Bill Text: IL SB1851 | 2017-2018 | 100th General Assembly | Engrossed


Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning Medicaid reimbursement for facilities that serve severely and chronically ill pediatric patients and clinically complex residents, replaces all references to "long-term care facilities for persons under 22 years of age" with "medically complex for the developmentally disabled facilities".

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Engrossed) 2017-11-10 - Rule 19(a) / Re-referred to Rules Committee [SB1851 Detail]

Download: Illinois-2017-SB1851-Engrossed.html



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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.4h as follows:
6 (305 ILCS 5/5-5.4h)
7 Sec. 5-5.4h. Medicaid reimbursement for medically complex
8for the developmentally disabled facilities long-term care
9facilities for persons under 22 years of age.
10 (a) Facilities licensed as medically complex for the
11developmentally disabled facilities long-term care facilities
12for persons under 22 years of age that serve severely and
13chronically ill pediatric patients shall have a specific
14reimbursement system designed to recognize the characteristics
15and needs of the patients they serve.
16 (b) For dates of services starting July 1, 2013 and until a
17new reimbursement system is designed, medically complex for the
18developmentally disabled facilities long-term care facilities
19for persons under 22 years of age that meet the following
20criteria:
21 (1) serve exceptional care patients; and
22 (2) have 30% or more of their patients receiving
23 ventilator care;

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1shall receive Medicaid reimbursement on a 30-day expedited
2schedule.
3 (c) Subject to federal approval of changes to the Title XIX
4State Plan, for dates of services starting July 1, 2014 and
5until a new reimbursement system is designed, medically complex
6for the developmentally disabled facilities long-term care
7facilities for persons under 22 years of age which meet the
8criteria in subsection (b) of this Section shall receive a per
9diem rate for clinically complex residents of $304. Clinically
10complex residents on a ventilator shall receive a per diem rate
11of $669.
12 (d) To qualify for the per diem rate of $669 for clinically
13complex residents on a ventilator pursuant to subsection (c),
14facilities shall have a policy documenting their method of
15routine assessment of a resident's weaning potential with
16interventions implemented noted in the resident's record.
17 (e) For the purposes of this Section, a resident is
18considered clinically complex if the resident requires at least
19one of the following medical services:
20 (1) Tracheostomy care with dependence on mechanical
21 ventilation for a minimum of 6 hours each day.
22 (2) Tracheostomy care requiring suctioning at least
23 every 6 hours, room air mist or oxygen as needed, and
24 dependence on one of the treatment procedures listed under
25 paragraph (4) excluding the procedure listed in
26 subparagraph (A) of paragraph (4).

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1 (3) Total parenteral nutrition or other intravenous
2 nutritional support and one of the treatment procedures
3 listed under paragraph (4).
4 (4) The following treatment procedures apply to the
5 conditions in paragraphs (2) and (3) of this subsection:
6 (A) Intermittent suctioning at least every 8 hours
7 and room air mist or oxygen as needed.
8 (B) Continuous intravenous therapy including
9 administration of therapeutic agents necessary for
10 hydration or of intravenous pharmaceuticals; or
11 intravenous pharmaceutical administration of more than
12 one agent via a peripheral or central line, without
13 continuous infusion.
14 (C) Peritoneal dialysis treatments requiring at
15 least 4 exchanges every 24 hours.
16 (D) Tube feeding via nasogastric or gastrostomy
17 tube.
18 (E) Other medical technologies required
19 continuously, which in the opinion of the attending
20 physician require the services of a professional
21 nurse.
22(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14.)
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