Bill Text: IL HB5485 | 2011-2012 | 97th General Assembly | Engrossed
Bill Title: Amends the Illinois Public Aid Code. Provides that any entity that contracts with the Department of Healthcare and Family Services, its subsequent agency, or the State to provide managed care to individuals enrolled as clients, beneficiaries, or recipients, who receive medical benefits under the Illinois medical assistance program, must be National Committee for Quality Assurance (NCQA) accredited within 3 years after beginning to provide services under the Illinois medical assistance program, and any such entities engaged in providing managed care or coordinated care under the Illinois medical assistance program on the effective date of this amendatory Act must be NCQA accredited by January 1, 2015.
Spectrum: Slight Partisan Bill (Republican 4-2)
Status: (Failed) 2013-01-08 - Session Sine Die [HB5485 Detail]
Download: Illinois-2011-HB5485-Engrossed.html
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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 5-30 as follows:
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6 | (305 ILCS 5/5-30) | ||||||
7 | Sec. 5-30. Care coordination. | ||||||
8 | (a) At least 50% of recipients eligible for comprehensive | ||||||
9 | medical benefits in all medical assistance programs or other | ||||||
10 | health benefit programs administered by the Department, | ||||||
11 | including the Children's Health Insurance Program Act and the | ||||||
12 | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | ||||||
13 | care coordination program by no later than January 1, 2015. For | ||||||
14 | purposes of this Section, "coordinated care" or "care | ||||||
15 | coordination" means delivery systems where recipients will | ||||||
16 | receive their care from providers who participate under | ||||||
17 | contract in integrated delivery systems that are responsible | ||||||
18 | for providing or arranging the majority of care, including | ||||||
19 | primary care physician services, referrals from primary care | ||||||
20 | physicians, diagnostic and treatment services, behavioral | ||||||
21 | health services, in-patient and outpatient hospital services, | ||||||
22 | dental services, and rehabilitation and long-term care | ||||||
23 | services. The Department shall designate or contract for such |
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1 | integrated delivery systems (i) to ensure enrollees have a | ||||||
2 | choice of systems and of primary care providers within such | ||||||
3 | systems; (ii) to ensure that enrollees receive quality care in | ||||||
4 | a culturally and linguistically appropriate manner; and (iii) | ||||||
5 | to ensure that coordinated care programs meet the diverse needs | ||||||
6 | of enrollees with developmental, mental health, physical, and | ||||||
7 | age-related disabilities. | ||||||
8 | (b) Payment for such coordinated care shall be based on | ||||||
9 | arrangements where the State pays for performance related to | ||||||
10 | health care outcomes, the use of evidence-based practices, the | ||||||
11 | use of primary care delivered through comprehensive medical | ||||||
12 | homes, the use of electronic medical records, and the | ||||||
13 | appropriate exchange of health information electronically made | ||||||
14 | either on a capitated basis in which a fixed monthly premium | ||||||
15 | per recipient is paid and full financial risk is assumed for | ||||||
16 | the delivery of services, or through other risk-based payment | ||||||
17 | arrangements. | ||||||
18 | (b-5) Any health insurance company that contracts with the | ||||||
19 | Department, its subsequent agency, or the State to provide | ||||||
20 | managed care to individuals enrolled as clients, | ||||||
21 | beneficiaries, or recipients, who receive medical benefits | ||||||
22 | under the Illinois medical assistance program, must be National | ||||||
23 | Committee for Quality Assurance (NCQA) accredited within 3 | ||||||
24 | years after beginning to provide services under the Illinois | ||||||
25 | medical assistance program, and any such health insurance | ||||||
26 | companies engaged in providing managed care or coordinated care |
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1 | under the Illinois medical assistance program on the effective | ||||||
2 | date of this amendatory Act of the 97th General Assembly must | ||||||
3 | be NCQA accredited by January 1, 2015. | ||||||
4 | (c) To qualify for compliance with this Section, the 50% | ||||||
5 | goal shall be achieved by enrolling medical assistance | ||||||
6 | enrollees from each medical assistance enrollment category, | ||||||
7 | including parents, children, seniors, and people with | ||||||
8 | disabilities to the extent that current State Medicaid payment | ||||||
9 | laws would not limit federal matching funds for recipients in | ||||||
10 | care coordination programs. In addition, services must be more | ||||||
11 | comprehensively defined and more risk shall be assumed than in | ||||||
12 | the Department's primary care case management program as of the | ||||||
13 | effective date of this amendatory Act of the 96th General | ||||||
14 | Assembly. | ||||||
15 | (d) The Department shall report to the General Assembly in | ||||||
16 | a separate part of its annual medical assistance program | ||||||
17 | report, beginning April, 2012 until April, 2016, on the | ||||||
18 | progress and implementation of the care coordination program | ||||||
19 | initiatives established by the provisions of this amendatory | ||||||
20 | Act of the 96th General Assembly. The Department shall include | ||||||
21 | in its April 2011 report a full analysis of federal laws or | ||||||
22 | regulations regarding upper payment limitations to providers | ||||||
23 | and the necessary revisions or adjustments in rate | ||||||
24 | methodologies and payments to providers under this Code that | ||||||
25 | would be necessary to implement coordinated care with full | ||||||
26 | financial risk by a party other than the Department.
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1 | (Source: P.A. 96-1501, eff. 1-25-11.)
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