28 to tenure, salaries and retirement benefits in accordance 29 with the State Universities Civil Service Act; the Board 30 shall, upon the written request of an employee of 31 Southern Illinois University, withhold from the 32 compensation of that employee any dues, payments or SB873 Enrolled -8- LRB9201523DJgc 1 contributions payable by such employee to any labor 2 organization as defined in the Illinois Educational Labor 3 Relations Act. Under such arrangement, an amount shall be 4 withheld from each regular payroll period which is equal 5 to the pro rata share of the annual dues plus any 6 payments or contributions, and the Board shall transmit 7 such withholdings to the specified labor organization 8 within 10 working days from the time of the withholding. 9 Whenever the Board establishes a search committee to fill 10 the position of president of Southern Illinois 11 University, there shall be minority representation, 12 including women, on that search committee; 13 3. To prescribe the course of study to be followed, 14 and textbooks and apparatus to be used at Southern 15 Illinois University; 16 4. To issue upon the recommendation of the faculty, 17 diplomas to such persons as have satisfactorily completed 18 the required studies of Southern Illinois University, and 19 confer such professional and literary degrees as are 20 usually conferred by other institutions of like character 21 for similar or equivalent courses of study, or such as 22 the Board may deem appropriate; 23 5. To examine into the conditions, management, and 24 administration of Southern Illinois University, to 25 provide the requisite buildings, apparatus, equipment and 26 auxiliary enterprises, and to fix and collect 27 matriculation fees; tuition fees; fees for student 28 activities; fees for student facilities such as student 29 union buildings or field houses or stadium or other 30 recreational facilities; student welfare fees; laboratory 31 fees and similar fees for supplies and material; 32 6. To succeed to and to administer all trusts, 33 trust property, and gifts now or hereafter belonging or 34 pertaining to Southern Illinois University; SB873 Enrolled -9- LRB9201523DJgc 1 7. To accept endowments of professorships or 2 departments in the University from any person who may 3 proffer them and, at regular meetings, to prescribe rules 4 and regulations in relation to endowments and declare on 5 what general principles they may be accepted; 6 8. To enter into contracts with the Federal 7 government for providing courses of instruction and other 8 services at Southern Illinois University for persons 9 serving in or with the military or naval forces of the 10 United States, and to provide such courses of instruction 11 and other services; 12 9. To provide for the receipt and expenditures of 13 Federal funds, paid to the Southern Illinois University 14 by the Federal government for instruction and other 15 services for persons serving in or with the military or 16 naval forces of the United States and to provide for 17 audits of such funds; 18 10. To appoint, subject to the applicable civil 19 service law, persons to be members of the Southern 20 Illinois University Police Department. Members of the 21 Police Department shall be conservators of the peace and 22 as such have all powers possessed by policemen in cities, 23 and sheriffs, including the power to make arrests on view 24 or warrants of violations of state statutes, university 25 rules and regulations and city or county ordinances, 26 except that they may exercise such powers only within 27 counties wherein the university and any of its branches 28 or properties are located when such is required for the 29 protection of university properties and interests, and 30 its students and personnel, and otherwise, within such 31 counties, when requested by appropriate State or local 32 law enforcement officials. However, such officers shall 33 have no power to serve and execute civil processes. 34 The Board must authorize to each member of the SB873 Enrolled -10- LRB9201523DJgc 1 Southern Illinois University Police Department and to any 2 other employee of Southern Illinois University exercising 3 the powers of a peace officer a distinct badge that, on 4 its face, (i) clearly states that the badge is authorized 5 by Southern Illinois University and (ii) contains a 6 unique identifying number. No other badge shall be 7 authorized by Southern Illinois University. 8 11. To administer a plan or plans established by 9 the clinical faculty of the School of Medicine for the 10 billing, collection and disbursement of charges made by 11 individual faculty members for professional services 12 performed by them in the course of or in support of their 13 academic responsibilities, provided that such plan has 14 been first approved by Board action. All such collections 15 shall be deposited into a special fund or funds 16 administered by the Board from which disbursements may be 17 made according to the provisions of said plan. The 18 reasonable costs incurred, by the University, 19 administering the billing, collection and disbursement 20 provisions of a plan shall have first priority for 21 payment before distribution or disbursement for any other 22 purpose. Charges established pursuant to this plan must 23 be itemized in any billing and any amounts collected 24 which are not used to off-set the cost of operating or 25 maintaining the activity which generated the funds 26 collected, must be accounted for separately. This 27 accounting must clearly show the use and application made 28 of the funds and the Board shall report such accountings 29 for the previous fiscal year to the Legislative Audit 30 Commission annually by December 31 of each fiscal year. 31 The Board of Trustees may own, operate, or govern, 32 by or through the School of Medicine, a managed care 33 community network established under subsection (b)(r)of 34 Section 5-115-16.3of the Illinois Public Aid Code. SB873 Enrolled -11- LRB9201523DJgc 1 12. The Board of Trustees may, directly or in 2 cooperation with other institutions of higher education, 3 acquire by purchase or lease or otherwise, and construct, 4 enlarge, improve, equip, complete, operate, control and 5 manage medical research and high technology parks, 6 together with the necessary lands, buildings, facilities, 7 equipment, and personal property therefor, to encourage 8 and facilitate (a) the location and development of 9 business and industry in the State of Illinois, and (b) 10 the increased application and development of technology 11 and (c) the improvement and development of the State's 12 economy. The Board of Trustees may lease to nonprofit 13 corporations all or any part of the land, buildings, 14 facilities, equipment or other property included in a 15 medical research and high technology park upon such terms 16 and conditions as the Board of Trustees may deem 17 advisable and enter into any contract or agreement with 18 such nonprofit corporations as may be necessary or 19 suitable for the construction, financing, operation and 20 maintenance and management of any such park; and may 21 lease to any person, firm, partnership or corporation, 22 either public or private, any part or all of the land, 23 building, facilities, equipment or other property of such 24 park for such purposes and upon such rentals, terms and 25 conditions as the Board of Trustees may deem advisable; 26 and may finance all or part of the cost of any such park, 27 including the purchase, lease, construction, 28 reconstruction, improvement, remodeling, addition to, and 29 extension and maintenance of all or part of such high 30 technology park, and all equipment and furnishings, by 31 legislative appropriations, government grants, contracts, 32 private gifts, loans, receipts from the operation of such 33 high technology park, rentals and similar receipts; and 34 may make its other facilities and services available to SB873 Enrolled -12- LRB9201523DJgc 1 tenants or other occupants of any such park at rates 2 which are reasonable and appropriate. 