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1 | | AN ACT concerning regulation.
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2 | | Be it enacted by the People of the State of Illinois, |
3 | | represented in the General Assembly:
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4 | | Article 1. |
5 | | Section 1-5. The Illinois Public Aid Code is amended by |
6 | | adding Section 5A-2.1 as follows: |
7 | | (305 ILCS 5/5A-2.1 new) |
8 | | Sec. 5A-2.1. Continuation of Section 5A-2 of this Code; |
9 | | validation. |
10 | | (a) The General Assembly finds and declares that: |
11 | | (1) Public Act 101-650, which took effect on July 7, |
12 | | 2020, contained provisions that would have changed the |
13 | | repeal date for Section 5A-2 of this Act from July 1, 2020 |
14 | | to December 31, 2022. |
15 | | (2) The Statute on Statutes sets forth general rules on |
16 | | the repeal of statutes and the construction of multiple |
17 | | amendments, but Section 1 of that Act also states that |
18 | | these rules will not be observed when the result would be |
19 | | "inconsistent with the manifest intent of the General |
20 | | Assembly or repugnant to the context of the statute". |
21 | | (3) This amendatory Act of the 101st General Assembly |
22 | | manifests the intention of the General Assembly to extend |
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1 | | the repeal date for Section 5A-2 of this Code and have |
2 | | Section 5A-2 of this Code, as amended by Public Act |
3 | | 101-650, continue in effect until December 31, 2022. |
4 | | (b) Any construction of this Code that results in the |
5 | | repeal of Section 5A-2 of this Code on July 1, 2020 would be |
6 | | inconsistent with the manifest intent of the General Assembly |
7 | | and repugnant to the context of this Code. |
8 | | (c) It is hereby declared to have been the intent of the |
9 | | General Assembly that Section 5A-2 of this Code shall not be |
10 | | subject to repeal on July 1, 2020. |
11 | | (d) Section 5A-2 of this Code shall be deemed to have been |
12 | | in continuous effect since July 8, 1992 (the effective date of |
13 | | Public Act 87-861), and it shall continue to be in effect, as |
14 | | amended by Public Act 101-650, until it is otherwise lawfully |
15 | | amended or repealed. All previously enacted amendments to the |
16 | | Section taking effect on or after July 8, 1992, are hereby |
17 | | validated. |
18 | | (e) In order to ensure the continuing effectiveness of |
19 | | Section 5A-2 of this Code, that Section is set forth in
full |
20 | | and reenacted by this amendatory Act of the 101st General
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21 | | Assembly. In this amendatory Act of the 101st General Assembly, |
22 | | the base text of the reenacted Section is set forth as amended |
23 | | by Public Act 101-650. |
24 | | (f) All actions of the Illinois Department or any other |
25 | | person or entity taken in reliance on or pursuant to Section |
26 | | 5A-2 of this Code are hereby validated. |
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1 | | Section 1-10. The Illinois Public Aid Code is amended by |
2 | | reenacting Section 5A-2 as follows: |
3 | | (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) |
4 | | Sec. 5A-2. Assessment.
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5 | | (a)(1)
Subject to Sections 5A-3 and 5A-10, for State fiscal |
6 | | years 2009 through 2018, or as long as continued under Section |
7 | | 5A-16, an annual assessment on inpatient services is imposed on |
8 | | each hospital provider in an amount equal to $218.38 multiplied |
9 | | by the difference of the hospital's occupied bed days less the |
10 | | hospital's Medicare bed days, provided, however, that the |
11 | | amount of $218.38 shall be increased by a uniform percentage to |
12 | | generate an amount equal to 75% of the State share of the |
13 | | payments authorized under Section 5A-12.5, with such increase |
14 | | only taking effect upon the date that a State share for such |
15 | | payments is required under federal law. For the period of April |
16 | | through June 2015, the amount of $218.38 used to calculate the |
17 | | assessment under this paragraph shall, by emergency rule under |
18 | | subsection (s) of Section 5-45 of the Illinois Administrative |
19 | | Procedure Act, be increased by a uniform percentage to generate |
20 | | $20,250,000 in the aggregate for that period from all hospitals |
21 | | subject to the annual assessment under this paragraph. |
22 | | (2) In addition to any other assessments imposed under this |
23 | | Article, effective July 1, 2016 and semi-annually thereafter |
24 | | through June 2018, or as provided in Section 5A-16, in addition |
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1 | | to any federally required State share as authorized under |
2 | | paragraph (1), the amount of $218.38 shall be increased by a |
3 | | uniform percentage to generate an amount equal to 75% of the |
4 | | ACA Assessment Adjustment, as defined in subsection (b-6) of |
5 | | this Section. |
6 | | For State fiscal years 2009 through 2018, or as provided in |
7 | | Section 5A-16, a hospital's occupied bed days and Medicare bed |
8 | | days shall be determined using the most recent data available |
9 | | from each hospital's 2005 Medicare cost report as contained in |
10 | | the Healthcare Cost Report Information System file, for the |
11 | | quarter ending on December 31, 2006, without regard to any |
12 | | subsequent adjustments or changes to such data. If a hospital's |
13 | | 2005 Medicare cost report is not contained in the Healthcare |
14 | | Cost Report Information System, then the Illinois Department |
15 | | may obtain the hospital provider's occupied bed days and |
16 | | Medicare bed days from any source available, including, but not |
17 | | limited to, records maintained by the hospital provider, which |
18 | | may be inspected at all times during business hours of the day |
19 | | by the Illinois Department or its duly authorized agents and |
20 | | employees. |
21 | | (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State |
22 | | fiscal years 2019 and 2020, an annual assessment on inpatient |
23 | | services is imposed on each hospital provider in an amount |
24 | | equal to $197.19 multiplied by the difference of the hospital's |
25 | | occupied bed days less the hospital's Medicare bed days. For |
26 | | State fiscal years 2019 and 2020, a hospital's occupied bed |
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1 | | days and Medicare bed days shall be determined using the most |
2 | | recent data available from each hospital's 2015 Medicare cost |
3 | | report as contained in the Healthcare Cost Report Information |
4 | | System file, for the quarter ending on March 31, 2017, without |
5 | | regard to any subsequent adjustments or changes to such data. |
6 | | If a hospital's 2015 Medicare cost report is not contained in |
7 | | the Healthcare Cost Report Information System, then the |
8 | | Illinois Department may obtain the hospital provider's |
9 | | occupied bed days and Medicare bed days from any source |
10 | | available, including, but not limited to, records maintained by |
11 | | the hospital provider, which may be inspected at all times |
12 | | during business hours of the day by the Illinois Department or |
13 | | its duly authorized agents and employees. Notwithstanding any |
14 | | other provision in this Article, for a hospital provider that |
15 | | did not have a 2015 Medicare cost report, but paid an |
16 | | assessment in State fiscal year 2018 on the basis of |
17 | | hypothetical data, that assessment amount shall be used for |
18 | | State fiscal years 2019 and 2020. |
19 | | (4) Subject to Sections 5A-3 and 5A-10, for the period of |
20 | | July 1, 2020 through December 31, 2020 and calendar years 2021 |
21 | | and 2022, an annual assessment on inpatient services is imposed |
22 | | on each hospital provider in an amount equal to $221.50 |
23 | | multiplied by the difference of the hospital's occupied bed |
24 | | days less the hospital's Medicare bed days, provided however: |
25 | | for the period of July 1, 2020 through December 31, 2020, (i) |
26 | | the assessment shall be equal to 50% of the annual amount; and |
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1 | | (ii) the amount of $221.50 shall be retroactively adjusted by a |
2 | | uniform percentage to generate an amount equal to 50% of the |
3 | | Assessment Adjustment, as defined in subsection (b-7). For the |
4 | | period of July 1, 2020 through December 31, 2020 and calendar |
5 | | years 2021 and 2022, a hospital's occupied bed days and |
6 | | Medicare bed days shall be determined using the most recent |
7 | | data available from each hospital's 2015 Medicare cost report |
8 | | as contained in the Healthcare Cost Report Information System |
9 | | file, for the quarter ending on March 31, 2017, without regard |
10 | | to any subsequent adjustments or changes to such data. If a |
11 | | hospital's 2015 Medicare cost report is not contained in the |
12 | | Healthcare Cost Report Information System, then the Illinois |
13 | | Department may obtain the hospital provider's occupied bed days |
14 | | and Medicare bed days from any source available, including, but |
15 | | not limited to, records maintained by the hospital provider, |
16 | | which may be inspected at all times during business hours of |
17 | | the day by the Illinois Department or its duly authorized |
18 | | agents and employees. Should the change in the assessment |
19 | | methodology for fiscal years 2021 through December 31, 2022 not |
20 | | be approved on or before June 30, 2020, the assessment and |
21 | | payments under this Article in effect for fiscal year 2020 |
22 | | shall remain in place until the new assessment is approved. If |
23 | | the assessment methodology for July 1, 2020 through December |
24 | | 31, 2022, is approved on or after July 1, 2020, it shall be |
25 | | retroactive to July 1, 2020, subject to federal approval and |
26 | | provided that the payments authorized under Section 5A-12.7 |
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1 | | have the same effective date as the new assessment methodology. |
2 | | In giving retroactive effect to the assessment approved after |
3 | | June 30, 2020, credit toward the new assessment shall be given |
4 | | for any payments of the previous assessment for periods after |
5 | | June 30, 2020. Notwithstanding any other provision of this |
6 | | Article, for a hospital provider that did not have a 2015 |
7 | | Medicare cost report, but paid an assessment in State Fiscal |
8 | | Year 2020 on the basis of hypothetical data, the data that was |
9 | | the basis for the 2020 assessment shall be used to calculate |
10 | | the assessment under this paragraph. |
11 | | (b) (Blank).
