Illinois 2023-2024 Regular Session

Illinois House Bill HB4117 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 HB4117 Introduced , by Rep. Norine K. Hammond SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.07305 ILCS 5/14-13 Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Children and Family Services to pay for all inpatient stays at a hospital beginning on the 3rd day a child is in the hospital beyond medical necessity, and the parent or caregiver has denied the child access to the home and has refused or failed to make provisions for another living arrangement for the child or the child's discharge is being delayed due to a pending inquiry or investigation by the Department of Children and Family Services. In a provision requiring the Department of Children and Family Services to pay the DCFS per diem rate for inpatient psychiatric stays at a free-standing psychiatric hospital or a hospital with a pediatric or adolescent inpatient psychiatric unit, requires the Department to pay the DCFS per diem rate effective the 3rd day (rather than the 11th day) when a child is in the hospital beyond medical necessity. LRB103 33244 KTG 63053 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4117 Introduced , by Rep. Norine K. Hammond SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.07305 ILCS 5/14-13 305 ILCS 5/5-5.07 305 ILCS 5/14-13 Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Children and Family Services to pay for all inpatient stays at a hospital beginning on the 3rd day a child is in the hospital beyond medical necessity, and the parent or caregiver has denied the child access to the home and has refused or failed to make provisions for another living arrangement for the child or the child's discharge is being delayed due to a pending inquiry or investigation by the Department of Children and Family Services. In a provision requiring the Department of Children and Family Services to pay the DCFS per diem rate for inpatient psychiatric stays at a free-standing psychiatric hospital or a hospital with a pediatric or adolescent inpatient psychiatric unit, requires the Department to pay the DCFS per diem rate effective the 3rd day (rather than the 11th day) when a child is in the hospital beyond medical necessity. LRB103 33244 KTG 63053 b LRB103 33244 KTG 63053 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4117 Introduced , by Rep. Norine K. Hammond SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-5.07305 ILCS 5/14-13 305 ILCS 5/5-5.07 305 ILCS 5/14-13
4	4	305 ILCS 5/5-5.07
5	5	305 ILCS 5/14-13
6	6	Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Children and Family Services to pay for all inpatient stays at a hospital beginning on the 3rd day a child is in the hospital beyond medical necessity, and the parent or caregiver has denied the child access to the home and has refused or failed to make provisions for another living arrangement for the child or the child's discharge is being delayed due to a pending inquiry or investigation by the Department of Children and Family Services. In a provision requiring the Department of Children and Family Services to pay the DCFS per diem rate for inpatient psychiatric stays at a free-standing psychiatric hospital or a hospital with a pediatric or adolescent inpatient psychiatric unit, requires the Department to pay the DCFS per diem rate effective the 3rd day (rather than the 11th day) when a child is in the hospital beyond medical necessity.
7	7	LRB103 33244 KTG 63053 b LRB103 33244 KTG 63053 b
8	8	LRB103 33244 KTG 63053 b
9	9	A BILL FOR
10	10	HB4117LRB103 33244 KTG 63053 b HB4117 LRB103 33244 KTG 63053 b
11	11	HB4117 LRB103 33244 KTG 63053 b
12	12	1 AN ACT concerning public aid.
13	13	2 Be it enacted by the People of the State of Illinois,
14	14	3 represented in the General Assembly:
15	15	4 Section 5. The Illinois Public Aid Code is amended by
16	16	5 changing Sections 5-5.07 and 14-13 as follows:
17	17	6 (305 ILCS 5/5-5.07)
18	18	7 Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem
19	19	8 rate. The Department of Children and Family Services shall pay
20	20	9 the DCFS per diem rate for inpatient psychiatric stay at a
21	21	10 free-standing psychiatric hospital or a hospital with a
22	22	11 pediatric or adolescent inpatient psychiatric unit effective
23	23	12 the 3rd day 11th day when a child is in the hospital beyond
24	24	13 medical necessity, and the parent or caregiver has denied the
25	25	14 child access to the home and has refused or failed to make
26	26	15 provisions for another living arrangement for the child or the
27	27	16 child's discharge is being delayed due to a pending inquiry or
28	28	17 investigation by the Department of Children and Family
29	29	18 Services. If any portion of a hospital stay is reimbursed
30	30	19 under this Section, the hospital stay shall not be eligible
31	31	20 for payment under the provisions of Section 14-13 of this
32	32	21 Code.
