Full Text of SB0115 101st General Assembly
SB0115ham001 101ST GENERAL ASSEMBLY | Rep. Robert Rita Adopted in House Comm. on Oct 29, 2019
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| 1 | | AMENDMENT TO SENATE BILL 115
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 115 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Emergency Medical Services (EMS) Systems | 5 | | Act is amended by changing Section 32.5 as follows:
| 6 | | (210 ILCS 50/32.5)
| 7 | | Sec. 32.5. Freestanding Emergency Center.
| 8 | | (a) The Department shall issue an annual Freestanding | 9 | | Emergency Center (FEC)
license to any facility that has | 10 | | received a permit from the Health Facilities and Services | 11 | | Review Board to establish a Freestanding Emergency Center by | 12 | | January 1, 2015, and:
| 13 | | (1) is located: (A) in a municipality with
a population
| 14 | | of 50,000 or fewer inhabitants; (B) within 50 miles of the
| 15 | | hospital that owns or controls the FEC; and (C) within 50 | 16 | | miles of the Resource
Hospital affiliated with the FEC as |
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| 1 | | part of the EMS System;
| 2 | | (2) is wholly owned or controlled by an Associate or | 3 | | Resource Hospital,
but is not a part of the hospital's | 4 | | physical plant;
| 5 | | (3) meets the standards for licensed FECs, adopted by | 6 | | rule of the
Department, including, but not limited to:
| 7 | | (A) facility design, specification, operation, and | 8 | | maintenance
standards;
| 9 | | (B) equipment standards; and
| 10 | | (C) the number and qualifications of emergency | 11 | | medical personnel and
other staff, which must include | 12 | | at least one board certified emergency
physician | 13 | | present at the FEC 24 hours per day.
| 14 | | (4) limits its participation in the EMS System strictly | 15 | | to receiving a
limited number of patients by ambulance: (A) | 16 | | according to the FEC's 24-hour capabilities; (B) according | 17 | | to protocols
developed by the Resource Hospital within the | 18 | | FEC's
designated EMS System; and (C) as pre-approved by | 19 | | both the EMS Medical Director and the Department;
| 20 | | (5) provides comprehensive emergency treatment | 21 | | services, as defined in the
rules adopted by the Department | 22 | | pursuant to the Hospital Licensing Act, 24
hours per day, | 23 | | on an outpatient basis;
| 24 | | (6) provides an ambulance and
maintains on site | 25 | | ambulance services staffed with paramedics 24 hours per | 26 | | day;
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| 1 | | (7) (blank);
| 2 | | (8) complies with all State and federal patient rights | 3 | | provisions,
including, but not limited to, the Emergency | 4 | | Medical Treatment Act and the
federal Emergency
Medical | 5 | | Treatment and Active Labor Act;
| 6 | | (9) maintains a communications system that is fully | 7 | | integrated with
its Resource Hospital within the FEC's | 8 | | designated EMS System;
| 9 | | (10) reports to the Department any patient transfers | 10 | | from the FEC to a
hospital within 48 hours of the transfer | 11 | | plus any other
data
determined to be relevant by the | 12 | | Department;
| 13 | | (11) submits to the Department, on a quarterly basis, | 14 | | the FEC's morbidity
and mortality rates for patients | 15 | | treated at the FEC and other data determined
to be relevant | 16 | | by the Department;
| 17 | | (12) does not describe itself or hold itself out to the | 18 | | general public as
a full service hospital or hospital | 19 | | emergency department in its advertising or
marketing
| 20 | | activities;
| 21 | | (13) complies with any other rules adopted by the
| 22 | | Department
under this Act that relate to FECs;
| 23 | | (14) passes the Department's site inspection for | 24 | | compliance with the FEC
requirements of this Act;
| 25 | | (15) submits a copy of the permit issued by
the Health | 26 | | Facilities and Services Review Board indicating that the |
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| 1 | | facility has complied with the Illinois Health Facilities | 2 | | Planning Act with respect to the health services to be | 3 | | provided at the facility;
| 4 | | (16) submits an application for designation as an FEC | 5 | | in a manner and form
prescribed by the Department by rule; | 6 | | and
| 7 | | (17) pays the annual license fee as determined by the | 8 | | Department by
rule.
