Bill Text: IL SB1521 | 2017-2018 | 100th General Assembly | Introduced
Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning the hospital rate reform payment system.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2019-01-09 - Session Sine Die [SB1521 Detail]
Download: Illinois-2017-SB1521-Introduced.html
| ||||||||||||||||||||
| ||||||||||||||||||||
| ||||||||||||||||||||
| ||||||||||||||||||||
| ||||||||||||||||||||
1 | AN ACT concerning public aid.
| |||||||||||||||||||
2 | Be it enacted by the People of the State of Illinois,
| |||||||||||||||||||
3 | represented in the General Assembly:
| |||||||||||||||||||
4 | Section 5. The Illinois Public Aid Code is amended by | |||||||||||||||||||
5 | changing Section 14-12 as follows:
| |||||||||||||||||||
6 | (305 ILCS 5/14-12) | |||||||||||||||||||
7 | Sec. 14-12. Hospital rate reform payment system. The The | |||||||||||||||||||
8 | hospital payment system pursuant to Section 14-11 of this | |||||||||||||||||||
9 | Article shall be as follows: | |||||||||||||||||||
10 | (a) Inpatient hospital services. Effective for discharges | |||||||||||||||||||
11 | on and after July 1, 2014, reimbursement for inpatient general | |||||||||||||||||||
12 | acute care services shall utilize the All Patient Refined | |||||||||||||||||||
13 | Diagnosis Related Grouping (APR-DRG) software, version 30, | |||||||||||||||||||
14 | distributed by 3M TM Health Information System. | |||||||||||||||||||
15 | (1) The Department shall establish Medicaid weighting | |||||||||||||||||||
16 | factors to be used in the reimbursement system established | |||||||||||||||||||
17 | under this subsection. Initial weighting factors shall be | |||||||||||||||||||
18 | the weighting factors as published by 3M Health Information | |||||||||||||||||||
19 | System, associated with Version 30.0 adjusted for the | |||||||||||||||||||
20 | Illinois experience. | |||||||||||||||||||
21 | (2) The Department shall establish a | |||||||||||||||||||
22 | statewide-standardized amount to be used in the inpatient | |||||||||||||||||||
23 | reimbursement system. The Department shall publish these |
| |||||||
| |||||||
1 | amounts on its website no later than 10 calendar days prior | ||||||
2 | to their effective date. | ||||||
3 | (3) In addition to the statewide-standardized amount, | ||||||
4 | the Department shall develop adjusters to adjust the rate | ||||||
5 | of reimbursement for critical Medicaid providers or | ||||||
6 | services for trauma, transplantation services, perinatal | ||||||
7 | care, and Graduate Medical Education (GME). | ||||||
8 | (4) The Department shall develop add-on payments to | ||||||
9 | account for exceptionally costly inpatient stays, | ||||||
10 | consistent with Medicare outlier principles. Outlier fixed | ||||||
11 | loss thresholds may be updated to control for excessive | ||||||
12 | growth in outlier payments no more frequently than on an | ||||||
13 | annual basis, but at least triennially. Upon updating the | ||||||
14 | fixed loss thresholds, the Department shall be required to | ||||||
15 | update base rates within 12 months. | ||||||
16 | (5) The Department shall define those hospitals or | ||||||
17 | distinct parts of hospitals that shall be exempt from the | ||||||
18 | APR-DRG reimbursement system established under this | ||||||
19 | Section. The Department shall publish these hospitals' | ||||||
20 | inpatient rates on its website no later than 10 calendar | ||||||
21 | days prior to their effective date. | ||||||
22 | (6) Beginning July 1, 2014 and ending on June 30, 2018, | ||||||
23 | in addition to the statewide-standardized amount, the | ||||||
24 | Department shall develop an adjustor to adjust the rate of | ||||||
