Full Text of SB1040 102nd General Assembly
SB1040enr 102ND GENERAL ASSEMBLY |
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| 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 Sections 5-5.02 and 14-12 as follows:
| 6 | | (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
| 7 | | Sec. 5-5.02. Hospital reimbursements.
| 8 | | (a) Reimbursement to hospitals; July 1, 1992 through | 9 | | September 30, 1992.
Notwithstanding any other provisions of | 10 | | this Code or the Illinois
Department's Rules promulgated under | 11 | | the Illinois Administrative Procedure
Act, reimbursement to | 12 | | hospitals for services provided during the period
July 1, 1992 | 13 | | through September 30, 1992, shall be as follows:
| 14 | | (1) For inpatient hospital services rendered, or if | 15 | | applicable, for
inpatient hospital discharges occurring, | 16 | | on or after July 1, 1992 and on
or before September 30, | 17 | | 1992, the Illinois Department shall reimburse
hospitals | 18 | | for inpatient services under the reimbursement | 19 | | methodologies in
effect for each hospital, and at the | 20 | | inpatient payment rate calculated for
each hospital, as of | 21 | | June 30, 1992. For purposes of this paragraph,
| 22 | | "reimbursement methodologies" means all reimbursement | 23 | | methodologies that
pertain to the provision of inpatient |
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| 1 | | hospital services, including, but not
limited to, any | 2 | | adjustments for disproportionate share, targeted access,
| 3 | | critical care access and uncompensated care, as defined by | 4 | | the Illinois
Department on June 30, 1992.
| 5 | | (2) For the purpose of calculating the inpatient | 6 | | payment rate for each
hospital eligible to receive | 7 | | quarterly adjustment payments for targeted
access and | 8 | | critical care, as defined by the Illinois Department on | 9 | | June 30,
1992, the adjustment payment for the period July | 10 | | 1, 1992 through September
30, 1992, shall be 25% of the | 11 | | annual adjustment payments calculated for
each eligible | 12 | | hospital, as of June 30, 1992. The Illinois Department | 13 | | shall
determine by rule the adjustment payments for | 14 | | targeted access and critical
care beginning October 1, | 15 | | 1992.
| 16 | | (3) For the purpose of calculating the inpatient | 17 | | payment rate for each
hospital eligible to receive | 18 | | quarterly adjustment payments for
uncompensated care, as | 19 | | defined by the Illinois Department on June 30, 1992,
the | 20 | | adjustment payment for the period August 1, 1992 through | 21 | | September 30,
1992, shall be one-sixth of the total | 22 | | uncompensated care adjustment payments
calculated for each | 23 | | eligible hospital for the uncompensated care rate year,
as | 24 | | defined by the Illinois Department, ending on July 31, | 25 | | 1992. The
Illinois Department shall determine by rule the | 26 | | adjustment payments for
uncompensated care beginning |
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| 1 | | October 1, 1992.
| 2 | | (b) Inpatient payments. For inpatient services provided on | 3 | | or after October
1, 1993, in addition to rates paid for | 4 | | hospital inpatient services pursuant to
the Illinois Health | 5 | | Finance Reform Act, as now or hereafter amended, or the
| 6 | | Illinois Department's prospective reimbursement methodology, | 7 | | or any other
methodology used by the Illinois Department for | 8 | | inpatient services, the
Illinois Department shall make | 9 | | adjustment payments, in an amount calculated
pursuant to the | 10 | | methodology described in paragraph (c) of this Section, to
| 11 | | hospitals that the Illinois Department determines satisfy any | 12 | | one of the
following requirements:
| 13 | | (1) Hospitals that are described in Section 1923 of | 14 | | the federal Social
Security Act, as now or hereafter | 15 | | amended, except that for rate year 2015 and after a | 16 | | hospital described in Section 1923(b)(1)(B) of the federal | 17 | | Social Security Act and qualified for the payments | 18 | | described in subsection (c) of this Section for rate year | 19 | | 2014 provided the hospital continues to meet the | 20 | | description in Section 1923(b)(1)(B) in the current | 21 | | determination year; or
| 22 | | (2) Illinois hospitals that have a Medicaid inpatient | 23 | | utilization
rate which is at least one-half a standard | 24 | | deviation above the mean Medicaid
inpatient utilization | 25 | | rate for all hospitals in Illinois receiving Medicaid
| 26 | | payments from the Illinois Department; or
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| 1 | | (3) Illinois hospitals that on July 1, 1991 had a | 2 | | Medicaid inpatient
utilization rate, as defined in | 3 | | paragraph (h) of this Section,
that was at least the mean | 4 | | Medicaid inpatient utilization rate for all
hospitals in | 5 | | Illinois receiving Medicaid payments from the Illinois
| 6 | | Department and which were located in a planning area with | 7 | | one-third or
fewer excess beds as determined by the Health | 8 | | Facilities and Services Review Board, and that, as of June | 9 | | 30, 1992, were located in a federally
designated Health | 10 | | Manpower Shortage Area; or
| 11 | | (4) Illinois hospitals that:
| 12 | | (A) have a Medicaid inpatient utilization rate | 13 | | that is at least
equal to the mean Medicaid inpatient | 14 | | utilization rate for all hospitals in
Illinois | 15 | | receiving Medicaid payments from the Department; and
| 16 | | (B) also have a Medicaid obstetrical inpatient | 17 | | utilization
rate that is at least one standard | 18 | | deviation above the mean Medicaid
obstetrical | 19 | | inpatient utilization rate for all hospitals in | 20 | | Illinois
receiving Medicaid payments from the | 21 | | Department for obstetrical services; or
| 22 | | (5) Any children's hospital, which means a hospital | 23 | | devoted exclusively
to caring for children. A hospital | 24 | | which includes a facility devoted
exclusively to caring | 25 | | for children shall be considered a
children's hospital to | 26 | | the degree that the hospital's Medicaid care is
provided |
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| 1 | | to children
if either (i) the facility devoted exclusively | 2 | | to caring for children is
separately licensed as a | 3 | | hospital by a municipality prior to February 28, 2013;
| 4 | | (ii) the hospital has been
designated
by the State
as a | 5 | | Level III perinatal care facility, has a Medicaid | 6 | | Inpatient
Utilization rate
greater than 55% for the rate | 7 | | year 2003 disproportionate share determination,
and has | 8 | | more than 10,000 qualified children days as defined by
the
| 9 | | Department in rulemaking; (iii) the hospital has been | 10 | | designated as a Perinatal Level III center by the State as | 11 | | of December 1, 2017, is a Pediatric Critical Care Center | 12 | | designated by the State as of December 1, 2017 and has a | 13 | | 2017 Medicaid inpatient utilization rate equal to or | 14 | | greater than 45%; or (iv) the hospital has been designated | 15 | | as a Perinatal Level II center by the State as of December | 16 | | 1, 2017, has a 2017 Medicaid Inpatient Utilization Rate | 17 | | greater than 70%, and has at least 10 pediatric beds as | 18 | | listed on the IDPH 2015 calendar year hospital profile ; or | 19 | | .
