Illinois 2023-2024 Regular Session

Illinois Senate Bill SB1763 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 SB1763 Introduced 2/9/2023, by Sen. Ann Gillespie SYNOPSIS AS INTRODUCED: See Index Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. Increases by 20% hospital reimbursement rates for dates of service on and after January 1, 2024, for specified services, including, but not limited to: inpatient general acute care services; inpatient psychiatric services for safety-net hospitals; general acute care hospitals that are not safety-net hospitals; and outpatient general acute care services. Provides that the rates for the listed services shall be increased, beginning on January 1, 2025 and each January 1 thereafter, based on the annual increase in the national hospital market basket price proxies (DRI) hospital cost index from the midpoint of the calendar year 2 years prior to the current year, to the midpoint of the preceding calendar year. Provides that in no instance shall the adjustment result in a reduction to the rates in place at the time of the required adjustment. Provides that if the federal Centers for Medicare and Medicaid Services finds that the increases required under the amendatory Act would result in rates of reimbursement which exceed the federal maximum limits applicable to hospital payments, then the payments and assessment tax imposed on hospital providers shall be reduced as provided in the Hospital Provider Funding Article. Requires the Department of Healthcare and Family Services to promptly take all actions necessary to ensure the changes authorized in the amendatory Act are in effect for dates of service on and after January 1, 2024. Requires the Department to ensure that all necessary adjustments to the managed care organization capitation base rates necessitated by the adjustments in the amendatory Act are completed, published, and applied 90 days prior to the implementation date of the changes required under the amendatory Act. Provides that, by October 1, 2023, the Department shall by rule implement a methodology effective for dates of service beginning on and after January 1, 2024 to reimburse hospitals for extended stays in a hospital emergency department. Amends the Illinois Administrative Procedure Act. Grants the Department emergency rulemaking authority. Effective immediately. LRB103 27744 KTG 54122 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1763 Introduced 2/9/2023, by Sen. Ann Gillespie SYNOPSIS AS INTRODUCED: See Index See Index Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. Increases by 20% hospital reimbursement rates for dates of service on and after January 1, 2024, for specified services, including, but not limited to: inpatient general acute care services; inpatient psychiatric services for safety-net hospitals; general acute care hospitals that are not safety-net hospitals; and outpatient general acute care services. Provides that the rates for the listed services shall be increased, beginning on January 1, 2025 and each January 1 thereafter, based on the annual increase in the national hospital market basket price proxies (DRI) hospital cost index from the midpoint of the calendar year 2 years prior to the current year, to the midpoint of the preceding calendar year. Provides that in no instance shall the adjustment result in a reduction to the rates in place at the time of the required adjustment. Provides that if the federal Centers for Medicare and Medicaid Services finds that the increases required under the amendatory Act would result in rates of reimbursement which exceed the federal maximum limits applicable to hospital payments, then the payments and assessment tax imposed on hospital providers shall be reduced as provided in the Hospital Provider Funding Article. Requires the Department of Healthcare and Family Services to promptly take all actions necessary to ensure the changes authorized in the amendatory Act are in effect for dates of service on and after January 1, 2024. Requires the Department to ensure that all necessary adjustments to the managed care organization capitation base rates necessitated by the adjustments in the amendatory Act are completed, published, and applied 90 days prior to the implementation date of the changes required under the amendatory Act. Provides that, by October 1, 2023, the Department shall by rule implement a methodology effective for dates of service beginning on and after January 1, 2024 to reimburse hospitals for extended stays in a hospital emergency department. Amends the Illinois Administrative Procedure Act. Grants the Department emergency rulemaking authority. Effective immediately. LRB103 27744 KTG 54122 b LRB103 27744 KTG 54122 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1763 Introduced 2/9/2023, by Sen. Ann Gillespie SYNOPSIS AS INTRODUCED:
3	3	See Index See Index
4	4	See Index
5	5	Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. Increases by 20% hospital reimbursement rates for dates of service on and after January 1, 2024, for specified services, including, but not limited to: inpatient general acute care services; inpatient psychiatric services for safety-net hospitals; general acute care hospitals that are not safety-net hospitals; and outpatient general acute care services. Provides that the rates for the listed services shall be increased, beginning on January 1, 2025 and each January 1 thereafter, based on the annual increase in the national hospital market basket price proxies (DRI) hospital cost index from the midpoint of the calendar year 2 years prior to the current year, to the midpoint of the preceding calendar year. Provides that in no instance shall the adjustment result in a reduction to the rates in place at the time of the required adjustment. Provides that if the federal Centers for Medicare and Medicaid Services finds that the increases required under the amendatory Act would result in rates of reimbursement which exceed the federal maximum limits applicable to hospital payments, then the payments and assessment tax imposed on hospital providers shall be reduced as provided in the Hospital Provider Funding Article. Requires the Department of Healthcare and Family Services to promptly take all actions necessary to ensure the changes authorized in the amendatory Act are in effect for dates of service on and after January 1, 2024. Requires the Department to ensure that all necessary adjustments to the managed care organization capitation base rates necessitated by the adjustments in the amendatory Act are completed, published, and applied 90 days prior to the implementation date of the changes required under the amendatory Act. Provides that, by October 1, 2023, the Department shall by rule implement a methodology effective for dates of service beginning on and after January 1, 2024 to reimburse hospitals for extended stays in a hospital emergency department. Amends the Illinois Administrative Procedure Act. Grants the Department emergency rulemaking authority. Effective immediately.
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8	8	A BILL FOR
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10	10	SB1763 LRB103 27744 KTG 54122 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 1. The Illinois Administrative Procedure Act is
15	15	5 amended by adding Section 5-45.35 as follows:
16	16	6 (5 ILCS 100/5-45.35 new)
17	17	7 Sec. 5-45.35. Emergency rulemaking; Medicaid reimbursement
18	18	8 rates for hospital inpatient and outpatient services. To
19	19	9 provide for the expeditious and timely implementation of the
20	20	10 changes made by this amendatory Act of the 103rd General
21	21	11 Assembly to Sections 5-5.05, 14-12, 14-12.5, and 14-13 of the
22	22	12 Illinois Public Aid Code, emergency rules implementing the
23	23	13 changes made by this amendatory Act of the 103rd General
24	24	14 Assembly to Sections 5-5.05, 14-12, 14-12.5, and 14-13 of the
25	25	15 Illinois Public Aid Code may be adopted in accordance with
26	26	16 Section 5-45 by the Department of Healthcare and Family
27	27	17 Services. The adoption of emergency rules authorized by
28	28	18 Section 5-45 and this Section is deemed to be necessary for the
29	29	19 public interest, safety, and welfare.
30	30	20 This Section is repealed one year after the effective date
31	31	21 of this amendatory Act of the 103rd General Assembly.
32	32	22 Section 5. The Illinois Public Aid Code is amended by
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36	36	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1763 Introduced 2/9/2023, by Sen. Ann Gillespie SYNOPSIS AS INTRODUCED:
37	37	See Index See Index
38	38	See Index
39	39	Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. Increases by 20% hospital reimbursement rates for dates of service on and after January 1, 2024, for specified services, including, but not limited to: inpatient general acute care services; inpatient psychiatric services for safety-net hospitals; general acute care hospitals that are not safety-net hospitals; and outpatient general acute care services. Provides that the rates for the listed services shall be increased, beginning on January 1, 2025 and each January 1 thereafter, based on the annual increase in the national hospital market basket price proxies (DRI) hospital cost index from the midpoint of the calendar year 2 years prior to the current year, to the midpoint of the preceding calendar year. Provides that in no instance shall the adjustment result in a reduction to the rates in place at the time of the required adjustment. Provides that if the federal Centers for Medicare and Medicaid Services finds that the increases required under the amendatory Act would result in rates of reimbursement which exceed the federal maximum limits applicable to hospital payments, then the payments and assessment tax imposed on hospital providers shall be reduced as provided in the Hospital Provider Funding Article. Requires the Department of Healthcare and Family Services to promptly take all actions necessary to ensure the changes authorized in the amendatory Act are in effect for dates of service on and after January 1, 2024. Requires the Department to ensure that all necessary adjustments to the managed care organization capitation base rates necessitated by the adjustments in the amendatory Act are completed, published, and applied 90 days prior to the implementation date of the changes required under the amendatory Act. Provides that, by October 1, 2023, the Department shall by rule implement a methodology effective for dates of service beginning on and after January 1, 2024 to reimburse hospitals for extended stays in a hospital emergency department. Amends the Illinois Administrative Procedure Act. Grants the Department emergency rulemaking authority. Effective immediately.
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42	42	A BILL FOR
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67	67	1 changing Sections 5-5.05, 14-12, and 14-13 and by adding
68	68	2 Section 14-12.5 as follows:
69	69	3 (305 ILCS 5/5-5.05)
70	70	4 Sec. 5-5.05. Hospitals; psychiatric services.
