Sen. Heather A. Steans

Filed: 1/12/2021

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 1653

2    AMENDMENT NO. ______. Amend House Bill 1653 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 14-12 as follows:
 
6    (305 ILCS 5/14-12)
7    Sec. 14-12. Hospital rate reform payment system. The
8hospital payment system pursuant to Section 14-11 of this
9Article shall be as follows:
10    (a) Inpatient hospital services. Effective for discharges
11on and after July 1, 2014, reimbursement for inpatient general
12acute care services shall utilize the All Patient Refined
13Diagnosis Related Grouping (APR-DRG) software, version 30,
14distributed by 3MTM Health Information System.
15        (1) The Department shall establish Medicaid weighting
16    factors to be used in the reimbursement system established

 

 

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

 

 

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1    inpatient rates on its website no later than 10 calendar
2    days prior to their effective date.
3        (6) Beginning July 1, 2014 and ending on June 30, 2024,
4    in addition to the statewide-standardized amount, the
5    Department shall develop an adjustor to adjust the rate of
6    reimbursement for safety-net hospitals defined in Section
7    5-5e.1 of this Code excluding pediatric hospitals.
8        (7) Beginning July 1, 2014, in addition to the
9    statewide-standardized amount, the Department shall
10    develop an adjustor to adjust the rate of reimbursement for
11    Illinois freestanding inpatient psychiatric hospitals that
12    are not designated as children's hospitals by the
13    Department but are primarily treating patients under the
14    age of 21.
15        (7.5) (Blank).
16        (8) Beginning July 1, 2018, in addition to the
17    statewide-standardized amount, the Department shall adjust
18    the rate of reimbursement for hospitals designated by the
19    Department of Public Health as a Perinatal Level II or II+
20    center by applying the same adjustor that is applied to
21    Perinatal and Obstetrical care cases for Perinatal Level
22    III centers, as of December 31, 2017.
23        (9) Beginning July 1, 2018, in addition to the
24    statewide-standardized amount, the Department shall apply
25    the same adjustor that is applied to trauma cases as of
26    December 31, 2017 to inpatient claims to treat patients

 

 

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1    with burns, including, but not limited to, APR-DRGs 841,
2    842, 843, and 844.
3        (10) Beginning July 1, 2018, the
4    statewide-standardized amount for inpatient general acute
5    care services shall be uniformly increased so that base
6    claims projected reimbursement is increased by an amount
7    equal to the funds allocated in paragraph (1) of subsection
8    (b) of Section 5A-12.6, less the amount allocated under
9    paragraphs (8) and (9) of this subsection and paragraphs
10    (3) and (4) of subsection (b) multiplied by 40%.
11        (11) Beginning July 1, 2018, the reimbursement for
12    inpatient rehabilitation services shall be increased by
13    the addition of a $96 per day add-on.
14    (b) Outpatient hospital services. Effective for dates of
15service on and after July 1, 2014, reimbursement for outpatient
16services shall utilize the Enhanced Ambulatory Procedure
17Grouping (EAPG) software, version 3.7 distributed by 3MTM
18Health Information System.
19        (1) The Department shall establish Medicaid weighting
20    factors to be used in the reimbursement system established
21    under this subsection. The initial weighting factors shall
22    be the weighting factors as published by 3M Health
23    Information System, associated with Version 3.7.
24        (2) The Department shall establish service specific
25    statewide-standardized amounts to be used in the
26    reimbursement system.

 

 

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1            (A) The initial statewide standardized amounts,
2        with the labor portion adjusted by the Calendar Year
3        2013 Medicare Outpatient Prospective Payment System
4        wage index with reclassifications, shall be published
5        by the Department on its website no later than 10
6        calendar days prior to their effective date.
7            (B) The Department shall establish adjustments to
8        the statewide-standardized amounts for each Critical
9        Access Hospital, as designated by the Department of
10        Public Health in accordance with 42 CFR 485, Subpart F.
11        For outpatient services provided on or before June 30,
12        2018, the EAPG standardized amounts are determined
13        separately for each critical access hospital such that
14        simulated EAPG payments using outpatient base period
15        paid claim data plus payments under Section 5A-12.4 of
16        this Code net of the associated tax costs are equal to
17        the estimated costs of outpatient base period claims
18        data with a rate year cost inflation factor applied.
19        (3) In addition to the statewide-standardized amounts,
20    the Department shall develop adjusters to adjust the rate
21    of reimbursement for critical Medicaid hospital outpatient
22    providers or services, including outpatient high volume or
23    safety-net hospitals. Beginning July 1, 2018, the
24    outpatient high volume adjustor shall be increased to
25    increase annual expenditures associated with this adjustor
26    by $79,200,000, based on the State Fiscal Year 2015 base