3 The powers of the Board as herein designated are subject 4 to the Board of Higher Education Act. 5 (Source: P.A. 91-883, eff. 1-1-01.) 6 Section 15. The Illinois Insurance Code is amended by 7 changing Section 352 as follows: 8 (215 ILCS 5/352) (from Ch. 73, par. 964) 9 Sec. 352. Scope of Article. 10 (a) Except as provided in subsections (b), (c), (d), and 11 (e), this Article shall apply to all companies transacting in 12 this State the kinds of business enumerated in clause (b) of 13 Class 1 and clause (a) of Class 2 of section 4. Nothing in 14 this Article shall apply to, or in any way affect policies or 15 contracts described in clause (a) of Class 1 of Section 4; 16 however, this Article shall apply to policies and contracts 17 which contain benefits providing reimbursement for the 18 expenses of long term health care which are certified or 19 ordered by a physician including but not limited to 20 professional nursing care, custodial nursing care, and 21 non-nursing custodial care provided in a nursing home or at a 22 residence of the insured. 23 (b) This Article does not apply to policies of accident 24 and health insurance issued in compliance with Article XIXB 25 of this Code. 26 (c) A policy issued and delivered in this State that 27 provides coverage under that policy for certificate holders 28 who are neither residents of nor employed in this State does 29 not need to provide to those nonresident certificate holders 30 who are not employed in this State the coverages or services 31 mandated by this Article. 32 (d) Stop-loss insurance is exempt from all Sections of SB873 Enrolled -13- LRB9201523DJgc 1 this Article, except this Section and Sections 353a, 354, 2 357.30, and 370. For purposes of this exemption, stop-loss 3 insurance is further defined as follows: 4 (1) The policy must be issued to and insure an 5 employer, trustee, or other sponsor of the plan, or the 6 plan itself, but not employees, members, or participants. 7 (2) Payments by the insurer must be made to the 8 employer, trustee, or other sponsors of the plan, or the 9 plan itself, but not to the employees, members, 10 participants, or health care providers. 11 (e) A policy issued or delivered in this State to the 12 Illinois Department of Public Aid and providing coverage, 13 under clause (b) of Class 1 or clause (a) of Class 2 as 14 described in Section 4, to persons who are enrolledin the15integrated health care program establishedunder Article V 16Section 5-16.3of the Illinois Public Aid Code or under the 17 Children's Health Insurance Program Act is exempt from all 18 restrictions, limitations, standards, rules, or regulations 19 respecting benefits imposed by or under authority of this 20 Code, except those specified by subsection (1) of Section 21 143. Nothing in this subsection, however, affects the total 22 medical services available to persons eligible for medical 23 assistance under the Illinois Public Aid Code. 24 (Source: P.A. 87-435; 87-757; 87-938; 87-956; 88-364; 88-554, 25 eff. 7-26-94.) 26 Section 20. The Health Maintenance Organization Act is 27 amended by changing Sections 1-2, 2-1, and 6-3 as follows: 28 (215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402) 29 Sec. 1-2. Definitions. As used in this Act, unless the 30 context otherwise requires, the following terms shall have 31 the meanings ascribed to them: 32 (1) "Advertisement" means any printed or published SB873 Enrolled -14- LRB9201523DJgc 1 material, audiovisual material and descriptive literature of 2 the health care plan used in direct mail, newspapers, 3 magazines, radio scripts, television scripts, billboards and 4 similar displays; and any descriptive literature or sales 5 aids of all kinds disseminated by a representative of the 6 health care plan for presentation to the public including, 7 but not limited to, circulars, leaflets, booklets, 8 depictions, illustrations, form letters and prepared sales 9 presentations. 10 (2) "Director" means the Director of Insurance. 11 (3) "Basic health care services" means emergency care, 12 and inpatient hospital and physician care, outpatient medical 13 services, mental health services and care for alcohol and 14 drug abuse, including any reasonable deductibles and 15 co-payments, all of which are subject to such limitations as 16 are determined by the Director pursuant to rule. 17 (4) "Enrollee" means an individual who has been enrolled 18 in a health care plan. 19 (5) "Evidence of coverage" means any certificate, 20 agreement, or contract issued to an enrollee setting out the 21 coverage to which he is entitled in exchange for a per capita 22 prepaid sum. 23 (6) "Group contract" means a contract for health care 24 services which by its terms limits eligibility to members of 25 a specified group. 26 (7) "Health care plan" means any arrangement whereby any 27 organization undertakes to provide or arrange for and pay for 28 or reimburse the cost of basic health care services from 29 providers selected by the Health Maintenance Organization and 30 such arrangement consists of arranging for or the provision 31 of such health care services, as distinguished from mere 32 indemnification against the cost of such services, except as 33 otherwise authorized by Section 2-3 of this Act, on a per 34 capita prepaid basis, through insurance or otherwise. A SB873 Enrolled -15- LRB9201523DJgc 1 "health care plan" also includes any arrangement whereby an 2 organization undertakes to provide or arrange for or pay for 3 or reimburse the cost of any health care service for persons 4 who are enrolledin the integrated health care program5establishedunder Article VSection 5-16.3of the Illinois 6 Public Aid Code or under the Children's Health Insurance 7 Program Act through providers selected by the organization 8 and the arrangement consists of making provision for the 9 delivery of health care services, as distinguished from mere 10 indemnification. A "health care plan" also includes any 11 arrangement pursuant to Section 4-17. Nothing in this 12 definition, however, affects the total medical services 13 available to persons eligible for medical assistance under 14 the Illinois Public Aid Code. 15 (8) "Health care services" means any services included 16 in the furnishing to any individual of medical or dental 17 care, or the hospitalization or incident to the furnishing of 18 such care or hospitalization as well as the furnishing to any 19 person of any and all other services for the purpose of 20 preventing, alleviating, curing or healing human illness or 21 injury. 22 (9) "Health Maintenance Organization" means any 23 organization formed under the laws of this or another state 24 to provide or arrange for one or more health care plans under 25 a system which causes any part of the risk of health care 26 delivery to be borne by the organization or its providers. 27 (10) "Net worth" means admitted assets, as defined in 28 Section 1-3 of this Act, minus liabilities. 29 (11) "Organization" means any insurance company, a 30 nonprofit corporation authorized under the Dental Service 31 Plan Act or the Voluntary Health Services Plans Act, or a 32 corporation organized under the laws of this or another state 33 for the purpose of operating one or more health care plans 34 and doing no business other than that of a Health Maintenance SB873 Enrolled -16- LRB9201523DJgc 1 Organization or an insurance company. "Organization" shall 2 also mean the University of Illinois Hospital as defined in 3 the University of Illinois Hospital Act. 4 (12) "Provider" means any physician, hospital facility, 5 or other person which is licensed or otherwise authorized to 6 furnish health care services and also includes any other 7 entity that arranges for the delivery or furnishing of health 8 care service. 