71	71	5 (a) On and after July 1, 2008, the inpatient, per diem rate
72	72	6 to be paid to a hospital for inpatient psychiatric services
73	73	7 shall be not less than $363.77.
74	74	8 (b) For purposes of this Section, "hospital" means the
75	75	9 following:
76	76	10 (1) Advocate Christ Hospital, Oak Lawn, Illinois.
77	77	11 (2) Barnes-Jewish Hospital, St. Louis, Missouri.
78	78	12 (3) BroMenn Healthcare, Bloomington, Illinois.
79	79	13 (4) Jackson Park Hospital, Chicago, Illinois.
80	80	14 (5) Katherine Shaw Bethea Hospital, Dixon, Illinois.
81	81	15 (6) Lawrence County Memorial Hospital, Lawrenceville,
82	82	16 Illinois.
83	83	17 (7) Advocate Lutheran General Hospital, Park Ridge,
84	84	18 Illinois.
85	85	19 (8) Mercy Hospital and Medical Center, Chicago,
86	86	20 Illinois.
87	87	21 (9) Methodist Medical Center of Illinois, Peoria,
88	88	22 Illinois.
89	89	23 (10) Provena United Samaritans Medical Center,
90	90	24 Danville, Illinois.
91	91	25 (11) Rockford Memorial Hospital, Rockford, Illinois.
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102	102	1 (12) Sarah Bush Lincoln Health Center, Mattoon,
103	103	2 Illinois.
104	104	3 (13) Provena Covenant Medical Center, Urbana,
105	105	4 Illinois.
106	106	5 (14) Rush-Presbyterian-St. Luke's Medical Center,
107	107	6 Chicago, Illinois.
108	108	7 (15) Mt. Sinai Hospital, Chicago, Illinois.
109	109	8 (16) Gateway Regional Medical Center, Granite City,
110	110	9 Illinois.
111	111	10 (17) St. Mary of Nazareth Hospital, Chicago, Illinois.
112	112	11 (18) Provena St. Mary's Hospital, Kankakee, Illinois.
113	113	12 (19) St. Mary's Hospital, Decatur, Illinois.
114	114	13 (20) Memorial Hospital, Belleville, Illinois.
115	115	14 (21) Swedish Covenant Hospital, Chicago, Illinois.
116	116	15 (22) Trinity Medical Center, Rock Island, Illinois.
117	117	16 (23) St. Elizabeth Hospital, Chicago, Illinois.
118	118	17 (24) Richland Memorial Hospital, Olney, Illinois.
119	119	18 (25) St. Elizabeth's Hospital, Belleville, Illinois.
120	120	19 (26) Samaritan Health System, Clinton, Iowa.
121	121	20 (27) St. John's Hospital, Springfield, Illinois.
122	122	21 (28) St. Mary's Hospital, Centralia, Illinois.
123	123	22 (29) Loretto Hospital, Chicago, Illinois.
124	124	23 (30) Kenneth Hall Regional Hospital, East St. Louis,
125	125	24 Illinois.
126	126	25 (31) Hinsdale Hospital, Hinsdale, Illinois.
127	127	26 (32) Pekin Hospital, Pekin, Illinois.
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138	138	1 (33) University of Chicago Medical Center, Chicago,
139	139	2 Illinois.
140	140	3 (34) St. Anthony's Health Center, Alton, Illinois.
141	141	4 (35) OSF St. Francis Medical Center, Peoria, Illinois.
142	142	5 (36) Memorial Medical Center, Springfield, Illinois.
143	143	6 (37) A hospital with a distinct part unit for
144	144	7 psychiatric services that begins operating on or after
145	145	8 July 1, 2008.
146	146	9 For purposes of this Section, "inpatient psychiatric
147	147	10 services" means those services provided to patients who are in
148	148	11 need of short-term acute inpatient hospitalization for active
149	149	12 treatment of an emotional or mental disorder.
150	150	13 (b-5) Notwithstanding any other provision of this Section,
151	151	14 and subject to appropriation, the inpatient, per diem rate to
152	152	15 be paid to all safety-net hospitals for inpatient psychiatric
153	153	16 services on and after January 1, 2021 shall be at least $630,
154	154	17 subject to the provisions of Section 14-12.5.
155	155	18 (b-10) Notwithstanding any other provision of this
156	156	19 Section, effective with dates of service on and after January
157	157	20 1, 2022, any general acute care hospital with more than 9,500
158	158	21 inpatient psychiatric Medicaid days in any calendar year shall
159	159	22 be paid the inpatient per diem rate of no less than $630,
160	160	23 subject to the provisions of Section 14-12.5.
161	161	24 (c) No rules shall be promulgated to implement this
162	162	25 Section. For purposes of this Section, "rules" is given the
163	163	26 meaning contained in Section 1-70 of the Illinois
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174	174	1 Administrative Procedure Act.
175	175	2 (d) (Blank). This Section shall not be in effect during
176	176	3 any period of time that the State has in place a fully
177	177	4 operational hospital assessment plan that has been approved by
178	178	5 the Centers for Medicare and Medicaid Services of the U.S.
179	179	6 Department of Health and Human Services.
180	180	7 (e) On and after July 1, 2012, the Department shall reduce
181	181	8 any rate of reimbursement for services or other payments or
182	182	9 alter any methodologies authorized by this Code to reduce any
183	183	10 rate of reimbursement for services or other payments in
184	184	11 accordance with Section 5-5e.
185	185	12 (Source: P.A. 102-4, eff. 4-27-21; 102-674, eff. 11-30-21.)
186	186	13 (305 ILCS 5/14-12)
187	187	14 Sec. 14-12. Hospital rate reform payment system. The
188	188	15 hospital payment system pursuant to Section 14-11 of this
189	189	16 Article shall be as follows:
190	190	17 (a) Inpatient hospital services. Effective for discharges
191	191	18 on and after July 1, 2014, reimbursement for inpatient general
192	192	19 acute care services shall utilize the All Patient Refined
193	193	20 Diagnosis Related Grouping (APR-DRG) software, version 30,
194	194	21 distributed by 3MTM Health Information System.
195	195	22 (1) The Department shall establish Medicaid weighting
196	196	23 factors to be used in the reimbursement system established
197	197	24 under this subsection. Initial weighting factors shall be
198	198	25 the weighting factors as published by 3M Health
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209	209	1 Information System, associated with Version 30.0 adjusted
210	210	2 for the Illinois experience.
211	211	3 (2) The Department shall establish a
212	212	4 statewide-standardized amount to be used in the inpatient
213	213	5 reimbursement system. The Department shall publish these
214	214	6 amounts on its website no later than 10 calendar days
215	215	7 prior to their effective date.
216	216	8 (3) In addition to the statewide-standardized amount,
217	217	9 the Department shall develop adjusters to adjust the rate
218	218	10 of reimbursement for critical Medicaid providers or
219	219	11 services for trauma, transplantation services, perinatal
220	220	12 care, and Graduate Medical Education (GME).
221	221	13 (4) The Department shall develop add-on payments to
222	222	14 account for exceptionally costly inpatient stays,
223	223	15 consistent with Medicare outlier principles. Outlier fixed
224	224	16 loss thresholds may be updated to control for excessive
225	225	17 growth in outlier payments no more frequently than on an
226	226	18 annual basis, but at least once every 4 years. Upon
227	227	19 updating the fixed loss thresholds, the Department shall
228	228	20 be required to update base rates within 12 months.
229	229	21 (5) The Department shall define those hospitals or
230	230	22 distinct parts of hospitals that shall be exempt from the
231	231	23 APR-DRG reimbursement system established under this
232	232	24 Section. The Department shall publish these hospitals'
233	233	25 inpatient rates on its website no later than 10 calendar
234	234	26 days prior to their effective date.
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245	245	1 (6) Beginning July 1, 2014 and ending on June 30,
246	246	2 2024, in addition to the statewide-standardized amount,
247	247	3 the Department shall develop an adjustor to adjust the
248	248	4 rate of reimbursement for safety-net hospitals defined in
249	249	5 Section 5-5e.1 of this Code excluding pediatric hospitals,
250	250	6 subject to the provisions of Section 14-12.5.
251	251	7 (7) Beginning July 1, 2014, in addition to the
252	252	8 statewide-standardized amount, the Department shall
253	253	9 develop an adjustor to adjust the rate of reimbursement
254	254	10 for Illinois freestanding inpatient psychiatric hospitals
255	255	11 that are not designated as children's hospitals by the
256	256	12 Department but are primarily treating patients under the
257	257	13 age of 21.
258	258	14 (7.5) (Blank).
