101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB2017

 

Introduced 2/15/2019, by Sen. Martin A. Sandoval

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Covering ALL KIDS Health Insurance Act. Changes the short title of the Act to the Covering ALL KIDS and Young Adults Health Insurance Act and makes conforming changes in various Acts. Changes the name of the Covering ALL KIDS Health Insurance Program to the Covering ALL KIDS Young Adults Health Insurance Program and makes conforming changes. Provides that the Department of Healthcare and Family services shall purchase or provide healthcare benefits for eligible young adults that are identical to the benefits provided for individuals under the Medical Assistance Program established under the Illinois Public Aid Code. Defines young adult.


LRB101 09603 RAB 54701 b

 

 

A BILL FOR

 

SB2017LRB101 09603 RAB 54701 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Mental Health and Developmental
5Disabilities Administrative Act is amended by changing Section
671a as follows:
 
7    (20 ILCS 1705/71a)
8    Sec. 71a. Community Behavioral Health Care.
9    (a) The Department shall strive to guarantee that persons,
10including children, suffering from mental illness, substance
11abuse, and other behavioral disorders have access to locally
12accessible behavioral health care providers who have the
13ability to treat the person's conditions in a cost effective,
14outcome-based manner. To ensure continuity and quality of care
15that is integrated with the person's overall medical care, the
16Department shall:
17        (1) Designate as essential community behavioral health
18    care providers organizations that meet the qualifications
19    set forth in subsection (b) of this Section.
20        (2) Promote the co-location of primary and behavioral
21    health care services centers.
22        (3) Promote access to necessary behavioral health care
23    services in the State's Health Insurance Exchange

 

 

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1    policies.
2        (4) Promote continuity of care for persons moving
3    between Medicaid, SCHIP, and programs administered by the
4    Department that provide behavioral health care services.
5        (5) Promote continuity of care for persons not yet
6    eligible for Medicaid or who are without insurance coverage
7    for their conditions.
8        (6) Work toward improving access in Illinois'
9    underserved and health professional shortage areas.
10    (b) The Department shall designate certain community
11behavioral health care providers as essential community
12behavioral health care providers. To qualify for the
13designation an organization must be a not-for-profit
14organization under the Internal Revenue Code or a governmental
15entity that:
16        (1) Demonstrates a commitment to serving low-income
17    and underserved populations.
18        (2) Provides outcome-based community behavioral health
19    care treatment or services.
20        (3) Does not restrict access or services because of a
21    client's financial limitation.
22        (4) Is a community behavioral health care provider
23    certified by the Department, or a licensed community
24    behavioral health care provider holding a purchase of care
25    contract with the State under the State's Medicaid program.
26    An organization that is licensed or certified by the

 

 

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1Department may apply to the Department for designation as an
2essential community behavioral health care provider. The
3Department, through administrative rule, shall describe the
4standards and process of designating an essential community
5behavioral health care provider, establishing the community to
6be served, other criteria for selection, and grounds for
7termination.
8    (c) An organization designated as an essential community
9behavioral health care provider under subsection (b) and all
10members of the care treatment and service staff of the
11essential community behavioral health care provider shall
12agree to serve enrollees of all health insurers or health care
13service contractors operating in the area that the designated
14essential community behavioral health care provider serves.
15Health insurers shall include State programs funded under Title
16XIX and Title XXI of the federal Social Security Act, including
17the State's Medicaid program and the Covering ALL KIDS and
18Young Adults Health Insurance Program; other programs funded by
19the Department of Healthcare and Family Services for non-public
20employees; and programs for both the insured and uninsured
21funded by the Department of Human Services.
22    (d) An essential community behavioral health care provider
23shall be compensated on a fee-for-service basis within a global
24budget or within a risk-based incentive contract in accordance
25with the contracts and standards of the respective payors.
26Staff members and other health care providers in the service

 

 

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1area of the designated essential community behavioral health
2care provider shall not be restricted from providing care,
3treatment, or services through affiliation with any other
4health insurer or health care service contractor.
5    (e) A designation of a community behavioral health care
6provider as an essential community behavioral health care
7provider shall end 5 years after the date the designation is
8granted. The Department, however, may terminate the
9designation for cause before the end of the 5-year period if
10the essential community behavioral health care provider fails
11to comply with the eligibility standards set forth in
12subsection (b).
13    A designated essential community behavioral health care
14provider may reapply for designation 6 months prior to the
15designation ending and shall provide documented evidence that
16the provider continues to meet all criteria for designation.
17    If the essential community behavioral health care provider
18continues to meet all criteria for designation, the Department
19shall continue the designation for an additional 5-year period.
20(Source: P.A. 97-166, eff. 7-22-11.)
 
21    Section 10. The State Finance Act is amended by changing
22Sections 6z-52, 6z-73, 6z-81, and 25 as follows:
 
23    (30 ILCS 105/6z-52)
24    Sec. 6z-52. Drug Rebate Fund.

 

 

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1    (a) There is created in the State Treasury a special fund
2to be known as the Drug Rebate Fund.
3    (b) The Fund is created for the purpose of receiving and
4disbursing moneys in accordance with this Section.
5Disbursements from the Fund shall be made, subject to
6appropriation, only as follows:
7        (1) For payments for reimbursement or coverage for
8    prescription drugs and other pharmacy products provided to
9    a recipient of medical assistance under the Illinois Public
10    Aid Code, the Children's Health Insurance Program Act, the
11    Covering ALL KIDS and Young Adults Health Insurance Act,
12    and the Veterans' Health Insurance Program Act of 2008.
13        (1.5) For payments to managed care organizations as
14    defined in Section 5-30.1 of the Illinois Public Aid Code.
15        (2) For reimbursement of moneys collected by the
16    Department of Healthcare and Family Services (formerly
17    Illinois Department of Public Aid) through error or
18    mistake.
19        (3) For payments of any amounts that are reimbursable
20    to the federal government resulting from a payment into
21    this Fund.
22        (4) For payments of operational and administrative
23    expenses related to providing and managing coverage for
24    prescription drugs and other pharmacy products provided to
25    a recipient of medical assistance under the Illinois Public
26    Aid Code, the Children's Health Insurance Program Act, the

 

 

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1    Covering ALL KIDS and Young Adults Health Insurance Act,
2    and the Veterans' Health Insurance Program Act of 2008.
3    (c) The Fund shall consist of the following:
4        (1) Upon notification from the Director of Healthcare
5    and Family Services, the Comptroller shall direct and the
6    Treasurer shall transfer the net State share (disregarding
7    the reduction in net State share attributable to the
8    American Recovery and Reinvestment Act of 2009 or any other
9    federal economic stimulus program) of all moneys received
10    by the Department of Healthcare and Family Services
11    (formerly Illinois Department of Public Aid) from drug
12    rebate agreements with pharmaceutical manufacturers
13    pursuant to Title XIX of the federal Social Security Act,
14    including any portion of the balance in the Public Aid
15    Recoveries Trust Fund on July 1, 2001 that is attributable
16    to such receipts.
17        (2) All federal matching funds received by the Illinois
18    Department as a result of expenditures made by the
19    Department that are attributable to moneys deposited in the
20    Fund.
21        (3) Any premium collected by the Illinois Department
22    from participants under a waiver approved by the federal
23    government relating to provision of pharmaceutical
24    services.
25        (4) All other moneys received for the Fund from any
26    other source, including interest earned thereon.

 

 

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1(Source: P.A. 100-23, eff. 7-6-17.)
 
2    (30 ILCS 105/6z-73)
3    Sec. 6z-73. Financial Institutions Settlement of 2008
4Fund. The Financial Institutions Settlement of 2008 Fund is
5created as a nonappropriated trust fund to be held outside the
6State treasury, with the State Treasurer as custodian. Moneys
7in the Fund shall be used by the Comptroller solely for the
8purpose of payment of outstanding vouchers as of the effective
9date of this amendatory Act of the 95th General Assembly for
10expenses related to medical assistance under the Illinois
11Public Aid Code, the Children's Health Insurance Program Act,
12the Covering ALL KIDS and Young Adults Health Insurance Act,
13and the Senior Citizens and Disabled Persons Property Tax
14Relief and Pharmaceutical Assistance Act. The Department of
15Healthcare and Family Services must submit all necessary and
16proper documentation to the Comptroller for administration of
17this Fund.
18(Source: P.A. 95-1047, eff. 4-6-09.)
 
19    (30 ILCS 105/6z-81)
20    Sec. 6z-81. Healthcare Provider Relief Fund.
21    (a) There is created in the State treasury a special fund
22to be known as the Healthcare Provider Relief Fund.
23    (b) The Fund is created for the purpose of receiving and
24disbursing moneys in accordance with this Section.

 

 

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1Disbursements from the Fund shall be made only as follows:
2        (1) Subject to appropriation, for payment by the
3    Department of Healthcare and Family Services or by the
4    Department of Human Services of medical bills and related
5    expenses, including administrative expenses, for which the
6    State is responsible under Titles XIX and XXI of the Social
7    Security Act, the Illinois Public Aid Code, the Children's
8    Health Insurance Program Act, the Covering ALL KIDS and
9    Young Adults Health Insurance Act, and the Long Term Acute
10    Care Hospital Quality Improvement Transfer Program Act.
11        (2) For repayment of funds borrowed from other State
12    funds or from outside sources, including interest thereon.
13        (3) For State fiscal years 2017, 2018, and 2019, for
14    making payments to the human poison control center pursuant
15    to Section 12-4.105 of the Illinois Public Aid Code.
16    (c) The Fund shall consist of the following:
17        (1) Moneys received by the State from short-term
18    borrowing pursuant to the Short Term Borrowing Act on or
19    after the effective date of Public Act 96-820.
20        (2) All federal matching funds received by the Illinois
21    Department of Healthcare and Family Services as a result of
22    expenditures made by the Department that are attributable
23    to moneys deposited in the Fund.
24        (3) All federal matching funds received by the Illinois
25    Department of Healthcare and Family Services as a result of
26    federal approval of Title XIX State plan amendment

 

 

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1    transmittal number 07-09.
2        (4) All other moneys received for the Fund from any
3    other source, including interest earned thereon.
4        (5) All federal matching funds received by the Illinois
5    Department of Healthcare and Family Services as a result of
6    expenditures made by the Department for Medical Assistance
7    from the General Revenue Fund, the Tobacco Settlement
8    Recovery Fund, the Long-Term Care Provider Fund, and the
9    Drug Rebate Fund related to individuals eligible for
10    medical assistance pursuant to the Patient Protection and
11    Affordable Care Act (P.L. 111-148) and Section 5-2 of the
12    Illinois Public Aid Code.
13    (d) In addition to any other transfers that may be provided
14for by law, on the effective date of Public Act 97-44, or as
15soon thereafter as practical, the State Comptroller shall
16direct and the State Treasurer shall transfer the sum of
17$365,000,000 from the General Revenue Fund into the Healthcare
18Provider Relief Fund.
19    (e) In addition to any other transfers that may be provided
20for by law, on July 1, 2011, or as soon thereafter as
21practical, the State Comptroller shall direct and the State
22Treasurer shall transfer the sum of $160,000,000 from the
23General Revenue Fund to the Healthcare Provider Relief Fund.
24    (f) Notwithstanding any other State law to the contrary,
25and in addition to any other transfers that may be provided for
26by law, the State Comptroller shall order transferred and the

 

 

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1State Treasurer shall transfer $500,000,000 to the Healthcare
2Provider Relief Fund from the General Revenue Fund in equal
3monthly installments of $100,000,000, with the first transfer
4to be made on July 1, 2012, or as soon thereafter as practical,
5and with each of the remaining transfers to be made on August
61, 2012, September 1, 2012, October 1, 2012, and November 1,
72012, or as soon thereafter as practical. This transfer may
8assist the Department of Healthcare and Family Services in
9improving Medical Assistance bill processing timeframes or in
10meeting the possible requirements of Senate Bill 3397, or other
11similar legislation, of the 97th General Assembly should it
12become law.
13    (g) Notwithstanding any other State law to the contrary,
14and in addition to any other transfers that may be provided for
15by law, on July 1, 2013, or as soon thereafter as may be
16practical, the State Comptroller shall direct and the State
17Treasurer shall transfer the sum of $601,000,000 from the
18General Revenue Fund to the Healthcare Provider Relief Fund.
19(Source: P.A. 99-516, eff. 6-30-16; 100-587, eff. 6-4-18.)
 
20    (30 ILCS 105/25)  (from Ch. 127, par. 161)
21    Sec. 25. Fiscal year limitations.
22    (a) All appropriations shall be available for expenditure
23for the fiscal year or for a lesser period if the Act making
24that appropriation so specifies. A deficiency or emergency
25appropriation shall be available for expenditure only through

 

 

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1June 30 of the year when the Act making that appropriation is
2enacted unless that Act otherwise provides.
3    (b) Outstanding liabilities as of June 30, payable from
4appropriations which have otherwise expired, may be paid out of
5the expiring appropriations during the 2-month period ending at
6the close of business on August 31. Any service involving
7professional or artistic skills or any personal services by an
8employee whose compensation is subject to income tax
9withholding must be performed as of June 30 of the fiscal year
10in order to be considered an "outstanding liability as of June
1130" that is thereby eligible for payment out of the expiring
12appropriation.
13    (b-1) However, payment of tuition reimbursement claims
14under Section 14-7.03 or 18-3 of the School Code may be made by
15the State Board of Education from its appropriations for those
16respective purposes for any fiscal year, even though the claims
17reimbursed by the payment may be claims attributable to a prior
18fiscal year, and payments may be made at the direction of the
19State Superintendent of Education from the fund from which the
20appropriation is made without regard to any fiscal year
21limitations, except as required by subsection (j) of this
22Section. Beginning on June 30, 2021, payment of tuition
23reimbursement claims under Section 14-7.03 or 18-3 of the
24School Code as of June 30, payable from appropriations that
25have otherwise expired, may be paid out of the expiring
26appropriation during the 4-month period ending at the close of

 

 

SB2017- 12 -LRB101 09603 RAB 54701 b

1business on October 31.
2    (b-2) All outstanding liabilities as of June 30, 2010,
3payable from appropriations that would otherwise expire at the
4conclusion of the lapse period for fiscal year 2010, and
5interest penalties payable on those liabilities under the State
6Prompt Payment Act, may be paid out of the expiring
7appropriations until December 31, 2010, without regard to the
8fiscal year in which the payment is made, as long as vouchers
9for the liabilities are received by the Comptroller no later
10than August 31, 2010.
11    (b-2.5) All outstanding liabilities as of June 30, 2011,
12payable from appropriations that would otherwise expire at the
13conclusion of the lapse period for fiscal year 2011, and
14interest penalties payable on those liabilities under the State
15Prompt Payment Act, may be paid out of the expiring
16appropriations until December 31, 2011, without regard to the
17fiscal year in which the payment is made, as long as vouchers
18for the liabilities are received by the Comptroller no later
19than August 31, 2011.
20    (b-2.6) All outstanding liabilities as of June 30, 2012,
21payable from appropriations that would otherwise expire at the
22conclusion of the lapse period for fiscal year 2012, and
23interest penalties payable on those liabilities under the State
24Prompt Payment Act, may be paid out of the expiring
25appropriations until December 31, 2012, without regard to the
26fiscal year in which the payment is made, as long as vouchers

 

 

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1for the liabilities are received by the Comptroller no later
2than August 31, 2012.
3    (b-2.6a) All outstanding liabilities as of June 30, 2017,
4payable from appropriations that would otherwise expire at the
5conclusion of the lapse period for fiscal year 2017, and
6interest penalties payable on those liabilities under the State
7Prompt Payment Act, may be paid out of the expiring
8appropriations until December 31, 2017, without regard to the
9fiscal year in which the payment is made, as long as vouchers
10for the liabilities are received by the Comptroller no later
11than September 30, 2017.
12    (b-2.6b) All outstanding liabilities as of June 30, 2018,
13payable from appropriations that would otherwise expire at the
14conclusion of the lapse period for fiscal year 2018, and
15interest penalties payable on those liabilities under the State
16Prompt Payment Act, may be paid out of the expiring
17appropriations until December 31, 2018, without regard to the
18fiscal year in which the payment is made, as long as vouchers
19for the liabilities are received by the Comptroller no later
20than October 31, 2018.
21    (b-2.7) For fiscal years 2012, 2013, and 2014, interest
22penalties payable under the State Prompt Payment Act associated
23with a voucher for which payment is issued after June 30 may be
24paid out of the next fiscal year's appropriation. The future
25year appropriation must be for the same purpose and from the
26same fund as the original payment. An interest penalty voucher

 

 

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1submitted against a future year appropriation must be submitted
2within 60 days after the issuance of the associated voucher,
3and the Comptroller must issue the interest payment within 60
4days after acceptance of the interest voucher.
5    (b-3) Medical payments may be made by the Department of
6Veterans' Affairs from its appropriations for those purposes
7for any fiscal year, without regard to the fact that the
8medical services being compensated for by such payment may have
9been rendered in a prior fiscal year, except as required by
10subsection (j) of this Section. Beginning on June 30, 2021,
11medical payments payable from appropriations that have
12otherwise expired may be paid out of the expiring appropriation
13during the 4-month period ending at the close of business on
14October 31.
15    (b-4) Medical payments and child care payments may be made
16by the Department of Human Services (as successor to the
17Department of Public Aid) from appropriations for those
18purposes for any fiscal year, without regard to the fact that
19the medical or child care services being compensated for by
20such payment may have been rendered in a prior fiscal year; and
21payments may be made at the direction of the Department of
22Healthcare and Family Services (or successor agency) from the
23Health Insurance Reserve Fund without regard to any fiscal year
24limitations, except as required by subsection (j) of this
25Section. Beginning on June 30, 2021, medical and child care
26payments made by the Department of Human Services and payments

 

 

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1made at the discretion of the Department of Healthcare and
2Family Services (or successor agency) from the Health Insurance
3Reserve Fund and payable from appropriations that have
4otherwise expired may be paid out of the expiring appropriation
5during the 4-month period ending at the close of business on
6October 31.
7    (b-5) Medical payments may be made by the Department of
8Human Services from its appropriations relating to substance
9abuse treatment services for any fiscal year, without regard to
10the fact that the medical services being compensated for by
11such payment may have been rendered in a prior fiscal year,
12provided the payments are made on a fee-for-service basis
13consistent with requirements established for Medicaid
14reimbursement by the Department of Healthcare and Family
15Services, except as required by subsection (j) of this Section.
16Beginning on June 30, 2021, medical payments made by the
17Department of Human Services relating to substance abuse
18treatment services payable from appropriations that have
19otherwise expired may be paid out of the expiring appropriation
20during the 4-month period ending at the close of business on
21October 31.
22    (b-6) Additionally, payments may be made by the Department
23of Human Services from its appropriations, or any other State
24agency from its appropriations with the approval of the
25Department of Human Services, from the Immigration Reform and
26Control Fund for purposes authorized pursuant to the

 

 

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1Immigration Reform and Control Act of 1986, without regard to
2any fiscal year limitations, except as required by subsection
3(j) of this Section. Beginning on June 30, 2021, payments made
4by the Department of Human Services from the Immigration Reform
5and Control Fund for purposes authorized pursuant to the
6Immigration Reform and Control Act of 1986 payable from
7appropriations that have otherwise expired may be paid out of
8the expiring appropriation during the 4-month period ending at
9the close of business on October 31.
10    (b-7) Payments may be made in accordance with a plan
11authorized by paragraph (11) or (12) of Section 405-105 of the
12Department of Central Management Services Law from
13appropriations for those payments without regard to fiscal year
14limitations.
15    (b-8) Reimbursements to eligible airport sponsors for the
16construction or upgrading of Automated Weather Observation
17Systems may be made by the Department of Transportation from
18appropriations for those purposes for any fiscal year, without
19regard to the fact that the qualification or obligation may
20have occurred in a prior fiscal year, provided that at the time
21the expenditure was made the project had been approved by the
22Department of Transportation prior to June 1, 2012 and, as a
23result of recent changes in federal funding formulas, can no
24longer receive federal reimbursement.
25    (b-9) Medical payments not exceeding $150,000,000 may be
26made by the Department on Aging from its appropriations

 

 

