Full Text of SB3743 96th General Assembly
SB3743enr 96TH GENERAL ASSEMBLY
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the Long | 5 |
| Term Acute Care Hospital Quality Improvement Transfer Program | 6 |
| Act. | 7 |
| Section 5. Purpose of Act. The General Assembly finds that | 8 |
| it is vital for the State of Illinois to find methods to | 9 |
| improve the health care outcomes of patients served by the | 10 |
| healthcare programs operated by the Department of Healthcare | 11 |
| and Family Services. Improving a patient's health not only | 12 |
| benefits the patient's quality of life but also results in a | 13 |
| more efficient use of the resources needed to provide care. | 14 |
| Estimates show that the Long Term Acute Care Hospital Quality | 15 |
| Improvement Transfer Program established under this Act could | 16 |
| save approximately $10,000,000 annually. The program focuses | 17 |
| on some of the most severely injured and ill patients in the | 18 |
| State of Illinois. It is designed to better utilize the | 19 |
| specialized services available in the State to improve these | 20 |
| patients' health outcomes and to enhance the continuity and | 21 |
| coordination of care for these patients. This program serves as | 22 |
| one of the many pieces needed to reform the State of Illinois' | 23 |
| healthcare programs to better serve the people of the State of |
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| Illinois. | 2 |
| Section 10. Definitions. As used in this Act: | 3 |
| (a) "CARE tool" means the Continuity and Record Evaluation | 4 |
| (CARE) tool. It is a patient assessment instrument that has | 5 |
| been developed to document the medical, cognitive, functional, | 6 |
| and discharge status of persons receiving health care services | 7 |
| in acute and post-acute care settings. The data collected is | 8 |
| able to document provider-level quality of care (patient | 9 |
| outcomes) and characterize the clinical complexity of | 10 |
| patients. | 11 |
| (b) "Department" means the Illinois Department of | 12 |
| Healthcare and Family Services. | 13 |
| (c) "Discharge" means the release of a patient from | 14 |
| hospital care for any discharge disposition other than a leave | 15 |
| of absence, even if for Medicare payment purposes the discharge | 16 |
| fits the definition of an interrupted stay.
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| (d) "FTE" means "full-time equivalent" or a person or | 18 |
| persons employed in one full-time position. | 19 |
| (e) "Hospital" means an institution, place, building, or | 20 |
| agency located in this State that is licensed as a general | 21 |
| acute hospital by the Illinois Department of Public Health | 22 |
| under the Hospital Licensing Act, whether public or private and | 23 |
| whether organized for profit or not-for-profit. | 24 |
| (f) "ICU" means intensive care unit. | 25 |
| (g) "LTAC hospital" means a hospital that is designated by |
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| Medicare as a long term acute care hospital as described in | 2 |
| Section 1886(d)(1)(B)(iv)(I) of the Social Security Act and has | 3 |
| an average length of Medicaid inpatient stay greater than 25 | 4 |
| days as reported on the hospital's 2008 Medicaid cost report on | 5 |
| file as of February 15, 2010, or a hospital that begins | 6 |
| operations after January 1, 2010 and is designated by Medicare | 7 |
| as a long term acute care hospital. | 8 |
| (h) "LTAC hospital criteria" means nationally recognized | 9 |
| evidence-based evaluation criteria that have been publicly | 10 |
| tested and includes criteria specific to an LTAC hospital for | 11 |
| admission, continuing stay, and discharge. The criteria cannot | 12 |
| include criteria derived or developed by or for a specific | 13 |
| hospital or group of hospitals. Criteria and tools developed by | 14 |
| hospitals or hospital associations or hospital-owned | 15 |
| organizations are not acceptable and do not meet the | 16 |
| requirements of this subsection. | 17 |
| (i) "Patient" means an individual who is admitted to a | 18 |
| hospital for an inpatient stay. | 19 |
| (j) "Program" means the Long Term Acute Care Hospital | 20 |
| Quality Improvement Transfer Program established by this Act. | 21 |
| (k) "STAC hospital" means a hospital that is not an LTAC | 22 |
| hospital as defined in this Act or a psychiatric hospital or a | 23 |
| rehabilitation hospital.