259	259	15 (8) Beginning July 1, 2018, in addition to the
260	260	16 statewide-standardized amount, the Department shall adjust
261	261	17 the rate of reimbursement for hospitals designated by the
262	262	18 Department of Public Health as a Perinatal Level II or II+
263	263	19 center by applying the same adjustor that is applied to
264	264	20 Perinatal and Obstetrical care cases for Perinatal Level
265	265	21 III centers, as of December 31, 2017.
266	266	22 (9) Beginning July 1, 2018, in addition to the
267	267	23 statewide-standardized amount, the Department shall apply
268	268	24 the same adjustor that is applied to trauma cases as of
269	269	25 December 31, 2017 to inpatient claims to treat patients
270	270	26 with burns, including, but not limited to, APR-DRGs 841,
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281	281	1 842, 843, and 844.
282	282	2 (10) Beginning July 1, 2018, the
283	283	3 statewide-standardized amount for inpatient general acute
284	284	4 care services shall be uniformly increased so that base
285	285	5 claims projected reimbursement is increased by an amount
286	286	6 equal to the funds allocated in paragraph (1) of
287	287	7 subsection (b) of Section 5A-12.6, less the amount
288	288	8 allocated under paragraphs (8) and (9) of this subsection
289	289	9 and paragraphs (3) and (4) of subsection (b) multiplied by
290	290	10 40%.
291	291	11 (11) Beginning July 1, 2018, the reimbursement for
292	292	12 inpatient rehabilitation services shall be increased by
293	293	13 the addition of a $96 per day add-on.
294	294	14 (b) Outpatient hospital services. Effective for dates of
295	295	15 service on and after July 1, 2014, reimbursement for
296	296	16 outpatient services shall utilize the Enhanced Ambulatory
297	297	17 Procedure Grouping (EAPG) software, version 3.7 distributed by
298	298	18 3MTM Health Information System.
299	299	19 (1) The Department shall establish Medicaid weighting
300	300	20 factors to be used in the reimbursement system established
301	301	21 under this subsection. The initial weighting factors shall
302	302	22 be the weighting factors as published by 3M Health
303	303	23 Information System, associated with Version 3.7.
304	304	24 (2) The Department shall establish service specific
305	305	25 statewide-standardized amounts to be used in the
306	306	26 reimbursement system.
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317	317	1 (A) The initial statewide standardized amounts,
318	318	2 with the labor portion adjusted by the Calendar Year
319	319	3 2013 Medicare Outpatient Prospective Payment System
320	320	4 wage index with reclassifications, shall be published
321	321	5 by the Department on its website no later than 10
322	322	6 calendar days prior to their effective date.
323	323	7 (B) The Department shall establish adjustments to
324	324	8 the statewide-standardized amounts for each Critical
325	325	9 Access Hospital, as designated by the Department of
326	326	10 Public Health in accordance with 42 CFR 485, Subpart
327	327	11 F. For outpatient services provided on or before June
328	328	12 30, 2018, the EAPG standardized amounts are determined
329	329	13 separately for each critical access hospital such that
330	330	14 simulated EAPG payments using outpatient base period
331	331	15 paid claim data plus payments under Section 5A-12.4 of
332	332	16 this Code net of the associated tax costs are equal to
333	333	17 the estimated costs of outpatient base period claims
334	334	18 data with a rate year cost inflation factor applied.
335	335	19 (3) In addition to the statewide-standardized amounts,
336	336	20 the Department shall develop adjusters to adjust the rate
337	337	21 of reimbursement for critical Medicaid hospital outpatient
338	338	22 providers or services, including outpatient high volume or
339	339	23 safety-net hospitals. Beginning July 1, 2018, the
340	340	24 outpatient high volume adjustor shall be increased to
341	341	25 increase annual expenditures associated with this adjustor
342	342	26 by $79,200,000, based on the State Fiscal Year 2015 base
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353	353	1 year data and this adjustor shall apply to public
354	354	2 hospitals, except for large public hospitals, as defined
355	355	3 under 89 Ill. Adm. Code 148.25(a).
356	356	4 (4) Beginning July 1, 2018, in addition to the
357	357	5 statewide standardized amounts, the Department shall make
358	358	6 an add-on payment for outpatient expensive devices and
359	359	7 drugs. This add-on payment shall at least apply to claim
360	360	8 lines that: (i) are assigned with one of the following
361	361	9 EAPGs: 490, 1001 to 1020, and coded with one of the
362	362	10 following revenue codes: 0274 to 0276, 0278; or (ii) are
363	363	11 assigned with one of the following EAPGs: 430 to 441, 443,
364	364	12 444, 460 to 465, 495, 496, 1090. The add-on payment shall
365	365	13 be calculated as follows: the claim line's covered charges
366	366	14 multiplied by the hospital's total acute cost to charge
367	367	15 ratio, less the claim line's EAPG payment plus $1,000,
368	368	16 multiplied by 0.8.
369	369	17 (5) Beginning July 1, 2018, the statewide-standardized
370	370	18 amounts for outpatient services shall be increased by a
371	371	19 uniform percentage so that base claims projected
372	372	20 reimbursement is increased by an amount equal to no less
373	373	21 than the funds allocated in paragraph (1) of subsection
374	374	22 (b) of Section 5A-12.6, less the amount allocated under
375	375	23 paragraphs (8) and (9) of subsection (a) and paragraphs
376	376	24 (3) and (4) of this subsection multiplied by 46%.
377	377	25 (6) Effective for dates of service on or after July 1,
378	378	26 2018, the Department shall establish adjustments to the
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389	389	1 statewide-standardized amounts for each Critical Access
390	390	2 Hospital, as designated by the Department of Public Health
391	391	3 in accordance with 42 CFR 485, Subpart F, such that each
392	392	4 Critical Access Hospital's standardized amount for
393	393	5 outpatient services shall be increased by the applicable
394	394	6 uniform percentage determined pursuant to paragraph (5) of
395	395	7 this subsection. It is the intent of the General Assembly
396	396	8 that the adjustments required under this paragraph (6) by
397	397	9 Public Act 100-1181 shall be applied retroactively to
398	398	10 claims for dates of service provided on or after July 1,
399	399	11 2018.
400	400	12 (7) Effective for dates of service on or after March
401	401	13 8, 2019 (the effective date of Public Act 100-1181), the
402	402	14 Department shall recalculate and implement an updated
403	403	15 statewide-standardized amount for outpatient services
404	404	16 provided by hospitals that are not Critical Access
405	405	17 Hospitals to reflect the applicable uniform percentage
406	406	18 determined pursuant to paragraph (5).
407	407	19 (1) Any recalculation to the
408	408	20 statewide-standardized amounts for outpatient services
409	409	21 provided by hospitals that are not Critical Access
410	410	22 Hospitals shall be the amount necessary to achieve the
411	411	23 increase in the statewide-standardized amounts for
412	412	24 outpatient services increased by a uniform percentage,
413	413	25 so that base claims projected reimbursement is
414	414	26 increased by an amount equal to no less than the funds
415	415
416	416
417	417
418	418
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424	424	SB1763 - 12 - LRB103 27744 KTG 54122 b
425	425	1 allocated in paragraph (1) of subsection (b) of
426	426	2 Section 5A-12.6, less the amount allocated under
427	427	3 paragraphs (8) and (9) of subsection (a) and
428	428	4 paragraphs (3) and (4) of this subsection, for all
429	429	5 hospitals that are not Critical Access Hospitals,
430	430	6 multiplied by 46%.
431	431	7 (2) It is the intent of the General Assembly that
432	432	8 the recalculations required under this paragraph (7)
433	433	9 by Public Act 100-1181 shall be applied prospectively
434	434	10 to claims for dates of service provided on or after
435	435	11 March 8, 2019 (the effective date of Public Act
436	436	12 100-1181) and that no recoupment or repayment by the
437	437	13 Department or an MCO of payments attributable to
438	438	14 recalculation under this paragraph (7), issued to the
439	439	15 hospital for dates of service on or after July 1, 2018
440	440	16 and before March 8, 2019 (the effective date of Public
441	441	17 Act 100-1181), shall be permitted.
442	442	18 (8) The Department shall ensure that all necessary
443	443	19 adjustments to the managed care organization capitation
444	444	20 base rates necessitated by the adjustments under
445	445	21 subparagraph (6) or (7) of this subsection are completed
446	446	22 and applied retroactively in accordance with Section
447	447	23 5-30.8 of this Code within 90 days of March 8, 2019 (the
448	448	24 effective date of Public Act 100-1181).
449	449	25 (9) Within 60 days after federal approval of the
450	450	26 change made to the assessment in Section 5A-2 by Public
451	451
452	452
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461	461	1 Act 101-650 this amendatory Act of the 101st General
462	462	2 Assembly, the Department shall incorporate into the EAPG
463	463	3 system for outpatient services those services performed by
464	464	4 hospitals currently billed through the Non-Institutional
465	465	5 Provider billing system.