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1relating to the Community Care Program for fiscal year 2014,
2without regard to the fact that the medical services being
3compensated for by such payment may have been rendered in a
4prior fiscal year, provided the payments are made on a
5fee-for-service basis consistent with requirements established
6for Medicaid reimbursement by the Department of Healthcare and
7Family Services, except as required by subsection (j) of this
8Section.
9    (c) Further, payments may be made by the Department of
10Public Health and the Department of Human Services (acting as
11successor to the Department of Public Health under the
12Department of Human Services Act) from their respective
13appropriations for grants for medical care to or on behalf of
14premature and high-mortality risk infants and their mothers and
15for grants for supplemental food supplies provided under the
16United States Department of Agriculture Women, Infants and
17Children Nutrition Program, for any fiscal year without regard
18to the fact that the services being compensated for by such
19payment may have been rendered in a prior fiscal year, except
20as required by subsection (j) of this Section. Beginning on
21June 30, 2021, payments made by the Department of Public Health
22and the Department of Human Services from their respective
23appropriations for grants for medical care to or on behalf of
24premature and high-mortality risk infants and their mothers and
25for grants for supplemental food supplies provided under the
26United States Department of Agriculture Women, Infants and

 

 

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1Children Nutrition Program payable from appropriations that
2have otherwise expired may be paid out of the expiring
3appropriations during the 4-month period ending at the close of
4business on October 31.
5    (d) The Department of Public Health and the Department of
6Human Services (acting as successor to the Department of Public
7Health under the Department of Human Services Act) shall each
8annually submit to the State Comptroller, Senate President,
9Senate Minority Leader, Speaker of the House, House Minority
10Leader, and the respective Chairmen and Minority Spokesmen of
11the Appropriations Committees of the Senate and the House, on
12or before December 31, a report of fiscal year funds used to
13pay for services provided in any prior fiscal year. This report
14shall document by program or service category those
15expenditures from the most recently completed fiscal year used
16to pay for services provided in prior fiscal years.
17    (e) The Department of Healthcare and Family Services, the
18Department of Human Services (acting as successor to the
19Department of Public Aid), and the Department of Human Services
20making fee-for-service payments relating to substance abuse
21treatment services provided during a previous fiscal year shall
22each annually submit to the State Comptroller, Senate
23President, Senate Minority Leader, Speaker of the House, House
24Minority Leader, the respective Chairmen and Minority
25Spokesmen of the Appropriations Committees of the Senate and
26the House, on or before November 30, a report that shall

 

 

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1document by program or service category those expenditures from
2the most recently completed fiscal year used to pay for (i)
3services provided in prior fiscal years and (ii) services for
4which claims were received in prior fiscal years.
5    (f) The Department of Human Services (as successor to the
6Department of Public Aid) shall annually submit to the State
7Comptroller, Senate President, Senate Minority Leader, Speaker
8of the House, House Minority Leader, and the respective
9Chairmen and Minority Spokesmen of the Appropriations
10Committees of the Senate and the House, on or before December
1131, a report of fiscal year funds used to pay for services
12(other than medical care) provided in any prior fiscal year.
13This report shall document by program or service category those
14expenditures from the most recently completed fiscal year used
15to pay for services provided in prior fiscal years.
16    (g) In addition, each annual report required to be
17submitted by the Department of Healthcare and Family Services
18under subsection (e) shall include the following information
19with respect to the State's Medicaid program:
20        (1) Explanations of the exact causes of the variance
21    between the previous year's estimated and actual
22    liabilities.
23        (2) Factors affecting the Department of Healthcare and
24    Family Services' liabilities, including but not limited to
25    numbers of aid recipients, levels of medical service
26    utilization by aid recipients, and inflation in the cost of

 

 

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1    medical services.
2        (3) The results of the Department's efforts to combat
3    fraud and abuse.
4    (h) As provided in Section 4 of the General Assembly
5Compensation Act, any utility bill for service provided to a
6General Assembly member's district office for a period
7including portions of 2 consecutive fiscal years may be paid
8from funds appropriated for such expenditure in either fiscal
9year.
10    (i) An agency which administers a fund classified by the
11Comptroller as an internal service fund may issue rules for:
12        (1) billing user agencies in advance for payments or
13    authorized inter-fund transfers based on estimated charges
14    for goods or services;
15        (2) issuing credits, refunding through inter-fund
16    transfers, or reducing future inter-fund transfers during
17    the subsequent fiscal year for all user agency payments or
18    authorized inter-fund transfers received during the prior
19    fiscal year which were in excess of the final amounts owed
20    by the user agency for that period; and
21        (3) issuing catch-up billings to user agencies during
22    the subsequent fiscal year for amounts remaining due when
23    payments or authorized inter-fund transfers received from
24    the user agency during the prior fiscal year were less than
25    the total amount owed for that period.
26User agencies are authorized to reimburse internal service

 

 

SB2017- 21 -LRB101 09603 RAB 54701 b

1funds for catch-up billings by vouchers drawn against their
2respective appropriations for the fiscal year in which the
3catch-up billing was issued or by increasing an authorized
4inter-fund transfer during the current fiscal year. For the
5purposes of this Act, "inter-fund transfers" means transfers
6without the use of the voucher-warrant process, as authorized
7by Section 9.01 of the State Comptroller Act.
8    (i-1) Beginning on July 1, 2021, all outstanding
9liabilities, not payable during the 4-month lapse period as
10described in subsections (b-1), (b-3), (b-4), (b-5), (b-6), and
11(c) of this Section, that are made from appropriations for that
12purpose for any fiscal year, without regard to the fact that
13the services being compensated for by those payments may have
14been rendered in a prior fiscal year, are limited to only those
15claims that have been incurred but for which a proper bill or
16invoice as defined by the State Prompt Payment Act has not been
17received by September 30th following the end of the fiscal year
18in which the service was rendered.
19    (j) Notwithstanding any other provision of this Act, the
20aggregate amount of payments to be made without regard for
21fiscal year limitations as contained in subsections (b-1),
22(b-3), (b-4), (b-5), (b-6), and (c) of this Section, and
23determined by using Generally Accepted Accounting Principles,
24shall not exceed the following amounts:
25        (1) $6,000,000,000 for outstanding liabilities related
26    to fiscal year 2012;

 

 

SB2017- 22 -LRB101 09603 RAB 54701 b

1        (2) $5,300,000,000 for outstanding liabilities related
2    to fiscal year 2013;
3        (3) $4,600,000,000 for outstanding liabilities related
4    to fiscal year 2014;
5        (4) $4,000,000,000 for outstanding liabilities related
6    to fiscal year 2015;
7        (5) $3,300,000,000 for outstanding liabilities related
8    to fiscal year 2016;
9        (6) $2,600,000,000 for outstanding liabilities related
10    to fiscal year 2017;
11        (7) $2,000,000,000 for outstanding liabilities related
12    to fiscal year 2018;
13        (8) $1,300,000,000 for outstanding liabilities related
14    to fiscal year 2019;
15        (9) $600,000,000 for outstanding liabilities related
16    to fiscal year 2020; and
17        (10) $0 for outstanding liabilities related to fiscal
18    year 2021 and fiscal years thereafter.
19    (k) Department of Healthcare and Family Services Medical
20Assistance Payments.
21        (1) Definition of Medical Assistance.
22            For purposes of this subsection, the term "Medical
23        Assistance" shall include, but not necessarily be
24        limited to, medical programs and services authorized
25        under Titles XIX and XXI of the Social Security Act,
26        the Illinois Public Aid Code, the Children's Health

 

 

SB2017- 23 -LRB101 09603 RAB 54701 b

1        Insurance Program Act, the Covering ALL KIDS and Young
2        Adults Health Insurance Act, the Long Term Acute Care
3        Hospital Quality Improvement Transfer Program Act, and
4        medical care to or on behalf of persons suffering from
5        chronic renal disease, persons suffering from
6        hemophilia, and victims of sexual assault.
7        (2) Limitations on Medical Assistance payments that
8    may be paid from future fiscal year appropriations.
9            (A) The maximum amounts of annual unpaid Medical
10        Assistance bills received and recorded by the
11        Department of Healthcare and Family Services on or
12        before June 30th of a particular fiscal year
13        attributable in aggregate to the General Revenue Fund,
14        Healthcare Provider Relief Fund, Tobacco Settlement
15        Recovery Fund, Long-Term Care Provider Fund, and the
16        Drug Rebate Fund that may be paid in total by the
17        Department from future fiscal year Medical Assistance
18        appropriations to those funds are: $700,000,000 for
19        fiscal year 2013 and $100,000,000 for fiscal year 2014
20        and each fiscal year thereafter.
21            (B) Bills for Medical Assistance services rendered
22        in a particular fiscal year, but received and recorded
23        by the Department of Healthcare and Family Services
24        after June 30th of that fiscal year, may be paid from
25        either appropriations for that fiscal year or future
26        fiscal year appropriations for Medical Assistance.

 

 

SB2017- 24 -LRB101 09603 RAB 54701 b

1        Such payments shall not be subject to the requirements
2        of subparagraph (A).
3            (C) Medical Assistance bills received by the
4        Department of Healthcare and Family Services in a
5        particular fiscal year, but subject to payment amount
6        adjustments in a future fiscal year may be paid from a
7        future fiscal year's appropriation for Medical
8        Assistance. Such payments shall not be subject to the
9        requirements of subparagraph (A).
10            (D) Medical Assistance payments made by the
11        Department of Healthcare and Family Services from
12        funds other than those specifically referenced in
13        subparagraph (A) may be made from appropriations for
14        those purposes for any fiscal year without regard to
15        the fact that the Medical Assistance services being
16        compensated for by such payment may have been rendered
17        in a prior fiscal year. Such payments shall not be
18        subject to the requirements of subparagraph (A).
19        (3) Extended lapse period for Department of Healthcare
20    and Family Services Medical Assistance payments.
21    Notwithstanding any other State law to the contrary,
22    outstanding Department of Healthcare and Family Services
23    Medical Assistance liabilities, as of June 30th, payable
24    from appropriations which have otherwise expired, may be
25    paid out of the expiring appropriations during the 6-month
26    period ending at the close of business on December 31st.

 

 

SB2017- 25 -LRB101 09603 RAB 54701 b

1    (l) The changes to this Section made by Public Act 97-691
2shall be effective for payment of Medical Assistance bills
3incurred in fiscal year 2013 and future fiscal years. The
4changes to this Section made by Public Act 97-691 shall not be
5applied to Medical Assistance bills incurred in fiscal year
62012 or prior fiscal years.
7    (m) The Comptroller must issue payments against
8outstanding liabilities that were received prior to the lapse
9period deadlines set forth in this Section as soon thereafter
10as practical, but no payment may be issued after the 4 months
11following the lapse period deadline without the signed
12authorization of the Comptroller and the Governor.
13(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18.)
 
14    Section 15. The State Prompt Payment Act is amended by
15changing Section 3-2 as follows:
 
16    (30 ILCS 540/3-2)
17    Sec. 3-2. Beginning July 1, 1993, in any instance where a
18State official or agency is late in payment of a vendor's bill
19or invoice for goods or services furnished to the State, as
20defined in Section 1, properly approved in accordance with
21rules promulgated under Section 3-3, the State official or
22agency shall pay interest to the vendor in accordance with the
23following:
24        (1) Any bill, except a bill submitted under Article V

 

 

SB2017- 26 -LRB101 09603 RAB 54701 b

1    of the Illinois Public Aid Code and except as provided
2    under paragraph (1.05) of this Section, approved for
3    payment under this Section must be paid or the payment
4    issued to the payee within 60 days of receipt of a proper
5    bill or invoice. If payment is not issued to the payee
6    within this 60-day period, an interest penalty of 1.0% of
7    any amount approved and unpaid shall be added for each
8    month or fraction thereof after the end of this 60-day
9    period, until final payment is made. Any bill, except a
10    bill for pharmacy or nursing facility services or goods,
11    and except as provided under paragraph (1.05) of this
12    Section, submitted under Article V of the Illinois Public
13    Aid Code approved for payment under this Section must be
14    paid or the payment issued to the payee within 60 days
15    after receipt of a proper bill or invoice, and, if payment
16    is not issued to the payee within this 60-day period, an
17    interest penalty of 2.0% of any amount approved and unpaid
18    shall be added for each month or fraction thereof after the
19    end of this 60-day period, until final payment is made. Any
20    bill for pharmacy or nursing facility services or goods
21    submitted under Article V of the Illinois Public Aid Code,
22    except as provided under paragraph (1.05) of this Section,
23    and approved for payment under this Section must be paid or
24    the payment issued to the payee within 60 days of receipt
25    of a proper bill or invoice. If payment is not issued to
26    the payee within this 60-day period, an interest penalty of

 

 

SB2017- 27 -LRB101 09603 RAB 54701 b

1    1.0% of any amount approved and unpaid shall be added for
2    each month or fraction thereof after the end of this 60-day
3    period, until final payment is made.
4        (1.05) For State fiscal year 2012 and future fiscal
5    years, any bill approved for payment under this Section
6    must be paid or the payment issued to the payee within 90
7    days of receipt of a proper bill or invoice. If payment is
8    not issued to the payee within this 90-day period, an
9    interest penalty of 1.0% of any amount approved and unpaid
10    shall be added for each month, or 0.033% (one-thirtieth of
11    one percent) of any amount approved and unpaid for each
12    day, after the end of this 90-day period, until final
13    payment is made.
14        (1.1) A State agency shall review in a timely manner
15    each bill or invoice after its receipt. If the State agency
16    determines that the bill or invoice contains a defect
17    making it unable to process the payment request, the agency
18    shall notify the vendor requesting payment as soon as
19    possible after discovering the defect pursuant to rules
20    promulgated under Section 3-3; provided, however, that the
21    notice for construction related bills or invoices must be
22    given not later than 30 days after the bill or invoice was
23    first submitted. The notice shall identify the defect and
24    any additional information necessary to correct the
25    defect. If one or more items on a construction related bill
26    or invoice are disapproved, but not the entire bill or

 

 

SB2017- 28 -LRB101 09603 RAB 54701 b

1    invoice, then the portion that is not disapproved shall be
2    paid.
3        (2) Where a State official or agency is late in payment
4    of a vendor's bill or invoice properly approved in
5    accordance with this Act, and different late payment terms
6    are not reduced to writing as a contractual agreement, the
7    State official or agency shall automatically pay interest
8    penalties required by this Section amounting to $50 or more
9    to the appropriate vendor. Each agency shall be responsible
10    for determining whether an interest penalty is owed and for
11    paying the interest to the vendor. Except as provided in
12    paragraph (4), an individual interest payment amounting to
13    $5 or less shall not be paid by the State. Interest due to
14    a vendor that amounts to greater than $5 and less than $50
15    shall not be paid but shall be accrued until all interest
16    due the vendor for all similar warrants exceeds $50, at
17    which time the accrued interest shall be payable and
18    interest will begin accruing again, except that interest
19    accrued as of the end of the fiscal year that does not
20    exceed $50 shall be payable at that time. In the event an
21    individual has paid a vendor for services in advance, the
22    provisions of this Section shall apply until payment is
23    made to that individual.
24        (3) The provisions of Public Act 96-1501 reducing the
25    interest rate on pharmacy claims under Article V of the
26    Illinois Public Aid Code to 1.0% per month shall apply to

 

 

SB2017- 29 -LRB101 09603 RAB 54701 b

1    any pharmacy bills for services and goods under Article V
2    of the Illinois Public Aid Code received on or after the
3    date 60 days before January 25, 2011 (the effective date of
4    Public Act 96-1501) except as provided under paragraph
5    (1.05) of this Section.
6        (4) Interest amounting to less than $5 shall not be
7    paid by the State, except for claims (i) to the Department
8    of Healthcare and Family Services or the Department of
9    Human Services, (ii) pursuant to Article V of the Illinois
10    Public Aid Code, the Covering ALL KIDS and Young Adults
11    Health Insurance Act, or the Children's Health Insurance
12    Program Act, and (iii) made (A) by pharmacies for
13    prescriptive services or (B) by any federally qualified
14    health center for prescriptive services or any other
15    services.
16    Notwithstanding any provision to the contrary, interest
17may not be paid under this Act when: (1) a Chief Procurement
18Officer has voided the underlying contract for goods or
19services under Article 50 of the Illinois Procurement Code; or
20(2) the Auditor General is conducting a performance or program
21audit and the Comptroller has held or is holding for review a
22related contract or vouchers for payment of goods or services
23in the exercise of duties under Section 9 of the State
24Comptroller Act. In such event, interest shall not accrue
25during the pendency of the Auditor General's review.
26(Source: P.A. 100-1064, eff. 8-24-18.)
 

 

 

SB2017- 30 -LRB101 09603 RAB 54701 b

1    Section 20. The Use Tax Act is amended by changing Section
23-8 as follows:
 
3    (35 ILCS 105/3-8)
4    Sec. 3-8. Hospital exemption.
5    (a) Tangible personal property sold to or used by a
6hospital owner that owns one or more hospitals licensed under
7the Hospital Licensing Act or operated under the University of
8Illinois Hospital Act, or a hospital affiliate that is not
9already exempt under another provision of this Act and meets
10the criteria for an exemption under this Section, is exempt
11from taxation under this Act.
12    (b) A hospital owner or hospital affiliate satisfies the
13conditions for an exemption under this Section if the value of
14qualified services or activities listed in subsection (c) of
15this Section for the hospital year equals or exceeds the
16relevant hospital entity's estimated property tax liability,
17without regard to any property tax exemption granted under
18Section 15-86 of the Property Tax Code, for the calendar year
19in which exemption or renewal of exemption is sought. For
20purposes of making the calculations required by this subsection
21(b), if the relevant hospital entity is a hospital owner that
22owns more than one hospital, the value of the services or
23activities listed in subsection (c) shall be calculated on the
24basis of only those services and activities relating to the

 

 

SB2017- 31 -LRB101 09603 RAB 54701 b

1hospital that includes the subject property, and the relevant
2hospital entity's estimated property tax liability shall be
3calculated only with respect to the properties comprising that
4hospital. In the case of a multi-state hospital system or
5hospital affiliate, the value of the services or activities
6listed in subsection (c) shall be calculated on the basis of
7only those services and activities that occur in Illinois and
8the relevant hospital entity's estimated property tax
9liability shall be calculated only with respect to its property
10located in Illinois.
11    (c) The following services and activities shall be
12considered for purposes of making the calculations required by
13subsection (b):
14        (1) Charity care. Free or discounted services provided
15    pursuant to the relevant hospital entity's financial
16    assistance policy, measured at cost, including discounts
17    provided under the Hospital Uninsured Patient Discount
18    Act.
19        (2) Health services to low-income and underserved
20    individuals. Other unreimbursed costs of the relevant
21    hospital entity for providing without charge, paying for,
22    or subsidizing goods, activities, or services for the
23    purpose of addressing the health of low-income or
24    underserved individuals. Those activities or services may
25    include, but are not limited to: financial or in-kind
26    support to affiliated or unaffiliated hospitals, hospital

 

 

SB2017- 32 -LRB101 09603 RAB 54701 b

1    affiliates, community clinics, or programs that treat
2    low-income or underserved individuals; paying for or
3    subsidizing health care professionals who care for
4    low-income or underserved individuals; providing or
5    subsidizing outreach or educational services to low-income
6    or underserved individuals for disease management and
7    prevention; free or subsidized goods, supplies, or
8    services needed by low-income or underserved individuals
9    because of their medical condition; and prenatal or
10    childbirth outreach to low-income or underserved persons.
11        (3) Subsidy of State or local governments. Direct or
12    indirect financial or in-kind subsidies of State or local
13    governments by the relevant hospital entity that pay for or
14    subsidize activities or programs related to health care for
15    low-income or underserved individuals.
16        (4) Support for State health care programs for
17    low-income individuals. At the election of the hospital
18    applicant for each applicable year, either (A) 10% of
19    payments to the relevant hospital entity and any hospital
20    affiliate designated by the relevant hospital entity
21    (provided that such hospital affiliate's operations
22    provide financial or operational support for or receive
23    financial or operational support from the relevant
24    hospital entity) under Medicaid or other means-tested
25    programs, including, but not limited to, General
26    Assistance, the Covering ALL KIDS and Young Adults Health

 

 

SB2017- 33 -LRB101 09603 RAB 54701 b

1    Insurance Act, and the State Children's Health Insurance
2    Program or (B) the amount of subsidy provided by the
3    relevant hospital entity and any hospital affiliate
4    designated by the relevant hospital entity (provided that
5    such hospital affiliate's operations provide financial or
6    operational support for or receive financial or
7    operational support from the relevant hospital entity) to
8    State or local government in treating Medicaid recipients
9    and recipients of means-tested programs, including but not
10    limited to General Assistance, the Covering ALL KIDS and
11    Young Adults Health Insurance Act, and the State Children's
12    Health Insurance Program. The amount of subsidy for purpose
13    of this item (4) is calculated in the same manner as
14    unreimbursed costs are calculated for Medicaid and other
15    means-tested government programs in the Schedule H of IRS
16    Form 990 in effect on the effective date of this amendatory
17    Act of the 97th General Assembly.
18        (5) Dual-eligible subsidy. The amount of subsidy
19    provided to government by treating dual-eligible
20    Medicare/Medicaid patients. The amount of subsidy for
21    purposes of this item (5) is calculated by multiplying the
22    relevant hospital entity's unreimbursed costs for
23    Medicare, calculated in the same manner as determined in
24    the Schedule H of IRS Form 990 in effect on the effective
25    date of this amendatory Act of the 97th General Assembly,
26    by the relevant hospital entity's ratio of dual-eligible

