Sen. Christine Radogno
Filed: 3/12/2010
 
 

 




 

 		












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AMENDMENT TO SENATE BILL 3743 




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    AMENDMENT NO. ______. Amend Senate Bill 3743, AS AMENDED, 
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with reference to Senate Amendment 1  as follows:


 
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on page 3, line 12, by adding before the period the following:
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", or a hospital that begins operations after January 1, 2010 
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and is designated by Medicare as a long term acute care 
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hospital."; and
 
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on page 4, line 4, by deleting "on the effective date of this 
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Act" and replacing it with "October 1, 2010"; and
 
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on page 5, line 1, by inserting "to the Department" before "the 
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CARE tool"; and
 
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on page 5, line 11, by inserting after "hospital" the 
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following:
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"with the exception of STAC hospitals identified in paragraphs 
 


 






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(1) and (2) under subsection (a) of Section 25 of this Act"; 
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and
 
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on  page 6, line 12, by deleting "The quotient of:"; and
 
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on page 6, by deleting lines 13 through 16; and
 
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on  page 6, line 19, by deleting "The quotient of:"; and
 
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on page 6, by deleting lines 20 through 22; and 
 
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on  page 6, line 25, by deleting "The"; and
 
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on page 6, by deleting line 26; and 
 
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on page 7, by deleting lines 1 through 17; and
 
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on page 7, line 22, by deleting "The quotient of:"; and
 
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on page 7, by deleting lines 23 through 26; and 
 
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by deleting page 8; and
 
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on  page 9, line 1, by deleting "The"; and
 
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on page 9, by deleting lines 2 through 20; and
 
 


 






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on page 9,  by deleting line 26; and
 
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by deleting page 10; and
 
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on page 11, by deleting lines 1 through 4; and
 
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on page 12, line 7, by replacing "with a notice to the 
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Department" with "with 30 calendar days' notice to the 
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Department."; and
 
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on page 12, by deleting lines 8 through 10; and
 
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on page 12, by replacing lines 11 through 13 with the 
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following:
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    "(c) The LTAC hospital must develop patient and family 
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education materials concerning the Program and submit those 
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materials to the Department for review and approval."; and
 
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on page 12, line 21, by replacing "who" with ":"; and
 
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on page 12, by replacing lines 22 and 23 with the following:
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        "(1) who upon admission to the LTAC hospital meet LTAC 
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    hospital criteria; and
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        (2) whose care is primarily paid for by the Department 
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    under Title XIX of the Social Security Act or whose care is 
 


 






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    primarily paid for by the Department after the patient has 
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    exhausted his or her benefits under Medicare."; and
 
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on page 13, line 1, by replacing "the LTAC hospital no" with 
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"any of the following conditions are met:"; and 
 
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on page 13, by replacing lines 2 through 6 with the following:
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        "(1) the LTAC hospital no longer meets the requirements 
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    under Section 15 of this Act or terminates the agreement 
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    specified under Section 15 of this Act;
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        (2) the patient does not meet the LTAC hospital 
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    criteria upon admission; or
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        (3) the patient's care is primarily paid for by 
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    Medicare and the patient has not exhausted his or her 
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    Medicare benefits, resulting in the Department becoming 
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    the primary payer."; and 
 
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on page 13, by replacing lines 7 through 14 with the following:
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    "(c) The Department may adjust the LTAC supplemental per 
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diem rate calculated under this Section based only on the 
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conditions and requirements described under Section 40 and 
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Section 45 of this Act."; and
 
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on page 14, by inserting immediately below line 12 the 
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following:
 
 


 






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    "Section 40. Rate adjustments for quality measures. 
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    (a) The Department may adjust the LTAC supplemental per 
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diem rate calculated under Section 35 of this Act based on the 
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requirements of this Section.
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    (b) After the first year of operation of the Program 
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established by this Act, the Department may reduce the LTAC 
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supplemental per diem rate calculated under Section 35 of this 
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Act by no more than 5% for an LTAC hospital that does not meet 
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benchmarks or targets set by the Department under paragraph (2) 
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of subsection (b) of Section 50. 
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    (c) After the first year of operation of the Program 
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established by this Act, the Department may increase the LTAC 
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supplemental per diem rate calculated under Section 35 of this 
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Act by no more than 5% for an LTAC hospital that exceeds the 
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benchmarks or targets set by the Department under paragraph (2) 
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of subsection (a) of Section 50.
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    (d) If an LTAC hospital misses a majority of the benchmarks 
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for quality measures for 3 consecutive years, the Department 
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may reduce the LTAC supplemental per diem rate calculated under 
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Section 35 of this Act to zero. 
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    (e) An LTAC hospital whose rate is reduced under subsection 
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(d) of this Section may have the LTAC supplemental per diem 
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rate calculated under Section 35 of this Act reinstated once 
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the LTAC hospital achieves the necessary benchmarks or targets.
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    (f) The Department may apply the reduction described in 
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subsection (d) of this Section after one year instead of 3 to 
 


