Bill Amendment: IL SB1851 | 2017-2018 | 100th General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: MEDICAID-MC/DD FACILITIES
Status: 2018-07-27 - Public Act . . . . . . . . . 100-0646 [SB1851 Detail]
Download: Illinois-2017-SB1851-House_Amendment_002.html
Bill Title: MEDICAID-MC/DD FACILITIES
Status: 2018-07-27 - Public Act . . . . . . . . . 100-0646 [SB1851 Detail]
Download: Illinois-2017-SB1851-House_Amendment_002.html
| |||||||
| |||||||
| |||||||
1 | AMENDMENT TO SENATE BILL 1851
| ||||||
2 | AMENDMENT NO. ______. Amend Senate Bill 1851, AS AMENDED, | ||||||
3 | by replacing everything after the enacting clause with the | ||||||
4 | following:
| ||||||
5 | "Section 1. Findings; intent. According to the | ||||||
6 | Congressional Research Service reporting, approximately 35% to | ||||||
7 | 60% of children placed in foster care have at least one chronic | ||||||
8 | or acute physical health condition that requires treatment, | ||||||
9 | including growth failure, asthma, obesity, vision impairment, | ||||||
10 | hearing loss, neurological problems, and complex chronic | ||||||
11 | illnesses; as many as 50% to 75% show behavioral or social | ||||||
12 | competency issues that may warrant mental health services; many | ||||||
13 | of these physical and mental health care issues persist and, | ||||||
14 | relative to their peers in the general population, children who | ||||||
15 | leave foster care for adoption and those who age out of care | ||||||
16 | continue to have greater health needs. | ||||||
17 | Federal child welfare policy requires states to develop |
| |||||||
| |||||||
1 | strategies to address the health care needs of each child in | ||||||
2 | foster care and mandates coordination of state child welfare | ||||||
3 | and Medicaid agencies to ensure that the health care needs of | ||||||
4 | children in foster care are properly identified and treated. | ||||||
5 | The Department of Children and Family Services is | ||||||
6 | responsible for ensuring safety, family permanence, and | ||||||
7 | well-being for the children placed in its custody and | ||||||
8 | protecting these children from further trauma by ensuring | ||||||
9 | timely access to appropriate placements and services, | ||||||
10 | especially those children with complex emotional and | ||||||
11 | behavioral needs who are at much greater risk for not achieving | ||||||
12 | the fundamental child welfare goals of safety, permanence, and | ||||||
13 | well-being. | ||||||
14 | The Department remains under federal court oversight | ||||||
15 | pursuant to the B.H. Consent Decree, in part, for failure to | ||||||
16 | provide constitutionally sufficient services and placements | ||||||
17 | for children with psychological, behavioral, or emotional | ||||||
18 | challenges; the 2015 court-appointed Expert Panel found too | ||||||
19 | many children in the class experience multiple disruptions of | ||||||
20 | placement, services, and relationships; these children and | ||||||
21 | their families endure indeterminate waits, month upon month, | ||||||
22 | for services the child and family need, without a concrete plan | ||||||
23 | or timeframe; these disruptions and delays and the inaction of | ||||||
24 | Department officials exacerbate children's already serious and | ||||||
25 | chronic mental health problems; the Department's approach to | ||||||
26 | treatment and its system of practice have been shaped by |
| |||||||
| |||||||
1 | crises, practitioner preferences, tradition, and system | ||||||
2 | expediency. | ||||||
3 | The American Academy of Pediatrics cautions that the | ||||||
4 | effects of managed care on children's access to services and | ||||||
5 | actual health outcomes are not yet clear; it outlines design | ||||||
6 | and implementation principles if managed care is to be | ||||||
7 | implemented for children. | ||||||
8 | It is the intent of the General Assembly to ensure that | ||||||
9 | children are provided a system of health care with full and | ||||||
10 | inclusive access to physical and behavioral health services | ||||||
11 | necessary for them to thrive. | ||||||
12 | The General Assembly finds it necessary to protect youth in | ||||||
13 | care by requiring the Department to plan the use of managed | ||||||
14 | care services transparently, collaboratively, and deliberately | ||||||
15 | to ensure quality outcomes and accountable oversight.
| ||||||
16 | Section 5. The Open Meetings Act is amended by changing | ||||||
17 | Section 2 as follows:
| ||||||
18 | (5 ILCS 120/2) (from Ch. 102, par. 42)
| ||||||
19 | Sec. 2. Open meetings.
| ||||||
20 | (a) Openness required. All meetings of public
bodies shall | ||||||
21 | be open to the public unless excepted in subsection (c)
and | ||||||
22 | closed in accordance with Section 2a.
| ||||||
23 | (b) Construction of exceptions. The exceptions contained | ||||||
24 | in subsection
(c) are in derogation of the requirement that |
| |||||||
| |||||||
1 | public bodies
meet in the open, and therefore, the exceptions | ||||||
2 | are to be strictly
construed, extending only to subjects | ||||||
3 | clearly within their scope.
The exceptions authorize but do not | ||||||
4 | require the holding of
a closed meeting to discuss a subject | ||||||
5 | included within an enumerated exception.
| ||||||
6 | (c) Exceptions. A public body may hold closed meetings to | ||||||
7 | consider the
following subjects:
| ||||||
8 | (1) The appointment, employment, compensation, | ||||||
9 | discipline, performance,
or dismissal of specific | ||||||
10 | employees of the public body or legal counsel for
the | ||||||
11 | public body, including hearing
testimony on a complaint | ||||||
12 | lodged against an employee of the public body or
against | ||||||
13 | legal counsel for the public body to determine its | ||||||
14 | validity. However, a meeting to consider an increase in | ||||||
15 | compensation to a specific employee of a public body that | ||||||
16 | is subject to the Local Government Wage Increase | ||||||
17 | Transparency Act may not be closed and shall be open to the | ||||||
18 | public and posted and held in accordance with this Act.
| ||||||
19 | (2) Collective negotiating matters between the public | ||||||
20 | body and its
employees or their representatives, or | ||||||
21 | deliberations concerning salary
schedules for one or more | ||||||
22 | classes of employees.
| ||||||
23 | (3) The selection of a person to fill a public office,
| ||||||
24 | as defined in this Act, including a vacancy in a public | ||||||
25 | office, when the public
body is given power to appoint | ||||||
26 | under law or ordinance, or the discipline,
performance or |
| |||||||
| |||||||
1 | removal of the occupant of a public office, when the public | ||||||
2 | body
is given power to remove the occupant under law or | ||||||
3 | ordinance.
| ||||||
4 | (4) Evidence or testimony presented in open hearing, or | ||||||
5 | in closed
hearing where specifically authorized by law, to
| ||||||
6 | a quasi-adjudicative body, as defined in this Act, provided | ||||||
7 | that the body
prepares and makes available for public | ||||||
8 | inspection a written decision
setting forth its | ||||||
9 | determinative reasoning.
| ||||||
10 | (5) The purchase or lease of real property for the use | ||||||
11 | of
the public body, including meetings held for the purpose | ||||||
12 | of discussing
whether a particular parcel should be | ||||||
13 | acquired.
| ||||||
14 | (6) The setting of a price for sale or lease of | ||||||
15 | property owned
by the public body.
| ||||||
16 | (7) The sale or purchase of securities, investments, or | ||||||
17 | investment
contracts. This exception shall not apply to the | ||||||
18 | investment of assets or income of funds deposited into the | ||||||
19 | Illinois Prepaid Tuition Trust Fund.
| ||||||
20 | (8) Security procedures, school building safety and | ||||||
21 | security, and the use of personnel and
equipment to respond | ||||||
22 | to an actual, a threatened, or a reasonably
potential | ||||||
23 | danger to the safety of employees, students, staff, the | ||||||
24 | public, or
public
property.
| ||||||
25 | (9) Student disciplinary cases.
| ||||||
26 | (10) The placement of individual students in special |
| |||||||
| |||||||
1 | education
programs and other matters relating to | ||||||
2 | individual students.
| ||||||
3 | (11) Litigation, when an action against, affecting or | ||||||
4 | on behalf of the
particular public body has been filed and | ||||||
5 | is pending before a court or
administrative tribunal, or | ||||||
6 | when the public body finds that an action is
probable or | ||||||
7 | imminent, in which case the basis for the finding shall be
| ||||||
8 | recorded and entered into the minutes of the closed | ||||||
9 | meeting.
| ||||||
10 | (12) The establishment of reserves or settlement of | ||||||
11 | claims as provided
in the Local Governmental and | ||||||
12 | Governmental Employees Tort Immunity Act, if
otherwise the | ||||||
13 | disposition of a claim or potential claim might be
| ||||||
14 | prejudiced, or the review or discussion of claims, loss or | ||||||
15 | risk management
information, records, data, advice or | ||||||
16 | communications from or with respect
to any insurer of the | ||||||
17 | public body or any intergovernmental risk management
| ||||||
18 | association or self insurance pool of which the public body | ||||||
19 | is a member.
| ||||||
20 | (13) Conciliation of complaints of discrimination in | ||||||
21 | the sale or rental
of housing, when closed meetings are | ||||||
22 | authorized by the law or ordinance
prescribing fair housing | ||||||
23 | practices and creating a commission or
administrative | ||||||
24 | agency for their enforcement.
| ||||||
25 | (14) Informant sources, the hiring or assignment of | ||||||
26 | undercover personnel
or equipment, or ongoing, prior or |
| |||||||
| |||||||
1 | future criminal investigations, when
discussed by a public | ||||||
2 | body with criminal investigatory responsibilities.
| ||||||
3 | (15) Professional ethics or performance when | ||||||
4 | considered by an advisory
body appointed to advise a | ||||||
5 | licensing or regulatory agency on matters
germane to the | ||||||
6 | advisory body's field of competence.
| ||||||
7 | (16) Self evaluation, practices and procedures or | ||||||
8 | professional ethics,
when meeting with a representative of | ||||||
9 | a statewide association of which the
public body is a | ||||||
10 | member.
| ||||||
11 | (17) The recruitment, credentialing, discipline or | ||||||
12 | formal peer review
of physicians or other
health care | ||||||
13 | professionals, or for the discussion of matters protected | ||||||
14 | under the federal Patient Safety and Quality Improvement | ||||||
15 | Act of 2005, and the regulations promulgated thereunder, | ||||||
16 | including 42 C.F.R. Part 3 (73 FR 70732), or the federal | ||||||
17 | Health Insurance Portability and Accountability Act of | ||||||
18 | 1996, and the regulations promulgated thereunder, | ||||||
19 | including 45 C.F.R. Parts 160, 162, and 164, by a hospital, | ||||||
20 | or
other institution providing medical care, that is | ||||||
21 | operated by the public body.
| ||||||
22 | (18) Deliberations for decisions of the Prisoner | ||||||
23 | Review Board.
| ||||||
24 | (19) Review or discussion of applications received | ||||||
25 | under the
Experimental Organ Transplantation Procedures | ||||||
26 | Act.
|
| |||||||
| |||||||
1 | (20) The classification and discussion of matters | ||||||
2 | classified as
confidential or continued confidential by | ||||||
3 | the State Government Suggestion Award
Board.
| ||||||
4 | (21) Discussion of minutes of meetings lawfully closed | ||||||
5 | under this Act,
whether for purposes of approval by the | ||||||
6 | body of the minutes or semi-annual
review of the minutes as | ||||||
7 | mandated by Section 2.06.
| ||||||
8 | (22) Deliberations for decisions of the State
| ||||||
9 | Emergency Medical Services Disciplinary
Review Board.
| ||||||
10 | (23) The operation by a municipality of a municipal | ||||||
11 | utility or the
operation of a
municipal power agency or | ||||||
12 | municipal natural gas agency when the
discussion involves | ||||||
13 | (i) contracts relating to the
purchase, sale, or delivery | ||||||
14 | of electricity or natural gas or (ii) the results
or | ||||||
15 | conclusions of load forecast studies.
| ||||||
16 | (24) Meetings of a residential health care facility | ||||||
17 | resident sexual
assault and death review
team or
the | ||||||
18 | Executive
Council under the Abuse Prevention Review
Team | ||||||
19 | Act.
