Rep. Sara Feigenholtz
Filed: 5/27/2013
| |||||||
| |||||||
| |||||||
1 | AMENDMENT TO SENATE BILL 26
| ||||||
2 | AMENDMENT NO. ______. Amend Senate Bill 26, AS AMENDED, | ||||||
3 | with reference to page and line numbers of House Amendment No. | ||||||
4 | 1 as follows:
| ||||||
5 | on page 4, by inserting immediately below line 8 the following: | ||||||
6 | ""Abuse" means any physical or mental injury or sexual | ||||||
7 | assault inflicted on a consumer other than by accidental means | ||||||
8 | in a facility."; and | ||||||
9 | on page 6, line 19, after "triage", by inserting "center"; and | ||||||
10 | on page 9, immediately below line 13, by inserting the | ||||||
11 | following: | ||||||
12 | ""Identified offender" means a person who meets any of the | ||||||
13 | following criteria: | ||||||
14 | (1) Has been convicted of, found guilty of, adjudicated | ||||||
15 | delinquent for, found not guilty by reason of insanity for, |
| |||||||
| |||||||
1 | or found unfit to stand trial for, any felony offense | ||||||
2 | listed in Section 25 of the Health Care Worker Background | ||||||
3 | Check Act, except for the following: | ||||||
4 | (i) a felony offense described in Section 10-5 of | ||||||
5 | the Nurse Practice Act; | ||||||
6 | (ii) a felony offense described in Section 4, 5, 6, | ||||||
7 | 8, or 17.02 of the Illinois Credit Card and Debit Card | ||||||
8 | Act; | ||||||
9 | (iii) a felony offense described in Section 5, 5.1, | ||||||
10 | 5.2, 7, or 9 of the Cannabis Control Act; | ||||||
11 | (iv) a felony offense described in Section 401, | ||||||
12 | 401.1, 404, 405, 405.1, 407, or 407.1 of the Illinois | ||||||
13 | Controlled Substances Act; and | ||||||
14 | (v) a felony offense described in the | ||||||
15 | Methamphetamine Control and Community Protection Act. | ||||||
16 | (2) Has been convicted of, adjudicated delinquent
for, | ||||||
17 | found not guilty by reason of insanity for, or found unfit | ||||||
18 | to stand trial for, any sex offense as defined in | ||||||
19 | subsection (c) of Section 10 of the Sex Offender Management | ||||||
20 | Board Act."; and
| ||||||
21 | on page 12, immediately below line 9, by inserting the | ||||||
22 | following: | ||||||
23 | "Section 2-100. Rulemaking. The Department is empowered to | ||||||
24 | promulgate any rules necessary to ensure proper implementation |
| |||||||
| |||||||
1 | and administration of this Act."; and | ||||||
2 | on page 15, immediately below line 1, by inserting the | ||||||
3 | following: | ||||||
4 | "Section 2-104. Screening prior to admission. | ||||||
5 | (a) A facility shall within 24 hours after admission, | ||||||
6 | request a criminal history background check pursuant to the | ||||||
7 | Uniform Conviction Information Act for all persons age 18 or | ||||||
8 | older seeking admission to the facility, unless a background | ||||||
9 | check was initiated by a hospital pursuant to subsection (d) of | ||||||
10 | Section 6.09 of the Hospital Licensing Act. Background checks | ||||||
11 | conducted pursuant to this Section shall be based on the | ||||||
12 | consumer's name, date of birth, and other identifiers as | ||||||
13 | required by the Department of State Police. If the results of | ||||||
14 | the background check are inconclusive, the facility shall | ||||||
15 | initiate a fingerprint-based check, unless the fingerprint | ||||||
16 | check is waived by the Director of Public Health based on | ||||||
17 | verification by the facility that the consumer meets criteria | ||||||
18 | related to the consumer's health or lack of potential risk | ||||||
19 | which may be established by Departmental rule. A waiver issued | ||||||
20 | pursuant to this Section shall be valid only while the consumer | ||||||
21 | is immobile or while the criteria supporting the waiver exist. | ||||||
22 | The facility shall provide for or arrange for any required | ||||||
23 | fingerprint-based checks to be taken on the premises of the | ||||||
24 | facility. If a fingerprint-based check is required, the |
| |||||||
| |||||||
1 | facility shall arrange for it to be conducted in a manner that | ||||||
2 | is respectful of the consumer's dignity and that minimizes any | ||||||
3 | emotional or physical hardship to the consumer. | ||||||
4 | (b) If the results of a consumer's criminal history | ||||||
5 | background check reveal that the consumer is an identified | ||||||
6 | offender as defined in this Act, the facility shall do the | ||||||
7 | following: | ||||||
8 | (1) Immediately notify the Department of State Police, | ||||||
9 | in the form and manner required by the Department of State | ||||||
10 | Police, in collaboration with the Department of Public | ||||||
11 | Health, that the consumer is an identified offender. | ||||||
12 | (2) Within 72 hours, arrange for a fingerprint-based
| ||||||
13 | criminal history record inquiry to be requested on the | ||||||
14 | identified offender consumer. The inquiry shall be based on | ||||||
15 | the subject's name, sex, race, date of birth, fingerprint | ||||||
16 | images, and other identifiers required by the Department of | ||||||
17 | State Police. The inquiry shall be processed through the | ||||||
18 | files of the Department of State Police and the Federal | ||||||
19 | Bureau of Investigation to locate any criminal history | ||||||
20 | record information that may exist regarding the subject. | ||||||
21 | The Federal Bureau of Investigation shall furnish to the | ||||||
22 | Department of State Police, pursuant to an inquiry under | ||||||
23 | this paragraph (2), any criminal history record | ||||||
24 | information contained in its files. | ||||||
25 | Section 2-105. Criminal History Report. |
| |||||||
| |||||||
1 | (a) The Department of State Police shall prepare a Criminal | ||||||
2 | History Report when it receives information, through the | ||||||
3 | criminal history background check required pursuant to | ||||||
4 | subsection (d) of Section 6.09 of the Hospital Licensing Act or | ||||||
5 | subsection (c) of Section 2-201.5 of the Nursing Home Care Act, | ||||||
6 | or through any other means, that a consumer of a facility is an | ||||||
7 | identified offender.
