SB3762 Enrolled

LRB096 20714 KTG 36441 b






1
    AN ACT concerning regulation.

 
2
    Be it enacted by the People of the State of Illinois,
 
3
represented in the General Assembly:






 
4
    Section 5. The Illinois Public Aid Code is amended  by 
5
adding Section 12-4.40 as follows:
 
6
    (305 ILCS 5/12-4.40 new)
7
    Sec. 12-4.40. Medicaid Revenue Maximization.
8
    (a) Purpose. The General Assembly finds that there is a 
9
need to make changes to the administration of services provided 
10
by State and local governments in order to maximize federal 
11
financial participation. 
12
    (b) Definitions. As used in this Section: 
13
    "Community Medicaid mental health services" means all 
14
mental health services outlined in Section 132 of Title 59 of 
15
the Illinois Administrative Code that are funded through DHS, 
16
eligible for federal financial participation, and provided by a 
17
community-based provider. 
18
    "Community-based provider" means an entity enrolled as a 
19
provider pursuant to Sections 140.11 and 140.12 of Title 89 of 
20
the Illinois Administrative Code and certified to provide 
21
community Medicaid mental health services in accordance with 
22
Section 132 of Title 59 of the Illinois Administrative Code. 
23
    "DCFS" means the Department of Children and Family 
 


 






SB3762 Enrolled
- 2 -
LRB096 20714 KTG 36441 b




1
Services.
2
    "Department" means the Illinois Department of Healthcare 
3
and Family Services.
4
    "Developmentally disabled care facility" means an 
5
intermediate care facility for the mentally retarded within the 
6
meaning of Title XIX of the Social Security Act, whether public 
7
or private and whether organized for profit or not-for-profit, 
8
but shall not include any facility operated by the State.
9
    "Developmentally disabled care provider" means a person 
10
conducting, operating, or maintaining a developmentally 
11
disabled care facility. For purposes of this definition, 
12
"person" means any political subdivision of the State, 
13
municipal corporation, individual, firm, partnership, 
14
corporation, company, limited liability company, association, 
15
joint stock association, or trust, or a receiver, executor, 
16
trustee, guardian, or other representative appointed by order 
17
of any court.
18
    "DHS" means the Illinois Department of Human Services.
19
    "Hospital" means an institution, place, building, or 
20
agency located in this State that is licensed as a general 
21
acute hospital by the Illinois Department of Public Health 
22
under the Hospital Licensing Act, whether public or private and 
23
whether organized for profit or not-for-profit.
24
    "Long term care facility" means (i) a skilled nursing or 
25
intermediate long term care facility, whether public or private 
26
and whether organized for profit or not-for-profit, that is 
 


 






SB3762 Enrolled
- 3 -
LRB096 20714 KTG 36441 b




1
subject to licensure by the Illinois Department of Public 
2
Health under the Nursing Home Care Act, including a county 
3
nursing home directed and maintained under Section 5-1005 of 
4
the Counties Code, and (ii) a part of a hospital in which 
5
skilled or intermediate long term care services within the 
6
meaning of Title XVIII or XIX of the Social Security Act are 
7
provided; except that the term "long term care facility" does 
8
not include a facility operated solely as an intermediate care 
9
facility for the mentally retarded within the meaning of Title 
10
XIX of the Social Security Act.
11
    "Long term care provider" means (i) a person licensed by 
12
the Department of Public Health to operate and maintain a 
13
skilled nursing or intermediate long term care facility or (ii) 
14
a hospital provider that provides skilled or intermediate long 
15
term care services within the meaning of Title XVIII or XIX of 
16
the Social Security Act. For purposes of this definition, 
17
"person" means any political subdivision of the State, 
18
municipal corporation, individual, firm, partnership, 
19
corporation, company, limited liability company, association, 
20
joint stock association, or trust, or a receiver, executor, 
21
trustee, guardian, or other representative appointed by order 
22
of any court.
23
    "State-operated developmentally disabled care facility" 
24
means an intermediate care facility for the mentally retarded 
25
within the meaning of Title XIX of the Social Security Act 
26
operated by the State. 
 


