Full Text of HB1653 101st General Assembly
HB1653sam001 101ST GENERAL ASSEMBLY | Sen. Heather A. Steans Filed: 1/12/2021
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| 1 | | AMENDMENT TO HOUSE BILL 1653
| 2 | | AMENDMENT NO. ______. Amend House Bill 1653 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 14-12 as follows: | 6 | | (305 ILCS 5/14-12) | 7 | | Sec. 14-12. Hospital rate reform payment system. The | 8 | | hospital payment system pursuant to Section 14-11 of this | 9 | | Article shall be as follows: | 10 | | (a) Inpatient hospital services. Effective for discharges | 11 | | on and after July 1, 2014, reimbursement for inpatient general | 12 | | acute care services shall utilize the All Patient Refined | 13 | | Diagnosis Related Grouping (APR-DRG) software, version 30, | 14 | | distributed by 3M TM Health Information System. | 15 | | (1) The Department shall establish Medicaid weighting | 16 | | factors to be used in the reimbursement system established |
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| 1 | | under this subsection. Initial weighting factors shall be | 2 | | the weighting factors as published by 3M Health Information | 3 | | System, associated with Version 30.0 adjusted for the | 4 | | Illinois experience. | 5 | | (2) The Department shall establish a | 6 | | statewide-standardized amount to be used in the inpatient | 7 | | reimbursement system. The Department shall publish these | 8 | | amounts on its website no later than 10 calendar days prior | 9 | | to their effective date. | 10 | | (3) In addition to the statewide-standardized amount, | 11 | | the Department shall develop adjusters to adjust the rate | 12 | | of reimbursement for critical Medicaid providers or | 13 | | services for trauma, transplantation services, perinatal | 14 | | care, and Graduate Medical Education (GME). | 15 | | (4) The Department shall develop add-on payments to | 16 | | account for exceptionally costly inpatient stays, | 17 | | consistent with Medicare outlier principles. Outlier fixed | 18 | | loss thresholds may be updated to control for excessive | 19 | | growth in outlier payments no more frequently than on an | 20 | | annual basis, but at least triennially. Upon updating the | 21 | | fixed loss thresholds, the Department shall be required to | 22 | | update base rates within 12 months. | 23 | | (5) The Department shall define those hospitals or | 24 | | distinct parts of hospitals that shall be exempt from the | 25 | | APR-DRG reimbursement system established under this | 26 | | Section. The Department shall publish these hospitals' |
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| 1 | | inpatient rates on its website no later than 10 calendar | 2 | | days prior to their effective date. | 3 | | (6) Beginning July 1, 2014 and ending on June 30, 2024, | 4 | | in addition to the statewide-standardized amount, the | 5 | | Department shall develop an adjustor to adjust the rate of | 6 | | reimbursement for safety-net hospitals defined in Section | 7 | | 5-5e.1 of this Code excluding pediatric hospitals. | 8 | | (7) Beginning July 1, 2014, in addition to the | 9 | | statewide-standardized amount, the Department shall | 10 | | develop an adjustor to adjust the rate of reimbursement for | 11 | | Illinois freestanding inpatient psychiatric hospitals that | 12 | | are not designated as children's hospitals by the | 13 | | Department but are primarily treating patients under the | 14 | | age of 21. | 15 | | (7.5) (Blank). | 16 | | (8) Beginning July 1, 2018, in addition to the | 17 | | statewide-standardized amount, the Department shall adjust | 18 | | the rate of reimbursement for hospitals designated by the | 19 | | Department of Public Health as a Perinatal Level II or II+ | 20 | | center by applying the same adjustor that is applied to | 21 | | Perinatal and Obstetrical care cases for Perinatal Level | 22 | | III centers, as of December 31, 2017. | 23 | | (9) Beginning July 1, 2018, in addition to the | 24 | | statewide-standardized amount, the Department shall apply | 25 | | the same adjustor that is applied to trauma cases as of | 26 | | December 31, 2017 to inpatient claims to treat patients |
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| 1 | | with burns, including, but not limited to, APR-DRGs 841, | 2 | | 842, 843, and 844. | 3 | | (10) Beginning July 1, 2018, the | 4 | | statewide-standardized amount for inpatient general acute | 5 | | care services shall be uniformly increased so that base | 6 | | claims projected reimbursement is increased by an amount | 7 | | equal to the funds allocated in paragraph (1) of subsection | 8 | | (b) of Section 5A-12.6, less the amount allocated under | 9 | | paragraphs (8) and (9) of this subsection and paragraphs | 10 | | (3) and (4) of subsection (b) multiplied by 40%. | 11 | | (11) Beginning July 1, 2018, the reimbursement for | 12 | | inpatient rehabilitation services shall be increased by | 13 | | the addition of a $96 per day add-on. | 14 | | (b) Outpatient hospital services. Effective for dates of | 15 | | service on and after July 1, 2014, reimbursement for outpatient | 16 | | services shall utilize the Enhanced Ambulatory Procedure | 17 | | Grouping (EAPG) software, version 3.7 distributed by 3M TM | 18 | | Health Information System. | 19 | | (1) The Department shall establish Medicaid weighting | 20 | | factors to be used in the reimbursement system established | 21 | | under this subsection. The initial weighting factors shall | 22 | | be the weighting factors as published by 3M Health | 23 | | Information System, associated with Version 3.7. | 24 | | (2) The Department shall establish service specific | 25 | | statewide-standardized amounts to be used in the | 26 | | reimbursement system. |