| ||||||
8 | (b) The Department of State Police shall complete the | ||||||
9 | Criminal History Report within 10 business days after receiving | ||||||
10 | information under subsection (a) that a consumer is an | ||||||
11 | identified offender. | ||||||
12 | (c) The Criminal History Report shall include, but not be | ||||||
13 | limited to, the following: | ||||||
14 | (1) Copies of the identified offender's parole, | ||||||
15 | mandatory supervised release, or probation orders. | ||||||
16 | (2) An interview with the identified offender. | ||||||
17 | (3) A detailed summary of the entire criminal history
| ||||||
18 | of the offender, including arrests, convictions, and the | ||||||
19 | date of the identified offender's last conviction relative | ||||||
20 | to the date of admission to a long-term care facility. | ||||||
21 | (4) If the identified offender is a convicted or
| ||||||
22 | registered sex offender, a review of any and all sex | ||||||
23 | offender evaluations conducted on that offender. If there | ||||||
24 | is no sex offender evaluation available, the Department of | ||||||
25 | State Police shall arrange, through the Department of | ||||||
26 | Public Health, for a sex offender evaluation to be |
| |||||||
| |||||||
1 | conducted on the identified offender. If the convicted or | ||||||
2 | registered sex offender is under supervision by the | ||||||
3 | Illinois Department of Corrections or a county probation | ||||||
4 | department, the sex offender evaluation shall be arranged | ||||||
5 | by and at the expense of the supervising agency. All | ||||||
6 | evaluations conducted on convicted or registered sex | ||||||
7 | offenders under this Act shall be conducted by sex offender | ||||||
8 | evaluators approved by the Sex Offender Management Board.
| ||||||
9 | (d) The Department of State Police shall provide the | ||||||
10 | Criminal History Report to a licensed forensic psychologist. | ||||||
11 | After (i) consideration of the Criminal History Report, (ii) | ||||||
12 | consultation with the facility administrator or the facility | ||||||
13 | medical director, or both, regarding the mental and physical | ||||||
14 | condition of the identified offender, and (iii) reviewing the | ||||||
15 | facility's file on the identified offender, including all | ||||||
16 | incident reports, all information regarding medication and | ||||||
17 | medication compliance, and all information regarding previous | ||||||
18 | discharges or transfers from other facilities, the licensed | ||||||
19 | forensic psychologist shall prepare an Identified Offender | ||||||
20 | Report and Recommendation. The Identified Offender Report and | ||||||
21 | Recommendation shall detail whether and to what extent the | ||||||
22 | identified offender's criminal history necessitates the | ||||||
23 | implementation of security measures within the long-term care | ||||||
24 | facility. If the identified offender is a convicted or | ||||||
25 | registered sex offender or if the Identified Offender Report | ||||||
26 | and Recommendation reveals that the identified offender poses a |
| |||||||
| |||||||
1 | significant risk of harm to others within the facility, the | ||||||
2 | offender shall be required to have his or her own room within | ||||||
3 | the facility. | ||||||
4 | (e) The licensed forensic psychologist shall complete the | ||||||
5 | Identified Offender Report and Recommendation within 14 | ||||||
6 | business days after receiving the Criminal History Report and | ||||||
7 | shall promptly provide the Identified Offender Report and | ||||||
8 | Recommendation to the Department of State Police, which shall | ||||||
9 | provide the Identified Offender Report and Recommendation to | ||||||
10 | the following:
| ||||||
11 | (1) The facility within which the identified offender | ||||||
12 | resides. | ||||||
13 | (2) The Chief of Police of the municipality in which
| ||||||
14 | the facility is located. | ||||||
15 | (3) The State of Illinois Long Term Care Ombudsman. | ||||||
16 | (4) The Department of Public Health. | ||||||
17 | (e-5) The Department of Public Health shall keep a | ||||||
18 | continuing record of all consumers determined to be identified | ||||||
19 | offenders as defined in Section 1-114.01 of the Nursing Home | ||||||
20 | Care Act and shall report the number of identified offender | ||||||
21 | consumers annually to the General Assembly. | ||||||
22 | (f) The facility shall incorporate the Identified Offender | ||||||
23 | Report and Recommendation into the identified offender's care | ||||||
24 | plan created pursuant to 42 CFR 483.20. | ||||||
25 | (g) If, based on the Identified Offender Report and | ||||||
26 | Recommendation, a facility determines that it cannot manage the |
| |||||||
| |||||||
1 | identified offender consumer safely within the facility, it | ||||||
2 | shall commence involuntary transfer or discharge proceedings | ||||||
3 | pursuant to Section 3-402. | ||||||
4 | (h) Except for willful and wanton misconduct, any person | ||||||
5 | authorized to participate in the development of a Criminal | ||||||
6 | History Report or Identified Offender Report and | ||||||