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| Section 15. Qualifying Hospitals. | 25 |
| (a) Beginning October 1, 2010, the Department shall |
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| establish the Long Term Acute Care Hospital Quality Improvement | 2 |
| Transfer Program. Any hospital may participate in the program | 3 |
| if it meets the requirements of this Section as determined by | 4 |
| the Department. | 5 |
| (b) To participate in the program a hospital must do the | 6 |
| following: | 7 |
| (1) Operate as an LTAC hospital. | 8 |
| (2) Employ one-half of an FTE (designated for case | 9 |
| management) for every 15 patients admitted to the hospital. | 10 |
| (3) Maintain on-site physician coverage 24 hours a day, | 11 |
| 7 days a week. | 12 |
| (4) Maintain on-site respiratory therapy coverage 24 | 13 |
| hours a day, 7 days a week. | 14 |
| (c) A hospital must also execute a program participation | 15 |
| agreement with the Department. The agreement must include: | 16 |
| (1) An attestation that the hospital complies with the | 17 |
| criteria in subsection (b) of this Section. | 18 |
| (2) A process for the hospital to report its continuing | 19 |
| compliance with subsection (b) of this Section. The | 20 |
| hospital must submit a compliance report at least annually. | 21 |
| (3) A requirement that the hospital complete and submit | 22 |
| to the Department the CARE tool (the most currently | 23 |
| available version or an equivalent tool designated and | 24 |
| approved for use by the Department) for each patient no | 25 |
| later than 7 calendar days after discharge. | 26 |
| (4) A requirement that the hospital use a patient |
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| satisfaction survey specifically designed for LTAC | 2 |
| hospital settings. The hospital must submit survey results | 3 |
| data to the Department at least annually.
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| (5) A requirement that the hospital accept all | 5 |
| clinically approved patients for admission or transfer | 6 |
| from a STAC hospital with the exception of STAC hospitals | 7 |
| identified in paragraphs (1) and (2) under subsection (a) | 8 |
| of Section 25 of this Act. The patient must be evaluated | 9 |
| using LTAC hospital criteria approved by the Department for | 10 |
| use in this program and meet the appropriate criteria. | 11 |
| (6) A requirement that the hospital report quality and | 12 |
| outcome measurement data, as described in Section 20 of | 13 |
| this Act, to the Department at least annually. | 14 |
| (7) A requirement that the hospital provide the | 15 |
| Department full access to patient data and other data | 16 |
| maintained by the hospital. Access must be in compliance | 17 |
| with State and federal law. | 18 |
| (8) A requirement that the hospital use LTAC hospital | 19 |
| criteria to evaluate patients that are admitted to the | 20 |
| hospital to determine that the patient is in the most | 21 |
| appropriate setting.
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| Section 20. Quality and outcome measurement data.
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| (a) For proper evaluation and monitoring of the program, | 24 |
| each LTAC hospital must provide quality and outcome measurement | 25 |
| data ("measures") as specified in subsections (c) through (h) |
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| of this Section to the Department for patients treated under | 2 |
| this program. The Department may develop measures in addition | 3 |
| to the minimum measures required under this Section. | 4 |
| (b) Two sets of measures must be calculated. The first set | 5 |
| should only use data for medical assistance patients, and the | 6 |
| second set should include all patients of the LTAC hospital | 7 |
| regardless of payer. | 8 |
| (c) Average LTAC hospital length of stay for patients | 9 |
| discharged during the reporting period. | 10 |
| (d) Adverse outcomes rates: Percent of patients who expired | 11 |
| or whose condition worsens and requires treatment in a STAC | 12 |
| hospital. | 13 |
| (e) Ventilator weaning rate: Percent of patients | 14 |
| discharged during the reporting period who have been | 15 |
| successfully weaned off invasive mechanical ventilation. | 16 |
| (f) Central Line Infection Rate per 1000 central line days: | 17 |
| Number of patients discharged from an LTAC hospital during the | 18 |
| reporting period that had a central line in place and developed | 19 |
| a bloodstream infection 48 hours or more after admission to the | 20 |
| LTAC hospital. | 21 |
| (g) Acquired pressure ulcers per 1000 patient days. | 22 |
| (h) Falls with injury per 1000 patient days: Number of | 23 |
| falls among discharged LTAC hospital patients discharged | 24 |
| during the reporting period, who fell during the LTAC hospital | 25 |
| stay, regardless of distance fallen, that required an ancillary | 26 |
| or surgical procedure (i.e. x-ray, MRI, sutures, surgery, etc.) |
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| Section 25. Quality improvement transfer program.
