Bill Text: IL SB1846 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning the tiered exceptional care per diem rates for medically complex for the developmentally disabled facilities, provides that on and after January 1, 2024, each tier rate shall be increased 6% over the amount in effect December 31, 2023. Provides that any reimbursement increases applied to the base rate to providers licensed under the ID/DD Community Care Act must also be applied in an equivalent manner to each tier of exceptional care per diem rates for medically complex for the developmentally disabled facilities. Effective immediately.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2023-03-10 - Rule 3-9(a) / Re-referred to Assignments [SB1846 Detail]

Download: Illinois-2023-SB1846-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1846 Introduced 2/9/2023, by Sen. Elgie R. Sims, Jr. SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5.4h
Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning the tiered exceptional care per diem rates for medically complex for the developmentally disabled facilities, provides that on and after January 1, 2024, each tier rate shall be increased 6% over the amount in effect December 31, 2023. Provides that any reimbursement increases applied to the base rate to providers licensed under the ID/DD Community Care Act must also be applied in an equivalent manner to each tier of exceptional care per diem rates for medically complex for the developmentally disabled facilities. Effective immediately.
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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 Section 5-5.4h as follows:
(305 ILCS 5/5-5.4h)
Sec. 5-5.4h. Medicaid reimbursement for medically complex
for the developmentally disabled facilities licensed under the
MC/DD Act.
(a) Facilities licensed as medically complex for the
developmentally disabled facilities that serve severely and
chronically ill patients shall have a specific reimbursement
system designed to recognize the characteristics and needs of
the patients they serve.
(b) For dates of services starting July 1, 2013 and until a
new reimbursement system is designed, medically complex for
the developmentally disabled facilities that meet the
following criteria:
(1) serve exceptional care patients; and
(2) have 30% or more of their patients receiving
ventilator care;
shall receive Medicaid reimbursement on a 30-day expedited
schedule.

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(c) Subject to federal approval of changes to the Title
XIX State Plan, for dates of services starting July 1, 2014
through March 31, 2019, medically complex for the
developmentally disabled facilities which meet the criteria in
subsection (b) of this Section shall receive a per diem rate
for clinically complex residents of $304. Clinically complex
residents on a ventilator shall receive a per diem rate of
$669. Subject to federal approval of changes to the Title XIX
State Plan, for dates of services starting April 1, 2019,
medically complex for the developmentally disabled facilities
must be reimbursed an exceptional care per diem rate, instead
of the base rate, for services to residents with complex or
extensive medical needs. Exceptional care per diem rates must
be paid for the conditions or services specified under
subsection (f) at the following per diem rates: Tier 1 $326,
Tier 2 $546, and Tier 3 $735. On and after January 1, 2024,
each tier rate shall be increased 6% over the amount in effect
December 31, 2023. Any reimbursement increases applied to the
base rate to providers licensed under the ID/DD Community Care
Act must also be applied in an equivalent manner to each tier
of exceptional care per diem rates for medically complex for
the developmentally disabled facilities.
(d) For residents on a ventilator pursuant to subsection
(c) or subsection (f), facilities shall have a policy
documenting their method of routine assessment of a resident's
weaning potential with interventions implemented noted in the

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resident's medical record.
(e) For services provided prior to April 1, 2019 and for
the purposes of this Section, a resident is considered
clinically complex if the resident requires at least one of
the following medical services:
(1) Tracheostomy care with dependence on mechanical
ventilation for a minimum of 6 hours each day.
(2) Tracheostomy care requiring suctioning at least
every 6 hours, room air mist or oxygen as needed, and
dependence on one of the treatment procedures listed under
paragraph (4) excluding the procedure listed in
subparagraph (A) of paragraph (4).
(3) Total parenteral nutrition or other intravenous
nutritional support and one of the treatment procedures
listed under paragraph (4).
(4) The following treatment procedures apply to the
conditions in paragraphs (2) and (3) of this subsection:
(A) Intermittent suctioning at least every 8 hours
and room air mist or oxygen as needed.
(B) Continuous intravenous therapy including
administration of therapeutic agents necessary for
hydration or of intravenous pharmaceuticals; or
intravenous pharmaceutical administration of more than
one agent via a peripheral or central line, without
continuous infusion.
(C) Peritoneal dialysis treatments requiring at

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least 4 exchanges every 24 hours.
(D) Tube feeding via nasogastric or gastrostomy
tube.
(E) Other medical technologies required
continuously, which in the opinion of the attending
physician require the services of a professional
nurse.
(f) Complex or extensive medical needs for exceptional
care reimbursement. The conditions and services used for the
purposes of this Section have the same meanings as ascribed to
those conditions and services under the Minimum Data Set (MDS)
Resident Assessment Instrument (RAI) and specified in the most
recent manual. Instead of submitting minimum data set
assessments to the Department, medically complex for the
developmentally disabled facilities must document within each
resident's medical record the conditions or services using the
minimum data set documentation standards and requirements to
qualify for exceptional care reimbursement.
(1) Tier 1 reimbursement is for residents who are
receiving at least 51% of their caloric intake via a
feeding tube.
(2) Tier 2 reimbursement is for residents who are
receiving tracheostomy care without a ventilator.
(3) Tier 3 reimbursement is for residents who are
receiving tracheostomy care and ventilator care.
(g) For dates of services starting April 1, 2019,

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reimbursement calculations and direct payment for services
provided by medically complex for the developmentally disabled
facilities are the responsibility of the Department of
Healthcare and Family Services instead of the Department of
Human Services. Appropriations for medically complex for the
developmentally disabled facilities must be shifted from the
Department of Human Services to the Department of Healthcare
and Family Services. Nothing in this Section prohibits the
Department of Healthcare and Family Services from paying more
than the rates specified in this Section. The rates in this
Section must be interpreted as a minimum amount. Any
reimbursement increases applied to providers licensed under
the ID/DD Community Care Act must also be applied in an
equivalent manner to medically complex for the developmentally
disabled facilities.
(h) The Department of Healthcare and Family Services shall
pay the rates in effect on March 31, 2019 until the changes
made to this Section by this amendatory Act of the 100th
General Assembly have been approved by the Centers for
Medicare and Medicaid Services of the U.S. Department of
Health and Human Services.
(i) The Department of Healthcare and Family Services may
adopt rules as allowed by the Illinois Administrative
Procedure Act to implement this Section; however, the
requirements of this Section must be implemented by the
Department of Healthcare and Family Services even if the

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Department of Healthcare and Family Services has not adopted
rules by the implementation date of April 1, 2019.
(Source: P.A. 100-646, eff. 7-27-18.)
Section 99. Effective date. This Act takes effect upon
becoming law.