Sen. Patricia Van Pelt
Filed: 3/31/2022
 
 

 

 

 
10200HB5013sam002LRB102 25451 KTG 38426 a



1
AMENDMENT TO HOUSE BILL 5013 




2    AMENDMENT NO. ______. Amend House Bill 5013 on page 6, 
3line 21, by deleting "no less than"; and


 
4on page 7, immediately below line 3, by inserting the 
5following:
6    "(c) The payment rate requirements under subsection (b) 
7shall not apply in the following circumstances:
8        (1) the services were not emergency services as 
9    defined in Section 5-30.1; and
10        (2) either of the following conditions are true:
11            (A) the non-affiliated provider is a perinatal 
12        hospital and has, within the 12 months preceding the 
13        date of service, rejected a contract that was offered 
14        in good faith by the health plan as determined by the 
15        Department; or
16            (B) the health plan has terminated a contract with 
17        the non-affiliated provider for cause, and the 
 
 
10200HB5013sam002- 2 -LRB102 25451 KTG 38426 a

1        Department has not deemed the termination to have been 
2        without merit. The Department may deem that a 
3        determination for cause has merit if:
4                (i) an institutional provider has repeatedly 
5            failed to conduct discharge planning; or
6                (ii) the provider's conduct adversely and 
7            substantially impacts the health of Medicaid 
8            patients; or
9                (iii) the provider's conduct constitutes 
10            fraud, waste, or abuse; or
11                (iv) the provider's conduct violates the code 
12            of ethics governing his or her profession.".