Illinois General Assembly - Full Text of HB5179
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Full Text of HB5179  102nd General Assembly

HB5179 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB5179

 

Introduced 1/27/2022, by Rep. Lindsey LaPointe

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-41

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in light of the heightened risk of overdose if a patient is discharged and not linked to treatment and recovery supports, and the need for appropriate access to the treatment and services available via community-based substance use disorder and mental health providers, the Department of Healthcare and Family Services and each hospital shall ensure coordination of care and treatment for each patient with community-based mental health and substance use disorder treatment providers. Requires hospitals to coordinate and collaborate with community-based providers by: (i) providing a warm handoff of patients in need of treatment and recovery support services to community-based providers; (ii) collaborating with community-based providers on the provision of 24/7 access to transitioning patients prior to discharge from the hospital; (iii) working with community-based providers on fully implementing substance use disorder treatment and recovery supports through existing and new hospital-located community-based provider projects; and (iv) engaging in such other programs established by the Department to prioritize treatment within the community-based system to the extent such treatment is deemed to best serve a patient, is considered medically necessary, and is fiscally prudent. Provides that if a hospital fails to address these requirements prior to discharging a patient, the provider shall forgo reimbursement for any observation or admission services provided to the patient.


LRB102 24822 KTG 34067 b

 

 

A BILL FOR

 

HB5179LRB102 24822 KTG 34067 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 5-41 as follows:
 
6    (305 ILCS 5/5-41)
7    Sec. 5-41. Inpatient hospitalization for opioid-related
8overdose or withdrawal patients.
9    (a) Due to the disproportionately high opioid-related
10fatality rates among African Americans in under-resourced
11communities in Illinois, the lack of community resources, the
12comorbidities experienced by these patients, and the high rate
13of hospital inpatient recidivism associated with this
14population when improperly treated, the Department shall
15ensure that patients, whether enrolled under the Medical
16Assistance Fee For Service program or enrolled with a Medicaid
17Managed Care Organization, experiencing opioid-related
18overdose or withdrawal are admitted on an inpatient status and
19the provider shall be reimbursed accordingly, when deemed
20medically necessary, as determined by either the patient's
21primary care physician, or the physician or other practitioner
22responsible for the patient's care at the hospital to which
23the patient presents, using criteria established by the

 

 

HB5179- 2 -LRB102 24822 KTG 34067 b

1American Society of Addiction Medicine. If it is determined by
2the physician or other practitioner responsible for the
3patient's care at the hospital to which the patient presents,
4that a patient does not meet medical necessity criteria for
5the admission, then the patient may be treated via observation
6and the provider shall seek reimbursement accordingly. Nothing
7in this Section shall diminish the requirements of a provider
8to document medical necessity in the patient's record.
9    (b) In light of the heightened risk of overdose if a
10patient is discharged and not linked to treatment and recovery
11supports, and the need for appropriate access to the treatment
12and services available via community-based substance use
13disorder and mental health providers, notwithstanding
14subsection (a), the Department and each hospital shall ensure
15coordination of care and treatment for each patient with
16community-based mental health and substance use disorder
17treatment providers. Hospitals shall coordinate and
18collaborate with community-based providers by:
19        (1) providing a warm handoff of patients in need of
20    treatment and recovery support services to community-based
21    providers;
22        (2) collaborating with community-based providers on
23    the provision of 24/7 access to transitioning patients
24    prior to discharge from the hospital;
25        (3) working with community-based providers on fully
26    implementing substance use disorder treatment and recovery

 

 

HB5179- 3 -LRB102 24822 KTG 34067 b

1    supports through existing and new hospital-located
2    community-based provider projects; and
3        (4) engaging in such other programs established by the
4    Department to prioritize treatment within the
5    community-based system to the extent such treatment is
6    deemed to best serve a patient, is considered medically
7    necessary, and is fiscally prudent.
8    (c) If a hospital fails to address the requirements of
9subsection (b) prior to discharging a patient, the provider
10shall forgo reimbursement for any observation or admission
11services provided to the patient.
12(Source: P.A. 102-43, eff. 7-6-21.)