Full Text of SB2552 101st General Assembly
SB2552 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 SB2552 Introduced 1/29/2020, 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, 2024, | 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, 2020, | 2 | | or upon implementation of inpatient psychiatric rate | 3 | | increases as described in subsection (n) of Section | 4 | | 5A-12.6, in addition to the statewide-standardized amount, | 5 | | the Department shall develop an adjustor to adjust the rate | 6 | | of reimbursement for Illinois freestanding inpatient | 7 | | psychiatric hospitals that are not designated as | 8 | | children's hospitals by the Department but are primarily | 9 | | treating patients under the age of 21. | 10 | | (7.5) Beginning July 1, 2020, the reimbursement for | 11 | | inpatient psychiatric services shall be so that base claims | 12 | | projected reimbursement is increased by an amount equal to | 13 | | the funds allocated in paragraph (2) of subsection (b) of | 14 | | Section 5A-12.6, less the amount allocated under | 15 | | paragraphs (8) and (9) of this subsection and paragraphs | 16 | | (3) and (4) of subsection (b) multiplied by 13%. Beginning | 17 | | July 1, 2022, the reimbursement for inpatient psychiatric | 18 | | services shall be so that base claims projected | 19 | | reimbursement is increased by an amount equal to the funds | 20 | | allocated in paragraph (3) of subsection (b) of Section | 21 | | 5A-12.6, less the amount allocated under paragraphs (8) and | 22 | | (9) of this subsection and paragraphs (3) and (4) of | 23 | | subsection (b) multiplied by 13%. Beginning July 1, 2024, | 24 | | the reimbursement for inpatient psychiatric services shall | 25 | | be so that base claims projected reimbursement is increased | 26 | | by an amount equal to the funds allocated in paragraph (4) |
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| 1 | | of subsection (b) of Section 5A-12.6, less the amount | 2 | | allocated under paragraphs (8) and (9) of this subsection | 3 | | and paragraphs (3) and (4) of subsection (b) multiplied by | 4 | | 13%. | 5 | | (8) Beginning July 1, 2018, in addition to the | 6 | | statewide-standardized amount, the Department shall adjust | 7 | | the rate of reimbursement for hospitals designated by the | 8 | | Department of Public Health as a Perinatal Level II or II+ | 9 | | center by applying the same adjustor that is applied to | 10 | | Perinatal and Obstetrical care cases for Perinatal Level | 11 | | III centers, as of December 31, 2017. | 12 | | (9) Beginning July 1, 2018, in addition to the | 13 | | statewide-standardized amount, the Department shall apply | 14 | | the same adjustor that is applied to trauma cases as of | 15 | | December 31, 2017 to inpatient claims to treat patients | 16 | | with burns, including, but not limited to, APR-DRGs 841, | 17 | | 842, 843, and 844. | 18 | | (10) Beginning July 1, 2018, the | 19 | | statewide-standardized amount for inpatient general acute | 20 | | care services shall be uniformly increased so that base | 21 | | claims projected reimbursement is increased by an amount | 22 | | equal to the funds allocated in paragraph (1) of subsection | 23 | | (b) of Section 5A-12.6, less the amount allocated under | 24 | | paragraphs (8) and (9) of this subsection and paragraphs | 25 | | (3) and (4) of subsection (b) multiplied by 40%. Beginning | 26 | | July 1, 2020, the statewide-standardized amount for |
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| 1 | | inpatient general acute care services shall be uniformly | 2 | | increased so that base claims projected reimbursement is | 3 | | increased by an amount equal to the funds allocated in | 4 | | paragraph (2) of subsection (b) of Section 5A-12.6, less | 5 | | the amount allocated under paragraphs (8) and (9) of this | 6 | | subsection and paragraphs (3) and (4) of subsection (b) | 7 | | multiplied by 40%. Beginning July 1, 2022, the | 8 | | statewide-standardized amount for inpatient general acute | 9 | | care services shall be uniformly increased so that base | 10 | | claims projected reimbursement is increased by an amount | 11 | | equal to the funds allocated in paragraph (3) of subsection | 12 | | (b) of Section 5A-12.6, less the amount allocated under | 13 | | paragraphs (8) and (9) of this subsection and paragraphs | 14 | | (3) and (4) of subsection (b) multiplied by 40%. Beginning | 15 | | July 1, 2023 the statewide-standardized amount for | 16 | | inpatient general acute care services shall be uniformly | 17 | | increased so that base claims projected reimbursement is | 18 | | increased by an amount equal to the funds allocated in | 19 | | paragraph (4) of subsection (b) of Section 5A-12.6, less | 20 | | the amount allocated under paragraphs (8) and (9) of this | 21 | | subsection and paragraphs (3) and (4) of subsection (b) | 22 | | multiplied by 40%. | 23 | | (11) Beginning July 1, 2018, the reimbursement for | 24 | | inpatient rehabilitation services shall be increased by | 25 | | the addition of a $96 per day add-on. | 26 | | Beginning July 1, 2020, the reimbursement for |
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| 1 | | inpatient rehabilitation services shall be uniformly | 2 | | increased so that the $96 per day add-on is increased by an | 3 | | amount equal to the funds allocated in paragraph (2) of | 4 | | subsection (b) of Section 5A-12.6, less the amount | 5 | | allocated under paragraphs (8) and (9) of this subsection | 6 | | and paragraphs (3) and (4) of subsection (b) multiplied by | 7 | | 0.9%. | 8 | | Beginning July 1, 2022, the reimbursement for | 9 | | inpatient rehabilitation services shall be uniformly | 10 | | increased so that the $96 per day add-on as adjusted by the | 11 | | July 1, 2020 increase, is increased by an amount equal to | 12 | | the funds allocated in paragraph (3) of subsection (b) of | 13 | | Section 5A-12.6, less the amount allocated under | 14 | | paragraphs (8) and (9) of this subsection and paragraphs | 15 | | (3) and (4) of subsection (b) multiplied by 0.9%. | 16 | | Beginning July 1, 2023, the reimbursement for | 17 | | inpatient rehabilitation services shall be uniformly | 18 | | increased so that the $96 per day add-on as adjusted by the | 19 | | July 1, 2022 increase, is increased by an amount equal to | 20 | | the funds allocated in paragraph (4) of subsection (b) of | 21 | | Section 5A-12.6, less the amount allocated under | 22 | | paragraphs (8) and (9) of this subsection and paragraphs | 23 | | (3) and (4) of subsection (b) multiplied by 0.9%. | 24 | | (b) Outpatient hospital services. Effective for dates of | 25 | | service on and after July 1, 2014, reimbursement for outpatient | 26 | | services shall utilize the Enhanced Ambulatory Procedure |
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| 1 | | Grouping (EAPG) software, version 3.7 distributed by 3M TM | 2 | | Health Information System. | 3 | | (1) The Department shall establish Medicaid weighting | 4 | | factors to be used in the reimbursement system established | 5 | | under this subsection. The initial weighting factors shall | 6 | | be the weighting factors as published by 3M Health | 7 | | Information System, associated with Version 3.7. | 8 | | (2) The Department shall establish service specific | 9 | | statewide-standardized amounts to be used in the | 10 | | reimbursement system. | 11 | | (A) The initial statewide standardized amounts, | 12 | | with the labor portion adjusted by the Calendar Year | 13 | | 2013 Medicare Outpatient Prospective Payment System | 14 | | wage index with reclassifications, shall be published | 15 | | by the Department on its website no later than 10 | 16 | | calendar days prior to their effective date. | 17 | | (B) The Department shall establish adjustments to | 18 | | the statewide-standardized amounts for each Critical | 19 | | Access Hospital, as designated by the Department of | 20 | | Public Health in accordance with 42 CFR 485, Subpart F. | 21 | | For outpatient services provided on or before June 30, | 22 | | 2018, the EAPG standardized amounts are determined | 23 | | separately for each critical access hospital such that | 24 | | simulated EAPG payments using outpatient base period | 25 | | paid claim data plus payments under Section 5A-12.4 of | 26 | | this Code net of the associated tax costs are equal to |
