SB1938sam002 95TH GENERAL ASSEMBLY

Sen. Mattie Hunter

Filed: 4/11/2008

09500SB1938sam002 LRB095 18039 DRJ 49345 a

AMENDMENT TO SENATE BILL 1938

AMENDMENT NO. ______. Amend Senate Bill 1938, AS AMENDED, by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Public Aid Code is amended by adding Section 5-5.26 as follows:

(305 ILCS 5/5-5.26 new)

Sec. 5-5.26. Cost-reporting mechanism for child and adult psychiatric services.

(a) The General Assembly finds that direct access to psychiatric mental health services for children and adults suffering from mental illness will improve the quality of life for these individuals and will reduce health care costs by avoiding the need for more costly inpatient hospitalization. Thus, it is the intent of the General Assembly to develop policy aimed at ensuring that psychiatrists providing child and adult psychiatric services on an outpatient basis are adequately reimbursed for the cost of providing these services. Therefore, in order to determine the actual costs, the Department of Healthcare and Family Services shall develop a cost-reporting mechanism for service providers as defined in this Section by no later than January 1, 2009. The Department of Healthcare and Family Services shall consult with service providers as defined in this Section to assist with the development of the cost-reporting mechanism. By no later than March 1, 2009, the Department of Healthcare and Family Services shall report to the Governor and the General Assembly on the results of the cost-reporting mechanism. This report shall include, but need not be limited to, details on the development of the cost-reporting mechanism and its accurate reflection of the actual costs to service providers for providing child and adult psychiatric services. The Department of Healthcare and Family Services shall, subject to appropriation, establish a separate cost-based reimbursement rate based on the cost-reporting mechanism for psychiatrists who provide child and adult psychiatric services on an outpatient basis for service providers as defined by this Section.

(b) This Section applies only to psychiatrists who provide child and adult psychiatric services on an outpatient basis for service providers as defined in this Section.

(c) For purposes of this Section:

"Cost-based reimbursement rate" means a rate of reimbursement equal to the allowable and audited reasonable costs reported.

"Psychiatrist" means a psychiatrist as defined in Section 1-121 of the Mental Health and Developmental Disabilities Code.

"Service provider" means any of the following that demonstrates a combined Medicaid, poverty, and uninsured patient population penetration rate of 60% or greater:

(1) An entity certified by the Illinois Department of Human Services under the Medicaid Community Mental Health Services Program under 59 Ill. Adm. Code 132.

(2) A person, corporation, or entity that furnishes medical, educational, psychiatric, vocational, or rehabilitative services to a recipient under this Code and enters into a contract or agreement with one or more of the following State agencies to provide such services:

(A) The Department of Human Services.

(B) The Department of Children and Family Services.

(C) The Department of Corrections.

(D) The Department of Juvenile Justice.

(3) A community mental health board established under the Community Mental Health Act.

"Service provider" does not include an employee of a State agency or county agency.

Section 99. Effective date. This Act takes effect upon becoming law.".