7 | Recommendation is immune from criminal or civil liability for | ||||||
8 | any acts or omissions as the result of his or her good faith | ||||||
9 | effort to comply with this Section."; and | ||||||
10 | on page 19, line 19, after "authorized", by inserting "under | ||||||
11 | Illinois law"; and | ||||||
12 | on page 20, line 2, by replacing the period with "to the | ||||||
13 | Department within 24 hours. Facilities shall comply with | ||||||
14 | Sections 3-610 and 3-810 of the Nursing Home Care Act. The | ||||||
15 | provisions under Sections 3-610 and 3-810 of the Nursing Home | ||||||
16 | Care Act shall apply to employees of facilities licensed under | ||||||
17 | this Act."; and | ||||||
18 | on page 20, line 4, by replacing "or crisis stabilization" with | ||||||
19 | "centers"; and | ||||||
20 | on page 20, line 13, by replacing "knock" with "reasonably | ||||||
21 | announce their intent to enter"; and |
| |||||||
| |||||||
1 | on page 20, immediately below line 15, by inserting the | ||||||
2 | following: | ||||||
3 | "Consumers shall be free to leave at any time. If a | ||||||
4 | consumer in a triage center expresses a desire to contact a | ||||||
5 | third party for any purpose, the facility staff shall contact | ||||||
6 | that third party on behalf of the consumer."; and | ||||||
7 | on page 21, line 6, by replacing "or crisis stabilization" with | ||||||
8 | "centers"; and | ||||||
9 | on page 22, line 12, after the period, by inserting "The | ||||||
10 | Department shall by rule establish criteria, hearings, and | ||||||
11 | procedures for involuntary discharge."; and | ||||||
12 | on page 23, by inserting immediately below line 7 the | ||||||
13 | following: | ||||||
14 | "Section 3-115. Informed consent; restraints. Informed | ||||||
15 | consent shall be required for restraints consistent with the | ||||||
16 | requirements contained in subsection (c) of Section 2-106 of | ||||||
17 | the Nursing Home Care Act. | ||||||
18 | Section 3-116. Experimental research. No consumer shall be | ||||||
19 | subjected to experimental research or treatment without first | ||||||
20 | obtaining his or her informed, written consent. The conduct of | ||||||
21 | any experimental research or treatment shall be authorized and |
| |||||||
| |||||||
1 | monitored by an institutional review board appointed by the | ||||||
2 | executive director. The membership, operating procedures and | ||||||
3 | review criteria for the institutional review board shall be | ||||||
4 | prescribed under rules and regulations of the Department and | ||||||
5 | shall comply with the requirements for institutional review | ||||||
6 | boards established by the federal Food and Drug Administration. | ||||||
7 | No person who has received compensation in the prior 3 years | ||||||
8 | from an entity that manufactures, distributes, or sells | ||||||
9 | pharmaceuticals, biologics, or medical devices may serve on the | ||||||
10 | institutional review board. | ||||||
11 | No facility shall permit experimental research or | ||||||
12 | treatment to be conducted on a consumer, or give access to any | ||||||
13 | person or person's records for a retrospective study about the | ||||||
14 | safety or efficacy of any care or treatment, without the prior | ||||||
15 | written approval of the institutional review board. No | ||||||
16 | executive director, or person licensed by the State to provide | ||||||
17 | medical care or treatment to any person, may assist or | ||||||
18 | participate in any experimental research on or treatment of a | ||||||
19 | consumer, including a retrospective study, that does not have | ||||||
20 | the prior written approval of the board. Such conduct shall be | ||||||
21 | grounds for professional discipline by the Department of | ||||||
22 | Financial and Professional Regulation. | ||||||
23 | The institutional review board may exempt from ongoing | ||||||
24 | review research or treatment initiated on a consumer before the | ||||||
25 | individual's admission to a facility and for which the board | ||||||
26 | determines there is adequate ongoing oversight by another |
| |||||||
| |||||||
1 | institutional review board. Nothing in this Section shall | ||||||
2 | prevent a facility, any facility employee, or any other person | ||||||
3 | from assisting or participating in any experimental research on | ||||||
4 | or treatment of a consumer, if the research or treatment began | ||||||
5 | before the person's admission to a facility, until the board | ||||||
6 | has reviewed the research or treatment and decided to grant or | ||||||
7 | deny approval or to exempt the research or treatment from | ||||||
8 | ongoing review."; and | ||||||
9 | on page 23, line 15, by replacing "units" with "centers"; and | ||||||
10 | on page 30, line 12, by replacing "units" with "centers"; and | ||||||
11 | on page 30, line 24, after "triage", by inserting "centers"; | ||||||
12 | and | ||||||
13 | on page 31, line 7, after "checks", by inserting ", consistent | ||||||
14 | with Section 1-114.01, subsections (b) and (c) of Section | ||||||
15 | 2-201.5, and Section 2-201.6 of the Nursing Home Care Act"; and | ||||||
16 | on page 31, line 16, after "check", by inserting ", consistent | ||||||
