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| | HB5485 Engrossed | | LRB097 20051 KTG 65383 b |
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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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| | HB5485 Engrossed | - 2 - | LRB097 20051 KTG 65383 b |
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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 health insurance company that contracts with the |
19 | | Department, its subsequent agency, or the State to provide |
20 | | managed care to individuals enrolled as clients, |
21 | | beneficiaries, or recipients, who receive medical benefits |
22 | | under the Illinois medical assistance program, must be National |
23 | | Committee for Quality Assurance (NCQA) accredited within 3 |
24 | | years after beginning to provide services under the Illinois |
25 | | medical assistance program, and any such health insurance |
26 | | companies engaged in providing managed care or coordinated care |
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| | HB5485 Engrossed | - 3 - | LRB097 20051 KTG 65383 b |
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1 | | under the Illinois medical assistance program on the effective |
2 | | date of this amendatory Act of the 97th General Assembly must |
3 | | be NCQA accredited by January 1, 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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