Full Text of SB0026 98th General Assembly
SB0026ham004 98TH GENERAL ASSEMBLY | Rep. Sara Feigenholtz Filed: 5/27/2013
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| 1 | | AMENDMENT TO SENATE BILL 26
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 26, AS AMENDED, | 3 | | with reference to page and line numbers of House Amendment No. | 4 | | 1 as follows:
| 5 | | on page 4, by inserting immediately below line 8 the following: | 6 | | ""Abuse" means any physical or mental injury or sexual | 7 | | assault inflicted on a consumer other than by accidental means | 8 | | in a facility."; and | 9 | | on page 6, line 19, after "triage", by inserting "center"; and | 10 | | on page 9, immediately below line 13, by inserting the | 11 | | following: | 12 | | ""Identified offender" means a person who meets any of the | 13 | | following criteria: | 14 | | (1) Has been convicted of, found guilty of, adjudicated | 15 | | delinquent for, found not guilty by reason of insanity for, |
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| 1 | | or found unfit to stand trial for, any felony offense | 2 | | listed in Section 25 of the Health Care Worker Background | 3 | | Check Act, except for the following: | 4 | | (i) a felony offense described in Section 10-5 of | 5 | | the Nurse Practice Act; | 6 | | (ii) a felony offense described in Section 4, 5, 6, | 7 | | 8, or 17.02 of the Illinois Credit Card and Debit Card | 8 | | Act; | 9 | | (iii) a felony offense described in Section 5, 5.1, | 10 | | 5.2, 7, or 9 of the Cannabis Control Act; | 11 | | (iv) a felony offense described in Section 401, | 12 | | 401.1, 404, 405, 405.1, 407, or 407.1 of the Illinois | 13 | | Controlled Substances Act; and | 14 | | (v) a felony offense described in the | 15 | | Methamphetamine Control and Community Protection Act. | 16 | | (2) Has been convicted of, adjudicated delinquent
for, | 17 | | found not guilty by reason of insanity for, or found unfit | 18 | | to stand trial for, any sex offense as defined in | 19 | | subsection (c) of Section 10 of the Sex Offender Management | 20 | | Board Act."; and
| 21 | | on page 12, immediately below line 9, by inserting the | 22 | | following: | 23 | | "Section 2-100. Rulemaking. The Department is empowered to | 24 | | promulgate any rules necessary to ensure proper implementation |
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| 1 | | and administration of this Act."; and | 2 | | on page 15, immediately below line 1, by inserting the | 3 | | following: | 4 | | "Section 2-104. Screening prior to admission. | 5 | | (a) A facility shall within 24 hours after admission, | 6 | | request a criminal history background check pursuant to the | 7 | | Uniform Conviction Information Act for all persons age 18 or | 8 | | older seeking admission to the facility, unless a background | 9 | | check was initiated by a hospital pursuant to subsection (d) of | 10 | | Section 6.09 of the Hospital Licensing Act. Background checks | 11 | | conducted pursuant to this Section shall be based on the | 12 | | consumer's name, date of birth, and other identifiers as | 13 | | required by the Department of State Police. If the results of | 14 | | the background check are inconclusive, the facility shall | 15 | | initiate a fingerprint-based check, unless the fingerprint | 16 | | check is waived by the Director of Public Health based on | 17 | | verification by the facility that the consumer meets criteria | 18 | | related to the consumer's health or lack of potential risk | 19 | | which may be established by Departmental rule. A waiver issued | 20 | | pursuant to this Section shall be valid only while the consumer | 21 | | is immobile or while the criteria supporting the waiver exist. | 22 | | The facility shall provide for or arrange for any required | 23 | | fingerprint-based checks to be taken on the premises of the | 24 | | facility. If a fingerprint-based check is required, the |
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| 1 | | facility shall arrange for it to be conducted in a manner that | 2 | | is respectful of the consumer's dignity and that minimizes any | 3 | | emotional or physical hardship to the consumer. | 4 | | (b) If the results of a consumer's criminal history | 5 | | background check reveal that the consumer is an identified | 6 | | offender as defined in this Act, the facility shall do the | 7 | | following: | 8 | | (1) Immediately notify the Department of State Police, | 9 | | in the form and manner required by the Department of State | 10 | | Police, in collaboration with the Department of Public | 11 | | Health, that the consumer is an identified offender. | 12 | | (2) Within 72 hours, arrange for a fingerprint-based
| 13 | | criminal history record inquiry to be requested on the | 14 | | identified offender consumer. The inquiry shall be based on | 15 | | the subject's name, sex, race, date of birth, fingerprint | 16 | | images, and other identifiers required by the Department of | 17 | | State Police. The inquiry shall be processed through the | 18 | | files of the Department of State Police and the Federal | 19 | | Bureau of Investigation to locate any criminal history | 20 | | record information that may exist regarding the subject. | 21 | | The Federal Bureau of Investigation shall furnish to the | 22 | | Department of State Police, pursuant to an inquiry under | 23 | | this paragraph (2), any criminal history record | 24 | | information contained in its files. | 25 | | Section 2-105. Criminal History Report. |
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| 1 | | (a) The Department of State Police shall prepare a Criminal | 2 | | History Report when it receives information, through the | 3 | | criminal history background check required pursuant to | 4 | | subsection (d) of Section 6.09 of the Hospital Licensing Act or | 5 | | subsection (c) of Section 2-201.5 of the Nursing Home Care Act, | 6 | | or through any other means, that a consumer of a facility is an | 7 | | identified offender.
