buy percocet Summer 2014 Legislative Update By Betsy D. Mitchell « ACOFP – IL

ACOFP – IL

Summer 2014 Legislative Update By Betsy D. Mitchell

At this writing, only two weeks remain of the Spring Legislative Session in Springfield. The main issue in Illinois is over extending or making the temporary income tax increase permanent. Two years ago, the income tax was increased as a temporary tax. It is set to expire at the end of this year unless legislative action is taken.

For physicians, the session began with the introduction several scope of practice bills (i.e. naturtopathic licensure, dentists to administer vaccinations, prescribing psychologists). As the session comes to a close, the one remaining controversy is over allowing psychologists to prescribe (More information below—See S.B. 2187).

Below highlights several bills that ACOFP-IL/IOMS have taken action on this session:

Psychologists Prescribing: SB 2187 passed the Senate last session in 2013. Since the beginning of the 2014 session, psychologists have been lobbying House members to keep this bill alive. Last week SB 2187 passed out of the House Committee. The bill, opposition, and fact sheets all remain the same. However, this year, the IL Psychiatric Society is taking a greater lead by hiring a public relations firm which created a website, http://coalitionforpatientsafety.com/home and is coordinating efforts for the opposition. We remain very opposed to this legislation.

Funding Poison Control Center (IPC): SB 2674 Harmon/ HB 4230 Lilly. ACOFP-IL and IOMS strongly support this legislation which would reallocate two cents of an existing cell phone surcharge to fund the IPC. Without long-term sustainable funding, the IPC is facing an impending closure date of June 30, 2014. SB2674 is moving. It has passed the Senate and is scheduled for action in the House.

Dentists to provide flu vaccinations: After much discussion, the dentists agreed to all of our concerns, so our opposition to Senate Bill 3409 was removed. The bill will allow dentists enrolled in a medical network or enrolled as a Medicare or Medicaid provider to administer flu vaccinations to patients enrolled in the same medical network or enrolled in Medicare or Medicaid upon completion of appropriate training. Further provides that vaccinations shall be limited to patients 18 years of age and older pursuant to a valid prescription or standing order by a physician and requires notification to the patient’s physician and appropriate reporting and record retention. The bill passed in the Senate and is expected to pass in the House soon.

Community Health Workers: HB 5412 is an initiative of the Governor’s Healthcare Reform Implementation Council and the IL Dept. of Public Health, along with the IL Workforce Investment Board (IWIB) – The abbreviated synopsis of the bill reads as follows: Provides that the core competencies of a community health worker include skills and areas of knowledge that are essential to bringing about expanded health and wellness in diverse communities and to reduce health disparities. Specifies that nothing in the provision concerning the integrated team-based health care, community health workers, and the creation of the Illinois Community Health Worker Advisory Board shall permit a non-certified community health worker to engage in or perform any act or service for which a license issued by a professional licensing board is required.

Flu vaccine required at IDPH facilities– SB 1610 was re-referred to the Senate Committee on Assignments. The abbreviated synopsis reads as follows: Provides that the Department shall require any facility licensed by the Department to implement an influenza vaccination program that requires onsite health care workers affiliated with the facility and persons with privileges on the medical staff to either annually receive an influenza vaccination or, as an alternative to the annual influenza vaccination, wear a facility-provided surgical or procedural mask or other mask that covers the mouth and nose area of the face while this person is performing his or her duties in any patient care area of the facility during the influenza season.

Family Practice Residency Act HB 3946 HA#1 (Ford) – the Family Practice Residency Act is not being resurrected to read as it did when IAFP overrode the Governor’s veto and had it funded in 2005. Instead, they’re using it (the written statute on the books) to codify the use of tobacco settlement $$ to supplement loan repayment. IDPH’s intent, once the amended bill passes, would be for all eligible providers (under the federal definition) to have access to this loan repayment (through tobacco $$) if they were to work in a HPSA (Health Professional Shortage Area). The amended bill has been re-referred to rules.

Uniformed Preauthorization Form HB 3638 Fine/SB 2585 Kotowski – The House bill passed and is now in the Senate. The bill amends the Illinois Insurance Code to provide after January 1, 2015, a health insurer who provides prescription drug benefits must, within 72 hours after receipt of a prior authorization form from a prescribing provider or pharmacist, either approve or deny the prior authorization; and in the case of an expedited coverage determination, the health insurer must either approve or deny the prior authorization within 24 hours after receipt of the prior authorization form. In the case of a denial, requires the health insurer to provide the prescriber with the reason for the denial, an alternative covered medication, if applicable, and information regarding the procedure for submitting an appeal to the denial. The bill also requires health insurers to provide confirmation of receipt of a prior authorization form within one hour after receipt of the prior authorization form. Insurers oppose the bill.

Mandated CME SB 3421-This bill passed the Senate and awaits assignment in House rules but indications are that Rep. Feigenholtz will pick it up as sponsor. Initially, providers were opposed but the amended bill eliminates the requirement that all persons licensed by DFPR who are also mandated reporters must complete the mandated reporter training offered by DCFS. Instead, it would require that IDFPR accept continuing education credit for mandated reporter training offered by the Department of Children and Family Services and completed by any person who holds a professional license issued by the Department and who is also a mandated reporter under the Abused and Neglected Child Reporting Act.

