Full Text of HB1447 94th General Assembly
HB1447eng 94TH GENERAL ASSEMBLY
|
|
|
HB1447 Engrossed |
|
LRB094 08802 RSP 39019 b |
|
| 1 |
| AN ACT concerning State government.
| 2 |
| Be it enacted by the People of the State of Illinois,
| 3 |
| represented in the General Assembly:
| 4 |
| Section 5. The Mental Health and Developmental | 5 |
| Disabilities Administrative Act is amended by changing Section | 6 |
| 54 as follows:
| 7 |
| (20 ILCS 1705/54) (from Ch. 91 1/2, par. 100-54)
| 8 |
| Sec. 54. Establishment of rates for purchase of services | 9 |
| including fee-for-service .
| 10 |
| (a) It is the purpose of this Section to establish | 11 |
| procedures
for the development, calculation, and communication | 12 |
| of rates promulgated
by the Department for the
purchase of | 13 |
| services including fee-for-service for persons with a | 14 |
| developmental disability, mental illness and substance abuse, | 15 |
| and persons
with mental illness; to require the promulgation of | 16 |
| rules which specify the
treatment of costs for purposes of | 17 |
| establishing rates for various purchase
care program | 18 |
| categories including fee-for-service ; to require that rates be | 19 |
| equitable, understandable,
and established through an open, | 20 |
| public process; and to require the delineation
of where | 21 |
| purchase care including fee-for-service , grant-in-aid, and | 22 |
| other payment mechanisms are most
appropriately utilized. The | 23 |
| Department's rate-setting policy should stimulate
the | 24 |
| development of cost effective, evidence based, clinically | 25 |
| appropriate, recovery oriented, community-based
residential, | 26 |
| and other support services for recipients according to an
| 27 |
| annual
statement of purchase care goals and objectives.
| 28 |
| (b) The Department shall establish rates in all instances | 29 |
| where services
are purchased by the Department for a specific | 30 |
| recipient from a specific
community service provider for which | 31 |
| the Department has the responsibility
for establishing payment | 32 |
| rates. When determining rates, the Department shall
take into |
|
|
|
HB1447 Engrossed |
- 2 - |
LRB094 08802 RSP 39019 b |
|
| 1 |
| consideration differences in the costs of doing business among | 2 |
| the
various geographic regions of the State and shall set rates | 3 |
| that reflect those
differences. In addition, the Department | 4 |
| shall consider market factors such as those published by the | 5 |
| United States Department of Labor, Bureau of Labor Statistics. | 6 |
| The Department may, for various program
categories, adopt rates | 7 |
| that are set by other State agencies.
| 8 |
| (c) The Department shall perform the following duties:
| 9 |
| (1) Develop rate-setting methodologies for purchase | 10 |
| care program and service
categories including | 11 |
| fee-for-service programs and services .
| 12 |
| (2) Promulgate rules and regulations governing | 13 |
| rate-setting, treatment
of costs, treatment of occupancy, | 14 |
| and payment and contracting processes
for purchase care | 15 |
| including fee-for-service .
| 16 |
| (3) Collect cost and performance information from care | 17 |
| providers in a form and format that is consistent with a | 18 |
| fee-for-service methodology . The
Department may stipulate | 19 |
| forms, unit of service definitions, reporting
procedures | 20 |
| and reporting intervals.
| 21 |
| (4) Calculate purchase of care , including | 22 |
| fee-for-service, reimbursement rates for specific | 23 |
| providers
based on the promulgated rate methodology for | 24 |
| that program or service category.
| 25 |
| (5) Negotiate and implement purchase of care | 26 |
| contracts , including fee-for-service contracts, with | 27 |
| specific
providers.
| 28 |
| (6) Develop capacity grants and capacity grant | 29 |
| contracts for services that require care availability, and | 30 |
| coverage that is not correlated with volume of service and | 31 |
| for financially supporting desired provision of care | 32 |
| throughout the State.
Develop an annual statement of | 33 |
| purchase care goals and objectives
detailing maximum units | 34 |
| of service by program category to be purchased.
The plan | 35 |
| for each fiscal year shall be completed by May 1 of the | 36 |
| previous
fiscal year.
|
|
|
|
HB1447 Engrossed |
- 3 - |
LRB094 08802 RSP 39019 b |
|
| 1 |
| (7) The Department shall contract with an independent | 2 |
| consulting firm for an annual study of the adequacy and | 3 |
| appropriateness of Title XIX and State-only reimbursement | 4 |
| rates to service providers. A complete study of | 5 |
| reimbursement rates shall be completed no less frequently | 6 |
| than once every 2 years. The Department shall report to the | 7 |
| General Assembly no later than January 30, 2007 and each | 8 |
| year thereafter.
Conduct an annual review and prepare an | 9 |
| annual report of rates and
units of service purchased, | 10 |
| comparing the annual purchase of care statement
with actual | 11 |
| services purchased, and the actual cost of providing those
| 12 |
| services.
The report shall be made available by May 1.
| 13 |
| (8) Establish and promulgate a process and criteria for | 14 |
| appealing rates.
| 15 |
| (9) Develop and promulgate standards and criteria by | 16 |
| which provider
performance shall be evaluated.
| 17 |
| (10) Set rates based on published methodologies and | 18 |
| subject to the
availability
of funds appropriated by the | 19 |
| General Assembly.
| 20 |
| (11) Establish and promulgate a policy that precludes
| 21 |
| regarding applicability of income
offsets in rate | 22 |
| calculation or payment processes.
| 23 |
| (12) Develop criteria for selection of payment | 24 |
| mechanisms to be employed
in funding community services | 25 |
| where fee-for-service is not appropriate .
| 26 |
| (d) The Department may investigate and employ alternative | 27 |
| rate setting
approaches such as per member or per month or case | 28 |
| rates and engage in demonstration projects. These approaches
| 29 |
| must be
publicly articulated by the Department, identifying the | 30 |
| purpose and scope
of the alternative approach and evaluation to | 31 |
| be conducted.
| 32 |
| (e) (Blank).
| 33 |
| (Source: P.A. 89-58, eff. 1-1-96; 89-507, eff. 7-1-97; 90-423, | 34 |
| eff.
8-15-97.)
| 35 |
| Section 99. Effective date. This Act takes effect July 1, |
|
|
|
HB1447 Engrossed |
- 4 - |
LRB094 08802 RSP 39019 b |
|
| 1 |
| 2005.
|
|