| 8 | | (b) The Department of State Police shall complete the | 9 | | Criminal History Report within 10 business days after receiving | 10 | | information under subsection (a) that a consumer is an | 11 | | identified offender. | 12 | | (c) The Criminal History Report shall include, but not be | 13 | | limited to, the following: | 14 | | (1) Copies of the identified offender's parole, | 15 | | mandatory supervised release, or probation orders. | 16 | | (2) An interview with the identified offender. | 17 | | (3) A detailed summary of the entire criminal history
| 18 | | of the offender, including arrests, convictions, and the | 19 | | date of the identified offender's last conviction relative | 20 | | to the date of admission to a long-term care facility. | 21 | | (4) If the identified offender is a convicted or
| 22 | | registered sex offender, a review of any and all sex | 23 | | offender evaluations conducted on that offender. If there | 24 | | is no sex offender evaluation available, the Department of | 25 | | State Police shall arrange, through the Department of | 26 | | Public Health, for a sex offender evaluation to be |
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| 1 | | conducted on the identified offender. If the convicted or | 2 | | registered sex offender is under supervision by the | 3 | | Illinois Department of Corrections or a county probation | 4 | | department, the sex offender evaluation shall be arranged | 5 | | by and at the expense of the supervising agency. All | 6 | | evaluations conducted on convicted or registered sex | 7 | | offenders under this Act shall be conducted by sex offender | 8 | | evaluators approved by the Sex Offender Management Board.
| 9 | | (d) The Department of State Police shall provide the | 10 | | Criminal History Report to a licensed forensic psychologist. | 11 | | After (i) consideration of the Criminal History Report, (ii) | 12 | | consultation with the facility administrator or the facility | 13 | | medical director, or both, regarding the mental and physical | 14 | | condition of the identified offender, and (iii) reviewing the | 15 | | facility's file on the identified offender, including all | 16 | | incident reports, all information regarding medication and | 17 | | medication compliance, and all information regarding previous | 18 | | discharges or transfers from other facilities, the licensed | 19 | | forensic psychologist shall prepare an Identified Offender | 20 | | Report and Recommendation. The Identified Offender Report and | 21 | | Recommendation shall detail whether and to what extent the | 22 | | identified offender's criminal history necessitates the | 23 | | implementation of security measures within the long-term care | 24 | | facility. If the identified offender is a convicted or | 25 | | registered sex offender or if the Identified Offender Report | 26 | | and Recommendation reveals that the identified offender poses a |
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| 1 | | significant risk of harm to others within the facility, the | 2 | | offender shall be required to have his or her own room within | 3 | | the facility. | 4 | | (e) The licensed forensic psychologist shall complete the | 5 | | Identified Offender Report and Recommendation within 14 | 6 | | business days after receiving the Criminal History Report and | 7 | | shall promptly provide the Identified Offender Report and | 8 | | Recommendation to the Department of State Police, which shall | 9 | | provide the Identified Offender Report and Recommendation to | 10 | | the following:
| 11 | | (1) The facility within which the identified offender | 12 | | resides. | 13 | | (2) The Chief of Police of the municipality in which
| 14 | | the facility is located. | 15 | | (3) The State of Illinois Long Term Care Ombudsman. | 16 | | (4) The Department of Public Health. | 17 | | (e-5) The Department of Public Health shall keep a | 18 | | continuing record of all consumers determined to be identified | 19 | | offenders as defined in Section 1-114.01 of the Nursing Home | 20 | | Care Act and shall report the number of identified offender | 21 | | consumers annually to the General Assembly. | 22 | | (f) The facility shall incorporate the Identified Offender | 23 | | Report and Recommendation into the identified offender's care | 24 | | plan created pursuant to 42 CFR 483.20. | 25 | | (g) If, based on the Identified Offender Report and | 26 | | Recommendation, a facility determines that it cannot manage the |
