103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4117

 

Introduced , by Rep. Norine K. Hammond

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.07
305 ILCS 5/14-13

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Children and Family Services to pay for all inpatient stays at a hospital beginning on the 3rd day a child is in the hospital beyond medical necessity, and the parent or caregiver has denied the child access to the home and has refused or failed to make provisions for another living arrangement for the child or the child's discharge is being delayed due to a pending inquiry or investigation by the Department of Children and Family Services. In a provision requiring the Department of Children and Family Services to pay the DCFS per diem rate for inpatient psychiatric stays at a free-standing psychiatric hospital or a hospital with a pediatric or adolescent inpatient psychiatric unit, requires the Department to pay the DCFS per diem rate effective the 3rd day (rather than the 11th day) when a child is in the hospital beyond medical necessity.


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A BILL FOR

 

HB4117LRB103 33244 KTG 63053 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 Sections 5-5.07 and 14-13 as follows:
 
6    (305 ILCS 5/5-5.07)
7    Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem
8rate. The Department of Children and Family Services shall pay
9the DCFS per diem rate for inpatient psychiatric stay at a
10free-standing psychiatric hospital or a hospital with a
11pediatric or adolescent inpatient psychiatric unit effective
12the 3rd day 11th day when a child is in the hospital beyond
13medical necessity, and the parent or caregiver has denied the
14child access to the home and has refused or failed to make
15provisions for another living arrangement for the child or the
16child's discharge is being delayed due to a pending inquiry or
17investigation by the Department of Children and Family
18Services. If any portion of a hospital stay is reimbursed
19under this Section, the hospital stay shall not be eligible
20for payment under the provisions of Section 14-13 of this
21Code.
22(Source: Reenacted by P.A. 101-15, eff. 6-14-19; reenacted by
23P.A. 101-209, eff. 8-5-19; P.A. 101-655, eff. 3-12-21;

 

 

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1102-201, eff. 7-30-21; 102-558, eff. 8-20-21; 102-1037, eff.
26-2-22.)
 
3    (305 ILCS 5/14-13)
4    Sec. 14-13. Reimbursement for inpatient stays extended
5beyond medical necessity.
6    (a) By October 1, 2019, the Department shall by rule
7implement a methodology effective for dates of service July 1,
82019 and later to reimburse hospitals for inpatient stays
9extended beyond medical necessity due to the inability of the
10Department or the managed care organization in which a
11recipient is enrolled or the hospital discharge planner to
12find an appropriate placement after discharge from the
13hospital. The Department shall evaluate the effectiveness of
14the current reimbursement rate for inpatient hospital stays
15beyond medical necessity.
16    (b) The methodology shall provide reasonable compensation
17for the services provided attributable to the days of the
18extended stay for which the prevailing rate methodology
19provides no reimbursement. The Department may use a day
20outlier program to satisfy this requirement. The reimbursement
21rate shall be set at a level so as not to act as an incentive
22to avoid transfer to the appropriate level of care needed or
23placement, after discharge.
24    (c) The Department shall require managed care
25organizations to adopt this methodology or an alternative

 

 

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1methodology that pays at least as much as the Department's
2adopted methodology unless otherwise mutually agreed upon
3contractual language is developed by the provider and the
4managed care organization for a risk-based or innovative
5payment methodology.
6    (d) Days beyond medical necessity shall not be eligible
7for per diem add-on payments under the Medicaid High Volume
8Adjustment (MHVA) or the Medicaid Percentage Adjustment (MPA)
9programs.
10    (e) For services covered by the fee-for-service program,
11reimbursement under this Section shall only be made for days
12beyond medical necessity that occur after the hospital has
13notified the Department of the need for post-discharge
14placement. For services covered by a managed care
15organization, hospitals shall notify the appropriate managed
16care organization of an admission within 24 hours of
17admission. For every 24-hour period beyond the initial 24
18hours after admission that the hospital fails to notify the
19managed care organization of the admission, reimbursement
20under this subsection shall be reduced by one day.
21    (f) The Department of Children and Family Services shall
22pay for all inpatient stays beginning on the 3rd day a child is
23in the hospital beyond medical necessity, and the parent or
24caregiver has denied the child access to the home and has
25refused or failed to make provisions for another living
26arrangement for the child or the child's discharge is being

 

 

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1delayed due to a pending inquiry or investigation by the
2Department of Children and Family Services.
3(Source: P.A. 101-209, eff. 8-5-19; 102-4, eff. 4-27-21.)