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215 ILCS 170/ Covering ALL KIDS Health Insurance Act.

    (215 ILCS 170/1)
    (Section scheduled to be repealed on July 1, 2011)
    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    (Section scheduled to be repealed on July 1, 2011)
    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 170/10)
    (Section scheduled to be repealed on July 1, 2011)
    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 July 1, 2011)
    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 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.
(Source: P.A. 94‑693, eff. 7‑1‑06.)

    (215 ILCS 170/20)
    (Section scheduled to be repealed on July 1, 2011)
    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; and
        (2) who is ineligible for medical assistance under

the Illinois Public Aid Code or benefits under the Children's Health Insurance Program Act; and

(3) either (i) who has been without health insurance

coverage for a period set forth by the Department in rules, but not less than 6 months during the first month of operation of the Program, 7 months during the second month of operation, 8 months during the third month of operation, 9 months during the fourth month of operation, 10 months during the fifth month of operation, 11 months during the sixth month of operation, and 12 months thereafter, (ii) whose parent has lost employment that made available affordable dependent health insurance coverage, until such time as affordable employer‑sponsored dependent health insurance coverage is again available for the child as set forth by the Department in rules, (iii) who is a newborn whose responsible relative does not have available affordable private or employer‑sponsored health insurance, or (iv) who, within one year of applying for coverage under this Act, lost medical benefits under the Illinois Public Aid Code or the Children's Health Insurance Program Act.

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 for the purpose of determining eligibility for the Program under this Act.     The Department of Healthcare and Family Services, in collaboration with the Department of Financial and Professional Regulation, Division 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

been timely paid; if the required premiums are not paid, the liability of the Program shall be limited to benefits incurred under the Program for the time period for which premiums have been paid; re‑enrollment shall be completed before the next covered medical visit, and the first month's required premium shall be paid in advance of the next covered medical visit; or

(2) the child is an inmate of a public institution or

an institution for mental diseases.

(f) The Department shall adopt eligibility rules, including, but not limited to: rules regarding annual renewals of eligibility for the Program; 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. (Source: P.A. 96‑1272, eff. 1‑1‑11.)

    (215 ILCS 170/25)
    (Section scheduled to be repealed on July 1, 2011)
    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)
    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 and in no less than 2 newspapers in the State the premiums or other cost sharing requirements of the Program.
(Source: P.A. 94‑693, eff. 7‑1‑06; 95‑985, eff. 6‑1‑09.)

    (215 ILCS 170/35)
    (Section scheduled to be repealed on July 1, 2011)
    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.
(Source: P.A. 94‑693, eff. 7‑1‑06.)

    (215 ILCS 170/40)
    (Section scheduled to be repealed on July 1, 2011)
    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

requirements concerning co‑payments and coinsurance for health care services and monthly premiums. This cost‑sharing shall be on a sliding scale based on family income. The Department may periodically modify such cost‑sharing.

(2) Notwithstanding paragraph (1), there shall be no

co‑payment required for well‑baby or well‑child health care, including, but not limited to, age‑appropriate immunizations as required under State or federal law.

(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)
    (This Section may contain text from a Public Act with a delayed effective date)
    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 July 1, 2011)
    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

the State, of the number of children with and without health insurance coverage; the number of children who are eligible for Medicaid or the Children's Health Insurance Program, and, of that number, the number who are enrolled in Medicaid or the Children's Health Insurance Program; and the number of children with access to dependent coverage through an employer, and, of that number, the number who are enrolled in dependent coverage through an employer.

(2) Surveying those families whose children have

access to employer‑sponsored dependent coverage but who decline such coverage as to the reasons for declining coverage.

(3) Ascertaining, for the population of children

accessing employer‑sponsored dependent coverage or who have access to such coverage, the comprehensiveness of dependent coverage available, the amount of cost‑sharing currently paid by the employees, and the cost‑sharing associated with such coverage.

(4) Measuring the health outcomes or other benefits

for children utilizing the Covering ALL KIDS Health Insurance Program and analyzing the effects on utilization of healthcare services for children after enrollment in the Program compared to the preceding period of uninsured status.

(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 July 1, 2011)
    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 primary care case management program, by licensed profession and by county, and, for counties with a population of 100,000 or greater, by geo zip code.
    (b) The number of non‑primary care providers accepting referrals, by specialty designation, by licensed profession and by county, and, for counties with a population of 100,000 or greater, by geo zip code.
    (c) The number of individuals enrolled in the Covering ALL KIDS Health Insurance Program by income or premium level and by county, and, for counties with a population of 100,000 or greater, by geo zip code.
(Source: P.A. 95‑650, eff. 6‑1‑08.)

    (215 ILCS 170/50)
    (Section scheduled to be repealed on July 1, 2011)
    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 July 1, 2011)
    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 July 1, 2011)
    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 170/55)
    (Section scheduled to be repealed on July 1, 2011)
    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 170/60)
    (Section scheduled to be repealed on July 1, 2011)
    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)
    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)
    (Section scheduled to be repealed on July 1, 2011)
    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 July 1, 2011)
    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 July 1, 2011)
    Sec. 98. Repealer. This Act is repealed on July 1, 2011.
(Source: P.A. 94‑693, eff. 7‑1‑06.)

    (215 ILCS 170/99)
    (Section scheduled to be repealed on July 1, 2011)
    Sec. 99. Effective date. This Act takes effect July 1, 2006.
(Source: P.A. 94‑693, eff. 7‑1‑06.)