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| 1 | | (A) The initial statewide standardized amounts, | 2 | | with the labor portion adjusted by the Calendar Year | 3 | | 2013 Medicare Outpatient Prospective Payment System | 4 | | wage index with reclassifications, shall be published | 5 | | by the Department on its website no later than 10 | 6 | | calendar days prior to their effective date. | 7 | | (B) The Department shall establish adjustments to | 8 | | the statewide-standardized amounts for each Critical | 9 | | Access Hospital, as designated by the Department of | 10 | | Public Health in accordance with 42 CFR 485, Subpart F. | 11 | | For outpatient services provided on or before June 30, | 12 | | 2018, the EAPG standardized amounts are determined | 13 | | separately for each critical access hospital such that | 14 | | simulated EAPG payments using outpatient base period | 15 | | paid claim data plus payments under Section 5A-12.4 of | 16 | | this Code net of the associated tax costs are equal to | 17 | | the estimated costs of outpatient base period claims | 18 | | data with a rate year cost inflation factor applied. | 19 | | (3) In addition to the statewide-standardized amounts, | 20 | | the Department shall develop adjusters to adjust the rate | 21 | | of reimbursement for critical Medicaid hospital outpatient | 22 | | providers or services, including outpatient high volume or | 23 | | safety-net hospitals. Beginning July 1, 2018, the | 24 | | outpatient high volume adjustor shall be increased to | 25 | | increase annual expenditures associated with this adjustor | 26 | | by $79,200,000, based on the State Fiscal Year 2015 base |
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| 1 | | year data and this adjustor shall apply to public | 2 | | hospitals, except for large public hospitals, as defined | 3 | | under 89 Ill. Adm. Code 148.25(a). | 4 | | (4) Beginning July 1, 2018, in addition to the | 5 | | statewide standardized amounts, the Department shall make | 6 | | an add-on payment for outpatient expensive devices and | 7 | | drugs. This add-on payment shall at least apply to claim | 8 | | lines that: (i) are assigned with one of the following | 9 | | EAPGs: 490, 1001 to 1020, and coded with one of the | 10 | | following revenue codes: 0274 to 0276, 0278; or (ii) are | 11 | | assigned with one of the following EAPGs: 430 to 441, 443, | 12 | | 444, 460 to 465, 495, 496, 1090. The add-on payment shall | 13 | | be calculated as follows: the claim line's covered charges | 14 | | multiplied by the hospital's total acute cost to charge | 15 | | ratio, less the claim line's EAPG payment plus $1,000, | 16 | | multiplied by 0.8. | 17 | | (5) Beginning July 1, 2018, the statewide-standardized | 18 | | amounts for outpatient services shall be increased by a | 19 | | uniform percentage so that base claims projected | 20 | | reimbursement is increased by an amount equal to no less | 21 | | than the funds allocated in paragraph (1) of subsection (b) | 22 | | of Section 5A-12.6, less the amount allocated under | 23 | | paragraphs (8) and (9) of subsection (a) and paragraphs (3) | 24 | | and (4) of this subsection multiplied by 46%. | 25 | | (6) Effective for dates of service on or after July 1, | 26 | | 2018, the Department shall establish adjustments to the |
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| 1 | | statewide-standardized amounts for each Critical Access | 2 | | Hospital, as designated by the Department of Public Health | 3 | | in accordance with 42 CFR 485, Subpart F, such that each | 4 | | Critical Access Hospital's standardized amount for | 5 | | outpatient services shall be increased by the applicable | 6 | | uniform percentage determined pursuant to paragraph (5) of | 7 | | this subsection. It is the intent of the General Assembly | 8 | | that the adjustments required under this paragraph (6) by | 9 | | Public Act 100-1181 shall be applied retroactively to | 10 | | claims for dates of service provided on or after July 1, | 11 | | 2018. | 12 | | (7) Effective for dates of service on or after March 8, | 13 | | 2019 (the effective date of Public Act 100-1181), the | 14 | | Department shall recalculate and implement an updated | 15 | | statewide-standardized amount for outpatient services | 16 | | provided by hospitals that are not Critical Access | 17 | | Hospitals to reflect the applicable uniform percentage | 18 | | determined pursuant to paragraph (5). | 19 | | (1) Any recalculation to the | 20 | | statewide-standardized amounts for outpatient services | 21 | | provided by hospitals that are not Critical Access | 22 | | Hospitals shall be the amount necessary to achieve the | 23 | | increase in the statewide-standardized amounts for | 24 | | outpatient services increased by a uniform percentage, | 25 | | so that base claims projected reimbursement is | 26 | | increased by an amount equal to no less than the funds |