 

 

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1    year data and this adjustor shall apply to public
2    hospitals, except for large public hospitals, as defined
3    under 89 Ill. Adm. Code 148.25(a).
4        (4) Beginning July 1, 2018, in addition to the
5    statewide standardized amounts, the Department shall make
6    an add-on payment for outpatient expensive devices and
7    drugs. This add-on payment shall at least apply to claim
8    lines that: (i) are assigned with one of the following
9    EAPGs: 490, 1001 to 1020, and coded with one of the
10    following revenue codes: 0274 to 0276, 0278; or (ii) are
11    assigned with one of the following EAPGs: 430 to 441, 443,
12    444, 460 to 465, 495, 496, 1090. The add-on payment shall
13    be calculated as follows: the claim line's covered charges
14    multiplied by the hospital's total acute cost to charge
15    ratio, less the claim line's EAPG payment plus $1,000,
16    multiplied by 0.8.
17        (5) Beginning July 1, 2018, the statewide-standardized
18    amounts for outpatient services shall be increased by a
19    uniform percentage so that base claims projected
20    reimbursement is increased by an amount equal to no less
21    than the funds allocated in paragraph (1) of subsection (b)
22    of Section 5A-12.6, less the amount allocated under
23    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
24    and (4) of this subsection multiplied by 46%.
25        (6) Effective for dates of service on or after July 1,
26    2018, the Department shall establish adjustments to the

 

 

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1    statewide-standardized amounts for each Critical Access
2    Hospital, as designated by the Department of Public Health
3    in accordance with 42 CFR 485, Subpart F, such that each
4    Critical Access Hospital's standardized amount for
5    outpatient services shall be increased by the applicable
6    uniform percentage determined pursuant to paragraph (5) of
7    this subsection. It is the intent of the General Assembly
8    that the adjustments required under this paragraph (6) by
9    Public Act 100-1181 shall be applied retroactively to
10    claims for dates of service provided on or after July 1,
11    2018.
12        (7) Effective for dates of service on or after March 8,
13    2019 (the effective date of Public Act 100-1181), the
14    Department shall recalculate and implement an updated
15    statewide-standardized amount for outpatient services
16    provided by hospitals that are not Critical Access
17    Hospitals to reflect the applicable uniform percentage
18    determined pursuant to paragraph (5).
19            (1) Any recalculation to the
20        statewide-standardized amounts for outpatient services
21        provided by hospitals that are not Critical Access
22        Hospitals shall be the amount necessary to achieve the
23        increase in the statewide-standardized amounts for
24        outpatient services increased by a uniform percentage,
25        so that base claims projected reimbursement is
26        increased by an amount equal to no less than the funds

 

 

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1        allocated in paragraph (1) of subsection (b) of Section
2        5A-12.6, less the amount allocated under paragraphs
3        (8) and (9) of subsection (a) and paragraphs (3) and
4        (4) of this subsection, for all hospitals that are not
5        Critical Access Hospitals, multiplied by 46%.
6            (2) It is the intent of the General Assembly that
7        the recalculations required under this paragraph (7)
8        by Public Act 100-1181 shall be applied prospectively
9        to claims for dates of service provided on or after
10        March 8, 2019 (the effective date of Public Act
11        100-1181) and that no recoupment or repayment by the
12        Department or an MCO of payments attributable to
13        recalculation under this paragraph (7), issued to the
14        hospital for dates of service on or after July 1, 2018
15        and before March 8, 2019 (the effective date of Public
16        Act 100-1181), shall be permitted.
17        (8) The Department shall ensure that all necessary
18    adjustments to the managed care organization capitation
19    base rates necessitated by the adjustments under
20    subparagraph (6) or (7) of this subsection are completed
21    and applied retroactively in accordance with Section
22    5-30.8 of this Code within 90 days of March 8, 2019 (the
23    effective date of Public Act 100-1181).
24        (9) Within 60 days after federal approval of the change
25    made to the assessment in Section 5A-2 by this amendatory
26    Act of the 101st General Assembly, the Department shall

