Bill Text: IL SB1040 | 2021-2022 | 102nd General Assembly | Enrolled
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning rates for inpatient services, requires the Department of Healthcare and Family Services to make adjustment payments to a hospital that reopens a previously closed hospital facility within 3 calendar years of the hospital facility's closure, if the previously closed hospital facility qualified for certain inpatient adjustment payments at the time of closure, until utilization data for the new facility is available for the Medicaid inpatient utilization rate calculation. Provides that a "closed hospital facility" shall include hospitals that have been terminated from participation in the medical assistance program. Provides that qualifying hospitals shall have the payment rate assigned to the previously closed hospital facility at the date of closure, until utilization data for the new facility is available for the Medicaid inpatient utilization rate calculation. In a provision requiring the Department to develop add-on payments that are consistent with Medicare outlier principles, provides that outlier fixed loss thresholds may be updated to control for excessive growth in outlier payments no more frequently than on an annual basis, but at least once every 4 years (rather than triennially). Requires the Department to update certain reimbursement components at least once every 4 years (rather than triennially). Effective immediately.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2021-12-10 - Public Act . . . . . . . . . 102-0682 [SB1040 Detail]
Download: Illinois-2021-SB1040-Enrolled.html
Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning rates for inpatient services, requires the Department of Healthcare and Family Services to make adjustment payments to a hospital that reopens a previously closed hospital facility within 3 calendar years of the hospital facility's closure, if the previously closed hospital facility qualified for certain inpatient adjustment payments at the time of closure, until utilization data for the new facility is available for the Medicaid inpatient utilization rate calculation. Provides that a "closed hospital facility" shall include hospitals that have been terminated from participation in the medical assistance program. Provides that qualifying hospitals shall have the payment rate assigned to the previously closed hospital facility at the date of closure, until utilization data for the new facility is available for the Medicaid inpatient utilization rate calculation. In a provision requiring the Department to develop add-on payments that are consistent with Medicare outlier principles, provides that outlier fixed loss thresholds may be updated to control for excessive growth in outlier payments no more frequently than on an annual basis, but at least once every 4 years (rather than triennially). Requires the Department to update certain reimbursement components at least once every 4 years (rather than triennially). Effective immediately.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2021-12-10 - Public Act . . . . . . . . . 102-0682 [SB1040 Detail]
Download: Illinois-2021-SB1040-Enrolled.html
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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois, | ||||||
3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Sections 5-5.02 and 14-12 as follows:
| ||||||
6 | (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
| ||||||
7 | Sec. 5-5.02. Hospital reimbursements.
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8 | (a) Reimbursement to hospitals; July 1, 1992 through | ||||||
9 | September 30, 1992.
Notwithstanding any other provisions of | ||||||
10 | this Code or the Illinois
Department's Rules promulgated under | ||||||
11 | the Illinois Administrative Procedure
Act, reimbursement to | ||||||
12 | hospitals for services provided during the period
July 1, 1992 | ||||||
13 | through September 30, 1992, shall be as follows:
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14 | (1) For inpatient hospital services rendered, or if | ||||||
15 | applicable, for
inpatient hospital discharges occurring, | ||||||
16 | on or after July 1, 1992 and on
or before September 30, | ||||||
17 | 1992, the Illinois Department shall reimburse
hospitals | ||||||
18 | for inpatient services under the reimbursement | ||||||
19 | methodologies in
effect for each hospital, and at the | ||||||
20 | inpatient payment rate calculated for
each hospital, as of | ||||||
21 | June 30, 1992. For purposes of this paragraph,
| ||||||
22 | "reimbursement methodologies" means all reimbursement | ||||||
23 | methodologies that
pertain to the provision of inpatient |
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1 | hospital services, including, but not
limited to, any | ||||||
2 | adjustments for disproportionate share, targeted access,
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3 | critical care access and uncompensated care, as defined by | ||||||
4 | the Illinois
Department on June 30, 1992.
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5 | (2) For the purpose of calculating the inpatient | ||||||
6 | payment rate for each
hospital eligible to receive | ||||||
7 | quarterly adjustment payments for targeted
access and | ||||||
8 | critical care, as defined by the Illinois Department on | ||||||
9 | June 30,
1992, the adjustment payment for the period July | ||||||
10 | 1, 1992 through September
30, 1992, shall be 25% of the | ||||||
11 | annual adjustment payments calculated for
each eligible | ||||||
12 | hospital, as of June 30, 1992. The Illinois Department | ||||||
13 | shall
determine by rule the adjustment payments for | ||||||
14 | targeted access and critical
care beginning October 1, | ||||||
15 | 1992.
| ||||||
16 | (3) For the purpose of calculating the inpatient | ||||||
17 | payment rate for each
hospital eligible to receive | ||||||
18 | quarterly adjustment payments for
uncompensated care, as | ||||||
19 | defined by the Illinois Department on June 30, 1992,
the | ||||||
20 | adjustment payment for the period August 1, 1992 through | ||||||
21 | September 30,
1992, shall be one-sixth of the total | ||||||
22 | uncompensated care adjustment payments
calculated for each | ||||||
23 | eligible hospital for the uncompensated care rate year,
as | ||||||
24 | defined by the Illinois Department, ending on July 31, | ||||||
25 | 1992. The
Illinois Department shall determine by rule the | ||||||
26 | adjustment payments for
uncompensated care beginning |
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1 | October 1, 1992.
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2 | (b) Inpatient payments. For inpatient services provided on | ||||||
3 | or after October
1, 1993, in addition to rates paid for | ||||||
4 | hospital inpatient services pursuant to
the Illinois Health | ||||||
5 | Finance Reform Act, as now or hereafter amended, or the
| ||||||
6 | Illinois Department's prospective reimbursement methodology, | ||||||
7 | or any other
methodology used by the Illinois Department for | ||||||
8 | inpatient services, the
Illinois Department shall make | ||||||
9 | adjustment payments, in an amount calculated
pursuant to the | ||||||
10 | methodology described in paragraph (c) of this Section, to
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11 | hospitals that the Illinois Department determines satisfy any | ||||||
12 | one of the
following requirements:
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13 | (1) Hospitals that are described in Section 1923 of | ||||||
14 | the federal Social
Security Act, as now or hereafter | ||||||
15 | amended, except that for rate year 2015 and after a | ||||||
16 | hospital described in Section 1923(b)(1)(B) of the federal | ||||||
17 | Social Security Act and qualified for the payments | ||||||
18 | described in subsection (c) of this Section for rate year | ||||||
19 | 2014 provided the hospital continues to meet the | ||||||
20 | description in Section 1923(b)(1)(B) in the current | ||||||
21 | determination year; or
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22 | (2) Illinois hospitals that have a Medicaid inpatient | ||||||
23 | utilization
rate which is at least one-half a standard | ||||||
24 | deviation above the mean Medicaid
inpatient utilization | ||||||
25 | rate for all hospitals in Illinois receiving Medicaid
| ||||||
26 | payments from the Illinois Department; or
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1 | (3) Illinois hospitals that on July 1, 1991 had a | ||||||
2 | Medicaid inpatient
utilization rate, as defined in | ||||||
3 | paragraph (h) of this Section,
that was at least the mean | ||||||
4 | Medicaid inpatient utilization rate for all
hospitals in | ||||||
5 | Illinois receiving Medicaid payments from the Illinois
| ||||||
6 | Department and which were located in a planning area with | ||||||
7 | one-third or
fewer excess beds as determined by the Health | ||||||
8 | Facilities and Services Review Board, and that, as of June | ||||||
9 | 30, 1992, were located in a federally
designated Health | ||||||
10 | Manpower Shortage Area; or
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11 | (4) Illinois hospitals that:
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12 | (A) have a Medicaid inpatient utilization rate | ||||||
13 | that is at least
equal to the mean Medicaid inpatient | ||||||
14 | utilization rate for all hospitals in
Illinois | ||||||
15 | receiving Medicaid payments from the Department; and
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16 | (B) also have a Medicaid obstetrical inpatient | ||||||
17 | utilization
rate that is at least one standard | ||||||
18 | deviation above the mean Medicaid
obstetrical | ||||||
19 | inpatient utilization rate for all hospitals in | ||||||
20 | Illinois
receiving Medicaid payments from the | ||||||
21 | Department for obstetrical services; or
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22 | (5) Any children's hospital, which means a hospital | ||||||
23 | devoted exclusively
to caring for children. A hospital | ||||||
24 | which includes a facility devoted
exclusively to caring | ||||||
25 | for children shall be considered a
children's hospital to | ||||||
26 | the degree that the hospital's Medicaid care is
provided |
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1 | to children
if either (i) the facility devoted exclusively | ||||||
2 | to caring for children is
separately licensed as a | ||||||
3 | hospital by a municipality prior to February 28, 2013;
| ||||||
4 | (ii) the hospital has been
designated
by the State
as a | ||||||
5 | Level III perinatal care facility, has a Medicaid | ||||||
6 | Inpatient
Utilization rate
greater than 55% for the rate | ||||||
7 | year 2003 disproportionate share determination,
and has | ||||||
8 | more than 10,000 qualified children days as defined by
the
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9 | Department in rulemaking; (iii) the hospital has been | ||||||
10 | designated as a Perinatal Level III center by the State as | ||||||
11 | of December 1, 2017, is a Pediatric Critical Care Center | ||||||
12 | designated by the State as of December 1, 2017 and has a | ||||||
13 | 2017 Medicaid inpatient utilization rate equal to or | ||||||
14 | greater than 45%; or (iv) the hospital has been designated | ||||||
15 | as a Perinatal Level II center by the State as of December | ||||||
16 | 1, 2017, has a 2017 Medicaid Inpatient Utilization Rate | ||||||
17 | greater than 70%, and has at least 10 pediatric beds as | ||||||
18 | listed on the IDPH 2015 calendar year hospital profile ; or | ||||||
19 | .
