Full Text of HB5883 100th General Assembly
HB5883 100TH GENERAL ASSEMBLY |
| | 100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018 HB5883 Introduced , by Rep. Gregory Harris SYNOPSIS AS INTRODUCED: |
| |
Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to contract with a vendor to perform the coordination of benefits for Medicaid fee-for-service and managed care enrollees (rather than contract with a vendor to support the Department in coordinating benefits for Medicaid enrollees). Provides that the contract with the vendor shall include, but not
be limited to, a review of the following populations: persons eligible for both Medicare and Medicaid benefits (dual-eligible clients);
persons enrolled in the fee-for-service medical assistance
program; persons enrolled in the managed care medical
assistance program; and persons eligible for benefits provided
under the Children's Health Insurance Program Act. Provides that if the Department does not issue a comprehensive procurement,
including both the identification of other insurance and the
recovery of funds for the populations listed, and contracts with a vendor for both pieces within
3 months after the effective date of the amendatory Act, the Department's Inspector General
shall procure for the identification and recovery of other
insurance.
|
| |
| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
|
| | | HB5883 | | LRB100 21964 KTG 39977 b |
|
| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 12-4.42 as follows:
| 6 | | (305 ILCS 5/12-4.42)
| 7 | | Sec. 12-4.42. Medicaid Revenue Maximization. | 8 | | (a) Purpose. The General Assembly finds that there is a | 9 | | need to make changes to the administration of services provided | 10 | | by State and local governments in order to maximize federal | 11 | | financial participation. | 12 | | (b) Definitions. As used in this Section: | 13 | | "Community Medicaid mental health services" means all | 14 | | mental health services outlined in Part 132 of Title 59 of the | 15 | | Illinois Administrative Code that are funded through DHS, | 16 | | eligible for federal financial participation, and provided by a | 17 | | community-based provider. | 18 | | "Community-based provider" means an entity enrolled as a | 19 | | provider pursuant to Sections 140.11 and 140.12 of Title 89 of | 20 | | the Illinois Administrative Code and certified to provide | 21 | | community Medicaid mental health services in accordance with | 22 | | Part 132 of Title 59 of the Illinois Administrative Code. | 23 | | "DCFS" means the Department of Children and Family |
| | | HB5883 | - 2 - | LRB100 21964 KTG 39977 b |
|
| 1 | | Services. | 2 | | "Department" means the Illinois Department of Healthcare | 3 | | and Family Services. | 4 | | "Care facility for persons with a developmental | 5 | | disability" means an intermediate care facility for persons | 6 | | with an intellectual disability within the meaning of Title XIX | 7 | | of the Social Security Act, whether public or private and | 8 | | whether organized for profit or not-for-profit, but shall not | 9 | | include any facility operated by the State. | 10 | | "Care provider for persons with a developmental | 11 | | disability" means a person conducting, operating, or | 12 | | maintaining a care facility for persons with a developmental | 13 | | disability. For purposes of this definition, "person" means any | 14 | | political subdivision of the State, municipal corporation, | 15 | | individual, firm, partnership, corporation, company, limited | 16 | | liability company, association, joint stock association, or | 17 | | trust, or a receiver, executor, trustee, guardian, or other | 18 | | representative appointed by order of any court. | 19 | | "DHS" means the Illinois Department of Human Services. | 20 | | "Hospital" means an institution, place, building, or | 21 | | agency located in this State that is licensed as a general | 22 | | acute hospital by the Illinois Department of Public Health | 23 | | under the Hospital Licensing Act, whether public or private and | 24 | | whether organized for profit or not-for-profit. | 25 | | "Long term care facility" means (i) a skilled nursing or | 26 | | intermediate long term care facility, whether public or private |
| | | HB5883 | - 3 - | LRB100 21964 KTG 39977 b |
|
| 1 | | and whether organized for profit or not-for-profit, that is | 2 | | subject to licensure by the Illinois Department of Public | 3 | | Health under the Nursing Home Care Act, including a county | 4 | | nursing home directed and maintained under Section 5-1005 of | 5 | | the Counties Code, and (ii) a part of a hospital in which | 6 | | skilled or intermediate long term care services within the | 7 | | meaning of Title XVIII or XIX of the Social Security Act are | 8 | | provided; except that the term "long term care facility" does | 9 | | not include a facility operated solely as an intermediate care | 10 | | facility for the intellectually disabled within the meaning of | 11 | | Title XIX of the Social Security Act. | 12 | | "Long term care provider" means (i) a person licensed by | 13 | | the Department of Public Health to operate and maintain a | 14 | | skilled nursing or intermediate long term care facility or (ii) | 15 | | a hospital provider that provides skilled or intermediate long | 16 | | term care services within the meaning of Title XVIII or XIX of | 17 | | the Social Security Act. For purposes of this definition, | 18 | | "person" means any political subdivision of the State, | 19 | | municipal corporation, individual, firm, partnership, | 20 | | corporation, company, limited liability company, association, | 21 | | joint stock association, or trust, or a receiver, executor, | 22 | | trustee, guardian, or other representative appointed by order | 23 | | of any court. | 24 | | "State-operated facility for persons with a developmental | 25 | | disability" means an intermediate care facility for persons | 26 | | with an intellectual disability within the meaning of Title XIX |
