Sen. Christine Radogno

Filed: 2/26/2010

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 3743

2     AMENDMENT NO. ______. Amend Senate Bill 3743 by replacing
3 everything after the enacting clause with the following:
 
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

 

 

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1 on some of the most severely injured and ill patients in the
2 State of Illinois. It is designed to better utilize the
3 specialized services available in the State to improve these
4 patients' health outcomes and to enhance the continuity and
5 coordination of care for these patients. This program serves as
6 one of the many pieces needed to reform the State of Illinois'
7 healthcare programs to better serve the people of the State of
8 Illinois.
 
9     Section 10. Definitions. As used in this Act:
10     (a) "CARE tool" means the Continuity and Record Evaluation
11 (CARE) tool. It is a patient assessment instrument that has
12 been developed to document the medical, cognitive, functional,
13 and discharge status of persons receiving health care services
14 in acute and post-acute care settings. The data collected is
15 able to document provider-level quality of care (patient
16 outcomes) and characterize the clinical complexity of
17 patients.
18     (b) "Department" means the Illinois Department of
19 Healthcare and Family Services.
20     (c) "Discharge" means the release of a patient from
21 hospital care for any discharge disposition other than a leave
22 of absence, even if for Medicare payment purposes the discharge
23 fits the definition of an interrupted stay.
24     (d) "FTE" means "full-time equivalent" or a person or
25 persons employed in one full-time position.

 

 

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1     (e) "Hospital" means an institution, place, building, or
2 agency located in this State that is licensed as a general
3 acute hospital by the Illinois Department of Public Health
4 under the Hospital Licensing Act, whether public or private and
5 whether organized for profit or not-for-profit.
6     (f) "ICU" means intensive care unit.
7     (g) "LTAC hospital" means a hospital that is designated by
8 Medicare as a long term acute care hospital as described in
9 Section 1886(d)(1)(B)(iv)(I) of the Social Security Act and has
10 an average length of Medicaid inpatient stay greater than 25
11 days as reported on the hospital's 2008 Medicaid cost report on
12 file as of February 15, 2010.
13     (h) "LTAC hospital criteria" means nationally recognized
14 evidence-based evaluation criteria that have been publicly
15 tested and includes criteria specific to an LTAC hospital for
16 admission, continuing stay, and discharge. The criteria cannot
17 include criteria derived or developed by or for a specific
18 hospital or group of hospitals. Criteria and tools developed by
19 hospitals or hospital associations or hospital-owned
20 organizations are not acceptable and do not meet the
21 requirements of this subsection.
22     (i) "Patient" means an individual who is admitted to a
23 hospital for an inpatient stay.
24     (j) "Program" means the Long Term Acute Care Hospital
25 Quality Improvement Transfer Program established by this Act.
26     (k) "STAC hospital" means a hospital that is not an LTAC

 

 

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1 hospital as defined in this Act or a psychiatric hospital or a
2 rehabilitation hospital.
 
3     Section 15. Qualifying Hospitals.
4     (a) Beginning on the effective date of this Act, the
5 Department shall establish the Long Term Acute Care Hospital
6 Quality Improvement Transfer Program. Any hospital may
7 participate in the program if it meets the requirements of this
8 Section as determined by the Department.
9     (b) To participate in the program a hospital must do the
10 following:
11         (1) Operate as an LTAC hospital.
12         (2) Employ one-half of an FTE (designated for case
13     management) for every 15 patients admitted to the hospital.
14         (3) Maintain on-site physician coverage 24 hours a day,
15     7 days a week.
16         (4) Maintain on-site respiratory therapy coverage 24
17     hours a day, 7 days a week.
18     (c) A hospital must also execute a program participation
19 agreement with the Department. The agreement must include:
20         (1) An attestation that the hospital complies with the
21     criteria in subsection (b) of this Section.
22         (2) A process for the hospital to report its continuing
23     compliance with subsection (b) of this Section. The
24     hospital must submit a compliance report at least annually.
25         (3) A requirement that the hospital complete and submit

 

 