 

 

SB2017- 34 -LRB101 09603 RAB 54701 b

1    patients to total Medicare patients.
2        (6) Relief of the burden of government related to
3    health care. Except to the extent otherwise taken into
4    account in this subsection, the portion of unreimbursed
5    costs of the relevant hospital entity attributable to
6    providing, paying for, or subsidizing goods, activities,
7    or services that relieve the burden of government related
8    to health care for low-income individuals. Such activities
9    or services shall include, but are not limited to,
10    providing emergency, trauma, burn, neonatal, psychiatric,
11    rehabilitation, or other special services; providing
12    medical education; and conducting medical research or
13    training of health care professionals. The portion of those
14    unreimbursed costs attributable to benefiting low-income
15    individuals shall be determined using the ratio calculated
16    by adding the relevant hospital entity's costs
17    attributable to charity care, Medicaid, other means-tested
18    government programs, Medicare patients with disabilities
19    under age 65, and dual-eligible Medicare/Medicaid patients
20    and dividing that total by the relevant hospital entity's
21    total costs. Such costs for the numerator and denominator
22    shall be determined by multiplying gross charges by the
23    cost to charge ratio taken from the hospital's most
24    recently filed Medicare cost report (CMS 2252-10
25    Worksheet, Part I). In the case of emergency services, the
26    ratio shall be calculated using costs (gross charges

 

 

SB2017- 35 -LRB101 09603 RAB 54701 b

1    multiplied by the cost to charge ratio taken from the
2    hospital's most recently filed Medicare cost report (CMS
3    2252-10 Worksheet, Part I)) of patients treated in the
4    relevant hospital entity's emergency department.
5        (7) Any other activity by the relevant hospital entity
6    that the Department determines relieves the burden of
7    government or addresses the health of low-income or
8    underserved individuals.
9    (d) The hospital applicant shall include information in its
10exemption application establishing that it satisfies the
11requirements of subsection (b). For purposes of making the
12calculations required by subsection (b), the hospital
13applicant may for each year elect to use either (1) the value
14of the services or activities listed in subsection (e) for the
15hospital year or (2) the average value of those services or
16activities for the 3 fiscal years ending with the hospital
17year. If the relevant hospital entity has been in operation for
18less than 3 completed fiscal years, then the latter
19calculation, if elected, shall be performed on a pro rata
20basis.
21    (e) For purposes of making the calculations required by
22this Section:
23        (1) particular services or activities eligible for
24    consideration under any of the paragraphs (1) through (7)
25    of subsection (c) may not be counted under more than one of
26    those paragraphs; and

 

 

SB2017- 36 -LRB101 09603 RAB 54701 b

1        (2) the amount of unreimbursed costs and the amount of
2    subsidy shall not be reduced by restricted or unrestricted
3    payments received by the relevant hospital entity as
4    contributions deductible under Section 170(a) of the
5    Internal Revenue Code.
6    (f) (Blank).
7    (g) Estimation of Exempt Property Tax Liability. The
8estimated property tax liability used for the determination in
9subsection (b) shall be calculated as follows:
10        (1) "Estimated property tax liability" means the
11    estimated dollar amount of property tax that would be owed,
12    with respect to the exempt portion of each of the relevant
13    hospital entity's properties that are already fully or
14    partially exempt, or for which an exemption in whole or in
15    part is currently being sought, and then aggregated as
16    applicable, as if the exempt portion of those properties
17    were subject to tax, calculated with respect to each such
18    property by multiplying:
19            (A) the lesser of (i) the actual assessed value, if
20        any, of the portion of the property for which an
21        exemption is sought or (ii) an estimated assessed value
22        of the exempt portion of such property as determined in
23        item (2) of this subsection (g), by
24            (B) the applicable State equalization rate
25        (yielding the equalized assessed value), by
26            (C) the applicable tax rate.

 

 

SB2017- 37 -LRB101 09603 RAB 54701 b

1        (2) The estimated assessed value of the exempt portion
2    of the property equals the sum of (i) the estimated fair
3    market value of buildings on the property, as determined in
4    accordance with subparagraphs (A) and (B) of this item (2),
5    multiplied by the applicable assessment factor, and (ii)
6    the estimated assessed value of the land portion of the
7    property, as determined in accordance with subparagraph
8    (C).
9            (A) The "estimated fair market value of buildings
10        on the property" means the replacement value of any
11        exempt portion of buildings on the property, minus
12        depreciation, determined utilizing the cost
13        replacement method whereby the exempt square footage
14        of all such buildings is multiplied by the replacement
15        cost per square foot for Class A Average building found
16        in the most recent edition of the Marshall & Swift
17        Valuation Services Manual, adjusted by any appropriate
18        current cost and local multipliers.
19            (B) Depreciation, for purposes of calculating the
20        estimated fair market value of buildings on the
21        property, is applied by utilizing a weighted mean life
22        for the buildings based on original construction and
23        assuming a 40-year life for hospital buildings and the
24        applicable life for other types of buildings as
25        specified in the American Hospital Association
26        publication "Estimated Useful Lives of Depreciable

 

 

SB2017- 38 -LRB101 09603 RAB 54701 b

1        Hospital Assets". In the case of hospital buildings,
2        the remaining life is divided by 40 and this ratio is
3        multiplied by the replacement cost of the buildings to
4        obtain an estimated fair market value of buildings. If
5        a hospital building is older than 35 years, a remaining
6        life of 5 years for residual value is assumed; and if a
7        building is less than 8 years old, a remaining life of
8        32 years is assumed.
9            (C) The estimated assessed value of the land
10        portion of the property shall be determined by
11        multiplying (i) the per square foot average of the
12        assessed values of three parcels of land (not including
13        farm land, and excluding the assessed value of the
14        improvements thereon) reasonably comparable to the
15        property, by (ii) the number of square feet comprising
16        the exempt portion of the property's land square
17        footage.
18        (3) The assessment factor, State equalization rate,
19    and tax rate (including any special factors such as
20    Enterprise Zones) used in calculating the estimated
21    property tax liability shall be for the most recent year
22    that is publicly available from the applicable chief county
23    assessment officer or officers at least 90 days before the
24    end of the hospital year.
25        (4) The method utilized to calculate estimated
26    property tax liability for purposes of this Section 15-86

 

 

SB2017- 39 -LRB101 09603 RAB 54701 b

1    shall not be utilized for the actual valuation, assessment,
2    or taxation of property pursuant to the Property Tax Code.
3    (h) For the purpose of this Section, the following terms
4shall have the meanings set forth below:
5        (1) "Hospital" means any institution, place, building,
6    buildings on a campus, or other health care facility
7    located in Illinois that is licensed under the Hospital
8    Licensing Act and has a hospital owner.
9        (2) "Hospital owner" means a not-for-profit
10    corporation that is the titleholder of a hospital, or the
11    owner of the beneficial interest in an Illinois land trust
12    that is the titleholder of a hospital.
13        (3) "Hospital affiliate" means any corporation,
14    partnership, limited partnership, joint venture, limited
15    liability company, association or other organization,
16    other than a hospital owner, that directly or indirectly
17    controls, is controlled by, or is under common control with
18    one or more hospital owners and that supports, is supported
19    by, or acts in furtherance of the exempt health care
20    purposes of at least one of those hospital owners'
21    hospitals.
22        (4) "Hospital system" means a hospital and one or more
23    other hospitals or hospital affiliates related by common
24    control or ownership.
25        (5) "Control" relating to hospital owners, hospital
26    affiliates, or hospital systems means possession, direct

 

 

SB2017- 40 -LRB101 09603 RAB 54701 b

1    or indirect, of the power to direct or cause the direction
2    of the management and policies of the entity, whether
3    through ownership of assets, membership interest, other
4    voting or governance rights, by contract or otherwise.
5        (6) "Hospital applicant" means a hospital owner or
6    hospital affiliate that files an application for an
7    exemption or renewal of exemption under this Section.
8        (7) "Relevant hospital entity" means (A) the hospital
9    owner, in the case of a hospital applicant that is a
10    hospital owner, and (B) at the election of a hospital
11    applicant that is a hospital affiliate, either (i) the
12    hospital affiliate or (ii) the hospital system to which the
13    hospital applicant belongs, including any hospitals or
14    hospital affiliates that are related by common control or
15    ownership.
16        (8) "Subject property" means property used for the
17    calculation under subsection (b) of this Section.
18        (9) "Hospital year" means the fiscal year of the
19    relevant hospital entity, or the fiscal year of one of the
20    hospital owners in the hospital system if the relevant
21    hospital entity is a hospital system with members with
22    different fiscal years, that ends in the year for which the
23    exemption is sought.
24(Source: P.A. 98-463, eff. 8-16-13; 99-143, eff. 7-27-15.)
 
25    Section 25. The Retailers' Occupation Tax Act is amended by

 

 

SB2017- 41 -LRB101 09603 RAB 54701 b

1changing Section 2-9 as follows:
 
2    (35 ILCS 120/2-9)
3    Sec. 2-9. Hospital exemption.
4    (a) Tangible personal property sold to or used by a
5hospital owner that owns one or more hospitals licensed under
6the Hospital Licensing Act or operated under the University of
7Illinois Hospital Act, or a hospital affiliate that is not
8already exempt under another provision of this Act and meets
9the criteria for an exemption under this Section, is exempt
10from taxation under this Act.
11    (b) A hospital owner or hospital affiliate satisfies the
12conditions for an exemption under this Section if the value of
13qualified services or activities listed in subsection (c) of
14this Section for the hospital year equals or exceeds the
15relevant hospital entity's estimated property tax liability,
16without regard to any property tax exemption granted under
17Section 15-86 of the Property Tax Code, for the calendar year
18in which exemption or renewal of exemption is sought. For
19purposes of making the calculations required by this subsection
20(b), if the relevant hospital entity is a hospital owner that
21owns more than one hospital, the value of the services or
22activities listed in subsection (c) shall be calculated on the
23basis of only those services and activities relating to the
24hospital that includes the subject property, and the relevant
25hospital entity's estimated property tax liability shall be

 

 

SB2017- 42 -LRB101 09603 RAB 54701 b

1calculated only with respect to the properties comprising that
2hospital. In the case of a multi-state hospital system or
3hospital affiliate, the value of the services or activities
4listed in subsection (c) shall be calculated on the basis of
5only those services and activities that occur in Illinois and
6the relevant hospital entity's estimated property tax
7liability shall be calculated only with respect to its property
8located in Illinois.
9    (c) The following services and activities shall be
10considered for purposes of making the calculations required by
11subsection (b):
12        (1) Charity care. Free or discounted services provided
13    pursuant to the relevant hospital entity's financial
14    assistance policy, measured at cost, including discounts
15    provided under the Hospital Uninsured Patient Discount
16    Act.
17        (2) Health services to low-income and underserved
18    individuals. Other unreimbursed costs of the relevant
19    hospital entity for providing without charge, paying for,
20    or subsidizing goods, activities, or services for the
21    purpose of addressing the health of low-income or
22    underserved individuals. Those activities or services may
23    include, but are not limited to: financial or in-kind
24    support to affiliated or unaffiliated hospitals, hospital
25    affiliates, community clinics, or programs that treat
26    low-income or underserved individuals; paying for or

 

 

SB2017- 43 -LRB101 09603 RAB 54701 b

1    subsidizing health care professionals who care for
2    low-income or underserved individuals; providing or
3    subsidizing outreach or educational services to low-income
4    or underserved individuals for disease management and
5    prevention; free or subsidized goods, supplies, or
6    services needed by low-income or underserved individuals
7    because of their medical condition; and prenatal or
8    childbirth outreach to low-income or underserved persons.
9        (3) Subsidy of State or local governments. Direct or
10    indirect financial or in-kind subsidies of State or local
11    governments by the relevant hospital entity that pay for or
12    subsidize activities or programs related to health care for
13    low-income or underserved individuals.
14        (4) Support for State health care programs for
15    low-income individuals. At the election of the hospital
16    applicant for each applicable year, either (A) 10% of
17    payments to the relevant hospital entity and any hospital
18    affiliate designated by the relevant hospital entity
19    (provided that such hospital affiliate's operations
20    provide financial or operational support for or receive
21    financial or operational support from the relevant
22    hospital entity) under Medicaid or other means-tested
23    programs, including, but not limited to, General
24    Assistance, the Covering ALL KIDS and Young Adults Health
25    Insurance Act, and the State Children's Health Insurance
26    Program or (B) the amount of subsidy provided by the

 

 

SB2017- 44 -LRB101 09603 RAB 54701 b

1    relevant hospital entity and any hospital affiliate
2    designated by the relevant hospital entity (provided that
3    such hospital affiliate's operations provide financial or
4    operational support for or receive financial or
5    operational support from the relevant hospital entity) to
6    State or local government in treating Medicaid recipients
7    and recipients of means-tested programs, including but not
8    limited to General Assistance, the Covering ALL KIDS Health
9    Insurance Act, and the State Children's Health Insurance
10    Program. The amount of subsidy for purposes of this item
11    (4) is calculated in the same manner as unreimbursed costs
12    are calculated for Medicaid and other means-tested
13    government programs in the Schedule H of IRS Form 990 in
14    effect on the effective date of this amendatory Act of the
15    97th General Assembly.
16        (5) Dual-eligible subsidy. The amount of subsidy
17    provided to government by treating dual-eligible
18    Medicare/Medicaid patients. The amount of subsidy for
19    purposes of this item (5) is calculated by multiplying the
20    relevant hospital entity's unreimbursed costs for
21    Medicare, calculated in the same manner as determined in
22    the Schedule H of IRS Form 990 in effect on the effective
23    date of this amendatory Act of the 97th General Assembly,
24    by the relevant hospital entity's ratio of dual-eligible
25    patients to total Medicare patients.
26        (6) Relief of the burden of government related to

 

 

SB2017- 45 -LRB101 09603 RAB 54701 b

1    health care. Except to the extent otherwise taken into
2    account in this subsection, the portion of unreimbursed
3    costs of the relevant hospital entity attributable to
4    providing, paying for, or subsidizing goods, activities,
5    or services that relieve the burden of government related
6    to health care for low-income individuals. Such activities
7    or services shall include, but are not limited to,
8    providing emergency, trauma, burn, neonatal, psychiatric,
9    rehabilitation, or other special services; providing
10    medical education; and conducting medical research or
11    training of health care professionals. The portion of those
12    unreimbursed costs attributable to benefiting low-income
13    individuals shall be determined using the ratio calculated
14    by adding the relevant hospital entity's costs
15    attributable to charity care, Medicaid, other means-tested
16    government programs, Medicare patients with disabilities
17    under age 65, and dual-eligible Medicare/Medicaid patients
18    and dividing that total by the relevant hospital entity's
19    total costs. Such costs for the numerator and denominator
20    shall be determined by multiplying gross charges by the
21    cost to charge ratio taken from the hospital's most
22    recently filed Medicare cost report (CMS 2252-10
23    Worksheet, Part I). In the case of emergency services, the
24    ratio shall be calculated using costs (gross charges
25    multiplied by the cost to charge ratio taken from the
26    hospital's most recently filed Medicare cost report (CMS

 

 

SB2017- 46 -LRB101 09603 RAB 54701 b

1    2252-10 Worksheet, Part I)) of patients treated in the
2    relevant hospital entity's emergency department.
3        (7) Any other activity by the relevant hospital entity
4    that the Department determines relieves the burden of
5    government or addresses the health of low-income or
6    underserved individuals.
7    (d) The hospital applicant shall include information in its
8exemption application establishing that it satisfies the
9requirements of subsection (b). For purposes of making the
10calculations required by subsection (b), the hospital
11applicant may for each year elect to use either (1) the value
12of the services or activities listed in subsection (e) for the
13hospital year or (2) the average value of those services or
14activities for the 3 fiscal years ending with the hospital
15year. If the relevant hospital entity has been in operation for
16less than 3 completed fiscal years, then the latter
17calculation, if elected, shall be performed on a pro rata
18basis.
19    (e) For purposes of making the calculations required by
20this Section:
21        (1) particular services or activities eligible for
22    consideration under any of the paragraphs (1) through (7)
23    of subsection (c) may not be counted under more than one of
24    those paragraphs; and
25        (2) the amount of unreimbursed costs and the amount of
26    subsidy shall not be reduced by restricted or unrestricted

 

 

SB2017- 47 -LRB101 09603 RAB 54701 b

1    payments received by the relevant hospital entity as
2    contributions deductible under Section 170(a) of the
3    Internal Revenue Code.
4    (f) (Blank).
5    (g) Estimation of Exempt Property Tax Liability. The
6estimated property tax liability used for the determination in
7subsection (b) shall be calculated as follows:
8        (1) "Estimated property tax liability" means the
9    estimated dollar amount of property tax that would be owed,
10    with respect to the exempt portion of each of the relevant
11    hospital entity's properties that are already fully or
12    partially exempt, or for which an exemption in whole or in
13    part is currently being sought, and then aggregated as
14    applicable, as if the exempt portion of those properties
15    were subject to tax, calculated with respect to each such
16    property by multiplying:
17            (A) the lesser of (i) the actual assessed value, if
18        any, of the portion of the property for which an
19        exemption is sought or (ii) an estimated assessed value
20        of the exempt portion of such property as determined in
21        item (2) of this subsection (g), by
22            (B) the applicable State equalization rate
23        (yielding the equalized assessed value), by
24            (C) the applicable tax rate.
25        (2) The estimated assessed value of the exempt portion
26    of the property equals the sum of (i) the estimated fair

 

 

SB2017- 48 -LRB101 09603 RAB 54701 b

1    market value of buildings on the property, as determined in
2    accordance with subparagraphs (A) and (B) of this item (2),
3    multiplied by the applicable assessment factor, and (ii)
4    the estimated assessed value of the land portion of the
5    property, as determined in accordance with subparagraph
6    (C).
7            (A) The "estimated fair market value of buildings
8        on the property" means the replacement value of any
9        exempt portion of buildings on the property, minus
10        depreciation, determined utilizing the cost
11        replacement method whereby the exempt square footage
12        of all such buildings is multiplied by the replacement
13        cost per square foot for Class A Average building found
14        in the most recent edition of the Marshall & Swift
15        Valuation Services Manual, adjusted by any appropriate
16        current cost and local multipliers.
17            (B) Depreciation, for purposes of calculating the
18        estimated fair market value of buildings on the
19        property, is applied by utilizing a weighted mean life
20        for the buildings based on original construction and
21        assuming a 40-year life for hospital buildings and the
22        applicable life for other types of buildings as
23        specified in the American Hospital Association
24        publication "Estimated Useful Lives of Depreciable
25        Hospital Assets". In the case of hospital buildings,
26        the remaining life is divided by 40 and this ratio is

 

 

SB2017- 49 -LRB101 09603 RAB 54701 b

1        multiplied by the replacement cost of the buildings to
2        obtain an estimated fair market value of buildings. If
3        a hospital building is older than 35 years, a remaining
4        life of 5 years for residual value is assumed; and if a
5        building is less than 8 years old, a remaining life of
6        32 years is assumed.
7            (C) The estimated assessed value of the land
8        portion of the property shall be determined by
9        multiplying (i) the per square foot average of the
10        assessed values of three parcels of land (not including
11        farm land, and excluding the assessed value of the
12        improvements thereon) reasonably comparable to the
13        property, by (ii) the number of square feet comprising
14        the exempt portion of the property's land square
15        footage.
16        (3) The assessment factor, State equalization rate,
17    and tax rate (including any special factors such as
18    Enterprise Zones) used in calculating the estimated
19    property tax liability shall be for the most recent year
20    that is publicly available from the applicable chief county
21    assessment officer or officers at least 90 days before the
22    end of the hospital year.
23        (4) The method utilized to calculate estimated
24    property tax liability for purposes of this Section 15-86
25    shall not be utilized for the actual valuation, assessment,
26    or taxation of property pursuant to the Property Tax Code.

