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
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1094 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
New Act 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
LRB103 04691 CPF 49700 b
A BILL FOR
HB1094LRB103 04691 CPF 49700 b HB1094 LRB103 04691 CPF 49700 b
HB1094 LRB103 04691 CPF 49700 b
1 AN ACT concerning health.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the Health
5 Care for All Illinois Act.
6 Section 5. Purposes. It is the purpose of this Act to
7 provide universal access to health care for all individuals
8 within the State, to promote and improve the health of all its
9 citizens, to stress the importance of good public health
10 through treatment and prevention of diseases, and to contain
11 costs to make the delivery of this care affordable. Should
12 legislation of this kind be enacted on a federal level, it is
13 the intent of this Act to become a part of a nationwide system.
14 Section 10. Definitions. In this Act:
15 "Board" means the Illinois Health Services Governing
16 Board.
17 "Program" means the Illinois Health Services Program.
18 Section 15. Eligibility; registration. All individuals
19 residing in this State are covered under the Illinois Health
20 Services Program for health insurance and shall receive a card
21 with a unique number in the mail. An individual's social
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB1094 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
New Act 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
LRB103 04691 CPF 49700 b
A BILL FOR
New Act
LRB103 04691 CPF 49700 b
HB1094 LRB103 04691 CPF 49700 b
HB1094- 2 -LRB103 04691 CPF 49700 b HB1094 - 2 - LRB103 04691 CPF 49700 b
HB1094 - 2 - LRB103 04691 CPF 49700 b
1 security number shall not be used for purposes of registration
2 under this Section. Individuals and families shall receive an
3 Illinois Health Services Insurance Card in the mail after
4 filling out a program application form at a health care
5 provider. Such application form shall be no more than 2 pages
6 long. Individuals who present themselves for covered services
7 from a participating provider shall be presumed to be eligible
8 for benefits under this Act, but shall complete an application
9 for benefits in order to receive an Illinois Health Services
10 Insurance Card and have payment made for such benefits.
11 Section 20. Benefits and portability.
12 (a) The health coverage benefits under this Act cover all
13 medically necessary services, including:
14 (1) primary care and prevention;
15 (2) specialty care (other than what is deemed elective
16 cosmetic);
17 (3) inpatient care;
18 (4) outpatient care;
19 (5) emergency care;
20 (6) prescription drugs;
21 (7) durable medical equipment;
22 (8) long-term care;
23 (9) mental health services;
24 (10) the full scope of dental services (other than
25 elective cosmetic dentistry);
HB1094 - 2 - LRB103 04691 CPF 49700 b
HB1094- 3 -LRB103 04691 CPF 49700 b HB1094 - 3 - LRB103 04691 CPF 49700 b
HB1094 - 3 - LRB103 04691 CPF 49700 b
1 (11) substance abuse treatment services;
2 (12) chiropractic services; and
3 (13) basic vision care and vision correction.
4 (b) Health coverage benefits under this Act are available
5 through any licensed health care provider anywhere in the
6 State that is legally qualified to provide such benefits and
7 for emergency care anywhere in the United States.
8 (c) No deductibles, copayments, coinsurance, or other cost
9 sharing shall be imposed with respect to covered benefits
10 except for those goods or services that exceed basic covered
11 benefits, as defined by the Board.
12 Section 25. Qualification of participating providers.
13 (a) Health care delivery facilities must meet regional and
14 State quality and licensing guidelines as a condition of
15 participation under the program, including guidelines
16 regarding safe staffing and quality of care.
17 (b) A participating health care provider must be licensed
18 by the State. No health care provider whose license is under
19 suspension or has been revoked may participate in the program.
20 (c) Only nonprofit health maintenance organizations that
21 actually deliver care in their own facilities and directly
22 employ clinicians may participate in the program.
23 (d) Patients shall have free choice of participating
24 eligible providers, hospitals, and inpatient care facilities.
