Illinois 2025-2026 Regular Session

Illinois House Bill HB3273 Compare Versions

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

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1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3273 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED: 305 ILCS 5/14-12 Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. In provisions concerning the hospital rate reform payment system, provides that reimbursement for inpatient general acute care services shall utilize the All Patient Refined Diagnosis Related Grouping (APR-DRG) software, version 30, distributed by Solventum previously known as 3MTM Health Information System. Provides that Solventum shall be the exclusive provider of this software unless the Department of Healthcare and Family Services determines that Solventum is unable to meet the required operational or contractual terms. Provides that only under such circumstances may an alternative authorized provider of the software be considered. Adds corresponding provisions regarding software used to process reimbursements for outpatient services. LRB104 10515 KTG 20590 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3273 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED: 305 ILCS 5/14-12 305 ILCS 5/14-12 Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. In provisions concerning the hospital rate reform payment system, provides that reimbursement for inpatient general acute care services shall utilize the All Patient Refined Diagnosis Related Grouping (APR-DRG) software, version 30, distributed by Solventum previously known as 3MTM Health Information System. Provides that Solventum shall be the exclusive provider of this software unless the Department of Healthcare and Family Services determines that Solventum is unable to meet the required operational or contractual terms. Provides that only under such circumstances may an alternative authorized provider of the software be considered. Adds corresponding provisions regarding software used to process reimbursements for outpatient services. LRB104 10515 KTG 20590 b LRB104 10515 KTG 20590 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3273 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/14-12 305 ILCS 5/14-12
4	4	305 ILCS 5/14-12
5	5	Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. In provisions concerning the hospital rate reform payment system, provides that reimbursement for inpatient general acute care services shall utilize the All Patient Refined Diagnosis Related Grouping (APR-DRG) software, version 30, distributed by Solventum previously known as 3MTM Health Information System. Provides that Solventum shall be the exclusive provider of this software unless the Department of Healthcare and Family Services determines that Solventum is unable to meet the required operational or contractual terms. Provides that only under such circumstances may an alternative authorized provider of the software be considered. Adds corresponding provisions regarding software used to process reimbursements for outpatient services.
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8	8	A BILL FOR
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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 14-12 as follows:
16	16	6 (305 ILCS 5/14-12)
17	17	7 Sec. 14-12. Hospital rate reform payment system. The
18	18	8 hospital payment system pursuant to Section 14-11 of this
19	19	9 Article shall be as follows:
20	20	10 (a) Inpatient hospital services. Effective for discharges
21	21	11 on and after the effective date of this amendatory Act of the
22	22	12 104th General Assembly July 1, 2014, reimbursement for
23	23	13 inpatient general acute care services shall utilize the All
24	24	14 Patient Refined Diagnosis Related Grouping (APR-DRG) software,
25	25	15 version 30, distributed by Solventum previously known as 3MTM
26	26	16 Health Information System. Solventum shall be the exclusive
27	27	17 provider of this software unless the Department determines
28	28	18 that Solventum is unable to meet the required operational or
29	29	19 contractual terms. Only under such circumstances may an
30	30	20 alternative authorized provider of the software be considered.
31	31	21 (1) The Department shall establish Medicaid weighting
32	32	22 factors to be used in the reimbursement system established
33	33	23 under this subsection. Initial weighting factors shall be
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37	37	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3273 Introduced , by Rep. Jay Hoffman SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/14-12 305 ILCS 5/14-12
39	39	305 ILCS 5/14-12
40	40	Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. In provisions concerning the hospital rate reform payment system, provides that reimbursement for inpatient general acute care services shall utilize the All Patient Refined Diagnosis Related Grouping (APR-DRG) software, version 30, distributed by Solventum previously known as 3MTM Health Information System. Provides that Solventum shall be the exclusive provider of this software unless the Department of Healthcare and Family Services determines that Solventum is unable to meet the required operational or contractual terms. Provides that only under such circumstances may an alternative authorized provider of the software be considered. Adds corresponding provisions regarding software used to process reimbursements for outpatient services.
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43	43	A BILL FOR
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68	68	1 the weighting factors as published by the authorized
69	69	2 provider of this software 3M Health Information System,
70	70	3 associated with Version 30.0 adjusted for the Illinois
71	71	4 experience.
72	72	5 (2) The Department shall establish a
73	73	6 statewide-standardized amount to be used in the inpatient
74	74	7 reimbursement system. The Department shall publish these
75	75	8 amounts on its website no later than 10 calendar days
76	76	9 prior to their effective date.
77	77	10 (3) In addition to the statewide-standardized amount,
78	78	11 the Department shall develop adjusters to adjust the rate
79	79	12 of reimbursement for critical Medicaid providers or
80	80	13 services for trauma, transplantation services, perinatal
81	81	14 care, and Graduate Medical Education (GME).
82	82	15 (4) The Department shall develop add-on payments to
83	83	16 account for exceptionally costly inpatient stays,
84	84	17 consistent with Medicare outlier principles. Outlier fixed
85	85	18 loss thresholds may be updated to control for excessive
86	86	19 growth in outlier payments no more frequently than on an
87	87	20 annual basis, but at least once every 4 years. Upon
88	88	21 updating the fixed loss thresholds, the Department shall
89	89	22 be required to update base rates within 12 months.
