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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | |||||||||||||||||||
5 | changing Section 5-30 as follows:
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6 | (305 ILCS 5/5-30) | |||||||||||||||||||
7 | Sec. 5-30. Care coordination. | |||||||||||||||||||
8 | (a) At least 50% of recipients eligible for comprehensive | |||||||||||||||||||
9 | medical benefits in all medical assistance programs or other | |||||||||||||||||||
10 | health benefit programs administered by the Department, | |||||||||||||||||||
11 | including the Children's Health Insurance Program Act and the | |||||||||||||||||||
12 | Covering ALL KIDS Health Insurance Act, shall be enrolled in a | |||||||||||||||||||
13 | care coordination program by no later than January 1, 2015. For | |||||||||||||||||||
14 | purposes of this Section, "coordinated care" or "care | |||||||||||||||||||
15 | coordination" means delivery systems where recipients will | |||||||||||||||||||
16 | receive their care from providers who participate under | |||||||||||||||||||
17 | contract in integrated delivery systems that are responsible | |||||||||||||||||||
18 | for providing or arranging the majority of care, including | |||||||||||||||||||
19 | primary care physician services, referrals from primary care | |||||||||||||||||||
20 | physicians, diagnostic and treatment services, behavioral | |||||||||||||||||||
21 | health services, in-patient and outpatient hospital services, | |||||||||||||||||||
22 | dental services, and rehabilitation and long-term care | |||||||||||||||||||
23 | services. The Department shall designate or contract for such |
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1 | integrated delivery systems (i) to ensure enrollees have a | ||||||
2 | choice of systems and of primary care providers within such | ||||||
3 | systems; (ii) to ensure that enrollees receive quality care in | ||||||
4 | a culturally and linguistically appropriate manner; and (iii) | ||||||
5 | to ensure that coordinated care programs meet the diverse needs | ||||||
6 | of enrollees with developmental, mental health, physical, and | ||||||
7 | age-related disabilities. | ||||||
8 | (b) Payment for such coordinated care shall be based on | ||||||
9 | arrangements where the State pays for performance related to | ||||||
10 | health care outcomes, the use of evidence-based practices, the | ||||||
11 | use of primary care delivered through comprehensive medical | ||||||
12 | homes, the use of electronic medical records, and the | ||||||
13 | appropriate exchange of health information electronically made | ||||||
14 | either on a capitated basis in which a fixed monthly premium | ||||||
15 | per recipient is paid and full financial risk is assumed for | ||||||
16 | the delivery of services, or through other risk-based payment | ||||||
17 | arrangements. | ||||||
18 | (b-5) Any entity that contracts with the Department, its | ||||||
19 | subsequent agency, or the State to provide managed care to | ||||||
20 | individuals enrolled as clients, beneficiaries, or recipients, | ||||||
21 | who receive medical benefits under the Illinois medical | ||||||
22 | assistance program, must be National Committee for Quality | ||||||
23 | Assurance (NCQA) accredited within 3 years after beginning to | ||||||
24 | provide services under the Illinois medical assistance | ||||||
25 | program, and any such entities engaged in providing managed | ||||||
26 | care or coordinated care under the Illinois medical assistance |
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1 | program on the effective date of this amendatory Act of the | ||||||
2 | 97th General Assembly must be NCQA accredited by January 1, | ||||||
3 | 2015. | ||||||
4 | (c) To qualify for compliance with this Section, the 50% | ||||||
5 | goal shall be achieved by enrolling medical assistance | ||||||
6 | enrollees from each medical assistance enrollment category, | ||||||
7 | including parents, children, seniors, and people with | ||||||
8 | disabilities to the extent that current State Medicaid payment | ||||||
9 | laws would not limit federal matching funds for recipients in | ||||||
10 | care coordination programs. In addition, services must be more | ||||||
11 | comprehensively defined and more risk shall be assumed than in | ||||||
12 | the Department's primary care case management program as of the | ||||||
13 | effective date of this amendatory Act of the 96th General | ||||||
14 | Assembly. | ||||||
15 | (d) The Department shall report to the General Assembly in | ||||||
16 | a separate part of its annual medical assistance program | ||||||
17 | report, beginning April, 2012 until April, 2016, on the | ||||||
18 | progress and implementation of the care coordination program | ||||||
19 | initiatives established by the provisions of this amendatory | ||||||
20 | Act of the 96th General Assembly. The Department shall include | ||||||
21 | in its April 2011 report a full analysis of federal laws or | ||||||
22 | regulations regarding upper payment limitations to providers | ||||||
23 | and the necessary revisions or adjustments in rate | ||||||
24 | methodologies and payments to providers under this Code that | ||||||
25 | would be necessary to implement coordinated care with full | ||||||
26 | financial risk by a party other than the Department.
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1 | (Source: P.A. 96-1501, eff. 1-25-11.)
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