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| 1 | | the estimated costs of outpatient base period claims | 2 | | data with a rate year cost inflation factor applied. | 3 | | (3) In addition to the statewide-standardized amounts, | 4 | | the Department shall develop adjusters to adjust the rate | 5 | | of reimbursement for critical Medicaid hospital outpatient | 6 | | providers or services, including outpatient high volume or | 7 | | safety-net hospitals. Beginning July 1, 2018, the | 8 | | outpatient high volume adjustor shall be increased to | 9 | | increase annual expenditures associated with this adjustor | 10 | | by $79,200,000, based on the State Fiscal Year 2015 base | 11 | | year data and this adjustor shall apply to public | 12 | | hospitals, except for large public hospitals, as defined | 13 | | under 89 Ill. Adm. Code 148.25(a). | 14 | | (4) Beginning July 1, 2018, in addition to the | 15 | | statewide standardized amounts, the Department shall make | 16 | | an add-on payment for outpatient expensive devices and | 17 | | drugs. This add-on payment shall at least apply to claim | 18 | | lines that: (i) are assigned with one of the following | 19 | | EAPGs: 490, 1001 to 1020, and coded with one of the | 20 | | following revenue codes: 0274 to 0276, 0278; or (ii) are | 21 | | assigned with one of the following EAPGs: 430 to 441, 443, | 22 | | 444, 460 to 465, 495, 496, 1090. The add-on payment shall | 23 | | be calculated as follows: the claim line's covered charges | 24 | | multiplied by the hospital's total acute cost to charge | 25 | | ratio, less the claim line's EAPG payment plus $1,000, | 26 | | multiplied by 0.8. |
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| 1 | | (5) Beginning July 1, 2018, the statewide-standardized | 2 | | amounts for outpatient services shall be increased by a | 3 | | uniform percentage so that base claims projected | 4 | | reimbursement is increased by an amount equal to no less | 5 | | than the funds allocated in paragraph (1) of subsection (b) | 6 | | of Section 5A-12.6, less the amount allocated under | 7 | | paragraphs (8) and (9) of subsection (a) and paragraphs (3) | 8 | | and (4) of this subsection multiplied by 46%. Beginning | 9 | | July 1, 2020, the statewide-standardized amounts for | 10 | | outpatient services shall be increased by a uniform | 11 | | percentage so that base claims projected reimbursement is | 12 | | increased by an amount equal to no less than the funds | 13 | | allocated in paragraph (2) of subsection (b) of Section | 14 | | 5A-12.6, less the amount allocated under paragraphs (8) and | 15 | | (9) of subsection (a) and paragraphs (3) and (4) of this | 16 | | subsection multiplied by 46%. Beginning July 1, 2022, the | 17 | | statewide-standardized amounts for outpatient services | 18 | | shall be increased by a uniform percentage so that base | 19 | | claims projected reimbursement is increased by an amount | 20 | | equal to the funds allocated in paragraph (3) of subsection | 21 | | (b) of Section 5A-12.6, less the amount allocated under | 22 | | paragraphs (8) and (9) of subsection (a) and paragraphs (3) | 23 | | and (4) of this subsection multiplied by 46%. Beginning | 24 | | July 1, 2023, the statewide-standardized amounts for | 25 | | outpatient services shall be increased by a uniform | 26 | | percentage so that base claims projected reimbursement is |
