Bill Text: IL HB5179 | 2021-2022 | 102nd General Assembly | Introduced
Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in light of the heightened risk of overdose if a patient is discharged and not linked to treatment and recovery supports, and the need for appropriate access to the treatment and services available via community-based substance use disorder and mental health providers, the Department of Healthcare and Family Services and each hospital shall ensure coordination of care and treatment for each patient with community-based mental health and substance use disorder treatment providers. Requires hospitals to coordinate and collaborate with community-based providers by: (i) providing a warm handoff of patients in need of treatment and recovery support services to community-based providers; (ii) collaborating with community-based providers on the provision of 24/7 access to transitioning patients prior to discharge from the hospital; (iii) working with community-based providers on fully implementing substance use disorder treatment and recovery supports through existing and new hospital-located community-based provider projects; and (iv) engaging in such other programs established by the Department to prioritize treatment within the community-based system to the extent such treatment is deemed to best serve a patient, is considered medically necessary, and is fiscally prudent. Provides that if a hospital fails to address these requirements prior to discharging a patient, the provider shall forgo reimbursement for any observation or admission services provided to the patient.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2022-02-18 - Rule 19(a) / Re-referred to Rules Committee [HB5179 Detail]
Download: Illinois-2021-HB5179-Introduced.html
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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | |||||||||||||||||||
5 | changing Section 5-41 as follows:
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6 | (305 ILCS 5/5-41) | |||||||||||||||||||
7 | Sec. 5-41. Inpatient hospitalization for opioid-related | |||||||||||||||||||
8 | overdose or withdrawal patients. | |||||||||||||||||||
9 | (a) Due to the disproportionately high opioid-related | |||||||||||||||||||
10 | fatality rates among African Americans in under-resourced | |||||||||||||||||||
11 | communities in Illinois, the lack of community resources, the | |||||||||||||||||||
12 | comorbidities experienced by these patients, and the high rate | |||||||||||||||||||
13 | of hospital inpatient recidivism associated with this | |||||||||||||||||||
14 | population when improperly treated, the Department shall | |||||||||||||||||||
15 | ensure that patients, whether enrolled under the Medical | |||||||||||||||||||
16 | Assistance Fee For Service program or enrolled with a Medicaid | |||||||||||||||||||
17 | Managed Care Organization, experiencing opioid-related | |||||||||||||||||||
18 | overdose or withdrawal are admitted on an inpatient status and | |||||||||||||||||||
19 | the provider shall be reimbursed accordingly, when deemed | |||||||||||||||||||
20 | medically necessary, as determined by either the patient's | |||||||||||||||||||
21 | primary care physician, or the physician or other practitioner | |||||||||||||||||||
22 | responsible for the patient's care at the hospital to which | |||||||||||||||||||
23 | the patient presents, using criteria established by the |
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1 | American Society of Addiction Medicine. If it is determined by | ||||||
2 | the physician or other practitioner responsible for the | ||||||
3 | patient's care at the hospital to which the patient presents, | ||||||
4 | that a patient does not meet medical necessity criteria for | ||||||
5 | the admission, then the patient may be treated via observation | ||||||
6 | and the provider shall seek reimbursement accordingly. Nothing | ||||||
7 | in this Section shall diminish the requirements of a provider | ||||||
8 | to document medical necessity in the patient's record.
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9 | (b) In light of the heightened risk of overdose if a | ||||||
10 | patient is discharged and not linked to
treatment and recovery | ||||||
11 | supports, and the need for appropriate access to the treatment | ||||||
12 | and
services available via community-based substance use | ||||||
13 | disorder and mental health providers,
notwithstanding | ||||||
14 | subsection (a), the Department and each hospital shall ensure | ||||||
15 | coordination of care and treatment for each patient with | ||||||
16 | community-based mental health and substance use
disorder | ||||||
17 | treatment providers. Hospitals shall coordinate and | ||||||
18 | collaborate with community-based
providers by: | ||||||
19 | (1) providing a warm handoff of patients in need of | ||||||
20 | treatment and recovery
support services to community-based | ||||||
21 | providers; | ||||||
22 | (2) collaborating with community-based
providers on | ||||||
23 | the provision of 24/7 access to transitioning patients | ||||||
24 | prior to discharge from the
hospital; | ||||||
25 | (3) working with community-based providers on fully | ||||||
26 | implementing substance use
disorder treatment and recovery |
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1 | supports through existing and new hospital-located
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2 | community-based provider projects; and | ||||||
3 | (4) engaging in such other programs established by
the | ||||||
4 | Department to prioritize treatment within the | ||||||
5 | community-based system to the extent
such treatment is | ||||||
6 | deemed to best serve a patient, is considered medically | ||||||
7 | necessary, and is fiscally prudent. | ||||||
8 | (c) If a hospital fails to address the requirements of | ||||||
9 | subsection (b) prior to discharging a patient, the provider | ||||||
10 | shall forgo reimbursement for any observation or admission | ||||||
11 | services provided
to the patient. | ||||||
12 | (Source: P.A. 102-43, eff. 7-6-21.)
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