 

 

SB2017- 50 -LRB101 09603 RAB 54701 b

1    (h) For the purpose of this Section, the following terms
2shall have the meanings set forth below:
3        (1) "Hospital" means any institution, place, building,
4    buildings on a campus, or other health care facility
5    located in Illinois that is licensed under the Hospital
6    Licensing Act and has a hospital owner.
7        (2) "Hospital owner" means a not-for-profit
8    corporation that is the titleholder of a hospital, or the
9    owner of the beneficial interest in an Illinois land trust
10    that is the titleholder of a hospital.
11        (3) "Hospital affiliate" means any corporation,
12    partnership, limited partnership, joint venture, limited
13    liability company, association or other organization,
14    other than a hospital owner, that directly or indirectly
15    controls, is controlled by, or is under common control with
16    one or more hospital owners and that supports, is supported
17    by, or acts in furtherance of the exempt health care
18    purposes of at least one of those hospital owners'
19    hospitals.
20        (4) "Hospital system" means a hospital and one or more
21    other hospitals or hospital affiliates related by common
22    control or ownership.
23        (5) "Control" relating to hospital owners, hospital
24    affiliates, or hospital systems means possession, direct
25    or indirect, of the power to direct or cause the direction
26    of the management and policies of the entity, whether

 

 

SB2017- 51 -LRB101 09603 RAB 54701 b

1    through ownership of assets, membership interest, other
2    voting or governance rights, by contract or otherwise.
3        (6) "Hospital applicant" means a hospital owner or
4    hospital affiliate that files an application for an
5    exemption or renewal of exemption under this Section.
6        (7) "Relevant hospital entity" means (A) the hospital
7    owner, in the case of a hospital applicant that is a
8    hospital owner, and (B) at the election of a hospital
9    applicant that is a hospital affiliate, either (i) the
10    hospital affiliate or (ii) the hospital system to which the
11    hospital applicant belongs, including any hospitals or
12    hospital affiliates that are related by common control or
13    ownership.
14        (8) "Subject property" means property used for the
15    calculation under subsection (b) of this Section.
16        (9) "Hospital year" means the fiscal year of the
17    relevant hospital entity, or the fiscal year of one of the
18    hospital owners in the hospital system if the relevant
19    hospital entity is a hospital system with members with
20    different fiscal years, that ends in the year for which the
21    exemption is sought.
22(Source: P.A. 98-463, eff. 8-16-13; 99-143, eff. 7-27-15.)
 
23    Section 30. The Property Tax Code is amended by changing
24Section 15-86 as follows:
 

 

 

SB2017- 52 -LRB101 09603 RAB 54701 b

1    (35 ILCS 200/15-86)
2    Sec. 15-86. Exemptions related to access to hospital and
3health care services by low-income and underserved
4individuals.
5    (a) The General Assembly finds:
6        (1) Despite the Supreme Court's decision in Provena
7    Covenant Medical Center v. Dept. of Revenue, 236 Ill.2d
8    368, there is considerable uncertainty surrounding the
9    test for charitable property tax exemption, especially
10    regarding the application of a quantitative or monetary
11    threshold. In Provena, the Department stated that the
12    primary basis for its decision was the hospital's
13    inadequate amount of charitable activity, but the
14    Department has not articulated what constitutes an
15    adequate amount of charitable activity. After Provena, the
16    Department denied property tax exemption applications of 3
17    more hospitals, and, on the effective date of this
18    amendatory Act of the 97th General Assembly, at least 20
19    other hospitals are awaiting rulings on applications for
20    property tax exemption.
21        (2) In Provena, two Illinois Supreme Court justices
22    opined that "setting a monetary or quantum standard is a
23    complex decision which should be left to our legislature,
24    should it so choose". The Appellate Court in Provena
25    stated: "The language we use in the State of Illinois to
26    determine whether real property is used for a charitable

 

 

SB2017- 53 -LRB101 09603 RAB 54701 b

1    purpose has its genesis in our 1870 Constitution. It is
2    obvious that such language may be difficult to apply to the
3    modern face of our nation's health care delivery systems".
4    The court noted the many significant changes in the health
5    care system since that time, but concluded that taking
6    these changes into account is a matter of public policy,
7    and "it is the legislature's job, not ours, to make public
8    policy".
9        (3) It is essential to ensure that tax exemption law
10    relating to hospitals accounts for the complexities of the
11    modern health care delivery system. Health care is moving
12    beyond the walls of the hospital. In addition to treating
13    individual patients, hospitals are assuming responsibility
14    for improving the health status of communities and
15    populations. Low-income and underserved communities
16    benefit disproportionately by these activities.
17        (4) The Supreme Court has explained that: "the
18    fundamental ground upon which all exemptions in favor of
19    charitable institutions are based is the benefit conferred
20    upon the public by them, and a consequent relief, to some
21    extent, of the burden upon the state to care for and
22    advance the interests of its citizens". Hospitals relieve
23    the burden of government in many ways, but most
24    significantly through their participation in and
25    substantial financial subsidization of the Illinois
26    Medicaid program, which could not operate without the

 

 

SB2017- 54 -LRB101 09603 RAB 54701 b

1    participation and partnership of Illinois hospitals.
2        (5) Working with the Illinois hospital community and
3    other interested parties, the General Assembly has
4    developed a comprehensive combination of related
5    legislation that addresses hospital property tax
6    exemption, significantly increases access to free health
7    care for indigent persons, and strengthens the Medical
8    Assistance program. It is the intent of the General
9    Assembly to establish a new category of ownership for
10    charitable property tax exemption to be applied to
11    not-for-profit hospitals and hospital affiliates in lieu
12    of the existing ownership category of "institutions of
13    public charity". It is also the intent of the General
14    Assembly to establish quantifiable standards for the
15    issuance of charitable exemptions for such property. It is
16    not the intent of the General Assembly to declare any
17    property exempt ipso facto, but rather to establish
18    criteria to be applied to the facts on a case-by-case
19    basis.
20    (b) For the purpose of this Section and Section 15-10, the
21following terms shall have the meanings set forth below:
22        (1) "Hospital" means any institution, place, building,
23    buildings on a campus, or other health care facility
24    located in Illinois that is licensed under the Hospital
25    Licensing Act and has a hospital owner.
26        (2) "Hospital owner" means a not-for-profit

 

 

SB2017- 55 -LRB101 09603 RAB 54701 b

1    corporation that is the titleholder of a hospital, or the
2    owner of the beneficial interest in an Illinois land trust
3    that is the titleholder of a hospital.
4        (3) "Hospital affiliate" means any corporation,
5    partnership, limited partnership, joint venture, limited
6    liability company, association or other organization,
7    other than a hospital owner, that directly or indirectly
8    controls, is controlled by, or is under common control with
9    one or more hospital owners and that supports, is supported
10    by, or acts in furtherance of the exempt health care
11    purposes of at least one of those hospital owners'
12    hospitals.
13        (4) "Hospital system" means a hospital and one or more
14    other hospitals or hospital affiliates related by common
15    control or ownership.
16        (5) "Control" relating to hospital owners, hospital
17    affiliates, or hospital systems means possession, direct
18    or indirect, of the power to direct or cause the direction
19    of the management and policies of the entity, whether
20    through ownership of assets, membership interest, other
21    voting or governance rights, by contract or otherwise.
22        (6) "Hospital applicant" means a hospital owner or
23    hospital affiliate that files an application for a property
24    tax exemption pursuant to Section 15-5 and this Section.
25        (7) "Relevant hospital entity" means (A) the hospital
26    owner, in the case of a hospital applicant that is a

 

 

SB2017- 56 -LRB101 09603 RAB 54701 b

1    hospital owner, and (B) at the election of a hospital
2    applicant that is a hospital affiliate, either (i) the
3    hospital affiliate or (ii) the hospital system to which the
4    hospital applicant belongs, including any hospitals or
5    hospital affiliates that are related by common control or
6    ownership.
7        (8) "Subject property" means property for which a
8    hospital applicant files an application for an exemption
9    pursuant to Section 15-5 and this Section.
10        (9) "Hospital year" means the fiscal year of the
11    relevant hospital entity, or the fiscal year of one of the
12    hospital owners in the hospital system if the relevant
13    hospital entity is a hospital system with members with
14    different fiscal years, that ends in the year for which the
15    exemption is sought.
16    (c) A hospital applicant satisfies the conditions for an
17exemption under this Section with respect to the subject
18property, and shall be issued a charitable exemption for that
19property, if the value of services or activities listed in
20subsection (e) for the hospital year equals or exceeds the
21relevant hospital entity's estimated property tax liability,
22as determined under subsection (g), for the year for which
23exemption is sought. For purposes of making the calculations
24required by this subsection (c), if the relevant hospital
25entity is a hospital owner that owns more than one hospital,
26the value of the services or activities listed in subsection

 

 

SB2017- 57 -LRB101 09603 RAB 54701 b

1(e) shall be calculated on the basis of only those services and
2activities relating to the hospital that includes the subject
3property, and the relevant hospital entity's estimated
4property tax liability shall be calculated only with respect to
5the properties comprising that hospital. In the case of a
6multi-state hospital system or hospital affiliate, the value of
7the services or activities listed in subsection (e) shall be
8calculated on the basis of only those services and activities
9that occur in Illinois and the relevant hospital entity's
10estimated property tax liability shall be calculated only with
11respect to its property located in Illinois.
12    Notwithstanding any other provisions of this Act, any
13parcel or portion thereof, that is owned by a for-profit entity
14whether part of the hospital system or not, or that is leased,
15licensed or operated by a for-profit entity regardless of
16whether healthcare services are provided on that parcel shall
17not qualify for exemption. If a parcel has both exempt and
18non-exempt uses, an exemption may be granted for the qualifying
19portion of that parcel. In the case of parking lots and common
20areas serving both exempt and non-exempt uses those parcels or
21portions thereof may qualify for an exemption in proportion to
22the amount of qualifying use.
23    (d) The hospital applicant shall include information in its
24exemption application establishing that it satisfies the
25requirements of subsection (c). For purposes of making the
26calculations required by subsection (c), the hospital

 

 

SB2017- 58 -LRB101 09603 RAB 54701 b

1applicant may for each year elect to use either (1) the value
2of the services or activities listed in subsection (e) for the
3hospital year or (2) the average value of those services or
4activities for the 3 fiscal years ending with the hospital
5year. If the relevant hospital entity has been in operation for
6less than 3 completed fiscal years, then the latter
7calculation, if elected, shall be performed on a pro rata
8basis.
9    (e) Services that address the health care needs of
10low-income or underserved individuals or relieve the burden of
11government with regard to health care services. The following
12services and activities shall be considered for purposes of
13making the calculations required by subsection (c):
14        (1) Charity care. Free or discounted services provided
15    pursuant to the relevant hospital entity's financial
16    assistance policy, measured at cost, including discounts
17    provided under the Hospital Uninsured Patient Discount
18    Act.
19        (2) Health services to low-income and underserved
20    individuals. Other unreimbursed costs of the relevant
21    hospital entity for providing without charge, paying for,
22    or subsidizing goods, activities, or services for the
23    purpose of addressing the health of low-income or
24    underserved individuals. Those activities or services may
25    include, but are not limited to: financial or in-kind
26    support to affiliated or unaffiliated hospitals, hospital

 

 

SB2017- 59 -LRB101 09603 RAB 54701 b

1    affiliates, community clinics, or programs that treat
2    low-income or underserved individuals; paying for or
3    subsidizing health care professionals who care for
4    low-income or underserved individuals; providing or
5    subsidizing outreach or educational services to low-income
6    or underserved individuals for disease management and
7    prevention; free or subsidized goods, supplies, or
8    services needed by low-income or underserved individuals
9    because of their medical condition; and prenatal or
10    childbirth outreach to low-income or underserved persons.
11        (3) Subsidy of State or local governments. Direct or
12    indirect financial or in-kind subsidies of State or local
13    governments by the relevant hospital entity that pay for or
14    subsidize activities or programs related to health care for
15    low-income or underserved individuals.
16        (4) Support for State health care programs for
17    low-income individuals. At the election of the hospital
18    applicant for each applicable year, either (A) 10% of
19    payments to the relevant hospital entity and any hospital
20    affiliate designated by the relevant hospital entity
21    (provided that such hospital affiliate's operations
22    provide financial or operational support for or receive
23    financial or operational support from the relevant
24    hospital entity) under Medicaid or other means-tested
25    programs, including, but not limited to, General
26    Assistance, the Covering ALL KIDS and Young Adults Health

 

 

SB2017- 60 -LRB101 09603 RAB 54701 b

1    Insurance Act, and the State Children's Health Insurance
2    Program or (B) the amount of subsidy provided by the
3    relevant hospital entity and any hospital affiliate
4    designated by the relevant hospital entity (provided that
5    such hospital affiliate's operations provide financial or
6    operational support for or receive financial or
7    operational support from the relevant hospital entity) to
8    State or local government in treating Medicaid recipients
9    and recipients of means-tested programs, including but not
10    limited to General Assistance, the Covering ALL KIDS Health
11    Insurance Act, and the State Children's Health Insurance
12    Program. The amount of subsidy for purposes of this item
13    (4) is calculated in the same manner as unreimbursed costs
14    are calculated for Medicaid and other means-tested
15    government programs in the Schedule H of IRS Form 990 in
16    effect on the effective date of this amendatory Act of the
17    97th General Assembly; provided, however, that in any event
18    unreimbursed costs shall be net of fee-for-services
19    payments, payments pursuant to an assessment, quarterly
20    payments, and all other payments included on the schedule H
21    of the IRS form 990.
22        (5) Dual-eligible subsidy. The amount of subsidy
23    provided to government by treating dual-eligible
24    Medicare/Medicaid patients. The amount of subsidy for
25    purposes of this item (5) is calculated by multiplying the
26    relevant hospital entity's unreimbursed costs for

 

 

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1    Medicare, calculated in the same manner as determined in
2    the Schedule H of IRS Form 990 in effect on the effective
3    date of this amendatory Act of the 97th General Assembly,
4    by the relevant hospital entity's ratio of dual-eligible
5    patients to total Medicare patients.
6        (6) Relief of the burden of government related to
7    health care of low-income individuals. Except to the extent
8    otherwise taken into account in this subsection, the
9    portion of unreimbursed costs of the relevant hospital
10    entity attributable to providing, paying for, or
11    subsidizing goods, activities, or services that relieve
12    the burden of government related to health care for
13    low-income individuals. Such activities or services shall
14    include, but are not limited to, providing emergency,
15    trauma, burn, neonatal, psychiatric, rehabilitation, or
16    other special services; providing medical education; and
17    conducting medical research or training of health care
18    professionals. The portion of those unreimbursed costs
19    attributable to benefiting low-income individuals shall be
20    determined using the ratio calculated by adding the
21    relevant hospital entity's costs attributable to charity
22    care, Medicaid, other means-tested government programs,
23    Medicare patients with disabilities under age 65, and
24    dual-eligible Medicare/Medicaid patients and dividing that
25    total by the relevant hospital entity's total costs. Such
26    costs for the numerator and denominator shall be determined

 

 

SB2017- 62 -LRB101 09603 RAB 54701 b

1    by multiplying gross charges by the cost to charge ratio
2    taken from the hospitals' most recently filed Medicare cost
3    report (CMS 2252-10 Worksheet C, Part I). In the case of
4    emergency services, the ratio shall be calculated using
5    costs (gross charges multiplied by the cost to charge ratio
6    taken from the hospitals' most recently filed Medicare cost
7    report (CMS 2252-10 Worksheet C, Part I)) of patients
8    treated in the relevant hospital entity's emergency
9    department.
10        (7) Any other activity by the relevant hospital entity
11    that the Department determines relieves the burden of
12    government or addresses the health of low-income or
13    underserved individuals.
14    (f) For purposes of making the calculations required by
15subsections (c) and (e):
16        (1) particular services or activities eligible for
17    consideration under any of the paragraphs (1) through (7)
18    of subsection (e) may not be counted under more than one of
19    those paragraphs; and
20        (2) the amount of unreimbursed costs and the amount of
21    subsidy shall not be reduced by restricted or unrestricted
22    payments received by the relevant hospital entity as
23    contributions deductible under Section 170(a) of the
24    Internal Revenue Code.
25    (g) Estimation of Exempt Property Tax Liability. The
26estimated property tax liability used for the determination in

 

 

SB2017- 63 -LRB101 09603 RAB 54701 b

1subsection (c) shall be calculated as follows:
2        (1) "Estimated property tax liability" means the
3    estimated dollar amount of property tax that would be owed,
4    with respect to the exempt portion of each of the relevant
5    hospital entity's properties that are already fully or
6    partially exempt, or for which an exemption in whole or in
7    part is currently being sought, and then aggregated as
8    applicable, as if the exempt portion of those properties
9    were subject to tax, calculated with respect to each such
10    property by multiplying:
11            (A) the lesser of (i) the actual assessed value, if
12        any, of the portion of the property for which an
13        exemption is sought or (ii) an estimated assessed value
14        of the exempt portion of such property as determined in
15        item (2) of this subsection (g), by:
16            (B) the applicable State equalization rate
17        (yielding the equalized assessed value), by
18            (C) the applicable tax rate.
19        (2) The estimated assessed value of the exempt portion
20    of the property equals the sum of (i) the estimated fair
21    market value of buildings on the property, as determined in
22    accordance with subparagraphs (A) and (B) of this item (2),
23    multiplied by the applicable assessment factor, and (ii)
24    the estimated assessed value of the land portion of the
25    property, as determined in accordance with subparagraph
26    (C).

 

 

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1            (A) The "estimated fair market value of buildings
2        on the property" means the replacement value of any
3        exempt portion of buildings on the property, minus
4        depreciation, determined utilizing the cost
5        replacement method whereby the exempt square footage
6        of all such buildings is multiplied by the replacement
7        cost per square foot for Class A Average building found
8        in the most recent edition of the Marshall & Swift
9        Valuation Services Manual, adjusted by any appropriate
10        current cost and local multipliers.
11            (B) Depreciation, for purposes of calculating the
12        estimated fair market value of buildings on the
13        property, is applied by utilizing a weighted mean life
14        for the buildings based on original construction and
15        assuming a 40-year life for hospital buildings and the
16        applicable life for other types of buildings as
17        specified in the American Hospital Association
18        publication "Estimated Useful Lives of Depreciable
19        Hospital Assets". In the case of hospital buildings,
20        the remaining life is divided by 40 and this ratio is
21        multiplied by the replacement cost of the buildings to
22        obtain an estimated fair market value of buildings. If
23        a hospital building is older than 35 years, a remaining
24        life of 5 years for residual value is assumed; and if a
25        building is less than 8 years old, a remaining life of
26        32 years is assumed.

 

 

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1            (C) The estimated assessed value of the land
2        portion of the property shall be determined by
3        multiplying (i) the per square foot average of the
4        assessed values of three parcels of land (not including
5        farm land, and excluding the assessed value of the
6        improvements thereon) reasonably comparable to the
7        property, by (ii) the number of square feet comprising
8        the exempt portion of the property's land square
9        footage.
10        (3) The assessment factor, State equalization rate,
11    and tax rate (including any special factors such as
12    Enterprise Zones) used in calculating the estimated
13    property tax liability shall be for the most recent year
14    that is publicly available from the applicable chief county
15    assessment officer or officers at least 90 days before the
16    end of the hospital year.
17        (4) The method utilized to calculate estimated
18    property tax liability for purposes of this Section 15-86
19    shall not be utilized for the actual valuation, assessment,
20    or taxation of property pursuant to the Property Tax Code.
21    (h) Application. Each hospital applicant applying for a
22property tax exemption pursuant to Section 15-5 and this
23Section shall use an application form provided by the
24Department. The application form shall specify the records
25required in support of the application and those records shall
26be submitted to the Department with the application form. Each

 

 

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1application or affidavit shall contain a verification by the
2Chief Executive Officer of the hospital applicant under oath or
3affirmation stating that each statement in the application or
4affidavit and each document submitted with the application or
5affidavit are true and correct. The records submitted with the
6application pursuant to this Section shall include an exhibit
7prepared by the relevant hospital entity showing (A) the value
8of the relevant hospital entity's services and activities, if
9any, under paragraphs (1) through (7) of subsection (e) of this
10Section stated separately for each paragraph, and (B) the value
11relating to the relevant hospital entity's estimated property
12tax liability under subsections (g)(1)(A), (B), and (C),
13subsections (g)(2)(A), (B), and (C), and subsection (g)(3) of
14this Section stated separately for each item. Such exhibit will
15be made available to the public by the chief county assessment
16officer. Nothing in this Section shall be construed as limiting
17the Attorney General's authority under the Illinois False
18Claims Act.
19    (i) Nothing in this Section shall be construed to limit the
20ability of otherwise eligible hospitals, hospital owners,
21hospital affiliates, or hospital systems to obtain or maintain
22property tax exemptions pursuant to a provision of the Property
23Tax Code other than this Section.
24(Source: P.A. 99-143, eff. 7-27-15.)
 
