Bill Text: IL HB4117 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Children and Family Services to pay for all inpatient stays at a hospital beginning on the 3rd day a child is in the hospital beyond medical necessity, and the parent or caregiver has denied the child access to the home and has refused or failed to make provisions for another living arrangement for the child or the child's discharge is being delayed due to a pending inquiry or investigation by the Department of Children and Family Services. In a provision requiring the Department of Children and Family Services to pay the DCFS per diem rate for inpatient psychiatric stays at a free-standing psychiatric hospital or a hospital with a pediatric or adolescent inpatient psychiatric unit, requires the Department to pay the DCFS per diem rate effective the 3rd day (rather than the 11th day) when a child is in the hospital beyond medical necessity.

Spectrum: Partisan Bill (Republican 7-0)

Status: (Failed) 2025-01-07 - Session Sine Die [HB4117 Detail]

Download: Illinois-2023-HB4117-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4117 Introduced , by Rep. Norine K. Hammond SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5.07
305 ILCS 5/14-13
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Children and Family Services to pay for all inpatient stays at a hospital beginning on the 3rd day a child is in the hospital beyond medical necessity, and the parent or caregiver has denied the child access to the home and has refused or failed to make provisions for another living arrangement for the child or the child's discharge is being delayed due to a pending inquiry or investigation by the Department of Children and Family Services. In a provision requiring the Department of Children and Family Services to pay the DCFS per diem rate for inpatient psychiatric stays at a free-standing psychiatric hospital or a hospital with a pediatric or adolescent inpatient psychiatric unit, requires the Department to pay the DCFS per diem rate effective the 3rd day (rather than the 11th day) when a child is in the hospital beyond medical necessity.
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A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Sections 5-5.07 and 14-13 as follows:
(305 ILCS 5/5-5.07)
Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem
rate. The Department of Children and Family Services shall pay
the DCFS per diem rate for inpatient psychiatric stay at a
free-standing psychiatric hospital or a hospital with a
pediatric or adolescent inpatient psychiatric unit effective
the 3rd day 11th day when a child is in the hospital beyond
medical necessity, and the parent or caregiver has denied the
child access to the home and has refused or failed to make
provisions for another living arrangement for the child or the
child's discharge is being delayed due to a pending inquiry or
investigation by the Department of Children and Family
Services. If any portion of a hospital stay is reimbursed
under this Section, the hospital stay shall not be eligible
for payment under the provisions of Section 14-13 of this
Code.
(Source: Reenacted by P.A. 101-15, eff. 6-14-19; reenacted by
P.A. 101-209, eff. 8-5-19; P.A. 101-655, eff. 3-12-21;

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102-201, eff. 7-30-21; 102-558, eff. 8-20-21; 102-1037, eff.
6-2-22.)
(305 ILCS 5/14-13)
Sec. 14-13. Reimbursement for inpatient stays extended
beyond medical necessity.
(a) By October 1, 2019, the Department shall by rule
implement a methodology effective for dates of service July 1,
2019 and later to reimburse hospitals for inpatient stays
extended beyond medical necessity due to the inability of the
Department or the managed care organization in which a
recipient is enrolled or the hospital discharge planner to
find an appropriate placement after discharge from the
hospital. The Department shall evaluate the effectiveness of
the current reimbursement rate for inpatient hospital stays
beyond medical necessity.
(b) The methodology shall provide reasonable compensation
for the services provided attributable to the days of the
extended stay for which the prevailing rate methodology
provides no reimbursement. The Department may use a day
outlier program to satisfy this requirement. The reimbursement
rate shall be set at a level so as not to act as an incentive
to avoid transfer to the appropriate level of care needed or
placement, after discharge.
(c) The Department shall require managed care
organizations to adopt this methodology or an alternative

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methodology that pays at least as much as the Department's
adopted methodology unless otherwise mutually agreed upon
contractual language is developed by the provider and the
managed care organization for a risk-based or innovative
payment methodology.
(d) Days beyond medical necessity shall not be eligible
for per diem add-on payments under the Medicaid High Volume
Adjustment (MHVA) or the Medicaid Percentage Adjustment (MPA)
programs.
(e) For services covered by the fee-for-service program,
reimbursement under this Section shall only be made for days
beyond medical necessity that occur after the hospital has
notified the Department of the need for post-discharge
placement. For services covered by a managed care
organization, hospitals shall notify the appropriate managed
care organization of an admission within 24 hours of
admission. For every 24-hour period beyond the initial 24
hours after admission that the hospital fails to notify the
managed care organization of the admission, reimbursement
under this subsection shall be reduced by one day.
(f) The Department of Children and Family Services shall
pay for all inpatient stays beginning on the 3rd day a child is
in the hospital beyond medical necessity, and the parent or
caregiver has denied the child access to the home and has
refused or failed to make provisions for another living
arrangement for the child or the child's discharge is being

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delayed due to a pending inquiry or investigation by the
Department of Children and Family Services.
(Source: P.A. 101-209, eff. 8-5-19; 102-4, eff. 4-27-21.)