100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB5294

 

Introduced , by Rep. Gregory Harris

 

SYNOPSIS AS INTRODUCED:
 
30 ILCS 105/5.886 new
305 ILCS 5/5-5.4h
305 ILCS 5/5C-1  from Ch. 23, par. 5C-1
305 ILCS 5/5C-2  from Ch. 23, par. 5C-2
305 ILCS 5/5C-11 new

    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.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5294LRB100 18354 KTG 33561 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. The State Finance Act is amended by adding
5Section 5.886 as follows:
 
6    (30 ILCS 105/5.886 new)
7    Sec. 5.886. The Medically Complex for the Developmentally
8Disabled Provider Fund.
 
9    Section 5. The Illinois Public Aid Code is amended by
10changing Sections 5-5.4h, 5C-1, and 5C-2 and by adding Section
115C-11 as follows:
 
12    (305 ILCS 5/5-5.4h)
13    Sec. 5-5.4h. Medicaid reimbursement for medically complex
14for the developmentally disabled facilities licensed under the
15MC/DD Act long-term care facilities for persons under 22 years
16of age.
17    (a) Facilities licensed as medically complex for the
18developmentally disabled facilities long-term care facilities
19for persons under 22 years of age that serve severely and
20chronically ill pediatric patients shall have a specific
21reimbursement system designed to recognize the characteristics

 

 

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1and needs of the patients they serve.
2    (b) For dates of services starting July 1, 2013 and until a
3new reimbursement system is designed, medically complex for the
4developmentally disabled facilities long-term care facilities
5for persons under 22 years of age that meet the following
6criteria:
7        (1) serve exceptional care patients; and
8        (2) have 30% or more of their patients receiving
9    ventilator care;
10shall receive Medicaid reimbursement on a 30-day expedited
11schedule.
12    (c) Subject to federal approval of changes to the Title XIX
13State Plan, for dates of services starting July 1, 2014 through
14June 30, 2018 and until a new reimbursement system is designed,
15medically complex for the developmentally disabled facilities
16long-term care facilities for persons under 22 years of age
17which meet the criteria in subsection (b) of this Section shall
18receive a per diem rate for clinically complex residents of
19$304. Clinically complex residents on a ventilator shall
20receive a per diem rate of $669. For dates of services starting
21July 1, 2018, the total base reimbursement per diem rate for
22services provided by medically complex for the developmentally
23disabled facilities must be no less than $216. For dates of
24services starting July 1, 2018, medically complex for the
25developmentally disabled facilities must be reimbursed an
26exceptional care per diem rate, instead of the base rate, for

 

 

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1services to residents with complex or extensive medical needs.
2Exceptional care per diem rates must be paid for the conditions
3or services specified under subsection (f) at the following per
4diem rates: Tier 1 $255, Tier 2 $569, and Tier 3 $765.
5    (d) For To qualify for the per diem rate of $669 for
6clinically complex residents on a ventilator pursuant to
7subsection (c) or subsection (f), facilities shall have a
8policy documenting their method of routine assessment of a
9resident's weaning potential with interventions implemented
10noted in the resident's medical record.
11    (e) For services provided prior to July 1, 2018 and for For
12the purposes of this Section, a resident is considered
13clinically complex if the resident requires at least one of the
14following medical services:
15        (1) Tracheostomy care with dependence on mechanical
16    ventilation for a minimum of 6 hours each day.
17        (2) Tracheostomy care requiring suctioning at least
18    every 6 hours, room air mist or oxygen as needed, and
19    dependence on one of the treatment procedures listed under
20    paragraph (4) excluding the procedure listed in
21    subparagraph (A) of paragraph (4).
22        (3) Total parenteral nutrition or other intravenous
23    nutritional support and one of the treatment procedures
24    listed under paragraph (4).
25        (4) The following treatment procedures apply to the
26    conditions in paragraphs (2) and (3) of this subsection:

 

 

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1            (A) Intermittent suctioning at least every 8 hours
2        and room air mist or oxygen as needed.
3            (B) Continuous intravenous therapy including
4        administration of therapeutic agents necessary for
5        hydration or of intravenous pharmaceuticals; or
6        intravenous pharmaceutical administration of more than
7        one agent via a peripheral or central line, without
8        continuous infusion.
9            (C) Peritoneal dialysis treatments requiring at
10        least 4 exchanges every 24 hours.
11            (D) Tube feeding via nasogastric or gastrostomy
12        tube.
13            (E) Other medical technologies required
14        continuously, which in the opinion of the attending
15        physician require the services of a professional
16        nurse.
17    (f) Complex or extensive medical needs for exceptional care
18reimbursement. The conditions and services used for the
19purposes of this Section have the same meanings as ascribed to
20those conditions and services under the Minimum Data Set (MDS)
21Resident Assessment Instrument (RAI) and specified in the most
22recent manual. Instead of submitting minimum data set
23assessments to the Department, medically complex for the
24developmentally disabled facilities must document within each
25resident's medical record the conditions or services using the
26minimum data set documentation standards and requirements to