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20 | (6) A hospital that reopens a previously closed | ||||||
21 | hospital facility within 3 calendar years of the hospital | ||||||
22 | facility's closure, if the previously closed hospital | ||||||
23 | facility qualified for payments under paragraph (c) at the | ||||||
24 | time of closure, until utilization data for the new | ||||||
25 | facility is available for the Medicaid inpatient | ||||||
26 | utilization rate calculation. For purposes of this clause, |
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1 | a "closed hospital facility" shall include hospitals that | ||||||
2 | have been terminated from participation in the medical | ||||||
3 | assistance program in accordance with Section 12-4.25 of | ||||||
4 | this Code. | ||||||
5 | (c) Inpatient adjustment payments. The adjustment payments | ||||||
6 | required by
paragraph (b) shall be calculated based upon the | ||||||
7 | hospital's Medicaid
inpatient utilization rate as follows:
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8 | (1) hospitals with a Medicaid inpatient utilization | ||||||
9 | rate below the mean
shall receive a per day adjustment | ||||||
10 | payment equal to $25;
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11 | (2) hospitals with a Medicaid inpatient utilization | ||||||
12 | rate
that is equal to or greater than the mean Medicaid | ||||||
13 | inpatient utilization rate
but less than one standard | ||||||
14 | deviation above the mean Medicaid inpatient
utilization | ||||||
15 | rate shall receive a per day adjustment payment
equal to | ||||||
16 | the sum of $25 plus $1 for each one percent that the | ||||||
17 | hospital's
Medicaid inpatient utilization rate exceeds the | ||||||
18 | mean Medicaid inpatient
utilization rate;
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19 | (3) hospitals with a Medicaid inpatient utilization | ||||||
20 | rate that is equal
to or greater than one standard | ||||||
21 | deviation above the mean Medicaid inpatient
utilization | ||||||
22 | rate but less than 1.5 standard deviations above the mean | ||||||
23 | Medicaid
inpatient utilization rate shall receive a per | ||||||
24 | day adjustment payment equal to
the sum of $40 plus $7 for | ||||||
25 | each one percent that the hospital's Medicaid
inpatient | ||||||
26 | utilization rate exceeds one standard deviation above the |
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1 | mean
Medicaid inpatient utilization rate; and
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2 | (4) hospitals with a Medicaid inpatient utilization | ||||||
3 | rate that is equal
to or greater than 1.5 standard | ||||||
4 | deviations above the mean Medicaid inpatient
utilization | ||||||
5 | rate shall receive a per day adjustment payment equal to | ||||||
6 | the sum of
$90 plus $2 for each one percent that the | ||||||
7 | hospital's Medicaid inpatient
utilization rate exceeds 1.5 | ||||||
8 | standard deviations above the mean Medicaid
inpatient | ||||||
9 | utilization rate ; and .
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10 | (5) Hospitals qualifying under clause (6) of paragraph | ||||||
11 | (b) shall have the rate assigned to the previously closed | ||||||
12 | hospital facility at the date of closure, until | ||||||
13 | utilization data for the new facility is available for the | ||||||
14 | Medicaid inpatient utilization rate calculation. | ||||||
15 | (d) Supplemental adjustment payments. In addition to the | ||||||
16 | adjustment
payments described in paragraph (c), hospitals as | ||||||
17 | defined in clauses
(1) through (6) (5) of paragraph (b), | ||||||
18 | excluding county hospitals (as defined in
subsection (c) of | ||||||
19 | Section 15-1 of this Code) and a hospital organized under the
| ||||||
20 | University of Illinois Hospital Act, shall be paid | ||||||
21 | supplemental inpatient
adjustment payments of $60 per day. For | ||||||
22 | purposes of Title XIX of the federal
Social Security Act, | ||||||
23 | these supplemental adjustment payments shall not be
classified | ||||||
24 | as adjustment payments to disproportionate share hospitals.
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25 | (e) The inpatient adjustment payments described in | ||||||
26 | paragraphs (c) and (d)
shall be increased on October 1, 1993 |
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1 | and annually thereafter by a percentage
equal to the lesser of | ||||||
2 | (i) the increase in the DRI hospital cost index for the
most | ||||||
3 | recent 12 month period for which data are available, or (ii) | ||||||
4 | the
percentage increase in the statewide average hospital | ||||||
5 | payment rate over the
previous year's statewide average | ||||||
6 | hospital payment rate. The sum of the
inpatient adjustment | ||||||
7 | payments under paragraphs (c) and (d) to a hospital, other
| ||||||
8 | than a county hospital (as defined in subsection (c) of | ||||||
9 | Section 15-1 of this
Code) or a hospital organized under the | ||||||
10 | University of Illinois Hospital Act,
however, shall not exceed | ||||||
11 | $275 per day; that limit shall be increased on
October 1, 1993 | ||||||
12 | and annually thereafter by a percentage equal to the lesser of
| ||||||
13 | (i) the increase in the DRI hospital cost index for the most | ||||||
14 | recent 12-month
period for which data are available or (ii) | ||||||
15 | the percentage increase in the
statewide average hospital | ||||||
16 | payment rate over the previous year's statewide
average | ||||||
17 | hospital payment rate.
| ||||||
18 | (f) Children's hospital inpatient adjustment payments. For | ||||||
19 | children's
hospitals, as defined in clause (5) of paragraph | ||||||
20 | (b), the adjustment payments
required pursuant to paragraphs | ||||||
21 | (c) and (d) shall be multiplied by 2.0.
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22 | (g) County hospital inpatient adjustment payments. For | ||||||
23 | county hospitals,
as defined in subsection (c) of Section 15-1 | ||||||
24 | of this Code, there shall be an
adjustment payment as | ||||||
25 | determined by rules issued by the Illinois Department.