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| (a) The Department may exempt the following STAC hospitals | 3 |
| from the requirements in this Section: | 4 |
| (1) A hospital operated by a county with a population | 5 |
| of 3,000,000 or more. | 6 |
| (2) A hospital operated by a State agency or a State | 7 |
| university. | 8 |
| (b) STAC hospitals may transfer patients who meet criteria | 9 |
| in the LTAC hospital criteria and are medically stable for | 10 |
| discharge from the STAC hospital. | 11 |
| (c) A patient in a STAC hospital may be exempt from a | 12 |
| transfer if: | 13 |
| (1) The patient's physician does not issue an order for | 14 |
| a transfer; | 15 |
| (2) The patient or the individual legally authorized to | 16 |
| make medical decisions for the patient refuses the | 17 |
| transfer; or | 18 |
| (3) The patient's care is primarily paid for by | 19 |
| Medicare or another third party. The exemption in this | 20 |
| paragraph (3) of subsection (c) does not apply to a patient | 21 |
| who has exhausted his or her Medicare benefits resulting in | 22 |
| the Department becoming the primary payer.
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| Section 30. LTAC hospital duties. | 24 |
| (a) The LTAC hospital must notify the Department within 5 |
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| calendar days if it no longer meets the requirements under | 2 |
| subsection (b) of Section 15. | 3 |
| (b) The LTAC hospital may terminate the agreement under | 4 |
| subsection (c) of Section 15 with 30 calendar days' notice to | 5 |
| the Department. | 6 |
| (c) The LTAC hospital must develop patient and family | 7 |
| education materials concerning the Program and submit those | 8 |
| materials to the Department for review and approval. | 9 |
| (d) The LTAC hospital must retain the patient's admission | 10 |
| evaluation to document that the patient meets the LTAC hospital | 11 |
| criteria and is eligible to receive the LTAC supplemental per | 12 |
| diem rate described in Section 35 of this Act.
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| Section 35. LTAC supplemental per diem rate. | 14 |
| (a) The Department must pay an LTAC supplemental per diem | 15 |
| rate calculated under this Section to LTAC hospitals that meet | 16 |
| the requirements of Section 15 of this Act for patients: | 17 |
| (1) who upon admission to the LTAC hospital meet LTAC | 18 |
| hospital criteria; and | 19 |
| (2) whose care is primarily paid for by the Department | 20 |
| under Title XIX of the Social Security Act or whose care is | 21 |
| primarily paid for by the Department after the patient has | 22 |
| exhausted his or her benefits under Medicare. | 23 |
| (b) The Department must not pay the LTAC supplemental per | 24 |
| diem rate calculated under this Section if any of the following | 25 |
| conditions are met: |
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| (1) the LTAC hospital no longer meets the requirements | 2 |
| under Section 15 of this Act or terminates the agreement | 3 |
| specified under Section 15 of this Act; | 4 |
| (2) the patient does not meet the LTAC hospital | 5 |
| criteria upon admission; or | 6 |
| (3) the patient's care is primarily paid for by | 7 |
| Medicare and the patient has not exhausted his or her | 8 |
| Medicare benefits, resulting in the Department becoming | 9 |
| the primary payer. | 10 |
| (c) The Department may adjust the LTAC supplemental per | 11 |
| diem rate calculated under this Section based only on the | 12 |
| conditions and requirements described under Section 40 and | 13 |
| Section 45 of this Act. | 14 |
| (d) The LTAC supplemental per diem rate shall be calculated | 15 |
| using the LTAC hospital's inflated cost per diem, defined in | 16 |
| subsection (f) of this Section, and subtracting the following: | 17 |
| (1) The LTAC hospital's Medicaid per diem inpatient | 18 |
| rate as calculated under 89 Ill. Adm. Code 148.270(c)(4). | 19 |
| (2) The LTAC hospital's disproportionate share (DSH) | 20 |
| rate as calculated under 89 Ill. Adm. Code 148.120. | 21 |
| (3) The LTAC hospital's Medicaid Percentage Adjustment | 22 |
| (MPA) rate as calculated under 89 Ill. Adm. Code 148.122. | 23 |
| (4) The LTAC hospital's Medicaid High Volume | 24 |
| Adjustment (MHVA) rate as calculated under 89 Ill. Adm. | 25 |
| Code 148.290(d). | 26 |
| (e) LTAC supplemental per diem rates are effective for 12 |
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| months beginning on October 1 of each year and must be updated | 2 |
| every 12 months. | 3 |
| (f) For the purposes of this Section, "inflated cost per | 4 |
| diem" means the quotient resulting from dividing the hospital's | 5 |
| inpatient Medicaid costs by the hospital's Medicaid inpatient | 6 |
| days and inflating it to the most current period using | 7 |
| methodologies consistent with the calculation of the rates | 8 |
| described in paragraphs (2), (3), and (4) of subsection (d). | 9 |
| The data is obtained from the LTAC hospital's most recent cost | 10 |
| report submitted to the Department as mandated under 89 Ill. | 11 |
| Adm. Code 148.210.
