Bill Text: IL HB2320 | 2013-2014 | 98th General Assembly | Introduced


Bill Title: Amends the Unified Code of Corrections concerning State correctional healthcare systems and State contracted managed correctional healthcare services. Provides that the State shall implement state-of-the art clinical code editing technology solutions to further automate claims resolution and enhance cost containment through improved claim accuracy and appropriate code correction. Provides that the technology shall identify and prevent errors or potential overbilling based on widely accepted and referenceable protocols such as the American Medical Association and the Centers for Medicare and Medicaid Services. Provides that the edits shall be applied automatically before claims are adjudicated to speed processing and reduce the number of pended or rejected claims and help ensure a smoother, more consistent and more open adjudication process and fewer delays in provider reimbursement. Provides that the State shall implement automated payment detection, prevention, and recovery solutions to assure that Medicaid is billed for eligible inpatient hospital and professional services. Provides that the State shall implement correctional healthcare claims audit and recovery services to identify improper payments due to non-fraudulent issues, audit claims, obtain provider sign-off on the audit results and recover validated overpayments. Post payment reviews shall ensure that the diagnoses and procedure codes are accurate and valid based on the supporting physician documentation within the medical records. Core categories of reviews could include: Coding Compliance Diagnosis Related Group (DRG) Reviews, Transfers, Readmissions, Cost Outlier Reviews, Outpatient 72-Hour Rule Reviews, Payment Errors, Billing Errors and others.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2014-12-03 - Session Sine Die [HB2320 Detail]

Download: Illinois-2013-HB2320-Introduced.html


98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB2320

Introduced , by Rep. Naomi D. Jakobsson

SYNOPSIS AS INTRODUCED:
730 ILCS 5/3-2-2 from Ch. 38, par. 1003-2-2

Amends the Unified Code of Corrections concerning State correctional healthcare systems and State contracted managed correctional healthcare services. Provides that the State shall implement state-of-the art clinical code editing technology solutions to further automate claims resolution and enhance cost containment through improved claim accuracy and appropriate code correction. Provides that the technology shall identify and prevent errors or potential overbilling based on widely accepted and referenceable protocols such as the American Medical Association and the Centers for Medicare and Medicaid Services. Provides that the edits shall be applied automatically before claims are adjudicated to speed processing and reduce the number of pended or rejected claims and help ensure a smoother, more consistent and more open adjudication process and fewer delays in provider reimbursement. Provides that the State shall implement automated payment detection, prevention, and recovery solutions to assure that Medicaid is billed for eligible inpatient hospital and professional services. Provides that the State shall implement correctional healthcare claims audit and recovery services to identify improper payments due to non-fraudulent issues, audit claims, obtain provider sign-off on the audit results and recover validated overpayments. Post payment reviews shall ensure that the diagnoses and procedure codes are accurate and valid based on the supporting physician documentation within the medical records. Core categories of reviews could include: Coding Compliance Diagnosis Related Group (DRG) Reviews, Transfers, Readmissions, Cost Outlier Reviews, Outpatient 72-Hour Rule Reviews, Payment Errors, Billing Errors and others.
LRB098 08027 RLC 38118 b
FISCAL NOTE ACT MAY APPLY

A BILL FOR

HB2320LRB098 08027 RLC 38118 b
1 AN ACT concerning correctional healthcare costs.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The Unified Code of Corrections is amended by
5changing Section 3-2-2 as follows:
6 (730 ILCS 5/3-2-2) (from Ch. 38, par. 1003-2-2)
7 Sec. 3-2-2. Powers and Duties of the Department.
8 (1) In addition to the powers, duties and responsibilities
9which are otherwise provided by law, the Department shall have
10the following powers:
11 (a) To accept persons committed to it by the courts of
12 this State for care, custody, treatment and
13 rehabilitation, and to accept federal prisoners and aliens
14 over whom the Office of the Federal Detention Trustee is
15 authorized to exercise the federal detention function for
16 limited purposes and periods of time.
17 (b) To develop and maintain reception and evaluation
18 units for purposes of analyzing the custody and
19 rehabilitation needs of persons committed to it and to
20 assign such persons to institutions and programs under its
21 control or transfer them to other appropriate agencies. In
22 consultation with the Department of Alcoholism and
23 Substance Abuse (now the Department of Human Services), the