| 9 | | (a-5) Notwithstanding any other provision of this Section, | 10 | | the Department may issue an annual FEC license to a facility | 11 | | that is located in a county that does not have a licensed | 12 | | general acute care hospital if the facility's application for a | 13 | | permit from the Illinois Health Facilities Planning Board has | 14 | | been deemed complete by the Department of Public Health by | 15 | | January 1, 2014 and if the facility complies with the | 16 | | requirements set forth in paragraphs (1) through (17) of | 17 | | subsection (a). | 18 | | (a-7) Notwithstanding any other provision of this Section, | 19 | | the Department may issue an annual FEC license to a facility | 20 | | that (i) is located in a county having a population of more | 21 | | than 3,000,000 and (ii) was approved to discontinue operations | 22 | | as a hospital by the Health Facilities and Services Review | 23 | | Board in calendar year 2019 under Health Facilities and | 24 | | Services Review Board project number E-024-19, if the facility | 25 | | complies with the requirements set forth in paragraphs (1) | 26 | | through (17) of subsection (a). |
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| 1 | | (a-10) Notwithstanding any other provision of this | 2 | | Section, the Department may issue an annual FEC license to a | 3 | | facility if the facility has, by January 1, 2014, filed a | 4 | | letter of intent to establish an FEC and if the facility | 5 | | complies with the requirements set forth in paragraphs (1) | 6 | | through (17) of subsection (a). | 7 | | (a-15) Notwithstanding any other provision of this | 8 | | Section, the Department shall issue an
annual FEC license to a | 9 | | facility if the facility: (i) discontinues operation as a | 10 | | hospital within 180 days after December 4, 2015 ( the effective | 11 | | date of Public Act 99-490) this amendatory Act of the 99th | 12 | | General Assembly with a Health Facilities and Services Review | 13 | | Board project number of E-017-15; (ii) has an application for a | 14 | | permit to establish an FEC from the Health Facilities and | 15 | | Services Review Board that is deemed complete by January 1, | 16 | | 2017; and (iii) complies with the requirements set forth in | 17 | | paragraphs (1) through (17) of subsection (a) of this Section. | 18 | | (a-20) Notwithstanding any other provision of this | 19 | | Section, the Department shall issue an annual FEC license to a | 20 | | facility if: | 21 | | (1) the facility is a hospital that has discontinued | 22 | | inpatient hospital services; | 23 | | (2) the Department of Healthcare and Family Services | 24 | | has certified the conversion to an FEC was approved by the | 25 | | Hospital Transformation Review Committee as a project | 26 | | subject to the hospital's transformation under subsection |
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| 1 | | (d-5) of Section 14-12 of the Illinois Public Aid Code; | 2 | | (3) the facility complies with the requirements set | 3 | | forth in paragraphs (1) through (17), provided however that | 4 | | the FEC may be located in a municipality with a population | 5 | | greater than 50,000 inhabitants and shall not be subject to | 6 | | the requirements of the Illinois Health Facilities | 7 | | Planning Act that are applicable to the conversion to an | 8 | | FEC if the Department of Healthcare and Family Services | 9 | | Service has certified the conversion to an FEC was approved | 10 | | by the Hospital Transformation Review Committee as a | 11 | | project subject to the hospital's transformation under | 12 | | subsection (d-5) of Section 14-12 of the Illinois Public | 13 | | Aid Code; and | 14 | | (4) the facility is located at the same physical | 15 | | location where the facility served as a hospital. | 16 | | (b) The Department shall:
| 17 | | (1) annually inspect facilities of initial FEC | 18 | | applicants and licensed
FECs, and issue
annual licenses to | 19 | | or annually relicense FECs that
satisfy the Department's | 20 | | licensure requirements as set forth in subsection (a);
| 21 | | (2) suspend, revoke, refuse to issue, or refuse to | 22 | | renew the license of
any
FEC, after notice and an | 23 | | opportunity for a hearing, when the Department finds
that | 24 | | the FEC has failed to comply with the standards and | 25 | | requirements of the
Act or rules adopted by the Department | 26 | | under the
Act;
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| 1 | | (3) issue an Emergency Suspension Order for any FEC | 2 | | when the
Director or his or her designee has determined | 3 | | that the continued operation of
the FEC poses an immediate | 4 | | and serious danger to
the public health, safety, and | 5 | | welfare.
An opportunity for a
hearing shall be promptly | 6 | | initiated after an Emergency Suspension Order has
been | 7 | | issued; and
| 8 | | (4) adopt rules as needed to implement this Section.
| 9 | | (Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16; | 10 | | 100-581, eff. 3-12-18; revised 7-23-19.)
