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1     AN ACT concerning public aid.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 1. Short title. This Act may be cited as the Long
5 Term Acute Care Hospital Quality Improvement Transfer Program
6 Act.
 
7     Section 5. Purpose of Act. The General Assembly finds that
8 it is vital for the State of Illinois to find methods to
9 improve the health care outcomes of patients served by the
10 healthcare programs operated by the Department of Healthcare
11 and Family Services. Improving a patient's health not only
12 benefits the patient's quality of life but also results in a
13 more efficient use of the resources needed to provide care.
14 Estimates show that the Long Term Acute Care Hospital Quality
15 Improvement Transfer Program established under this Act could
16 save approximately $10,000,000 annually. The program focuses
17 on some of the most severely injured and ill patients in the
18 State of Illinois. It is designed to better utilize the
19 specialized services available in the State to improve these
20 patients' health outcomes and to enhance the continuity and
21 coordination of care for these patients. This program serves as
22 one of the many pieces needed to reform the State of Illinois'
23 healthcare programs to better serve the people of the State of

 

 

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1 Illinois.
 
2     Section 10. Definitions. As used in this Act:
3     (a) "CARE tool" means the Continuity and Record Evaluation
4 (CARE) tool. It is a patient assessment instrument that has
5 been developed to document the medical, cognitive, functional,
6 and discharge status of persons receiving health care services
7 in acute and post-acute care settings. The data collected is
8 able to document provider-level quality of care (patient
9 outcomes) and characterize the clinical complexity of
10 patients.
11     (b) "Department" means the Illinois Department of
12 Healthcare and Family Services.
13     (c) "Discharge" means the release of a patient from
14 hospital care for any discharge disposition other than a leave
15 of absence, even if for Medicare payment purposes the discharge
16 fits the definition of an interrupted stay.
17     (d) "FTE" means "full-time equivalent" or a person or
18 persons employed in one full-time position.
19     (e) "Hospital" means an institution, place, building, or
20 agency located in this State that is licensed as a general
21 acute hospital by the Illinois Department of Public Health
22 under the Hospital Licensing Act, whether public or private and
23 whether organized for profit or not-for-profit.
24     (f) "ICU" means intensive care unit.
25     (g) "LTAC hospital" means a hospital that is designated by

 

 

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1 Medicare as a long term acute care hospital as described in
2 Section 1886(d)(1)(B)(iv)(I) of the Social Security Act and has
3 an average length of Medicaid inpatient stay greater than 25
4 days as reported on the hospital's 2008 Medicaid cost report on
5 file as of February 15, 2010, or a hospital that begins
6 operations after January 1, 2010 and is designated by Medicare
7 as a long term acute care hospital.
8     (h) "LTAC hospital criteria" means nationally recognized
9 evidence-based evaluation criteria that have been publicly
10 tested and includes criteria specific to an LTAC hospital for
11 admission, continuing stay, and discharge. The criteria cannot
12 include criteria derived or developed by or for a specific
13 hospital or group of hospitals. Criteria and tools developed by
14 hospitals or hospital associations or hospital-owned
15 organizations are not acceptable and do not meet the
16 requirements of this subsection.
17     (i) "Patient" means an individual who is admitted to a
18 hospital for an inpatient stay.
19     (j) "Program" means the Long Term Acute Care Hospital
20 Quality Improvement Transfer Program established by this Act.
21     (k) "STAC hospital" means a hospital that is not an LTAC
22 hospital as defined in this Act or a psychiatric hospital or a
23 rehabilitation hospital.
 
24     Section 15. Qualifying Hospitals.
25     (a) Beginning October 1, 2010, the Department shall

 

 

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1 establish the Long Term Acute Care Hospital Quality Improvement
2 Transfer Program. Any hospital may participate in the program
3 if it meets the requirements of this Section as determined by
4 the Department.
5     (b) To participate in the program a hospital must do the
6 following:
7         (1) Operate as an LTAC hospital.
8         (2) Employ one-half of an FTE (designated for case
9     management) for every 15 patients admitted to the hospital.
10         (3) Maintain on-site physician coverage 24 hours a day,
11     7 days a week.
12         (4) Maintain on-site respiratory therapy coverage 24
13     hours a day, 7 days a week.
14     (c) A hospital must also execute a program participation
15 agreement with the Department. The agreement must include:
16         (1) An attestation that the hospital complies with the
17     criteria in subsection (b) of this Section.
18         (2) A process for the hospital to report its continuing
19     compliance with subsection (b) of this Section. The
20     hospital must submit a compliance report at least annually.
21         (3) A requirement that the hospital complete and submit
22     to the Department the CARE tool (the most currently
23     available version or an equivalent tool designated and
24     approved for use by the Department) for each patient no
25     later than 7 calendar days after discharge.
26         (4) A requirement that the hospital use a patient