| ||||||
20 | (25) Meetings of an independent team of experts under | ||||||
21 | Brian's Law. | ||||||
22 | (26) Meetings of a mortality review team appointed | ||||||
23 | under the Department of Juvenile Justice Mortality Review | ||||||
24 | Team Act. | ||||||
25 | (27) (Blank). | ||||||
26 | (28) Correspondence and records (i) that may not be |
| |||||||
| |||||||
1 | disclosed under Section 11-9 of the Illinois Public Aid | ||||||
2 | Code or (ii) that pertain to appeals under Section 11-8 of | ||||||
3 | the Illinois Public Aid Code. | ||||||
4 | (29) Meetings between internal or external auditors | ||||||
5 | and governmental audit committees, finance committees, and | ||||||
6 | their equivalents, when the discussion involves internal | ||||||
7 | control weaknesses, identification of potential fraud risk | ||||||
8 | areas, known or suspected frauds, and fraud interviews | ||||||
9 | conducted in accordance with generally accepted auditing | ||||||
10 | standards of the United States of America. | ||||||
11 | (30) Those meetings or portions of meetings of a | ||||||
12 | fatality review team or the Illinois Fatality Review Team | ||||||
13 | Advisory Council during which a review of the death of an | ||||||
14 | eligible adult in which abuse or neglect is suspected, | ||||||
15 | alleged, or substantiated is conducted pursuant to Section | ||||||
16 | 15 of the Adult Protective Services Act. | ||||||
17 | (31) Meetings and deliberations for decisions of the | ||||||
18 | Concealed Carry Licensing Review Board under the Firearm | ||||||
19 | Concealed Carry Act. | ||||||
20 | (32) Meetings between the Regional Transportation | ||||||
21 | Authority Board and its Service Boards when the discussion | ||||||
22 | involves review by the Regional Transportation Authority | ||||||
23 | Board of employment contracts under Section 28d of the | ||||||
24 | Metropolitan Transit Authority Act and Sections 3A.18 and | ||||||
25 | 3B.26 of the Regional Transportation Authority Act. | ||||||
26 | (33) Those meetings or portions of meetings of the |
| |||||||
| |||||||
1 | advisory committee and peer review subcommittee created | ||||||
2 | under Section 320 of the Illinois Controlled Substances Act | ||||||
3 | during which specific controlled substance prescriber, | ||||||
4 | dispenser, or patient information is discussed. | ||||||
5 | (34) Meetings of the Tax Increment Financing Reform | ||||||
6 | Task Force under Section 2505-800 of the Department of | ||||||
7 | Revenue Law of the Civil Administrative Code of Illinois. | ||||||
8 | (35) Meetings of the group established to discuss | ||||||
9 | Medicaid capitation rates under Section 5-30.8 of the | ||||||
10 | Illinois Public Aid Code. | ||||||
11 | (d) Definitions. For purposes of this Section:
| ||||||
12 | "Employee" means a person employed by a public body whose | ||||||
13 | relationship
with the public body constitutes an | ||||||
14 | employer-employee relationship under
the usual common law | ||||||
15 | rules, and who is not an independent contractor.
| ||||||
16 | "Public office" means a position created by or under the
| ||||||
17 | Constitution or laws of this State, the occupant of which is | ||||||
18 | charged with
the exercise of some portion of the sovereign | ||||||
19 | power of this State. The term
"public office" shall include | ||||||
20 | members of the public body, but it shall not
include | ||||||
21 | organizational positions filled by members thereof, whether
| ||||||
22 | established by law or by a public body itself, that exist to | ||||||
23 | assist the
body in the conduct of its business.
| ||||||
24 | "Quasi-adjudicative body" means an administrative body | ||||||
25 | charged by law or
ordinance with the responsibility to conduct | ||||||
26 | hearings, receive evidence or
testimony and make |
| |||||||
| |||||||
1 | determinations based
thereon, but does not include
local | ||||||
2 | electoral boards when such bodies are considering petition | ||||||
3 | challenges.
| ||||||
4 | (e) Final action. No final action may be taken at a closed | ||||||
5 | meeting.
Final action shall be preceded by a public recital of | ||||||
6 | the nature of the
matter being considered and other information | ||||||
7 | that will inform the
public of the business being conducted.
| ||||||
8 | (Source: P.A. 99-78, eff. 7-20-15; 99-235, eff. 1-1-16; 99-480, | ||||||
9 | eff. 9-9-15; 99-642, eff. 7-28-16; 99-646, eff. 7-28-16; | ||||||
10 | 99-687, eff. 1-1-17; 100-201, eff. 8-18-17; 100-465, eff. | ||||||
11 | 8-31-17.)
| ||||||
12 | Section 10. The Freedom of Information Act is amended by | ||||||
13 | changing Section 7.5 as follows:
| ||||||
14 | (5 ILCS 140/7.5) | ||||||
15 | (Text of Section before amendment by P.A. 100-512 and | ||||||
16 | 100-517 ) | ||||||
17 | Sec. 7.5. Statutory exemptions. To the extent provided for | ||||||
18 | by the statutes referenced below, the following shall be exempt | ||||||
19 | from inspection and copying: | ||||||
20 | (a) All information determined to be confidential | ||||||
21 | under Section 4002 of the Technology Advancement and | ||||||
22 | Development Act. | ||||||
23 | (b) Library circulation and order records identifying | ||||||
24 | library users with specific materials under the Library |
| |||||||
| |||||||
1 | Records Confidentiality Act. | ||||||
2 | (c) Applications, related documents, and medical | ||||||
3 | records received by the Experimental Organ Transplantation | ||||||
4 | Procedures Board and any and all documents or other records | ||||||
5 | prepared by the Experimental Organ Transplantation | ||||||
6 | Procedures Board or its staff relating to applications it | ||||||
7 | has received. | ||||||
8 | (d) Information and records held by the Department of | ||||||
9 | Public Health and its authorized representatives relating | ||||||
10 | to known or suspected cases of sexually transmissible | ||||||
11 | disease or any information the disclosure of which is | ||||||
12 | restricted under the Illinois Sexually Transmissible | ||||||
13 | Disease Control Act. | ||||||
14 | (e) Information the disclosure of which is exempted | ||||||
15 | under Section 30 of the Radon Industry Licensing Act. | ||||||
16 | (f) Firm performance evaluations under Section 55 of | ||||||
17 | the Architectural, Engineering, and Land Surveying | ||||||
18 | Qualifications Based Selection Act. | ||||||
19 | (g) Information the disclosure of which is restricted | ||||||
20 | and exempted under Section 50 of the Illinois Prepaid | ||||||
21 | Tuition Act. | ||||||
22 | (h) Information the disclosure of which is exempted | ||||||
23 | under the State Officials and Employees Ethics Act, and | ||||||
24 | records of any lawfully created State or local inspector | ||||||
25 | general's office that would be exempt if created or | ||||||
26 | obtained by an Executive Inspector General's office under |
| |||||||
| |||||||
1 | that Act. | ||||||
2 | (i) Information contained in a local emergency energy | ||||||
3 | plan submitted to a municipality in accordance with a local | ||||||
4 | emergency energy plan ordinance that is adopted under | ||||||
5 | Section 11-21.5-5 of the Illinois Municipal Code. | ||||||
6 | (j) Information and data concerning the distribution | ||||||
7 | of surcharge moneys collected and remitted by carriers | ||||||
8 | under the Emergency Telephone System Act. | ||||||
9 | (k) Law enforcement officer identification information | ||||||
10 | or driver identification information compiled by a law | ||||||
11 | enforcement agency or the Department of Transportation | ||||||
12 | under Section 11-212 of the Illinois Vehicle Code. | ||||||
13 | (l) Records and information provided to a residential | ||||||
14 | health care facility resident sexual assault and death | ||||||
15 | review team or the Executive Council under the Abuse | ||||||
16 | Prevention Review Team Act. | ||||||
17 | (m) Information provided to the predatory lending | ||||||
18 | database created pursuant to Article 3 of the Residential | ||||||
19 | Real Property Disclosure Act, except to the extent | ||||||
20 | authorized under that Article. | ||||||
21 | (n) Defense budgets and petitions for certification of | ||||||
22 | compensation and expenses for court appointed trial | ||||||
23 | counsel as provided under Sections 10 and 15 of the Capital | ||||||
24 | Crimes Litigation Act. This subsection (n) shall apply | ||||||
25 | until the conclusion of the trial of the case, even if the | ||||||
26 | prosecution chooses not to pursue the death penalty prior |
| |||||||
| |||||||
1 | to trial or sentencing. | ||||||
2 | (o) Information that is prohibited from being | ||||||
3 | disclosed under Section 4 of the Illinois Health and | ||||||
4 | Hazardous Substances Registry Act. | ||||||
5 | (p) Security portions of system safety program plans, | ||||||
6 | investigation reports, surveys, schedules, lists, data, or | ||||||
7 | information compiled, collected, or prepared by or for the | ||||||
8 | Regional Transportation Authority under Section 2.11 of | ||||||
9 | the Regional Transportation Authority Act or the St. Clair | ||||||
10 | County Transit District under the Bi-State Transit Safety | ||||||
11 | Act. | ||||||
12 | (q) Information prohibited from being disclosed by the | ||||||
13 | Personnel Records Review Act. | ||||||
14 | (r) Information prohibited from being disclosed by the | ||||||
15 | Illinois School Student Records Act. | ||||||
16 | (s) Information the disclosure of which is restricted | ||||||
17 | under Section 5-108 of the Public Utilities Act.
| ||||||
18 | (t) All identified or deidentified health information | ||||||
19 | in the form of health data or medical records contained in, | ||||||
20 | stored in, submitted to, transferred by, or released from | ||||||
21 | the Illinois Health Information Exchange, and identified | ||||||
22 | or deidentified health information in the form of health | ||||||
23 | data and medical records of the Illinois Health Information | ||||||
24 | Exchange in the possession of the Illinois Health | ||||||
25 | Information Exchange Authority due to its administration | ||||||
26 | of the Illinois Health Information Exchange. The terms |
| |||||||
| |||||||
1 | "identified" and "deidentified" shall be given the same | ||||||
2 | meaning as in the Health Insurance Portability and | ||||||
3 | Accountability Act of 1996, Public Law 104-191, or any | ||||||
4 | subsequent amendments thereto, and any regulations | ||||||
5 | promulgated thereunder. | ||||||
6 | (u) Records and information provided to an independent | ||||||
7 | team of experts under Brian's Law. | ||||||
8 | (v) Names and information of people who have applied | ||||||
9 | for or received Firearm Owner's Identification Cards under | ||||||
10 | the Firearm Owners Identification Card Act or applied for | ||||||
11 | or received a concealed carry license under the Firearm | ||||||
12 | Concealed Carry Act, unless otherwise authorized by the | ||||||
13 | Firearm Concealed Carry Act; and databases under the | ||||||
14 | Firearm Concealed Carry Act, records of the Concealed Carry | ||||||
15 | Licensing Review Board under the Firearm Concealed Carry | ||||||
16 | Act, and law enforcement agency objections under the | ||||||
17 | Firearm Concealed Carry Act. | ||||||
18 | (w) Personally identifiable information which is | ||||||
19 | exempted from disclosure under subsection (g) of Section | ||||||
20 | 19.1 of the Toll Highway Act. | ||||||
21 | (x) Information which is exempted from disclosure | ||||||
22 | under Section 5-1014.3 of the Counties Code or Section | ||||||
23 | 8-11-21 of the Illinois Municipal Code. | ||||||
24 | (y) Confidential information under the Adult | ||||||
25 | Protective Services Act and its predecessor enabling | ||||||
26 | statute, the Elder Abuse and Neglect Act, including |
| |||||||
| |||||||
1 | information about the identity and administrative finding | ||||||
2 | against any caregiver of a verified and substantiated | ||||||
3 | decision of abuse, neglect, or financial exploitation of an | ||||||
4 | eligible adult maintained in the Registry established | ||||||
5 | under Section 7.5 of the Adult Protective Services Act. | ||||||
6 | (z) Records and information provided to a fatality | ||||||
7 | review team or the Illinois Fatality Review Team Advisory | ||||||
8 | Council under Section 15 of the Adult Protective Services | ||||||
9 | Act. | ||||||
10 | (aa) Information which is exempted from disclosure | ||||||
11 | under Section 2.37 of the Wildlife Code. | ||||||
12 | (bb) Information which is or was prohibited from | ||||||
13 | disclosure by the Juvenile Court Act of 1987. | ||||||
14 | (cc) Recordings made under the Law Enforcement | ||||||
15 | Officer-Worn Body Camera Act, except to the extent | ||||||
16 | authorized under that Act. | ||||||
17 | (dd) Information that is prohibited from being | ||||||
18 | disclosed under Section 45 of the Condominium and Common | ||||||
19 | Interest Community Ombudsperson Act. | ||||||
20 | (ee) Information that is exempted from disclosure | ||||||
21 | under Section 30.1 of the Pharmacy Practice Act. | ||||||
22 | (ff) Information that is exempted from disclosure | ||||||
23 | under the Revised Uniform Unclaimed Property Act. | ||||||
24 | (gg) (ff) Information that is prohibited from being | ||||||
25 | disclosed under Section 7-603.5 of the Illinois Vehicle | ||||||
26 | Code. |
| |||||||
| |||||||
1 | (hh) (ff) Records that are exempt from disclosure under | ||||||
2 | Section 1A-16.7 of the Election Code. | ||||||
3 | (ii) (ff) Information which is exempted from | ||||||
4 | disclosure under Section 2505-800 of the Department of | ||||||
5 | Revenue Law of the Civil Administrative Code of Illinois. | ||||||
6 | (ll) Information the disclosure of which is restricted | ||||||
7 | and exempted under Section 5-30.8 of the Illinois Public | ||||||
8 | Aid Code. | ||||||
9 | (Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, | ||||||
10 | eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; | ||||||
11 | 99-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; | ||||||
12 | 100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. | ||||||
13 | 8-28-17; 100-465, eff. 8-31-17; revised 11-2-17.)
