98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB1808

 

Introduced 2/15/2013, by Sen. William Delgado

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/14-11

    Amends the Hospital Services Trust Fund Article of the Illinois Public Aid Code. Provides that payments shall not be made for inpatient services under an All Patient Refined Diagnosis Related Groups (APR-DRG) payment system until individual hospitals have received 9 months of claims processed under the APR-DRG system. Provides that payments shall not be made for outpatient services under an Enhanced Ambulatory Procedure Grouping (EAPG) system until individual hospitals have received 9 months of claims processed under the EAPG system. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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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 14-11 as follows:
 
6    (305 ILCS 5/14-11)
7    Sec. 14-11. Hospital payment reform.
8    (a) The Department may, by rule, implement the All Patient
9Refined Diagnosis Related Groups (APR-DRG) payment system for
10inpatient services provided on or after July 1, 2013, in a
11manner consistent with the actions authorized in this Section.
12    (b) On or before October 1, 2012 and through June 30, 2013,
13the Department shall begin testing the APR-DRG system. During
14the testing period the Department shall process and price
15inpatient services using the APR-DRG system; however, actual
16payments for those inpatient services shall be made using the
17current reimbursement system. During the testing period, the
18Department, in collaboration with the statewide representative
19of hospitals, shall provide information and technical
20assistance to hospitals to encourage and facilitate their
21transition to the APR-DRG system.
22    (c) The Department may, by rule, implement the Enhanced
23Ambulatory Procedure Grouping (EAPG) system for outpatient

 

 

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1services provided on or after January 1, 2014, in a manner
2consistent with the actions authorized in this Section. On or
3before January 1, 2013 and through December 31, 2013, the
4Department shall begin testing the EAPG system. During the
5testing period the Department shall process and price
6outpatient services using the EAPG system; however, actual
7payments for those outpatient services shall be made using the
8current reimbursement system. During the testing period, the
9Department, in collaboration with the statewide representative
10of hospitals, shall provide information and technical
11assistance to hospitals to encourage and facilitate their
12transition to the EAPG system.
13    (d) The Department in consultation with the current
14hospital technical advisory group shall review the test claims
15for inpatient and outpatient services at least monthly,
16including the estimated impact on hospitals, and, in developing
17the rules, policies, and procedures to implement the new
18payment systems, shall consider at least the following issues:
19        (1) The use of national relative weights provided by
20    the vendor of the APR-DRG system, adjusted to reflect
21    characteristics of the Illinois Medical Assistance
22    population.
23        (2) An updated outlier payment methodology based on
24    current data and consistent with the APR-DRG system.
25        (3) The use of policy adjusters to enhance payments to
26    hospitals treating a high percentage of individuals

 

 

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1    covered by the Medical Assistance program and uninsured
2    patients.
3        (4) Reimbursement for inpatient specialty services
4    such as psychiatric, rehabilitation, and long-term acute
5    care using updated per diem rates that account for service
6    acuity.
7        (5) The creation of one or more transition funding
8    pools to preserve access to care and to ensure financial
9    stability as hospitals transition to the new payment
10    system.
11        (6) Whether, beginning July 1, 2014, some of the static
12    adjustment payments financed by General Revenue funds
13    should be used as part of the base payment system,
14    including as policy adjusters to recognize the additional
15    costs of certain services, such as pediatric or neonatal,
16    or providers, such as trauma centers, Critical Access
17    Hospitals, or high Medicaid hospitals, or for services to
18    uninsured patients.
19    (e) The Department shall provide the association
20representing the majority of hospitals in Illinois, as the
21statewide representative of the hospital community, with a
22monthly file of claims adjudicated under the test system for
23the purpose of review and analysis as part of the collaboration
24between the State and the hospital community. The file shall
25consist of a de-identified extract compliant with the Health
26Insurance Portability and Accountability Act (HIPAA).

 

 

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1    (f) The current hospital technical advisory group shall
2make recommendations for changes during the testing period and
3recommendations for changes prior to the effective dates of the
4new payment systems. The Department shall draft administrative
5rules to implement the new payment systems and provide them to
6the technical advisory group at least 90 days prior to the
7proposed effective dates of the new payment systems.
8    (g) The payments to hospitals financed by the current
9hospital assessment, authorized under Article V-A of this Code,
10are scheduled to sunset on June 30, 2014. The continuation of
11or revisions to the hospital assessment program shall take into
12consideration the impact on hospitals and access to care as a
13result of the changes to the hospital payment system.
14    (h) Beginning July 1, 2014, the Department may transition
15current General Revenue funded supplemental payments into the
16claims based system over a period of no less than 2 years from
17the implementation date of the new payment systems and no more
18than 4 years from the implementation date of the new payment
19systems, provided however that the Department may adopt, by
20rule, supplemental payments to help ensure access to care in a
21geographic area or to help ensure access to specialty services.
22For any supplemental payments that are adopted that are based
23on historic data, the data shall be no older than 3 years and
24the supplemental payment shall be effective for no longer than
252 years before requiring the data to be updated.
26    (i) Any payments authorized under 89 Illinois

 

 

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1Administrative Code 148 set to expire in State fiscal year 2012
2and that were paid out to hospitals in State fiscal year 2012
3shall remain in effect as long as the assessment imposed by
4Section 5A-2 is in effect.
5    (j) Subsections (a) and (c) of this Section shall remain
6operative unless the Auditor General has reported that: (i) the
7Department has not undertaken the required actions listed in
8the report required by subsection (a) of Section 2-20 of the
9Illinois State Auditing Act; or (ii) the Department has failed
10to comply with the reporting requirements of Section 2-20 of
11the Illinois State Auditing Act.
12    (k) Subsections (a) and (c) of this Section shall not be
13operative until final federal approval by the Centers for
14Medicare and Medicaid Services of the U.S. Department of Health
15and Human Services and implementation of all of the payments
16and assessments in Article V-A in its form as of the effective
17date of this amendatory Act of the 97th General Assembly or as
18it may be amended.
19    (l) Payments shall not be made for inpatient services under
20an APR-DRG system authorized under subsection (a) until
21individual hospitals have received 9 months of claims processed
22under the APR-DRG system including any modifications agreed
23upon under subsection (d).
24    (m) Payments shall not be made for outpatient services
25under an EAPG system authorized under subsection (c) until
26individual hospitals have received 9 months of claims processed

 

 

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1under the EAPG system including any modifications agreed upon
2under subsection (d).
3(Source: P.A. 97-689, eff. 6-14-12.)
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.