|
|
|
SB1580 Enrolled |
|
LRB095 09918 KBJ 30129 b |
|
|
1 |
| AN ACT concerning public health.
|
2 |
| Be it enacted by the People of the State of Illinois,
|
3 |
| represented in the General Assembly:
|
4 |
| Section 1. Short title. This Act may be cited as the FY2008 |
5 |
| Budget
Implementation (Human Services) Act. |
6 |
| Section 5. Purpose. It is the purpose of this Act to |
7 |
| implement the Governor's FY2008
budget recommendations |
8 |
| concerning human services.
|
9 |
| Section 10. The Illinois Administrative Procedure Act is |
10 |
| amended by changing Section 5-45 as follows:
|
11 |
| (5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
|
12 |
| Sec. 5-45. Emergency rulemaking.
|
13 |
| (a) "Emergency" means the existence of any situation that |
14 |
| any agency
finds reasonably constitutes a threat to the public |
15 |
| interest, safety, or
welfare.
|
16 |
| (b) If any agency finds that an
emergency exists that |
17 |
| requires adoption of a rule upon fewer days than
is required by |
18 |
| Section 5-40 and states in writing its reasons for that
|
19 |
| finding, the agency may adopt an emergency rule without prior |
20 |
| notice or
hearing upon filing a notice of emergency rulemaking |
21 |
| with the Secretary of
State under Section 5-70. The notice |
|
|
|
SB1580 Enrolled |
- 2 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| shall include the text of the
emergency rule and shall be |
2 |
| published in the Illinois Register. Consent
orders or other |
3 |
| court orders adopting settlements negotiated by an agency
may |
4 |
| be adopted under this Section. Subject to applicable |
5 |
| constitutional or
statutory provisions, an emergency rule |
6 |
| becomes effective immediately upon
filing under Section 5-65 or |
7 |
| at a stated date less than 10 days
thereafter. The agency's |
8 |
| finding and a statement of the specific reasons
for the finding |
9 |
| shall be filed with the rule. The agency shall take
reasonable |
10 |
| and appropriate measures to make emergency rules known to the
|
11 |
| persons who may be affected by them.
|
12 |
| (c) An emergency rule may be effective for a period of not |
13 |
| longer than
150 days, but the agency's authority to adopt an |
14 |
| identical rule under Section
5-40 is not precluded. No |
15 |
| emergency rule may be adopted more
than once in any 24 month |
16 |
| period, except that this limitation on the number
of emergency |
17 |
| rules that may be adopted in a 24 month period does not apply
|
18 |
| to (i) emergency rules that make additions to and deletions |
19 |
| from the Drug
Manual under Section 5-5.16 of the Illinois |
20 |
| Public Aid Code or the
generic drug formulary under Section |
21 |
| 3.14 of the Illinois Food, Drug
and Cosmetic Act, (ii) |
22 |
| emergency rules adopted by the Pollution Control
Board before |
23 |
| July 1, 1997 to implement portions of the Livestock Management
|
24 |
| Facilities Act, or (iii) emergency rules adopted by the |
25 |
| Illinois Department of Public Health under subsections (a) |
26 |
| through (i) of Section 2 of the Department of Public Health Act |
|
|
|
SB1580 Enrolled |
- 3 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| when necessary to protect the public's health. Two or more |
2 |
| emergency rules having substantially the same
purpose and |
3 |
| effect shall be deemed to be a single rule for purposes of this
|
4 |
| Section.
|
5 |
| (d) In order to provide for the expeditious and timely |
6 |
| implementation
of the State's fiscal year 1999 budget, |
7 |
| emergency rules to implement any
provision of Public Act 90-587 |
8 |
| or 90-588
or any other budget initiative for fiscal year 1999 |
9 |
| may be adopted in
accordance with this Section by the agency |
10 |
| charged with administering that
provision or initiative, |
11 |
| except that the 24-month limitation on the adoption
of |
12 |
| emergency rules and the provisions of Sections 5-115 and 5-125 |
13 |
| do not apply
to rules adopted under this subsection (d). The |
14 |
| adoption of emergency rules
authorized by this subsection (d) |
15 |
| shall be deemed to be necessary for the
public interest, |
16 |
| safety, and welfare.
|
17 |
| (e) In order to provide for the expeditious and timely |
18 |
| implementation
of the State's fiscal year 2000 budget, |
19 |
| emergency rules to implement any
provision of this amendatory |
20 |
| Act of the 91st General Assembly
or any other budget initiative |
21 |
| for fiscal year 2000 may be adopted in
accordance with this |
22 |
| Section by the agency charged with administering that
provision |
23 |
| or initiative, except that the 24-month limitation on the |
24 |
| adoption
of emergency rules and the provisions of Sections |
25 |
| 5-115 and 5-125 do not apply
to rules adopted under this |
26 |
| subsection (e). The adoption of emergency rules
authorized by |
|
|
|
SB1580 Enrolled |
- 4 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| this subsection (e) shall be deemed to be necessary for the
|
2 |
| public interest, safety, and welfare.