HB1094 - 3 - LRB103 04691 CPF 49700 b
HB1094- 4 -LRB103 04691 CPF 49700 b HB1094 - 4 - LRB103 04691 CPF 49700 b
HB1094 - 4 - LRB103 04691 CPF 49700 b
1 Section 30. Provider reimbursement.
2 (a) The program shall pay all health care providers
3 according to the following standards:
4 (1) Physicians and other practitioners can choose to
5 be paid fee-for-service, salaried by institutions
6 receiving global budgets, or salaried by group practices
7 or health maintenance organizations receiving capitation
8 payments. Investor-owned health maintenance organizations
9 and group practices shall be converted to not-for-profit
10 status. Only institutions that deliver care shall be
11 eligible for program payments.
12 (2) The program will pay each hospital and providing
13 institution a monthly lump sum (global budget) to cover
14 all operating expenses. The hospital and program will
15 negotiate the amount of this payment annually based on
16 past budgets, clinical performance, projected changes in
17 demand for services and input costs, and proposed new
18 programs. Hospitals shall not bill patients for services
19 covered by the program, and cannot use any of their
20 operating budgets for expansion, profit, excessive
21 executive income, marketing, or major capital purchases or
22 leases.
23 (3) The program budget will fund major capital
24 expenditures, including the construction of new health
25 facilities and the purchase of expensive equipment. The
26 regional health planning districts shall allocate these
HB1094 - 4 - LRB103 04691 CPF 49700 b
HB1094- 5 -LRB103 04691 CPF 49700 b HB1094 - 5 - LRB103 04691 CPF 49700 b
HB1094 - 5 - LRB103 04691 CPF 49700 b
1 capital funds and oversee capital projects funded from
2 private donations.
3 (b) The program shall reimburse physicians choosing to be
4 paid fee-for-service according to a fee schedule negotiated
5 between physician representatives and the program on at least
6 an annual basis.
7 (c) Hospitals, nursing homes, community health centers,
8 nonprofit staff model health maintenance organizations, and
9 home health care agencies will receive a global budget to
10 cover operating expenses, negotiated annually with the program
11 based on past expenditures, past budgets, clinical
12 performance, projected changes in demand for services and
13 input costs, and proposed new programs. Expansions and other
14 substantive capital investments will be funded separately.
15 (d) All covered prescription drugs and durable medical
16 supplies will be paid for according to a fee schedule
17 negotiated between manufacturers and the program on at least
18 an annual basis. Price reductions shall be achieved by bulk
19 purchasing whenever possible. Where therapeutically equivalent
20 drugs are available, the formulary shall specify the use of
21 the lowest-cost medication, with exceptions available in the
22 case of medical necessity.
23 Section 35. Prohibition against duplicating coverage;
24 investor-ownership of health delivery facilities.
25 (a) It is unlawful for a private health insurer to sell
HB1094 - 5 - LRB103 04691 CPF 49700 b
HB1094- 6 -LRB103 04691 CPF 49700 b HB1094 - 6 - LRB103 04691 CPF 49700 b
HB1094 - 6 - LRB103 04691 CPF 49700 b
1 health insurance coverage that duplicates the benefits
2 provided under this Act. Nothing in this Act shall be
3 construed as prohibiting the sale of health insurance coverage
4 for any additional benefits not covered by this Act.
5 (b) Investor-ownership of health delivery facilities,
6 including hospitals, health maintenance organizations, nursing
7 homes, and clinics, is unlawful. Investor-owners of health
8 delivery facilities at the time of the effective date of this
9 Act shall be compensated for the loss of their facilities, but
10 not for loss of business opportunities or for administrative
11 capacity not used by the program.
12 Section 40. Illinois Health Services Trust.
13 (a) The State shall establish the Illinois Health Services
14 Trust (IHST), the sole purpose of which shall be to provide the
15 financing reserve for the purposes outlined in this Act.
16 Specifically, the IHST shall provide all of the following:
17 (1) The funds for the general operating budget of the
18 program.
