Full Text of SB2898 100th General Assembly
SB2898eng 100TH 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 Section 5-5.4h as follows: | 6 | | (305 ILCS 5/5-5.4h) | 7 | | Sec. 5-5.4h. Medicaid reimbursement for medically complex | 8 | | for the developmentally disabled facilities licensed under the | 9 | | MC/DD Act long-term care facilities for persons under 22 years | 10 | | of age . | 11 | | (a) Facilities licensed as medically complex for the | 12 | | developmentally disabled facilities long-term care facilities | 13 | | for persons under 22 years of age that serve severely and | 14 | | chronically ill pediatric patients shall have a specific | 15 | | reimbursement system designed to recognize the characteristics | 16 | | and needs of the patients they serve. | 17 | | (b) For dates of services starting July 1, 2013 and until a | 18 | | new reimbursement system is designed, medically complex for the | 19 | | developmentally disabled facilities long-term care facilities | 20 | | for persons under 22 years of age that meet the following | 21 | | criteria: | 22 | | (1) serve exceptional care patients; and | 23 | | (2) have 30% or more of their patients receiving |
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| 1 | | ventilator care; | 2 | | shall receive Medicaid reimbursement on a 30-day expedited | 3 | | schedule.
| 4 | | (c) Subject to federal approval of changes to the Title XIX | 5 | | State Plan, for dates of services starting July 1, 2014 through | 6 | | March 31, 2019, medically complex for the developmentally | 7 | | disabled facilities and until a new reimbursement system is | 8 | | designed, long-term care facilities for persons under 22 years | 9 | | of age which meet the criteria in subsection (b) of this | 10 | | Section shall receive a per diem rate for clinically complex | 11 | | residents of $304. Clinically complex residents on a ventilator | 12 | | shall receive a per diem rate of $669. Subject to federal | 13 | | approval of changes to the Title XIX State Plan, for dates of | 14 | | services starting April 1, 2019, medically complex for the | 15 | | developmentally disabled facilities must be reimbursed an | 16 | | exceptional care per diem rate, instead of the base rate, for | 17 | | services to residents with complex or extensive medical needs. | 18 | | Exceptional care per diem rates must be paid for the conditions | 19 | | or services specified under subsection (f) at the following per | 20 | | diem rates: Tier 1 $326, Tier 2 $546, and Tier 3 $735. | 21 | | (d) For To qualify for the per diem rate of $669 for | 22 | | clinically complex residents on a ventilator pursuant to | 23 | | subsection (c) or subsection (f) , facilities shall have a | 24 | | policy documenting their method of routine assessment of a | 25 | | resident's weaning potential with interventions implemented | 26 | | noted in the resident's medical record. |
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| 1 | | (e) For services provided prior to April 1, 2019 and for | 2 | | For the purposes of this Section, a resident is considered | 3 | | clinically complex if the resident requires at least one of the | 4 | | following medical services: | 5 | | (1) Tracheostomy care with dependence on mechanical | 6 | | ventilation for a minimum of 6 hours each day. | 7 | | (2) Tracheostomy care requiring suctioning at least | 8 | | every 6 hours, room air mist or oxygen as needed, and | 9 | | dependence on one of the treatment procedures listed under | 10 | | paragraph (4) excluding the procedure listed in | 11 | | subparagraph (A) of paragraph (4). | 12 | | (3) Total parenteral nutrition or other intravenous | 13 | | nutritional support and one of the treatment procedures | 14 | | listed under paragraph (4). | 15 | | (4) The following treatment procedures apply to the | 16 | | conditions in paragraphs (2) and (3) of this subsection: | 17 | | (A) Intermittent suctioning at least every 8 hours | 18 | | and room air mist or oxygen as needed. | 19 | | (B) Continuous intravenous therapy including | 20 | | administration of therapeutic agents necessary for | 21 | | hydration or of intravenous pharmaceuticals; or | 22 | | intravenous pharmaceutical administration of more than | 23 | | one agent via a peripheral or central line, without | 24 | | continuous infusion. | 25 | | (C) Peritoneal dialysis treatments requiring at | 26 | | least 4 exchanges every 24 hours. |
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| 1 | | (D) Tube feeding via nasogastric or gastrostomy | 2 | | tube. | 3 | | (E) Other medical technologies required | 4 | | continuously, which in the opinion of the attending | 5 | | physician require the services of a professional | 6 | | nurse. | 7 | | (f) Complex or extensive medical needs for exceptional care | 8 | | reimbursement. The conditions and services used for the | 9 | | purposes of this Section have the same meanings as ascribed to | 10 | | those conditions and services under the Minimum Data Set (MDS) | 11 | | Resident Assessment Instrument (RAI) and specified in the most | 12 | | recent manual. Instead of submitting minimum data set | 13 | | assessments to the Department, medically complex for the | 14 | | developmentally disabled facilities must document within each | 15 | | resident's medical record the conditions or services using the | 16 | | minimum data set documentation standards and requirements to | 17 | | qualify for exceptional care reimbursement. | 18 | | (1) Tier 1 reimbursement is for residents who are | 19 | | receiving at least 51% of their caloric intake via a | 20 | | feeding tube. | 21 | | (2) Tier 2 reimbursement is for residents who are | 22 | | receiving tracheostomy care without a ventilator. | 23 | | (3) Tier 3 reimbursement is for residents who are | 24 | | receiving tracheostomy care and ventilator care. | 25 | | (g) For dates of services starting April 1, 2019, | 26 | | reimbursement calculations and direct payment for services |
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| 1 | | provided by medically complex for the developmentally disabled | 2 | | facilities are the responsibility of the Department of | 3 | | Healthcare and Family Services instead of the Department of | 4 | | Human Services. Appropriations for medically complex for the | 5 | | developmentally disabled facilities must be shifted from the | 6 | | Department of Human Services to the Department of Healthcare | 7 | | and Family Services. Nothing in this Section prohibits the | 8 | | Department of Healthcare and Family Services from paying more | 9 | | than the rates specified in this Section. The rates in this | 10 | | Section must be interpreted as a minimum amount. Any | 11 | | reimbursement increases applied to providers licensed under | 12 | | the ID/DD Community Care Act must also be applied in an | 13 | | equivalent manner to medically complex for the developmentally | 14 | | disabled facilities. | 15 | | (h) The Department of Healthcare and Family Services shall | 16 | | pay the rates in effect on March 31, 2019 until the changes | 17 | | made to this Section by this amendatory Act of the 100th | 18 | | General Assembly have been approved by the Centers for Medicare | 19 | | and Medicaid Services of the U.S. Department of Health and | 20 | | Human Services. | 21 | | (i) The Department of Healthcare and Family Services may | 22 | | adopt rules as allowed by the Illinois Administrative Procedure | 23 | | Act to implement this Section; however, the requirements of | 24 | | this Section must be implemented by the Department of | 25 | | Healthcare and Family Services even if the Department of | 26 | | Healthcare and Family Services has not adopted rules by the |
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| 1 | | implementation date of April 1, 2019. | 2 | | (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
| 3 | | Section 99. Effective date. This Act takes effect upon | 4 | | becoming law.
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