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92_SB0885eng
SB885 Engrossed LRB9202681JSpc
1 AN ACT concerning children's health care.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Children's Health Insurance Program Act
5 is amended by changing Sections 25 and 40 as follows:
6 (215 ILCS 106/25)
7 (Section scheduled to be repealed on July 1, 2002)
8 Sec. 25. Health benefits for children.
9 (a) The Department shall, subject to appropriation,
10 provide health benefits coverage to eligible children by:
11 (1) Subsidizing the cost of privately sponsored
12 health insurance, including employer based health
13 insurance, to assist families to take advantage of
14 available privately sponsored health insurance for their
15 eligible children; and
16 (2) Purchasing or providing health care benefits
17 for eligible children. The health benefits provided
18 under this subdivision (a)(2) shall, subject to
19 appropriation and without regard to any applicable cost
20 sharing under Section 30, be identical to the benefits
21 provided for children under the State's approved plan
22 under Title XIX of the Social Security Act. Providers
23 under this subdivision (a)(2) shall be subject to
24 approval by the Department to provide health care under
25 the Illinois Public Aid Code and shall be reimbursed at
26 the same rate as providers under the State's approved
27 plan under Title XIX of the Social Security Act. In
28 addition, providers may retain co-payments when
29 determined appropriate by the Department.
30 (b) The subsidization provided pursuant to subdivision
31 (a)(1) shall be credited to the family of the eligible child.
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1 The Department shall make the subsidization pursuant to
2 subdivision (a)(1) available to children whose annual
3 household income is at or below 133% of the federal poverty
4 level.
5 (c) The Department is prohibited from denying coverage
6 to a child who is enrolled in a privately sponsored health
7 insurance plan pursuant to subdivision (a)(1) because the
8 plan does not meet federal benchmarking standards or cost
9 sharing and contribution requirements. To be eligible for
10 inclusion in the Program, the plan shall contain
11 comprehensive major medical coverage which shall consist of
12 physician and hospital inpatient services. The Department is
13 prohibited from denying coverage to a child who is enrolled
14 in a privately sponsored health insurance plan pursuant to
15 subdivision (a)(1) because the plan offers benefits in
16 addition to physician and hospital inpatient services.
17 (d) The total dollar amount of subsidizing coverage per
18 child per month pursuant to subdivision (a)(1) shall be equal
19 to the average dollar payments, less premiums incurred, per
20 child per month pursuant to subdivision (a)(2). The
21 Department shall set this amount prospectively based upon the
22 prior fiscal year's experience adjusted for incurred but not
23 reported claims and estimated increases or decreases in the
24 cost of medical care. Payments obligated before July 1,
25 1999, will be computed using State Fiscal Year 1996 payments
26 for children eligible for Medical Assistance and income
27 assistance under the Aid to Families with Dependent Children
28 Program, with appropriate adjustments for cost and
29 utilization changes through January 1, 1999. The Department
30 is prohibited from providing a subsidy pursuant to
31 subdivision (a)(1) that is more than the individual's monthly
32 portion of the premium.
33 (e) An eligible child may obtain immediate coverage
34 under this Program only once during a medical visit. If
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1 coverage lapses, re-enrollment shall be completed in advance
2 of the next covered medical visit and the first month's
3 required premium shall be paid in advance of any covered
4 medical visit.
5 (f) In order to accelerate and facilitate the
6 development of networks to deliver services to children in
7 areas outside counties with populations in excess of
8 3,000,000, in the event less than 25% of the eligible
9 children in a county or contiguous counties has enrolled with
10 a Health Maintenance Organization pursuant to Section 5-11 of
11 the Illinois Public Aid Code, the Department may develop and
12 implement demonstration projects to create alternative
13 networks designed to enhance enrollment and participation in
14 the program. The Department shall prescribe by rule the
15 criteria, standards, and procedures for effecting
16 demonstration projects under this Section.
17 (Source: P.A. 90-736, eff. 8-12-98.)
18 (215 ILCS 106/40)
19 (Section scheduled to be repealed on July 1, 2002)
20 Sec. 40. Waivers.
21 (a) The Department shall request any necessary waivers
22 of federal requirements in order to allow receipt of federal
23 funding for:
24 (1) the coverage of families with eligible children
25 under this Act; and
26 (2) for the coverage of children who would
27 otherwise be eligible under this Act, but who have health
28 insurance; and.
29 (3) the coverage of children that are eligible
30 under subsection (b) of Section 25.
31 (b) The failure of the responsible federal agency to
32 approve a waiver for children who would otherwise be eligible
33 under this Act but who have health insurance shall not
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1 prevent the implementation of any Section of this Act
2 provided that there are sufficient appropriated funds.
3 (Source: P.A. 90-736, eff. 8-12-98.)
4 Section 99. Effective date. This Act takes effect upon
5 becoming law.
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