25 | reimbursement for safety-net hospitals defined in Section | ||||||
26 | 5-5e.1 of this Code excluding pediatric hospitals. |
| |||||||
| |||||||
1 | (7) Beginning July 1, 2014 and ending on June 30, 2018, | ||||||
2 | in addition to the statewide-standardized amount, the | ||||||
3 | Department shall develop an adjustor to adjust the rate of | ||||||
4 | reimbursement for Illinois freestanding inpatient | ||||||
5 | psychiatric hospitals that are not designated as | ||||||
6 | children's hospitals by the Department but are primarily | ||||||
7 | treating patients under the age of 21. | ||||||
8 | (b) Outpatient hospital services. Effective for dates of | ||||||
9 | service on and after July 1, 2014, reimbursement for outpatient | ||||||
10 | services shall utilize the Enhanced Ambulatory Procedure | ||||||
11 | Grouping (E-APG) software, version 3.7 distributed by 3M TM | ||||||
12 | Health Information System. | ||||||
13 | (1) The Department shall establish Medicaid weighting | ||||||
14 | factors to be used in the reimbursement system established | ||||||
15 | under this subsection. The initial weighting factors shall | ||||||
16 | be the weighting factors as published by 3M Health | ||||||
17 | Information System, associated with Version 3.7. | ||||||
18 | (2) The Department shall establish service specific | ||||||
19 | statewide-standardized amounts to be used in the | ||||||
20 | reimbursement system. | ||||||
21 | (A) The initial statewide standardized amounts, | ||||||
22 | with the labor portion adjusted by the Calendar Year | ||||||
23 | 2013 Medicare Outpatient Prospective Payment System | ||||||
24 | wage index with reclassifications, shall be published | ||||||
25 | by the Department on its website no later than 10 | ||||||
26 | calendar days prior to their effective date. |
| |||||||
| |||||||
1 | (B) The Department shall establish adjustments to | ||||||
2 | the statewide-standardized amounts for each Critical | ||||||
3 | Access Hospital, as designated by the Department of | ||||||
4 | Public Health in accordance with 42 CFR 485, Subpart F. | ||||||
5 | The EAPG standardized amounts are determined | ||||||
6 | separately for each critical access hospital such that | ||||||
7 | simulated EAPG payments using outpatient base period | ||||||
8 | paid claim data plus payments under Section 5A-12.4 of | ||||||
9 | this Code net of the associated tax costs are equal to | ||||||
10 | the estimated costs of outpatient base period claims | ||||||
11 | data with a rate year cost inflation factor applied. | ||||||
12 | (3) In addition to the statewide-standardized amounts, | ||||||
13 | the Department shall develop adjusters to adjust the rate | ||||||
14 | of reimbursement for critical Medicaid hospital outpatient | ||||||
15 | providers or services, including outpatient high volume or | ||||||
16 | safety-net hospitals. | ||||||
17 | (c) In consultation with the hospital community, the | ||||||
18 | Department is authorized to replace 89 Ill. Admin. Code 152.150 | ||||||
19 | as published in 38 Ill. Reg. 4980 through 4986 within 12 months | ||||||
20 | of the effective date of this amendatory Act of the 98th | ||||||
21 | General Assembly. If the Department does not replace these | ||||||
22 | rules within 12 months of the effective date of this amendatory | ||||||
23 | Act of the 98th General Assembly, the rules in effect for | ||||||
24 | 152.150 as published in 38 Ill. Reg. 4980 through 4986 shall | ||||||
25 | remain in effect until modified by rule by the Department. | ||||||
26 | Nothing in this subsection shall be construed to mandate that |
| |||||||
| |||||||
1 | the Department file a replacement rule. | ||||||
2 | (d) Transition period.