|
3 |
| (f) In order to provide for the expeditious and timely |
4 |
| implementation
of the State's fiscal year 2001 budget, |
5 |
| emergency rules to implement any
provision of this amendatory |
6 |
| Act of the 91st General Assembly
or any other budget initiative |
7 |
| for fiscal year 2001 may be adopted in
accordance with this |
8 |
| Section by the agency charged with administering that
provision |
9 |
| or initiative, except that the 24-month limitation on the |
10 |
| adoption
of emergency rules and the provisions of Sections |
11 |
| 5-115 and 5-125 do not apply
to rules adopted under this |
12 |
| subsection (f). The adoption of emergency rules
authorized by |
13 |
| this subsection (f) shall be deemed to be necessary for the
|
14 |
| public interest, safety, and welfare.
|
15 |
| (g) In order to provide for the expeditious and timely |
16 |
| implementation
of the State's fiscal year 2002 budget, |
17 |
| emergency rules to implement any
provision of this amendatory |
18 |
| Act of the 92nd General Assembly
or any other budget initiative |
19 |
| for fiscal year 2002 may be adopted in
accordance with this |
20 |
| Section by the agency charged with administering that
provision |
21 |
| or initiative, except that the 24-month limitation on the |
22 |
| adoption
of emergency rules and the provisions of Sections |
23 |
| 5-115 and 5-125 do not apply
to rules adopted under this |
24 |
| subsection (g). The adoption of emergency rules
authorized by |
25 |
| this subsection (g) shall be deemed to be necessary for the
|
26 |
| public interest, safety, and welfare.
|
|
|
|
SB1580 Enrolled |
- 5 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| (h) In order to provide for the expeditious and timely |
2 |
| implementation
of the State's fiscal year 2003 budget, |
3 |
| emergency rules to implement any
provision of this amendatory |
4 |
| Act of the 92nd General Assembly
or any other budget initiative |
5 |
| for fiscal year 2003 may be adopted in
accordance with this |
6 |
| Section by the agency charged with administering that
provision |
7 |
| or initiative, except that the 24-month limitation on the |
8 |
| adoption
of emergency rules and the provisions of Sections |
9 |
| 5-115 and 5-125 do not apply
to rules adopted under this |
10 |
| subsection (h). The adoption of emergency rules
authorized by |
11 |
| this subsection (h) shall be deemed to be necessary for the
|
12 |
| public interest, safety, and welfare.
|
13 |
| (i) In order to provide for the expeditious and timely |
14 |
| implementation
of the State's fiscal year 2004 budget, |
15 |
| emergency rules to implement any
provision of this amendatory |
16 |
| Act of the 93rd General Assembly
or any other budget initiative |
17 |
| for fiscal year 2004 may be adopted in
accordance with this |
18 |
| Section by the agency charged with administering that
provision |
19 |
| or initiative, except that the 24-month limitation on the |
20 |
| adoption
of emergency rules and the provisions of Sections |
21 |
| 5-115 and 5-125 do not apply
to rules adopted under this |
22 |
| subsection (i). The adoption of emergency rules
authorized by |
23 |
| this subsection (i) shall be deemed to be necessary for the
|
24 |
| public interest, safety, and welfare.
|
25 |
| (j) In order to provide for the expeditious and timely |
26 |
| implementation of the provisions of the State's fiscal year |
|
|
|
SB1580 Enrolled |
- 6 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| 2005 budget as provided under the Fiscal Year 2005 Budget |
2 |
| Implementation (Human Services) Act, emergency rules to |
3 |
| implement any provision of the Fiscal Year 2005 Budget |
4 |
| Implementation (Human Services) Act may be adopted in |
5 |
| accordance with this Section by the agency charged with |
6 |
| administering that provision, except that the 24-month |
7 |
| limitation on the adoption of emergency rules and the |
8 |
| provisions of Sections 5-115 and 5-125 do not apply to rules |
9 |
| adopted under this subsection (j). The Department of Public Aid |
10 |
| may also adopt rules under this subsection (j) necessary to |
11 |
| administer the Illinois Public Aid Code and the Children's |
12 |
| Health Insurance Program Act. The adoption of emergency rules |
13 |
| authorized by this subsection (j) shall be deemed to be |
14 |
| necessary for the public interest, safety, and welfare.