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1     the CARE tool (the most currently available version or an
2     equivalent tool designated and approved for use by the
3     Department) for each patient no later than 7 calendar days
4     after discharge.
5         (4) A requirement that the hospital use a patient
6     satisfaction survey specifically designed for LTAC
7     hospital settings. The hospital must submit survey results
8     data to the Department at least annually.
9         (5) A requirement that the hospital accept all
10     clinically-approved patients for admission or transfer
11     from a STAC hospital. The patient must be evaluated using
12     LTAC hospital criteria approved by the Department for use
13     in this program and meet the appropriate criteria.
14         (6) A requirement that the hospital report quality and
15     outcome measurement data, as described in Section 20 of
16     this Act, to the Department at least annually.
17         (7) A requirement that the hospital provide the
18     Department full access to patient data and other data
19     maintained by the hospital. Access must be in compliance
20     with State and federal law.
21         (8) A requirement that the hospital use LTAC hospital
22     criteria to evaluate patients that are admitted to the
23     hospital to determine that the patient is in the most
24     appropriate setting.
 
25     Section 20. Quality and outcome measurement data.

 

 

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1     (a) For proper evaluation and monitoring of the program,
2 each LTAC hospital must provide quality and outcome measurement
3 data ("measures") as specified in subsections (c) through (h)
4 of this Section to the Department for patients treated under
5 this program. The Department may develop measures in addition
6 to the minimum measures required under this Section.
7     (b) Two sets of measures must be calculated. The first set
8 should only use data for medical assistance patients, and the
9 second set should include all patients of the LTAC hospital
10 regardless of payer.
11     (c) Average LTAC hospital length of stay for patients
12 discharged during the reporting period. The quotient of:
13         (1) Numerator: all patient days for discharged
14     patients during the reporting period.
15         (2) Denominator: number of patient discharges
16     associated with the days included in the numerator.
17     (d) Adverse outcomes rates: Percent of patients who expired
18 or whose condition worsens and requires treatment in a STAC
19 hospital. The quotient of:
20         (1) Numerator: sum of expirations plus discharges to a
21     STAC Hospital.
22         (2) Denominator: total discharges.
23     (e) Ventilator weaning rate: Percent of patients
24 discharged during the reporting period who have been
25 successfully weaned off invasive mechanical ventilation. The
26 quotient of:

 

 

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1         (1) Numerator:
2             (A) Includes all patients who were admitted on
3         invasive mechanical ventilation (per endotracheal or
4         tracheostomy tube) and were completely weaned from
5         invasive mechanical ventilation at discharge from the
6         LTAC hospital, patients admitted receiving part-time
7         or nocturnal invasive mechanical ventilation, patients
8         admitted on invasive mechanical and transitioned to
9         noninvasive ventilation at time of discharge.
10             (B) Excludes patients who have not yet been
11         discharged, patients who were not completely weaned
12         from invasive mechanical ventilation, patients that
13         were weaned for a period of time but returned to
14         ventilator support and were ventilator-dependent at
15         time of discharge, and patients who expired.
16         (2) Denominator: includes all ventilator dependent
17     patients.
18     (f) Central Line Infection Rate per 1000 central line days:
19 Number of patients discharged from an LTAC hospital during the
20 reporting period that had a central line in place and developed
21 a bloodstream infection 48 hours or more after admission to the
22 LTAC hospital. The quotient of:
23         (1) Numerator:
24             (A) Includes all discharged patients that had a
25         central line and developed a bloodstream infection as
26         defined by the Centers for Disease Control and

 

 

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1         Prevention. The definition of central line includes
2         any device that is not peripheral, including Single,
3         Double, and Triple Lumen vascular catheters,
4         percutaneously inserted central catheter lines, and
5         Tunneled catheters such as Mediports and Groshongs.
6         Number of primary bloodstream infections in patients
7         with a central line catheter, including patients whose
8         primary blood stream infection was identified at least
9         48 hours after admission.
10             (B) Excludes patients that:
11                 (i) Were admitted to the LTAC hospital with a
12             bloodstream infection;
13                 (ii) Had a bloodstream infection identified by
14             the LTAC hospital within 48 hours of the LTAC
15             hospital admission;
16                 (iii) Were not discharged; or
17                 (iv) Did not have a central line.
18          (2) Denominator: Number of central line catheter days
19     for the reporting period.
20             (A) Includes central line catheter patient days
21         for all discharges from the LTAC hospital.
22             (B) Excludes patients that did not have a central
23         line and exclude patient days for patients that left
24         the facility for a leave of absence and subsequently
25         returned to the LTAC hospital and therefore were not
26         discharged.