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| 1 | | increased by an amount equal to no less than the funds | 2 | | allocated in paragraph (4) of subsection (b) of Section | 3 | | 5A-12.6, less the amount allocated under paragraphs (8) and | 4 | | (9) of subsection (a) and paragraphs (3) and (4) of this | 5 | | subsection multiplied by 46%. | 6 | | (6) Effective for dates of service on or after July 1, | 7 | | 2018, the Department shall establish adjustments to the | 8 | | statewide-standardized amounts for each Critical Access | 9 | | Hospital, as designated by the Department of Public Health | 10 | | in accordance with 42 CFR 485, Subpart F, such that each | 11 | | Critical Access Hospital's standardized amount for | 12 | | outpatient services shall be increased by the applicable | 13 | | uniform percentage determined pursuant to paragraph (5) of | 14 | | this subsection. It is the intent of the General Assembly | 15 | | that the adjustments required under this paragraph (6) by | 16 | | Public Act 100-1181 this amendatory Act of the 100th | 17 | | General Assembly shall be applied retroactively to claims | 18 | | for dates of service provided on or after July 1, 2018. | 19 | | (7) Effective for dates of service on or after March 8, | 20 | | 2019 ( the effective date of Public Act 100-1181) this | 21 | | amendatory Act of the 100th General Assembly , the | 22 | | Department shall recalculate and implement an updated | 23 | | statewide-standardized amount for outpatient services | 24 | | provided by hospitals that are not Critical Access | 25 | | Hospitals to reflect the applicable uniform percentage | 26 | | determined pursuant to paragraph (5). |
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| 1 | | (1) Any recalculation to the | 2 | | statewide-standardized amounts for outpatient services | 3 | | provided by hospitals that are not Critical Access | 4 | | Hospitals shall be the amount necessary to achieve the | 5 | | increase in the statewide-standardized amounts for | 6 | | outpatient services increased by a uniform percentage, | 7 | | so that base claims projected reimbursement is | 8 | | increased by an amount equal to no less than the funds | 9 | | allocated in paragraph (1) of subsection (b) of Section | 10 | | 5A-12.6, less the amount allocated under paragraphs | 11 | | (8) and (9) of subsection (a) and paragraphs (3) and | 12 | | (4) of this subsection, for all hospitals that are not | 13 | | Critical Access Hospitals, multiplied by 46%. | 14 | | (2) It is the intent of the General Assembly that | 15 | | the recalculations required under this paragraph (7) | 16 | | by Public Act 100-1181 this amendatory Act of the 100th | 17 | | General Assembly shall be applied prospectively to | 18 | | claims for dates of service provided on or after March | 19 | | 8, 2019 ( the effective date of Public Act 100-1181) | 20 | | this amendatory Act of the 100th General Assembly and | 21 | | that no recoupment or repayment by the Department or an | 22 | | MCO of payments attributable to recalculation under | 23 | | this paragraph (7), issued to the hospital for dates of | 24 | | service on or after July 1, 2018 and before March 8, | 25 | | 2019 ( the effective date of Public Act 100-1181) this | 26 | | amendatory Act of the 100th General Assembly , shall be |
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| 1 | | permitted. | 2 | | (8) The Department shall ensure that all necessary | 3 | | adjustments to the managed care organization capitation | 4 | | base rates necessitated by the adjustments under | 5 | | subparagraph (6) or (7) of this subsection are completed | 6 | | and applied retroactively in accordance with Section | 7 | | 5-30.8 of this Code within 90 days of March 8, 2019 ( the | 8 | | effective date of Public Act 100-1181) this amendatory Act | 9 | | of the 100th General Assembly . | 10 | | (c) In consultation with the hospital community, the | 11 | | Department is authorized to replace 89 Ill. Admin. Code 152.150 | 12 | | as published in 38 Ill. Reg. 4980 through 4986 within 12 months | 13 | | of June 16, 2014 (the effective date of Public Act 98-651). If | 14 | | the Department does not replace these rules within 12 months of | 15 | | June 16, 2014 (the effective date of Public Act 98-651), the | 16 | | rules in effect for 152.150 as published in 38 Ill. Reg. 4980 | 17 | | through 4986 shall remain in effect until modified by rule by | 18 | | the Department. Nothing in this subsection shall be construed | 19 | | to mandate that the Department file a replacement rule. | 20 | | (d) Transition period.
