Rep. Robyn Gabel

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that in the event that a hospital is not a contracted provider with a Medicaid managed care payor, and an enrollee of that Medicaid managed care payor requires care at that non-contracted facility, the Medicaid managed care payor shall be required to pay the non-contracted facility no less than the equivalent of what the State payment rate would be for the same non-elective services, including all policy adjustments and outlier payments. Provides that hospital triage services required under the federal Emergency Medical Treatment and Labor Act for enrollees presenting in the emergency room shall be considered a non-elective service as the provider is required by law to provide such services; and that the Medicaid managed care payor shall not be required to pay a State equivalent rate for any service deemed elective but may instead negotiate an agreement for such elective services with the non-contracted provider or redirect the enrollee within its contracted provider network. Effective immediately.

Amends the Developmentally Disabled Care Provider Fund Article of the Illinois Public Aid Code. Provides that a developmentally disabled care facility that has delayed payment due to the State's failure to reimburse for services rendered may request an extension of the due date for payment and shall pay the assessment within 30 days of reimbursement by the Department of Healthcare and Family Services for the period the assessment is levied. Provides that the Department shall not deny a request for delay of payment of the assessment if the developmentally disabled care provider has not been paid for services provided during the quarter on which the assessment is levied. Effective immediately.

Creates the Water Loss Accounting Awareness Act. Provides that, before July 31, 2015, the Illinois Environmental Protection Agency, in consultation with the Department of Natural Resources, the Illinois Commerce Commission, the Illinois State Water Survey of the University of Illinois, and other local and regional water management leaders and interested parties as the Agency deems appropriate, shall submit to the General Assembly and the Governor a report that reviews and evaluates the latest available information on water loss in Illinois including existing data, policies, procedures, and institutional knowledge (including publicly available reports from the federal Environmental Protection Agency, the American Water Works Association, and the State archives). Effective immediately.

Amends the Illinois Insurance Code. Provides that, with respect to long-term care insurance coverage, no policy or certificate, or modification thereof, shall be issued or delivered to any person in this State until the classification of risks and the premium rates pertaining thereto have been approved by the Director of Insurance and that any subsequent addition to or change in premium rates shall also be subject to the Director's approval. Sets forth provisions concerning the standards for approval, determinations by the Director, and public hearings. Provides that, with respect to long-term care insurance, a filing of premium rates shall not be considered complete unless it contains all information necessary to justify the premium rate and such other information as the Director may require to determine the rate's compliance with the provision concerning long-term care insurance rates and prior approval. Sets forth additional requirements for rate filings. Effective immediately.

Amends the Child Care Act of 1969. Provides that the licensing standards for day care centers and day care homes shall include a requirement that such facilities adopt policies regarding immunizations for day care staff, and that the most current recommendations of the Advisory Committee on Immunization Practices may be used as a guideline in adopting such policies. Further provides that the licensing standards shall include exemptions for day care staff who object to immunization on religious grounds or for clinical reasons. Effective immediately.

Appropriates $17,100,000 from the General Revenue Fund to the Department of Public Health for local health protection grants for health protection programs. Effective July 1, 2014.

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that one preventive dental visit a year shall be covered under the medical assistance program for pregnant women who are eligible for assistance. Provides that the Department of Healthcare and Family Services may (rather than shall) limit adult dental services to emergencies, except that this limitation shall not apply to pregnant women. Effective July 1, 2013.

Amends the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services' contracts with Managed Care Organizations and other entities reimbursed by risk based capitation shall (i) have a minimum medical loss ratio of 85% prior to December 31, 2014 and a minimum medical loss ratio of 90% thereafter; (ii) require the MCO or other entity to pay claims within 30 days of receiving a bill that contains all the essential information needed to adjudicate the bill; (iii) require the MCO or other entity to pay a penalty that is at least equal to the penalty imposed under the Illinois Insurance Code for any claims not timely paid; (iv) require the MCO or other entity to notify the billing party within 30 days of receiving a bill of any essential information needed to adjudicate the bill; (v) require payments for hospital services in an amount not less than the Department would pay on a fee-for-service basis; (vi) contain a warranty by the MCO or other entity that its network is in place at the time the contract is in effect; (vii) provide for shared savings requirements between the MCO or other entity and its hospital providers; (viii) require that the MCO or other entity post a bond to cover the risk of failure to pay any pass-through payments; and (ix) contain dispute resolution protocols and utilization review or denial management standards consistent with the standards required pursuant to the Medicare Advantage program (rather than shall have a minimum medical loss ratio of 85%, shall require the MCO or other entity to pay claims within 30 days of receiving a bill that contains all the essential information needed to adjudicate the bill, and shall require the entity to pay a penalty that is at least equal to the penalty imposed under the Illinois Insurance Code for any claims not paid within this time period). Effective immediately.

Amends the Family Military Leave Act. Makes a technical change in a Section concerning the short title.

Appropriates $17,100,000 to the Department of Public Health from the General Revenue Fund for local health protection grants for health protection programs. Effective July 1, 2013.