HB5285 100TH GENERAL ASSEMBLY

LRB100 17873 KTG 35899 b

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.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

WHEREAS, Medicaid reimbursements for psychiatrists have not increased since 1996; and

WHEREAS, The Psychiatric Leadership Capacity Grants that were used to help pay for psychiatrist services due to the low reimbursement rates for psychiatrists were eliminated in 2015; and

WHEREAS, In 2014, the amount of funding for Psychiatric Leadership Capacity Grants was $27,000,000; and

WHEREAS, In 2014, Medicaid reimbursement for psychiatrists was $47,677,158; and

WHEREAS, In 2017, Medicaid reimbursement for psychiatrists was $21,584,859; and

WHEREAS, The Centers for Medicare and Medicaid Services recently stated that "low reimbursement rates can impede access to care"; and

WHEREAS, Underfunding community-centered health care leads to greater costs because patient care is shifted to inpatient hospitalizations, emergency rooms, and jails or prisons; and

WHEREAS, Whereas, according to the Milliman Research Report, "Addiction and mental health vs. physical health: Analyzing disparities in network use and provider reimbursement rates", (December 2017), the reimbursement rates for the same exact Evaluation & Management (E&M) Codes for moderate complexity cases are 18.3% higher for primary care providers than for psychiatrists and 20.1% higher for medical and surgical specialists than for psychiatrists; and

WHEREAS, Whereas, based on the findings in the Milliman Research Report, reimbursement rates for psychiatrists in Illinois are in violation of federal parity law; therefore

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The State Prompt Payment Act is amended by changing Section 3-2 as follows:

(30 ILCS 540/3-2)

Sec. 3-2. Beginning July 1, 1993, in any instance where a State official or agency is late in payment of a vendor's bill or invoice for goods or services furnished to the State, as defined in Section 1, properly approved in accordance with rules promulgated under Section 3-3, the State official or agency shall pay interest to the vendor in accordance with the following:

(1) Any bill, except a bill submitted under Article V of the Illinois Public Aid Code and except as provided under paragraphs paragraph (1.05) and (1.06) of this Section, approved for payment under this Section must be paid or the payment issued to the payee within 60 days of receipt of a proper bill or invoice. If payment is not issued to the payee within this 60-day period, an interest penalty of 1.0% of any amount approved and unpaid shall be added for each month or fraction thereof after the end of this 60-day period, until final payment is made. Any bill, except a bill for pharmacy or nursing facility services or goods, and except as provided under paragraphs paragraph (1.05) and (1.06) of this Section, submitted under Article V of the Illinois Public Aid Code approved for payment under this Section must be paid or the payment issued to the payee within 60 days after receipt of a proper bill or invoice, and, if payment is not issued to the payee within this 60-day period, an interest penalty of 2.0% of any amount approved and unpaid shall be added for each month or fraction thereof after the end of this 60-day period, until final payment is made. Any bill for pharmacy or nursing facility services or goods submitted under Article V of the Illinois Public Aid Code, except as provided under paragraphs paragraph (1.05) and (1.06) of this Section, and approved for payment under this Section must be paid or the payment issued to the payee within 60 days of receipt of a proper bill or invoice. If payment is not issued to the payee within this 60-day period, an interest penalty of 1.0% of any amount approved and unpaid shall be added for each month or fraction thereof after the end of this 60-day period, until final payment is made.

(1.05) For State fiscal year 2012 and future fiscal years, any bill approved for payment under this Section must be paid or the payment issued to the payee within 90 days of receipt of a proper bill or invoice. If payment is not issued to the payee within this 90-day period, an interest penalty of 1.0% of any amount approved and unpaid shall be added for each month, or 0.033% (one-thirtieth of one percent) of any amount approved and unpaid for each day, after the end of this 90-day period, until final payment is made.

(1.06) After the effective date of this amendatory Act of the 100th General Assembly, any bill approved for payment under this Section 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 under this Section. If payment is not issued to the payee in a timely manner under this Section, 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. As used in this paragraph, "prime commercial rate" means the Wall Street Journal Prime Rate, as published from time to time.

(1.1) A State agency shall review in a timely manner each bill or invoice after its receipt. If the State agency determines that the bill or invoice contains a defect making it unable to process the payment request, the agency shall notify the vendor requesting payment as soon as possible after discovering the defect pursuant to rules promulgated under Section 3-3; provided, however, that the notice for construction related bills or invoices must be given not later than 30 days after the bill or invoice was first submitted. The notice shall identify the defect and any additional information necessary to correct the defect. If one or more items on a construction related bill or invoice are disapproved, but not the entire bill or invoice, then the portion that is not disapproved shall be paid.

(2) Where a State official or agency is late in payment of a vendor's bill or invoice properly approved in accordance with this Act, and different late payment terms are not reduced to writing as a contractual agreement, the State official or agency shall automatically pay interest penalties required by this Section amounting to $50 or more to the appropriate vendor. Each agency shall be responsible for determining whether an interest penalty is owed and for paying the interest to the vendor. Except as provided in paragraph (4), an individual interest payment amounting to $5 or less shall not be paid by the State. Interest due to a vendor that amounts to greater than $5 and less than $50 shall not be paid but shall be accrued until all interest due the vendor for all similar warrants exceeds $50, at which time the accrued interest shall be payable and interest will begin accruing again, except that interest accrued as of the end of the fiscal year that does not exceed $50 shall be payable at that time. In the event an individual has paid a vendor for services in advance, the provisions of this Section shall apply until payment is made to that individual.

(3) The provisions of Public Act 96-1501 reducing the interest rate on pharmacy claims under Article V of the Illinois Public Aid Code to 1.0% per month shall apply to any pharmacy bills for services and goods under Article V of the Illinois Public Aid Code received on or after the date 60 days before January 25, 2011 (the effective date of Public Act 96-1501) except as provided under paragraph (1.05) of this Section.

(4) Interest amounting to less than $5 shall not be paid by the State, except for claims (i) to the Department of Healthcare and Family Services or the Department of Human Services, (ii) pursuant to Article V of the Illinois Public Aid Code, the Covering ALL KIDS Health Insurance Act, or the Children's Health Insurance Program Act, and (iii) made (A) by pharmacies for prescriptive services or (B) by any federally qualified health center for prescriptive services or any other services.

(Source: P.A. 96-555, eff. 8-18-09; 96-802, eff. 1-1-10; 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1501, eff. 1-25-11; 96-1530, eff. 2-16-11; 97-72, eff. 7-1-11; 97-74, eff. 6-30-11; 97-348, eff. 8-12-11; 97-813, eff. 7-13-12; 97-932, eff. 8-10-12; 97-1142, eff. 12-28-12.)

Section 10. The Illinois Public Aid Code is amended by adding Section 5-5.25a as follows:

(305 ILCS 5/5-5.25a new)

Sec. 5-5.25a. Psychiatric treatment; payment rate increases. On and after January 1, 2019, psychiatrists approved by the Department shall be reimbursed for psychiatric services at a rate that is no lower than 95% of the Medicare program's rates for the following codes: 99213, 99214, 99215, 90792, 90833, and 90834.