Sen. Heather A. Steans

Filed: 5/8/2018

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 2898

2    AMENDMENT NO. ______. Amend Senate Bill 2898 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.4h as follows:
 
6    (305 ILCS 5/5-5.4h)
7    Sec. 5-5.4h. Medicaid reimbursement for medically complex
8for the developmentally disabled facilities licensed under the
9MC/DD Act long-term care facilities for persons under 22 years
10of age.
11    (a) Facilities licensed as medically complex for the
12developmentally disabled facilities long-term care facilities
13for persons under 22 years of age that serve severely and
14chronically ill pediatric patients shall have a specific
15reimbursement system designed to recognize the characteristics
16and needs of the patients they serve.

 

 

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1    (b) For dates of services starting July 1, 2013 and until a
2new reimbursement system is designed, medically complex for the
3developmentally disabled facilities long-term care facilities
4for persons under 22 years of age that meet the following
5criteria:
6        (1) serve exceptional care patients; and
7        (2) have 30% or more of their patients receiving
8    ventilator care;
9shall receive Medicaid reimbursement on a 30-day expedited
10schedule.
11    (c) Subject to federal approval of changes to the Title XIX
12State Plan, for dates of services starting July 1, 2014 through
13March 31, 2019, medically complex for the developmentally
14disabled facilities and until a new reimbursement system is
15designed, long-term care facilities for persons under 22 years
16of age which meet the criteria in subsection (b) of this
17Section shall receive a per diem rate for clinically complex
18residents of $304. Clinically complex residents on a ventilator
19shall receive a per diem rate of $669. Subject to federal
20approval of changes to the Title XIX State Plan, for dates of
21services starting April 1, 2019, medically complex for the
22developmentally disabled facilities must be reimbursed an
23exceptional care per diem rate, instead of the base rate, for
24services to residents with complex or extensive medical needs.
25Exceptional care per diem rates must be paid for the conditions
26or services specified under subsection (f) at the following per

 

 

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1diem rates: Tier 1 $326, Tier 2 $546, and Tier 3 $735.
2    (d) For To qualify for the per diem rate of $669 for
3clinically complex residents on a ventilator pursuant to
4subsection (c) or subsection (f), facilities shall have a
5policy documenting their method of routine assessment of a
6resident's weaning potential with interventions implemented
7noted in the resident's medical record.
8    (e) For services provided prior to April 1, 2019 and for
9For the purposes of this Section, a resident is considered
10clinically complex if the resident requires at least one of the
11following medical services:
12        (1) Tracheostomy care with dependence on mechanical
13    ventilation for a minimum of 6 hours each day.
14        (2) Tracheostomy care requiring suctioning at least
15    every 6 hours, room air mist or oxygen as needed, and
16    dependence on one of the treatment procedures listed under
17    paragraph (4) excluding the procedure listed in
18    subparagraph (A) of paragraph (4).
19        (3) Total parenteral nutrition or other intravenous
20    nutritional support and one of the treatment procedures
21    listed under paragraph (4).
22        (4) The following treatment procedures apply to the
23    conditions in paragraphs (2) and (3) of this subsection:
24            (A) Intermittent suctioning at least every 8 hours
25        and room air mist or oxygen as needed.
26            (B) Continuous intravenous therapy including

 

 

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1        administration of therapeutic agents necessary for
2        hydration or of intravenous pharmaceuticals; or
3        intravenous pharmaceutical administration of more than
4        one agent via a peripheral or central line, without
5        continuous infusion.
6            (C) Peritoneal dialysis treatments requiring at
7        least 4 exchanges every 24 hours.
8            (D) Tube feeding via nasogastric or gastrostomy
9        tube.
10            (E) Other medical technologies required
11        continuously, which in the opinion of the attending
12        physician require the services of a professional
13        nurse.
14    (f) Complex or extensive medical needs for exceptional care
15reimbursement. The conditions and services used for the
16purposes of this Section have the same meanings as ascribed to
17those conditions and services under the Minimum Data Set (MDS)
18Resident Assessment Instrument (RAI) and specified in the most
19recent manual. Instead of submitting minimum data set
20assessments to the Department, medically complex for the
21developmentally disabled facilities must document within each
22resident's medical record the conditions or services using the
23minimum data set documentation standards and requirements to
24qualify for exceptional care reimbursement.
25        (1) Tier 1 reimbursement is for residents who are
26    receiving at least 51% of their caloric intake via a

 

 

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1    feeding tube.
2        (2) Tier 2 reimbursement is for residents who are
3    receiving tracheostomy care without a ventilator.
4        (3) Tier 3 reimbursement is for residents who are
5    receiving tracheostomy care and ventilator care.
6    (g) For dates of services starting April 1, 2019,
7reimbursement calculations and direct payment for services
8provided by medically complex for the developmentally disabled
9facilities are the responsibility of the Department of
10Healthcare and Family Services instead of the Department of
11Human Services. Appropriations for medically complex for the
12developmentally disabled facilities must be shifted from the
13Department of Human Services to the Department of Healthcare
14and Family Services. Nothing in this Section prohibits the
15Department of Healthcare and Family Services from paying more
16than the rates specified in this Section. The rates in this
17Section must be interpreted as a minimum amount. Any
18reimbursement increases applied to providers licensed under
19the ID/DD Community Care Act must also be applied in an
20equivalent manner to medically complex for the developmentally
21disabled facilities.
22    (h) The Department of Healthcare and Family Services shall
23pay the rates in effect on March 31, 2019 until the changes
24made to this Section by this amendatory Act of the 100th
25General Assembly have been approved by the Centers for Medicare
26and Medicaid Services of the U.S. Department of Health and

 

 

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1Human Services.
2    (i) The Department of Healthcare and Family Services may
3adopt rules as allowed by the Illinois Administrative Procedure
4Act to implement this Section; however, the requirements of
5this Section must be implemented by the Department of
6Healthcare and Family Services even if the Department of
7Healthcare and Family Services has not adopted rules by the
8implementation date of April 1, 2019.
9(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
 
10    Section 99. Effective date. This Act takes effect upon
11becoming law.".