Bill Amendment: IL HB4880 | 2019-2020 | 101st General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: DCFS-MECHANICAL RESTRAINTS
Status: 2020-06-23 - Rule 19(b) / Re-referred to Rules Committee [HB4880 Detail]
Download: Illinois-2019-HB4880-House_Amendment_001.html
Bill Title: DCFS-MECHANICAL RESTRAINTS
Status: 2020-06-23 - Rule 19(b) / Re-referred to Rules Committee [HB4880 Detail]
Download: Illinois-2019-HB4880-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 4880
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2 | AMENDMENT NO. ______. Amend House Bill 4880 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Children and Family Services Act is amended | ||||||
5 | by changing Section 5.45 as follows:
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6 | (20 ILCS 505/5.45) | ||||||
7 | Sec. 5.45. Managed care plan services. | ||||||
8 | (a) As used in this Section: | ||||||
9 | "Caregiver" means an individual or entity directly | ||||||
10 | providing the day-to-day care of a child ensuring the child's | ||||||
11 | safety and well-being. | ||||||
12 | "Child" means a child placed in the care of the Department | ||||||
13 | pursuant to the Juvenile Court Act of 1987. | ||||||
14 | "Department" means the Department of Children and Family | ||||||
15 | Services, or any successor State agency. | ||||||
16 | "Director" means the Director of Children and Family |
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1 | Services. | ||||||
2 | "Managed care organization" has the meaning ascribed to | ||||||
3 | that term in Section 5-30.1 of the Illinois Public Aid Code. | ||||||
4 | "Medicaid managed care plan" means a health care plan | ||||||
5 | operated by a managed care organization under the Medical | ||||||
6 | Assistance Program established in Article V of the Illinois | ||||||
7 | Public Aid Code. | ||||||
8 | "Workgroup" means the Child Welfare Medicaid Managed Care | ||||||
9 | Implementation Advisory Workgroup. | ||||||
10 | (b) Every child who is in the care of the Department | ||||||
11 | pursuant to the Juvenile Court Act of 1987 shall receive the | ||||||
12 | necessary services required by this Act and the Juvenile Court | ||||||
13 | Act of 1987, including any child enrolled in a Medicaid managed | ||||||
14 | care plan. | ||||||
15 | (c) The Department shall not relinquish its authority or | ||||||
16 | diminish its responsibility to determine and provide necessary | ||||||
17 | services that are in the best interest of a child even if those | ||||||
18 | services are directly or indirectly: | ||||||
19 | (1) provided by a managed care organization, another | ||||||
20 | State agency, or other third parties; | ||||||
21 | (2) coordinated through a managed care organization, | ||||||
22 | another State agency, or other third parties; or | ||||||
23 | (3) paid for by a managed care organization, another | ||||||
24 | State agency, or other third parties. | ||||||
25 | (d) The Department shall: | ||||||
26 | (1) implement and enforce measures to ensure that a |
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1 | child's enrollment in Medicaid managed care supports | ||||||
2 | continuity of treatment and does not hinder service | ||||||
3 | delivery; | ||||||
4 | (2) establish a single point of contact for health care | ||||||
5 | coverage inquiries and dispute resolution systemwide | ||||||
6 | without transferring this responsibility to a third party | ||||||
7 | such as a managed care coordinator; | ||||||
8 | (3) not require any child to participate in Medicaid | ||||||
9 | managed care if the child would otherwise be exempt from | ||||||
10 | enrolling in a Medicaid managed care plan under any rule or | ||||||
11 | statute of this State; and | ||||||
12 | (4) make recommendations regarding managed care | ||||||
13 | contract measures, quality assurance activities, and | ||||||
14 | performance delivery evaluations in consultation with the | ||||||
15 | Workgroup; and | ||||||
16 | (5) post on its website: | ||||||
17 | (A) a link to any rule adopted or procedures | ||||||
18 | changed to address the provisions of this Section, if | ||||||
19 | applicable; | ||||||
20 | (B) each managed care organization's contract, | ||||||
21 | enrollee handbook, and directory; | ||||||
22 | (C) the notification process and timeframe | ||||||
23 | requirements used to inform managed care plan | ||||||
24 | enrollees, enrollees' caregivers, and enrollees' legal | ||||||
25 | representation of any changes in health care coverage | ||||||
26 | or change in a child's managed care provider; |
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1 | (D) defined prior authorization requirements for | ||||||
2 | prescriptions, goods, and services in emergency and | ||||||
3 | non-emergency situations; | ||||||
4 | (E) the State's current Health Care Oversight and | ||||||
5 | Coordination Plan developed in accordance with federal | ||||||
6 | requirements; and | ||||||
7 | (F) the transition plan required under subsection | ||||||
8 | (f), including: | ||||||
9 | (i) the public comments submitted to the | ||||||
10 | Department, the Department of Healthcare and | ||||||
11 | Family Services, and the Workgroup for | ||||||
12 | consideration in development of the transition | ||||||
13 | plan; | ||||||
14 | (ii) a list and summary of recommendations of | ||||||
15 | the Workgroup that the Director or Director of | ||||||
