Rep. Robert Rita

Adopted in House Comm. on Oct 29, 2019

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 115

2    AMENDMENT NO. ______. Amend Senate Bill 115 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Emergency Medical Services (EMS) Systems
5Act is amended by changing Section 32.5 as follows:
 
6    (210 ILCS 50/32.5)
7    Sec. 32.5. Freestanding Emergency Center.
8    (a) The Department shall issue an annual Freestanding
9Emergency Center (FEC) license to any facility that has
10received a permit from the Health Facilities and Services
11Review Board to establish a Freestanding Emergency Center by
12January 1, 2015, and:
13        (1) is located: (A) in a municipality with a population
14    of 50,000 or fewer inhabitants; (B) within 50 miles of the
15    hospital that owns or controls the FEC; and (C) within 50
16    miles of the Resource Hospital affiliated with the FEC as

 

 

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1    part of the EMS System;
2        (2) is wholly owned or controlled by an Associate or
3    Resource Hospital, but is not a part of the hospital's
4    physical plant;
5        (3) meets the standards for licensed FECs, adopted by
6    rule of the Department, including, but not limited to:
7            (A) facility design, specification, operation, and
8        maintenance standards;
9            (B) equipment standards; and
10            (C) the number and qualifications of emergency
11        medical personnel and other staff, which must include
12        at least one board certified emergency physician
13        present at the FEC 24 hours per day.
14        (4) limits its participation in the EMS System strictly
15    to receiving a limited number of patients by ambulance: (A)
16    according to the FEC's 24-hour capabilities; (B) according
17    to protocols developed by the Resource Hospital within the
18    FEC's designated EMS System; and (C) as pre-approved by
19    both the EMS Medical Director and the Department;
20        (5) provides comprehensive emergency treatment
21    services, as defined in the rules adopted by the Department
22    pursuant to the Hospital Licensing Act, 24 hours per day,
23    on an outpatient basis;
24        (6) provides an ambulance and maintains on site
25    ambulance services staffed with paramedics 24 hours per
26    day;

 

 

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1        (7) (blank);
2        (8) complies with all State and federal patient rights
3    provisions, including, but not limited to, the Emergency
4    Medical Treatment Act and the federal Emergency Medical
5    Treatment and Active Labor Act;
6        (9) maintains a communications system that is fully
7    integrated with its Resource Hospital within the FEC's
8    designated EMS System;
9        (10) reports to the Department any patient transfers
10    from the FEC to a hospital within 48 hours of the transfer
11    plus any other data determined to be relevant by the
12    Department;
13        (11) submits to the Department, on a quarterly basis,
14    the FEC's morbidity and mortality rates for patients
15    treated at the FEC and other data determined to be relevant
16    by the Department;
17        (12) does not describe itself or hold itself out to the
18    general public as a full service hospital or hospital
19    emergency department in its advertising or marketing
20    activities;
21        (13) complies with any other rules adopted by the
22    Department under this Act that relate to FECs;
23        (14) passes the Department's site inspection for
24    compliance with the FEC requirements of this Act;
25        (15) submits a copy of the permit issued by the Health
26    Facilities and Services Review Board indicating that the

 

 

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1    facility has complied with the Illinois Health Facilities
2    Planning Act with respect to the health services to be
3    provided at the facility;
4        (16) submits an application for designation as an FEC
5    in a manner and form prescribed by the Department by rule;
6    and
7        (17) pays the annual license fee as determined by the
8    Department by rule.
9    (a-5) Notwithstanding any other provision of this Section,
10the Department may issue an annual FEC license to a facility
11that is located in a county that does not have a licensed
12general acute care hospital if the facility's application for a
13permit from the Illinois Health Facilities Planning Board has
14been deemed complete by the Department of Public Health by
15January 1, 2014 and if the facility complies with the
16requirements set forth in paragraphs (1) through (17) of
17subsection (a).
18    (a-7) Notwithstanding any other provision of this Section,
19the Department may issue an annual FEC license to a facility
20that (i) is located in a county having a population of more
21than 3,000,000 and (ii) was approved to discontinue operations
22as a hospital by the Health Facilities and Services Review
23Board in calendar year 2019 under Health Facilities and
24Services Review Board project number E-024-19, if the facility
25complies with the requirements set forth in paragraphs (1)
26through (17) of subsection (a).

