Bill Text: IL HB5561 | 2013-2014 | 98th General Assembly | Introduced


Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a health plan, including an Accountable Care Entity (ACE), a Care Coordination Entity (CCE), a Managed Care Community Network (MCCN), or a Managed Care Organization (MCO), that has met the Department of Healthcare and Family Services' requirements to provide services to Medicaid managed care enrollees must meet minimum specialty pediatric network adequacy requirements. Provides that to meet those requirements (i) a network must include at least one Pediatric Essential Community Provider; (ii) as determined by the Department, the health plan must show that its network has access to the full range of primary, specialty, and ancillary pediatric providers, and must ensure coordination and continuity of care among all providers; and (iii) the health plan must provide annual reports to the Department that demonstrate its assessment of pediatric provider networks and whether gaps in access to care have been identified, accompanied by a plan to remedy those gaps and monitor access to care in those specifically identified areas. Provides that a health plan must demonstrate to the Department that it meets certain minimum pediatric network adequacy requirements and that the Department may only contract with health plans serving children that meet the pediatric network adequacy requirements. Contains a provision concerning certain annual reports submitted by the Office of Health Innovation and Transformation created by Executive Order 14-01. Effective immediately.

Spectrum: Slight Partisan Bill (Democrat 2-1)

Status: (Failed) 2014-12-03 - Session Sine Die [HB5561 Detail]

Download: Illinois-2013-HB5561-Introduced.html


98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB5561

Introduced , by Rep. Robyn Gabel

SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-30a new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a health plan, including an Accountable Care Entity (ACE), a Care Coordination Entity (CCE), a Managed Care Community Network (MCCN), or a Managed Care Organization (MCO), that has met the Department of Healthcare and Family Services' requirements to provide services to Medicaid managed care enrollees must meet minimum specialty pediatric network adequacy requirements. Provides that to meet those requirements (i) a network must include at least one Pediatric Essential Community Provider; (ii) as determined by the Department, the health plan must show that its network has access to the full range of primary, specialty, and ancillary pediatric providers, and must ensure coordination and continuity of care among all providers; and (iii) the health plan must provide annual reports to the Department that demonstrate its assessment of pediatric provider networks and whether gaps in access to care have been identified, accompanied by a plan to remedy those gaps and monitor access to care in those specifically identified areas. Provides that a health plan must demonstrate to the Department that it meets certain minimum pediatric network adequacy requirements and that the Department may only contract with health plans serving children that meet the pediatric network adequacy requirements. Contains a provision concerning certain annual reports submitted by the Office of Health Innovation and Transformation created by Executive Order 14-01. Effective immediately.
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FISCAL NOTE ACT MAY APPLY

A BILL FOR

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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-30a as follows:
6 (305 ILCS 5/5-30a new)
7 Sec. 5-30a. Pediatric network adequacy requirements.
8 (a) Pediatric network adequacy. A health plan, serving
9persons less than 21 years of age, including an Accountable
10Care Entity (ACE), a Care Coordination Entity (CCE), a Managed
11Care Community Network (MCCN), or a Managed Care Organization
12(MCO), that has met the Department of Healthcare and Family
13Services' requirements to provide services to Medicaid managed
14care enrollees must meet minimum specialty pediatric network
15adequacy requirements. To meet those requirements (i) a network
16must include at least one Pediatric Essential Community
17Provider; (ii) as determined by the Department, the health plan
18must show that its network has access to the full range of
19primary, specialty, and ancillary pediatric providers, and
20must ensure coordination and continuity of care among all
21providers; and (iii) the health plan must provide annual
22reports to the Department that demonstrate its assessment of
23pediatric provider networks and whether gaps in access to care

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1have been identified, accompanied by a plan to remedy those
2gaps and monitor access to care in those specifically
3identified areas. For purposes of this Section, "Pediatric
4Essential Community Provider" means an acute care hospital and
5its affiliated clinics that meet the following criteria:
6 (1) if the hospital is located within the State, the
7 hospital must have a pediatric intensive care unit (PICU)
8 that is recognized by the Department of Public Health and
9 the hospital must provide at least 1600 annual pediatric
10 Medicaid discharges; or
11 (2) if the hospital is located out-of-state, the
12 hospital must have a pediatric intensive care unit (PICU)
13 and the hospital must provide at least 1000 annual
14 pediatric Medicaid discharges.
15 (b) Demonstration. A health plan must demonstrate to the
16Department that it meets certain minimum pediatric network
17adequacy requirements. The Department may only contract with
18health plans serving children that meet the pediatric network
19adequacy requirements.
20 (c) Annual report. The Office of Health Innovation and
21Transformation created by Executive Order 14-01 shall issue an
22annual report to the Governor, to the 4 legislative leaders,
23and to the Directors of the Department of Healthcare and Family
24Services and the Department of Insurance determining whether
25the pediatric network adequacy requirements established under
26this Section should be integrated into the Illinois Health

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1Benefits Exchange's qualification requirements and whether
2additions to the pediatric network adequacy requirements are
3needed under the State's Medicaid program.
4 Section 99. Effective date. This Act takes effect upon
5becoming law.
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