25    Section 35. The Illinois Pension Code is amended by

 

 

SB2017- 67 -LRB101 09603 RAB 54701 b

1changing Section 24-102 as follows:
 
2    (40 ILCS 5/24-102)  (from Ch. 108 1/2, par. 24-102)
3    Sec. 24-102. As used in this Article, "employee" means any
4person, including a person elected, appointed or under
5contract, receiving compensation from the State or a unit of
6local government or school district for personal services
7rendered, including salaried persons. A health care provider
8who elects to participate in the State Employees Deferred
9Compensation Plan established under Section 24-104 of this Code
10shall, for purposes of that participation, be deemed an
11"employee" as defined in this Section.
12    As used in this Article, "health care provider" means a
13dentist, physician, optometrist, pharmacist, or podiatric
14physician that participates and receives compensation as a
15provider under the Illinois Public Aid Code, the Children's
16Health Insurance Act, or the Covering ALL KIDS and Young Adults
17Health Insurance Act.
18    As used in this Article, "compensation" includes
19compensation received in a lump sum for accumulated unused
20vacation, personal leave or sick leave, with the exception of
21health care providers. "Compensation" with respect to health
22care providers is defined under the Illinois Public Aid Code,
23the Children's Health Insurance Act, or the Covering ALL KIDS
24Health Insurance Act.
25    Where applicable, in no event shall the total of the amount

 

 

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1of deferred compensation of an employee set aside in relation
2to a particular year under the Illinois State Employees
3Deferred Compensation Plan and the employee's nondeferred
4compensation for that year exceed the total annual salary or
5compensation under the existing salary schedule or
6classification plan applicable to such employee in such year;
7except that any compensation received in a lump sum for
8accumulated unused vacation, personal leave or sick leave shall
9not be included in the calculation of such totals.
10(Source: P.A. 98-214, eff. 8-9-13.)
 
11    Section 40. The Loan Repayment Assistance for Dentists Act
12is amended by changing Section 10, 25, and 30 as follows:
 
13    (110 ILCS 948/10)
14    Sec. 10. Definitions. In this Act, unless the context
15otherwise requires:
16    "Dental hygienist" means a person who holds a license under
17the Illinois Dental Practice Act to perform dental services as
18authorized by Section 18 of the Illinois Dental Practice Act.
19    "Dental payments" means compensation provided to dentists
20and dental specialists for services rendered under Article V of
21the Illinois Public Aid Code, the Covering ALL KIDS and Young
22Adults Health Insurance Act, or the Children's Health Insurance
23Program Act.
24    "Dental specialist" means a person who has received a

 

 

SB2017- 69 -LRB101 09603 RAB 54701 b

1license as a dentist in this State and who is trained and
2qualified to practice in one or more of the following
3specialties of dentistry: endodontics, oral and maxillofacial
4surgery, orthodontics, pedodontics, periodontics, and
5prosthodontics.
6    "Dentist" means a person who has received a general license
7pursuant to paragraph (a) of Section 11 of the Illinois Dental
8Practice Act, who may perform any intraoral and extraoral
9procedure required in the practice of dentistry, and to whom is
10reserved the responsibilities specified in Section 17 of the
11Illinois Dental Practice Act.
12    "Department" means the Department of Public Health.
13    "Designated shortage area" means a medically underserved
14area or health manpower shortage area as defined by the United
15States Department of Health and Human Services or as otherwise
16designated by the Department of Public Health.
17    "Educational loans" means higher education student loans
18that a person has incurred in attending a registered
19professional dental education program.
20    "Program" means the educational loan repayment assistance
21program for dentists and dental specialists or dental
22hygienists established by the Department under this Act.
23(Source: P.A. 95-297, eff. 8-20-07; 96-757, eff. 8-25-09.)
 
24    (110 ILCS 948/25)
25    Sec. 25. Eligibility. To be eligible for assistance under

 

 

SB2017- 70 -LRB101 09603 RAB 54701 b

1the program, an applicant must meet all of the following
2qualifications:
3        (1) He or she must be a citizen or permanent resident
4    of the United States.
5        (2) He or she must be a resident of this State.
6        (3) He or she must be practicing full time in this
7    State as a dentist, dental specialist, or dental hygienist.
8        (4) He or she must currently be repaying educational
9    loans.
10        (5) He or she must accept dental payments as defined in
11    this Act.
12        (6) He or she must practice or commit to practice full
13    time in this State in a designated shortage area.
14        (7) He or she must allocate at least 20% of all patient
15    appointments to patients covered by Article V of the
16    Illinois Public Aid Code, the Covering ALL KIDS and Young
17    Adults Health Insurance Act, or the Children's Health
18    Insurance Program Act.
19(Source: P.A. 95-297, eff. 8-20-07; 96-757, eff. 8-25-09.)
 
20    (110 ILCS 948/30)
21    Sec. 30. The award of grants.
22    (a) Under the program, for each year that a qualified
23applicant practices full time in this State in a designated
24shortage area as a dentist or dental specialist, the Department
25shall, subject to appropriation, award a grant to that person

 

 

SB2017- 71 -LRB101 09603 RAB 54701 b

1in an amount equal to the amount in educational loans that the
2person must repay that year. However, the total amount in
3grants that a person may be awarded under the program must not
4exceed $25,000 per year for a 4-year period.
5    The grant award for a dental hygienist shall be set by rule
6of the Department.
7    (b) The Department shall require recipients to use the
8grants to pay off their educational loans.
9    (c) The initial grant awarded to a dentist or dental
10specialist under this Act shall be for a 2-year period. Based
11on the successful completion of the initial 2-year grant, the
12grantees may be awarded up to 2 subsequent one-year grants.
13Grantees are eligible to receive grant funds for no more than a
144-year period. Previous grant recipients shall be given
15priority for years 3 and 4 grant funding, provided that the
16grantee continues to meet the eligibility requirements set
17forth in Section 25 of this Act. Grantees shall practice full
18time in a designated shortage area for the period of each grant
19awarded.
20    The grant award for a dental hygienist shall be for a
21maximum of 2 years.
22    (d) Successful applicants shall be eligible for a grant
23award upon execution of the grant agreement and shall then
24begin to receive grant award payments on a quarterly basis.
25    (e) The Department shall award grants to otherwise eligible
26dental applicants by using the following criteria:

 

 

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1        (1) Dental specialist willing to practice in any
2    designated shortage area.
3        (2) Dentist willing to practice in a designated
4    shortage area with the highest Health Professional
5    Shortage Area (HPSA) score.
6        (3) Dentist willing to practice in a designated
7    shortage area with the highest HPSA score and agreeing to
8    allocate the highest percentage of patient appointments to
9    those that are covered by Article V of the Illinois Public
10    Aid Code, the Covering ALL KIDS and Young Adults Health
11    Insurance Act, or the Children's Health Insurance Program
12    Act.
13(Source: P.A. 95-297, eff. 8-20-07; 96-757, eff. 8-25-09.)
 
14    Section 45. The Children's Health Insurance Program Act is
15amended by changing Section 23 as follows:
 
16    (215 ILCS 106/23)
17    Sec. 23. Care coordination.
18    (a) At least 50% of recipients eligible for comprehensive
19medical benefits in all medical assistance programs or other
20health benefit programs administered by the Department,
21including the Children's Health Insurance Program Act and the
22Covering ALL KIDS and Young Adults Health Insurance Act, shall
23be enrolled in a care coordination program by no later than
24January 1, 2015. For purposes of this Section, "coordinated

 

 

SB2017- 73 -LRB101 09603 RAB 54701 b

1care" or "care coordination" means delivery systems where
2recipients will receive their care from providers who
3participate under contract in integrated delivery systems that
4are responsible for providing or arranging the majority of
5care, including primary care physician services, referrals
6from primary care physicians, diagnostic and treatment
7services, behavioral health services, in-patient and
8outpatient hospital services, dental services, and
9rehabilitation and long-term care services. The Department
10shall designate or contract for such integrated delivery
11systems (i) to ensure enrollees have a choice of systems and of
12primary care providers within such systems; (ii) to ensure that
13enrollees receive quality care in a culturally and
14linguistically appropriate manner; and (iii) to ensure that
15coordinated care programs meet the diverse needs of enrollees
16with developmental, mental health, physical, and age-related
17disabilities.
18    (b) Payment for such coordinated care shall be based on
19arrangements where the State pays for performance related to
20health care outcomes, the use of evidence-based practices, the
21use of primary care delivered through comprehensive medical
22homes, the use of electronic medical records, and the
23appropriate exchange of health information electronically made
24either on a capitated basis in which a fixed monthly premium
25per recipient is paid and full financial risk is assumed for
26the delivery of services, or through other risk-based payment

 

 

SB2017- 74 -LRB101 09603 RAB 54701 b

1arrangements.
2    (c) To qualify for compliance with this Section, the 50%
3goal shall be achieved by enrolling medical assistance
4enrollees from each medical assistance enrollment category,
5including parents, children, seniors, and people with
6disabilities to the extent that current State Medicaid payment
7laws would not limit federal matching funds for recipients in
8care coordination programs. In addition, services must be more
9comprehensively defined and more risk shall be assumed than in
10the Department's primary care case management program as of the
11effective date of this amendatory Act of the 96th General
12Assembly.
13    (d) The Department shall report to the General Assembly in
14a separate part of its annual medical assistance program
15report, beginning April, 2012 until April, 2016, on the
16progress and implementation of the care coordination program
17initiatives established by the provisions of this amendatory
18Act of the 96th General Assembly. The Department shall include
19in its April 2011 report a full analysis of federal laws or
20regulations regarding upper payment limitations to providers
21and the necessary revisions or adjustments in rate
22methodologies and payments to providers under this Code that
23would be necessary to implement coordinated care with full
24financial risk by a party other than the Department.
25(Source: P.A. 96-1501, eff. 1-25-11.)
 

 

 

SB2017- 75 -LRB101 09603 RAB 54701 b

1    Section 50. The Covering ALL KIDS Health Insurance Act is
2amended by changing Sections 1, 5, 10, 15, 20, 25, 35, 40, 45,
347, and 56 as follows:
 
4    (215 ILCS 170/1)
5    (Section scheduled to be repealed on October 1, 2019)
6    Sec. 1. Short title. This Act may be cited as the Covering
7ALL KIDS and Young Adults Health Insurance Act.
8(Source: P.A. 94-693, eff. 7-1-06.)
 
9    (215 ILCS 170/5)
10    (Section scheduled to be repealed on October 1, 2019)
11    Sec. 5. Legislative intent. The General Assembly finds
12that, for the economic and social benefit of all residents of
13the State, it is important to enable all children and young
14adults of this State to access affordable health insurance that
15offers comprehensive coverage and emphasizes preventive
16healthcare. Many children and young adults in working families,
17including many families whose family income ranges between
18$40,000 and $80,000, are uninsured. Numerous studies,
19including the Institute of Medicine's report, "Health
20Insurance Matters", demonstrate that lack of insurance
21negatively affects health status. The General Assembly further
22finds that access to healthcare is a key component for
23children's and young adults' healthy development and
24successful education. The effects of lack of insurance also

 

 

SB2017- 76 -LRB101 09603 RAB 54701 b

1negatively impact those who are insured because the cost of
2paying for care to the uninsured is often shifted to those who
3have insurance in the form of higher health insurance premiums.
4A Families USA 2005 report indicates that family premiums in
5Illinois are increased by $1,059 due to cost-shifting from the
6uninsured. It is, therefore, the intent of this legislation to
7provide access to affordable health insurance to all uninsured
8children and young adults in Illinois.
9(Source: P.A. 94-693, eff. 7-1-06.)
 
10    (215 ILCS 170/10)
11    (Section scheduled to be repealed on October 1, 2019)
12    Sec. 10. Definitions. In this Act:
13    "Application agent" means an organization or individual,
14such as a licensed health care provider, school, youth service
15agency, employer, labor union, local chamber of commerce,
16community-based organization, or other organization, approved
17by the Department to assist in enrolling children and young
18adults in the Program.
19    "Child" means a person under the age of 19.
20    "Young adult" means a person age 19 to 26.
21    "Department" means the Department of Healthcare and Family
22Services.
23    "Medical assistance" means health care benefits provided
24under Article V of the Illinois Public Aid Code.
25    "Program" means the Covering ALL KIDS and Young Adults

 

 

SB2017- 77 -LRB101 09603 RAB 54701 b

1Health Insurance Program.
2    "Resident" means an individual (i) who is in the State for
3other than a temporary or transitory purpose during the taxable
4year or (ii) who is domiciled in this State but is absent from
5the State for a temporary or transitory purpose during the
6taxable year.
7(Source: P.A. 94-693, eff. 7-1-06.)
 
8    (215 ILCS 170/15)
9    (Section scheduled to be repealed on October 1, 2019)
10    Sec. 15. Operation of Program. The Covering ALL KIDS and
11Young Adults Health Insurance Program is created. The Program
12shall be administered by the Department of Healthcare and
13Family Services. The Department shall have the same powers and
14authority to administer the Program as are provided to the
15Department in connection with the Department's administration
16of the Illinois Public Aid Code, including, but not limited to,
17the provisions under Section 11-5.1 of the Code, and the
18Children's Health Insurance Program Act. The Department shall
19coordinate the Program with the existing children's health
20programs operated by the Department and other State agencies.
21Effective October 1, 2013, the determination of eligibility
22under this Act shall comply with the requirements of 42 U.S.C.
231397bb(b)(1)(B)(v) and applicable federal regulations. If
24changes made to this Section require federal approval, they
25shall not take effect until such approval has been received.

 

 

SB2017- 78 -LRB101 09603 RAB 54701 b

1(Source: P.A. 98-104, eff. 7-22-13.)
 
2    (215 ILCS 170/20)
3    (Section scheduled to be repealed on October 1, 2019)
4    Sec. 20. Eligibility.
5    (a) To be eligible for the Program, a person must be a
6child or young adult:
7        (1) who is a resident of the State of Illinois;
8        (2) who is ineligible for medical assistance under the
9    Illinois Public Aid Code or benefits under the Children's
10    Health Insurance Program Act;
11        (3) who (i) effective July 1, 2014, in accordance with
12    42 CFR 457.805 (78 FR 42313, July 15, 2013) or any other
13    federal requirement necessary to obtain federal financial
14    participation for expenditures made under this Act, has
15    been without health insurance coverage for 90 days; (ii) is
16    a newborn whose responsible relative does not have
17    available affordable private or employer-sponsored health
18    insurance; or (iii) within one year of applying for
19    coverage under this Act, lost medical benefits under the
20    Illinois Public Aid Code or the Children's Health Insurance
21    Program Act; and
22        (3.5) whose household income, as determined, effective
23    October 1, 2013, by the Department, is at or below 300% of
24    the federal poverty level as determined in compliance with
25    42 U.S.C. 1397bb(b)(1)(B)(v) and applicable federal

 

 

SB2017- 79 -LRB101 09603 RAB 54701 b

1    regulations.
2    An entity that provides health insurance coverage (as
3defined in Section 2 of the Comprehensive Health Insurance Plan
4Act) to Illinois residents shall provide health insurance data
5match to the Department of Healthcare and Family Services as
6provided by and subject to Section 5.5 of the Illinois
7Insurance Code. The Department of Healthcare and Family
8Services may impose an administrative penalty as provided under
9Section 12-4.45 of the Illinois Public Aid Code on entities
10that have established a pattern of failure to provide the
11information required under this Section.
12    The Department of Healthcare and Family Services, in
13collaboration with the Department of Insurance, shall adopt
14rules governing the exchange of information under this Section.
15The rules shall be consistent with all laws relating to the
16confidentiality or privacy of personal information or medical
17records, including provisions under the Federal Health
18Insurance Portability and Accountability Act (HIPAA).
19    (b) The Department shall monitor the availability and
20retention of employer-sponsored dependent health insurance
21coverage and shall modify the period described in subdivision
22(a)(3) if necessary to promote retention of private or
23employer-sponsored health insurance and timely access to
24healthcare services, but at no time shall the period described
25in subdivision (a)(3) be less than 6 months.
26    (c) The Department, at its discretion, may take into

 

 

SB2017- 80 -LRB101 09603 RAB 54701 b

1account the affordability of dependent health insurance when
2determining whether employer-sponsored dependent health
3insurance coverage is available upon reemployment of a child's
4parent as provided in subdivision (a)(3).
5    (d) A child or young adult who is determined to be eligible
6for the Program shall remain eligible for 12 months, provided
7that the child or young adult maintains his or her residence in
8this State, has not yet attained 26 19 years of age, and is not
9excluded under subsection (e).
10    (e) A child or young adult is not eligible for coverage
11under the Program if:
12        (1) the premium required under Section 40 has not been
13    timely paid; if the required premiums are not paid, the
14    liability of the Program shall be limited to benefits
15    incurred under the Program for the time period for which
16    premiums have been paid; re-enrollment shall be completed
17    before the next covered medical visit, and the first
18    month's required premium shall be paid in advance of the
19    next covered medical visit; or
20        (2) the child or young adult is an inmate of a public
21    institution or an institution for mental diseases.
22    (f) The Department may adopt rules, including, but not
23limited to: rules regarding annual renewals of eligibility for
24the Program in conformance with Section 7 of this Act; rules
25providing for re-enrollment, grace periods, notice
26requirements, and hearing procedures under subdivision (e)(1)

 

 

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1of this Section; and rules regarding what constitutes
2availability and affordability of private or
3employer-sponsored health insurance, with consideration of
4such factors as the percentage of income needed to purchase
5children or family health insurance, the availability of
6employer subsidies, and other relevant factors.
7    (g) Each child enrolled in the Program as of July 1, 2011
8whose family income, as established by the Department, exceeds
9300% of the federal poverty level may remain enrolled in the
10Program for 12 additional months commencing July 1, 2011.
11Continued enrollment pursuant to this subsection shall be
12available only if the child continues to meet all eligibility
13criteria established under the Program as of the effective date
14of this amendatory Act of the 96th General Assembly without a
15break in coverage. Nothing contained in this subsection shall
16prevent a child from qualifying for any other health benefits
17program operated by the Department.
18(Source: P.A. 98-130, eff. 8-2-13; 98-651, eff. 6-16-14.)
 
19    (215 ILCS 170/25)
20    (Section scheduled to be repealed on October 1, 2019)
21    Sec. 25. Enrollment in Program. The Department shall
22develop procedures to allow application agents to assist in
23enrolling children and young adults in the Program or other
24children's health programs operated by the Department. At the
25Department's discretion, technical assistance payments may be

 

 

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1made available for approved applications facilitated by an
2application agent. The Department shall permit day and
3temporary labor service agencies, as defined in the Day and
4Temporary Labor Services Act and doing business in Illinois, to
5enroll as unpaid application agents. As established in the Free
6Healthcare Benefits Application Assistance Act, it shall be
7unlawful for any person to charge another person or family for
8assisting in completing and submitting an application for
9enrollment in this Program.
10(Source: P.A. 96-326, eff. 8-11-09.)
 
11    (215 ILCS 170/35)
12    (Section scheduled to be repealed on October 1, 2019)
13    Sec. 35. Health care benefits for children.
14    (a) The Department shall purchase or provide health care
15benefits for eligible children that are identical to the
16benefits provided for children under the Illinois Children's
17Health Insurance Program Act, except for non-emergency
18transportation. The Department shall purchase or provide
19health care benefits for eligible young adults that are
20identical to the benefits provided for individuals under the
21Medical Assistance Program established under Article V of the
22Illinois Public Aid Code.
23    (b) As an alternative to the benefits set forth in
24subsection (a), and when cost-effective, the Department may
25offer families subsidies toward the cost of privately sponsored

 

 

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1health insurance, including employer-sponsored health
2insurance.
3    (c) Notwithstanding clause (i) of subdivision (a)(3) of
4Section 20, the Department may consider offering, as an
5alternative to the benefits set forth in subsection (a),
6partial coverage to children and young adults who are enrolled
7in a high-deductible private health insurance plan.
8    (d) Notwithstanding clause (i) of subdivision (a)(3) of
9Section 20, the Department may consider offering, as an
10alternative to the benefits set forth in subsection (a), a
11limited package of benefits to children or young adults in
12families who have private or employer-sponsored health
13insurance that does not cover certain benefits such as dental
14or vision benefits.
15    (e) The content and availability of benefits described in
16subsections (b), (c), and (d), and the terms of eligibility for
17those benefits, shall be at the Department's discretion and the
18Department's determination of efficacy and cost-effectiveness
19as a means of promoting retention of private or
20employer-sponsored health insurance.
21    (f) On and after July 1, 2012, the Department shall reduce
22any rate of reimbursement for services or other payments or
23alter any methodologies authorized by this Act or the Illinois
24Public Aid Code to reduce any rate of reimbursement for
25services or other payments in accordance with Section 5-5e of
26the Illinois Public Aid Code.