466	466	6 (b-5) Notwithstanding any other provision of this Section,
467	467	7 beginning with dates of service on and after January 1, 2023,
468	468	8 any general acute care hospital with more than 500 outpatient
469	469	9 psychiatric Medicaid services to persons under 19 years of age
470	470	10 in any calendar year shall be paid the outpatient add-on
471	471	11 payment of no less than $113.
472	472	12 (c) In consultation with the hospital community, the
473	473	13 Department is authorized to replace 89 Ill. Adm. Admin. Code
474	474	14 152.150 as published in 38 Ill. Reg. 4980 through 4986 within
475	475	15 12 months of June 16, 2014 (the effective date of Public Act
476	476	16 98-651). If the Department does not replace these rules within
477	477	17 12 months of June 16, 2014 (the effective date of Public Act
478	478	18 98-651), the rules in effect for 152.150 as published in 38
479	479	19 Ill. Reg. 4980 through 4986 shall remain in effect until
480	480	20 modified by rule by the Department. Nothing in this subsection
481	481	21 shall be construed to mandate that the Department file a
482	482	22 replacement rule.
483	483	23 (d) Transition period. There shall be a transition period
484	484	24 to the reimbursement systems authorized under this Section
485	485	25 that shall begin on the effective date of these systems and
486	486	26 continue until June 30, 2018, unless extended by rule by the
487	487
488	488
489	489
490	490
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497	497	1 Department. To help provide an orderly and predictable
498	498	2 transition to the new reimbursement systems and to preserve
499	499	3 and enhance access to the hospital services during this
500	500	4 transition, the Department shall allocate a transitional
501	501	5 hospital access pool of at least $290,000,000 annually so that
502	502	6 transitional hospital access payments are made to hospitals.
503	503	7 (1) After the transition period, the Department may
504	504	8 begin incorporating the transitional hospital access pool
505	505	9 into the base rate structure; however, the transitional
506	506	10 hospital access payments in effect on June 30, 2018 shall
507	507	11 continue to be paid, if continued under Section 5A-16.
508	508	12 (2) After the transition period, if the Department
509	509	13 reduces payments from the transitional hospital access
510	510	14 pool, it shall increase base rates, develop new adjustors,
511	511	15 adjust current adjustors, develop new hospital access
512	512	16 payments based on updated information, or any combination
513	513	17 thereof by an amount equal to the decreases proposed in
514	514	18 the transitional hospital access pool payments, ensuring
515	515	19 that the entire transitional hospital access pool amount
516	516	20 shall continue to be used for hospital payments.
517	517	21 (d-5) Hospital and health care transformation program. The
518	518	22 Department shall develop a hospital and health care
519	519	23 transformation program to provide financial assistance to
520	520	24 hospitals in transforming their services and care models to
521	521	25 better align with the needs of the communities they serve. The
522	522	26 payments authorized in this Section shall be subject to
523	523
524	524
525	525
526	526
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533	533	1 approval by the federal government.
534	534	2 (1) Phase 1. In State fiscal years 2019 through 2020,
535	535	3 the Department shall allocate funds from the transitional
536	536	4 access hospital pool to create a hospital transformation
537	537	5 pool of at least $262,906,870 annually and make hospital
538	538	6 transformation payments to hospitals. Subject to Section
539	539	7 5A-16, in State fiscal years 2019 and 2020, an Illinois
540	540	8 hospital that received either a transitional hospital
541	541	9 access payment under subsection (d) or a supplemental
542	542	10 payment under subsection (f) of this Section in State
543	543	11 fiscal year 2018, shall receive a hospital transformation
544	544	12 payment as follows:
545	545	13 (A) If the hospital's Rate Year 2017 Medicaid
546	546	14 inpatient utilization rate is equal to or greater than
547	547	15 45%, the hospital transformation payment shall be
548	548	16 equal to 100% of the sum of its transitional hospital
549	549	17 access payment authorized under subsection (d) and any
550	550	18 supplemental payment authorized under subsection (f).
551	551	19 (B) If the hospital's Rate Year 2017 Medicaid
552	552	20 inpatient utilization rate is equal to or greater than
553	553	21 25% but less than 45%, the hospital transformation
554	554	22 payment shall be equal to 75% of the sum of its
555	555	23 transitional hospital access payment authorized under
556	556	24 subsection (d) and any supplemental payment authorized
557	557	25 under subsection (f).
558	558	26 (C) If the hospital's Rate Year 2017 Medicaid
559	559
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565	565
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569	569	1 inpatient utilization rate is less than 25%, the
570	570	2 hospital transformation payment shall be equal to 50%
571	571	3 of the sum of its transitional hospital access payment
572	572	4 authorized under subsection (d) and any supplemental
573	573	5 payment authorized under subsection (f).
574	574	6 (2) Phase 2.
575	575	7 (A) The funding amount from phase one shall be
576	576	8 incorporated into directed payment and pass-through
577	577	9 payment methodologies described in Section 5A-12.7.
578	578	10 (B) Because there are communities in Illinois that
579	579	11 experience significant health care disparities due to
580	580	12 systemic racism, as recently emphasized by the
581	581	13 COVID-19 pandemic, aggravated by social determinants
582	582	14 of health and a lack of sufficiently allocated
583	583	15 healthcare resources, particularly community-based
584	584	16 services, preventive care, obstetric care, chronic
585	585	17 disease management, and specialty care, the Department
586	586	18 shall establish a health care transformation program
587	587	19 that shall be supported by the transformation funding
588	588	20 pool. It is the intention of the General Assembly that
589	589	21 innovative partnerships funded by the pool must be
590	590	22 designed to establish or improve integrated health
591	591	23 care delivery systems that will provide significant
592	592	24 access to the Medicaid and uninsured populations in
593	593	25 their communities, as well as improve health care
594	594	26 equity. It is also the intention of the General
595	595
596	596
597	597
598	598
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605	605	1 Assembly that partnerships recognize and address the
606	606	2 disparities revealed by the COVID-19 pandemic, as well
607	607	3 as the need for post-COVID care. During State fiscal
608	608	4 years 2021 through 2027, the hospital and health care
609	609	5 transformation program shall be supported by an annual
610	610	6 transformation funding pool of up to $150,000,000,
611	611	7 pending federal matching funds, to be allocated during
612	612	8 the specified fiscal years for the purpose of
613	613	9 facilitating hospital and health care transformation.
614	614	10 No disbursement of moneys for transformation projects
615	615	11 from the transformation funding pool described under
616	616	12 this Section shall be considered an award, a grant, or
617	617	13 an expenditure of grant funds. Funding agreements made
618	618	14 in accordance with the transformation program shall be
619	619	15 considered purchases of care under the Illinois
620	620	16 Procurement Code, and funds shall be expended by the
621	621	17 Department in a manner that maximizes federal funding
622	622	18 to expend the entire allocated amount.
623	623	19 The Department shall convene, within 30 days after
624	624	20 March 12, 2021 (the effective date of Public Act
625	625	21 101-655) this amendatory Act of the 101st General
626	626	22 Assembly, a workgroup that includes subject matter
627	627	23 experts on healthcare disparities and stakeholders
628	628	24 from distressed communities, which could be a
629	629	25 subcommittee of the Medicaid Advisory Committee, to
630	630	26 review and provide recommendations on how Department
631	631
632	632
633	633
634	634
635	635
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637	637
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641	641	1 policy, including health care transformation, can
642	642	2 improve health disparities and the impact on
643	643	3 communities disproportionately affected by COVID-19.
644	644	4 The workgroup shall consider and make recommendations
645	645	5 on the following issues: a community safety-net
646	646	6 designation of certain hospitals, racial equity, and a
647	647	7 regional partnership to bring additional specialty
648	648	8 services to communities.
649	649	9 (C) As provided in paragraph (9) of Section 3 of
650	650	10 the Illinois Health Facilities Planning Act, any
651	651	11 hospital participating in the transformation program
652	652	12 may be excluded from the requirements of the Illinois
653	653	13 Health Facilities Planning Act for those projects
654	654	14 related to the hospital's transformation. To be
655	655	15 eligible, the hospital must submit to the Health
656	656	16 Facilities and Services Review Board approval from the
657	657	17 Department that the project is a part of the
658	658	18 hospital's transformation.
659	659	19 (D) As provided in subsection (a-20) of Section
660	660	20 32.5 of the Emergency Medical Services (EMS) Systems
661	661	21 Act, a hospital that received hospital transformation
662	662	22 payments under this Section may convert to a
663	663	23 freestanding emergency center. To be eligible for such
664	664	24 a conversion, the hospital must submit to the
665	665	25 Department of Public Health approval from the
666	666	26 Department that the project is a part of the
667	667
668	668
669	669
670	670
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677	677	1 hospital's transformation.