| 11 | | Section 10. The Illinois Public Aid Code is amended by | 12 | | changing Section 14-12 as follows: | 13 | | (305 ILCS 5/14-12) | 14 | | Sec. 14-12. Hospital rate reform payment system. The | 15 | | hospital payment system pursuant to Section 14-11 of this | 16 | | Article shall be as follows: | 17 | | (a) Inpatient hospital services. Effective for discharges | 18 | | on and after July 1, 2014, reimbursement for inpatient general | 19 | | acute care services shall utilize the All Patient Refined | 20 | | Diagnosis Related Grouping (APR-DRG) software, version 30, | 21 | | distributed by 3M TM Health Information System. | 22 | | (1) The Department shall establish Medicaid weighting | 23 | | factors to be used in the reimbursement system established | 24 | | under this subsection. Initial weighting factors shall be |
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| 1 | | the weighting factors as published by 3M Health Information | 2 | | System, associated with Version 30.0 adjusted for the | 3 | | Illinois experience. | 4 | | (2) The Department shall establish a | 5 | | statewide-standardized amount to be used in the inpatient | 6 | | reimbursement system. The Department shall publish these | 7 | | amounts on its website no later than 10 calendar days prior | 8 | | to their effective date. | 9 | | (3) In addition to the statewide-standardized amount, | 10 | | the Department shall develop adjusters to adjust the rate | 11 | | of reimbursement for critical Medicaid providers or | 12 | | services for trauma, transplantation services, perinatal | 13 | | care, and Graduate Medical Education (GME). | 14 | | (4) The Department shall develop add-on payments to | 15 | | account for exceptionally costly inpatient stays, | 16 | | consistent with Medicare outlier principles. Outlier fixed | 17 | | loss thresholds may be updated to control for excessive | 18 | | growth in outlier payments no more frequently than on an | 19 | | annual basis, but at least triennially. Upon updating the | 20 | | fixed loss thresholds, the Department shall be required to | 21 | | update base rates within 12 months. | 22 | | (5) The Department shall define those hospitals or | 23 | | distinct parts of hospitals that shall be exempt from the | 24 | | APR-DRG reimbursement system established under this | 25 | | Section. The Department shall publish these hospitals' | 26 | | inpatient rates on its website no later than 10 calendar |
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| 1 | | days prior to their effective date. | 2 | | (6) Beginning July 1, 2014 and ending on June 30, 2024, | 3 | | in addition to the statewide-standardized amount, the | 4 | | Department shall develop an adjustor to adjust the rate of | 5 | | reimbursement for safety-net hospitals defined in Section | 6 | | 5-5e.1 of this Code excluding pediatric hospitals. | 7 | | (7) Beginning July 1, 2014 and ending on June 30, 2020, | 8 | | or upon implementation of inpatient psychiatric rate | 9 | | increases as described in subsection (n) of Section | 10 | | 5A-12.6, in addition to the statewide-standardized amount, | 11 | | the Department shall develop an adjustor to adjust the rate | 12 | | of reimbursement for Illinois freestanding inpatient | 13 | | psychiatric hospitals that are not designated as | 14 | | children's hospitals by the Department but are primarily | 15 | | treating patients under the age of 21. | 16 | | (7.5) Beginning July 1, 2020, the reimbursement for | 17 | | inpatient psychiatric services shall be so that base claims | 18 | | projected reimbursement is increased by an amount equal to | 19 | | the funds allocated in paragraph (2) of subsection (b) of | 20 | | Section 5A-12.6, less the amount allocated under | 21 | | paragraphs (8) and (9) of this subsection and paragraphs | 22 | | (3) and (4) of subsection (b) multiplied by 13%. Beginning | 23 | | July 1, 2022, the reimbursement for inpatient psychiatric | 24 | | services shall be so that base claims projected | 25 | | reimbursement is increased by an amount equal to the funds | 26 | | allocated in paragraph (3) of subsection (b) of Section |
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| 1 | | 5A-12.6, less the amount allocated under paragraphs (8) and | 2 | | (9) of this subsection and paragraphs (3) and (4) of | 3 | | subsection (b) multiplied by 13%. Beginning July 1, 2024, | 4 | | the reimbursement for inpatient psychiatric services shall | 5 | | be so that base claims projected reimbursement is increased | 6 | | by an amount equal to the funds allocated in paragraph (4) | 7 | | of subsection (b) of Section 5A-12.6, less the amount | 8 | | allocated under paragraphs (8) and (9) of this subsection | 9 | | and paragraphs (3) and (4) of subsection (b) multiplied by | 10 | | 13%. | 11 | | (8) Beginning July 1, 2018, in addition to the | 12 | | statewide-standardized amount, the Department shall adjust | 13 | | the rate of reimbursement for hospitals designated by the | 14 | | Department of Public Health as a Perinatal Level II or II+ | 15 | | center by applying the same adjustor that is applied to | 16 | | Perinatal and Obstetrical care cases for Perinatal Level | 17 | | III centers, as of December 31, 2017. | 18 | | (9) Beginning July 1, 2018, in addition to the | 19 | | statewide-standardized amount, the Department shall apply | 20 | | the same adjustor that is applied to trauma cases as of | 21 | | December 31, 2017 to inpatient claims to treat patients | 22 | | with burns, including, but not limited to, APR-DRGs 841, | 23 | | 842, 843, and 844. | 24 | | (10) Beginning July 1, 2018, the | 25 | | statewide-standardized amount for inpatient general acute | 26 | | care services shall be uniformly increased so that base |