| ||||||
14 | (Text of Section after amendment by P.A. 100-517 but before | ||||||
15 | amendment by P.A. 100-512 ) | ||||||
16 | Sec. 7.5. Statutory exemptions. To the extent provided for | ||||||
17 | by the statutes referenced below, the following shall be exempt | ||||||
18 | from inspection and copying: | ||||||
19 | (a) All information determined to be confidential | ||||||
20 | under Section 4002 of the Technology Advancement and | ||||||
21 | Development Act. | ||||||
22 | (b) Library circulation and order records identifying | ||||||
23 | library users with specific materials under the Library | ||||||
24 | Records Confidentiality Act. | ||||||
25 | (c) Applications, related documents, and medical |
| |||||||
| |||||||
1 | records received by the Experimental Organ Transplantation | ||||||
2 | Procedures Board and any and all documents or other records | ||||||
3 | prepared by the Experimental Organ Transplantation | ||||||
4 | Procedures Board or its staff relating to applications it | ||||||
5 | has received. | ||||||
6 | (d) Information and records held by the Department of | ||||||
7 | Public Health and its authorized representatives relating | ||||||
8 | to known or suspected cases of sexually transmissible | ||||||
9 | disease or any information the disclosure of which is | ||||||
10 | restricted under the Illinois Sexually Transmissible | ||||||
11 | Disease Control Act. | ||||||
12 | (e) Information the disclosure of which is exempted | ||||||
13 | under Section 30 of the Radon Industry Licensing Act. | ||||||
14 | (f) Firm performance evaluations under Section 55 of | ||||||
15 | the Architectural, Engineering, and Land Surveying | ||||||
16 | Qualifications Based Selection Act. | ||||||
17 | (g) Information the disclosure of which is restricted | ||||||
18 | and exempted under Section 50 of the Illinois Prepaid | ||||||
19 | Tuition Act. | ||||||
20 | (h) Information the disclosure of which is exempted | ||||||
21 | under the State Officials and Employees Ethics Act, and | ||||||
22 | records of any lawfully created State or local inspector | ||||||
23 | general's office that would be exempt if created or | ||||||
24 | obtained by an Executive Inspector General's office under | ||||||
25 | that Act. | ||||||
26 | (i) Information contained in a local emergency energy |
| |||||||
| |||||||
1 | plan submitted to a municipality in accordance with a local | ||||||
2 | emergency energy plan ordinance that is adopted under | ||||||
3 | Section 11-21.5-5 of the Illinois Municipal Code. | ||||||
4 | (j) Information and data concerning the distribution | ||||||
5 | of surcharge moneys collected and remitted by carriers | ||||||
6 | under the Emergency Telephone System Act. | ||||||
7 | (k) Law enforcement officer identification information | ||||||
8 | or driver identification information compiled by a law | ||||||
9 | enforcement agency or the Department of Transportation | ||||||
10 | under Section 11-212 of the Illinois Vehicle Code. | ||||||
11 | (l) Records and information provided to a residential | ||||||
12 | health care facility resident sexual assault and death | ||||||
13 | review team or the Executive Council under the Abuse | ||||||
14 | Prevention Review Team Act. | ||||||
15 | (m) Information provided to the predatory lending | ||||||
16 | database created pursuant to Article 3 of the Residential | ||||||
17 | Real Property Disclosure Act, except to the extent | ||||||
18 | authorized under that Article. | ||||||
19 | (n) Defense budgets and petitions for certification of | ||||||
20 | compensation and expenses for court appointed trial | ||||||
21 | counsel as provided under Sections 10 and 15 of the Capital | ||||||
22 | Crimes Litigation Act. This subsection (n) shall apply | ||||||
23 | until the conclusion of the trial of the case, even if the | ||||||
24 | prosecution chooses not to pursue the death penalty prior | ||||||
25 | to trial or sentencing. | ||||||
26 | (o) Information that is prohibited from being |
| |||||||
| |||||||
1 | disclosed under Section 4 of the Illinois Health and | ||||||
2 | Hazardous Substances Registry Act. | ||||||
3 | (p) Security portions of system safety program plans, | ||||||
4 | investigation reports, surveys, schedules, lists, data, or | ||||||
5 | information compiled, collected, or prepared by or for the | ||||||
6 | Regional Transportation Authority under Section 2.11 of | ||||||
7 | the Regional Transportation Authority Act or the St. Clair | ||||||
8 | County Transit District under the Bi-State Transit Safety | ||||||
9 | Act. | ||||||
10 | (q) Information prohibited from being disclosed by the | ||||||
11 | Personnel Records Review Act. | ||||||
12 | (r) Information prohibited from being disclosed by the | ||||||
13 | Illinois School Student Records Act. | ||||||
14 | (s) Information the disclosure of which is restricted | ||||||
15 | under Section 5-108 of the Public Utilities Act.
| ||||||
16 | (t) All identified or deidentified health information | ||||||
17 | in the form of health data or medical records contained in, | ||||||
18 | stored in, submitted to, transferred by, or released from | ||||||
19 | the Illinois Health Information Exchange, and identified | ||||||
20 | or deidentified health information in the form of health | ||||||
21 | data and medical records of the Illinois Health Information | ||||||
22 | Exchange in the possession of the Illinois Health | ||||||
23 | Information Exchange Authority due to its administration | ||||||
24 | of the Illinois Health Information Exchange. The terms | ||||||
25 | "identified" and "deidentified" shall be given the same | ||||||
26 | meaning as in the Health Insurance Portability and |
| |||||||
| |||||||
1 | Accountability Act of 1996, Public Law 104-191, or any | ||||||
2 | subsequent amendments thereto, and any regulations | ||||||
3 | promulgated thereunder. | ||||||
4 | (u) Records and information provided to an independent | ||||||
5 | team of experts under Brian's Law. | ||||||
6 | (v) Names and information of people who have applied | ||||||
7 | for or received Firearm Owner's Identification Cards under | ||||||
8 | the Firearm Owners Identification Card Act or applied for | ||||||
9 | or received a concealed carry license under the Firearm | ||||||
10 | Concealed Carry Act, unless otherwise authorized by the | ||||||
11 | Firearm Concealed Carry Act; and databases under the | ||||||
12 | Firearm Concealed Carry Act, records of the Concealed Carry | ||||||
13 | Licensing Review Board under the Firearm Concealed Carry | ||||||
14 | Act, and law enforcement agency objections under the | ||||||
15 | Firearm Concealed Carry Act. | ||||||
16 | (w) Personally identifiable information which is | ||||||
17 | exempted from disclosure under subsection (g) of Section | ||||||
18 | 19.1 of the Toll Highway Act. | ||||||
19 | (x) Information which is exempted from disclosure | ||||||
20 | under Section 5-1014.3 of the Counties Code or Section | ||||||
21 | 8-11-21 of the Illinois Municipal Code. | ||||||
22 | (y) Confidential information under the Adult | ||||||
23 | Protective Services Act and its predecessor enabling | ||||||
24 | statute, the Elder Abuse and Neglect Act, including | ||||||
25 | information about the identity and administrative finding | ||||||
26 | against any caregiver of a verified and substantiated |
| |||||||
| |||||||
1 | decision of abuse, neglect, or financial exploitation of an | ||||||
2 | eligible adult maintained in the Registry established | ||||||
3 | under Section 7.5 of the Adult Protective Services Act. | ||||||
4 | (z) Records and information provided to a fatality | ||||||
5 | review team or the Illinois Fatality Review Team Advisory | ||||||
6 | Council under Section 15 of the Adult Protective Services | ||||||
7 | Act. | ||||||
8 | (aa) Information which is exempted from disclosure | ||||||
9 | under Section 2.37 of the Wildlife Code. | ||||||
10 | (bb) Information which is or was prohibited from | ||||||
11 | disclosure by the Juvenile Court Act of 1987. | ||||||
12 | (cc) Recordings made under the Law Enforcement | ||||||
13 | Officer-Worn Body Camera Act, except to the extent | ||||||
14 | authorized under that Act. | ||||||
15 | (dd) Information that is prohibited from being | ||||||
16 | disclosed under Section 45 of the Condominium and Common | ||||||
17 | Interest Community Ombudsperson Act. | ||||||
18 | (ee) Information that is exempted from disclosure | ||||||
19 | under Section 30.1 of the Pharmacy Practice Act. | ||||||
20 | (ff) Information that is exempted from disclosure | ||||||
21 | under the Revised Uniform Unclaimed Property Act. | ||||||
22 | (gg) (ff) Information that is prohibited from being | ||||||
23 | disclosed under Section 7-603.5 of the Illinois Vehicle | ||||||
24 | Code. | ||||||
25 | (hh) (ff) Records that are exempt from disclosure under | ||||||
26 | Section 1A-16.7 of the Election Code. |
| |||||||
| |||||||
1 | (ii) (ff) Information which is exempted from | ||||||
2 | disclosure under Section 2505-800 of the Department of | ||||||
3 | Revenue Law of the Civil Administrative Code of Illinois. | ||||||
4 | (jj) (ff) Information and reports that are required to | ||||||
5 | be submitted to the Department of Labor by registering day | ||||||
6 | and temporary labor service agencies but are exempt from | ||||||
7 | disclosure under subsection (a-1) of Section 45 of the Day | ||||||
8 | and Temporary Labor Services Act. | ||||||
9 | (ll) Information the disclosure of which is restricted | ||||||
10 | and exempted under Section 5-30.8 of the Illinois Public | ||||||
11 | Aid Code. | ||||||
12 | (Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, | ||||||
13 | eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; | ||||||
14 | 99-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; | ||||||
15 | 100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. | ||||||
16 | 8-28-17; 100-465, eff. 8-31-17; 100-517, eff. 6-1-18; revised | ||||||
17 | 11-2-17.)
| ||||||
18 | (Text of Section after amendment by P.A. 100-512 ) | ||||||
19 | Sec. 7.5. Statutory exemptions. To the extent provided for | ||||||
20 | by the statutes referenced below, the following shall be exempt | ||||||
21 | from inspection and copying: | ||||||
22 | (a) All information determined to be confidential | ||||||
23 | under Section 4002 of the Technology Advancement and | ||||||
24 | Development Act. | ||||||
25 | (b) Library circulation and order records identifying |
| |||||||
| |||||||
1 | library users with specific materials under the Library | ||||||
2 | Records Confidentiality Act. | ||||||
3 | (c) Applications, related documents, and medical | ||||||
4 | records received by the Experimental Organ Transplantation | ||||||
5 | Procedures Board and any and all documents or other records | ||||||
6 | prepared by the Experimental Organ Transplantation | ||||||
7 | Procedures Board or its staff relating to applications it | ||||||
8 | has received. | ||||||
9 | (d) Information and records held by the Department of | ||||||
10 | Public Health and its authorized representatives relating | ||||||
11 | to known or suspected cases of sexually transmissible | ||||||
12 | disease or any information the disclosure of which is | ||||||
13 | restricted under the Illinois Sexually Transmissible | ||||||
14 | Disease Control Act. | ||||||
15 | (e) Information the disclosure of which is exempted | ||||||
16 | under Section 30 of the Radon Industry Licensing Act. | ||||||
17 | (f) Firm performance evaluations under Section 55 of | ||||||
18 | the Architectural, Engineering, and Land Surveying | ||||||
19 | Qualifications Based Selection Act. | ||||||
20 | (g) Information the disclosure of which is restricted | ||||||
21 | and exempted under Section 50 of the Illinois Prepaid | ||||||
22 | Tuition Act. | ||||||
23 | (h) Information the disclosure of which is exempted | ||||||
24 | under the State Officials and Employees Ethics Act, and | ||||||
25 | records of any lawfully created State or local inspector | ||||||
26 | general's office that would be exempt if created or |
| |||||||
| |||||||
1 | obtained by an Executive Inspector General's office under | ||||||
2 | that Act. | ||||||
3 | (i) Information contained in a local emergency energy | ||||||
4 | plan submitted to a municipality in accordance with a local | ||||||
5 | emergency energy plan ordinance that is adopted under | ||||||
6 | Section 11-21.5-5 of the Illinois Municipal Code. | ||||||
7 | (j) Information and data concerning the distribution | ||||||
8 | of surcharge moneys collected and remitted by carriers | ||||||
9 | under the Emergency Telephone System Act. | ||||||
10 | (k) Law enforcement officer identification information | ||||||
11 | or driver identification information compiled by a law | ||||||
12 | enforcement agency or the Department of Transportation | ||||||
13 | under Section 11-212 of the Illinois Vehicle Code. | ||||||
14 | (l) Records and information provided to a residential | ||||||
15 | health care facility resident sexual assault and death | ||||||
16 | review team or the Executive Council under the Abuse | ||||||
17 | Prevention Review Team Act. | ||||||
18 | (m) Information provided to the predatory lending | ||||||
19 | database created pursuant to Article 3 of the Residential | ||||||
20 | Real Property Disclosure Act, except to the extent | ||||||
21 | authorized under that Article. | ||||||
22 | (n) Defense budgets and petitions for certification of | ||||||
23 | compensation and expenses for court appointed trial | ||||||
24 | counsel as provided under Sections 10 and 15 of the Capital | ||||||
25 | Crimes Litigation Act. This subsection (n) shall apply | ||||||
26 | until the conclusion of the trial of the case, even if the |
| |||||||
| |||||||
1 | prosecution chooses not to pursue the death penalty prior | ||||||
2 | to trial or sentencing. | ||||||
3 | (o) Information that is prohibited from being | ||||||
4 | disclosed under Section 4 of the Illinois Health and | ||||||
5 | Hazardous Substances Registry Act. | ||||||
6 | (p) Security portions of system safety program plans, | ||||||
7 | investigation reports, surveys, schedules, lists, data, or | ||||||
8 | information compiled, collected, or prepared by or for the | ||||||
9 | Regional Transportation Authority under Section 2.11 of | ||||||
10 | the Regional Transportation Authority Act or the St. Clair | ||||||
11 | County Transit District under the Bi-State Transit Safety | ||||||
12 | Act. | ||||||
13 | (q) Information prohibited from being disclosed by the | ||||||
14 | Personnel Records Review Act. | ||||||
15 | (r) Information prohibited from being disclosed by the | ||||||
16 | Illinois School Student Records Act. | ||||||
17 | (s) Information the disclosure of which is restricted | ||||||
18 | under Section 5-108 of the Public Utilities Act.