 

 

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1(Source: P.A. 97-689, eff. 6-14-12.)
 
2    (215 ILCS 170/40)
3    (Section scheduled to be repealed on October 1, 2019)
4    Sec. 40. Cost-sharing.
5    (a) Children and young adults enrolled in the Program under
6subsection (a) of Section 35 are subject to the following
7cost-sharing requirements:
8        (1) The Department, by rule, shall set forth
9    requirements concerning co-payments and coinsurance for
10    health care services and monthly premiums. This
11    cost-sharing shall be on a sliding scale based on family
12    income. The Department may periodically modify such
13    cost-sharing.
14        (2) Notwithstanding paragraph (1), there shall be no
15    co-payment required for well-baby or well-child health
16    care, including, but not limited to, age-appropriate
17    immunizations as required under State or federal law.
18    (b) Children and young adults enrolled in a privately
19sponsored health insurance plan under subsection (b) of Section
2035 are subject to the cost-sharing provisions stated in the
21privately sponsored health insurance plan.
22    (c) Notwithstanding any other provision of law, rates paid
23by the Department shall not be used in any way to determine the
24usual and customary or reasonable charge, which is the charge
25for health care that is consistent with the average rate or

 

 

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1charge for similar services furnished by similar providers in a
2certain geographic area.
3(Source: P.A. 94-693, eff. 7-1-06.)
 
4    (215 ILCS 170/45)
5    (Section scheduled to be repealed on October 1, 2019)
6    Sec. 45. Study; contracts.
7    (a) The Department shall conduct a study that includes, but
8is not limited to, the following:
9        (1) Establishing estimates, broken down by regions of
10    the State, of the number of children with and without
11    health insurance coverage; the number of children who are
12    eligible for Medicaid or the Children's Health Insurance
13    Program, and, of that number, the number who are enrolled
14    in Medicaid or the Children's Health Insurance Program; and
15    the number of children with access to dependent coverage
16    through an employer, and, of that number, the number who
17    are enrolled in dependent coverage through an employer.
18        (2) Surveying those families whose children have
19    access to employer-sponsored dependent coverage but who
20    decline such coverage as to the reasons for declining
21    coverage.
22        (3) Ascertaining, for the population of children
23    accessing employer-sponsored dependent coverage or who
24    have access to such coverage, the comprehensiveness of
25    dependent coverage available, the amount of cost-sharing

 

 

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1    currently paid by the employees, and the cost-sharing
2    associated with such coverage.
3        (4) Measuring the health outcomes or other benefits for
4    children utilizing the Covering ALL KIDS and Young Adults
5    Health Insurance Program and analyzing the effects on
6    utilization of healthcare services for children after
7    enrollment in the Program compared to the preceding period
8    of uninsured status.
9    (b) The studies described in subsection (a) shall be
10conducted in a manner that compares a time period preceding or
11at the initiation of the program with a later period.
12    (c) The Department shall submit the preliminary results of
13the study to the Governor and the General Assembly no later
14than July 1, 2008 and shall submit the final results to the
15Governor and the General Assembly no later than July 1, 2010.
16    (d) The Department shall submit copies of all contracts
17awarded for the administration of the Program to the Speaker of
18the House of Representatives, the Minority Leader of the House
19of Representatives, the President of the Senate, and the
20Minority Leader of the Senate.
21(Source: P.A. 94-693, eff. 7-1-06; 95-985, eff. 6-1-09.)
 
22    (215 ILCS 170/47)
23    (Section scheduled to be repealed on October 1, 2019)
24    Sec. 47. Program information. The Department shall report
25to the General Assembly no later than September 1 of each year

 

 

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1beginning in 2007, all of the following information:
2        (a) The number of professionals serving in the primary
3    care case management program, by licensed profession and by
4    county, and, for counties with a population of 100,000 or
5    greater, by geo zip code.
6        (b) The number of non-primary care providers accepting
7    referrals, by specialty designation, by licensed
8    profession and by county, and, for counties with a
9    population of 100,000 or greater, by geo zip code.
10        (c) The number of individuals enrolled in the Covering
11    ALL KIDS and Young Adults Health Insurance Program by
12    income or premium level and by county, and, for counties
13    with a population of 100,000 or greater, by geo zip code.
14(Source: P.A. 95-650, eff. 6-1-08.)
 
15    (215 ILCS 170/56)
16    (Section scheduled to be repealed on October 1, 2019)
17    Sec. 56. Care coordination.
18    (a) At least 50% of recipients eligible for comprehensive
19medical benefits in all medical assistance programs or other
20health benefit programs administered by the Department,
21including the Children's Health Insurance Program Act and the
22Covering ALL KIDS and Young Adults Health Insurance Act, shall
23be enrolled in a care coordination program by no later than
24January 1, 2015. For purposes of this Section, "coordinated
25care" or "care coordination" means delivery systems where

 

 

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1recipients will receive their care from providers who
2participate under contract in integrated delivery systems that
3are responsible for providing or arranging the majority of
4care, including primary care physician services, referrals
5from primary care physicians, diagnostic and treatment
6services, behavioral health services, in-patient and
7outpatient hospital services, dental services, and
8rehabilitation and long-term care services. The Department
9shall designate or contract for such integrated delivery
10systems (i) to ensure enrollees have a choice of systems and of
11primary care providers within such systems; (ii) to ensure that
12enrollees receive quality care in a culturally and
13linguistically appropriate manner; and (iii) to ensure that
14coordinated care programs meet the diverse needs of enrollees
15with developmental, mental health, physical, and age-related
16disabilities.
17    (b) Payment for such coordinated care shall be based on
18arrangements where the State pays for performance related to
19health care outcomes, the use of evidence-based practices, the
20use of primary care delivered through comprehensive medical
21homes, the use of electronic medical records, and the
22appropriate exchange of health information electronically made
23either on a capitated basis in which a fixed monthly premium
24per recipient is paid and full financial risk is assumed for
25the delivery of services, or through other risk-based payment
26arrangements.

 

 

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1    (c) To qualify for compliance with this Section, the 50%
2goal shall be achieved by enrolling medical assistance
3enrollees from each medical assistance enrollment category,
4including parents, children, seniors, and people with
5disabilities to the extent that current State Medicaid payment
6laws would not limit federal matching funds for recipients in
7care coordination programs. In addition, services must be more
8comprehensively defined and more risk shall be assumed than in
9the Department's primary care case management program as of the
10effective date of this amendatory Act of the 96th General
11Assembly.
12    (d) The Department shall report to the General Assembly in
13a separate part of its annual medical assistance program
14report, beginning April, 2012 until April, 2016, on the
15progress and implementation of the care coordination program
16initiatives established by the provisions of this amendatory
17Act of the 96th General Assembly. The Department shall include
18in its April 2011 report a full analysis of federal laws or
19regulations regarding upper payment limitations to providers
20and the necessary revisions or adjustments in rate
21methodologies and payments to providers under this Code that
22would be necessary to implement coordinated care with full
23financial risk by a party other than the Department.
24(Source: P.A. 96-1501, eff. 1-25-11.)
 
25    Section 55. The Illinois Public Aid Code is amended by

 

 

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1changing Sections 5-5, 5-29, and 5-30 as follows:
 
2    (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
3    Sec. 5-5. Medical services. The Illinois Department, by
4rule, shall determine the quantity and quality of and the rate
5of reimbursement for the medical assistance for which payment
6will be authorized, and the medical services to be provided,
7which may include all or part of the following: (1) inpatient
8hospital services; (2) outpatient hospital services; (3) other
9laboratory and X-ray services; (4) skilled nursing home
10services; (5) physicians' services whether furnished in the
11office, the patient's home, a hospital, a skilled nursing home,
12or elsewhere; (6) medical care, or any other type of remedial
13care furnished by licensed practitioners; (7) home health care
14services; (8) private duty nursing service; (9) clinic
15services; (10) dental services, including prevention and
16treatment of periodontal disease and dental caries disease for
17pregnant women, provided by an individual licensed to practice
18dentistry or dental surgery; for purposes of this item (10),
19"dental services" means diagnostic, preventive, or corrective
20procedures provided by or under the supervision of a dentist in
21the practice of his or her profession; (11) physical therapy
22and related services; (12) prescribed drugs, dentures, and
23prosthetic devices; and eyeglasses prescribed by a physician
24skilled in the diseases of the eye, or by an optometrist,
25whichever the person may select; (13) other diagnostic,

 

 

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1screening, preventive, and rehabilitative services, including
2to ensure that the individual's need for intervention or
3treatment of mental disorders or substance use disorders or
4co-occurring mental health and substance use disorders is
5determined using a uniform screening, assessment, and
6evaluation process inclusive of criteria, for children and
7adults; for purposes of this item (13), a uniform screening,
8assessment, and evaluation process refers to a process that
9includes an appropriate evaluation and, as warranted, a
10referral; "uniform" does not mean the use of a singular
11instrument, tool, or process that all must utilize; (14)
12transportation and such other expenses as may be necessary;
13(15) medical treatment of sexual assault survivors, as defined
14in Section 1a of the Sexual Assault Survivors Emergency
15Treatment Act, for injuries sustained as a result of the sexual
16assault, including examinations and laboratory tests to
17discover evidence which may be used in criminal proceedings
18arising from the sexual assault; (16) the diagnosis and
19treatment of sickle cell anemia; and (17) any other medical
20care, and any other type of remedial care recognized under the
21laws of this State. The term "any other type of remedial care"
22shall include nursing care and nursing home service for persons
23who rely on treatment by spiritual means alone through prayer
24for healing.
25    Notwithstanding any other provision of this Section, a
26comprehensive tobacco use cessation program that includes

 

 

SB2017- 92 -LRB101 09603 RAB 54701 b

1purchasing prescription drugs or prescription medical devices
2approved by the Food and Drug Administration shall be covered
3under the medical assistance program under this Article for
4persons who are otherwise eligible for assistance under this
5Article.
6    Notwithstanding any other provision of this Code,
7reproductive health care that is otherwise legal in Illinois
8shall be covered under the medical assistance program for
9persons who are otherwise eligible for medical assistance under
10this Article.
11    Notwithstanding any other provision of this Code, the
12Illinois Department may not require, as a condition of payment
13for any laboratory test authorized under this Article, that a
14physician's handwritten signature appear on the laboratory
15test order form. The Illinois Department may, however, impose
16other appropriate requirements regarding laboratory test order
17documentation.
18    Upon receipt of federal approval of an amendment to the
19Illinois Title XIX State Plan for this purpose, the Department
20shall authorize the Chicago Public Schools (CPS) to procure a
21vendor or vendors to manufacture eyeglasses for individuals
22enrolled in a school within the CPS system. CPS shall ensure
23that its vendor or vendors are enrolled as providers in the
24medical assistance program and in any capitated Medicaid
25managed care entity (MCE) serving individuals enrolled in a
26school within the CPS system. Under any contract procured under

 

 

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1this provision, the vendor or vendors must serve only
2individuals enrolled in a school within the CPS system. Claims
3for services provided by CPS's vendor or vendors to recipients
4of benefits in the medical assistance program under this Code,
5the Children's Health Insurance Program, or the Covering ALL
6KIDS and Young Adults Health Insurance Program shall be
7submitted to the Department or the MCE in which the individual
8is enrolled for payment and shall be reimbursed at the
9Department's or the MCE's established rates or rate
10methodologies for eyeglasses.
11    On and after July 1, 2012, the Department of Healthcare and
12Family Services may provide the following services to persons
13eligible for assistance under this Article who are
14participating in education, training or employment programs
15operated by the Department of Human Services as successor to
16the Department of Public Aid:
17        (1) dental services provided by or under the
18    supervision of a dentist; and
19        (2) eyeglasses prescribed by a physician skilled in the
20    diseases of the eye, or by an optometrist, whichever the
21    person may select.
22    On and after July 1, 2018, the Department of Healthcare and
23Family Services shall provide dental services to any adult who
24is otherwise eligible for assistance under the medical
25assistance program. As used in this paragraph, "dental
26services" means diagnostic, preventative, restorative, or

 

 

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1corrective procedures, including procedures and services for
2the prevention and treatment of periodontal disease and dental
3caries disease, provided by an individual who is licensed to
4practice dentistry or dental surgery or who is under the
5supervision of a dentist in the practice of his or her
6profession.
7    On and after July 1, 2018, targeted dental services, as set
8forth in Exhibit D of the Consent Decree entered by the United
9States District Court for the Northern District of Illinois,
10Eastern Division, in the matter of Memisovski v. Maram, Case
11No. 92 C 1982, that are provided to adults under the medical
12assistance program shall be established at no less than the
13rates set forth in the "New Rate" column in Exhibit D of the
14Consent Decree for targeted dental services that are provided
15to persons under the age of 18 under the medical assistance
16program.
17    Notwithstanding any other provision of this Code and
18subject to federal approval, the Department may adopt rules to
19allow a dentist who is volunteering his or her service at no
20cost to render dental services through an enrolled
21not-for-profit health clinic without the dentist personally
22enrolling as a participating provider in the medical assistance
23program. A not-for-profit health clinic shall include a public
24health clinic or Federally Qualified Health Center or other
25enrolled provider, as determined by the Department, through
26which dental services covered under this Section are performed.

 

 

SB2017- 95 -LRB101 09603 RAB 54701 b

1The Department shall establish a process for payment of claims
2for reimbursement for covered dental services rendered under
3this provision.
4    The Illinois Department, by rule, may distinguish and
5classify the medical services to be provided only in accordance
6with the classes of persons designated in Section 5-2.
7    The Department of Healthcare and Family Services must
8provide coverage and reimbursement for amino acid-based
9elemental formulas, regardless of delivery method, for the
10diagnosis and treatment of (i) eosinophilic disorders and (ii)
11short bowel syndrome when the prescribing physician has issued
12a written order stating that the amino acid-based elemental
13formula is medically necessary.
14    The Illinois Department shall authorize the provision of,
15and shall authorize payment for, screening by low-dose
16mammography for the presence of occult breast cancer for women
1735 years of age or older who are eligible for medical
18assistance under this Article, as follows:
19        (A) A baseline mammogram for women 35 to 39 years of
20    age.
21        (B) An annual mammogram for women 40 years of age or
22    older.
23        (C) A mammogram at the age and intervals considered
24    medically necessary by the woman's health care provider for
25    women under 40 years of age and having a family history of
26    breast cancer, prior personal history of breast cancer,

 

 

SB2017- 96 -LRB101 09603 RAB 54701 b

1    positive genetic testing, or other risk factors.
2        (D) A comprehensive ultrasound screening and MRI of an
3    entire breast or breasts if a mammogram demonstrates
4    heterogeneous or dense breast tissue, when medically
5    necessary as determined by a physician licensed to practice
6    medicine in all of its branches.
7        (E) A screening MRI when medically necessary, as
8    determined by a physician licensed to practice medicine in
9    all of its branches.
10    All screenings shall include a physical breast exam,
11instruction on self-examination and information regarding the
12frequency of self-examination and its value as a preventative
13tool. For purposes of this Section, "low-dose mammography"
14means the x-ray examination of the breast using equipment
15dedicated specifically for mammography, including the x-ray
16tube, filter, compression device, and image receptor, with an
17average radiation exposure delivery of less than one rad per
18breast for 2 views of an average size breast. The term also
19includes digital mammography and includes breast
20tomosynthesis. As used in this Section, the term "breast
21tomosynthesis" means a radiologic procedure that involves the
22acquisition of projection images over the stationary breast to
23produce cross-sectional digital three-dimensional images of
24the breast. If, at any time, the Secretary of the United States
25Department of Health and Human Services, or its successor
26agency, promulgates rules or regulations to be published in the

 

 

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1Federal Register or publishes a comment in the Federal Register
2or issues an opinion, guidance, or other action that would
3require the State, pursuant to any provision of the Patient
4Protection and Affordable Care Act (Public Law 111-148),
5including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
6successor provision, to defray the cost of any coverage for
7breast tomosynthesis outlined in this paragraph, then the
8requirement that an insurer cover breast tomosynthesis is
9inoperative other than any such coverage authorized under
10Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
11the State shall not assume any obligation for the cost of
12coverage for breast tomosynthesis set forth in this paragraph.
13    On and after January 1, 2016, the Department shall ensure
14that all networks of care for adult clients of the Department
15include access to at least one breast imaging Center of Imaging
16Excellence as certified by the American College of Radiology.
17    On and after January 1, 2012, providers participating in a
18quality improvement program approved by the Department shall be
19reimbursed for screening and diagnostic mammography at the same
20rate as the Medicare program's rates, including the increased
21reimbursement for digital mammography.
22    The Department shall convene an expert panel including
23representatives of hospitals, free-standing mammography
24facilities, and doctors, including radiologists, to establish
25quality standards for mammography.
26    On and after January 1, 2017, providers participating in a

 

 

SB2017- 98 -LRB101 09603 RAB 54701 b

1breast cancer treatment quality improvement program approved
2by the Department shall be reimbursed for breast cancer
3treatment at a rate that is no lower than 95% of the Medicare
4program's rates for the data elements included in the breast
5cancer treatment quality program.
6    The Department shall convene an expert panel, including
7representatives of hospitals, free-standing breast cancer
8treatment centers, breast cancer quality organizations, and
9doctors, including breast surgeons, reconstructive breast
10surgeons, oncologists, and primary care providers to establish
11quality standards for breast cancer treatment.
12    Subject to federal approval, the Department shall
13establish a rate methodology for mammography at federally
14qualified health centers and other encounter-rate clinics.
15These clinics or centers may also collaborate with other
16hospital-based mammography facilities. By January 1, 2016, the
17Department shall report to the General Assembly on the status
18of the provision set forth in this paragraph.
19    The Department shall establish a methodology to remind
20women who are age-appropriate for screening mammography, but
21who have not received a mammogram within the previous 18
22months, of the importance and benefit of screening mammography.
23The Department shall work with experts in breast cancer
24outreach and patient navigation to optimize these reminders and
25shall establish a methodology for evaluating their
26effectiveness and modifying the methodology based on the

 

 

SB2017- 99 -LRB101 09603 RAB 54701 b

1evaluation.
2    The Department shall establish a performance goal for
3primary care providers with respect to their female patients
4over age 40 receiving an annual mammogram. This performance
5goal shall be used to provide additional reimbursement in the
6form of a quality performance bonus to primary care providers
7who meet that goal.
8    The Department shall devise a means of case-managing or
9patient navigation for beneficiaries diagnosed with breast
10cancer. This program shall initially operate as a pilot program
11in areas of the State with the highest incidence of mortality
12related to breast cancer. At least one pilot program site shall
13be in the metropolitan Chicago area and at least one site shall
14be outside the metropolitan Chicago area. On or after July 1,
152016, the pilot program shall be expanded to include one site
16in western Illinois, one site in southern Illinois, one site in
17central Illinois, and 4 sites within metropolitan Chicago. An
18evaluation of the pilot program shall be carried out measuring
19health outcomes and cost of care for those served by the pilot
20program compared to similarly situated patients who are not
21served by the pilot program.
22    The Department shall require all networks of care to
23develop a means either internally or by contract with experts
24in navigation and community outreach to navigate cancer
25patients to comprehensive care in a timely fashion. The
26Department shall require all networks of care to include access

 

 

SB2017- 100 -LRB101 09603 RAB 54701 b

1for patients diagnosed with cancer to at least one academic
2commission on cancer-accredited cancer program as an
3in-network covered benefit.
4    Any medical or health care provider shall immediately
5recommend, to any pregnant woman who is being provided prenatal
6services and is suspected of having a substance use disorder as
7defined in the Substance Use Disorder Act, referral to a local
8substance use disorder treatment program licensed by the
9Department of Human Services or to a licensed hospital which
10provides substance abuse treatment services. The Department of
11Healthcare and Family Services shall assure coverage for the
12cost of treatment of the drug abuse or addiction for pregnant
13recipients in accordance with the Illinois Medicaid Program in
14conjunction with the Department of Human Services.
15    All medical providers providing medical assistance to
16pregnant women under this Code shall receive information from
17the Department on the availability of services under any
18program providing case management services for addicted women,
19including information on appropriate referrals for other
20social services that may be needed by addicted women in
21addition to treatment for addiction.
22    The Illinois Department, in cooperation with the
23Departments of Human Services (as successor to the Department
24of Alcoholism and Substance Abuse) and Public Health, through a
25public awareness campaign, may provide information concerning
26treatment for alcoholism and drug abuse and addiction, prenatal

 

 