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| 1 | | allocated in paragraph (1) of subsection (b) of Section | 2 | | 5A-12.6, less the amount allocated under paragraphs | 3 | | (8) and (9) of subsection (a) and paragraphs (3) and | 4 | | (4) of this subsection, for all hospitals that are not | 5 | | Critical Access Hospitals, multiplied by 46%. | 6 | | (2) It is the intent of the General Assembly that | 7 | | the recalculations required under this paragraph (7) | 8 | | by Public Act 100-1181 shall be applied prospectively | 9 | | to claims for dates of service provided on or after | 10 | | March 8, 2019 (the effective date of Public Act | 11 | | 100-1181) and that no recoupment or repayment by the | 12 | | Department or an MCO of payments attributable to | 13 | | recalculation under this paragraph (7), issued to the | 14 | | hospital for dates of service on or after July 1, 2018 | 15 | | and before March 8, 2019 (the effective date of Public | 16 | | Act 100-1181), shall be permitted. | 17 | | (8) The Department shall ensure that all necessary | 18 | | adjustments to the managed care organization capitation | 19 | | base rates necessitated by the adjustments under | 20 | | subparagraph (6) or (7) of this subsection are completed | 21 | | and applied retroactively in accordance with Section | 22 | | 5-30.8 of this Code within 90 days of March 8, 2019 (the | 23 | | effective date of Public Act 100-1181). | 24 | | (9) Within 60 days after federal approval of the change | 25 | | made to the assessment in Section 5A-2 by this amendatory | 26 | | Act of the 101st General Assembly, the Department shall |
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| 1 | | incorporate into the EAPG system for outpatient services | 2 | | those services performed by hospitals currently billed | 3 | | through the Non-Institutional Provider billing system. | 4 | | (c) In consultation with the hospital community, the | 5 | | Department is authorized to replace 89 Ill. Admin. Code 152.150 | 6 | | as published in 38 Ill. Reg. 4980 through 4986 within 12 months | 7 | | of June 16, 2014 (the effective date of Public Act 98-651). If | 8 | | the Department does not replace these rules within 12 months of | 9 | | June 16, 2014 (the effective date of Public Act 98-651), the | 10 | | rules in effect for 152.150 as published in 38 Ill. Reg. 4980 | 11 | | through 4986 shall remain in effect until modified by rule by | 12 | | the Department. Nothing in this subsection shall be construed | 13 | | to mandate that the Department file a replacement rule. | 14 | | (d) Transition period.
There shall be a transition period | 15 | | to the reimbursement systems authorized under this Section that | 16 | | shall begin on the effective date of these systems and continue | 17 | | until June 30, 2018, unless extended by rule by the Department. | 18 | | To help provide an orderly and predictable transition to the | 19 | | new reimbursement systems and to preserve and enhance access to | 20 | | the hospital services during this transition, the Department | 21 | | shall allocate a transitional hospital access pool of at least | 22 | | $290,000,000 annually so that transitional hospital access | 23 | | payments are made to hospitals. | 24 | | (1) After the transition period, the Department may | 25 | | begin incorporating the transitional hospital access pool | 26 | | into the base rate structure; however, the transitional |
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| 1 | | hospital access payments in effect on June 30, 2018 shall | 2 | | continue to be paid, if continued under Section 5A-16. | 3 | | (2) After the transition period, if the Department | 4 | | reduces payments from the transitional hospital access | 5 | | pool, it shall increase base rates, develop new adjustors, | 6 | | adjust current adjustors, develop new hospital access | 7 | | payments based on updated information, or any combination | 8 | | thereof by an amount equal to the decreases proposed in the | 9 | | transitional hospital access pool payments, ensuring that | 10 | | the entire transitional hospital access pool amount shall | 11 | | continue to be used for hospital payments. | 12 | | (d-5) Hospital and health care transformation program. The | 13 | | Department shall develop a hospital and health care | 14 | | transformation program to provide financial assistance to | 15 | | hospitals in transforming their services and care models to | 16 | | better align with the needs of the communities they serve. The | 17 | | payments authorized in this Section shall be subject to | 18 | | approval by the federal government. | 19 | | (1) Phase 1. In State fiscal years 2019 through 2020, | 20 | | the Department shall allocate funds from the transitional | 21 | | access hospital pool to create a hospital transformation | 22 | | pool of at least $262,906,870 annually and make hospital | 23 | | transformation payments to hospitals. Subject to Section | 24 | | 5A-16, in State fiscal years 2019 and 2020, an Illinois | 25 | | hospital that received either a transitional hospital | 26 | | access payment under subsection (d) or a supplemental |