 

 

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1qualify for exceptional care reimbursement.
2        (1) Tier 1 reimbursement is for residents who are
3    receiving at least 51% of their caloric intake via a
4    feeding tube and who are receiving either respiratory
5    therapy or oxygen therapy.
6        (2) Tier 2 reimbursement is for residents who are
7    receiving tracheostomy care without a ventilator and who
8    are receiving:
9            (A) dialysis;
10            (B) suctioning; or
11            (C) at least 51% of their caloric intake via a
12        feeding tube.
13        (3) Tier 3 reimbursement is for residents who are
14    receiving tracheostomy care and ventilator care.
15    (g) For dates of services starting July 1, 2018,
16reimbursement calculations and direct payment for services
17provided by medically complex for the developmentally disabled
18facilities are the responsibility of the Department instead of
19the Department of Human Services. Appropriations for medically
20complex for the developmentally disabled facilities must be
21shifted from the Department of Human Services to the
22Department. Nothing in this Section prohibits the Department
23from paying more than the rates specified in this Section. The
24rates in this Section must be interpreted as a minimum amount.
25Any reimbursement increases applied to providers licensed
26under the ID/DD Community Care Act must also be applied in an

 

 

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1equivalent manner to medically complex for the developmentally
2disabled facilities.
3(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
 
4    (305 ILCS 5/5C-1)  (from Ch. 23, par. 5C-1)
5    Sec. 5C-1. Definitions. As used in this Article, unless the
6context requires otherwise:
7    "Fund" means the Care Provider Fund for Persons with a
8Developmental Disability.
9    "Care facility for persons with a developmental
10disability" means an intermediate care facility for the
11intellectually disabled within the meaning of Title XIX of the
12Social Security Act, whether public or private and whether
13organized for profit or not-for-profit, but shall not include
14any facility operated by the State.
15    "Care provider for persons with a developmental
16disability" means a person conducting, operating, or
17maintaining a facility for persons with a developmental
18disability. For this purpose, "person" means any political
19subdivision of the State, municipal corporation, individual,
20firm, partnership, corporation, company, limited liability
21company, association, joint stock association, or trust, or a
22receiver, executor, trustee, guardian or other representative
23appointed by order of any court.
24    "Adjusted gross developmentally disabled care revenue"
25shall be computed separately for each facility for persons with

 

 

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1a developmental disability conducted, operated, or maintained
2by a care provider for persons with a developmental disability,
3and means the total revenue of the care provider for persons
4with a developmental disability for inpatient residential
5services less contractual allowances and discounts on
6patients' accounts, but does not include non-patient revenue
7from sources such as contributions, donations or bequests,
8investments, day training services, television and telephone
9service, and rental of facility space.
10    "Long-term care facility for persons under 22 years of age
11serving clinically complex residents" means a facility
12licensed by the Department of Public Health as a long-term care
13facility for persons under 22 meeting the qualifications of
14Section 5-5.4h of this Code.
15    "Medically complex for the developmentally disabled
16facility" means a facility licensed by the Department of Public
17Health under the MC/DD Act.
18(Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14;
1999-143, eff. 7-27-15.)
 
20    (305 ILCS 5/5C-2)  (from Ch. 23, par. 5C-2)
21    Sec. 5C-2. Assessment; no local authorization to tax.
22    (a) For the privilege of engaging in the occupation of care
23provider for persons with a developmental disability, an
24assessment is imposed upon each care provider for persons with
25a developmental disability in an amount equal to 6%, or the

 

 