| 20 | | (6) A hospital that reopens a previously closed | 21 | | hospital facility within 3 calendar years of the hospital | 22 | | facility's closure, if the previously closed hospital | 23 | | facility qualified for payments under paragraph (c) at the | 24 | | time of closure, until utilization data for the new | 25 | | facility is available for the Medicaid inpatient | 26 | | utilization rate calculation. For purposes of this clause, |
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| 1 | | a "closed hospital facility" shall include hospitals that | 2 | | have been terminated from participation in the medical | 3 | | assistance program in accordance with Section 12-4.25 of | 4 | | this Code. | 5 | | (c) Inpatient adjustment payments. The adjustment payments | 6 | | required by
paragraph (b) shall be calculated based upon the | 7 | | hospital's Medicaid
inpatient utilization rate as follows:
| 8 | | (1) hospitals with a Medicaid inpatient utilization | 9 | | rate below the mean
shall receive a per day adjustment | 10 | | payment equal to $25;
| 11 | | (2) hospitals with a Medicaid inpatient utilization | 12 | | rate
that is equal to or greater than the mean Medicaid | 13 | | inpatient utilization rate
but less than one standard | 14 | | deviation above the mean Medicaid inpatient
utilization | 15 | | rate shall receive a per day adjustment payment
equal to | 16 | | the sum of $25 plus $1 for each one percent that the | 17 | | hospital's
Medicaid inpatient utilization rate exceeds the | 18 | | mean Medicaid inpatient
utilization rate;
| 19 | | (3) hospitals with a Medicaid inpatient utilization | 20 | | rate that is equal
to or greater than one standard | 21 | | deviation above the mean Medicaid inpatient
utilization | 22 | | rate but less than 1.5 standard deviations above the mean | 23 | | Medicaid
inpatient utilization rate shall receive a per | 24 | | day adjustment payment equal to
the sum of $40 plus $7 for | 25 | | each one percent that the hospital's Medicaid
inpatient | 26 | | utilization rate exceeds one standard deviation above the |
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| 1 | | mean
Medicaid inpatient utilization rate; and
| 2 | | (4) hospitals with a Medicaid inpatient utilization | 3 | | rate that is equal
to or greater than 1.5 standard | 4 | | deviations above the mean Medicaid inpatient
utilization | 5 | | rate shall receive a per day adjustment payment equal to | 6 | | the sum of
$90 plus $2 for each one percent that the | 7 | | hospital's Medicaid inpatient
utilization rate exceeds 1.5 | 8 | | standard deviations above the mean Medicaid
inpatient | 9 | | utilization rate ; and .
| 10 | | (5) Hospitals qualifying under clause (6) of paragraph | 11 | | (b) shall have the rate assigned to the previously closed | 12 | | hospital facility at the date of closure, until | 13 | | utilization data for the new facility is available for the | 14 | | Medicaid inpatient utilization rate calculation. | 15 | | (d) Supplemental adjustment payments. In addition to the | 16 | | adjustment
payments described in paragraph (c), hospitals as | 17 | | defined in clauses
(1) through (6) (5) of paragraph (b), | 18 | | excluding county hospitals (as defined in
subsection (c) of | 19 | | Section 15-1 of this Code) and a hospital organized under the
| 20 | | University of Illinois Hospital Act, shall be paid | 21 | | supplemental inpatient
adjustment payments of $60 per day. For | 22 | | purposes of Title XIX of the federal
Social Security Act, | 23 | | these supplemental adjustment payments shall not be
classified | 24 | | as adjustment payments to disproportionate share hospitals.
| 25 | | (e) The inpatient adjustment payments described in | 26 | | paragraphs (c) and (d)
shall be increased on October 1, 1993 |
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| 1 | | and annually thereafter by a percentage
equal to the lesser of | 2 | | (i) the increase in the DRI hospital cost index for the
most | 3 | | recent 12 month period for which data are available, or (ii) | 4 | | the
percentage increase in the statewide average hospital | 5 | | payment rate over the
previous year's statewide average | 6 | | hospital payment rate. The sum of the
inpatient adjustment | 7 | | payments under paragraphs (c) and (d) to a hospital, other
| 8 | | than a county hospital (as defined in subsection (c) of | 9 | | Section 15-1 of this
Code) or a hospital organized under the | 10 | | University of Illinois Hospital Act,
however, shall not exceed | 11 | | $275 per day; that limit shall be increased on
October 1, 1993 | 12 | | and annually thereafter by a percentage equal to the lesser of
| 13 | | (i) the increase in the DRI hospital cost index for the most | 14 | | recent 12-month
period for which data are available or (ii) | 15 | | the percentage increase in the
statewide average hospital | 16 | | payment rate over the previous year's statewide
average | 17 | | hospital payment rate.
| 18 | | (f) Children's hospital inpatient adjustment payments. For | 19 | | children's
hospitals, as defined in clause (5) of paragraph | 20 | | (b), the adjustment payments
required pursuant to paragraphs | 21 | | (c) and (d) shall be multiplied by 2.0.
| 22 | | (g) County hospital inpatient adjustment payments. For | 23 | | county hospitals,
as defined in subsection (c) of Section 15-1 | 24 | | of this Code, there shall be an
adjustment payment as | 25 | | determined by rules issued by the Illinois Department.
| 26 | | (h) For the purposes of this Section the following terms |
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| 1 | | shall be defined
as follows:
| 2 | | (1) "Medicaid inpatient utilization rate" means a | 3 | | fraction, the numerator
of which is the number of a | 4 | | hospital's inpatient days provided in a given
12-month | 5 | | period to patients who, for such days, were eligible for | 6 | | Medicaid
under Title XIX of the federal Social Security | 7 | | Act, and the denominator of
which is the total number of | 8 | | the hospital's inpatient days in that same period.
| 9 | | (2) "Mean Medicaid inpatient utilization rate" means | 10 | | the total number
of Medicaid inpatient days provided by | 11 | | all Illinois Medicaid-participating
hospitals divided by | 12 | | the total number of inpatient days provided by those same
| 13 | | hospitals.
| 14 | | (3) "Medicaid obstetrical inpatient utilization rate" | 15 | | means the
ratio of Medicaid obstetrical inpatient days to | 16 | | total Medicaid inpatient
days for all Illinois hospitals | 17 | | receiving Medicaid payments from the
Illinois Department.
