101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB2552

 

Introduced 1/29/2020, by Sen. Heather A. Steans

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/14-12

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning the hospital rate reform payment system.


LRB101 18762 KTG 68217 b

 

 

A BILL FOR

 

SB2552LRB101 18762 KTG 68217 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 14-12 as follows:
 
6    (305 ILCS 5/14-12)
7    Sec. 14-12. Hospital rate reform payment system. The The
8hospital payment system pursuant to Section 14-11 of this
9Article shall be as follows:
10    (a) Inpatient hospital services. Effective for discharges
11on and after July 1, 2014, reimbursement for inpatient general
12acute care services shall utilize the All Patient Refined
13Diagnosis Related Grouping (APR-DRG) software, version 30,
14distributed by 3MTM Health Information System.
15        (1) The Department shall establish Medicaid weighting
16    factors to be used in the reimbursement system established
17    under this subsection. Initial weighting factors shall be
18    the weighting factors as published by 3M Health Information
19    System, associated with Version 30.0 adjusted for the
20    Illinois experience.
21        (2) The Department shall establish a
22    statewide-standardized amount to be used in the inpatient
23    reimbursement system. The Department shall publish these

 

 

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1    amounts on its website no later than 10 calendar days prior
2    to their effective date.
3        (3) In addition to the statewide-standardized amount,
4    the Department shall develop adjusters to adjust the rate
5    of reimbursement for critical Medicaid providers or
6    services for trauma, transplantation services, perinatal
7    care, and Graduate Medical Education (GME).
8        (4) The Department shall develop add-on payments to
9    account for exceptionally costly inpatient stays,
10    consistent with Medicare outlier principles. Outlier fixed
11    loss thresholds may be updated to control for excessive
12    growth in outlier payments no more frequently than on an
13    annual basis, but at least triennially. Upon updating the
14    fixed loss thresholds, the Department shall be required to
15    update base rates within 12 months.
16        (5) The Department shall define those hospitals or
17    distinct parts of hospitals that shall be exempt from the
18    APR-DRG reimbursement system established under this
19    Section. The Department shall publish these hospitals'
20    inpatient rates on its website no later than 10 calendar
21    days prior to their effective date.
22        (6) Beginning July 1, 2014 and ending on June 30, 2024,
23    in addition to the statewide-standardized amount, the
24    Department shall develop an adjustor to adjust the rate of
25    reimbursement for safety-net hospitals defined in Section
26    5-5e.1 of this Code excluding pediatric hospitals.

 

 

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

 

 

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1    of subsection (b) of Section 5A-12.6, less the amount
2    allocated under paragraphs (8) and (9) of this subsection
3    and paragraphs (3) and (4) of subsection (b) multiplied by
4    13%.
5        (8) Beginning July 1, 2018, in addition to the
6    statewide-standardized amount, the Department shall adjust
7    the rate of reimbursement for hospitals designated by the
8    Department of Public Health as a Perinatal Level II or II+
9    center by applying the same adjustor that is applied to
10    Perinatal and Obstetrical care cases for Perinatal Level
11    III centers, as of December 31, 2017.
12        (9) Beginning July 1, 2018, in addition to the
13    statewide-standardized amount, the Department shall apply
14    the same adjustor that is applied to trauma cases as of
15    December 31, 2017 to inpatient claims to treat patients
16    with burns, including, but not limited to, APR-DRGs 841,
17    842, 843, and 844.
18        (10) Beginning July 1, 2018, the
19    statewide-standardized amount for inpatient general acute
20    care services shall be uniformly increased so that base
21    claims projected reimbursement is increased by an amount
22    equal to the funds allocated in paragraph (1) of subsection
23    (b) of Section 5A-12.6, less the amount allocated under
24    paragraphs (8) and (9) of this subsection and paragraphs
25    (3) and (4) of subsection (b) multiplied by 40%. Beginning
26    July 1, 2020, the statewide-standardized amount for

 

 

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

 

 

