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92_SB0885eng SB885 Engrossed LRB9202681JSpc 1 AN ACT concerning children's health care. 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Program Act 5 is amended by changing Sections 25 and 40 as follows: 6 (215 ILCS 106/25) 7 (Section scheduled to be repealed on July 1, 2002) 8 Sec. 25. Health benefits for children. 9 (a) The Department shall, subject to appropriation, 10 provide health benefits coverage to eligible children by: 11 (1) Subsidizing the cost of privately sponsored 12 health insurance, including employer based health 13 insurance, to assist families to take advantage of 14 available privately sponsored health insurance for their 15 eligible children; and 16 (2) Purchasing or providing health care benefits 17 for eligible children. The health benefits provided 18 under this subdivision (a)(2) shall, subject to 19 appropriation and without regard to any applicable cost 20 sharing under Section 30, be identical to the benefits 21 provided for children under the State's approved plan 22 under Title XIX of the Social Security Act. Providers 23 under this subdivision (a)(2) shall be subject to 24 approval by the Department to provide health care under 25 the Illinois Public Aid Code and shall be reimbursed at 26 the same rate as providers under the State's approved 27 plan under Title XIX of the Social Security Act. In 28 addition, providers may retain co-payments when 29 determined appropriate by the Department. 30 (b) The subsidization provided pursuant to subdivision 31 (a)(1) shall be credited to the family of the eligible child. SB885 Engrossed -2- LRB9202681JSpc 1 The Department shall make the subsidization pursuant to 2 subdivision (a)(1) available to children whose annual 3 household income is at or below 133% of the federal poverty 4 level. 5 (c) The Department is prohibited from denying coverage 6 to a child who is enrolled in a privately sponsored health 7 insurance plan pursuant to subdivision (a)(1) because the 8 plan does not meet federal benchmarking standards or cost 9 sharing and contribution requirements. To be eligible for 10 inclusion in the Program, the plan shall contain 11 comprehensive major medical coverage which shall consist of 12 physician and hospital inpatient services. The Department is 13 prohibited from denying coverage to a child who is enrolled 14 in a privately sponsored health insurance plan pursuant to 15 subdivision (a)(1) because the plan offers benefits in 16 addition to physician and hospital inpatient services. 17 (d) The total dollar amount of subsidizing coverage per 18 child per month pursuant to subdivision (a)(1) shall be equal 19 to the average dollar payments, less premiums incurred, per 20 child per month pursuant to subdivision (a)(2). The 21 Department shall set this amount prospectively based upon the 22 prior fiscal year's experience adjusted for incurred but not 23 reported claims and estimated increases or decreases in the 24 cost of medical care. Payments obligated before July 1, 25 1999, will be computed using State Fiscal Year 1996 payments 26 for children eligible for Medical Assistance and income 27 assistance under the Aid to Families with Dependent Children 28 Program, with appropriate adjustments for cost and 29 utilization changes through January 1, 1999. The Department 30 is prohibited from providing a subsidy pursuant to 31 subdivision (a)(1) that is more than the individual's monthly 32 portion of the premium. 33 (e) An eligible child may obtain immediate coverage 34 under this Program only once during a medical visit. If SB885 Engrossed -3- LRB9202681JSpc 1 coverage lapses, re-enrollment shall be completed in advance 2 of the next covered medical visit and the first month's 3 required premium shall be paid in advance of any covered 4 medical visit. 5 (f) In order to accelerate and facilitate the 6 development of networks to deliver services to children in 7 areas outside counties with populations in excess of 8 3,000,000, in the event less than 25% of the eligible 9 children in a county or contiguous counties has enrolled with 10 a Health Maintenance Organization pursuant to Section 5-11 of 11 the Illinois Public Aid Code, the Department may develop and 12 implement demonstration projects to create alternative 13 networks designed to enhance enrollment and participation in 14 the program. The Department shall prescribe by rule the 15 criteria, standards, and procedures for effecting 16 demonstration projects under this Section. 17 (Source: P.A. 90-736, eff. 8-12-98.) 18 (215 ILCS 106/40) 19 (Section scheduled to be repealed on July 1, 2002) 20 Sec. 40. Waivers. 21 (a) The Department shall request any necessary waivers 22 of federal requirements in order to allow receipt of federal 23 funding for: 24 (1) the coverage of families with eligible children 25 under this Act;and26 (2)forthe coverage of children who would 27 otherwise be eligible under this Act, but who have health 28 insurance; and.29 (3) the coverage of children that are eligible 30 under subsection (b) of Section 25. 31 (b) The failure of the responsible federal agency to 32 approve a waiver for children who would otherwise be eligible 33 under this Act but who have health insurance shall not SB885 Engrossed -4- LRB9202681JSpc 1 prevent the implementation of any Section of this Act 2 provided that there are sufficient appropriated funds. 3 (Source: P.A. 90-736, eff. 8-12-98.) 4 Section 99. Effective date. This Act takes effect upon 5 becoming law.