9 (13) "Producer" means a person directly or indirectly 10 associated with a health care plan who engages in 11 solicitation or enrollment. 12 (14) "Per capita prepaid" means a basis of prepayment by 13 which a fixed amount of money is prepaid per individual or 14 any other enrollment unit to the Health Maintenance 15 Organization or for health care services which are provided 16 during a definite time period regardless of the frequency or 17 extent of the services rendered by the Health Maintenance 18 Organization, except for copayments and deductibles and 19 except as provided in subsection (f) of Section 5-3 of this 20 Act. 21 (15) "Subscriber" means a person who has entered into a 22 contractual relationship with the Health Maintenance 23 Organization for the provision of or arrangement of at least 24 basic health care services to the beneficiaries of such 25 contract. 26 (Source: P.A. 89-90, eff. 6-30-95; 90-177, eff. 7-23-97; 27 90-372, eff. 7-1-98; 90-376, eff. 8-14-97; 90-655, eff. 28 7-30-98.) 29 (215 ILCS 125/2-1) (from Ch. 111 1/2, par. 1403) 30 Sec. 2-1. Certificate of authority - Exception for 31 corporate employee programs - Applications - Material 32 modification of operation. 33 (a) No organization shall establish or operate a Health SB873 Enrolled -17- LRB9201523DJgc 1 Maintenance Organization in this State without obtaining a 2 certificate of authority under this Act. No person other 3 than an organization may lawfully establish or operate a 4 Health Maintenance Organization in this State. This Act 5 shall not apply to the establishment and operation of a 6 Health Maintenance Organization exclusively providing or 7 arranging for health care services to employees of a 8 corporate affiliate of such Health Maintenance Organization. 9 This exclusion shall be available only to those Health 10 Maintenance Organizations which require employee 11 contributions which equal less than 50% of the total cost of 12 the health care plan, with the remainder of the cost being 13 paid by the corporate affiliate which is the employer of the 14 participants in the plan. This Act shall not apply to the 15 establishment and operation of a Health Maintenance 16 Organization exclusively providing or arranging health care 17 services under contract with the State to persons committed 18 to the custody of the Illinois Department of Corrections. 19This Act does not apply to the establishment and operation of20(i) a managed care community network providing or arranging21health care services under contract with the State22exclusively to persons who are enrolled in the integrated23health care program established under Section 5-16.3 of the24Illinois Public Aid Code or (ii) a managed care community25network owned, operated, or governed by a county provider as26defined in Section 15-1 of that Code.27 This Act does not apply to the establishment and 28 operation of managed care community networks that are 29 certified as risk-bearing entities under Section 5-11 of the 30 Illinois Public Aid Code and that contract with the Illinois 31 Department of Public Aid pursuant to that Section. 32 (b) Any organization may apply to the Director for and 33 obtain a certificate of authority to establish and operate a 34 Health Maintenance Organization in compliance with this Act. SB873 Enrolled -18- LRB9201523DJgc 1 A foreign corporation may qualify under this Act, subject to 2 its registration to do business in this State as a foreign 3 corporation. 4 (c) Each application for a certificate of authority 5 shall be filed in triplicate and verified by an officer or 6 authorized representative of the applicant, shall be in a 7 form prescribed by the Director, and shall set forth, without 8 limiting what may be required by the Director, the following: 9 (1) A copy of the organizational document; 10 (2) A copy of the bylaws, rules and regulations, or 11 similar document regulating the conduct of the internal 12 affairs of the applicant, which shall include a mechanism 13 to afford the enrollees an opportunity to participate in 14 an advisory capacity in matters of policy and operations; 15 (3) A list of the names, addresses, and official 16 positions of the persons who are to be responsible for 17 the conduct of the affairs of the applicant; including, 18 but not limited to, all members of the board of 19 directors, executive committee, the principal officers, 20 and any person or entity owning or having the right to 21 acquire 10% or more of the voting securities or 22 subordinated debt of the applicant; 23 (4) A statement generally describing the applicant, 24 geographic area to be served, its facilities, personnel 25 and the health care services to be offered; 26 (5) A copy of the form of any contract made or to 27 be made between the applicant and any providers regarding 28 the provision of health care services to enrollees; 29 (6) A copy of the form of any contract made or to 30 be made between the applicant and any person listed in 31 paragraph (3) of this subsection; 32 (7) A copy of the form of any contract made or to 33 be made between the applicant and any person, 34 corporation, partnership or other entity for the SB873 Enrolled -19- LRB9201523DJgc 1 performance on the applicant's behalf of any functions 2 including, but not limited to, marketing, administration, 3 enrollment, investment management and subcontracting for 4 the provision of health services to enrollees; 5 (8) A copy of the form of any group contract which 6 is to be issued to employers, unions, trustees, or other 7 organizations and a copy of any form of evidence of 8 coverage to be issued to any enrollee or subscriber and 9 any advertising material; 10 (9) Descriptions of the applicant's procedures for 11 resolving enrollee grievances which must include 12 procedures providing for enrollees participation in the 13 resolution of grievances; 14 (10) A copy of the applicant's most recent 15 financial statements audited by an independent certified 16 public accountant. If the financial affairs of the 17 applicant's parent company are audited by an independent 18 certified public accountant but those of the applicant 19 are not, then a copy of the most recent audited financial 20 statement of the applicant's parent, attached to which 21 shall be consolidating financial statements of the parent 22 including separate unaudited financial statements of the 23 applicant, unless the Director determines that additional 24 or more recent financial information is required for the 25 proper administration of this Act; 26 (11) A copy of the applicant's financial plan, 27 including a three-year projection of anticipated 28 operating results, a statement of the sources of working 29 capital, and any other sources of funding and provisions 30 for contingencies; 31 (12) A description of rate methodology; 32 (13) A description of the proposed method of 33 marketing; 34 (14) A copy of every filing made with the Illinois SB873 Enrolled -20- LRB9201523DJgc 1 Secretary of State which relates to the applicant's 2 registered agent or registered office; 3 (15) A description of the complaint procedures to 4 be established and maintained as required under Section 5 4-6 of this Act; 6 (16) A description, in accordance with regulations 7 promulgated by the Illinois Department of Public Health, 8 of the quality assessment and utilization review 9 procedures to be utilized by the applicant; 10 (17) The fee for filing an application for issuance 11 of a certificate of authority provided in Section 408 of 12 the Illinois Insurance Code, as now or hereafter amended; 13 and 14 (18) Such other information as the Director may 15 reasonably require to make the determinations required by 16 this Act. 17 (Source: P.A. 90-618, eff. 7-10-98.) 