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12 | | (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the |
13 | | portion of State fiscal year 2012, beginning June 10, 2012 |
14 | | through June 30, 2012, and for State fiscal years 2013 through |
15 | | 2018, or as provided in Section 5A-16, an annual assessment on |
16 | | outpatient services is imposed on each hospital provider in an |
17 | | amount equal to .008766 multiplied by the hospital's outpatient |
18 | | gross revenue, provided, however, that the amount of .008766 |
19 | | shall be increased by a uniform percentage to generate an |
20 | | amount equal to 25% of the State share of the payments |
21 | | authorized under Section 5A-12.5, with such increase only |
22 | | taking effect upon the date that a State share for such |
23 | | payments is required under federal law. For the period |
24 | | beginning June 10, 2012 through June 30, 2012, the annual |
25 | | assessment on outpatient services shall be prorated by |
26 | | multiplying the assessment amount by a fraction, the numerator |
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1 | | of which is 21 days and the denominator of which is 365 days. |
2 | | For the period of April through June 2015, the amount of |
3 | | .008766 used to calculate the assessment under this paragraph |
4 | | shall, by emergency rule under subsection (s) of Section 5-45 |
5 | | of the Illinois Administrative Procedure Act, be increased by a |
6 | | uniform percentage to generate $6,750,000 in the aggregate for |
7 | | that period from all hospitals subject to the annual assessment |
8 | | under this paragraph. |
9 | | (2) In addition to any other assessments imposed under this |
10 | | Article, effective July 1, 2016 and semi-annually thereafter |
11 | | through June 2018, in addition to any federally required State |
12 | | share as authorized under paragraph (1), the amount of .008766 |
13 | | shall be increased by a uniform percentage to generate an |
14 | | amount equal to 25% of the ACA Assessment Adjustment, as |
15 | | defined in subsection (b-6) of this Section. |
16 | | For the portion of State fiscal year 2012, beginning June |
17 | | 10, 2012 through June 30, 2012, and State fiscal years 2013 |
18 | | through 2018, or as provided in Section 5A-16, a hospital's |
19 | | outpatient gross revenue shall be determined using the most |
20 | | recent data available from each hospital's 2009 Medicare cost |
21 | | report as contained in the Healthcare Cost Report Information |
22 | | System file, for the quarter ending on June 30, 2011, without |
23 | | regard to any subsequent adjustments or changes to such data. |
24 | | If a hospital's 2009 Medicare cost report is not contained in |
25 | | the Healthcare Cost Report Information System, then the |
26 | | Department may obtain the hospital provider's outpatient gross |
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1 | | revenue from any source available, including, but not limited |
2 | | to, records maintained by the hospital provider, which may be |
3 | | inspected at all times during business hours of the day by the |
4 | | Department or its duly authorized agents and employees. |
5 | | (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State |
6 | | fiscal years 2019 and 2020, an annual assessment on outpatient |
7 | | services is imposed on each hospital provider in an amount |
8 | | equal to .01358 multiplied by the hospital's outpatient gross |
9 | | revenue. For State fiscal years 2019 and 2020, a hospital's |
10 | | outpatient gross revenue shall be determined using the most |
11 | | recent data available from each hospital's 2015 Medicare cost |
12 | | report as contained in the Healthcare Cost Report Information |
13 | | System file, for the quarter ending on March 31, 2017, without |
14 | | regard to any subsequent adjustments or changes to such data. |
15 | | If a hospital's 2015 Medicare cost report is not contained in |
16 | | the Healthcare Cost Report Information System, then the |
17 | | Department may obtain the hospital provider's outpatient gross |
18 | | revenue from any source available, including, but not limited |
19 | | to, records maintained by the hospital provider, which may be |
20 | | inspected at all times during business hours of the day by the |
21 | | Department or its duly authorized agents and employees. |
22 | | Notwithstanding any other provision in this Article, for a |
23 | | hospital provider that did not have a 2015 Medicare cost |
24 | | report, but paid an assessment in State fiscal year 2018 on the |
25 | | basis of hypothetical data, that assessment amount shall be |
26 | | used for State fiscal years 2019 and 2020. |
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1 | | (4) Subject to Sections 5A-3 and 5A-10, for the period of |
2 | | July 1, 2020 through December 31, 2020 and calendar years 2021 |
3 | | and 2022, an annual assessment on outpatient services is |
4 | | imposed on each hospital provider in an amount equal to .01525 |
5 | | multiplied by the hospital's outpatient gross revenue, |
6 | | provided however: (i) for the period of July 1, 2020 through |
7 | | December 31, 2020, the assessment shall be equal to 50% of the |
8 | | annual amount; and (ii) the amount of .01525 shall be |
9 | | retroactively adjusted by a uniform percentage to generate an |
10 | | amount equal to 50% of the Assessment Adjustment, as defined in |
11 | | subsection (b-7). For the period of July 1, 2020 through |
12 | | December 31, 2020 and calendar years 2021 and 2022, a |
13 | | hospital's outpatient gross revenue shall be determined using |
14 | | the most recent data available from each hospital's 2015 |
15 | | Medicare cost report as contained in the Healthcare Cost Report |
16 | | Information System file, for the quarter ending on March 31, |
17 | | 2017, without regard to any subsequent adjustments or changes |
18 | | to such data. If a hospital's 2015 Medicare cost report is not |
19 | | contained in the Healthcare Cost Report Information System, |
20 | | then the Illinois Department may obtain the hospital provider's |
21 | | outpatient revenue data from any source available, including, |
22 | | but not limited to, records maintained by the hospital |
23 | | provider, which may be inspected at all times during business |
24 | | hours of the day by the Illinois Department or its duly |
25 | | authorized agents and employees. Should the change in the |
26 | | assessment methodology above for fiscal years 2021 through |
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1 | | calendar year 2022 not be approved prior to July 1, 2020, the |
2 | | assessment and payments under this Article in effect for fiscal |
3 | | year 2020 shall remain in place until the new assessment is |
4 | | approved. If the change in the assessment methodology above for |
5 | | July 1, 2020 through December 31, 2022, is approved after June |
6 | | 30, 2020, it shall have a retroactive effective date of July 1, |
7 | | 2020, subject to federal approval and provided that the |
8 | | payments authorized under Section 12A-7 have the same effective |
9 | | date as the new assessment methodology. In giving retroactive |
10 | | effect to the assessment approved after June 30, 2020, credit |
11 | | toward the new assessment shall be given for any payments of |
12 | | the previous assessment for periods after June 30, 2020. |
13 | | Notwithstanding any other provision of this Article, for a |
14 | | hospital provider that did not have a 2015 Medicare cost |
15 | | report, but paid an assessment in State Fiscal Year 2020 on the |
16 | | basis of hypothetical data, the data that was the basis for the |
17 | | 2020 assessment shall be used to calculate the assessment under |
18 | | this paragraph. |
19 | | (b-6)(1) As used in this Section, "ACA Assessment |
20 | | Adjustment" means: |
21 | | (A) For the period of July 1, 2016 through December 31, |
22 | | 2016, the product of .19125 multiplied by the sum of the |
23 | | fee-for-service payments to hospitals as authorized under |
24 | | Section 5A-12.5 and the adjustments authorized under |
25 | | subsection (t) of Section 5A-12.2 to managed care |
26 | | organizations for hospital services due and payable in the |
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1 | | month of April 2016 multiplied by 6. |
2 | | (B) For the period of January 1, 2017 through June 30, |
3 | | 2017, the product of .19125 multiplied by the sum of the |
4 | | fee-for-service payments to hospitals as authorized under |
5 | | Section 5A-12.5 and the adjustments authorized under |
6 | | subsection (t) of Section 5A-12.2 to managed care |
7 | | organizations for hospital services due and payable in the |
8 | | month of October 2016 multiplied by 6, except that the |
9 | | amount calculated under this subparagraph (B) shall be |
10 | | adjusted, either positively or negatively, to account for |
11 | | the difference between the actual payments issued under |
12 | | Section 5A-12.5 for the period beginning July 1, 2016 |
13 | | through December 31, 2016 and the estimated payments due |
14 | | and payable in the month of April 2016 multiplied by 6 as |
15 | | described in subparagraph (A). |
16 | | (C) For the period of July 1, 2017 through December 31, |
17 | | 2017, the product of .19125 multiplied by the sum of the |
18 | | fee-for-service payments to hospitals as authorized under |
19 | | Section 5A-12.5 and the adjustments authorized under |
20 | | subsection (t) of Section 5A-12.2 to managed care |
21 | | organizations for hospital services due and payable in the |
22 | | month of April 2017 multiplied by 6, except that the amount |
23 | | calculated under this subparagraph (C) shall be adjusted, |
24 | | either positively or negatively, to account for the |
25 | | difference between the actual payments issued under |
26 | | Section 5A-12.5 for the period beginning January 1, 2017 |
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1 | | through June 30, 2017 and the estimated payments due and |
2 | | payable in the month of October 2016 multiplied by 6 as |
3 | | described in subparagraph (B). |
4 | | (D) For the period of January 1, 2018 through June 30, |
5 | | 2018, the product of .19125 multiplied by the sum of the |
6 | | fee-for-service payments to hospitals as authorized under |
7 | | Section 5A-12.5 and the adjustments authorized under |
8 | | subsection (t) of Section 5A-12.2 to managed care |
9 | | organizations for hospital services due and payable in the |
10 | | month of October 2017 multiplied by 6, except that: |
11 | | (i) the amount calculated under this subparagraph |
12 | | (D) shall be adjusted, either positively or |
13 | | negatively, to account for the difference between the |
14 | | actual payments issued under Section 5A-12.5 for the |
15 | | period of July 1, 2017 through December 31, 2017 and |
16 | | the estimated payments due and payable in the month of |
17 | | April 2017 multiplied by 6 as described in subparagraph |
18 | | (C); and |
19 | | (ii) the amount calculated under this subparagraph |
20 | | (D) shall be adjusted to include the product of .19125 |
21 | | multiplied by the sum of the fee-for-service payments, |
22 | | if any, estimated to be paid to hospitals under |
23 | | subsection (b) of Section 5A-12.5. |
24 | | (2) The Department shall complete and apply a final |
25 | | reconciliation of the ACA Assessment Adjustment prior to June |
26 | | 30, 2018 to account for: |
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1 | | (A) any differences between the actual payments issued |
2 | | or scheduled to be issued prior to June 30, 2018 as |
3 | | authorized in Section 5A-12.5 for the period of January 1, |
4 | | 2018 through June 30, 2018 and the estimated payments due |
5 | | and payable in the month of October 2017 multiplied by 6 as |
6 | | described in subparagraph (D); and |
7 | | (B) any difference between the estimated |
8 | | fee-for-service payments under subsection (b) of Section |
9 | | 5A-12.5 and the amount of such payments that are actually |
10 | | scheduled to be paid. |
11 | | The Department shall notify hospitals of any additional |
12 | | amounts owed or reduction credits to be applied to the June |
13 | | 2018 ACA Assessment Adjustment. This is to be considered the |
14 | | final reconciliation for the ACA Assessment Adjustment. |
15 | | (3) Notwithstanding any other provision of this Section, if |
16 | | for any reason the scheduled payments under subsection (b) of |
17 | | Section 5A-12.5 are not issued in full by the final day of the |
18 | | period authorized under subsection (b) of Section 5A-12.5, |
19 | | funds collected from each hospital pursuant to subparagraph (D) |
20 | | of paragraph (1) and pursuant to paragraph (2), attributable to |
21 | | the scheduled payments authorized under subsection (b) of |
22 | | Section 5A-12.5 that are not issued in full by the final day of |
23 | | the period attributable to each payment authorized under |
24 | | subsection (b) of Section 5A-12.5, shall be refunded. |
25 | | (4) The increases authorized under paragraph (2) of |
26 | | subsection (a) and paragraph (2) of subsection (b-5) shall be |
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1 | | limited to the federally required State share of the total |
2 | | payments authorized under Section 5A-12.5 if the sum of such |
3 | | payments yields an annualized amount equal to or less than |
4 | | $450,000,000, or if the adjustments authorized under |
5 | | subsection (t) of Section 5A-12.2 are found not to be |
6 | | actuarially sound; however, this limitation shall not apply to |
7 | | the fee-for-service payments described in subsection (b) of |
8 | | Section 5A-12.5. |
9 | | (b-7)(1) As used in this Section, "Assessment Adjustment" |
10 | | means: |
11 | | (A) For the period of July 1, 2020 through December 31, |
12 | | 2020, the product of .3853 multiplied by the total of the |
13 | | actual payments made under subsections (c) through (k) of |
14 | | Section 5A-12.7 attributable to the period, less the total |
15 | | of the assessment imposed under subsections (a) and (b-5) |
16 | | of this Section for the period. |
17 | | (B) For each calendar quarter beginning on and after |
18 | | January 1, 2021, the product of .3853 multiplied by the |
19 | | total of the actual payments made under subsections (c) |
20 | | through (k) of Section 5A-12.7 attributable to the period, |
21 | | less the total of the assessment imposed under subsections |
22 | | (a) and (b-5) of this Section for the period. |
23 | | (2) The Department shall calculate and notify each hospital |
24 | | of the total Assessment Adjustment and any additional |
25 | | assessment owed by the hospital or refund owed to the hospital |
26 | | on either a semi-annual or annual basis. Such notice shall be |
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1 | | issued at least 30 days prior to any period in which the |
2 | | assessment will be adjusted. Any additional assessment owed by |
3 | | the hospital or refund owed to the hospital shall be uniformly |
4 | | applied to the assessment owed by the hospital in monthly |
5 | | installments for the subsequent semi-annual period or calendar |
6 | | year. If no assessment is owed in the subsequent year, any |
7 | | amount owed by the hospital or refund due to the hospital, |
8 | | shall be paid in a lump sum. |
9 | | (3) The Department shall publish all details of the |
10 | | Assessment Adjustment calculation performed each year on its |
11 | | website within 30 days of completing the calculation, and also |
12 | | submit the details of the Assessment Adjustment calculation as |
13 | | part of the Department's annual report to the General Assembly. |
14 | | (c) (Blank).