There shall be a transition period | 21 | | to the reimbursement systems authorized under this Section that | 22 | | shall begin on the effective date of these systems and continue | 23 | | until June 30, 2018, unless extended by rule by the Department. | 24 | | To help provide an orderly and predictable transition to the | 25 | | new reimbursement systems and to preserve and enhance access to | 26 | | the hospital services during this transition, the Department |
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| 1 | | shall allocate a transitional hospital access pool of at least | 2 | | $290,000,000 annually so that transitional hospital access | 3 | | payments are made to hospitals. | 4 | | (1) After the transition period, the Department may | 5 | | begin incorporating the transitional hospital access pool | 6 | | into the base rate structure; however, the transitional | 7 | | hospital access payments in effect on June 30, 2018 shall | 8 | | continue to be paid, if continued under Section 5A-16. | 9 | | (2) After the transition period, if the Department | 10 | | reduces payments from the transitional hospital access | 11 | | pool, it shall increase base rates, develop new adjustors, | 12 | | adjust current adjustors, develop new hospital access | 13 | | payments based on updated information, or any combination | 14 | | thereof by an amount equal to the decreases proposed in the | 15 | | transitional hospital access pool payments, ensuring that | 16 | | the entire transitional hospital access pool amount shall | 17 | | continue to be used for hospital payments. | 18 | | (d-5) Hospital transformation program. The Department, in | 19 | | conjunction with the Hospital Transformation Review Committee | 20 | | created under subsection (d-5), shall develop a hospital | 21 | | transformation program to provide financial assistance to | 22 | | hospitals in transforming their services and care models to | 23 | | better align with the needs of the communities they serve. The | 24 | | payments authorized in this Section shall be subject to | 25 | | approval by the federal government. | 26 | | (1) Phase 1. In State fiscal years 2019 through 2020, |
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| 1 | | the Department shall allocate funds from the transitional | 2 | | access hospital pool to create a hospital transformation | 3 | | pool of at least $262,906,870 annually and make hospital | 4 | | transformation payments to hospitals. Subject to Section | 5 | | 5A-16, in State fiscal years 2019 and 2020, an Illinois | 6 | | hospital that received either a transitional hospital | 7 | | access payment under subsection (d) or a supplemental | 8 | | payment under subsection (f) of this Section in State | 9 | | fiscal year 2018, shall receive a hospital transformation | 10 | | payment as follows: | 11 | | (A) If the hospital's Rate Year 2017 Medicaid | 12 | | inpatient utilization rate is equal to or greater than | 13 | | 45%, the hospital transformation payment shall be | 14 | | equal to 100% of the sum of its transitional hospital | 15 | | access payment authorized under subsection (d) and any | 16 | | supplemental payment authorized under subsection (f). | 17 | | (B) If the hospital's Rate Year 2017 Medicaid | 18 | | inpatient utilization rate is equal to or greater than | 19 | | 25% but less than 45%, the hospital transformation | 20 | | payment shall be equal to 75% of the sum of its | 21 | | transitional hospital access payment authorized under | 22 | | subsection (d) and any supplemental payment authorized | 23 | | under subsection (f). | 24 | | (C) If the hospital's Rate Year 2017 Medicaid | 25 | | inpatient utilization rate is less than 25%, the | 26 | | hospital transformation payment shall be equal to 50% |
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| 1 | | of the sum of its transitional hospital access payment | 2 | | authorized under subsection (d) and any supplemental | 3 | | payment authorized under subsection (f). | 4 | | (2) Phase 2. During State fiscal years 2021 and 2022, | 5 | | the Department shall allocate funds from the transitional | 6 | | access hospital pool to create a hospital transformation | 7 | | pool annually and make hospital transformation payments to | 8 | | hospitals participating in the transformation program. Any | 9 | | hospital may seek transformation funding in Phase 2. Any | 10 | | hospital that seeks transformation funding in Phase 2 to | 11 | | update or repurpose the hospital's physical structure to | 12 | | transition to a new delivery model, must submit to the | 13 | | Department in writing a transformation plan, based on the | 14 | | Department's guidelines, that describes the desired | 15 | | delivery model with projections of patient volumes by | 16 | | service lines and projected revenues, expenses, and net | 17 | | income that correspond to the new delivery model. In Phase | 18 | | 2, subject to the approval of rules, the Department may use | 19 | | the hospital transformation pool to increase base rates, | 20 | | develop new adjustors, adjust current adjustors, or | 21 | | develop new access payments in order to support and | 22 | | incentivize hospitals to pursue such transformation. In | 23 | | developing such methodologies, the Department shall ensure | 24 | | that the entire hospital transformation pool continues to | 25 | | be expended to ensure access to hospital services or to | 26 | | support organizations that had received hospital |
