Bill Text: IL SB3326 | 2011-2012 | 97th General Assembly | Amended

---

Bill Title: Amends the Children's Health Insurance Program Act, the Covering ALL KIDS Health Insurance Act, and the Medical Assistance Article of the Illinois Public Aid Code. Provides that at least 70% (rather than 50%) of recipients eligible for comprehensive medical benefits in all medical assistance programs or other health benefit programs administered by the Department of Healthcare and Family Services, including the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act, shall be enrolled in a care coordination program by no later than January 1, 2015. Provides that the Department of Healthcare and Family Services' primary care case management program shall be considered a care coordination program. Effective immediately.

Sponsorship: Partisan Bill (Democrat 2)

Status: (Failed) 2013-01-08 - Session Sine Die [SB3326 Detail]

Download: Illinois-2011-SB3326-Amended.html

---

Sen. Don Harmon

Filed: 3/23/2012

09700SB3326sam001 LRB097 17848 KTG 67773 a
AMENDMENT TO SENATE BILL 3326
AMENDMENT NO. ______. Amend Senate Bill 3326 by replacing
everything after the enacting clause with the following:
"Section 5. The Children's Health Insurance Program Act is
amended by changing Section 23 as follows:
(215 ILCS 106/23)
Sec. 23. Care coordination.
(a) At least 70% 50% of recipients eligible for
comprehensive medical benefits in all medical assistance
programs or other health benefit programs administered by the
Department, including the Children's Health Insurance Program
Act and the Covering ALL KIDS Health Insurance Act, shall be
enrolled in a care coordination program by no later than
January 1, 2015. For purposes of this Section, "coordinated
care" or "care coordination" means delivery systems where
recipients will receive their care from providers who

09700SB3326sam001 - 2 - LRB097 17848 KTG 67773 a
participate under contract in integrated delivery systems that
are responsible for providing or arranging the majority of
care, including primary care physician services, referrals
from primary care physicians, diagnostic and treatment
services, behavioral health services, in-patient and
outpatient hospital services, dental services, and
rehabilitation and long-term care services. The Department
shall designate or contract for such integrated delivery
systems (i) to ensure enrollees have a choice of systems and of
primary care providers within such systems; (ii) to ensure that
enrollees receive quality care in a culturally and
linguistically appropriate manner; and (iii) to ensure that
coordinated care programs meet the diverse needs of enrollees
with developmental, mental health, physical, and age-related
disabilities.
(b) Payment for such coordinated care shall be based on
arrangements where the State pays for performance related to
health care outcomes, the use of evidence-based practices, the
use of primary care delivered through comprehensive medical
homes, the use of electronic medical records, and the
appropriate exchange of health information electronically made
either on a capitated basis in which a fixed monthly premium
per recipient is paid and full financial risk is assumed for
the delivery of services, or through other risk-based payment
arrangements.
(c) To qualify for compliance with this Section, the 70%

09700SB3326sam001 - 3 - LRB097 17848 KTG 67773 a
50% goal shall be achieved by enrolling medical assistance
enrollees from each medical assistance enrollment category,
including parents, children, seniors, and people with
disabilities to the extent that current State Medicaid payment
laws would not limit federal matching funds for recipients in
care coordination programs. In addition, services must be more
comprehensively defined and more risk shall be assumed than in
the Department's primary care case management program as of the
effective date of this amendatory Act of the 96th General
Assembly.
(c-5) An enhanced primary care case management program that
includes collaboration between primary care providers,
hospitals, and behavioral health providers with protocols for
coordination, electronic exchange of health information, and
fees at risk based on performance and outcomes qualifies as
care coordination under this Section.
(d) The Department shall report to the General Assembly in
a separate part of its annual medical assistance program
report, beginning April, 2012 until April, 2016, on the
progress and implementation of the care coordination program
initiatives established by the provisions of this amendatory
Act of the 96th General Assembly. The Department shall include
in its April 2011 report a full analysis of federal laws or
regulations regarding upper payment limitations to providers
and the necessary revisions or adjustments in rate
methodologies and payments to providers under this Code that

09700SB3326sam001 - 4 - LRB097 17848 KTG 67773 a
would be necessary to implement coordinated care with full
financial risk by a party other than the Department.
(Source: P.A. 96-1501, eff. 1-25-11.)
Section 10. The Covering ALL KIDS Health Insurance Act is
amended by changing Section 56 as follows:
(215 ILCS 170/56)
(Section scheduled to be repealed on July 1, 2016)
Sec. 56. Care coordination.
(a) At least 70% 50% of recipients eligible for
comprehensive medical benefits in all medical assistance
programs or other health benefit programs administered by the
Department, including the Children's Health Insurance Program
Act and the Covering ALL KIDS Health Insurance Act, shall be
enrolled in a care coordination program by no later than
January 1, 2015. For purposes of this Section, "coordinated
care" or "care coordination" means delivery systems where
recipients will receive their care from providers who
participate under contract in integrated delivery systems that
are responsible for providing or arranging the majority of
care, including primary care physician services, referrals
from primary care physicians, diagnostic and treatment
services, behavioral health services, in-patient and
outpatient hospital services, dental services, and
rehabilitation and long-term care services. The Department