 

 

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1     satisfaction survey specifically designed for LTAC
2     hospital settings. The hospital must submit survey results
3     data to the Department at least annually.
4         (5) A requirement that the hospital accept all
5     clinically approved patients for admission or transfer
6     from a STAC hospital with the exception of STAC hospitals
7     identified in paragraphs (1) and (2) under subsection (a)
8     of Section 25 of this Act. The patient must be evaluated
9     using LTAC hospital criteria approved by the Department for
10     use in this program and meet the appropriate criteria.
11         (6) A requirement that the hospital report quality and
12     outcome measurement data, as described in Section 20 of
13     this Act, to the Department at least annually.
14         (7) A requirement that the hospital provide the
15     Department full access to patient data and other data
16     maintained by the hospital. Access must be in compliance
17     with State and federal law.
18         (8) A requirement that the hospital use LTAC hospital
19     criteria to evaluate patients that are admitted to the
20     hospital to determine that the patient is in the most
21     appropriate setting.
 
22     Section 20. Quality and outcome measurement data.
23     (a) For proper evaluation and monitoring of the program,
24 each LTAC hospital must provide quality and outcome measurement
25 data ("measures") as specified in subsections (c) through (h)

 

 

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1 of this Section to the Department for patients treated under
2 this program. The Department may develop measures in addition
3 to the minimum measures required under this Section.
4     (b) Two sets of measures must be calculated. The first set
5 should only use data for medical assistance patients, and the
6 second set should include all patients of the LTAC hospital
7 regardless of payer.
8     (c) Average LTAC hospital length of stay for patients
9 discharged during the reporting period.
10     (d) Adverse outcomes rates: Percent of patients who expired
11 or whose condition worsens and requires treatment in a STAC
12 hospital.
13     (e) Ventilator weaning rate: Percent of patients
14 discharged during the reporting period who have been
15 successfully weaned off invasive mechanical ventilation.
16     (f) Central Line Infection Rate per 1000 central line days:
17 Number of patients discharged from an LTAC hospital during the
18 reporting period that had a central line in place and developed
19 a bloodstream infection 48 hours or more after admission to the
20 LTAC hospital.
21     (g) Acquired pressure ulcers per 1000 patient days.
22     (h) Falls with injury per 1000 patient days: Number of
23 falls among discharged LTAC hospital patients discharged
24 during the reporting period, who fell during the LTAC hospital
25 stay, regardless of distance fallen, that required an ancillary
26 or surgical procedure (i.e. x-ray, MRI, sutures, surgery, etc.)
 

 

 

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1     Section 25. Quality improvement transfer program.
2     (a) The Department may exempt the following STAC hospitals
3 from the requirements in this Section:
4         (1) A hospital operated by a county with a population
5     of 3,000,000 or more.
6         (2) A hospital operated by a State agency or a State
7     university.
8     (b) STAC hospitals may transfer patients who meet criteria
9 in the LTAC hospital criteria and are medically stable for
10 discharge from the STAC hospital.
11     (c) A patient in a STAC hospital may be exempt from a
12 transfer if:
13         (1) The patient's physician does not issue an order for
14     a transfer;
15         (2) The patient or the individual legally authorized to
16     make medical decisions for the patient refuses the
17     transfer; or
18         (3) The patient's care is primarily paid for by
19     Medicare or another third party. The exemption in this
20     paragraph (3) of subsection (c) does not apply to a patient
21     who has exhausted his or her Medicare benefits resulting in
22     the Department becoming the primary payer.
 
23     Section 30. LTAC hospital duties.
24     (a) The LTAC hospital must notify the Department within 5

 

 

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1 calendar days if it no longer meets the requirements under
2 subsection (b) of Section 15.
3     (b) The LTAC hospital may terminate the agreement under
4 subsection (c) of Section 15 with 30 calendar days' notice to
5 the Department.
6     (c) The LTAC hospital must develop patient and family
7 education materials concerning the Program and submit those
8 materials to the Department for review and approval.
9     (d) The LTAC hospital must retain the patient's admission
10 evaluation to document that the patient meets the LTAC hospital
11 criteria and is eligible to receive the LTAC supplemental per
12 diem rate described in Section 35 of this Act.
 