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| 1 | | payment under subsection (f) of this Section in State | 2 | | fiscal year 2018, shall receive a hospital transformation | 3 | | payment as follows: | 4 | | (A) If the hospital's Rate Year 2017 Medicaid | 5 | | inpatient utilization rate is equal to or greater than | 6 | | 45%, the hospital transformation payment shall be | 7 | | equal to 100% of the sum of its transitional hospital | 8 | | access payment authorized under subsection (d) and any | 9 | | supplemental payment authorized under subsection (f). | 10 | | (B) If the hospital's Rate Year 2017 Medicaid | 11 | | inpatient utilization rate is equal to or greater than | 12 | | 25% but less than 45%, the hospital transformation | 13 | | payment shall be equal to 75% of the sum of its | 14 | | transitional hospital access payment authorized under | 15 | | subsection (d) and any supplemental payment authorized | 16 | | under subsection (f). | 17 | | (C) If the hospital's Rate Year 2017 Medicaid | 18 | | inpatient utilization rate is less than 25%, the | 19 | | hospital transformation payment shall be equal to 50% | 20 | | of the sum of its transitional hospital access payment | 21 | | authorized under subsection (d) and any supplemental | 22 | | payment authorized under subsection (f). | 23 | | (2) Phase 2. | 24 | | (A) The funding amount from phase one shall be | 25 | | incorporated into directed payment and pass-through | 26 | | payment methodologies described in Section 5A-12.7. |
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| 1 | | (B) Because there are communities in Illinois that | 2 | | experience significant health care disparities due to | 3 | | systemic racism, as recently emphasized by the | 4 | | COVID-19 pandemic, aggravated by social determinants | 5 | | of health and a lack of sufficiently allocated | 6 | | healthcare resources, particularly community-based | 7 | | services, preventive care, obstetric care, chronic | 8 | | disease management, and specialty care, the Department | 9 | | shall establish a health care transformation program | 10 | | that shall be supported by the transformation funding | 11 | | pool. It is the intention of the General Assembly that | 12 | | innovative partnerships funded by the pool must be | 13 | | designed to establish or improve integrated health | 14 | | care delivery systems that will provide significant | 15 | | access to the Medicaid and uninsured populations in | 16 | | their communities, as well as improve health care | 17 | | equity. It is also the intention of the General | 18 | | Assembly that partnerships recognize and address the | 19 | | disparities revealed by the COVID-19 pandemic, as well | 20 | | as the need for post-COVID care. During State fiscal | 21 | | years 2021 through 2027, the hospital and health care | 22 | | transformation program shall be supported by an annual | 23 | | transformation funding pool of up to $150,000,000, | 24 | | pending federal matching funds, to be allocated during | 25 | | the specified fiscal years for the purpose of | 26 | | facilitating hospital and health care transformation. |
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| 1 | | No disbursement of moneys for transformation projects | 2 | | from the transformation funding pool described under | 3 | | this Section shall be considered an award, a grant, or | 4 | | an expenditure of grant funds. Funding agreements made | 5 | | in accordance with the transformation program shall be | 6 | | considered purchases of care under the Illinois | 7 | | Procurement Code, and funds shall be expended by the | 8 | | Department in a manner that maximizes federal funding | 9 | | to expend the entire allocated amount. | 10 | | The Department shall convene, within 30 days after | 11 | | the effective date of this amendatory Act of the 101st | 12 | | General Assembly, a workgroup that includes subject | 13 | | matter experts on healthcare disparities and | 14 | | stakeholders from distressed communities, which could | 15 | | be a subcommittee of the Medicaid Advisory Committee, | 16 | | to review and provide recommendations on how | 17 | | Department policy, including health care | 18 | | transformation, can improve health disparities and the | 19 | | impact on communities disproportionately affected by | 20 | | COVID-19. The workgroup shall consider and make | 21 | | recommendations on the following issues: a community | 22 | | safety-net designation of certain hospitals, racial | 23 | | equity, and a regional partnership to bring additional | 24 | | specialty services to communities. Whereas there are | 25 | | communities in Illinois that suffer from significant | 26 | | health care disparities aggravated by social |
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| 1 | | determinants of health and a lack of sufficiently | 2 | | allocated healthcare resources, particularly | 3 | | community-based services and preventive care, there is | 4 | | established a new hospital and health care | 5 | | transformation program, which shall be supported by a | 6 | | transformation funding pool. An application for | 7 | | funding from the hospital and health care | 8 | | transformation program may incorporate the campus of a | 9 | | hospital closed after January 1, 2018 or a hospital | 10 | | that has provided notice of its intent to close | 11 | | pursuant to Section 8.7 of the Illinois Health | 12 | | Facilities Planning Act. During State Fiscal Years | 13 | | 2021 through 2023, the hospital and health care | 14 | | transformation program shall be supported by an annual | 15 | | transformation funding pool of at least $150,000,000 | 16 | | to be allocated during the specified fiscal years for | 17 | | the purpose of facilitating hospital and health care | 18 | | transformation. The Department shall not allocate | 19 | | funds associated with the hospital and health care | 20 | | transformation pool as established in this | 21 | | subparagraph until the General Assembly has | 22 | | established in law or resolution, further criteria for | 23 | | dispersal or allocation of those funds after the | 24 | | effective date of this amendatory Act of 101st General | 25 | | Assembly. | 26 | | (C) As provided in paragraph (9) of Section 3 of |