 

 

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1    (a-10) Notwithstanding any other provision of this
2Section, the Department may issue an annual FEC license to a
3facility if the facility has, by January 1, 2014, filed a
4letter of intent to establish an FEC and if the facility
5complies with the requirements set forth in paragraphs (1)
6through (17) of subsection (a).
7    (a-15) Notwithstanding any other provision of this
8Section, the Department shall issue an annual FEC license to a
9facility if the facility: (i) discontinues operation as a
10hospital within 180 days after December 4, 2015 (the effective
11date of Public Act 99-490) this amendatory Act of the 99th
12General Assembly with a Health Facilities and Services Review
13Board project number of E-017-15; (ii) has an application for a
14permit to establish an FEC from the Health Facilities and
15Services Review Board that is deemed complete by January 1,
162017; and (iii) complies with the requirements set forth in
17paragraphs (1) through (17) of subsection (a) of this Section.
18    (a-20) Notwithstanding any other provision of this
19Section, the Department shall issue an annual FEC license to a
20facility if:
21        (1) the facility is a hospital that has discontinued
22    inpatient hospital services;
23        (2) the Department of Healthcare and Family Services
24    has certified the conversion to an FEC was approved by the
25    Hospital Transformation Review Committee as a project
26    subject to the hospital's transformation under subsection

 

 

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1    (d-5) of Section 14-12 of the Illinois Public Aid Code;
2        (3) the facility complies with the requirements set
3    forth in paragraphs (1) through (17), provided however that
4    the FEC may be located in a municipality with a population
5    greater than 50,000 inhabitants and shall not be subject to
6    the requirements of the Illinois Health Facilities
7    Planning Act that are applicable to the conversion to an
8    FEC if the Department of Healthcare and Family Services
9    Service has certified the conversion to an FEC was approved
10    by the Hospital Transformation Review Committee as a
11    project subject to the hospital's transformation under
12    subsection (d-5) of Section 14-12 of the Illinois Public
13    Aid Code; and
14        (4) the facility is located at the same physical
15    location where the facility served as a hospital.
16    (b) The Department shall:
17        (1) annually inspect facilities of initial FEC
18    applicants and licensed FECs, and issue annual licenses to
19    or annually relicense FECs that satisfy the Department's
20    licensure requirements as set forth in subsection (a);
21        (2) suspend, revoke, refuse to issue, or refuse to
22    renew the license of any FEC, after notice and an
23    opportunity for a hearing, when the Department finds that
24    the FEC has failed to comply with the standards and
25    requirements of the Act or rules adopted by the Department
26    under the Act;

 

 

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1        (3) issue an Emergency Suspension Order for any FEC
2    when the Director or his or her designee has determined
3    that the continued operation of the FEC poses an immediate
4    and serious danger to the public health, safety, and
5    welfare. An opportunity for a hearing shall be promptly
6    initiated after an Emergency Suspension Order has been
7    issued; and
8        (4) adopt rules as needed to implement this Section.
9(Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16;
10100-581, eff. 3-12-18; revised 7-23-19.)
 
11    Section 10. The Illinois Public Aid Code is amended by
12changing Section 14-12 as follows:
 
13    (305 ILCS 5/14-12)
14    Sec. 14-12. Hospital rate reform payment system. The
15hospital payment system pursuant to Section 14-11 of this
16Article shall be as follows:
17    (a) Inpatient hospital services. Effective for discharges
18on and after July 1, 2014, reimbursement for inpatient general
19acute care services shall utilize the All Patient Refined
20Diagnosis Related Grouping (APR-DRG) software, version 30,
21distributed by 3MTM Health Information System.
22        (1) The Department shall establish Medicaid weighting
23    factors to be used in the reimbursement system established
24    under this subsection. Initial weighting factors shall be

 

 

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1    the weighting factors as published by 3M Health Information
2    System, associated with Version 30.0 adjusted for the
3    Illinois experience.
4        (2) The Department shall establish a
5    statewide-standardized amount to be used in the inpatient
6    reimbursement system. The Department shall publish these
7    amounts on its website no later than 10 calendar days prior
8    to their effective date.
9        (3) In addition to the statewide-standardized amount,
10    the Department shall develop adjusters to adjust the rate
11    of reimbursement for critical Medicaid providers or
12    services for trauma, transplantation services, perinatal
13    care, and Graduate Medical Education (GME).
14        (4) The Department shall develop add-on payments to
15    account for exceptionally costly inpatient stays,
16    consistent with Medicare outlier principles. Outlier fixed
17    loss thresholds may be updated to control for excessive
18    growth in outlier payments no more frequently than on an
19    annual basis, but at least triennially. Upon updating the
20    fixed loss thresholds, the Department shall be required to
21    update base rates within 12 months.
22        (5) The Department shall define those hospitals or
23    distinct parts of hospitals that shall be exempt from the
24    APR-DRG reimbursement system established under this
25    Section. The Department shall publish these hospitals'
26    inpatient rates on its website no later than 10 calendar

