Bill Text: IL HB5883 | 2017-2018 | 100th General Assembly | Introduced
Bill Title: Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to contract with a vendor to perform the coordination of benefits for Medicaid fee-for-service and managed care enrollees (rather than contract with a vendor to support the Department in coordinating benefits for Medicaid enrollees). Provides that the contract with the vendor shall include, but not be limited to, a review of the following populations: persons eligible for both Medicare and Medicaid benefits (dual-eligible clients); persons enrolled in the fee-for-service medical assistance program; persons enrolled in the managed care medical assistance program; and persons eligible for benefits provided under the Children's Health Insurance Program Act. Provides that if the Department does not issue a comprehensive procurement, including both the identification of other insurance and the recovery of funds for the populations listed, and contracts with a vendor for both pieces within 3 months after the effective date of the amendatory Act, the Department's Inspector General shall procure for the identification and recovery of other insurance.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2019-01-08 - Session Sine Die [HB5883 Detail]
Download: Illinois-2017-HB5883-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 12-4.42 as follows:
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6 | (305 ILCS 5/12-4.42)
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7 | Sec. 12-4.42. Medicaid Revenue Maximization. | ||||||||||||||||||||||||
8 | (a) Purpose. The General Assembly finds that there is a | ||||||||||||||||||||||||
9 | need to make changes to the administration of services provided | ||||||||||||||||||||||||
10 | by State and local governments in order to maximize federal | ||||||||||||||||||||||||
11 | financial participation. | ||||||||||||||||||||||||
12 | (b) Definitions. As used in this Section: | ||||||||||||||||||||||||
13 | "Community Medicaid mental health services" means all | ||||||||||||||||||||||||
14 | mental health services outlined in Part 132 of Title 59 of the | ||||||||||||||||||||||||
15 | Illinois Administrative Code that are funded through DHS, | ||||||||||||||||||||||||
16 | eligible for federal financial participation, and provided by a | ||||||||||||||||||||||||
17 | community-based provider. | ||||||||||||||||||||||||
18 | "Community-based provider" means an entity enrolled as a | ||||||||||||||||||||||||
19 | provider pursuant to Sections 140.11 and 140.12 of Title 89 of | ||||||||||||||||||||||||
20 | the Illinois Administrative Code and certified to provide | ||||||||||||||||||||||||
21 | community Medicaid mental health services in accordance with | ||||||||||||||||||||||||
22 | Part 132 of Title 59 of the Illinois Administrative Code. | ||||||||||||||||||||||||
23 | "DCFS" means the Department of Children and Family |
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1 | Services. | ||||||
2 | "Department" means the Illinois Department of Healthcare | ||||||
3 | and Family Services. | ||||||
4 | "Care facility for persons with a developmental | ||||||
5 | disability" means an intermediate care facility for persons | ||||||
6 | with an intellectual disability within the meaning of Title XIX | ||||||
7 | of the Social Security Act, whether public or private and | ||||||
8 | whether organized for profit or not-for-profit, but shall not | ||||||
9 | include any facility operated by the State. | ||||||
10 | "Care provider for persons with a developmental | ||||||
11 | disability" means a person conducting, operating, or | ||||||
12 | maintaining a care facility for persons with a developmental | ||||||
13 | disability. For purposes of this definition, "person" means any | ||||||
14 | political subdivision of the State, municipal corporation, | ||||||
15 | individual, firm, partnership, corporation, company, limited | ||||||
16 | liability company, association, joint stock association, or | ||||||
17 | trust, or a receiver, executor, trustee, guardian, or other | ||||||
18 | representative appointed by order of any court. | ||||||
19 | "DHS" means the Illinois Department of Human Services. | ||||||
20 | "Hospital" means an institution, place, building, or | ||||||
21 | agency located in this State that is licensed as a general | ||||||
22 | acute hospital by the Illinois Department of Public Health | ||||||
23 | under the Hospital Licensing Act, whether public or private and | ||||||
24 | whether organized for profit or not-for-profit. | ||||||
25 | "Long term care facility" means (i) a skilled nursing or | ||||||
26 | intermediate long term care facility, whether public or private |
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1 | and whether organized for profit or not-for-profit, that is | ||||||
2 | subject to licensure by the Illinois Department of Public | ||||||
3 | Health under the Nursing Home Care Act, including a county | ||||||
4 | nursing home directed and maintained under Section 5-1005 of | ||||||
5 | the Counties Code, and (ii) a part of a hospital in which | ||||||
6 | skilled or intermediate long term care services within the | ||||||
7 | meaning of Title XVIII or XIX of the Social Security Act are | ||||||
8 | provided; except that the term "long term care facility" does | ||||||
9 | not include a facility operated solely as an intermediate care | ||||||
10 | facility for the intellectually disabled within the meaning of | ||||||
11 | Title XIX of the Social Security Act. | ||||||
12 | "Long term care provider" means (i) a person licensed by | ||||||
13 | the Department of Public Health to operate and maintain a | ||||||
14 | skilled nursing or intermediate long term care facility or (ii) | ||||||
15 | a hospital provider that provides skilled or intermediate long | ||||||
16 | term care services within the meaning of Title XVIII or XIX of | ||||||
17 | the Social Security Act. For purposes of this definition, | ||||||
18 | "person" means any political subdivision of the State, | ||||||
19 | municipal corporation, individual, firm, partnership, | ||||||
20 | corporation, company, limited liability company, association, | ||||||
21 | joint stock association, or trust, or a receiver, executor, | ||||||