17 | with the Health Care Worker Background Check Act"; and | ||||||
18 | on page 33, line 14 by inserting after "Act" the following: | ||||||
19 | "and the rules promulgated under this Act. The Department shall | ||||||
20 | have access to and may reproduce or photocopy any books, |
| |||||||
| |||||||
1 | records, and other documents maintained by the facility to the | ||||||
2 | extent necessary to carry out this Act and the rules | ||||||
3 | promulgated under this Act. The Department shall not divulge or | ||||||
4 | disclose the contents of a record under this Section as | ||||||
5 | otherwise prohibited by this Act. Any holder of a license or | ||||||
6 | applicant for a license shall be deemed to have given consent | ||||||
7 | to any authorized officer, employee, or agent of the Department | ||||||
8 | to enter and inspect the facility in accordance with this | ||||||
9 | Article. Refusal to permit such entry or inspection shall | ||||||
10 | constitute grounds for denial, suspension, or revocation of a | ||||||
11 | license under this Act"; and | ||||||
12 | on page 33, line 15, by deleting "scheduled"; and | ||||||
13 | on page 33, line 16, by deleting "unscheduled"; and | ||||||
14 | on page 34, by replacing lines 2 and 3 with the following: | ||||||
15 | "(a) The Department may revoke a license for any failure to | ||||||
16 | substantially comply with this Act and the rules promulgated | ||||||
17 | under this Act, including, but not limited to, the following:"; | ||||||
18 | and | ||||||
19 | on page 34, line 5, by replacing "or" with "and"; and | ||||||
20 | on page 35, line 3, by replacing "the standards of this" with | ||||||
21 | "this Act and the rules promulgated under this Act."; and |
| |||||||
| |||||||
1 | on page 35, by deleting line 4; and | ||||||
2 | on page 35, line 5, by replacing "the standards" with "this Act | ||||||
3 | and the rules promulgated under this Act"; and | ||||||
4 | on page 35, line 8, by replacing "the standards" with "this Act | ||||||
5 | and the rules promulgated under this Act"; and | ||||||
6 | on page 35, line 11, by replacing "the standards" with "this | ||||||
7 | Act and the rules promulgated under this Act"; and | ||||||
8 | on page 35, lines 15 and 16, by replacing "the standards. The | ||||||
9 | agency" with "this Act and the rules promulgated under this | ||||||
10 | Act. The facility"; and | ||||||
11 | on page 36, line 7, by replacing "Part" with "Act or the rules | ||||||
12 | promulgated under this Act"; and | ||||||
13 | on page 36, line 8, by replacing "agency" with "facility"; and | ||||||
14 | on page 36, line 17, by replacing "Part" with "Act or the rules | ||||||
15 | promulgated under this Act"; and | ||||||
16 | on page 36, line 18, by replacing "standards" with "this Act | ||||||
17 | and the rules promulgated under this Act"; and |
| |||||||
| |||||||
1 | on page 36, line 22, by replacing "agency" with "facility"; and | ||||||
2 | on page 36, line 23, by replacing "agency" with "facility"; and | ||||||
3 | on page 37, line 10, by replacing "agency" with "facility"; and | ||||||
4 | on page 37, line 11, by replacing "agency" with "facility"; and | ||||||
5 | on page 39, by inserting immediately below line 1 the | ||||||
6 | following: | ||||||
7 | "Section 4-111. Notwithstanding the existence or pursuit | ||||||
8 | of any other remedy, the Director of the Department may, in the | ||||||
9 | manner provided by law, upon the advice of the Attorney General | ||||||
10 | who shall represent the Director of the Department in the | ||||||
11 | proceedings, maintain an action in the name of the State for | ||||||
12 | injunction or other process against any person or governmental | ||||||
13 | unit to restrain or prevent the establishment of a facility | ||||||
14 | without a license issued pursuant to this Act, or to restrain | ||||||
15 | or prevent the opening, conduction, operating, or maintaining | ||||||
16 | of a facility without a license issued pursuant to this Act. In | ||||||
17 | addition, the Director of the Department may, in the manner | ||||||
18 | provided by law, in the name of the People of the State and | ||||||
19 | through the Attorney General who shall represent the Director | ||||||
20 | of the Department in the proceedings, maintain an action for |
| |||||||
| |||||||
1 | injunction or other relief or process against any licensee or | ||||||
2 | other person to enforce and compel compliance with the | ||||||
3 | provisions of this Act and the standards, rules, and | ||||||
4 | regulations established by virtue of this Act and any order | ||||||
5 | entered for any response action pursuant to this Act and such | ||||||
6 | standards, rules, and regulations."; and | ||||||
7 | by deleting lines 7 through 23 of page 490, all of pages 491 | ||||||
8 | through 538, and lines 1 through 20 of page 539; and | ||||||
9 | on page 539, immediately below line 21, by inserting the | ||||||
10 | following: | ||||||
11 | "Section 11-1. The Illinois Public Aid Code is amended by | ||||||
12 | changing Section 14-8 as follows:
| ||||||
13 | (305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
| ||||||
14 | Sec. 14-8. Disbursements to Hospitals.