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| 1 | | identified offender consumer safely within the facility, it | 2 | | shall commence involuntary transfer or discharge proceedings | 3 | | pursuant to Section 3-402. | 4 | | (h) Except for willful and wanton misconduct, any person | 5 | | authorized to participate in the development of a Criminal | 6 | | History Report or Identified Offender Report and | 7 | | Recommendation is immune from criminal or civil liability for | 8 | | any acts or omissions as the result of his or her good faith | 9 | | effort to comply with this Section."; and | 10 | | on page 19, line 19, after "authorized", by inserting "under | 11 | | Illinois law"; and | 12 | | on page 20, line 2, by replacing the period with "to the | 13 | | Department within 24 hours. Facilities shall comply with | 14 | | Sections 3-610 and 3-810 of the Nursing Home Care Act. The | 15 | | provisions under Sections 3-610 and 3-810 of the Nursing Home | 16 | | Care Act shall apply to employees of facilities licensed under | 17 | | this Act."; and | 18 | | on page 20, line 4, by replacing "or crisis stabilization" with | 19 | | "centers"; and | 20 | | on page 20, line 13, by replacing "knock" with "reasonably | 21 | | announce their intent to enter"; and |
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| 1 | | on page 20, immediately below line 15, by inserting the | 2 | | following: | 3 | | "Consumers shall be free to leave at any time. If a | 4 | | consumer in a triage center expresses a desire to contact a | 5 | | third party for any purpose, the facility staff shall contact | 6 | | that third party on behalf of the consumer."; and | 7 | | on page 21, line 6, by replacing "or crisis stabilization" with | 8 | | "centers"; and | 9 | | on page 22, line 12, after the period, by inserting "The | 10 | | Department shall by rule establish criteria, hearings, and | 11 | | procedures for involuntary discharge."; and | 12 | | on page 23, by inserting immediately below line 7 the | 13 | | following: | 14 | | "Section 3-115. Informed consent; restraints. Informed | 15 | | consent shall be required for restraints consistent with the | 16 | | requirements contained in subsection (c) of Section 2-106 of | 17 | | the Nursing Home Care Act. | 18 | | Section 3-116. Experimental research. No consumer shall be | 19 | | subjected to experimental research or treatment without first | 20 | | obtaining his or her informed, written consent. The conduct of | 21 | | any experimental research or treatment shall be authorized and |
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| 1 | | monitored by an institutional review board appointed by the | 2 | | executive director. The membership, operating procedures and | 3 | | review criteria for the institutional review board shall be | 4 | | prescribed under rules and regulations of the Department and | 5 | | shall comply with the requirements for institutional review | 6 | | boards established by the federal Food and Drug Administration. | 7 | | No person who has received compensation in the prior 3 years | 8 | | from an entity that manufactures, distributes, or sells | 9 | | pharmaceuticals, biologics, or medical devices may serve on the | 10 | | institutional review board. | 11 | | No facility shall permit experimental research or | 12 | | treatment to be conducted on a consumer, or give access to any | 13 | | person or person's records for a retrospective study about the | 14 | | safety or efficacy of any care or treatment, without the prior | 15 | | written approval of the institutional review board. No | 16 | | executive director, or person licensed by the State to provide | 17 | | medical care or treatment to any person, may assist or | 18 | | participate in any experimental research on or treatment of a | 19 | | consumer, including a retrospective study, that does not have | 20 | | the prior written approval of the board. Such conduct shall be | 21 | | grounds for professional discipline by the Department of | 22 | | Financial and Professional Regulation. | 23 | | The institutional review board may exempt from ongoing | 24 | | review research or treatment initiated on a consumer before the | 25 | | individual's admission to a facility and for which the board | 26 | | determines there is adequate ongoing oversight by another |
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| 1 | | institutional review board. Nothing in this Section shall | 2 | | prevent a facility, any facility employee, or any other person | 3 | | from assisting or participating in any experimental research on | 4 | | or treatment of a consumer, if the research or treatment began | 5 | | before the person's admission to a facility, until the board | 6 | | has reviewed the research or treatment and decided to grant or | 7 | | deny approval or to exempt the research or treatment from | 8 | | ongoing review."; and | 9 | | on page 23, line 15, by replacing "units" with "centers"; and | 10 | | on page 30, line 12, by replacing "units" with "centers"; and | 11 | | on page 30, line 24, after "triage", by inserting "centers"; | 12 | | and | 13 | | on page 31, line 7, after "checks", by inserting ", consistent | 14 | | with Section 1-114.01, subsections (b) and (c) of Section | 15 | | 2-201.5, and Section 2-201.6 of the Nursing Home Care Act"; and | 16 | | on page 31, line 16, after "check", by inserting ", consistent | 17 | | with the Health Care Worker Background Check Act"; and | 18 | | on page 33, line 14 by inserting after "Act" the following: | 19 | | "and the rules promulgated under this Act. The Department shall | 20 | | have access to and may reproduce or photocopy any books, |