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26 | (h) For the purposes of this Section the following terms |
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1 | shall be defined
as follows:
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2 | (1) "Medicaid inpatient utilization rate" means a | ||||||
3 | fraction, the numerator
of which is the number of a | ||||||
4 | hospital's inpatient days provided in a given
12-month | ||||||
5 | period to patients who, for such days, were eligible for | ||||||
6 | Medicaid
under Title XIX of the federal Social Security | ||||||
7 | Act, and the denominator of
which is the total number of | ||||||
8 | the hospital's inpatient days in that same period.
| ||||||
9 | (2) "Mean Medicaid inpatient utilization rate" means | ||||||
10 | the total number
of Medicaid inpatient days provided by | ||||||
11 | all Illinois Medicaid-participating
hospitals divided by | ||||||
12 | the total number of inpatient days provided by those same
| ||||||
13 | hospitals.
| ||||||
14 | (3) "Medicaid obstetrical inpatient utilization rate" | ||||||
15 | means the
ratio of Medicaid obstetrical inpatient days to | ||||||
16 | total Medicaid inpatient
days for all Illinois hospitals | ||||||
17 | receiving Medicaid payments from the
Illinois Department.
| ||||||
18 | (i) Inpatient adjustment payment limit. In order to meet | ||||||
19 | the limits
of Public Law 102-234 and Public Law 103-66, the
| ||||||
20 | Illinois Department shall by rule adjust
disproportionate | ||||||
21 | share adjustment payments.
| ||||||
22 | (j) University of Illinois Hospital inpatient adjustment | ||||||
23 | payments. For
hospitals organized under the University of | ||||||
24 | Illinois Hospital Act, there shall
be an adjustment payment as | ||||||
25 | determined by rules adopted by the Illinois
Department.
| ||||||
26 | (k) The Illinois Department may by rule establish criteria |
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1 | for and develop
methodologies for adjustment payments to | ||||||
2 | hospitals participating under this
Article.
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3 | (l) On and after July 1, 2012, the Department shall reduce | ||||||
4 | any rate of reimbursement for services or other payments or | ||||||
5 | alter any methodologies authorized by this Code to reduce any | ||||||
6 | rate of reimbursement for services or other payments in | ||||||
7 | accordance with Section 5-5e. | ||||||
8 | (m) The Department shall establish a cost-based | ||||||
9 | reimbursement methodology for determining payments to | ||||||
10 | hospitals for approved graduate medical education (GME) | ||||||
11 | programs for dates of service on and after July 1, 2018. | ||||||
12 | (1) As used in this subsection, "hospitals" means the | ||||||
13 | University of Illinois Hospital as defined in the | ||||||
14 | University of Illinois Hospital Act and a county hospital | ||||||
15 | in a county of over 3,000,000 inhabitants. | ||||||
16 | (2) An amendment to the Illinois Title XIX State Plan | ||||||
17 | defining GME shall maximize reimbursement, shall not be | ||||||
18 | limited to the education programs or special patient care | ||||||
19 | payments allowed under Medicare, and shall include: | ||||||
20 | (A) inpatient days; | ||||||
21 | (B) outpatient days; | ||||||
22 | (C) direct costs; | ||||||
23 | (D) indirect costs; | ||||||
24 | (E) managed care days; | ||||||
25 | (F) all stages of medical training and education | ||||||
26 | including students, interns, residents, and fellows |
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1 | with no caps on the number of persons who may qualify; | ||||||
2 | and | ||||||
3 | (G) patient care payments related to the | ||||||
4 | complexities of treating Medicaid enrollees including | ||||||
5 | clinical and social determinants of health. | ||||||
6 | (3) The Department shall make all GME payments | ||||||
7 | directly to hospitals including such costs in support of | ||||||
8 | clients enrolled in Medicaid managed care entities. | ||||||
9 | (4) The Department shall promptly take all actions | ||||||
10 | necessary for reimbursement to be effective for dates of | ||||||
11 | service on and after July 1, 2018 including publishing all | ||||||
12 | appropriate public notices, amendments to the Illinois | ||||||
13 | Title XIX State Plan, and adoption of administrative rules | ||||||
14 | if necessary. | ||||||
15 | (5) As used in this subsection, "managed care days" | ||||||
16 | means costs associated with services rendered to enrollees | ||||||
17 | of Medicaid managed care entities. "Medicaid managed care | ||||||
18 | entities" means any entity which contracts with the | ||||||
19 | Department to provide services paid for on a capitated | ||||||
20 | basis. "Medicaid managed care entities" includes a managed | ||||||
21 | care organization and a managed care community network. | ||||||
22 | (6) All payments under this Section are contingent | ||||||
23 | upon federal approval of changes to the Illinois Title XIX | ||||||
24 | State Plan, if that approval is required. | ||||||
25 | (7) The Department may adopt rules necessary to | ||||||
26 | implement Public Act 100-581 through the use of emergency |
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| |||||||
1 | rulemaking in accordance with subsection (aa) of Section | ||||||
2 | 5-45 of the Illinois Administrative Procedure Act. For | ||||||
3 | purposes of that Act, the General Assembly finds that the | ||||||
4 | adoption of rules to implement Public Act 100-581 is | ||||||
5 | deemed an emergency and necessary for the public interest, | ||||||
6 | safety, and welfare. | ||||||
7 | (Source: P.A. 100-580, eff. 3-12-18; 100-581, eff. 3-12-18; | ||||||
8 | 101-81, eff. 7-12-19.)
| ||||||
9 | (305 ILCS 5/14-12) | ||||||
10 | Sec. 14-12. Hospital rate reform payment system. The | ||||||
11 | hospital payment system pursuant to Section 14-11 of this | ||||||
12 | Article shall be as follows: | ||||||
13 | (a) Inpatient hospital services. Effective for discharges | ||||||
14 | on and after July 1, 2014, reimbursement for inpatient general | ||||||
15 | acute care services shall utilize the All Patient Refined | ||||||
16 | Diagnosis Related Grouping (APR-DRG) software, version 30, | ||||||
17 | distributed by 3M TM Health Information System. | ||||||
18 | (1) The Department shall establish Medicaid weighting | ||||||
19 | factors to be used in the reimbursement system established | ||||||
20 | under this subsection. Initial weighting factors shall be | ||||||
21 | the weighting factors as published by 3M Health | ||||||
22 | Information System, associated with Version 30.0 adjusted | ||||||
23 | for the Illinois experience. | ||||||
24 | (2) The Department shall establish a | ||||||
25 | statewide-standardized amount to be used in the inpatient |
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| |||||||
1 | reimbursement system. The Department shall publish these | ||||||
2 | amounts on its website no later than 10 calendar days | ||||||
3 | prior to their effective date. | ||||||
4 | (3) In addition to the statewide-standardized amount, | ||||||
5 | the Department shall develop adjusters to adjust the rate | ||||||
6 | of reimbursement for critical Medicaid providers or | ||||||
7 | services for trauma, transplantation services, perinatal | ||||||
8 | care, and Graduate Medical Education (GME). | ||||||
9 | (4) The Department shall develop add-on payments to | ||||||
10 | account for exceptionally costly inpatient stays, | ||||||
11 | consistent with Medicare outlier principles. Outlier fixed | ||||||
12 | loss thresholds may be updated to control for excessive | ||||||
13 | growth in outlier payments no more frequently than on an | ||||||
14 | annual basis, but at least once every 4 years triennially . | ||||||
15 | Upon updating the fixed loss thresholds, the Department | ||||||
16 | shall be required to update base rates within 12 months. | ||||||
17 | (5) The Department shall define those hospitals or | ||||||
18 | distinct parts of hospitals that shall be exempt from the | ||||||
19 | APR-DRG reimbursement system established under this | ||||||
20 | Section. The Department shall publish these hospitals' | ||||||