|
15 |
| (k) In order to provide for the expeditious and timely |
16 |
| implementation of the provisions of the State's fiscal year |
17 |
| 2006 budget, emergency rules to implement any provision of this |
18 |
| amendatory Act of the 94th General Assembly or any other budget |
19 |
| initiative for fiscal year 2006 may be adopted in accordance |
20 |
| with this Section by the agency charged with administering that |
21 |
| provision or initiative, except that the 24-month limitation on |
22 |
| the adoption of emergency rules and the provisions of Sections |
23 |
| 5-115 and 5-125 do not apply to rules adopted under this |
24 |
| subsection (k). The Department of Healthcare and Family |
25 |
| Services may also adopt rules under this subsection (k) |
26 |
| necessary to administer the Illinois Public Aid Code, the |
|
|
|
SB1580 Enrolled |
- 7 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| Senior Citizens and Disabled Persons Property Tax Relief and |
2 |
| Pharmaceutical Assistance Act, the Senior Citizens and |
3 |
| Disabled Persons Prescription Drug Discount Program Act (now |
4 |
| the Illinois Prescription Drug Discount Program Act) , and the |
5 |
| Children's Health Insurance Program Act. The adoption of |
6 |
| emergency rules authorized by this subsection (k) shall be |
7 |
| deemed to be necessary for the public interest, safety, and |
8 |
| welfare.
|
9 |
| (l) In order to provide for the expeditious and timely |
10 |
| implementation of the provisions of the
State's fiscal year |
11 |
| 2007 budget, the Department of Healthcare and Family Services |
12 |
| may adopt emergency rules during fiscal year 2007, including |
13 |
| rules effective July 1, 2007, in
accordance with this |
14 |
| subsection to the extent necessary to administer the |
15 |
| Department's responsibilities with respect to amendments to |
16 |
| the State plans and Illinois waivers approved by the federal |
17 |
| Centers for Medicare and Medicaid Services necessitated by the |
18 |
| requirements of Title XIX and Title XXI of the federal Social |
19 |
| Security Act. The adoption of emergency rules
authorized by |
20 |
| this subsection (l) shall be deemed to be necessary for the |
21 |
| public interest,
safety, and welfare.
|
22 |
| (m) In order to provide for the expeditious and timely |
23 |
| implementation of the provisions of the
State's fiscal year |
24 |
| 2008 budget, the Department of Healthcare and Family Services |
25 |
| may adopt emergency rules during fiscal year 2008, including |
26 |
| rules effective July 1, 2008, in
accordance with this |
|
|
|
SB1580 Enrolled |
- 8 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| subsection to the extent necessary to administer the |
2 |
| Department's responsibilities with respect to amendments to |
3 |
| the State plans and Illinois waivers approved by the federal |
4 |
| Centers for Medicare and Medicaid Services necessitated by the |
5 |
| requirements of Title XIX and Title XXI of the federal Social |
6 |
| Security Act. The adoption of emergency rules
authorized by |
7 |
| this subsection (m) shall be deemed to be necessary for the |
8 |
| public interest,
safety, and welfare.
|
9 |
| (Source: P.A. 93-20, eff. 6-20-03; 93-829, eff. 7-28-04; |
10 |
| 93-841, eff. 7-30-04; 94-48, eff. 7-1-05; 94-838, eff. 6-6-06; |
11 |
| revised 10-19-06.)
|
12 |
| Section 15. The Illinois Public Aid Code is amended by |
13 |
| changing Section 5-5.4 as follows: |
14 |
| (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
|
15 |
| Sec. 5-5.4. Standards of Payment - Department of Healthcare |
16 |
| and Family Services.
The Department of Healthcare and Family |
17 |
| Services shall develop standards of payment of skilled
nursing |
18 |
| and intermediate care services in facilities providing such |
19 |
| services
under this Article which:
|
20 |
| (1) Provide for the determination of a facility's payment
|
21 |
| for skilled nursing and intermediate care services on a |
22 |
| prospective basis.
The amount of the payment rate for all |
23 |
| nursing facilities certified by the
Department of Public Health |
24 |
| under the Nursing Home Care Act as Intermediate
Care for the |
|
|
|
SB1580 Enrolled |
- 9 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| Developmentally Disabled facilities, Long Term Care for Under |
2 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate |
3 |
| Care facilities
under the
medical assistance program shall be |
4 |
| prospectively established annually on the
basis of historical, |
5 |
| financial, and statistical data reflecting actual costs
from |
6 |
| prior years, which shall be applied to the current rate year |
7 |
| and updated
for inflation, except that the capital cost element |
8 |
| for newly constructed
facilities shall be based upon projected |
9 |
| budgets. The annually established
payment rate shall take |
10 |
| effect on July 1 in 1984 and subsequent years. No rate
increase |
11 |
| and no
update for inflation shall be provided on or after July |
12 |
| 1, 1994 and before
July 1, 2008
2007 , unless specifically |
13 |
| provided for in this
Section.