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| 1 | | records, and other documents maintained by the facility to the | 2 | | extent necessary to carry out this Act and the rules | 3 | | promulgated under this Act. The Department shall not divulge or | 4 | | disclose the contents of a record under this Section as | 5 | | otherwise prohibited by this Act. Any holder of a license or | 6 | | applicant for a license shall be deemed to have given consent | 7 | | to any authorized officer, employee, or agent of the Department | 8 | | to enter and inspect the facility in accordance with this | 9 | | Article. Refusal to permit such entry or inspection shall | 10 | | constitute grounds for denial, suspension, or revocation of a | 11 | | license under this Act"; and | 12 | | on page 33, line 15, by deleting "scheduled"; and | 13 | | on page 33, line 16, by deleting "unscheduled"; and | 14 | | on page 34, by replacing lines 2 and 3 with the following: | 15 | | "(a) The Department may revoke a license for any failure to | 16 | | substantially comply with this Act and the rules promulgated | 17 | | under this Act, including, but not limited to, the following:"; | 18 | | and | 19 | | on page 34, line 5, by replacing "or" with "and"; and | 20 | | on page 35, line 3, by replacing "the standards of this" with | 21 | | "this Act and the rules promulgated under this Act."; and |
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| 1 | | on page 35, by deleting line 4; and | 2 | | on page 35, line 5, by replacing "the standards" with "this Act | 3 | | and the rules promulgated under this Act"; and | 4 | | on page 35, line 8, by replacing "the standards" with "this Act | 5 | | and the rules promulgated under this Act"; and | 6 | | on page 35, line 11, by replacing "the standards" with "this | 7 | | Act and the rules promulgated under this Act"; and | 8 | | on page 35, lines 15 and 16, by replacing "the standards. The | 9 | | agency" with "this Act and the rules promulgated under this | 10 | | Act. The facility"; and | 11 | | on page 36, line 7, by replacing "Part" with "Act or the rules | 12 | | promulgated under this Act"; and | 13 | | on page 36, line 8, by replacing "agency" with "facility"; and | 14 | | on page 36, line 17, by replacing "Part" with "Act or the rules | 15 | | promulgated under this Act"; and | 16 | | on page 36, line 18, by replacing "standards" with "this Act | 17 | | and the rules promulgated under this Act"; and |
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| 1 | | on page 36, line 22, by replacing "agency" with "facility"; and | 2 | | on page 36, line 23, by replacing "agency" with "facility"; and | 3 | | on page 37, line 10, by replacing "agency" with "facility"; and | 4 | | on page 37, line 11, by replacing "agency" with "facility"; and | 5 | | on page 39, by inserting immediately below line 1 the | 6 | | following: | 7 | | "Section 4-111. Notwithstanding the existence or pursuit | 8 | | of any other remedy, the Director of the Department may, in the | 9 | | manner provided by law, upon the advice of the Attorney General | 10 | | who shall represent the Director of the Department in the | 11 | | proceedings, maintain an action in the name of the State for | 12 | | injunction or other process against any person or governmental | 13 | | unit to restrain or prevent the establishment of a facility | 14 | | without a license issued pursuant to this Act, or to restrain | 15 | | or prevent the opening, conduction, operating, or maintaining | 16 | | of a facility without a license issued pursuant to this Act. In | 17 | | addition, the Director of the Department may, in the manner | 18 | | provided by law, in the name of the People of the State and | 19 | | through the Attorney General who shall represent the Director | 20 | | of the Department in the proceedings, maintain an action for |
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| 1 | | injunction or other relief or process against any licensee or | 2 | | other person to enforce and compel compliance with the | 3 | | provisions of this Act and the standards, rules, and | 4 | | regulations established by virtue of this Act and any order | 5 | | entered for any response action pursuant to this Act and such | 6 | | standards, rules, and regulations."; and | 7 | | by deleting lines 7 through 23 of page 490, all of pages 491 | 8 | | through 538, and lines 1 through 20 of page 539; and | 9 | | on page 539, immediately below line 21, by inserting the | 10 | | following: | 11 | | "Section 11-1. The Illinois Public Aid Code is amended by | 12 | | changing Section 14-8 as follows:
| 13 | | (305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
| 14 | | Sec. 14-8. Disbursements to Hospitals.
