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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		Article 1
5		Section 1-5. The Illinois Public Aid Code is amended by
6		adding Article V-F as follows:
7		(305 ILCS 5/Art. V-F heading new)
8		ARTICLE V-F. MEDICARE-MEDICAID ALIGNMENT
9		INITIATIVE (MMAI) NURSING HOME
10		RESIDENTS' MANAGED CARE RIGHTS LAW
11		(305 ILCS 5/5F-1 new)
12		Sec. 5F-1. Short title. This Article may be referred to as
13		the Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home
14		Residents' Managed Care Rights Law.
15		(305 ILCS 5/5F-5 new)
16		Sec. 5F-5. Findings. The General Assembly finds that
17		elderly Illinoisans residing in a nursing home have the right
18		to:
19		(1) quality health care regardless of the payer;
20		(2) receive medically necessary care prescribed by

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1		their doctors;
2		(3) a simple appeal process when care is denied; and
3		(4) make decisions about their care and where they
4		receive it.
5		(305 ILCS 5/5F-10 new)
6		Sec. 5F-10. Scope. This Article applies to policies and
7		contracts amended, delivered, issued, or renewed on or after
8		the effective date of this amendatory Act of the 98th General
9		Assembly for the nursing home component of the
10		Medicare-Medicaid Alignment Initiative. This Article does not
11		diminish a managed care organization's duties and
12		responsibilities under other federal or State laws or rules
13		adopted under those laws and the 3-way Medicare-Medicaid
14		Alignment Initiative contract.
15		(305 ILCS 5/5F-15 new)
16		Sec. 5F-15. Definitions. As used in this Article:
17		"Appeal" means any of the procedures that deal with the
18		review of adverse organization determinations on the health
19		care services the enrollee believes he or she is entitled to
20		receive, including delay in providing, arranging for, or
21		approving the health care services, such that a delay would
22		adversely affect the health of the enrollee or on any amounts
23		the enrollee must pay for a service, as defined under 42 CFR
24		422.566(b). These procedures include reconsiderations by the

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1		managed care organization and, if necessary, an independent
2		review entity as provided by the Health Carrier External Review
3		Act, hearings before administrative law judges, review by the
4		Medicare Appeals Council, and judicial review.
5		"Demonstration Project" means the nursing home component
6		of the Medicare-Medicaid Alignment Initiative Demonstration
7		Project.
8		"Department" means the Department of Healthcare and Family
9		Services.
10		"Enrollee" means an individual who resides in a nursing
11		home or is qualified to be admitted to a nursing home and is
12		enrolled with a managed care organization participating in the
13		Demonstration Project.
14		"Health care services" means the diagnosis, treatment, and
15		prevention of disease and includes medication, primary care,
16		nursing or medical care, mental health treatment, psychiatric
17		rehabilitation, memory loss services, physical, occupational,
18		and speech rehabilitation, enhanced care, medical supplies and
19		equipment and the repair of such equipment, and assistance with
20		activities of daily living.
21		"Managed care organization" or "MCO" means an entity that
22		meets the definition of health maintenance organization as
23		defined in the Health Maintenance Organization Act, is
24		licensed, regulated and in good standing with the Department of
25		Insurance, and is authorized to participate in the nursing home
26		component of the Medicare-Medicaid Alignment Initiative

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1		Demonstration Project by a 3-way contract with the Department
2		of Healthcare and Family Services and the Centers for Medicare
3		and Medicaid Services.
4		"Medical professional" means a physician, physician
5		assistant, or nurse practitioner.
6		"Medically necessary" means health care services that a
7		medical professional, exercising prudent clinical judgment,
8		would provide to a patient for the purpose of preventing,
9		evaluating, diagnosing, or treating an illness, injury, or
10		disease or its symptoms, and that are: (i) in accordance with
11		the generally accepted standards of medical practice; (ii)
12		clinically appropriate, in terms of type, frequency, extent,
13		site, and duration, and considered effective for the patient's
14		illness, injury, or disease; and (iii) not primarily for the
15		convenience of the patient, a medical professional, other
16		health care provider, caregiver, family member, or other
17		interested party.
18		"Nursing home" means a facility licensed under the Nursing
19		Home Care Act.
20		"Nurse practitioner" means an individual properly licensed
21		as a nurse practitioner under the Nurse Practice Act.
22		"Physician" means an individual licensed to practice in all
23		branches of medicine under the Medical Practice Act of 1987.
24		"Physician assistant" means an individual properly
25		licensed under the Physician Assistant Practice Act of 1987.
26		"Resident" means an enrollee who is receiving personal or