90	90	23 (5) The Department shall define those hospitals or
91	91	24 distinct parts of hospitals that shall be exempt from the
92	92	25 APR-DRG reimbursement system established under this
93	93	26 Section. The Department shall publish these hospitals'
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104	104	1 inpatient rates on its website no later than 10 calendar
105	105	2 days prior to their effective date.
106	106	3 (6) Beginning July 1, 2014 and ending on December 31,
107	107	4 2023, in addition to the statewide-standardized amount,
108	108	5 the Department shall develop an adjustor to adjust the
109	109	6 rate of reimbursement for safety-net hospitals defined in
110	110	7 Section 5-5e.1 of this Code excluding pediatric hospitals.
111	111	8 (7) Beginning July 1, 2014, in addition to the
112	112	9 statewide-standardized amount, the Department shall
113	113	10 develop an adjustor to adjust the rate of reimbursement
114	114	11 for Illinois freestanding inpatient psychiatric hospitals
115	115	12 that are not designated as children's hospitals by the
116	116	13 Department but are primarily treating patients under the
117	117	14 age of 21.
118	118	15 (7.5) (Blank).
119	119	16 (8) Beginning July 1, 2018, in addition to the
120	120	17 statewide-standardized amount, the Department shall adjust
121	121	18 the rate of reimbursement for hospitals designated by the
122	122	19 Department of Public Health as a Perinatal Level II or II+
123	123	20 center by applying the same adjustor that is applied to
124	124	21 Perinatal and Obstetrical care cases for Perinatal Level
125	125	22 III centers, as of December 31, 2017.
126	126	23 (9) Beginning July 1, 2018, in addition to the
127	127	24 statewide-standardized amount, the Department shall apply
128	128	25 the same adjustor that is applied to trauma cases as of
129	129	26 December 31, 2017 to inpatient claims to treat patients
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140	140	1 with burns, including, but not limited to, APR-DRGs 841,
141	141	2 842, 843, and 844.
142	142	3 (10) Beginning July 1, 2018, the
143	143	4 statewide-standardized amount for inpatient general acute
144	144	5 care services shall be uniformly increased so that base
145	145	6 claims projected reimbursement is increased by an amount
146	146	7 equal to the funds allocated in paragraph (1) of
147	147	8 subsection (b) of Section 5A-12.6, less the amount
148	148	9 allocated under paragraphs (8) and (9) of this subsection
149	149	10 and paragraphs (3) and (4) of subsection (b) multiplied by
150	150	11 40%.
151	151	12 (11) Beginning July 1, 2018, the reimbursement for
152	152	13 inpatient rehabilitation services shall be increased by
153	153	14 the addition of a $96 per day add-on.
154	154	15 (b) Outpatient hospital services. Effective for dates of
155	155	16 service on and after the effective date of this amendatory Act
156	156	17 of the 104th General Assembly July 1, 2014, reimbursement for
157	157	18 outpatient services shall utilize the Enhanced Ambulatory
158	158	19 Procedure Grouping (EAPG) software, version 3.7 distributed by
159	159	20 Solventum previously known as 3MTM Health Information System.
160	160	21 Solventum shall be the exclusive provider of this software
161	161	22 unless the Department determines that Solventum is unable to
162	162	23 meet the required operational or contractual terms. Only under
163	163	24 such circumstances may an alternative authorized provider of
164	164	25 the software be considered.
165	165	26 (1) The Department shall establish Medicaid weighting
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176	176	1 factors to be used in the reimbursement system established
177	177	2 under this subsection. The initial weighting factors shall
178	178	3 be the weighting factors as published by the authorized
179	179	4 provider 3M Health Information System, associated with
180	180	5 Version 3.7.
181	181	6 (2) The Department shall establish service specific
182	182	7 statewide-standardized amounts to be used in the
183	183	8 reimbursement system.
184	184	9 (A) The initial statewide standardized amounts,
185	185	10 with the labor portion adjusted by the Calendar Year
186	186	11 2013 Medicare Outpatient Prospective Payment System
187	187	12 wage index with reclassifications, shall be published
188	188	13 by the Department on its website no later than 10
189	189	14 calendar days prior to their effective date.
190	190	15 (B) The Department shall establish adjustments to
191	191	16 the statewide-standardized amounts for each Critical
192	192	17 Access Hospital, as designated by the Department of
193	193	18 Public Health in accordance with 42 CFR 485, Subpart
194	194	19 F. For outpatient services provided on or before June
195	195	20 30, 2018, the EAPG standardized amounts are determined
196	196	21 separately for each critical access hospital such that
197	197	22 simulated EAPG payments using outpatient base period
198	198	23 paid claim data plus payments under Section 5A-12.4 of
199	199	24 this Code net of the associated tax costs are equal to
200	200	25 the estimated costs of outpatient base period claims
201	201	26 data with a rate year cost inflation factor applied.
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212	212	1 (3) In addition to the statewide-standardized amounts,
213	213	2 the Department shall develop adjusters to adjust the rate
214	214	3 of reimbursement for critical Medicaid hospital outpatient
215	215	4 providers or services, including outpatient high volume or
216	216	5 safety-net hospitals. Beginning July 1, 2018, the
217	217	6 outpatient high volume adjustor shall be increased to
218	218	7 increase annual expenditures associated with this adjustor
219	219	8 by $79,200,000, based on the State Fiscal Year 2015 base
220	220	9 year data and this adjustor shall apply to public
221	221	10 hospitals, except for large public hospitals, as defined
222	222	11 under 89 Ill. Adm. Code 148.25(a).