| 15 | | (a) For inpatient hospital services rendered on and after | 16 | | September 1,
1991, the Illinois Department shall reimburse
| 17 | | hospitals for inpatient services at an inpatient payment rate | 18 | | calculated for
each hospital based upon the Medicare | 19 | | Prospective Payment System as set forth
in Sections 1886(b), | 20 | | (d), (g), and (h) of the federal Social Security Act, and
the | 21 | | regulations, policies, and procedures promulgated thereunder, | 22 | | except as
modified by this Section. Payment rates for inpatient |
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| 1 | | hospital services
rendered on or after September 1, 1991 and on | 2 | | or before September 30, 1992
shall be calculated using the | 3 | | Medicare Prospective Payment rates in effect on
September 1, | 4 | | 1991. Payment rates for inpatient hospital services rendered on
| 5 | | or after October 1, 1992 and on or before March 31, 1994 shall | 6 | | be calculated
using the Medicare Prospective Payment rates in | 7 | | effect on September 1, 1992.
Payment rates for inpatient | 8 | | hospital services rendered on or after April 1,
1994 shall be | 9 | | calculated using the Medicare Prospective Payment rates
| 10 | | (including the Medicare grouping methodology and weighting | 11 | | factors as adjusted
pursuant to paragraph (1) of this | 12 | | subsection) in effect 90 days prior to the
date of admission. | 13 | | For services rendered on or after July 1, 1995, the
| 14 | | reimbursement methodology implemented under this subsection | 15 | | shall not include
those costs referred to in Sections | 16 | | 1886(d)(5)(B) and 1886(h) of the Social
Security Act. The | 17 | | additional payment amounts required under Section
| 18 | | 1886(d)(5)(F) of the Social Security Act, for hospitals serving | 19 | | a
disproportionate share of low-income or indigent patients, | 20 | | are not required
under this Section. For hospital inpatient | 21 | | services rendered on or after July
1, 1995, the Illinois | 22 | | Department shall
reimburse hospitals using the relative | 23 | | weighting factors and the base payment
rates calculated for | 24 | | each hospital that were in effect on June 30, 1995, less
the | 25 | | portion of such rates attributed by the Illinois Department to | 26 | | the cost of
medical education.
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| 1 | | (1) The weighting factors established under Section | 2 | | 1886(d)(4) of the
Social Security Act shall not be used in | 3 | | the reimbursement system
established under this Section. | 4 | | Rather, the Illinois Department shall
establish by rule | 5 | | Medicaid weighting factors to be used in the reimbursement
| 6 | | system established under this Section.
| 7 | | (2) The Illinois Department shall define by rule those | 8 | | hospitals or
distinct parts of hospitals that shall be | 9 | | exempt from the reimbursement
system established under | 10 | | this Section. In defining such hospitals, the
Illinois | 11 | | Department shall take into consideration those hospitals | 12 | | exempt
from the Medicare Prospective Payment System as of | 13 | | September 1, 1991. For
hospitals defined as exempt under | 14 | | this subsection, the Illinois Department
shall by rule | 15 | | establish a reimbursement system for payment of inpatient
| 16 | | hospital services rendered on and after September 1, 1991. | 17 | | For all
hospitals that are children's hospitals as defined | 18 | | in Section 5-5.02 of
this Code, the reimbursement | 19 | | methodology shall, through June 30, 1992, net
of all | 20 | | applicable fees, at least equal each children's hospital | 21 | | 1990 ICARE
payment rates, indexed to the current year by | 22 | | application of the DRI hospital
cost index from 1989 to the | 23 | | year in which payments are made. Excepting county
providers | 24 | | as defined in Article XV of this Code, hospitals licensed | 25 | | under the
University of Illinois Hospital Act, and | 26 | | facilities operated by the
Department of Mental Health and |
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| 1 | | Developmental Disabilities (or its successor,
the | 2 | | Department of Human Services) for hospital inpatient | 3 | | services rendered on
or after July 1, 1995, the Illinois | 4 | | Department shall reimburse children's
hospitals, as | 5 | | defined in 89 Illinois Administrative Code Section | 6 | | 149.50(c)(3),
at the rates in effect on June 30, 1995, and | 7 | | shall reimburse all other
hospitals at the rates in effect | 8 | | on June 30, 1995, less the portion of such
rates attributed | 9 | | by the Illinois Department to the cost of medical | 10 | | education.