| ||||||
15 | (a) For inpatient hospital services rendered on and after | ||||||
16 | September 1,
1991, the Illinois Department shall reimburse
| ||||||
17 | hospitals for inpatient services at an inpatient payment rate | ||||||
18 | calculated for
each hospital based upon the Medicare | ||||||
19 | Prospective Payment System as set forth
in Sections 1886(b), | ||||||
20 | (d), (g), and (h) of the federal Social Security Act, and
the | ||||||
21 | regulations, policies, and procedures promulgated thereunder, | ||||||
22 | except as
modified by this Section. Payment rates for inpatient |
| |||||||
| |||||||
1 | hospital services
rendered on or after September 1, 1991 and on | ||||||
2 | or before September 30, 1992
shall be calculated using the | ||||||
3 | Medicare Prospective Payment rates in effect on
September 1, | ||||||
4 | 1991. Payment rates for inpatient hospital services rendered on
| ||||||
5 | or after October 1, 1992 and on or before March 31, 1994 shall | ||||||
6 | be calculated
using the Medicare Prospective Payment rates in | ||||||
7 | effect on September 1, 1992.
Payment rates for inpatient | ||||||
8 | hospital services rendered on or after April 1,
1994 shall be | ||||||
9 | calculated using the Medicare Prospective Payment rates
| ||||||
10 | (including the Medicare grouping methodology and weighting | ||||||
11 | factors as adjusted
pursuant to paragraph (1) of this | ||||||
12 | subsection) in effect 90 days prior to the
date of admission. | ||||||
13 | For services rendered on or after July 1, 1995, the
| ||||||
14 | reimbursement methodology implemented under this subsection | ||||||
15 | shall not include
those costs referred to in Sections | ||||||
16 | 1886(d)(5)(B) and 1886(h) of the Social
Security Act. The | ||||||
17 | additional payment amounts required under Section
| ||||||
18 | 1886(d)(5)(F) of the Social Security Act, for hospitals serving | ||||||
19 | a
disproportionate share of low-income or indigent patients, | ||||||
20 | are not required
under this Section. For hospital inpatient | ||||||
21 | services rendered on or after July
1, 1995, the Illinois | ||||||
22 | Department shall
reimburse hospitals using the relative | ||||||
23 | weighting factors and the base payment
rates calculated for | ||||||
24 | each hospital that were in effect on June 30, 1995, less
the | ||||||
25 | portion of such rates attributed by the Illinois Department to | ||||||
26 | the cost of
medical education.
|
| |||||||
| |||||||
1 | (1) The weighting factors established under Section | ||||||
2 | 1886(d)(4) of the
Social Security Act shall not be used in | ||||||
3 | the reimbursement system
established under this Section. | ||||||
4 | Rather, the Illinois Department shall
establish by rule | ||||||
5 | Medicaid weighting factors to be used in the reimbursement
| ||||||
6 | system established under this Section.
| ||||||
7 | (2) The Illinois Department shall define by rule those | ||||||
8 | hospitals or
distinct parts of hospitals that shall be | ||||||
9 | exempt from the reimbursement
system established under | ||||||
10 | this Section. In defining such hospitals, the
Illinois | ||||||
11 | Department shall take into consideration those hospitals | ||||||
12 | exempt
from the Medicare Prospective Payment System as of | ||||||
13 | September 1, 1991. For
hospitals defined as exempt under | ||||||
14 | this subsection, the Illinois Department
shall by rule | ||||||
15 | establish a reimbursement system for payment of inpatient
| ||||||
16 | hospital services rendered on and after September 1, 1991. | ||||||
17 | For all
hospitals that are children's hospitals as defined | ||||||
18 | in Section 5-5.02 of
this Code, the reimbursement | ||||||
19 | methodology shall, through June 30, 1992, net
of all | ||||||
20 | applicable fees, at least equal each children's hospital | ||||||
21 | 1990 ICARE
payment rates, indexed to the current year by | ||||||
22 | application of the DRI hospital
cost index from 1989 to the | ||||||
23 | year in which payments are made. Excepting county
providers | ||||||
24 | as defined in Article XV of this Code, hospitals licensed | ||||||
25 | under the
University of Illinois Hospital Act, and | ||||||
26 | facilities operated by the
Department of Mental Health and |
| |||||||
| |||||||
1 | Developmental Disabilities (or its successor,
the | ||||||
2 | Department of Human Services) for hospital inpatient | ||||||
3 | services rendered on
or after July 1, 1995, the Illinois | ||||||
4 | Department shall reimburse children's
hospitals, as | ||||||
5 | defined in 89 Illinois Administrative Code Section | ||||||
6 | 149.50(c)(3),
at the rates in effect on June 30, 1995, and | ||||||
7 | shall reimburse all other
hospitals at the rates in effect | ||||||
8 | on June 30, 1995, less the portion of such
rates attributed | ||||||
9 | by the Illinois Department to the cost of medical | ||||||
10 | education.