223	223	12 (4) Beginning July 1, 2018, in addition to the
224	224	13 statewide standardized amounts, the Department shall make
225	225	14 an add-on payment for outpatient expensive devices and
226	226	15 drugs. This add-on payment shall at least apply to claim
227	227	16 lines that: (i) are assigned with one of the following
228	228	17 EAPGs: 490, 1001 to 1020, and coded with one of the
229	229	18 following revenue codes: 0274 to 0276, 0278; or (ii) are
230	230	19 assigned with one of the following EAPGs: 430 to 441, 443,
231	231	20 444, 460 to 465, 495, 496, 1090. The add-on payment shall
232	232	21 be calculated as follows: the claim line's covered charges
233	233	22 multiplied by the hospital's total acute cost to charge
234	234	23 ratio, less the claim line's EAPG payment plus $1,000,
235	235	24 multiplied by 0.8.
236	236	25 (5) Beginning July 1, 2018, the statewide-standardized
237	237	26 amounts for outpatient services shall be increased by a
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248	248	1 uniform percentage so that base claims projected
249	249	2 reimbursement is increased by an amount equal to no less
250	250	3 than the funds allocated in paragraph (1) of subsection
251	251	4 (b) of Section 5A-12.6, less the amount allocated under
252	252	5 paragraphs (8) and (9) of subsection (a) and paragraphs
253	253	6 (3) and (4) of this subsection multiplied by 46%.
254	254	7 (6) Effective for dates of service on or after July 1,
255	255	8 2018, the Department shall establish adjustments to the
256	256	9 statewide-standardized amounts for each Critical Access
257	257	10 Hospital, as designated by the Department of Public Health
258	258	11 in accordance with 42 CFR 485, Subpart F, such that each
259	259	12 Critical Access Hospital's standardized amount for
260	260	13 outpatient services shall be increased by the applicable
261	261	14 uniform percentage determined pursuant to paragraph (5) of
262	262	15 this subsection. It is the intent of the General Assembly
263	263	16 that the adjustments required under this paragraph (6) by
264	264	17 Public Act 100-1181 shall be applied retroactively to
265	265	18 claims for dates of service provided on or after July 1,
266	266	19 2018.
267	267	20 (7) Effective for dates of service on or after March
268	268	21 8, 2019 (the effective date of Public Act 100-1181), the
269	269	22 Department shall recalculate and implement an updated
270	270	23 statewide-standardized amount for outpatient services
271	271	24 provided by hospitals that are not Critical Access
272	272	25 Hospitals to reflect the applicable uniform percentage
273	273	26 determined pursuant to paragraph (5).
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284	284	1 (1) Any recalculation to the
285	285	2 statewide-standardized amounts for outpatient services
286	286	3 provided by hospitals that are not Critical Access
287	287	4 Hospitals shall be the amount necessary to achieve the
288	288	5 increase in the statewide-standardized amounts for
289	289	6 outpatient services increased by a uniform percentage,
290	290	7 so that base claims projected reimbursement is
291	291	8 increased by an amount equal to no less than the funds
292	292	9 allocated in paragraph (1) of subsection (b) of
293	293	10 Section 5A-12.6, less the amount allocated under
294	294	11 paragraphs (8) and (9) of subsection (a) and
295	295	12 paragraphs (3) and (4) of this subsection, for all
296	296	13 hospitals that are not Critical Access Hospitals,
297	297	14 multiplied by 46%.
298	298	15 (2) It is the intent of the General Assembly that
299	299	16 the recalculations required under this paragraph (7)
300	300	17 by Public Act 100-1181 shall be applied prospectively
301	301	18 to claims for dates of service provided on or after
302	302	19 March 8, 2019 (the effective date of Public Act
303	303	20 100-1181) and that no recoupment or repayment by the
304	304	21 Department or an MCO of payments attributable to
305	305	22 recalculation under this paragraph (7), issued to the
306	306	23 hospital for dates of service on or after July 1, 2018
307	307	24 and before March 8, 2019 (the effective date of Public
308	308	25 Act 100-1181), shall be permitted.
309	309	26 (8) The Department shall ensure that all necessary
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320	320	1 adjustments to the managed care organization capitation
321	321	2 base rates necessitated by the adjustments under
322	322	3 subparagraph (6) or (7) of this subsection are completed
323	323	4 and applied retroactively in accordance with Section
324	324	5 5-30.8 of this Code within 90 days of March 8, 2019 (the
325	325	6 effective date of Public Act 100-1181).
326	326	7 (9) Within 60 days after federal approval of the
327	327	8 change made to the assessment in Section 5A-2 by Public
328	328	9 Act 101-650, the Department shall incorporate into the
329	329	10 EAPG system for outpatient services those services
330	330	11 performed by hospitals currently billed through the
331	331	12 Non-Institutional Provider billing system.