Mandated Hep C Screening SB 2670 – The chairman of Public Health in the Senate, John Mulroe (D-10 Chicago), introduced SB 2670, an initiative of AbbVie, which creates the Hepatitis C Screening Act. The bill synopsis reads as follows: Provides that every individual born between the years of 1945 and 1965 who receives health services from a hospital as an inpatient or in the emergency department of a hospital or who receives primary care services in an outpatient department of a hospital or who receives health services from a health care practitioner providing primary care shall be offered a hepatitis C-related test, unless the health care practitioner providing the services reasonably believes that certain conditions are present. Effective January 1, 2015. After considerable debate in Committee, Senator Mulroe is holding the bill at this time.

Updates on Medicaid Reform and ACA enrollment — This information was published in Illinois Health Connect’s 2nd Quarter News which will be distributed April – June to participating providers.

Care Coordination, aligned with the Illinois Medicaid reform law (Public Acts 096-1501 and 97-689) and the federal Affordable Care Act (ACA, Public Law 111-148), continues to be the centerpiece of the Illinois Department of Healthcare and Family Services Medicaid reform. As Illinois expands its Care Coordination Program, beginning in July 2014, Illinois Health Connect members in the 5 managed care regions (see Care Coordination Expansion map link below) will join a managed care entity. This means that most children, families and newly eligible ACA adults will receive care coordination services in the 5 managed care regions primarily from one of three types of managed care entities. These three types of entities are described below. Counties not included in the 5 managed care regions will continue to include Illinois Health Connect as a plan choice for most individuals enrolled in the HFS Medical program.

Three Managed Care Entity types:

  • Managed Care Organizations (MCOs) – either Health Maintenance Organizations (HMOs), which are traditional insurance-based companies accepting full-risk capitated payments, or Managed Care Community Networks (MCCN), which are provider-organized entities accepting partial-risk or full-risk capitated payments;
  • Care Coordination Entities (CCE) – provider-organized networks providing care coordination, for risk- and performance-based fees, but with medical and other services paid on a fee-for-service basis (this includes Children with Complex Medical Needs); and
  • Accountable Care Entities (ACE) – provider-organized entities on a three-year path to operating a full-risk capitated plan.

Both CCEs and ACEs have a direct link to the Illinois Health Connect program:
• PCPs who participate in a CCE or an ACE are required to be an active IHC PCP. If you are not enrolled as a PCP in IHC, contact us today.
• Enrollees will need to select both a plan (MCO, CCE or ACE) and PCP for care coordination.
• IHC will process all PCP changes within a members assigned CCE or ACE.
• CCEs and ACEs will collaborate with IHC to manage their panels and assure access to both the medical home and the continuum of services within the CCEs and ACEs.

Finally, the IL Dept. of Healthcare and Family Services Director Julie Hamos reported on the Accountable Care Entities and enrollment numbers below:

6 ACEs were conditionally awarded and need to be ready by July:
1) Advocate Health Care
2) Loyola University Health System
3) ACE Care Services: Presence Health (based in Chicago, a 12-hospital system)
4) Health Hura: Access Community Health Network
5) Accountable Care Chicago: Swedish Covenant hospital, Norwegian American Hospital and Mercy Hospital & Medical Center
6) Illinois Partnership for Health Inc. – “large downstate”, likely Urbana-Champaign region

4 ACES that will start later on
1. Chicago South Side – St. Bernard and Loretto hospital
2. NorthShore University Health System
3. Population Health of Illinois: Alexian Brothers Health System
4. Trinity Community Ace: Rock Island

Enrollment packets will be mailed from May throughout the fall based on geographical regions for patients to move from Illinois Health Connect into Managed Care Entities in mandatory managed care regions. This HFS Care Coordination Expansion Map http://www.illinoishealthconnect.com/clients/CareCoordinationExpansion.aspx shows the regions and related programs, and this two-page summary http://www2.illinois.gov/hfs/SiteCollectionDocuments/CareCoorPlan.pdf outlines the rollout process and timeline.

Latest numbers of newly enrolled ACA patients is 330,000
36,000 express (childless adults in the 19-64 age group currently in the SNAP program)
121,000 Applications for Benefits Eligibility – ABE (many are still pending)
94,000 County Care (some are pending)
82,000 from Federally Facilitated Marketplace www.healthcare.gov (FFM) initially 125,000 applications sent to Illinois State Marketplace (many pending).

IL Workforce Investment Board Health Care Task Force  The Governor’s Health Care Reform Implementation Council and the IL Dept. of Public Health have partnered with IWIB to develop a report with recommendations stemming from the collective work of the five working groups listed below:
1. Effects of Change in Health Care Delivery on Occupational Demand
2. Scope of Practice Issues
3. Front-line paraprofessionals
4. Inter-professional education and practice
5. Regional Strategies to Address Workforce Shortages

Redistricting Amendment There is a campaign to place an amendment on the ballot for the November General election to establish an independent commission the independent Commission which would draw district boundaries for redistricting. Here is the link: http://independentmaps.org/amendment

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