Illinois General Assembly - Full Text of SB2294
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Full Text of SB2294  102nd General Assembly


Rep. Greg Harris

Filed: 5/30/2021





10200SB2294ham003LRB102 10643 KTG 27329 a


2    AMENDMENT NO. ______. Amend Senate Bill 2294, AS AMENDED,
3with reference to page and line numbers of House Amendment No.
42, on page 8, by replacing lines 16 through 25 with the
6    "(305 ILCS 5/5-41 new)
7    Sec. 5-41. Inpatient hospitalization for opioid-related
8overdose or withdrawal patients. Due to the disproportionately
9high opioid-related fatality rates among African Americans in
10under-resourced communities in Illinois, the lack of community
11resources, the comorbidities experienced by these patients,
12and the high rate of hospital inpatient recidivism associated
13with this population when improperly treated, the Department
14shall ensure that patients, whether enrolled under the Medical
15Assistance Fee For Service program or enrolled with a Medicaid
16Managed Care Organization, experiencing opioid-related
17overdose or withdrawal are admitted on an inpatient status and



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1the provider shall be reimbursed accordingly, when deemed
2medically necessary, as determined by either the patient's
3primary care physician, or the physician or other practitioner
4responsible for the patient's care at the hospital to which
5the patient presents, using criteria established by the
6American Society of Addiction Medicine. If it is determined by
7the physician or other practitioner responsible for the
8patient's care at the hospital to which the patient presents,
9that a patient does not meet medical necessity criteria for
10the admission, then the patient may be treated via observation
11and the provider shall seek reimbursement accordingly. Nothing
12in this Section shall diminish the requirements of a provider
13to document medical necessity in the patient's record."; and
14on page 9, by deleting lines 1 through 19; and
15on page 12, by replacing lines 1 through 16 with the following:
16    "(305 ILCS 5/5-5.4k new)
17    Sec. 5-5.4k. Payments for long-acting injectable
18medications for mental health or substance use disorders.
19Notwithstanding any other provision of this Code, effective
20for dates of service on and after January 1, 2022, the medical
21assistance program shall separately reimburse at the
22prevailing fee schedule, for long-acting injectable
23medications administered for mental health or substance use



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1disorder in the hospital inpatient setting, and which are
2compliant with the prior authorization requirements of this
3Section. The Department, in consultation with a statewide
4association representing a majority of hospitals and Managed
5Care Organizations shall implement, by rule, reimbursement
6policy and prior authorization criteria for the use of
7long-acting injectable medications administered in the
8hospital inpatient setting for the treatment of mental health
9disorders."; and
10on page 169, by deleting lines 4 through 23; and
11by deleting pages 170 through 198; and
12on page 199, by deleting lines 1 through 7.