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1		medical care, including, but not limited to, mental health
2		treatment, psychiatric rehabilitation, physical
3		rehabilitation, and assistance with activities of daily
4		living, from a nursing home.
5		"RAI Manual" means the most recent Resident Assessment
6		Instrument Manual, published by the Centers for Medicare and
7		Medicaid Services.
8		"Resident's representative" means a person designated in
9		writing by a resident to be the resident's representative or
10		the resident's guardian, as described by the Nursing Home Care
11		Act.
12		"SNFist" means a medical professional specializing in the
13		care of individuals residing in nursing homes employed by or
14		under contract with a MCO.
15		"Transition period" means a period of time immediately
16		following enrollment into the Demonstration Project or an
17		enrollee's movement from one managed care organization to
18		another managed care organization or one care setting to
19		another care setting.
20		(305 ILCS 5/5F-20 new)
21		Sec. 5F-20. Network adequacy.
22		(a) Every managed care organization shall allow every
23		nursing home in its service area an opportunity to be a network
24		contracted facility at the plan's standard terms, conditions,
25		and rates. Either party may opt to limit the contract to

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1		existing residents only.
2		(b) With the exception of subsection (c) of this Section, a
3		managed care organization shall only terminate or refuse to
4		renew a contract with a nursing home if the nursing home fails
5		to meet quality standards if the following conditions are met:
6		(1) the quality standards are made known to the nursing
7		home;
8		(2) the quality standards can be objectively measured
9		through data;
10		(3) the nursing home is measured on at least a year's
11		worth of performance;
12		(4) a nursing home that the MCO has determined did not
13		meet a quality standard has the opportunity to contest that
14		determination by challenging the accuracy or the
15		measurement of the data through an arbitration process
16		agreed to by contract; and
17		(5) the Department may attempt to mediate a dispute
18		prior to arbitration.
19		(c) A managed care organization may terminate or refuse to
20		renew a contract with a nursing home for a material breach of
21		the contract, including, but not limited to, failure to grant
22		reasonable and timely access to the MCO's care coordinators,
23		SNFists and other providers, termination from the Medicare or
24		Medicaid program, or revocation of license.
25		(305 ILCS 5/5F-25 new)

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1		Sec. 5F-25. Care coordination. Care coordination provided
2		to all enrollees in the Demonstration Project shall conform to
3		the following requirements:
4		(1) care coordination services shall be
5		enrollee-driven and person-centered;
6		(2) all enrollees in the Demonstration Project shall
7		have the right to receive health care services in the care
8		setting of their choice, except as permitted by Part 4 of
9		Article III of the Nursing Home Care Act with respect to
10		involuntary transfers and discharges; and
11		(3) decisions shall be based on the enrollee's best
12		interests.
13		(305 ILCS 5/5F-30 new)
14		Sec. 5F-30. Continuity of care. When a nursing home
15		resident first transitions to a managed care organization from
16		the fee-for-service system or from another managed care
17		organization, the managed care organization shall honor the
18		existing care plan and any necessary changes to that care plan
19		until the MCO has completed a comprehensive assessment and new
20		care plan, to the extent such services are covered benefits
21		under the contract, which shall be consistent with the
22		requirements of the RAI Manual.
23		When an enrollee of a managed care organization is moving
24		from a community setting to a nursing home, and the MCO is
25		properly notified of the proposed admission by a network