For inpatient hospital services provided on or | 11 | | after August 1, 1998, the
Illinois Department may establish | 12 | | by rule a means of adjusting the rates of
children's | 13 | | hospitals, as defined in 89 Illinois Administrative Code | 14 | | Section
149.50(c)(3), that did not meet that definition | 15 | | before February 28, 2013 on June 30, 1995 , in order
for the | 16 | | inpatient hospital rates of such hospitals to take into | 17 | | account the
average inpatient hospital rates of those | 18 | | children's hospitals that did meet
the definition of | 19 | | children's hospitals before February 28, 2013. The | 20 | | Department shall adopt any emergency rules necessary to
| 21 | | implement this Section on June 30, 1995 .
| 22 | | (3) (Blank) .
| 23 | | (4) Notwithstanding any other provision of this | 24 | | Section, hospitals
that on August 31, 1991, have a contract | 25 | | with the Illinois Department under
Section 3-4 of the | 26 | | Illinois Health Finance Reform Act may elect to continue
to |
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| 1 | | be reimbursed at rates stated in such contracts for general | 2 | | and specialty
care.
| 3 | | (5) In addition to any payments made under this | 4 | | subsection (a), the
Illinois Department shall make the | 5 | | adjustment payments required by Section
5-5.02 of this | 6 | | Code; provided, that in the case of any hospital reimbursed
| 7 | | under a per case methodology, the Illinois Department shall | 8 | | add an amount
equal to the product of the hospital's | 9 | | average length of stay, less one
day, multiplied by 20, for | 10 | | inpatient hospital services rendered on or
after September | 11 | | 1, 1991 and on or before September 30, 1992.
| 12 | | (b) (Blank) .
| 13 | | (b-5) Excepting county providers as defined in Article XV | 14 | | of this Code,
hospitals licensed under the University of | 15 | | Illinois Hospital Act, and
facilities operated by the Illinois | 16 | | Department of Mental Health and
Developmental Disabilities (or | 17 | | its successor, the Department of Human
Services), for | 18 | | outpatient services rendered on or after July 1, 1995
and | 19 | | before July 1, 1998 the Illinois Department shall reimburse
| 20 | | children's hospitals, as defined in the Illinois | 21 | | Administrative Code
Section 149.50(c)(3), at the rates in | 22 | | effect on June 30, 1995, less that
portion of such rates | 23 | | attributed by the Illinois Department to the outpatient
| 24 | | indigent volume adjustment and shall reimburse all other | 25 | | hospitals at the rates
in effect on June 30, 1995, less the | 26 | | portions of such rates attributed by the
Illinois Department to |
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| 1 | | the cost of medical education and attributed by the
Illinois | 2 | | Department to the outpatient indigent volume adjustment. For
| 3 | | outpatient services provided on or after July 1, 1998, | 4 | | reimbursement rates
shall be established by rule.
| 5 | | (c) In addition to any other payments under this Code, the | 6 | | Illinois
Department shall develop a hospital disproportionate | 7 | | share reimbursement
methodology that, effective July 1, 1991, | 8 | | through September 30, 1992,
shall reimburse hospitals | 9 | | sufficiently to expend the fee monies described
in subsection | 10 | | (b) of Section 14-3 of this Code and the federal matching
funds | 11 | | received by the Illinois Department as a result of expenditures | 12 | | made
by the Illinois Department as required by this subsection | 13 | | (c) and Section
14-2 that are attributable to fee monies | 14 | | deposited in the Fund, less
amounts applied to adjustment | 15 | | payments under Section 5-5.02.
| 16 | | (d) Critical Care Access Payments.
