Full Text of SB2294 102nd General Assembly
SB2294ham003 102ND GENERAL ASSEMBLY | Rep. Greg Harris Filed: 5/30/2021
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| 1 | | AMENDMENT TO SENATE BILL 2294
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2294, AS AMENDED, | 3 | | with reference to page and line numbers of House Amendment No. | 4 | | 2, on page 8, by replacing lines 16 through 25 with the | 5 | | following:
| 6 | | "(305 ILCS 5/5-41 new) | 7 | | Sec. 5-41. Inpatient hospitalization for opioid-related | 8 | | overdose or withdrawal patients. Due to the disproportionately | 9 | | high opioid-related fatality rates among African Americans in | 10 | | under-resourced communities in Illinois, the lack of community | 11 | | resources, the comorbidities experienced by these patients, | 12 | | and the high rate of hospital inpatient recidivism associated | 13 | | with this population when improperly treated, the Department | 14 | | shall ensure that patients, whether enrolled under the Medical | 15 | | Assistance Fee For Service program or enrolled with a Medicaid | 16 | | Managed Care Organization, experiencing opioid-related | 17 | | overdose or withdrawal are admitted on an inpatient status and |
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| 1 | | the provider shall be reimbursed accordingly, when deemed | 2 | | medically necessary, as determined by either the patient's | 3 | | primary care physician, or the physician or other practitioner | 4 | | responsible for the patient's care at the hospital to which | 5 | | the patient presents, using criteria established by the | 6 | | American Society of Addiction Medicine. If it is determined by | 7 | | the physician or other practitioner responsible for the | 8 | | patient's care at the hospital to which the patient presents, | 9 | | that a patient does not meet medical necessity criteria for | 10 | | the admission, then the patient may be treated via observation | 11 | | and the provider shall seek reimbursement accordingly. Nothing | 12 | | in this Section shall diminish the requirements of a provider | 13 | | to document medical necessity in the patient's record. "; and | 14 | | on page 9, by deleting lines 1 through 19; and | 15 | | on 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 | 18 | | medications for mental health or substance use disorders. | 19 | | Notwithstanding any other provision of this Code, effective | 20 | | for dates of service on and after January 1, 2022, the medical | 21 | | assistance program shall separately reimburse at the | 22 | | prevailing fee schedule, for long-acting injectable | 23 | | medications administered for mental health or substance use |
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| 1 | | disorder in the hospital inpatient setting, and which are | 2 | | compliant with the prior authorization requirements of this | 3 | | Section. The Department, in consultation with a statewide | 4 | | association representing a majority of hospitals and Managed | 5 | | Care Organizations shall implement, by rule, reimbursement | 6 | | policy and prior authorization criteria for the use of | 7 | | long-acting injectable medications administered in the | 8 | | hospital inpatient setting for the treatment of mental health | 9 | | disorders. "; and | 10 | | on page 169, by deleting lines 4 through 23; and | 11 | | by deleting pages 170 through 198; and | 12 | | on page 199, by deleting lines 1 through 7.
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