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15 | | (d) Notwithstanding any of the other provisions of this |
16 | | Section, the Department is authorized to adopt rules to reduce |
17 | | the rate of any annual assessment imposed under this Section, |
18 | | as authorized by Section 5-46.2 of the Illinois Administrative |
19 | | Procedure Act.
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20 | | (e) Notwithstanding any other provision of this Section, |
21 | | any plan providing for an assessment on a hospital provider as |
22 | | a permissible tax under Title XIX of the federal Social |
23 | | Security Act and Medicaid-eligible payments to hospital |
24 | | providers from the revenues derived from that assessment shall |
25 | | be reviewed by the Illinois Department of Healthcare and Family |
26 | | Services, as the Single State Medicaid Agency required by |
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1 | | federal law, to determine whether those assessments and |
2 | | hospital provider payments meet federal Medicaid standards. If |
3 | | the Department determines that the elements of the plan may |
4 | | meet federal Medicaid standards and a related State Medicaid |
5 | | Plan Amendment is prepared in a manner and form suitable for |
6 | | submission, that State Plan Amendment shall be submitted in a |
7 | | timely manner for review by the Centers for Medicare and |
8 | | Medicaid Services of the United States Department of Health and |
9 | | Human Services and subject to approval by the Centers for |
10 | | Medicare and Medicaid Services of the United States Department |
11 | | of Health and Human Services. No such plan shall become |
12 | | effective without approval by the Illinois General Assembly by |
13 | | the enactment into law of related legislation. Notwithstanding |
14 | | any other provision of this Section, the Department is |
15 | | authorized to adopt rules to reduce the rate of any annual |
16 | | assessment imposed under this Section. Any such rules may be |
17 | | adopted by the Department under Section 5-50 of the Illinois |
18 | | Administrative Procedure Act. |
19 | | (Source: P.A. 100-581, eff. 3-12-18; 101-10, eff. 6-5-19; |
20 | | 101-650, eff. 7-7-20.)
|
21 | | Article 5. |
22 | | Section 5-5. The Illinois Public Aid Code is amended by |
23 | | changing Sections 5-5.07, 5-5e.1, and 14-12 as follows: |
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1 | | (305 ILCS 5/5-5.07) |
2 | | Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem |
3 | | rate. The Department of Children and Family Services shall pay |
4 | | the DCFS per diem rate for inpatient psychiatric stay at a |
5 | | free-standing psychiatric hospital effective the 11th day when |
6 | | a child is in the hospital beyond medical necessity, and the |
7 | | parent or caregiver has denied the child access to the home and |
8 | | has refused or failed to make provisions for another living |
9 | | arrangement for the child or the child's discharge is being |
10 | | delayed due to a pending inquiry or investigation by the |
11 | | Department of Children and Family Services. If any portion of a |
12 | | hospital stay is reimbursed under this Section, the hospital |
13 | | stay shall not be eligible for payment under the provisions of |
14 | | Section 14-13 of this Code. This Section is inoperative on and |
15 | | after July 1, 2021 2020 2019 . Notwithstanding the provision of |
16 | | Public Act 101-209 stating that this Section is inoperative on |
17 | | and
after July 1, 2020, this Section is operative from July 1, |
18 | | 2020 through June 30, 2021.
|
19 | | (Source: P.A. 100-646, eff. 7-27-18; reenacted by 101-15, eff. |
20 | | 6-14-19; reenacted by 101-209, eff. 8-5-19; revised 9-24-19.) |
21 | | Article 10. |
22 | | Section 10-5. The Illinois Public Aid Code is amended by |
23 | | changing Section 14-12 as follows: |
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1 | | (305 ILCS 5/14-12) |
2 | | Sec. 14-12. Hospital rate reform payment system. The |
3 | | hospital payment system pursuant to Section 14-11 of this |
4 | | Article shall be as follows: |
5 | | (a) Inpatient hospital services. Effective for discharges |
6 | | on and after July 1, 2014, reimbursement for inpatient general |
7 | | acute care services shall utilize the All Patient Refined |
8 | | Diagnosis Related Grouping (APR-DRG) software, version 30, |
9 | | distributed by 3M TM Health Information System. |
10 | | (1) The Department shall establish Medicaid weighting |
11 | | factors to be used in the reimbursement system established |
12 | | under this subsection. Initial weighting factors shall be |
13 | | the weighting factors as published by 3M Health Information |
14 | | System, associated with Version 30.0 adjusted for the |
15 | | Illinois experience. |
16 | | (2) The Department shall establish a |
17 | | statewide-standardized amount to be used in the inpatient |
18 | | reimbursement system. The Department shall publish these |
19 | | amounts on its website no later than 10 calendar days prior |
20 | | to their effective date. |
21 | | (3) In addition to the statewide-standardized amount, |
22 | | the Department shall develop adjusters to adjust the rate |
23 | | of reimbursement for critical Medicaid providers or |
24 | | services for trauma, transplantation services, perinatal |
25 | | care, and Graduate Medical Education (GME). |
26 | | (4) The Department shall develop add-on payments to |
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1 | | account for exceptionally costly inpatient stays, |
2 | | consistent with Medicare outlier principles. Outlier fixed |
3 | | loss thresholds may be updated to control for excessive |
4 | | growth in outlier payments no more frequently than on an |
5 | | annual basis, but at least triennially. Upon updating the |
6 | | fixed loss thresholds, the Department shall be required to |
7 | | update base rates within 12 months. |
8 | | (5) The Department shall define those hospitals or |
9 | | distinct parts of hospitals that shall be exempt from the |
10 | | APR-DRG reimbursement system established under this |
11 | | Section. The Department shall publish these hospitals' |
12 | | inpatient rates on its website no later than 10 calendar |
13 | | days prior to their effective date. |
14 | | (6) Beginning July 1, 2014 and ending on June 30, 2024, |
15 | | in addition to the statewide-standardized amount, the |
16 | | Department shall develop an adjustor to adjust the rate of |
17 | | reimbursement for safety-net hospitals defined in Section |
18 | | 5-5e.1 of this Code excluding pediatric hospitals. |
19 | | (7) Beginning July 1, 2014, in addition to the |
20 | | statewide-standardized amount, the Department shall |
21 | | develop an adjustor to adjust the rate of reimbursement for |
22 | | Illinois freestanding inpatient psychiatric hospitals that |
23 | | are not designated as children's hospitals by the |
24 | | Department but are primarily treating patients under the |
25 | | age of 21. |
26 | | (7.5) (Blank). |
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1 | | (8) Beginning July 1, 2018, in addition to the |
2 | | statewide-standardized amount, the Department shall adjust |
3 | | the rate of reimbursement for hospitals designated by the |
4 | | Department of Public Health as a Perinatal Level II or II+ |
5 | | center by applying the same adjustor that is applied to |
6 | | Perinatal and Obstetrical care cases for Perinatal Level |
7 | | III centers, as of December 31, 2017. |
8 | | (9) Beginning July 1, 2018, in addition to the |
9 | | statewide-standardized amount, the Department shall apply |
10 | | the same adjustor that is applied to trauma cases as of |
11 | | December 31, 2017 to inpatient claims to treat patients |
12 | | with burns, including, but not limited to, APR-DRGs 841, |
13 | | 842, 843, and 844. |
14 | | (10) Beginning July 1, 2018, the |
15 | | statewide-standardized amount for inpatient general acute |
16 | | care services shall be uniformly increased so that base |
17 | | claims projected reimbursement is increased by an amount |
18 | | equal to the funds allocated in paragraph (1) of subsection |
19 | | (b) of Section 5A-12.6, less the amount allocated under |
20 | | paragraphs (8) and (9) of this subsection and paragraphs |
21 | | (3) and (4) of subsection (b) multiplied by 40%. |
22 | | (11) Beginning July 1, 2018, the reimbursement for |
23 | | inpatient rehabilitation services shall be increased by |
24 | | the addition of a $96 per day add-on. |
25 | | (b) Outpatient hospital services. Effective for dates of |
26 | | service on and after July 1, 2014, reimbursement for outpatient |
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1 | | services shall utilize the Enhanced Ambulatory Procedure |
2 | | Grouping (EAPG) software, version 3.7 distributed by 3M TM |
3 | | Health Information System. |
4 | | (1) The Department shall establish Medicaid weighting |
5 | | factors to be used in the reimbursement system established |
6 | | under this subsection. The initial weighting factors shall |
7 | | be the weighting factors as published by 3M Health |
8 | | Information System, associated with Version 3.7. |
9 | | (2) The Department shall establish service specific |
10 | | statewide-standardized amounts to be used in the |
11 | | reimbursement system. |
12 | | (A) The initial statewide standardized amounts, |
13 | | with the labor portion adjusted by the Calendar Year |
14 | | 2013 Medicare Outpatient Prospective Payment System |
15 | | wage index with reclassifications, shall be published |
16 | | by the Department on its website no later than 10 |
17 | | calendar days prior to their effective date. |
18 | | (B) The Department shall establish adjustments to |
19 | | the statewide-standardized amounts for each Critical |
20 | | Access Hospital, as designated by the Department of |
21 | | Public Health in accordance with 42 CFR 485, Subpart F. |
22 | | For outpatient services provided on or before June 30, |
23 | | 2018, the EAPG standardized amounts are determined |
24 | | separately for each critical access hospital such that |
25 | | simulated EAPG payments using outpatient base period |
26 | | paid claim data plus payments under Section 5A-12.4 of |
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1 | | this Code net of the associated tax costs are equal to |
2 | | the estimated costs of outpatient base period claims |
3 | | data with a rate year cost inflation factor applied. |
4 | | (3) In addition to the statewide-standardized amounts, |
5 | | the Department shall develop adjusters to adjust the rate |
6 | | of reimbursement for critical Medicaid hospital outpatient |
7 | | providers or services, including outpatient high volume or |
8 | | safety-net hospitals. Beginning July 1, 2018, the |
9 | | outpatient high volume adjustor shall be increased to |
10 | | increase annual expenditures associated with this adjustor |
11 | | by $79,200,000, based on the State Fiscal Year 2015 base |
12 | | year data and this adjustor shall apply to public |
13 | | hospitals, except for large public hospitals, as defined |
14 | | under 89 Ill. Adm. Code 148.25(a). |
15 | | (4) Beginning July 1, 2018, in addition to the |
16 | | statewide standardized amounts, the Department shall make |
17 | | an add-on payment for outpatient expensive devices and |
18 | | drugs. This add-on payment shall at least apply to claim |
19 | | lines that: (i) are assigned with one of the following |
20 | | EAPGs: 490, 1001 to 1020, and coded with one of the |
21 | | following revenue codes: 0274 to 0276, 0278; or (ii) are |
22 | | assigned with one of the following EAPGs: 430 to 441, 443, |
23 | | 444, 460 to 465, 495, 496, 1090. The add-on payment shall |
24 | | be calculated as follows: the claim line's covered charges |
25 | | multiplied by the hospital's total acute cost to charge |
26 | | ratio, less the claim line's EAPG payment plus $1,000, |
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1 | | multiplied by 0.8. |
2 | | (5) Beginning July 1, 2018, the statewide-standardized |
3 | | amounts for outpatient services shall be increased by a |
4 | | uniform percentage so that base claims projected |
5 | | reimbursement is increased by an amount equal to no less |