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| 1 | | claims projected reimbursement is increased by an amount | 2 | | equal to the funds allocated in paragraph (1) of subsection | 3 | | (b) of Section 5A-12.6, less the amount allocated under | 4 | | paragraphs (8) and (9) of this subsection and paragraphs | 5 | | (3) and (4) of subsection (b) multiplied by 40%. Beginning | 6 | | July 1, 2020, the statewide-standardized amount for | 7 | | inpatient general acute care services shall be uniformly | 8 | | increased so that base claims projected reimbursement is | 9 | | increased by an amount equal to the funds allocated in | 10 | | paragraph (2) of subsection (b) of Section 5A-12.6, less | 11 | | the amount allocated under paragraphs (8) and (9) of this | 12 | | subsection and paragraphs (3) and (4) of subsection (b) | 13 | | multiplied by 40%. Beginning July 1, 2022, the | 14 | | statewide-standardized amount for inpatient general acute | 15 | | care services shall be uniformly increased so that base | 16 | | claims projected reimbursement is increased by an amount | 17 | | equal to the funds allocated in paragraph (3) of subsection | 18 | | (b) of Section 5A-12.6, less the amount allocated under | 19 | | paragraphs (8) and (9) of this subsection and paragraphs | 20 | | (3) and (4) of subsection (b) multiplied by 40%. Beginning | 21 | | July 1, 2023 the statewide-standardized amount for | 22 | | inpatient general acute care services shall be uniformly | 23 | | increased so that base claims projected reimbursement is | 24 | | increased by an amount equal to the funds allocated in | 25 | | paragraph (4) of subsection (b) of Section 5A-12.6, less | 26 | | the amount allocated under paragraphs (8) and (9) of this |
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| 1 | | subsection and paragraphs (3) and (4) of subsection (b) | 2 | | multiplied by 40%. | 3 | | (11) Beginning July 1, 2018, the reimbursement for | 4 | | inpatient rehabilitation services shall be increased by | 5 | | the addition of a $96 per day add-on. | 6 | | Beginning July 1, 2020, the reimbursement for | 7 | | inpatient rehabilitation services shall be uniformly | 8 | | increased so that the $96 per day add-on is increased by an | 9 | | amount equal to the funds allocated in paragraph (2) of | 10 | | subsection (b) of Section 5A-12.6, less the amount | 11 | | allocated under paragraphs (8) and (9) of this subsection | 12 | | and paragraphs (3) and (4) of subsection (b) multiplied by | 13 | | 0.9%. | 14 | | Beginning July 1, 2022, the reimbursement for | 15 | | inpatient rehabilitation services shall be uniformly | 16 | | increased so that the $96 per day add-on as adjusted by the | 17 | | July 1, 2020 increase, is increased by an amount equal to | 18 | | the funds allocated in paragraph (3) of subsection (b) of | 19 | | Section 5A-12.6, less the amount allocated under | 20 | | paragraphs (8) and (9) of this subsection and paragraphs | 21 | | (3) and (4) of subsection (b) multiplied by 0.9%. | 22 | | Beginning July 1, 2023, the reimbursement for | 23 | | inpatient rehabilitation services shall be uniformly | 24 | | increased so that the $96 per day add-on as adjusted by the | 25 | | July 1, 2022 increase, is increased by an amount equal to | 26 | | the funds allocated in paragraph (4) of subsection (b) of |
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| 1 | | Section 5A-12.6, less the amount allocated under | 2 | | paragraphs (8) and (9) of this subsection and paragraphs | 3 | | (3) and (4) of subsection (b) multiplied by 0.9%. | 4 | | (b) Outpatient hospital services. Effective for dates of | 5 | | service on and after July 1, 2014, reimbursement for outpatient | 6 | | services shall utilize the Enhanced Ambulatory Procedure | 7 | | Grouping (EAPG) software, version 3.7 distributed by 3M TM | 8 | | Health Information System. | 9 | | (1) The Department shall establish Medicaid weighting | 10 | | factors to be used in the reimbursement system established | 11 | | under this subsection. The initial weighting factors shall | 12 | | be the weighting factors as published by 3M Health | 13 | | Information System, associated with Version 3.7. | 14 | | (2) The Department shall establish service specific | 15 | | statewide-standardized amounts to be used in the | 16 | | reimbursement system. | 17 | | (A) The initial statewide standardized amounts, | 18 | | with the labor portion adjusted by the Calendar Year | 19 | | 2013 Medicare Outpatient Prospective Payment System | 20 | | wage index with reclassifications, shall be published | 21 | | by the Department on its website no later than 10 | 22 | | calendar days prior to their effective date. | 23 | | (B) The Department shall establish adjustments to | 24 | | the statewide-standardized amounts for each Critical | 25 | | Access Hospital, as designated by the Department of | 26 | | Public Health in accordance with 42 CFR 485, Subpart F. |
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| 1 | | For outpatient services provided on or before June 30, | 2 | | 2018, the EAPG standardized amounts are determined | 3 | | separately for each critical access hospital such that | 4 | | simulated EAPG payments using outpatient base period | 5 | | paid claim data plus payments under Section 5A-12.4 of | 6 | | this Code net of the associated tax costs are equal to | 7 | | the estimated costs of outpatient base period claims | 8 | | data with a rate year cost inflation factor applied. | 9 | | (3) In addition to the statewide-standardized amounts, | 10 | | the Department shall develop adjusters to adjust the rate | 11 | | of reimbursement for critical Medicaid hospital outpatient | 12 | | providers or services, including outpatient high volume or | 13 | | safety-net hospitals. Beginning July 1, 2018, the | 14 | | outpatient high volume adjustor shall be increased to | 15 | | increase annual expenditures associated with this adjustor | 16 | | by $79,200,000, based on the State Fiscal Year 2015 base | 17 | | year data and this adjustor shall apply to public | 18 | | hospitals, except for large public hospitals, as defined | 19 | | under 89 Ill. Adm. Code 148.25(a). | 20 | | (4) Beginning July 1, 2018, in addition to the | 21 | | statewide standardized amounts, the Department shall make | 22 | | an add-on payment for outpatient expensive devices and | 23 | | drugs. This add-on payment shall at least apply to claim | 24 | | lines that: (i) are assigned with one of the following | 25 | | EAPGs: 490, 1001 to 1020, and coded with one of the | 26 | | following revenue codes: 0274 to 0276, 0278; or (ii) are |