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1    inpatient rehabilitation services shall be uniformly
2    increased so that the $96 per day add-on is increased by an
3    amount equal to the funds allocated in paragraph (2) of
4    subsection (b) of Section 5A-12.6, less the amount
5    allocated under paragraphs (8) and (9) of this subsection
6    and paragraphs (3) and (4) of subsection (b) multiplied by
7    0.9%.
8        Beginning July 1, 2022, the reimbursement for
9    inpatient rehabilitation services shall be uniformly
10    increased so that the $96 per day add-on as adjusted by the
11    July 1, 2020 increase, is increased by an amount equal to
12    the funds allocated in paragraph (3) of subsection (b) of
13    Section 5A-12.6, less the amount allocated under
14    paragraphs (8) and (9) of this subsection and paragraphs
15    (3) and (4) of subsection (b) multiplied by 0.9%.
16        Beginning July 1, 2023, the reimbursement for
17    inpatient rehabilitation services shall be uniformly
18    increased so that the $96 per day add-on as adjusted by the
19    July 1, 2022 increase, is increased by an amount equal to
20    the funds allocated in paragraph (4) of subsection (b) of
21    Section 5A-12.6, less the amount allocated under
22    paragraphs (8) and (9) of this subsection and paragraphs
23    (3) and (4) of subsection (b) multiplied by 0.9%.
24    (b) Outpatient hospital services. Effective for dates of
25service on and after July 1, 2014, reimbursement for outpatient
26services shall utilize the Enhanced Ambulatory Procedure

 

 

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1Grouping (EAPG) software, version 3.7 distributed by 3MTM
2Health Information System.
3        (1) The Department shall establish Medicaid weighting
4    factors to be used in the reimbursement system established
5    under this subsection. The initial weighting factors shall
6    be the weighting factors as published by 3M Health
7    Information System, associated with Version 3.7.
8        (2) The Department shall establish service specific
9    statewide-standardized amounts to be used in the
10    reimbursement system.
11            (A) The initial statewide standardized amounts,
12        with the labor portion adjusted by the Calendar Year
13        2013 Medicare Outpatient Prospective Payment System
14        wage index with reclassifications, shall be published
15        by the Department on its website no later than 10
16        calendar days prior to their effective date.
17            (B) The Department shall establish adjustments to
18        the statewide-standardized amounts for each Critical
19        Access Hospital, as designated by the Department of
20        Public Health in accordance with 42 CFR 485, Subpart F.
21        For outpatient services provided on or before June 30,
22        2018, the EAPG standardized amounts are determined
23        separately for each critical access hospital such that
24        simulated EAPG payments using outpatient base period
25        paid claim data plus payments under Section 5A-12.4 of
26        this Code net of the associated tax costs are equal to

 

 

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1        the estimated costs of outpatient base period claims
2        data with a rate year cost inflation factor applied.
3        (3) In addition to the statewide-standardized amounts,
4    the Department shall develop adjusters to adjust the rate
5    of reimbursement for critical Medicaid hospital outpatient
6    providers or services, including outpatient high volume or
7    safety-net hospitals. Beginning July 1, 2018, the
8    outpatient high volume adjustor shall be increased to
9    increase annual expenditures associated with this adjustor
10    by $79,200,000, based on the State Fiscal Year 2015 base
11    year data and this adjustor shall apply to public
12    hospitals, except for large public hospitals, as defined
13    under 89 Ill. Adm. Code 148.25(a).
14        (4) Beginning July 1, 2018, in addition to the
15    statewide standardized amounts, the Department shall make
16    an add-on payment for outpatient expensive devices and
17    drugs. This add-on payment shall at least apply to claim
18    lines that: (i) are assigned with one of the following
19    EAPGs: 490, 1001 to 1020, and coded with one of the
20    following revenue codes: 0274 to 0276, 0278; or (ii) are
21    assigned with one of the following EAPGs: 430 to 441, 443,
22    444, 460 to 465, 495, 496, 1090. The add-on payment shall
23    be calculated as follows: the claim line's covered charges
24    multiplied by the hospital's total acute cost to charge
25    ratio, less the claim line's EAPG payment plus $1,000,
26    multiplied by 0.8.

 

 

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1        (5) Beginning July 1, 2018, the statewide-standardized
2    amounts for outpatient services shall be increased by a
3    uniform percentage so that base claims projected
4    reimbursement is increased by an amount equal to no less
5    than the funds allocated in paragraph (1) of subsection (b)
6    of Section 5A-12.6, less the amount allocated under
7    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
8    and (4) of this subsection multiplied by 46%. Beginning
9    July 1, 2020, the statewide-standardized amounts for
10    outpatient services shall be increased by a uniform
11    percentage so that base claims projected reimbursement is
12    increased by an amount equal to no less than the funds
13    allocated in paragraph (2) of subsection (b) of Section
14    5A-12.6, less the amount allocated under paragraphs (8) and
15    (9) of subsection (a) and paragraphs (3) and (4) of this
16    subsection multiplied by 46%. Beginning July 1, 2022, the
17    statewide-standardized amounts for outpatient services
18    shall be increased by a uniform percentage so that base
19    claims projected reimbursement is increased by an amount
20    equal to the funds allocated in paragraph (3) of subsection
21    (b) of Section 5A-12.6, less the amount allocated under
22    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
23    and (4) of this subsection multiplied by 46%. Beginning
24    July 1, 2023, the statewide-standardized amounts for
25    outpatient services shall be increased by a uniform
26    percentage so that base claims projected reimbursement is