| ||||||
19 | (t) All identified or deidentified health information | ||||||
20 | in the form of health data or medical records contained in, | ||||||
21 | stored in, submitted to, transferred by, or released from | ||||||
22 | the Illinois Health Information Exchange, and identified | ||||||
23 | or deidentified health information in the form of health | ||||||
24 | data and medical records of the Illinois Health Information | ||||||
25 | Exchange in the possession of the Illinois Health | ||||||
26 | Information Exchange Authority due to its administration |
| |||||||
| |||||||
1 | of the Illinois Health Information Exchange. The terms | ||||||
2 | "identified" and "deidentified" shall be given the same | ||||||
3 | meaning as in the Health Insurance Portability and | ||||||
4 | Accountability Act of 1996, Public Law 104-191, or any | ||||||
5 | subsequent amendments thereto, and any regulations | ||||||
6 | promulgated thereunder. | ||||||
7 | (u) Records and information provided to an independent | ||||||
8 | team of experts under Brian's Law. | ||||||
9 | (v) Names and information of people who have applied | ||||||
10 | for or received Firearm Owner's Identification Cards under | ||||||
11 | the Firearm Owners Identification Card Act or applied for | ||||||
12 | or received a concealed carry license under the Firearm | ||||||
13 | Concealed Carry Act, unless otherwise authorized by the | ||||||
14 | Firearm Concealed Carry Act; and databases under the | ||||||
15 | Firearm Concealed Carry Act, records of the Concealed Carry | ||||||
16 | Licensing Review Board under the Firearm Concealed Carry | ||||||
17 | Act, and law enforcement agency objections under the | ||||||
18 | Firearm Concealed Carry Act. | ||||||
19 | (w) Personally identifiable information which is | ||||||
20 | exempted from disclosure under subsection (g) of Section | ||||||
21 | 19.1 of the Toll Highway Act. | ||||||
22 | (x) Information which is exempted from disclosure | ||||||
23 | under Section 5-1014.3 of the Counties Code or Section | ||||||
24 | 8-11-21 of the Illinois Municipal Code. | ||||||
25 | (y) Confidential information under the Adult | ||||||
26 | Protective Services Act and its predecessor enabling |
| |||||||
| |||||||
1 | statute, the Elder Abuse and Neglect Act, including | ||||||
2 | information about the identity and administrative finding | ||||||
3 | against any caregiver of a verified and substantiated | ||||||
4 | decision of abuse, neglect, or financial exploitation of an | ||||||
5 | eligible adult maintained in the Registry established | ||||||
6 | under Section 7.5 of the Adult Protective Services Act. | ||||||
7 | (z) Records and information provided to a fatality | ||||||
8 | review team or the Illinois Fatality Review Team Advisory | ||||||
9 | Council under Section 15 of the Adult Protective Services | ||||||
10 | Act. | ||||||
11 | (aa) Information which is exempted from disclosure | ||||||
12 | under Section 2.37 of the Wildlife Code. | ||||||
13 | (bb) Information which is or was prohibited from | ||||||
14 | disclosure by the Juvenile Court Act of 1987. | ||||||
15 | (cc) Recordings made under the Law Enforcement | ||||||
16 | Officer-Worn Body Camera Act, except to the extent | ||||||
17 | authorized under that Act. | ||||||
18 | (dd) Information that is prohibited from being | ||||||
19 | disclosed under Section 45 of the Condominium and Common | ||||||
20 | Interest Community Ombudsperson Act. | ||||||
21 | (ee) Information that is exempted from disclosure | ||||||
22 | under Section 30.1 of the Pharmacy Practice Act. | ||||||
23 | (ff) Information that is exempted from disclosure | ||||||
24 | under the Revised Uniform Unclaimed Property Act. | ||||||
25 | (gg) (ff) Information that is prohibited from being | ||||||
26 | disclosed under Section 7-603.5 of the Illinois Vehicle |
| |||||||
| |||||||
1 | Code. | ||||||
2 | (hh) (ff) Records that are exempt from disclosure under | ||||||
3 | Section 1A-16.7 of the Election Code. | ||||||
4 | (ii) (ff) Information which is exempted from | ||||||
5 | disclosure under Section 2505-800 of the Department of | ||||||
6 | Revenue Law of the Civil Administrative Code of Illinois. | ||||||
7 | (jj) (ff) Information and reports that are required to | ||||||
8 | be submitted to the Department of Labor by registering day | ||||||
9 | and temporary labor service agencies but are exempt from | ||||||
10 | disclosure under subsection (a-1) of Section 45 of the Day | ||||||
11 | and Temporary Labor Services Act. | ||||||
12 | (kk) (ff) Information prohibited from disclosure under | ||||||
13 | the Seizure and Forfeiture Reporting Act. | ||||||
14 | (ll) Information the disclosure of which is restricted | ||||||
15 | and exempted under Section 5-30.8 of the Illinois Public | ||||||
16 | Aid Code. | ||||||
17 | (Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, | ||||||
18 | eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; | ||||||
19 | 99-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; | ||||||
20 | 100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. | ||||||
21 | 8-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517, | ||||||
22 | eff. 6-1-18; revised 11-2-17.)
| ||||||
23 | Section 15. The Children and Family Services Act is amended | ||||||
24 | by adding Section 5.45 as follows:
|
| |||||||
| |||||||
1 | (20 ILCS 505/5.45 new) | ||||||
2 | Sec. 5.45. Managed care plan services. | ||||||
3 | (a) As used in this Section: | ||||||
4 | "Caregiver" means an individual or entity directly | ||||||
5 | providing the day-to-day care of a child ensuring the child's | ||||||
6 | safety and well-being. | ||||||
7 | "Child" means a child placed in the care of the Department | ||||||
8 | pursuant to the Juvenile Court Act of 1987. | ||||||
9 | "Department" means the Department of Children and Family | ||||||
10 | Services, or any successor State agency. | ||||||
11 | "Director" means the Director of Children and Family | ||||||
12 | Services. | ||||||
13 | "Managed care organization" has the meaning ascribed to | ||||||
14 | that term in Section 5-30.1 of the Illinois Public Aid Code. | ||||||
15 | "Medicaid managed care plan" means a health care plan | ||||||
16 | operated by a managed care organization under the Medical | ||||||
17 | Assistance Program established in Article V of the Illinois | ||||||
18 | Public Aid Code. | ||||||
19 | "Workgroup" means the Child Welfare Medicaid Managed Care | ||||||
20 | Implementation Advisory Workgroup. | ||||||
21 | (b) Every child who is in the care of the Department | ||||||
22 | pursuant to the Juvenile Court Act of 1987 shall receive the | ||||||
23 | necessary services required by this Act and the Juvenile Court | ||||||
24 | Act of 1987, including any child enrolled in a Medicaid managed | ||||||
25 | care plan. | ||||||
26 | (c) The Department shall not relinquish its authority or |
| |||||||
| |||||||
1 | diminish its responsibility to determine and provide necessary | ||||||
2 | services that are in the best interest of a child even if those | ||||||
3 | services are directly or indirectly: | ||||||
4 | (1) provided by a managed care organization, another | ||||||
5 | State agency, or other third parties; | ||||||
6 | (2) coordinated through a managed care organization, | ||||||
7 | another State agency, or other third parties; or | ||||||
8 | (3) paid for by a managed care organization, another | ||||||
9 | State agency, or other third parties. | ||||||
10 | (d) The Department shall: | ||||||
11 | (1) implement and enforce measures to ensure that a | ||||||
12 | child's enrollment in Medicaid managed care supports | ||||||
13 | continuity of treatment and does not hinder service | ||||||
14 | delivery; | ||||||
15 | (2) establish a single point of contact for health care | ||||||
16 | coverage inquiries and dispute resolution systemwide | ||||||
17 | without transferring this responsibility to a third party | ||||||
18 | such as a managed care coordinator; | ||||||
19 | (3) not require any child to participate in Medicaid | ||||||
20 | managed care if the child would otherwise be exempt from | ||||||
21 | enrolling in a Medicaid managed care plan under any rule or | ||||||
22 | statute of this State; and | ||||||
23 | (4) make recommendations regarding managed care | ||||||
24 | contract measures, quality assurance activities, and | ||||||
25 | performance delivery evaluations in consultation with the | ||||||
26 | Workgroup; and |
| |||||||
| |||||||
1 | (5) post on its website: | ||||||
2 | (A) a link to any rule adopted or procedures | ||||||
3 | changed to address the provisions of this Section, if | ||||||
4 | applicable; | ||||||
5 | (B) each managed care organization's contract, | ||||||
6 | enrollee handbook, and directory; | ||||||
7 | (C) the notification process and timeframe | ||||||
8 | requirements used to inform managed care plan | ||||||
9 | enrollees, enrollees' caregivers, and enrollees' legal | ||||||
10 | representation of any changes in health care coverage | ||||||
11 | or change in a child's managed care provider; | ||||||
12 | (D) defined prior authorization requirements for | ||||||
13 | prescriptions, goods, and services in emergency and | ||||||
14 | non-emergency situations; | ||||||
15 | (E) the State's current Health Care Oversight and | ||||||
16 | Coordination Plan developed in accordance with federal | ||||||
17 | requirements; and | ||||||
18 | (F) the transition plan required under subsection | ||||||
19 | (f), including: | ||||||
20 | (i) the public comments submitted to the | ||||||
21 | Department, the Department of Healthcare and | ||||||
22 | Family Services, and the Workgroup for | ||||||
23 | consideration in development of the transition | ||||||
24 | plan; | ||||||
25 | (ii) a list and summary of recommendations of | ||||||
26 | the Workgroup that the Director or Director of |
| |||||||
| |||||||
1 | Healthcare and Family Services declined to adopt | ||||||
2 | or implement; and | ||||||
3 | (iii) the Department's attestation that the | ||||||
4 | transition plan will not impede the Department's | ||||||
5 | ability to timely identify the service needs of | ||||||
6 | youth in care and the timely and appropriate | ||||||
7 | provision of services to address those identified | ||||||
8 | needs. | ||||||
9 | (e) The Child Welfare Medicaid Managed Care Implementation | ||||||
10 | Advisory Workgroup is established to advise the Department on | ||||||
11 | the transition and implementation of managed care for children. | ||||||
12 | The Director of Children and Family Services and the Director | ||||||
13 | of Healthcare and Family Services shall serve as | ||||||
14 | co-chairpersons of the Workgroup. The Directors shall jointly | ||||||
15 | appoint members to the Workgroup who are stakeholders from the | ||||||
16 | child welfare community, including: | ||||||
17 | (1) employees of the Department of Children and Family | ||||||
18 | Services who have responsibility in the areas of (i) | ||||||
19 | managed care services, (ii) performance monitoring and | ||||||
20 | oversight, (iii) placement operations, and (iv) budget | ||||||
21 | revenue maximization; | ||||||
22 | (2) employees of the Department of Healthcare and | ||||||
23 | Family Services who have responsibility in the areas of (i) | ||||||
24 | managed care contracting, (ii) performance monitoring and | ||||||
25 | oversight, (iii) children's behavioral health, and (iv) | ||||||
26 | budget revenue maximization; |
| |||||||
| |||||||
1 | (3) 2 representatives of youth in care; | ||||||
2 | (4) one representative of managed care organizations | ||||||
3 | serving youth in care; | ||||||
4 | (5) 4 representatives of child welfare providers; | ||||||
5 | (6) one representative of parents of children in | ||||||
6 | out-of-home care; | ||||||
7 | (7) one representative of universities or research | ||||||
8 | institutions; | ||||||
9 | (8) one representative of pediatric physicians; | ||||||
10 | (9) one representative of the juvenile court; | ||||||
11 | (10) one representative of caregivers of youth in care; | ||||||
12 | (11) one practitioner with expertise in child and | ||||||
13 | adolescent psychiatry; | ||||||
14 | (12) one representative of substance abuse and
mental | ||||||
15 | health providers with expertise in serving children | ||||||
16 | involved in child welfare and their families; | ||||||
17 | (13) at least one member of the Medicaid Advisory | ||||||
18 | Committee; | ||||||
19 | (14) one representative of a statewide organization | ||||||
20 | representing hospitals; | ||||||
21 | (15) one representative of a statewide organization | ||||||
22 | representing child welfare providers; | ||||||
23 | (16) one representative of a statewide organization | ||||||
24 | representing substance abuse and mental health providers; | ||||||
25 | and | ||||||
26 | (17) other child advocates as deemed appropriate by the |
| |||||||
| |||||||
1 | Directors. | ||||||
2 | To the greatest extent possible, the co-chairpersons shall | ||||||
3 | appoint members who reflect the geographic diversity of the | ||||||
4 | State and include members who represent rural service areas. | ||||||
5 | Members shall serve 2-year terms or until the Workgroup | ||||||
6 | dissolves. If a vacancy occurs in the Workgroup membership, the | ||||||