678	678	2 (E) Criteria for proposals. To be eligible for
679	679	3 funding under this Section, a transformation proposal
680	680	4 shall meet all of the following criteria:
681	681	5 (i) the proposal shall be designed based on
682	682	6 community needs assessment completed by either a
683	683	7 University partner or other qualified entity with
684	684	8 significant community input;
685	685	9 (ii) the proposal shall be a collaboration
686	686	10 among providers across the care and community
687	687	11 spectrum, including preventative care, primary
688	688	12 care specialty care, hospital services, mental
689	689	13 health and substance abuse services, as well as
690	690	14 community-based entities that address the social
691	691	15 determinants of health;
692	692	16 (iii) the proposal shall be specifically
693	693	17 designed to improve healthcare outcomes and reduce
694	694	18 healthcare disparities, and improve the
695	695	19 coordination, effectiveness, and efficiency of
696	696	20 care delivery;
697	697	21 (iv) the proposal shall have specific
698	698	22 measurable metrics related to disparities that
699	699	23 will be tracked by the Department and made public
700	700	24 by the Department;
701	701	25 (v) the proposal shall include a commitment to
702	702	26 include Business Enterprise Program certified
703	703
704	704
705	705
706	706
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713	713	1 vendors or other entities controlled and managed
714	714	2 by minorities or women; and
715	715	3 (vi) the proposal shall specifically increase
716	716	4 access to primary, preventive, or specialty care.
717	717	5 (F) Entities eligible to be funded.
718	718	6 (i) Proposals for funding should come from
719	719	7 collaborations operating in one of the most
720	720	8 distressed communities in Illinois as determined
721	721	9 by the U.S. Centers for Disease Control and
722	722	10 Prevention's Social Vulnerability Index for
723	723	11 Illinois and areas disproportionately impacted by
724	724	12 COVID-19 or from rural areas of Illinois.
725	725	13 (ii) The Department shall prioritize
726	726	14 partnerships from distressed communities, which
727	727	15 include Business Enterprise Program certified
728	728	16 vendors or other entities controlled and managed
729	729	17 by minorities or women and also include one or
730	730	18 more of the following: safety-net hospitals,
731	731	19 critical access hospitals, the campuses of
732	732	20 hospitals that have closed since January 1, 2018,
733	733	21 or other healthcare providers designed to address
734	734	22 specific healthcare disparities, including the
735	735	23 impact of COVID-19 on individuals and the
736	736	24 community and the need for post-COVID care. All
737	737	25 funded proposals must include specific measurable
738	738	26 goals and metrics related to improved outcomes and
739	739
740	740
741	741
742	742
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749	749	1 reduced disparities which shall be tracked by the
750	750	2 Department.
751	751	3 (iii) The Department should target the funding
752	752	4 in the following ways: $30,000,000 of
753	753	5 transformation funds to projects that are a
754	754	6 collaboration between a safety-net hospital,
755	755	7 particularly community safety-net hospitals, and
756	756	8 other providers and designed to address specific
757	757	9 healthcare disparities, $20,000,000 of
758	758	10 transformation funds to collaborations between
759	759	11 safety-net hospitals and a larger hospital partner
760	760	12 that increases specialty care in distressed
761	761	13 communities, $30,000,000 of transformation funds
762	762	14 to projects that are a collaboration between
763	763	15 hospitals and other providers in distressed areas
764	764	16 of the State designed to address specific
765	765	17 healthcare disparities, $15,000,000 to
766	766	18 collaborations between critical access hospitals
767	767	19 and other providers designed to address specific
768	768	20 healthcare disparities, and $15,000,000 to
769	769	21 cross-provider collaborations designed to address
770	770	22 specific healthcare disparities, and $5,000,000 to
771	771	23 collaborations that focus on workforce
772	772	24 development.
773	773	25 (iv) The Department may allocate up to
774	774	26 $5,000,000 for planning, racial equity analysis,
775	775
776	776
777	777
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785	785	1 or consulting resources for the Department or
786	786	2 entities without the resources to develop a plan
787	787	3 to meet the criteria of this Section. Any contract
788	788	4 for consulting services issued by the Department
789	789	5 under this subparagraph shall comply with the
790	790	6 provisions of Section 5-45 of the State Officials
791	791	7 and Employees Ethics Act. Based on availability of
792	792	8 federal funding, the Department may directly
793	793	9 procure consulting services or provide funding to
794	794	10 the collaboration. The provision of resources
795	795	11 under this subparagraph is not a guarantee that a
796	796	12 project will be approved.
797	797	13 (v) The Department shall take steps to ensure
798	798	14 that safety-net hospitals operating in
799	799	15 under-resourced communities receive priority
800	800	16 access to hospital and healthcare transformation
801	801	17 funds, including consulting funds, as provided
802	802	18 under this Section.
803	803	19 (G) Process for submitting and approving projects
804	804	20 for distressed communities. The Department shall issue
805	805	21 a template for application. The Department shall post
806	806	22 any proposal received on the Department's website for
807	807	23 at least 2 weeks for public comment, and any such
808	808	24 public comment shall also be considered in the review
809	809	25 process. Applicants may request that proprietary
810	810	26 financial information be redacted from publicly posted
811	811
812	812
813	813
814	814
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821	821	1 proposals and the Department in its discretion may
822	822	2 agree. Proposals for each distressed community must
823	823	3 include all of the following:
824	824	4 (i) A detailed description of how the project
825	825	5 intends to affect the goals outlined in this
826	826	6 subsection, describing new interventions, new
827	827	7 technology, new structures, and other changes to
828	828	8 the healthcare delivery system planned.
829	829	9 (ii) A detailed description of the racial and
830	830	10 ethnic makeup of the entities' board and
831	831	11 leadership positions and the salaries of the
832	832	12 executive staff of entities in the partnership
833	833	13 that is seeking to obtain funding under this
834	834	14 Section.
835	835	15 (iii) A complete budget, including an overall
836	836	16 timeline and a detailed pathway to sustainability
837	837	17 within a 5-year period, specifying other sources
838	838	18 of funding, such as in-kind, cost-sharing, or
839	839	19 private donations, particularly for capital needs.
840	840	20 There is an expectation that parties to the
841	841	21 transformation project dedicate resources to the
842	842	22 extent they are able and that these expectations
843	843	23 are delineated separately for each entity in the
844	844	24 proposal.
845	845	25 (iv) A description of any new entities formed
846	846	26 or other legal relationships between collaborating
847	847
848	848
849	849
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857	857	1 entities and how funds will be allocated among
858	858	2 participants.
859	859	3 (v) A timeline showing the evolution of sites
860	860	4 and specific services of the project over a 5-year
861	861	5 period, including services available to the
862	862	6 community by site.
863	863	7 (vi) Clear milestones indicating progress
864	864	8 toward the proposed goals of the proposal as
865	865	9 checkpoints along the way to continue receiving
866	866	10 funding. The Department is authorized to refine
867	867	11 these milestones in agreements, and is authorized
868	868	12 to impose reasonable penalties, including
869	869	13 repayment of funds, for substantial lack of
870	870	14 progress.
871	871	15 (vii) A clear statement of the level of
872	872	16 commitment the project will include for minorities
873	873	17 and women in contracting opportunities, including
874	874	18 as equity partners where applicable, or as
875	875	19 subcontractors and suppliers in all phases of the
876	876	20 project.
877	877	21 (viii) If the community study utilized is not
878	878	22 the study commissioned and published by the
879	879	23 Department, the applicant must define the
880	880	24 methodology used, including documentation of clear
881	881	25 community participation.
882	882	26 (ix) A description of the process used in
883	883
884	884
885	885
886	886
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889	889
890	890
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893	893	1 collaborating with all levels of government in the
894	894	2 community served in the development of the
895	895	3 project, including, but not limited to,
896	896	4 legislators and officials of other units of local
897	897	5 government.
898	898	6 (x) Documentation of a community input process
899	899	7 in the community served, including links to
900	900	8 proposal materials on public websites.
901	901	9 (xi) Verifiable project milestones and quality
902	902	10 metrics that will be impacted by transformation.
903	903	11 These project milestones and quality metrics must
904	904	12 be identified with improvement targets that must
905	905	13 be met.
906	906	14 (xii) Data on the number of existing employees
907	907	15 by various job categories and wage levels by the
908	908	16 zip code of the employees' residence and
909	909	17 benchmarks for the continued maintenance and
910	910	18 improvement of these levels. The proposal must
911	911	19 also describe any retraining or other workforce
912	912	20 development planned for the new project.
913	913	21 (xiii) If a new entity is created by the
914	914	22 project, a description of how the board will be
915	915	23 reflective of the community served by the
916	916	24 proposal.