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1		nursing home, and the managed care organization fails to
2		participate in developing a care plan within the time frames
3		required by nursing home regulations, the MCO must honor a care
4		plan developed by the nursing home until the MCO has completed
5		a comprehensive assessment and a new care plan to the extent
6		such services are covered benefits under the contract,
7		consistent with the requirements of the RAI Manual.
8		A nursing home shall have the ability to refuse admission
9		of an enrollee for whom care is required that the nursing home
10		determines is outside the scope of its license and healthcare
11		capabilities.
12		(305 ILCS 5/5F-32 new)
13		Sec. 5F-32. Non-emergency prior approval and appeal.
14		(a) MCOs must have a method of receiving prior approval
15		requests 24 hours a day, 7 days a week, 365 days a year for
16		nursing home residents. If a response is not provided within 24
17		hours of the request and the nursing home is required by
18		regulation to provide a service because a physician ordered it,
19		the MCO must pay for the service if it is a covered service
20		under the MCO's contract in the Demonstration Project, provided
21		that the request is consistent with the policies and procedures
22		of the MCO.
23		In a non-emergency situation, notwithstanding any
24		provisions in State law to the contrary, in the event a
25		resident's physician orders a service, treatment, or test that

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1		is not approved by the MCO, the physician and the provider may
2		utilize an expedited appeal to the MCO.
3		If an enrollee or provider requests an expedited appeal
4		pursuant to 42 CFR 438.410, the MCO shall notify the enrollee
5		or provider within 24 hours after the submission of the appeal
6		of all information from the enrollee or provider that the MCO
7		requires to evaluate the appeal. The MCO shall render a
8		decision on an expedited appeal within 24 hours after receipt
9		of the required information.
10		(b) While the appeal is pending or if the ordered service,
11		treatment, or test is denied after appeal, the Department of
12		Public Health may not cite the nursing home for failure to
13		provide the ordered service, treatment, or test. The nursing
14		home shall not be liable or responsible for an injury in any
15		regulatory proceeding for the following:
16		(1) failure to follow the appealed or denied order; or
17		(2) injury to the extent it was caused by the delay or
18		failure to perform the appealed or denied service,
19		treatment, or test.
20		Provided however, a nursing home shall continue to monitor,
21		document, and ensure the patient's safety. Nothing in this
22		subsection (b) is intended to otherwise change the nursing
23		home's existing obligations under State and federal law to
24		appropriately care for its residents.
25		(305 ILCS 5/5F-35 new)

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1		Sec. 5F-35. Reimbursement. The Department shall provide
2		each managed care organization with the quarterly
3		facility-specific RUG-IV nursing component per diem along with
4		any add-ons for enhanced care services, support component per
5		diem, and capital component per diem effective for each nursing
6		home under contract with the managed care organization.
7		(305 ILCS 5/5F-40 new)
8		Sec. 5F-40. Contractual requirements.
9		(a) Every contract shall contain a clause for termination
10		consistent with the Managed Care Reform and Patient Rights Act
11		providing nursing homes the ability to terminate the contract.
12		(b) All changes to the contract by the MCO shall be
13		preceded by 30 days' written notice sent to the nursing home.
14		(305 ILCS 5/5F-45 new)
15		Sec. 5F-45. Prohibition. No managed care organization or
16		contract shall contain any provision, policy, or procedure that
17		limits, restricts, or waives any rights set forth in this
18		Article or is expressly prohibited by this Article. Any such
19		policy or procedure is void and unenforceable.
20		Section 1-10. The Health Maintenance Organization Act is
21		amended by changing Section 1-2 as follows:
22		(215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402)