 

 

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1    days prior to their effective date.
2        (6) Beginning July 1, 2014 and ending on June 30, 2024,
3    in addition to the statewide-standardized amount, the
4    Department shall develop an adjustor to adjust the rate of
5    reimbursement for safety-net hospitals defined in Section
6    5-5e.1 of this Code excluding pediatric hospitals.
7        (7) Beginning July 1, 2014 and ending on June 30, 2020,
8    or upon implementation of inpatient psychiatric rate
9    increases as described in subsection (n) of Section
10    5A-12.6, in addition to the statewide-standardized amount,
11    the Department shall develop an adjustor to adjust the rate
12    of reimbursement for Illinois freestanding inpatient
13    psychiatric hospitals that are not designated as
14    children's hospitals by the Department but are primarily
15    treating patients under the age of 21.
16        (7.5) Beginning July 1, 2020, the reimbursement for
17    inpatient psychiatric services shall be so that base claims
18    projected reimbursement is increased by an amount equal to
19    the funds allocated in paragraph (2) of subsection (b) of
20    Section 5A-12.6, less the amount allocated under
21    paragraphs (8) and (9) of this subsection and paragraphs
22    (3) and (4) of subsection (b) multiplied by 13%. Beginning
23    July 1, 2022, the reimbursement for inpatient psychiatric
24    services shall be so that base claims projected
25    reimbursement is increased by an amount equal to the funds
26    allocated in paragraph (3) of subsection (b) of Section

 

 

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1    5A-12.6, less the amount allocated under paragraphs (8) and
2    (9) of this subsection and paragraphs (3) and (4) of
3    subsection (b) multiplied by 13%. Beginning July 1, 2024,
4    the reimbursement for inpatient psychiatric services shall
5    be so that base claims projected reimbursement is increased
6    by an amount equal to the funds allocated in paragraph (4)
7    of subsection (b) of Section 5A-12.6, less the amount
8    allocated under paragraphs (8) and (9) of this subsection
9    and paragraphs (3) and (4) of subsection (b) multiplied by
10    13%.
11        (8) Beginning July 1, 2018, in addition to the
12    statewide-standardized amount, the Department shall adjust
13    the rate of reimbursement for hospitals designated by the
14    Department of Public Health as a Perinatal Level II or II+
15    center by applying the same adjustor that is applied to
16    Perinatal and Obstetrical care cases for Perinatal Level
17    III centers, as of December 31, 2017.
18        (9) Beginning July 1, 2018, in addition to the
19    statewide-standardized amount, the Department shall apply
20    the same adjustor that is applied to trauma cases as of
21    December 31, 2017 to inpatient claims to treat patients
22    with burns, including, but not limited to, APR-DRGs 841,
23    842, 843, and 844.
24        (10) Beginning July 1, 2018, the
25    statewide-standardized amount for inpatient general acute
26    care services shall be uniformly increased so that base

 

 

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1    claims projected reimbursement is increased by an amount
2    equal to the funds allocated in paragraph (1) of subsection
3    (b) of Section 5A-12.6, less the amount allocated under
4    paragraphs (8) and (9) of this subsection and paragraphs
5    (3) and (4) of subsection (b) multiplied by 40%. Beginning
6    July 1, 2020, the statewide-standardized amount for
7    inpatient general acute care services shall be uniformly
8    increased so that base claims projected reimbursement is
9    increased by an amount equal to the funds allocated in
10    paragraph (2) of subsection (b) of Section 5A-12.6, less
11    the amount allocated under paragraphs (8) and (9) of this
12    subsection and paragraphs (3) and (4) of subsection (b)
13    multiplied by 40%. Beginning July 1, 2022, the
14    statewide-standardized amount for inpatient general acute
15    care services shall be uniformly increased so that base
16    claims projected reimbursement is increased by an amount
17    equal to the funds allocated in paragraph (3) of subsection
18    (b) of Section 5A-12.6, less the amount allocated under
19    paragraphs (8) and (9) of this subsection and paragraphs
20    (3) and (4) of subsection (b) multiplied by 40%. Beginning
21    July 1, 2023 the statewide-standardized amount for
22    inpatient general acute care services shall be uniformly
23    increased so that base claims projected reimbursement is
24    increased by an amount equal to the funds allocated in
25    paragraph (4) of subsection (b) of Section 5A-12.6, less
26    the amount allocated under paragraphs (8) and (9) of this