For inpatient hospital services provided on or | ||||||
11 | after August 1, 1998, the
Illinois Department may establish | ||||||
12 | by rule a means of adjusting the rates of
children's | ||||||
13 | hospitals, as defined in 89 Illinois Administrative Code | ||||||
14 | Section
149.50(c)(3), that did not meet that definition | ||||||
15 | before February 28, 2013 on June 30, 1995 , in order
for the | ||||||
16 | inpatient hospital rates of such hospitals to take into | ||||||
17 | account the
average inpatient hospital rates of those | ||||||
18 | children's hospitals that did meet
the definition of | ||||||
19 | children's hospitals before February 28, 2013. The | ||||||
20 | Department shall adopt any emergency rules necessary to
| ||||||
21 | implement this Section on June 30, 1995 .
| ||||||
22 | (3) (Blank) .
| ||||||
23 | (4) Notwithstanding any other provision of this | ||||||
24 | Section, hospitals
that on August 31, 1991, have a contract | ||||||
25 | with the Illinois Department under
Section 3-4 of the | ||||||
26 | Illinois Health Finance Reform Act may elect to continue
to |
| |||||||
| |||||||
1 | be reimbursed at rates stated in such contracts for general | ||||||
2 | and specialty
care.
| ||||||
3 | (5) In addition to any payments made under this | ||||||
4 | subsection (a), the
Illinois Department shall make the | ||||||
5 | adjustment payments required by Section
5-5.02 of this | ||||||
6 | Code; provided, that in the case of any hospital reimbursed
| ||||||
7 | under a per case methodology, the Illinois Department shall | ||||||
8 | add an amount
equal to the product of the hospital's | ||||||
9 | average length of stay, less one
day, multiplied by 20, for | ||||||
10 | inpatient hospital services rendered on or
after September | ||||||
11 | 1, 1991 and on or before September 30, 1992.
| ||||||
12 | (b) (Blank) .
| ||||||
13 | (b-5) Excepting county providers as defined in Article XV | ||||||
14 | of this Code,
hospitals licensed under the University of | ||||||
15 | Illinois Hospital Act, and
facilities operated by the Illinois | ||||||
16 | Department of Mental Health and
Developmental Disabilities (or | ||||||
17 | its successor, the Department of Human
Services), for | ||||||
18 | outpatient services rendered on or after July 1, 1995
and | ||||||
19 | before July 1, 1998 the Illinois Department shall reimburse
| ||||||
20 | children's hospitals, as defined in the Illinois | ||||||
21 | Administrative Code
Section 149.50(c)(3), at the rates in | ||||||
22 | effect on June 30, 1995, less that
portion of such rates | ||||||
23 | attributed by the Illinois Department to the outpatient
| ||||||
24 | indigent volume adjustment and shall reimburse all other | ||||||
25 | hospitals at the rates
in effect on June 30, 1995, less the | ||||||
26 | portions of such rates attributed by the
Illinois Department to |
| |||||||
| |||||||
1 | the cost of medical education and attributed by the
Illinois | ||||||
2 | Department to the outpatient indigent volume adjustment. For
| ||||||
3 | outpatient services provided on or after July 1, 1998, | ||||||
4 | reimbursement rates
shall be established by rule.
| ||||||
5 | (c) In addition to any other payments under this Code, the | ||||||
6 | Illinois
Department shall develop a hospital disproportionate | ||||||
7 | share reimbursement
methodology that, effective July 1, 1991, | ||||||
8 | through September 30, 1992,
shall reimburse hospitals | ||||||
9 | sufficiently to expend the fee monies described
in subsection | ||||||
10 | (b) of Section 14-3 of this Code and the federal matching
funds | ||||||
11 | received by the Illinois Department as a result of expenditures | ||||||
12 | made
by the Illinois Department as required by this subsection | ||||||
13 | (c) and Section
14-2 that are attributable to fee monies | ||||||
14 | deposited in the Fund, less
amounts applied to adjustment | ||||||
15 | payments under Section 5-5.02.
| ||||||
16 | (d) Critical Care Access Payments.