 

 

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1    incorporate into the EAPG system for outpatient services
2    those services performed by hospitals currently billed
3    through the Non-Institutional Provider billing system.
4    (c) In consultation with the hospital community, the
5Department is authorized to replace 89 Ill. Admin. Code 152.150
6as published in 38 Ill. Reg. 4980 through 4986 within 12 months
7of June 16, 2014 (the effective date of Public Act 98-651). If
8the Department does not replace these rules within 12 months of
9June 16, 2014 (the effective date of Public Act 98-651), the
10rules in effect for 152.150 as published in 38 Ill. Reg. 4980
11through 4986 shall remain in effect until modified by rule by
12the Department. Nothing in this subsection shall be construed
13to mandate that the Department file a replacement rule.
14    (d) Transition period. There shall be a transition period
15to the reimbursement systems authorized under this Section that
16shall begin on the effective date of these systems and continue
17until June 30, 2018, unless extended by rule by the Department.
18To help provide an orderly and predictable transition to the
19new reimbursement systems and to preserve and enhance access to
20the hospital services during this transition, the Department
21shall allocate a transitional hospital access pool of at least
22$290,000,000 annually so that transitional hospital access
23payments are made to hospitals.
24        (1) After the transition period, the Department may
25    begin incorporating the transitional hospital access pool
26    into the base rate structure; however, the transitional

 

 

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1    hospital access payments in effect on June 30, 2018 shall
2    continue to be paid, if continued under Section 5A-16.
3        (2) After the transition period, if the Department
4    reduces payments from the transitional hospital access
5    pool, it shall increase base rates, develop new adjustors,
6    adjust current adjustors, develop new hospital access
7    payments based on updated information, or any combination
8    thereof by an amount equal to the decreases proposed in the
9    transitional hospital access pool payments, ensuring that
10    the entire transitional hospital access pool amount shall
11    continue to be used for hospital payments.
12    (d-5) Hospital and health care transformation program. The
13Department shall develop a hospital and health care
14transformation program to provide financial assistance to
15hospitals in transforming their services and care models to
16better align with the needs of the communities they serve. The
17payments authorized in this Section shall be subject to
18approval by the federal government.
19        (1) Phase 1. In State fiscal years 2019 through 2020,
20    the Department shall allocate funds from the transitional
21    access hospital pool to create a hospital transformation
22    pool of at least $262,906,870 annually and make hospital
23    transformation payments to hospitals. Subject to Section
24    5A-16, in State fiscal years 2019 and 2020, an Illinois
25    hospital that received either a transitional hospital
26    access payment under subsection (d) or a supplemental

 

 

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1    payment under subsection (f) of this Section in State
2    fiscal year 2018, shall receive a hospital transformation
3    payment as follows:
4            (A) If the hospital's Rate Year 2017 Medicaid
5        inpatient utilization rate is equal to or greater than
6        45%, the hospital transformation payment shall be
7        equal to 100% of the sum of its transitional hospital
8        access payment authorized under subsection (d) and any
9        supplemental payment authorized under subsection (f).
10            (B) If the hospital's Rate Year 2017 Medicaid
11        inpatient utilization rate is equal to or greater than
12        25% but less than 45%, the hospital transformation
13        payment shall be equal to 75% of the sum of its
14        transitional hospital access payment authorized under
15        subsection (d) and any supplemental payment authorized
16        under subsection (f).
17            (C) If the hospital's Rate Year 2017 Medicaid
18        inpatient utilization rate is less than 25%, the
19        hospital transformation payment shall be equal to 50%
20        of the sum of its transitional hospital access payment
21        authorized under subsection (d) and any supplemental
22        payment authorized under subsection (f).
23        (2) Phase 2.
24            (A) The funding amount from phase one shall be
25        incorporated into directed payment and pass-through
26        payment methodologies described in Section 5A-12.7.