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| 1 | | the Illinois Health Facilities Planning Act, any | 2 | | hospital participating in the transformation program | 3 | | may be excluded from the requirements of the Illinois | 4 | | Health Facilities Planning Act for those projects | 5 | | related to the hospital's transformation. To be | 6 | | eligible, the hospital must submit to the Health | 7 | | Facilities and Services Review Board approval from the | 8 | | Department that the project is a part of the hospital's | 9 | | transformation. | 10 | | (D) As provided in subsection (a-20) of Section | 11 | | 32.5 of the Emergency Medical Services (EMS) Systems | 12 | | Act, a hospital that received hospital transformation | 13 | | payments under this Section may convert to a | 14 | | freestanding emergency center. To be eligible for such | 15 | | a conversion, the hospital must submit to the | 16 | | Department of Public Health approval from the | 17 | | Department that the project is a part of the hospital's | 18 | | transformation. | 19 | | (E) Criteria for proposals. To be eligible for | 20 | | funding under this Section, a transformation proposal | 21 | | shall meet all of the following criteria: | 22 | | (i) the proposal shall be designed based on | 23 | | community needs assessment completed by either a | 24 | | University partner or other qualified entity with | 25 | | significant community input; | 26 | | (ii) the proposal shall be a collaboration |
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| 1 | | among providers across the care and community | 2 | | spectrum, including preventative care, primary | 3 | | care specialty care, hospital services, mental | 4 | | health and substance abuse services, as well as | 5 | | community-based entities that address the social | 6 | | determinants of health; | 7 | | (iii) the proposal shall be specifically | 8 | | designed to improve healthcare outcomes and reduce | 9 | | healthcare disparities, and improve the | 10 | | coordination, effectiveness, and efficiency of | 11 | | care delivery; | 12 | | (iv) the proposal shall have specific | 13 | | measurable metrics related to disparities that | 14 | | will be tracked by the Department and made public | 15 | | by the Department; | 16 | | (v) the proposal shall include a commitment to | 17 | | include Business Enterprise Program certified | 18 | | vendors or other entities controlled and managed | 19 | | by minorities or women; and | 20 | | (vi) the proposal shall specifically increase | 21 | | access to primary, preventive, or specialty care. | 22 | | (F) Entities eligible to be funded. | 23 | | (i) Proposals for funding should come from | 24 | | collaborations operating in one of the most | 25 | | distressed communities in Illinois as determined | 26 | | by the U.S. Centers for Disease Control and |
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| 1 | | Prevention's Social Vulnerability Index for | 2 | | Illinois and areas disproportionately impacted by | 3 | | COVID-19 or from rural areas of Illinois. | 4 | | (ii) The Department shall prioritize | 5 | | partnerships from distressed communities, which | 6 | | include Business Enterprise Program certified | 7 | | vendors or other entities controlled and managed | 8 | | by minorities or women and also include one or more | 9 | | of the following: safety-net hospitals, critical | 10 | | access hospitals, the campuses of hospitals that | 11 | | have closed since January 1, 2018, or other | 12 | | healthcare providers designed to address specific | 13 | | healthcare disparities, including the impact of | 14 | | COVID-19 on individuals and the community and the | 15 | | need for post-COVID care. All funded proposals | 16 | | must include specific measurable goals and metrics | 17 | | related to improved outcomes and reduced | 18 | | disparities which shall be tracked by the | 19 | | Department. | 20 | | (iii) The Department should target the funding | 21 | | in the following ways: $30,000,000 of | 22 | | transformation funds to projects that are a | 23 | | collaboration between a safety-net hospital, | 24 | | particularly community safety-net hospitals, and | 25 | | other providers and designed to address specific | 26 | | healthcare disparities, $20,000,000 of |