6 | | than the funds allocated in paragraph (1) of subsection (b) |
7 | | of Section 5A-12.6, less the amount allocated under |
8 | | paragraphs (8) and (9) of subsection (a) and paragraphs (3) |
9 | | and (4) of this subsection multiplied by 46%. |
10 | | (6) Effective for dates of service on or after July 1, |
11 | | 2018, the Department shall establish adjustments to the |
12 | | statewide-standardized amounts for each Critical Access |
13 | | Hospital, as designated by the Department of Public Health |
14 | | in accordance with 42 CFR 485, Subpart F, such that each |
15 | | Critical Access Hospital's standardized amount for |
16 | | outpatient services shall be increased by the applicable |
17 | | uniform percentage determined pursuant to paragraph (5) of |
18 | | this subsection. It is the intent of the General Assembly |
19 | | that the adjustments required under this paragraph (6) by |
20 | | Public Act 100-1181 shall be applied retroactively to |
21 | | claims for dates of service provided on or after July 1, |
22 | | 2018. |
23 | | (7) Effective for dates of service on or after March 8, |
24 | | 2019 (the effective date of Public Act 100-1181), the |
25 | | Department shall recalculate and implement an updated |
26 | | statewide-standardized amount for outpatient services |
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1 | | provided by hospitals that are not Critical Access |
2 | | Hospitals to reflect the applicable uniform percentage |
3 | | determined pursuant to paragraph (5). |
4 | | (1) Any recalculation to the |
5 | | statewide-standardized amounts for outpatient services |
6 | | provided by hospitals that are not Critical Access |
7 | | Hospitals shall be the amount necessary to achieve the |
8 | | increase in the statewide-standardized amounts for |
9 | | outpatient services increased by a uniform percentage, |
10 | | so that base claims projected reimbursement is |
11 | | increased by an amount equal to no less than the funds |
12 | | allocated in paragraph (1) of subsection (b) of Section |
13 | | 5A-12.6, less the amount allocated under paragraphs |
14 | | (8) and (9) of subsection (a) and paragraphs (3) and |
15 | | (4) of this subsection, for all hospitals that are not |
16 | | Critical Access Hospitals, multiplied by 46%. |
17 | | (2) It is the intent of the General Assembly that |
18 | | the recalculations required under this paragraph (7) |
19 | | by Public Act 100-1181 shall be applied prospectively |
20 | | to claims for dates of service provided on or after |
21 | | March 8, 2019 (the effective date of Public Act |
22 | | 100-1181) and that no recoupment or repayment by the |
23 | | Department or an MCO of payments attributable to |
24 | | recalculation under this paragraph (7), issued to the |
25 | | hospital for dates of service on or after July 1, 2018 |
26 | | and before March 8, 2019 (the effective date of Public |
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1 | | Act 100-1181), shall be permitted. |
2 | | (8) The Department shall ensure that all necessary |
3 | | adjustments to the managed care organization capitation |
4 | | base rates necessitated by the adjustments under |
5 | | subparagraph (6) or (7) of this subsection are completed |
6 | | and applied retroactively in accordance with Section |
7 | | 5-30.8 of this Code within 90 days of March 8, 2019 (the |
8 | | effective date of Public Act 100-1181). |
9 | | (9) Within 60 days after federal approval of the change |
10 | | made to the assessment in Section 5A-2 by this amendatory |
11 | | Act of the 101st General Assembly, the Department shall |
12 | | incorporate into the EAPG system for outpatient services |
13 | | those services performed by hospitals currently billed |
14 | | through the Non-Institutional Provider billing system. |
15 | | (c) In consultation with the hospital community, the |
16 | | Department is authorized to replace 89 Ill. Admin. Code 152.150 |
17 | | as published in 38 Ill. Reg. 4980 through 4986 within 12 months |
18 | | of June 16, 2014 (the effective date of Public Act 98-651). If |
19 | | the Department does not replace these rules within 12 months of |
20 | | June 16, 2014 (the effective date of Public Act 98-651), the |
21 | | rules in effect for 152.150 as published in 38 Ill. Reg. 4980 |
22 | | through 4986 shall remain in effect until modified by rule by |
23 | | the Department. Nothing in this subsection shall be construed |
24 | | to mandate that the Department file a replacement rule. |
25 | | (d) Transition period.
There shall be a transition period |
26 | | to the reimbursement systems authorized under this Section that |
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1 | | shall begin on the effective date of these systems and continue |
2 | | until June 30, 2018, unless extended by rule by the Department. |
3 | | To help provide an orderly and predictable transition to the |
4 | | new reimbursement systems and to preserve and enhance access to |
5 | | the hospital services during this transition, the Department |
6 | | shall allocate a transitional hospital access pool of at least |
7 | | $290,000,000 annually so that transitional hospital access |
8 | | payments are made to hospitals. |
9 | | (1) After the transition period, the Department may |
10 | | begin incorporating the transitional hospital access pool |
11 | | into the base rate structure; however, the transitional |
12 | | hospital access payments in effect on June 30, 2018 shall |
13 | | continue to be paid, if continued under Section 5A-16. |
14 | | (2) After the transition period, if the Department |
15 | | reduces payments from the transitional hospital access |
16 | | pool, it shall increase base rates, develop new adjustors, |
17 | | adjust current adjustors, develop new hospital access |
18 | | payments based on updated information, or any combination |
19 | | thereof by an amount equal to the decreases proposed in the |
20 | | transitional hospital access pool payments, ensuring that |
21 | | the entire transitional hospital access pool amount shall |
22 | | continue to be used for hospital payments. |
23 | | (d-5) Hospital and health care transformation program. The |
24 | | Department shall develop a hospital and health care |
25 | | transformation program to provide financial assistance to |
26 | | hospitals in transforming their services and care models to |
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1 | | better align with the needs of the communities they serve. The |
2 | | payments authorized in this Section shall be subject to |
3 | | approval by the federal government. |
4 | | (1) Phase 1. In State fiscal years 2019 through 2020, |
5 | | the Department shall allocate funds from the transitional |
6 | | access hospital pool to create a hospital transformation |
7 | | pool of at least $262,906,870 annually and make hospital |
8 | | transformation payments to hospitals. Subject to Section |
9 | | 5A-16, in State fiscal years 2019 and 2020, an Illinois |
10 | | hospital that received either a transitional hospital |
11 | | access payment under subsection (d) or a supplemental |
12 | | payment under subsection (f) of this Section in State |
13 | | fiscal year 2018, shall receive a hospital transformation |
14 | | payment as follows: |
15 | | (A) If the hospital's Rate Year 2017 Medicaid |
16 | | inpatient utilization rate is equal to or greater than |
17 | | 45%, the hospital transformation payment shall be |
18 | | equal to 100% of the sum of its transitional hospital |
19 | | access payment authorized under subsection (d) and any |
20 | | supplemental payment authorized under subsection (f). |
21 | | (B) If the hospital's Rate Year 2017 Medicaid |
22 | | inpatient utilization rate is equal to or greater than |
23 | | 25% but less than 45%, the hospital transformation |
24 | | payment shall be equal to 75% of the sum of its |
25 | | transitional hospital access payment authorized under |
26 | | subsection (d) and any supplemental payment authorized |
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1 | | under subsection (f). |
2 | | (C) If the hospital's Rate Year 2017 Medicaid |
3 | | inpatient utilization rate is less than 25%, the |
4 | | hospital transformation payment shall be equal to 50% |
5 | | of the sum of its transitional hospital access payment |
6 | | authorized under subsection (d) and any supplemental |
7 | | payment authorized under subsection (f). |
8 | | (2) Phase 2. |
9 | | (A) The funding amount from phase one shall be |
10 | | incorporated into directed payment and pass-through |
11 | | payment methodologies described in Section 5A-12.7. |
12 | | (B) Because there are communities in Illinois that |
13 | | experience significant health care disparities due to |
14 | | systemic racism, as recently emphasized by the |
15 | | COVID-19 pandemic, aggravated by social determinants |
16 | | of health and a lack of sufficiently allocated |
17 | | healthcare resources, particularly community-based |
18 | | services, preventive care, obstetric care, chronic |
19 | | disease management, and specialty care, the Department |
20 | | shall establish a health care transformation program |
21 | | that shall be supported by the transformation funding |
22 | | pool. It is the intention of the General Assembly that |
23 | | innovative partnerships funded by the pool must be |
24 | | designed to establish or improve integrated health |
25 | | care delivery systems that will provide significant |
26 | | access to the Medicaid and uninsured populations in |
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1 | | their communities, as well as improve health care |
2 | | equity. It is also the intention of the General |
3 | | Assembly that partnerships recognize and address the |
4 | | disparities revealed by the COVID-19 pandemic, as well |
5 | | as the need for post-COVID care. During State fiscal |
6 | | years 2021 through 2027, the hospital and health care |
7 | | transformation program shall be supported by an annual |
8 | | transformation funding pool of up to $150,000,000, |
9 | | pending federal matching funds, to be allocated during |
10 | | the specified fiscal years for the purpose of |
11 | | facilitating hospital and health care transformation. |
12 | | No disbursement of moneys for transformation projects |
13 | | from the transformation funding pool described under |
14 | | this Section shall be considered an award, a grant, or |
15 | | an expenditure of grant funds. Funding agreements made |
16 | | in accordance with the transformation program shall be |
17 | | considered purchases of care under the Illinois |
18 | | Procurement Code, and funds shall be expended by the |
19 | | Department in a manner that maximizes federal funding |
20 | | to expend the entire allocated amount. |
21 | | The Department shall convene, within 30 days after |
22 | | the effective date of this amendatory Act of the 101st |
23 | | General Assembly, a workgroup that includes subject |
24 | | matter experts on healthcare disparities and |
25 | | stakeholders from distressed communities, which could |
26 | | be a subcommittee of the Medicaid Advisory Committee, |
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1 | | to review and provide recommendations on how |
2 | | Department policy, including health care |
3 | | transformation, can improve health disparities and the |
4 | | impact on communities disproportionately affected by |
5 | | COVID-19. The workgroup shall consider and make |
6 | | recommendations on the following issues: a community |
7 | | safety-net designation of certain hospitals, racial |
8 | | equity, and a regional partnership to bring additional |
9 | | specialty services to communities. Whereas there are |
10 | | communities in Illinois that suffer from significant |
11 | | health care disparities aggravated by social |
12 | | determinants of health and a lack of sufficiently |
13 | | allocated healthcare resources, particularly |
14 | | community-based services and preventive care, there is |
15 | | established a new hospital and health care |
16 | | transformation program, which shall be supported by a |
17 | | transformation funding pool. An application for |
18 | | funding from the hospital and health care |
19 | | transformation program may incorporate the campus of a |