 

 

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1            (B) Because there are communities in Illinois that
2        experience significant health care disparities due to
3        systemic racism, as recently emphasized by the
4        COVID-19 pandemic, aggravated by social determinants
5        of health and a lack of sufficiently allocated
6        healthcare resources, particularly community-based
7        services, preventive care, obstetric care, chronic
8        disease management, and specialty care, the Department
9        shall establish a health care transformation program
10        that shall be supported by the transformation funding
11        pool. It is the intention of the General Assembly that
12        innovative partnerships funded by the pool must be
13        designed to establish or improve integrated health
14        care delivery systems that will provide significant
15        access to the Medicaid and uninsured populations in
16        their communities, as well as improve health care
17        equity. It is also the intention of the General
18        Assembly that partnerships recognize and address the
19        disparities revealed by the COVID-19 pandemic, as well
20        as the need for post-COVID care. During State fiscal
21        years 2021 through 2027, the hospital and health care
22        transformation program shall be supported by an annual
23        transformation funding pool of up to $150,000,000,
24        pending federal matching funds, to be allocated during
25        the specified fiscal years for the purpose of
26        facilitating hospital and health care transformation.

 

 

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1        No disbursement of moneys for transformation projects
2        from the transformation funding pool described under
3        this Section shall be considered an award, a grant, or
4        an expenditure of grant funds. Funding agreements made
5        in accordance with the transformation program shall be
6        considered purchases of care under the Illinois
7        Procurement Code, and funds shall be expended by the
8        Department in a manner that maximizes federal funding
9        to expend the entire allocated amount.
10            The Department shall convene, within 30 days after
11        the effective date of this amendatory Act of the 101st
12        General Assembly, a workgroup that includes subject
13        matter experts on healthcare disparities and
14        stakeholders from distressed communities, which could
15        be a subcommittee of the Medicaid Advisory Committee,
16        to review and provide recommendations on how
17        Department policy, including health care
18        transformation, can improve health disparities and the
19        impact on communities disproportionately affected by
20        COVID-19. The workgroup shall consider and make
21        recommendations on the following issues: a community
22        safety-net designation of certain hospitals, racial
23        equity, and a regional partnership to bring additional
24        specialty services to communities. Whereas there are
25        communities in Illinois that suffer from significant
26        health care disparities aggravated by social

 

 

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1        determinants of health and a lack of sufficiently
2        allocated healthcare resources, particularly
3        community-based services and preventive care, there is
4        established a new hospital and health care
5        transformation program, which shall be supported by a
6        transformation funding pool. An application for
7        funding from the hospital and health care
8        transformation program may incorporate the campus of a
9        hospital closed after January 1, 2018 or a hospital
10        that has provided notice of its intent to close
11        pursuant to Section 8.7 of the Illinois Health
12        Facilities Planning Act. During State Fiscal Years
13        2021 through 2023, the hospital and health care
14        transformation program shall be supported by an annual
15        transformation funding pool of at least $150,000,000
16        to be allocated during the specified fiscal years for
17        the purpose of facilitating hospital and health care
18        transformation. The Department shall not allocate
19        funds associated with the hospital and health care
20        transformation pool as established in this
21        subparagraph until the General Assembly has
22        established in law or resolution, further criteria for
23        dispersal or allocation of those funds after the
24        effective date of this amendatory Act of 101st General
25        Assembly.
26            (C) As provided in paragraph (9) of Section 3 of

 

 

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1        the Illinois Health Facilities Planning Act, any
2        hospital participating in the transformation program
3        may be excluded from the requirements of the Illinois
4        Health Facilities Planning Act for those projects
5        related to the hospital's transformation. To be
6        eligible, the hospital must submit to the Health
7        Facilities and Services Review Board approval from the
8        Department that the project is a part of the hospital's
9        transformation.
10            (D) As provided in subsection (a-20) of Section
11        32.5 of the Emergency Medical Services (EMS) Systems
12        Act, a hospital that received hospital transformation
13        payments under this Section may convert to a
14        freestanding emergency center. To be eligible for such
15        a conversion, the hospital must submit to the
16        Department of Public Health approval from the
17        Department that the project is a part of the hospital's
18        transformation.
19            (E) Criteria for proposals. To be eligible for
20        funding under this Section, a transformation proposal
21        shall meet all of the following criteria:
22                (i) the proposal shall be designed based on
23            community needs assessment completed by either a
24            University partner or other qualified entity with
25            significant community input;
26                (ii) the proposal shall be a collaboration