There shall be a transition period | ||||||
3 | to the reimbursement systems authorized under this Section that | ||||||
4 | shall begin on the effective date of these systems and continue | ||||||
5 | until June 30, 2018, unless extended by rule by the Department. | ||||||
6 | To help provide an orderly and predictable transition to the | ||||||
7 | new reimbursement systems and to preserve and enhance access to | ||||||
8 | the hospital services during this transition, the Department | ||||||
9 | shall allocate a transitional hospital access pool of at least | ||||||
10 | $290,000,000 annually so that transitional hospital access | ||||||
11 | payments are made to hospitals. | ||||||
12 | (1) After the transition period, the Department may | ||||||
13 | begin incorporating the transitional hospital access pool | ||||||
14 | into the base rate structure. | ||||||
15 | (2) After the transition period, if the Department | ||||||
16 | reduces payments from the transitional hospital access | ||||||
17 | pool, it shall increase base rates, develop new adjustors, | ||||||
18 | adjust current adjustors, develop new hospital access | ||||||
19 | payments based on updated information, or any combination | ||||||
20 | thereof by an amount equal to the decreases proposed in the | ||||||
21 | transitional hospital access pool payments, ensuring that | ||||||
22 | the entire transitional hospital access pool amount shall | ||||||
23 | continue to be used for hospital payments. | ||||||
24 | (e) Beginning 36 months after initial implementation, the | ||||||
25 | Department shall update the reimbursement components in | ||||||
26 | subsections (a) and (b), including standardized amounts and |
| |||||||
| |||||||
1 | weighting factors, and at least triennially and no more | ||||||
2 | frequently than annually thereafter. The Department shall | ||||||
3 | publish these updates on its website no later than 30 calendar | ||||||
4 | days prior to their effective date. | ||||||
5 | (f) Continuation of supplemental payments. Any | ||||||
6 | supplemental payments authorized under Illinois Administrative | ||||||
7 | Code 148 effective January 1, 2014 and that continue during the | ||||||
8 | period of July 1, 2014 through December 31, 2014 shall remain | ||||||
9 | in effect as long as the assessment imposed by Section 5A-2 is | ||||||
10 | in effect. | ||||||
11 | (g) Notwithstanding subsections (a) through (f) of this | ||||||
12 | Section and notwithstanding the changes authorized under | ||||||
13 | Section 5-5b.1, any updates to the system shall not result in | ||||||
14 | any diminishment of the overall effective rates of | ||||||
15 | reimbursement as of the implementation date of the new system | ||||||
16 | (July 1, 2014). These updates shall not preclude variations in | ||||||
17 | any individual component of the system or hospital rate | ||||||
18 | variations. Nothing in this Section shall prohibit the | ||||||
19 | Department from increasing the rates of reimbursement or | ||||||
20 | developing payments to ensure access to hospital services. | ||||||
21 | Nothing in this Section shall be construed to guarantee a | ||||||
22 | minimum amount of spending in the aggregate or per hospital as | ||||||
23 | spending may be impacted by factors including but not limited | ||||||
24 | to the number of individuals in the medical assistance program | ||||||
25 | and the severity of illness of the individuals. | ||||||
26 | (h) The Department shall have the authority to modify by |
| |||||||
| |||||||
1 | rulemaking any changes to the rates or methodologies in this | ||||||
2 | Section as required by the federal government to obtain federal | ||||||
3 | financial participation for expenditures made under this | ||||||
4 | Section. | ||||||
5 | (i) Except for subsections (g) and (h) of this Section, the | ||||||
6 | Department shall, pursuant to subsection (c) of Section 5-40 of | ||||||
7 | the Illinois Administrative Procedure Act, provide for | ||||||
8 | presentation at the June 2014 hearing of the Joint Committee on | ||||||
9 | Administrative Rules (JCAR) additional written notice to JCAR | ||||||
10 | of the following rules in order to commence the second notice | ||||||
11 | period for the following rules: rules published in the Illinois | ||||||
12 | Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559 | ||||||
13 | (Medical Payment), 4628 (Specialized Health Care Delivery | ||||||
14 | Systems), 4640 (Hospital Services), 4932 (Diagnostic Related | ||||||
15 | Grouping (DRG) Prospective Payment System (PPS)), and 4977 | ||||||
16 | (Hospital Reimbursement Changes), and published in the | ||||||
17 | Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499 | ||||||
18 | (Specialized Health Care Delivery Systems) and 6505 (Hospital | ||||||
19 | Services).
| ||||||
20 | (Source: P.A. 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)
|