13     Section 35. LTAC supplemental per diem rate.
14     (a) The Department must pay an LTAC supplemental per diem
15 rate calculated under this Section to LTAC hospitals that meet
16 the requirements of Section 15 of this Act for patients:
17         (1) who upon admission to the LTAC hospital meet LTAC
18     hospital criteria; and
19         (2) whose care is primarily paid for by the Department
20     under Title XIX of the Social Security Act or whose care is
21     primarily paid for by the Department after the patient has
22     exhausted his or her benefits under Medicare.
23     (b) The Department must not pay the LTAC supplemental per
24 diem rate calculated under this Section if any of the following
25 conditions are met:

 

 

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1         (1) the LTAC hospital no longer meets the requirements
2     under Section 15 of this Act or terminates the agreement
3     specified under Section 15 of this Act;
4         (2) the patient does not meet the LTAC hospital
5     criteria upon admission; or
6         (3) the patient's care is primarily paid for by
7     Medicare and the patient has not exhausted his or her
8     Medicare benefits, resulting in the Department becoming
9     the primary payer.
10     (c) The Department may adjust the LTAC supplemental per
11 diem rate calculated under this Section based only on the
12 conditions and requirements described under Section 40 and
13 Section 45 of this Act.
14     (d) The LTAC supplemental per diem rate shall be calculated
15 using the LTAC hospital's inflated cost per diem, defined in
16 subsection (f) of this Section, and subtracting the following:
17         (1) The LTAC hospital's Medicaid per diem inpatient
18     rate as calculated under 89 Ill. Adm. Code 148.270(c)(4).
19         (2) The LTAC hospital's disproportionate share (DSH)
20     rate as calculated under 89 Ill. Adm. Code 148.120.
21         (3) The LTAC hospital's Medicaid Percentage Adjustment
22     (MPA) rate as calculated under 89 Ill. Adm. Code 148.122.
23         (4) The LTAC hospital's Medicaid High Volume
24     Adjustment (MHVA) rate as calculated under 89 Ill. Adm.
25     Code 148.290(d).
26     (e) LTAC supplemental per diem rates are effective for 12

 

 

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1 months beginning on October 1 of each year and must be updated
2 every 12 months.
3     (f) For the purposes of this Section, "inflated cost per
4 diem" means the quotient resulting from dividing the hospital's
5 inpatient Medicaid costs by the hospital's Medicaid inpatient
6 days and inflating it to the most current period using
7 methodologies consistent with the calculation of the rates
8 described in paragraphs (2), (3), and (4) of subsection (d).
9 The data is obtained from the LTAC hospital's most recent cost
10 report submitted to the Department as mandated under 89 Ill.
11 Adm. Code 148.210.
 
12     Section 40. Rate adjustments for quality measures.
13     (a) The Department may adjust the LTAC supplemental per
14 diem rate calculated under Section 35 of this Act based on the
15 requirements of this Section.
16     (b) After the first year of operation of the Program
17 established by this Act, the Department may reduce the LTAC
18 supplemental per diem rate calculated under Section 35 of this
19 Act by no more than 5% for an LTAC hospital that does not meet
20 benchmarks or targets set by the Department under paragraph (2)
21 of subsection (b) of Section 50.
22     (c) After the first year of operation of the Program
23 established by this Act, the Department may increase the LTAC
24 supplemental per diem rate calculated under Section 35 of this
25 Act by no more than 5% for an LTAC hospital that exceeds the

 

 

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1 benchmarks or targets set by the Department under paragraph (2)
2 of subsection (a) of Section 50.
3     (d) If an LTAC hospital misses a majority of the benchmarks
4 for quality measures for 3 consecutive years, the Department
5 may reduce the LTAC supplemental per diem rate calculated under
6 Section 35 of this Act to zero.
7     (e) An LTAC hospital whose rate is reduced under subsection
8 (d) of this Section may have the LTAC supplemental per diem
9 rate calculated under Section 35 of this Act reinstated once
10 the LTAC hospital achieves the necessary benchmarks or targets.
11     (f) The Department may apply the reduction described in
12 subsection (d) of this Section after one year instead of 3 to
13 an LTAC hospital that has had its rate previously reduced under
14 subsection (d) of this Section and later has had it reinstated
15 under subsection (e) of this Section.
16     (g) The rate adjustments described in this Section shall be
17 determined and applied only at the beginning of each rate year.
 