 

 

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1            among providers across the care and community
2            spectrum, including preventative care, primary
3            care specialty care, hospital services, mental
4            health and substance abuse services, as well as
5            community-based entities that address the social
6            determinants of health;
7                (iii) the proposal shall be specifically
8            designed to improve healthcare outcomes and reduce
9            healthcare disparities, and improve the
10            coordination, effectiveness, and efficiency of
11            care delivery;
12                (iv) the proposal shall have specific
13            measurable metrics related to disparities that
14            will be tracked by the Department and made public
15            by the Department;
16                (v) the proposal shall include a commitment to
17            include Business Enterprise Program certified
18            vendors or other entities controlled and managed
19            by minorities or women; and
20                (vi) the proposal shall specifically increase
21            access to primary, preventive, or specialty care.
22            (F) Entities eligible to be funded.
23                (i) Proposals for funding should come from
24            collaborations operating in one of the most
25            distressed communities in Illinois as determined
26            by the U.S. Centers for Disease Control and

 

 

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1            Prevention's Social Vulnerability Index for
2            Illinois and areas disproportionately impacted by
3            COVID-19 or from rural areas of Illinois.
4                (ii) The Department shall prioritize
5            partnerships from distressed communities, which
6            include Business Enterprise Program certified
7            vendors or other entities controlled and managed
8            by minorities or women and also include one or more
9            of the following: safety-net hospitals, critical
10            access hospitals, the campuses of hospitals that
11            have closed since January 1, 2018, or other
12            healthcare providers designed to address specific
13            healthcare disparities, including the impact of
14            COVID-19 on individuals and the community and the
15            need for post-COVID care. All funded proposals
16            must include specific measurable goals and metrics
17            related to improved outcomes and reduced
18            disparities which shall be tracked by the
19            Department.
20                (iii) The Department should target the funding
21            in the following ways: $30,000,000 of
22            transformation funds to projects that are a
23            collaboration between a safety-net hospital,
24            particularly community safety-net hospitals, and
25            other providers and designed to address specific
26            healthcare disparities, $20,000,000 of

 

 

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1            transformation funds to collaborations between
2            safety-net hospitals and a larger hospital partner
3            that increases specialty care in distressed
4            communities, $30,000,000 of transformation funds
5            to projects that are a collaboration between
6            hospitals and other providers in distressed areas
7            of the State designed to address specific
8            healthcare disparities, $15,000,000 to
9            collaborations between critical access hospitals
10            and other providers designed to address specific
11            healthcare disparities, and $15,000,000 to
12            cross-provider collaborations designed to address
13            specific healthcare disparities, and $5,000,000 to
14            collaborations that focus on workforce
15            development.
16                (iv) The Department may allocate up to
17            $5,000,000 for planning, racial equity analysis,
18            or consulting resources for the Department or
19            entities without the resources to develop a plan to
20            meet the criteria of this Section. Any contract for
21            consulting services issued by the Department under
22            this subparagraph shall comply with the provisions
23            of Section 5-45 of the State Officials and
24            Employees Ethics Act. Based on availability of
25            federal funding, the Department may directly
26            procure consulting services or provide funding to

 

 

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1            the collaboration. The provision of resources
2            under this subparagraph is not a guarantee that a
3            project will be approved.
4                (v) The Department shall take steps to ensure
5            that safety-net hospitals operating in
6            under-resourced communities receive priority
7            access to hospital and healthcare transformation
8            funds, including consulting funds, as provided
9            under this Section.
10            (G) Process for submitting and approving projects
11        for distressed communities. The Department shall issue
12        a template for application. The Department shall post
13        any proposal received on the Department's website for
14        at least 2 weeks for public comment, and any such
15        public comment shall also be considered in the review
16        process. Applicants may request that proprietary
17        financial information be redacted from publicly posted
18        proposals and the Department in its discretion may
19        agree. Proposals for each distressed community must
20        include all of the following:
21                (i) A detailed description of how the project
22            intends to affect the goals outlined in this
23            subsection, describing new interventions, new
24            technology, new structures, and other changes to
25            the healthcare delivery system planned.
26                (ii) A detailed description of the racial and

