Illinois General Assembly - Bill Status for SB2840

Creates the Program Integrity for Medicaid and the Children's Health Insurance Program Act. Provides that it is the intent of the General Assembly to implement waste, fraud, and abuse detection, prevention, and recovery solutions to improve program integrity for Medicaid and the Children's Health Insurance Program in the State and create efficiency and cost savings through a shift from a retrospective "pay and chase" model to a prospective pre-payment model; and to comply with program integrity provisions of the federal Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. In furtherance of these goals, requires the State to implement several technologies and services including (i) provider data verification and provider screening technology; (ii) state-of-the-art clinical code editing technology; (iii) state-of-the-art predictive modeling and analytics technologies; (iv) fraud investigative services; and (v) Medicaid and CHIP claims audit and recovery services. Requires the State to either contract with The Cooperative Purchasing Network (TCPN) to issue a request for proposals (RFP) when selecting a contractor or use the specified contractor selection process. Contains provisions concerning contracts, reporting requirements, and savings. Effective immediately.

Replaces everything after the enacting clause. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall have the authority to establish by rule the necessary procedures and policies to comply with the federal Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, and with subsequent federal statutes, rules, and regulations pertaining to Department functions. Provides that prior to enrollment in the medical assistance program, all vendors shall be subject to enhanced oversight, screening, and review based on categories of risk of fraud, waste, and abuse. Contains provisions concerning eligibility and payment verifications; data sharing; and the benefits of a pre-payment, post-adjudication, and post-edit claims system. Amends the Administration Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services' Inspector General shall oversee the Department's integrity functions, which include, but are not limited to, prepayment and post-payment audits of medical providers (rather than audits of medical providers); and the monitoring of quality assurance programs administered by the Department (rather than the monitoring of quality assurance programs generally related to the medical assistance program and specifically related to any managed care program). Adds the offices of the Centers for Medicare and Medicaid Services that administer the Medicare and Medicaid integrity programs to the list of agencies the Inspector General shall liaison with on behalf of the Department. Contains provisions concerning enhanced program integrity functions; data sharing for vendor screening, vendor review, and payment verification; and other matters. Makes other changes. Effective immediately.

Replaces everything after the enacting clause. Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning payment under the Medicaid program for obligations incurred but not paid for at the time of a recipient's death.

Replaces everything after the enacting clause. Provides that the Act may be referred to as the Save Medicaid Access and Resources Together (SMART) Act. Provides that, in order to address the significant spending and liability deficit in the medical assistance program budget of the Department of Healthcare and Family Services, the SMART Act implements changes, improvements, and efficiencies to enhance Medicaid program integrity to prevent client and provider fraud; imposes controls on use of Medicaid services to prevent over-use or waste; expands cost-sharing by clients; redesigns the Medicaid healthcare delivery system; and makes rate adjustments and reductions to update rates or reflect budget realities. Amends the Illinois Administrative Procedure Act to authorize the adoption of emergency rules. Amends the Personnel Code in relation to exempt positions. Amends the Illinois State Auditing Act. Requires the filing of reports and evidence regarding amendments to the Illinois Title XIX State plan, federal waiver request, or administrative rules required to implement the amendatory Act. Amends the State Finance Act regarding the Drug Rebate Fund and transfers among line item appropriations; also repeals provisions regarding certain funds. Amends the Illinois Procurement Code regarding applicability. Repeals the Excellence in Academic Medicine Act. Amends the Nursing Home Care Act in relation to staffing requirements. Amends the Emergency Medical Services (EMS) Systems Act regarding stretcher vans. Amends various Acts to provide for the reduction of rates of reimbursement for services or other payments or the alteration of any methodologies authorized by specified provisions to reduce any rate of reimbursement for services or other payments in accordance with specified provisions of the Illinois Public Aid Code. Amends the Long Term Acute Care Hospital Quality Improvement Transfer Program Act in relation to Long Term Acute Care supplemental per diem rates, program evaluation, and development of a demonstration care coordination program. Amends the Children's Health Insurance Program Act to provide that the Department of Healthcare and Family Services shall request any necessary waivers of federal requirements in order to allow receipt of federal funding. Amends the Covering ALL KIDS Health Insurance Act in relation to certain publication requirements. Amends the Illinois Public Aid Code concerning: determinations of need; general assistance; verification of eligibility and fraud deterrence; procurement; actions by vendors; abuse of medical care privileges; participation as a vendor of goods or services; the FamilyCare Program; dental clinic grants; the Medical Special Purposes Trust Fund; Inspector General duties; hospital payments; the County Provider Trust Fund; and other matters. In the Medical Assistance Article of the Code, makes changes concerning: the moratorium on the expansion of eligibility; various eligibility criteria; amounts of assistance; drug co-payments; ambulance services; medical services; vendor enrollment; payment for various services; rates of reimbursement; designation of Safety-Net Hospitals; elimination of and limitations on certain medical assistance; and an Integrated Care Program for individuals with chronic mental health conditions. In the Hospital Provider Funding Article of the Code, makes changes concerning: definition; assessments; exemptions; payments; notices; uses of the Hospital Provider Fund; and applicability. Makes the Pediatric Palliative Care Act inoperative. Amends the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act by terminating the Pharmaceutical Assistance Program and changing the short title to the Senior Citizens and Disabled Persons Property Tax Relief Act; also amends various Acts to change references to the short title. Amends the Sexual Assault Survivors Emergency Treatment Act in relation to reimbursement for certain products or services provided to sexual assault survivors. Amends the Code of Civil Procedure regarding a reference to Transitional Assistance. Amends the Unemployment Insurance Act in relation to household workers, penalties, payments in lieu of contributions by nonprofit organizations, newly hired employees, and disclosures. Makes other changes. Effective immediately, except certain provisions are effective July 1, 2012.

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