97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5906

 

Introduced 2/16/2012, by Rep. Patricia R. Bellock

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/12-4.42

    Amends the Administration Article of the Illinois Public Aid Code. In regard to the recovery of Medicaid funds paid by the Department of Healthcare and Family Services when another payer was liable, requires the Department to provide an annual report to the General Assembly detailing the amount of funds recovered. Effective immediately.


LRB097 17027 KTG 62223 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5906LRB097 17027 KTG 62223 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 12-4.42 as follows:
 
6    (305 ILCS 5/12-4.42)
7    Sec. 12-4.42. Medicaid Revenue Maximization.
8    (a) Purpose. The General Assembly finds that there is a
9need to make changes to the administration of services provided
10by State and local governments in order to maximize federal
11financial participation.
12    (b) Definitions. As used in this Section:
13    "Community Medicaid mental health services" means all
14mental health services outlined in Section 132 of Title 59 of
15the Illinois Administrative Code that are funded through DHS,
16eligible for federal financial participation, and provided by a
17community-based provider.
18    "Community-based provider" means an entity enrolled as a
19provider pursuant to Sections 140.11 and 140.12 of Title 89 of
20the Illinois Administrative Code and certified to provide
21community Medicaid mental health services in accordance with
22Section 132 of Title 59 of the Illinois Administrative Code.
23    "DCFS" means the Department of Children and Family

 

 

HB5906- 2 -LRB097 17027 KTG 62223 b

1Services.
2    "Department" means the Illinois Department of Healthcare
3and Family Services.
4    "Developmentally disabled care facility" means an
5intermediate care facility for the intellectually disabled
6within the meaning of Title XIX of the Social Security Act,
7whether public or private and whether organized for profit or
8not-for-profit, but shall not include any facility operated by
9the State.
10    "Developmentally disabled care provider" means a person
11conducting, operating, or maintaining a developmentally
12disabled care facility. For purposes of this definition,
13"person" means any political subdivision of the State,
14municipal corporation, individual, firm, partnership,
15corporation, company, limited liability company, association,
16joint stock association, or trust, or a receiver, executor,
17trustee, guardian, or other representative appointed by order
18of any court.
19    "DHS" means the Illinois Department of Human Services.
20    "Hospital" means an institution, place, building, or
21agency located in this State that is licensed as a general
22acute hospital by the Illinois Department of Public Health
23under the Hospital Licensing Act, whether public or private and
24whether organized for profit or not-for-profit.
25    "Long term care facility" means (i) a skilled nursing or
26intermediate long term care facility, whether public or private

 

 

HB5906- 3 -LRB097 17027 KTG 62223 b

1and whether organized for profit or not-for-profit, that is
2subject to licensure by the Illinois Department of Public
3Health under the Nursing Home Care Act, including a county
4nursing home directed and maintained under Section 5-1005 of
5the Counties Code, and (ii) a part of a hospital in which
6skilled or intermediate long term care services within the
7meaning of Title XVIII or XIX of the Social Security Act are
8provided; except that the term "long term care facility" does
9not include a facility operated solely as an intermediate care
10facility for the intellectually disabled within the meaning of
11Title XIX of the Social Security Act.
12    "Long term care provider" means (i) a person licensed by
13the Department of Public Health to operate and maintain a
14skilled nursing or intermediate long term care facility or (ii)
15a hospital provider that provides skilled or intermediate long
16term care services within the meaning of Title XVIII or XIX of
17the Social Security Act. For purposes of this definition,
18"person" means any political subdivision of the State,
19municipal corporation, individual, firm, partnership,
20corporation, company, limited liability company, association,
21joint stock association, or trust, or a receiver, executor,
22trustee, guardian, or other representative appointed by order
23of any court.
24    "State-operated developmentally disabled care facility"
25means an intermediate care facility for the intellectually
26disabled within the meaning of Title XIX of the Social Security

 

 

HB5906- 4 -LRB097 17027 KTG 62223 b

1Act operated by the State.
2    (c) Administration and deposit of Revenues. The Department
3shall coordinate the implementation of changes required by this
4amendatory Act of the 96th General Assembly amongst the various
5State and local government bodies that administer programs
6referred to in this Section.
7    Revenues generated by program changes mandated by any
8provision in this Section, less reasonable administrative
9costs associated with the implementation of these program
10changes, which would otherwise be deposited into the General
11Revenue Fund shall be deposited into the Healthcare Provider
12Relief Fund.
13    The Department shall issue a report to the General Assembly
14detailing the implementation progress of this amendatory Act of
15the 96th General Assembly as a part of the Department's Medical
16Programs annual report for fiscal years 2010 and 2011.
17    (d) Acceleration of payment vouchers. To the extent
18practicable and permissible under federal law, the Department
19shall create all vouchers for long term care facilities and
20developmentally disabled care facilities for dates of service
21in the month in which the enhanced federal medical assistance
22percentage (FMAP) originally set forth in the American Recovery
23and Reinvestment Act (ARRA) expires and for dates of service in
24the month prior to that month and shall, no later than the 15th
25of the month in which the enhanced FMAP expires, submit these
26vouchers to the Comptroller for payment.

 

 

HB5906- 5 -LRB097 17027 KTG 62223 b

1    The Department of Human Services shall create the necessary
2documentation for State-operated developmentally disabled care
3facilities so that the necessary data for all dates of service
4before the expiration of the enhanced FMAP originally set forth
5in the ARRA can be adjudicated by the Department no later than
6the 15th of the month in which the enhanced FMAP expires.
7    (e) Billing of DHS community Medicaid mental health
8services. No later than July 1, 2011, community Medicaid mental
9health services provided by a community-based provider must be
10billed directly to the Department.
11    (f) DCFS Medicaid services. The Department shall work with
12DCFS to identify existing programs, pending qualifying
13services, that can be converted in an economically feasible
14manner to Medicaid in order to secure federal financial
15revenue.
16    (g) Third Party Liability recoveries. The Department shall
17contract with a vendor to support the Department in
18coordinating benefits for Medicaid enrollees. The scope of work
19shall include, at a minimum, the identification of other
20insurance for Medicaid enrollees and the recovery of funds paid
21by the Department when another payer was liable. The vendor may
22be paid a percentage of actual cash recovered when practical
23and subject to federal law. The Department shall provide an
24annual report to the General Assembly detailing the amount of
25funds recovered under this provision.
26    (h) Public health departments. The Department shall

 

 

HB5906- 6 -LRB097 17027 KTG 62223 b

1identify unreimbursed costs for persons covered by Medicaid who
2are served by the Chicago Department of Public Health.
3    The Department shall assist the Chicago Department of
4Public Health in determining total unreimbursed costs
5associated with the provision of healthcare services to
6Medicaid enrollees.
7    The Department shall determine and draw the maximum
8allowable federal matching dollars associated with the cost of
9Chicago Department of Public Health services provided to
10Medicaid enrollees.
11    (i) Acceleration of hospital-based payments. The
12Department shall, by the 10th day of the month in which the
13enhanced FMAP originally set forth in the ARRA expires, create
14vouchers for all State fiscal year 2011 hospital payments
15exempt from the prompt payment requirements of the ARRA. The
16Department shall submit these vouchers to the Comptroller for
17payment.
18(Source: P.A. 96-1405, eff. 7-29-10; 97-48, eff. 6-28-11;
1997-227, eff. 1-1-12; 97-333, eff. 8-12-11; revised 10-4-11.)
 
20    Section 99. Effective date. This Act takes effect upon
21becoming law.