Full Text of SB1521 100th General Assembly
SB1521 100TH GENERAL ASSEMBLY |
| | 100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018 SB1521 Introduced 2/9/2017, by Sen. Heather A. Steans SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning the hospital rate reform payment system.
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| | A BILL FOR |
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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 Section 14-12 as follows: | 6 | | (305 ILCS 5/14-12) | 7 | | Sec. 14-12. Hospital rate reform payment system. The 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 | 17 | | under this subsection. Initial weighting factors shall be | 18 | | the weighting factors as published by 3M Health Information | 19 | | System, associated with Version 30.0 adjusted for the | 20 | | Illinois experience. | 21 | | (2) The Department shall establish a | 22 | | statewide-standardized amount to be used in the inpatient | 23 | | reimbursement system. The Department shall publish these |
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| 1 | | amounts on its website no later than 10 calendar days prior | 2 | | to their effective date. | 3 | | (3) In addition to the statewide-standardized amount, | 4 | | the Department shall develop adjusters to adjust the rate | 5 | | of reimbursement for critical Medicaid providers or | 6 | | services for trauma, transplantation services, perinatal | 7 | | care, and Graduate Medical Education (GME). | 8 | | (4) The Department shall develop add-on payments to | 9 | | account for exceptionally costly inpatient stays, | 10 | | consistent with Medicare outlier principles. Outlier fixed | 11 | | loss thresholds may be updated to control for excessive | 12 | | growth in outlier payments no more frequently than on an | 13 | | annual basis, but at least triennially. Upon updating the | 14 | | fixed loss thresholds, the Department shall be required to | 15 | | update base rates within 12 months. | 16 | | (5) The Department shall define those hospitals or | 17 | | distinct parts of hospitals that shall be exempt from the | 18 | | APR-DRG reimbursement system established under this | 19 | | Section. The Department shall publish these hospitals' | 20 | | inpatient rates on its website no later than 10 calendar | 21 | | days prior to their effective date. | 22 | | (6) Beginning July 1, 2014 and ending on June 30, 2018, | 23 | | in addition to the statewide-standardized amount, the | 24 | | Department shall develop an adjustor to adjust the rate of | 25 | | reimbursement for safety-net hospitals defined in Section | 26 | | 5-5e.1 of this Code excluding pediatric hospitals. |
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| 1 | | (7) Beginning July 1, 2014 and ending on June 30, 2018, | 2 | | in addition to the statewide-standardized amount, the | 3 | | Department shall develop an adjustor to adjust the rate of | 4 | | reimbursement for Illinois freestanding inpatient | 5 | | psychiatric hospitals that are not designated as | 6 | | children's hospitals by the Department but are primarily | 7 | | treating patients under the age of 21. | 8 | | (b) Outpatient hospital services. Effective for dates of | 9 | | service on and after July 1, 2014, reimbursement for outpatient | 10 | | services shall utilize the Enhanced Ambulatory Procedure | 11 | | Grouping (E-APG) software, version 3.7 distributed by 3M TM | 12 | | Health Information System. | 13 | | (1) The Department shall establish Medicaid weighting | 14 | | factors to be used in the reimbursement system established | 15 | | under this subsection. The initial weighting factors shall | 16 | | be the weighting factors as published by 3M Health | 17 | | Information System, associated with Version 3.7. | 18 | | (2) The Department shall establish service specific | 19 | | statewide-standardized amounts to be used in the | 20 | | reimbursement system. | 21 | | (A) The initial statewide standardized amounts, | 22 | | with the labor portion adjusted by the Calendar Year | 23 | | 2013 Medicare Outpatient Prospective Payment System | 24 | | wage index with reclassifications, shall be published | 25 | | by the Department on its website no later than 10 | 26 | | calendar days prior to their effective date. |
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| 1 | | (B) The Department shall establish adjustments to | 2 | | the statewide-standardized amounts for each Critical | 3 | | Access Hospital, as designated by the Department of | 4 | | Public Health in accordance with 42 CFR 485, Subpart F. | 5 | | The EAPG standardized amounts are determined | 6 | | separately for each critical access hospital such that | 7 | | simulated EAPG payments using outpatient base period | 8 | | paid claim data plus payments under Section 5A-12.4 of | 9 | | this Code net of the associated tax costs are equal to | 10 | | the estimated costs of outpatient base period claims | 11 | | data with a rate year cost inflation factor applied. | 12 | | (3) In addition to the statewide-standardized amounts, | 13 | | the Department shall develop adjusters to adjust the rate | 14 | | of reimbursement for critical Medicaid hospital outpatient | 15 | | providers or services, including outpatient high volume or | 16 | | safety-net hospitals. | 17 | | (c) In consultation with the hospital community, the | 18 | | Department is authorized to replace 89 Ill. Admin. Code 152.150 | 19 | | as published in 38 Ill. Reg. 4980 through 4986 within 12 months | 20 | | of the effective date of this amendatory Act of the 98th | 21 | | General Assembly. If the Department does not replace these | 22 | | rules within 12 months of the effective date of this amendatory | 23 | | Act of the 98th General Assembly, the rules in effect for | 24 | | 152.150 as published in 38 Ill. Reg. 4980 through 4986 shall | 25 | | remain in effect until modified by rule by the Department. | 26 | | Nothing in this subsection shall be construed to mandate that |
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| 1 | | the Department file a replacement rule. | 2 | | (d) Transition period.