332	332	13 (b-5) Notwithstanding any other provision of this Section,
333	333	14 beginning with dates of service on and after January 1, 2023,
334	334	15 any general acute care hospital with more than 500 outpatient
335	335	16 psychiatric Medicaid services to persons under 19 years of age
336	336	17 in any calendar year shall be paid the outpatient add-on
337	337	18 payment of no less than $113.
338	338	19 (c) In consultation with the hospital community, the
339	339	20 Department is authorized to replace 89 Ill. Adm. Code 152.150
340	340	21 as published in 38 Ill. Reg. 4980 through 4986 within 12 months
341	341	22 of June 16, 2014 (the effective date of Public Act 98-651). If
342	342	23 the Department does not replace these rules within 12 months
343	343	24 of June 16, 2014 (the effective date of Public Act 98-651), the
344	344	25 rules in effect for 152.150 as published in 38 Ill. Reg. 4980
345	345	26 through 4986 shall remain in effect until modified by rule by
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356	356	1 the Department. Nothing in this subsection shall be construed
357	357	2 to mandate that the Department file a replacement rule.
358	358	3 (d) Transition period. There shall be a transition period
359	359	4 to the reimbursement systems authorized under this Section
360	360	5 that shall begin on the effective date of these systems and
361	361	6 continue until June 30, 2018, unless extended by rule by the
362	362	7 Department. To help provide an orderly and predictable
363	363	8 transition to the new reimbursement systems and to preserve
364	364	9 and enhance access to the hospital services during this
365	365	10 transition, the Department shall allocate a transitional
366	366	11 hospital access pool of at least $290,000,000 annually so that
367	367	12 transitional hospital access payments are made to hospitals.
368	368	13 (1) After the transition period, the Department may
369	369	14 begin incorporating the transitional hospital access pool
370	370	15 into the base rate structure; however, the transitional
371	371	16 hospital access payments in effect on June 30, 2018 shall
372	372	17 continue to be paid, if continued under Section 5A-16.
373	373	18 (2) After the transition period, if the Department
374	374	19 reduces payments from the transitional hospital access
375	375	20 pool, it shall increase base rates, develop new adjustors,
376	376	21 adjust current adjustors, develop new hospital access
377	377	22 payments based on updated information, or any combination
378	378	23 thereof by an amount equal to the decreases proposed in
379	379	24 the transitional hospital access pool payments, ensuring
380	380	25 that the entire transitional hospital access pool amount
381	381	26 shall continue to be used for hospital payments.
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392	392	1 (d-5) Hospital and health care transformation program. The
393	393	2 Department shall develop a hospital and health care
394	394	3 transformation program to provide financial assistance to
395	395	4 hospitals in transforming their services and care models to
396	396	5 better align with the needs of the communities they serve. The
397	397	6 payments authorized in this Section shall be subject to
398	398	7 approval by the federal government.
399	399	8 (1) Phase 1. In State fiscal years 2019 through 2020,
400	400	9 the Department shall allocate funds from the transitional
401	401	10 access hospital pool to create a hospital transformation
402	402	11 pool of at least $262,906,870 annually and make hospital
403	403	12 transformation payments to hospitals. Subject to Section
404	404	13 5A-16, in State fiscal years 2019 and 2020, an Illinois
405	405	14 hospital that received either a transitional hospital
406	406	15 access payment under subsection (d) or a supplemental
407	407	16 payment under subsection (f) of this Section in State
408	408	17 fiscal year 2018, shall receive a hospital transformation
409	409	18 payment as follows:
410	410	19 (A) If the hospital's Rate Year 2017 Medicaid
411	411	20 inpatient utilization rate is equal to or greater than
412	412	21 45%, the hospital transformation payment shall be
413	413	22 equal to 100% of the sum of its transitional hospital
414	414	23 access payment authorized under subsection (d) and any
415	415	24 supplemental payment authorized under subsection (f).
416	416	25 (B) If the hospital's Rate Year 2017 Medicaid
417	417	26 inpatient utilization rate is equal to or greater than
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428	428	1 25% but less than 45%, the hospital transformation
429	429	2 payment shall be equal to 75% of the sum of its
430	430	3 transitional hospital access payment authorized under
431	431	4 subsection (d) and any supplemental payment authorized
432	432	5 under subsection (f).
433	433	6 (C) If the hospital's Rate Year 2017 Medicaid
434	434	7 inpatient utilization rate is less than 25%, the
435	435	8 hospital transformation payment shall be equal to 50%
436	436	9 of the sum of its transitional hospital access payment
437	437	10 authorized under subsection (d) and any supplemental
438	438	11 payment authorized under subsection (f).
439	439	12 (2) Phase 2.
440	440	13 (A) The funding amount from phase one shall be
441	441	14 incorporated into directed payment and pass-through
442	442	15 payment methodologies described in Section 5A-12.7.
443	443	16 (B) Because there are communities in Illinois that
444	444	17 experience significant health care disparities due to
445	445	18 systemic racism, as recently emphasized by the
446	446	19 COVID-19 pandemic, aggravated by social determinants
447	447	20 of health and a lack of sufficiently allocated health
448	448	21 care healthcare resources, particularly
449	449	22 community-based services, preventive care, obstetric
450	450	23 care, chronic disease management, and specialty care,
451	451	24 the Department shall establish a health care
452	452	25 transformation program that shall be supported by the
453	453	26 transformation funding pool. It is the intention of
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464	464	1 the General Assembly that innovative partnerships
465	465	2 funded by the pool must be designed to establish or
466	466	3 improve integrated health care delivery systems that
467	467	4 will provide significant access to the Medicaid and
468	468	5 uninsured populations in their communities, as well as
469	469	6 improve health care equity. It is also the intention
470	470	7 of the General Assembly that partnerships recognize
471	471	8 and address the disparities revealed by the COVID-19
472	472	9 pandemic, as well as the need for post-COVID care.