| 18 | | (i) Inpatient adjustment payment limit. In order to meet | 19 | | the limits
of Public Law 102-234 and Public Law 103-66, the
| 20 | | Illinois Department shall by rule adjust
disproportionate | 21 | | share adjustment payments.
| 22 | | (j) University of Illinois Hospital inpatient adjustment | 23 | | payments. For
hospitals organized under the University of | 24 | | Illinois Hospital Act, there shall
be an adjustment payment as | 25 | | determined by rules adopted by the Illinois
Department.
| 26 | | (k) The Illinois Department may by rule establish criteria |
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| 1 | | for and develop
methodologies for adjustment payments to | 2 | | hospitals participating under this
Article.
| 3 | | (l) On and after July 1, 2012, the Department shall reduce | 4 | | any rate of reimbursement for services or other payments or | 5 | | alter any methodologies authorized by this Code to reduce any | 6 | | rate of reimbursement for services or other payments in | 7 | | accordance with Section 5-5e. | 8 | | (m) The Department shall establish a cost-based | 9 | | reimbursement methodology for determining payments to | 10 | | hospitals for approved graduate medical education (GME) | 11 | | programs for dates of service on and after July 1, 2018. | 12 | | (1) As used in this subsection, "hospitals" means the | 13 | | University of Illinois Hospital as defined in the | 14 | | University of Illinois Hospital Act and a county hospital | 15 | | in a county of over 3,000,000 inhabitants. | 16 | | (2) An amendment to the Illinois Title XIX State Plan | 17 | | defining GME shall maximize reimbursement, shall not be | 18 | | limited to the education programs or special patient care | 19 | | payments allowed under Medicare, and shall include: | 20 | | (A) inpatient days; | 21 | | (B) outpatient days; | 22 | | (C) direct costs; | 23 | | (D) indirect costs; | 24 | | (E) managed care days; | 25 | | (F) all stages of medical training and education | 26 | | including students, interns, residents, and fellows |
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| 1 | | with no caps on the number of persons who may qualify; | 2 | | and | 3 | | (G) patient care payments related to the | 4 | | complexities of treating Medicaid enrollees including | 5 | | clinical and social determinants of health. | 6 | | (3) The Department shall make all GME payments | 7 | | directly to hospitals including such costs in support of | 8 | | clients enrolled in Medicaid managed care entities. | 9 | | (4) The Department shall promptly take all actions | 10 | | necessary for reimbursement to be effective for dates of | 11 | | service on and after July 1, 2018 including publishing all | 12 | | appropriate public notices, amendments to the Illinois | 13 | | Title XIX State Plan, and adoption of administrative rules | 14 | | if necessary. | 15 | | (5) As used in this subsection, "managed care days" | 16 | | means costs associated with services rendered to enrollees | 17 | | of Medicaid managed care entities. "Medicaid managed care | 18 | | entities" means any entity which contracts with the | 19 | | Department to provide services paid for on a capitated | 20 | | basis. "Medicaid managed care entities" includes a managed | 21 | | care organization and a managed care community network. | 22 | | (6) All payments under this Section are contingent | 23 | | upon federal approval of changes to the Illinois Title XIX | 24 | | State Plan, if that approval is required. | 25 | | (7) The Department may adopt rules necessary to | 26 | | implement Public Act 100-581 through the use of emergency |
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| 1 | | rulemaking in accordance with subsection (aa) of Section | 2 | | 5-45 of the Illinois Administrative Procedure Act. For | 3 | | purposes of that Act, the General Assembly finds that the | 4 | | adoption of rules to implement Public Act 100-581 is | 5 | | deemed an emergency and necessary for the public interest, | 6 | | safety, and welfare. | 7 | | (Source: P.A. 100-580, eff. 3-12-18; 100-581, eff. 3-12-18; | 8 | | 101-81, eff. 7-12-19.)
| 9 | | (305 ILCS 5/14-12) | 10 | | Sec. 14-12. Hospital rate reform payment system. The | 11 | | hospital payment system pursuant to Section 14-11 of this | 12 | | Article shall be as follows: | 13 | | (a) Inpatient hospital services. Effective for discharges | 14 | | on and after July 1, 2014, reimbursement for inpatient general | 15 | | acute care services shall utilize the All Patient Refined | 16 | | Diagnosis Related Grouping (APR-DRG) software, version 30, | 17 | | distributed by 3M TM Health Information System. | 18 | | (1) The Department shall establish Medicaid weighting | 19 | | factors to be used in the reimbursement system established | 20 | | under this subsection. Initial weighting factors shall be | 21 | | the weighting factors as published by 3M Health | 22 | | Information System, associated with Version 30.0 adjusted | 23 | | for the Illinois experience. | 24 | | (2) The Department shall establish a | 25 | | statewide-standardized amount to be used in the inpatient |
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| 1 | | reimbursement system. The Department shall publish these | 2 | | amounts on its website no later than 10 calendar days | 3 | | prior to their effective date. | 4 | | (3) In addition to the statewide-standardized amount, | 5 | | the Department shall develop adjusters to adjust the rate | 6 | | of reimbursement for critical Medicaid providers or | 7 | | services for trauma, transplantation services, perinatal | 8 | | care, and Graduate Medical Education (GME). | 9 | | (4) The Department shall develop add-on payments to | 10 | | account for exceptionally costly inpatient stays, | 11 | | consistent with Medicare outlier principles. Outlier fixed | 12 | | loss thresholds may be updated to control for excessive | 13 | | growth in outlier payments no more frequently than on an | 14 | | annual basis, but at least once every 4 years triennially . | 15 | | Upon updating the fixed loss thresholds, the Department | 16 | | shall be required to update base rates within 12 months. | 17 | | (5) The Department shall define those hospitals or | 18 | | distinct parts of hospitals that shall be exempt from the | 19 | | APR-DRG reimbursement system established under this | 20 | | Section. The Department shall publish these hospitals' | 21 | | inpatient rates on its website no later than 10 calendar | 22 | | days prior to their effective date. | 23 | | (6) Beginning July 1, 2014 and ending on June 30, | 24 | | 2024, in addition to the statewide-standardized amount, | 25 | | the Department shall develop an adjustor to adjust the | 26 | | rate of reimbursement for safety-net hospitals defined in |
