SB3743sam002 96TH GENERAL ASSEMBLY

Sen. Christine Radogno

Filed: 3/12/2010

09600SB3743sam002 LRB096 20325 KTG 38837 a

AMENDMENT TO SENATE BILL 3743

AMENDMENT NO. ______. Amend Senate Bill 3743, AS AMENDED, with reference to Senate Amendment 1 as follows:

on page 3, line 12, by adding before the period the following: ", or a hospital that begins operations after January 1, 2010 and is designated by Medicare as a long term acute care hospital."; and

on page 4, line 4, by deleting "on the effective date of this Act" and replacing it with "October 1, 2010"; and

on page 5, line 1, by inserting "to the Department" before "the CARE tool"; and

on page 5, line 11, by inserting after "hospital" the following: "with the exception of STAC hospitals identified in paragraphs (1) and (2) under subsection (a) of Section 25 of this Act"; and

on page 6, line 12, by deleting "The quotient of:"; and

on page 6, by deleting lines 13 through 16; and

on page 6, line 19, by deleting "The quotient of:"; and

on page 6, by deleting lines 20 through 22; and

on page 6, line 25, by deleting "The"; and

on page 6, by deleting line 26; and

on page 7, by deleting lines 1 through 17; and

on page 7, line 22, by deleting "The quotient of:"; and

on page 7, by deleting lines 23 through 26; and

by deleting page 8; and

on page 9, line 1, by deleting "The"; and

on page 9, by deleting lines 2 through 20; and

on page 9, by deleting line 26; and

by deleting page 10; and

on page 11, by deleting lines 1 through 4; and

on page 12, line 7, by replacing "with a notice to the Department" with "with 30 calendar days' notice to the Department."; and

on page 12, by deleting lines 8 through 10; and

on page 12, by replacing lines 11 through 13 with the following:

"(c) The LTAC hospital must develop patient and family education materials concerning the Program and submit those materials to the Department for review and approval."; and

on page 12, line 21, by replacing "who" with ":"; and

on page 12, by replacing lines 22 and 23 with the following:

"(1) who upon admission to the LTAC hospital meet LTAC hospital criteria; and

(2) whose care is primarily paid for by the Department under Title XIX of the Social Security Act or whose care is primarily paid for by the Department after the patient has exhausted his or her benefits under Medicare."; and

on page 13, line 1, by replacing "the LTAC hospital no" with "any of the following conditions are met:"; and

on page 13, by replacing lines 2 through 6 with the following:

"(1) the LTAC hospital no longer meets the requirements under Section 15 of this Act or terminates the agreement specified under Section 15 of this Act;

(2) the patient does not meet the LTAC hospital criteria upon admission; or

(3) the patient's care is primarily paid for by Medicare and the patient has not exhausted his or her Medicare benefits, resulting in the Department becoming the primary payer."; and

on page 13, by replacing lines 7 through 14 with the following:

"(c) The Department may adjust the LTAC supplemental per diem rate calculated under this Section based only on the conditions and requirements described under Section 40 and Section 45 of this Act."; and

on page 14, by inserting immediately below line 12 the following:

"Section 40. Rate adjustments for quality measures.

(a) The Department may adjust the LTAC supplemental per diem rate calculated under Section 35 of this Act based on the requirements of this Section.

(b) After the first year of operation of the Program established by this Act, the Department may reduce the LTAC supplemental per diem rate calculated under Section 35 of this Act by no more than 5% for an LTAC hospital that does not meet benchmarks or targets set by the Department under paragraph (2) of subsection (b) of Section 50.

(c) After the first year of operation of the Program established by this Act, the Department may increase the LTAC supplemental per diem rate calculated under Section 35 of this Act by no more than 5% for an LTAC hospital that exceeds the benchmarks or targets set by the Department under paragraph (2) of subsection (a) of Section 50.

(d) If an LTAC hospital misses a majority of the benchmarks for quality measures for 3 consecutive years, the Department may reduce the LTAC supplemental per diem rate calculated under Section 35 of this Act to zero.

(e) An LTAC hospital whose rate is reduced under subsection (d) of this Section may have the LTAC supplemental per diem rate calculated under Section 35 of this Act reinstated once the LTAC hospital achieves the necessary benchmarks or targets.

(f) The Department may apply the reduction described in subsection (d) of this Section after one year instead of 3 to an LTAC hospital that has had its rate previously reduced under subsection (d) of this Section and later has had it reinstated under subsection (e) of this Section.

(g) The rate adjustments described in this Section shall be determined and applied only at the beginning of each rate year.

Section 45. Program evaluation.

(a) After the Program completes the 3rd full year of operation on September 30, 2013, the Department must complete an evaluation of the Program to determine the actual savings or costs generated by the Program, both on an aggregate basis and on an LTAC hospital-specific basis. The evaluation must be conducted in each subsequent year.

(b) The Department and qualified LTAC hospitals must determine the appropriate methodology to accurately calculate the Program's savings and costs.

(c) The evaluation must also determine the effects the Program has had in improving patient satisfaction and health outcomes.

(d) If the evaluation indicates that the Program generates a net cost to the Department, the Department may prospectively adjust an individual hospital's LTAC supplemental per diem rate under Section 35 of this Act to establish cost neutrality. The rate adjustments applied under this subsection (d) do not need to be applied uniformly to all qualified LTAC hospitals as long as the adjustments are based on data from the evaluation on hospital-specific information. Cost neutrality under this Section means that the cost to the Department resulting from the LTAC supplemental per diem rate must not exceed the savings generated from transferring the patient from a STAC hospital.

(e) The rate adjustment described in subsection (d) of this Section, if necessary, shall be applied to the LTAC supplemental per diem rate for the rate year beginning October 1, 2014. The Department may apply this rate adjustment in subsequent rate years if the conditions under subsection (d) of this Section are met. The Department must apply the rate adjustment to an individual LTAC hospital's LTAC supplemental per diem rate only in years when the Program evaluation indicates a net cost for the Department.

(f) The rate adjustments described in this Section shall be determined and applied only at the beginning of each rate year."; and

on page 14, line 13, by replacing "40" with "50"; and

on page 15, by replacing lines 2 through 14 with the following:

"(b) The Department shall include specific information on the Program in its annual medical programs report."; and

on page 15, line 25, by replacing "execute an agreement as" with "create and distribute to LTAC hospitals the agreement"; and

on page 15, line 26, by replacing "45 days after" with "September 1, 2010."; and

on page 16, by deleting line 1; and

on page 16, line 16, by inserting after the period the following:

"The Department must also notify LTAC hospitals that accepting transfers from the STAC hospitals identified in paragraphs (1) and (2) under subsection (a) of Section 25 of this Act are not required under paragraph (5) of subsection (c) of Section 15 of this Act. The Department must notify LTAC hospitals that accepting transfers from the STAC hospitals identified in paragraphs (1) and (2) under subsection (a) of Section 25 of this Act shall negatively impact the savings calculations under the Program evaluation required by Section 40 of this Act and shall in turn require the Department to initiate the penalty described in subsection (d) of Section 40 of this Act."; and

on page 16, by replacing lines 17 through 20 with the following:

"(j) The Department shall deem LTAC hospitals qualified under Section 15 of this Act as qualifying for expedited payments."; and

on page 16, by inserting immediately below line 26 the following:

"(l) The Department may promulgate rules as allowed by the Illinois Administrative Procedure Act to implement this Act; however, the requirements under this Act shall be implemented by the Department even if the Department's proposed rules are not yet adopted by the implementation date of October 1, 2010.".