SPRINGFIELD — The state of Illinois is about to overhaul the way it provides health care to an estimated 74,000 of the state’s most vulnerable children and young adults, and the prospect of that is making many lawmakers and health care providers nervous.
At issue is a plan by the Department of Children and Family Services to place all of the children under its charge into a single managed care health insurance program, similar to those that now manage the bulk of the state’s Medicaid program, by Nov. 1.
Those involved will be an estimated 17,100 children in foster care, another 18,800 former foster children who still receive health coverage from the state, plus another 38,200 children with special needs that qualify them for federal Supplemental Security Income benefits.
Managed care is a system in which private insurance companies, known as managed care organizations, or MCOs, are paid a flat, per-patient monthly fee to manage the health care of Medicaid patients. In Illinois, it has been the source of controversy, especially among health care providers who have complained about late reimbursement payments, high rates of claim denials and lengthy appeal processes to resolve claim disputes.
“I want to acknowledge that we’ve had some growing pains with managed care in Illinois,” Theresa Eagleson, director of the Department of Healthcare and Family Services, the agency that administers Illinois’ Medicaid program, told lawmakers during a hearing Tuesday, Sept. 10, in Chicago.
Eagleson, along with Leslie Naamon, president and CEO of IlliniCare Health, the company selected to run the program for DCFS children, tried to assure lawmakers they are trying to work out those issues before the new program launches.
Some lawmakers indicated Tuesday they were just beginning to learn about the transition, and some, like state Rep. Celina Villanueva, D-Chicago, said they were not comforted by what they were hearing.
“I don’t need fluff. I need answers,” Villanueva said. “I acknowledge that this is new and this is unique, and that in and of itself is great. But with that also comes the situation where DCFS right now is not in the best light.”
A number of lawmakers also questioned whether managed care would be appropriate for those children and young adults because of the number of times they are moved from one setting to another. And they expressed particular concern about the children who age out of the system, many of whom lose contact with state officials and therefore may never learn about their health care options.
Tuesday’s hearing was for discussion purposes only and no action was taken. But many lawmakers who were present indicated they wanted to be kept informed as the scheduled start date approaches.
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LAWSUITS VS. OPIOID MANUFACTURERS: Illinois Attorney General Kwame Raoul said he would reject a settlement agreement with opioid manufacturer Purdue Pharma under its reported current terms and announced a lawsuit against several other opioid manufacturers.
In April, Raoul’s office filed a lawsuit against Purdue Pharma, the manufacturer of the opioid OxyContin and defendant in thousands of other lawsuits from local municipalities and states affected by the opioid epidemic.
Raoul’s suit alleged the company “dispatched sales representatives to Illinois hundreds of thousands of times” between 2008 and 2017, and “funded third-party publications under the guise of educational materials to promote opioids and downplay their risks.”
Raoul alleged these tactics more than tripled prescriptions of Purdue’s opioids in Illinois. In a news release, he pointed to Illinois Department of Public Health statistics that showed more than 2,000 Illinoisans were killed by opioid overdoses in 2017. IDPH also reported instances of babies born with neonatal abstinence syndrome, which can be caused by opioid exposure, increased by 64 percent from 2011 to 2017.
In August, Raoul expanded the suit against Purdue to include members of the Sackler family, which founded and operates Purdue Pharma.
Raoul’s statement was in response to media reports that detailed a tentative settlement between Purdue and thousands of municipal governments and more than 20 states.
Raoul, however, was among at least 20 attorneys general who told NBC News they had not agreed to the deal.
Raoul filed a similar lawsuit Tuesday, Sept. 10, against 16 other opioid manufacturers, alleging they “carried out unfair and deceptive marketing campaigns that prioritized profits over public health.”
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GOOGLE LAWSUIT: The advertising and other business practices of tech giant Google will be under heavy scrutiny in the coming months as part of a bipartisan investigation led by 50 attorneys general, including Democrat Kwame Raoul of Illinois.
Raoul’s office announced the joint investigation in a news release this week, noting it will “determine whether the tech giant operates in violation of state and federal antitrust laws” and will be conducted in conjunction with federal authorities.
The investigation will focus on Google’s advertising practices, and whether its dominance in the advertising and search market constitutes “anticompetitive behavior that harms consumers,” according to a news release from Raoul’s office.
“I am committed to protecting consumers’ right to internet access that is free from anticompetitive behavior,” Raoul said in a statement. “This investigation aims to safeguard consumer choice, foster innovation, ensure online privacy, and maintain the free flow of online information.”
The probe will be led by Republican Attorney General Ken Paxton, of Texas, and the coalition includes bipartisan attorneys general from 48 states, Washington D.C. and Puerto Rico.
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RETIREMENT PROGRAM: More than 24,000 private sector Illinois workers have collectively stashed away more than $5 million in retirement savings since January as part of a new state program that increases access to retirement accounts for individuals whose employers do not already offer them.
Illinois Secure Choice was created by state law in 2015, requiring businesses with 25 employees or more to offer retirement savings plans or take part in the new program, which automatically enrolls workers in a state-created but independently managed retirement plan.
Illinois Treasurer Mike Frerichs said in a phone interview Tuesday, Sept. 10, that the program, which will roll out its final phase in November, is the state’s attempt at addressing a nationwide “retirement crisis.”
“Half of working adults have a mean retirement account of zero dollars,” Frerichs said. “It is in our best interest to make sure that people have saved their own money for their retirement. Not just so they can enjoy their golden years, … but also because it is bad for our economy when an entire generation of people reach retirement, and then dramatically decrease their spending because they're living on a much lower fixed income.”