09700SB3326sam001 - 5 - LRB097 17848 KTG 67773 a
shall designate or contract for such integrated delivery
systems (i) to ensure enrollees have a choice of systems and of
primary care providers within such systems; (ii) to ensure that
enrollees receive quality care in a culturally and
linguistically appropriate manner; and (iii) to ensure that
coordinated care programs meet the diverse needs of enrollees
with developmental, mental health, physical, and age-related
disabilities.
(b) Payment for such coordinated care shall be based on
arrangements where the State pays for performance related to
health care outcomes, the use of evidence-based practices, the
use of primary care delivered through comprehensive medical
homes, the use of electronic medical records, and the
appropriate exchange of health information electronically made
either on a capitated basis in which a fixed monthly premium
per recipient is paid and full financial risk is assumed for
the delivery of services, or through other risk-based payment
arrangements.
(c) To qualify for compliance with this Section, the 70%
50% goal shall be achieved by enrolling medical assistance
enrollees from each medical assistance enrollment category,
including parents, children, seniors, and people with
disabilities to the extent that current State Medicaid payment
laws would not limit federal matching funds for recipients in
care coordination programs. In addition, services must be more
comprehensively defined and more risk shall be assumed than in

09700SB3326sam001 - 6 - LRB097 17848 KTG 67773 a
the Department's primary care case management program as of the
effective date of this amendatory Act of the 96th General
Assembly.
(c-5) An enhanced primary care case management program that
includes collaboration between primary care providers,
hospitals, and behavioral health providers with protocols for
coordination, electronic exchange of health information, and
fees at risk based on performance and outcomes qualifies as
care coordination under this Section.
(d) The Department shall report to the General Assembly in
a separate part of its annual medical assistance program
report, beginning April, 2012 until April, 2016, on the
progress and implementation of the care coordination program
initiatives established by the provisions of this amendatory
Act of the 96th General Assembly. The Department shall include
in its April 2011 report a full analysis of federal laws or
regulations regarding upper payment limitations to providers
and the necessary revisions or adjustments in rate
methodologies and payments to providers under this Code that
would be necessary to implement coordinated care with full
financial risk by a party other than the Department.
(Source: P.A. 96-1501, eff. 1-25-11.)
Section 15. The Illinois Public Aid Code is amended by
changing Section 5-30 as follows:

09700SB3326sam001 - 7 - LRB097 17848 KTG 67773 a
(305 ILCS 5/5-30)
Sec. 5-30. Care coordination.
(a) At least 70% 50% of recipients eligible for
comprehensive medical benefits in all medical assistance
programs or other health benefit programs administered by the
Department, including the Children's Health Insurance Program
Act and the Covering ALL KIDS Health Insurance Act, shall be
enrolled in a care coordination program by no later than
January 1, 2015. For purposes of this Section, "coordinated
care" or "care coordination" means delivery systems where
recipients will receive their care from providers who
participate under contract in integrated delivery systems that
are responsible for providing or arranging the majority of
care, including primary care physician services, referrals
from primary care physicians, diagnostic and treatment
services, behavioral health services, in-patient and
outpatient hospital services, dental services, and
rehabilitation and long-term care services. The Department
shall designate or contract for such integrated delivery
systems (i) to ensure enrollees have a choice of systems and of
primary care providers within such systems; (ii) to ensure that
enrollees receive quality care in a culturally and
linguistically appropriate manner; and (iii) to ensure that
coordinated care programs meet the diverse needs of enrollees
with developmental, mental health, physical, and age-related
disabilities.

09700SB3326sam001 - 8 - LRB097 17848 KTG 67773 a
(b) Payment for such coordinated care shall be based on
arrangements where the State pays for performance related to
health care outcomes, the use of evidence-based practices, the
use of primary care delivered through comprehensive medical
homes, the use of electronic medical records, and the
appropriate exchange of health information electronically made
either on a capitated basis in which a fixed monthly premium
per recipient is paid and full financial risk is assumed for
the delivery of services, or through other risk-based payment
arrangements.
(c) To qualify for compliance with this Section, the 70%
50% goal shall be achieved by enrolling medical assistance
enrollees from each medical assistance enrollment category,
including parents, children, seniors, and people with
disabilities to the extent that current State Medicaid payment
laws would not limit federal matching funds for recipients in
care coordination programs. In addition, services must be more
comprehensively defined and more risk shall be assumed than in
the Department's primary care case management program as of the
effective date of this amendatory Act of the 96th General
Assembly.
(c-5) An enhanced primary care case management program that
includes collaboration between primary care providers,
hospitals, and behavioral health providers with protocols for
coordination, electronic exchange of health information, and
fees at risk based on performance and outcomes qualifies as

09700SB3326sam001 - 9 - LRB097 17848 KTG 67773 a
care coordination under this Section.
(d) The Department shall report to the General Assembly in
a separate part of its annual medical assistance program
report, beginning April, 2012 until April, 2016, on the
progress and implementation of the care coordination program
initiatives established by the provisions of this amendatory
Act of the 96th General Assembly. The Department shall include
in its April 2011 report a full analysis of federal laws or
regulations regarding upper payment limitations to providers
and the necessary revisions or adjustments in rate
methodologies and payments to providers under this Code that
would be necessary to implement coordinated care with full
financial risk by a party other than the Department.
(Source: P.A. 96-1501, eff. 1-25-11.)
Section 99. Effective date. This Act takes effect upon
becoming law.".