473	473	10 During State fiscal years 2021 through 2027, the
474	474	11 hospital and health care transformation program shall
475	475	12 be supported by an annual transformation funding pool
476	476	13 of up to $150,000,000, pending federal matching funds,
477	477	14 to be allocated during the specified fiscal years for
478	478	15 the purpose of facilitating hospital and health care
479	479	16 transformation. No disbursement of moneys for
480	480	17 transformation projects from the transformation
481	481	18 funding pool described under this Section shall be
482	482	19 considered an award, a grant, or an expenditure of
483	483	20 grant funds. Funding agreements made in accordance
484	484	21 with the transformation program shall be considered
485	485	22 purchases of care under the Illinois Procurement Code,
486	486	23 and funds shall be expended by the Department in a
487	487	24 manner that maximizes federal funding to expend the
488	488	25 entire allocated amount.
489	489	26 The Department shall convene, within 30 days after
490	490
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500	500	1 March 12, 2021 (the effective date of Public Act
501	501	2 101-655), a workgroup that includes subject matter
502	502	3 experts on health care healthcare disparities and
503	503	4 stakeholders from distressed communities, which could
504	504	5 be a subcommittee of the Medicaid Advisory Committee,
505	505	6 to review and provide recommendations on how
506	506	7 Department policy, including health care
507	507	8 transformation, can improve health disparities and the
508	508	9 impact on communities disproportionately affected by
509	509	10 COVID-19. The workgroup shall consider and make
510	510	11 recommendations on the following issues: a community
511	511	12 safety-net designation of certain hospitals, racial
512	512	13 equity, and a regional partnership to bring additional
513	513	14 specialty services to communities.
514	514	15 (C) As provided in paragraph (9) of Section 3 of
515	515	16 the Illinois Health Facilities Planning Act, any
516	516	17 hospital participating in the transformation program
517	517	18 may be excluded from the requirements of the Illinois
518	518	19 Health Facilities Planning Act for those projects
519	519	20 related to the hospital's transformation. To be
520	520	21 eligible, the hospital must submit to the Health
521	521	22 Facilities and Services Review Board approval from the
522	522	23 Department that the project is a part of the
523	523	24 hospital's transformation.
524	524	25 (D) As provided in subsection (a-20) of Section
525	525	26 32.5 of the Emergency Medical Services (EMS) Systems
526	526
527	527
528	528
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536	536	1 Act, a hospital that received hospital transformation
537	537	2 payments under this Section may convert to a
538	538	3 freestanding emergency center. To be eligible for such
539	539	4 a conversion, the hospital must submit to the
540	540	5 Department of Public Health approval from the
541	541	6 Department that the project is a part of the
542	542	7 hospital's transformation.
543	543	8 (E) Criteria for proposals. To be eligible for
544	544	9 funding under this Section, a transformation proposal
545	545	10 shall meet all of the following criteria:
546	546	11 (i) the proposal shall be designed based on
547	547	12 community needs assessment completed by either a
548	548	13 University partner or other qualified entity with
549	549	14 significant community input;
550	550	15 (ii) the proposal shall be a collaboration
551	551	16 among providers across the care and community
552	552	17 spectrum, including preventative care, primary
553	553	18 care specialty care, hospital services, mental
554	554	19 health and substance abuse services, as well as
555	555	20 community-based entities that address the social
556	556	21 determinants of health;
557	557	22 (iii) the proposal shall be specifically
558	558	23 designed to improve health care healthcare
559	559	24 outcomes and reduce health care healthcare
560	560	25 disparities, and improve the coordination,
561	561	26 effectiveness, and efficiency of care delivery;
562	562
563	563
564	564
565	565
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572	572	1 (iv) the proposal shall have specific
573	573	2 measurable metrics related to disparities that
574	574	3 will be tracked by the Department and made public
575	575	4 by the Department;
576	576	5 (v) the proposal shall include a commitment to
577	577	6 include Business Enterprise Program certified
578	578	7 vendors or other entities controlled and managed
579	579	8 by minorities or women; and
580	580	9 (vi) the proposal shall specifically increase
581	581	10 access to primary, preventive, or specialty care.
582	582	11 (F) Entities eligible to be funded.
583	583	12 (i) Proposals for funding should come from
584	584	13 collaborations operating in one of the most
585	585	14 distressed communities in Illinois as determined
586	586	15 by the U.S. Centers for Disease Control and
587	587	16 Prevention's Social Vulnerability Index for
588	588	17 Illinois and areas disproportionately impacted by
589	589	18 COVID-19 or from rural areas of Illinois.