There shall be a transition period | 3 | | to the reimbursement systems authorized under this Section that | 4 | | shall begin on the effective date of these systems and continue | 5 | | until June 30, 2018, unless extended by rule by the Department. | 6 | | To help provide an orderly and predictable transition to the | 7 | | new reimbursement systems and to preserve and enhance access to | 8 | | the hospital services during this transition, the Department | 9 | | shall allocate a transitional hospital access pool of at least | 10 | | $290,000,000 annually so that transitional hospital access | 11 | | payments are made to hospitals. | 12 | | (1) After the transition period, the Department may | 13 | | begin incorporating the transitional hospital access pool | 14 | | into the base rate structure. | 15 | | (2) After the transition period, if the Department | 16 | | reduces payments from the transitional hospital access | 17 | | pool, it shall increase base rates, develop new adjustors, | 18 | | adjust current adjustors, develop new hospital access | 19 | | payments based on updated information, or any combination | 20 | | thereof by an amount equal to the decreases proposed in the | 21 | | transitional hospital access pool payments, ensuring that | 22 | | the entire transitional hospital access pool amount shall | 23 | | continue to be used for hospital payments. | 24 | | (e) Beginning 36 months after initial implementation, the | 25 | | Department shall update the reimbursement components in | 26 | | subsections (a) and (b), including standardized amounts and |
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| 1 | | weighting factors, and at least triennially and no more | 2 | | frequently than annually thereafter. The Department shall | 3 | | publish these updates on its website no later than 30 calendar | 4 | | days prior to their effective date. | 5 | | (f) Continuation of supplemental payments. Any | 6 | | supplemental payments authorized under Illinois Administrative | 7 | | Code 148 effective January 1, 2014 and that continue during the | 8 | | period of July 1, 2014 through December 31, 2014 shall remain | 9 | | in effect as long as the assessment imposed by Section 5A-2 is | 10 | | in effect. | 11 | | (g) Notwithstanding subsections (a) through (f) of this | 12 | | Section and notwithstanding the changes authorized under | 13 | | Section 5-5b.1, any updates to the system shall not result in | 14 | | any diminishment of the overall effective rates of | 15 | | reimbursement as of the implementation date of the new system | 16 | | (July 1, 2014). These updates shall not preclude variations in | 17 | | any individual component of the system or hospital rate | 18 | | variations. Nothing in this Section shall prohibit the | 19 | | Department from increasing the rates of reimbursement or | 20 | | developing payments to ensure access to hospital services. | 21 | | Nothing in this Section shall be construed to guarantee a | 22 | | minimum amount of spending in the aggregate or per hospital as | 23 | | spending may be impacted by factors including but not limited | 24 | | to the number of individuals in the medical assistance program | 25 | | and the severity of illness of the individuals. | 26 | | (h) The Department shall have the authority to modify by |
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| 1 | | rulemaking any changes to the rates or methodologies in this | 2 | | Section as required by the federal government to obtain federal | 3 | | financial participation for expenditures made under this | 4 | | Section. | 5 | | (i) Except for subsections (g) and (h) of this Section, the | 6 | | Department shall, pursuant to subsection (c) of Section 5-40 of | 7 | | the Illinois Administrative Procedure Act, provide for | 8 | | presentation at the June 2014 hearing of the Joint Committee on | 9 | | Administrative Rules (JCAR) additional written notice to JCAR | 10 | | of the following rules in order to commence the second notice | 11 | | period for the following rules: rules published in the Illinois | 12 | | Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559 | 13 | | (Medical Payment), 4628 (Specialized Health Care Delivery | 14 | | Systems), 4640 (Hospital Services), 4932 (Diagnostic Related | 15 | | Grouping (DRG) Prospective Payment System (PPS)), and 4977 | 16 | | (Hospital Reimbursement Changes), and published in the | 17 | | Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499 | 18 | | (Specialized Health Care Delivery Systems) and 6505 (Hospital | 19 | | Services).
| 20 | | (Source: P.A. 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)
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