HB5000ham004 93RD GENERAL ASSEMBLY

Rep. Lee A. Daniels

Filed: 3/31/2004

09300HB5000ham004 LRB093 16715 DRJ 49437 a

AMENDMENT TO HOUSE BILL 5000

AMENDMENT NO. ______. Amend House Bill 5000, AS AMENDED, in Section 5, Sec. 1-36, by replacing subsections (b) through (f) with the following:

"(b) Contracts must ensure that the transition to a fee-for-service payment methodology beginning July 1, 2004 will not cause any person receiving services to become ineligible or the level or quality of their service to be diminished, nor cause any person to be denied necessary services if the person is eligible for services.

(c) The Department of Human Services, in consultation with the departments of Public Aid, Public Health, and Children and Family Services and the Department on Aging, if applicable to the services under contract, shall adopt rules establishing the criteria, standards, and procedures for issuing the fee-for-service contracts, including but not limited to the fees to be paid for the services.

(d) In developing rules establishing conditions of participation and in developing performance standards, the Department shall provide an opportunity for public review and comment and for consultation with stakeholders before publishing and adopting those rules and performance standards.

(e) For the fiscal year beginning July 1, 2004, approved claims for payments for community services by grants, or payments by reimbursements for services billed under fee-for-service contracts, shall be paid in 12 monthly payments equal to 1/12 of the grant amount or as prospective payments of estimated bills, and these payments must be received no later than the 8th calendar day of each month. The Department may adjust the amount of payments for errors or improper payments and for the reconciliation of estimated and actual billings that shall be determined quarterly. The Department may revise the schedule of payments after July 1, 2005 by rule.

(f) For the fiscal year beginning July 1, 2004, to ensure continuity of services for recipients of community services administered by the Department, and to ensure a smooth transition from any payment methodology not based on fee-for-service contracts, the Department shall provide an aggregate amount of funding through a combination of grants and contracts that will at least maintain the same level of services in effect for the prior fiscal year beginning July 1, 2003. Individuals, organizations, or agencies who were providers of community services in the fiscal year beginning July 1, 2003, who are willing to comply with conditions of participation, and who meet performance standards established by the Department, shall be eligible as providers of services after July 1, 2004 for contracts under this Section that include terms that will enable them to at least maintain the same service capacity that they were providing in that prior fiscal year.

(g) Contracts under this Section shall include provisions for (i) adequate and timely notice to a provider of any determination by the Department that the provider is not in compliance with the contract or any standards of performance and (ii) an opportunity for the provider to take corrective action. A contract may be terminated if the provider fails to take corrective action. In the event of a contract termination, the Department must ensure that eligible persons receiving services under the contract will otherwise continue to receive necessary services in the community.

(h) The Department shall implement policies and procedures for recipients and providers of services to submit inquiries and resolve disputes with regard to the community services subject to contracts under this Section.

(i) Additional procedures, supplementary payments, or special rates may be adopted and implemented by the Department to ensure that unique circumstances of local areas, as defined by rule, can be met, including but not limited to circumstances in which there are not sufficient services available to meet basic needs or in which there is a need for specialty care.

(j) The Department shall require cost reports from providers of community services, as prescribed by rule, for the community services for which it will contract on a fee-for-service basis under this Section to determine the cost of services and other factors upon which the rates of payment shall be based. The Department, by rule, shall set rates to be paid for the various types of community services based on the cost reports. In developing rules establishing rates under this Section, the Department shall provide an opportunity for public review and comment and consultation with stakeholders before publishing and adopting those rules. Before adopting the rules, the Department shall obtain an evaluation and opinion by an independent certified public accountant comparing reported costs and proposed rates.".