 

 

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1    subsection and paragraphs (3) and (4) of subsection (b)
2    multiplied by 40%.
3        (11) Beginning July 1, 2018, the reimbursement for
4    inpatient rehabilitation services shall be increased by
5    the addition of a $96 per day add-on.
6        Beginning July 1, 2020, the reimbursement for
7    inpatient rehabilitation services shall be uniformly
8    increased so that the $96 per day add-on is increased by an
9    amount equal to the funds allocated in paragraph (2) of
10    subsection (b) of Section 5A-12.6, less the amount
11    allocated under paragraphs (8) and (9) of this subsection
12    and paragraphs (3) and (4) of subsection (b) multiplied by
13    0.9%.
14        Beginning July 1, 2022, the reimbursement for
15    inpatient rehabilitation services shall be uniformly
16    increased so that the $96 per day add-on as adjusted by the
17    July 1, 2020 increase, is increased by an amount equal to
18    the funds allocated in paragraph (3) of subsection (b) of
19    Section 5A-12.6, less the amount allocated under
20    paragraphs (8) and (9) of this subsection and paragraphs
21    (3) and (4) of subsection (b) multiplied by 0.9%.
22        Beginning July 1, 2023, the reimbursement for
23    inpatient rehabilitation services shall be uniformly
24    increased so that the $96 per day add-on as adjusted by the
25    July 1, 2022 increase, is increased by an amount equal to
26    the funds allocated in paragraph (4) of subsection (b) of

 

 

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1    Section 5A-12.6, less the amount allocated under
2    paragraphs (8) and (9) of this subsection and paragraphs
3    (3) and (4) of subsection (b) multiplied by 0.9%.
4    (b) Outpatient hospital services. Effective for dates of
5service on and after July 1, 2014, reimbursement for outpatient
6services shall utilize the Enhanced Ambulatory Procedure
7Grouping (EAPG) software, version 3.7 distributed by 3MTM
8Health Information System.
9        (1) The Department shall establish Medicaid weighting
10    factors to be used in the reimbursement system established
11    under this subsection. The initial weighting factors shall
12    be the weighting factors as published by 3M Health
13    Information System, associated with Version 3.7.
14        (2) The Department shall establish service specific
15    statewide-standardized amounts to be used in the
16    reimbursement system.
17            (A) The initial statewide standardized amounts,
18        with the labor portion adjusted by the Calendar Year
19        2013 Medicare Outpatient Prospective Payment System
20        wage index with reclassifications, shall be published
21        by the Department on its website no later than 10
22        calendar days prior to their effective date.
23            (B) The Department shall establish adjustments to
24        the statewide-standardized amounts for each Critical
25        Access Hospital, as designated by the Department of
26        Public Health in accordance with 42 CFR 485, Subpart F.

 

 

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1        For outpatient services provided on or before June 30,
2        2018, the EAPG standardized amounts are determined
3        separately for each critical access hospital such that
4        simulated EAPG payments using outpatient base period
5        paid claim data plus payments under Section 5A-12.4 of
6        this Code net of the associated tax costs are equal to
7        the estimated costs of outpatient base period claims
8        data with a rate year cost inflation factor applied.
9        (3) In addition to the statewide-standardized amounts,
10    the Department shall develop adjusters to adjust the rate
11    of reimbursement for critical Medicaid hospital outpatient
12    providers or services, including outpatient high volume or
13    safety-net hospitals. Beginning July 1, 2018, the
14    outpatient high volume adjustor shall be increased to
15    increase annual expenditures associated with this adjustor
16    by $79,200,000, based on the State Fiscal Year 2015 base
17    year data and this adjustor shall apply to public
18    hospitals, except for large public hospitals, as defined
19    under 89 Ill. Adm. Code 148.25(a).
20        (4) Beginning July 1, 2018, in addition to the
21    statewide standardized amounts, the Department shall make
22    an add-on payment for outpatient expensive devices and
23    drugs. This add-on payment shall at least apply to claim
24    lines that: (i) are assigned with one of the following
25    EAPGs: 490, 1001 to 1020, and coded with one of the
26    following revenue codes: 0274 to 0276, 0278; or (ii) are