18 (215 ILCS 125/6-3) (from Ch. 111 1/2, par. 1418.3) 19 Sec. 6-3. Scope. This Article applies to direct 20 individual contracts, group contracts and certificates issued 21 thereunder, or any other evidence of coverage, each of which 22 provides for coverage under a health care plan, and has been 23 issued by organizations licensed to transact health 24 maintenance organization business in this State under the 25 Health Maintenance Organization Act, but not to any business 26 of such organization not transacted under its health 27 maintenance organization certificate of authority.This28Article does not apply to (i) a managed care community29network providing or arranging health care services under30contract with the State exclusively to persons who are31enrolled in the integrated health care program established32under Section 5-16.3 of the Illinois Public Aid Code or (ii)33a managed care community network owned, operated, or governedSB873 Enrolled -21- LRB9201523DJgc 1by a county provider as defined in Section 15-1 of that Code.2 (Source: P.A. 88-554, eff. 7-26-94.) 3 Section 25. The Health Care Worker Self-Referral Act is 4 amended by changing Section 20 as follows: 5 (225 ILCS 47/20) 6 Sec. 20. Prohibited referrals and claims for payment. 7 (a) A health care worker shall not refer a patient for 8 health services to an entity outside the health care worker's 9 office or group practice in which the health care worker is 10 an investor, unless the health care worker directly provides 11 health services within the entity and will be personally 12 involved with the provision of care to the referred patient. 13 (b) Pursuant to Board determination that the following 14 exception is applicable, a health care worker may invest in 15 and refer to an entity, whether or not the health care worker 16 provides direct services within said entity, if there is a 17 demonstrated need in the community for the entity and 18 alternative financing is not available. For purposes of this 19 subsection (b), "demonstrated need" in the community for the 20 entity may exist if (1) there is no facility of reasonable 21 quality that provides medically appropriate service, (2) use 22 of existing facilities is onerous or creates too great a 23 hardship for patients, (3) the entity is formed to own or 24 lease medical equipment which replaces obsolete or otherwise 25 inadequate equipment in or under the control of a hospital 26 located in a federally designated health manpower shortage 27 area, or (4) such other standards as established, by rule, by 28 the Board. "Community" shall be defined as a metropolitan 29 area for a city, and a county for a rural area. In addition, 30 the following provisions must be met to be exempt under this 31 Section: 32 (1) Individuals who are not in a position to refer SB873 Enrolled -22- LRB9201523DJgc 1 patients to an entity are given a bona fide opportunity 2 to also invest in the entity on the same terms as those 3 offered a referring health care worker; and 4 (2) No health care worker who invests shall be 5 required or encouraged to make referrals to the entity or 6 otherwise generate business as a condition of becoming or 7 remaining an investor; and 8 (3) The entity shall market or furnish its services 9 to referring health care worker investors and other 10 investors on equal terms; and 11 (4) The entity shall not loan funds or guarantee 12 any loans for health care workers who are in a position 13 to refer to an entity; and 14 (5) The income on the health care worker's 15 investment shall be tied to the health care worker's 16 equity in the facility rather than to the volume of 17 referrals made; and 18 (6) Any investment contract between the entity and 19 the health care worker shall not include any covenant or 20 non-competition clause that prevents a health care worker 21 from investing in other entities; and 22 (7) When making a referral, a health care worker 23 must disclose his investment interest in an entity to the 24 patient being referred to such entity. If alternative 25 facilities are reasonably available, the health care 26 worker must provide the patient with a list of 27 alternative facilities. The health care worker shall 28 inform the patient that they have the option to use an 29 alternative facility other than one in which the health 30 care worker has an investment interest and the patient 31 will not be treated differently by the health care worker 32 if the patient chooses to use another entity. This shall 33 be applicable to all health care worker investors, 34 including those who provide direct care or services for SB873 Enrolled -23- LRB9201523DJgc 1 their patients in entities outside their office 2 practices; and 3 (8) If a third party payor requests information 4 with regard to a health care worker's investment 5 interest, the same shall be disclosed; and 6 (9) The entity shall establish an internal 7 utilization review program to ensure that investing 8 health care workers provided appropriate or necessary 9 utilization; and 10 (10) If a health care worker's financial interest 11 in an entity is incompatible with a referred patient's 12 interest, the health care worker shall make alternative 13 arrangements for the patient's care. 14 The Board shall make such a determination for a health 15 care worker within 90 days of a completed written request. 16 Failure to make such a determination within the 90 day time 17 frame shall mean that no alternative is practical based upon 18 the facts set forth in the completed written request. 19 (c) It shall not be a violation of this Act for a health 20 care worker to refer a patient for health services to a 21 publicly traded entity in which he or she has an investment 22 interest provided that: 23 (1) the entity is listed for trading on the New 24 York Stock Exchange or on the American Stock Exchange, or 25 is a national market system security traded under an 26 automated inter-dealer quotation system operated by the 27 National Association of Securities Dealers; and 28 (2) the entity had, at the end of the corporation's 29 most recent fiscal year, total net assets of at least 30 $30,000,000 related to the furnishing of health services; 31 and 32 (3) any investment interest obtained after the 33 effective date of this Act is traded on the exchanges 34 listed in paragraph 1 of subsection (c) of this Section SB873 Enrolled -24- LRB9201523DJgc 1 after the entity became a publicly traded corporation; 2 and 3 (4) the entity markets or furnishes its services to 4 referring health care worker investors and other health 5 care workers on equal terms; and 6 (5) all stock held in such publicly traded 7 companies, including stock held in the predecessor 8 privately held company, shall be of one class without 9 preferential treatment as to status or remuneration; and 10 (6) the entity does not loan funds or guarantee any 11 loans for health care workers who are in a position to be 12 referred to an entity; and 13 (7) the income on the health care worker's 14 investment is tied to the health care worker's equity in 15 the entity rather than to the volume of referrals made; 16 and 17 (8) the investment interest does not exceed 1/2 of 18 1% of the entity's total equity. 