19 (2) Reimbursement for those benefits outlined in
20 Section 20 of this Act.
21 (3) Public health services.
22 (4) Capital expenditures for construction or
23 renovation of health care facilities or major equipment
24 purchases deemed necessary throughout the State and
25 approved by the Board.
HB1094 - 6 - LRB103 04691 CPF 49700 b
HB1094- 7 -LRB103 04691 CPF 49700 b HB1094 - 7 - LRB103 04691 CPF 49700 b
HB1094 - 7 - LRB103 04691 CPF 49700 b
1 (5) Re-education and job placement of persons who have
2 lost their jobs as a result of this transition, limited to
3 the first 5 years.
4 (b) The General Assembly or the Governor may provide funds
5 to the IHST, but may not remove or borrow funds from the IHST.
6 (c) The IHST shall be administered by the Board, under the
7 oversight of the General Assembly.
8 (d) Funding of the IHST shall include, but is not limited
9 to, all of the following:
10 (1) Funds appropriated as outlined by the General
11 Assembly on a yearly basis.
12 (2) A progressive set of graduated income
13 contributions; 20% paid by individuals, 20% paid by
14 businesses, and 60% paid by the government.
15 (3) All federal moneys that are designated for health
16 care, including, but not limited to, all moneys designated
17 for Medicaid. The Secretary of Human Services shall be
18 authorized to negotiate with the federal government for
19 funding of Medicare recipients.
20 (4) Grants and contributions, both public and private.
21 (5) Any other tax revenues designated by the General
22 Assembly.
23 (6) Any other funds specifically earmarked for health
24 care or health care education, such as settlements from
25 litigation.
26 (e) The total overhead and administrative portion of the
HB1094 - 7 - LRB103 04691 CPF 49700 b
HB1094- 8 -LRB103 04691 CPF 49700 b HB1094 - 8 - LRB103 04691 CPF 49700 b
HB1094 - 8 - LRB103 04691 CPF 49700 b
1 program budget may not exceed 12% of the total operating
2 budget of the program for the first 2 years that the program is
3 in operation; 8% for the following 2 years; and 5% for each
4 year thereafter.
5 (f) The program may be divided into regional districts for
6 the purposes of local administration and oversight of programs
7 that are specific to each region's needs.
8 (g) Claims billing from all providers must be submitted
9 electronically and in compliance with current State and
10 federal privacy laws within 5 years after the effective date
11 of this Act. Electronic claims and billing must be uniform
12 across the State. The Board shall create and implement a
13 statewide uniform system of electronic medical records that is
14 in compliance with current State and federal privacy laws
15 within 7 years after the effective date of this Act. Payments
16 to providers must be made in a timely fashion as outlined under
17 current State and federal law. Providers who accept payment
18 from the program for services rendered may not bill any
19 patient for covered services. Providers may elect either to
20 participate fully, or not at all, in the program.
21 Section 45. Long-term care payment. The Board shall
22 establish funding for long-term care services, including
23 in-home, nursing home, and community-based care. A local
24 public agency shall be established in each community to
25 determine eligibility and coordinate home and nursing home
HB1094 - 8 - LRB103 04691 CPF 49700 b
HB1094- 9 -LRB103 04691 CPF 49700 b HB1094 - 9 - LRB103 04691 CPF 49700 b
HB1094 - 9 - LRB103 04691 CPF 49700 b
1 long-term care. This agency may contract with long-term care
2 providers for the full range of needed long-term care
3 services.
4 Section 50. Mental health services. The program shall
5 provide coverage for all medically necessary mental health
6 care on the same basis as the coverage for other conditions.
7 The program shall cover supportive residences, occupational
8 therapy, and ongoing mental health and counseling services
9 outside the hospital for patients with serious mental illness.
10 In all cases the highest quality and most effective care shall
11 be delivered, including institutional care.
12 Section 55. Payment for prescription medications, medical
13 supplies, and medically necessary assistive equipment.