| ||||||
17 | (1) In addition to any other payments made under this | ||||||
18 | Code,
the Illinois Department shall develop a | ||||||
19 | reimbursement methodology that shall
reimburse Critical | ||||||
20 | Care Access Hospitals for the specialized services that
| ||||||
21 | qualify them as Critical Care Access Hospitals. No | ||||||
22 | adjustment payments shall be
made under this subsection on | ||||||
23 | or after July 1, 1995.
| ||||||
24 | (2) "Critical Care Access Hospitals" includes, but is | ||||||
25 | not limited to,
hospitals that meet at least one of the | ||||||
26 | following criteria:
|
| |||||||
| |||||||
1 | (A) Hospitals located outside of a metropolitan | ||||||
2 | statistical area that
are designated as Level II | ||||||
3 | Perinatal Centers and that provide a
disproportionate | ||||||
4 | share of perinatal services to recipients; or
| ||||||
5 | (B) Hospitals that are designated as Level I Trauma | ||||||
6 | Centers (adult
or pediatric) and certain Level II | ||||||
7 | Trauma Centers as determined by the
Illinois | ||||||
8 | Department; or
| ||||||
9 | (C) Hospitals located outside of a metropolitan | ||||||
10 | statistical area and
that provide a disproportionate | ||||||
11 | share of obstetrical services to recipients.
| ||||||
12 | (e) Inpatient high volume adjustment. For hospital | ||||||
13 | inpatient services,
effective with rate periods beginning on or | ||||||
14 | after October 1, 1993, in
addition to rates paid for inpatient | ||||||
15 | services by the Illinois Department, the
Illinois Department | ||||||
16 | shall make adjustment payments for inpatient services
| ||||||
17 | furnished by Medicaid high volume hospitals. The Illinois | ||||||
18 | Department shall
establish by rule criteria for qualifying as a | ||||||
19 | Medicaid high volume hospital
and shall establish by rule a | ||||||
20 | reimbursement methodology for calculating these
adjustment | ||||||
21 | payments to Medicaid high volume hospitals. No adjustment | ||||||
22 | payment
shall be made under this subsection for services | ||||||
23 | rendered on or after July 1,
1995.
| ||||||
24 | (f) The Illinois Department shall modify its current rules | ||||||
25 | governing
adjustment payments for targeted access, critical | ||||||
26 | care access, and
uncompensated care to classify those |
| |||||||
| |||||||
1 | adjustment payments as not being payments
to disproportionate | ||||||
2 | share hospitals under Title XIX of the federal Social
Security | ||||||
3 | Act. Rules adopted under this subsection shall not be effective | ||||||
4 | with
respect to services rendered on or after July 1, 1995. The | ||||||
5 | Illinois Department
has no obligation to adopt or implement any | ||||||
6 | rules or make any payments under
this subsection for services | ||||||
7 | rendered on or after July 1, 1995.
| ||||||
8 | (f-5) The State recognizes that adjustment payments to | ||||||
9 | hospitals providing
certain services or incurring certain | ||||||
10 | costs may be necessary to assure that
recipients of medical | ||||||
11 | assistance have adequate access to necessary medical
services. | ||||||
12 | These adjustments include payments for teaching costs and
| ||||||
13 | uncompensated care, trauma center payments, rehabilitation | ||||||
14 | hospital payments,
perinatal center payments, obstetrical care | ||||||
15 | payments, targeted access payments,
Medicaid high volume | ||||||
16 | payments, and outpatient indigent volume payments. On or
before | ||||||
17 | April 1, 1995, the Illinois Department shall issue | ||||||
18 | recommendations
regarding (i) reimbursement mechanisms or | ||||||
19 | adjustment payments to reflect these
costs and services, | ||||||
20 | including methods by which the payments may be calculated
and | ||||||
21 | the method by which the payments may be financed, and (ii) | ||||||
22 | reimbursement
mechanisms or adjustment payments to reflect | ||||||
23 | costs and services of federally
qualified health centers with | ||||||
24 | respect to recipients of medical assistance.
| ||||||
25 | (g) If one or more hospitals file suit in any court | ||||||
26 | challenging any part of
this Article XIV, payments to hospitals |
| |||||||
| |||||||
1 | under this Article XIV shall be made
only to the extent that | ||||||
2 | sufficient monies are available in the Fund and only to
the | ||||||
3 | extent that any monies in the Fund are not prohibited from | ||||||
4 | disbursement
under any order of the court.
| ||||||
5 | (h) Payments under the disbursement methodology described | ||||||
6 | in this Section
are subject to approval by the federal | ||||||
7 | government in an appropriate State plan
amendment.
| ||||||
8 | (i) The Illinois Department may by rule establish criteria | ||||||
9 | for and develop
methodologies for adjustment payments to | ||||||
10 | hospitals participating under this
Article.
| ||||||
11 | (j) Hospital Residing Long Term Care Services. In addition | ||||||
12 | to any other
payments made under this Code, the Illinois | ||||||
13 | Department may by rule establish
criteria and develop | ||||||
14 | methodologies for payments to hospitals for Hospital
Residing | ||||||
15 | Long Term Care Services.
