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| [ Engrossed ] | [ House Amendment 001 ] |
91_HB2760
LRB9104075SMdv
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 5-16 and adding Section 5-16.12.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Section 5-16 and adding Section 5-16.12 as follows:
7 (305 ILCS 5/5-16) (from Ch. 23, par. 5-16)
8 Sec. 5-16. Managed Care. The Illinois Department may
9 develop and implement a Primary Care Sponsor System
10 consistent with the provisions of this Section. The purpose
11 of this managed care delivery system shall be to contain the
12 costs of providing medical care to Medicaid recipients by
13 having one provider responsible for managing all aspects of a
14 recipient's medical care. This managed care system shall
15 have the following characteristics:
16 (a) The Department, by rule, shall establish
17 criteria to determine which clients must participate in
18 this program or any other managed care program except as
19 limited by Section 5-16.12;
20 (b) Providers participating in the program may be
21 paid an amount per patient per month, to be set by the
22 Illinois Department, for managing each recipient's
23 medical care;
24 (c) Providers eligible to participate in the
25 program shall be physicians licensed to practice medicine
26 in all its branches, and the Illinois Department may
27 terminate a provider's participation if the provider is
28 determined to have failed to comply with any applicable
29 program standard or procedure established by the Illinois
30 Department;
31 (d) Each recipient required to participate in the
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1 program must select from a panel of primary care
2 providers or networks established by the Department in
3 their communities;
4 (e) A recipient may change his designated primary
5 care provider:
6 (1) when the designated source becomes
7 unavailable, as the Illinois Department shall
8 determine by rule; or
9 (2) when the designated primary care provider
10 notifies the Illinois Department that it wishes to
11 withdraw from any obligation as primary care
12 provider; or
13 (3) in other situations, as the Illinois
14 Department shall provide by rule;
15 (f) The Illinois Department shall, by rule,
16 establish procedures for providing medical services when
17 the designated source becomes unavailable or wishes to
18 withdraw from any obligation as primary care provider
19 taking into consideration the need for emergency or
20 temporary medical assistance and ensuring that the
21 recipient has continuous and unrestricted access to
22 medical care from the date on which such unavailability
23 or withdrawal becomes effective until such time as the
24 recipient designates a primary care source;
25 (g) Only medical care services authorized by a
26 recipient's designated provider, except for emergency
27 services, services performed by a provider that is owned
28 or operated by a county and that provides non-emergency
29 services without regard to ability to pay and such other
30 services as provided by the Illinois Department, shall be
31 subject to payment by the Illinois Department. The
32 Illinois Department shall enter into an intergovernmental
33 agreement with each county that owns or operates such a
34 provider to develop and implement policies to minimize
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1 the provision of medical care services provided by county
2 owned or operated providers pursuant to the foregoing
3 exception.
4 The Illinois Department shall seek and obtain necessary
5 authorization provided under federal law to implement such a
6 program including the waiver of any federal regulations.
7 The Illinois Department may implement the amendatory
8 changes to this Section made by this amendatory Act of 1991
9 through the use of emergency rules in accordance with the
10 provisions of Section 5.02 of the Illinois Administrative
11 Procedure Act. For purposes of the Illinois Administrative
12 Procedure Act, the adoption of rules to implement the
13 amendatory changes to this Section made by this amendatory
14 Act of 1991 shall be deemed an emergency and necessary for
15 the public interest, safety and welfare.
16 The Illinois Department may establish a managed care
17 system demonstration program, on a limited basis, as
18 described in this Section. The demonstration program shall
19 terminate on June 30, 1997. Within 30 days after the end of
20 each year of the demonstration program's operation, the
21 Illinois Department shall report to the Governor and the
22 General Assembly concerning the operation of the
23 demonstration program.
24 (Source: P.A. 87-14; 88-490.)
25 (305 ILCS 5/5-16.12 new)
26 Sec. 5-16.12. Exemption from mandatory enrollment in
27 managed care programs and eligibility for wards of court.
28 The Department may not require any individual under 19 years
29 of age to enroll in any managed care program who is in foster
30 care or otherwise in an out-of-home placement, including
31 children who are wards of the court or mandated by a court to
32 foster care, detention, substance abuse treatment, mental
33 health services, or group living facilities. As required by
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1 Section 1932(a)(2)(A) of the federal Social Security Act,
2 such children shall be exempt from mandatory enrollment in
3 managed care programs. A person under age 18 who has been
4 removed from his or her home by a circuit court shall be
5 Medicaid eligible if he or she satisfies Department criteria
6 for citizen/Immigration and Naturalization Service status,
7 residence, Supplemental Security Income (SSI), social
8 security number, and client cooperation. Financial
9 eligibility factors shall not apply to wards of the court nor
10 affect a ward's Medicaid eligibility. However, the
11 Department may seek reimbursement for services rendered to
12 the ward from the ward's parents pursuant to Section 6-9 of
13 the Juvenile Court Act of 1987.
14 Section 99. Effective date. This Act takes effect upon
15 becoming law.