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1		Sec. 1-2. Definitions. As used in this Act, unless the
2		context otherwise requires, the following terms shall have the
3		meanings ascribed to them:
4		(1) "Advertisement" means any printed or published
5		material, audiovisual material and descriptive literature of
6		the health care plan used in direct mail, newspapers,
7		magazines, radio scripts, television scripts, billboards and
8		similar displays; and any descriptive literature or sales aids
9		of all kinds disseminated by a representative of the health
10		care plan for presentation to the public including, but not
11		limited to, circulars, leaflets, booklets, depictions,
12		illustrations, form letters and prepared sales presentations.
13		(2) "Director" means the Director of Insurance.
14		(3) "Basic health care services" means emergency care, and
15		inpatient hospital and physician care, outpatient medical
16		services, mental health services and care for alcohol and drug
17		abuse, including any reasonable deductibles and co-payments,
18		all of which are subject to the limitations described in
19		Section 4-20 of this Act and as determined by the Director
20		pursuant to rule.
21		(4) "Enrollee" means an individual who has been enrolled in
22		a health care plan.
23		(5) "Evidence of coverage" means any certificate,
24		agreement, or contract issued to an enrollee setting out the
25		coverage to which he is entitled in exchange for a per capita
26		prepaid sum.

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1		(6) "Group contract" means a contract for health care
2		services which by its terms limits eligibility to members of a
3		specified group.
4		(7) "Health care plan" means any arrangement whereby any
5		organization undertakes to provide or arrange for and pay for
6		or reimburse the cost of basic health care services, excluding
7		any reasonable deductibles and copayments, from providers
8		selected by the Health Maintenance Organization and such
9		arrangement consists of arranging for or the provision of such
10		health care services, as distinguished from mere
11		indemnification against the cost of such services, except as
12		otherwise authorized by Section 2-3 of this Act, on a per
13		capita prepaid basis, through insurance or otherwise. A "health
14		care plan" also includes any arrangement whereby an
15		organization undertakes to provide or arrange for or pay for or
16		reimburse the cost of any health care service for persons who
17		are enrolled under Article V of the Illinois Public Aid Code or
18		under the Children's Health Insurance Program Act through
19		providers selected by the organization and the arrangement
20		consists of making provision for the delivery of health care
21		services, as distinguished from mere indemnification. A
22		"health care plan" also includes any arrangement pursuant to
23		Section 4-17. Nothing in this definition, however, affects the
24		total medical services available to persons eligible for
25		medical assistance under the Illinois Public Aid Code.
26		(8) "Health care services" means any services included in

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1		the furnishing to any individual of medical or dental care, or
2		the hospitalization or incident to the furnishing of such care
3		or hospitalization as well as the furnishing to any person of
4		any and all other services for the purpose of preventing,
5		alleviating, curing or healing human illness or injury.
6		(9) "Health Maintenance Organization" means any
7		organization formed under the laws of this or another state to
8		provide or arrange for one or more health care plans under a
9		system which causes any part of the risk of health care
10		delivery to be borne by the organization or its providers.
11		(10) "Net worth" means admitted assets, as defined in
12		Section 1-3 of this Act, minus liabilities.
13		(11) "Organization" means any insurance company, a
14		nonprofit corporation authorized under the Dental Service Plan
15		Act or the Voluntary Health Services Plans Act, or a
16		corporation organized under the laws of this or another state
17		for the purpose of operating one or more health care plans and
18		doing no business other than that of a Health Maintenance
19		Organization or an insurance company. "Organization" shall
20		also mean the University of Illinois Hospital as defined in the
21		University of Illinois Hospital Act or a unit of local
22		government health system operating within a county with a
23		population of 3,000,000 or more.
24		(12) "Provider" means any physician, hospital facility,
25		facility licensed under the Nursing Home Care Act, or other
26		person which is licensed or otherwise authorized to furnish

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1		health care services and also includes any other entity that
2		arranges for the delivery or furnishing of health care service.
3		(13) "Producer" means a person directly or indirectly
4		associated with a health care plan who engages in solicitation
5		or enrollment.
6		(14) "Per capita prepaid" means a basis of prepayment by
7		which a fixed amount of money is prepaid per individual or any
8		other enrollment unit to the Health Maintenance Organization or
9		for health care services which are provided during a definite
10		time period regardless of the frequency or extent of the
11		services rendered by the Health Maintenance Organization,
12		except for copayments and deductibles and except as provided in
13		subsection (f) of Section 5-3 of this Act.
14		(15) "Subscriber" means a person who has entered into a
15		contractual relationship with the Health Maintenance
16		Organization for the provision of or arrangement of at least
17		basic health care services to the beneficiaries of such
18		contract.
19		(Source: P.A. 97-1148, eff. 1-24-13.)
20		Section 1-15. The Managed Care Reform and Patient Rights
21		Act is amended by changing Section 10 as follows:
22		(215 ILCS 134/10)
23		Sec. 10. Definitions:
24		"Adverse determination" means a determination by a health