7 | vacancy shall be filled in the same manner as the original | ||||||
8 | appointment for the remainder of the unexpired term. The | ||||||
9 | Workgroup shall hold meetings, as it deems appropriate, in the | ||||||
10 | northern, central, and southern regions of the State to solicit | ||||||
11 | public comments to develop its recommendations. To ensure the | ||||||
12 | Department of Children and Family Services and the Department | ||||||
13 | of Healthcare and Family Services are provided time to confer | ||||||
14 | and determine their use of pertinent Workgroup recommendations | ||||||
15 | in the transition plan required under subsection (f), the | ||||||
16 | co-chairpersons shall convene at least 3 meetings. The | ||||||
17 | Department of Children and Family Services and the Department | ||||||
18 | of Healthcare and Family Services shall provide administrative | ||||||
19 | support to the Workgroup. Workgroup members shall serve without | ||||||
20 | compensation. The Workgroup shall dissolve 5 years after the | ||||||
21 | Department of Children and Family Services' implementation of | ||||||
22 | managed care. | ||||||
23 | (f) Prior to transitioning any child to managed care, the | ||||||
24 | Department of Children and Family Services and the Department | ||||||
25 | of Healthcare and Family Services, in consultation with the | ||||||
26 | Workgroup, must develop and post publicly, a transition plan |
| |||||||
| |||||||
1 | for the provision of health care services to children enrolled | ||||||
2 | in Medicaid managed care plans. Interim transition plans must | ||||||
3 | be posted to the Department's website by July 15, 2018. The | ||||||
4 | transition plan shall be posted at least 28 days before the | ||||||
5 | Department's implementation of managed care. The transition | ||||||
6 | plan shall address, but is not limited to, the following: | ||||||
7 | (1) an assessment of existing network adequacy, plans | ||||||
8 | to address gaps in network, and ongoing network evaluation; | ||||||
9 | (2) a framework for preparing and training | ||||||
10 | organizations, caregivers, frontline staff, and managed | ||||||
11 | care organizations; | ||||||
12 | (3) the identification of administrative changes | ||||||
13 | necessary for successful transition to managed care, and | ||||||
14 | the timeframes to make changes; | ||||||
15 | (4) defined roles, responsibilities, and lines of | ||||||
16 | authority for care coordination, placement providers, | ||||||
17 | service providers, and each State agency involved in | ||||||
18 | management and oversight of managed care services; | ||||||
19 | (5) data used to establish baseline performance and | ||||||
20 | quality of care, which shall be utilized to assess quality | ||||||
21 | outcomes and identify ongoing areas for improvement; | ||||||
22 | (6) a process for stakeholder input into managed care | ||||||
23 | planning and implementation; | ||||||
24 | (7) a dispute resolution process, including the rights | ||||||
25 | of enrollees and representatives of enrollees under the | ||||||
26 | dispute process and timeframes for dispute resolution |
| |||||||
| |||||||
1 | determinations and remedies; | ||||||
2 | (8) the process for health care transition for youth | ||||||
3 | exiting the Department's care through emancipation or | ||||||
4 | achieving permanency; and | ||||||
5 | (9) protections to ensure the continued provision of | ||||||
6 | health care services if a child's residence or legal | ||||||
7 | guardian changes. | ||||||
8 | (g) Reports. | ||||||
9 | (1) On or before February 1, 2019, and on or before | ||||||
10 | each February 1 thereafter, the Department shall submit a | ||||||
11 | report to the House and Senate Human Services Committees, | ||||||
12 | or to any successor committees, on measures of access to | ||||||
13 | and the quality of health care services for children | ||||||
14 | enrolled in Medicaid managed care plans, including, but not | ||||||
15 | limited to, data showing whether: | ||||||
16 | (A) children enrolled in Medicaid managed care | ||||||
17 | plans have continuity of care across placement types, | ||||||
18 | geographic regions, and specialty service needs; | ||||||
19 | (B) each child is receiving the early periodic | ||||||
20 | screening, diagnosis, and treatment services as | ||||||
21 | required by federal law, including, but not limited to, | ||||||
22 | regular preventative care and timely specialty care; | ||||||
23 | (C) children are assigned to health homes; | ||||||
24 | (D) each child has a health care oversight and | ||||||
25 | coordination plan as required by federal law; | ||||||
26 | (E) there exist complaints and grievances |
| |||||||
| |||||||
1 | indicating gaps or barriers in service delivery; and | ||||||
2 | (F) the Workgroup and other stakeholders have and | ||||||
3 | continue to be engaged in quality improvement | ||||||
4 | initiatives. | ||||||
5 | The report shall be prepared in consultation with the | ||||||
6 | Workgroup and other agencies, organizations, or | ||||||
7 | individuals the Director deems appropriate in order to | ||||||
8 | obtain comprehensive and objective information about the | ||||||
9 | managed care plan operation. | ||||||
10 | (2) During each legislative session, the House and | ||||||
11 | Senate Human Services Committees shall hold hearings to | ||||||
12 | take public testimony about managed care implementation | ||||||
13 | for children in the care of, adopted from, or placed in | ||||||
14 | guardianship by the Department. The Department shall | ||||||
15 | present testimony, including information provided in the | ||||||
16 | report required under paragraph (1), the Department's | ||||||
17 | compliance with the provisions of this Section, and any | ||||||
18 | recommendations for statutory changes to improve health | ||||||
19 | care for children in the Department's care. | ||||||
20 | (h) If any provision of this Section or its application to | ||||||
21 | any person or circumstance is held invalid, the invalidity of | ||||||
22 | that provision or application does not affect other provisions | ||||||
23 | or applications of this Section that can be given effect | ||||||
24 | without the invalid provision or application.
| ||||||
25 | Section 16. The Nursing Home Care Act is amended by |
| |||||||
| |||||||
1 | changing Section 2-217 as follows:
| ||||||
2 | (210 ILCS 45/2-217) | ||||||
3 | Sec. 2-217. Order for transportation of resident by an | ||||||
4 | ambulance service provider . If a facility orders medi-car, | ||||||
5 | service car, or ground ambulance transportation of a resident | ||||||
6 | of the facility by an ambulance service provider , the facility | ||||||
7 | must maintain a written record that shows (i) the name of the | ||||||
8 | person who placed the order for that transportation and (ii) | ||||||
9 | the medical reason for that transportation. Additionally, the | ||||||
10 | facility must provide the ambulance service provider with a | ||||||
11 | Physician Certification Statement on a form prescribed by the | ||||||
12 | Department of Healthcare and Family Services in accordance with | ||||||
13 | subsection (g) of Section 5-4.2 of the Illinois Public Aid | ||||||
14 | Code. The facility shall provide a copy of the Physician | ||||||
15 | Certification Statement to the ambulance service provider | ||||||
16 | prior to or at the time of transport. The Physician | ||||||
17 | Certification Statement is not required prior to the transport | ||||||
18 | if a delay in transport can be expected to negatively affect | ||||||
19 | the patient outcome; however, the facility shall provide a copy | ||||||
20 | of the Physician Certification Statement to the ambulance | ||||||
21 | service provider at no charge within 10 days after the request. | ||||||
22 | A facility shall, upon request, furnish assistance to the | ||||||
23 | transportation provider in the completion of the form if the | ||||||
24 | Physician Certification Statement is incomplete. The facility | ||||||
25 | must maintain the record for a period of at least 3 years after |
| |||||||
| |||||||
1 | the date of the order for transportation by ambulance.
| ||||||
2 | (Source: P.A. 94-1063, eff. 1-31-07 .)
| ||||||
3 | Section 17. The Specialized Mental Health Rehabilitation | ||||||
4 | Act of 2013 is amended by adding Section 5-104 as follows:
| ||||||
5 | (210 ILCS 49/5-104 new) | ||||||
6 | Sec. 5-104. Therapeutic visit rates. For a facility | ||||||
7 | licensed under this Act by June 1, 2018 or provisionally | ||||||
8 | licensed under this Act by June 1, 2018, a payment shall be | ||||||
9 | made for therapeutic visits that have been indicated by an | ||||||
10 | interdisciplinary team as therapeutically beneficial. Payment | ||||||
11 | under this Section shall be at a rate of 75% of the facility's | ||||||
12 | rate on the effective date of this amendatory Act of the 100th | ||||||
13 | General Assembly and may not exceed 20 days in a fiscal year | ||||||
14 | and shall not exceed 10 days consecutively.
| ||||||
15 | Section 18. The Hospital Licensing Act is amended by | ||||||
16 | changing Section 6.22 as follows:
| ||||||
17 | (210 ILCS 85/6.22) | ||||||
18 | Sec. 6.22. Arrangement for transportation of patient by an | ||||||
19 | ambulance service provider .
| ||||||
20 | (a) In this Section: | ||||||
21 | "Ambulance service provider" means a Vehicle Service | ||||||
22 | Provider as defined in the Emergency Medical Services (EMS) |
| |||||||
| |||||||
1 | Systems Act who provides non-emergency transportation | ||||||
2 | services by ambulance. | ||||||
3 | "Patient" means a person who is transported by an | ||||||
4 | ambulance service provider.
| ||||||
5 | (b) If a hospital arranges for medi-car, service car, or | ||||||
6 | ground ambulance transportation of a patient of the hospital by | ||||||
7 | ambulance , the hospital must provide the ambulance service | ||||||
8 | provider, at or prior to transport, a Physician Certification | ||||||
9 | Statement formatted and completed in compliance with federal | ||||||
10 | regulations or an equivalent form developed by the hospital. | ||||||
11 | Each hospital shall develop a policy requiring a physician or | ||||||
12 | the physician's designee to complete the Physician | ||||||
13 | Certification
Statement. The Physician Certification
Statement | ||||||
14 | shall be maintained as part of the patient's medical record. A | ||||||
15 | hospital shall, upon request, furnish assistance to the | ||||||
16 | ambulance service provider in the completion of the form if the | ||||||
17 | Physician Certification
Statement is incomplete. The Physician | ||||||
18 | Certification Statement or equivalent form is not required | ||||||
19 | prior to transport if a delay in transport can be expected to | ||||||
20 | negatively affect the patient outcome ; however, a hospital | ||||||
21 | shall provide a copy of the Physician Certification
Statement | ||||||
22 | to the ambulance service provider at no charge within 10 days | ||||||
23 | after the request . | ||||||
24 | (c) If a hospital is unable to provide a Physician | ||||||
25 | Certification Statement or equivalent form, then the hospital | ||||||
26 | shall provide to the patient a written notice and a verbal |
| |||||||
| |||||||
1 | explanation of the written notice, which notice must meet all | ||||||
2 | of the following requirements:
| ||||||
3 | (1) The following caption must appear at the beginning | ||||||
4 | of the notice in at least 14-point type: Notice to Patient | ||||||
5 | Regarding Non-Emergency Ambulance Services. | ||||||
6 | (2) The notice must contain each of the following | ||||||
7 | statements in at least 14-point type: | ||||||
8 | (A) The purpose of this notice is to help you make | ||||||
9 | an informed choice about whether you want to be | ||||||
10 | transported by ambulance because your medical | ||||||
11 | condition does not meet medical necessity for | ||||||
12 | transportation by an ambulance. | ||||||
13 | (B) Your insurance may not cover the charges for | ||||||
14 | ambulance transportation. | ||||||
15 | (C) You may be responsible for the cost of | ||||||
16 | ambulance transportation. | ||||||
17 | (D) The estimated cost of ambulance transportation | ||||||
18 | is $(amount). | ||||||
19 | (3) The notice must be signed by the patient or by the | ||||||
20 | patient's authorized representative. A copy shall be given | ||||||
21 | to the patient and the hospital shall retain a copy. | ||||||
22 | (d) The notice set forth in subsection (c) of this Section | ||||||
23 | shall not be required if a delay in transport can be expected | ||||||
24 | to negatively affect the patient outcome. | ||||||
25 | (e) If a patient is physically or mentally unable to sign | ||||||
26 | the notice described in subsection (c) of this Section and no |
| |||||||
| |||||||
1 | authorized representative of the patient is available to sign | ||||||
2 | the notice on the patient's behalf, the hospital must be able | ||||||
3 | to provide documentation of the patient's inability to sign the | ||||||
4 | notice and the unavailability of an authorized representative. | ||||||
5 | In any case described in this subsection (e), the hospital | ||||||
6 | shall be considered to have met the requirements of subsection | ||||||
7 | (c) of this Section.