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| 1 | | transformation payments under this Section. | 2 | | (A) Any hospital participating in the hospital | 3 | | transformation program shall provide an opportunity | 4 | | for public input by local community groups, hospital | 5 | | workers, and healthcare professionals and assist in | 6 | | facilitating discussions about any transformations or | 7 | | changes to the hospital. | 8 | | (B) As provided in paragraph (9) of Section 3 of | 9 | | the Illinois Health Facilities Planning Act, any | 10 | | hospital participating in the transformation program | 11 | | may be excluded from the requirements of the Illinois | 12 | | Health Facilities Planning Act for those projects | 13 | | related to the hospital's transformation. To be | 14 | | eligible, the hospital must submit to the Health | 15 | | Facilities and Services Review Board certification | 16 | | from the Department, approved by the Hospital | 17 | | Transformation Review Committee, that the project is a | 18 | | part of the hospital's transformation. | 19 | | (C) As provided in subsection (a-20) of Section | 20 | | 32.5 of the Emergency Medical Services (EMS) Systems | 21 | | Act, a hospital that received hospital transformation | 22 | | payments under this Section may convert to a | 23 | | freestanding emergency center. To be eligible for such | 24 | | a conversion, the hospital must submit to the | 25 | | Department of Public Health certification from the | 26 | | Department, approved by the Hospital Transformation |
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| 1 | | Review Committee, that the project is a part of the | 2 | | hospital's transformation. | 3 | | (3) By April 1, 2019 , March 12, 2018 (Public Act | 4 | | 100-581) the Department, in conjunction with the Hospital | 5 | | Transformation Review Committee, shall develop and file as | 6 | | an administrative rule with the Secretary of State the | 7 | | goals, objectives, policies, standards, payment models, or | 8 | | criteria to be applied in Phase 2 of the program to | 9 | | allocate the hospital transformation funds. The goals, | 10 | | objectives, and policies to be considered may include, but | 11 | | are not limited to, achieving unmet needs of a community | 12 | | that a hospital serves such as behavioral health services, | 13 | | outpatient services, or drug rehabilitation services; | 14 | | attaining certain quality or patient safety benchmarks for | 15 | | health care services; or improving the coordination, | 16 | | effectiveness, and efficiency of care delivery. | 17 | | Notwithstanding any other provision of law, any rule | 18 | | adopted in accordance with this subsection (d-5) may be | 19 | | submitted to the Joint Committee on Administrative Rules | 20 | | for approval only if the rule has first been approved by 9 | 21 | | of the 14 members of the Hospital Transformation Review | 22 | | Committee. | 23 | | (4) Hospital Transformation Review Committee. There is | 24 | | created the Hospital Transformation Review Committee. The | 25 | | Committee shall consist of 14 members. No later than 30 | 26 | | days after March 12, 2018 (the effective date of Public Act |
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| 1 | | 100-581), the 4 legislative leaders shall each appoint 3 | 2 | | members; the Governor shall appoint the Director of | 3 | | Healthcare and Family Services, or his or her designee, as | 4 | | a member; and the Director of Healthcare and Family | 5 | | Services shall appoint one member. Any vacancy shall be | 6 | | filled by the applicable appointing authority within 15 | 7 | | calendar days. The members of the Committee shall select a | 8 | | Chair and a Vice-Chair from among its members, provided | 9 | | that the Chair and Vice-Chair cannot be appointed by the | 10 | | same appointing authority and must be from different | 11 | | political parties. The Chair shall have the authority to | 12 | | establish a meeting schedule and convene meetings of the | 13 | | Committee, and the Vice-Chair shall have the authority to | 14 | | convene meetings in the absence of the Chair. The Committee | 15 | | may establish its own rules with respect to meeting | 16 | | schedule, notice of meetings, and the disclosure of | 17 | | documents; however, the Committee shall not have the power | 18 | | to subpoena individuals or documents and any rules must be | 19 | | approved by 9 of the 14 members. The Committee shall | 20 | | perform the functions described in this Section and advise | 21 | | and consult with the Director in the administration of this | 22 | | Section. In addition to reviewing and approving the | 23 | | policies, procedures, and rules for the hospital | 24 | | transformation program, the Committee shall consider and | 25 | | make recommendations related to qualifying criteria and | 26 | | payment methodologies related to safety-net hospitals and |