20 | | hospital closed after January 1, 2018 or a hospital |
21 | | that has provided notice of its intent to close |
22 | | pursuant to Section 8.7 of the Illinois Health |
23 | | Facilities Planning Act. During State Fiscal Years |
24 | | 2021 through 2023, the hospital and health care |
25 | | transformation program shall be supported by an annual |
26 | | transformation funding pool of at least $150,000,000 |
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1 | | to be allocated during the specified fiscal years for |
2 | | the purpose of facilitating hospital and health care |
3 | | transformation. The Department shall not allocate |
4 | | funds associated with the hospital and health care |
5 | | transformation pool as established in this |
6 | | subparagraph until the General Assembly has |
7 | | established in law or resolution, further criteria for |
8 | | dispersal or allocation of those funds after the |
9 | | effective date of this amendatory Act of 101st General |
10 | | Assembly. |
11 | | (C) As provided in paragraph (9) of Section 3 of |
12 | | the Illinois Health Facilities Planning Act, any |
13 | | hospital participating in the transformation program |
14 | | may be excluded from the requirements of the Illinois |
15 | | Health Facilities Planning Act for those projects |
16 | | related to the hospital's transformation. To be |
17 | | eligible, the hospital must submit to the Health |
18 | | Facilities and Services Review Board approval from the |
19 | | Department that the project is a part of the hospital's |
20 | | transformation. |
21 | | (D) As provided in subsection (a-20) of Section |
22 | | 32.5 of the Emergency Medical Services (EMS) Systems |
23 | | Act, a hospital that received hospital transformation |
24 | | payments under this Section may convert to a |
25 | | freestanding emergency center. To be eligible for such |
26 | | a conversion, the hospital must submit to the |
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1 | | Department of Public Health approval from the |
2 | | Department that the project is a part of the hospital's |
3 | | transformation. |
4 | | (E) Criteria for proposals. To be eligible for |
5 | | funding under this Section, a transformation proposal |
6 | | shall meet all of the following criteria: |
7 | | (i) the proposal shall be designed based on |
8 | | community needs assessment completed by either a |
9 | | University partner or other qualified entity with |
10 | | significant community input; |
11 | | (ii) the proposal shall be a collaboration |
12 | | among providers across the care and community |
13 | | spectrum, including preventative care, primary |
14 | | care specialty care, hospital services, mental |
15 | | health and substance abuse services, as well as |
16 | | community-based entities that address the social |
17 | | determinants of health; |
18 | | (iii) the proposal shall be specifically |
19 | | designed to improve healthcare outcomes and reduce |
20 | | healthcare disparities, and improve the |
21 | | coordination, effectiveness, and efficiency of |
22 | | care delivery; |
23 | | (iv) the proposal shall have specific |
24 | | measurable metrics related to disparities that |
25 | | will be tracked by the Department and made public |
26 | | by the Department; |
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1 | | (v) the proposal shall include a commitment to |
2 | | include Business Enterprise Program certified |
3 | | vendors or other entities controlled and managed |
4 | | by minorities or women; and |
5 | | (vi) the proposal shall specifically increase |
6 | | access to primary, preventive, or specialty care. |
7 | | (F) Entities eligible to be funded. |
8 | | (i) Proposals for funding should come from |
9 | | collaborations operating in one of the most |
10 | | distressed communities in Illinois as determined |
11 | | by the U.S. Centers for Disease Control and |
12 | | Prevention's Social Vulnerability Index for |
13 | | Illinois and areas disproportionately impacted by |
14 | | COVID-19 or from rural areas of Illinois. |
15 | | (ii) The Department shall prioritize |
16 | | partnerships from distressed communities, which |
17 | | include Business Enterprise Program certified |
18 | | vendors or other entities controlled and managed |
19 | | by minorities or women and also include one or more |
20 | | of the following: safety-net hospitals, critical |
21 | | access hospitals, the campuses of hospitals that |
22 | | have closed since January 1, 2018, or other |
23 | | healthcare providers designed to address specific |
24 | | healthcare disparities, including the impact of |
25 | | COVID-19 on individuals and the community and the |
26 | | need for post-COVID care. All funded proposals |
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1 | | must include specific measurable goals and metrics |
2 | | related to improved outcomes and reduced |
3 | | disparities which shall be tracked by the |
4 | | Department. |
5 | | (iii) The Department should target the funding |
6 | | in the following ways: $30,000,000 of |
7 | | transformation funds to projects that are a |
8 | | collaboration between a safety-net hospital, |
9 | | particularly community safety-net hospitals, and |
10 | | other providers and designed to address specific |
11 | | healthcare disparities, $20,000,000 of |
12 | | transformation funds to collaborations between |
13 | | safety-net hospitals and a larger hospital partner |
14 | | that increases specialty care in distressed |
15 | | communities, $30,000,000 of transformation funds |
16 | | to projects that are a collaboration between |
17 | | hospitals and other providers in distressed areas |
18 | | of the State designed to address specific |
19 | | healthcare disparities, $15,000,000 to |
20 | | collaborations between critical access hospitals |
21 | | and other providers designed to address specific |
22 | | healthcare disparities, and $15,000,000 to |
23 | | cross-provider collaborations designed to address |
24 | | specific healthcare disparities, and $5,000,000 to |
25 | | collaborations that focus on workforce |
26 | | development. |
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1 | | (iv) The Department may allocate up to |
2 | | $5,000,000 for planning, racial equity analysis, |
3 | | or consulting resources for the Department or |
4 | | entities without the resources to develop a plan to |
5 | | meet the criteria of this Section. Any contract for |
6 | | consulting services issued by the Department under |
7 | | this subparagraph shall comply with the provisions |
8 | | of Section 5-45 of the State Officials and |
9 | | Employees Ethics Act. Based on availability of |
10 | | federal funding, the Department may directly |
11 | | procure consulting services or provide funding to |
12 | | the collaboration. The provision of resources |
13 | | under this subparagraph is not a guarantee that a |
14 | | project will be approved. |
15 | | (v) The Department shall take steps to ensure |
16 | | that safety-net hospitals operating in |
17 | | under-resourced communities receive priority |
18 | | access to hospital and healthcare transformation |
19 | | funds, including consulting funds, as provided |
20 | | under this Section. |
21 | | (G) Process for submitting and approving projects |
22 | | for distressed communities. The Department shall issue |
23 | | a template for application. The Department shall post |
24 | | any proposal received on the Department's website for |
25 | | at least 2 weeks for public comment, and any such |
26 | | public comment shall also be considered in the review |
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1 | | process. Applicants may request that proprietary |
2 | | financial information be redacted from publicly posted |
3 | | proposals and the Department in its discretion may |
4 | | agree. Proposals for each distressed community must |
5 | | include all of the following: |
6 | | (i) A detailed description of how the project |
7 | | intends to affect the goals outlined in this |
8 | | subsection, describing new interventions, new |
9 | | technology, new structures, and other changes to |
10 | | the healthcare delivery system planned. |
11 | | (ii) A detailed description of the racial and |
12 | | ethnic makeup of the entities' board and |
13 | | leadership positions and the salaries of the |
14 | | executive staff of entities in the partnership |
15 | | that is seeking to obtain funding under this |
16 | | Section. |
17 | | (iii) A complete budget, including an overall |
18 | | timeline and a detailed pathway to sustainability |
19 | | within a 5-year period, specifying other sources |
20 | | of funding, such as in-kind, cost-sharing, or |
21 | | private donations, particularly for capital needs. |
22 | | There is an expectation that parties to the |
23 | | transformation project dedicate resources to the |
24 | | extent they are able and that these expectations |
25 | | are delineated separately for each entity in the |
26 | | proposal. |
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1 | | (iv) A description of any new entities formed |
2 | | or other legal relationships between collaborating |
3 | | entities and how funds will be allocated among |
4 | | participants. |
5 | | (v) A timeline showing the evolution of sites |
6 | | and specific services of the project over a 5-year |
7 | | period, including services available to the |
8 | | community by site. |
9 | | (vi) Clear milestones indicating progress |
10 | | toward the proposed goals of the proposal as |
11 | | checkpoints along the way to continue receiving |
12 | | funding. The Department is authorized to refine |
13 | | these milestones in agreements, and is authorized |
14 | | to impose reasonable penalties, including |
15 | | repayment of funds, for substantial lack of |
16 | | progress. |
17 | | (vii) A clear statement of the level of |
18 | | commitment the project will include for minorities |
19 | | and women in contracting opportunities, including |
20 | | as equity partners where applicable, or as |
21 | | subcontractors and suppliers in all phases of the |
22 | | project. |
23 | | (viii) If the community study utilized is not |
24 | | the study commissioned and published by the |
25 | | Department, the applicant must define the |
26 | | methodology used, including documentation of clear |
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1 | | community participation. |
2 | | (ix) A description of the process used in |
3 | | collaborating with all levels of government in the |
4 | | community served in the development of the |
5 | | project, including, but not limited to, |
6 | | legislators and officials of other units of local |
7 | | government. |
8 | | (x) Documentation of a community input process |
9 | | in the community served, including links to |
10 | | proposal materials on public websites. |
11 | | (xi) Verifiable project milestones and quality |
12 | | metrics that will be impacted by transformation. |
13 | | These project milestones and quality metrics must |
14 | | be identified with improvement targets that must |
15 | | be met. |
16 | | (xii) Data on the number of existing employees |
17 | | by various job categories and wage levels by the |
18 | | zip code of the employees' residence and |
19 | | benchmarks for the continued maintenance and |
20 | | improvement of these levels. The proposal must |
21 | | also describe any retraining or other workforce |
22 | | development planned for the new project. |
23 | | (xiii) If a new entity is created by the |
24 | | project, a description of how the board will be |
25 | | reflective of the community served by the |
26 | | proposal. |
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1 | | (xiv) An explanation of how the proposal will |
2 | | address the existing disparities that exacerbated |
3 | | the impact of COVID-19 and the need for post-COVID |
4 | | care in the community, if applicable. |
5 | | (xv) An explanation of how the proposal is |
6 | | designed to increase access to care, including |
7 | | specialty care based upon the community's needs. |
8 | | (H) The Department shall evaluate proposals for |
9 | | compliance with the criteria listed under subparagraph |