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| 1 | | Section 5-5e.1 of this Code excluding pediatric hospitals. | 2 | | (7) Beginning July 1, 2014, in addition to the | 3 | | statewide-standardized amount, the Department shall | 4 | | develop an adjustor to adjust the rate of reimbursement | 5 | | for Illinois freestanding inpatient psychiatric hospitals | 6 | | that are not designated as children's hospitals by the | 7 | | Department but are primarily treating patients under the | 8 | | age of 21. | 9 | | (7.5) (Blank). | 10 | | (8) Beginning July 1, 2018, in addition to the | 11 | | statewide-standardized amount, the Department shall adjust | 12 | | the rate of reimbursement for hospitals designated by the | 13 | | Department of Public Health as a Perinatal Level II or II+ | 14 | | center by applying the same adjustor that is applied to | 15 | | Perinatal and Obstetrical care cases for Perinatal Level | 16 | | III centers, as of December 31, 2017. | 17 | | (9) Beginning July 1, 2018, in addition to the | 18 | | statewide-standardized amount, the Department shall apply | 19 | | the same adjustor that is applied to trauma cases as of | 20 | | December 31, 2017 to inpatient claims to treat patients | 21 | | with burns, including, but not limited to, APR-DRGs 841, | 22 | | 842, 843, and 844. | 23 | | (10) Beginning July 1, 2018, the | 24 | | statewide-standardized amount for inpatient general acute | 25 | | care services shall be uniformly increased so that base | 26 | | claims projected reimbursement is increased by an amount |
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| 1 | | equal to the funds allocated in paragraph (1) of | 2 | | subsection (b) of Section 5A-12.6, less the amount | 3 | | allocated under paragraphs (8) and (9) of this subsection | 4 | | and paragraphs (3) and (4) of subsection (b) multiplied by | 5 | | 40%. | 6 | | (11) Beginning July 1, 2018, the reimbursement for | 7 | | inpatient rehabilitation services shall be increased by | 8 | | the addition of a $96 per day add-on. | 9 | | (b) Outpatient hospital services. Effective for dates of | 10 | | service on and after July 1, 2014, reimbursement for | 11 | | outpatient services shall utilize the Enhanced Ambulatory | 12 | | Procedure Grouping (EAPG) software, version 3.7 distributed by | 13 | | 3M TM Health Information System. | 14 | | (1) The Department shall establish Medicaid weighting | 15 | | factors to be used in the reimbursement system established | 16 | | under this subsection. The initial weighting factors shall | 17 | | be the weighting factors as published by 3M Health | 18 | | Information System, associated with Version 3.7. | 19 | | (2) The Department shall establish service specific | 20 | | statewide-standardized amounts to be used in the | 21 | | reimbursement system. | 22 | | (A) The initial statewide standardized amounts, | 23 | | with the labor portion adjusted by the Calendar Year | 24 | | 2013 Medicare Outpatient Prospective Payment System | 25 | | wage index with reclassifications, shall be published | 26 | | by the Department on its website no later than 10 |
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| 1 | | calendar days prior to their effective date. | 2 | | (B) The Department shall establish adjustments to | 3 | | the statewide-standardized amounts for each Critical | 4 | | Access Hospital, as designated by the Department of | 5 | | Public Health in accordance with 42 CFR 485, Subpart | 6 | | F. For outpatient services provided on or before June | 7 | | 30, 2018, the EAPG standardized amounts are determined | 8 | | separately for each critical access hospital such that | 9 | | simulated EAPG payments using outpatient base period | 10 | | paid claim data plus payments under Section 5A-12.4 of | 11 | | this Code net of the associated tax costs are equal to | 12 | | the estimated costs of outpatient base period claims | 13 | | data with a rate year cost inflation factor applied. | 14 | | (3) In addition to the statewide-standardized amounts, | 15 | | the Department shall develop adjusters to adjust the rate | 16 | | of reimbursement for critical Medicaid hospital outpatient | 17 | | providers or services, including outpatient high volume or | 18 | | safety-net hospitals. Beginning July 1, 2018, the | 19 | | outpatient high volume adjustor shall be increased to | 20 | | increase annual expenditures associated with this adjustor | 21 | | by $79,200,000, based on the State Fiscal Year 2015 base | 22 | | year data and this adjustor shall apply to public | 23 | | hospitals, except for large public hospitals, as defined | 24 | | under 89 Ill. Adm. Code 148.25(a). | 25 | | (4) Beginning July 1, 2018, in addition to the | 26 | | statewide standardized amounts, the Department shall make |
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| 1 | | an add-on payment for outpatient expensive devices and | 2 | | drugs. This add-on payment shall at least apply to claim | 3 | | lines that: (i) are assigned with one of the following | 4 | | EAPGs: 490, 1001 to 1020, and coded with one of the | 5 | | following revenue codes: 0274 to 0276, 0278; or (ii) are | 6 | | assigned with one of the following EAPGs: 430 to 441, 443, | 7 | | 444, 460 to 465, 495, 496, 1090. The add-on payment shall | 8 | | be calculated as follows: the claim line's covered charges | 9 | | multiplied by the hospital's total acute cost to charge | 10 | | ratio, less the claim line's EAPG payment plus $1,000, | 11 | | multiplied by 0.8. | 12 | | (5) Beginning July 1, 2018, the statewide-standardized | 13 | | amounts for outpatient services shall be increased by a | 14 | | uniform percentage so that base claims projected | 15 | | reimbursement is increased by an amount equal to no less | 16 | | than the funds allocated in paragraph (1) of subsection | 17 | | (b) of Section 5A-12.6, less the amount allocated under | 18 | | paragraphs (8) and (9) of subsection (a) and paragraphs | 19 | | (3) and (4) of this subsection multiplied by 46%. | 20 | | (6) Effective for dates of service on or after July 1, | 21 | | 2018, the Department shall establish adjustments to the | 22 | | statewide-standardized amounts for each Critical Access | 23 | | Hospital, as designated by the Department of Public Health | 24 | | in accordance with 42 CFR 485, Subpart F, such that each | 25 | | Critical Access Hospital's standardized amount for | 26 | | outpatient services shall be increased by the applicable |
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| 1 | | uniform percentage determined pursuant to paragraph (5) of | 2 | | this subsection. It is the intent of the General Assembly | 3 | | that the adjustments required under this paragraph (6) by | 4 | | Public Act 100-1181 shall be applied retroactively to | 5 | | claims for dates of service provided on or after July 1, | 6 | | 2018. | 7 | | (7) Effective for dates of service on or after March | 8 | | 8, 2019 (the effective date of Public Act 100-1181), the | 9 | | Department shall recalculate and implement an updated | 10 | | statewide-standardized amount for outpatient services | 11 | | provided by hospitals that are not Critical Access | 12 | | Hospitals to reflect the applicable uniform percentage | 13 | | determined pursuant to paragraph (5). | 14 | | (1) Any recalculation to the | 15 | | statewide-standardized amounts for outpatient services | 16 | | provided by hospitals that are not Critical Access | 17 | | Hospitals shall be the amount necessary to achieve the | 18 | | increase in the statewide-standardized amounts for | 19 | | outpatient services increased by a uniform percentage, | 20 | | so that base claims projected reimbursement is | 21 | | increased by an amount equal to no less than the funds | 22 | | allocated in paragraph (1) of subsection (b) of | 23 | | Section 5A-12.6, less the amount allocated under | 24 | | paragraphs (8) and (9) of subsection (a) and | 25 | | paragraphs (3) and (4) of this subsection, for all | 26 | | hospitals that are not Critical Access Hospitals, |
