HB0108 Engrossed LRB099 03603 JLK 23611 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
5		Illinois Universal Health Care 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

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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);

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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 State
6		that is legally qualified to provide such benefits and for
7		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 non-profit 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.

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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 be
5		paid fee-for-service, salaried by institutions receiving
6		global budgets, or salaried by group practices or HMOs
7		receiving capitation payments. Investor-owned HMOs and
8		group practices shall be converted to not-for-profit
9		status. Only institutions that deliver care shall be
10		eligible for Program payments.
11		(2) The Program shall pay each hospital and providing
12		institution a monthly lump sum (global budget) to cover all
13		operating expenses. The hospital and Program shall
14		negotiate the amount of this payment annually based on past
15		budgets, clinical performance, projected changes in demand
16		for services and input costs, and proposed new programs.
17		Hospitals shall not bill patients for services covered by
18		the Program, and cannot use any of their operating budgets
19		for expansion, profit, excessive executive income,
20		marketing, or major capital purchases or leases.
21		(3) The Program budget shall fund major capital
22		expenditures, including the construction of new health
23		facilities and the purchase of expensive equipment. The
24		regional health planning districts shall allocate these
25		capital funds and oversee capital projects funded from
26		private donations.

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1		(b) The Program shall reimburse physicians choosing to be
2		paid fee-for-service according to a fee schedule negotiated
3		between physician representatives and the Program on at least
4		an annual basis.
5		(c) Hospitals, nursing homes, community health centers,
6		non-profit staff model HMOs, and home health care agencies
7		shall receive a global budget to cover operating expenses,
8		negotiated annually with the Program based on past
9		expenditures, past budgets, clinical performance, projected
10		changes in demand for services and input costs, and proposed
11		new programs. Expansions and other substantive capital
12		investments shall be funded separately.
13		(d) All covered prescription drugs and durable medical
14		supplies shall be paid for according to a fee schedule
15		negotiated between manufacturers and the Program on at least an
16		annual basis. Price reductions shall be achieved by bulk
17		purchasing whenever possible. Where therapeutically equivalent
18		drugs are available, the formulary shall specify the use of the
19		lowest-cost medication, with exceptions available in the case
20		of medical necessity.
21		Section 35. Prohibition against duplicating coverage;
22		investor-ownership of health delivery facilities.
23		(a) It is unlawful for a private health insurer to sell
24		health insurance coverage that duplicates the benefits
25		provided under this Act. Nothing in this Act shall be construed

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1		as prohibiting the sale of health insurance coverage for any
2		additional benefits not covered by this Act.
3		(b) Investor-ownership of health delivery facilities,
4		including hospitals, health maintenance organizations, nursing
5		homes, and clinics, is unlawful. Investor-owners of health
6		delivery facilities at the time of the effective date of this
7		Act shall be compensated for the loss of their facilities, but
8		not for loss of business opportunities or for administrative
9		capacity not used by the Program.
10		Section 40. Illinois Health Services Trust.
11		(a) The State shall establish the Illinois Health Services
12		Trust (IHST), the sole purpose of which shall be to provide the
13		financing reserve for the purposes outlined in this Act.
14		Specifically, the IHST shall provide all of the following:
15		(1) The funds for the general operating budget of the
16		Program.
17		(2) Reimbursement for those benefits outlined in
18		Section 20 of this Act.
19		(3) Public health services.
20		(4) Capital expenditures for construction or
21		renovation of health care facilities or major equipment
22		purchases deemed necessary throughout the State and
23		approved by the Board.
24		(5) Re-education and job placement of persons who have
25		lost their jobs as a result of this transition, limited to

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1		the first 5 years.
2		(b) The General Assembly or the Governor may provide funds
3		to the IHST, but may not remove or borrow funds from the IHST.
4		(c) The IHST shall be administered by the Board, under the
5		oversight of the General Assembly.
6		(d) Funding of the IHST shall include, but is not limited
7		to, all of the following:
8		(1) Funds appropriated as outlined by the General
9		Assembly on a yearly basis.
10		(2) A progressive set of graduated income
11		contributions: 20% paid by individuals, 20% paid by a
12		business, and 60% paid by the government.
13		(3) All federal moneys that are designated for health
14		care, including, but not limited to, all moneys designated
15		for Medicaid. The Secretary shall be authorized to
16		negotiate with the federal government for funding of
17		Medicare recipients.
18		(4) Grants and contributions, both public and private.
19		(5) Any other tax revenues designated by the General
20		Assembly.
21		(6) Any other funds specifically ear-marked for health
22		care or health care education, such as settlements from
23		litigation.
24		(e) The total overhead and administrative portion of the
25		Program budget may not exceed 12% of the total operating budget
26		of the Program for the first 2 years that the Program is in