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| 1 | | assigned with one of the following EAPGs: 430 to 441, 443, | 2 | | 444, 460 to 465, 495, 496, 1090. The add-on payment shall | 3 | | be calculated as follows: the claim line's covered charges | 4 | | multiplied by the hospital's total acute cost to charge | 5 | | ratio, less the claim line's EAPG payment plus $1,000, | 6 | | multiplied by 0.8. | 7 | | (5) Beginning July 1, 2018, the statewide-standardized | 8 | | amounts for outpatient services shall be increased by a | 9 | | uniform percentage so that base claims projected | 10 | | reimbursement is increased by an amount equal to no less | 11 | | than the funds allocated in paragraph (1) of subsection (b) | 12 | | of Section 5A-12.6, less the amount allocated under | 13 | | paragraphs (8) and (9) of subsection (a) and paragraphs (3) | 14 | | and (4) of this subsection multiplied by 46%. Beginning | 15 | | July 1, 2020, the statewide-standardized amounts for | 16 | | outpatient services shall be increased by a uniform | 17 | | percentage so that base claims projected reimbursement is | 18 | | increased by an amount equal to no less than the funds | 19 | | allocated in paragraph (2) of subsection (b) of Section | 20 | | 5A-12.6, less the amount allocated under paragraphs (8) and | 21 | | (9) of subsection (a) and paragraphs (3) and (4) of this | 22 | | subsection multiplied by 46%. Beginning July 1, 2022, the | 23 | | statewide-standardized amounts for outpatient services | 24 | | shall be increased by a uniform percentage so that base | 25 | | claims projected reimbursement is increased by an amount | 26 | | equal to the funds allocated in paragraph (3) of subsection |
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| 1 | | (b) of Section 5A-12.6, less the amount allocated under | 2 | | paragraphs (8) and (9) of subsection (a) and paragraphs (3) | 3 | | and (4) of this subsection multiplied by 46%. Beginning | 4 | | July 1, 2023, the statewide-standardized amounts for | 5 | | outpatient services shall be increased by a uniform | 6 | | percentage so that base claims projected reimbursement is | 7 | | increased by an amount equal to no less than the funds | 8 | | allocated in paragraph (4) of subsection (b) of Section | 9 | | 5A-12.6, less the amount allocated under paragraphs (8) and | 10 | | (9) of subsection (a) and paragraphs (3) and (4) of this | 11 | | subsection multiplied by 46%. | 12 | | (6) Effective for dates of service on or after July 1, | 13 | | 2018, the Department shall establish adjustments to the | 14 | | statewide-standardized amounts for each Critical Access | 15 | | Hospital, as designated by the Department of Public Health | 16 | | in accordance with 42 CFR 485, Subpart F, such that each | 17 | | Critical Access Hospital's standardized amount for | 18 | | outpatient services shall be increased by the applicable | 19 | | uniform percentage determined pursuant to paragraph (5) of | 20 | | this subsection. It is the intent of the General Assembly | 21 | | that the adjustments required under this paragraph (6) by | 22 | | Public Act 100-1181 this amendatory Act of the 100th | 23 | | General Assembly shall be applied retroactively to claims | 24 | | for dates of service provided on or after July 1, 2018. | 25 | | (7) Effective for dates of service on or after March 8, | 26 | | 2019 ( the effective date of Public Act 100-1181) this |
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| 1 | | amendatory Act of the 100th General Assembly , the | 2 | | Department shall recalculate and implement an updated | 3 | | statewide-standardized amount for outpatient services | 4 | | provided by hospitals that are not Critical Access | 5 | | Hospitals to reflect the applicable uniform percentage | 6 | | determined pursuant to paragraph (5). | 7 | | (1) Any recalculation to the | 8 | | statewide-standardized amounts for outpatient services | 9 | | provided by hospitals that are not Critical Access | 10 | | Hospitals shall be the amount necessary to achieve the | 11 | | increase in the statewide-standardized amounts for | 12 | | outpatient services increased by a uniform percentage, | 13 | | so that base claims projected reimbursement is | 14 | | increased by an amount equal to no less than the funds | 15 | | allocated in paragraph (1) of subsection (b) of Section | 16 | | 5A-12.6, less the amount allocated under paragraphs | 17 | | (8) and (9) of subsection (a) and paragraphs (3) and | 18 | | (4) of this subsection, for all hospitals that are not | 19 | | Critical Access Hospitals, multiplied by 46%. | 20 | | (2) It is the intent of the General Assembly that | 21 | | the recalculations required under this paragraph (7) | 22 | | by Public Act 100-1181 this amendatory Act of the 100th | 23 | | General Assembly shall be applied prospectively to | 24 | | claims for dates of service provided on or after March | 25 | | 8, 2019 ( the effective date of Public Act 100-1181) | 26 | | this amendatory Act of the 100th General Assembly and |
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| 1 | | that no recoupment or repayment by the Department or an | 2 | | MCO of payments attributable to recalculation under | 3 | | this paragraph (7), issued to the hospital for dates of | 4 | | service on or after July 1, 2018 and before March 8, | 5 | | 2019 ( the effective date of Public Act 100-1181) this | 6 | | amendatory Act of the 100th General Assembly , shall be | 7 | | permitted. | 8 | | (8) The Department shall ensure that all necessary | 9 | | adjustments to the managed care organization capitation | 10 | | base rates necessitated by the adjustments under | 11 | | subparagraph (6) or (7) of this subsection are completed | 12 | | and applied retroactively in accordance with Section | 13 | | 5-30.8 of this Code within 90 days of March 8, 2019 ( the | 14 | | effective date of Public Act 100-1181) this amendatory Act | 15 | | of the 100th General Assembly . | 16 | | (c) In consultation with the hospital community, the | 17 | | Department is authorized to replace 89 Ill. Admin. Code 152.150 | 18 | | as published in 38 Ill. Reg. 4980 through 4986 within 12 months | 19 | | of June 16, 2014 (the effective date of Public Act 98-651). If | 20 | | the Department does not replace these rules within 12 months of | 21 | | June 16, 2014 (the effective date of Public Act 98-651), the | 22 | | rules in effect for 152.150 as published in 38 Ill. Reg. 4980 | 23 | | through 4986 shall remain in effect until modified by rule by | 24 | | the Department. Nothing in this subsection shall be construed | 25 | | to mandate that the Department file a replacement rule. | 26 | | (d) Transition period.
