97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB6257

 

Introduced , by Rep. Cynthia Soto

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5f

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that in the event hospitals are deemed not to have reached the $40,000,000 in reduced expenditures as set forth under the Code, then for any individual hospital not meeting its established threshold, the Department of Public Health shall assess a penalty payment equal to one-half the amount of the differential between the hospital's actual liability related to readmissions and that of the threshold amount. Provides that these penalty payments shall be deposited into the Healthcare Provider Relief Fund and that in the event the Centers for Medicare and Medicaid Services finds that the penalty payments are an impermissible healthcare-related tax, the penalty payments shall be doubled. Further provides that the expenditures are to be defined as General Revenue Fund-based expenditures. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB6257LRB097 23599 KTG 72642 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 5-5f as follows:
 
6    (305 ILCS 5/5-5f)
7    Sec. 5-5f. Elimination and limitations of medical
8assistance services. Notwithstanding any other provision of
9this Code to the contrary, on and after July 1, 2012:
10    (a) The following services shall no longer be a covered
11service available under this Code: group psychotherapy for
12residents of any facility licensed under the Nursing Home Care
13Act or the Specialized Mental Health Rehabilitation Act; and
14adult chiropractic services.
15    (b) The Department shall place the following limitations on
16services: (i) the Department shall limit adult eyeglasses to
17one pair every 2 years; (ii) the Department shall set an annual
18limit of a maximum of 20 visits for each of the following
19services: adult speech, hearing, and language therapy
20services, adult occupational therapy services, and physical
21therapy services; (iii) the Department shall limit podiatry
22services to individuals with diabetes; (iv) the Department
23shall pay for caesarean sections at the normal vaginal delivery

 

 

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1rate unless a caesarean section was medically necessary; (v)
2the Department shall limit adult dental services to
3emergencies; and (vi) effective July 1, 2012, the Department
4shall place limitations and require concurrent review on every
5inpatient detoxification stay to prevent repeat admissions to
6any hospital for detoxification within 60 days of a previous
7inpatient detoxification stay. The Department shall convene a
8workgroup of hospitals, substance abuse providers, care
9coordination entities, managed care plans, and other
10stakeholders to develop recommendations for quality standards,
11diversion to other settings, and admission criteria for
12patients who need inpatient detoxification.
13    (c) The Department shall require prior approval of the
14following services: wheelchair repairs, regardless of the cost
15of the repairs, coronary artery bypass graft, and bariatric
16surgery consistent with Medicare standards concerning patient
17responsibility. The wholesale cost of power wheelchairs shall
18be actual acquisition cost including all discounts.
19    (d) The Department shall establish benchmarks for
20hospitals to measure and align payments to reduce potentially
21preventable hospital readmissions, inpatient complications,
22and unnecessary emergency room visits. In doing so, the
23Department shall consider items, including, but not limited to,
24historic and current acuity of care and historic and current
25trends in readmission. The Department shall publish
26provider-specific historical readmission data and anticipated

 

 

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1potentially preventable targets 60 days prior to the start of
2the program. In the instance of readmissions, the Department
3shall adopt policies and rates of reimbursement for services
4and other payments provided under this Code to ensure that, by
5June 30, 2013, expenditures to hospitals are reduced by, at a
6minimum, $40,000,000.
7        (1) In the event hospitals are deemed not to have
8    reached the $40,000,000 in reduced expenditures, then for
9    any individual hospital not meeting its established
10    threshold, the Department of Public Health shall assess a
11    penalty payment equal to one-half the amount of the
12    differential between the hospital's actual liability
13    related to readmissions and that of the threshold amount.
14    These penalty payments shall be deposited into the
15    Healthcare Provider Relief Fund.
16        (2) In the event the Centers for Medicare and Medicaid
17    Services finds that the penalty payments are an
18    impermissible healthcare-related tax, the penalty payments
19    calculated above shall be doubled.
20        (3) For purposes of this subsection, expenditures are
21    defined as General Revenue Fund-based expenditures.
22    (e) The Department shall establish utilization controls
23for the hospice program such that it shall not pay for other
24care services when an individual is in hospice.
25    (f) For home health services, the Department shall require
26Medicare certification of providers participating in the

 

 

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1program, implement the Medicare face-to-face encounter rule,
2and limit services to post-hospitalization. The Department
3shall require providers to implement auditable electronic
4service verification based on global positioning systems or
5other cost-effective technology.
6    (g) For the Home Services Program operated by the
7Department of Human Services and the Community Care Program
8operated by the Department on Aging, the Department of Human
9Services, in cooperation with the Department on Aging, shall
10implement an electronic service verification based on global
11positioning systems or other cost-effective technology.
12    (h) The Department shall not pay for hospital admissions
13when the claim indicates a hospital acquired condition that
14would cause Medicare to reduce its payment on the claim had the
15claim been submitted to Medicare, nor shall the Department pay
16for hospital admissions where a Medicare identified "never
17event" occurred.
18    (i) The Department shall implement cost savings
19initiatives for advanced imaging services, cardiac imaging
20services, pain management services, and back surgery. Such
21initiatives shall be designed to achieve annual costs savings.
22(Source: P.A. 97-689, eff. 6-14-12.)
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.