16 | Healthcare and Family Services declined to adopt | ||||||
17 | or implement; and | ||||||
18 | (iii) the Department's attestation that the | ||||||
19 | transition plan will not impede the Department's | ||||||
20 | ability to timely identify the service needs of | ||||||
21 | youth in care and the timely and appropriate | ||||||
22 | provision of services to address those identified | ||||||
23 | needs ; and . | ||||||
24 | (6) review and automatically appeal all claim denials | ||||||
25 | for youth in care and former youth in care who are enrolled | ||||||
26 | in or received services provided by a Medicaid managed care |
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1 | plan. The Department shall cover all costs associated with | ||||||
2 | any appeal it files in accordance with this paragraph. The | ||||||
3 | Department shall cover all costs associated with any | ||||||
4 | medications or health care services provided to a youth in | ||||||
5 | care or a former youth in care during the appeal process if | ||||||
6 | the youth's claim is ultimately denied after appeal. | ||||||
7 | (e) The Child Welfare Medicaid Managed Care Implementation | ||||||
8 | Advisory Workgroup is established to advise the Department on | ||||||
9 | the transition and implementation of managed care for children. | ||||||
10 | The Director of Children and Family Services and the Director | ||||||
11 | of Healthcare and Family Services shall serve as | ||||||
12 | co-chairpersons of the Workgroup. The Directors shall jointly | ||||||
13 | appoint members to the Workgroup who are stakeholders from the | ||||||
14 | child welfare community, including: | ||||||
15 | (1) employees of the Department of Children and Family | ||||||
16 | Services who have responsibility in the areas of (i) | ||||||
17 | managed care services, (ii) performance monitoring and | ||||||
18 | oversight, (iii) placement operations, and (iv) budget | ||||||
19 | revenue maximization; | ||||||
20 | (2) employees of the Department of Healthcare and | ||||||
21 | Family Services who have responsibility in the areas of (i) | ||||||
22 | managed care contracting, (ii) performance monitoring and | ||||||
23 | oversight, (iii) children's behavioral health, and (iv) | ||||||
24 | budget revenue maximization; | ||||||
25 | (3) 2 representatives of youth in care; | ||||||
26 | (4) one representative of managed care organizations |
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1 | serving youth in care; | ||||||
2 | (5) 4 representatives of child welfare providers; | ||||||
3 | (6) one representative of parents of children in | ||||||
4 | out-of-home care; | ||||||
5 | (7) one representative of universities or research | ||||||
6 | institutions; | ||||||
7 | (8) one representative of pediatric physicians; | ||||||
8 | (9) one representative of the juvenile court; | ||||||
9 | (10) one representative of caregivers of youth in care; | ||||||
10 | (11) one practitioner with expertise in child and | ||||||
11 | adolescent psychiatry; | ||||||
12 | (12) one representative of substance abuse and
mental | ||||||
13 | health providers with expertise in serving children | ||||||
14 | involved in child welfare and their families; | ||||||
15 | (13) at least one member of the Medicaid Advisory | ||||||
16 | Committee; | ||||||
17 | (14) one representative of a statewide organization | ||||||
18 | representing hospitals; | ||||||
19 | (15) one representative of a statewide organization | ||||||
20 | representing child welfare providers; | ||||||
21 | (16) one representative of a statewide organization | ||||||
22 | representing substance abuse and mental health providers; | ||||||
23 | and | ||||||
24 | (17) other child advocates as deemed appropriate by the | ||||||
25 | Directors. | ||||||
26 | To the greatest extent possible, the co-chairpersons shall |
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1 | appoint members who reflect the geographic diversity of the | ||||||
2 | State and include members who represent rural service areas. | ||||||
3 | Members shall serve 2-year terms or until the Workgroup | ||||||
4 | dissolves. If a vacancy occurs in the Workgroup membership, the | ||||||
5 | vacancy shall be filled in the same manner as the original | ||||||
6 | appointment for the remainder of the unexpired term. The | ||||||
7 | Workgroup shall hold meetings, as it deems appropriate, in the | ||||||
8 | northern, central, and southern regions of the State to solicit | ||||||
9 | public comments to develop its recommendations. To ensure the | ||||||
10 | Department of Children and Family Services and the Department | ||||||
11 | of Healthcare and Family Services are provided time to confer | ||||||
12 | and determine their use of pertinent Workgroup recommendations | ||||||
13 | in the transition plan required under subsection (f), the | ||||||
14 | co-chairpersons shall convene at least 3 meetings. The | ||||||
15 | Department of Children and Family Services and the Department | ||||||
16 | of Healthcare and Family Services shall provide administrative | ||||||
17 | support to the Workgroup. Workgroup members shall serve without | ||||||
18 | compensation. The Workgroup shall dissolve 5 years after the | ||||||
19 | Department of Children and Family Services' implementation of | ||||||
20 | managed care. | ||||||
21 | (f) Prior to transitioning any child to managed care, the | ||||||