| ||||||
8 | (Source: P.A. 94-1063, eff. 1-31-07 .)
| ||||||
9 | Section 20. The Illinois Public Aid Code is amended by | ||||||
10 | changing Sections 5-4.2, 5-5.4h, and 5A-16 and by adding | ||||||
11 | Sections 5-5.07 and 5-30.8 as follows:
| ||||||
12 | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
| ||||||
13 | Sec. 5-4.2. Ambulance services payments. | ||||||
14 | (a) For
ambulance
services provided to a recipient of aid | ||||||
15 | under this Article on or after
January 1, 1993, the Illinois | ||||||
16 | Department shall reimburse ambulance service
providers at | ||||||
17 | rates calculated in accordance with this Section. It is the | ||||||
18 | intent
of the General Assembly to provide adequate | ||||||
19 | reimbursement for ambulance
services so as to ensure adequate | ||||||
20 | access to services for recipients of aid
under this Article and | ||||||
21 | to provide appropriate incentives to ambulance service
| ||||||
22 | providers to provide services in an efficient and | ||||||
23 | cost-effective manner. Thus,
it is the intent of the General | ||||||
24 | Assembly that the Illinois Department implement
a |
| |||||||
| |||||||
1 | reimbursement system for ambulance services that, to the extent | ||||||
2 | practicable
and subject to the availability of funds | ||||||
3 | appropriated by the General Assembly
for this purpose, is | ||||||
4 | consistent with the payment principles of Medicare. To
ensure | ||||||
5 | uniformity between the payment principles of Medicare and | ||||||
6 | Medicaid, the
Illinois Department shall follow, to the extent | ||||||
7 | necessary and practicable and
subject to the availability of | ||||||
8 | funds appropriated by the General Assembly for
this purpose, | ||||||
9 | the statutes, laws, regulations, policies, procedures,
| ||||||
10 | principles, definitions, guidelines, and manuals used to | ||||||
11 | determine the amounts
paid to ambulance service providers under | ||||||
12 | Title XVIII of the Social Security
Act (Medicare).
| ||||||
13 | (b) For ambulance services provided to a recipient of aid | ||||||
14 | under this Article
on or after January 1, 1996, the Illinois | ||||||
15 | Department shall reimburse ambulance
service providers based | ||||||
16 | upon the actual distance traveled if a natural
disaster, | ||||||
17 | weather conditions, road repairs, or traffic congestion | ||||||
18 | necessitates
the use of a
route other than the most direct | ||||||
19 | route.
| ||||||
20 | (c) For purposes of this Section, "ambulance services" | ||||||
21 | includes medical
transportation services provided by means of | ||||||
22 | an ambulance, medi-car, service
car, or
taxi.
| ||||||
23 | (c-1) For purposes of this Section, "ground ambulance | ||||||
24 | service" means medical transportation services that are | ||||||
25 | described as ground ambulance services by the Centers for | ||||||
26 | Medicare and Medicaid Services and provided in a vehicle that |
| |||||||
| |||||||
1 | is licensed as an ambulance by the Illinois Department of | ||||||
2 | Public Health pursuant to the Emergency Medical Services (EMS) | ||||||
3 | Systems Act. | ||||||
4 | (c-2) For purposes of this Section, "ground ambulance | ||||||
5 | service provider" means a vehicle service provider as described | ||||||
6 | in the Emergency Medical Services (EMS) Systems Act that | ||||||
7 | operates licensed ambulances for the purpose of providing | ||||||
8 | emergency ambulance services, or non-emergency ambulance | ||||||
9 | services, or both. For purposes of this Section, this includes | ||||||
10 | both ambulance providers and ambulance suppliers as described | ||||||
11 | by the Centers for Medicare and Medicaid Services. | ||||||
12 | (c-3) For purposes of this Section, "medi-car" means | ||||||
13 | transportation services provided to a patient who is confined | ||||||
14 | to a wheelchair and requires the use of a hydraulic or electric | ||||||
15 | lift or ramp and wheelchair lockdown when the patient's | ||||||
16 | condition does not require medical observation, medical | ||||||
17 | supervision, medical equipment, the administration of | ||||||
18 | medications, or the administration of oxygen. | ||||||
19 | (c-4) For purposes of this Section, "service car" means | ||||||
20 | transportation services provided to a patient by a passenger | ||||||
21 | vehicle where that patient does not require the specialized | ||||||
22 | modes described in subsection (c-1) or (c-3). | ||||||
23 | (d) This Section does not prohibit separate billing by | ||||||
24 | ambulance service
providers for oxygen furnished while | ||||||
25 | providing advanced life support
services.
| ||||||
26 | (e) Beginning with services rendered on or after July 1, |
| |||||||
| |||||||
1 | 2008, all providers of non-emergency medi-car and service car | ||||||
2 | transportation must certify that the driver and employee | ||||||
3 | attendant, as applicable, have completed a safety program | ||||||
4 | approved by the Department to protect both the patient and the | ||||||
5 | driver, prior to transporting a patient.
The provider must | ||||||
6 | maintain this certification in its records. The provider shall | ||||||
7 | produce such documentation upon demand by the Department or its | ||||||
8 | representative. Failure to produce documentation of such | ||||||
9 | training shall result in recovery of any payments made by the | ||||||
10 | Department for services rendered by a non-certified driver or | ||||||
11 | employee attendant. Medi-car and service car providers must | ||||||
12 | maintain legible documentation in their records of the driver | ||||||
13 | and, as applicable, employee attendant that actually | ||||||
14 | transported the patient. Providers must recertify all drivers | ||||||
15 | and employee attendants every 3 years.
| ||||||
16 | Notwithstanding the requirements above, any public | ||||||
17 | transportation provider of medi-car and service car | ||||||
18 | transportation that receives federal funding under 49 U.S.C. | ||||||
19 | 5307 and 5311 need not certify its drivers and employee | ||||||
20 | attendants under this Section, since safety training is already | ||||||
21 | federally mandated.
| ||||||
22 | (f) With respect to any policy or program administered by | ||||||
23 | the Department or its agent regarding approval of non-emergency | ||||||
24 | medical transportation by ground ambulance service providers, | ||||||
25 | including, but not limited to, the Non-Emergency | ||||||
26 | Transportation Services Prior Approval Program (NETSPAP), the |
| |||||||
| |||||||
1 | Department shall establish by rule a process by which ground | ||||||
2 | ambulance service providers of non-emergency medical | ||||||
3 | transportation may appeal any decision by the Department or its | ||||||
4 | agent for which no denial was received prior to the time of | ||||||
5 | transport that either (i) denies a request for approval for | ||||||
6 | payment of non-emergency transportation by means of ground | ||||||
7 | ambulance service or (ii) grants a request for approval of | ||||||
8 | non-emergency transportation by means of ground ambulance | ||||||
9 | service at a level of service that entitles the ground | ||||||
10 | ambulance service provider to a lower level of compensation | ||||||
11 | from the Department than the ground ambulance service provider | ||||||
12 | would have received as compensation for the level of service | ||||||
13 | requested. The rule shall be filed by December 15, 2012 and | ||||||
14 | shall provide that, for any decision rendered by the Department | ||||||
15 | or its agent on or after the date the rule takes effect, the | ||||||
16 | ground ambulance service provider shall have 60 days from the | ||||||
17 | date the decision is received to file an appeal. The rule | ||||||
18 | established by the Department shall be, insofar as is | ||||||
19 | practical, consistent with the Illinois Administrative | ||||||
20 | Procedure Act. The Director's decision on an appeal under this | ||||||
21 | Section shall be a final administrative decision subject to | ||||||
22 | review under the Administrative Review Law. | ||||||
23 | (f-5) Beginning 90 days after July 20, 2012 (the effective | ||||||
24 | date of Public Act 97-842), (i) no denial of a request for | ||||||
25 | approval for payment of non-emergency transportation by means | ||||||
26 | of ground ambulance service, and (ii) no approval of |
| |||||||
| |||||||
1 | non-emergency transportation by means of ground ambulance | ||||||
2 | service at a level of service that entitles the ground | ||||||
3 | ambulance service provider to a lower level of compensation | ||||||
4 | from the Department than would have been received at the level | ||||||
5 | of service submitted by the ground ambulance service provider, | ||||||
6 | may be issued by the Department or its agent unless the | ||||||
7 | Department has submitted the criteria for determining the | ||||||
8 | appropriateness of the transport for first notice publication | ||||||
9 | in the Illinois Register pursuant to Section 5-40 of the | ||||||
10 | Illinois Administrative Procedure Act. | ||||||
11 | (g) Whenever a patient covered by a medical assistance | ||||||
12 | program under this Code or by another medical program | ||||||
13 | administered by the Department , including a patient covered | ||||||
14 | under the State's Medicaid managed care program, is being | ||||||
15 | transported discharged from a facility and requires | ||||||
16 | non-emergency transportation including ground ambulance, | ||||||
17 | medi-car, or service car transportation, a Physician | ||||||
18 | Certification Statement , a physician discharge order as | ||||||
19 | described in this Section shall be required for each patient | ||||||
20 | whose discharge requires medically supervised ground ambulance | ||||||
21 | services . Facilities shall develop procedures for a licensed | ||||||
22 | medical professional physician with medical staff privileges | ||||||
23 | to provide a written and signed Physician Certification | ||||||
24 | Statement physician discharge order . The Physician | ||||||
25 | Certification Statement physician discharge order shall | ||||||
26 | specify the level of transportation ground ambulance services |
| |||||||
| |||||||
1 | needed and complete a medical certification establishing the | ||||||
2 | criteria for approval of non-emergency ambulance | ||||||
3 | transportation, as published by the Department of Healthcare | ||||||
4 | and Family Services, that is met by the patient. This order and | ||||||
5 | the medical certification shall be completed prior to ordering | ||||||
6 | the transportation an ambulance service and prior to patient | ||||||
7 | discharge. The Physician Certification Statement is not | ||||||
8 | required prior to transport if a delay in transport can be | ||||||
9 | expected to negatively affect the patient outcome. discharge. | ||||||
10 | The medical certification specifying the level and type of | ||||||
11 | non-emergency transportation needed shall be in the form of the | ||||||
12 | Physician Certification Statement on a standardized form | ||||||
13 | prescribed by the Department of Healthcare and Family Services. | ||||||
14 | Within 75 days after the effective date of this amendatory Act | ||||||
15 | of the 100th General Assembly, the Department of Healthcare and | ||||||
16 | Family Services shall develop a standardized form of the | ||||||
17 | Physician Certification Statement specifying the level and | ||||||
18 | type of transportation services needed in consultation with the | ||||||
19 | Department of Public Health, Medicaid managed care | ||||||
20 | organizations, a statewide association representing ambulance | ||||||
21 | providers, a statewide association representing hospitals, 3 | ||||||
22 | statewide associations representing nursing homes, and other | ||||||
23 | stakeholders. The Physician Certification Statement shall | ||||||
24 | include, but is not limited to, the criteria necessary to | ||||||
25 | demonstrate medical necessity for the level of transport needed | ||||||
26 | as required by (i) the Department of Healthcare and Family |
| |||||||
| |||||||
1 | Services and (ii) the federal Centers for Medicare and Medicaid | ||||||
2 | Services as outlined in the Centers for Medicare and Medicaid | ||||||
3 | Services' Medicare Benefit Policy Manual, Pub. 100-02, Chap. | ||||||
4 | 10, Sec. 10.2.1, et seq. The use of the Physician Certification | ||||||
5 | Statement shall satisfy the obligations of hospitals under | ||||||
6 | Section 6.22 of the Hospital Licensing Act and nursing homes | ||||||
7 | under Section 2-217 of the Nursing Home Care Act. | ||||||
8 | Implementation and acceptance of the Physician Certification | ||||||
9 | Statement shall take place no later than 90 days after the | ||||||
10 | issuance of the Physician Certification Statement by the | ||||||
11 | Department of Healthcare and Family Services. | ||||||
12 | Pursuant to subsection (E) of Section 12-4.25 of this Code, | ||||||
13 | the Department is entitled to recover overpayments paid to a | ||||||
14 | provider or vendor, including, but not limited to, from the | ||||||
15 | discharging physician, the discharging facility, and the | ||||||
16 | ground ambulance service provider, in instances where a | ||||||
17 | non-emergency ground ambulance service is rendered as the | ||||||
18 | result of improper or false certification. | ||||||
19 | Beginning October 1, 2018, the Department of Healthcare and | ||||||
20 | Family Services shall collect data from Medicaid managed care | ||||||
21 | organizations and transportation brokers, including the | ||||||
22 | Department's NETSPAP broker, regarding denials and appeals | ||||||
23 | related to the missing or incomplete Physician Certification | ||||||
24 | Statement forms and overall compliance with this subsection. | ||||||
25 | The Department of Healthcare and Family Services shall publish | ||||||
26 | quarterly results on its website within 15 days following the |
| |||||||
| |||||||
1 | end of each quarter. | ||||||
2 | (h) On and after July 1, 2012, the Department shall reduce | ||||||
3 | any rate of reimbursement for services or other payments or | ||||||
4 | alter any methodologies authorized by this Code to reduce any | ||||||
5 | rate of reimbursement for services or other payments in | ||||||
6 | accordance with Section 5-5e. | ||||||
7 | (Source: P.A. 97-584, eff. 8-26-11; 97-689, eff. 6-14-12; | ||||||
8 | 97-842, eff. 7-20-12; 98-463, eff. 8-16-13.)