 

 

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1    increased by an amount equal to no less than the funds
2    allocated in paragraph (4) of subsection (b) of Section
3    5A-12.6, less the amount allocated under paragraphs (8) and
4    (9) of subsection (a) and paragraphs (3) and (4) of this
5    subsection multiplied by 46%.
6        (6) Effective for dates of service on or after July 1,
7    2018, the Department shall establish adjustments to the
8    statewide-standardized amounts for each Critical Access
9    Hospital, as designated by the Department of Public Health
10    in accordance with 42 CFR 485, Subpart F, such that each
11    Critical Access Hospital's standardized amount for
12    outpatient services shall be increased by the applicable
13    uniform percentage determined pursuant to paragraph (5) of
14    this subsection. It is the intent of the General Assembly
15    that the adjustments required under this paragraph (6) by
16    Public Act 100-1181 this amendatory Act of the 100th
17    General Assembly shall be applied retroactively to claims
18    for dates of service provided on or after July 1, 2018.
19        (7) Effective for dates of service on or after March 8,
20    2019 (the effective date of Public Act 100-1181) this
21    amendatory Act of the 100th General Assembly, the
22    Department shall recalculate and implement an updated
23    statewide-standardized amount for outpatient services
24    provided by hospitals that are not Critical Access
25    Hospitals to reflect the applicable uniform percentage
26    determined pursuant to paragraph (5).

 

 

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1            (1) Any recalculation to the
2        statewide-standardized amounts for outpatient services
3        provided by hospitals that are not Critical Access
4        Hospitals shall be the amount necessary to achieve the
5        increase in the statewide-standardized amounts for
6        outpatient services increased by a uniform percentage,
7        so that base claims projected reimbursement is
8        increased by an amount equal to no less than the funds
9        allocated in paragraph (1) of subsection (b) of Section
10        5A-12.6, less the amount allocated under paragraphs
11        (8) and (9) of subsection (a) and paragraphs (3) and
12        (4) of this subsection, for all hospitals that are not
13        Critical Access Hospitals, multiplied by 46%.
14            (2) It is the intent of the General Assembly that
15        the recalculations required under this paragraph (7)
16        by Public Act 100-1181 this amendatory Act of the 100th
17        General Assembly shall be applied prospectively to
18        claims for dates of service provided on or after March
19        8, 2019 (the effective date of Public Act 100-1181)
20        this amendatory Act of the 100th General Assembly and
21        that no recoupment or repayment by the Department or an
22        MCO of payments attributable to recalculation under
23        this paragraph (7), issued to the hospital for dates of
24        service on or after July 1, 2018 and before March 8,
25        2019 (the effective date of Public Act 100-1181) this
26        amendatory Act of the 100th General Assembly, shall be

 

 

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1        permitted.
2        (8) The Department shall ensure that all necessary
3    adjustments to the managed care organization capitation
4    base rates necessitated by the adjustments under
5    subparagraph (6) or (7) of this subsection are completed
6    and applied retroactively in accordance with Section
7    5-30.8 of this Code within 90 days of March 8, 2019 (the
8    effective date of Public Act 100-1181) this amendatory Act
9    of the 100th General Assembly.
10    (c) In consultation with the hospital community, the
11Department is authorized to replace 89 Ill. Admin. Code 152.150
12as published in 38 Ill. Reg. 4980 through 4986 within 12 months
13of June 16, 2014 (the effective date of Public Act 98-651). If
14the Department does not replace these rules within 12 months of
15June 16, 2014 (the effective date of Public Act 98-651), the
16rules in effect for 152.150 as published in 38 Ill. Reg. 4980
17through 4986 shall remain in effect until modified by rule by
18the Department. Nothing in this subsection shall be construed
19to mandate that the Department file a replacement rule.
20    (d) Transition period. There shall be a transition period
21to the reimbursement systems authorized under this Section that
22shall begin on the effective date of these systems and continue
23until June 30, 2018, unless extended by rule by the Department.
24To help provide an orderly and predictable transition to the
25new reimbursement systems and to preserve and enhance access to
26the hospital services during this transition, the Department

 

 