21 | inpatient rates on its website no later than 10 calendar | ||||||
22 | days prior to their effective date. | ||||||
23 | (6) Beginning July 1, 2014 and ending on June 30, | ||||||
24 | 2024, in addition to the statewide-standardized amount, | ||||||
25 | the Department shall develop an adjustor to adjust the | ||||||
26 | rate of reimbursement for safety-net hospitals defined in |
| |||||||
| |||||||
1 | Section 5-5e.1 of this Code excluding pediatric hospitals. | ||||||
2 | (7) Beginning July 1, 2014, in addition to the | ||||||
3 | statewide-standardized amount, the Department shall | ||||||
4 | develop an adjustor to adjust the rate of reimbursement | ||||||
5 | for Illinois freestanding inpatient psychiatric hospitals | ||||||
6 | that are not designated as children's hospitals by the | ||||||
7 | Department but are primarily treating patients under the | ||||||
8 | age of 21. | ||||||
9 | (7.5) (Blank). | ||||||
10 | (8) Beginning July 1, 2018, in addition to the | ||||||
11 | statewide-standardized amount, the Department shall adjust | ||||||
12 | the rate of reimbursement for hospitals designated by the | ||||||
13 | Department of Public Health as a Perinatal Level II or II+ | ||||||
14 | center by applying the same adjustor that is applied to | ||||||
15 | Perinatal and Obstetrical care cases for Perinatal Level | ||||||
16 | III centers, as of December 31, 2017. | ||||||
17 | (9) Beginning July 1, 2018, in addition to the | ||||||
18 | statewide-standardized amount, the Department shall apply | ||||||
19 | the same adjustor that is applied to trauma cases as of | ||||||
20 | December 31, 2017 to inpatient claims to treat patients | ||||||
21 | with burns, including, but not limited to, APR-DRGs 841, | ||||||
22 | 842, 843, and 844. | ||||||
23 | (10) Beginning July 1, 2018, the | ||||||
24 | statewide-standardized amount for inpatient general acute | ||||||
25 | care services shall be uniformly increased so that base | ||||||
26 | claims projected reimbursement is increased by an amount |
| |||||||
| |||||||
1 | equal to the funds allocated in paragraph (1) of | ||||||
2 | subsection (b) of Section 5A-12.6, less the amount | ||||||
3 | allocated under paragraphs (8) and (9) of this subsection | ||||||
4 | and paragraphs (3) and (4) of subsection (b) multiplied by | ||||||
5 | 40%. | ||||||
6 | (11) Beginning July 1, 2018, the reimbursement for | ||||||
7 | inpatient rehabilitation services shall be increased by | ||||||
8 | the addition of a $96 per day add-on. | ||||||
9 | (b) Outpatient hospital services. Effective for dates of | ||||||
10 | service on and after July 1, 2014, reimbursement for | ||||||
11 | outpatient services shall utilize the Enhanced Ambulatory | ||||||
12 | Procedure Grouping (EAPG) software, version 3.7 distributed by | ||||||
13 | 3M TM Health Information System. | ||||||
14 | (1) The Department shall establish Medicaid weighting | ||||||
15 | factors to be used in the reimbursement system established | ||||||
16 | under this subsection. The initial weighting factors shall | ||||||
17 | be the weighting factors as published by 3M Health | ||||||
18 | Information System, associated with Version 3.7. | ||||||
19 | (2) The Department shall establish service specific | ||||||
20 | statewide-standardized amounts to be used in the | ||||||
21 | reimbursement system. | ||||||
22 | (A) The initial statewide standardized amounts, | ||||||
23 | with the labor portion adjusted by the Calendar Year | ||||||
24 | 2013 Medicare Outpatient Prospective Payment System | ||||||
25 | wage index with reclassifications, shall be published | ||||||
26 | by the Department on its website no later than 10 |
| |||||||
| |||||||
1 | calendar days prior to their effective date. | ||||||
2 | (B) The Department shall establish adjustments to | ||||||
3 | the statewide-standardized amounts for each Critical | ||||||
4 | Access Hospital, as designated by the Department of | ||||||
5 | Public Health in accordance with 42 CFR 485, Subpart | ||||||
6 | F. For outpatient services provided on or before June | ||||||
7 | 30, 2018, the EAPG standardized amounts are determined | ||||||
8 | separately for each critical access hospital such that | ||||||
9 | simulated EAPG payments using outpatient base period | ||||||
10 | paid claim data plus payments under Section 5A-12.4 of | ||||||
11 | this Code net of the associated tax costs are equal to | ||||||
12 | the estimated costs of outpatient base period claims | ||||||
13 | data with a rate year cost inflation factor applied. | ||||||
14 | (3) In addition to the statewide-standardized amounts, | ||||||
15 | the Department shall develop adjusters to adjust the rate | ||||||
16 | of reimbursement for critical Medicaid hospital outpatient | ||||||
17 | providers or services, including outpatient high volume or | ||||||
18 | safety-net hospitals. Beginning July 1, 2018, the | ||||||
19 | outpatient high volume adjustor shall be increased to | ||||||
20 | increase annual expenditures associated with this adjustor | ||||||
21 | by $79,200,000, based on the State Fiscal Year 2015 base | ||||||
22 | year data and this adjustor shall apply to public | ||||||
23 | hospitals, except for large public hospitals, as defined | ||||||
24 | under 89 Ill. Adm. Code 148.25(a). | ||||||
25 | (4) Beginning July 1, 2018, in addition to the | ||||||
26 | statewide standardized amounts, the Department shall make |
| |||||||
| |||||||
1 | an add-on payment for outpatient expensive devices and | ||||||
2 | drugs. This add-on payment shall at least apply to claim | ||||||
3 | lines that: (i) are assigned with one of the following | ||||||
4 | EAPGs: 490, 1001 to 1020, and coded with one of the | ||||||
5 | following revenue codes: 0274 to 0276, 0278; or (ii) are | ||||||
6 | assigned with one of the following EAPGs: 430 to 441, 443, | ||||||
7 | 444, 460 to 465, 495, 496, 1090. The add-on payment shall | ||||||
8 | be calculated as follows: the claim line's covered charges | ||||||
9 | multiplied by the hospital's total acute cost to charge | ||||||
10 | ratio, less the claim line's EAPG payment plus $1,000, | ||||||
11 | multiplied by 0.8. | ||||||
12 | (5) Beginning July 1, 2018, the statewide-standardized | ||||||
13 | amounts for outpatient services shall be increased by a | ||||||
14 | uniform percentage so that base claims projected | ||||||
15 | reimbursement is increased by an amount equal to no less | ||||||
16 | than the funds allocated in paragraph (1) of subsection | ||||||
17 | (b) of Section 5A-12.6, less the amount allocated under | ||||||
18 | paragraphs (8) and (9) of subsection (a) and paragraphs | ||||||
19 | (3) and (4) of this subsection multiplied by 46%. | ||||||
20 | (6) Effective for dates of service on or after July 1, | ||||||
21 | 2018, the Department shall establish adjustments to the | ||||||
22 | statewide-standardized amounts for each Critical Access | ||||||
23 | Hospital, as designated by the Department of Public Health | ||||||
24 | in accordance with 42 CFR 485, Subpart F, such that each | ||||||
25 | Critical Access Hospital's standardized amount for | ||||||
26 | outpatient services shall be increased by the applicable |
| |||||||
| |||||||
1 | uniform percentage determined pursuant to paragraph (5) of | ||||||
2 | this subsection. It is the intent of the General Assembly | ||||||
3 | that the adjustments required under this paragraph (6) by | ||||||
4 | Public Act 100-1181 shall be applied retroactively to | ||||||
5 | claims for dates of service provided on or after July 1, | ||||||
6 | 2018. | ||||||
7 | (7) Effective for dates of service on or after March | ||||||
8 | 8, 2019 (the effective date of Public Act 100-1181), the | ||||||
9 | Department shall recalculate and implement an updated | ||||||
10 | statewide-standardized amount for outpatient services | ||||||
11 | provided by hospitals that are not Critical Access | ||||||
12 | Hospitals to reflect the applicable uniform percentage | ||||||
13 | determined pursuant to paragraph (5). | ||||||
14 | (1) Any recalculation to the | ||||||
15 | statewide-standardized amounts for outpatient services | ||||||
16 | provided by hospitals that are not Critical Access | ||||||
