Full Text of HB1447 94th General Assembly
HB1447 94TH GENERAL ASSEMBLY
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94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 HB1447
Introduced 2/10/2005, by Rep. Lee A. Daniels - Raymond Poe - Patricia R. Bellock - Eileen Lyons SYNOPSIS AS INTRODUCED: |
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20 ILCS 1705/54 |
from Ch. 91 1/2, par. 100-54 |
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Amends the Mental Health and Developmental Disabilities Administrative Act. Provides that the Department may perform certain acts for the development of rates for the purchase of fee-for-service care. Adds persons with mental illness and substance abuse as persons the Department may develop the rates for. Provides that in setting rates the Department should consider market factors such as those published by the United States Department of Labor, Bureau of Labor Statistics. Authorizes the Department to contract with an independent consulting firm for certain studies of reimbursement rates to service providers. Provides that the Department shall establish and promulgate a policy that precludes applicability of income
offsets in rate calculation or payment processes (now, establish and promulgate a policy regarding applicability of these offsets). Makes other changes. Effective July 1, 2005.
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| FISCAL NOTE ACT MAY APPLY | |
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A BILL FOR
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HB1447 |
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LRB094 08802 RSP 39019 b |
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| AN ACT concerning State government.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Mental Health and Developmental | 5 |
| Disabilities Administrative Act is amended by changing Section | 6 |
| 54 as follows:
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| (20 ILCS 1705/54) (from Ch. 91 1/2, par. 100-54)
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| Sec. 54. Establishment of rates for purchase of services | 9 |
| including fee-for-service .
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| (a) It is the purpose of this Section to establish | 11 |
| procedures
for the development, calculation, and communication | 12 |
| of rates promulgated
by the Department for the
purchase of | 13 |
| services including fee-for-service for persons with a | 14 |
| developmental disability, mental illness and substance abuse, | 15 |
| and persons
with mental illness; to require the promulgation of | 16 |
| rules which specify the
treatment of costs for purposes of | 17 |
| establishing rates for various purchase
care program | 18 |
| categories including fee-for-service ; to require that rates be | 19 |
| equitable, understandable,
and established through an open, | 20 |
| public process; and to require the delineation
of where | 21 |
| purchase care including fee-for-service , grant-in-aid, and | 22 |
| other payment mechanisms are most
appropriately utilized. The | 23 |
| Department's rate-setting policy should stimulate
the | 24 |
| development of cost effective, evidence based, clinically | 25 |
| appropriate, recovery oriented, community-based
residential, | 26 |
| and other support services for recipients according to an
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| annual
statement of purchase care goals and objectives.
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| (b) The Department shall establish rates in all instances | 29 |
| where services
are purchased by the Department for a specific | 30 |
| recipient from a specific
community service provider for which | 31 |
| the Department has the responsibility
for establishing payment | 32 |
| rates. When determining rates, the Department shall
take into |
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LRB094 08802 RSP 39019 b |
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| consideration differences in the costs of doing business among | 2 |
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various geographic regions of the State and shall set rates | 3 |
| that reflect those
differences. In addition, the Department | 4 |
| shall consider market factors such as those published by the | 5 |
| United States Department of Labor, Bureau of Labor Statistics. | 6 |
| The Department may, for various program
categories, adopt rates | 7 |
| that are set by other State agencies.
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| (c) The Department shall perform the following duties:
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| (1) Develop rate-setting methodologies for purchase | 10 |
| care program and service
categories including | 11 |
| fee-for-service programs and services .
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| (2) Promulgate rules and regulations governing | 13 |
| rate-setting, treatment
of costs, treatment of occupancy, | 14 |
| and payment and contracting processes
for purchase care | 15 |
| including fee-for-service .
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| (3) Collect cost and performance information from care | 17 |
| providers in a form and format that is consistent with a | 18 |
| fee-for-service methodology . The
Department may stipulate | 19 |
| forms, unit of service definitions, reporting
procedures | 20 |
| and reporting intervals.
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| (4) Calculate purchase of care , including | 22 |
| fee-for-service, reimbursement rates for specific | 23 |
| providers
based on the promulgated rate methodology for | 24 |
| that program or service category.
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| (5) Negotiate and implement purchase of care | 26 |
| contracts , including fee-for-service contracts, with | 27 |
| specific
providers.
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| (6) Develop capacity grants and capacity grant | 29 |
| contracts for services that require care availability, and | 30 |
| coverage that is not correlated with volume of service and | 31 |
| for financially supporting desired provision of care | 32 |
| throughout the State. Develop an annual statement of | 33 |
| purchase care goals and objectives
detailing maximum units | 34 |
| of service by program category to be purchased.
The plan | 35 |
| for each fiscal year shall be completed by May 1 of the | 36 |
| previous
fiscal year.
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LRB094 08802 RSP 39019 b |
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| (7) The Department shall contract with an independent | 2 |
| consulting firm for an annual study of the adequacy and | 3 |
| appropriateness of Title XIX and State-only reimbursement | 4 |
| rates to service providers. A complete study of | 5 |
| reimbursement rates shall be completed no less frequently | 6 |
| than once every 2 years. The Department shall report to the | 7 |
| General Assembly no later than January 30, 2007 and each | 8 |
| year thereafter. Conduct an annual review and prepare an | 9 |
| annual report of rates and
units of service purchased, | 10 |
| comparing the annual purchase of care statement
with actual | 11 |
| services purchased, and the actual cost of providing those
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| services.
The report shall be made available by May 1.
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| (8) Establish and promulgate a process and criteria for | 14 |
| appealing rates.
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| (9) Develop and promulgate standards and criteria by | 16 |
| which provider
performance shall be evaluated.
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| (10) Set rates based on published methodologies and | 18 |
| subject to the
availability
of funds appropriated by the | 19 |
| General Assembly.
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| (11) Establish and promulgate a policy that precludes
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| regarding applicability of income
offsets in rate | 22 |
| calculation or payment processes.
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| (12) Develop criteria for selection of payment | 24 |
| mechanisms to be employed
in funding community services | 25 |
| where fee-for-service is not appropriate .
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| (d) The Department may investigate and employ alternative | 27 |
| rate setting
approaches such as per member or per month or case | 28 |
| rates and engage in demonstration projects. These approaches
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| must be
publicly articulated by the Department, identifying the | 30 |
| purpose and scope
of the alternative approach and evaluation to | 31 |
| be conducted.
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| (e) (Blank).
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| (Source: P.A. 89-58, eff. 1-1-96; 89-507, eff. 7-1-97; 90-423, | 34 |
| eff.
8-15-97.)
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| Section 99. Effective date. This Act takes effect July 1, |
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