10 | | (G). Proposals meeting all of the criteria may be |
11 | | eligible for funding with the areas of focus |
12 | | prioritized as described in item (ii) of subparagraph |
13 | | (F). Based on the funds available, the Department may |
14 | | negotiate funding agreements with approved applicants |
15 | | to maximize federal funding. Nothing in this |
16 | | subsection requires that an approved project be funded |
17 | | to the level requested. Agreements shall specify the |
18 | | amount of funding anticipated annually, the |
19 | | methodology of payments, the limit on the number of |
20 | | years such funding may be provided, and the milestones |
21 | | and quality metrics that must be met by the projects in |
22 | | order to continue to receive funding during each year |
23 | | of the program. Agreements shall specify the terms and |
24 | | conditions under which a health care facility that |
25 | | receives funds under a purchase of care agreement and |
26 | | closes in violation of the terms of the agreement must |
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1 | | pay an early closure fee no greater than 50% of the |
2 | | funds it received under the agreement, prior to the |
3 | | Health Facilities and Services Review Board |
4 | | considering an application for closure of the |
5 | | facility. Any project that is funded shall be required |
6 | | to provide quarterly written progress reports, in a |
7 | | form prescribed by the Department, and at a minimum |
8 | | shall include the progress made in achieving any |
9 | | milestones or metrics or Business Enterprise Program |
10 | | commitments in its plan. The Department may reduce or |
11 | | end payments, as set forth in transformation plans, if |
12 | | milestones or metrics or Business Enterprise Program |
13 | | commitments are not achieved. The Department shall |
14 | | seek to make payments from the transformation fund in a |
15 | | manner that is eligible for federal matching funds. |
16 | | In reviewing the proposals, the Department shall |
17 | | take into account the needs of the community, data from |
18 | | the study commissioned by the Department from the |
19 | | University of Illinois-Chicago if applicable, feedback |
20 | | from public comment on the Department's website, as |
21 | | well as how the proposal meets the criteria listed |
22 | | under subparagraph (G). Alignment with the |
23 | | Department's overall strategic initiatives shall be an |
24 | | important factor. To the extent that fiscal year |
25 | | funding is not adequate to fund all eligible projects |
26 | | that apply, the Department shall prioritize |
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1 | | applications that most comprehensively and effectively |
2 | | address the criteria listed under subparagraph (G). |
3 | | (3) (Blank). |
4 | | (4) Hospital Transformation Review Committee. There is |
5 | | created the Hospital Transformation Review Committee. The |
6 | | Committee shall consist of 14 members. No later than 30 |
7 | | days after March 12, 2018 (the effective date of Public Act |
8 | | 100-581), the 4 legislative leaders shall each appoint 3 |
9 | | members; the Governor shall appoint the Director of |
10 | | Healthcare and Family Services, or his or her designee, as |
11 | | a member; and the Director of Healthcare and Family |
12 | | Services shall appoint one member. Any vacancy shall be |
13 | | filled by the applicable appointing authority within 15 |
14 | | calendar days. The members of the Committee shall select a |
15 | | Chair and a Vice-Chair from among its members, provided |
16 | | that the Chair and Vice-Chair cannot be appointed by the |
17 | | same appointing authority and must be from different |
18 | | political parties. The Chair shall have the authority to |
19 | | establish a meeting schedule and convene meetings of the |
20 | | Committee, and the Vice-Chair shall have the authority to |
21 | | convene meetings in the absence of the Chair. The Committee |
22 | | may establish its own rules with respect to meeting |
23 | | schedule, notice of meetings, and the disclosure of |
24 | | documents; however, the Committee shall not have the power |
25 | | to subpoena individuals or documents and any rules must be |
26 | | approved by 9 of the 14 members. The Committee shall |
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1 | | perform the functions described in this Section and advise |
2 | | and consult with the Director in the administration of this |
3 | | Section. In addition to reviewing and approving the |
4 | | policies, procedures, and rules for the hospital and health |
5 | | care transformation program, the Committee shall consider |
6 | | and make recommendations related to qualifying criteria |
7 | | and payment methodologies related to safety-net hospitals |
8 | | and children's hospitals. Members of the Committee |
9 | | appointed by the legislative leaders shall be subject to |
10 | | the jurisdiction of the Legislative Ethics Commission, not |
11 | | the Executive Ethics Commission, and all requests under the |
12 | | Freedom of Information Act shall be directed to the |
13 | | applicable Freedom of Information officer for the General |
14 | | Assembly. The Department shall provide operational support |
15 | | to the Committee as necessary. The Committee is dissolved |
16 | | on April 1, 2019. |
17 | | (e) Beginning 36 months after initial implementation, the |
18 | | Department shall update the reimbursement components in |
19 | | subsections (a) and (b), including standardized amounts and |
20 | | weighting factors, and at least triennially and no more |
21 | | frequently than annually thereafter. The Department shall |
22 | | publish these updates on its website no later than 30 calendar |
23 | | days prior to their effective date. |
24 | | (f) Continuation of supplemental payments. Any |
25 | | supplemental payments authorized under Illinois Administrative |
26 | | Code 148 effective January 1, 2014 and that continue during the |
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1 | | period of July 1, 2014 through December 31, 2014 shall remain |
2 | | in effect as long as the assessment imposed by Section 5A-2 |
3 | | that is in effect on December 31, 2017 remains in effect. |
4 | | (g) Notwithstanding subsections (a) through (f) of this |
5 | | Section and notwithstanding the changes authorized under |
6 | | Section 5-5b.1, any updates to the system shall not result in |
7 | | any diminishment of the overall effective rates of |
8 | | reimbursement as of the implementation date of the new system |
9 | | (July 1, 2014). These updates shall not preclude variations in |
10 | | any individual component of the system or hospital rate |
11 | | variations. Nothing in this Section shall prohibit the |
12 | | Department from increasing the rates of reimbursement or |
13 | | developing payments to ensure access to hospital services. |
14 | | Nothing in this Section shall be construed to guarantee a |
15 | | minimum amount of spending in the aggregate or per hospital as |
16 | | spending may be impacted by factors, including, but not limited |
17 | | to, the number of individuals in the medical assistance program |
18 | | and the severity of illness of the individuals. |
19 | | (h) The Department shall have the authority to modify by |
20 | | rulemaking any changes to the rates or methodologies in this |
21 | | Section as required by the federal government to obtain federal |
22 | | financial participation for expenditures made under this |
23 | | Section. |
24 | | (i) Except for subsections (g) and (h) of this Section, the |
25 | | Department shall, pursuant to subsection (c) of Section 5-40 of |
26 | | the Illinois Administrative Procedure Act, provide for |
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1 | | presentation at the June 2014 hearing of the Joint Committee on |
2 | | Administrative Rules (JCAR) additional written notice to JCAR |
3 | | of the following rules in order to commence the second notice |
4 | | period for the following rules: rules published in the Illinois |
5 | | Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559 |
6 | | (Medical Payment), 4628 (Specialized Health Care Delivery |
7 | | Systems), 4640 (Hospital Services), 4932 (Diagnostic Related |
8 | | Grouping (DRG) Prospective Payment System (PPS)), and 4977 |
9 | | (Hospital Reimbursement Changes), and published in the |
10 | | Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499 |
11 | | (Specialized Health Care Delivery Systems) and 6505 (Hospital |
12 | | Services).
|
13 | | (j) Out-of-state hospitals. Beginning July 1, 2018, for |
14 | | purposes of determining for State fiscal years 2019 and 2020 |
15 | | and subsequent fiscal years the hospitals eligible for the |
16 | | payments authorized under subsections (a) and (b) of this |
17 | | Section, the Department shall include out-of-state hospitals |
18 | | that are designated a Level I pediatric trauma center or a |
19 | | Level I trauma center by the Department of Public Health as of |
20 | | December 1, 2017. |
21 | | (k) The Department shall notify each hospital and managed |
22 | | care organization, in writing, of the impact of the updates |
23 | | under this Section at least 30 calendar days prior to their |
24 | | effective date. |
25 | | (Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19; |
26 | | 101-81, eff. 7-12-19; 101-650, eff. 7-7-20.) |
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1 | | Article 13. |
2 | | Section 13-5. The Illinois Public Aid Code is amended by |
3 | | changing Section 12-4.53 as follows: |
4 | | (305 ILCS 5/12-4.53) |
5 | | Sec. 12-4.53. Prospective Payment System (PPS) rates. |
6 | | Effective January 1, 2021, and subsequent years, based on |
7 | | specific appropriation, the Prospective Payment System (PPS) |
8 | | rates for FQHCs shall be increased based on the cost principles |
9 | | found at 45 Code of Federal Regulations Part 75 or its |
10 | | successor. Such rates shall be increased by using any of the |
11 | | following methods: reducing the current minimum productivity |
12 | | and efficiency standards no lower than 3500 encounters per FTE |
13 | | physician; increasing the statewide median cost cap from 105% |
14 | | to 120%, or a one-time re-basing of rates utilizing 2018 FQHC |
15 | | cost reports , or another alternative payment method acceptable |
16 | | to the Centers for Medicare and Medicaid Services and the |
17 | | FQHCs, including an across the board percentage increase to |
18 | | existing rates .
|
19 | | (Source: P.A. 101-636, eff. 6-10-20.) |
20 | | Article 15. |
21 | | Section 15-1. Short title. This Act may be cited as the |
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1 | | COVID-19 Medically Necessary Diagnostic Testing Act. |
2 | | Section 15-5. Findings. The General Assembly finds that |
3 | | COVID-19 has infected hundreds of thousands of Illinois |
4 | | residents and taken the lives of tens of thousands all within |
5 | | less than a year's time. Nursing home residents are at |
6 | | particular risk of the virus due to many factors, and routine |
7 | | testing among residents and staff is critical to control the |
8 | | spread within facilities. Nursing facilities are required by |
9 | | federal and State regulation to conduct COVID-19 routine |
10 | | testing at specified intervals. |
11 | | The General Assembly finds that some insurance companies |
12 | | are denying coverage of routine COVID-19 testing for insured |
13 | | staff because it is not deemed medically necessary. |
14 | | The General Assembly also finds that diagnostic testing for |
15 | | COVID-19 is a medically necessary basic health care service for |
16 | | nursing home employees, regardless of whether the employee has |
17 | | symptoms of COVID-19 infection or is asymptomatic, or whether |
18 | | the employee has a known or suspected exposure to a person with |
19 | | COVID-19. |
20 | | The General Assembly therefore finds and declares that |
21 | | routine COVID-19 testing of nursing home facility employees, as |
22 | | mandated by State or federal laws, rules, regulations, or |
23 | | guidance, is medically necessary and insurance companies must |
24 | | cover the cost associated with such testing.