19 (d) Any hospital licensed under the Hospital Licensing 20 Act shall not discriminate against or otherwise penalize a 21 health care worker for compliance with this Act. 22 (e) Any health care worker or other entity shall not 23 enter into an arrangement or scheme seeking to make referrals 24 to another health care worker or entity based upon the 25 condition that the health care worker or entity will make 26 referrals with an intent to evade the prohibitions of this 27 Act by inducing patient referrals which would be prohibited 28 by this Section if the health care worker or entity made the 29 referral directly. 30 (f) If compliance with the need and alternative investor 31 criteria is not practical, the health care worker shall 32 identify to the patient reasonably available alternative 33 facilities. The Board shall, by rule, designate when 34 compliance is "not practical". SB873 Enrolled -25- LRB9201523DJgc 1 (g) Health care workers may request from the Board that 2 it render an advisory opinion that a referral to an existing 3 or proposed entity under specified circumstances does or does 4 not violate the provisions of this Act. The Board's opinion 5 shall be presumptively correct. Failure to render such an 6 advisory opinion within 90 days of a completed written 7 request pursuant to this Section shall create a rebuttable 8 presumption that a referral described in the completed 9 written request is not or will not be a violation of this 10 Act. 11 (h) Notwithstanding any provision of this Act to the 12 contrary, a health care worker may refer a patient, who is a 13 member of a health maintenance organization "HMO" licensed in 14 this State, for health services to an entity, outside the 15 health care worker's office or group practice, in which the 16 health care worker is an investor, provided that any such 17 referral is made pursuant to a contract with the HMO. 18 Furthermore, notwithstanding any provision of this Act to the 19 contrary, a health care worker may refer an enrollee of a 20 "managed care community network", as defined in subsection 21 (b) of Section 5-115-16.3of the Illinois Public Aid Code, 22 for health services to an entity, outside the health care 23 worker's office or group practice, in which the health care 24 worker is an investor, provided that any such referral is 25 made pursuant to a contract with the managed care community 26 network. 27 (Source: P.A. 87-1207; 88-554, eff. 7-26-94.) 28 Section 30. The Illinois Public Aid Code is amended by 29 changing Sections 5-11, 5-16.9, 5-16.11, 15-2, 15-3, 15-4, 30 and 15-5 as follows: 31 (305 ILCS 5/5-11) (from Ch. 23, par. 5-11) 32 Sec. 5-11. Co-operative arrangements; contracts with SB873 Enrolled -26- LRB9201523DJgc 1 other State agencies, health care and rehabilitation 2 organizations, and fiscal intermediaries. 3 (a) The Illinois Department may enter into co-operative 4 arrangements with State agencies responsible for 5 administering or supervising the administration of health 6 services and vocational rehabilitation services to the end 7 that there may be maximum utilization of such services in the 8 provision of medical assistance. 9 The Illinois Department shall, not later than June 30, 10 1993, enter into one or more co-operative arrangements with 11 the Department of Mental Health and Developmental 12 Disabilities providing that the Department of Mental Health 13 and Developmental Disabilities will be responsible for 14 administering or supervising all programs for services to 15 persons in community care facilities for persons with 16 developmental disabilities, including but not limited to 17 intermediate care facilities, that are supported by State 18 funds or by funding under Title XIX of the federal Social 19 Security Act. The responsibilities of the Department of 20 Mental Health and Developmental Disabilities under these 21 agreements are transferred to the Department of Human 22 Services as provided in the Department of Human Services Act. 23 The Department may also contract with such State health 24 and rehabilitation agencies and other public or private 25 health care and rehabilitation organizations to act for it in 26 supplying designated medical services to persons eligible 27 therefor under this Article. Any contracts with health 28 services or health maintenance organizations shall be 29 restricted to organizations which have been certified as 30 being in compliance with standards promulgated pursuant to 31 the laws of this State governing the establishment and 32 operation of health services or health maintenance 33 organizations. The Department may also contract with 34 insurance companies or other corporate entities serving as SB873 Enrolled -27- LRB9201523DJgc 1 fiscal intermediaries in this State for the Federal 2 Government in respect to Medicare payments under Title XVIII 3 of the Federal Social Security Act to act for the Department 4 in paying medical care suppliers. The provisions of Section 5 9 of "An Act in relation to State finance", approved June 10, 6 1919, as amended, notwithstanding, such contracts with State 7 agencies, other health care and rehabilitation organizations, 8 or fiscal intermediaries may provide for advance payments. 9 (b) For purposes of this subsection (b), "managed care 10 community network" means an entity, other than a health 11 maintenance organization, that is owned, operated, or 12 governed by providers of health care services within this 13 State and that provides or arranges primary, secondary, and 14 tertiary managed health care services under contract with the 15 Illinois Department exclusively to persons participating in 16 programs administered by the Illinois Department. 17 The Illinois Department may certify managed care 18 community networks, including managed care community networks 19 owned, operated, managed, or governed by State-funded medical 20 schools, as risk-bearing entities eligible to contract with 21 the Illinois Department as Medicaid managed care 22 organizations. The Illinois Department may contract with 23 those managed care community networks to furnish health care 24 services to or arrange those services for individuals 25 participating in programs administered by the Illinois 26 Department. The rates for those provider-sponsored 27 organizations may be determined on a prepaid, capitated 28 basis. A managed care community network may choose to 29 contract with the Illinois Department to provide only 30 pediatric health care services. The Illinois Department shall 31 by rule adopt the criteria, standards, and procedures by 32 which a managed care community network may be permitted to 33 contract with the Illinois Department and shall consult with 34 the Department of Insurance in adopting these rules. SB873 Enrolled -28- LRB9201523DJgc 1 A county provider as defined in Section 15-1 of this Code 2 may contract with the Illinois Department to provide primary, 3 secondary, or tertiary managed health care services as a 4 managed care community network without the need to establish 5 a separate entity and shall be deemed a managed care 6 community network for purposes of this Code only to the 7 extent it provides services to participating individuals. A 8 county provider is entitled to contract with the Illinois 9 Department with respect to any contracting region located in 10 whole or in part within the county. A county provider is not 11 required to accept enrollees who do not reside within the 12 county. 13 In order to (i) accelerate and facilitate the development 14 of integrated health care in contracting areas outside 15 counties with populations in excess of 3,000,000 and counties 16 adjacent to those counties and (ii) maintain and sustain the 17 high quality of education and residency programs coordinated 18 and associated with local area hospitals, the Illinois 19 Department may develop and implement a demonstration program 20 from managed care community networks owned, operated, 21 managed, or governed by State-funded medical schools. The 22 Illinois Department shall prescribe by rule the criteria, 23 standards, and procedures for effecting this demonstration 24 program. 