Illinois 2023-2024 Regular Session

Illinois House Bill HB1094 Compare Versions

Only one version of the bill is available at this time.

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1094 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED: New Act Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health care providers. Sets forth the specific standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the program. Requires the State to establish the Illinois Health Services Trust to provide financing for the program. Sets forth the specific requirements for claims billed under the program. Provides that the program shall include funding for long-term care services and mental health services. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Provides that patients in the program shall have the same rights and privacy as they are entitled to under current State and federal law. Provides that the Commissioner, the Chief Medical Officer, the public State board members, and employees of the program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective July 1, 2023. LRB103 04691 CPF 49700 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1094 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED: New Act New Act Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health care providers. Sets forth the specific standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the program. Requires the State to establish the Illinois Health Services Trust to provide financing for the program. Sets forth the specific requirements for claims billed under the program. Provides that the program shall include funding for long-term care services and mental health services. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Provides that patients in the program shall have the same rights and privacy as they are entitled to under current State and federal law. Provides that the Commissioner, the Chief Medical Officer, the public State board members, and employees of the program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective July 1, 2023. LRB103 04691 CPF 49700 b LRB103 04691 CPF 49700 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1094 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
3	3	New Act New Act
4	4	New Act
5	5	Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health care providers. Sets forth the specific standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the program. Requires the State to establish the Illinois Health Services Trust to provide financing for the program. Sets forth the specific requirements for claims billed under the program. Provides that the program shall include funding for long-term care services and mental health services. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Provides that patients in the program shall have the same rights and privacy as they are entitled to under current State and federal law. Provides that the Commissioner, the Chief Medical Officer, the public State board members, and employees of the program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective July 1, 2023.
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11	11	1 AN ACT concerning health.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 1. Short title. This Act may be cited as the Health
15	15	5 Care for All Illinois Act.
16	16	6 Section 5. Purposes. It is the purpose of this Act to
17	17	7 provide universal access to health care for all individuals
18	18	8 within the State, to promote and improve the health of all its
19	19	9 citizens, to stress the importance of good public health
20	20	10 through treatment and prevention of diseases, and to contain
21	21	11 costs to make the delivery of this care affordable. Should
22	22	12 legislation of this kind be enacted on a federal level, it is
23	23	13 the intent of this Act to become a part of a nationwide system.
24	24	14 Section 10. Definitions. In this Act:
25	25	15 "Board" means the Illinois Health Services Governing
26	26	16 Board.
27	27	17 "Program" means the Illinois Health Services Program.
28	28	18 Section 15. Eligibility; registration. All individuals
29	29	19 residing in this State are covered under the Illinois Health
30	30	20 Services Program for health insurance and shall receive a card
31	31	21 with a unique number in the mail. An individual's social
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35	35	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1094 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
36	36	New Act New Act
37	37	New Act
38	38	Creates the Health Care for All Illinois Act. Provides that all individuals residing in this State are covered under the Illinois Health Services Program for health insurance. Sets forth requirements and qualifications of participating health care providers. Sets forth the specific standards for provider reimbursement. Provides that it is unlawful for private health insurers to sell health insurance coverage that duplicates the coverage of the program. Requires the State to establish the Illinois Health Services Trust to provide financing for the program. Sets forth the specific requirements for claims billed under the program. Provides that the program shall include funding for long-term care services and mental health services. Creates the Pharmaceutical and Durable Medical Goods Committee to negotiate the prices of pharmaceuticals and durable medical goods with suppliers or manufacturers on an open bid competitive basis. Provides that patients in the program shall have the same rights and privacy as they are entitled to under current State and federal law. Provides that the Commissioner, the Chief Medical Officer, the public State board members, and employees of the program shall be compensated in accordance with the current pay scale for State employees and as deemed professionally appropriate by the General Assembly. Effective July 1, 2023.
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66	66	1 security number shall not be used for purposes of registration
67	67	2 under this Section. Individuals and families shall receive an
68	68	3 Illinois Health Services Insurance Card in the mail after
69	69	4 filling out a program application form at a health care
70	70	5 provider. Such application form shall be no more than 2 pages
71	71	6 long. Individuals who present themselves for covered services
72	72	7 from a participating provider shall be presumed to be eligible
73	73	8 for benefits under this Act, but shall complete an application
74	74	9 for benefits in order to receive an Illinois Health Services
75	75	10 Insurance Card and have payment made for such benefits.
76	76	11 Section 20. Benefits and portability.