There shall be a transition period |
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| 1 | | to the reimbursement systems authorized under this Section that | 2 | | shall begin on the effective date of these systems and continue | 3 | | until June 30, 2018, unless extended by rule by the Department. | 4 | | To help provide an orderly and predictable transition to the | 5 | | new reimbursement systems and to preserve and enhance access to | 6 | | the hospital services during this transition, the Department | 7 | | shall allocate a transitional hospital access pool of at least | 8 | | $290,000,000 annually so that transitional hospital access | 9 | | payments are made to hospitals. | 10 | | (1) After the transition period, the Department may | 11 | | begin incorporating the transitional hospital access pool | 12 | | into the base rate structure; however, the transitional | 13 | | hospital access payments in effect on June 30, 2018 shall | 14 | | continue to be paid, if continued under Section 5A-16. | 15 | | (2) After the transition period, if the Department | 16 | | reduces payments from the transitional hospital access | 17 | | pool, it shall increase base rates, develop new adjustors, | 18 | | adjust current adjustors, develop new hospital access | 19 | | payments based on updated information, or any combination | 20 | | thereof by an amount equal to the decreases proposed in the | 21 | | transitional hospital access pool payments, ensuring that | 22 | | the entire transitional hospital access pool amount shall | 23 | | continue to be used for hospital payments. | 24 | | (d-5) Hospital transformation program. The Department, in | 25 | | conjunction with the Hospital Transformation Review Committee | 26 | | created under subsection (d-5), shall develop a hospital |
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| 1 | | transformation program to provide financial assistance to | 2 | | hospitals in transforming their services and care models to | 3 | | better align with the needs of the communities they serve. The | 4 | | payments authorized in this Section shall be subject to | 5 | | approval by the federal government. | 6 | | (1) Phase 1. In State fiscal years 2019 through 2020, | 7 | | the Department shall allocate funds from the transitional | 8 | | access hospital pool to create a hospital transformation | 9 | | pool of at least $262,906,870 annually and make hospital | 10 | | transformation payments to hospitals. Subject to Section | 11 | | 5A-16, in State fiscal years 2019 and 2020, an Illinois | 12 | | hospital that received either a transitional hospital | 13 | | access payment under subsection (d) or a supplemental | 14 | | payment under subsection (f) of this Section in State | 15 | | fiscal year 2018, shall receive a hospital transformation | 16 | | payment as follows: | 17 | | (A) If the hospital's Rate Year 2017 Medicaid | 18 | | inpatient utilization rate is equal to or greater than | 19 | | 45%, the hospital transformation payment shall be | 20 | | equal to 100% of the sum of its transitional hospital | 21 | | access payment authorized under subsection (d) and any | 22 | | supplemental payment authorized under subsection (f). | 23 | | (B) If the hospital's Rate Year 2017 Medicaid | 24 | | inpatient utilization rate is equal to or greater than | 25 | | 25% but less than 45%, the hospital transformation | 26 | | payment shall be equal to 75% of the sum of its |
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| 1 | | transitional hospital access payment authorized under | 2 | | subsection (d) and any supplemental payment authorized | 3 | | under subsection (f). | 4 | | (C) If the hospital's Rate Year 2017 Medicaid | 5 | | inpatient utilization rate is less than 25%, the | 6 | | hospital transformation payment shall be equal to 50% | 7 | | of the sum of its transitional hospital access payment | 8 | | authorized under subsection (d) and any supplemental | 9 | | payment authorized under subsection (f). | 10 | | (2) Phase 2. During State fiscal years 2021 and 2022, | 11 | | the Department shall allocate funds from the transitional | 12 | | access hospital pool to create a hospital transformation | 13 | | pool annually and make hospital transformation payments to | 14 | | hospitals participating in the transformation program. Any | 15 | | hospital may seek transformation funding in Phase 2. Any | 16 | | hospital that seeks transformation funding in Phase 2 to | 17 | | update or repurpose the hospital's physical structure to | 18 | | transition to a new delivery model, must submit to the | 19 | | Department in writing a transformation plan, based on the | 20 | | Department's guidelines, that describes the desired | 21 | | delivery model with projections of patient volumes by | 22 | | service lines and projected revenues, expenses, and net | 23 | | income that correspond to the new delivery model. In Phase | 24 | | 2, subject to the approval of rules, the Department may use | 25 | | the hospital transformation pool to increase base rates, | 26 | | develop new adjustors, adjust current adjustors, or |
