(215 ILCS 170/1)
(Section scheduled to be repealed on October 1, 2019) Sec. 1. Short title. This Act may be cited as the Covering ALL KIDS Health Insurance Act.
(Source: P.A. 94-693, eff. 7-1-06 .) |
(215 ILCS 170/5) (Section scheduled to be repealed on October 1, 2019)
Sec. 5. Legislative intent. The
General Assembly finds that, for the economic and social benefit of all
residents of the State, it is important to enable all children of this
State to access affordable health insurance that offers comprehensive
coverage and emphasizes preventive healthcare. Many children in working
families, including many families whose family income ranges between
$40,000 and $80,000, are uninsured. Numerous studies, including the
Institute of Medicine's report, "Health Insurance Matters", demonstrate
that lack of insurance negatively affects health status. The General
Assembly further finds that access to healthcare is a key component for
children's healthy development and successful education. The effects of
lack of insurance also negatively impact those who are insured because
the cost of paying for care to the uninsured is often shifted to those
who have insurance in the form of higher health insurance premiums. A
Families USA 2005 report indicates that family premiums in Illinois are
increased by $1,059 due to cost-shifting from the uninsured. It is,
therefore, the intent of this legislation to provide access to
affordable health insurance to all uninsured children in Illinois.
(Source: P.A. 94-693, eff. 7-1-06 .) |
(215 ILCS 170/7) (Section scheduled to be repealed on October 1, 2019) Sec. 7. Eligibility verification. Notwithstanding
any other provision of this Act, with respect to applications for
benefits provided under the Program, eligibility shall be determined in a
manner that ensures program integrity and that complies with federal
law and regulations while minimizing unnecessary barriers to enrollment.
To this end, as soon as practicable, and unless the Department receives
written denial from the federal government, this Section shall be
implemented: (a) The Department of Healthcare and Family Services or its designees shall: (1) By July 1, 2011, require verification of, at a | ||
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(2) By October 1, 2011, require verification of, at a | ||
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(3) By July 1, 2011, require verification of | ||
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(b)
The Department shall establish or continue cooperative
arrangements with the Social Security Administration, the
Illinois Secretary of State, the Department of Human Services,
the Department of Revenue, the Department of Employment
Security, and any other appropriate entity to gain electronic
access, to the extent allowed by law, to information available
to those entities that may be appropriate for electronically
verifying any factor of eligibility for benefits under the
Program. Data relevant to eligibility shall be provided for no
other purpose than to verify the eligibility of new applicants
or current recipients of health benefits under the Program. Data will
be requested or provided for any new applicant or current recipient only
insofar as that individual's circumstances are relevant to that
individual's or another individual's eligibility. (c)
Within 90 days of the effective date of this amendatory Act of the 96th
General Assembly, the Department of Healthcare and Family Services
shall send notice to current recipients informing them of the changes
regarding their eligibility verification.
(Source: P.A. 98-651, eff. 6-16-14 .) |
(215 ILCS 170/10) (Section scheduled to be repealed on October 1, 2019)
Sec. 10. Definitions. In this Act: "Application
agent" means an organization or individual, such as a licensed health
care provider, school, youth service agency, employer, labor union,
local chamber of commerce, community-based organization, or other
organization, approved by the Department to assist in enrolling children
in the Program.
"Child" means a person under the age of 19.
"Department" means the Department of Healthcare and Family Services.
"Medical assistance" means health care benefits provided under Article V of the Illinois Public Aid Code.
"Program" means the Covering ALL KIDS Health Insurance Program.
"Resident"
means an individual (i) who is in the State for other than a temporary
or transitory purpose during the taxable year or (ii) who is domiciled
in this State but is absent from the State for a temporary or transitory
purpose during the taxable year.
(Source: P.A. 94-693, eff. 7-1-06 .) |
(215 ILCS 170/15) (Section scheduled to be repealed on October 1, 2019)
Sec. 15. Operation of Program. The
Covering ALL KIDS Health Insurance Program is created. The Program
shall be administered by the Department of Healthcare and Family
Services. The Department shall have the same powers and authority to
administer the Program as are provided to the Department in connection
with the Department's administration of the Illinois Public Aid Code,
including, but not limited to, the provisions under Section 11-5.1 of
the Code, and the Children's Health Insurance Program Act. The
Department shall coordinate the Program with the existing children's
health programs operated by the Department and other State agencies.