33	33	22 (Source: Reenacted by P.A. 101-15, eff. 6-14-19; reenacted by
34	34	23 P.A. 101-209, eff. 8-5-19; P.A. 101-655, eff. 3-12-21;
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38	38	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4117 Introduced , by Rep. Norine K. Hammond SYNOPSIS AS INTRODUCED:
39	39	305 ILCS 5/5-5.07305 ILCS 5/14-13 305 ILCS 5/5-5.07 305 ILCS 5/14-13
40	40	305 ILCS 5/5-5.07
41	41	305 ILCS 5/14-13
42	42	Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Children and Family Services to pay for all inpatient stays at a hospital beginning on the 3rd day a child is in the hospital beyond medical necessity, and the parent or caregiver has denied the child access to the home and has refused or failed to make provisions for another living arrangement for the child or the child's discharge is being delayed due to a pending inquiry or investigation by the Department of Children and Family Services. In a provision requiring the Department of Children and Family Services to pay the DCFS per diem rate for inpatient psychiatric stays at a free-standing psychiatric hospital or a hospital with a pediatric or adolescent inpatient psychiatric unit, requires the Department to pay the DCFS per diem rate effective the 3rd day (rather than the 11th day) when a child is in the hospital beyond medical necessity.
43	43	LRB103 33244 KTG 63053 b LRB103 33244 KTG 63053 b
44	44	LRB103 33244 KTG 63053 b
45	45	A BILL FOR
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51	51	305 ILCS 5/5-5.07
52	52	305 ILCS 5/14-13
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71	71	1 102-201, eff. 7-30-21; 102-558, eff. 8-20-21; 102-1037, eff.
72	72	2 6-2-22.)
73	73	3 (305 ILCS 5/14-13)
74	74	4 Sec. 14-13. Reimbursement for inpatient stays extended
75	75	5 beyond medical necessity.
76	76	6 (a) By October 1, 2019, the Department shall by rule
77	77	7 implement a methodology effective for dates of service July 1,
78	78	8 2019 and later to reimburse hospitals for inpatient stays
79	79	9 extended beyond medical necessity due to the inability of the
80	80	10 Department or the managed care organization in which a
81	81	11 recipient is enrolled or the hospital discharge planner to
82	82	12 find an appropriate placement after discharge from the
83	83	13 hospital. The Department shall evaluate the effectiveness of
84	84	14 the current reimbursement rate for inpatient hospital stays
85	85	15 beyond medical necessity.
86	86	16 (b) The methodology shall provide reasonable compensation
87	87	17 for the services provided attributable to the days of the
88	88	18 extended stay for which the prevailing rate methodology
89	89	19 provides no reimbursement. The Department may use a day
90	90	20 outlier program to satisfy this requirement. The reimbursement
91	91	21 rate shall be set at a level so as not to act as an incentive
92	92	22 to avoid transfer to the appropriate level of care needed or
93	93	23 placement, after discharge.
94	94	24 (c) The Department shall require managed care
95	95	25 organizations to adopt this methodology or an alternative
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106	106	1 methodology that pays at least as much as the Department's
107	107	2 adopted methodology unless otherwise mutually agreed upon
108	108	3 contractual language is developed by the provider and the
109	109	4 managed care organization for a risk-based or innovative
110	110	5 payment methodology.
111	111	6 (d) Days beyond medical necessity shall not be eligible
112	112	7 for per diem add-on payments under the Medicaid High Volume
113	113	8 Adjustment (MHVA) or the Medicaid Percentage Adjustment (MPA)
114	114	9 programs.
115	115	10 (e) For services covered by the fee-for-service program,
116	116	11 reimbursement under this Section shall only be made for days
117	117	12 beyond medical necessity that occur after the hospital has
118	118	13 notified the Department of the need for post-discharge
119	119	14 placement. For services covered by a managed care
120	120	15 organization, hospitals shall notify the appropriate managed
121	121	16 care organization of an admission within 24 hours of
122	122	17 admission. For every 24-hour period beyond the initial 24
123	123	18 hours after admission that the hospital fails to notify the
124	124	19 managed care organization of the admission, reimbursement
125	125	20 under this subsection shall be reduced by one day.
126	126	21 (f) The Department of Children and Family Services shall
127	127	22 pay for all inpatient stays beginning on the 3rd day a child is
128	128	23 in the hospital beyond medical necessity, and the parent or
129	129	24 caregiver has denied the child access to the home and has
130	130	25 refused or failed to make provisions for another living
131	131	26 arrangement for the child or the child's discharge is being
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142	142	1 delayed due to a pending inquiry or investigation by the
143	143	2 Department of Children and Family Services.
144	144	3 (Source: P.A. 101-209, eff. 8-5-19; 102-4, eff. 4-27-21.)
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150	150	HB4117 - 4 - LRB103 33244 KTG 63053 b