The changes made by Public Act |
14 |
| 93-841
extending the duration of the prohibition against a rate |
15 |
| increase or update for inflation are effective retroactive to |
16 |
| July 1, 2004.
|
17 |
| For facilities licensed by the Department of Public Health |
18 |
| under the Nursing
Home Care Act as Intermediate Care for the |
19 |
| Developmentally Disabled facilities
or Long Term Care for Under |
20 |
| Age 22 facilities, the rates taking effect on July
1, 1998 |
21 |
| shall include an increase of 3%. For facilities licensed by the
|
22 |
| Department of Public Health under the Nursing Home Care Act as |
23 |
| Skilled Nursing
facilities or Intermediate Care facilities, |
24 |
| the rates taking effect on July 1,
1998 shall include an |
25 |
| increase of 3% plus $1.10 per resident-day, as defined by
the |
26 |
| Department. For facilities licensed by the Department of Public |
|
|
|
SB1580 Enrolled |
- 10 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| Health under the Nursing Home Care Act as Intermediate Care |
2 |
| Facilities for the Developmentally Disabled or Long Term Care |
3 |
| for Under Age 22 facilities, the rates taking effect on January |
4 |
| 1, 2006 shall include an increase of 3%.
|
5 |
| For facilities licensed by the Department of Public Health |
6 |
| under the
Nursing Home Care Act as Intermediate Care for the |
7 |
| Developmentally Disabled
facilities or Long Term Care for Under |
8 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 |
9 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, |
10 |
| as defined by the Department. For facilities licensed by the
|
11 |
| Department of Public Health under the Nursing Home Care Act as |
12 |
| Skilled Nursing
facilities or Intermediate Care facilities, |
13 |
| the rates taking effect on July 1,
1999 shall include an |
14 |
| increase of 1.6% and, for services provided on or after
October |
15 |
| 1, 1999, shall be increased by $4.00 per resident-day, as |
16 |
| defined by
the Department.
|
17 |
| For facilities licensed by the Department of Public Health |
18 |
| under the
Nursing Home Care Act as Intermediate Care for the |
19 |
| Developmentally Disabled
facilities or Long Term Care for Under |
20 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 |
21 |
| shall include an increase of 2.5% per resident-day,
as defined |
22 |
| by the Department. For facilities licensed by the Department of
|
23 |
| Public Health under the Nursing Home Care Act as Skilled |
24 |
| Nursing facilities or
Intermediate Care facilities, the rates |
25 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% |
26 |
| per resident-day, as defined by the Department.
|
|
|
|
SB1580 Enrolled |
- 11 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| For facilities licensed by the Department of Public Health |
2 |
| under the
Nursing Home Care Act as skilled nursing facilities |
3 |
| or intermediate care
facilities, a new payment methodology must |
4 |
| be implemented for the nursing
component of the rate effective |
5 |
| July 1, 2003. The Department of Public Aid
(now Healthcare and |
6 |
| Family Services) shall develop the new payment methodology |
7 |
| using the Minimum Data Set
(MDS) as the instrument to collect |
8 |
| information concerning nursing home
resident condition |
9 |
| necessary to compute the rate. The Department
shall develop the |
10 |
| new payment methodology to meet the unique needs of
Illinois |
11 |
| nursing home residents while remaining subject to the |
12 |
| appropriations
provided by the General Assembly.
A transition |
13 |
| period from the payment methodology in effect on June 30, 2003
|
14 |
| to the payment methodology in effect on July 1, 2003 shall be |
15 |
| provided for a
period not exceeding 3 years and 184 days after |
16 |
| implementation of the new payment
methodology as follows:
|
17 |
| (A) For a facility that would receive a lower
nursing |
18 |
| component rate per patient day under the new system than |
19 |
| the facility
received
effective on the date immediately |
20 |
| preceding the date that the Department
implements the new |
21 |
| payment methodology, the nursing component rate per |
22 |
| patient
day for the facility
shall be held at
the level in |
23 |
| effect on the date immediately preceding the date that the
|
24 |
| Department implements the new payment methodology until a |
25 |
| higher nursing
component rate of
reimbursement is achieved |
26 |
| by that
facility.
|
|
|
|
SB1580 Enrolled |
- 12 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| (B) For a facility that would receive a higher nursing |
2 |
| component rate per
patient day under the payment |
3 |
| methodology in effect on July 1, 2003 than the
facility |
4 |
| received effective on the date immediately preceding the |
5 |
| date that the
Department implements the new payment |
6 |
| methodology, the nursing component rate
per patient day for |
7 |
| the facility shall be adjusted.