14 (a) The program shall establish a single prescription drug
15 formulary and list of approved durable medical goods and
16 supplies. The Board shall, by itself or by a committee of
17 health professionals and related individuals appointed by the
18 Board and called the Pharmaceutical and Durable Medical Goods
19 Committee, meet on a quarterly basis to discuss, reverse, add
20 to, or remove items from the formulary according to sound
21 medical practice.
22 (b) The Pharmaceutical and Durable Medical Goods Committee
23 shall negotiate the prices of pharmaceuticals and durable
24 medical goods with suppliers or manufacturers on an open bid
HB1094 - 9 - LRB103 04691 CPF 49700 b
HB1094- 10 -LRB103 04691 CPF 49700 b HB1094 - 10 - LRB103 04691 CPF 49700 b
HB1094 - 10 - LRB103 04691 CPF 49700 b
1 competitive basis. Prices shall be reviewed, negotiated, or
2 renegotiated on no less than an annual basis. The
3 Pharmaceutical and Durable Medical Goods Committee shall
4 establish a process of open forum to the public for the
5 purposes of grievance and petition from suppliers, provider
6 groups, and the public regarding the formulary no less than 2
7 times a year.
8 (c) All pharmacy and durable medical goods vendors must be
9 licensed to distribute medical goods through the regulations
10 outlined by the Board.
11 (d) All decisions and determinations of the Pharmaceutical
12 and Durable Medical Goods Committee must be presented to and
13 approved by the Board on an annual basis.
14 Section 60. Illinois Health Services Governing Board.
15 (a) The program shall be administered by an independent
16 agency known as the Illinois Health Services Governing Board.
17 The Board will consist of a Commissioner, a Chief Medical
18 Officer, and public State board members. The Board is
19 responsible for administration of the program, including:
20 (1) implementation of eligibility standards and
21 program enrollment;
22 (2) adoption of the benefits package;
23 (3) establishing formulas for setting health
24 expenditure budgets;
25 (4) administration of global budgets, capital
HB1094 - 10 - LRB103 04691 CPF 49700 b
HB1094- 11 -LRB103 04691 CPF 49700 b HB1094 - 11 - LRB103 04691 CPF 49700 b
HB1094 - 11 - LRB103 04691 CPF 49700 b
1 expenditure budgets, and prompt reimbursement of
2 providers;
3 (5) negotiations of service fee schedules and prices
4 for prescription drugs and durable medical supplies;
5 (6) recommending evidence-based changes to benefits;
6 and
7 (7) quality and planning functions, including criteria
8 for capital expansion and infrastructure development,
9 measurement and evaluation of health quality indicators,
10 and the establishment of regions for long-term care
11 integration.
12 (b) At least one-third of the members of the Board,
13 including all committees dedicated to benefits design, health
14 planning, quality, and long-term care, shall be consumer
15 representatives.
16 Section 65. Patients' rights. The program shall protect
17 the rights and privacy of the patients that it serves in
18 accordance with all current State and federal statutes. With
19 the development of the electronic medical records, patients
20 shall be afforded the right and option of keeping any portion
21 of their medical records separate from the electronic medical
22 records. Patients have the right to access their medical
23 records upon demand.
24 Section 70. Compensation. The Commissioner, the Chief
HB1094 - 11 - LRB103 04691 CPF 49700 b
HB1094- 12 -LRB103 04691 CPF 49700 b HB1094 - 12 - LRB103 04691 CPF 49700 b
HB1094 - 12 - LRB103 04691 CPF 49700 b
1 Medical Officer, public State board members, and employees of
2 the program shall be compensated in accordance with the
3 current pay scale for State employees and as deemed
4 professionally appropriate by the General Assembly and
5 reviewed in accordance with all other State employees.
6 Section 99. Effective date. This Act takes effect July 1,
7 2023.
HB1094 - 12 - LRB103 04691 CPF 49700 b