18     Section 45. Program evaluation.
19     (a) After the Program completes the 3rd full year of
20 operation on September 30, 2013, the Department must complete
21 an evaluation of the Program to determine the actual savings or
22 costs generated by the Program, both on an aggregate basis and
23 on an LTAC hospital-specific basis. The evaluation must be
24 conducted in each subsequent year.
25     (b) The Department and qualified LTAC hospitals must

 

 

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1 determine the appropriate methodology to accurately calculate
2 the Program's savings and costs.
3     (c) The evaluation must also determine the effects the
4 Program has had in improving patient satisfaction and health
5 outcomes.
6     (d) If the evaluation indicates that the Program generates
7 a net cost to the Department, the Department may prospectively
8 adjust an individual hospital's LTAC supplemental per diem rate
9 under Section 35 of this Act to establish cost neutrality. The
10 rate adjustments applied under this subsection (d) do not need
11 to be applied uniformly to all qualified LTAC hospitals as long
12 as the adjustments are based on data from the evaluation on
13 hospital-specific information. Cost neutrality under this
14 Section means that the cost to the Department resulting from
15 the LTAC supplemental per diem rate must not exceed the savings
16 generated from transferring the patient from a STAC hospital.
17     (e) The rate adjustment described in subsection (d) of this
18 Section, if necessary, shall be applied to the LTAC
19 supplemental per diem rate for the rate year beginning October
20 1, 2014. The Department may apply this rate adjustment in
21 subsequent rate years if the conditions under subsection (d) of
22 this Section are met. The Department must apply the rate
23 adjustment to an individual LTAC hospital's LTAC supplemental
24 per diem rate only in years when the Program evaluation
25 indicates a net cost for the Department.
26     (f) The rate adjustments described in this Section shall be

 

 

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1 determined and applied only at the beginning of each rate year.
 
2     Section 50. Duties of the Department.
3     (a) The Department is responsible for implementing,
4 monitoring, and evaluating the program. This includes but is
5 not limited to:
6         (1) Collecting data required under Section 15 and data
7     necessary to calculate the measures under Section 20 of
8     this Act.
9         (2) Setting annual benchmarks or targets for the
10     measures in Section 20 of this Act or other measures beyond
11     the minimum required under Section 20. The Department must
12     consult participating LTAC hospitals when setting these
13     benchmarks and targets.
14         (3) Monitoring compliance with all requirements of
15     this Act.
16     (b) The Department shall include specific information on
17 the Program in its annual medical programs report.
18     (c) The Department must establish monitoring procedures
19 that ensure the LTAC supplemental payment is only paid for
20 patients who upon admission meet the LTAC hospital criteria.
21 The Department must notify qualified LTAC hospitals of the
22 procedures and establish an appeals process as part of those
23 procedures. The Department must recoup any LTAC supplemental
24 payments that are identified as being paid for patients who do
25 not meet the LTAC hospital criteria.

 

 

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1     (d) The Department must implement the program by October 1,
2 2010.
3     (e) The Department must create and distribute to LTAC
4 hospitals the agreement required under subsection (c) of
5 Section 15 no later than September 1, 2010.
6     (f) The Department must notify Illinois hospitals which
7 LTAC hospital criteria are approved for use under the program.
8 The Department may limit LTAC hospital criteria to the most
9 strict criteria that meet the definitions of this Act.
10     (g) The Department must identify discharge tools that are
11 considered equivalent to the CARE tool and approved for use
12 under the program. The Department must notify LTAC hospitals
13 which tools are approved for use under the program.
14     (h) The Department must notify Illinois LTAC hospitals of
15 the program and inform them how to apply for qualification and
16 what the qualification requirements are as described under
17 Section 15 of this Act.
18     (i) The Department must notify Illinois STAC hospitals
19 about the operation and implementation of the program
20 established by this Act. The Department must also notify LTAC
21 hospitals that accepting transfers from the STAC hospitals
22 identified in paragraphs (1) and (2) under subsection (a) of
23 Section 25 of this Act are not required under paragraph (5) of
24 subsection (c) of Section 15 of this Act. The Department must
25 notify LTAC hospitals that accepting transfers from the STAC
26 hospitals identified in paragraphs (1) and (2) under subsection

 

 

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1 (a) of Section 25 of this Act shall negatively impact the
2 savings calculations under the Program evaluation required by
3 Section 40 of this Act and shall in turn require the Department
4 to initiate the penalty described in subsection (d) of Section
5 40 of this Act.
6     (j) The Department shall deem LTAC hospitals qualified
7 under Section 15 of this Act as qualifying for expedited
8 payments.
9     (k) The Department may use up to $500,000 of funds
10 contained in the Public Aid Recoveries Trust Fund per State
11 fiscal year to operate the program under this Act. The
12 Department may expand existing contracts, issue new contracts,
13 issue personal service contracts, or purchase other services,
14 supplies, or equipment.
15     (l) The Department may promulgate rules as allowed by the
16 Illinois Administrative Procedure Act to implement this Act;
17 however, the requirements under this Act shall be implemented
18 by the Department even if the Department's proposed rules are
19 not yet adopted by the implementation date of October 1, 2010.
 
20     Section 99. Effective date. This Act takes effect upon
21 becoming law.