Bill Text: IL SB3942 | 2011-2012 | 97th General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that in the event hospitals are deemed not to have reached the $40,000,000 in reduced expenditures as set forth under the Code, then for any individual hospital not meeting its established threshold, the Department of Public Health shall assess a penalty payment equal to one-half the amount of the differential between the hospital's actual liability related to readmissions and that of the threshold amount. Provides that these penalty payments shall be deposited into the Healthcare Provider Relief Fund and that in the event the Centers for Medicare and Medicaid Services finds that the penalty payments are an impermissible healthcare-related tax, the penalty payments shall be doubled. Further provides that the expenditures are to be defined as General Revenue Fund-based expenditures. Effective immediately.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Failed) 2013-01-08 - Session Sine Die [SB3942 Detail]

Download: Illinois-2011-SB3942-Introduced.html

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97TH GENERAL ASSEMBLY State of Illinois 2011 and 2012 SB3942 Introduced 12/4/2012, by Sen. William Delgado SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5f
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that in the event hospitals are deemed not to have reached the $40,000,000 in reduced expenditures as set forth under the Code, then for any individual hospital not meeting its established threshold, the Department of Public Health shall assess a penalty payment equal to one-half the amount of the differential between the hospital's actual liability related to readmissions and that of the threshold amount. Provides that these penalty payments shall be deposited into the Healthcare Provider Relief Fund and that in the event the Centers for Medicare and Medicaid Services finds that the penalty payments are an impermissible healthcare-related tax, the penalty payments shall be doubled. Further provides that the expenditures are to be defined as General Revenue Fund-based expenditures. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5f as follows:
(305 ILCS 5/5-5f)
Sec. 5-5f. Elimination and limitations of medical
assistance services. Notwithstanding any other provision of
this Code to the contrary, on and after July 1, 2012:
(a) The following services shall no longer be a covered
service available under this Code: group psychotherapy for
residents of any facility licensed under the Nursing Home Care
Act or the Specialized Mental Health Rehabilitation Act; and
adult chiropractic services.
(b) The Department shall place the following limitations on
services: (i) the Department shall limit adult eyeglasses to
one pair every 2 years; (ii) the Department shall set an annual
limit of a maximum of 20 visits for each of the following
services: adult speech, hearing, and language therapy
services, adult occupational therapy services, and physical
therapy services; (iii) the Department shall limit podiatry
services to individuals with diabetes; (iv) the Department
shall pay for caesarean sections at the normal vaginal delivery

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rate unless a caesarean section was medically necessary; (v)
the Department shall limit adult dental services to
emergencies; and (vi) effective July 1, 2012, the Department
shall place limitations and require concurrent review on every
inpatient detoxification stay to prevent repeat admissions to
any hospital for detoxification within 60 days of a previous
inpatient detoxification stay. The Department shall convene a
workgroup of hospitals, substance abuse providers, care
coordination entities, managed care plans, and other
stakeholders to develop recommendations for quality standards,
diversion to other settings, and admission criteria for
patients who need inpatient detoxification.
(c) The Department shall require prior approval of the
following services: wheelchair repairs, regardless of the cost
of the repairs, coronary artery bypass graft, and bariatric
surgery consistent with Medicare standards concerning patient
responsibility. The wholesale cost of power wheelchairs shall
be actual acquisition cost including all discounts.
(d) The Department shall establish benchmarks for
hospitals to measure and align payments to reduce potentially
preventable hospital readmissions, inpatient complications,
and unnecessary emergency room visits. In doing so, the
Department shall consider items, including, but not limited to,
historic and current acuity of care and historic and current
trends in readmission. The Department shall publish
provider-specific historical readmission data and anticipated

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potentially preventable targets 60 days prior to the start of
the program. In the instance of readmissions, the Department
shall adopt policies and rates of reimbursement for services
and other payments provided under this Code to ensure that, by
June 30, 2013, expenditures to hospitals are reduced by, at a
minimum, $40,000,000.
(1) In the event hospitals are deemed not to have
reached the $40,000,000 in reduced expenditures, then for
any individual hospital not meeting its established
threshold, the Department of Public Health shall assess a
penalty payment equal to one-half the amount of the
differential between the hospital's actual liability
related to readmissions and that of the threshold amount.
These penalty payments shall be deposited into the
Healthcare Provider Relief Fund.
(2) In the event the Centers for Medicare and Medicaid
Services finds that the penalty payments are an
impermissible healthcare-related tax, the penalty payments
calculated above shall be doubled.
(3) For purposes of this subsection, expenditures are
defined as General Revenue Fund-based expenditures.
(e) The Department shall establish utilization controls
for the hospice program such that it shall not pay for other
care services when an individual is in hospice.
(f) For home health services, the Department shall require
Medicare certification of providers participating in the

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program, implement the Medicare face-to-face encounter rule,
and limit services to post-hospitalization. The Department
shall require providers to implement auditable electronic
service verification based on global positioning systems or
other cost-effective technology.
(g) For the Home Services Program operated by the
Department of Human Services and the Community Care Program
operated by the Department on Aging, the Department of Human
Services, in cooperation with the Department on Aging, shall
implement an electronic service verification based on global
positioning systems or other cost-effective technology.
(h) The Department shall not pay for hospital admissions
when the claim indicates a hospital acquired condition that
would cause Medicare to reduce its payment on the claim had the
claim been submitted to Medicare, nor shall the Department pay
for hospital admissions where a Medicare identified "never
event" occurred.
(i) The Department shall implement cost savings
initiatives for advanced imaging services, cardiac imaging
services, pain management services, and back surgery. Such
initiatives shall be designed to achieve annual costs savings.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 99. Effective date. This Act takes effect upon
becoming law.