Illinois 2023-2024 Regular Session

Illinois House Bill HB2370 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2370 Introduced , by Rep. Robyn Gabel SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.4h Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning the tiered exceptional care per diem rates for medically complex for the developmentally disabled facilities, provides that on and after January 1, 2024, each tier rate shall be increased 6% over the amount in effect December 31, 2023. Provides that any reimbursement increases applied to the base rate to providers licensed under the ID/DD Community Care Act must also be applied in an equivalent manner to each tier of exceptional care per diem rates for medically complex for the developmentally disabled facilities. Effective immediately. LRB103 28496 KTG 54877 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2370 Introduced , by Rep. Robyn Gabel SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.4h 305 ILCS 5/5-5.4h Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning the tiered exceptional care per diem rates for medically complex for the developmentally disabled facilities, provides that on and after January 1, 2024, each tier rate shall be increased 6% over the amount in effect December 31, 2023. Provides that any reimbursement increases applied to the base rate to providers licensed under the ID/DD Community Care Act must also be applied in an equivalent manner to each tier of exceptional care per diem rates for medically complex for the developmentally disabled facilities. Effective immediately. LRB103 28496 KTG 54877 b LRB103 28496 KTG 54877 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2370 Introduced , by Rep. Robyn Gabel SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-5.4h 305 ILCS 5/5-5.4h
4	4	305 ILCS 5/5-5.4h
5	5	Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning the tiered exceptional care per diem rates for medically complex for the developmentally disabled facilities, provides that on and after January 1, 2024, each tier rate shall be increased 6% over the amount in effect December 31, 2023. Provides that any reimbursement increases applied to the base rate to providers licensed under the ID/DD Community Care Act must also be applied in an equivalent manner to each tier of exceptional care per diem rates for medically complex for the developmentally disabled facilities. Effective immediately.
6	6	LRB103 28496 KTG 54877 b LRB103 28496 KTG 54877 b
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8	8	A BILL FOR
9	9	HB2370LRB103 28496 KTG 54877 b HB2370 LRB103 28496 KTG 54877 b
10	10	HB2370 LRB103 28496 KTG 54877 b
11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Public Aid Code is amended by
15	15	5 changing Section 5-5.4h as follows:
16	16	6 (305 ILCS 5/5-5.4h)
17	17	7 Sec. 5-5.4h. Medicaid reimbursement for medically complex
18	18	8 for the developmentally disabled facilities licensed under the
19	19	9 MC/DD Act.
20	20	10 (a) Facilities licensed as medically complex for the
21	21	11 developmentally disabled facilities that serve severely and
22	22	12 chronically ill patients shall have a specific reimbursement
23	23	13 system designed to recognize the characteristics and needs of
24	24	14 the patients they serve.
25	25	15 (b) For dates of services starting July 1, 2013 and until a
26	26	16 new reimbursement system is designed, medically complex for
27	27	17 the developmentally disabled facilities that meet the
28	28	18 following criteria:
29	29	19 (1) serve exceptional care patients; and
30	30	20 (2) have 30% or more of their patients receiving
31	31	21 ventilator care;
32	32	22 shall receive Medicaid reimbursement on a 30-day expedited
33	33	23 schedule.
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2370 Introduced , by Rep. Robyn Gabel SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/5-5.4h 305 ILCS 5/5-5.4h
39	39	305 ILCS 5/5-5.4h
40	40	Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning the tiered exceptional care per diem rates for medically complex for the developmentally disabled facilities, provides that on and after January 1, 2024, each tier rate shall be increased 6% over the amount in effect December 31, 2023. Provides that any reimbursement increases applied to the base rate to providers licensed under the ID/DD Community Care Act must also be applied in an equivalent manner to each tier of exceptional care per diem rates for medically complex for the developmentally disabled facilities. Effective immediately.
41	41	LRB103 28496 KTG 54877 b LRB103 28496 KTG 54877 b
42	42	LRB103 28496 KTG 54877 b
43	43	A BILL FOR
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49	49	305 ILCS 5/5-5.4h
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68	68	1 (c) Subject to federal approval of changes to the Title
69	69	2 XIX State Plan, for dates of services starting July 1, 2014
70	70	3 through March 31, 2019, medically complex for the
71	71	4 developmentally disabled facilities which meet the criteria in
72	72	5 subsection (b) of this Section shall receive a per diem rate
73	73	6 for clinically complex residents of $304. Clinically complex
74	74	7 residents on a ventilator shall receive a per diem rate of
75	75	8 $669. Subject to federal approval of changes to the Title XIX
76	76	9 State Plan, for dates of services starting April 1, 2019,
77	77	10 medically complex for the developmentally disabled facilities
78	78	11 must be reimbursed an exceptional care per diem rate, instead
79	79	12 of the base rate, for services to residents with complex or
80	80	13 extensive medical needs. Exceptional care per diem rates must
81	81	14 be paid for the conditions or services specified under
82	82	15 subsection (f) at the following per diem rates: Tier 1 $326,
83	83	16 Tier 2 $546, and Tier 3 $735. On and after January 1, 2024,
84	84	17 each tier rate shall be increased 6% over the amount in effect
85	85	18 December 31, 2023. Any reimbursement increases applied to the
86	86	19 base rate to providers licensed under the ID/DD Community Care
87	87	20 Act must also be applied in an equivalent manner to each tier
88	88	21 of exceptional care per diem rates for medically complex for
89	89	22 the developmentally disabled facilities.