| ||||||
9 | (305 ILCS 5/5-5.4h) | ||||||
10 | Sec. 5-5.4h. Medicaid reimbursement for medically complex | ||||||
11 | for the developmentally disabled facilities licensed under the | ||||||
12 | MC/DD Act long-term care facilities for persons under 22 years | ||||||
13 | of age . | ||||||
14 | (a) Facilities licensed as medically complex for the | ||||||
15 | developmentally disabled facilities long-term care facilities | ||||||
16 | for persons under 22 years of age that serve severely and | ||||||
17 | chronically ill pediatric patients shall have a specific | ||||||
18 | reimbursement system designed to recognize the characteristics | ||||||
19 | and needs of the patients they serve. | ||||||
20 | (b) For dates of services starting July 1, 2013 and until a | ||||||
21 | new reimbursement system is designed, medically complex for the | ||||||
22 | developmentally disabled facilities long-term care facilities | ||||||
23 | for persons under 22 years of age that meet the following | ||||||
24 | criteria: | ||||||
25 | (1) serve exceptional care patients; and |
| |||||||
| |||||||
1 | (2) have 30% or more of their patients receiving | ||||||
2 | ventilator care; | ||||||
3 | shall receive Medicaid reimbursement on a 30-day expedited | ||||||
4 | schedule.
| ||||||
5 | (c) Subject to federal approval of changes to the Title XIX | ||||||
6 | State Plan, for dates of services starting July 1, 2014 through | ||||||
7 | March 31, 2019, medically complex for the developmentally | ||||||
8 | disabled facilities and until a new reimbursement system is | ||||||
9 | designed, long-term care facilities for persons under 22 years | ||||||
10 | of age which meet the criteria in subsection (b) of this | ||||||
11 | Section shall receive a per diem rate for clinically complex | ||||||
12 | residents of $304. Clinically complex residents on a ventilator | ||||||
13 | shall receive a per diem rate of $669. Subject to federal | ||||||
14 | approval of changes to the Title XIX State Plan, for dates of | ||||||
15 | services starting April 1, 2019, medically complex for the | ||||||
16 | developmentally disabled facilities must be reimbursed an | ||||||
17 | exceptional care per diem rate, instead of the base rate, for | ||||||
18 | services to residents with complex or extensive medical needs. | ||||||
19 | Exceptional care per diem rates must be paid for the conditions | ||||||
20 | or services specified under subsection (f) at the following per | ||||||
21 | diem rates: Tier 1 $326, Tier 2 $546, and Tier 3 $735. | ||||||
22 | (d) For To qualify for the per diem rate of $669 for | ||||||
23 | clinically complex residents on a ventilator pursuant to | ||||||
24 | subsection (c) or subsection (f) , facilities shall have a | ||||||
25 | policy documenting their method of routine assessment of a | ||||||
26 | resident's weaning potential with interventions implemented |
| |||||||
| |||||||
1 | noted in the resident's medical record. | ||||||
2 | (e) For services provided prior to April 1, 2019 and for | ||||||
3 | For the purposes of this Section, a resident is considered | ||||||
4 | clinically complex if the resident requires at least one of the | ||||||
5 | following medical services: | ||||||
6 | (1) Tracheostomy care with dependence on mechanical | ||||||
7 | ventilation for a minimum of 6 hours each day. | ||||||
8 | (2) Tracheostomy care requiring suctioning at least | ||||||
9 | every 6 hours, room air mist or oxygen as needed, and | ||||||
10 | dependence on one of the treatment procedures listed under | ||||||
11 | paragraph (4) excluding the procedure listed in | ||||||
12 | subparagraph (A) of paragraph (4). | ||||||
13 | (3) Total parenteral nutrition or other intravenous | ||||||
14 | nutritional support and one of the treatment procedures | ||||||
15 | listed under paragraph (4). | ||||||
16 | (4) The following treatment procedures apply to the | ||||||
17 | conditions in paragraphs (2) and (3) of this subsection: | ||||||
18 | (A) Intermittent suctioning at least every 8 hours | ||||||
19 | and room air mist or oxygen as needed. | ||||||
20 | (B) Continuous intravenous therapy including | ||||||
21 | administration of therapeutic agents necessary for | ||||||
22 | hydration or of intravenous pharmaceuticals; or | ||||||
23 | intravenous pharmaceutical administration of more than | ||||||
24 | one agent via a peripheral or central line, without | ||||||
25 | continuous infusion. | ||||||
26 | (C) Peritoneal dialysis treatments requiring at |
| |||||||
| |||||||
1 | least 4 exchanges every 24 hours. | ||||||
2 | (D) Tube feeding via nasogastric or gastrostomy | ||||||
3 | tube. | ||||||
4 | (E) Other medical technologies required | ||||||
5 | continuously, which in the opinion of the attending | ||||||
6 | physician require the services of a professional | ||||||
7 | nurse. | ||||||
8 | (f) Complex or extensive medical needs for exceptional care | ||||||
9 | reimbursement. The conditions and services used for the | ||||||
10 | purposes of this Section have the same meanings as ascribed to | ||||||
11 | those conditions and services under the Minimum Data Set (MDS) | ||||||
12 | Resident Assessment Instrument (RAI) and specified in the most | ||||||
13 | recent manual. Instead of submitting minimum data set | ||||||
14 | assessments to the Department, medically complex for the | ||||||
15 | developmentally disabled facilities must document within each | ||||||
16 | resident's medical record the conditions or services using the | ||||||
17 | minimum data set documentation standards and requirements to | ||||||
18 | qualify for exceptional care reimbursement. | ||||||
19 | (1) Tier 1 reimbursement is for residents who are | ||||||
20 | receiving at least 51% of their caloric intake via a | ||||||
21 | feeding tube. | ||||||
22 | (2) Tier 2 reimbursement is for residents who are | ||||||
23 | receiving tracheostomy care without a ventilator. | ||||||
24 | (3) Tier 3 reimbursement is for residents who are | ||||||
25 | receiving tracheostomy care and ventilator care. | ||||||
26 | (g) For dates of services starting April 1, 2019, |
| |||||||
| |||||||
1 | reimbursement calculations and direct payment for services | ||||||
2 | provided by medically complex for the developmentally disabled | ||||||
3 | facilities are the responsibility of the Department of | ||||||
4 | Healthcare and Family Services instead of the Department of | ||||||
5 | Human Services. Appropriations for medically complex for the | ||||||
6 | developmentally disabled facilities must be shifted from the | ||||||
7 | Department of Human Services to the Department of Healthcare | ||||||
8 | and Family Services. Nothing in this Section prohibits the | ||||||
9 | Department of Healthcare and Family Services from paying more | ||||||
10 | than the rates specified in this Section. The rates in this | ||||||
11 | Section must be interpreted as a minimum amount. Any | ||||||
12 | reimbursement increases applied to providers licensed under | ||||||
13 | the ID/DD Community Care Act must also be applied in an | ||||||
14 | equivalent manner to medically complex for the developmentally | ||||||
15 | disabled facilities. | ||||||
16 | (h) The Department of Healthcare and Family Services shall | ||||||
17 | pay the rates in effect on March 31, 2019 until the changes | ||||||
18 | made to this Section by this amendatory Act of the 100th | ||||||
19 | General Assembly have been approved by the Centers for Medicare | ||||||
20 | and Medicaid Services of the U.S. Department of Health and | ||||||
21 | Human Services. | ||||||
22 | (i) The Department of Healthcare and Family Services may | ||||||
23 | adopt rules as allowed by the Illinois Administrative Procedure | ||||||
24 | Act to implement this Section; however, the requirements of | ||||||
25 | this Section must be implemented by the Department of | ||||||
26 | Healthcare and Family Services even if the Department of |
| |||||||
| |||||||
1 | Healthcare and Family Services has not adopted rules by the | ||||||
2 | implementation date of April 1, 2019. | ||||||
3 | (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
| ||||||
4 | (305 ILCS 5/5-5.07 new) | ||||||
5 | Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem | ||||||
6 | rate. The Department of Children and Family Services shall pay | ||||||
7 | the DCFS per diem rate for inpatient psychiatric stay at a | ||||||
8 | free-standing psychiatric hospital effective the 11th day when | ||||||
9 | a child is in the hospital beyond medical necessity, and the | ||||||
10 | parent or caregiver has denied the child access to the home and | ||||||
11 | has refused or failed to make provisions for another living | ||||||
12 | arrangement for the child or the child's discharge is being | ||||||
13 | delayed due to a pending inquiry or investigation by the | ||||||
14 | Department of Children and Family Services. This Section is | ||||||
15 | repealed 6 months after the effective date of this amendatory | ||||||
16 | Act of the 100th General Assembly.
| ||||||
17 | (305 ILCS 5/5-30.8 new) | ||||||
18 | Sec. 5-30.8. Managed care organization rate transparency. | ||||||
19 | (a) For the establishment of Managed care
organization | ||||||
20 | (MCO) capitated base rate payments from the State,
including, | ||||||
21 | but not limited to: (i) hospital fee schedule
reforms and | ||||||
22 | updates, (ii) rates related to a single
State-mandated | ||||||
23 | preferred drug list, (iii) rate updates related
to the State's | ||||||
24 | preferred drug list, (iv) inclusion of coverage
for children |
| |||||||
| |||||||
1 | with special needs, (v) inclusion of coverage for
children | ||||||
2 | within the child welfare system, (vi) annual MCO
capitated | ||||||
3 | rates, and (vii) any retroactive provider fee
schedule | ||||||
4 | adjustments or other changes required by legislation
or other | ||||||
5 | actions, the Department of Healthcare and Family
Services shall | ||||||
6 | implement a capitation base rate setting process beginning
on | ||||||
7 | the effective date of this amendatory Act of the 100th
General | ||||||
8 | Assembly which shall include all of the following
elements of | ||||||
9 | transparency: | ||||||
10 | (1) The Department shall include participating MCOs | ||||||
11 | and a statewide trade association representing a majority | ||||||
12 | of participating MCOs in meetings to discuss the impact to | ||||||
13 | base capitation rates as a result of any new or updated | ||||||
14 | hospital fee schedules or
other provider fee schedules. | ||||||
15 | Additionally, the Department
shall share any data or | ||||||
16 | reports used to develop MCO capitation rates
with | ||||||
17 | participating MCOs. This data shall be comprehensive
| ||||||
18 | enough for MCO actuaries to recreate and verify the
| ||||||
19 | accuracy of the capitation base rate build-up. | ||||||
20 | (2) The Department shall not limit the number of
| ||||||
21 | experts that each MCO is allowed to bring to the draft | ||||||
22 | capitation base rate
meeting or the final capitation base | ||||||
23 | rate review meeting. Draft and final capitation base rate | ||||||
24 | review meetings shall be held in at least 2 locations. | ||||||
25 | (3) The Department and its contracted actuary shall
| ||||||
26 | meet with all participating MCOs simultaneously and
|
| |||||||
| |||||||
1 | together along with consulting actuaries contracted with
| ||||||
2 | statewide trade association representing a majority of | ||||||
3 | Medicaid health plans at the request of the plans.
| ||||||
4 | Participating MCOs shall additionally, at their request,
| ||||||
5 | be granted individual capitation rate development meetings | ||||||
6 | with the
Department. | ||||||
7 | (4) Any quality incentive or other incentive
| ||||||
8 | withholding of any portion of the actuarially certified
| ||||||
9 | capitation rates must be budget-neutral. The entirety of | ||||||
10 | any aggregate
withheld amounts must be returned to the MCOs | ||||||
11 | in proportion
to their performance on the relevant | ||||||
12 | performance metric. No
amounts shall be returned to the | ||||||
13 | Department if
all performance measures are not achieved to | ||||||
14 | the extent allowable by federal law and regulations. | ||||||
15 | (5) Upon request, the Department shall provide written | ||||||
16 | responses to
questions regarding MCO capitation base | ||||||
17 | rates, the capitation base development
methodology, and | ||||||
18 | MCO capitation rate data, and all other requests regarding
| ||||||
19 | capitation rates from MCOs. Upon request, the Department | ||||||
20 | shall also provide to the MCOs materials used in | ||||||
21 | incorporating provider fee schedules into base capitation | ||||||
22 | rates. | ||||||
23 | (b) For the development of capitation base rates for new | ||||||
24 | capitation rate years: | ||||||
25 | (1) The Department shall take into account emerging
| ||||||
26 | experience in the development of the annual MCO capitation |
| |||||||
| |||||||
1 | base rates,
including, but not limited to, current-year | ||||||
2 | cost and
utilization trends observed by MCOs in an | ||||||
3 | actuarially sound manner and in accordance with federal law | ||||||
4 | and regulations. | ||||||
5 | (2) No later than January 1 of each year, the | ||||||
6 | Department shall release an agreed upon annual calendar | ||||||
7 | that outlines dates for capitation rate setting meetings | ||||||
8 | for that year. The calendar shall include at least the | ||||||
9 | following meetings and deadlines: | ||||||
10 | (A) An initial meeting for the Department to review | ||||||
11 | MCO data and draft rate assumptions to be used in the | ||||||
12 | development of capitation base rates for the following | ||||||
13 | year. | ||||||
14 | (B) A draft rate meeting after the Department | ||||||
15 | provides the MCOs with the
draft capitated base
rates
| ||||||
16 | to discuss, review, and seek feedback regarding the | ||||||
17 | draft capitation base
rates. | ||||||
18 | (3) Prior to the submission of final capitation rates | ||||||
19 | to the federal Centers for
Medicare and Medicaid Services, | ||||||
20 | the Department shall
provide the MCOs with a final | ||||||
21 | actuarial report including
the final capitation base rates | ||||||
22 | for the following year and
subsequently conduct a final | ||||||
23 | capitation base review meeting.