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| 1 | | transformation funds to collaborations between | 2 | | safety-net hospitals and a larger hospital partner | 3 | | that increases specialty care in distressed | 4 | | communities, $30,000,000 of transformation funds | 5 | | to projects that are a collaboration between | 6 | | hospitals and other providers in distressed areas | 7 | | of the State designed to address specific | 8 | | healthcare disparities, $15,000,000 to | 9 | | collaborations between critical access hospitals | 10 | | and other providers designed to address specific | 11 | | healthcare disparities, and $15,000,000 to | 12 | | cross-provider collaborations designed to address | 13 | | specific healthcare disparities, and $5,000,000 to | 14 | | collaborations that focus on workforce | 15 | | development. | 16 | | (iv) The Department may allocate up to | 17 | | $5,000,000 for planning, racial equity analysis, | 18 | | or consulting resources for the Department or | 19 | | entities without the resources to develop a plan to | 20 | | meet the criteria of this Section. Any contract for | 21 | | consulting services issued by the Department under | 22 | | this subparagraph shall comply with the provisions | 23 | | of Section 5-45 of the State Officials and | 24 | | Employees Ethics Act. Based on availability of | 25 | | federal funding, the Department may directly | 26 | | procure consulting services or provide funding to |
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| 1 | | the collaboration. The provision of resources | 2 | | under this subparagraph is not a guarantee that a | 3 | | project will be approved. | 4 | | (v) The Department shall take steps to ensure | 5 | | that safety-net hospitals operating in | 6 | | under-resourced communities receive priority | 7 | | access to hospital and healthcare transformation | 8 | | funds, including consulting funds, as provided | 9 | | under this Section. | 10 | | (G) Process for submitting and approving projects | 11 | | for distressed communities. The Department shall issue | 12 | | a template for application. The Department shall post | 13 | | any proposal received on the Department's website for | 14 | | at least 2 weeks for public comment, and any such | 15 | | public comment shall also be considered in the review | 16 | | process. Applicants may request that proprietary | 17 | | financial information be redacted from publicly posted | 18 | | proposals and the Department in its discretion may | 19 | | agree. Proposals for each distressed community must | 20 | | include all of the following: | 21 | | (i) A detailed description of how the project | 22 | | intends to affect the goals outlined in this | 23 | | subsection, describing new interventions, new | 24 | | technology, new structures, and other changes to | 25 | | the healthcare delivery system planned. | 26 | | (ii) A detailed description of the racial and |
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| 1 | | ethnic makeup of the entities' board and | 2 | | leadership positions and the salaries of the | 3 | | executive staff of entities in the partnership | 4 | | that is seeking to obtain funding under this | 5 | | Section. | 6 | | (iii) A complete budget, including an overall | 7 | | timeline and a detailed pathway to sustainability | 8 | | within a 5-year period, specifying other sources | 9 | | of funding, such as in-kind, cost-sharing, or | 10 | | private donations, particularly for capital needs. | 11 | | There is an expectation that parties to the | 12 | | transformation project dedicate resources to the | 13 | | extent they are able and that these expectations | 14 | | are delineated separately for each entity in the | 15 | | proposal. | 16 | | (iv) A description of any new entities formed | 17 | | or other legal relationships between collaborating | 18 | | entities and how funds will be allocated among | 19 | | participants. | 20 | | (v) A timeline showing the evolution of sites | 21 | | and specific services of the project over a 5-year | 22 | | period, including services available to the | 23 | | community by site. | 24 | | (vi) Clear milestones indicating progress | 25 | | toward the proposed goals of the proposal as | 26 | | checkpoints along the way to continue receiving |
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| 1 | | funding. The Department is authorized to refine | 2 | | these milestones in agreements, and is authorized | 3 | | to impose reasonable penalties, including | 4 | | repayment of funds, for substantial lack of | 5 | | progress. | 6 | | (vii) A clear statement of the level of | 7 | | commitment the project will include for minorities | 8 | | and women in contracting opportunities, including | 9 | | as equity partners where applicable, or as | 10 | | subcontractors and suppliers in all phases of the | 11 | | project. | 12 | | (viii) If the community study utilized is not | 13 | | the study commissioned and published by the | 14 | | Department, the applicant must define the | 15 | | methodology used, including documentation of clear | 16 | | community participation. | 17 | | (ix) A description of the process used in | 18 | | collaborating with all levels of government in the | 19 | | community served in the development of the | 20 | | project, including, but not limited to, | 21 | | legislators and officials of other units of local | 22 | | government. | 23 | | (x) Documentation of a community input process | 24 | | in the community served, including links to | 25 | | proposal materials on public websites. | 26 | | (xi) Verifiable project milestones and quality |
