100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB5285

 

Introduced , by Rep. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
30 ILCS 540/3-2
305 ILCS 5/5-5.25a new

    Amends the State Prompt Payment Act. Provides that after the effective date of the amendatory Act, any bill approved for payment under the Act and pursuant to a health benefit plan under the State Employees Group Insurance Act of 1971 or submitted under Article V of the Illinois Public Aid Code, except a bill for pharmacy or nursing facility services or goods, must be paid or the payment issued to the payee in a timely manner. Provides that if payment is not issued to the payee in a timely manner, the following interest penalty shall apply to any amount approved and unpaid until final payment is made: the sum of the prime commercial rate plus 4.0% per year, applied pro rata for the amount of time the bill remains unpaid. Defines "prime commercial rate". Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on and after January 1, 2019, psychiatrists approved by the Department of Healthcare and Family Services shall be reimbursed for psychiatric services at a rate that is no lower than 95% of the Medicare program's rates for specified codes.


LRB100 17873 KTG 35899 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5285LRB100 17873 KTG 35899 b

1    AN ACT concerning public aid.
 
2    WHEREAS, Medicaid reimbursements for psychiatrists have
3not increased since 1996; and
 
4    WHEREAS, The Psychiatric Leadership Capacity Grants that
5were used to help pay for psychiatrist services due to the low
6reimbursement rates for psychiatrists were eliminated in 2015;
7and
 
8    WHEREAS, In 2014, the amount of funding for Psychiatric
9Leadership Capacity Grants was $27,000,000; and
 
10    WHEREAS, In 2014, Medicaid reimbursement for psychiatrists
11was $47,677,158; and
 
12    WHEREAS, In 2017, Medicaid reimbursement for psychiatrists
13was $21,584,859; and
 
14    WHEREAS, The Centers for Medicare and Medicaid Services
15recently stated that "low reimbursement rates can impede access
16to care"; and
 
17    WHEREAS, Underfunding community-centered health care leads
18to greater costs because patient care is shifted to inpatient
19hospitalizations, emergency rooms, and jails or prisons; and
 

 

 

HB5285- 2 -LRB100 17873 KTG 35899 b

1    WHEREAS, Whereas, according to the Milliman Research
2Report, "Addiction and mental health vs. physical health:
3Analyzing disparities in network use and provider
4reimbursement rates", (December 2017), the reimbursement rates
5for the same exact Evaluation & Management (E&M) Codes for
6moderate complexity cases are 18.3% higher for primary care
7providers than for psychiatrists and 20.1% higher for medical
8and surgical specialists than for psychiatrists; and
 
9    WHEREAS, Whereas, based on the findings in the Milliman
10Research Report, reimbursement rates for psychiatrists in
11Illinois are in violation of federal parity law; therefore
 
12    Be it enacted by the People of the State of Illinois,
13represented in the General Assembly:
 
14    Section 5. The State Prompt Payment Act is amended by
15changing Section 3-2 as follows:
 
16    (30 ILCS 540/3-2)
17    Sec. 3-2. Beginning July 1, 1993, in any instance where a
18State official or agency is late in payment of a vendor's bill
19or invoice for goods or services furnished to the State, as
20defined in Section 1, properly approved in accordance with
21rules promulgated under Section 3-3, the State official or
22agency shall pay interest to the vendor in accordance with the

 

 

HB5285- 3 -LRB100 17873 KTG 35899 b

1following:
2        (1) Any bill, except a bill submitted under Article V
3    of the Illinois Public Aid Code and except as provided
4    under paragraphs paragraph (1.05) and (1.06) of this
5    Section, approved for payment under this Section must be
6    paid or the payment issued to the payee within 60 days of
7    receipt of a proper bill or invoice. If payment is not
8    issued to the payee within this 60-day period, an interest
9    penalty of 1.0% of any amount approved and unpaid shall be
10    added for each month or fraction thereof after the end of
11    this 60-day period, until final payment is made. Any bill,
12    except a bill for pharmacy or nursing facility services or
13    goods, and except as provided under paragraphs paragraph
14    (1.05) and (1.06) of this Section, submitted under Article
15    V of the Illinois Public Aid Code approved for payment
16    under this Section must be paid or the payment issued to
17    the payee within 60 days after receipt of a proper bill or
18    invoice, and, if payment is not issued to the payee within
19    this 60-day period, an interest penalty of 2.0% of any
20    amount approved and unpaid shall be added for each month or
21    fraction thereof after the end of this 60-day period, until
22    final payment is made. Any bill for pharmacy or nursing
23    facility services or goods submitted under Article V of the
24    Illinois Public Aid Code, except as provided under
25    paragraphs paragraph (1.05) and (1.06) of this Section, and
26    approved for payment under this Section must be paid or the

 

 