917	917	25 (xiv) An explanation of how the proposal will
918	918	26 address the existing disparities that exacerbated
919	919
920	920
921	921
922	922
923	923
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926	926
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929	929	1 the impact of COVID-19 and the need for post-COVID
930	930	2 care in the community, if applicable.
931	931	3 (xv) An explanation of how the proposal is
932	932	4 designed to increase access to care, including
933	933	5 specialty care based upon the community's needs.
934	934	6 (H) The Department shall evaluate proposals for
935	935	7 compliance with the criteria listed under subparagraph
936	936	8 (G). Proposals meeting all of the criteria may be
937	937	9 eligible for funding with the areas of focus
938	938	10 prioritized as described in item (ii) of subparagraph
939	939	11 (F). Based on the funds available, the Department may
940	940	12 negotiate funding agreements with approved applicants
941	941	13 to maximize federal funding. Nothing in this
942	942	14 subsection requires that an approved project be funded
943	943	15 to the level requested. Agreements shall specify the
944	944	16 amount of funding anticipated annually, the
945	945	17 methodology of payments, the limit on the number of
946	946	18 years such funding may be provided, and the milestones
947	947	19 and quality metrics that must be met by the projects in
948	948	20 order to continue to receive funding during each year
949	949	21 of the program. Agreements shall specify the terms and
950	950	22 conditions under which a health care facility that
951	951	23 receives funds under a purchase of care agreement and
952	952	24 closes in violation of the terms of the agreement must
953	953	25 pay an early closure fee no greater than 50% of the
954	954	26 funds it received under the agreement, prior to the
955	955
956	956
957	957
958	958
959	959
960	960	SB1763 - 26 - LRB103 27744 KTG 54122 b
961	961
962	962
963	963	SB1763- 27 -LRB103 27744 KTG 54122 b SB1763 - 27 - LRB103 27744 KTG 54122 b
964	964	SB1763 - 27 - LRB103 27744 KTG 54122 b
965	965	1 Health Facilities and Services Review Board
966	966	2 considering an application for closure of the
967	967	3 facility. Any project that is funded shall be required
968	968	4 to provide quarterly written progress reports, in a
969	969	5 form prescribed by the Department, and at a minimum
970	970	6 shall include the progress made in achieving any
971	971	7 milestones or metrics or Business Enterprise Program
972	972	8 commitments in its plan. The Department may reduce or
973	973	9 end payments, as set forth in transformation plans, if
974	974	10 milestones or metrics or Business Enterprise Program
975	975	11 commitments are not achieved. The Department shall
976	976	12 seek to make payments from the transformation fund in
977	977	13 a manner that is eligible for federal matching funds.
978	978	14 In reviewing the proposals, the Department shall
979	979	15 take into account the needs of the community, data
980	980	16 from the study commissioned by the Department from the
981	981	17 University of Illinois-Chicago if applicable, feedback
982	982	18 from public comment on the Department's website, as
983	983	19 well as how the proposal meets the criteria listed
984	984	20 under subparagraph (G). Alignment with the
985	985	21 Department's overall strategic initiatives shall be an
986	986	22 important factor. To the extent that fiscal year
987	987	23 funding is not adequate to fund all eligible projects
988	988	24 that apply, the Department shall prioritize
989	989	25 applications that most comprehensively and effectively
990	990	26 address the criteria listed under subparagraph (G).
991	991
992	992
993	993
994	994
995	995
996	996	SB1763 - 27 - LRB103 27744 KTG 54122 b
997	997
998	998
999	999	SB1763- 28 -LRB103 27744 KTG 54122 b SB1763 - 28 - LRB103 27744 KTG 54122 b
1000	1000	SB1763 - 28 - LRB103 27744 KTG 54122 b
1001	1001	1 (3) (Blank).
1002	1002	2 (4) Hospital Transformation Review Committee. There is
1003	1003	3 created the Hospital Transformation Review Committee. The
1004	1004	4 Committee shall consist of 14 members. No later than 30
1005	1005	5 days after March 12, 2018 (the effective date of Public
1006	1006	6 Act 100-581), the 4 legislative leaders shall each appoint
1007	1007	7 3 members; the Governor shall appoint the Director of
1008	1008	8 Healthcare and Family Services, or his or her designee, as
1009	1009	9 a member; and the Director of Healthcare and Family
1010	1010	10 Services shall appoint one member. Any vacancy shall be
1011	1011	11 filled by the applicable appointing authority within 15
1012	1012	12 calendar days. The members of the Committee shall select a
1013	1013	13 Chair and a Vice-Chair from among its members, provided
1014	1014	14 that the Chair and Vice-Chair cannot be appointed by the
1015	1015	15 same appointing authority and must be from different
1016	1016	16 political parties. The Chair shall have the authority to
1017	1017	17 establish a meeting schedule and convene meetings of the
1018	1018	18 Committee, and the Vice-Chair shall have the authority to
1019	1019	19 convene meetings in the absence of the Chair. The
1020	1020	20 Committee may establish its own rules with respect to
1021	1021	21 meeting schedule, notice of meetings, and the disclosure
1022	1022	22 of documents; however, the Committee shall not have the
1023	1023	23 power to subpoena individuals or documents and any rules
1024	1024	24 must be approved by 9 of the 14 members. The Committee
1025	1025	25 shall perform the functions described in this Section and
1026	1026	26 advise and consult with the Director in the administration
1027	1027
1028	1028
1029	1029
1030	1030
1031	1031
1032	1032	SB1763 - 28 - LRB103 27744 KTG 54122 b
1033	1033
1034	1034
1035	1035	SB1763- 29 -LRB103 27744 KTG 54122 b SB1763 - 29 - LRB103 27744 KTG 54122 b
1036	1036	SB1763 - 29 - LRB103 27744 KTG 54122 b
1037	1037	1 of this Section. In addition to reviewing and approving
1038	1038	2 the policies, procedures, and rules for the hospital and
1039	1039	3 health care transformation program, the Committee shall
1040	1040	4 consider and make recommendations related to qualifying
1041	1041	5 criteria and payment methodologies related to safety-net
1042	1042	6 hospitals and children's hospitals. Members of the
1043	1043	7 Committee appointed by the legislative leaders shall be
1044	1044	8 subject to the jurisdiction of the Legislative Ethics
1045	1045	9 Commission, not the Executive Ethics Commission, and all
1046	1046	10 requests under the Freedom of Information Act shall be
1047	1047	11 directed to the applicable Freedom of Information officer
1048	1048	12 for the General Assembly. The Department shall provide
1049	1049	13 operational support to the Committee as necessary. The
1050	1050	14 Committee is dissolved on April 1, 2019.
1051	1051	15 (e) Beginning 36 months after initial implementation, the
1052	1052	16 Department shall update the reimbursement components in
1053	1053	17 subsections (a) and (b), including standardized amounts and
1054	1054	18 weighting factors, and at least once every 4 years and no more
1055	1055	19 frequently than annually thereafter. The Department shall
1056	1056	20 publish these updates on its website no later than 30 calendar
1057	1057	21 days prior to their effective date.
1058	1058	22 (f) Continuation of supplemental payments. Any
1059	1059	23 supplemental payments authorized under Illinois Administrative
1060	1060	24 Code 148 effective January 1, 2014 and that continue during
1061	1061	25 the period of July 1, 2014 through December 31, 2014 shall
1062	1062	26 remain in effect as long as the assessment imposed by Section
1063	1063
1064	1064
1065	1065
1066	1066
1067	1067
1068	1068	SB1763 - 29 - LRB103 27744 KTG 54122 b
1069	1069
1070	1070
1071	1071	SB1763- 30 -LRB103 27744 KTG 54122 b SB1763 - 30 - LRB103 27744 KTG 54122 b
1072	1072	SB1763 - 30 - LRB103 27744 KTG 54122 b
1073	1073	1 5A-2 that is in effect on December 31, 2017 remains in effect.
1074	1074	2 (g) Notwithstanding subsections (a) through (f) of this
1075	1075	3 Section and notwithstanding the changes authorized under
1076	1076	4 Section 5-5b.1, any updates to the system shall not result in
1077	1077	5 any diminishment of the overall effective rates of
1078	1078	6 reimbursement as of the implementation date of the new system
1079	1079	7 (July 1, 2014). These updates shall not preclude variations in
1080	1080	8 any individual component of the system or hospital rate
1081	1081	9 variations. Nothing in this Section shall prohibit the
1082	1082	10 Department from increasing the rates of reimbursement or
1083	1083	11 developing payments to ensure access to hospital services.
1084	1084	12 Nothing in this Section shall be construed to guarantee a
1085	1085	13 minimum amount of spending in the aggregate or per hospital as
1086	1086	14 spending may be impacted by factors, including, but not
1087	1087	15 limited to, the number of individuals in the medical
1088	1088	16 assistance program and the severity of illness of the
1089	1089	17 individuals.