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1 Department of Corrections shall develop a master plan for
2 the screening and evaluation of persons committed to its
3 custody who have alcohol or drug abuse problems, and for
4 making appropriate treatment available to such persons;
5 the Department shall report to the General Assembly on such
6 plan not later than April 1, 1987. The maintenance and
7 implementation of such plan shall be contingent upon the
8 availability of funds.
9 (b-1) To create and implement, on January 1, 2002, a
10 pilot program to establish the effectiveness of
11 pupillometer technology (the measurement of the pupil's
12 reaction to light) as an alternative to a urine test for
13 purposes of screening and evaluating persons committed to
14 its custody who have alcohol or drug problems. The pilot
15 program shall require the pupillometer technology to be
16 used in at least one Department of Corrections facility.
17 The Director may expand the pilot program to include an
18 additional facility or facilities as he or she deems
19 appropriate. A minimum of 4,000 tests shall be included in
20 the pilot program. The Department must report to the
21 General Assembly on the effectiveness of the program by
22 January 1, 2003.
23 (b-5) To develop, in consultation with the Department
24 of State Police, a program for tracking and evaluating each
25 inmate from commitment through release for recording his or
26 her gang affiliations, activities, or ranks.

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1 (c) To maintain and administer all State correctional
2 institutions and facilities under its control and to
3 establish new ones as needed. Pursuant to its power to
4 establish new institutions and facilities, the Department
5 may, with the written approval of the Governor, authorize
6 the Department of Central Management Services to enter into
7 an agreement of the type described in subsection (d) of
8 Section 405-300 of the Department of Central Management
9 Services Law (20 ILCS 405/405-300). The Department shall
10 designate those institutions which shall constitute the
11 State Penitentiary System.
12 Pursuant to its power to establish new institutions and
13 facilities, the Department may authorize the Department of
14 Central Management Services to accept bids from counties
15 and municipalities for the construction, remodeling or
16 conversion of a structure to be leased to the Department of
17 Corrections for the purposes of its serving as a
18 correctional institution or facility. Such construction,
19 remodeling or conversion may be financed with revenue bonds
20 issued pursuant to the Industrial Building Revenue Bond Act
21 by the municipality or county. The lease specified in a bid
22 shall be for a term of not less than the time needed to
23 retire any revenue bonds used to finance the project, but
24 not to exceed 40 years. The lease may grant to the State
25 the option to purchase the structure outright.
26 Upon receipt of the bids, the Department may certify

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1 one or more of the bids and shall submit any such bids to
2 the General Assembly for approval. Upon approval of a bid
3 by a constitutional majority of both houses of the General
4 Assembly, pursuant to joint resolution, the Department of
5 Central Management Services may enter into an agreement
6 with the county or municipality pursuant to such bid.
7 (c-5) To build and maintain regional juvenile
8 detention centers and to charge a per diem to the counties
9 as established by the Department to defray the costs of
10 housing each minor in a center. In this subsection (c-5),
11 "juvenile detention center" means a facility to house
12 minors during pendency of trial who have been transferred
13 from proceedings under the Juvenile Court Act of 1987 to
14 prosecutions under the criminal laws of this State in
15 accordance with Section 5-805 of the Juvenile Court Act of
16 1987, whether the transfer was by operation of law or
17 permissive under that Section. The Department shall
18 designate the counties to be served by each regional
19 juvenile detention center.
20 (d) To develop and maintain programs of control,
21 rehabilitation and employment of committed persons within
22 its institutions.
23 (d-5) To provide a pre-release job preparation program
24 for inmates at Illinois adult correctional centers.
25 (e) To establish a system of supervision and guidance
26 of committed persons in the community.