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1 | | Section 15-10. Applicability. This Act applies to |
2 | | companies as defined in subsection (e) of Section 2 of the |
3 | | Illinois Insurance Code, which offer insurance policies and |
4 | | coverage to employees of long-term care facilities as defined |
5 | | in Section 1-113 of the Nursing Home Care Act. |
6 | | Section 15-15. Definitions. |
7 | | "COVID-19" means the disease caused by SARS-CoV-2 or any |
8 | | further mutation. |
9 | | "Diagnostic testing" means testing administered for the |
10 | | purposes of diagnosing COVID-19 or a related virus and the |
11 | | administration of such tests if the test is: |
12 | | (1) approved, cleared, or authorized under Section |
13 | | 510(k), 513, 515, or 564 of the Federal Food, Drug, and |
14 | | Cosmetic Act (21 U.S.C. 360(k), 360c, 360e, and 360bbb-3); |
15 | | (2)
the subject of a request or intended request for |
16 | | emergency use authorization under Section 564 of the |
17 | | Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-3), |
18 | | until the emergency use authorization request has been |
19 | | denied or the developer of the test does not submit a |
20 | | request within a reasonable timeframe; |
21 | | (3)
developed and authorized by a state that has |
22 | | notified the Secretary of the United States Department of |
23 | | Health and Human Services of its intention to review a test |
24 | | intended to diagnose COVID-19; or |
25 | | (4)
determined by the Secretary of the United States |
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1 | | Department of Health and Human Services or the Director of |
2 | | the Centers for Disease Control and Prevention as |
3 | | appropriate for the diagnosis of COVID-19. |
4 | | "Enrollee" means a nursing home employee who is covered by |
5 | | a health plan. |
6 | | "Health plan" means all policies, contracts, and |
7 | | certificates of health insurance coverage that are or will be |
8 | | enforced, issued, delivered, amended, or renewed in this State |
9 | | and subject to the authority of the Director of Insurance under |
10 | | any insurance law. |
11 | | "Nursing home employee" means anyone employed by or under |
12 | | contract with a long-term care facility as defined in Section |
13 | | 1-113 of the Nursing Home Care Act, or under contract with a |
14 | | third party to provide services within a long-term care |
15 | | facility. |
16 | | "Testing provider" means any professional person, |
17 | | organization, health facility, or other person or institution |
18 | | licensed or authorized by the State to deliver or furnish |
19 | | COVID-19 diagnostic tests. Testing providers include |
20 | | physicians and other primary care providers; urgent care |
21 | | centers; State-run or county-run clinics or testing sites; |
22 | | pharmacies; university laboratories; hospital emergency |
23 | | departments; skilled nursing facilities; and any other |
24 | | outpatient provider setting for which the diagnosis of COVID-19 |
25 | | is within the scope of the provider's State licensure or |
26 | | authorization. |
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1 | | Section 15-20. Diagnostic testing. |
2 | | (a)
A health plan shall not impose utilization management |
3 | | requirements on COVID-19 diagnostic tests for nursing home |
4 | | employees.
|
5 | | (b) A health plan may inquire as to whether an enrollee is |
6 | | a nursing home employee as defined in this Act, but shall |
7 | | require no further evidence or verification of the enrollee's |
8 | | nursing home employee status when determining whether the |
9 | | enrollee is a nursing home employee.
|
10 | | (c) Medically necessary COVID-19 testing is urgent care, |
11 | | and health plans shall not extend the applicable wait time for |
12 | | a COVID-19 testing appointment, even if such an extension would |
13 | | otherwise be permitted. |
14 | | (d)
A health plan shall reimburse the testing provider for |
15 | | medically necessary COVID-19 testing at the contracted rate if |
16 | | the health plan has a contract with the testing provider. If |
17 | | the health plan and the testing provider do not have a contract |
18 | | that encompasses COVID-19 testing, the health plan shall |
19 | | reimburse the provider at the provider's cash price, when |
20 | | required by federal law. In all other instances, the health |
21 | | plan shall reimburse the provider for the reasonable and |
22 | | customary value of the services.
|
23 | | (e) Changes to a contract between a health plan and a |
24 | | provider delegating financial risk for COVID-19 diagnostic |
25 | | testing, including related items and services, shall be |
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1 | | considered a material change to the parties' contract. A health |
2 | | plan shall not delegate the financial risk to a contracted |
3 | | provider for the cost of the enrollee services provided under |
4 | | this Section unless the parties have negotiated and agreed upon |
5 | | a new provision of the parties' contract.
|
6 | | (f) The timeframes specified in the Illinois Insurance Code |
7 | | apply for the submission and payment of claims for COVID-19 |
8 | | diagnostic testing and related items and services. A health |
9 | | plan shall not delay or deny payment of a testing provider's |
10 | | claim for services received by an enrollee in accordance with |
11 | | this Section.
|
12 | | (g) For purposes of the submission of claims in accordance |
13 | | with this Section, "provider" includes the State of Illinois, |
14 | | university laboratories, and State-run or county-run clinics |
15 | | or other testing sites. |
16 | | (h)
Failure by a health plan to comply with the |
17 | | requirements of this Act may constitute a basis for |
18 | | disciplinary action against the health plan. The Director of |
19 | | Insurance shall have all the civil, criminal, and |
20 | | administrative remedies available under the Illinois Insurance |
21 | | Code.
|
22 | | Article 30. |
23 | | Section 30-5. The Nursing Home Care Act is amended by |
24 | | changing Section 3-206 as follows:
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1 | | (210 ILCS 45/3-206) (from Ch. 111 1/2, par. 4153-206)
|
2 | | Sec. 3-206.
The Department shall prescribe a curriculum for |
3 | | training
nursing assistants, habilitation aides, and child |
4 | | care aides.
|
5 | | (a) No person, except a volunteer who receives no |
6 | | compensation from a
facility and is not included for the |
7 | | purpose of meeting any staffing
requirements set forth by the |
8 | | Department, shall act as a nursing assistant,
habilitation |
9 | | aide, or child care aide in a facility, nor shall any person, |
10 | | under any
other title, not licensed, certified, or registered |
11 | | to render medical care
by the Department of Financial and |
12 | | Professional Regulation, assist with the
personal, medical, or |
13 | | nursing care of residents in a facility, unless such
person |
14 | | meets the following requirements:
|
15 | | (1) Be at least 16 years of age, of temperate habits |
16 | | and good moral
character, honest, reliable and |
17 | | trustworthy.
|
18 | | (2) Be able to speak and understand the English |
19 | | language or a language
understood by a substantial |
20 | | percentage of the facility's residents.
|
21 | | (3) Provide evidence of employment or occupation, if |
22 | | any, and residence
for 2 years prior to his present |
23 | | employment.
|
24 | | (4) Have completed at least 8 years of grade school or |
25 | | provide proof of
equivalent knowledge.
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1 | | (5) Begin a current course of training for nursing |
2 | | assistants,
habilitation aides, or child care aides, |
3 | | approved by the Department, within 45 days of initial
|
4 | | employment in the capacity of a nursing assistant, |
5 | | habilitation aide, or
child care aide
at any facility. Such |
6 | | courses of training shall be successfully completed
within |
7 | | 120 days of initial employment in the capacity of nursing |
8 | | assistant,
habilitation aide, or child care aide at a |
9 | | facility. Nursing assistants, habilitation
aides, and |
10 | | child care aides who are enrolled in approved courses in |
11 | | community
colleges or other educational institutions on a |
12 | | term, semester or trimester
basis, shall be exempt from the |
13 | | 120-day completion time limit. The
Department shall adopt |
14 | | rules for such courses of training.
These rules shall |
15 | | include procedures for facilities to
carry on an approved |
16 | | course of training within the facility. The Department |
17 | | shall allow an individual to satisfy the supervised |
18 | | clinical experience requirement for placement on the |
19 | | Health Care Worker Registry under 77 Ill. Adm. Code 300.663 |
20 | | through supervised clinical experience at an assisted |
21 | | living establishment licensed under the Assisted Living |
22 | | and Shared Housing Act. The Department shall adopt rules |
23 | | requiring that the Health Care Worker Registry include |
24 | | information identifying where an individual on the Health |
25 | | Care Worker Registry received his or her clinical training.
|
26 | | The Department may accept comparable training in lieu |
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1 | | of the 120-hour
course for student nurses, foreign nurses, |
2 | | military personnel, or employees of
the Department of Human |
3 | | Services.
|
4 | | The Department shall accept on-the-job experience in |
5 | | lieu of clinical training from any individual who |
6 | | participated in the temporary nursing assistant program |
7 | | during the COVID-19 pandemic before the end date of the |
8 | | temporary nursing assistant program and left the program in |
9 | | good standing, and the Department shall notify all approved |
10 | | certified nurse assistant training programs in the State of |
11 | | this requirement. The individual shall receive one hour of |
12 | | credit for every hour employed as a temporary nursing |
13 | | assistant, up to 40 total hours, and shall be permitted 90 |
14 | | days after the end date of the temporary nursing assistant |
15 | | program to enroll in an approved certified nursing |
16 | | assistant training program and 240 days to successfully |
17 | | complete the certified nursing assistant training program. |
18 | | Temporary nursing assistants who enroll in a certified |
19 | | nursing assistant training program within 90 days of the |
20 | | end of the temporary nursing assistant program may continue |
21 | | to work as a nursing assistant for up to 240 days after |
22 | | enrollment in the certified nursing assistant training |
23 | | program. As used in this Section, "temporary nursing |
24 | | assistant program" means the program implemented by the |
25 | | Department of Public Health by emergency rule, as listed in |
26 | | 44 Ill. Reg. 7936, effective April 21, 2020. |
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1 | | The facility shall develop and implement procedures, |
2 | | which shall be
approved by the Department, for an ongoing |
3 | | review process, which shall take
place within the facility, |
4 | | for nursing assistants, habilitation aides, and
child care |
5 | | aides.
|
6 | | At the time of each regularly scheduled licensure |
7 | | survey, or at the time
of a complaint investigation, the |
8 | | Department may require any nursing
assistant, habilitation |
9 | | aide, or child care aide to demonstrate, either through |
10 | | written
examination or action, or both, sufficient |
11 | | knowledge in all areas of
required training. If such |
12 | | knowledge is inadequate the Department shall
require the |
13 | | nursing assistant, habilitation aide, or child care aide to |
14 | | complete inservice
training and review in the facility |
15 | | until the nursing assistant, habilitation
aide, or child |
16 | | care aide demonstrates to the Department, either through |
17 | | written
examination or action, or both, sufficient |
18 | | knowledge in all areas of
required training.
|
19 | | (6) Be familiar with and have general skills related to |
20 | | resident care.
|
21 | | (a-0.5) An educational entity, other than a secondary |
22 | | school, conducting a
nursing assistant, habilitation aide, or |
23 | | child care aide
training program
shall initiate a criminal |
24 | | history record check in accordance with the Health Care Worker |
25 | | Background Check Act prior to entry of an
individual into the |
26 | | training program.