1090	1090	18 (h) The Department shall have the authority to modify by
1091	1091	19 rulemaking any changes to the rates or methodologies in this
1092	1092	20 Section as required by the federal government to obtain
1093	1093	21 federal financial participation for expenditures made under
1094	1094	22 this Section.
1095	1095	23 (i) Except for subsections (g) and (h) of this Section,
1096	1096	24 the Department shall, pursuant to subsection (c) of Section
1097	1097	25 5-40 of the Illinois Administrative Procedure Act, provide for
1098	1098	26 presentation at the June 2014 hearing of the Joint Committee
1099	1099
1100	1100
1101	1101
1102	1102
1103	1103
1104	1104	SB1763 - 30 - LRB103 27744 KTG 54122 b
1105	1105
1106	1106
1107	1107	SB1763- 31 -LRB103 27744 KTG 54122 b SB1763 - 31 - LRB103 27744 KTG 54122 b
1108	1108	SB1763 - 31 - LRB103 27744 KTG 54122 b
1109	1109	1 on Administrative Rules (JCAR) additional written notice to
1110	1110	2 JCAR of the following rules in order to commence the second
1111	1111	3 notice period for the following rules: rules published in the
1112	1112	4 Illinois Register, rule dated February 21, 2014 at 38 Ill.
1113	1113	5 Reg. 4559 (Medical Payment), 4628 (Specialized Health Care
1114	1114	6 Delivery Systems), 4640 (Hospital Services), 4932 (Diagnostic
1115	1115	7 Related Grouping (DRG) Prospective Payment System (PPS)), and
1116	1116	8 4977 (Hospital Reimbursement Changes), and published in the
1117	1117	9 Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
1118	1118	10 (Specialized Health Care Delivery Systems) and 6505 (Hospital
1119	1119	11 Services).
1120	1120	12 (j) Out-of-state hospitals. Beginning July 1, 2018, for
1121	1121	13 purposes of determining for State fiscal years 2019 and 2020
1122	1122	14 and subsequent fiscal years the hospitals eligible for the
1123	1123	15 payments authorized under subsections (a) and (b) of this
1124	1124	16 Section, the Department shall include out-of-state hospitals
1125	1125	17 that are designated a Level I pediatric trauma center or a
1126	1126	18 Level I trauma center by the Department of Public Health as of
1127	1127	19 December 1, 2017.
1128	1128	20 (k) The Department shall notify each hospital and managed
1129	1129	21 care organization, in writing, of the impact of the updates
1130	1130	22 under this Section at least 30 calendar days prior to their
1131	1131	23 effective date.
1132	1132	24 (l) This Section is subject to Section 14-12.5.
1133	1133	25 (Source: P.A. 101-81, eff. 7-12-19; 101-650, eff. 7-7-20;
1134	1134	26 101-655, eff. 3-12-21; 102-682, eff. 12-10-21; 102-1037, eff.
1135	1135
1136	1136
1137	1137
1138	1138
1139	1139
1140	1140	SB1763 - 31 - LRB103 27744 KTG 54122 b
1141	1141
1142	1142
1143	1143	SB1763- 32 -LRB103 27744 KTG 54122 b SB1763 - 32 - LRB103 27744 KTG 54122 b
1144	1144	SB1763 - 32 - LRB103 27744 KTG 54122 b
1145	1145	1 6-2-22; revised 8-22-22.)
1146	1146	2 (305 ILCS 5/14-12.5 new)
1147	1147	3 Sec. 14-12.5. Hospital preservation and stabilization rate
1148	1148	4 update.
1149	1149	5 (a) Notwithstanding any other provision of this Code, the
1150	1150	6 hospital rates of reimbursement authorized under Sections
1151	1151	7 5-5.05, 14-12, and 14-13 of this Code shall be adjusted in
1152	1152	8 accordance with the provisions of this Section.
1153	1153	9 (b) Notwithstanding any other provision of this Code,
1154	1154	10 effective for dates of service on and after January 1, 2024,
1155	1155	11 hospital reimbursement rates shall be revised as follows:
1156	1156	12 (1) For inpatient general acute care services, the
1157	1157	13 statewide-standardized amount in effect January 1, 2023 as
1158	1158	14 published by the Department on December 1, 2022, shall be
1159	1159	15 increased by 20%.
1160	1160	16 (2) For inpatient psychiatric services:
1161	1161	17 (A) For safety-net hospitals, the per diem rates
1162	1162	18 in effect January 1, 2023, shall be increased by 20%,
1163	1163	19 and the minimum per diem rate of $630, authorized in
1164	1164	20 subsection (b-5) of Section 5-5.05 of this Code, shall
1165	1165	21 be increased by 20%.
1166	1166	22 (B) For all general acute care hospitals that are
1167	1167	23 not safety-net hospitals, the per diem rates in effect
1168	1168	24 January 1, 2023 shall be increased by 20%, except that
1169	1169	25 all rates shall be at least 90% of the minimum
1170	1170
1171	1171
1172	1172
1173	1173
1174	1174
1175	1175	SB1763 - 32 - LRB103 27744 KTG 54122 b
1176	1176
1177	1177
1178	1178	SB1763- 33 -LRB103 27744 KTG 54122 b SB1763 - 33 - LRB103 27744 KTG 54122 b
1179	1179	SB1763 - 33 - LRB103 27744 KTG 54122 b
1180	1180	1 inpatient per diem rate for safety-net hospitals as
1181	1181	2 authorized in subsection (b-5) of Section 5-5.05 of
1182	1182	3 this Code, including the adjustment authorized in this
1183	1183	4 Section.
1184	1184	5 (C) For all psychiatric specialty hospitals, the
1185	1185	6 per diem rates in effect January 1, 2023, shall be
1186	1186	7 increased by 20%, and the statewide default per diem
1187	1187	8 rates for new psychiatric specialty hospitals shall be
1188	1188	9 increased by 20%.
1189	1189	10 (3) For inpatient rehabilitative services, the per
1190	1190	11 diem rates in effect January 1, 2023, shall be increased
1191	1191	12 by 20%, and the statewide default inpatient rehabilitative
1192	1192	13 services per diem rates, for general acute care hospitals
1193	1193	14 and for rehabilitation specialty hospitals respectively,
1194	1194	15 shall be increased by 20%.
1195	1195	16 (4) The statewide-standardized amount for outpatient
1196	1196	17 general acute care services in effect January 1, 2023, as
1197	1197	18 published by the Department on December 1, 2022, shall be
1198	1198	19 increased by 20%.
1199	1199	20 (5) The statewide-standardized amount for outpatient
1200	1200	21 psychiatric care services in effect January 1, 2023, as
1201	1201	22 published by the Department on December 1, 2022, shall be
1202	1202	23 increased by 20%.
1203	1203	24 (6) The statewide-standardized amount for outpatient
1204	1204	25 rehabilitative care services in effect January 1, 2023, as
1205	1205	26 published by the Department on December 1, 2022, shall be
1206	1206
1207	1207
1208	1208
1209	1209
1210	1210
1211	1211	SB1763 - 33 - LRB103 27744 KTG 54122 b
1212	1212
1213	1213
1214	1214	SB1763- 34 -LRB103 27744 KTG 54122 b SB1763 - 34 - LRB103 27744 KTG 54122 b
1215	1215	SB1763 - 34 - LRB103 27744 KTG 54122 b
1216	1216	1 increased by 20%.
1217	1217	2 (7) The per diem rate in effect January 1, 2023, as
1218	1218	3 authorized in subsection (a) of Section 14-13 shall be
1219	1219	4 increased by 20%.
1220	1220	5 (8) The per diem add-on payment for safety-net
1221	1221	6 hospitals authorized in paragraph (6) of subsection (a) of
1222	1222	7 Section 14-12, as in effect on January 1, 2023, shall be
1223	1223	8 increased to $115.
1224	1224	9 (c) Beginning on January 1, 2025 and each January 1
1225	1225	10 thereafter, all rates identified in paragraphs (1) through (8)
1226	1226	11 of subsection (b) in effect December 31st of the year
1227	1227	12 preceding the January 1 adjustment shall be increased based on
1228	1228	13 the annual increase in the national hospital market basket
1229	1229	14 price proxies (DRI) hospital cost index from the midpoint of
1230	1230	15 the calendar year 2 years prior to the current year, to the
1231	1231	16 midpoint of the preceding calendar year. In no instance shall
1232	1232	17 the adjustment required in this subsection result in a
1233	1233	18 reduction to the rates in place at the time of the required
1234	1234	19 adjustment.