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| Section 40. Rate adjustments for quality measures. | 13 |
| (a) The Department may adjust the LTAC supplemental per | 14 |
| diem rate calculated under Section 35 of this Act based on the | 15 |
| requirements of this Section. | 16 |
| (b) After the first year of operation of the Program | 17 |
| established by this Act, the Department may reduce the LTAC | 18 |
| supplemental per diem rate calculated under Section 35 of this | 19 |
| Act by no more than 5% for an LTAC hospital that does not meet | 20 |
| benchmarks or targets set by the Department under paragraph (2) | 21 |
| of subsection (b) of Section 50. | 22 |
| (c) After the first year of operation of the Program | 23 |
| established by this Act, the Department may increase the LTAC | 24 |
| supplemental per diem rate calculated under Section 35 of this | 25 |
| Act by no more than 5% for an LTAC hospital that exceeds the |
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| benchmarks or targets set by the Department under paragraph (2) | 2 |
| of subsection (a) of Section 50. | 3 |
| (d) If an LTAC hospital misses a majority of the benchmarks | 4 |
| for quality measures for 3 consecutive years, the Department | 5 |
| may reduce the LTAC supplemental per diem rate calculated under | 6 |
| Section 35 of this Act to zero. | 7 |
| (e) An LTAC hospital whose rate is reduced under subsection | 8 |
| (d) of this Section may have the LTAC supplemental per diem | 9 |
| rate calculated under Section 35 of this Act reinstated once | 10 |
| the LTAC hospital achieves the necessary benchmarks or targets. | 11 |
| (f) The Department may apply the reduction described in | 12 |
| subsection (d) of this Section after one year instead of 3 to | 13 |
| an LTAC hospital that has had its rate previously reduced under | 14 |
| subsection (d) of this Section and later has had it reinstated | 15 |
| under subsection (e) of this Section. | 16 |
| (g) The rate adjustments described in this Section shall be | 17 |
| determined and applied only at the beginning of each rate year. | 18 |
| Section 45. Program evaluation. | 19 |
| (a) After the Program completes the 3rd full year of | 20 |
| operation on September 30, 2013, the Department must complete | 21 |
| an evaluation of the Program to determine the actual savings or | 22 |
| costs generated by the Program, both on an aggregate basis and | 23 |
| on an LTAC hospital-specific basis. The evaluation must be | 24 |
| conducted in each subsequent year. | 25 |
| (b) The Department and qualified LTAC hospitals must |
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| determine the appropriate methodology to accurately calculate | 2 |
| the Program's savings and costs. | 3 |
| (c) The evaluation must also determine the effects the | 4 |
| Program has had in improving patient satisfaction and health | 5 |
| outcomes. | 6 |
| (d) If the evaluation indicates that the Program generates | 7 |
| a net cost to the Department, the Department may prospectively | 8 |
| adjust an individual hospital's LTAC supplemental per diem rate | 9 |
| under Section 35 of this Act to establish cost neutrality. The | 10 |
| rate adjustments applied under this subsection (d) do not need | 11 |
| to be applied uniformly to all qualified LTAC hospitals as long | 12 |
| as the adjustments are based on data from the evaluation on | 13 |
| hospital-specific information. Cost neutrality under this | 14 |
| Section means that the cost to the Department resulting from | 15 |
| the LTAC supplemental per diem rate must not exceed the savings | 16 |
| generated from transferring the patient from a STAC hospital. | 17 |
| (e) The rate adjustment described in subsection (d) of this | 18 |
| Section, if necessary, shall be applied to the LTAC | 19 |
| supplemental per diem rate for the rate year beginning October | 20 |
| 1, 2014. The Department may apply this rate adjustment in | 21 |
| subsequent rate years if the conditions under subsection (d) of | 22 |
| this Section are met. The Department must apply the rate | 23 |
| adjustment to an individual LTAC hospital's LTAC supplemental | 24 |
| per diem rate only in years when the Program evaluation | 25 |
| indicates a net cost for the Department. | 26 |
| (f) The rate adjustments described in this Section shall be |
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| determined and applied only at the beginning of each rate year. | 2 |
| Section 50. Duties of the Department. | 3 |