17 | Hospitals shall be the amount necessary to achieve the | ||||||
18 | increase in the statewide-standardized amounts for | ||||||
19 | outpatient services increased by a uniform percentage, | ||||||
20 | so that base claims projected reimbursement is | ||||||
21 | increased by an amount equal to no less than the funds | ||||||
22 | allocated in paragraph (1) of subsection (b) of | ||||||
23 | Section 5A-12.6, less the amount allocated under | ||||||
24 | paragraphs (8) and (9) of subsection (a) and | ||||||
25 | paragraphs (3) and (4) of this subsection, for all | ||||||
26 | hospitals that are not Critical Access Hospitals, |
| |||||||
| |||||||
1 | multiplied by 46%. | ||||||
2 | (2) It is the intent of the General Assembly that | ||||||
3 | the recalculations required under this paragraph (7) | ||||||
4 | by Public Act 100-1181 shall be applied prospectively | ||||||
5 | to claims for dates of service provided on or after | ||||||
6 | March 8, 2019 (the effective date of Public Act | ||||||
7 | 100-1181) and that no recoupment or repayment by the | ||||||
8 | Department or an MCO of payments attributable to | ||||||
9 | recalculation under this paragraph (7), issued to the | ||||||
10 | hospital for dates of service on or after July 1, 2018 | ||||||
11 | and before March 8, 2019 (the effective date of Public | ||||||
12 | Act 100-1181), shall be permitted. | ||||||
13 | (8) The Department shall ensure that all necessary | ||||||
14 | adjustments to the managed care organization capitation | ||||||
15 | base rates necessitated by the adjustments under | ||||||
16 | subparagraph (6) or (7) of this subsection are completed | ||||||
17 | and applied retroactively in accordance with Section | ||||||
18 | 5-30.8 of this Code within 90 days of March 8, 2019 (the | ||||||
19 | effective date of Public Act 100-1181). | ||||||
20 | (9) Within 60 days after federal approval of the | ||||||
21 | change made to the assessment in Section 5A-2 by this | ||||||
22 | amendatory Act of the 101st General Assembly, the | ||||||
23 | Department shall incorporate into the EAPG system for | ||||||
24 | outpatient services those services performed by hospitals | ||||||
25 | currently billed through the Non-Institutional Provider | ||||||
26 | billing system. |
| |||||||
| |||||||
1 | (c) In consultation with the hospital community, the | ||||||
2 | Department is authorized to replace 89 Ill. Admin. Code | ||||||
3 | 152.150 as published in 38 Ill. Reg. 4980 through 4986 within | ||||||
4 | 12 months of June 16, 2014 (the effective date of Public Act | ||||||
5 | 98-651). If the Department does not replace these rules within | ||||||
6 | 12 months of June 16, 2014 (the effective date of Public Act | ||||||
7 | 98-651), the rules in effect for 152.150 as published in 38 | ||||||
8 | Ill. Reg. 4980 through 4986 shall remain in effect until | ||||||
9 | modified by rule by the Department. Nothing in this subsection | ||||||
10 | shall be construed to mandate that the Department file a | ||||||
11 | replacement rule. | ||||||
12 | (d) Transition period.
There shall be a transition period | ||||||
13 | to the reimbursement systems authorized under this Section | ||||||
14 | that shall begin on the effective date of these systems and | ||||||
15 | continue until June 30, 2018, unless extended by rule by the | ||||||
16 | Department. To help provide an orderly and predictable | ||||||
17 | transition to the new reimbursement systems and to preserve | ||||||
18 | and enhance access to the hospital services during this | ||||||
19 | transition, the Department shall allocate a transitional | ||||||
20 | hospital access pool of at least $290,000,000 annually so that | ||||||
21 | transitional hospital access payments are made to hospitals. | ||||||
22 | (1) After the transition period, the Department may | ||||||
23 | begin incorporating the transitional hospital access pool | ||||||
24 | into the base rate structure; however, the transitional | ||||||
25 | hospital access payments in effect on June 30, 2018 shall | ||||||
26 | continue to be paid, if continued under Section 5A-16. |
| |||||||
| |||||||
1 | (2) After the transition period, if the Department | ||||||
2 | reduces payments from the transitional hospital access | ||||||
3 | pool, it shall increase base rates, develop new adjustors, | ||||||
4 | adjust current adjustors, develop new hospital access | ||||||
5 | payments based on updated information, or any combination | ||||||
6 | thereof by an amount equal to the decreases proposed in | ||||||
7 | the transitional hospital access pool payments, ensuring | ||||||
8 | that the entire transitional hospital access pool amount | ||||||
9 | shall continue to be used for hospital payments. | ||||||
10 | (d-5) Hospital and health care transformation program. The | ||||||
11 | Department shall develop a hospital and health care | ||||||
12 | transformation program to provide financial assistance to | ||||||
13 | hospitals in transforming their services and care models to | ||||||
14 | better align with the needs of the communities they serve. The | ||||||
15 | payments authorized in this Section shall be subject to | ||||||
16 | approval by the federal government. | ||||||
17 | (1) Phase 1. In State fiscal years 2019 through 2020, | ||||||
18 | the Department shall allocate funds from the transitional | ||||||
19 | access hospital pool to create a hospital transformation | ||||||
20 | pool of at least $262,906,870 annually and make hospital | ||||||
21 | transformation payments to hospitals. Subject to Section | ||||||
22 | 5A-16, in State fiscal years 2019 and 2020, an Illinois | ||||||
23 | hospital that received either a transitional hospital | ||||||
24 | access payment under subsection (d) or a supplemental | ||||||
25 | payment under subsection (f) of this Section in State | ||||||
26 | fiscal year 2018, shall receive a hospital transformation |
| |||||||
| |||||||
1 | payment as follows: | ||||||
2 | (A) If the hospital's Rate Year 2017 Medicaid | ||||||
3 | inpatient utilization rate is equal to or greater than | ||||||
4 | 45%, the hospital transformation payment shall be | ||||||
5 | equal to 100% of the sum of its transitional hospital | ||||||
6 | access payment authorized under subsection (d) and any | ||||||
7 | supplemental payment authorized under subsection (f). | ||||||
8 | (B) If the hospital's Rate Year 2017 Medicaid | ||||||
9 | inpatient utilization rate is equal to or greater than | ||||||
10 | 25% but less than 45%, the hospital transformation | ||||||
11 | payment shall be equal to 75% of the sum of its | ||||||
12 | transitional hospital access payment authorized under | ||||||
13 | subsection (d) and any supplemental payment authorized | ||||||
14 | under subsection (f). | ||||||
15 | (C) If the hospital's Rate Year 2017 Medicaid | ||||||
16 | inpatient utilization rate is less than 25%, the | ||||||
17 | hospital transformation payment shall be equal to 50% | ||||||
18 | of the sum of its transitional hospital access payment | ||||||
19 | authorized under subsection (d) and any supplemental | ||||||
20 | payment authorized under subsection (f). | ||||||
21 | (2) Phase 2. | ||||||
22 | (A) The funding amount from phase one shall be | ||||||
23 | incorporated into directed payment and pass-through | ||||||
24 | payment methodologies described in Section 5A-12.7. | ||||||
25 | (B) Because there are communities in Illinois that | ||||||
26 | experience significant health care disparities due to |
| |||||||
| |||||||
1 | systemic racism, as recently emphasized by the | ||||||
2 | COVID-19 pandemic, aggravated by social determinants | ||||||
3 | of health and a lack of sufficiently allocated | ||||||
4 | healthcare resources, particularly community-based | ||||||
5 | services, preventive care, obstetric care, chronic | ||||||
6 | disease management, and specialty care, the Department | ||||||
7 | shall establish a health care transformation program | ||||||
8 | that shall be supported by the transformation funding | ||||||
9 | pool. It is the intention of the General Assembly that | ||||||
10 | innovative partnerships funded by the pool must be | ||||||
11 | designed to establish or improve integrated health | ||||||
12 | care delivery systems that will provide significant | ||||||