25 A managed care community network that contracts with the 26 Illinois Department to furnish health care services to or 27 arrange those services for enrollees participating in 28 programs administered by the Illinois Department shall do all 29 of the following: 30 (1) Provide that any provider affiliated with the 31 managed care community network may also provide services 32 on a fee-for-service basis to Illinois Department clients 33 not enrolled in such managed care entities. 34 (2) Provide client education services as determined SB873 Enrolled -29- LRB9201523DJgc 1 and approved by the Illinois Department, including but 2 not limited to (i) education regarding appropriate 3 utilization of health care services in a managed care 4 system, (ii) written disclosure of treatment policies and 5 restrictions or limitations on health services, 6 including, but not limited to, physical services, 7 clinical laboratory tests, hospital and surgical 8 procedures, prescription drugs and biologics, and 9 radiological examinations, and (iii) written notice that 10 the enrollee may receive from another provider those 11 covered services that are not provided by the managed 12 care community network. 13 (3) Provide that enrollees within the system may 14 choose the site for provision of services and the panel 15 of health care providers. 16 (4) Not discriminate in enrollment or disenrollment 17 practices among recipients of medical services or 18 enrollees based on health status. 19 (5) Provide a quality assurance and utilization 20 review program that meets the requirements established by 21 the Illinois Department in rules that incorporate those 22 standards set forth in the Health Maintenance 23 Organization Act. 24 (6) Issue a managed care community network 25 identification card to each enrollee upon enrollment. 26 The card must contain all of the following: 27 (A) The enrollee's health plan. 28 (B) The name and telephone number of the 29 enrollee's primary care physician or the site for 30 receiving primary care services. 31 (C) A telephone number to be used to confirm 32 eligibility for benefits and authorization for 33 services that is available 24 hours per day, 7 days 34 per week. SB873 Enrolled -30- LRB9201523DJgc 1 (7) Ensure that every primary care physician and 2 pharmacy in the managed care community network meets the 3 standards established by the Illinois Department for 4 accessibility and quality of care. The Illinois 5 Department shall arrange for and oversee an evaluation of 6 the standards established under this paragraph (7) and 7 may recommend any necessary changes to these standards. 8 (8) Provide a procedure for handling complaints 9 that meets the requirements established by the Illinois 10 Department in rules that incorporate those standards set 11 forth in the Health Maintenance Organization Act. 12 (9) Maintain, retain, and make available to the 13 Illinois Department records, data, and information, in a 14 uniform manner determined by the Illinois Department, 15 sufficient for the Illinois Department to monitor 16 utilization, accessibility, and quality of care. 17 (10) Provide that the pharmacy formulary used by 18 the managed care community network and its contract 19 providers be no more restrictive than the Illinois 20 Department's pharmaceutical program on the effective date 21 of this amendatory Act of 1998 and as amended after that 22 date. 23 The Illinois Department shall contract with an entity or 24 entities to provide external peer-based quality assurance 25 review for the managed health care programs administered by 26 the Illinois Department. The entity shall be representative 27 of Illinois physicians licensed to practice medicine in all 28 its branches and have statewide geographic representation in 29 all specialities of medical care that are provided in managed 30 health care programs administered by the Illinois Department. 31 The entity may not be a third party payer and shall maintain 32 offices in locations around the State in order to provide 33 service and continuing medical education to physician 34 participants within those managed health care programs SB873 Enrolled -31- LRB9201523DJgc 1 administered by the Illinois Department. The review process 2 shall be developed and conducted by Illinois physicians 3 licensed to practice medicine in all its branches. In 4 consultation with the entity, the Illinois Department may 5 contract with other entities for professional peer-based 6 quality assurance review of individual categories of services 7 other than services provided, supervised, or coordinated by 8 physicians licensed to practice medicine in all its branches. 9 The Illinois Department shall establish, by rule, criteria to 10 avoid conflicts of interest in the conduct of quality 11 assurance activities consistent with professional peer-review 12 standards. All quality assurance activities shall be 13 coordinated by the Illinois Department. 14 Each managed care community network must demonstrate its 15 ability to bear the financial risk of serving individuals 16 under this program. The Illinois Department shall by rule 17 adopt standards for assessing the solvency and financial 18 soundness of each managed care community network. Any 19 solvency and financial standards adopted for managed care 20 community networks shall be no more restrictive than the 21 solvency and financial standards adopted under Section 22 1856(a) of the Social Security Act for provider-sponsored 23 organizations under Part C of Title XVIII of the Social 24 Security Act. 25 The Illinois Department may implement the amendatory 26 changes to this Code made by this amendatory Act of 1998 27 through the use of emergency rules in accordance with Section 28 5-45 of the Illinois Administrative Procedure Act. For 29 purposes of that Act, the adoption of rules to implement 30 these changes is deemed an emergency and necessary for the 31 public interest, safety, and welfare. 32 (c) Not later than June 30, 1996, the Illinois 33 Department shall enter into one or more cooperative 34 arrangements with the Department of Public Health for the SB873 Enrolled -32- LRB9201523DJgc 1 purpose of developing a single survey for nursing facilities, 2 including but not limited to facilities funded under Title 3 XVIII or Title XIX of the federal Social Security Act or 4 both, which shall be administered and conducted solely by the 5 Department of Public Health. The Departments shall test the 6 single survey process on a pilot basis, with both the 7 Departments of Public Aid and Public Health represented on 8 the consolidated survey team. The pilot will sunset June 30, 9 1997. After June 30, 1997, unless otherwise determined by 10 the Governor, a single survey shall be implemented by the 11 Department of Public Health which would not preclude staff 12 from the Department of Public Aid from going on-site to 13 nursing facilities to perform necessary audits and reviews 14 which shall not replicate the single State agency survey 15 required by this Act. This Section shall not apply to 16 community or intermediate care facilities for persons with 17 developmental disabilities. 18 (d) Nothing in this Code in any way limits or otherwise 19 impairs the authority or power of the Illinois Department to 20 enter into a negotiated contract pursuant to this Section 21 with a managed care community network or a health maintenance 22 organization, as defined in the Health Maintenance 23 Organization Act, that provides for termination or nonrenewal 24 of the contract without cause, upon notice as provided in the 25 contract, and without a hearing. 