Public Act 099-0106

SB1253 Enrolled LRB099 10248 KTG 30474 b

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 5-30 as follows:

(305 ILCS 5/5-30)

Sec. 5-30. Care coordination.

(a) At least 50% of recipients eligible for comprehensive

medical benefits in all medical assistance programs or other

health benefit programs administered by the Department,

including the Children's Health Insurance Program Act and the

Covering ALL KIDS Health Insurance Act, shall be enrolled in a

care coordination program by no later than January 1, 2015. For

purposes of this Section, "coordinated care" or "care

coordination" means delivery systems where recipients will

receive their care from providers who participate under

contract in integrated delivery systems that are responsible

for providing or arranging the majority of care, including

primary care physician services, referrals from primary care

physicians, diagnostic and treatment services, behavioral

health services, in-patient and outpatient hospital services,

dental services, and rehabilitation and long-term care

services. The Department shall designate or contract for such

integrated delivery systems (i) to ensure enrollees have a

choice of systems and of primary care providers within such

systems; (ii) to ensure that enrollees receive quality care in

a culturally and linguistically appropriate manner; and (iii)

to ensure that coordinated care programs meet the diverse needs

of enrollees with developmental, mental health, physical, and

age-related disabilities.

(b) Payment for such coordinated care shall be based on

arrangements where the State pays for performance related to

health care outcomes, the use of evidence-based practices, the

use of primary care delivered through comprehensive medical

homes, the use of electronic medical records, and the

appropriate exchange of health information electronically made

either on a capitated basis in which a fixed monthly premium

per recipient is paid and full financial risk is assumed for

the delivery of services, or through other risk-based payment

arrangements.

(c) To qualify for compliance with this Section, the 50%

goal shall be achieved by enrolling medical assistance

enrollees from each medical assistance enrollment category,

including parents, children, seniors, and people with

disabilities to the extent that current State Medicaid payment

laws would not limit federal matching funds for recipients in

care coordination programs. In addition, services must be more

comprehensively defined and more risk shall be assumed than in

the Department's primary care case management program as of the

effective date of this amendatory Act of the 96th General

Assembly.

(d) The Department shall report to the General Assembly in

a separate part of its annual medical assistance program

report, beginning April, 2012 until April, 2016, on the

progress and implementation of the care coordination program

initiatives established by the provisions of this amendatory

Act of the 96th General Assembly. The Department shall include

in its April 2011 report a full analysis of federal laws or

regulations regarding upper payment limitations to providers

and the necessary revisions or adjustments in rate

methodologies and payments to providers under this Code that

would be necessary to implement coordinated care with full

financial risk by a party other than the Department.