Bill Text: IL SB2890 | 2015-2016 | 99th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. Provides that certain Medicaid Facilitation and Utilization payments authorized under the Illinois Administrative Code and initially paid out in State fiscal year 2015 shall remain in effect as long as the annual assessment on inpatient services imposed under the Illinois Public Aid Code is in effect. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2016-07-31 - Pursuant to Senate Rule 3-9(b) / Referred to Assignments [SB2890 Detail]

Download: Illinois-2015-SB2890-Introduced.html

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99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 SB2890 Introduced 2/18/2016, by Sen. Pat McGuire SYNOPSIS AS INTRODUCED:
305 ILCS 5/14-11
Amends the Illinois Public Aid Code. Provides that certain Medicaid Facilitation and Utilization payments authorized under the Illinois Administrative Code and initially paid out in State fiscal year 2015 shall remain in effect as long as the annual assessment on inpatient services imposed under the Illinois Public Aid Code is in effect. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
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 14-11 as follows:
(305 ILCS 5/14-11)
Sec. 14-11. Hospital payment reform.
(a) The Department may, by rule, implement the All Patient
Refined Diagnosis Related Groups (APR-DRG) payment system for
inpatient services provided on or after July 1, 2013, in a
manner consistent with the actions authorized in this Section.
(b) On or before October 1, 2012 and through June 30, 2013,
the Department shall begin testing the APR-DRG system. During
the testing period the Department shall process and price
inpatient services using the APR-DRG system; however, actual
payments for those inpatient services shall be made using the
current reimbursement system. During the testing period, the
Department, in collaboration with the statewide representative
of hospitals, shall provide information and technical
assistance to hospitals to encourage and facilitate their
transition to the APR-DRG system.
(c) The Department may, by rule, implement the Enhanced
Ambulatory Procedure Grouping (EAPG) system for outpatient

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services provided on or after January 1, 2014, in a manner
consistent with the actions authorized in this Section. On or
before January 1, 2013 and through December 31, 2013, the
Department shall begin testing the EAPG system. During the
testing period the Department shall process and price
outpatient services using the EAPG system; however, actual
payments for those outpatient services shall be made using the
current reimbursement system. During the testing period, the
Department, in collaboration with the statewide representative
of hospitals, shall provide information and technical
assistance to hospitals to encourage and facilitate their
transition to the EAPG system.
(d) The Department in consultation with the current
hospital technical advisory group shall review the test claims
for inpatient and outpatient services at least monthly,
including the estimated impact on hospitals, and, in developing
the rules, policies, and procedures to implement the new
payment systems, shall consider at least the following issues:
(1) The use of national relative weights provided by
the vendor of the APR-DRG system, adjusted to reflect
characteristics of the Illinois Medical Assistance
population.
(2) An updated outlier payment methodology based on
current data and consistent with the APR-DRG system.
(3) The use of policy adjusters to enhance payments to
hospitals treating a high percentage of individuals

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covered by the Medical Assistance program and uninsured
patients.
(4) Reimbursement for inpatient specialty services
such as psychiatric, rehabilitation, and long-term acute
care using updated per diem rates that account for service
acuity.
(5) The creation of one or more transition funding
pools to preserve access to care and to ensure financial
stability as hospitals transition to the new payment
system.
(6) Whether, beginning July 1, 2014, some of the static
adjustment payments financed by General Revenue funds
should be used as part of the base payment system,
including as policy adjusters to recognize the additional
costs of certain services, such as pediatric or neonatal,
or providers, such as trauma centers, Critical Access
Hospitals, or high Medicaid hospitals, or for services to
uninsured patients.
(e) The Department shall provide the association
representing the majority of hospitals in Illinois, as the
statewide representative of the hospital community, with a
monthly file of claims adjudicated under the test system for
the purpose of review and analysis as part of the collaboration
between the State and the hospital community. The file shall
consist of a de-identified extract compliant with the Health
Insurance Portability and Accountability Act (HIPAA).

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(f) The current hospital technical advisory group shall
make recommendations for changes during the testing period and
recommendations for changes prior to the effective dates of the
new payment systems. The Department shall draft administrative
rules to implement the new payment systems and provide them to
the technical advisory group at least 90 days prior to the
proposed effective dates of the new payment systems.
(g) The payments to hospitals financed by the current
hospital assessment, authorized under Article V-A of this Code,
are scheduled to sunset on June 30, 2014. The continuation of
or revisions to the hospital assessment program shall take into
consideration the impact on hospitals and access to care as a
result of the changes to the hospital payment system.
(h) Beginning July 1, 2014, the Department may transition
current General Revenue funded supplemental payments into the
claims based system over a period of no less than 2 years from
the implementation date of the new payment systems and no more
than 4 years from the implementation date of the new payment
systems, provided however that the Department may adopt, by
rule, supplemental payments to help ensure access to care in a
geographic area or to help ensure access to specialty services.
For any supplemental payments that are adopted that are based
on historic data, the data shall be no older than 3 years and
the supplemental payment shall be effective for no longer than
2 years before requiring the data to be updated.
(i) Any payments authorized under 89 Illinois

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Administrative Code 148 set to expire in State fiscal year 2012
and that were paid out to hospitals in State fiscal year 2012
and any payments authorized under 89 Illinois Administrative
Code 148.299(b)(1)(A) and initially paid out in State fiscal
year 2015 shall remain in effect as long as the assessment
imposed by Section 5A-2 is in effect.
(j) Subsections (a) and (c) of this Section shall remain
operative unless the Auditor General has reported that: (i) the
Department has not undertaken the required actions listed in
the report required by subsection (a) of Section 2-20 of the
Illinois State Auditing Act; or (ii) the Department has failed
to comply with the reporting requirements of Section 2-20 of
the Illinois State Auditing Act.
(k) Subsections (a) and (c) of this Section shall not be
operative until final federal approval by the Centers for
Medicare and Medicaid Services of the U.S. Department of Health
and Human Services and implementation of all of the payments
and assessments in Article V-A in its form as of the effective
date of this amendatory Act of the 97th General Assembly or as
it may be amended.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 99. Effective date. This Act takes effect upon
becoming law.