103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB0547 Introduced , by Rep. Emanuel Chris Welch SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-16 from Ch. 23, par. 5-16 Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care. LRB103 04117 KTG 49123 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB0547 Introduced , by Rep. Emanuel Chris Welch SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-16 from Ch. 23, par. 5-16 305 ILCS 5/5-16 from Ch. 23, par. 5-16 Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care. LRB103 04117 KTG 49123 b LRB103 04117 KTG 49123 b A BILL FOR
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB0547 Introduced , by Rep. Emanuel Chris Welch SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-16 from Ch. 23, par. 5-16 305 ILCS 5/5-16 from Ch. 23, par. 5-16
305 ILCS 5/5-16 from Ch. 23, par. 5-16
Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care.
LRB103 04117 KTG 49123 b LRB103 04117 KTG 49123 b
LRB103 04117 KTG 49123 b
A BILL FOR
HB0547LRB103 04117 KTG 49123 b HB0547 LRB103 04117 KTG 49123 b
HB0547 LRB103 04117 KTG 49123 b
1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5 changing Section 5-16 as follows:
6 (305 ILCS 5/5-16) (from Ch. 23, par. 5-16)
7 Sec. 5-16. Managed Care. The The Illinois Department may
8 develop and implement a Primary Care Sponsor System consistent
9 with the provisions of this Section. The purpose of this
10 managed care delivery system shall be to contain the costs of
11 providing medical care to Medicaid recipients by having one
12 provider responsible for managing all aspects of a recipient's
13 medical care. This managed care system shall have the
14 following characteristics:
15 (a) The Department, by rule, shall establish criteria
16 to determine which clients must participate in this
17 program;
18 (b) Providers participating in the program may be paid
19 an amount per patient per month, to be set by the Illinois
20 Department, for managing each recipient's medical care;
21 (c) Providers eligible to participate in the program
22 shall be physicians licensed to practice medicine in all
23 its branches, and the Illinois Department may terminate a
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB0547 Introduced , by Rep. Emanuel Chris Welch SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-16 from Ch. 23, par. 5-16 305 ILCS 5/5-16 from Ch. 23, par. 5-16
305 ILCS 5/5-16 from Ch. 23, par. 5-16
Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning managed care.
LRB103 04117 KTG 49123 b LRB103 04117 KTG 49123 b
LRB103 04117 KTG 49123 b
A BILL FOR
305 ILCS 5/5-16 from Ch. 23, par. 5-16
LRB103 04117 KTG 49123 b
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1 provider's participation if the provider is determined to
2 have failed to comply with any applicable program standard
3 or procedure established by the Illinois Department;
4 (d) Each recipient required to participate in the
5 program must select from a panel of primary care providers
6 or networks established by the Department in their
7 communities;
8 (e) A recipient may change his designated primary care
9 provider:
10 (1) when the designated source becomes
11 unavailable, as the Illinois Department shall
12 determine by rule; or
13 (2) when the designated primary care provider
14 notifies the Illinois Department that it wishes to
15 withdraw from any obligation as primary care provider;
16 or
17 (3) in other situations, as the Illinois
18 Department shall provide by rule;
19 (f) The Illinois Department shall, by rule, establish
20 procedures for providing medical services when the
21 designated source becomes unavailable or wishes to
22 withdraw from any obligation as primary care provider
23 taking into consideration the need for emergency or
24 temporary medical assistance and ensuring that the
25 recipient has continuous and unrestricted access to
26 medical care from the date on which such unavailability or
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1 withdrawal becomes effective until such time as the
2 recipient designates a primary care source;
3 (g) Only medical care services authorized by a
4 recipient's designated provider, except for emergency
5 services, services performed by a provider that is owned
6 or operated by a county and that provides non-emergency
7 services without regard to ability to pay and such other
8 services as provided by the Illinois Department, shall be
9 subject to payment by the Illinois Department. The
10 Illinois Department shall enter into an intergovernmental
11 agreement with each county that owns or operates such a
12 provider to develop and implement policies to minimize the
13 provision of medical care services provided by county
14 owned or operated providers pursuant to the foregoing
15 exception.
16 The Illinois Department shall seek and obtain necessary
17 authorization provided under federal law to implement such a
18 program including the waiver of any federal regulations.
19 The Illinois Department may implement the amendatory
20 changes to this Section made by this amendatory Act of 1991
21 through the use of emergency rules in accordance with the
22 provisions of Section 5.02 of the Illinois Administrative
23 Procedure Act. For purposes of the Illinois Administrative
24 Procedure Act, the adoption of rules to implement the
25 amendatory changes to this Section made by this amendatory Act
26 of 1991 shall be deemed an emergency and necessary for the
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1 public interest, safety and welfare.
2 The Illinois Department may establish a managed care
3 system demonstration program, on a limited basis, as described
4 in this Section. The demonstration program shall terminate on
5 June 30, 1997. Within 30 days after the end of each year of the
6 demonstration program's operation, the Illinois Department
7 shall report to the Governor and the General Assembly
8 concerning the operation of the demonstration program.
9 (Source: P.A. 87-14; 88-490.)
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