While the treasurer’s office and an appointed, unpaid board of advisors oversee the program, the money invested by Illinois workers goes straight to an account managed by Ascensus, an independent Pennsylvania-based financial services company that won the bid to administer the program.
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That means employees opening the retirement accounts remain in complete control of their money and the state cannot use the funds for any other purpose.
For those saving their money, the only restrictions on the retirement accounts are those that apply to any other privately held retirement account.
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STERIGENICS UPDATE: A DuPage County judge approved a consent order Friday, Sept. 6, that will allow Sterigenics, a medical supply sterilization company linked to increased cancer rates in the Willowbrook area, to reopen if it meets stringent new requirements.
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Illinois Attorney General Kwame Raoul and DuPage County State’s Attorney Robert Berlin issued a statement saying their consent order with Sterigenics gives their offices “the tools to act quickly to protect the community and hold Sterigenics accountable for any future violations of Illinois’ new ethylene oxide restrictions or other state environmental laws.”
One state lawmaker, however, has filed a bill that would give certain local municipalities the authority to ban emitters of ethylene oxide, a known cancer-causing gas, from operating in their communities.
“Sterigenics continues to prove they cannot be trusted and have no place in our region,” Illinois House Republican Leader Jim Durkin said in a statement.
Durkin filed House Bill 3885 Friday to allow home rule municipalities including Willowbrook to “impose additional operating restrictions” or prohibitions above and beyond state law on companies that emit ethylene oxide.
Home rule is a status that state law confers to any municipality with more than 25,000 residents or other municipalities that choose to adopt it by referendum. Those municipalities have greater authority to control their own local affairs. According to the Illinois Municipal League, 217 of Illinois’ 1,298 incorporated municipalities have home rule powers.
Sterigenics has been closed since February, when Democratic Gov. J.B. Pritzker ordered the IEPA to issue a seal order on the company’s use of ethylene oxide. The consent order paves the way for Sterigenics to continue its use of the chemical if it installs new systems to capture and control emissions and submits plans for testing the new systems to be reviewed and approved by the IEPA.
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NURSING RATIOS: Advocates for a law that would limit the number of patients each hospital nurse is allowed to care for at one time are touting a new national survey that suggests such a rule would lead to better working conditions for nurses and better care for patients.
But Illinois’ leading hospital lobby group remains solidly opposed to the idea, arguing it would result in the closure of many hospitals, especially in rural areas, and accelerate the already rising cost of health care.
The survey was conducted in 2018 by the group Nurses Take DC, a national organization that lobbies for stricter nurse-to-patient ratios. Two Illinois-based organizations, the Illinois Economic Policy Institute and the University of Illinois’ Project for Middle Class Renewal, then took the results of that survey and produced a report on the differences between Illinois and California, which so far is the only state to impose nurse-to-patient ratio limits.
“By reducing patient-to-nurse ratios, enacting a safe patient limits law in Illinois could improve occupational safety, increase nurse retention rates, and promote better health outcomes for patients and have little to no negative impact on the financial performance of Illinois’ hospitals,” the Illinois groups said in their report.
Illinois has standards for nurse staffing that require hospitals to have a written plan based on the recommendation of one or more nursing care committees.
However, the survey found, only 29 percent of Illinois nurses who responded to the survey indicated their hospital has such a committee. And of those, fewer than half (44 percent), said their recommendations were being implemented in daily staffing decisions.
In addition, the survey found that Illinois nurses, on average, are responsible for 5.2 patients at a time, compared to 4.3 patients in California, and that only 18 percent of Illinois nurses considered the nurse-patient ratio to be “safe,” compared to 40 percent in California.
A bill that would have imposed minimum nurse staffing levels for hospitals was debated in an Illinois House committee earlier this year. House Bill 2604, sponsored by Rep. Fred Crespo, D-Hoffman Estates, passed out of the Labor and Commerce Committee in March but was never voted on by the full House.
That’s partly due to strong opposition from the Illinois Health and Hospital Association, which argued strongly against the bill.
“Mandatory nurse-staffing ratios will not improve patient outcomes or quality,” IHA spokesman Danny Chun said in a separate interview.
And he said the results would be “devastating” for rural hospitals in Illinois, many of which are already struggling financially.
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CASINO LICENSING: The Illinois Gaming Board announced Friday, Sept. 6, that it had adopted new rules it said will strengthen existing ethical safeguards and require more people to file ethical disclosure reports as part of the casino license selection process.
The new rules are the result of legislation enacted this year that allows for the development of six new land-based casinos, including one in Chicago, along with legalized sports wagering.
The new rules were enacted under the board’s emergency rulemaking authority, which allows the board to adopt temporary rules, under certain circumstances, without going through the normal process of public notice and hearings. Such rules are effective for only a maximum of 150 days, and the agency would have to go through the regular rulemaking process to make them permanent.
“The purpose of the emergency rule is to further strengthen the IGB’s existing ethics requirements and enhance the transparency of the casino license selection process authorized under the Illinois Gambling Act,” IGB Administrator Marcus Fruchter said in a statement.
The new rules expand the definition of an “applicant” to include, “any person or entity which has directly or indirectly expressed interest to an official or employee of a host community in obtaining an owners license … regardless of whether that person or entity has submitted an application to the board.”
In addition, all applicants and licensees will be required to disclose any potential or actual violations of ethics laws spelled out in state law that are committed, by the applicant, licensee or any of their agents or employees; violations by any other applicant, licensee or their agents or employees; or violations by any current or former official or employee of a host community, or their spouse, child, or parent.
“This is another step in our process to ethically and expeditiously implement gaming expansion in Illinois,” Fruchter said.