77	77	12 (a) The health coverage benefits under this Act cover all
78	78	13 medically necessary services, including:
79	79	14 (1) primary care and prevention;
80	80	15 (2) specialty care (other than what is deemed elective
81	81	16 cosmetic);
82	82	17 (3) inpatient care;
83	83	18 (4) outpatient care;
84	84	19 (5) emergency care;
85	85	20 (6) prescription drugs;
86	86	21 (7) durable medical equipment;
87	87	22 (8) long-term care;
88	88	23 (9) mental health services;
89	89	24 (10) the full scope of dental services (other than
90	90	25 elective cosmetic dentistry);
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101	101	1 (11) substance abuse treatment services;
102	102	2 (12) chiropractic services; and
103	103	3 (13) basic vision care and vision correction.
104	104	4 (b) Health coverage benefits under this Act are available
105	105	5 through any licensed health care provider anywhere in the
106	106	6 State that is legally qualified to provide such benefits and
107	107	7 for emergency care anywhere in the United States.
108	108	8 (c) No deductibles, copayments, coinsurance, or other cost
109	109	9 sharing shall be imposed with respect to covered benefits
110	110	10 except for those goods or services that exceed basic covered
111	111	11 benefits, as defined by the Board.
112	112	12 Section 25. Qualification of participating providers.
113	113	13 (a) Health care delivery facilities must meet regional and
114	114	14 State quality and licensing guidelines as a condition of
115	115	15 participation under the program, including guidelines
116	116	16 regarding safe staffing and quality of care.
117	117	17 (b) A participating health care provider must be licensed
118	118	18 by the State. No health care provider whose license is under
119	119	19 suspension or has been revoked may participate in the program.
120	120	20 (c) Only nonprofit health maintenance organizations that
121	121	21 actually deliver care in their own facilities and directly
122	122	22 employ clinicians may participate in the program.
123	123	23 (d) Patients shall have free choice of participating
124	124	24 eligible providers, hospitals, and inpatient care facilities.
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135	135	1 Section 30. Provider reimbursement.
136	136	2 (a) The program shall pay all health care providers
137	137	3 according to the following standards:
138	138	4 (1) Physicians and other practitioners can choose to
139	139	5 be paid fee-for-service, salaried by institutions
140	140	6 receiving global budgets, or salaried by group practices
141	141	7 or health maintenance organizations receiving capitation
142	142	8 payments. Investor-owned health maintenance organizations
143	143	9 and group practices shall be converted to not-for-profit
144	144	10 status. Only institutions that deliver care shall be
145	145	11 eligible for program payments.
146	146	12 (2) The program will pay each hospital and providing
147	147	13 institution a monthly lump sum (global budget) to cover
148	148	14 all operating expenses. The hospital and program will
149	149	15 negotiate the amount of this payment annually based on
150	150	16 past budgets, clinical performance, projected changes in
151	151	17 demand for services and input costs, and proposed new
152	152	18 programs. Hospitals shall not bill patients for services
153	153	19 covered by the program, and cannot use any of their
154	154	20 operating budgets for expansion, profit, excessive
155	155	21 executive income, marketing, or major capital purchases or
156	156	22 leases.
157	157	23 (3) The program budget will fund major capital
158	158	24 expenditures, including the construction of new health
159	159	25 facilities and the purchase of expensive equipment. The
160	160	26 regional health planning districts shall allocate these
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171	171	1 capital funds and oversee capital projects funded from
172	172	2 private donations.
173	173	3 (b) The program shall reimburse physicians choosing to be
174	174	4 paid fee-for-service according to a fee schedule negotiated
175	175	5 between physician representatives and the program on at least
176	176	6 an annual basis.
177	177	7 (c) Hospitals, nursing homes, community health centers,
178	178	8 nonprofit staff model health maintenance organizations, and
179	179	9 home health care agencies will receive a global budget to
180	180	10 cover operating expenses, negotiated annually with the program
181	181	11 based on past expenditures, past budgets, clinical
182	182	12 performance, projected changes in demand for services and
183	183	13 input costs, and proposed new programs. Expansions and other
184	184	14 substantive capital investments will be funded separately.
185	185	15 (d) All covered prescription drugs and durable medical
186	186	16 supplies will be paid for according to a fee schedule
187	187	17 negotiated between manufacturers and the program on at least
188	188	18 an annual basis. Price reductions shall be achieved by bulk
189	189	19 purchasing whenever possible. Where therapeutically equivalent
190	190	20 drugs are available, the formulary shall specify the use of
191	191	21 the lowest-cost medication, with exceptions available in the
192	192	22 case of medical necessity.