590	590	19 (ii) The Department shall prioritize
591	591	20 partnerships from distressed communities, which
592	592	21 include Business Enterprise Program certified
593	593	22 vendors or other entities controlled and managed
594	594	23 by minorities or women and also include one or
595	595	24 more of the following: safety-net hospitals,
596	596	25 critical access hospitals, the campuses of
597	597	26 hospitals that have closed since January 1, 2018,
598	598
599	599
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601	601
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608	608	1 or other health care healthcare providers designed
609	609	2 to address specific health care healthcare
610	610	3 disparities, including the impact of COVID-19 on
611	611	4 individuals and the community and the need for
612	612	5 post-COVID care. All funded proposals must include
613	613	6 specific measurable goals and metrics related to
614	614	7 improved outcomes and reduced disparities which
615	615	8 shall be tracked by the Department.
616	616	9 (iii) The Department should target the funding
617	617	10 in the following ways: $30,000,000 of
618	618	11 transformation funds to projects that are a
619	619	12 collaboration between a safety-net hospital,
620	620	13 particularly community safety-net hospitals, and
621	621	14 other providers and designed to address specific
622	622	15 health care healthcare disparities, $20,000,000 of
623	623	16 transformation funds to collaborations between
624	624	17 safety-net hospitals and a larger hospital partner
625	625	18 that increases specialty care in distressed
626	626	19 communities, $30,000,000 of transformation funds
627	627	20 to projects that are a collaboration between
628	628	21 hospitals and other providers in distressed areas
629	629	22 of the State designed to address specific health
630	630	23 care healthcare disparities, $15,000,000 to
631	631	24 collaborations between critical access hospitals
632	632	25 and other providers designed to address specific
633	633	26 health care healthcare disparities, and
634	634
635	635
636	636
637	637
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644	644	1 $15,000,000 to cross-provider collaborations
645	645	2 designed to address specific health care
646	646	3 healthcare disparities, and $5,000,000 to
647	647	4 collaborations that focus on workforce
648	648	5 development.
649	649	6 (iv) The Department may allocate up to
650	650	7 $5,000,000 for planning, racial equity analysis,
651	651	8 or consulting resources for the Department or
652	652	9 entities without the resources to develop a plan
653	653	10 to meet the criteria of this Section. Any contract
654	654	11 for consulting services issued by the Department
655	655	12 under this subparagraph shall comply with the
656	656	13 provisions of Section 5-45 of the State Officials
657	657	14 and Employees Ethics Act. Based on availability of
658	658	15 federal funding, the Department may directly
659	659	16 procure consulting services or provide funding to
660	660	17 the collaboration. The provision of resources
661	661	18 under this subparagraph is not a guarantee that a
662	662	19 project will be approved.
663	663	20 (v) The Department shall take steps to ensure
664	664	21 that safety-net hospitals operating in
665	665	22 under-resourced communities receive priority
666	666	23 access to hospital and health care healthcare
667	667	24 transformation funds, including consulting funds,
668	668	25 as provided under this Section.
669	669	26 (G) Process for submitting and approving projects
670	670
671	671
672	672
673	673
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680	680	1 for distressed communities. The Department shall issue
681	681	2 a template for application. The Department shall post
682	682	3 any proposal received on the Department's website for
683	683	4 at least 2 weeks for public comment, and any such
684	684	5 public comment shall also be considered in the review
685	685	6 process. Applicants may request that proprietary
686	686	7 financial information be redacted from publicly posted
687	687	8 proposals and the Department in its discretion may
688	688	9 agree. Proposals for each distressed community must
689	689	10 include all of the following:
690	690	11 (i) A detailed description of how the project
691	691	12 intends to affect the goals outlined in this
692	692	13 subsection, describing new interventions, new
693	693	14 technology, new structures, and other changes to
694	694	15 the health care healthcare delivery system
695	695	16 planned.
696	696	17 (ii) A detailed description of the racial and
697	697	18 ethnic makeup of the entities' board and
698	698	19 leadership positions and the salaries of the
699	699	20 executive staff of entities in the partnership
700	700	21 that is seeking to obtain funding under this
701	701	22 Section.
702	702	23 (iii) A complete budget, including an overall
703	703	24 timeline and a detailed pathway to sustainability
704	704	25 within a 5-year period, specifying other sources
705	705	26 of funding, such as in-kind, cost-sharing, or
706	706
707	707
708	708
709	709
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716	716	1 private donations, particularly for capital needs.
717	717	2 There is an expectation that parties to the
718	718	3 transformation project dedicate resources to the
719	719	4 extent they are able and that these expectations
720	720	5 are delineated separately for each entity in the
721	721	6 proposal.
722	722	7 (iv) A description of any new entities formed
723	723	8 or other legal relationships between collaborating
724	724	9 entities and how funds will be allocated among
725	725	10 participants.
726	726	11 (v) A timeline showing the evolution of sites
727	727	12 and specific services of the project over a 5-year
728	728	13 period, including services available to the
729	729	14 community by site.
730	730	15 (vi) Clear milestones indicating progress
731	731	16 toward the proposed goals of the proposal as
732	732	17 checkpoints along the way to continue receiving
733	733	18 funding. The Department is authorized to refine
734	734	19 these milestones in agreements, and is authorized
735	735	20 to impose reasonable penalties, including
736	736	21 repayment of funds, for substantial lack of
737	737	22 progress.