13 | access to the Medicaid and uninsured populations in | ||||||
14 | their communities, as well as improve health care | ||||||
15 | equity. It is also the intention of the General | ||||||
16 | Assembly that partnerships recognize and address the | ||||||
17 | disparities revealed by the COVID-19 pandemic, as well | ||||||
18 | as the need for post-COVID care. During State fiscal | ||||||
19 | years 2021 through 2027, the hospital and health care | ||||||
20 | transformation program shall be supported by an annual | ||||||
21 | transformation funding pool of up to $150,000,000, | ||||||
22 | pending federal matching funds, to be allocated during | ||||||
23 | the specified fiscal years for the purpose of | ||||||
24 | facilitating hospital and health care transformation. | ||||||
25 | No disbursement of moneys for transformation projects | ||||||
26 | from the transformation funding pool described under |
| |||||||
| |||||||
1 | this Section shall be considered an award, a grant, or | ||||||
2 | an expenditure of grant funds. Funding agreements made | ||||||
3 | in accordance with the transformation program shall be | ||||||
4 | considered purchases of care under the Illinois | ||||||
5 | Procurement Code, and funds shall be expended by the | ||||||
6 | Department in a manner that maximizes federal funding | ||||||
7 | to expend the entire allocated amount. | ||||||
8 | The Department shall convene, within 30 days after | ||||||
9 | the effective date of this amendatory Act of the 101st | ||||||
10 | General Assembly, a workgroup that includes subject | ||||||
11 | matter experts on healthcare disparities and | ||||||
12 | stakeholders from distressed communities, which could | ||||||
13 | be a subcommittee of the Medicaid Advisory Committee, | ||||||
14 | to review and provide recommendations on how | ||||||
15 | Department policy, including health care | ||||||
16 | transformation, can improve health disparities and the | ||||||
17 | impact on communities disproportionately affected by | ||||||
18 | COVID-19. The workgroup shall consider and make | ||||||
19 | recommendations on the following issues: a community | ||||||
20 | safety-net designation of certain hospitals, racial | ||||||
21 | equity, and a regional partnership to bring additional | ||||||
22 | specialty services to communities. | ||||||
23 | (C) As provided in paragraph (9) of Section 3 of | ||||||
24 | the Illinois Health Facilities Planning Act, any | ||||||
25 | hospital participating in the transformation program | ||||||
26 | may be excluded from the requirements of the Illinois |
| |||||||
| |||||||
1 | Health Facilities Planning Act for those projects | ||||||
2 | related to the hospital's transformation. To be | ||||||
3 | eligible, the hospital must submit to the Health | ||||||
4 | Facilities and Services Review Board approval from the | ||||||
5 | Department that the project is a part of the | ||||||
6 | hospital's transformation. | ||||||
7 | (D) As provided in subsection (a-20) of Section | ||||||
8 | 32.5 of the Emergency Medical Services (EMS) Systems | ||||||
9 | Act, a hospital that received hospital transformation | ||||||
10 | payments under this Section may convert to a | ||||||
11 | freestanding emergency center. To be eligible for such | ||||||
12 | a conversion, the hospital must submit to the | ||||||
13 | Department of Public Health approval from the | ||||||
14 | Department that the project is a part of the | ||||||
15 | hospital's transformation. | ||||||
16 | (E) Criteria for proposals. To be eligible for | ||||||
17 | funding under this Section, a transformation proposal | ||||||
18 | shall meet all of the following criteria: | ||||||
19 | (i) the proposal shall be designed based on | ||||||
20 | community needs assessment completed by either a | ||||||
21 | University partner or other qualified entity with | ||||||
22 | significant community input; | ||||||
23 | (ii) the proposal shall be a collaboration | ||||||
24 | among providers across the care and community | ||||||
25 | spectrum, including preventative care, primary | ||||||
26 | care specialty care, hospital services, mental |
| |||||||
| |||||||
1 | health and substance abuse services, as well as | ||||||
2 | community-based entities that address the social | ||||||
3 | determinants of health; | ||||||
4 | (iii) the proposal shall be specifically | ||||||
5 | designed to improve healthcare outcomes and reduce | ||||||
6 | healthcare disparities, and improve the | ||||||
7 | coordination, effectiveness, and efficiency of | ||||||
8 | care delivery; | ||||||
9 | (iv) the proposal shall have specific | ||||||
10 | measurable metrics related to disparities that | ||||||
11 | will be tracked by the Department and made public | ||||||
12 | by the Department; | ||||||
13 | (v) the proposal shall include a commitment to | ||||||
14 | include Business Enterprise Program certified | ||||||
15 | vendors or other entities controlled and managed | ||||||
16 | by minorities or women; and | ||||||
17 | (vi) the proposal shall specifically increase | ||||||
18 | access to primary, preventive, or specialty care. | ||||||
19 | (F) Entities eligible to be funded. | ||||||
20 | (i) Proposals for funding should come from | ||||||
21 | collaborations operating in one of the most | ||||||
22 | distressed communities in Illinois as determined | ||||||
23 | by the U.S. Centers for Disease Control and | ||||||
24 | Prevention's Social Vulnerability Index for | ||||||
25 | Illinois and areas disproportionately impacted by | ||||||
26 | COVID-19 or from rural areas of Illinois. |
| |||||||
| |||||||
1 | (ii) The Department shall prioritize | ||||||
2 | partnerships from distressed communities, which | ||||||
3 | include Business Enterprise Program certified | ||||||
4 | vendors or other entities controlled and managed | ||||||
5 | by minorities or women and also include one or | ||||||
6 | more of the following: safety-net hospitals, | ||||||
7 | critical access hospitals, the campuses of | ||||||
8 | hospitals that have closed since January 1, 2018, | ||||||
9 | or other healthcare providers designed to address | ||||||
10 | specific healthcare disparities, including the | ||||||
11 | impact of COVID-19 on individuals and the | ||||||
12 | community and the need for post-COVID care. All | ||||||
13 | funded proposals must include specific measurable | ||||||
14 | goals and metrics related to improved outcomes and | ||||||
15 | reduced disparities which shall be tracked by the | ||||||
16 | Department. | ||||||
17 | (iii) The Department should target the funding | ||||||
18 | in the following ways: $30,000,000 of | ||||||
19 | transformation funds to projects that are a | ||||||
20 | collaboration between a safety-net hospital, | ||||||
21 | particularly community safety-net hospitals, and | ||||||
22 | other providers and designed to address specific | ||||||
23 | healthcare disparities, $20,000,000 of | ||||||
24 | transformation funds to collaborations between | ||||||
25 | safety-net hospitals and a larger hospital partner | ||||||
26 | that increases specialty care in distressed |
| |||||||
| |||||||
1 | communities, $30,000,000 of transformation funds | ||||||
2 | to projects that are a collaboration between | ||||||
3 | hospitals and other providers in distressed areas | ||||||
4 | of the State designed to address specific | ||||||
5 | healthcare disparities, $15,000,000 to | ||||||
6 | collaborations between critical access hospitals | ||||||
7 | and other providers designed to address specific | ||||||
8 | healthcare disparities, and $15,000,000 to | ||||||
9 | cross-provider collaborations designed to address | ||||||
10 | specific healthcare disparities, and $5,000,000 to | ||||||
11 | collaborations that focus on workforce | ||||||
12 | development. | ||||||
13 | (iv) The Department may allocate up to | ||||||
14 | $5,000,000 for planning, racial equity analysis, | ||||||
15 | or consulting resources for the Department or | ||||||
16 | entities without the resources to develop a plan | ||||||
17 | to meet the criteria of this Section. Any contract | ||||||
18 | for consulting services issued by the Department | ||||||
19 | under this subparagraph shall comply with the | ||||||
