Bill Text: IL HB3893 | 2011-2012 | 97th General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Creates the Consumer Alternatives Program Act. Directs the Department of Human Services to implement the Consumer Alternatives Program to prevent or avoid the unnecessary institutional care treatment of individuals with mental disorders or a co-occurring disorder of mental illness and substance abuse or addiction and to provide cost effective, community alternatives and supports that enable these individuals to live successfully in the community. Requires implementation of the Program during fiscal year 2013. Makes implementation of the Program dependent upon funds appropriated by the General Assembly. Provides that participants in the program may receive certain services such as a comprehensive evaluation that includes an assessment of skills, abilities, and potential for living in the community and work placement; family or individual support services; case coordination services; and vocational training. Prohibits the denial of program services because of age, sex, ethnic origin, marital status, ability to pay (except when contrary to law), degree of disability, or illness. Requires the Department of Commerce and Economic Opportunity to assist the Department of Human Services in developing housing assistance programs aimed at promoting the ability of individuals with a mental disorder to move from institutions to the most integrated community residence. Effective July 1, 2012.

Spectrum: Strong Partisan Bill (Democrat 16-1)

Status: (Passed) 2012-08-24 - Public Act . . . . . . . . . 97-1061 [HB3893 Detail]

Download: Illinois-2011-HB3893-Amended.html

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Rep. Esther Golar

Filed: 3/1/2012

09700HB3893ham001 LRB097 14519 KTG 66964 a
AMENDMENT TO HOUSE BILL 3893
AMENDMENT NO. ______. Amend House Bill 3893 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 50% of recipients eligible for 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

09700HB3893ham001 - 2 - LRB097 14519 KTG 66964 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 50%

09700HB3893ham001 - 3 - LRB097 14519 KTG 66964 a
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.
(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 10. The Covering ALL KIDS Health Insurance Act is
amended by changing Section 56 as follows:

09700HB3893ham001 - 4 - LRB097 14519 KTG 66964 a
(215 ILCS 170/56)
(Section scheduled to be repealed on July 1, 2016)
Sec. 56. Care coordination.
(a) At least 50% of recipients eligible for 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

09700HB3893ham001 - 5 - LRB097 14519 KTG 66964 a
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 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.
(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

09700HB3893ham001 - 6 - LRB097 14519 KTG 66964 a
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:
(305 ILCS 5/5-30)
Sec. 5-30. Care coordination.
(a) At least 50% of recipients eligible for 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

09700HB3893ham001 - 7 - LRB097 14519 KTG 66964 a
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 50%
goal shall be achieved by enrolling medical assistance

09700HB3893ham001 - 8 - LRB097 14519 KTG 66964 a
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.
(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.)".