 

 

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1            ethnic makeup of the entities' board and
2            leadership positions and the salaries of the
3            executive staff of entities in the partnership
4            that is seeking to obtain funding under this
5            Section.
6                (iii) A complete budget, including an overall
7            timeline and a detailed pathway to sustainability
8            within a 5-year period, specifying other sources
9            of funding, such as in-kind, cost-sharing, or
10            private donations, particularly for capital needs.
11            There is an expectation that parties to the
12            transformation project dedicate resources to the
13            extent they are able and that these expectations
14            are delineated separately for each entity in the
15            proposal.
16                (iv) A description of any new entities formed
17            or other legal relationships between collaborating
18            entities and how funds will be allocated among
19            participants.
20                (v) A timeline showing the evolution of sites
21            and specific services of the project over a 5-year
22            period, including services available to the
23            community by site.
24                (vi) Clear milestones indicating progress
25            toward the proposed goals of the proposal as
26            checkpoints along the way to continue receiving

 

 

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1            funding. The Department is authorized to refine
2            these milestones in agreements, and is authorized
3            to impose reasonable penalties, including
4            repayment of funds, for substantial lack of
5            progress.
6                (vii) A clear statement of the level of
7            commitment the project will include for minorities
8            and women in contracting opportunities, including
9            as equity partners where applicable, or as
10            subcontractors and suppliers in all phases of the
11            project.
12                (viii) If the community study utilized is not
13            the study commissioned and published by the
14            Department, the applicant must define the
15            methodology used, including documentation of clear
16            community participation.
17                (ix) A description of the process used in
18            collaborating with all levels of government in the
19            community served in the development of the
20            project, including, but not limited to,
21            legislators and officials of other units of local
22            government.
23                (x) Documentation of a community input process
24            in the community served, including links to
25            proposal materials on public websites.
26                (xi) Verifiable project milestones and quality

 

 

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1            metrics that will be impacted by transformation.
2            These project milestones and quality metrics must
3            be identified with improvement targets that must
4            be met.
5                (xii) Data on the number of existing employees
6            by various job categories and wage levels by the
7            zip code of the employees' residence and
8            benchmarks for the continued maintenance and
9            improvement of these levels. The proposal must
10            also describe any retraining or other workforce
11            development planned for the new project.
12                (xiii) If a new entity is created by the
13            project, a description of how the board will be
14            reflective of the community served by the
15            proposal.
16                (xiv) An explanation of how the proposal will
17            address the existing disparities that exacerbated
18            the impact of COVID-19 and the need for post-COVID
19            care in the community, if applicable.
20                (xv) An explanation of how the proposal is
21            designed to increase access to care, including
22            specialty care based upon the community's needs.
23            (H) The Department shall evaluate proposals for
24        compliance with the criteria listed under subparagraph
25        (G). Proposals meeting all of the criteria may be
26        eligible for funding with the areas of focus

 

 

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1        prioritized as described in item (ii) of subparagraph
2        (F). Based on the funds available, the Department may
3        negotiate funding agreements with approved applicants
4        to maximize federal funding. Nothing in this
5        subsection requires that an approved project be funded
6        to the level requested. Agreements shall specify the
7        amount of funding anticipated annually, the
8        methodology of payments, the limit on the number of
9        years such funding may be provided, and the milestones
10        and quality metrics that must be met by the projects in
11        order to continue to receive funding during each year
12        of the program. Agreements shall specify the terms and
13        conditions under which a health care facility that
14        receives funds under a purchase of care agreement and
15        closes in violation of the terms of the agreement must
16        pay an early closure fee no greater than 50% of the
17        funds it received under the agreement, prior to the
18        Health Facilities and Services Review Board
19        considering an application for closure of the
20        facility. Any project that is funded shall be required
21        to provide quarterly written progress reports, in a
22        form prescribed by the Department, and at a minimum
23        shall include the progress made in achieving any
24        milestones or metrics or Business Enterprise Program
25        commitments in its plan. The Department may reduce or
26        end payments, as set forth in transformation plans, if

 

 