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1shall allocate a transitional hospital access pool of at least
2$290,000,000 annually so that transitional hospital access
3payments are made to hospitals.
4        (1) After the transition period, the Department may
5    begin incorporating the transitional hospital access pool
6    into the base rate structure; however, the transitional
7    hospital access payments in effect on June 30, 2018 shall
8    continue to be paid, if continued under Section 5A-16.
9        (2) After the transition period, if the Department
10    reduces payments from the transitional hospital access
11    pool, it shall increase base rates, develop new adjustors,
12    adjust current adjustors, develop new hospital access
13    payments based on updated information, or any combination
14    thereof by an amount equal to the decreases proposed in the
15    transitional hospital access pool payments, ensuring that
16    the entire transitional hospital access pool amount shall
17    continue to be used for hospital payments.
18    (d-5) Hospital transformation program. The Department, in
19conjunction with the Hospital Transformation Review Committee
20created under subsection (d-5), shall develop a hospital
21transformation program to provide financial assistance to
22hospitals in transforming their services and care models to
23better align with the needs of the communities they serve. The
24payments authorized in this Section shall be subject to
25approval by the federal government.
26        (1) Phase 1. In State fiscal years 2019 through 2020,

 

 

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1    the Department shall allocate funds from the transitional
2    access hospital pool to create a hospital transformation
3    pool of at least $262,906,870 annually and make hospital
4    transformation payments to hospitals. Subject to Section
5    5A-16, in State fiscal years 2019 and 2020, an Illinois
6    hospital that received either a transitional hospital
7    access payment under subsection (d) or a supplemental
8    payment under subsection (f) of this Section in State
9    fiscal year 2018, shall receive a hospital transformation
10    payment as follows:
11            (A) If the hospital's Rate Year 2017 Medicaid
12        inpatient utilization rate is equal to or greater than
13        45%, the hospital transformation payment shall be
14        equal to 100% of the sum of its transitional hospital
15        access payment authorized under subsection (d) and any
16        supplemental payment authorized under subsection (f).
17            (B) If the hospital's Rate Year 2017 Medicaid
18        inpatient utilization rate is equal to or greater than
19        25% but less than 45%, the hospital transformation
20        payment shall be equal to 75% of the sum of its
21        transitional hospital access payment authorized under
22        subsection (d) and any supplemental payment authorized
23        under subsection (f).
24            (C) If the hospital's Rate Year 2017 Medicaid
25        inpatient utilization rate is less than 25%, the
26        hospital transformation payment shall be equal to 50%

 

 

SB2552- 15 -LRB101 18762 KTG 68217 b

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

 

 

SB2552- 16 -LRB101 18762 KTG 68217 b

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

 

 

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

 

 

SB2552- 18 -LRB101 18762 KTG 68217 b

1    100-581), the 4 legislative leaders shall each appoint 3
2    members; the Governor shall appoint the Director of
3    Healthcare and Family Services, or his or her designee, as
4    a member; and the Director of Healthcare and Family
5    Services shall appoint one member. Any vacancy shall be
6    filled by the applicable appointing authority within 15
7    calendar days. The members of the Committee shall select a
8    Chair and a Vice-Chair from among its members, provided
9    that the Chair and Vice-Chair cannot be appointed by the
10    same appointing authority and must be from different
11    political parties. The Chair shall have the authority to
12    establish a meeting schedule and convene meetings of the
13    Committee, and the Vice-Chair shall have the authority to
14    convene meetings in the absence of the Chair. The Committee
15    may establish its own rules with respect to meeting
16    schedule, notice of meetings, and the disclosure of
17    documents; however, the Committee shall not have the power
18    to subpoena individuals or documents and any rules must be
19    approved by 9 of the 14 members. The Committee shall
20    perform the functions described in this Section and advise
21    and consult with the Director in the administration of this
22    Section. In addition to reviewing and approving the
23    policies, procedures, and rules for the hospital
24    transformation program, the Committee shall consider and
25    make recommendations related to qualifying criteria and
26    payment methodologies related to safety-net hospitals and

 

 

SB2552- 19 -LRB101 18762 KTG 68217 b

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

 

 

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

 

 

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1Grouping (DRG) Prospective Payment System (PPS)), and 4977
2(Hospital Reimbursement Changes), and published in the
3Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
4(Specialized Health Care Delivery Systems) and 6505 (Hospital
5Services).
6    (j) Out-of-state hospitals. Beginning July 1, 2018, for
7purposes of determining for State fiscal years 2019 and 2020
8the hospitals eligible for the payments authorized under
9subsections (a) and (b) of this Section, the Department shall
10include out-of-state hospitals that are designated a Level I
11pediatric trauma center or a Level I trauma center by the
12Department of Public Health as of December 1, 2017.
13    (k) The Department shall notify each hospital and managed
14care organization, in writing, of the impact of the updates
15under this Section at least 30 calendar days prior to their
16effective date.
17(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
18101-81, eff. 7-12-19; revised 7-29-19.)