Bill Text: IL SB1515 | 2009-2010 | 96th General Assembly | Introduced

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Bill Title: Amends the Covering ALL KIDS Health Insurance Act and the Illinois Public Aid Code. Provides that beginning January 1, 2010, the physician fee schedule for the Covering ALL KIDS Health Insurance Program and for pediatric physician specialists under the medical assistance program must increase to become competitive with those of non-governmental, third-party health insurance programs. Provides that by January 1, 2012, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Provides that the Department shall annually increase pediatric specialty physician payments under the provisions of the Act by an amount approximately equal to one-third of the difference between the actual rates available for such purposes on January 1, 2009 and the Medicare reimbursement rates effective on January 1, 2007. Makes other changes.

Spectrum: Moderate Partisan Bill (Democrat 8-2)

Status: (Introduced - Dead) 2009-04-08 - Added as Co-Sponsor Sen. Pamela J. Althoff [SB1515 Detail]

Download: Illinois-2009-SB1515-Introduced.html

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96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 SB1515 Introduced 2/18/2009, by Sen. Heather Steans SYNOPSIS AS INTRODUCED:
215 ILCS 170/52.5 new
305 ILCS 5/5-5.06 new
Amends the Covering ALL KIDS Health Insurance Act and the Illinois Public Aid Code. Provides that beginning January 1, 2010, the physician fee schedule for the Covering ALL KIDS Health Insurance Program and for pediatric physician specialists under the medical assistance program must increase to become competitive with those of non-governmental, third-party health insurance programs. Provides that by January 1, 2012, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Provides that the Department shall annually increase pediatric specialty physician payments under the provisions of the Act by an amount approximately equal to one-third of the difference between the actual rates available for such purposes on January 1, 2009 and the Medicare reimbursement rates effective on January 1, 2007. Makes other changes.
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A BILL FOR
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AN ACT concerning insurance.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Covering ALL KIDS Health Insurance Act is
amended by adding Section 52.5 as follows:
(215 ILCS 170/52.5 new)
Sec. 52.5. Specialty physician care; fee schedule.
(a) Beginning January 1, 2010, the physician fee schedule
for the Covering ALL KIDS Insurance Program must increase to
become competitive with those of non-governmental, third-party
health insurance programs. By January 1, 2012, the payment for
a pediatric specialty physician service must not be lower than
Medicare reimbursement in accordance with the Medicare payment
localities for Illinois. Payment for services must be made
within 30 days after receipt of a bill or claim meeting the
requirements of the Department of Healthcare and Family
Services.
(b) For payments made or authorized by the Department of
Healthcare and Family Services, the Department shall annually
increase pediatric specialty physician payments under
subsection (a) by an amount approximately equal to one-third of
the difference between the actual rates available for such
purposes on January 1, 2009 and the Medicare reimbursement

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rates effective on January 1, 2007. If the General Assembly
determines that resources are not available to fully fund the
fee schedule for pediatric specialty physician care required by
this subsection (b), then, until such time as the General
Assembly determines that such funding is available, the
Department shall increase any payment for physicians who
provide pediatric specialty care services under the Covering
All KIDS Health Insurance Program by an amount proportionately
equivalent to any other increases for physicians, federally
qualified health centers, rural health centers, or other
non-institutional providers providing services to children for
any services provided under this Act.
Section 10. The Illinois Public Aid Code is amended by
adding Section 5-5.06 as follows:
(305 ILCS 5/5-5.06 new)
Sec. 5-5.06. Physician payments; pediatric specialty
physician services.
(a) Notwithstanding any other provisions of this Article,
beginning January 1, 2010, the physician fee schedule for
pediatric physician specialists must increase to become
competitive with those of non-governmental, third-party health
insurance programs. By January 1, 2012, the payment for a
pediatric specialty physician service must not be lower than
Medicare reimbursement in accordance with the Medicare payment

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localities for Illinois. Payment for services must be made
within 30 days after receipt of a bill or claim meeting the
requirements of the Department of Healthcare and Family
Services.
(b) For payments made or authorized by the Department of
Healthcare and Family Services, the Department shall annually
increase pediatric specialty physician payments under
subsection (a) by an amount approximately equal to one-third of
the difference between the actual rates available for such
purposes on January 1, 2009 and the Medicare reimbursement
rates effective on January 1, 2007. If the General Assembly
determines that resources are not available to fully fund the
fee schedule for pediatric specialty physician care required by
this subsection (b), then, until such time as the General
Assembly determines that such funding is available, the
Department shall increase any payment for physicians who
provide pediatric specialty care services under the medical
assistance program by an amount proportionately equivalent to
any other increases for physicians, federally qualified health
centers, rural health centers, or other non-institutional
providers providing services to children for any services
provided under this Act.