Illinois General Assembly - Full Text of SB2898
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Full Text of SB2898  100th General Assembly




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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 5-5.4h as follows:
6    (305 ILCS 5/5-5.4h)
7    Sec. 5-5.4h. Medicaid reimbursement for medically complex
8for the developmentally disabled facilities licensed under the
9MC/DD Act long-term care facilities for persons under 22 years
10of age.
11    (a) Facilities licensed as medically complex for the
12developmentally disabled facilities long-term care facilities
13for persons under 22 years of age that serve severely and
14chronically ill pediatric patients shall have a specific
15reimbursement system designed to recognize the characteristics
16and needs of the patients they serve.
17    (b) For dates of services starting July 1, 2013 and until a
18new reimbursement system is designed, medically complex for the
19developmentally disabled facilities long-term care facilities
20for persons under 22 years of age that meet the following
22        (1) serve exceptional care patients; and
23        (2) have 30% or more of their patients receiving



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1    ventilator care;
2shall receive Medicaid reimbursement on a 30-day expedited
4    (c) Subject to federal approval of changes to the Title XIX
5State Plan, for dates of services starting July 1, 2014 through
6March 31, 2019, medically complex for the developmentally
7disabled facilities and until a new reimbursement system is
8designed, long-term care facilities for persons under 22 years
9of age which meet the criteria in subsection (b) of this
10Section shall receive a per diem rate for clinically complex
11residents of $304. Clinically complex residents on a ventilator
12shall receive a per diem rate of $669. Subject to federal
13approval of changes to the Title XIX State Plan, for dates of
14services starting April 1, 2019, medically complex for the
15developmentally disabled facilities must be reimbursed an
16exceptional care per diem rate, instead of the base rate, for
17services to residents with complex or extensive medical needs.
18Exceptional care per diem rates must be paid for the conditions
19or services specified under subsection (f) at the following per
20diem rates: Tier 1 $326, Tier 2 $546, and Tier 3 $735.
21    (d) For To qualify for the per diem rate of $669 for
22clinically complex residents on a ventilator pursuant to
23subsection (c) or subsection (f), facilities shall have a
24policy documenting their method of routine assessment of a
25resident's weaning potential with interventions implemented
26noted in the resident's medical record.



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1    (e) For services provided prior to April 1, 2019 and for
2For the purposes of this Section, a resident is considered
3clinically complex if the resident requires at least one of the
4following medical services:
5        (1) Tracheostomy care with dependence on mechanical
6    ventilation for a minimum of 6 hours each day.
7        (2) Tracheostomy care requiring suctioning at least
8    every 6 hours, room air mist or oxygen as needed, and
9    dependence on one of the treatment procedures listed under
10    paragraph (4) excluding the procedure listed in
11    subparagraph (A) of paragraph (4).
12        (3) Total parenteral nutrition or other intravenous
13    nutritional support and one of the treatment procedures
14    listed under paragraph (4).
15        (4) The following treatment procedures apply to the
16    conditions in paragraphs (2) and (3) of this subsection:
17            (A) Intermittent suctioning at least every 8 hours
18        and room air mist or oxygen as needed.
19            (B) Continuous intravenous therapy including
20        administration of therapeutic agents necessary for
21        hydration or of intravenous pharmaceuticals; or
22        intravenous pharmaceutical administration of more than
23        one agent via a peripheral or central line, without
24        continuous infusion.
25            (C) Peritoneal dialysis treatments requiring at
26        least 4 exchanges every 24 hours.



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1            (D) Tube feeding via nasogastric or gastrostomy
2        tube.
3            (E) Other medical technologies required
4        continuously, which in the opinion of the attending
5        physician require the services of a professional
6        nurse.
7    (f) Complex or extensive medical needs for exceptional care
8reimbursement. The conditions and services used for the
9purposes of this Section have the same meanings as ascribed to
10those conditions and services under the Minimum Data Set (MDS)
11Resident Assessment Instrument (RAI) and specified in the most
12recent manual. Instead of submitting minimum data set
13assessments to the Department, medically complex for the
14developmentally disabled facilities must document within each
15resident's medical record the conditions or services using the
16minimum data set documentation standards and requirements to
17qualify for exceptional care reimbursement.
18        (1) Tier 1 reimbursement is for residents who are
19    receiving at least 51% of their caloric intake via a
20    feeding tube.
21        (2) Tier 2 reimbursement is for residents who are
22    receiving tracheostomy care without a ventilator.
23        (3) Tier 3 reimbursement is for residents who are
24    receiving tracheostomy care and ventilator care.
25    (g) For dates of services starting April 1, 2019,
26reimbursement calculations and direct payment for services



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1provided by medically complex for the developmentally disabled
2facilities are the responsibility of the Department of
3Healthcare and Family Services instead of the Department of
4Human Services. Appropriations for medically complex for the
5developmentally disabled facilities must be shifted from the
6Department of Human Services to the Department of Healthcare
7and Family Services. Nothing in this Section prohibits the
8Department of Healthcare and Family Services from paying more
9than the rates specified in this Section. The rates in this
10Section must be interpreted as a minimum amount. Any
11reimbursement increases applied to providers licensed under
12the ID/DD Community Care Act must also be applied in an
13equivalent manner to medically complex for the developmentally
14disabled facilities.
15    (h) The Department of Healthcare and Family Services shall
16pay the rates in effect on March 31, 2019 until the changes
17made to this Section by this amendatory Act of the 100th
18General Assembly have been approved by the Centers for Medicare
19and Medicaid Services of the U.S. Department of Health and
20Human Services.
21    (i) The Department of Healthcare and Family Services may
22adopt rules as allowed by the Illinois Administrative Procedure
23Act to implement this Section; however, the requirements of
24this Section must be implemented by the Department of
25Healthcare and Family Services even if the Department of
26Healthcare and Family Services has not adopted rules by the



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1implementation date of April 1, 2019.
2(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
3    Section 99. Effective date. This Act takes effect upon
4becoming law.