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| 1 | | metrics that will be impacted by transformation. | 2 | | These project milestones and quality metrics must | 3 | | be identified with improvement targets that must | 4 | | be met. | 5 | | (xii) Data on the number of existing employees | 6 | | by various job categories and wage levels by the | 7 | | zip code of the employees' residence and | 8 | | benchmarks for the continued maintenance and | 9 | | improvement of these levels. The proposal must | 10 | | also describe any retraining or other workforce | 11 | | development planned for the new project. | 12 | | (xiii) If a new entity is created by the | 13 | | project, a description of how the board will be | 14 | | reflective of the community served by the | 15 | | proposal. | 16 | | (xiv) An explanation of how the proposal will | 17 | | address the existing disparities that exacerbated | 18 | | the impact of COVID-19 and the need for post-COVID | 19 | | care in the community, if applicable. | 20 | | (xv) An explanation of how the proposal is | 21 | | designed to increase access to care, including | 22 | | specialty care based upon the community's needs. | 23 | | (H) The Department shall evaluate proposals for | 24 | | compliance with the criteria listed under subparagraph | 25 | | (G). Proposals meeting all of the criteria may be | 26 | | eligible for funding with the areas of focus |
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| 1 | | prioritized as described in item (ii) of subparagraph | 2 | | (F). Based on the funds available, the Department may | 3 | | negotiate funding agreements with approved applicants | 4 | | to maximize federal funding. Nothing in this | 5 | | subsection requires that an approved project be funded | 6 | | to the level requested. Agreements shall specify the | 7 | | amount of funding anticipated annually, the | 8 | | methodology of payments, the limit on the number of | 9 | | years such funding may be provided, and the milestones | 10 | | and quality metrics that must be met by the projects in | 11 | | order to continue to receive funding during each year | 12 | | of the program. Agreements shall specify the terms and | 13 | | conditions under which a health care facility that | 14 | | receives funds under a purchase of care agreement and | 15 | | closes in violation of the terms of the agreement must | 16 | | pay an early closure fee no greater than 50% of the | 17 | | funds it received under the agreement, prior to the | 18 | | Health Facilities and Services Review Board | 19 | | considering an application for closure of the | 20 | | facility. Any project that is funded shall be required | 21 | | to provide quarterly written progress reports, in a | 22 | | form prescribed by the Department, and at a minimum | 23 | | shall include the progress made in achieving any | 24 | | milestones or metrics or Business Enterprise Program | 25 | | commitments in its plan. The Department may reduce or | 26 | | end payments, as set forth in transformation plans, if |
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| 1 | | milestones or metrics or Business Enterprise Program | 2 | | commitments are not achieved. The Department shall | 3 | | seek to make payments from the transformation fund in a | 4 | | manner that is eligible for federal matching funds. | 5 | | In reviewing the proposals, the Department shall | 6 | | take into account the needs of the community, data from | 7 | | the study commissioned by the Department from the | 8 | | University of Illinois-Chicago if applicable, feedback | 9 | | from public comment on the Department's website, as | 10 | | well as how the proposal meets the criteria listed | 11 | | under subparagraph (G). Alignment with the | 12 | | Department's overall strategic initiatives shall be an | 13 | | important factor. To the extent that fiscal year | 14 | | funding is not adequate to fund all eligible projects | 15 | | that apply, the Department shall prioritize | 16 | | applications that most comprehensively and effectively | 17 | | address the criteria listed under subparagraph (G). | 18 | | (3) (Blank). | 19 | | (4) Hospital Transformation Review Committee. There is | 20 | | created the Hospital Transformation Review Committee. The | 21 | | Committee shall consist of 14 members. No later than 30 | 22 | | days after March 12, 2018 (the effective date of Public Act | 23 | | 100-581), the 4 legislative leaders shall each appoint 3 | 24 | | members; the Governor shall appoint the Director of | 25 | | Healthcare and Family Services, or his or her designee, as | 26 | | a member; and the Director of Healthcare and Family |
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| 1 | | Services shall appoint one member. Any vacancy shall be | 2 | | filled by the applicable appointing authority within 15 | 3 | | calendar days. The members of the Committee shall select a | 4 | | Chair and a Vice-Chair from among its members, provided | 5 | | that the Chair and Vice-Chair cannot be appointed by the | 6 | | same appointing authority and must be from different | 7 | | political parties. The Chair shall have the authority to | 8 | | establish a meeting schedule and convene meetings of the | 9 | | Committee, and the Vice-Chair shall have the authority to | 10 | | convene meetings in the absence of the Chair. The Committee | 11 | | may establish its own rules with respect to meeting | 12 | | schedule, notice of meetings, and the disclosure of | 13 | | documents; however, the Committee shall not have the power | 14 | | to subpoena individuals or