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1		care plan under Section 45 or by a utilization review program
2		under Section 85 that a health care service is not medically
3		necessary.
4		"Clinical peer" means a health care professional who is in
5		the same profession and the same or similar specialty as the
6		health care provider who typically manages the medical
7		condition, procedures, or treatment under review.
8		"Department" means the Department of Insurance.
9		"Emergency medical condition" means a medical condition
10		manifesting itself by acute symptoms of sufficient severity
11		(including, but not limited to, severe pain) such that a
12		prudent layperson, who possesses an average knowledge of health
13		and medicine, could reasonably expect the absence of immediate
14		medical attention to result in:
15		(1) placing the health of the individual (or, with
16		respect to a pregnant woman, the health of the woman or her
17		unborn child) in serious jeopardy;
18		(2) serious impairment to bodily functions; or
19		(3) serious dysfunction of any bodily organ or part.
20		"Emergency medical screening examination" means a medical
21		screening examination and evaluation by a physician licensed to
22		practice medicine in all its branches, or to the extent
23		permitted by applicable laws, by other appropriately licensed
24		personnel under the supervision of or in collaboration with a
25		physician licensed to practice medicine in all its branches to
26		determine whether the need for emergency services exists.

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1		"Emergency services" means, with respect to an enrollee of
2		a health care plan, transportation services, including but not
3		limited to ambulance services, and covered inpatient and
4		outpatient hospital services furnished by a provider qualified
5		to furnish those services that are needed to evaluate or
6		stabilize an emergency medical condition. "Emergency services"
7		does not refer to post-stabilization medical services.
8		"Enrollee" means any person and his or her dependents
9		enrolled in or covered by a health care plan.
10		"Health care plan" means a plan, including, but not limited
11		to, a health maintenance organization, a managed care community
12		network as defined in the Illinois Public Aid Code, or an
13		accountable care entity as defined in the Illinois Public Aid
14		Code that receives capitated payments to cover medical services
15		from the Department of Healthcare and Family Services, that
16		establishes, operates, or maintains a network of health care
17		providers that has entered into an agreement with the plan to
18		provide health care services to enrollees to whom the plan has
19		the ultimate obligation to arrange for the provision of or
20		payment for services through organizational arrangements for
21		ongoing quality assurance, utilization review programs, or
22		dispute resolution. Nothing in this definition shall be
23		construed to mean that an independent practice association or a
24		physician hospital organization that subcontracts with a
25		health care plan is, for purposes of that subcontract, a health
26		care plan.

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1		For purposes of this definition, "health care plan" shall
2		not include the following:
3		(1) indemnity health insurance policies including
4		those using a contracted provider network;
5		(2) health care plans that offer only dental or only
6		vision coverage;
7		(3) preferred provider administrators, as defined in
8		Section 370g(g) of the Illinois Insurance Code;
9		(4) employee or employer self-insured health benefit
10		plans under the federal Employee Retirement Income
11		Security Act of 1974;
12		(5) health care provided pursuant to the Workers'
13		Compensation Act or the Workers' Occupational Diseases
14		Act; and
15		(6) not-for-profit voluntary health services plans
16		with health maintenance organization authority in
17		existence as of January 1, 1999 that are affiliated with a
18		union and that only extend coverage to union members and
19		their dependents.
20		"Health care professional" means a physician, a registered
21		professional nurse, or other individual appropriately licensed
22		or registered to provide health care services.
23		"Health care provider" means any physician, hospital
24		facility, facility licensed under the Nursing Home Care Act, or
25		other person that is licensed or otherwise authorized to
26		deliver health care services. Nothing in this Act shall be