26 (Source: P.A. 89-415, eff. 1-1-96; 89-507, eff. 7-1-97; 27 90-618, eff. 7-10-98.) 28 (305 ILCS 5/5-16.9) 29 Sec. 5-16.9. Woman's health care provider. The medical 30 assistance program is subject to the provisions of Section 31 356r of the Illinois Insurance Code. The Illinois Department 32 shall adopt rules to implement the requirements of Section 33 356r of the Illinois Insurance Code in the medical assistance SB873 Enrolled -33- LRB9201523DJgc 1 program including managed care componentsdefined in Section25-16.3. 3 (Source: P.A. 89-514, eff. 7-17-96.) 4 (305 ILCS 5/5-16.11) 5 Sec. 5-16.11. Uniform standards applied to managed care 6 entities. Any managed care entity providing services under 7 this Code shall use a pharmacy formulary that is no more 8 restrictive than the Illinois Department's pharmaceutical 9 programcomply with the criteria, standards, and procedures10imposed on managed care entities under paragraph (14) of11subsection (d) of Section 5-16.3 of this Code. 12 (Source: P.A. 90-538, eff. 12-1-97.) 13 (305 ILCS 5/15-2) (from Ch. 23, par. 15-2) 14 Sec. 15-2. County Provider Trust Fund. 15 (a) There is created in the State Treasury the County 16 Provider Trust Fund. Interest earned by the Fund shall be 17 credited to the Fund. The Fund shall not be used to replace 18 any funds appropriated to the Medicaid program by the General 19 Assembly. 20 (b) The Fund is created solely for the purposes of 21 receiving, investing, and distributing monies in accordance 22 with this Article XV. The Fund shall consist of: 23 (1) All monies collected or received by the 24 Illinois Department under Section 15-3 of this Code; 25 (2) All federal financial participation monies 26 received by the Illinois Department pursuant to Title XIX 27 of the Social Security Act, 42 U.S.C. 1396(b), 28 attributable to eligible expenditures made by the 29 Illinois Department pursuant to Section 15-5 of this 30 Code; 31 (3) All federal moneys received by the Illinois 32 Department pursuant to Title XXI of the Social Security SB873 Enrolled -34- LRB9201523DJgc 1 Act attributable to eligible expenditures made by the 2 Illinois Department pursuant to Section 15-5 of this 3 Code; and 4 (4) All other monies received by the Fund from any 5 source, including interest thereon. 6 (c) Disbursements from the Fund shall be by warrants 7 drawn by the State Comptroller upon receipt of vouchers duly 8 executed and certified by the Illinois Department and shall 9 be made only: 10 (1) For hospital inpatient care, hospital 11 outpatient care, care provided by other outpatient 12 facilities operated by a county, and disproportionate 13 share hospital payments made under Title XIX of the 14 Social Security Act and Article V of this Code as 15 required by Section 15-5 of this Code; 16 (1.5) For services provided by county providers 17 pursuant to Section 5-11or 5-16.3of this Code; 18 (2) For the reimbursement of administrative 19 expenses incurred by county providers on behalf of the 20 Illinois Department as permitted by Section 15-4 of this 21 Code; 22 (3) For the reimbursement of monies received by the 23 Fund through error or mistake; 24 (4) For the payment of administrative expenses 25 necessarily incurred by the Illinois Department or its 26 agent in performing the activities required by this 27 Article XV; 28 (5) For the payment of any amounts that are 29 reimbursable to the federal government, attributable 30 solely to the Fund, and required to be paid by State 31 warrant; and 32 (6) For hospital inpatient care, hospital 33 outpatient care, care provided by other outpatient 34 facilities operated by a county, and disproportionate SB873 Enrolled -35- LRB9201523DJgc 1 share hospital payments made under Title XXI of the 2 Social Security Act, pursuant to Section 15-5 of this 3 Code. 4 (Source: P.A. 90-618, eff. 7-10-98; 91-24, eff. 7-1-99.) 5 (305 ILCS 5/15-3) (from Ch. 23, par. 15-3) 6 Sec. 15-3. Intergovernmental Transfers. 7 (a) Each qualifying county shall make an annual 8 intergovernmental transfer to the Illinois Department in an 9 amount equal to 71.7% of the difference between the total 10 payments made by the Illinois Department to such county 11 provider for hospital services under Titles XIX and XXI of 12 the Social Security Act or pursuant to Section 5-11or 5-16.313 of this Code in each fiscal year ending June 30 (or fraction 14 thereof during the fiscal year ending June 30, 1993) and 15 $108,800,000 (or fraction thereof), except that the annual 16 intergovernmental transfer shall not exceed the total 17 payments made by the Illinois Department to such county 18 provider for hospital services under this Codeor pursuant to19Section 5-16.3 of this Code, less the sum of (i) 50% of 20 payments reimbursable under the Social Security Act at a rate 21 of 50% and (ii) 65% of payments reimbursable under the Social 22 Security Act at a rate of 65%, in each fiscal year ending 23 June 30 (or fraction thereof). 24 (b) The payment schedule for the intergovernmental 25 transfer made hereunder shall be established by 26 intergovernmental agreement between the Illinois Department 27 and the applicable county, which agreement shall at a minimum 28 provide: 29 (1) For periodic payments no less frequently than 30 monthly to the county provider for inpatient and 31 outpatient approved or adjudicated claims and for 32 disproportionate share payments under Section 5-5.02 of 33 this Code (in the initial year, for services after July SB873 Enrolled -36- LRB9201523DJgc 1 1, 1991, or such other date as an approved State Medical 2 Assistance Plan shall provide)and to the county provider3pursuant to Section 5-16.3 of this Code. 4 (2) For periodic payments no less frequently than 5 monthly to the county provider for supplemental 6 disproportionate share payments hereunder based on a 7 federally approved State Medical Assistance Plan. 8 (3) For calculation of the intergovernmental 9 transfer payment to be made by the county equal to 71.7% 10 of the difference between the amount of the periodic 11 payment and the base amount; provided, however, that if 12 the periodic payment for any period is less than the base 13 amount for such period, the base amount for the 14 succeeding period (and any successive period if 15 necessary) shall be increased by the amount of such 16 shortfall. 17 (4) For an intergovernmental transfer methodology 18 which obligates the Illinois Department to notify the 19 county and county provider in writing of each impending 20 periodic payment and the intergovernmental transfer 21 payment attributable thereto and which obligates the 22 Comptroller to release the periodic payment to the county 23 provider within one working day of receipt of the 24 intergovernmental transfer payment from the county. 25 (Source: P.A. 90-618, eff. 7-10-98; 91-24, eff. 7-1-99.) 26 (305 ILCS 5/15-4) (from Ch. 23, par. 15-4) 27 Sec. 15-4. Contractual assumption of certain expenses. 