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1health care, and other pertinent programs directed at reducing
2the number of drug-affected infants born to recipients of
3medical assistance.
4    Neither the Department of Healthcare and Family Services
5nor the Department of Human Services shall sanction the
6recipient solely on the basis of her substance abuse.
7    The Illinois Department shall establish such regulations
8governing the dispensing of health services under this Article
9as it shall deem appropriate. The Department should seek the
10advice of formal professional advisory committees appointed by
11the Director of the Illinois Department for the purpose of
12providing regular advice on policy and administrative matters,
13information dissemination and educational activities for
14medical and health care providers, and consistency in
15procedures to the Illinois Department.
16    The Illinois Department may develop and contract with
17Partnerships of medical providers to arrange medical services
18for persons eligible under Section 5-2 of this Code.
19Implementation of this Section may be by demonstration projects
20in certain geographic areas. The Partnership shall be
21represented by a sponsor organization. The Department, by rule,
22shall develop qualifications for sponsors of Partnerships.
23Nothing in this Section shall be construed to require that the
24sponsor organization be a medical organization.
25    The sponsor must negotiate formal written contracts with
26medical providers for physician services, inpatient and

 

 

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1outpatient hospital care, home health services, treatment for
2alcoholism and substance abuse, and other services determined
3necessary by the Illinois Department by rule for delivery by
4Partnerships. Physician services must include prenatal and
5obstetrical care. The Illinois Department shall reimburse
6medical services delivered by Partnership providers to clients
7in target areas according to provisions of this Article and the
8Illinois Health Finance Reform Act, except that:
9        (1) Physicians participating in a Partnership and
10    providing certain services, which shall be determined by
11    the Illinois Department, to persons in areas covered by the
12    Partnership may receive an additional surcharge for such
13    services.
14        (2) The Department may elect to consider and negotiate
15    financial incentives to encourage the development of
16    Partnerships and the efficient delivery of medical care.
17        (3) Persons receiving medical services through
18    Partnerships may receive medical and case management
19    services above the level usually offered through the
20    medical assistance program.
21    Medical providers shall be required to meet certain
22qualifications to participate in Partnerships to ensure the
23delivery of high quality medical services. These
24qualifications shall be determined by rule of the Illinois
25Department and may be higher than qualifications for
26participation in the medical assistance program. Partnership

 

 

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1sponsors may prescribe reasonable additional qualifications
2for participation by medical providers, only with the prior
3written approval of the Illinois Department.
4    Nothing in this Section shall limit the free choice of
5practitioners, hospitals, and other providers of medical
6services by clients. In order to ensure patient freedom of
7choice, the Illinois Department shall immediately promulgate
8all rules and take all other necessary actions so that provided
9services may be accessed from therapeutically certified
10optometrists to the full extent of the Illinois Optometric
11Practice Act of 1987 without discriminating between service
12providers.
13    The Department shall apply for a waiver from the United
14States Health Care Financing Administration to allow for the
15implementation of Partnerships under this Section.
16    The Illinois Department shall require health care
17providers to maintain records that document the medical care
18and services provided to recipients of Medical Assistance under
19this Article. Such records must be retained for a period of not
20less than 6 years from the date of service or as provided by
21applicable State law, whichever period is longer, except that
22if an audit is initiated within the required retention period
23then the records must be retained until the audit is completed
24and every exception is resolved. The Illinois Department shall
25require health care providers to make available, when
26authorized by the patient, in writing, the medical records in a

 

 

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1timely fashion to other health care providers who are treating
2or serving persons eligible for Medical Assistance under this
3Article. All dispensers of medical services shall be required
4to maintain and retain business and professional records
5sufficient to fully and accurately document the nature, scope,
6details and receipt of the health care provided to persons
7eligible for medical assistance under this Code, in accordance
8with regulations promulgated by the Illinois Department. The
9rules and regulations shall require that proof of the receipt
10of prescription drugs, dentures, prosthetic devices and
11eyeglasses by eligible persons under this Section accompany
12each claim for reimbursement submitted by the dispenser of such
13medical services. No such claims for reimbursement shall be
14approved for payment by the Illinois Department without such
15proof of receipt, unless the Illinois Department shall have put
16into effect and shall be operating a system of post-payment
17audit and review which shall, on a sampling basis, be deemed
18adequate by the Illinois Department to assure that such drugs,
19dentures, prosthetic devices and eyeglasses for which payment
20is being made are actually being received by eligible
21recipients. Within 90 days after September 16, 1984 (the
22effective date of Public Act 83-1439), the Illinois Department
23shall establish a current list of acquisition costs for all
24prosthetic devices and any other items recognized as medical
25equipment and supplies reimbursable under this Article and
26shall update such list on a quarterly basis, except that the

 

 

SB2017- 105 -LRB101 09603 RAB 54701 b

1acquisition costs of all prescription drugs shall be updated no
2less frequently than every 30 days as required by Section
35-5.12.
4    Notwithstanding any other law to the contrary, the Illinois
5Department shall, within 365 days after July 22, 2013 (the
6effective date of Public Act 98-104), establish procedures to
7permit skilled care facilities licensed under the Nursing Home
8Care Act to submit monthly billing claims for reimbursement
9purposes. Following development of these procedures, the
10Department shall, by July 1, 2016, test the viability of the
11new system and implement any necessary operational or
12structural changes to its information technology platforms in
13order to allow for the direct acceptance and payment of nursing
14home claims.
15    Notwithstanding any other law to the contrary, the Illinois
16Department shall, within 365 days after August 15, 2014 (the
17effective date of Public Act 98-963), establish procedures to
18permit ID/DD facilities licensed under the ID/DD Community Care
19Act and MC/DD facilities licensed under the MC/DD Act to submit
20monthly billing claims for reimbursement purposes. Following
21development of these procedures, the Department shall have an
22additional 365 days to test the viability of the new system and
23to ensure that any necessary operational or structural changes
24to its information technology platforms are implemented.
25    The Illinois Department shall require all dispensers of
26medical services, other than an individual practitioner or

 

 

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1group of practitioners, desiring to participate in the Medical
2Assistance program established under this Article to disclose
3all financial, beneficial, ownership, equity, surety or other
4interests in any and all firms, corporations, partnerships,
5associations, business enterprises, joint ventures, agencies,
6institutions or other legal entities providing any form of
7health care services in this State under this Article.
8    The Illinois Department may require that all dispensers of
9medical services desiring to participate in the medical
10assistance program established under this Article disclose,
11under such terms and conditions as the Illinois Department may
12by rule establish, all inquiries from clients and attorneys
13regarding medical bills paid by the Illinois Department, which
14inquiries could indicate potential existence of claims or liens
15for the Illinois Department.
16    Enrollment of a vendor shall be subject to a provisional
17period and shall be conditional for one year. During the period
18of conditional enrollment, the Department may terminate the
19vendor's eligibility to participate in, or may disenroll the
20vendor from, the medical assistance program without cause.
21Unless otherwise specified, such termination of eligibility or
22disenrollment is not subject to the Department's hearing
23process. However, a disenrolled vendor may reapply without
24penalty.
25    The Department has the discretion to limit the conditional
26enrollment period for vendors based upon category of risk of

 

 

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1the vendor.
2    Prior to enrollment and during the conditional enrollment
3period in the medical assistance program, all vendors shall be
4subject to enhanced oversight, screening, and review based on
5the risk of fraud, waste, and abuse that is posed by the
6category of risk of the vendor. The Illinois Department shall
7establish the procedures for oversight, screening, and review,
8which may include, but need not be limited to: criminal and
9financial background checks; fingerprinting; license,
10certification, and authorization verifications; unscheduled or
11unannounced site visits; database checks; prepayment audit
12reviews; audits; payment caps; payment suspensions; and other
13screening as required by federal or State law.
14    The Department shall define or specify the following: (i)
15by provider notice, the "category of risk of the vendor" for
16each type of vendor, which shall take into account the level of
17screening applicable to a particular category of vendor under
18federal law and regulations; (ii) by rule or provider notice,
19the maximum length of the conditional enrollment period for
20each category of risk of the vendor; and (iii) by rule, the
21hearing rights, if any, afforded to a vendor in each category
22of risk of the vendor that is terminated or disenrolled during
23the conditional enrollment period.
24    To be eligible for payment consideration, a vendor's
25payment claim or bill, either as an initial claim or as a
26resubmitted claim following prior rejection, must be received

 

 

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1by the Illinois Department, or its fiscal intermediary, no
2later than 180 days after the latest date on the claim on which
3medical goods or services were provided, with the following
4exceptions:
5        (1) In the case of a provider whose enrollment is in
6    process by the Illinois Department, the 180-day period
7    shall not begin until the date on the written notice from
8    the Illinois Department that the provider enrollment is
9    complete.
10        (2) In the case of errors attributable to the Illinois
11    Department or any of its claims processing intermediaries
12    which result in an inability to receive, process, or
13    adjudicate a claim, the 180-day period shall not begin
14    until the provider has been notified of the error.
15        (3) In the case of a provider for whom the Illinois
16    Department initiates the monthly billing process.
17        (4) In the case of a provider operated by a unit of
18    local government with a population exceeding 3,000,000
19    when local government funds finance federal participation
20    for claims payments.
21    For claims for services rendered during a period for which
22a recipient received retroactive eligibility, claims must be
23filed within 180 days after the Department determines the
24applicant is eligible. For claims for which the Illinois
25Department is not the primary payer, claims must be submitted
26to the Illinois Department within 180 days after the final

 

 

SB2017- 109 -LRB101 09603 RAB 54701 b

1adjudication by the primary payer.
2    In the case of long term care facilities, within 45
3calendar days of receipt by the facility of required
4prescreening information, new admissions with associated
5admission documents shall be submitted through the Medical
6Electronic Data Interchange (MEDI) or the Recipient
7Eligibility Verification (REV) System or shall be submitted
8directly to the Department of Human Services using required
9admission forms. Effective September 1, 2014, admission
10documents, including all prescreening information, must be
11submitted through MEDI or REV. Confirmation numbers assigned to
12an accepted transaction shall be retained by a facility to
13verify timely submittal. Once an admission transaction has been
14completed, all resubmitted claims following prior rejection
15are subject to receipt no later than 180 days after the
16admission transaction has been completed.
17    Claims that are not submitted and received in compliance
18with the foregoing requirements shall not be eligible for
19payment under the medical assistance program, and the State
20shall have no liability for payment of those claims.
21    To the extent consistent with applicable information and
22privacy, security, and disclosure laws, State and federal
23agencies and departments shall provide the Illinois Department
24access to confidential and other information and data necessary
25to perform eligibility and payment verifications and other
26Illinois Department functions. This includes, but is not

 

 

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1limited to: information pertaining to licensure;
2certification; earnings; immigration status; citizenship; wage
3reporting; unearned and earned income; pension income;
4employment; supplemental security income; social security
5numbers; National Provider Identifier (NPI) numbers; the
6National Practitioner Data Bank (NPDB); program and agency
7exclusions; taxpayer identification numbers; tax delinquency;
8corporate information; and death records.
9    The Illinois Department shall enter into agreements with
10State agencies and departments, and is authorized to enter into
11agreements with federal agencies and departments, under which
12such agencies and departments shall share data necessary for
13medical assistance program integrity functions and oversight.
14The Illinois Department shall develop, in cooperation with
15other State departments and agencies, and in compliance with
16applicable federal laws and regulations, appropriate and
17effective methods to share such data. At a minimum, and to the
18extent necessary to provide data sharing, the Illinois
19Department shall enter into agreements with State agencies and
20departments, and is authorized to enter into agreements with
21federal agencies and departments, including but not limited to:
22the Secretary of State; the Department of Revenue; the
23Department of Public Health; the Department of Human Services;
24and the Department of Financial and Professional Regulation.
25    Beginning in fiscal year 2013, the Illinois Department
26shall set forth a request for information to identify the

 

 

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1benefits of a pre-payment, post-adjudication, and post-edit
2claims system with the goals of streamlining claims processing
3and provider reimbursement, reducing the number of pending or
4rejected claims, and helping to ensure a more transparent
5adjudication process through the utilization of: (i) provider
6data verification and provider screening technology; and (ii)
7clinical code editing; and (iii) pre-pay, pre- or
8post-adjudicated predictive modeling with an integrated case
9management system with link analysis. Such a request for
10information shall not be considered as a request for proposal
11or as an obligation on the part of the Illinois Department to
12take any action or acquire any products or services.
13    The Illinois Department shall establish policies,
14procedures, standards and criteria by rule for the acquisition,
15repair and replacement of orthotic and prosthetic devices and
16durable medical equipment. Such rules shall provide, but not be
17limited to, the following services: (1) immediate repair or
18replacement of such devices by recipients; and (2) rental,
19lease, purchase or lease-purchase of durable medical equipment
20in a cost-effective manner, taking into consideration the
21recipient's medical prognosis, the extent of the recipient's
22needs, and the requirements and costs for maintaining such
23equipment. Subject to prior approval, such rules shall enable a
24recipient to temporarily acquire and use alternative or
25substitute devices or equipment pending repairs or
26replacements of any device or equipment previously authorized

 

 

SB2017- 112 -LRB101 09603 RAB 54701 b

1for such recipient by the Department. Notwithstanding any
2provision of Section 5-5f to the contrary, the Department may,
3by rule, exempt certain replacement wheelchair parts from prior
4approval and, for wheelchairs, wheelchair parts, wheelchair
5accessories, and related seating and positioning items,
6determine the wholesale price by methods other than actual
7acquisition costs.
8    The Department shall require, by rule, all providers of
9durable medical equipment to be accredited by an accreditation
10organization approved by the federal Centers for Medicare and
11Medicaid Services and recognized by the Department in order to
12bill the Department for providing durable medical equipment to
13recipients. No later than 15 months after the effective date of
14the rule adopted pursuant to this paragraph, all providers must
15meet the accreditation requirement.
16    In order to promote environmental responsibility, meet the
17needs of recipients and enrollees, and achieve significant cost
18savings, the Department, or a managed care organization under
19contract with the Department, may provide recipients or managed
20care enrollees who have a prescription or Certificate of
21Medical Necessity access to refurbished durable medical
22equipment under this Section (excluding prosthetic and
23orthotic devices as defined in the Orthotics, Prosthetics, and
24Pedorthics Practice Act and complex rehabilitation technology
25products and associated services) through the State's
26assistive technology program's reutilization program, using

 

 

SB2017- 113 -LRB101 09603 RAB 54701 b

1staff with the Assistive Technology Professional (ATP)
2Certification if the refurbished durable medical equipment:
3(i) is available; (ii) is less expensive, including shipping
4costs, than new durable medical equipment of the same type;
5(iii) is able to withstand at least 3 years of use; (iv) is
6cleaned, disinfected, sterilized, and safe in accordance with
7federal Food and Drug Administration regulations and guidance
8governing the reprocessing of medical devices in health care
9settings; and (v) equally meets the needs of the recipient or
10enrollee. The reutilization program shall confirm that the
11recipient or enrollee is not already in receipt of same or
12similar equipment from another service provider, and that the
13refurbished durable medical equipment equally meets the needs
14of the recipient or enrollee. Nothing in this paragraph shall
15be construed to limit recipient or enrollee choice to obtain
16new durable medical equipment or place any additional prior
17authorization conditions on enrollees of managed care
18organizations.
19    The Department shall execute, relative to the nursing home
20prescreening project, written inter-agency agreements with the
21Department of Human Services and the Department on Aging, to
22effect the following: (i) intake procedures and common
23eligibility criteria for those persons who are receiving
24non-institutional services; and (ii) the establishment and
25development of non-institutional services in areas of the State
26where they are not currently available or are undeveloped; and

 

 

SB2017- 114 -LRB101 09603 RAB 54701 b

1(iii) notwithstanding any other provision of law, subject to
2federal approval, on and after July 1, 2012, an increase in the
3determination of need (DON) scores from 29 to 37 for applicants
4for institutional and home and community-based long term care;
5if and only if federal approval is not granted, the Department
6may, in conjunction with other affected agencies, implement
7utilization controls or changes in benefit packages to
8effectuate a similar savings amount for this population; and
9(iv) no later than July 1, 2013, minimum level of care
10eligibility criteria for institutional and home and
11community-based long term care; and (v) no later than October
121, 2013, establish procedures to permit long term care
13providers access to eligibility scores for individuals with an
14admission date who are seeking or receiving services from the
15long term care provider. In order to select the minimum level
16of care eligibility criteria, the Governor shall establish a
17workgroup that includes affected agency representatives and
18stakeholders representing the institutional and home and
19community-based long term care interests. This Section shall
20not restrict the Department from implementing lower level of
21care eligibility criteria for community-based services in
22circumstances where federal approval has been granted.
23    The Illinois Department shall develop and operate, in
24cooperation with other State Departments and agencies and in
25compliance with applicable federal laws and regulations,
26appropriate and effective systems of health care evaluation and

 

 

SB2017- 115 -LRB101 09603 RAB 54701 b

1programs for monitoring of utilization of health care services
2and facilities, as it affects persons eligible for medical
3assistance under this Code.
4    The Illinois Department shall report annually to the
5General Assembly, no later than the second Friday in April of
61979 and each year thereafter, in regard to:
7        (a) actual statistics and trends in utilization of
8    medical services by public aid recipients;
9        (b) actual statistics and trends in the provision of
10    the various medical services by medical vendors;
11        (c) current rate structures and proposed changes in
12    those rate structures for the various medical vendors; and
13        (d) efforts at utilization review and control by the
14    Illinois Department.
15    The period covered by each report shall be the 3 years
16ending on the June 30 prior to the report. The report shall
17include suggested legislation for consideration by the General
18Assembly. The requirement for reporting to the General Assembly
19shall be satisfied by filing copies of the report as required
20by Section 3.1 of the General Assembly Organization Act, and
21filing such additional copies with the State Government Report
22Distribution Center for the General Assembly as is required
23under paragraph (t) of Section 7 of the State Library Act.
24    Rulemaking authority to implement Public Act 95-1045, if
25any, is conditioned on the rules being adopted in accordance
26with all provisions of the Illinois Administrative Procedure

 

 

SB2017- 116 -LRB101 09603 RAB 54701 b

1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4    On and after July 1, 2012, the Department shall reduce any
5rate of reimbursement for services or other payments or alter
6any methodologies authorized by this Code to reduce any rate of
7reimbursement for services or other payments in accordance with
8Section 5-5e.
9    Because kidney transplantation can be an appropriate,
10cost-effective alternative to renal dialysis when medically
11necessary and notwithstanding the provisions of Section 1-11 of
12this Code, beginning October 1, 2014, the Department shall
13cover kidney transplantation for noncitizens with end-stage
14renal disease who are not eligible for comprehensive medical
15benefits, who meet the residency requirements of Section 5-3 of
16this Code, and who would otherwise meet the financial
17requirements of the appropriate class of eligible persons under
18Section 5-2 of this Code. To qualify for coverage of kidney
19transplantation, such person must be receiving emergency renal
20dialysis services covered by the Department. Providers under
21this Section shall be prior approved and certified by the
22Department to perform kidney transplantation and the services
23under this Section shall be limited to services associated with
24kidney transplantation.
25    Notwithstanding any other provision of this Code to the
26contrary, on or after July 1, 2015, all FDA approved forms of

 

 

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1medication assisted treatment prescribed for the treatment of
2alcohol dependence or treatment of opioid dependence shall be
3covered under both fee for service and managed care medical
4assistance programs for persons who are otherwise eligible for
5medical assistance under this Article and shall not be subject
6to any (1) utilization control, other than those established
7under the American Society of Addiction Medicine patient
8placement criteria, (2) prior authorization mandate, or (3)
9lifetime restriction limit mandate.
10    On or after July 1, 2015, opioid antagonists prescribed for
11the treatment of an opioid overdose, including the medication
12product, administration devices, and any pharmacy fees related
13to the dispensing and administration of the opioid antagonist,
14shall be covered under the medical assistance program for
15persons who are otherwise eligible for medical assistance under
16this Article. As used in this Section, "opioid antagonist"
17means a drug that binds to opioid receptors and blocks or
18inhibits the effect of opioids acting on those receptors,
19including, but not limited to, naloxone hydrochloride or any
20other similarly acting drug approved by the U.S. Food and Drug
21Administration.
22    Upon federal approval, the Department shall provide
23coverage and reimbursement for all drugs that are approved for
24marketing by the federal Food and Drug Administration and that
25are recommended by the federal Public Health Service or the
26United States Centers for Disease Control and Prevention for

 

 

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1pre-exposure prophylaxis and related pre-exposure prophylaxis
2services, including, but not limited to, HIV and sexually
3transmitted infection screening, treatment for sexually
4transmitted infections, medical monitoring, assorted labs, and
5counseling to reduce the likelihood of HIV infection among
6individuals who are not infected with HIV but who are at high
7risk of HIV infection.
8    A federally qualified health center, as defined in Section
91905(l)(2)(B) of the federal Social Security Act, shall be
10reimbursed by the Department in accordance with the federally
11qualified health center's encounter rate for services provided
12to medical assistance recipients that are performed by a dental
13hygienist, as defined under the Illinois Dental Practice Act,
14working under the general supervision of a dentist and employed
15by a federally qualified health center.
16    Notwithstanding any other provision of this Code, the
17Illinois Department shall authorize licensed dietitian
18nutritionists and certified diabetes educators to counsel
19senior diabetes patients in the senior diabetes patients' homes
20to remove the hurdle of transportation for senior diabetes
21patients to receive treatment.
22(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
2399-236, eff. 8-3-15; 99-407 (see Section 20 of P.A. 99-588 for
24the effective date of P.A. 99-407); 99-433, eff. 8-21-15;
2599-480, eff. 9-9-15; 99-588, eff. 7-20-16; 99-642, eff.
267-28-16; 99-772, eff. 1-1-17; 99-895, eff. 1-1-17; 100-201,

 

 

SB2017- 119 -LRB101 09603 RAB 54701 b

1eff. 8-18-17; 100-395, eff. 1-1-18; 100-449, eff. 1-1-18;
2100-538, eff. 1-1-18; 100-587, eff. 6-4-18; 100-759, eff.
31-1-19; 100-863, eff. 8-14-18; 100-974, eff. 8-19-18;
4100-1009, eff. 1-1-19; 100-1018, eff. 1-1-19; 100-1148, eff.
512-10-18.)
 