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1		operation; 8% for the following 2 years; and 5% for each year
2		thereafter.
3		(f) The Program may be divided into regional districts for
4		the purposes of local administration and oversight of programs
5		that are specific to each region's needs.
6		(g) Claims billing from all providers must be submitted
7		electronically and in compliance with current State and federal
8		privacy laws within 5 years after the effective date of this
9		Act. Electronic claims and billing must be uniform across the
10		State. The Board shall create and implement a statewide uniform
11		system of electronic medical records that is in compliance with
12		current State and federal privacy laws within 7 years after the
13		effective date of this Act. Payments to providers must be made
14		in a timely fashion as outlined under current State and federal
15		law. Providers who accept payment from the Program for services
16		rendered may not bill any patient for covered services.
17		Providers may elect either to participate fully, or not at all,
18		in the Program.
19		Section 45. Long-term care payment. The Board shall
20		establish funding for long-term care services, including
21		in-home, nursing home, and community-based care. A local public
22		agency shall be established in each community to determine
23		eligibility and coordinate home and nursing home long-term
24		care. This agency may contract with long-term care providers
25		for the full range of needed long-term care services.

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1		Section 50. Mental health services. The Program shall
2		provide coverage for all medically necessary mental health care
3		on the same basis as the coverage for other conditions. The
4		Program shall cover supportive residences, occupational
5		therapy, and ongoing mental health and counseling services
6		outside the hospital for patients with serious mental illness.
7		In all cases the highest quality and most effective care shall
8		be delivered, including institutional care.
9		Section 55. Payment for prescription medications, medical
10		supplies, and medically necessary assistive equipment.
11		(a) The Program shall establish a single prescription drug
12		formulary and list of approved durable medical goods and
13		supplies. The Board shall, by itself or by a committee of
14		health professionals and related individuals appointed by the
15		Board and called the Pharmaceutical and Durable Medical Goods
16		Committee, meet on a quarterly basis to discuss, reverse, add
17		to, or remove items from the formulary according to sound
18		medical practice.
19		(b) The Pharmaceutical and Durable Medical Goods Committee
20		shall negotiate the prices of pharmaceuticals and durable
21		medical goods with suppliers or manufacturers on an open bid
22		competitive basis. Prices shall be reviewed, negotiated, or
23		re-negotiated on no less than an annual basis. The
24		Pharmaceutical and Durable Medical Goods Committee shall

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1		establish a process of open forum to the public for the
2		purposes of grievance and petition from suppliers, provider
3		groups, and the public regarding the formulary no less than 2
4		times a year.
5		(c) All pharmacy and durable medical goods vendors must be
6		licensed to distribute medical goods through the regulations
7		outlined by the Board.
8		(d) All decisions and determinations of the Pharmacy and
9		Durable Medical Goods Committee must be presented to and
10		approved by the Board on an annual basis.
11		Section 60. Illinois Health Services Governing Board.
12		(a) The Program shall be administered by an independent
13		agency known as the Illinois Health Services Governing Board.
14		The Board will consist of a Commissioner, a Chief Medical
15		Officer, and public State board members. The Board is
16		responsible for administration of the Program, including:
17		(1) implementation of eligibility standards and
18		Program enrollment;
19		(2) adoption of the benefits package;
20		(3) establishing formulas for setting health
21		expenditure budgets;
22		(4) administration of global budgets, capital
23		expenditure budgets, and prompt reimbursement of
24		providers;
25		(5) negotiations of service fee schedules and prices

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1		for prescription drugs and durable medical supplies;
2		(6) recommending evidenced-based changes to benefits;
3		and
4		(7) quality and planning functions including criteria
5		for capital expansion and infrastructure development,
6		measurement and evaluation of health quality indicators,
7		and the establishment of regions for long-term care
8		integration.
9		(b) At least one-third of the members of the Board,
10		including all committees dedicated to benefits design, health
11		planning, quality, and long-term care, shall be consumer
12		representatives.
13		Section 65. Patients' rights. The Program shall protect the
14		rights and privacy of the patients that it serves in accordance
15		with all current State and federal statutes. With the
16		development of the electronic medical records, patients shall
17		be afforded the right and option of keeping any portion of
18		their medical records separate from the electronic medical
19		records. Patients have the right to access their medical
20		records upon demand.
21		Section 70. Compensation. The Commissioner, the Chief
22		Medical Officer, public State board members, and subsequent
23		employees of the Program shall be compensated in accordance
24		with the current pay scale for State employees and as deemed

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1		professionally appropriate by the General Assembly and
2		reviewed in accordance with all other State employees.