A secondary school may initiate a criminal |
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1 | | history record check in accordance with the Health Care Worker |
2 | | Background Check Act at any time during or after a training |
3 | | program.
|
4 | | (a-1) Nursing assistants, habilitation aides, or child |
5 | | care aides seeking to be included on the Health Care Worker |
6 | | Registry under the Health Care Worker Background Check Act on |
7 | | or
after January 1, 1996 must authorize the Department of |
8 | | Public Health or its
designee
to request a criminal history |
9 | | record check in accordance with the Health Care Worker |
10 | | Background Check Act and submit all necessary
information. An |
11 | | individual may not newly be included on the Health Care Worker |
12 | | Registry unless a criminal history record check has been |
13 | | conducted with respect to the individual.
|
14 | | (b) Persons subject to this Section shall perform their |
15 | | duties under the
supervision of a licensed nurse.
|
16 | | (c) It is unlawful for any facility to employ any person in |
17 | | the capacity
of nursing assistant, habilitation aide, or child |
18 | | care aide, or under any other title, not
licensed by the State |
19 | | of Illinois to assist in the personal, medical, or
nursing care |
20 | | of residents in such facility unless such person has complied
|
21 | | with this Section.
|
22 | | (d) Proof of compliance by each employee with the |
23 | | requirements set out
in this Section shall be maintained for |
24 | | each such employee by each facility
in the individual personnel |
25 | | folder of the employee. Proof of training shall be obtained |
26 | | only from the Health Care Worker Registry.
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1 | | (e) Each facility shall obtain access to the Health Care |
2 | | Worker Registry's web application, maintain the employment and |
3 | | demographic information relating to each employee, and verify |
4 | | by the category and type of employment that
each employee |
5 | | subject to this Section meets all the requirements of this
|
6 | | Section.
|
7 | | (f) Any facility that is operated under Section 3-803 shall |
8 | | be
exempt
from the requirements of this Section.
|
9 | | (g) Each skilled nursing and intermediate care facility |
10 | | that
admits
persons who are diagnosed as having Alzheimer's |
11 | | disease or related
dementias shall require all nursing |
12 | | assistants, habilitation aides, or child
care aides, who did |
13 | | not receive 12 hours of training in the care and
treatment of |
14 | | such residents during the training required under paragraph
(5) |
15 | | of subsection (a), to obtain 12 hours of in-house training in |
16 | | the care
and treatment of such residents. If the facility does |
17 | | not provide the
training in-house, the training shall be |
18 | | obtained from other facilities,
community colleges or other |
19 | | educational institutions that have a
recognized course for such |
20 | | training. The Department shall, by rule,
establish a recognized |
21 | | course for such training. The Department's rules shall provide |
22 | | that such
training may be conducted in-house at each facility |
23 | | subject to the
requirements of this subsection, in which case |
24 | | such training shall be
monitored by the Department.
|
25 | | The Department's rules shall also provide for |
26 | | circumstances and procedures
whereby any person who has |
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1 | | received training that meets
the
requirements of this |
2 | | subsection shall not be required to undergo additional
training |
3 | | if he or she is transferred to or obtains employment at a
|
4 | | different facility or a facility other than a long-term care |
5 | | facility but remains continuously employed for pay as a nursing |
6 | | assistant,
habilitation aide, or child care aide. Individuals
|
7 | | who have performed no nursing or nursing-related services
for a |
8 | | period of 24 consecutive months shall be listed as "inactive"
|
9 | | and as such do not meet the requirements of this Section. |
10 | | Licensed sheltered care facilities
shall be
exempt from the |
11 | | requirements of this Section.
|
12 | | An individual employed during the COVID-19 pandemic as a |
13 | | nursing assistant in accordance with any Executive Orders, |
14 | | emergency rules, or policy memoranda related to COVID-19 shall |
15 | | be assumed to meet competency standards and may continue to be |
16 | | employed as a certified nurse assistant when the pandemic ends |
17 | | and the Executive Orders or emergency rules lapse. Such |
18 | | individuals shall be listed on the Department's Health Care |
19 | | Worker Registry website as "active". |
20 | | (Source: P.A. 100-297, eff. 8-24-17; 100-432, eff. 8-25-17; |
21 | | 100-863, eff. 8-14-18.)
|
22 | | Article 40. |
23 | | Section 40-5. The Nurse Practice Act is amended by changing |
24 | | Sections 55-35 and 60-40 as follows: |
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1 | | (225 ILCS 65/55-35) |
2 | | (Section scheduled to be repealed on January 1, 2028)
|
3 | | Sec. 55-35. Continuing education for LPN licensees. The |
4 | | Department may adopt rules of continuing education for licensed |
5 | | practical nurses that require 20 hours of continuing education |
6 | | per 2-year license renewal cycle. The rules shall address |
7 | | variances in part or in whole for good cause, including without |
8 | | limitation illness or hardship. The continuing education rules |
9 | | must ensure that licensees are given the opportunity to |
10 | | participate in programs sponsored by or through their State or |
11 | | national professional associations, hospitals, or other |
12 | | providers of continuing education. The continuing education |
13 | | rules must allow for a licensee to complete all required hours |
14 | | of continuing education in an online format. Each licensee is |
15 | | responsible for maintaining records of completion of |
16 | | continuing education and shall be prepared to produce the |
17 | | records when requested by the Department.
|
18 | | (Source: P.A. 95-639, eff. 10-5-07 .) |
19 | | (225 ILCS 65/60-40) |
20 | | (Section scheduled to be repealed on January 1, 2028)
|
21 | | Sec. 60-40. Continuing education for RN licensees. The |
22 | | Department may adopt rules of continuing education for |
23 | | registered professional nurses licensed under this Act that |
24 | | require 20 hours of continuing education per 2-year license |
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1 | | renewal cycle. The rules shall address variances in part or in |
2 | | whole for good cause, including without limitation illness or |
3 | | hardship. The continuing education rules must ensure that |
4 | | licensees are given the opportunity to participate in programs |
5 | | sponsored by or through their State or national professional |
6 | | associations, hospitals, or other providers of continuing |
7 | | education. The continuing education rules must allow for a |
8 | | licensee to complete all required hours of continuing education |
9 | | in an online format. Each licensee is responsible for |
10 | | maintaining records of completion of continuing education and |
11 | | shall be prepared to produce the records when requested by the |
12 | | Department.
|
13 | | (Source: P.A. 95-639, eff. 10-5-07 .) |
14 | | Section 40-10. The Nursing Home Administrators Licensing |
15 | | and Disciplinary Act is amended by changing Section 11 as |
16 | | follows:
|
17 | | (225 ILCS 70/11) (from Ch. 111, par. 3661)
|
18 | | (Section scheduled to be repealed on January 1, 2028)
|
19 | | Sec. 11. Expiration; renewal; continuing education. The |
20 | | expiration date
and renewal period for each license
issued |
21 | | under this Act shall be set by rule.
|
22 | | Each licensee shall provide proof of having obtained 36 |
23 | | hours of
continuing education in the 2 year period preceding |
24 | | the renewal date of the
license as a condition of license |
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1 | | renewal. The continuing education rules must allow for a |
2 | | licensee to complete all required hours of continuing education |
3 | | in an online format. The continuing education
requirement may |
4 | | be waived in part or in whole for such good cause as may be
|
5 | | determined by rule.
|
6 | | Any continuing education course for nursing home |
7 | | administrators approved
by the National Continuing Education |
8 | | Review Service of the National
Association of Boards of |
9 | | Examiners of Nursing Home Administrators will be
accepted |
10 | | toward satisfaction of these requirements.
|
11 | | Any continuing education course for nursing home |
12 | | administrators sponsored
by the Life Services Network of |
13 | | Illinois, Illinois Council on
Long Term Care, County Nursing |
14 | | Home Association of Illinois, Illinois Health
Care |
15 | | Association, Illinois Chapter of American College of Health |
16 | | Care
Administrators, and the Illinois Nursing Home |
17 | | Administrators Association
will be accepted toward |
18 | | satisfaction of these requirements.
|
19 | | Any school, college or university, State agency, or other |
20 | | entity may
apply to the Department for approval as a continuing |
21 | | education
sponsor.
Criteria for qualification as a continuing |
22 | | education sponsor shall be
established by rule.
|
23 | | It shall be the responsibility of each continuing education |
24 | | sponsor to
maintain records, as prescribed by rule, to verify |
25 | | attendance.
|
26 | | The Department shall establish by rule a means for the |
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1 | | verification of
completion of the continuing education |
2 | | required by this Section. This
verification may be accomplished |
3 | | through audits of records maintained by
registrants; by |
4 | | requiring the filing of continuing education certificates
with |
5 | | the Department; or by other means
established by the |
6 | | Department.
|
7 | | Any nursing home administrator who has permitted his or her |
8 | | license to
expire or
who has had his or her license on inactive |
9 | | status may have his or her
license restored by
making |
10 | | application to the Department and filing proof acceptable to |
11 | | the
Department, as defined by rule, of his or her fitness to |
12 | | have his or her license restored
and by paying the
required |
13 | | fee. Proof of fitness may include evidence certifying to active
|
14 | | lawful practice in another jurisdiction satisfactory to the |
15 | | Department and
by paying the required restoration fee.
|
16 | | However, any nursing home administrator whose license |
17 | | expired while he or
she
was (1) in federal service on active |
18 | | duty with the Armed Forces of the
United States, or the State |
19 | | Militia called into service or training, or (2)
in training or |
20 | | education under the supervision of the United States
|
21 | | preliminary to induction into the military services, may have |
22 | | his or her
license
renewed or restored without paying any |
23 | | lapsed renewal fees if within 2
years after honorable |
24 | | termination of such service, training or education,
he or she |
25 | | furnishes the Department with satisfactory evidence to the |
26 | | effect
that
he or she has been so engaged and that his or her |