 

 

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1    assigned with one of the following EAPGs: 430 to 441, 443,
2    444, 460 to 465, 495, 496, 1090. The add-on payment shall
3    be calculated as follows: the claim line's covered charges
4    multiplied by the hospital's total acute cost to charge
5    ratio, less the claim line's EAPG payment plus $1,000,
6    multiplied by 0.8.
7        (5) Beginning July 1, 2018, the statewide-standardized
8    amounts for outpatient services shall be increased by a
9    uniform percentage so that base claims projected
10    reimbursement is increased by an amount equal to no less
11    than the funds allocated in paragraph (1) of subsection (b)
12    of Section 5A-12.6, less the amount allocated under
13    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
14    and (4) of this subsection multiplied by 46%. Beginning
15    July 1, 2020, the statewide-standardized amounts for
16    outpatient services shall be increased by a uniform
17    percentage so that base claims projected reimbursement is
18    increased by an amount equal to no less than the funds
19    allocated in paragraph (2) of subsection (b) of Section
20    5A-12.6, less the amount allocated under paragraphs (8) and
21    (9) of subsection (a) and paragraphs (3) and (4) of this
22    subsection multiplied by 46%. Beginning July 1, 2022, the
23    statewide-standardized amounts for outpatient services
24    shall be increased by a uniform percentage so that base
25    claims projected reimbursement is increased by an amount
26    equal to the funds allocated in paragraph (3) of subsection

 

 

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1    (b) of Section 5A-12.6, less the amount allocated under
2    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
3    and (4) of this subsection multiplied by 46%. Beginning
4    July 1, 2023, the statewide-standardized amounts for
5    outpatient services shall be increased by a uniform
6    percentage so that base claims projected reimbursement is
7    increased by an amount equal to no less than the funds
8    allocated in paragraph (4) of subsection (b) of Section
9    5A-12.6, less the amount allocated under paragraphs (8) and
10    (9) of subsection (a) and paragraphs (3) and (4) of this
11    subsection multiplied by 46%.
12        (6) Effective for dates of service on or after July 1,
13    2018, the Department shall establish adjustments to the
14    statewide-standardized amounts for each Critical Access
15    Hospital, as designated by the Department of Public Health
16    in accordance with 42 CFR 485, Subpart F, such that each
17    Critical Access Hospital's standardized amount for
18    outpatient services shall be increased by the applicable
19    uniform percentage determined pursuant to paragraph (5) of
20    this subsection. It is the intent of the General Assembly
21    that the adjustments required under this paragraph (6) by
22    Public Act 100-1181 this amendatory Act of the 100th
23    General Assembly shall be applied retroactively to claims
24    for dates of service provided on or after July 1, 2018.
25        (7) Effective for dates of service on or after March 8,
26    2019 (the effective date of Public Act 100-1181) this

 

 

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1    amendatory Act of the 100th General Assembly, the
2    Department shall recalculate and implement an updated
3    statewide-standardized amount for outpatient services
4    provided by hospitals that are not Critical Access
5    Hospitals to reflect the applicable uniform percentage
6    determined pursuant to paragraph (5).
7            (1) Any recalculation to the
8        statewide-standardized amounts for outpatient services
9        provided by hospitals that are not Critical Access
10        Hospitals shall be the amount necessary to achieve the
11        increase in the statewide-standardized amounts for
12        outpatient services increased by a uniform percentage,
13        so that base claims projected reimbursement is
14        increased by an amount equal to no less than the funds
15        allocated in paragraph (1) of subsection (b) of Section
16        5A-12.6, less the amount allocated under paragraphs
17        (8) and (9) of subsection (a) and paragraphs (3) and
18        (4) of this subsection, for all hospitals that are not
19        Critical Access Hospitals, multiplied by 46%.
20            (2) It is the intent of the General Assembly that
21        the recalculations required under this paragraph (7)
22        by Public Act 100-1181 this amendatory Act of the 100th
23        General Assembly shall be applied prospectively to
24        claims for dates of service provided on or after March
25        8, 2019 (the effective date of Public Act 100-1181)
26        this amendatory Act of the 100th General Assembly and

 

 

