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Public Act 096-1405


 

Public Act 1405 96TH GENERAL ASSEMBLY



 


 
Public Act 096-1405
 
SB3762 EnrolledLRB096 20714 KTG 36441 b

    AN ACT concerning regulation.
 
    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
adding Section 12-4.40 as follows:
 
    (305 ILCS 5/12-4.40 new)
    Sec. 12-4.40. Medicaid Revenue Maximization.
    (a) Purpose. The General Assembly finds that there is a
need to make changes to the administration of services provided
by State and local governments in order to maximize federal
financial participation.
    (b) Definitions. As used in this Section:
    "Community Medicaid mental health services" means all
mental health services outlined in Section 132 of Title 59 of
the Illinois Administrative Code that are funded through DHS,
eligible for federal financial participation, and provided by a
community-based provider.
    "Community-based provider" means an entity enrolled as a
provider pursuant to Sections 140.11 and 140.12 of Title 89 of
the Illinois Administrative Code and certified to provide
community Medicaid mental health services in accordance with
Section 132 of Title 59 of the Illinois Administrative Code.
    "DCFS" means the Department of Children and Family
Services.
    "Department" means the Illinois Department of Healthcare
and Family Services.
    "Developmentally disabled care facility" means an
intermediate care facility for the mentally retarded within the
meaning of Title XIX of the Social Security Act, whether public
or private and whether organized for profit or not-for-profit,
but shall not include any facility operated by the State.
    "Developmentally disabled care provider" means a person
conducting, operating, or maintaining a developmentally
disabled care facility. For purposes of this definition,
"person" means any political subdivision of the State,
municipal corporation, individual, firm, partnership,
corporation, company, limited liability company, association,
joint stock association, or trust, or a receiver, executor,
trustee, guardian, or other representative appointed by order
of any court.
    "DHS" means the Illinois Department of Human Services.
    "Hospital" means an institution, place, building, or
agency located in this State that is licensed as a general
acute hospital by the Illinois Department of Public Health
under the Hospital Licensing Act, whether public or private and
whether organized for profit or not-for-profit.
    "Long term care facility" means (i) a skilled nursing or
intermediate long term care facility, whether public or private
and whether organized for profit or not-for-profit, that is
subject to licensure by the Illinois Department of Public
Health under the Nursing Home Care Act, including a county
nursing home directed and maintained under Section 5-1005 of
the Counties Code, and (ii) a part of a hospital in which
skilled or intermediate long term care services within the
meaning of Title XVIII or XIX of the Social Security Act are
provided; except that the term "long term care facility" does
not include a facility operated solely as an intermediate care
facility for the mentally retarded within the meaning of Title
XIX of the Social Security Act.
    "Long term care provider" means (i) a person licensed by
the Department of Public Health to operate and maintain a
skilled nursing or intermediate long term care facility or (ii)
a hospital provider that provides skilled or intermediate long
term care services within the meaning of Title XVIII or XIX of
the Social Security Act. For purposes of this definition,
"person" means any political subdivision of the State,
municipal corporation, individual, firm, partnership,
corporation, company, limited liability company, association,
joint stock association, or trust, or a receiver, executor,
trustee, guardian, or other representative appointed by order
of any court.
    "State-operated developmentally disabled care facility"
means an intermediate care facility for the mentally retarded
within the meaning of Title XIX of the Social Security Act
operated by the State.
    (c) Administration and deposit of Revenues. The Department
shall coordinate the implementation of changes required by this
amendatory Act of the 96th General Assembly amongst the various
State and local government bodies that administer programs
referred to in this Section.
    Revenues generated by program changes mandated by any
provision in this Section, less reasonable administrative
costs associated with the implementation of these program
changes, shall be deposited into the Healthcare Provider Relief
Fund.
    The Department shall issue a report to the General Assembly
detailing the implementation progress of this amendatory Act of
the 96th General Assembly as a part of the Department's Medical
Programs annual report for fiscal years 2010 and 2011.
    (d) Acceleration of payment vouchers. To the extent
practicable and permissible under federal law, the Department
shall create all vouchers for long term care facilities and
developmentally disabled care facilities for dates of service
in the month in which the enhanced federal medical assistance
percentage (FMAP) originally set forth in the American Recovery
and Reinvestment Act (ARRA) expires and for dates of service in
the month prior to that month and shall, no later than the 15th
of the month in which the enhanced FMAP expires, submit these
vouchers to the Comptroller for payment.
    The Department of Human Services shall create the necessary
documentation for State-operated developmentally disabled care
facilities so that the necessary data for all dates of service
before the expiration of the enhanced FMAP originally set forth
in the ARRA can be adjudicated by the Department no later than
the 15th of the month in which the enhanced FMAP expires.
    (e) Billing of DHS community Medicaid mental health
services. No later than July 1, 2011, community Medicaid mental
health services provided by a community-based provider must be
billed directly to the Department.
    (f) DCFS Medicaid services. The Department shall work with
DCFS to identify existing programs, pending qualifying
services, that can be converted in an economically feasible
manner to Medicaid in order to secure federal financial
revenue.
    (g) Third Party Liability recoveries. The Department shall
contract with a vendor to support the Department in
coordinating benefits for Medicaid enrollees. The scope of work
shall include, at a minimum, the identification of other
insurance for Medicaid enrollees and the recovery of funds paid
by the Department when another payer was liable. The vendor may
be paid a percentage of actual cash recovered when practical
and subject to federal law.
    (h) Public health departments. The Department shall
identify unreimbursed costs for persons covered by Medicaid who
are served by the Chicago Department of Public Health.
    The Department shall assist the Chicago Department of
Public Health in determining total unreimbursed costs
associated with the provision of healthcare services to
Medicaid enrollees.
    The Department shall determine and draw the maximum
allowable federal matching dollars associated with the cost of
Chicago Department of Public Health services provided to
Medicaid enrollees.
    (i) Acceleration of hospital-based payments. The
Department shall, by the 10th day of the month in which the
enhanced FMAP originally set forth in the ARRA expires, create
vouchers for all State fiscal year 2011 hospital payments
exempt from the prompt payment requirements of the ARRA. The
Department shall submit these vouchers to the Comptroller for
payment.
 
    Section 10. The Community Services Act is amended by adding
Section 4.8 as follows:
 
    (405 ILCS 30/4.8 new)
    Sec. 4.8. Payments for community Medicaid mental health
services.
    (a) No later than July 1, 2011, community Medicaid mental
health services provided by a community-based provider must be
billed directly to the Department of Healthcare and Family
Services.
    (b) For purposes of this Section:
    "Community Medicaid mental health services" means all
mental health services outlined in Section 132 of Title 59 of
the Illinois Administrative Code that are funded through the
Department of Human Services, eligible for federal financial
participation, and provided by a community-based provider.
    "Community-based provider" means an entity enrolled as a
provider pursuant to Sections 140.11 and 140.12 of Title 89 of
the Illinois Administrative Code and certified to provide
community Medicaid mental health services in accordance with
Section 132 of Title 59 of the Illinois Administrative Code.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 7/29/2010