| | | HB5883 | - 4 - | LRB100 21964 KTG 39977 b |
|
| 1 | | of the Social Security Act operated by the State. | 2 | | (c) Administration and deposit of Revenues. The Department | 3 | | shall coordinate the implementation of changes required by | 4 | | Public Act 96-1405 amongst the various State and local | 5 | | government bodies that administer programs referred to in this | 6 | | Section. | 7 | | Revenues generated by program changes mandated by any | 8 | | provision in this Section, less reasonable administrative | 9 | | costs associated with the implementation of these program | 10 | | changes, which would otherwise be deposited into the General | 11 | | Revenue Fund shall be deposited into the Healthcare Provider | 12 | | Relief Fund. | 13 | | The Department shall issue a report to the General Assembly | 14 | | detailing the implementation progress of Public Act 96-1405 as | 15 | | a part of the Department's Medical Programs annual report for | 16 | | fiscal years 2010 and 2011. | 17 | | (d) Acceleration of payment vouchers. To the extent | 18 | | practicable and permissible under federal law, the Department | 19 | | shall create all vouchers for long term care facilities and | 20 | | facilities for persons with a developmental disability for | 21 | | dates of service in the month in which the enhanced federal | 22 | | medical assistance percentage (FMAP) originally set forth in | 23 | | the American Recovery and Reinvestment Act (ARRA) expires and | 24 | | for dates of service in the month prior to that month and | 25 | | shall, no later than the 15th of the month in which the | 26 | | enhanced FMAP expires, submit these vouchers to the Comptroller |
| | | HB5883 | - 5 - | LRB100 21964 KTG 39977 b |
|
| 1 | | for payment. | 2 | | The Department of Human Services shall create the necessary | 3 | | documentation for State-operated facilities for persons with a | 4 | | developmental disability so that the necessary data for all | 5 | | dates of service before the expiration of the enhanced FMAP | 6 | | originally set forth in the ARRA can be adjudicated by the | 7 | | Department no later than the 15th of the month in which the | 8 | | enhanced FMAP expires. | 9 | | (e) Billing of DHS community Medicaid mental health | 10 | | services. No later than July 1, 2011, community Medicaid mental | 11 | | health services provided by a community-based provider must be | 12 | | billed directly to the Department. | 13 | | (f) DCFS Medicaid services. The Department shall work with | 14 | | DCFS to identify existing programs, pending qualifying | 15 | | services, that can be converted in an economically feasible | 16 | | manner to Medicaid in order to secure federal financial | 17 | | revenue. | 18 | | (g) Third Party Liability recoveries . The Department shall | 19 | | contract with a vendor to perform the coordination of support | 20 | | the Department in coordinating benefits for Medicaid | 21 | | fee-for-service and managed care enrollees. The scope of work | 22 | | shall include, but not be limited to, at a minimum, the | 23 | | identification of other insurance for Medicaid enrollees and | 24 | | the recovery of funds paid by the Department when another payer | 25 | | was liable. The contract with the vendor shall include, but not | 26 | | be limited to, a review of the following populations: persons |
| | | HB5883 | - 6 - | LRB100 21964 KTG 39977 b |
|
| 1 | | eligible for both Medicare and Medicaid benefits | 2 | | (dual-eligible clients); persons enrolled in the | 3 | | fee-for-service medical assistance program; persons enrolled | 4 | | in the managed care medical assistance program; and persons | 5 | | eligible for benefits provided under the Children's Health | 6 | | Insurance Program Act. If the Department does not issue a | 7 | | comprehensive procurement, including both the identification | 8 | | of other insurance and the recovery of funds for the | 9 | | populations listed in this subsection, and contracts with a | 10 | | vendor for both pieces within 3 months after the effective date | 11 | | of this amendatory Act of the 100th General Assembly, the | 12 | | Department's Inspector General shall procure for the | 13 | | identification and recovery of other insurance. The vendor may | 14 | | be paid a percentage of actual cash recovered when practical | 15 | | and subject to federal law. | 16 | | (h) Public health departments.
The Department shall | 17 | | identify unreimbursed costs for persons covered by Medicaid who | 18 | | are served by the Chicago Department of Public Health. | 19 | | The Department shall assist the Chicago Department of | 20 | | Public Health in determining total unreimbursed costs | 21 | | associated with the provision of healthcare services to | 22 | | Medicaid enrollees. | 23 | | The Department shall determine and draw the maximum | 24 | | allowable federal matching dollars associated with the cost of | 25 | | Chicago Department of Public Health services provided to | 26 | | Medicaid enrollees. |
| | | HB5883 | - 7 - | LRB100 21964 KTG 39977 b |
|
| 1 | | (i) Acceleration of hospital-based payments.
The | 2 | | Department shall, by the 10th day of the month in which the | 3 | | enhanced FMAP originally set forth in the ARRA expires, create | 4 | | vouchers for all State fiscal year 2011 hospital payments | 5 | | exempt from the prompt payment requirements of the ARRA. The | 6 | | Department shall submit these vouchers to the Comptroller for | 7 | | payment.
| 8 | | (Source: P.A. 99-143, eff. 7-27-15; 100-201, eff. 8-18-17.)
|
|