HB2558 104TH GENERAL ASSEMBLY

LRB104 06253 KTG 16288 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB2558

Introduced 2/4/2025, by Rep. Maura Hirschauer

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-2b

Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning provider reimbursement rates for services provided to medically fragile and technology dependent children, provides that by December 31, 2025, the Department of Healthcare and Family Services shall conduct a rate evaluation to study the soundness of the rate paid for private duty nursing services. Requires the Department to contract with an outside entity to conduct this study or utilize one of its existing contractors to conduct this evaluation. Provides that the contractor shall consult with Department-enrolled private duty providers to ensure the accuracy of this study as it is being created. Requires the study to include, at a minimum, a comparison of rates paid by other states for similar services and the cost of providing similar care in an institutional setting. Effective immediately.

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 5-2b as follows:

(305 ILCS 5/5-2b)

Sec. 5-2b. Medically fragile and technology dependent children eligibility and program; provider reimbursement rates.

(a) Notwithstanding any other provision of law except as provided in Section 5-30a, on and after September 1, 2012, subject to federal approval, medical assistance under this Article shall be available to children who qualify as persons with a disability, as defined under the federal Supplemental Security Income program and who are medically fragile and technology dependent. The program shall allow eligible children to receive the medical assistance provided under this Article in the community and must maximize, to the fullest extent permissible under federal law, federal reimbursement and family cost-sharing, including co-pays, premiums, or any other family contributions, except that the Department shall be permitted to incentivize the utilization of selected services through the use of cost-sharing adjustments. The Department shall establish the policies, procedures, standards, services, and criteria for this program by rule.

(b) Notwithstanding any other provision of this Code, subject to federal approval, on and after January 1, 2024, the reimbursement rates for nursing paid through Nursing and Personal Care Services for non-waiver customers and to providers of private duty nursing services for children eligible for medical assistance under this Section shall be 20% higher than the reimbursement rates in effect for nursing services on December 31, 2023.

(c) Notwithstanding any other provision of this Code, subject to federal approval, on and after January 1, 2025, the reimbursement rates for nursing paid through Nursing and Personal Care Services for non-waiver customers and to providers of private duty nursing services for children eligible for medical assistance under this Section shall be 7% higher than the reimbursement rates in effect for nursing services on December 31, 2024.

(d) Rate study. By December 31, 2025, the Department shall conduct a rate evaluation to study the soundness of the rate paid for private duty nursing services. The Department shall contract with an outside entity to conduct this study or utilize one of its existing contractors to conduct this evaluation. The contractor shall consult with Department-enrolled private duty providers to ensure the accuracy of this study as it is being created. The study shall include, at a minimum, a comparison of rates paid by other states for similar services and the cost of providing similar care in an institutional setting.

(Source: P.A. 103-102, eff. 1-1-24; 103-593, eff. 6-7-24.)

Section 99. Effective date. This Act takes effect upon becoming law.