documents and any rules must be | 15 | | approved by 9 of the 14 members. The Committee shall | 16 | | perform the functions described in this Section and advise | 17 | | and consult with the Director in the administration of this | 18 | | Section. In addition to reviewing and approving the | 19 | | policies, procedures, and rules for the hospital and health | 20 | | care transformation program, the Committee shall consider | 21 | | and make recommendations related to qualifying criteria | 22 | | and payment methodologies related to safety-net hospitals | 23 | | and children's hospitals. Members of the Committee | 24 | | appointed by the legislative leaders shall be subject to | 25 | | the jurisdiction of the Legislative Ethics Commission, not | 26 | | the Executive Ethics Commission, and all requests under the |
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| 1 | | Freedom of Information Act shall be directed to the | 2 | | applicable Freedom of Information officer for the General | 3 | | Assembly. The Department shall provide operational support | 4 | | to the Committee as necessary. The Committee is dissolved | 5 | | on April 1, 2019. | 6 | | (e) Beginning 36 months after initial implementation, the | 7 | | Department shall update the reimbursement components in | 8 | | subsections (a) and (b), including standardized amounts and | 9 | | weighting factors, and at least triennially and no more | 10 | | frequently than annually thereafter. The Department shall | 11 | | publish these updates on its website no later than 30 calendar | 12 | | days prior to their effective date. | 13 | | (f) Continuation of supplemental payments. Any | 14 | | supplemental payments authorized under Illinois Administrative | 15 | | Code 148 effective January 1, 2014 and that continue during the | 16 | | period of July 1, 2014 through December 31, 2014 shall remain | 17 | | in effect as long as the assessment imposed by Section 5A-2 | 18 | | that is in effect on December 31, 2017 remains in effect. | 19 | | (g) Notwithstanding subsections (a) through (f) of this | 20 | | Section and notwithstanding the changes authorized under | 21 | | Section 5-5b.1, any updates to the system shall not result in | 22 | | any diminishment of the overall effective rates of | 23 | | reimbursement as of the implementation date of the new system | 24 | | (July 1, 2014). These updates shall not preclude variations in | 25 | | any individual component of the system or hospital rate | 26 | | variations. Nothing in this Section shall prohibit the |
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| 1 | | Department from increasing the rates of reimbursement or | 2 | | developing payments to ensure access to hospital services. | 3 | | Nothing in this Section shall be construed to guarantee a | 4 | | minimum amount of spending in the aggregate or per hospital as | 5 | | spending may be impacted by factors, including, but not limited | 6 | | to, the number of individuals in the medical assistance program | 7 | | and the severity of illness of the individuals. | 8 | | (h) The Department shall have the authority to modify by | 9 | | rulemaking any changes to the rates or methodologies in this | 10 | | Section as required by the federal government to obtain federal | 11 | | financial participation for expenditures made under this | 12 | | Section. | 13 | | (i) Except for subsections (g) and (h) of this Section, the | 14 | | Department shall, pursuant to subsection (c) of Section 5-40 of | 15 | | the Illinois Administrative Procedure Act, provide for | 16 | | presentation at the June 2014 hearing of the Joint Committee on | 17 | | Administrative Rules (JCAR) additional written notice to JCAR | 18 | | of the following rules in order to commence the second notice | 19 | | period for the following rules: rules published in the Illinois | 20 | | Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559 | 21 | | (Medical Payment), 4628 (Specialized Health Care Delivery | 22 | | Systems), 4640 (Hospital Services), 4932 (Diagnostic Related | 23 | | Grouping (DRG) Prospective Payment System (PPS)), and 4977 | 24 | | (Hospital Reimbursement Changes), and published in the | 25 | | Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499 | 26 | | (Specialized Health Care Delivery Systems) and 6505 (Hospital |
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| 1 | | Services).
| 2 | | (j) Out-of-state hospitals. Beginning July 1, 2018, for | 3 | | purposes of determining for State fiscal years 2019 and 2020 | 4 | | and subsequent fiscal years the hospitals eligible for the | 5 | | payments authorized under subsections (a) and (b) of this | 6 | | Section, the Department shall include out-of-state hospitals | 7 | | that are designated a Level I pediatric trauma center or a | 8 | | Level I trauma center by the Department of Public Health as of | 9 | | December 1, 2017. | 10 | | (k) The Department shall notify each hospital and managed | 11 | | care organization, in writing, of the impact of the updates | 12 | | under this Section at least 30 calendar days prior to their | 13 | | effective date. | 14 | | (Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19; | 15 | | 101-81, eff. 7-12-19; 101-650, eff. 7-7-20.)
| 16 | | Section 99. Effective date. This Act takes effect upon | 17 | | becoming law.".
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