|
8 |
| (C) Notwithstanding paragraphs (A) and (B), the |
9 |
| nursing component rate per
patient day for the facility |
10 |
| shall be adjusted subject to appropriations
provided by the |
11 |
| General Assembly.
|
12 |
| For facilities licensed by the Department of Public Health |
13 |
| under the
Nursing Home Care Act as Intermediate Care for the |
14 |
| Developmentally Disabled
facilities or Long Term Care for Under |
15 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 |
16 |
| shall include a statewide increase of 7.85%, as
defined by the |
17 |
| Department.
|
18 |
| For facilities licensed by the Department of Public Health |
19 |
| under the
Nursing Home Care Act as Intermediate Care for the |
20 |
| Developmentally Disabled
facilities or Long Term Care for Under |
21 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 |
22 |
| shall include a statewide increase of 2.0%, as
defined by the |
23 |
| Department.
This increase terminates on July 1, 2002;
beginning |
24 |
| July 1, 2002 these rates are reduced to the level of the rates
|
25 |
| in effect on March 31, 2002, as defined by the Department.
|
26 |
| For facilities licensed by the Department of Public Health |
|
|
|
SB1580 Enrolled |
- 13 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| under the
Nursing Home Care Act as skilled nursing facilities |
2 |
| or intermediate care
facilities, the rates taking effect on |
3 |
| July 1, 2001 shall be computed using the most recent cost |
4 |
| reports
on file with the Department of Public Aid no later than |
5 |
| April 1, 2000,
updated for inflation to January 1, 2001. For |
6 |
| rates effective July 1, 2001
only, rates shall be the greater |
7 |
| of the rate computed for July 1, 2001
or the rate effective on |
8 |
| June 30, 2001.
|
9 |
| Notwithstanding any other provision of this Section, for |
10 |
| facilities
licensed by the Department of Public Health under |
11 |
| the Nursing Home Care Act
as skilled nursing facilities or |
12 |
| intermediate care facilities, the Illinois
Department shall |
13 |
| determine by rule the rates taking effect on July 1, 2002,
|
14 |
| which shall be 5.9% less than the rates in effect on June 30, |
15 |
| 2002.
|
16 |
| Notwithstanding any other provision of this Section, for |
17 |
| facilities
licensed by the Department of Public Health under |
18 |
| the Nursing Home Care Act as
skilled nursing
facilities or |
19 |
| intermediate care facilities, if the payment methodologies |
20 |
| required under Section 5A-12 and the waiver granted under 42 |
21 |
| CFR 433.68 are approved by the United States Centers for |
22 |
| Medicare and Medicaid Services, the rates taking effect on July |
23 |
| 1, 2004 shall be 3.0% greater than the rates in effect on June |
24 |
| 30, 2004. These rates shall take
effect only upon approval and
|
25 |
| implementation of the payment methodologies required under |
26 |
| Section 5A-12.
|
|
|
|
SB1580 Enrolled |
- 14 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| Notwithstanding any other provisions of this Section, for |
2 |
| facilities licensed by the Department of Public Health under |
3 |
| the Nursing Home Care Act as skilled nursing facilities or |
4 |
| intermediate care facilities, the rates taking effect on |
5 |
| January 1, 2005 shall be 3% more than the rates in effect on |
6 |
| December 31, 2004.
|
7 |
| Notwithstanding any other provisions of this Section, for |
8 |
| facilities licensed by the Department of Public Health under |
9 |
| the Nursing Home Care Act as intermediate care facilities that |
10 |
| are federally defined as Institutions for Mental Disease, a |
11 |
| socio-development component rate equal to 6.6% of the |
12 |
| facility's nursing component rate as of January 1, 2006 shall |
13 |
| be established and paid effective July 1, 2006. The Illinois |
14 |
| Department may by rule adjust these socio-development |
15 |
| component rates, but in no case may such rates be diminished.
|
16 |
| For facilities
licensed
by the
Department of Public Health |
17 |
| under the Nursing Home Care Act as Intermediate
Care for
the |
18 |
| Developmentally Disabled facilities or as long-term care |
19 |
| facilities for
residents under 22 years of age, the rates |
20 |
| taking effect on July 1,
2003 shall
include a statewide |
21 |
| increase of 4%, as defined by the Department.
|
22 |
| Notwithstanding any other provision of this Section, for |
23 |
| facilities licensed by the Department of Public Health under |
24 |
| the Nursing Home Care Act as skilled nursing facilities or |
25 |
| intermediate care facilities, effective January 1, 2005, |
26 |
| facility rates shall be increased by the difference between (i) |
|
|
|
SB1580 Enrolled |
- 15 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| a facility's per diem property, liability, and malpractice |
2 |
| insurance costs as reported in the cost report filed with the |
3 |
| Department of Public Aid and used to establish rates effective |
4 |
| July 1, 2001 and (ii) those same costs as reported in the |
5 |
| facility's 2002 cost report. These costs shall be passed |
6 |
| through to the facility without caps or limitations, except for |
7 |
| adjustments required under normal auditing procedures.