1235	1235	20 (d) If the federal Centers for Medicare and Medicaid
1236	1236	21 Services finds that the increases required under this Section
1237	1237	22 would result in rates of reimbursement which exceed the
1238	1238	23 federal maximum limits applicable to hospital payments, then
1239	1239	24 the payments and assessment tax authorized under Article V-A
1240	1240	25 of this Code shall be reduced in accordance with Section 5A-15
1241	1241	26 of this Code.
1242	1242
1243	1243
1244	1244
1245	1245
1246	1246
1247	1247	SB1763 - 34 - LRB103 27744 KTG 54122 b
1248	1248
1249	1249
1250	1250	SB1763- 35 -LRB103 27744 KTG 54122 b SB1763 - 35 - LRB103 27744 KTG 54122 b
1251	1251	SB1763 - 35 - LRB103 27744 KTG 54122 b
1252	1252	1 (e) The Department shall promptly take all actions
1253	1253	2 necessary to ensure the changes authorized in this amendatory
1254	1254	3 Act of the 103rd General Assembly are in effect for dates of
1255	1255	4 service on and after January 1, 2024, including publishing all
1256	1256	5 appropriate public notices, applying for federal approval of
1257	1257	6 amendments to the Illinois Title XIX State Plan, and adopting
1258	1258	7 administrative rules if necessary.
1259	1259	8 (f) The Department of Healthcare and Family Services may
1260	1260	9 adopt rules necessary to implement the changes made by this
1261	1261	10 amendatory Act of the 103rd General Assembly through the use
1262	1262	11 of emergency rulemaking in accordance with Section 5-45 of the
1263	1263	12 Illinois Administrative Procedure Act. The 24-month limitation
1264	1264	13 on the adoption of emergency rules does not apply to rules
1265	1265	14 adopted under this Section. The General Assembly finds that
1266	1266	15 the adoption of rules to implement the changes made by this
1267	1267	16 amendatory Act of the 103rd General Assembly is deemed an
1268	1268	17 emergency and necessary for the public interest, safety, and
1269	1269	18 welfare.
1270	1270	19 (g) The Department shall ensure that all necessary
1271	1271	20 adjustments to the managed care organization capitation base
1272	1272	21 rates necessitated by the adjustments in this Section are
1273	1273	22 completed, published, and applied in accordance with Section
1274	1274	23 5-30.8 of this Code 90 days prior to the implementation date of
1275	1275	24 the changes required under this amendatory Act of the 103rd
1276	1276	25 General Assembly.
1277	1277
1278	1278
1279	1279
1280	1280
1281	1281
1282	1282	SB1763 - 35 - LRB103 27744 KTG 54122 b
1283	1283
1284	1284
1285	1285	SB1763- 36 -LRB103 27744 KTG 54122 b SB1763 - 36 - LRB103 27744 KTG 54122 b
1286	1286	SB1763 - 36 - LRB103 27744 KTG 54122 b
1287	1287	1 (305 ILCS 5/14-13)
1288	1288	2 Sec. 14-13. Reimbursement for inpatient stays extended
1289	1289	3 beyond medical necessity.
1290	1290	4 (a) By October 1, 2019, the Department shall by rule
1291	1291	5 implement a methodology effective for dates of service July 1,
1292	1292	6 2019 and later to reimburse hospitals for inpatient stays
1293	1293	7 extended beyond medical necessity due to the inability of the
1294	1294	8 Department or the managed care organization in which a
1295	1295	9 recipient is enrolled or the hospital discharge planner to
1296	1296	10 find an appropriate placement after discharge from the
1297	1297	11 hospital. The Department shall evaluate the effectiveness of
1298	1298	12 the current reimbursement rate for inpatient hospital stays
1299	1299	13 beyond medical necessity.
1300	1300	14 (a-5) By October 1, 2023, the Department shall by rule
1301	1301	15 implement a methodology effective for dates of service
1302	1302	16 beginning on and after January 1, 2024 to reimburse hospitals
1303	1303	17 for extended stays in a hospital emergency department due to
1304	1304	18 the inability of the Department or the managed care
1305	1305	19 organization in which a recipient is enrolled or the hospital
1306	1306	20 discharge planner to find an appropriate placement or transfer
1307	1307	21 to an appropriate facility other than the hospital to which
1308	1308	22 the patient presented. The per diem rate established shall be
1309	1309	23 equal to 2 times the per diem rate paid for stays identified in
1310	1310	24 subsection (a), prorated in hourly increments for each new
1311	1311	25 hour beyond the 4th hour after the time that the patient is
1312	1312	26 determined to be ready for transfer or admission. The rate
1313	1313
1314	1314
1315	1315
1316	1316
1317	1317
1318	1318	SB1763 - 36 - LRB103 27744 KTG 54122 b
1319	1319
1320	1320
1321	1321	SB1763- 37 -LRB103 27744 KTG 54122 b SB1763 - 37 - LRB103 27744 KTG 54122 b
1322	1322	SB1763 - 37 - LRB103 27744 KTG 54122 b
1323	1323	1 established under this subsection shall be paid based on the
1324	1324	2 entire length of the stay in the hospital emergency department
1325	1325	3 awaiting transfer.
1326	1326	4 (b) The methodology shall provide reasonable compensation
1327	1327	5 for the services provided attributable to the days of the
1328	1328	6 extended stay for which the prevailing rate methodology
1329	1329	7 provides no reimbursement. The Department may use a day
1330	1330	8 outlier program to satisfy this requirement. The reimbursement
1331	1331	9 rate shall be set at a level so as not to act as an incentive
1332	1332	10 to avoid transfer to the appropriate level of care needed or
1333	1333	11 placement, after discharge.
1334	1334	12 (c) The Department shall require managed care
1335	1335	13 organizations to adopt this methodology or an alternative
1336	1336	14 methodology that pays at least as much as the Department's
1337	1337	15 adopted methodology unless otherwise mutually agreed upon
1338	1338	16 contractual language is developed by the provider and the
1339	1339	17 managed care organization for a risk-based or innovative
1340	1340	18 payment methodology.
1341	1341	19 (d) Days beyond medical necessity shall not be eligible
1342	1342	20 for per diem add-on payments under the Medicaid High Volume
1343	1343	21 Adjustment (MHVA) or the Medicaid Percentage Adjustment (MPA)
1344	1344	22 programs.
1345	1345	23 (e) For services covered by the fee-for-service program,
1346	1346	24 reimbursement under this Section shall only be made for days
1347	1347	25 beyond medical necessity that occur after the hospital has
1348	1348	26 notified the Department of the need for post-discharge
1349	1349
1350	1350
1351	1351
1352	1352
1353	1353
1354	1354	SB1763 - 37 - LRB103 27744 KTG 54122 b
1355	1355
1356	1356
1357	1357	SB1763- 38 -LRB103 27744 KTG 54122 b SB1763 - 38 - LRB103 27744 KTG 54122 b
1358	1358	SB1763 - 38 - LRB103 27744 KTG 54122 b
1359	1359	1 placement. For services covered by a managed care
1360	1360	2 organization, hospitals shall notify the appropriate managed
1361	1361	3 care organization of an admission within 24 hours of
1362	1362	4 admission. For every 24-hour period beyond the initial 24
1363	1363	5 hours after admission that the hospital fails to notify the
1364	1364	6 managed care organization of the admission, reimbursement
1365	1365	7 under this subsection shall be reduced by one day.
1366	1366	8 (Source: P.A. 101-209, eff. 8-5-19; 102-4, eff. 4-27-21.)
1367	1367	9 Section 99. Effective date. This Act takes effect upon
1368	1368	10 becoming law.
1369	1369	SB1763- 39 -LRB103 27744 KTG 54122 b 1 INDEX 2 Statutes amended in order of appearance SB1763- 39 -LRB103 27744 KTG 54122 b SB1763 - 39 - LRB103 27744 KTG 54122 b 1 INDEX 2 Statutes amended in order of appearance
1370	1370	SB1763- 39 -LRB103 27744 KTG 54122 b SB1763 - 39 - LRB103 27744 KTG 54122 b
1371	1371	SB1763 - 39 - LRB103 27744 KTG 54122 b
1372	1372	1 INDEX
1373	1373	2 Statutes amended in order of appearance
1374	1374
1375	1375
1376	1376
1377	1377
1378	1378
1379	1379	SB1763 - 38 - LRB103 27744 KTG 54122 b
1380	1380
1381	1381
1382	1382
1383	1383	SB1763- 39 -LRB103 27744 KTG 54122 b SB1763 - 39 - LRB103 27744 KTG 54122 b
1384	1384	SB1763 - 39 - LRB103 27744 KTG 54122 b
1385	1385	1 INDEX
1386	1386	2 Statutes amended in order of appearance
1387	1387
1388	1388
1389	1389
1390	1390
1391	1391
1392	1392	SB1763 - 39 - LRB103 27744 KTG 54122 b