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| 1 | | multiplied by 46%. | 2 | | (2) It is the intent of the General Assembly that | 3 | | the recalculations required under this paragraph (7) | 4 | | by Public Act 100-1181 shall be applied prospectively | 5 | | to claims for dates of service provided on or after | 6 | | March 8, 2019 (the effective date of Public Act | 7 | | 100-1181) and that no recoupment or repayment by the | 8 | | Department or an MCO of payments attributable to | 9 | | recalculation under this paragraph (7), issued to the | 10 | | hospital for dates of service on or after July 1, 2018 | 11 | | and before March 8, 2019 (the effective date of Public | 12 | | Act 100-1181), shall be permitted. | 13 | | (8) The Department shall ensure that all necessary | 14 | | adjustments to the managed care organization capitation | 15 | | base rates necessitated by the adjustments under | 16 | | subparagraph (6) or (7) of this subsection are completed | 17 | | and applied retroactively in accordance with Section | 18 | | 5-30.8 of this Code within 90 days of March 8, 2019 (the | 19 | | effective date of Public Act 100-1181). | 20 | | (9) Within 60 days after federal approval of the | 21 | | change made to the assessment in Section 5A-2 by this | 22 | | amendatory Act of the 101st General Assembly, the | 23 | | Department shall incorporate into the EAPG system for | 24 | | outpatient services those services performed by hospitals | 25 | | currently billed through the Non-Institutional Provider | 26 | | billing system. |
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| 1 | | (c) In consultation with the hospital community, the | 2 | | Department is authorized to replace 89 Ill. Admin. Code | 3 | | 152.150 as published in 38 Ill. Reg. 4980 through 4986 within | 4 | | 12 months of June 16, 2014 (the effective date of Public Act | 5 | | 98-651). If the Department does not replace these rules within | 6 | | 12 months of June 16, 2014 (the effective date of Public Act | 7 | | 98-651), the rules in effect for 152.150 as published in 38 | 8 | | Ill. Reg. 4980 through 4986 shall remain in effect until | 9 | | modified by rule by the Department. Nothing in this subsection | 10 | | shall be construed to mandate that the Department file a | 11 | | replacement rule. | 12 | | (d) Transition period.
There shall be a transition period | 13 | | to the reimbursement systems authorized under this Section | 14 | | that shall begin on the effective date of these systems and | 15 | | continue until June 30, 2018, unless extended by rule by the | 16 | | Department. To help provide an orderly and predictable | 17 | | transition to the new reimbursement systems and to preserve | 18 | | and enhance access to the hospital services during this | 19 | | transition, the Department shall allocate a transitional | 20 | | hospital access pool of at least $290,000,000 annually so that | 21 | | transitional hospital access payments are made to hospitals. | 22 | | (1) After the transition period, the Department may | 23 | | begin incorporating the transitional hospital access pool | 24 | | into the base rate structure; however, the transitional | 25 | | hospital access payments in effect on June 30, 2018 shall | 26 | | continue to be paid, if continued under Section 5A-16. |
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| 1 | | (2) After the transition period, if the Department | 2 | | reduces payments from the transitional hospital access | 3 | | pool, it shall increase base rates, develop new adjustors, | 4 | | adjust current adjustors, develop new hospital access | 5 | | payments based on updated information, or any combination | 6 | | thereof by an amount equal to the decreases proposed in | 7 | | the transitional hospital access pool payments, ensuring | 8 | | that the entire transitional hospital access pool amount | 9 | | shall continue to be used for hospital payments. | 10 | | (d-5) Hospital and health care transformation program. The | 11 | | Department shall develop a hospital and health care | 12 | | transformation program to provide financial assistance to | 13 | | hospitals in transforming their services and care models to | 14 | | better align with the needs of the communities they serve. The | 15 | | payments authorized in this Section shall be subject to | 16 | | approval by the federal government. | 17 | | (1) Phase 1. In State fiscal years 2019 through 2020, | 18 | | the Department shall allocate funds from the transitional | 19 | | access hospital pool to create a hospital transformation | 20 | | pool of at least $262,906,870 annually and make hospital | 21 | | transformation payments to hospitals. Subject to Section | 22 | | 5A-16, in State fiscal years 2019 and 2020, an Illinois | 23 | | hospital that received either a transitional hospital | 24 | | access payment under subsection (d) or a supplemental | 25 | | payment under subsection (f) of this Section in State | 26 | | fiscal year 2018, shall receive a hospital transformation |
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| 1 | | payment as follows: | 2 | | (A) If the hospital's Rate Year 2017 Medicaid | 3 | | inpatient utilization rate is equal to or greater than | 4 | | 45%, the hospital transformation payment shall be | 5 | | equal to 100% of the sum of its transitional hospital | 6 | | access payment authorized under subsection (d) and any | 7 | | supplemental payment authorized under subsection (f). | 8 | | (B) If the hospital's Rate Year 2017 Medicaid | 9 | | inpatient utilization rate is equal to or greater than | 10 | | 25% but less than 45%, the hospital transformation | 11 | | payment shall be equal to 75% of the sum of its | 12 | | transitional hospital access payment authorized under | 13 | | subsection (d) and any supplemental payment authorized | 14 | | under subsection (f). | 15 | | (C) If the hospital's Rate Year 2017 Medicaid | 16 | | inpatient utilization rate is less than 25%, the | 17 | | hospital transformation payment shall be equal to 50% | 18 | | of the sum of its transitional hospital access payment | 19 | | authorized under subsection (d) and any supplemental | 20 | | payment authorized under subsection (f). | 21 | | (2) Phase 2. | 22 | | (A) The funding amount from phase one shall be | 23 | | incorporated into directed payment and pass-through | 24 | | payment methodologies described in Section 5A-12.7. | 25 | | (B) Because there are communities in Illinois that | 26 | | experience significant health care disparities due to |
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| 1 | | systemic racism, as recently emphasized by the | 2 | | COVID-19 pandemic, aggravated by social determinants | 3 | | of health and a lack of sufficiently allocated | 4 | | healthcare resources, particularly community-based | 5 | | services, preventive care, obstetric care, chronic | 6 | | disease management, and specialty care, the Department | 7 | | shall establish a health care transformation program | 8 | | that shall be supported by the transformation funding | 9 | | pool. It is the intention of the General Assembly that | 10 | | innovative partnerships funded by the pool must be | 11 | | designed to establish or improve integrated health | 12 | | care delivery systems that will provide significant | 13 | | access to the Medicaid and uninsured populations in | 14 | | their communities, as well as improve health care | 15 | | equity. It is also the intention of the General | 16 | | Assembly that partnerships recognize and address the | 17 | | disparities revealed by the COVID-19 pandemic, as well | 18 | | as the need for post-COVID care. During State fiscal | 19 | | years 2021 through 2027, the hospital and health care | 20 | | transformation program shall be supported by an annual | 21 | | transformation funding pool of up to $150,000,000, | 22 | | pending federal matching funds, to be allocated during | 23 | | the specified fiscal years for the purpose of | 24 | | facilitating hospital and health care transformation. | 25 | | No disbursement of moneys for transformation projects | 26 | | from the transformation funding pool described under |