22 | Department of Children and Family Services and the Department | ||||||
23 | of Healthcare and Family Services, in consultation with the | ||||||
24 | Workgroup, must develop and post publicly, a transition plan | ||||||
25 | for the provision of health care services to children enrolled | ||||||
26 | in Medicaid managed care plans. Interim transition plans must |
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1 | be posted to the Department's website by July 15, 2018. The | ||||||
2 | transition plan shall be posted at least 28 days before the | ||||||
3 | Department's implementation of managed care. The transition | ||||||
4 | plan shall address, but is not limited to, the following: | ||||||
5 | (1) an assessment of existing network adequacy, plans | ||||||
6 | to address gaps in network, and ongoing network evaluation; | ||||||
7 | (2) a framework for preparing and training | ||||||
8 | organizations, caregivers, frontline staff, and managed | ||||||
9 | care organizations; | ||||||
10 | (3) the identification of administrative changes | ||||||
11 | necessary for successful transition to managed care, and | ||||||
12 | the timeframes to make changes; | ||||||
13 | (4) defined roles, responsibilities, and lines of | ||||||
14 | authority for care coordination, placement providers, | ||||||
15 | service providers, and each State agency involved in | ||||||
16 | management and oversight of managed care services; | ||||||
17 | (5) data used to establish baseline performance and | ||||||
18 | quality of care, which shall be utilized to assess quality | ||||||
19 | outcomes and identify ongoing areas for improvement; | ||||||
20 | (6) a process for stakeholder input into managed care | ||||||
21 | planning and implementation; | ||||||
22 | (7) a dispute resolution process, including the rights | ||||||
23 | of enrollees and representatives of enrollees under the | ||||||
24 | dispute process and timeframes for dispute resolution | ||||||
25 | determinations and remedies; | ||||||
26 | (8) the process for health care transition for youth |
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1 | exiting the Department's care through emancipation or | ||||||
2 | achieving permanency; and | ||||||
3 | (9) protections to ensure the continued provision of | ||||||
4 | health care services if a child's residence or legal | ||||||
5 | guardian changes. | ||||||
6 | (g) Reports. | ||||||
7 | (1) On or before February 1, 2019, and on or before | ||||||
8 | each February 1 thereafter, the Department shall submit a | ||||||
9 | report to the House and Senate Human Services Committees, | ||||||
10 | or to any successor committees, on measures of access to | ||||||
11 | and the quality of health care services for children | ||||||
12 | enrolled in Medicaid managed care plans, including, but not | ||||||
13 | limited to, data showing whether: | ||||||
14 | (A) children enrolled in Medicaid managed care | ||||||
15 | plans have continuity of care across placement types, | ||||||
16 | geographic regions, and specialty service needs; | ||||||
17 | (B) each child is receiving the early periodic | ||||||
18 | screening, diagnosis, and treatment services as | ||||||
19 | required by federal law, including, but not limited to, | ||||||
20 | regular preventative care and timely specialty care; | ||||||
21 | (C) children are assigned to health homes; | ||||||
22 | (D) each child has a health care oversight and | ||||||
23 | coordination plan as required by federal law; | ||||||
24 | (E) there exist complaints and grievances | ||||||
25 | indicating gaps or barriers in service delivery; and | ||||||
26 | (F) the Workgroup and other stakeholders have and |
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1 | continue to be engaged in quality improvement | ||||||
2 | initiatives. | ||||||
3 | The report shall be prepared in consultation with the | ||||||
4 | Workgroup and other agencies, organizations, or | ||||||
5 | individuals the Director deems appropriate in order to | ||||||
6 | obtain comprehensive and objective information about the | ||||||
7 | managed care plan operation. | ||||||
8 | (2) During each legislative session, the House and | ||||||
9 | Senate Human Services Committees shall hold hearings to | ||||||
10 | take public testimony about managed care implementation | ||||||
11 | for children in the care of, adopted from, or placed in | ||||||
12 | guardianship by the Department. The Department shall | ||||||
13 | present testimony, including information provided in the | ||||||
14 | report required under paragraph (1), the Department's | ||||||
15 | compliance with the provisions of this Section, and any | ||||||
16 | recommendations for statutory changes to improve health | ||||||
17 | care for children in the Department's care. | ||||||
18 | (h) If any provision of this Section or its application to | ||||||
19 | any person or circumstance is held invalid, the invalidity of | ||||||
20 | that provision or application does not affect other provisions | ||||||
21 | or applications of this Section that can be given effect | ||||||
22 | without the invalid provision or application.
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23 | (Source: P.A. 100-646, eff. 7-27-18.)
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24 | Section 99. Effective date. This Act takes effect upon | ||||||
25 | becoming law.".
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