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1 (f) To establish in cooperation with the Department of
2 Transportation to supply a sufficient number of prisoners
3 for use by the Department of Transportation to clean up the
4 trash and garbage along State, county, township, or
5 municipal highways as designated by the Department of
6 Transportation. The Department of Corrections, at the
7 request of the Department of Transportation, shall furnish
8 such prisoners at least annually for a period to be agreed
9 upon between the Director of Corrections and the Director
10 of Transportation. The prisoners used on this program shall
11 be selected by the Director of Corrections on whatever
12 basis he deems proper in consideration of their term,
13 behavior and earned eligibility to participate in such
14 program - where they will be outside of the prison facility
15 but still in the custody of the Department of Corrections.
16 Prisoners convicted of first degree murder, or a Class X
17 felony, or armed violence, or aggravated kidnapping, or
18 criminal sexual assault, aggravated criminal sexual abuse
19 or a subsequent conviction for criminal sexual abuse, or
20 forcible detention, or arson, or a prisoner adjudged a
21 Habitual Criminal shall not be eligible for selection to
22 participate in such program. The prisoners shall remain as
23 prisoners in the custody of the Department of Corrections
24 and such Department shall furnish whatever security is
25 necessary. The Department of Transportation shall furnish
26 trucks and equipment for the highway cleanup program and

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1 personnel to supervise and direct the program. Neither the
2 Department of Corrections nor the Department of
3 Transportation shall replace any regular employee with a
4 prisoner.
5 (g) To maintain records of persons committed to it and
6 to establish programs of research, statistics and
7 planning.
8 (h) To investigate the grievances of any person
9 committed to the Department, to inquire into any alleged
10 misconduct by employees or committed persons, and to
11 investigate the assets of committed persons to implement
12 Section 3-7-6 of this Code; and for these purposes it may
13 issue subpoenas and compel the attendance of witnesses and
14 the production of writings and papers, and may examine
15 under oath any witnesses who may appear before it; to also
16 investigate alleged violations of a parolee's or
17 releasee's conditions of parole or release; and for this
18 purpose it may issue subpoenas and compel the attendance of
19 witnesses and the production of documents only if there is
20 reason to believe that such procedures would provide
21 evidence that such violations have occurred.
22 If any person fails to obey a subpoena issued under
23 this subsection, the Director may apply to any circuit
24 court to secure compliance with the subpoena. The failure
25 to comply with the order of the court issued in response
26 thereto shall be punishable as contempt of court.

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1 (i) To appoint and remove the chief administrative
2 officers, and administer programs of training and
3 development of personnel of the Department. Personnel
4 assigned by the Department to be responsible for the
5 custody and control of committed persons or to investigate
6 the alleged misconduct of committed persons or employees or
7 alleged violations of a parolee's or releasee's conditions
8 of parole shall be conservators of the peace for those
9 purposes, and shall have the full power of peace officers
10 outside of the facilities of the Department in the
11 protection, arrest, retaking and reconfining of committed
12 persons or where the exercise of such power is necessary to
13 the investigation of such misconduct or violations.
14 (j) To cooperate with other departments and agencies
15 and with local communities for the development of standards
16 and programs for better correctional services in this
17 State.
18 (k) To administer all moneys and properties of the
19 Department.
20 (l) To report annually to the Governor on the committed
21 persons, institutions and programs of the Department.
22 (l-5) (Blank).
23 (m) To make all rules and regulations and exercise all
24 powers and duties vested by law in the Department.
25 (n) To establish rules and regulations for
26 administering a system of sentence credits, established in

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1 accordance with Section 3-6-3, subject to review by the
2 Prisoner Review Board.
3 (o) To administer the distribution of funds from the
4 State Treasury to reimburse counties where State penal
5 institutions are located for the payment of assistant
6 state's attorneys' salaries under Section 4-2001 of the
7 Counties Code.
8 (p) To exchange information with the Department of
9 Human Services and the Department of Healthcare and Family
10 Services for the purpose of verifying living arrangements
11 and for other purposes directly connected with the
12 administration of this Code and the Illinois Public Aid
13 Code.
14 (q) To establish a diversion program.
15 The program shall provide a structured environment for
16 selected technical parole or mandatory supervised release
17 violators and committed persons who have violated the rules
18 governing their conduct while in work release. This program
19 shall not apply to those persons who have committed a new
20 offense while serving on parole or mandatory supervised
21 release or while committed to work release.
22 Elements of the program shall include, but shall not be
23 limited to, the following:
24 (1) The staff of a diversion facility shall provide
25 supervision in accordance with required objectives set
26 by the facility.