20 | provisions of Section 5-45 of the State Officials | ||||||
21 | and Employees Ethics Act. Based on availability of | ||||||
22 | federal funding, the Department may directly | ||||||
23 | procure consulting services or provide funding to | ||||||
24 | the collaboration. The provision of resources | ||||||
25 | under this subparagraph is not a guarantee that a | ||||||
26 | project will be approved. |
| |||||||
| |||||||
1 | (v) The Department shall take steps to ensure | ||||||
2 | that safety-net hospitals operating in | ||||||
3 | under-resourced communities receive priority | ||||||
4 | access to hospital and healthcare transformation | ||||||
5 | funds, including consulting funds, as provided | ||||||
6 | under this Section. | ||||||
7 | (G) Process for submitting and approving projects | ||||||
8 | for distressed communities. The Department shall issue | ||||||
9 | a template for application. The Department shall post | ||||||
10 | any proposal received on the Department's website for | ||||||
11 | at least 2 weeks for public comment, and any such | ||||||
12 | public comment shall also be considered in the review | ||||||
13 | process. Applicants may request that proprietary | ||||||
14 | financial information be redacted from publicly posted | ||||||
15 | proposals and the Department in its discretion may | ||||||
16 | agree. Proposals for each distressed community must | ||||||
17 | include all of the following: | ||||||
18 | (i) A detailed description of how the project | ||||||
19 | intends to affect the goals outlined in this | ||||||
20 | subsection, describing new interventions, new | ||||||
21 | technology, new structures, and other changes to | ||||||
22 | the healthcare delivery system planned. | ||||||
23 | (ii) A detailed description of the racial and | ||||||
24 | ethnic makeup of the entities' board and | ||||||
25 | leadership positions and the salaries of the | ||||||
26 | executive staff of entities in the partnership |
| |||||||
| |||||||
1 | that is seeking to obtain funding under this | ||||||
2 | Section. | ||||||
3 | (iii) A complete budget, including an overall | ||||||
4 | timeline and a detailed pathway to sustainability | ||||||
5 | within a 5-year period, specifying other sources | ||||||
6 | of funding, such as in-kind, cost-sharing, or | ||||||
7 | private donations, particularly for capital needs. | ||||||
8 | There is an expectation that parties to the | ||||||
9 | transformation project dedicate resources to the | ||||||
10 | extent they are able and that these expectations | ||||||
11 | are delineated separately for each entity in the | ||||||
12 | proposal. | ||||||
13 | (iv) A description of any new entities formed | ||||||
14 | or other legal relationships between collaborating | ||||||
15 | entities and how funds will be allocated among | ||||||
16 | participants. | ||||||
17 | (v) A timeline showing the evolution of sites | ||||||
18 | and specific services of the project over a 5-year | ||||||
19 | period, including services available to the | ||||||
20 | community by site. | ||||||
21 | (vi) Clear milestones indicating progress | ||||||
22 | toward the proposed goals of the proposal as | ||||||
23 | checkpoints along the way to continue receiving | ||||||
24 | funding. The Department is authorized to refine | ||||||
25 | these milestones in agreements, and is authorized | ||||||
26 | to impose reasonable penalties, including |
| |||||||
| |||||||
1 | repayment of funds, for substantial lack of | ||||||
2 | progress. | ||||||
3 | (vii) A clear statement of the level of | ||||||
4 | commitment the project will include for minorities | ||||||
5 | and women in contracting opportunities, including | ||||||
6 | as equity partners where applicable, or as | ||||||
7 | subcontractors and suppliers in all phases of the | ||||||
8 | project. | ||||||
9 | (viii) If the community study utilized is not | ||||||
10 | the study commissioned and published by the | ||||||
11 | Department, the applicant must define the | ||||||
12 | methodology used, including documentation of clear | ||||||
13 | community participation. | ||||||
14 | (ix) A description of the process used in | ||||||
15 | collaborating with all levels of government in the | ||||||
16 | community served in the development of the | ||||||
17 | project, including, but not limited to, | ||||||
18 | legislators and officials of other units of local | ||||||
19 | government. | ||||||
20 | (x) Documentation of a community input process | ||||||
21 | in the community served, including links to | ||||||
22 | proposal materials on public websites. | ||||||
23 | (xi) Verifiable project milestones and quality | ||||||
24 | metrics that will be impacted by transformation. | ||||||
25 | These project milestones and quality metrics must | ||||||
26 | be identified with improvement targets that must |
| |||||||
| |||||||
1 | be met. | ||||||
2 | (xii) Data on the number of existing employees | ||||||
3 | by various job categories and wage levels by the | ||||||
4 | zip code of the employees' residence and | ||||||
5 | benchmarks for the continued maintenance and | ||||||
6 | improvement of these levels. The proposal must | ||||||
7 | also describe any retraining or other workforce | ||||||
8 | development planned for the new project. | ||||||
9 | (xiii) If a new entity is created by the | ||||||
10 | project, a description of how the board will be | ||||||
11 | reflective of the community served by the | ||||||
12 | proposal. | ||||||
13 | (xiv) An explanation of how the proposal will | ||||||
14 | address the existing disparities that exacerbated | ||||||
15 | the impact of COVID-19 and the need for post-COVID | ||||||
16 | care in the community, if applicable. | ||||||
17 | (xv) An explanation of how the proposal is | ||||||
18 | designed to increase access to care, including | ||||||
19 | specialty care based upon the community's needs. | ||||||
20 | (H) The Department shall evaluate proposals for | ||||||
21 | compliance with the criteria listed under subparagraph | ||||||
22 | (G). Proposals meeting all of the criteria may be | ||||||
23 | eligible for funding with the areas of focus | ||||||
24 | prioritized as described in item (ii) of subparagraph | ||||||
25 | (F). Based on the funds available, the Department may | ||||||
26 | negotiate funding agreements with approved applicants |
| |||||||
| |||||||
1 | to maximize federal funding. Nothing in this | ||||||
2 | subsection requires that an approved project be funded | ||||||
3 | to the level requested. Agreements shall specify the | ||||||
4 | amount of funding anticipated annually, the | ||||||
5 | methodology of payments, the limit on the number of | ||||||
6 | years such funding may be provided, and the milestones | ||||||
7 | and quality metrics that must be met by the projects in | ||||||
8 | order to continue to receive funding during each year | ||||||
9 | of the program. Agreements shall specify the terms and | ||||||
10 | conditions under which a health care facility that | ||||||
11 | receives funds under a purchase of care agreement and | ||||||
12 | closes in violation of the terms of the agreement must | ||||||
13 | pay an early closure fee no greater than 50% of the | ||||||
14 | funds it received under the agreement, prior to the | ||||||
15 | Health Facilities and Services Review Board | ||||||
16 | considering an application for closure of the | ||||||
17 | facility. Any project that is funded shall be required | ||||||
18 | to provide quarterly written progress reports, in a | ||||||
19 | form prescribed by the Department, and at a minimum | ||||||
20 | shall include the progress made in achieving any | ||||||
21 | milestones or metrics or Business Enterprise Program | ||||||
22 | commitments in its plan. The Department may reduce or | ||||||
23 | end payments, as set forth in transformation plans, if | ||||||
24 | milestones or metrics or Business Enterprise Program | ||||||
25 | commitments are not achieved. The Department shall | ||||||
26 | seek to make payments from the transformation fund in |
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1 | a manner that is eligible for federal matching funds. | ||||||
2 | In reviewing the proposals, the Department shall | ||||||