Effective October 1, 2013, the determination of eligibility under this
Act shall comply with the requirements of 42 U.S.C. 1397bb(b)(1)(B)(v)
and applicable federal regulations. If changes made to this Section
require federal approval, they shall not take effect until such approval
has been received.
(Source: P.A. 98-104, eff. 7-22-13 .) |
(215 ILCS 170/20) (Section scheduled to be repealed on October 1, 2019)
Sec. 20. Eligibility. (a) To be eligible for the Program, a person must be a child:
(1) who is a resident of the State of Illinois; (2) who is ineligible for medical assistance under | ||
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(3) who (i) effective July 1, 2014, in accordance | ||
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(3.5) whose household income, as determined, | ||
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An
entity that provides health insurance coverage (as defined in Section 2
of the Comprehensive Health Insurance Plan Act) to Illinois residents
shall provide health insurance data match to the Department of
Healthcare and Family Services as provided by and subject to Section 5.5
of the Illinois Insurance Code. The Department of Healthcare and Family
Services may impose an administrative penalty as provided under Section
12-4.45 of the Illinois Public Aid Code on entities that have
established a pattern of failure to provide the information required
under this Section. The
Department of Healthcare and Family Services, in collaboration with the
Department of Insurance, shall adopt rules governing the exchange of
information under this Section. The rules shall be consistent with all
laws relating to the confidentiality or privacy of personal information
or medical records, including provisions under the Federal Health
Insurance Portability and Accountability Act (HIPAA). (b)
The Department shall monitor the availability and retention of
employer-sponsored dependent health insurance coverage and shall modify
the period described in subdivision (a)(3) if necessary to promote
retention of private or employer-sponsored health insurance and timely
access to healthcare services, but at no time shall the period described
in subdivision (a)(3) be less than 6 months.
(c)
The Department, at its discretion, may take into account the
affordability of dependent health insurance when determining whether
employer-sponsored dependent health insurance coverage is available upon
reemployment of a child's parent as provided in subdivision (a)(3). (d)
A child who is determined to be eligible for the Program shall remain
eligible for 12 months, provided that the child maintains his or her
residence in this State, has not yet attained 19 years of age, and is
not excluded under subsection (e). (e) A child is not eligible for coverage under the Program if: (1) the premium required under Section 40 has not | ||
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(2) the child is an inmate of a public institution or | ||
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(f)
The Department may adopt rules, including, but not limited to: rules
regarding annual renewals of eligibility for the Program in conformance
with Section 7 of this Act; rules providing for re-enrollment, grace
periods, notice requirements, and hearing procedures under subdivision
(e)(1) of this Section; and rules regarding what constitutes
availability and affordability of private or employer-sponsored health
insurance, with consideration of such factors as the percentage of
income needed to purchase children or family health insurance, the
availability of employer subsidies, and other relevant factors.
(g)
Each child enrolled in the Program as of July 1, 2011 whose family
income, as established by the Department, exceeds 300% of the federal
poverty level may remain enrolled in the Program for 12 additional
months commencing July 1, 2011. Continued enrollment pursuant to this
subsection shall be available only if the child continues to meet all
eligibility criteria established under the Program as of the effective
date of this amendatory Act of the 96th General Assembly without a break
in coverage. Nothing contained in this subsection shall prevent a child
from qualifying for any other health benefits program operated by the
Department. (Source: P.A. 98-130, eff. 8-2-13; 98-651, eff. 6-16-14 .) |
(215 ILCS 170/21) (Section scheduled to be repealed on October 1, 2019) Sec. 21. Presumptive eligibility. Beginning
on the effective date of this amendatory Act of the 96th General
Assembly and except where federal law or regulation requires presumptive
eligibility, no adult may be presumed eligible for health care
coverage under the Program and the Department may not cover any service
rendered to an adult unless the adult has completed an application for
benefits, all required verifications have been received, and the
Department or its designee has found the adult eligible for the date on
which that service was provided. Nothing in this Section shall apply to
pregnant women.