6    (305 ILCS 5/5-29)
7    Sec. 5-29. Income Limits and Parental Responsibility. In
8light of the unprecedented fiscal crisis confronting the State,
9it is the intent of the General Assembly to explore whether the
10income limits and income counting methods established for
11children under the Covering ALL KIDS and Young Adults Health
12Insurance Act, pursuant to this amendatory Act of the 96th
13General Assembly, should apply to medical assistance programs
14available to children made eligible under the Illinois Public
15Aid Code, including through home and community based services
16waiver programs authorized under Section 1915(c) of the Social
17Security Act, where parental income is currently not considered
18in determining a child's eligibility for medical assistance.
19The Department of Healthcare and Family Services is hereby
20directed, with the participation of the Department of Human
21Services and stakeholders, to conduct an analysis of these
22programs to determine parental cost sharing opportunities, how
23these opportunities may impact the children currently in the
24programs, waivers and on the waiting list, and any other
25factors which may increase efficiencies and decrease State

 

 

SB2017- 120 -LRB101 09603 RAB 54701 b

1costs. The Department is further directed to review how
2services under these programs and waivers may be provided by
3the use of a combination of skilled, unskilled, and
4uncompensated care and to advise as to what revisions to the
5Nurse Practice Act, and Acts regulating other relevant
6professions, are necessary to accomplish this combination of
7care. The Department shall submit a written analysis on the
8children's programs and waivers as part of the Department's
9annual Medicaid reports due to the General Assembly in 2011 and
102012.
11(Source: P.A. 96-1501, eff. 1-25-11.)
 
12    (305 ILCS 5/5-30)
13    Sec. 5-30. Care coordination.
14    (a) At least 50% of recipients eligible for comprehensive
15medical benefits in all medical assistance programs or other
16health benefit programs administered by the Department,
17including the Children's Health Insurance Program Act and the
18Covering ALL KIDS and Young Adults Health Insurance Act, shall
19be enrolled in a care coordination program by no later than
20January 1, 2015. For purposes of this Section, "coordinated
21care" or "care coordination" means delivery systems where
22recipients will receive their care from providers who
23participate under contract in integrated delivery systems that
24are responsible for providing or arranging the majority of
25care, including primary care physician services, referrals

 

 

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1from primary care physicians, diagnostic and treatment
2services, behavioral health services, in-patient and
3outpatient hospital services, dental services, and
4rehabilitation and long-term care services. The Department
5shall designate or contract for such integrated delivery
6systems (i) to ensure enrollees have a choice of systems and of
7primary care providers within such systems; (ii) to ensure that
8enrollees receive quality care in a culturally and
9linguistically appropriate manner; and (iii) to ensure that
10coordinated care programs meet the diverse needs of enrollees
11with developmental, mental health, physical, and age-related
12disabilities.
13    (b) Payment for such coordinated care shall be based on
14arrangements where the State pays for performance related to
15health care outcomes, the use of evidence-based practices, the
16use of primary care delivered through comprehensive medical
17homes, the use of electronic medical records, and the
18appropriate exchange of health information electronically made
19either on a capitated basis in which a fixed monthly premium
20per recipient is paid and full financial risk is assumed for
21the delivery of services, or through other risk-based payment
22arrangements.
23    (c) To qualify for compliance with this Section, the 50%
24goal shall be achieved by enrolling medical assistance
25enrollees from each medical assistance enrollment category,
26including parents, children, seniors, and people with

 

 

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1disabilities to the extent that current State Medicaid payment
2laws would not limit federal matching funds for recipients in
3care coordination programs. In addition, services must be more
4comprehensively defined and more risk shall be assumed than in
5the Department's primary care case management program as of
6January 25, 2011 (the effective date of Public Act 96-1501).
7    (d) The Department shall report to the General Assembly in
8a separate part of its annual medical assistance program
9report, beginning April, 2012 until April, 2016, on the
10progress and implementation of the care coordination program
11initiatives established by the provisions of Public Act
1296-1501. The Department shall include in its April 2011 report
13a full analysis of federal laws or regulations regarding upper
14payment limitations to providers and the necessary revisions or
15adjustments in rate methodologies and payments to providers
16under this Code that would be necessary to implement
17coordinated care with full financial risk by a party other than
18the Department.
19    (e) Integrated Care Program for individuals with chronic
20mental health conditions.
21        (1) The Integrated Care Program shall encompass
22    services administered to recipients of medical assistance
23    under this Article to prevent exacerbations and
24    complications using cost-effective, evidence-based
25    practice guidelines and mental health management
26    strategies.

 

 

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1        (2) The Department may utilize and expand upon existing
2    contractual arrangements with integrated care plans under
3    the Integrated Care Program for providing the coordinated
4    care provisions of this Section.
5        (3) Payment for such coordinated care shall be based on
6    arrangements where the State pays for performance related
7    to mental health outcomes on a capitated basis in which a
8    fixed monthly premium per recipient is paid and full
9    financial risk is assumed for the delivery of services, or
10    through other risk-based payment arrangements such as
11    provider-based care coordination.
12        (4) The Department shall examine whether chronic
13    mental health management programs and services for
14    recipients with specific chronic mental health conditions
15    do any or all of the following:
16            (A) Improve the patient's overall mental health in
17        a more expeditious and cost-effective manner.
18            (B) Lower costs in other aspects of the medical
19        assistance program, such as hospital admissions,
20        emergency room visits, or more frequent and
21        inappropriate psychotropic drug use.
22        (5) The Department shall work with the facilities and
23    any integrated care plan participating in the program to
24    identify and correct barriers to the successful
25    implementation of this subsection (e) prior to and during
26    the implementation to best facilitate the goals and

 

 

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1    objectives of this subsection (e).
2    (f) A hospital that is located in a county of the State in
3which the Department mandates some or all of the beneficiaries
4of the Medical Assistance Program residing in the county to
5enroll in a Care Coordination Program, as set forth in Section
65-30 of this Code, shall not be eligible for any non-claims
7based payments not mandated by Article V-A of this Code for
8which it would otherwise be qualified to receive, unless the
9hospital is a Coordinated Care Participating Hospital no later
10than 60 days after June 14, 2012 (the effective date of Public
11Act 97-689) or 60 days after the first mandatory enrollment of
12a beneficiary in a Coordinated Care program. For purposes of
13this subsection, "Coordinated Care Participating Hospital"
14means a hospital that meets one of the following criteria:
15        (1) The hospital has entered into a contract to provide
16    hospital services with one or more MCOs to enrollees of the
17    care coordination program.
18        (2) The hospital has not been offered a contract by a
19    care coordination plan that the Department has determined
20    to be a good faith offer and that pays at least as much as
21    the Department would pay, on a fee-for-service basis, not
22    including disproportionate share hospital adjustment
23    payments or any other supplemental adjustment or add-on
24    payment to the base fee-for-service rate, except to the
25    extent such adjustments or add-on payments are
26    incorporated into the development of the applicable MCO

 

 

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1    capitated rates.
2    As used in this subsection (f), "MCO" means any entity
3which contracts with the Department to provide services where
4payment for medical services is made on a capitated basis.
5    (g) No later than August 1, 2013, the Department shall
6issue a purchase of care solicitation for Accountable Care
7Entities (ACE) to serve any children and parents or caretaker
8relatives of children eligible for medical assistance under
9this Article. An ACE may be a single corporate structure or a
10network of providers organized through contractual
11relationships with a single corporate entity. The solicitation
12shall require that:
13        (1) An ACE operating in Cook County be capable of
14    serving at least 40,000 eligible individuals in that
15    county; an ACE operating in Lake, Kane, DuPage, or Will
16    Counties be capable of serving at least 20,000 eligible
17    individuals in those counties and an ACE operating in other
18    regions of the State be capable of serving at least 10,000
19    eligible individuals in the region in which it operates.
20    During initial periods of mandatory enrollment, the
21    Department shall require its enrollment services
22    contractor to use a default assignment algorithm that
23    ensures if possible an ACE reaches the minimum enrollment
24    levels set forth in this paragraph.
25        (2) An ACE must include at a minimum the following
26    types of providers: primary care, specialty care,

 

 

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1    hospitals, and behavioral healthcare.
2        (3) An ACE shall have a governance structure that
3    includes the major components of the health care delivery
4    system, including one representative from each of the
5    groups listed in paragraph (2).
6        (4) An ACE must be an integrated delivery system,
7    including a network able to provide the full range of
8    services needed by Medicaid beneficiaries and system
9    capacity to securely pass clinical information across
10    participating entities and to aggregate and analyze that
11    data in order to coordinate care.
12        (5) An ACE must be capable of providing both care
13    coordination and complex case management, as necessary, to
14    beneficiaries. To be responsive to the solicitation, a
15    potential ACE must outline its care coordination and
16    complex case management model and plan to reduce the cost
17    of care.
18        (6) In the first 18 months of operation, unless the ACE
19    selects a shorter period, an ACE shall be paid care
20    coordination fees on a per member per month basis that are
21    projected to be cost neutral to the State during the term
22    of their payment and, subject to federal approval, be
23    eligible to share in additional savings generated by their
24    care coordination.
25        (7) In months 19 through 36 of operation, unless the
26    ACE selects a shorter period, an ACE shall be paid on a

 

 

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1    pre-paid capitation basis for all medical assistance
2    covered services, under contract terms similar to Managed
3    Care Organizations (MCO), with the Department sharing the
4    risk through either stop-loss insurance for extremely high
5    cost individuals or corridors of shared risk based on the
6    overall cost of the total enrollment in the ACE. The ACE
7    shall be responsible for claims processing, encounter data
8    submission, utilization control, and quality assurance.
9        (8) In the fourth and subsequent years of operation, an
10    ACE shall convert to a Managed Care Community Network
11    (MCCN), as defined in this Article, or Health Maintenance
12    Organization pursuant to the Illinois Insurance Code,
13    accepting full-risk capitation payments.
14    The Department shall allow potential ACE entities 5 months
15from the date of the posting of the solicitation to submit
16proposals. After the solicitation is released, in addition to
17the MCO rate development data available on the Department's
18website, subject to federal and State confidentiality and
19privacy laws and regulations, the Department shall provide 2
20years of de-identified summary service data on the targeted
21population, split between children and adults, showing the
22historical type and volume of services received and the cost of
23those services to those potential bidders that sign a data use
24agreement. The Department may add up to 2 non-state government
25employees with expertise in creating integrated delivery
26systems to its review team for the purchase of care

 

 

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1solicitation described in this subsection. Any such
2individuals must sign a no-conflict disclosure and
3confidentiality agreement and agree to act in accordance with
4all applicable State laws.
5    During the first 2 years of an ACE's operation, the
6Department shall provide claims data to the ACE on its
7enrollees on a periodic basis no less frequently than monthly.
8    Nothing in this subsection shall be construed to limit the
9Department's mandate to enroll 50% of its beneficiaries into
10care coordination systems by January 1, 2015, using all
11available care coordination delivery systems, including Care
12Coordination Entities (CCE), MCCNs, or MCOs, nor be construed
13to affect the current CCEs, MCCNs, and MCOs selected to serve
14seniors and persons with disabilities prior to that date.
15    Nothing in this subsection precludes the Department from
16considering future proposals for new ACEs or expansion of
17existing ACEs at the discretion of the Department.
18    (h) Department contracts with MCOs and other entities
19reimbursed by risk based capitation shall have a minimum
20medical loss ratio of 85%, shall require the entity to
21establish an appeals and grievances process for consumers and
22providers, and shall require the entity to provide a quality
23assurance and utilization review program. Entities contracted
24with the Department to coordinate healthcare regardless of risk
25shall be measured utilizing the same quality metrics. The
26quality metrics may be population specific. Any contracted

 

 

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1entity serving at least 5,000 seniors or people with
2disabilities or 15,000 individuals in other populations
3covered by the Medical Assistance Program that has been
4receiving full-risk capitation for a year shall be accredited
5by a national accreditation organization authorized by the
6Department within 2 years after the date it is eligible to
7become accredited. The requirements of this subsection shall
8apply to contracts with MCOs entered into or renewed or
9extended after June 1, 2013.
10    (h-5) The Department shall monitor and enforce compliance
11by MCOs with agreements they have entered into with providers
12on issues that include, but are not limited to, timeliness of
13payment, payment rates, and processes for obtaining prior
14approval. The Department may impose sanctions on MCOs for
15violating provisions of those agreements that include, but are
16not limited to, financial penalties, suspension of enrollment
17of new enrollees, and termination of the MCO's contract with
18the Department. As used in this subsection (h-5), "MCO" has the
19meaning ascribed to that term in Section 5-30.1 of this Code.
20    (i) Unless otherwise required by federal law, Medicaid
21Managed Care Entities and their respective business associates
22shall not disclose, directly or indirectly, including by
23sending a bill or explanation of benefits, information
24concerning the sensitive health services received by enrollees
25of the Medicaid Managed Care Entity to any person other than
26covered entities and business associates, which may receive,

 

 

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1use, and further disclose such information solely for the
2purposes permitted under applicable federal and State laws and
3regulations if such use and further disclosure satisfies all
4applicable requirements of such laws and regulations. The
5Medicaid Managed Care Entity or its respective business
6associates may disclose information concerning the sensitive
7health services if the enrollee who received the sensitive
8health services requests the information from the Medicaid
9Managed Care Entity or its respective business associates and
10authorized the sending of a bill or explanation of benefits.
11Communications including, but not limited to, statements of
12care received or appointment reminders either directly or
13indirectly to the enrollee from the health care provider,
14health care professional, and care coordinators, remain
15permissible. Medicaid Managed Care Entities or their
16respective business associates may communicate directly with
17their enrollees regarding care coordination activities for
18those enrollees.
19    For the purposes of this subsection, the term "Medicaid
20Managed Care Entity" includes Care Coordination Entities,
21Accountable Care Entities, Managed Care Organizations, and
22Managed Care Community Networks.
23    For purposes of this subsection, the term "sensitive health
24services" means mental health services, substance abuse
25treatment services, reproductive health services, family
26planning services, services for sexually transmitted

 

 

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1infections and sexually transmitted diseases, and services for
2sexual assault or domestic abuse. Services include prevention,
3screening, consultation, examination, treatment, or follow-up.
4    For purposes of this subsection, "business associate",
5"covered entity", "disclosure", and "use" have the meanings
6ascribed to those terms in 45 CFR 160.103.
7    Nothing in this subsection shall be construed to relieve a
8Medicaid Managed Care Entity or the Department of any duty to
9report incidents of sexually transmitted infections to the
10Department of Public Health or to the local board of health in
11accordance with regulations adopted under a statute or
12ordinance or to report incidents of sexually transmitted
13infections as necessary to comply with the requirements under
14Section 5 of the Abused and Neglected Child Reporting Act or as
15otherwise required by State or federal law.
16    The Department shall create policy in order to implement
17the requirements in this subsection.
18    (j) Managed Care Entities (MCEs), including MCOs and all
19other care coordination organizations, shall develop and
20maintain a written language access policy that sets forth the
21standards, guidelines, and operational plan to ensure language
22appropriate services and that is consistent with the standard
23of meaningful access for populations with limited English
24proficiency. The language access policy shall describe how the
25MCEs will provide all of the following required services:
26        (1) Translation (the written replacement of text from

 

 

SB2017- 132 -LRB101 09603 RAB 54701 b

1    one language into another) of all vital documents and forms
2    as identified by the Department.
3        (2) Qualified interpreter services (the oral
4    communication of a message from one language into another
5    by a qualified interpreter).
6        (3) Staff training on the language access policy,
7    including how to identify language needs, access and
8    provide language assistance services, work with
9    interpreters, request translations, and track the use of
10    language assistance services.
11        (4) Data tracking that identifies the language need.
12        (5) Notification to participants on the availability
13    of language access services and on how to access such
14    services.
15    (k) The Department shall actively monitor the contractual
16relationship between Managed Care Organizations (MCOs) and any
17dental administrator contracted by an MCO to provide dental
18services. The Department shall adopt appropriate dental
19Healthcare Effectiveness Data and Information Set (HEDIS)
20measures and shall include the Annual Dental Visit (ADV) HEDIS
21measure in its Health Plan Comparison Tool and Illinois
22Medicaid Plan Report Card that is available on the Department's
23website for enrolled individuals.
24    The Department shall collect from each MCO specific
25information about the types of contracted, broad-based care
26coordination occurring between the MCO and any dental

 

 

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1administrator, including, but not limited to, pregnant women
2and diabetic patients in need of oral care.
3(Source: P.A. 99-106, eff. 1-1-16; 99-181, eff. 7-29-15;
499-566, eff. 1-1-17; 99-642, eff. 7-28-16; 100-587, eff.
56-4-18.)
 
6    Section 60. The Prenatal and Newborn Care Act is amended by
7changing Section 9 as follows:
 
8    (410 ILCS 225/9)
9    Sec. 9. The Illinois Department of Healthcare and Family
10Services; consultation; data reporting.
11    (a) The Illinois Department of Healthcare and Family
12Services, which administers the Illinois Medicaid Program and
13the Covering ALL KIDS and Young Adults Health Insurance
14Program, shall consult with statewide organizations focused on
15premature infant healthcare in order to:
16        (1) examine and improve hospital discharge and
17    follow-up care procedures for premature infants born
18    earlier than 37 weeks gestational age to ensure
19    standardized and coordinated processes are followed as
20    premature infants leave the hospital from either a Level 1
21    (well baby nursery), Level 2 (step down or transitional
22    nursery), or Level 3 (neonatal intensive care unit) unit
23    and transition to follow-up care by a health care provider
24    in the community; and

 

 

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1        (2) use guidance from the Centers for Medicare and
2    Medicaid Services' Neonatal Outcome Improvement Project to
3    implement programs to improve newborn outcome, reduce
4    newborn health costs, and establish ongoing quality
5    improvement for newborns.
6    (b) In consultation with statewide organizations
7representing hospitals, the Department of Public Health shall
8consider mechanisms to collect discharge data for purposes of
9analyzing readmission rates of certain premature infants.
10(Source: P.A. 96-1117, eff. 7-20-10.)

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    20 ILCS 1705/71a
4    30 ILCS 105/6z-52
5    30 ILCS 105/6z-73
6    30 ILCS 105/6z-81
7    30 ILCS 105/25from Ch. 127, par. 161
8    30 ILCS 540/3-2
9    35 ILCS 105/3-8
10    35 ILCS 120/2-9
11    35 ILCS 200/15-86
12    40 ILCS 5/24-102from Ch. 108 1/2, par. 24-102
13    110 ILCS 948/10
14    110 ILCS 948/25
15    110 ILCS 948/30
16    215 ILCS 106/23
17    215 ILCS 170/1
18    215 ILCS 170/5
19    215 ILCS 170/10
20    215 ILCS 170/15
21    215 ILCS 170/20
22    215 ILCS 170/25
23    215 ILCS 170/35
24    215 ILCS 170/40
25    215 ILCS 170/45

 

 

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1    215 ILCS 170/47
2    215 ILCS 170/56
3    305 ILCS 5/5-5from Ch. 23, par. 5-5
4    305 ILCS 5/5-29
5    305 ILCS 5/5-30
6    410 ILCS 225/9