| 17 | | (1) In addition to any other payments made under this | 18 | | Code,
the Illinois Department shall develop a | 19 | | reimbursement methodology that shall
reimburse Critical | 20 | | Care Access Hospitals for the specialized services that
| 21 | | qualify them as Critical Care Access Hospitals. No | 22 | | adjustment payments shall be
made under this subsection on | 23 | | or after July 1, 1995.
| 24 | | (2) "Critical Care Access Hospitals" includes, but is | 25 | | not limited to,
hospitals that meet at least one of the | 26 | | following criteria:
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| 1 | | (A) Hospitals located outside of a metropolitan | 2 | | statistical area that
are designated as Level II | 3 | | Perinatal Centers and that provide a
disproportionate | 4 | | share of perinatal services to recipients; or
| 5 | | (B) Hospitals that are designated as Level I Trauma | 6 | | Centers (adult
or pediatric) and certain Level II | 7 | | Trauma Centers as determined by the
Illinois | 8 | | Department; or
| 9 | | (C) Hospitals located outside of a metropolitan | 10 | | statistical area and
that provide a disproportionate | 11 | | share of obstetrical services to recipients.
| 12 | | (e) Inpatient high volume adjustment. For hospital | 13 | | inpatient services,
effective with rate periods beginning on or | 14 | | after October 1, 1993, in
addition to rates paid for inpatient | 15 | | services by the Illinois Department, the
Illinois Department | 16 | | shall make adjustment payments for inpatient services
| 17 | | furnished by Medicaid high volume hospitals. The Illinois | 18 | | Department shall
establish by rule criteria for qualifying as a | 19 | | Medicaid high volume hospital
and shall establish by rule a | 20 | | reimbursement methodology for calculating these
adjustment | 21 | | payments to Medicaid high volume hospitals. No adjustment | 22 | | payment
shall be made under this subsection for services | 23 | | rendered on or after July 1,
1995.
| 24 | | (f) The Illinois Department shall modify its current rules | 25 | | governing
adjustment payments for targeted access, critical | 26 | | care access, and
uncompensated care to classify those |
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| 1 | | adjustment payments as not being payments
to disproportionate | 2 | | share hospitals under Title XIX of the federal Social
Security | 3 | | Act. Rules adopted under this subsection shall not be effective | 4 | | with
respect to services rendered on or after July 1, 1995. The | 5 | | Illinois Department
has no obligation to adopt or implement any | 6 | | rules or make any payments under
this subsection for services | 7 | | rendered on or after July 1, 1995.
| 8 | | (f-5) The State recognizes that adjustment payments to | 9 | | hospitals providing
certain services or incurring certain | 10 | | costs may be necessary to assure that
recipients of medical | 11 | | assistance have adequate access to necessary medical
services. | 12 | | These adjustments include payments for teaching costs and
| 13 | | uncompensated care, trauma center payments, rehabilitation | 14 | | hospital payments,
perinatal center payments, obstetrical care | 15 | | payments, targeted access payments,
Medicaid high volume | 16 | | payments, and outpatient indigent volume payments. On or
before | 17 | | April 1, 1995, the Illinois Department shall issue | 18 | | recommendations
regarding (i) reimbursement mechanisms or | 19 | | adjustment payments to reflect these
costs and services, | 20 | | including methods by which the payments may be calculated
and | 21 | | the method by which the payments may be financed, and (ii) | 22 | | reimbursement
mechanisms or adjustment payments to reflect | 23 | | costs and services of federally
qualified health centers with | 24 | | respect to recipients of medical assistance.
| 25 | | (g) If one or more hospitals file suit in any court | 26 | | challenging any part of
this Article XIV, payments to hospitals |
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| 1 | | under this Article XIV shall be made
only to the extent that | 2 | | sufficient monies are available in the Fund and only to
the | 3 | | extent that any monies in the Fund are not prohibited from | 4 | | disbursement
under any order of the court.
| 5 | | (h) Payments under the disbursement methodology described | 6 | | in this Section
are subject to approval by the federal | 7 | | government in an appropriate State plan
amendment.
| 8 | | (i) The Illinois Department may by rule establish criteria | 9 | | for and develop
methodologies for adjustment payments to | 10 | | hospitals participating under this
Article.
| 11 | | (j) Hospital Residing Long Term Care Services. In addition | 12 | | to any other
payments made under this Code, the Illinois | 13 | | Department may by rule establish
criteria and develop | 14 | | methodologies for payments to hospitals for Hospital
Residing | 15 | | Long Term Care Services.
