102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB0254

 

Introduced 2/17/2021, by Sen. Michael E. Hastings

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.4k new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that beginning July 1, 2021, to receive the additional Long-Acting Injectable for Mental Health or Addiction Medicaid payment, a hospital shall submit a separate professional claim specifying "place of service 21 Inpatient Hospital". Provides that the professional claim shall include the hospital as the billing provider and list the practitioner performing the procedure as the rendering provider. Requires the hospital to use the appropriate Healthcare Common Procedure Coding System Level II procedure code and the National Drug Code. Requires facilities participating in the federal 340B Drug Pricing Program to continue to bill the 340B actual acquisition cost for the medication. Provides that long-acting injectable medications for mental health or addiction shall not be subject to prior authorization under the medical assistance program or under any Medicaid managed-care plans when initiated at an inpatient hospital setting or when continued at an outpatient treatment facility. Effective July 1, 2021.


LRB102 10960 KTG 16292 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB0254LRB102 10960 KTG 16292 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.4k as follows:
 
6    (305 ILCS 5/5-5.4k new)
7    Sec. 5-5.4k. Payments for long-acting injectable
8medications for mental health or addiction. Notwithstanding
9any other provision of this Code, beginning July 1, 2021, to
10receive the additional Long-Acting Injectable for Mental
11Health or Addiction Medicaid payment, a hospital shall submit
12a separate professional claim specifying "place of service 21
13 Inpatient Hospital". The professional claim shall include
14the hospital as the billing provider and list the practitioner
15performing the procedure as the rendering provider. The
16hospital shall use the appropriate Healthcare Common Procedure
17Coding System Level II procedure code and the National Drug
18Code. Facilities participating in the federal 340B Drug
19Pricing Program shall continue to bill the 340B actual
20acquisition cost for the medication. Long-acting injectable
21medications for mental health or addiction shall not be
22subject to prior authorization under the medical assistance
23program or under any Medicaid managed-care plans when

 

 

SB0254- 2 -LRB102 10960 KTG 16292 b

1initiated at an inpatient hospital setting or when continued
2at an outpatient treatment facility.
 
3    Section 99. Effective date. This Act takes effect July 1,
42021.