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1        milestones or metrics or Business Enterprise Program
2        commitments are not achieved. The Department shall
3        seek to make payments from the transformation fund in a
4        manner that is eligible for federal matching funds.
5            In reviewing the proposals, the Department shall
6        take into account the needs of the community, data from
7        the study commissioned by the Department from the
8        University of Illinois-Chicago if applicable, feedback
9        from public comment on the Department's website, as
10        well as how the proposal meets the criteria listed
11        under subparagraph (G). Alignment with the
12        Department's overall strategic initiatives shall be an
13        important factor. To the extent that fiscal year
14        funding is not adequate to fund all eligible projects
15        that apply, the Department shall prioritize
16        applications that most comprehensively and effectively
17        address the criteria listed under subparagraph (G).
18        (3) (Blank).
19        (4) Hospital Transformation Review Committee. There is
20    created the Hospital Transformation Review Committee. The
21    Committee shall consist of 14 members. No later than 30
22    days after March 12, 2018 (the effective date of Public Act
23    100-581), the 4 legislative leaders shall each appoint 3
24    members; the Governor shall appoint the Director of
25    Healthcare and Family Services, or his or her designee, as
26    a member; and the Director of Healthcare and Family

 

 

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

 

 

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1    Freedom of Information Act shall be directed to the
2    applicable Freedom of Information officer for the General
3    Assembly. The Department shall provide operational support
4    to the Committee as necessary. The Committee is dissolved
5    on April 1, 2019.
6    (e) Beginning 36 months after initial implementation, the
7Department shall update the reimbursement components in
8subsections (a) and (b), including standardized amounts and
9weighting factors, and at least triennially and no more
10frequently than annually thereafter. The Department shall
11publish these updates on its website no later than 30 calendar
12days prior to their effective date.
13    (f) Continuation of supplemental payments. Any
14supplemental payments authorized under Illinois Administrative
15Code 148 effective January 1, 2014 and that continue during the
16period of July 1, 2014 through December 31, 2014 shall remain
17in effect as long as the assessment imposed by Section 5A-2
18that is in effect on December 31, 2017 remains in effect.
19    (g) Notwithstanding subsections (a) through (f) of this
20Section and notwithstanding the changes authorized under
21Section 5-5b.1, any updates to the system shall not result in
22any diminishment of the overall effective rates of
23reimbursement as of the implementation date of the new system
24(July 1, 2014). These updates shall not preclude variations in
25any individual component of the system or hospital rate
26variations. Nothing in this Section shall prohibit the

 

 

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1Department from increasing the rates of reimbursement or
2developing payments to ensure access to hospital services.
3Nothing in this Section shall be construed to guarantee a
4minimum amount of spending in the aggregate or per hospital as
5spending may be impacted by factors, including, but not limited
6to, the number of individuals in the medical assistance program
7and the severity of illness of the individuals.
8    (h) The Department shall have the authority to modify by
9rulemaking any changes to the rates or methodologies in this
10Section as required by the federal government to obtain federal
11financial participation for expenditures made under this
12Section.
13    (i) Except for subsections (g) and (h) of this Section, the
14Department shall, pursuant to subsection (c) of Section 5-40 of
15the Illinois Administrative Procedure Act, provide for
16presentation at the June 2014 hearing of the Joint Committee on
17Administrative Rules (JCAR) additional written notice to JCAR
18of the following rules in order to commence the second notice
19period for the following rules: rules published in the Illinois
20Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
21(Medical Payment), 4628 (Specialized Health Care Delivery
22Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
23Grouping (DRG) Prospective Payment System (PPS)), and 4977
24(Hospital Reimbursement Changes), and published in the
25Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
26(Specialized Health Care Delivery Systems) and 6505 (Hospital

 

 

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1Services).
2    (j) Out-of-state hospitals. Beginning July 1, 2018, for
3purposes of determining for State fiscal years 2019 and 2020
4and subsequent fiscal years the hospitals eligible for the
5payments authorized under subsections (a) and (b) of this
6Section, the Department shall include out-of-state hospitals
7that are designated a Level I pediatric trauma center or a
8Level I trauma center by the Department of Public Health as of
9December 1, 2017.
10    (k) The Department shall notify each hospital and managed
11care organization, in writing, of the impact of the updates
12under this Section at least 30 calendar days prior to their
13effective date.
14(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
15101-81, eff. 7-12-19; 101-650, eff. 7-7-20.)
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.".