305 ILCS 5/5-16
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

 (from Ch. 23, par. 5-16)Sec. 5-16.     Managed Care.     The Illinois Department may develop and implement  a Primary Care Sponsor System consistent with the provisions of this Section.  The purpose of this managed care delivery system shall be to contain the costs  of providing medical care to Medicaid recipients by having one provider  responsible for managing all aspects of a recipient's medical care.  This  managed care system shall have the following characteristics:(a) The Department, by rule, shall establish criteria     to determine which clients must participate in this program;(b) Providers participating in the program may be     paid an amount per patient per month, to be set by the Illinois Department, for managing each recipient's medical care;(c) Providers eligible to participate in the program     shall be physicians licensed to practice medicine in all its branches, and the Illinois Department may terminate a provider's participation if the provider is determined to have failed to comply with any applicable program standard or procedure established by the Illinois Department;(d) Each recipient required to participate in the     program must select from a panel of primary care providers or networks established by the Department in their communities;(e) A recipient may change his designated primary     care provider:(1) when the designated source becomes         unavailable, as the Illinois Department shall determine by rule; or(2) when the designated primary care provider         notifies the Illinois Department that it wishes to withdraw from any obligation as primary care provider; or(3) in other situations, as the Illinois         Department shall provide by rule;(f) The Illinois Department shall, by rule, establish     procedures for providing medical services when the designated source becomes unavailable or wishes to withdraw from any obligation as primary care provider taking into consideration the need for emergency or temporary medical assistance and ensuring that the recipient has continuous and unrestricted access to medical care from the date on which such unavailability or withdrawal becomes effective until such time as the recipient designates a primary care source;(g) Only medical care services authorized by a     recipient's designated provider, except for emergency services, services performed by a provider that is owned or operated by a county and that provides non-emergency services without regard to ability to pay and such other services as provided by the Illinois Department, shall be subject to payment by the Illinois Department.  The Illinois Department shall enter into an intergovernmental agreement with each county that owns or operates such a provider to develop and implement policies to minimize the provision of medical care services provided by county owned or operated providers pursuant to the foregoing exception.The Illinois Department shall seek and obtain necessary authorization  provided under federal law to implement such a program including the waiver of  any federal regulations.The Illinois Department may implement the amendatory changes to  this Section made by this amendatory Act of 1991 through the use of emergency  rules in accordance with the provisions of Section 5.02 of the Illinois  Administrative Procedure Act. For purposes of the Illinois Administrative  Procedure Act, the adoption of rules to implement the amendatory changes to  this Section made by this amendatory Act of 1991 shall be deemed an emergency  and necessary for the public interest, safety and welfare.The Illinois Department may establish a managed care system demonstration  program, on a limited basis, as described in this Section.  The demonstration  program shall terminate on June 30, 1997.  Within 30 days after the end of each  year of the demonstration program's operation, the Illinois Department shall  report to the Governor and the General Assembly concerning the operation of the  demonstration program.    (Source: P.A. 87-14; 88-490.)