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1 (2) Participants shall be required to maintain
2 employment.
3 (3) Each participant shall pay for room and board
4 at the facility on a sliding-scale basis according to
5 the participant's income.
6 (4) Each participant shall:
7 (A) provide restitution to victims in
8 accordance with any court order;
9 (B) provide financial support to his
10 dependents; and
11 (C) make appropriate payments toward any other
12 court-ordered obligations.
13 (5) Each participant shall complete community
14 service in addition to employment.
15 (6) Participants shall take part in such
16 counseling, educational and other programs as the
17 Department may deem appropriate.
18 (7) Participants shall submit to drug and alcohol
19 screening.
20 (8) The Department shall promulgate rules
21 governing the administration of the program.
22 (r) To enter into intergovernmental cooperation
23 agreements under which persons in the custody of the
24 Department may participate in a county impact
25 incarceration program established under Section 3-6038 or
26 3-15003.5 of the Counties Code.

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1 (r-5) (Blank).
2 (r-10) To systematically and routinely identify with
3 respect to each streetgang active within the correctional
4 system: (1) each active gang; (2) every existing inter-gang
5 affiliation or alliance; and (3) the current leaders in
6 each gang. The Department shall promptly segregate leaders
7 from inmates who belong to their gangs and allied gangs.
8 "Segregate" means no physical contact and, to the extent
9 possible under the conditions and space available at the
10 correctional facility, prohibition of visual and sound
11 communication. For the purposes of this paragraph (r-10),
12 "leaders" means persons who:
13 (i) are members of a criminal streetgang;
14 (ii) with respect to other individuals within the
15 streetgang, occupy a position of organizer,
16 supervisor, or other position of management or
17 leadership; and
18 (iii) are actively and personally engaged in
19 directing, ordering, authorizing, or requesting
20 commission of criminal acts by others, which are
21 punishable as a felony, in furtherance of streetgang
22 related activity both within and outside of the
23 Department of Corrections.
24 "Streetgang", "gang", and "streetgang related" have the
25 meanings ascribed to them in Section 10 of the Illinois
26 Streetgang Terrorism Omnibus Prevention Act.

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1 (s) To operate a super-maximum security institution,
2 in order to manage and supervise inmates who are disruptive
3 or dangerous and provide for the safety and security of the
4 staff and the other inmates.
5 (t) To monitor any unprivileged conversation or any
6 unprivileged communication, whether in person or by mail,
7 telephone, or other means, between an inmate who, before
8 commitment to the Department, was a member of an organized
9 gang and any other person without the need to show cause or
10 satisfy any other requirement of law before beginning the
11 monitoring, except as constitutionally required. The
12 monitoring may be by video, voice, or other method of
13 recording or by any other means. As used in this
14 subdivision (1)(t), "organized gang" has the meaning
15 ascribed to it in Section 10 of the Illinois Streetgang
16 Terrorism Omnibus Prevention Act.
17 As used in this subdivision (1)(t), "unprivileged
18 conversation" or "unprivileged communication" means a
19 conversation or communication that is not protected by any
20 privilege recognized by law or by decision, rule, or order
21 of the Illinois Supreme Court.
22 (u) To establish a Women's and Children's Pre-release
23 Community Supervision Program for the purpose of providing
24 housing and services to eligible female inmates, as
25 determined by the Department, and their newborn and young
26 children.