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| 1 | | this Section shall be considered an award, a grant, or | 2 | | an expenditure of grant funds. Funding agreements made | 3 | | in accordance with the transformation program shall be | 4 | | considered purchases of care under the Illinois | 5 | | Procurement Code, and funds shall be expended by the | 6 | | Department in a manner that maximizes federal funding | 7 | | to expend the entire allocated amount. | 8 | | The Department shall convene, within 30 days after | 9 | | the effective date of this amendatory Act of the 101st | 10 | | General Assembly, a workgroup that includes subject | 11 | | matter experts on healthcare disparities and | 12 | | stakeholders from distressed communities, which could | 13 | | be a subcommittee of the Medicaid Advisory Committee, | 14 | | to review and provide recommendations on how | 15 | | Department policy, including health care | 16 | | transformation, can improve health disparities and the | 17 | | impact on communities disproportionately affected by | 18 | | COVID-19. The workgroup shall consider and make | 19 | | recommendations on the following issues: a community | 20 | | safety-net designation of certain hospitals, racial | 21 | | equity, and a regional partnership to bring additional | 22 | | specialty services to communities. | 23 | | (C) As provided in paragraph (9) of Section 3 of | 24 | | the Illinois Health Facilities Planning Act, any | 25 | | hospital participating in the transformation program | 26 | | may be excluded from the requirements of the Illinois |
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| 1 | | Health Facilities Planning Act for those projects | 2 | | related to the hospital's transformation. To be | 3 | | eligible, the hospital must submit to the Health | 4 | | Facilities and Services Review Board approval from the | 5 | | Department that the project is a part of the | 6 | | hospital's transformation. | 7 | | (D) As provided in subsection (a-20) of Section | 8 | | 32.5 of the Emergency Medical Services (EMS) Systems | 9 | | Act, a hospital that received hospital transformation | 10 | | payments under this Section may convert to a | 11 | | freestanding emergency center. To be eligible for such | 12 | | a conversion, the hospital must submit to the | 13 | | Department of Public Health approval from the | 14 | | Department that the project is a part of the | 15 | | hospital's transformation. | 16 | | (E) Criteria for proposals. To be eligible for | 17 | | funding under this Section, a transformation proposal | 18 | | shall meet all of the following criteria: | 19 | | (i) the proposal shall be designed based on | 20 | | community needs assessment completed by either a | 21 | | University partner or other qualified entity with | 22 | | significant community input; | 23 | | (ii) the proposal shall be a collaboration | 24 | | among providers across the care and community | 25 | | spectrum, including preventative care, primary | 26 | | care specialty care, hospital services, mental |
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| 1 | | health and substance abuse services, as well as | 2 | | community-based entities that address the social | 3 | | determinants of health; | 4 | | (iii) the proposal shall be specifically | 5 | | designed to improve healthcare outcomes and reduce | 6 | | healthcare disparities, and improve the | 7 | | coordination, effectiveness, and efficiency of | 8 | | care delivery; | 9 | | (iv) the proposal shall have specific | 10 | | measurable metrics related to disparities that | 11 | | will be tracked by the Department and made public | 12 | | by the Department; | 13 | | (v) the proposal shall include a commitment to | 14 | | include Business Enterprise Program certified | 15 | | vendors or other entities controlled and managed | 16 | | by minorities or women; and | 17 | | (vi) the proposal shall specifically increase | 18 | | access to primary, preventive, or specialty care. | 19 | | (F) Entities eligible to be funded. | 20 | | (i) Proposals for funding should come from | 21 | | collaborations operating in one of the most | 22 | | distressed communities in Illinois as determined | 23 | | by the U.S. Centers for Disease Control and | 24 | | Prevention's Social Vulnerability Index for | 25 | | Illinois and areas disproportionately impacted by | 26 | | COVID-19 or from rural areas of Illinois. |
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| 1 | | (ii) The Department shall prioritize | 2 | | partnerships from distressed communities, which | 3 | | include Business Enterprise Program certified | 4 | | vendors or other entities controlled and managed | 5 | | by minorities or women and also include one or | 6 | | more of the following: safety-net hospitals, | 7 | | critical access hospitals, the campuses of | 8 | | hospitals that have closed since January 1, 2018, | 9 | | or other healthcare providers designed to address | 10 | | specific healthcare disparities, including the | 11 | | impact of COVID-19 on individuals and the | 12 | | community and the need for post-COVID care. All | 13 | | funded proposals must include specific measurable | 14 | | goals and metrics related to improved outcomes and | 15 | | reduced disparities which shall be tracked by the | 16 | | Department. | 17 | | (iii) The Department should target the funding | 18 | | in the following ways: $30,000,000 of | 19 | | transformation funds to projects that are a | 20 | | collaboration between a safety-net hospital, | 21 | | particularly community safety-net hospitals, and | 22 | | other providers and designed to address specific | 23 | | healthcare disparities, $20,000,000 of | 24 | | transformation funds to collaborations between | 25 | | safety-net hospitals and a larger hospital partner | 26 | | that increases specialty care in distressed |
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| 1 | | communities, $30,000,000 of transformation funds | 2 | | to projects that are a collaboration between | 3 | | hospitals and other providers in distressed areas | 4 | | of the State designed to address specific | 5 | | healthcare disparities, $15,000,000 to | 6 | | collaborations between critical access hospitals | 7 | | and other providers designed to address specific | 8 | | healthcare disparities, and $15,000,000 to | 9 | | cross-provider collaborations designed to address | 10 | | specific healthcare disparities, and $5,000,000 to | 11 | | collaborations that focus on workforce | 12 | | development. | 13 | | (iv) The Department may allocate up to | 14 | | $5,000,000 for planning, racial equity analysis, | 15 | | or consulting resources for the Department or | 16 | | entities without the resources to develop a plan | 17 | | to meet the criteria of this Section. Any contract | 18 | | for consulting services issued by the Department | 19 | | under this subparagraph shall comply with the | 20 | | provisions of Section 5-45 of the State Officials | 21 | | and Employees Ethics Act. Based on availability of | 22 | | federal funding, the Department may directly | 23 | | procure consulting services or provide funding to | 24 | | the collaboration. The provision of resources | 25 | | under this subparagraph is not a guarantee that a | 26 | | project will be approved. |
