HB5179 102ND GENERAL ASSEMBLY

LRB102 24822 KTG 34067 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB5179

Introduced 1/27/2022, by Rep. Lindsey LaPointe

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-41

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in light of the heightened risk of overdose if a patient is discharged and not linked to treatment and recovery supports, and the need for appropriate access to the treatment and services available via community-based substance use disorder and mental health providers, the Department of Healthcare and Family Services and each hospital shall ensure coordination of care and treatment for each patient with community-based mental health and substance use disorder treatment providers. Requires hospitals to coordinate and collaborate with community-based providers by: (i) providing a warm handoff of patients in need of treatment and recovery support services to community-based providers; (ii) collaborating with community-based providers on the provision of 24/7 access to transitioning patients prior to discharge from the hospital; (iii) working with community-based providers on fully implementing substance use disorder treatment and recovery supports through existing and new hospital-located community-based provider projects; and (iv) engaging in such other programs established by the Department to prioritize treatment within the community-based system to the extent such treatment is deemed to best serve a patient, is considered medically necessary, and is fiscally prudent. Provides that if a hospital fails to address these requirements prior to discharging a patient, the provider shall forgo reimbursement for any observation or admission services provided to the patient.

A BILL FOR

AN ACT concerning public aid.

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

Section 5. The Illinois Public Aid Code is amended by changing Section 5-41 as follows:

(305 ILCS 5/5-41)

Sec. 5-41. Inpatient hospitalization for opioid-related overdose or withdrawal patients.

(a) Due to the disproportionately high opioid-related fatality rates among African Americans in under-resourced communities in Illinois, the lack of community resources, the comorbidities experienced by these patients, and the high rate of hospital inpatient recidivism associated with this population when improperly treated, the Department shall ensure that patients, whether enrolled under the Medical Assistance Fee For Service program or enrolled with a Medicaid Managed Care Organization, experiencing opioid-related overdose or withdrawal are admitted on an inpatient status and the provider shall be reimbursed accordingly, when deemed medically necessary, as determined by either the patient's primary care physician, or the physician or other practitioner responsible for the patient's care at the hospital to which the patient presents, using criteria established by the American Society of Addiction Medicine. If it is determined by the physician or other practitioner responsible for the patient's care at the hospital to which the patient presents, that a patient does not meet medical necessity criteria for the admission, then the patient may be treated via observation and the provider shall seek reimbursement accordingly. Nothing in this Section shall diminish the requirements of a provider to document medical necessity in the patient's record.

(b) In light of the heightened risk of overdose if a patient is discharged and not linked to treatment and recovery supports, and the need for appropriate access to the treatment and services available via community-based substance use disorder and mental health providers, notwithstanding subsection (a), the Department and each hospital shall ensure coordination of care and treatment for each patient with community-based mental health and substance use disorder treatment providers. Hospitals shall coordinate and collaborate with community-based providers by:

(1) providing a warm handoff of patients in need of treatment and recovery support services to community-based providers;

(2) collaborating with community-based providers on the provision of 24/7 access to transitioning patients prior to discharge from the hospital;

(3) working with community-based providers on fully implementing substance use disorder treatment and recovery supports through existing and new hospital-located community-based provider projects; and

(4) engaging in such other programs established by the Department to prioritize treatment within the community-based system to the extent such treatment is deemed to best serve a patient, is considered medically necessary, and is fiscally prudent.

(c) If a hospital fails to address the requirements of subsection (b) prior to discharging a patient, the provider shall forgo reimbursement for any observation or admission services provided to the patient.

(Source: P.A. 102-43, eff. 7-6-21.)