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| 1 | | children's hospitals. Members of the Committee appointed | 2 | | by the legislative leaders shall be subject to the | 3 | | jurisdiction of the Legislative Ethics Commission, not the | 4 | | Executive Ethics Commission, and all requests under the | 5 | | Freedom of Information Act shall be directed to the | 6 | | applicable Freedom of Information officer for the General | 7 | | Assembly. The Department shall provide operational support | 8 | | to the Committee as necessary. The Committee is dissolved | 9 | | on April 1, 2019. | 10 | | (e) Beginning 36 months after initial implementation, the | 11 | | Department shall update the reimbursement components in | 12 | | subsections (a) and (b), including standardized amounts and | 13 | | weighting factors, and at least triennially and no more | 14 | | frequently than annually thereafter. The Department shall | 15 | | publish these updates on its website no later than 30 calendar | 16 | | days prior to their effective date. | 17 | | (f) Continuation of supplemental payments. Any | 18 | | supplemental payments authorized under Illinois Administrative | 19 | | Code 148 effective January 1, 2014 and that continue during the | 20 | | period of July 1, 2014 through December 31, 2014 shall remain | 21 | | in effect as long as the assessment imposed by Section 5A-2 | 22 | | that is in effect on December 31, 2017 remains in effect. | 23 | | (g) Notwithstanding subsections (a) through (f) of this | 24 | | Section and notwithstanding the changes authorized under | 25 | | Section 5-5b.1, any updates to the system shall not result in | 26 | | any diminishment of the overall effective rates of |
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| 1 | | reimbursement as of the implementation date of the new system | 2 | | (July 1, 2014). These updates shall not preclude variations in | 3 | | any individual component of the system or hospital rate | 4 | | variations. Nothing in this Section shall prohibit the | 5 | | Department from increasing the rates of reimbursement or | 6 | | developing payments to ensure access to hospital services. | 7 | | Nothing in this Section shall be construed to guarantee a | 8 | | minimum amount of spending in the aggregate or per hospital as | 9 | | spending may be impacted by factors , including , but not limited | 10 | | to , the number of individuals in the medical assistance program | 11 | | and the severity of illness of the individuals. | 12 | | (h) The Department shall have the authority to modify by | 13 | | rulemaking any changes to the rates or methodologies in this | 14 | | Section as required by the federal government to obtain federal | 15 | | financial participation for expenditures made under this | 16 | | Section. | 17 | | (i) Except for subsections (g) and (h) of this Section, the | 18 | | Department shall, pursuant to subsection (c) of Section 5-40 of | 19 | | the Illinois Administrative Procedure Act, provide for | 20 | | presentation at the June 2014 hearing of the Joint Committee on | 21 | | Administrative Rules (JCAR) additional written notice to JCAR | 22 | | of the following rules in order to commence the second notice | 23 | | period for the following rules: rules published in the Illinois | 24 | | Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559 | 25 | | (Medical Payment), 4628 (Specialized Health Care Delivery | 26 | | Systems), 4640 (Hospital Services), 4932 (Diagnostic Related |
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| 1 | | Grouping (DRG) Prospective Payment System (PPS)), and 4977 | 2 | | (Hospital Reimbursement Changes), and published in the | 3 | | Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499 | 4 | | (Specialized Health Care Delivery Systems) and 6505 (Hospital | 5 | | Services).
| 6 | | (j) Out-of-state hospitals. Beginning July 1, 2018, for | 7 | | purposes of determining for State fiscal years 2019 and 2020 | 8 | | the hospitals eligible for the payments authorized under | 9 | | subsections (a) and (b) of this Section, the Department shall | 10 | | include out-of-state hospitals that are designated a Level I | 11 | | pediatric trauma center or a Level I trauma center by the | 12 | | Department of Public Health as of December 1, 2017. | 13 | | (k) The Department shall notify each hospital and managed | 14 | | care organization, in writing, of the impact of the updates | 15 | | under this Section at least 30 calendar days prior to their | 16 | | effective date. | 17 | | (Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19; | 18 | | 101-81, eff. 7-12-19; revised 7-29-19.)
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