22 | trustee, guardian, or other representative appointed by order | ||||||
23 | of any court. | ||||||
24 | "State-operated facility for persons with a developmental | ||||||
25 | disability" means an intermediate care facility for persons | ||||||
26 | with an intellectual disability within the meaning of Title XIX |
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1 | of the Social Security Act operated by the State. | ||||||
2 | (c) Administration and deposit of Revenues. The Department | ||||||
3 | shall coordinate the implementation of changes required by | ||||||
4 | Public Act 96-1405 amongst the various State and local | ||||||
5 | government bodies that administer programs referred to in this | ||||||
6 | Section. | ||||||
7 | Revenues generated by program changes mandated by any | ||||||
8 | provision in this Section, less reasonable administrative | ||||||
9 | costs associated with the implementation of these program | ||||||
10 | changes, which would otherwise be deposited into the General | ||||||
11 | Revenue Fund shall be deposited into the Healthcare Provider | ||||||
12 | Relief Fund. | ||||||
13 | The Department shall issue a report to the General Assembly | ||||||
14 | detailing the implementation progress of Public Act 96-1405 as | ||||||
15 | a part of the Department's Medical Programs annual report for | ||||||
16 | fiscal years 2010 and 2011. | ||||||
17 | (d) Acceleration of payment vouchers. To the extent | ||||||
18 | practicable and permissible under federal law, the Department | ||||||
19 | shall create all vouchers for long term care facilities and | ||||||
20 | facilities for persons with a developmental disability for | ||||||
21 | dates of service in the month in which the enhanced federal | ||||||
22 | medical assistance percentage (FMAP) originally set forth in | ||||||
23 | the American Recovery and Reinvestment Act (ARRA) expires and | ||||||
24 | for dates of service in the month prior to that month and | ||||||
25 | shall, no later than the 15th of the month in which the | ||||||
26 | enhanced FMAP expires, submit these vouchers to the Comptroller |
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1 | for payment. | ||||||
2 | The Department of Human Services shall create the necessary | ||||||
3 | documentation for State-operated facilities for persons with a | ||||||
4 | developmental disability so that the necessary data for all | ||||||
5 | dates of service before the expiration of the enhanced FMAP | ||||||
6 | originally set forth in the ARRA can be adjudicated by the | ||||||
7 | Department no later than the 15th of the month in which the | ||||||
8 | enhanced FMAP expires. | ||||||
9 | (e) Billing of DHS community Medicaid mental health | ||||||
10 | services. No later than July 1, 2011, community Medicaid mental | ||||||
11 | health services provided by a community-based provider must be | ||||||
12 | billed directly to the Department. | ||||||
13 | (f) DCFS Medicaid services. The Department shall work with | ||||||
14 | DCFS to identify existing programs, pending qualifying | ||||||
15 | services, that can be converted in an economically feasible | ||||||
16 | manner to Medicaid in order to secure federal financial | ||||||
17 | revenue. | ||||||
18 | (g) Third Party Liability recoveries . The Department shall | ||||||
19 | contract with a vendor to perform the coordination of support | ||||||
20 | the Department in coordinating benefits for Medicaid | ||||||
21 | fee-for-service and managed care enrollees. The scope of work | ||||||
22 | shall include, but not be limited to, at a minimum, the | ||||||
23 | identification of other insurance for Medicaid enrollees and | ||||||
24 | the recovery of funds paid by the Department when another payer | ||||||
25 | was liable. The contract with the vendor shall include, but not | ||||||
26 | be limited to, a review of the following populations: persons |
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1 | eligible for both Medicare and Medicaid benefits | ||||||
2 | (dual-eligible clients); persons enrolled in the | ||||||
3 | fee-for-service medical assistance program; persons enrolled | ||||||
4 | in the managed care medical assistance program; and persons | ||||||
5 | eligible for benefits provided under the Children's Health | ||||||
6 | Insurance Program Act. If the Department does not issue a | ||||||
7 | comprehensive procurement, including both the identification | ||||||
8 | of other insurance and the recovery of funds for the | ||||||
9 | populations listed in this subsection, and contracts with a | ||||||
10 | vendor for both pieces within 3 months after the effective date | ||||||
11 | of this amendatory Act of the 100th General Assembly, the | ||||||
12 | Department's Inspector General shall procure for the | ||||||
13 | identification and recovery of other insurance. The vendor may | ||||||
14 | be paid a percentage of actual cash recovered when practical | ||||||
15 | and subject to federal law. | ||||||
16 | (h) Public health departments.
The Department shall | ||||||
17 | identify unreimbursed costs for persons covered by Medicaid who | ||||||
18 | are served by the Chicago Department of Public Health. | ||||||
19 | The Department shall assist the Chicago Department of | ||||||
20 | Public Health in determining total unreimbursed costs | ||||||
21 | associated with the provision of healthcare services to | ||||||
22 | Medicaid enrollees. | ||||||
23 | The Department shall determine and draw the maximum | ||||||
24 | allowable federal matching dollars associated with the cost of | ||||||
25 | Chicago Department of Public Health services provided to | ||||||
26 | Medicaid enrollees. |
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1 | (i) Acceleration of hospital-based payments.
The | ||||||
2 | Department shall, by the 10th day of the month in which the | ||||||
3 | enhanced FMAP originally set forth in the ARRA expires, create | ||||||
4 | vouchers for all State fiscal year 2011 hospital payments | ||||||
5 | exempt from the prompt payment requirements of the ARRA. The | ||||||
6 | Department shall submit these vouchers to the Comptroller for | ||||||
7 | payment.
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8 | (Source: P.A. 99-143, eff. 7-27-15; 100-201, eff. 8-18-17.)
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