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| 1 | | (v) The Department shall take steps to ensure | 2 | | that safety-net hospitals operating in | 3 | | under-resourced communities receive priority | 4 | | access to hospital and healthcare transformation | 5 | | funds, including consulting funds, as provided | 6 | | under this Section. | 7 | | (G) Process for submitting and approving projects | 8 | | for distressed communities. The Department shall issue | 9 | | a template for application. The Department shall post | 10 | | any proposal received on the Department's website for | 11 | | at least 2 weeks for public comment, and any such | 12 | | public comment shall also be considered in the review | 13 | | process. Applicants may request that proprietary | 14 | | financial information be redacted from publicly posted | 15 | | proposals and the Department in its discretion may | 16 | | agree. Proposals for each distressed community must | 17 | | include all of the following: | 18 | | (i) A detailed description of how the project | 19 | | intends to affect the goals outlined in this | 20 | | subsection, describing new interventions, new | 21 | | technology, new structures, and other changes to | 22 | | the healthcare delivery system planned. | 23 | | (ii) A detailed description of the racial and | 24 | | ethnic makeup of the entities' board and | 25 | | leadership positions and the salaries of the | 26 | | executive staff of entities in the partnership |
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| 1 | | that is seeking to obtain funding under this | 2 | | Section. | 3 | | (iii) A complete budget, including an overall | 4 | | timeline and a detailed pathway to sustainability | 5 | | within a 5-year period, specifying other sources | 6 | | of funding, such as in-kind, cost-sharing, or | 7 | | private donations, particularly for capital needs. | 8 | | There is an expectation that parties to the | 9 | | transformation project dedicate resources to the | 10 | | extent they are able and that these expectations | 11 | | are delineated separately for each entity in the | 12 | | proposal. | 13 | | (iv) A description of any new entities formed | 14 | | or other legal relationships between collaborating | 15 | | entities and how funds will be allocated among | 16 | | participants. | 17 | | (v) A timeline showing the evolution of sites | 18 | | and specific services of the project over a 5-year | 19 | | period, including services available to the | 20 | | community by site. | 21 | | (vi) Clear milestones indicating progress | 22 | | toward the proposed goals of the proposal as | 23 | | checkpoints along the way to continue receiving | 24 | | funding. The Department is authorized to refine | 25 | | these milestones in agreements, and is authorized | 26 | | to impose reasonable penalties, including |
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| 1 | | repayment of funds, for substantial lack of | 2 | | progress. | 3 | | (vii) A clear statement of the level of | 4 | | commitment the project will include for minorities | 5 | | and women in contracting opportunities, including | 6 | | as equity partners where applicable, or as | 7 | | subcontractors and suppliers in all phases of the | 8 | | project. | 9 | | (viii) If the community study utilized is not | 10 | | the study commissioned and published by the | 11 | | Department, the applicant must define the | 12 | | methodology used, including documentation of clear | 13 | | community participation. | 14 | | (ix) A description of the process used in | 15 | | collaborating with all levels of government in the | 16 | | community served in the development of the | 17 | | project, including, but not limited to, | 18 | | legislators and officials of other units of local | 19 | | government. | 20 | | (x) Documentation of a community input process | 21 | | in the community served, including links to | 22 | | proposal materials on public websites. | 23 | | (xi) Verifiable project milestones and quality | 24 | | metrics that will be impacted by transformation. | 25 | | These project milestones and quality metrics must | 26 | | be identified with improvement targets that must |
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| 1 | | be met. | 2 | | (xii) Data on the number of existing employees | 3 | | by various job categories and wage levels by the | 4 | | zip code of the employees' residence and | 5 | | benchmarks for the continued maintenance and | 6 | | improvement of these levels. The proposal must | 7 | | also describe any retraining or other workforce | 8 | | development planned for the new project. | 9 | | (xiii) If a new entity is created by the | 10 | | project, a description of how the board will be | 11 | | reflective of the community served by the | 12 | | proposal. | 13 | | (xiv) An explanation of how the proposal will | 14 | | address the existing disparities that exacerbated | 15 | | the impact of COVID-19 and the need for post-COVID | 16 | | care in the community, if applicable. | 17 | | (xv) An explanation of how the proposal is | 18 | | designed to increase access to care, including | 19 | | specialty care based upon the community's needs. | 20 | | (H) The Department shall evaluate proposals for | 21 | | compliance with the criteria listed under subparagraph | 22 | | (G). Proposals meeting all of the criteria may be | 23 | | eligible for funding with the areas of focus | 24 | | prioritized as described in item (ii) of subparagraph | 25 | | (F). Based on the funds available, the Department may | 26 | | negotiate funding agreements with approved applicants |
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| 1 | | to maximize federal funding. Nothing in this | 2 | | subsection requires that an approved project be funded | 3 | | to the level requested. Agreements shall specify the | 4 | | amount of funding anticipated annually, the | 5 | | methodology of payments, the limit on the number of | 6 | | years such funding may be provided, and the milestones | 7 | | and quality metrics that must be met by the projects in | 8 | | order to continue to receive funding during each year | 9 | | of the program. Agreements shall specify the terms and | 10 | | conditions under which a health care facility that | 11 | | receives funds under a purchase of care agreement and | 12 | | closes in violation of the terms of the agreement must | 13 | | pay an early closure fee no greater than 50% of the | 14 | | funds it received under the agreement, prior to the | 15 | | Health Facilities and Services Review Board | 16 | | considering an application for closure of the | 17 | | facility. Any project that is funded shall be required | 18 | | to provide quarterly written progress reports, in a | 19 | | form prescribed by the Department, and at a minimum | 20 | | shall include the progress made in achieving any | 21 | | milestones or metrics or Business Enterprise Program | 22 | | commitments in its plan. The Department may reduce or | 23 | | end payments, as set forth in transformation plans, if | 24 | | milestones or metrics or Business Enterprise Program | 25 | | commitments are not achieved. The Department shall | 26 | | seek to make payments from the transformation fund in |
