Bill Text: IL SB1379 | 2017-2018 | 100th General Assembly | Introduced


Bill Title: Amends the Children's Health Insurance Program Act. In a provision concerning care coordination, provides that mandatory assignments into managed care organizations must not occur when 50% of persons eligible for selecting a managed care service are covered through an integrated care program until the Department of Healthcare and Family Services demonstrates that the net per-recipient cost paid by non-federal, State revenue sources in those contracts, adjusted for age and gender, is less than the non-federal, net State per-recipient cost in fee-for-service for fiscal year 2014 and the health outcome goals required in contracts have been achieved. Requires that all per-recipient cost calculations be performed between like eligibility categories. Excludes Hospital Assessment Program payments from these calculations. Requires the Department to annually calculate and publish on its website a report on the per-recipient cost calculations and certain other information.

Spectrum: Slight Partisan Bill (Republican 2-1)

Status: (Introduced) 2017-05-05 - Rule 3-9(a) / Re-referred to Assignments [SB1379 Detail]

Download: Illinois-2017-SB1379-Introduced.html


100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
SB1379

Introduced 2/9/2017, by Sen. David Koehler - Kyle McCarter

SYNOPSIS AS INTRODUCED:
215 ILCS 106/23

Amends the Children's Health Insurance Program Act. In a provision concerning care coordination, provides that mandatory assignments into managed care organizations must not occur when 50% of persons eligible for selecting a managed care service are covered through an integrated care program until the Department of Healthcare and Family Services demonstrates that the net per-recipient cost paid by non-federal, State revenue sources in those contracts, adjusted for age and gender, is less than the non-federal, net State per-recipient cost in fee-for-service for fiscal year 2014 and the health outcome goals required in contracts have been achieved. Requires that all per-recipient cost calculations be performed between like eligibility categories. Excludes Hospital Assessment Program payments from these calculations. Requires the Department to annually calculate and publish on its website a report on the per-recipient cost calculations and certain other information.
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A BILL FOR

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1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The Children's Health Insurance Program Act is
5amended by changing Section 23 as follows:
6 (215 ILCS 106/23)
7 Sec. 23. Care coordination.
8 (a) At least 50% of recipients eligible for comprehensive
9medical benefits in all medical assistance programs or other
10health benefit programs administered by the Department,
11including the Children's Health Insurance Program Act and the
12Covering ALL KIDS Health Insurance Act, shall be enrolled in a
13care coordination program by no later than January 1, 2015.
14However, mandatory assignments into managed care organizations
15must not occur when 50% of persons eligible for selecting a
16managed care service are covered through an integrated care
17program until the Department demonstrates that the net
18per-recipient cost paid by non-federal, State revenue sources
19in those contracts, adjusted for age and gender, is less than
20the non-federal, net State per-recipient cost in
21fee-for-service for fiscal year 2014 and the health outcome
22goals required in those contracts have been achieved. All
23per-recipient cost calculations shall be performed between

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1like eligibility categories. Hospital Assessment Program
2payments are excluded from these calculations. The Department
3shall annually calculate and publish the results on the
4Department's website. The report shall include the details of
5the data included, data excluded, any adjustments made, and
6detailed justifications for such adjustments. For purposes of
7this Section, "coordinated care" or "care coordination" means
8delivery systems where recipients will receive their care from
9providers who participate under contract in integrated
10delivery systems that are responsible for providing or
11arranging the majority of care, including primary care
12physician services, referrals from primary care physicians,
13diagnostic and treatment services, behavioral health services,
14in-patient and outpatient hospital services, dental services,
15and rehabilitation and long-term care services. The Department
16shall designate or contract for such integrated delivery
17systems (i) to ensure enrollees have a choice of systems and of
18primary care providers within such systems; (ii) to ensure that
19enrollees receive quality care in a culturally and
20linguistically appropriate manner; and (iii) to ensure that
21coordinated care programs meet the diverse needs of enrollees
22with developmental, mental health, physical, and age-related
23disabilities.
24 (b) Payment for such coordinated care shall be based on
25arrangements where the State pays for performance related to
26health care outcomes, the use of evidence-based practices, the

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1use of primary care delivered through comprehensive medical
2homes, the use of electronic medical records, and the
3appropriate exchange of health information electronically made
4either on a capitated basis in which a fixed monthly premium
5per recipient is paid and full financial risk is assumed for
6the delivery of services, or through other risk-based payment
7arrangements.
8 (c) To qualify for compliance with this Section, the 50%
9goal shall be achieved by enrolling medical assistance
10enrollees from each medical assistance enrollment category,
11including parents, children, seniors, and people with
12disabilities to the extent that current State Medicaid payment
13laws would not limit federal matching funds for recipients in
14care coordination programs. In addition, services must be more
15comprehensively defined and more risk shall be assumed than in
16the Department's primary care case management program as of the
17effective date of this amendatory Act of the 96th General
18Assembly.
19 (d) The Department shall report to the General Assembly in
20a separate part of its annual medical assistance program
21report, beginning April, 2012 until April, 2016, on the
22progress and implementation of the care coordination program
23initiatives established by the provisions of this amendatory
24Act of the 96th General Assembly. The Department shall include
25in its April 2011 report a full analysis of federal laws or
26regulations regarding upper payment limitations to providers

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1and the necessary revisions or adjustments in rate
2methodologies and payments to providers under this Code that
3would be necessary to implement coordinated care with full
4financial risk by a party other than the Department.
5(Source: P.A. 96-1501, eff. 1-25-11.)
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