Bill Text: IL SB2898 | 2017-2018 | 100th General Assembly | Engrossed

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Bill Title: Amends the Illinois Public Aid Code. Provides that licensed medically complex for the developmentally disabled facilities (MC/DD) (rather than licensed long-term care facilities for persons under 22 years of age) that serve severely and chronically ill patients (rather than pediatric patients) shall have a specific reimbursement system designed to recognize the characteristics and needs of the patients they serve. Sets forth certain reimbursement rates for MC/DD facilities for date of services starting July 1, 2018. Requires MC/DD facilities to 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. Provides that the Department of Healthcare and Family Services shall be responsible for reimbursement calculations and direct payment for services. Imposes an assessment and licensing fee on MC/DD facilities. Creates the Medically Complex for the Developmentally Disabled Provider Fund for the purpose of receiving and disbursing assessment moneys, including making payments to intermediate care facilities for persons with a developmental disability that are also licensed as MC/DD facilities and making payments of any amounts which are reimbursable to the federal government. Makes other changes. Amends the State Finance Act to create the Medically Complex for the Developmentally Disabled Provider Fund. Effective immediately.

Spectrum: Bipartisan Bill

Status: (Failed) 2019-01-09 - Session Sine Die [SB2898 Detail]

Download: Illinois-2017-SB2898-Engrossed.html

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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 long-term care facilities for persons under 22 years
of age.
(a) Facilities licensed as medically complex for the
developmentally disabled facilities long-term care facilities
for persons under 22 years of age that serve severely and
chronically ill pediatric 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 long-term care facilities
for persons under 22 years of age that meet the following
criteria:
(1) serve exceptional care patients; and
(2) have 30% or more of their patients receiving

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ventilator care;
shall receive Medicaid reimbursement on a 30-day expedited
schedule.
(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 and until a new reimbursement system is
designed, long-term care facilities for persons under 22 years
of age 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.
(d) For To qualify for the per diem rate of $669 for
clinically complex 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 resident's medical record.

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(e) For services provided prior to April 1, 2019 and for
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
least 4 exchanges every 24 hours.

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(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,
reimbursement calculations and direct payment for services

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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 Department of
Healthcare and Family Services has not adopted rules by the

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implementation date of April 1, 2019.
(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
Section 99. Effective date. This Act takes effect upon
becoming law.