738	738	23 (vii) A clear statement of the level of
739	739	24 commitment the project will include for minorities
740	740	25 and women in contracting opportunities, including
741	741	26 as equity partners where applicable, or as
742	742
743	743
744	744
745	745
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748	748
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752	752	1 subcontractors and suppliers in all phases of the
753	753	2 project.
754	754	3 (viii) If the community study utilized is not
755	755	4 the study commissioned and published by the
756	756	5 Department, the applicant must define the
757	757	6 methodology used, including documentation of clear
758	758	7 community participation.
759	759	8 (ix) A description of the process used in
760	760	9 collaborating with all levels of government in the
761	761	10 community served in the development of the
762	762	11 project, including, but not limited to,
763	763	12 legislators and officials of other units of local
764	764	13 government.
765	765	14 (x) Documentation of a community input process
766	766	15 in the community served, including links to
767	767	16 proposal materials on public websites.
768	768	17 (xi) Verifiable project milestones and quality
769	769	18 metrics that will be impacted by transformation.
770	770	19 These project milestones and quality metrics must
771	771	20 be identified with improvement targets that must
772	772	21 be met.
773	773	22 (xii) Data on the number of existing employees
774	774	23 by various job categories and wage levels by the
775	775	24 zip code of the employees' residence and
776	776	25 benchmarks for the continued maintenance and
777	777	26 improvement of these levels. The proposal must
778	778
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784	784
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788	788	1 also describe any retraining or other workforce
789	789	2 development planned for the new project.
790	790	3 (xiii) If a new entity is created by the
791	791	4 project, a description of how the board will be
792	792	5 reflective of the community served by the
793	793	6 proposal.
794	794	7 (xiv) An explanation of how the proposal will
795	795	8 address the existing disparities that exacerbated
796	796	9 the impact of COVID-19 and the need for post-COVID
797	797	10 care in the community, if applicable.
798	798	11 (xv) An explanation of how the proposal is
799	799	12 designed to increase access to care, including
800	800	13 specialty care based upon the community's needs.
801	801	14 (H) The Department shall evaluate proposals for
802	802	15 compliance with the criteria listed under subparagraph
803	803	16 (G). Proposals meeting all of the criteria may be
804	804	17 eligible for funding with the areas of focus
805	805	18 prioritized as described in item (ii) of subparagraph
806	806	19 (F). Based on the funds available, the Department may
807	807	20 negotiate funding agreements with approved applicants
808	808	21 to maximize federal funding. Nothing in this
809	809	22 subsection requires that an approved project be funded
810	810	23 to the level requested. Agreements shall specify the
811	811	24 amount of funding anticipated annually, the
812	812	25 methodology of payments, the limit on the number of
813	813	26 years such funding may be provided, and the milestones
814	814
815	815
816	816
817	817
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824	824	1 and quality metrics that must be met by the projects in
825	825	2 order to continue to receive funding during each year
826	826	3 of the program. Agreements shall specify the terms and
827	827	4 conditions under which a health care facility that
828	828	5 receives funds under a purchase of care agreement and
829	829	6 closes in violation of the terms of the agreement must
830	830	7 pay an early closure fee no greater than 50% of the
831	831	8 funds it received under the agreement, prior to the
832	832	9 Health Facilities and Services Review Board
833	833	10 considering an application for closure of the
834	834	11 facility. Any project that is funded shall be required
835	835	12 to provide quarterly written progress reports, in a
836	836	13 form prescribed by the Department, and at a minimum
837	837	14 shall include the progress made in achieving any
838	838	15 milestones or metrics or Business Enterprise Program
839	839	16 commitments in its plan. The Department may reduce or
840	840	17 end payments, as set forth in transformation plans, if
841	841	18 milestones or metrics or Business Enterprise Program
842	842	19 commitments are not achieved. The Department shall
843	843	20 seek to make payments from the transformation fund in
844	844	21 a manner that is eligible for federal matching funds.
845	845	22 In reviewing the proposals, the Department shall
846	846	23 take into account the needs of the community, data
847	847	24 from the study commissioned by the Department from the
848	848	25 University of Illinois-Chicago if applicable, feedback
849	849	26 from public comment on the Department's website, as
850	850
851	851
852	852
853	853
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860	860	1 well as how the proposal meets the criteria listed
861	861	2 under subparagraph (G). Alignment with the
862	862	3 Department's overall strategic initiatives shall be an
863	863	4 important factor. To the extent that fiscal year
864	864	5 funding is not adequate to fund all eligible projects
865	865	6 that apply, the Department shall prioritize
866	866	7 applications that most comprehensively and effectively
867	867	8 address the criteria listed under subparagraph (G).
868	868	9 (3) (Blank).