| 16 | | (k) Critical Access Hospital outpatient payments. In | 17 | | addition to any other payments authorized under this Code, the | 18 | | Illinois Department shall reimburse critical access hospitals, | 19 | | as designated by the Illinois Department of Public Health in | 20 | | accordance with 42 CFR 485, Subpart F, for outpatient services | 21 | | at an amount that is no less than the cost of providing such | 22 | | services, based on Medicare cost principles. Payments under | 23 | | this subsection shall be subject to appropriation. | 24 | | (l) On and after July 1, 2012, the Department shall reduce | 25 | | any rate of reimbursement for services or other payments or | 26 | | alter any methodologies authorized by this Code to reduce any |
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| 1 | | rate of reimbursement for services or other payments in | 2 | | accordance with Section 5-5e. | 3 | | (Source: P.A. 96-1382, eff. 1-1-11; 97-689, eff. 6-14-12; | 4 | | revised 8-3-12.)"; and
| 5 | | on page 544, line 26, after " research ", by inserting " and | 6 | | education "; and | 7 | | on page 545, line 17, after " research ", by inserting " and | 8 | | education "; and | 9 | | on page 548, by deleting lines 8 and 9; and | 10 | | on page 561, by replacing lines 15 through 16 with "a | 11 | | municipality prior to September 30,
1998 or (ii) the hospital | 12 | | has been designated by the State"; and | 13 | | on page 578, line 24 by replacing " resident " with " residents "; | 14 | | and | 15 | | on page 582, line 12 by inserting before " Transition " the | 16 | | following: | 17 | | " For dates of services beginning January 1, 2014, the RUG-IV | 18 | | nursing component per diem for a nursing home shall be the | 19 | | product of the statewide RUG-IV nursing base per diem rate, the | 20 | | facility average case mix index, and the regional wage |
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| 1 | | adjustor. "; and | 2 | | on page 582, line 15 by replacing " subsection (d-1) " with " this | 3 | | subsection (e-2) "; and | 4 | | on page 582, line 25 by replacing " subsection (d-1) " with " this | 5 | | subsection (e-2) "; and | 6 | | on page 584, line 21, after " triage " by inserting " center "; and | 7 | | on page 585, by inserting immediately below line 13 the | 8 | | following: | 9 | | "Section 11-45. The Illinois Public Aid Code is amended by | 10 | | adding Section 5-5.4h as follows: | 11 | | (305 ILCS 5/5-5.4h new) | 12 | | Sec. 5-5.4h. Medicaid reimbursement for pediatric skilled | 13 | | nursing facilities. | 14 | | (a) Facilities uniquely licensed as pediatric skilled | 15 | | nursing facilities that serve severely and chronically ill | 16 | | pediatric patients shall have a specific reimbursement system | 17 | | designed to recognize the characteristics and needs of the | 18 | | patients they serve. | 19 | | (b) For dates of services starting July 1, 2013 and until a | 20 | | new reimbursement system is designed, pediatric skilled |
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| 1 | | nursing facilities that meet the following criteria: | 2 | | (1) serve exceptional care patients; and | 3 | | (2) have 30% or more of their patients receiving | 4 | | ventilator care; | 5 | | shall receive Medicaid reimbursement on a 30-day expedited | 6 | | schedule. "; and | 7 | | on page 596, line 11, by replacing " 60 " with " 75 "; and | 8 | | on page 597, by replacing lines 1 through 3 with the following: | 9 | | " the portions of the health and life safety survey | 10 | | associated with federal certification and State licensure | 11 | | surveys must be started within 7 working days of each | 12 | | other. Nothing in this paragraph (1) of subsection (f) of | 13 | | this Section applies to a complaint investigation. "; and | 14 | | on page 597, line 4, after " complaint ", by inserting " and | 15 | | incident report "; and | 16 | | on page 597, by replacing lines 5 and 6 with the following: | 17 | | " shall permit the facility to challenge the amount of the fine | 18 | | due to the excessive length of "; and | 19 | | on page 597, immediately below line 15, by inserting the | 20 | | following: |
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| 1 | | " This paragraph (2) does not apply to complaint | 2 | | investigations exited within 14 working days or a situation | 3 | | that triggers an extended survey. "; and | 4 | | on page 624, line 8, after " occurred, ", by inserting " and the | 5 | | facility in which the applicant resides is notified, "; and | 6 | | on page 625, line 5, by replacing " 2014 " with " 2013 "; and | 7 | | on page 625, line 6, by replacing " 2015 " with " 2014 ".
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