| (a) The Department is responsible for implementing, | 4 |
| monitoring, and evaluating the program. This includes but is | 5 |
| not limited to: | 6 |
| (1) Collecting data required under Section 15 and data | 7 |
| necessary to calculate the measures under Section 20 of | 8 |
| this Act. | 9 |
| (2) Setting annual benchmarks or targets for the | 10 |
| measures in Section 20 of this Act or other measures beyond | 11 |
| the minimum required under Section 20. The Department must | 12 |
| consult participating LTAC hospitals when setting these | 13 |
| benchmarks and targets. | 14 |
| (3) Monitoring compliance with all requirements of | 15 |
| this Act. | 16 |
| (b) The Department shall include specific information on | 17 |
| the Program in its annual medical programs report. | 18 |
| (c) The Department must establish monitoring procedures | 19 |
| that ensure the LTAC supplemental payment is only paid for | 20 |
| patients who upon admission meet the LTAC hospital criteria. | 21 |
| The Department must notify qualified LTAC hospitals of the | 22 |
| procedures and establish an appeals process as part of those | 23 |
| procedures. The Department must recoup any LTAC supplemental | 24 |
| payments that are identified as being paid for patients who do | 25 |
| not meet the LTAC hospital criteria. |
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| (d) The Department must implement the program by October 1, | 2 |
| 2010. | 3 |
| (e) The Department must create and distribute to LTAC | 4 |
| hospitals the agreement required under subsection (c) of | 5 |
| Section 15 no later than September 1, 2010. | 6 |
| (f) The Department must notify Illinois hospitals which | 7 |
| LTAC hospital criteria are approved for use under the program.
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| The Department may limit LTAC hospital criteria to the most | 9 |
| strict criteria that meet the definitions of this Act. | 10 |
| (g) The Department must identify discharge tools that are | 11 |
| considered equivalent to the CARE tool and approved for use | 12 |
| under the program. The Department must notify LTAC hospitals | 13 |
| which tools are approved for use under the program. | 14 |
| (h) The Department must notify Illinois LTAC hospitals of | 15 |
| the program and inform them how to apply for qualification and | 16 |
| what the qualification requirements are as described under | 17 |
| Section 15 of this Act. | 18 |
| (i) The Department must notify Illinois STAC hospitals | 19 |
| about the operation and implementation of the program | 20 |
| established by this Act. The Department must also notify LTAC | 21 |
| hospitals that accepting transfers from the STAC hospitals | 22 |
| identified in paragraphs (1) and (2) under subsection (a) of | 23 |
| Section 25 of this Act are not required under paragraph (5) of | 24 |
| subsection (c) of Section 15 of this Act. The Department must | 25 |
| notify LTAC hospitals that accepting transfers from the STAC | 26 |
| hospitals identified in paragraphs (1) and (2) under subsection |
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| (a) of Section 25 of this Act shall negatively impact the | 2 |
| savings calculations under the Program evaluation required by | 3 |
| Section 40 of this Act and shall in turn require the Department | 4 |
| to initiate the penalty described in subsection (d) of Section | 5 |
| 40 of this Act. | 6 |
| (j) The Department shall deem LTAC hospitals qualified | 7 |
| under Section 15 of this Act as qualifying for expedited | 8 |
| payments. | 9 |
| (k) The Department may use up to $500,000 of funds | 10 |
| contained in the Public Aid Recoveries Trust Fund per State | 11 |
| fiscal year to operate the program under this Act. The | 12 |
| Department may expand existing contracts, issue new contracts, | 13 |
| issue personal service contracts, or purchase other services, | 14 |
| supplies, or equipment.
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| (l) The Department may promulgate rules as allowed by the | 16 |
| Illinois Administrative Procedure Act to implement this Act; | 17 |
| however, the requirements under this Act shall be implemented | 18 |
| by the Department even if the Department's proposed rules are | 19 |
| not yet adopted by the implementation date of October 1, 2010.
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| Section 99. Effective date. This Act takes effect upon | 21 |
| becoming law.
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