|
8 |
| Rates established effective each July 1 shall govern |
9 |
| payment
for services rendered throughout that fiscal year, |
10 |
| except that rates
established on July 1, 1996 shall be |
11 |
| increased by 6.8% for services
provided on or after January 1, |
12 |
| 1997. Such rates will be based
upon the rates calculated for |
13 |
| the year beginning July 1, 1990, and for
subsequent years |
14 |
| thereafter until June 30, 2001 shall be based on the
facility |
15 |
| cost reports
for the facility fiscal year ending at any point |
16 |
| in time during the previous
calendar year, updated to the |
17 |
| midpoint of the rate year. The cost report
shall be on file |
18 |
| with the Department no later than April 1 of the current
rate |
19 |
| year. Should the cost report not be on file by April 1, the |
20 |
| Department
shall base the rate on the latest cost report filed |
21 |
| by each skilled care
facility and intermediate care facility, |
22 |
| updated to the midpoint of the
current rate year. In |
23 |
| determining rates for services rendered on and after
July 1, |
24 |
| 1985, fixed time shall not be computed at less than zero. The
|
25 |
| Department shall not make any alterations of regulations which |
26 |
| would reduce
any component of the Medicaid rate to a level |
|
|
|
SB1580 Enrolled |
- 16 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| below what that component would
have been utilizing in the rate |
2 |
| effective on July 1, 1984.
|
3 |
| (2) Shall take into account the actual costs incurred by |
4 |
| facilities
in providing services for recipients of skilled |
5 |
| nursing and intermediate
care services under the medical |
6 |
| assistance program.
|
7 |
| (3) Shall take into account the medical and psycho-social
|
8 |
| characteristics and needs of the patients.
|
9 |
| (4) Shall take into account the actual costs incurred by |
10 |
| facilities in
meeting licensing and certification standards |
11 |
| imposed and prescribed by the
State of Illinois, any of its |
12 |
| political subdivisions or municipalities and by
the U.S. |
13 |
| Department of Health and Human Services pursuant to Title XIX |
14 |
| of the
Social Security Act.
|
15 |
| The Department of Healthcare and Family Services
shall |
16 |
| develop precise standards for
payments to reimburse nursing |
17 |
| facilities for any utilization of
appropriate rehabilitative |
18 |
| personnel for the provision of rehabilitative
services which is |
19 |
| authorized by federal regulations, including
reimbursement for |
20 |
| services provided by qualified therapists or qualified
|
21 |
| assistants, and which is in accordance with accepted |
22 |
| professional
practices. Reimbursement also may be made for |
23 |
| utilization of other
supportive personnel under appropriate |
24 |
| supervision.
|
25 |
| (Source: P.A. 93-20, eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, |
26 |
| eff. 2-3-04; 93-841, eff. 7-30-04; 93-1087, eff. 2-28-05; |
|
|
|
SB1580 Enrolled |
- 17 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697, eff. 11-21-05; |
2 |
| 94-838, eff. 6-6-06; 94-964, eff. 6-28-06; revised 8-3-06.)
|
3 |
| Section 20. The Hemophilia Care Act is amended by changing |
4 |
| Section 1 and by adding Sections 1.5 and 2.5 as follows:
|
5 |
| (410 ILCS 420/1) (from Ch. 111 1/2, par. 2901)
|
6 |
| Sec. 1. Definitions. As used in this Act, unless the |
7 |
| context clearly
requires otherwise:
|
8 |
| (1) "Department" means the Illinois Department of |
9 |
| Healthcare and Family Services
Public Aid .
|
10 |
| (1.5) "Director" means the Director of Healthcare and |
11 |
| Family Services and the Director of Insurance
Public Aid .
|
12 |
| (2) (Blank).
|
13 |
| (3) "Hemophilia" means a bleeding tendency resulting from a |
14 |
| genetically
determined deficiency in the blood.
|
15 |
| (4) (Blank).