3 | take into account the needs of the community, data | ||||||
4 | from the study commissioned by the Department from the | ||||||
5 | University of Illinois-Chicago if applicable, feedback | ||||||
6 | from public comment on the Department's website, as | ||||||
7 | well as how the proposal meets the criteria listed | ||||||
8 | under subparagraph (G). Alignment with the | ||||||
9 | Department's overall strategic initiatives shall be an | ||||||
10 | important factor. To the extent that fiscal year | ||||||
11 | funding is not adequate to fund all eligible projects | ||||||
12 | that apply, the Department shall prioritize | ||||||
13 | applications that most comprehensively and effectively | ||||||
14 | address the criteria listed under subparagraph (G). | ||||||
15 | (3) (Blank). | ||||||
16 | (4) Hospital Transformation Review Committee. There is | ||||||
17 | created the Hospital Transformation Review Committee. The | ||||||
18 | Committee shall consist of 14 members. No later than 30 | ||||||
19 | days after March 12, 2018 (the effective date of Public | ||||||
20 | Act 100-581), the 4 legislative leaders shall each appoint | ||||||
21 | 3 members; the Governor shall appoint the Director of | ||||||
22 | Healthcare and Family Services, or his or her designee, as | ||||||
23 | a member; and the Director of Healthcare and Family | ||||||
24 | Services shall appoint one member. Any vacancy shall be | ||||||
25 | filled by the applicable appointing authority within 15 | ||||||
26 | calendar days. The members of the Committee shall select a |
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1 | Chair and a Vice-Chair from among its members, provided | ||||||
2 | that the Chair and Vice-Chair cannot be appointed by the | ||||||
3 | same appointing authority and must be from different | ||||||
4 | political parties. The Chair shall have the authority to | ||||||
5 | establish a meeting schedule and convene meetings of the | ||||||
6 | Committee, and the Vice-Chair shall have the authority to | ||||||
7 | convene meetings in the absence of the Chair. The | ||||||
8 | Committee may establish its own rules with respect to | ||||||
9 | meeting schedule, notice of meetings, and the disclosure | ||||||
10 | of documents; however, the Committee shall not have the | ||||||
11 | power to subpoena individuals or documents and any rules | ||||||
12 | must be approved by 9 of the 14 members. The Committee | ||||||
13 | shall perform the functions described in this Section and | ||||||
14 | advise and consult with the Director in the administration | ||||||
15 | of this Section. In addition to reviewing and approving | ||||||
16 | the policies, procedures, and rules for the hospital and | ||||||
17 | health care transformation program, the Committee shall | ||||||
18 | consider and make recommendations related to qualifying | ||||||
19 | criteria and payment methodologies related to safety-net | ||||||
20 | hospitals and children's hospitals. Members of the | ||||||
21 | Committee appointed by the legislative leaders shall be | ||||||
22 | subject to the jurisdiction of the Legislative Ethics | ||||||
23 | Commission, not the Executive Ethics Commission, and all | ||||||
24 | requests under the Freedom of Information Act shall be | ||||||
25 | directed to the applicable Freedom of Information officer | ||||||
26 | for the General Assembly. The Department shall provide |
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1 | operational support to the Committee as necessary. The | ||||||
2 | Committee is dissolved on April 1, 2019. | ||||||
3 | (e) Beginning 36 months after initial implementation, the | ||||||
4 | Department shall update the reimbursement components in | ||||||
5 | subsections (a) and (b), including standardized amounts and | ||||||
6 | weighting factors, and at least once every 4 years triennially | ||||||
7 | and no more frequently than annually thereafter. The | ||||||
8 | Department shall publish these updates on its website no later | ||||||
9 | than 30 calendar days prior to their effective date. | ||||||
10 | (f) Continuation of supplemental payments. Any | ||||||
11 | supplemental payments authorized under Illinois Administrative | ||||||
12 | Code 148 effective January 1, 2014 and that continue during | ||||||
13 | the period of July 1, 2014 through December 31, 2014 shall | ||||||
14 | remain in effect as long as the assessment imposed by Section | ||||||
15 | 5A-2 that is in effect on December 31, 2017 remains in effect. | ||||||
16 | (g) Notwithstanding subsections (a) through (f) of this | ||||||
17 | Section and notwithstanding the changes authorized under | ||||||
18 | Section 5-5b.1, any updates to the system shall not result in | ||||||
19 | any diminishment of the overall effective rates of | ||||||
20 | reimbursement as of the implementation date of the new system | ||||||
21 | (July 1, 2014). These updates shall not preclude variations in | ||||||
22 | any individual component of the system or hospital rate | ||||||
23 | variations. Nothing in this Section shall prohibit the | ||||||
24 | Department from increasing the rates of reimbursement or | ||||||
25 | developing payments to ensure access to hospital services. | ||||||
26 | Nothing in this Section shall be construed to guarantee a |
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1 | minimum amount of spending in the aggregate or per hospital as | ||||||
2 | spending may be impacted by factors, including, but not | ||||||
3 | limited to, the number of individuals in the medical | ||||||
4 | assistance program and the severity of illness of the | ||||||
5 | individuals. | ||||||
6 | (h) The Department shall have the authority to modify by | ||||||
7 | rulemaking any changes to the rates or methodologies in this | ||||||
8 | Section as required by the federal government to obtain | ||||||
9 | federal financial participation for expenditures made under | ||||||
10 | this Section. | ||||||
11 | (i) Except for subsections (g) and (h) of this Section, | ||||||
12 | the Department shall, pursuant to subsection (c) of Section | ||||||
13 | 5-40 of the Illinois Administrative Procedure Act, provide for | ||||||
14 | presentation at the June 2014 hearing of the Joint Committee | ||||||
15 | on Administrative Rules (JCAR) additional written notice to | ||||||
16 | JCAR of the following rules in order to commence the second | ||||||
17 | notice period for the following rules: rules published in the | ||||||
18 | Illinois Register, rule dated February 21, 2014 at 38 Ill. | ||||||
19 | Reg. 4559 (Medical Payment), 4628 (Specialized Health Care | ||||||
20 | Delivery Systems), 4640 (Hospital Services), 4932 (Diagnostic | ||||||
21 | Related Grouping (DRG) Prospective Payment System (PPS)), and | ||||||
22 | 4977 (Hospital Reimbursement Changes), and published in the | ||||||
23 | Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499 | ||||||
24 | (Specialized Health Care Delivery Systems) and 6505 (Hospital | ||||||
25 | Services).
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26 | (j) Out-of-state hospitals. Beginning July 1, 2018, for |
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1 | purposes of determining for State fiscal years 2019 and 2020 | ||||||
2 | and subsequent fiscal years the hospitals eligible for the | ||||||
3 | payments authorized under subsections (a) and (b) of this | ||||||
4 | Section, the Department shall include out-of-state hospitals | ||||||
5 | that are designated a Level I pediatric trauma center or a | ||||||
6 | Level I trauma center by the Department of Public Health as of | ||||||
7 | December 1, 2017. | ||||||
8 | (k) The Department shall notify each hospital and managed | ||||||
9 | care organization, in writing, of the impact of the updates | ||||||
10 | under this Section at least 30 calendar days prior to their | ||||||
11 | effective date. | ||||||
12 | (Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19; | ||||||
13 | 101-81, eff. 7-12-19; 101-650, eff. 7-7-20; 101-655, eff. | ||||||
14 | 3-12-21.)
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15 | Section 99. Effective date. This Act takes effect upon | ||||||
16 | becoming law.
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