Final capitation rates | ||||||
24 | shall be marked final. | ||||||
25 | (c) For the development of capitation base rates reflecting | ||||||
26 | policy changes: |
| |||||||
| |||||||
1 | (1) Unless contrary to federal law and regulation,
the | ||||||
2 | Department must provide notice to MCOs
of any significant | ||||||
3 | operational policy change no later than 60 days
prior to | ||||||
4 | the effective date of an operational policy change in order | ||||||
5 | to give MCOs time to prepare for and implement the | ||||||
6 | operational policy change and to ensure that the quality | ||||||
7 | and delivery of enrollee health care is not disrupted. | ||||||
8 | "Operational policy change" means a change to operational | ||||||
9 | requirements such as reporting formats, encounter | ||||||
10 | submission definitional changes, or required provider | ||||||
11 | interfaces
made at the sole discretion of the Department
| ||||||
12 | and not required by legislation with a retroactive
| ||||||
13 | effective date. Nothing in this Section shall be construed | ||||||
14 | as a requirement to delay or prohibit implementation of | ||||||
15 | policy changes that impact enrollee benefits as determined | ||||||
16 | in the sole discretion of the Department. | ||||||
17 | (2) No later than 60 days after the effective date of | ||||||
18 | the policy change or
program implementation, the | ||||||
19 | Department shall meet with the
MCOs regarding the initial | ||||||
20 | data collection needed to
establish capitation base rates | ||||||
21 | for the policy change. Additionally,
the Department shall | ||||||
22 | share with the participating MCOs what
other data is needed | ||||||
23 | to estimate the change and the processes for collection of | ||||||
24 | that data that shall be
utilized to develop capitation base | ||||||
25 | rates. | ||||||
26 | (3) No later than 60 days after the effective date of |
| |||||||
| |||||||
1 | the policy change or
program implementation, the | ||||||
2 | Department shall meet with
MCOs to review data and the | ||||||
3 | Department's written draft
assumptions to be used in | ||||||
4 | development of capitation base rates for the
policy change, | ||||||
5 | and shall provide opportunities for
questions to be asked | ||||||
6 | and answered. | ||||||
7 | (4) No later than 60 days after the effective date of | ||||||
8 | the policy change or
program implementation, the | ||||||
9 | Department shall provide the
MCOs with draft capitation | ||||||
10 | base rates and shall also conduct
a draft capitation base | ||||||
11 | rate meeting with MCOs to discuss, review, and seek
| ||||||
12 | feedback regarding the draft capitation base rates. | ||||||
13 | (d) For the development of capitation base rates for | ||||||
14 | retroactive policy or
fee schedule changes: | ||||||
15 | (1) The Department shall meet with the MCOs regarding
| ||||||
16 | the initial data collection needed to establish capitation | ||||||
17 | base rates for
the policy change. Additionally, the | ||||||
18 | Department shall
share with the participating MCOs what | ||||||
19 | other data is needed to estimate the change and the
| ||||||
20 | processes for collection of the data that shall be utilized | ||||||
21 | to develop capitation base
rates. | ||||||
22 | (2) The Department shall meet with MCOs to review data
| ||||||
23 | and the Department's written draft assumptions to be used
| ||||||
24 | in development of capitation base rates for the policy | ||||||
25 | change. The Department shall
provide opportunities for | ||||||
26 | questions to be asked and
answered. |
| |||||||
| |||||||
1 | (3) The Department shall provide the MCOs with draft
| ||||||
2 | capitated rates and shall also conduct a draft rate meeting
| ||||||
3 | with MCOs to discuss, review, and seek feedback regarding
| ||||||
4 | the draft capitation base rates. | ||||||
5 | (4) The Department shall inform MCOs no less than | ||||||
6 | quarterly of upcoming benefit and policy changes to the | ||||||
7 | Medicaid program. | ||||||
8 | (e) Meetings of the group established to discuss Medicaid | ||||||
9 | capitation rates under this Section shall be closed to the | ||||||
10 | public and shall not be subject to the Open Meetings Act. | ||||||
11 | Records and information produced by the group established to | ||||||
12 | discuss Medicaid capitation rates under this Section shall be | ||||||
13 | confidential and not subject to the Freedom of Information Act.
| ||||||
14 | (305 ILCS 5/5A-16) | ||||||
15 | Sec. 5A-16. State fiscal year 2019 implementation | ||||||
16 | protection. | ||||||
17 | (a) To preserve access to hospital services and to ensure | ||||||
18 | continuity of payments and stability of access to hospital | ||||||
19 | services , it is the intent of the General Assembly that there | ||||||
20 | not be a gap in payments to hospitals while the changes | ||||||
21 | authorized under Public Act 100-581 this amendatory Act of the | ||||||
22 | 100th General Assembly are being reviewed by the federal | ||||||
23 | Centers for Medicare and Medicaid Services and implemented by | ||||||
24 | the Department. Therefore, pending the review and approval of | ||||||
25 | the changes to the assessment and hospital reimbursement |
| |||||||
| |||||||
1 | methodologies authorized under Public Act 100-581 this | ||||||
2 | amendatory Act of the 100th General Assembly by the federal | ||||||
3 | Centers for Medicare and Medicaid Services and the final | ||||||
4 | implementation of such program by the Department, the | ||||||
5 | Department shall take all actions necessary to continue the | ||||||
6 | reimbursement methodologies and payments to hospitals that are | ||||||
7 | changed under Public Act 100-581 this amendatory Act of the | ||||||
8 | 100th General Assembly , as they are in effect on June 30, 2018, | ||||||
9 | until the first day of the second month after the new and | ||||||
10 | revised methodologies and payments authorized under Public Act | ||||||
11 | 100-581 this amendatory Act of the 100th General Assembly are | ||||||
12 | effective and implemented by the Department. Such actions by | ||||||
13 | the Department shall include, but not be limited to, requesting | ||||||
14 | prior to June 15, 2018 the extension of any federal approval of | ||||||
15 | the currently approved payment methodologies contained in | ||||||
16 | Illinois' Medicaid State Plan while the federal Centers for | ||||||
17 | Medicare and Medicaid Services reviews the proposed changes | ||||||
18 | authorized under Public Act 100-581 this amendatory Act of the | ||||||
19 | 100th General Assembly . | ||||||
20 | (b) Notwithstanding any other provision of this Code, if | ||||||
21 | the federal Centers for Medicare and Medicaid Services should | ||||||
22 | approve the continuation of the reimbursement methodologies | ||||||
23 | and payments to hospitals under Sections 5A-12.2, 5A-12.4, | ||||||
24 | 5A-12.5 and , and Section 14-12, as they are in effect on June | ||||||
25 | 30, 2018, until the new and revised methodologies and payments | ||||||
26 | authorized under Sections 5A-12.6 and Section 14-12 of this |
| |||||||
| |||||||
1 | Code amendatory Act of the 100th General Assembly are federally | ||||||
2 | approved, then the reimbursement methodologies and payments to | ||||||
3 | hospitals under Sections 5A-12.2, 5A-12.4, 5A-12.5, and 14-12, | ||||||
4 | and the assessments imposed under Section 5A-2, as they are in | ||||||
5 | effect on June 30, 2018, shall continue until the effective | ||||||
6 | date of the new and revised methodologies and payments, which | ||||||
7 | shall be the first day of the second month following the date | ||||||
8 | of approval by the federal Centers for Medicare and Medicaid | ||||||
9 | Services.
| ||||||
10 | (c) Notwithstanding any other provision of this Code, if by | ||||||
11 | July 11, 2018 the federal Centers for Medicare and Medicaid | ||||||
12 | Services has neither approved the changes authorized under | ||||||
13 | Public Act 100-581 nor has formally approved an extension of | ||||||
14 | the reimbursement methodologies and payments to hospitals | ||||||
15 | under Sections 5A-12.5 and 14-12 as they are in effect on June | ||||||
16 | 30, 2018, then the following shall apply: | ||||||
17 | (1) all reimbursement methodologies and payments for | ||||||
18 | hospital services authorized under Sections 5A-12.2, | ||||||
19 | 5A-12.4, and 5A-12.5 in effect on June 30, 2018 shall | ||||||
20 | continue subject to the availability of federal matching | ||||||
21 | funds for such expenditures and subject to the provisions | ||||||
22 | of subsection (c) of Section 5A-15; and | ||||||
23 | (2) all supplemental payments to hospitals authorized | ||||||
24 | in Illinois' Medicaid State
Plan in effect on June 30, | ||||||
25 | 2018, which are scheduled to terminate under Illinois' | ||||||
26 | Medicaid State
Plan on June 30, 2018, shall continue |
| |||||||
| |||||||
1 | subject to the availability of federal matching funds for | ||||||
2 | such expenditures; and | ||||||
3 | (3) all assessments imposed under Section 5A-2, as they | ||||||
4 | are in effect on June 30, 2018, shall continue. | ||||||
5 | Notwithstanding any other provision in this subsection, | ||||||
6 | the Department shall make monthly advance payments to any | ||||||
7 | safety-net hospital or critical access hospital requesting | ||||||
8 | such advance payments in an amount, as requested by the | ||||||
9 | hospital, provided that the total monthly payments to the | ||||||
10 | hospital under this subsection shall not exceed 1/12th of the | ||||||
11 | payments the hospital would have received under Sections | ||||||
12 | 5A-12.2, 5A-12.4, and 5A-12.5 and subsections (d) and (f) of | ||||||
13 | Section 14-12. | ||||||
14 | Notwithstanding any other provision in this subsection, | ||||||
15 | the Department may make monthly advance payments to a hospital | ||||||
16 | requesting such advance payments in an amount, as requested by | ||||||
17 | the hospital, provided that the total monthly payments to the | ||||||
18 | hospital under this subsection shall not exceed 1/12th of the | ||||||
19 | payments the hospital would have received under Sections | ||||||
20 | 5A-12.2, 5A-12.4, and 5A-12.5 and subsections (d) and (f) of | ||||||
21 | Section 14-12. | ||||||
22 | Payments under this subsection shall be made regardless of | ||||||
23 | federal approval for federal financial participation under | ||||||
24 | Title XIX or XXI of the federal Social Security Act. | ||||||
25 | As used in this subsection, "safety-net hospital" means a | ||||||
26 | hospital as defined in Section 5-5e.1 for Rate Year 2017 or an |
| |||||||
| |||||||
1 | Illinois hospital that meets the criteria in paragraphs (2) and | ||||||
2 | (3) of subsection (a) of Section 5-5e.1 for Rate Year 2017. | ||||||
3 | As used in this subsection, "critical access hospital" | ||||||
4 | means a hospital that has such status as of June 30, 2018. | ||||||
5 | The changes authorized under this subsection shall | ||||||
6 | continue, on the same time schedule as otherwise authorized | ||||||
7 | under this Article, until the effective date of the new and | ||||||
8 | revised methodologies and payments under Public Act 100-581, | ||||||
9 | which shall be the first day of the second month following the | ||||||
10 | date of approval by the federal Centers for Medicare and | ||||||
11 | Medicaid Services. | ||||||
12 | (Source: P.A. 100-581, eff. 3-12-18.)
| ||||||
13 | Section 95. No acceleration or delay. Where this Act makes | ||||||
14 | changes in a statute that is represented in this Act by text | ||||||
15 | that is not yet or no longer in effect (for example, a Section | ||||||
16 | represented by multiple versions), the use of that text does | ||||||
17 | not accelerate or delay the taking effect of (i) the changes | ||||||
18 | made by this Act or (ii) provisions derived from any other | ||||||
19 | Public Act.
| ||||||
20 | Section 999. Effective date. This Act takes effect upon | ||||||
21 | becoming law.".
|