Public Act 095-0650
Public Act 0650 95TH GENERAL ASSEMBLY
|Public Act 095-0650
||LRB095 09974 MJR 30187 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
The Covering ALL KIDS Health Insurance Act is
amended by changing Section 50 and by adding Sections 47, 52,
and 53 as follows:
(215 ILCS 170/47 new)
The Department shall report
to the General Assembly no later than September 1 of each year
beginning in 2007, all of the following information:
(a) The number of professionals serving in the primary care
case management program, by licensed profession and by county,
and, for counties with a population of 100,000 or greater, by
geo zip code.
(b) The number of non-primary care providers accepting
referrals, by specialty designation, by licensed profession
and by county, and, for counties with a population of 100,000
or greater, by geo zip code.
(c) The number of individuals enrolled in the Covering ALL
KIDS Health Insurance Program by income or premium level and by
county, and, for counties with a population of 100,000 or
greater, by geo zip code.
(215 ILCS 170/50)
(Section scheduled to be repealed on July 1, 2011)
Consultation with stakeholders.
shall present details regarding implementation of the Program
to the Medicaid Advisory Committee, and the Committee shall
serve as the forum for healthcare providers, advocates,
consumers, and other interested parties to advise the
Department with respect to the Program.
The Department shall
consult with stakeholders on the rules for healthcare
professional participation in the Program pursuant to Sections
52 and 53 of this Act.
(Source: P.A. 94-693, eff. 7-1-06
(215 ILCS 170/52 new)
Adequate access to specialty care.
(a) The Department shall ensure adequate access to
specialty physician care for Program participants by allowing
referrals to be accomplished without undue delay.
(b) The Department shall allow a primary care provider to
make appropriate referrals to specialist physicians or other
healthcare providers for an enrollee who has a condition that
requires care from a specialist physician or other healthcare
provider. The Department may specify the necessary criteria and
conditions that must be met in order for an enrollee to obtain
a standing referral. A referral shall be effective for the
period necessary to provide the referred services or one year,
whichever is less. A primary care provider may renew and
re-renew a referral.
(c) The enrollee's primary care provider shall remain
responsible for coordinating the care of an enrollee who has
received a standing referral to a specialist physician or other
healthcare provider. If a secondary referral is necessary, the
specialist physician or other healthcare provider shall advise
the primary care physician. The primary care physician or
specialist physician shall be responsible for making the
secondary referral. In addition, the Department shall require
the specialist physician or other healthcare provider to
provide regular updates to the enrollee's primary care
(215 ILCS 170/53 new)
(a) Any disease management program implemented by the
Department must be or must have been developed in consultation
with physician organizations, such as State, national, and
specialty medical societies, and any available standards or
guidelines of these organizations. These programs must be based
on evidence-based, scientifically sound principles that are
accepted by the medical community. An enrollee must be excused
from participation in a disease management program if the
enrollee's physician licensed to practice medicine in all its
branches, in his or her professional judgment, determines that
participation is not beneficial to the enrollee.
(b) Any performance measures, such as primary care provider
monitoring, implemented by the Department must be or must have
been developed on consultation with physician organizations,
such as State, national, and specialty medical societies, and
any available standards or guidelines of these organizations.
These measures must be based on evidence-based, scientifically
sound principles that are accepted by the medical community.
(c) The Department shall adopt variance procedures for the
application of any disease management program or any
performance measures to an individual enrollee.
Effective Date: 6/1/2008