193	193	23 Section 35. Prohibition against duplicating coverage;
194	194	24 investor-ownership of health delivery facilities.
195	195	25 (a) It is unlawful for a private health insurer to sell
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206	206	1 health insurance coverage that duplicates the benefits
207	207	2 provided under this Act. Nothing in this Act shall be
208	208	3 construed as prohibiting the sale of health insurance coverage
209	209	4 for any additional benefits not covered by this Act.
210	210	5 (b) Investor-ownership of health delivery facilities,
211	211	6 including hospitals, health maintenance organizations, nursing
212	212	7 homes, and clinics, is unlawful. Investor-owners of health
213	213	8 delivery facilities at the time of the effective date of this
214	214	9 Act shall be compensated for the loss of their facilities, but
215	215	10 not for loss of business opportunities or for administrative
216	216	11 capacity not used by the program.
217	217	12 Section 40. Illinois Health Services Trust.
218	218	13 (a) The State shall establish the Illinois Health Services
219	219	14 Trust (IHST), the sole purpose of which shall be to provide the
220	220	15 financing reserve for the purposes outlined in this Act.
221	221	16 Specifically, the IHST shall provide all of the following:
222	222	17 (1) The funds for the general operating budget of the
223	223	18 program.
224	224	19 (2) Reimbursement for those benefits outlined in
225	225	20 Section 20 of this Act.
226	226	21 (3) Public health services.
227	227	22 (4) Capital expenditures for construction or
228	228	23 renovation of health care facilities or major equipment
229	229	24 purchases deemed necessary throughout the State and
230	230	25 approved by the Board.
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241	241	1 (5) Re-education and job placement of persons who have
242	242	2 lost their jobs as a result of this transition, limited to
243	243	3 the first 5 years.
244	244	4 (b) The General Assembly or the Governor may provide funds
245	245	5 to the IHST, but may not remove or borrow funds from the IHST.
246	246	6 (c) The IHST shall be administered by the Board, under the
247	247	7 oversight of the General Assembly.
248	248	8 (d) Funding of the IHST shall include, but is not limited
249	249	9 to, all of the following:
250	250	10 (1) Funds appropriated as outlined by the General
251	251	11 Assembly on a yearly basis.
252	252	12 (2) A progressive set of graduated income
253	253	13 contributions; 20% paid by individuals, 20% paid by
254	254	14 businesses, and 60% paid by the government.
255	255	15 (3) All federal moneys that are designated for health
256	256	16 care, including, but not limited to, all moneys designated
257	257	17 for Medicaid. The Secretary of Human Services shall be
258	258	18 authorized to negotiate with the federal government for
259	259	19 funding of Medicare recipients.
260	260	20 (4) Grants and contributions, both public and private.
261	261	21 (5) Any other tax revenues designated by the General
262	262	22 Assembly.
263	263	23 (6) Any other funds specifically earmarked for health
264	264	24 care or health care education, such as settlements from
265	265	25 litigation.
266	266	26 (e) The total overhead and administrative portion of the
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277	277	1 program budget may not exceed 12% of the total operating
278	278	2 budget of the program for the first 2 years that the program is
279	279	3 in operation; 8% for the following 2 years; and 5% for each
280	280	4 year thereafter.
281	281	5 (f) The program may be divided into regional districts for
282	282	6 the purposes of local administration and oversight of programs
283	283	7 that are specific to each region's needs.
284	284	8 (g) Claims billing from all providers must be submitted
285	285	9 electronically and in compliance with current State and
286	286	10 federal privacy laws within 5 years after the effective date
287	287	11 of this Act. Electronic claims and billing must be uniform
288	288	12 across the State. The Board shall create and implement a
289	289	13 statewide uniform system of electronic medical records that is
290	290	14 in compliance with current State and federal privacy laws
291	291	15 within 7 years after the effective date of this Act. Payments
292	292	16 to providers must be made in a timely fashion as outlined under
293	293	17 current State and federal law. Providers who accept payment
294	294	18 from the program for services rendered may not bill any
295	295	19 patient for covered services. Providers may elect either to
296	296	20 participate fully, or not at all, in the program.