28 Hospitals may, at their election, by written agreement 29 between the counties owning and operating the hospitals and 30 the Illinois Department, assume specified expenses of the 31 operation of the Illinois Department associated with the 32 determination of eligibility, direct payment of which 33 expenses by the Illinois Department would qualify as public SB873 Enrolled -37- LRB9201523DJgc 1 funds expended by the Illinois Department for the Illinois 2 Medical Assistance Program or other health care programs 3 administered by the Illinois Department. The Illinois 4 Department shall open an adequately staffed special on-site 5 office or offices at facilities designated by the county for 6 the purpose of assisting the county in ensuring that all 7 eligible individuals are enrolled in the Illinois Medical 8 Assistance Programand, to the extent that enrollment into9the integrated health care program established under Section105-16.3 of this Code is conducted at local public assistance11offices in the county, for the purpose of enrollment of12persons into any managed health care entity operated by the13county. The enrollment process shall meet the requirements14of subsection (e) of Section 5-16.3. Each such agreement, 15 executed in accordance with Section 3 of the 16 Intergovernmental Cooperation Act, shall describe the 17 operational expenses to be assumed in sufficient detail to 18 permit the Illinois Department to certify upon such written 19 obligation or performance thereunder that the hospital's 20 compliance with the terms of the agreement will amount to the 21 commitment of public funds eligible for the federal financial 22 participation or other federal funding called for in Title 23 XIX or Title XXI of the Social Security Act. 24 (Source: P.A. 91-24, eff. 7-1-99.) 25 (305 ILCS 5/15-5) (from Ch. 23, par. 15-5) 26 Sec. 15-5. Disbursements from the Fund. 27 (a) The monies in the Fund shall be disbursed only as 28 provided in Section 15-2 of this Code and as follows: 29 (1) To pay the county hospitals' inpatient 30 reimbursement rate based on actual costs, trended forward 31 annually by an inflation index and supplemented by 32 teaching, capital, and other direct and indirect costs, 33 according to a State plan approved by the federal SB873 Enrolled -38- LRB9201523DJgc 1 government. Effective October 1, 1992, the inpatient 2 reimbursement rate (including any disproportionate or 3 supplemental disproportionate share payments) for 4 hospital services provided by county operated facilities 5 within the County shall be no less than the reimbursement 6 rates in effect on June 1, 1992, except that this minimum 7 shall be adjusted as of July 1, 1992 and each July 1 8 thereafter by the annual percentage change in the per 9 diem cost of inpatient hospital services as reported in 10 the most recent annual Medicaid cost report. 11 (2) To pay county hospitals and county operated 12 outpatient facilities for outpatient services based on a 13 federally approved methodology to cover the maximum 14 allowable costs per patient visit. Effective October 1, 15 1992, the outpatient reimbursement rate for outpatient 16 services provided by county hospitals and county operated 17 outpatient facilities shall be no less than the 18 reimbursement rates in effect on June 1, 1992, except 19 that this minimum shall be adjusted as of July 1, 1992 20 and each July 1 thereafter by the annual percentage 21 change in the per diem cost of inpatient hospital 22 services as reported in the most recent annual Medicaid 23 cost report. 24 (3) To pay the county hospitals' disproportionate 25 share payments as established by the Illinois Department 26 under Section 5-5.02 of this Code. Effective October 1, 27 1992, the disproportionate share payments for hospital 28 services provided by county operated facilities within 29 the County shall be no less than the reimbursement rates 30 in effect on June 1, 1992, except that this minimum shall 31 be adjusted as of July 1, 1992 and each July 1 thereafter 32 by the annual percentage change in the per diem cost of 33 inpatient hospital services as reported in the most 34 recent annual Medicaid cost report. SB873 Enrolled -39- LRB9201523DJgc 1 (3.5) To pay county providers for services provided 2 pursuant to Section 5-11or 5-16.3of this Code. 3 (4) To reimburse the county providers for expenses 4 contractually assumed pursuant to Section 15-4 of this 5 Code. 6 (5) To pay the Illinois Department its necessary 7 administrative expenses relative to the Fund and other 8 amounts agreed to, if any, by the county providers in the 9 agreement provided for in subsection (c). 10 (6) To pay the county hospitals' supplemental 11 disproportionate share payments, hereby authorized, as 12 specified in the agreement provided for in subsection (c) 13 and according to a federally approved State plan. 14 Effective October 1, 1992, the supplemental 15 disproportionate share payments for hospital services 16 provided by county operated facilities within the County 17 shall be no less than the reimbursement rates in effect 18 on June 1, 1992, except that this minimum shall be 19 adjusted as of July 1, 1992 and each July 1 thereafter by 20 the annual percentage change in the per diem cost of 21 inpatient hospital services as reported in the most 22 recent annual Medicaid cost report. 23 (b) The Illinois Department shall promptly seek all 24 appropriate amendments to the Illinois State Plan to effect 25 the foregoing payment methodology. 26 (c) The Illinois Department shall implement the changes 27 made by Article 3 of this amendatory Act of 1992 beginning 28 October 1, 1992. All terms and conditions of the 29 disbursement of monies from the Fund not set forth expressly 30 in this Article shall be set forth in the agreement executed 31 under the Intergovernmental Cooperation Act so long as those 32 terms and conditions are not inconsistent with this Article 33 or applicable federal law. The Illinois Department shall 34 report in writing to the Hospital Service Procurement SB873 Enrolled -40- LRB9201523DJgc 1 Advisory Board and the Health Care Cost Containment Council 2 by October 15, 1992, the terms and conditions of all such 3 initial agreements and, where no such initial agreement has 4 yet been executed with a qualifying county, the Illinois 5 Department's reasons that each such initial agreement has not 6 been executed. Copies and reports of amended agreements 7 following the initial agreements shall likewise be filed by 8 the Illinois Department with the Hospital Service Procurement 9 Advisory Board and the Health Care Cost Containment Council 10 within 30 days following their execution. The foregoing 11 filing obligations of the Illinois Department are 12 informational only, to allow the Board and Council, 13 respectively, to better perform their public roles, except 14 that the Board or Council may, at its discretion, advise the 15 Illinois Department in the case of the failure of the 16 Illinois Department to reach agreement with any qualifying 17 county by the required date. 18 (d) The payments provided for herein are intended to 19 cover services rendered on and after July 1, 1991, and any 20 agreement executed between a qualifying county and the 21 Illinois Department pursuant to this Section may relate back 22 to that date, provided the Illinois Department obtains 23 federal approval. Any changes in payment rates resulting 24 from the provisions of Article 3 of this amendatory Act of 25 1992 are intended to apply to services rendered on or after 26 October 1, 1992, and any agreement executed between a 27 qualifying county and the Illinois Department pursuant to 28 this Section may be effective as of that date. 29 (e) If one or more hospitals file suit in any court 30 challenging any part of this Article XV, payments to 31 hospitals from the Fund under this Article XV shall be made 32 only to the extent that sufficient monies are available in 33 the Fund and only to the extent that any monies in the Fund 34 are not prohibited from disbursement and may be disbursed SB873 Enrolled -41- LRB9201523DJgc 1 under any order of the court. 2 (f) All payments under this Section are contingent upon 3 federal approval of changes to the State plan, if that 4 approval is required. 5 (Source: P.A. 90-618, eff. 7-10-98.) 6 (305 ILCS 5/5-16.3 rep.) 7 Section 31. The Illinois Public Aid Code is amended by 8 repealing Section 5-16.3. 9 Section 99. Effective date. This Act takes effect upon 10 becoming law.