 

 

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1     (g) Acquired pressure ulcers per 1000 patient days. The
2     quotient of:
3         (1) Numerator: Number of pressure ulcers that
4     developed during the LTAC hospital hospitalization in
5     patients discharged from an LTAC hospital during the
6     reporting period.
7             (A) Includes total number of stage 2-4 ulcers
8     identified more than 48 hours after admission to the LTAC
9     hospital.
10             (B) Excludes the following:
11                 (i) Ulcers in patients that have not yet been
12             discharged.
13                 (ii) Pressure ulcers Stage 2 and greater
14             present at admission to the LTAC hospital.
15                 (iii) Stage 1 pressure ulcers.
16                 (iv) Pressure ulcers that were identified
17             within the first 48 hours of admission to the LTAC
18             hospital.
19         (2) Denominator: total patient days for the reporting
20     period.
21     (h) Falls with injury per 1000 patient days: Number of
22 falls among discharged LTAC hospital patients discharged
23 during the reporting period, who fell during the LTAC hospital
24 stay, regardless of distance fallen, that required an ancillary
25 or surgical procedure (i.e. x-ray, MRI, sutures, surgery, etc.)
26 The quotient of:

 

 

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1         (1) Numerator:
2             (A) Includes the following:
3                 (i) Falls with injury levels of minor,
4             moderate, major, and death in accordance with the
5             guidelines for falls with injury Fall Prevention
6             Protocol of the National Database of Nursing
7             Quality Indicators (NDNQI).
8                 (ii) Assisted falls among discharged LTAC
9             hospital patients (patient caught themselves,
10             staff or witness assisted falls, falls caught to
11             prevent further falling).
12             (B) Excludes the following:
13                 (i) Assisted falls (patient caught themselves,
14             staff or witness assisted falls, falls caught to
15             prevent further falling) among discharged LTAC
16             hospital patients that required physician exam or
17             bandage but no ancillary test or procedure.
18                 (ii) Falls that required a physician exam or
19             bandage or ancillary test that was negative such as
20             x-ray.
21                 (iii) Falls with no injury according to NDNQI
22             definitions.
23                 (iv) Falls among the patients who have not yet
24             been discharged.
25          (2) Denominator: Number of discharged LTAC hospital
26     patient days for the reporting period, with patient days

 

 

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

 

 

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1     the Department becoming the primary payer.
 
2     Section 30. LTAC hospital duties.
3     (a) The LTAC hospital must notify the Department within 5
4 calendar days if it no longer meets the requirements under
5 subsection (b) of Section 15.
6     (b) The LTAC hospital may terminate the agreement under
7 subsection (c) of Section 15 with a notice to the Department
8 within 15 calendar days if the State of Illinois fails to issue
9 payment within 50 days of submission of an appropriately
10 submitted claim.
11     (c) The LTAC hospital must assist the Department in
12 creating patient and family education material concerning the
13 program.
14     (d) The LTAC hospital must retain the patient's admission
15 evaluation to document that the patient meets the LTAC hospital
16 criteria and is eligible to receive the LTAC supplemental per
17 diem rate described in Section 35 of this Act.
 
18     Section 35. LTAC supplemental per diem rate.
19     (a) The Department must pay an LTAC supplemental per diem
20 rate calculated under this Section to LTAC hospitals that meet
21 the requirements of Section 15 of this Act for patients who
22 upon admission to the LTAC hospital meet LTAC hospital
23 criteria.
24     (b) The Department must not pay the LTAC supplemental per

 

 

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1 diem rate calculated under this Section if the LTAC hospital no
2 longer meets the requirements under Section 15 or terminates
3 the agreement specified under Section 15. The Department must
4 not pay the LTAC supplemental per diem rate calculated under
5 this Section if the patient does not meet the LTAC hospital
6 criteria upon admission.
7     (c) After the first year of operation of the program
8 established by this Act, the Department may reduce the LTAC
9 supplemental per diem rate calculated under this Section by no
10 more than 5% for an LTAC hospital that does not meet benchmarks
11 or targets set by the Department. The Department may also
12 increase the LTAC supplemental per diem rate calculated under
13 this Section by no more than 5% for an LTAC hospital that
14 exceeds the benchmarks or targets set by the Department.
15     (d) The LTAC supplemental per diem rate shall be calculated
16 using the LTAC hospital's inflated cost per diem, defined in
17 subsection (f) of this Section, and subtracting the following:
18         (1) The LTAC hospital's Medicaid per diem inpatient
19     rate as calculated under 89 Ill. Adm. Code 148.270(c)(4).
20         (2) The LTAC hospital's disproportionate share (DSH)
21     rate as calculated under 89 Ill. Adm. Code 148.120.
22         (3) The LTAC hospital's Medicaid Percentage Adjustment
23     (MPA) rate as calculated under 89 Ill. Adm. Code 148.122.
24         (4) The LTAC hospital's Medicaid High Volume
25     Adjustment (MHVA) rate as calculated under 89 Ill. Adm.
26     Code 148.290(d).