 






SB3762 Enrolled
- 4 -
LRB096 20714 KTG 36441 b




1
    (c) Administration and deposit of Revenues. The Department 
2
shall coordinate the implementation of changes required by this 
3
amendatory Act of the 96th General Assembly amongst the various 
4
State and local government bodies that administer programs 
5
referred to in this Section.
6
    Revenues generated by program changes mandated by any 
7
provision in this Section, less reasonable administrative 
8
costs associated with the implementation of these program 
9
changes, shall be deposited into the Healthcare Provider Relief 
10
Fund. 
11
    The Department shall issue a report to the General Assembly 
12
detailing the implementation progress of this amendatory Act of 
13
the 96th General Assembly as a part of the Department's Medical 
14
Programs annual report for fiscal years 2010 and 2011. 
15
    (d) Acceleration of payment vouchers. To the  extent 
16
practicable and permissible under federal law, the Department 
17
shall create all vouchers for long term care facilities and 
18
developmentally disabled care facilities for dates of service 
19
in the month in which the enhanced federal medical assistance 
20
percentage (FMAP) originally set forth in the American Recovery 
21
and Reinvestment Act (ARRA) expires and for dates of service in 
22
the month prior to that month and shall, no later than the 15th 
23
of the month in which the enhanced FMAP expires, submit these 
24
vouchers to the Comptroller for payment. 
25
    The Department of Human Services shall create the necessary 
26
documentation for State-operated developmentally disabled care 
 


 






SB3762 Enrolled
- 5 -
LRB096 20714 KTG 36441 b




1
facilities so that the necessary data for all dates of service 
2
before the expiration of the enhanced FMAP originally set forth 
3
in the ARRA can be adjudicated by the Department no later than 
4
the 15th of the month in which the enhanced FMAP expires. 
5
    (e) Billing of DHS community Medicaid mental health 
6
services. No later than July 1, 2011, community Medicaid mental 
7
health services provided by a community-based provider must be 
8
billed directly to the Department. 
9
    (f) DCFS Medicaid services. The Department shall work with 
10
DCFS to identify existing programs, pending qualifying 
11
services, that can be converted in an economically feasible 
12
manner to  Medicaid in order to secure federal financial 
13
revenue. 
14
    (g) Third Party Liability recoveries. The Department shall 
15
contract with a vendor to support the Department in 
16
coordinating benefits for Medicaid enrollees.   The scope of work 
17
shall include, at a minimum, the identification of other 
18
insurance for Medicaid enrollees and the recovery of funds paid 
19
by the Department when another payer was liable. The vendor may 
20
be paid a percentage of actual cash recovered when practical 
21
and subject to federal law. 
22
    (h) Public health departments.
The Department shall 
23
identify unreimbursed costs for persons covered by Medicaid who 
24
are served by the Chicago Department of Public Health.
25
    The Department shall assist the Chicago Department of 
26
Public Health in determining total unreimbursed costs 
 


 






SB3762 Enrolled
- 6 -
LRB096 20714 KTG 36441 b




1
associated with the provision of healthcare services to 
2
Medicaid enrollees.
3
    The Department shall determine and draw the maximum 
4
allowable federal matching dollars associated with the cost of 
5
Chicago Department of Public Health services provided to 
6
Medicaid enrollees. 
7
    (i) Acceleration of hospital-based payments.
The 
8
Department shall, by the 10th day of the month in which the 
9
enhanced FMAP originally set forth in the ARRA expires, create 
10
vouchers for all State fiscal year 2011 hospital payments 
11
exempt from the prompt payment requirements of the ARRA.  The 
12
Department shall submit these vouchers to the Comptroller for 
13
payment. 
 
14
    Section 10. The Community Services Act is amended  by adding 
15
Section 4.8 as follows:
 
16
    (405 ILCS 30/4.8 new)
17
    Sec. 4.8. Payments for community Medicaid mental health 
18
services. 
19
    (a) No later than July 1, 2011, community Medicaid mental 
20
health services provided by a community-based provider must be 
21
billed directly to the Department of Healthcare and Family 
22
Services.
23
    (b) For purposes of this Section:
24
    "Community Medicaid mental health services" means all 
 


 






SB3762 Enrolled
- 7 -
LRB096 20714 KTG 36441 b




1
mental health services outlined in Section 132 of Title 59 of 
2
the Illinois Administrative Code that are funded through the 
3
Department of Human Services, eligible for federal financial 
4
participation, and provided by a community-based provider.
5
    "Community-based provider" means an entity enrolled as a 
6
provider pursuant to Sections 140.11 and 140.12 of Title 89 of 
7
the Illinois Administrative Code and certified to provide 
8
community Medicaid mental health services in accordance with 
9
Section 132 of Title 59 of the Illinois Administrative Code. 
 

10
    Section 99. Effective date. This Act takes effect upon 
11
becoming law.