Bill Text: IL HB3285 | 2015-2016 | 99th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. In a provision concerning certain requirements care coordination services must conform to when such services are provided to enrollees participating in the Medicare-Medicaid Alignment Initiative Demonstration Project, adds the requirement that all rights guaranteed an enrollee under federal and State law be protected, including the right of an enrollee to select his or her own physician. In a provision concerning continuity of care for nursing home residents transitioning to a managed care organization, provides that the managed care organization shall, within 24 hours of receiving a request, change an enrollee's primary care provider and notify the enrollee in writing. Provides that if the enrollee states that a medical emergency exists, the managed care organization shall make the necessary changes immediately and notify by phone all involved parties followed by a written confirmation. Effective immediately.

Sponsorship: Slight Partisan Bill (Democrat 5-3)

Status: (Introduced - Dead) 2015-03-27 - Rule 19(a) / Re-referred to Rules Committee [HB3285 Detail]

Download: Illinois-2015-HB3285-Introduced.html

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99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 HB3285 Introduced , by Rep. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
305 ILCS 5/5F-25
305 ILCS 5/5F-30
Amends the Illinois Public Aid Code. In a provision concerning certain requirements care coordination services must conform to when such services are provided to enrollees participating in the Medicare-Medicaid Alignment Initiative Demonstration Project, adds the requirement that all rights guaranteed an enrollee under federal and State law be protected, including the right of an enrollee to select his or her own physician. In a provision concerning continuity of care for nursing home residents transitioning to a managed care organization, provides that the managed care organization shall, within 24 hours of receiving a request, change an enrollee's primary care provider and notify the enrollee in writing. Provides that if the enrollee states that a medical emergency exists, the managed care organization shall make the necessary changes immediately and notify by phone all involved parties followed by a written confirmation. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
HB3285 LRB099 10146 KTG 30369 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Sections 5F-25 and 5F-30 as follows:
(305 ILCS 5/5F-25)
Sec. 5F-25. Care coordination. Care coordination provided
to all enrollees in the Demonstration Project shall conform to
the following requirements:
(1) care coordination services shall be
enrollee-driven and person-centered;
(2) all enrollees in the Demonstration Project shall
have the right to receive health care services in the care
setting of their choice, except as permitted by Part 4 of
Article III of the Nursing Home Care Act with respect to
involuntary transfers and discharges; and
(3) decisions shall be based on the enrollee's best
interests; and .
(4) all rights guaranteed an enrollee under federal and
State law shall be protected, including the right of an
enrollee to select his or her own physician.
(Source: P.A. 98-651, eff. 6-16-14.)

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(305 ILCS 5/5F-30)
Sec. 5F-30. Continuity of care. When a nursing home
resident first transitions to a managed care organization from
the fee-for-service system or from another managed care
organization, the managed care organization shall honor the
existing care plan and any necessary changes to that care plan
until the MCO has completed a comprehensive assessment and new
care plan, to the extent such services are covered benefits
under the contract, which shall be consistent with the
requirements of the RAI Manual.
When an enrollee of a managed care organization is moving
from a community setting to a nursing home, and the MCO is
properly notified of the proposed admission by a network
nursing home, and the managed care organization fails to
participate in developing a care plan within the time frames
required by nursing home regulations, the MCO must honor a care
plan developed by the nursing home until the MCO has completed
a comprehensive assessment and a new care plan to the extent
such services are covered benefits under the contract,
consistent with the requirements of the RAI Manual.
A managed care organization shall, within 24 hours of
receiving a request, change an enrollee's primary care provider
and notify the enrollee in writing. If the enrollee states that
a medical emergency exists, the managed care organization shall
make the necessary changes immediately and notify by phone all
involved parties followed by a written confirmation.

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A nursing home shall have the ability to refuse admission
of an enrollee for whom care is required that the nursing home
determines is outside the scope of its license and healthcare
capabilities.
(Source: P.A. 98-651, eff. 6-16-14.)
Section 99. Effective date. This Act takes effect upon
becoming law.