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1 (u-5) To issue an order, whenever a person committed to
2 the Department absconds or absents himself or herself,
3 without authority to do so, from any facility or program to
4 which he or she is assigned. The order shall be certified
5 by the Director, the Supervisor of the Apprehension Unit,
6 or any person duly designated by the Director, with the
7 seal of the Department affixed. The order shall be directed
8 to all sheriffs, coroners, and police officers, or to any
9 particular person named in the order. Any order issued
10 pursuant to this subdivision (1) (u-5) shall be sufficient
11 warrant for the officer or person named in the order to
12 arrest and deliver the committed person to the proper
13 correctional officials and shall be executed the same as
14 criminal process.
15 (v) To do all other acts necessary to carry out the
16 provisions of this Chapter.
17 (2) The Department of Corrections shall by January 1, 1998,
18consider building and operating a correctional facility within
19100 miles of a county of over 2,000,000 inhabitants, especially
20a facility designed to house juvenile participants in the
21impact incarceration program.
22 (3) When the Department lets bids for contracts for medical
23services to be provided to persons committed to Department
24facilities by a health maintenance organization, medical
25service corporation, or other health care provider, the bid may
26only be let to a health care provider that has obtained an

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1irrevocable letter of credit or performance bond issued by a
2company whose bonds have an investment grade or higher rating
3by a bond rating organization.
4 (4) When the Department lets bids for contracts for food or
5commissary services to be provided to Department facilities,
6the bid may only be let to a food or commissary services
7provider that has obtained an irrevocable letter of credit or
8performance bond issued by a company whose bonds have an
9investment grade or higher rating by a bond rating
10organization.
11 (5)(A) The General Assembly finds that states have saved
12millions of dollars by implementing solutions to eliminate and
13recover correctional healthcare overpayments. Similarly,
14states have significantly reduced correctional healthcare
15costs by billing Medicaid for eligible inpatient health care
16costs. It is the intent of the General Assembly to implement
17automated payment detection, prevention, and recovery
18solutions to reduce correctional healthcare overpayments and
19to assure that Medicaid is billed for eligible inpatient
20hospital and professional services.
21 (B) Unless otherwise stated, this subsection (5) shall
22specifically apply to:
23 (i) State correctional healthcare systems and
24 services.
25 (ii) State contracted managed correctional healthcare
26 services.

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1 (C) The State shall implement state-of-the art clinical
2code editing technology solutions to further automate claims
3resolution and enhance cost containment through improved claim
4accuracy and appropriate code correction. The technology shall
5identify and prevent errors or potential overbilling based on
6widely accepted and referenceable protocols such as the
7American Medical Association and the Centers for Medicare and
8Medicaid Services. The edits shall be applied automatically
9before claims are adjudicated to speed processing and reduce
10the number of pended or rejected claims and help ensure a
11smoother, more consistent and more open adjudication process
12and fewer delays in provider reimbursement.
13 (D) The State shall implement correctional healthcare
14claims audit and recovery services to identify improper
15payments due to non-fraudulent issues, audit claims, obtain
16provider sign-off on the audit results and recover validated
17overpayments. Post payment reviews shall ensure that the
18diagnoses and procedure codes are accurate and valid based on
19the supporting physician documentation within the medical
20records. Core categories of reviews could include: Coding
21Compliance Diagnosis Related Group (DRG) Reviews, Transfers,
22Readmissions, Cost Outlier Reviews, Outpatient 72-Hour Rule
23Reviews, Payment Errors, Billing Errors and others.
24 (E) The State shall implement automated payment detection,
25prevention, and recovery solutions to assure that Medicaid is
26billed for eligible inpatient hospital and professional

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1services.
2 (F) It is the intent of the General Assembly that the State
3shall contract for these services and that the savings achieved
4through implementing this subsection (5) shall more than cover
5the cost of implementation and administration. To the extent
6possible, technology services used in carrying out this
7subsection (5) shall be secured using the savings generated by
8the program, whereby the State's only direct cost will be
9funded through the actual savings achieved. To enable this
10model, reimbursement to the contractor may be contracted on the
11basis of a percentage of achieved savings model, a per
12beneficiary per month model, a per transaction model, a
13case-rate model, or any blended model of the aforementioned
14methodologies. Reimbursement models with the contractor may
15also include performance guarantees of the contractor to ensure
16savings identified exceeds program costs.
17(Source: P.A. 96-1265, eff. 7-26-10; 97-697, eff. 6-22-12;
1897-800, eff. 7-13-12; 97-802, eff. 7-13-12; revised 7-23-12.)
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