"Committee" means the Hemophilia Advisory |
16 |
| Committee created under this
Act.
|
17 |
| (5) "Eligible person" means any resident of the State |
18 |
| suffering from
hemophilia.
|
19 |
| (6) "Family" means:
|
20 |
| (a) In the case of a patient who is a dependent of |
21 |
| another person or
couple
as defined by the Illinois Income |
22 |
| Tax Act, all those persons for whom exemption
is claimed in |
23 |
| the State income tax return of the person or couple whose
|
24 |
| dependent the eligible person is, and
|
|
|
|
SB1580 Enrolled |
- 18 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| (b) In all other cases, all those persons for whom |
2 |
| exemption is
claimed
in the State income tax return of the |
3 |
| eligible person, or of the eligible
person and his spouse.
|
4 |
| (7) "Eligible cost of hemophilia services" means the cost |
5 |
| of blood
transfusions,
blood derivatives, and for outpatient |
6 |
| services, of physician charges, medical
supplies, and |
7 |
| appliances, used in the treatment of eligible persons for
|
8 |
| hemophilia, plus one half of the cost of hospital inpatient |
9 |
| care, minus
any amount of such cost which is eligible for |
10 |
| payment or reimbursement by
any hospital or medical insurance |
11 |
| program, by any other government medical
or financial |
12 |
| assistance program, or by any charitable assistance
program.
|
13 |
| (8) "Gross income" means the base income for State income |
14 |
| tax purposes
of all members of the family.
|
15 |
| (9) "Available family income" means the lesser of:
|
16 |
| (a) Gross income minus the sum of (1) $5,500,
and (2) |
17 |
| $3,500 times the number of persons
in the family, or
|
18 |
| (b) One half of gross income.
|
19 |
| (10) "Board" means the Hemophilia Advisory Review Board.
|
20 |
| (Source: P.A. 89-507, eff. 7-1-97; 90-587, eff. 7-1-98; revised |
21 |
| 12-15-05.)
|
22 |
| (410 ILCS 420/1.5 new) |
23 |
| Sec. 1.5. Findings. The General Assembly finds all of the |
24 |
| following: |
25 |
| (1) Inherited hemophilia and other bleeding disorders |
|
|
|
SB1580 Enrolled |
- 19 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| are devastating health conditions that can cause serious |
2 |
| financial, social, and emotional hardships for patients |
3 |
| and their families. Hemophilia, which occurs predominantly |
4 |
| in males, is a rare but well-known type of inherited |
5 |
| bleeding disorder in which one of several proteins normally |
6 |
| found in blood are either deficient or inactive, and |
7 |
| causing pain, swelling, and permanent damage to joints and |
8 |
| muscles. The disorder affects Americans of all racial and |
9 |
| ethnic backgrounds. In about one-third of all cases, there |
10 |
| is no known family history of the disorder. In these cases, |
11 |
| the disease developed after a new or spontaneous gene |
12 |
| mutation. |
13 |
| (2) Hemophilia is one of a spectrum of devastating |
14 |
| chronic bleeding disorders impacting Americans. Von |
15 |
| Willebrand Disease, another type of bleeding disorder, is |
16 |
| caused by a deficiency on the von Willebrand protein. |
17 |
| Persons with the disorder often bruise easily, have |
18 |
| frequent nosebleeds, or bleed after tooth extraction, |
19 |
| tonsillectomy, or other surgery. In some instances, women |
20 |
| will have prolonged menstrual bleeding. The disorder |
21 |
| occurs in about 1% to 2% of the U.S. population. |
22 |
| (3) Appropriate care and treatment are necessities for |
23 |
| maintaining optimum health for persons afflicted with |
24 |
| hemophilia and other bleeding disorders. |
25 |
| (4) While hemophilia and other bleeding disorders are |
26 |
| incurable, advancements in drug therapies are allowing |
|
|
|
SB1580 Enrolled |
- 20 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| individuals greater latitude in managing their conditions, |
2 |
| fostering independence, and minimizing chronic |
3 |
| complications such as damage to the joints and muscles, |
4 |
| blood-transmitted infectious diseases, and chronic liver |
5 |
| diseases. At the same time, treatment for clotting |
6 |
| disorders is saving more and more lives. The rarity of |
7 |
| these disorders coupled with the delicate processes for |
8 |
| producing factors, however, makes treating these disorders |
9 |
| extremely costly. As a result, insurance coverage is a |
10 |
| major concern for patients and their families. |
11 |
| (5) It is thus the intent of the General Assembly |
12 |
| through implementation of this Act to establish an advisory |
13 |
| board to provide expert advice to the State on health and |
14 |
| insurance policies, plans, and public health programs that |
15 |
| impact individuals with hemophilia and other bleeding |
16 |
| disorders. |
17 |
| (410 ILCS 420/2.5 new) |
18 |
| Sec. 2.5. Hemophilia Advisory Review Board. |
19 |
| (a) The Director of Public Health in collaboration and in |
20 |
| consultation with the Director of Insurance, shall establish an |
21 |
| independent advisory board known as the Hemophilia Advisory |
22 |
| Review Board. The Board shall review, may comment upon, and |