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1        that no recoupment or repayment by the Department or an
2        MCO of payments attributable to recalculation under
3        this paragraph (7), issued to the hospital for dates of
4        service on or after July 1, 2018 and before March 8,
5        2019 (the effective date of Public Act 100-1181) this
6        amendatory Act of the 100th General Assembly, shall be
7        permitted.
8        (8) The Department shall ensure that all necessary
9    adjustments to the managed care organization capitation
10    base rates necessitated by the adjustments under
11    subparagraph (6) or (7) of this subsection are completed
12    and applied retroactively in accordance with Section
13    5-30.8 of this Code within 90 days of March 8, 2019 (the
14    effective date of Public Act 100-1181) this amendatory Act
15    of the 100th General Assembly.
16    (c) In consultation with the hospital community, the
17Department is authorized to replace 89 Ill. Admin. Code 152.150
18as published in 38 Ill. Reg. 4980 through 4986 within 12 months
19of June 16, 2014 (the effective date of Public Act 98-651). If
20the Department does not replace these rules within 12 months of
21June 16, 2014 (the effective date of Public Act 98-651), the
22rules in effect for 152.150 as published in 38 Ill. Reg. 4980
23through 4986 shall remain in effect until modified by rule by
24the Department. Nothing in this subsection shall be construed
25to mandate that the Department file a replacement rule.
26    (d) Transition period. There shall be a transition period

 

 

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1to the reimbursement systems authorized under this Section that
2shall begin on the effective date of these systems and continue
3until June 30, 2018, unless extended by rule by the Department.
4To help provide an orderly and predictable transition to the
5new reimbursement systems and to preserve and enhance access to
6the hospital services during this transition, the Department
7shall allocate a transitional hospital access pool of at least
8$290,000,000 annually so that transitional hospital access
9payments are made to hospitals.
10        (1) After the transition period, the Department may
11    begin incorporating the transitional hospital access pool
12    into the base rate structure; however, the transitional
13    hospital access payments in effect on June 30, 2018 shall
14    continue to be paid, if continued under Section 5A-16.
15        (2) After the transition period, if the Department
16    reduces payments from the transitional hospital access
17    pool, it shall increase base rates, develop new adjustors,
18    adjust current adjustors, develop new hospital access
19    payments based on updated information, or any combination
20    thereof by an amount equal to the decreases proposed in the
21    transitional hospital access pool payments, ensuring that
22    the entire transitional hospital access pool amount shall
23    continue to be used for hospital payments.
24    (d-5) Hospital transformation program. The Department, in
25conjunction with the Hospital Transformation Review Committee
26created under subsection (d-5), shall develop a hospital

 

 

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1transformation program to provide financial assistance to
2hospitals in transforming their services and care models to
3better align with the needs of the communities they serve. The
4payments authorized in this Section shall be subject to
5approval by the federal government.
6        (1) Phase 1. In State fiscal years 2019 through 2020,
7    the Department shall allocate funds from the transitional
8    access hospital pool to create a hospital transformation
9    pool of at least $262,906,870 annually and make hospital
10    transformation payments to hospitals. Subject to Section
11    5A-16, in State fiscal years 2019 and 2020, an Illinois
12    hospital that received either a transitional hospital
13    access payment under subsection (d) or a supplemental
14    payment under subsection (f) of this Section in State
15    fiscal year 2018, shall receive a hospital transformation
16    payment as follows:
17            (A) If the hospital's Rate Year 2017 Medicaid
18        inpatient utilization rate is equal to or greater than
19        45%, the hospital transformation payment shall be
20        equal to 100% of the sum of its transitional hospital
21        access payment authorized under subsection (d) and any
22        supplemental payment authorized under subsection (f).
23            (B) If the hospital's Rate Year 2017 Medicaid
24        inpatient utilization rate is equal to or greater than
25        25% but less than 45%, the hospital transformation
26        payment shall be equal to 75% of the sum of its

 

 

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1        transitional hospital access payment authorized under
2        subsection (d) and any supplemental payment authorized
3        under subsection (f).
4            (C) If the hospital's Rate Year 2017 Medicaid
5        inpatient utilization rate is less than 25%, the
6        hospital transformation payment shall be equal to 50%
7        of the sum of its transitional hospital access payment
8        authorized under subsection (d) and any supplemental
9        payment authorized under subsection (f).
10        (2) Phase 2. During State fiscal years 2021 and 2022,
11    the Department shall allocate funds from the transitional
12    access hospital pool to create a hospital transformation
13    pool annually and make hospital transformation payments to
14    hospitals participating in the transformation program. Any
15    hospital may seek transformation funding in Phase 2. Any
16    hospital that seeks transformation funding in Phase 2 to
17    update or repurpose the hospital's physical structure to
18    transition to a new delivery model, must submit to the
19    Department in writing a transformation plan, based on the
20    Department's guidelines, that describes the desired
21    delivery model with projections of patient volumes by
22    service lines and projected revenues, expenses, and net
23    income that correspond to the new delivery model. In Phase
24    2, subject to the approval of rules, the Department may use
25    the hospital transformation pool to increase base rates,
26    develop new adjustors, adjust current adjustors, or