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| 1 | | develop new access payments in order to support and | 2 | | incentivize hospitals to pursue such transformation. In | 3 | | developing such methodologies, the Department shall ensure | 4 | | that the entire hospital transformation pool continues to | 5 | | be expended to ensure access to hospital services or to | 6 | | support organizations that had received hospital | 7 | | transformation payments under this Section. | 8 | | (A) Any hospital participating in the hospital | 9 | | transformation program shall provide an opportunity | 10 | | for public input by local community groups, hospital | 11 | | workers, and healthcare professionals and assist in | 12 | | facilitating discussions about any transformations or | 13 | | changes to the hospital. | 14 | | (B) As provided in paragraph (9) of Section 3 of | 15 | | the Illinois Health Facilities Planning Act, any | 16 | | hospital participating in the transformation program | 17 | | may be excluded from the requirements of the Illinois | 18 | | Health Facilities Planning Act for those projects | 19 | | related to the hospital's transformation. To be | 20 | | eligible, the hospital must submit to the Health | 21 | | Facilities and Services Review Board certification | 22 | | from the Department, approved by the Hospital | 23 | | Transformation Review Committee, that the project is a | 24 | | part of the hospital's transformation. | 25 | | (C) As provided in subsection (a-20) of Section | 26 | | 32.5 of the Emergency Medical Services (EMS) Systems |
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| 1 | | Act, a hospital that received hospital transformation | 2 | | payments under this Section may convert to a | 3 | | freestanding emergency center. To be eligible for such | 4 | | a conversion, the hospital must submit to the | 5 | | Department of Public Health certification from the | 6 | | Department, approved by the Hospital Transformation | 7 | | Review Committee, that the project is a part of the | 8 | | hospital's transformation. | 9 | | (2.5) The hospital transformation payment amount | 10 | | allocated to a facility in State fiscal years 2019 through | 11 | | 2020 as provided under paragraph (1) shall not be reduced | 12 | | or altered during State fiscal years 2021 and 2022 if: | 13 | | (i) the facility is located in a county having a | 14 | | population of more than 3,000,000; and | 15 | | (ii) the facility was a licensed general acute care | 16 | | hospital that discontinued operations as a hospital on | 17 | | October 22, 2019 and has a Health Facilities and | 18 | | Services Review Board project number of E-024-19. | 19 | | The hospital transformation payment amount shall | 20 | | instead be paid to any entity that purchases the facility | 21 | | for the purpose of converting the facility to a | 22 | | freestanding emergency center as provided in subsection | 23 | | (a-7) of Section 32.5 of the Emergency Medical Services | 24 | | (EMS) Systems Act, pending approval by the Health | 25 | | Facilities and Services
Review Board of the permit to | 26 | | establish a freestanding emergency center as defined by the |
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| 1 | | Health Facilities and Services Review Board. | 2 | | (3) By April 1, 2019 , March 12, 2018 (Public Act | 3 | | 100-581) the Department, in conjunction with the Hospital | 4 | | Transformation Review Committee, shall develop and file as | 5 | | an administrative rule with the Secretary of State the | 6 | | goals, objectives, policies, standards, payment models, or | 7 | | criteria to be applied in Phase 2 of the program to | 8 | | allocate the hospital transformation funds. The goals, | 9 | | objectives, and policies to be considered may include, but | 10 | | are not limited to, achieving unmet needs of a community | 11 | | that a hospital serves such as behavioral health services, | 12 | | outpatient services, or drug rehabilitation services; | 13 | | attaining certain quality or patient safety benchmarks for | 14 | | health care services; or improving the coordination, | 15 | | effectiveness, and efficiency of care delivery. | 16 | | Notwithstanding any other provision of law, any rule | 17 | | adopted in accordance with this subsection (d-5) may be | 18 | | submitted to the Joint Committee on Administrative Rules | 19 | | for approval only if the rule has first been approved by 9 | 20 | | of the 14 members of the Hospital Transformation Review | 21 | | Committee. | 22 | | (4) Hospital Transformation Review Committee. There is | 23 | | created the Hospital Transformation Review Committee. The | 24 | | Committee shall consist of 14 members. No later than 30 | 25 | | days after March 12, 2018 (the effective date of Public Act | 26 | | 100-581), the 4 legislative leaders shall each appoint 3 |
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| 1 | | members; the Governor shall appoint the Director of | 2 | | Healthcare and Family Services, or his or her designee, as | 3 | | a member; and the Director of Healthcare and Family | 4 | | Services shall appoint one member. Any vacancy shall be | 5 | | filled by the applicable appointing authority within 15 | 6 | | calendar days. The members of the Committee shall select a | 7 | | Chair and a Vice-Chair from among its members, provided | 8 | | that the Chair and Vice-Chair cannot be appointed by the | 9 | | same appointing authority and must be from different | 10 | | political parties. The Chair shall have the authority to | 11 | | establish a meeting schedule and convene meetings of the | 12 | | Committee, and the Vice-Chair shall have the authority to | 13 | | convene meetings in the absence of the Chair. The Committee | 14 | | may establish its own rules with respect to meeting | 15 | | schedule, notice of meetings, and the disclosure of | 16 | | documents; however, the Committee shall not have the power | 17 | | to subpoena individuals or documents and any rules must be | 18 | | approved by 9 of the 14 members. The Committee shall | 19 | | perform the functions described in this Section and advise | 20 | | and consult with the Director in the administration of this | 21 | | Section. In addition to reviewing and approving the | 22 | | policies, procedures, and rules for the hospital | 23 | | transformation program, the Committee shall consider and | 24 | | make recommendations related to qualifying criteria and | 25 | | payment methodologies related to safety-net hospitals and | 26 | | children's hospitals. Members of the Committee appointed |