23 |
| make recommendations to the Directors with regard to, but not |
24 |
| limited to the following: |
25 |
| (1) Proposed legislative or administrative changes to |
|
|
|
SB1580 Enrolled |
- 21 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| policies and programs that are integral to the health and |
2 |
| wellness of individuals with hemophilia and other bleeding |
3 |
| disorders. |
4 |
| (2) Standards of care and treatment for persons living |
5 |
| with hemophilia and other bleeding disorders. In examining |
6 |
| standards of care, the Board shall protect open access to |
7 |
| any and all treatments for hemophilia and other bleeding |
8 |
| disorders, in accordance with federal guidelines and |
9 |
| standards of care guidelines developed by the Medical and |
10 |
| Scientific Advisory Council (MASAC) of National Hemophilia |
11 |
| Foundation (NHF), an internationally recognized body whose |
12 |
| guidelines set the standards of care for hemophilia and |
13 |
| other bleeding disorders around the world. |
14 |
| (3) The development of community-based initiatives to |
15 |
| increase awareness of care and treatment for persons living |
16 |
| with hemophilia and other bleeding disorders. The |
17 |
| Department of Health may provide such services through |
18 |
| cooperative agreements with Hemophilia Treatment Centers, |
19 |
| medical facilities, schools, nonprofit organizations |
20 |
| servicing the bleeding disorder community, or other |
21 |
| appropriate means. |
22 |
| (4) Facilitating linkages for persons with hemophilia |
23 |
| and other bleeding disorders. |
24 |
| (5) Protecting the rights of people living with |
25 |
| hemophilia and other bleeding disorders to appropriate |
26 |
| health insurance coverage be it under a private or |
|
|
|
SB1580 Enrolled |
- 22 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| State-sponsored health insurance provider. |
2 |
| (b) The Board shall consist of the Director of Healthcare |
3 |
| and Family Services and the Director of Insurance or their |
4 |
| designee, who shall serve as non-voting members, and 7 voting |
5 |
| members appointed by the Governor in consultation and in |
6 |
| collaboration with the Directors. The voting members shall be |
7 |
| selected from among the following member groups: |
8 |
| (1) one board-certified physician licensed, practicing |
9 |
| and currently treating individuals with hemophilia or |
10 |
| other bleeding disorders; |
11 |
| (2) one nurse licensed, practicing and currently |
12 |
| treating individuals with hemophilia or other bleeding |
13 |
| disorders; |
14 |
| (3) one social worker licensed, practicing and |
15 |
| currently treating individuals with hemophilia or other |
16 |
| bleeding disorders; |
17 |
| (4) one representative of a federally funded |
18 |
| Hemophilia Treatment Center; |
19 |
| (5) one representative of an organization established |
20 |
| under the Illinois Insurance Code for the purpose of |
21 |
| providing health insurance; |
22 |
| (6) one representative of a voluntary health |
23 |
| organization that currently services the hemophilia and |
24 |
| other bleeding disorders community; and |
25 |
| (7) one patient or caregiver of a patient with |
26 |
| hemophilia or other bleeding disorder.
|
|
|
|
SB1580 Enrolled |
- 23 - |
LRB095 09918 KBJ 30129 b |
|
|
1 |
| The Board may also have up to 5 additional nonvoting members as |
2 |
| determined appropriate by the Directors. Nonvoting members may |
3 |
| be persons with or caregivers of a patient with hemophilia or a |
4 |
| bleeding disorder other than hemophilia or persons experienced |
5 |
| in the diagnosis, treatment, care, and support of individuals |
6 |
| with hemophilia or other bleeding disorders. |
7 |
| No more than a majority of the voting members may be of the |
8 |
| same political party.
Members of the Board shall elect one of |
9 |
| its members to act as chair for a term of 3 years. The chair |
10 |
| shall retain all voting rights. If there is a vacancy on the |
11 |
| Board, such position may be filled in the same manner as the |
12 |
| original appointment.
Members of the Board shall receive no |
13 |
| compensation, but may be reimbursed for actual expenses |
14 |
| incurred in the carrying out of their duties. The Board shall |
15 |
| meet no less than 4 times per year and follow all policies and |
16 |
| procedures of the State of Illinois Open Meetings Law. |
17 |
| (c) No later than 6 months after the date of enactment of |
18 |
| this amendatory Act, the Board shall submit to the Governor and |
19 |
| the General Assembly a report with recommendations for |
20 |
| maintaining access to care and obtaining appropriate health |
21 |
| insurance coverage for individuals with hemophilia and other |
22 |
| bleeding disorders. The report shall be subject to public |
23 |
| review and comment prior to adoption. No later than 6 months |
24 |
| after adoption by the Governor and Legislature and annually |
25 |
| thereafter, the Director of Healthcare and Family Services |
26 |
| shall issue a report, which shall be made available to the |