(Source: P.A. 96-1501, eff. 1-25-11 .) |
(215 ILCS 170/25) (Section scheduled to be repealed on October 1, 2019)
Sec. 25. Enrollment in Program. The
Department shall develop procedures to allow application agents to
assist in enrolling children in the Program or other children's health
programs operated by the Department. At the Department's discretion,
technical assistance payments may be made available for approved
applications facilitated by an application agent. The Department shall
permit day and temporary labor service agencies, as defined in the Day
and Temporary Labor Services Act and doing business in Illinois, to
enroll as unpaid application agents. As established in the Free
Healthcare Benefits Application Assistance Act, it shall be unlawful for
any person to charge another person or family for assisting in
completing and submitting an application for enrollment in this Program.
(Source: P.A. 96-326, eff. 8-11-09 .) |
(215 ILCS 170/30) (Section scheduled to be repealed on October 1, 2019)
Sec. 30. Program outreach and marketing. The
Department may provide grants to application agents and other
community-based organizations to educate the public about the
availability of the Program. The Department shall adopt rules regarding
performance standards and outcomes measures expected of organizations
that are awarded grants under this Section, including penalties for
nonperformance of contract standards.
The
Department shall annually publish electronically on a State website the
premiums or other cost sharing requirements of the Program.
(Source: P.A. 97-689, eff. 6-14-12 .) |
(215 ILCS 170/35) (Section scheduled to be repealed on October 1, 2019)
Sec. 35. Health care benefits for children. (a)
The Department shall purchase or provide health care benefits for
eligible children that are identical to the benefits provided for
children under the Illinois Children's Health Insurance Program Act,
except for non-emergency transportation.
(b)
As an alternative to the benefits set forth in subsection (a), and when
cost-effective, the Department may offer families subsidies toward the
cost of privately sponsored health insurance, including
employer-sponsored health insurance.
(c)
Notwithstanding clause (i) of subdivision (a)(3) of Section 20, the
Department may consider offering, as an alternative to the benefits set
forth in subsection (a), partial coverage to children who are enrolled
in a high-deductible private health insurance plan.
(d)
Notwithstanding clause (i) of subdivision (a)(3) of Section 20, the
Department may consider offering, as an alternative to the benefits set
forth in subsection (a), a limited package of benefits to children in
families who have private or employer-sponsored health insurance that
does not cover certain benefits such as dental or vision benefits.
(e)
The content and availability of benefits described in subsections (b),
(c), and (d), and the terms of eligibility for those benefits, shall be
at the Department's discretion and the Department's determination of
efficacy and cost-effectiveness as a means of promoting retention of
private or employer-sponsored health insurance.
(f)
On and after July 1, 2012, the Department shall reduce any rate of
reimbursement for services or other payments or alter any methodologies
authorized by this Act or the Illinois Public Aid Code to reduce any
rate of reimbursement for services or other payments in accordance with
Section 5-5e of the Illinois Public Aid Code. (Source: P.A. 97-689, eff. 6-14-12 .) |
(215 ILCS 170/36) (Section scheduled to be repealed on October 1, 2019) Sec. 36. Moratorium on eligibility expansions. Beginning
on the effective date of this amendatory Act of the 96th General
Assembly, there shall be a 2-year moratorium on the expansion of
eligibility through increasing financial eligibility standards, or
through increasing income disregards, or through the creation of new
programs that would add new categories of eligible individuals under the
medical assistance program under the Illinois Public Aid Code in
addition to those categories covered on January 1, 2011. This moratorium
shall not apply to expansions required as a federal condition of State
participation in the medical assistance program.
(Source: P.A. 96-1501, eff. 1-25-11 .) |
(215 ILCS 170/40) (Section scheduled to be repealed on October 1, 2019)
Sec. 40. Cost-sharing. (a) Children enrolled in the Program under subsection (a) of Section 35 are subject to the following cost-sharing requirements:
(1) The Department, by rule, shall set forth | ||
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(2) Notwithstanding paragraph (1), there shall be no | ||
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(b)
Children enrolled in a privately sponsored health insurance plan under
subsection (b) of Section 35 are subject to the cost-sharing provisions
stated in the privately sponsored health insurance plan.