297	297	21 Section 45. Long-term care payment. The Board shall
298	298	22 establish funding for long-term care services, including
299	299	23 in-home, nursing home, and community-based care. A local
300	300	24 public agency shall be established in each community to
301	301	25 determine eligibility and coordinate home and nursing home
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312	312	1 long-term care. This agency may contract with long-term care
313	313	2 providers for the full range of needed long-term care
314	314	3 services.
315	315	4 Section 50. Mental health services. The program shall
316	316	5 provide coverage for all medically necessary mental health
317	317	6 care on the same basis as the coverage for other conditions.
318	318	7 The program shall cover supportive residences, occupational
319	319	8 therapy, and ongoing mental health and counseling services
320	320	9 outside the hospital for patients with serious mental illness.
321	321	10 In all cases the highest quality and most effective care shall
322	322	11 be delivered, including institutional care.
323	323	12 Section 55. Payment for prescription medications, medical
324	324	13 supplies, and medically necessary assistive equipment.
325	325	14 (a) The program shall establish a single prescription drug
326	326	15 formulary and list of approved durable medical goods and
327	327	16 supplies. The Board shall, by itself or by a committee of
328	328	17 health professionals and related individuals appointed by the
329	329	18 Board and called the Pharmaceutical and Durable Medical Goods
330	330	19 Committee, meet on a quarterly basis to discuss, reverse, add
331	331	20 to, or remove items from the formulary according to sound
332	332	21 medical practice.
333	333	22 (b) The Pharmaceutical and Durable Medical Goods Committee
334	334	23 shall negotiate the prices of pharmaceuticals and durable
335	335	24 medical goods with suppliers or manufacturers on an open bid
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346	346	1 competitive basis. Prices shall be reviewed, negotiated, or
347	347	2 renegotiated on no less than an annual basis. The
348	348	3 Pharmaceutical and Durable Medical Goods Committee shall
349	349	4 establish a process of open forum to the public for the
350	350	5 purposes of grievance and petition from suppliers, provider
351	351	6 groups, and the public regarding the formulary no less than 2
352	352	7 times a year.
353	353	8 (c) All pharmacy and durable medical goods vendors must be
354	354	9 licensed to distribute medical goods through the regulations
355	355	10 outlined by the Board.
356	356	11 (d) All decisions and determinations of the Pharmaceutical
357	357	12 and Durable Medical Goods Committee must be presented to and
358	358	13 approved by the Board on an annual basis.
359	359	14 Section 60. Illinois Health Services Governing Board.
360	360	15 (a) The program shall be administered by an independent
361	361	16 agency known as the Illinois Health Services Governing Board.
362	362	17 The Board will consist of a Commissioner, a Chief Medical
363	363	18 Officer, and public State board members. The Board is
364	364	19 responsible for administration of the program, including:
365	365	20 (1) implementation of eligibility standards and
366	366	21 program enrollment;
367	367	22 (2) adoption of the benefits package;
368	368	23 (3) establishing formulas for setting health
369	369	24 expenditure budgets;
370	370	25 (4) administration of global budgets, capital
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381	381	1 expenditure budgets, and prompt reimbursement of
382	382	2 providers;
383	383	3 (5) negotiations of service fee schedules and prices
384	384	4 for prescription drugs and durable medical supplies;
385	385	5 (6) recommending evidence-based changes to benefits;
386	386	6 and
387	387	7 (7) quality and planning functions, including criteria
388	388	8 for capital expansion and infrastructure development,
389	389	9 measurement and evaluation of health quality indicators,
390	390	10 and the establishment of regions for long-term care
391	391	11 integration.
392	392	12 (b) At least one-third of the members of the Board,
393	393	13 including all committees dedicated to benefits design, health
394	394	14 planning, quality, and long-term care, shall be consumer
395	395	15 representatives.
396	396	16 Section 65. Patients' rights. The program shall protect
397	397	17 the rights and privacy of the patients that it serves in
398	398	18 accordance with all current State and federal statutes. With
399	399	19 the development of the electronic medical records, patients
400	400	20 shall be afforded the right and option of keeping any portion
401	401	21 of their medical records separate from the electronic medical
402	402	22 records. Patients have the right to access their medical
403	403	23 records upon demand.
404	404	24 Section 70. Compensation. The Commissioner, the Chief
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415	415	1 Medical Officer, public State board members, and employees of
416	416	2 the program shall be compensated in accordance with the
417	417	3 current pay scale for State employees and as deemed
418	418	4 professionally appropriate by the General Assembly and
419	419	5 reviewed in accordance with all other State employees.
420	420	6 Section 99. Effective date. This Act takes effect July 1,
421	421	7 2023.
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