HB5285- 4 -LRB100 17873 KTG 35899 b

1    payment issued to the payee within 60 days of receipt of a
2    proper bill or invoice. If payment is not issued to the
3    payee within this 60-day period, an interest penalty of
4    1.0% of any amount approved and unpaid shall be added for
5    each month or fraction thereof after the end of this 60-day
6    period, until final payment is made.
7        (1.05) For State fiscal year 2012 and future fiscal
8    years, any bill approved for payment under this Section
9    must be paid or the payment issued to the payee within 90
10    days of receipt of a proper bill or invoice. If payment is
11    not issued to the payee within this 90-day period, an
12    interest penalty of 1.0% of any amount approved and unpaid
13    shall be added for each month, or 0.033% (one-thirtieth of
14    one percent) of any amount approved and unpaid for each
15    day, after the end of this 90-day period, until final
16    payment is made.
17        (1.06) After the effective date of this amendatory Act
18    of the 100th General Assembly, any bill approved for
19    payment under this Section and pursuant to a health benefit
20    plan under the State Employees Group Insurance Act of 1971
21    or submitted under Article V of the Illinois Public Aid
22    Code, except a bill for pharmacy or nursing facility
23    services or goods, must be paid or the payment issued to
24    the payee in a timely manner under this Section. If payment
25    is not issued to the payee in a timely manner under this
26    Section, the following interest penalty shall apply to any

 

 

HB5285- 5 -LRB100 17873 KTG 35899 b

1    amount approved and unpaid until final payment is made: the
2    sum of the prime commercial rate plus 4.0% per year,
3    applied pro rata for the amount of time the bill remains
4    unpaid. As used in this paragraph, "prime commercial rate"
5    means the Wall Street Journal Prime Rate, as published from
6    time to time.
7        (1.1) A State agency shall review in a timely manner
8    each bill or invoice after its receipt. If the State agency
9    determines that the bill or invoice contains a defect
10    making it unable to process the payment request, the agency
11    shall notify the vendor requesting payment as soon as
12    possible after discovering the defect pursuant to rules
13    promulgated under Section 3-3; provided, however, that the
14    notice for construction related bills or invoices must be
15    given not later than 30 days after the bill or invoice was
16    first submitted. The notice shall identify the defect and
17    any additional information necessary to correct the
18    defect. If one or more items on a construction related bill
19    or invoice are disapproved, but not the entire bill or
20    invoice, then the portion that is not disapproved shall be
21    paid.
22        (2) Where a State official or agency is late in payment
23    of a vendor's bill or invoice properly approved in
24    accordance with this Act, and different late payment terms
25    are not reduced to writing as a contractual agreement, the
26    State official or agency shall automatically pay interest

 

 

HB5285- 6 -LRB100 17873 KTG 35899 b

1    penalties required by this Section amounting to $50 or more
2    to the appropriate vendor. Each agency shall be responsible
3    for determining whether an interest penalty is owed and for
4    paying the interest to the vendor. Except as provided in
5    paragraph (4), an individual interest payment amounting to
6    $5 or less shall not be paid by the State. Interest due to
7    a vendor that amounts to greater than $5 and less than $50
8    shall not be paid but shall be accrued until all interest
9    due the vendor for all similar warrants exceeds $50, at
10    which time the accrued interest shall be payable and
11    interest will begin accruing again, except that interest
12    accrued as of the end of the fiscal year that does not
13    exceed $50 shall be payable at that time. In the event an
14    individual has paid a vendor for services in advance, the
15    provisions of this Section shall apply until payment is
16    made to that individual.
17        (3) The provisions of Public Act 96-1501 reducing the
18    interest rate on pharmacy claims under Article V of the
19    Illinois Public Aid Code to 1.0% per month shall apply to
20    any pharmacy bills for services and goods under Article V
21    of the Illinois Public Aid Code received on or after the
22    date 60 days before January 25, 2011 (the effective date of
23    Public Act 96-1501) except as provided under paragraph
24    (1.05) of this Section.
25        (4) Interest amounting to less than $5 shall not be
26    paid by the State, except for claims (i) to the Department

 

 

HB5285- 7 -LRB100 17873 KTG 35899 b

1    of Healthcare and Family Services or the Department of
2    Human Services, (ii) pursuant to Article V of the Illinois
3    Public Aid Code, the Covering ALL KIDS Health Insurance
4    Act, or the Children's Health Insurance Program Act, and
5    (iii) made (A) by pharmacies for prescriptive services or
6    (B) by any federally qualified health center for
7    prescriptive services or any other services.
8(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10;
996-959, eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1501, eff.
101-25-11; 96-1530, eff. 2-16-11; 97-72, eff. 7-1-11; 97-74, eff.
116-30-11; 97-348, eff. 8-12-11; 97-813, eff. 7-13-12; 97-932,
12eff. 8-10-12; 97-1142, eff. 12-28-12.)
 
13    Section 10. The Illinois Public Aid Code is amended by
14adding Section 5-5.25a as follows:
 
15    (305 ILCS 5/5-5.25a new)
16    Sec. 5-5.25a. Psychiatric treatment; payment rate
17increases. On and after January 1, 2019, psychiatrists approved
18by the Department shall be reimbursed for psychiatric services
19at a rate that is no lower than 95% of the Medicare program's
20rates for the following codes: 99213, 99214, 99215, 90792,
2190833, and 90834.