(c)
Notwithstanding any other provision of law, rates paid by the
Department shall not be used in any way to determine the usual and
customary or reasonable charge, which is the charge for health care that
is consistent with the average rate or charge for similar services
furnished by similar providers in a certain geographic area.
(Source: P.A. 94-693, eff. 7-1-06 .) |
(215 ILCS 170/41) (Section scheduled to be repealed on October 1, 2019)
Sec. 41. Health care provider participation in State Employees Deferred Compensation Plan. Notwithstanding
any other provision of law, a health care provider who participates
under the Program may elect, in lieu of receiving direct payment for
services provided under the Program, to participate in the State
Employees Deferred Compensation Plan adopted under Article 24 of the
Illinois Pension Code. A health care provider who elects to participate
in the plan does not have a cause of action against the State for any
damages allegedly suffered by the provider as a result of any delay by
the State in crediting the amount of any contribution to the provider's
plan account.
(Source: P.A. 96-806, eff. 7-1-10 .) |
(215 ILCS 170/45)
(Section scheduled to be repealed on October 1, 2019) Sec. 45. Study; contracts. (a) The Department shall conduct a study that includes, but is not limited to, the following: (1) Establishing estimates, broken down by regions of | ||
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(2) Surveying those families whose children have | ||
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(3) Ascertaining, for the population of children | ||
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(4) Measuring the health outcomes or other benefits | ||
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(b)
The studies described in subsection (a) shall be conducted in a manner
that compares a time period preceding or at the initiation of the
program with a later period. (c)
The Department shall submit the preliminary results of the study to the
Governor and the General Assembly no later than July 1, 2008 and shall
submit the final results to the Governor and the General Assembly no
later than July 1, 2010.
(d)
The Department shall submit copies of all contracts awarded for the
administration of the Program to the Speaker of the House of
Representatives, the Minority Leader of the House of Representatives,
the President of the Senate, and the Minority Leader of the Senate.
(Source: P.A. 94-693, eff. 7-1-06; 95-985, eff. 6-1-09 .) |
(215 ILCS 170/47) (Section scheduled to be repealed on October 1, 2019)
Sec. 47. Program information. The
Department shall report to the General Assembly no later than September
1 of each year beginning in 2007, all of the following information: (a) The number of professionals serving in the | ||
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(b) The number of non-primary care providers | ||
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(c) The number of individuals enrolled in the | ||
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(Source: P.A. 95-650, eff. 6-1-08 .) |
(215 ILCS 170/50) (Section scheduled to be repealed on October 1, 2019)
Sec. 50. Consultation with stakeholders. The
Department shall present details regarding implementation of the
Program to the Medicaid Advisory Committee, and the Committee shall
serve as the forum for healthcare providers, advocates, consumers, and
other interested parties to advise the Department with respect to the
Program. The Department shall consult with stakeholders on the rules for
healthcare professional participation in the Program pursuant to
Sections 52 and 53 of this Act.
(Source: P.A. 94-693, eff. 7-1-06; 95-650, eff. 6-1-08 .) |
(215 ILCS 170/52) (Section scheduled to be repealed on October 1, 2019) Sec. 52. Adequate access to specialty care. (a)
The Department shall ensure adequate access to specialty physician care
for Program participants by allowing referrals to be accomplished
without undue delay. (b)
The Department shall allow a primary care provider to make appropriate
referrals to specialist physicians or other healthcare providers for an
enrollee who has a condition that requires care from a specialist
physician or other healthcare provider. The Department may specify the
necessary criteria and conditions that must be met in order for an
enrollee to obtain a standing referral. A referral shall be effective
for the period necessary to provide the referred services or one year,
whichever is less. A primary care provider may renew and re-renew a
referral. (c)
The enrollee's primary care provider shall remain responsible for
coordinating the care of an enrollee who has received a standing
referral to a specialist physician or other healthcare provider. If a
secondary referral is necessary, the specialist physician or other
healthcare provider shall advise the primary care physician. The primary
care physician or specialist physician shall be responsible for making
the secondary referral. In addition, the Department shall require the
specialist physician or other healthcare provider to provide regular
updates to the enrollee's primary care provider.
