Bill Text: IL HB4332 | 2011-2012 | 97th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-01-08 - Session Sine Die [HB4332 Detail]

Download: Illinois-2011-HB4332-Introduced.html

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97TH GENERAL ASSEMBLY State of Illinois 2011 and 2012 HB4332 Introduced , by Rep. Michael J. Madigan SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-16 from Ch. 23, par. 5-16
Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care.
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A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 5-16 as follows:
(305 ILCS 5/5-16) (from Ch. 23, par. 5-16)
Sec. 5-16. Managed Care. The The Illinois Department may
develop and implement a Primary Care Sponsor System consistent
with the provisions of this Section. The purpose of this
managed care delivery system shall be to contain the costs of
providing medical care to Medicaid recipients by having one
provider responsible for managing all aspects of a recipient's
medical care. This managed care system shall have the following
characteristics:
(a) The Department, by rule, shall establish criteria
to determine which clients must participate in this
program;
(b) Providers participating in the program may be paid
an amount per patient per month, to be set by the Illinois
Department, for managing each recipient's medical care;
(c) Providers eligible to participate in the program
shall be physicians licensed to practice medicine in all
its branches, and the Illinois Department may terminate a

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provider's participation if the provider is determined to
have failed to comply with any applicable program standard
or procedure established by the Illinois Department;
(d) Each recipient required to participate in the
program must select from a panel of primary care providers
or networks established by the Department in their
communities;
(e) A recipient may change his designated primary care
provider:
(1) when the designated source becomes
unavailable, as the Illinois Department shall
determine by rule; or
(2) when the designated primary care provider
notifies the Illinois Department that it wishes to
withdraw from any obligation as primary care provider;
or
(3) in other situations, as the Illinois
Department shall provide by rule;
(f) The Illinois Department shall, by rule, establish
procedures for providing medical services when the
designated source becomes unavailable or wishes to
withdraw from any obligation as primary care provider
taking into consideration the need for emergency or
temporary medical assistance and ensuring that the
recipient has continuous and unrestricted access to
medical care from the date on which such unavailability or

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withdrawal becomes effective until such time as the
recipient designates a primary care source;
(g) Only medical care services authorized by a
recipient's designated provider, except for emergency
services, services performed by a provider that is owned or
operated by a county and that provides non-emergency
services without regard to ability to pay and such other
services as provided by the Illinois Department, shall be
subject to payment by the Illinois Department. The Illinois
Department shall enter into an intergovernmental agreement
with each county that owns or operates such a provider to
develop and implement policies to minimize the provision of
medical care services provided by county owned or operated
providers pursuant to the foregoing exception.
The Illinois Department shall seek and obtain necessary
authorization provided under federal law to implement such a
program including the waiver of any federal regulations.
The Illinois Department may implement the amendatory
changes to this Section made by this amendatory Act of 1991
through the use of emergency rules in accordance with the
provisions of Section 5.02 of the Illinois Administrative
Procedure Act. For purposes of the Illinois Administrative
Procedure Act, the adoption of rules to implement the
amendatory changes to this Section made by this amendatory Act
of 1991 shall be deemed an emergency and necessary for the
public interest, safety and welfare.

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The Illinois Department may establish a managed care system
demonstration program, on a limited basis, as described in this
Section. The demonstration program shall terminate on June 30,
1997. Within 30 days after the end of each year of the
demonstration program's operation, the Illinois Department
shall report to the Governor and the General Assembly
concerning the operation of the demonstration program.
(Source: P.A. 87-14; 88-490.)