 






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an LTAC hospital that has had its rate previously reduced under 
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subsection (d) of this Section and later has had it reinstated 
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under subsection (e) of this Section.
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    (g) The rate adjustments described in this Section shall be 
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determined and applied only at the beginning of each rate year.
 
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    Section 45. Program evaluation. 
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    (a) After the Program completes the 3rd full year of 
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operation on September 30, 2013, the Department must complete 
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an evaluation of the Program to determine the actual savings or 
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costs generated by the Program, both on an aggregate basis and 
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on an LTAC hospital-specific basis. The evaluation must be 
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conducted in each subsequent year.
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    (b) The Department and qualified LTAC hospitals must 
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determine the appropriate methodology to accurately calculate 
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the Program's savings and costs.
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    (c) The evaluation must also determine the effects the 
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Program has had in improving patient satisfaction and health 
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outcomes.
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    (d) If the evaluation indicates that the Program generates 
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a net cost to the Department, the Department may prospectively 
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adjust an individual hospital's LTAC supplemental per diem rate 
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under Section 35 of this Act to establish cost neutrality. The 
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rate adjustments applied under this subsection (d) do not need 
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to be applied uniformly to all qualified LTAC hospitals as long 
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as the adjustments are based on data from the evaluation on 
 


 






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hospital-specific information. Cost neutrality under this 
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Section means that the cost to the Department resulting from 
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the LTAC supplemental per diem rate must not exceed the savings 
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generated from transferring the patient from a STAC hospital.
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    (e) The rate adjustment described in subsection (d) of this 
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Section, if necessary, shall be applied to the LTAC 
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supplemental per diem rate for the rate year beginning October 
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1, 2014. The Department may apply this rate adjustment in 
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subsequent rate years if the conditions under subsection (d) of 
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this Section are met. The Department must apply the rate 
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adjustment to an individual LTAC hospital's LTAC supplemental 
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per diem rate only in years when the Program evaluation 
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indicates a net cost for the Department. 
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    (f) The rate adjustments described in this Section shall be 
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determined and applied only at the beginning of each rate 
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year."; and
 
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on page 14, line 13, by replacing "40" with "50"; and
 
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on page 15, by replacing lines 2 through 14 with the following:
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    "(b) The Department shall include specific information on 
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the Program in its annual medical programs report."; and
 
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on page 15, line 25, by replacing "execute an agreement as" 
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with "create and distribute to LTAC hospitals the agreement"; 
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and
 
 


 






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on page 15, line 26, by replacing "45 days after" with 
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"September 1, 2010."; and
 
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on page 16, by deleting line 1; and
 
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on page 16, line 16, by inserting after the period the 
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following:
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    "The Department must also notify LTAC hospitals that 
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accepting transfers from the STAC hospitals identified in 
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paragraphs (1) and (2) under subsection (a) of Section 25 of 
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this Act are not required under paragraph (5) of subsection (c) 
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of Section 15 of this Act. The Department must notify LTAC 
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hospitals that accepting transfers from the STAC hospitals 
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identified in paragraphs (1) and (2) under subsection (a) of 
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Section 25 of this Act shall negatively impact the savings 
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calculations under the Program evaluation required by Section 
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40 of this Act and shall in turn require the Department to 
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initiate the penalty described in subsection (d) of Section 40 
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of this Act."; and
 
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on page 16, by replacing lines 17 through 20 with the 
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following:
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    "(j) The Department shall deem LTAC hospitals qualified 
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under Section 15 of this Act as qualifying for expedited 
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payments."; and
 
 


 






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on page 16, by inserting immediately below line 26 the 
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following:
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    "(l) The Department may promulgate rules as allowed by the 
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Illinois Administrative Procedure Act to implement this Act; 
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however, the requirements under this Act shall be implemented 
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by the Department even if the Department's proposed rules are 
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not yet adopted by the implementation date of October 1, 
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2010.".