 

 

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1    develop new access payments in order to support and
2    incentivize hospitals to pursue such transformation. In
3    developing such methodologies, the Department shall ensure
4    that the entire hospital transformation pool continues to
5    be expended to ensure access to hospital services or to
6    support organizations that had received hospital
7    transformation payments under this Section.
8            (A) Any hospital participating in the hospital
9        transformation program shall provide an opportunity
10        for public input by local community groups, hospital
11        workers, and healthcare professionals and assist in
12        facilitating discussions about any transformations or
13        changes to the hospital.
14            (B) As provided in paragraph (9) of Section 3 of
15        the Illinois Health Facilities Planning Act, any
16        hospital participating in the transformation program
17        may be excluded from the requirements of the Illinois
18        Health Facilities Planning Act for those projects
19        related to the hospital's transformation. To be
20        eligible, the hospital must submit to the Health
21        Facilities and Services Review Board certification
22        from the Department, approved by the Hospital
23        Transformation Review Committee, that the project is a
24        part of the hospital's transformation.
25            (C) As provided in subsection (a-20) of Section
26        32.5 of the Emergency Medical Services (EMS) Systems

 

 

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1        Act, a hospital that received hospital transformation
2        payments under this Section may convert to a
3        freestanding emergency center. To be eligible for such
4        a conversion, the hospital must submit to the
5        Department of Public Health certification from the
6        Department, approved by the Hospital Transformation
7        Review Committee, that the project is a part of the
8        hospital's transformation.
9        (2.5) The hospital transformation payment amount
10    allocated to a facility in State fiscal years 2019 through
11    2020 as provided under paragraph (1) shall not be reduced
12    or altered during State fiscal years 2021 and 2022 if:
13            (i) the facility is located in a county having a
14        population of more than 3,000,000; and
15            (ii) the facility was a licensed general acute care
16        hospital that discontinued operations as a hospital on
17        October 22, 2019 and has a Health Facilities and
18        Services Review Board project number of E-024-19.
19        The hospital transformation payment amount shall
20    instead be paid to any entity that purchases the facility
21    for the purpose of converting the facility to a
22    freestanding emergency center as provided in subsection
23    (a-7) of Section 32.5 of the Emergency Medical Services
24    (EMS) Systems Act, pending approval by the Health
25    Facilities and Services Review Board of the permit to
26    establish a freestanding emergency center as defined by the

 

 

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1    Health Facilities and Services Review Board.
2        (3) By April 1, 2019, March 12, 2018 (Public Act
3    100-581) the Department, in conjunction with the Hospital
4    Transformation Review Committee, shall develop and file as
5    an administrative rule with the Secretary of State the
6    goals, objectives, policies, standards, payment models, or
7    criteria to be applied in Phase 2 of the program to
8    allocate the hospital transformation funds. The goals,
9    objectives, and policies to be considered may include, but
10    are not limited to, achieving unmet needs of a community
11    that a hospital serves such as behavioral health services,
12    outpatient services, or drug rehabilitation services;
13    attaining certain quality or patient safety benchmarks for
14    health care services; or improving the coordination,
15    effectiveness, and efficiency of care delivery.
16    Notwithstanding any other provision of law, any rule
17    adopted in accordance with this subsection (d-5) may be
18    submitted to the Joint Committee on Administrative Rules
19    for approval only if the rule has first been approved by 9
20    of the 14 members of the Hospital Transformation Review
21    Committee.
22        (4) Hospital Transformation Review Committee. There is
23    created the Hospital Transformation Review Committee. The
24    Committee shall consist of 14 members. No later than 30
25    days after March 12, 2018 (the effective date of Public Act
26    100-581), the 4 legislative leaders shall each appoint 3

 

 