869	869	10 (4) Hospital Transformation Review Committee. There is
870	870	11 created the Hospital Transformation Review Committee. The
871	871	12 Committee shall consist of 14 members. No later than 30
872	872	13 days after March 12, 2018 (the effective date of Public
873	873	14 Act 100-581), the 4 legislative leaders shall each appoint
874	874	15 3 members; the Governor shall appoint the Director of
875	875	16 Healthcare and Family Services, or his or her designee, as
876	876	17 a member; and the Director of Healthcare and Family
877	877	18 Services shall appoint one member. Any vacancy shall be
878	878	19 filled by the applicable appointing authority within 15
879	879	20 calendar days. The members of the Committee shall select a
880	880	21 Chair and a Vice-Chair from among its members, provided
881	881	22 that the Chair and Vice-Chair cannot be appointed by the
882	882	23 same appointing authority and must be from different
883	883	24 political parties. The Chair shall have the authority to
884	884	25 establish a meeting schedule and convene meetings of the
885	885	26 Committee, and the Vice-Chair shall have the authority to
886	886
887	887
888	888
889	889
890	890
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892	892
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896	896	1 convene meetings in the absence of the Chair. The
897	897	2 Committee may establish its own rules with respect to
898	898	3 meeting schedule, notice of meetings, and the disclosure
899	899	4 of documents; however, the Committee shall not have the
900	900	5 power to subpoena individuals or documents and any rules
901	901	6 must be approved by 9 of the 14 members. The Committee
902	902	7 shall perform the functions described in this Section and
903	903	8 advise and consult with the Director in the administration
904	904	9 of this Section. In addition to reviewing and approving
905	905	10 the policies, procedures, and rules for the hospital and
906	906	11 health care transformation program, the Committee shall
907	907	12 consider and make recommendations related to qualifying
908	908	13 criteria and payment methodologies related to safety-net
909	909	14 hospitals and children's hospitals. Members of the
910	910	15 Committee appointed by the legislative leaders shall be
911	911	16 subject to the jurisdiction of the Legislative Ethics
912	912	17 Commission, not the Executive Ethics Commission, and all
913	913	18 requests under the Freedom of Information Act shall be
914	914	19 directed to the applicable Freedom of Information officer
915	915	20 for the General Assembly. The Department shall provide
916	916	21 operational support to the Committee as necessary. The
917	917	22 Committee is dissolved on April 1, 2019.
918	918	23 (e) Beginning 36 months after initial implementation, the
919	919	24 Department shall update the reimbursement components in
920	920	25 subsections (a) and (b), including standardized amounts and
921	921	26 weighting factors, and at least once every 4 years and no more
922	922
923	923
924	924
925	925
926	926
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928	928
929	929
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932	932	1 frequently than annually thereafter. The Department shall
933	933	2 publish these updates on its website no later than 30 calendar
934	934	3 days prior to their effective date.
935	935	4 (f) Continuation of supplemental payments. Any
936	936	5 supplemental payments authorized under 89 Illinois
937	937	6 Administrative Code 148 effective January 1, 2014 and that
938	938	7 continue during the period of July 1, 2014 through December
939	939	8 31, 2014 shall remain in effect as long as the assessment
940	940	9 imposed by Section 5A-2 that is in effect on December 31, 2017
941	941	10 remains in effect.
942	942	11 (g) Notwithstanding subsections (a) through (f) of this
943	943	12 Section and notwithstanding the changes authorized under
944	944	13 Section 5-5b.1, any updates to the system shall not result in
945	945	14 any diminishment of the overall effective rates of
946	946	15 reimbursement as of the implementation date of the new system
947	947	16 (July 1, 2014). These updates shall not preclude variations in
948	948	17 any individual component of the system or hospital rate
949	949	18 variations. Nothing in this Section shall prohibit the
950	950	19 Department from increasing the rates of reimbursement or
951	951	20 developing payments to ensure access to hospital services.
952	952	21 Nothing in this Section shall be construed to guarantee a
953	953	22 minimum amount of spending in the aggregate or per hospital as
954	954	23 spending may be impacted by factors, including, but not
955	955	24 limited to, the number of individuals in the medical
956	956	25 assistance program and the severity of illness of the
957	957	26 individuals.
958	958
959	959
960	960
961	961
962	962
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964	964
965	965
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968	968	1 (h) The Department shall have the authority to modify by
969	969	2 rulemaking any changes to the rates or methodologies in this
970	970	3 Section as required by the federal government to obtain
971	971	4 federal financial participation for expenditures made under
972	972	5 this Section.
973	973	6 (i) Except for subsections (g) and (h) of this Section,
974	974	7 the Department shall, pursuant to subsection (c) of Section
975	975	8 5-40 of the Illinois Administrative Procedure Act, provide for
976	976	9 presentation at the June 2014 hearing of the Joint Committee
977	977	10 on Administrative Rules (JCAR) additional written notice to
978	978	11 JCAR of the following rules in order to commence the second
979	979	12 notice period for the following rules: rules published in the
980	980	13 Illinois Register, rule dated February 21, 2014 at 38 Ill.
981	981	14 Reg. 4559 (Medical Payment), 4628 (Specialized Health Care
982	982	15 Delivery Systems), 4640 (Hospital Services), 4932 (Diagnostic
983	983	16 Related Grouping (DRG) Prospective Payment System (PPS)), and
984	984	17 4977 (Hospital Reimbursement Changes), and published in the
985	985	18 Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
986	986	19 (Specialized Health Care Delivery Systems) and 6505 (Hospital
987	987	20 Services).
988	988	21 (j) Out-of-state hospitals. Beginning July 1, 2018, for
989	989	22 purposes of determining for State fiscal years 2019 and 2020
990	990	23 and subsequent fiscal years the hospitals eligible for the
991	991	24 payments authorized under subsections (a) and (b) of this
992	992	25 Section, the Department shall include out-of-state hospitals
993	993	26 that are designated a Level I pediatric trauma center or a
994	994
995	995
996	996
997	997
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