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| 1 | | a manner that is eligible for federal matching funds. | 2 | | In reviewing the proposals, the Department shall | 3 | | take into account the needs of the community, data | 4 | | from the study commissioned by the Department from the | 5 | | University of Illinois-Chicago if applicable, feedback | 6 | | from public comment on the Department's website, as | 7 | | well as how the proposal meets the criteria listed | 8 | | under subparagraph (G). Alignment with the | 9 | | Department's overall strategic initiatives shall be an | 10 | | important factor. To the extent that fiscal year | 11 | | funding is not adequate to fund all eligible projects | 12 | | that apply, the Department shall prioritize | 13 | | applications that most comprehensively and effectively | 14 | | address the criteria listed under subparagraph (G). | 15 | | (3) (Blank). | 16 | | (4) Hospital Transformation Review Committee. There is | 17 | | created the Hospital Transformation Review Committee. The | 18 | | Committee shall consist of 14 members. No later than 30 | 19 | | days after March 12, 2018 (the effective date of Public | 20 | | Act 100-581), the 4 legislative leaders shall each appoint | 21 | | 3 members; the Governor shall appoint the Director of | 22 | | Healthcare and Family Services, or his or her designee, as | 23 | | a member; and the Director of Healthcare and Family | 24 | | Services shall appoint one member. Any vacancy shall be | 25 | | filled by the applicable appointing authority within 15 | 26 | | calendar days. The members of the Committee shall select a |
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| 1 | | Chair and a Vice-Chair from among its members, provided | 2 | | that the Chair and Vice-Chair cannot be appointed by the | 3 | | same appointing authority and must be from different | 4 | | political parties. The Chair shall have the authority to | 5 | | establish a meeting schedule and convene meetings of the | 6 | | Committee, and the Vice-Chair shall have the authority to | 7 | | convene meetings in the absence of the Chair. The | 8 | | Committee may establish its own rules with respect to | 9 | | meeting schedule, notice of meetings, and the disclosure | 10 | | of documents; however, the Committee shall not have the | 11 | | power to subpoena individuals or documents and any rules | 12 | | must be approved by 9 of the 14 members. The Committee | 13 | | shall perform the functions described in this Section and | 14 | | advise and consult with the Director in the administration | 15 | | of this Section. In addition to reviewing and approving | 16 | | the policies, procedures, and rules for the hospital and | 17 | | health care transformation program, the Committee shall | 18 | | consider and make recommendations related to qualifying | 19 | | criteria and payment methodologies related to safety-net | 20 | | hospitals and children's hospitals. Members of the | 21 | | Committee appointed by the legislative leaders shall be | 22 | | subject to the jurisdiction of the Legislative Ethics | 23 | | Commission, not the Executive Ethics Commission, and all | 24 | | requests under the Freedom of Information Act shall be | 25 | | directed to the applicable Freedom of Information officer | 26 | | for the General Assembly. The Department shall provide |
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| 1 | | operational support to the Committee as necessary. The | 2 | | Committee is dissolved on April 1, 2019. | 3 | | (e) Beginning 36 months after initial implementation, the | 4 | | Department shall update the reimbursement components in | 5 | | subsections (a) and (b), including standardized amounts and | 6 | | weighting factors, and at least once every 4 years triennially | 7 | | and no more frequently than annually thereafter. The | 8 | | Department shall publish these updates on its website no later | 9 | | than 30 calendar days prior to their effective date. | 10 | | (f) Continuation of supplemental payments. Any | 11 | | supplemental payments authorized under Illinois Administrative | 12 | | Code 148 effective January 1, 2014 and that continue during | 13 | | the period of July 1, 2014 through December 31, 2014 shall | 14 | | remain in effect as long as the assessment imposed by Section | 15 | | 5A-2 that is in effect on December 31, 2017 remains in effect. | 16 | | (g) Notwithstanding subsections (a) through (f) of this | 17 | | Section and notwithstanding the changes authorized under | 18 | | Section 5-5b.1, any updates to the system shall not result in | 19 | | any diminishment of the overall effective rates of | 20 | | reimbursement as of the implementation date of the new system | 21 | | (July 1, 2014). These updates shall not preclude variations in | 22 | | any individual component of the system or hospital rate | 23 | | variations. Nothing in this Section shall prohibit the | 24 | | Department from increasing the rates of reimbursement or | 25 | | developing payments to ensure access to hospital services. | 26 | | Nothing in this Section shall be construed to guarantee a |
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| 1 | | minimum amount of spending in the aggregate or per hospital as | 2 | | spending may be impacted by factors, including, but not | 3 | | limited to, the number of individuals in the medical | 4 | | assistance program and the severity of illness of the | 5 | | individuals. | 6 | | (h) The Department shall have the authority to modify by | 7 | | rulemaking any changes to the rates or methodologies in this | 8 | | Section as required by the federal government to obtain | 9 | | federal financial participation for expenditures made under | 10 | | this Section. | 11 | | (i) Except for subsections (g) and (h) of this Section, | 12 | | the Department shall, pursuant to subsection (c) of Section | 13 | | 5-40 of the Illinois Administrative Procedure Act, provide for | 14 | | presentation at the June 2014 hearing of the Joint Committee | 15 | | on Administrative Rules (JCAR) additional written notice to | 16 | | JCAR of the following rules in order to commence the second | 17 | | notice period for the following rules: rules published in the | 18 | | Illinois Register, rule dated February 21, 2014 at 38 Ill. | 19 | | Reg. 4559 (Medical Payment), 4628 (Specialized Health Care | 20 | | Delivery Systems), 4640 (Hospital Services), 4932 (Diagnostic | 21 | | Related Grouping (DRG) Prospective Payment System (PPS)), and | 22 | | 4977 (Hospital Reimbursement Changes), and published in the | 23 | | Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499 | 24 | | (Specialized Health Care Delivery Systems) and 6505 (Hospital | 25 | | Services).
| 26 | | (j) Out-of-state hospitals. Beginning July 1, 2018, for |
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| 1 | | purposes of determining for State fiscal years 2019 and 2020 | 2 | | and subsequent fiscal years the hospitals eligible for the | 3 | | payments authorized under subsections (a) and (b) of this | 4 | | Section, the Department shall include out-of-state hospitals | 5 | | that are designated a Level I pediatric trauma center or a | 6 | | Level I trauma center by the Department of Public Health as of | 7 | | December 1, 2017. | 8 | | (k) The Department shall notify each hospital and managed | 9 | | care organization, in writing, of the impact of the updates | 10 | | under this Section at least 30 calendar days prior to their | 11 | | effective date. | 12 | | (Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19; | 13 | | 101-81, eff. 7-12-19; 101-650, eff. 7-7-20; 101-655, eff. | 14 | | 3-12-21.)
| 15 | | Section 99. Effective date. This Act takes effect upon | 16 | | becoming law.
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