| ||||||
16 | (k) Critical Access Hospital outpatient payments. In | ||||||
17 | addition to any other payments authorized under this Code, the | ||||||
18 | Illinois Department shall reimburse critical access hospitals, | ||||||
19 | as designated by the Illinois Department of Public Health in | ||||||
20 | accordance with 42 CFR 485, Subpart F, for outpatient services | ||||||
21 | at an amount that is no less than the cost of providing such | ||||||
22 | services, based on Medicare cost principles. Payments under | ||||||
23 | this subsection shall be subject to appropriation. | ||||||
24 | (l) On and after July 1, 2012, the Department shall reduce | ||||||
25 | any rate of reimbursement for services or other payments or | ||||||
26 | alter any methodologies authorized by this Code to reduce any |
| |||||||
| |||||||
1 | rate of reimbursement for services or other payments in | ||||||
2 | accordance with Section 5-5e. | ||||||
3 | (Source: P.A. 96-1382, eff. 1-1-11; 97-689, eff. 6-14-12; | ||||||
4 | revised 8-3-12.)"; and
| ||||||
5 | on page 544, line 26, after " research ", by inserting " and | ||||||
6 | education "; and | ||||||
7 | on page 545, line 17, after " research ", by inserting " and | ||||||
8 | education "; and | ||||||
9 | on page 548, by deleting lines 8 and 9; and | ||||||
10 | on page 561, by replacing lines 15 through 16 with "a | ||||||
11 | municipality prior to September 30,
1998 or (ii) the hospital | ||||||
12 | has been designated by the State"; and | ||||||
13 | on page 578, line 24 by replacing " resident " with " residents "; | ||||||
14 | and | ||||||
15 | on page 582, line 12 by inserting before " Transition " the | ||||||
16 | following: | ||||||
17 | " For dates of services beginning January 1, 2014, the RUG-IV | ||||||
18 | nursing component per diem for a nursing home shall be the | ||||||
19 | product of the statewide RUG-IV nursing base per diem rate, the | ||||||
20 | facility average case mix index, and the regional wage |
| |||||||
| |||||||
1 | adjustor. "; and | ||||||
2 | on page 582, line 15 by replacing " subsection (d-1) " with " this | ||||||
3 | subsection (e-2) "; and | ||||||
4 | on page 582, line 25 by replacing " subsection (d-1) " with " this | ||||||
5 | subsection (e-2) "; and | ||||||
6 | on page 584, line 21, after " triage " by inserting " center "; and | ||||||
7 | on page 585, by inserting immediately below line 13 the | ||||||
8 | following: | ||||||
9 | "Section 11-45. The Illinois Public Aid Code is amended by | ||||||
10 | adding Section 5-5.4h as follows: | ||||||
11 | (305 ILCS 5/5-5.4h new) | ||||||
12 | Sec. 5-5.4h. Medicaid reimbursement for pediatric skilled | ||||||
13 | nursing facilities. | ||||||
14 | (a) Facilities uniquely licensed as pediatric skilled | ||||||
15 | nursing facilities that serve severely and chronically ill | ||||||
16 | pediatric patients shall have a specific reimbursement system | ||||||
17 | designed to recognize the characteristics and needs of the | ||||||
18 | patients they serve. | ||||||
19 | (b) For dates of services starting July 1, 2013 and until a | ||||||
20 | new reimbursement system is designed, pediatric skilled |
| |||||||
| |||||||
1 | nursing facilities that meet the following criteria: | ||||||
2 | (1) serve exceptional care patients; and | ||||||
3 | (2) have 30% or more of their patients receiving | ||||||
4 | ventilator care; | ||||||
5 | shall receive Medicaid reimbursement on a 30-day expedited | ||||||
6 | schedule. "; and | ||||||
7 | on page 596, line 11, by replacing " 60 " with " 75 "; and | ||||||
8 | on page 597, by replacing lines 1 through 3 with the following: | ||||||
9 | " the portions of the health and life safety survey | ||||||
10 | associated with federal certification and State licensure | ||||||
11 | surveys must be started within 7 working days of each | ||||||
12 | other. Nothing in this paragraph (1) of subsection (f) of | ||||||
13 | this Section applies to a complaint investigation. "; and | ||||||
14 | on page 597, line 4, after " complaint ", by inserting " and | ||||||
15 | incident report "; and | ||||||
16 | on page 597, by replacing lines 5 and 6 with the following: | ||||||
17 | " shall permit the facility to challenge the amount of the fine | ||||||
18 | due to the excessive length of "; and | ||||||
19 | on page 597, immediately below line 15, by inserting the | ||||||
20 | following: |
| |||||||
| |||||||
1 | " This paragraph (2) does not apply to complaint | ||||||
2 | investigations exited within 14 working days or a situation | ||||||
3 | that triggers an extended survey. "; and | ||||||
4 | on page 624, line 8, after " occurred, ", by inserting " and the | ||||||
5 | facility in which the applicant resides is notified, "; and | ||||||
6 | on page 625, line 5, by replacing " 2014 " with " 2013 "; and | ||||||
7 | on page 625, line 6, by replacing " 2015 " with " 2014 ".
|