90	90	23 (d) For residents on a ventilator pursuant to subsection
91	91	24 (c) or subsection (f), facilities shall have a policy
92	92	25 documenting their method of routine assessment of a resident's
93	93	26 weaning potential with interventions implemented noted in the
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104	104	1 resident's medical record.
105	105	2 (e) For services provided prior to April 1, 2019 and for
106	106	3 the purposes of this Section, a resident is considered
107	107	4 clinically complex if the resident requires at least one of
108	108	5 the following medical services:
109	109	6 (1) Tracheostomy care with dependence on mechanical
110	110	7 ventilation for a minimum of 6 hours each day.
111	111	8 (2) Tracheostomy care requiring suctioning at least
112	112	9 every 6 hours, room air mist or oxygen as needed, and
113	113	10 dependence on one of the treatment procedures listed under
114	114	11 paragraph (4) excluding the procedure listed in
115	115	12 subparagraph (A) of paragraph (4).
116	116	13 (3) Total parenteral nutrition or other intravenous
117	117	14 nutritional support and one of the treatment procedures
118	118	15 listed under paragraph (4).
119	119	16 (4) The following treatment procedures apply to the
120	120	17 conditions in paragraphs (2) and (3) of this subsection:
121	121	18 (A) Intermittent suctioning at least every 8 hours
122	122	19 and room air mist or oxygen as needed.
123	123	20 (B) Continuous intravenous therapy including
124	124	21 administration of therapeutic agents necessary for
125	125	22 hydration or of intravenous pharmaceuticals; or
126	126	23 intravenous pharmaceutical administration of more than
127	127	24 one agent via a peripheral or central line, without
128	128	25 continuous infusion.
129	129	26 (C) Peritoneal dialysis treatments requiring at
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140	140	1 least 4 exchanges every 24 hours.
141	141	2 (D) Tube feeding via nasogastric or gastrostomy
142	142	3 tube.
143	143	4 (E) Other medical technologies required
144	144	5 continuously, which in the opinion of the attending
145	145	6 physician require the services of a professional
146	146	7 nurse.
147	147	8 (f) Complex or extensive medical needs for exceptional
148	148	9 care reimbursement. The conditions and services used for the
149	149	10 purposes of this Section have the same meanings as ascribed to
150	150	11 those conditions and services under the Minimum Data Set (MDS)
151	151	12 Resident Assessment Instrument (RAI) and specified in the most
152	152	13 recent manual. Instead of submitting minimum data set
153	153	14 assessments to the Department, medically complex for the
154	154	15 developmentally disabled facilities must document within each
155	155	16 resident's medical record the conditions or services using the
156	156	17 minimum data set documentation standards and requirements to
157	157	18 qualify for exceptional care reimbursement.
158	158	19 (1) Tier 1 reimbursement is for residents who are
159	159	20 receiving at least 51% of their caloric intake via a
160	160	21 feeding tube.
161	161	22 (2) Tier 2 reimbursement is for residents who are
162	162	23 receiving tracheostomy care without a ventilator.
163	163	24 (3) Tier 3 reimbursement is for residents who are
164	164	25 receiving tracheostomy care and ventilator care.
165	165	26 (g) For dates of services starting April 1, 2019,
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176	176	1 reimbursement calculations and direct payment for services
177	177	2 provided by medically complex for the developmentally disabled
178	178	3 facilities are the responsibility of the Department of
179	179	4 Healthcare and Family Services instead of the Department of
180	180	5 Human Services. Appropriations for medically complex for the
181	181	6 developmentally disabled facilities must be shifted from the
182	182	7 Department of Human Services to the Department of Healthcare
183	183	8 and Family Services. Nothing in this Section prohibits the
184	184	9 Department of Healthcare and Family Services from paying more
185	185	10 than the rates specified in this Section. The rates in this
186	186	11 Section must be interpreted as a minimum amount. Any
187	187	12 reimbursement increases applied to providers licensed under
188	188	13 the ID/DD Community Care Act must also be applied in an
189	189	14 equivalent manner to medically complex for the developmentally
190	190	15 disabled facilities.
191	191	16 (h) The Department of Healthcare and Family Services shall
192	192	17 pay the rates in effect on March 31, 2019 until the changes
193	193	18 made to this Section by this amendatory Act of the 100th
194	194	19 General Assembly have been approved by the Centers for
195	195	20 Medicare and Medicaid Services of the U.S. Department of
196	196	21 Health and Human Services.
197	197	22 (i) The Department of Healthcare and Family Services may
198	198	23 adopt rules as allowed by the Illinois Administrative
199	199	24 Procedure Act to implement this Section; however, the
200	200	25 requirements of this Section must be implemented by the
201	201	26 Department of Healthcare and Family Services even if the
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212	212	1 Department of Healthcare and Family Services has not adopted
213	213	2 rules by the implementation date of April 1, 2019.
214	214	3 (Source: P.A. 100-646, eff. 7-27-18.)
215	215	4 Section 99. Effective date. This Act takes effect upon
216	216	5 becoming law.
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