 

 

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1     (e) LTAC supplemental per diem rates are effective for 12
2 months beginning on October 1 of each year and must be updated
3 every 12 months.
4     (f) For the purposes of this Section, "inflated cost per
5 diem" means the quotient resulting from dividing the hospital's
6 inpatient Medicaid costs by the hospital's Medicaid inpatient
7 days and inflating it to the most current period using
8 methodologies consistent with the calculation of the rates
9 described in paragraphs (2),(3), and (4) of subsection (d). The
10 data is obtained from the LTAC hospital's most recent cost
11 report submitted to the Department as mandated under 89 Ill.
12 Adm. Code 148.210.
 
13     Section 40. Duties of the Department.
14     (a) The Department is responsible for implementing,
15 monitoring, and evaluating the program. This includes but is
16 not limited to:
17         (1) Collecting data required under Section 15 and data
18     necessary to calculate the measures under Section 20 of
19     this Act.
20         (2) Setting annual benchmarks or targets for the
21     measures in Section 20 of this Act or other measures beyond
22     the minimum required under Section 20. The Department must
23     consult participating LTAC hospitals when setting these
24     benchmarks and targets.
25         (3) Monitoring compliance with all requirements of

 

 

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1     this Act.
2         (4) Creating patient and family education material
3     about the program for STAC hospitals to use.
4     (b) The Department must issue an annual report by posting
5 it to the Department's website. The annual report must include
6 at least the following information:
7         (1) Information on the LTAC hospitals that are
8     qualified and participating in the program.
9         (2) Quality and outcome measures, as described in
10     Section 20 of this Act, for each LTAC hospital.
11         (3) A calculation of the savings generated by the
12     program.
13         (4) Observations on how the program is working and any
14     suggestions to improve the program in the future.
15     (c) The Department must establish monitoring procedures
16 that ensure the LTAC supplemental payment is only paid for
17 patients who upon admission meet the LTAC hospital criteria.
18 The Department must notify qualified LTAC hospitals of the
19 procedures and establish an appeals process as part of those
20 procedures. The Department must recoup any LTAC supplemental
21 payments that are identified as being paid for patients who do
22 not meet the LTAC hospital criteria.
23     (d) The Department must implement the program by October 1,
24 2010.
25     (e) The Department must execute an agreement as required
26 under subsection (c) of Section 15 no later than 45 days after

 

 

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1 the effective date of this Act.
2     (f) The Department must notify Illinois hospitals which
3 LTAC hospital criteria are approved for use under the program.
4 The Department may limit LTAC hospital criteria to the most
5 strict criteria that meet the definitions of this Act.
6     (g) The Department must identify discharge tools that are
7 considered equivalent to the CARE tool and approved for use
8 under the program. The Department must notify LTAC hospitals
9 which tools are approved for use under the program.
10     (h) The Department must notify Illinois LTAC hospitals of
11 the program and inform them how to apply for qualification and
12 what the qualification requirements are as described under
13 Section 15 of this Act.
14     (i) The Department must notify Illinois STAC hospitals
15 about the operation and implementation of the program
16 established by this Act.
17     (j) The Department must work with the Comptroller to ensure
18 a process to issue payments to LTAC hospitals qualified and
19 participating in the program within 50 days of submission of an
20 appropriate claim.
21     (k) The Department may use up to $500,000 of funds
22 contained in the Public Aid Recoveries Trust Fund per State
23 fiscal year to operate the program under this Act. The
24 Department may expand existing contracts, issue new contracts,
25 issue personal service contracts, or purchase other services,
26 supplies, or equipment.
 

 

 

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1     Section 99. Effective date. This Act takes effect upon
2 becoming law.".