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1    members; the Governor shall appoint the Director of
2    Healthcare and Family Services, or his or her designee, as
3    a member; and the Director of Healthcare and Family
4    Services shall appoint one member. Any vacancy shall be
5    filled by the applicable appointing authority within 15
6    calendar days. The members of the Committee shall select a
7    Chair and a Vice-Chair from among its members, provided
8    that the Chair and Vice-Chair cannot be appointed by the
9    same appointing authority and must be from different
10    political parties. The Chair shall have the authority to
11    establish a meeting schedule and convene meetings of the
12    Committee, and the Vice-Chair shall have the authority to
13    convene meetings in the absence of the Chair. The Committee
14    may establish its own rules with respect to meeting
15    schedule, notice of meetings, and the disclosure of
16    documents; however, the Committee shall not have the power
17    to subpoena individuals or documents and any rules must be
18    approved by 9 of the 14 members. The Committee shall
19    perform the functions described in this Section and advise
20    and consult with the Director in the administration of this
21    Section. In addition to reviewing and approving the
22    policies, procedures, and rules for the hospital
23    transformation program, the Committee shall consider and
24    make recommendations related to qualifying criteria and
25    payment methodologies related to safety-net hospitals and
26    children's hospitals. Members of the Committee appointed

 

 

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1    by the legislative leaders shall be subject to the
2    jurisdiction of the Legislative Ethics Commission, not the
3    Executive Ethics Commission, and all requests under the
4    Freedom of Information Act shall be directed to the
5    applicable Freedom of Information officer for the General
6    Assembly. The Department shall provide operational support
7    to the Committee as necessary. The Committee is dissolved
8    on April 1, 2019.
9    (e) Beginning 36 months after initial implementation, the
10Department shall update the reimbursement components in
11subsections (a) and (b), including standardized amounts and
12weighting factors, and at least triennially and no more
13frequently than annually thereafter. The Department shall
14publish these updates on its website no later than 30 calendar
15days prior to their effective date.
16    (f) Continuation of supplemental payments. Any
17supplemental payments authorized under Illinois Administrative
18Code 148 effective January 1, 2014 and that continue during the
19period of July 1, 2014 through December 31, 2014 shall remain
20in effect as long as the assessment imposed by Section 5A-2
21that is in effect on December 31, 2017 remains in effect.
22    (g) Notwithstanding subsections (a) through (f) of this
23Section and notwithstanding the changes authorized under
24Section 5-5b.1, any updates to the system shall not result in
25any diminishment of the overall effective rates of
26reimbursement as of the implementation date of the new system

 

 

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1(July 1, 2014). These updates shall not preclude variations in
2any individual component of the system or hospital rate
3variations. Nothing in this Section shall prohibit the
4Department from increasing the rates of reimbursement or
5developing payments to ensure access to hospital services.
6Nothing in this Section shall be construed to guarantee a
7minimum amount of spending in the aggregate or per hospital as
8spending may be impacted by factors, including, but not limited
9to, the number of individuals in the medical assistance program
10and the severity of illness of the individuals.
11    (h) The Department shall have the authority to modify by
12rulemaking any changes to the rates or methodologies in this
13Section as required by the federal government to obtain federal
14financial participation for expenditures made under this
15Section.
16    (i) Except for subsections (g) and (h) of this Section, the
17Department shall, pursuant to subsection (c) of Section 5-40 of
18the Illinois Administrative Procedure Act, provide for
19presentation at the June 2014 hearing of the Joint Committee on
20Administrative Rules (JCAR) additional written notice to JCAR
21of the following rules in order to commence the second notice
22period for the following rules: rules published in the Illinois
23Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
24(Medical Payment), 4628 (Specialized Health Care Delivery
25Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
26Grouping (DRG) Prospective Payment System (PPS)), and 4977

 

 

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1(Hospital Reimbursement Changes), and published in the
2Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
3(Specialized Health Care Delivery Systems) and 6505 (Hospital
4Services).
5    (j) Out-of-state hospitals. Beginning July 1, 2018, for
6purposes of determining for State fiscal years 2019 and 2020
7the hospitals eligible for the payments authorized under
8subsections (a) and (b) of this Section, the Department shall
9include out-of-state hospitals that are designated a Level I
10pediatric trauma center or a Level I trauma center by the
11Department of Public Health as of December 1, 2017.
12    (k) The Department shall notify each hospital and managed
13care organization, in writing, of the impact of the updates
14under this Section at least 30 calendar days prior to their
15effective date.
16(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
17101-0081, eff. 7-12-19; revised 7-29-19.)
 
18    Section 99. Effective date. This Act takes effect upon
19becoming law.".