(Source: P.A. 95-650, eff. 6-1-08 .) |
(215 ILCS 170/53) (Section scheduled to be repealed on October 1, 2019) Sec. 53. Program standards. (a)
Any disease management program implemented by the Department must be or
must have been developed in consultation with physician organizations,
such as State, national, and specialty medical societies, and any
available standards or guidelines of these organizations. These programs
must be based on evidence-based, scientifically sound principles that
are accepted by the medical community. An enrollee must be excused from
participation in a disease management program if the enrollee's
physician licensed to practice medicine in all its branches, in his or
her professional judgment, determines that participation is not
beneficial to the enrollee. (b)
Any performance measures, such as primary care provider monitoring,
implemented by the Department must be or must have been developed on
consultation with physician organizations, such as State, national, and
specialty medical societies, and any available standards or guidelines
of these organizations. These measures must be based on evidence-based,
scientifically sound principles that are accepted by the medical
community. (c)
The Department shall adopt variance procedures for the application of
any disease management program or any performance measures to an
individual enrollee.
(Source: P.A. 95-650, eff. 6-1-08 .) |
(215 ILCS 170/54) (Section scheduled to be repealed on October 1, 2019) Sec. 54. Dental home initiative. The
Department, in cooperation with the dental community and other affected
organizations such as Head Start, shall work to develop and promote the
concept of a dental home for children covered under this Act. Included
in this dental home outreach should be an effort to ensure an ongoing
relationship between the patient and the dentist with an effort to
provide comprehensive, coordinated, oral health care so that all
children covered under this Act have access to preventative and
restorative oral health care.
(Source: P.A. 97-283, eff. 8-9-11 .) |
(215 ILCS 170/55) (Section scheduled to be repealed on October 1, 2019)
Sec. 55. Charge upon claims and causes of action; right of subrogation; recoveries. Sections
11-22, 11-22a, 11-22b, and 11-22c of the Illinois Public Aid Code apply
to health care benefits provided to children under this Act, as
provided in those Sections.
(Source: P.A. 94-693, eff. 7-1-06 .) |
(215 ILCS 170/56) (Section scheduled to be repealed on October 1, 2019) Sec. 56. 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.
(Source: P.A. 96-1501, eff. 1-25-11 .) |
(215 ILCS 170/60) (Section scheduled to be repealed on October 1, 2019)
Sec. 60. Federal financial participation. The
Department shall request any necessary state plan amendments or waivers
of federal requirements in order to allow receipt of federal funds for
implementing any or all of the provisions of the Program. The failure
of the responsible federal agency to approve a waiver or other State
plan amendment shall not prevent the implementation of any provision of
this Act.
(Source: P.A. 94-693, eff. 7-1-06 .) |
(215 ILCS 170/63) (Section scheduled to be repealed on October 1, 2019) Sec. 63. Audits by the Auditor General. The
Auditor General shall annually cause an audit to be made of the
Program, beginning June 30, 2008 and each June 30th thereafter. The
audit shall include payments for health services covered by the Program
and contracts entered into by the Department in relation to the Program.
(Source: P.A. 95-985, eff. 6-1-09 .) |
(215 ILCS 170/65)
Sec. 65. (Repealed).
(Source: P.A. 94-693, eff. 7-1-06. Repealed internally, eff. 7-1-08.) |
(215 ILCS 170/90)
Sec. 90.
(Amendatory provisions; text omitted).
(Source: P.A. 94-693, eff. 7-1-06; text omitted .) |
(215 ILCS 170/97) (Section scheduled to be repealed on October 1, 2019)
Sec. 97. Severability. If
any provision of this Act or its application to any person or
circumstance is held invalid, the invalidity of that provision or
application does not affect other provisions or applications of this Act
that can be given effect without the invalid provision or application,
and to this end the provisions of this Act are severable.
(Source: P.A. 94-693, eff. 7-1-06 .) |
(215 ILCS 170/98) (Section scheduled to be repealed on October 1, 2019)
Sec. 98. Repealer. This Act is repealed on October 1, 2019.
(Source: P.A. 99-518, eff. 6-30-16.) |
(215 ILCS 170/99) (Section scheduled to be repealed on October 1, 2019)
Sec. 99. Effective date. This Act takes effect July 1, 2006.
(Source: P.A. 94-693, eff. 7-1-06 .) |