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| 1 | | by the legislative leaders shall be subject to the | 2 | | jurisdiction of the Legislative Ethics Commission, not the | 3 | | Executive Ethics Commission, and all requests under the | 4 | | Freedom of Information Act shall be directed to the | 5 | | applicable Freedom of Information officer for the General | 6 | | Assembly. The Department shall provide operational support | 7 | | to the Committee as necessary. The Committee is dissolved | 8 | | on April 1, 2019. | 9 | | (e) Beginning 36 months after initial implementation, the | 10 | | Department shall update the reimbursement components in | 11 | | subsections (a) and (b), including standardized amounts and | 12 | | weighting factors, and at least triennially and no more | 13 | | frequently than annually thereafter. The Department shall | 14 | | publish these updates on its website no later than 30 calendar | 15 | | days prior to their effective date. | 16 | | (f) Continuation of supplemental payments. Any | 17 | | supplemental payments authorized under Illinois Administrative | 18 | | Code 148 effective January 1, 2014 and that continue during the | 19 | | period of July 1, 2014 through December 31, 2014 shall remain | 20 | | in effect as long as the assessment imposed by Section 5A-2 | 21 | | that is in effect on December 31, 2017 remains in effect. | 22 | | (g) Notwithstanding subsections (a) through (f) of this | 23 | | Section and notwithstanding the changes authorized under | 24 | | Section 5-5b.1, any updates to the system shall not result in | 25 | | any diminishment of the overall effective rates of | 26 | | reimbursement as of the implementation date of the new system |
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| 1 | | (July 1, 2014). These updates shall not preclude variations in | 2 | | any individual component of the system or hospital rate | 3 | | variations. Nothing in this Section shall prohibit the | 4 | | Department from increasing the rates of reimbursement or | 5 | | developing payments to ensure access to hospital services. | 6 | | Nothing in this Section shall be construed to guarantee a | 7 | | minimum amount of spending in the aggregate or per hospital as | 8 | | spending may be impacted by factors , including , but not limited | 9 | | to , the number of individuals in the medical assistance program | 10 | | and the severity of illness of the individuals. | 11 | | (h) The Department shall have the authority to modify by | 12 | | rulemaking any changes to the rates or methodologies in this | 13 | | Section as required by the federal government to obtain federal | 14 | | financial participation for expenditures made under this | 15 | | Section. | 16 | | (i) Except for subsections (g) and (h) of this Section, the | 17 | | Department shall, pursuant to subsection (c) of Section 5-40 of | 18 | | the Illinois Administrative Procedure Act, provide for | 19 | | presentation at the June 2014 hearing of the Joint Committee on | 20 | | Administrative Rules (JCAR) additional written notice to JCAR | 21 | | of the following rules in order to commence the second notice | 22 | | period for the following rules: rules published in the Illinois | 23 | | Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559 | 24 | | (Medical Payment), 4628 (Specialized Health Care Delivery | 25 | | Systems), 4640 (Hospital Services), 4932 (Diagnostic Related | 26 | | Grouping (DRG) Prospective Payment System (PPS)), and 4977 |
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| 1 | | (Hospital Reimbursement Changes), and published in the | 2 | | Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499 | 3 | | (Specialized Health Care Delivery Systems) and 6505 (Hospital | 4 | | Services).
| 5 | | (j) Out-of-state hospitals. Beginning July 1, 2018, for | 6 | | purposes of determining for State fiscal years 2019 and 2020 | 7 | | the hospitals eligible for the payments authorized under | 8 | | subsections (a) and (b) of this Section, the Department shall | 9 | | include out-of-state hospitals that are designated a Level I | 10 | | pediatric trauma center or a Level I trauma center by the | 11 | | Department of Public Health as of December 1, 2017. | 12 | | (k) The Department shall notify each hospital and managed | 13 | | care organization, in writing, of the impact of the updates | 14 | | under this Section at least 30 calendar days prior to their | 15 | | effective date. | 16 | | (Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19; | 17 | | 101-0081, eff. 7-12-19; revised 7-29-19.)
| 18 | | Section 99. Effective date. This Act takes effect upon | 19 | | becoming law.".
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