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1maximum allowed under federal regulation, whichever is less, of
2its adjusted gross developmentally disabled care revenue for
3the prior State fiscal year. Notwithstanding any provision of
4any other Act to the contrary, this assessment shall be
5construed as a tax, but may not be added to the charges of an
6individual's nursing home care that is paid for in whole, or in
7part, by a federal, State, or combined federal-state medical
8care program, except those individuals receiving Medicare Part
9B benefits solely.
10    (b) Nothing in this amendatory Act of 1995 shall be
11construed to authorize any home rule unit or other unit of
12local government to license for revenue or impose a tax or
13assessment upon a care provider for persons with a
14developmental disability or the occupation of care provider for
15persons with a developmental disability, or a tax or assessment
16measured by the income or earnings of a care provider for
17persons with a developmental disability.
18    (c) Effective July 1, 2013, for the privilege of engaging
19in the occupation of long-term care facility for persons under
2022 years of age serving clinically complex residents provider,
21an assessment is imposed upon each long-term care facility for
22persons under 22 years of age serving clinically complex
23residents provider in the same amount and upon the same
24conditions and requirements as imposed in Article V-B of this
25Code and a license fee is imposed in the same amount and upon
26the same conditions and requirements as imposed in Article V-E

 

 

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1of this Code. Notwithstanding any provision of any other Act to
2the contrary, the assessment and license fee imposed by this
3subsection (c) shall be construed as a tax, but may not be
4added to the charges of an individual's nursing home care that
5is paid for in whole, or in part, by a federal, State, or
6combined federal-State medical care program, except for those
7individuals receiving Medicare Part B benefits solely.
8    (d) Beginning July 1, 2018, for the privilege of engaging
9in the occupation of a medically complex for the
10developmentally disabled facility, an assessment is imposed
11upon each medically complex for the developmentally disabled
12facility in the same amount and upon the same conditions and
13requirements as imposed in Article V-B of this Code and a
14license fee is imposed in the same amount and upon the same
15conditions and requirements as imposed in Article V-E of this
16Code. Notwithstanding any provision of any other Act to the
17contrary, the assessment and license fee imposed by this
18subsection (d) shall be construed as a tax, but may not be
19added to the charges of an individual's care that is paid for
20in whole, or in part, by a federal, State, or combined
21federal-State medical care program, except for those
22individuals receiving Medicare Part B benefits solely. The
23assessment and license fee collected under this subsection (d)
24must be deposited in the Medically Complex for the
25Developmentally Disabled Provider Fund.
26(Source: P.A. 98-651, eff. 6-16-14; 99-143, eff. 7-27-15.)
 

 

 

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1    (305 ILCS 5/5C-11 new)
2    Sec. 5C-11. Medically Complex for the Developmentally
3Disabled Provider Fund.
4    (a) The Medically Complex for the Developmentally Disabled
5Provider Fund is created as a special fund in the State
6treasury. All interest earned on moneys in the Fund shall be
7credited to the Fund. The Fund shall not be used to replace any
8moneys appropriated to the Medical Assistance Program by the
9General Assembly.
10    (b) The Fund is created for the purpose of receiving and
11disbursing assessment moneys in accordance with this Article.
12Disbursements from the Fund shall be made only as follows:
13        (1) For payments to intermediate care facilities for
14    persons with a developmental disability under Title XIX of
15    the Social Security Act that are also licensed by the
16    Department of Public Health as a medically complex for the
17    developmentally disabled facility under the MC/DD Act.
18        (2) For the reimbursement of moneys collected by the
19    Department through error or mistake.
20        (3) For payment of administrative expenses incurred by
21    the Department or its agent in performing the activities
22    authorized by subsection (d) of Section 5C-2.
23        (4) For payments of any amounts which are reimbursable
24    to the federal government for payments from the Fund which
25    are required to be paid by State warrant. Disbursements

 

 

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1    from the Fund shall be by warrants drawn by the State
2    Comptroller upon receipt of vouchers duly executed and
3    certified by the Department.
4    (c) The Fund shall consist of the following:
5        (1) All moneys collected or received by the Department
6    from the assessment imposed on medically complex for the
7    developmentally disabled facilities under subsection (d)
8    of Section 5C-2.
9        (2) All federal matching funds received by the
10    Department as a result of expenditures made by the
11    Department that are attributable to moneys deposited in the
12    Fund.
13        (3) Any interest or penalty levied in conjunction with
14    the administration of subsection (d) of Section 5C-2.
15        (4) All other moneys received for the Fund from any
16    other source, including interest earned thereon.
 
17    Section 90. Implementation mandate. The Department of
18Healthcare and Family Services may adopt rules as allowed by
19the Illinois Administrative Procedure Act to implement this
20Act; however, the requirements of this Act must be implemented
21by the Department of Healthcare and Family Services even if the
22Department of Healthcare and Family Services has not adopted
23rules by the implementation date of July 1, 2018.
 
24    Section 99. Effective date. This Act takes effect upon
25becoming law.