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1		construed to define Independent Practice Associations or
2		Physician-Hospital Organizations as health care providers.
3		"Health care services" means any services included in the
4		furnishing to any individual of medical care, or the
5		hospitalization incident to the furnishing of such care, as
6		well as the furnishing to any person of any and all other
7		services for the purpose of preventing, alleviating, curing, or
8		healing human illness or injury including home health and
9		pharmaceutical services and products.
10		"Medical director" means a physician licensed in any state
11		to practice medicine in all its branches appointed by a health
12		care plan.
13		"Person" means a corporation, association, partnership,
14		limited liability company, sole proprietorship, or any other
15		legal entity.
16		"Physician" means a person licensed under the Medical
17		Practice Act of 1987.
18		"Post-stabilization medical services" means health care
19		services provided to an enrollee that are furnished in a
20		licensed hospital by a provider that is qualified to furnish
21		such services, and determined to be medically necessary and
22		directly related to the emergency medical condition following
23		stabilization.
24		"Stabilization" means, with respect to an emergency
25		medical condition, to provide such medical treatment of the
26		condition as may be necessary to assure, within reasonable

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1		medical probability, that no material deterioration of the
2		condition is likely to result.
3		"Utilization review" means the evaluation of the medical
4		necessity, appropriateness, and efficiency of the use of health
5		care services, procedures, and facilities.
6		"Utilization review program" means a program established
7		by a person to perform utilization review.
8		(Source: P.A. 91-617, eff. 1-1-00.)
9		Article 5
10		Section 5-5. The Illinois Health Facilities Planning Act is
11		amended by changing Sections 3 and 12 as follows:
12		(20 ILCS 3960/3) (from Ch. 111 1/2, par. 1153)
13		(Section scheduled to be repealed on December 31, 2019)
14		Sec. 3. Definitions. As used in this Act:
15		"Health care facilities" means and includes the following
16		facilities, organizations, and related persons:
17		1. An ambulatory surgical treatment center required to
18		be licensed pursuant to the Ambulatory Surgical Treatment
19		Center Act;
20		2. An institution, place, building, or agency required
21		to be licensed pursuant to the Hospital Licensing Act;
22		3. Skilled and intermediate long term care facilities
23		licensed under the Nursing Home Care Act;

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1		3.5. Skilled and intermediate care facilities licensed
2		under the ID/DD Community Care Act;
3		3.7. Facilities licensed under the Specialized Mental
4		Health Rehabilitation Act of 2013;
5		4. Hospitals, nursing homes, ambulatory surgical
6		treatment centers, or kidney disease treatment centers
7		maintained by the State or any department or agency
8		thereof;
9		5. Kidney disease treatment centers, including a
10		free-standing hemodialysis unit required to be licensed
11		under the End Stage Renal Disease Facility Act;
12		6. An institution, place, building, or room used for
13		the performance of outpatient surgical procedures that is
14		leased, owned, or operated by or on behalf of an
15		out-of-state facility;
16		7. An institution, place, building, or room used for
17		provision of a health care category of service, including,
18		but not limited to, cardiac catheterization and open heart
19		surgery; and
20		8. An institution, place, building, or room used for
21		provision of major medical equipment used in the direct
22		clinical diagnosis or treatment of patients, and whose
23		project cost is in excess of the capital expenditure
24		minimum.
25		This Act shall not apply to the construction of any new
26		facility or the renovation of any existing facility located on

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1		any campus facility as defined in Section 5-5.8b of the
2		Illinois Public Aid Code, provided that the campus facility
3		encompasses 30 or more contiguous acres and that the new or
4		renovated facility is intended for use by a licensed
5		residential facility.
6		No federally owned facility shall be subject to the
7		provisions of this Act, nor facilities used solely for healing
8		by prayer or spiritual means.
9		No facility licensed under the Supportive Residences
10		Licensing Act or the Assisted Living and Shared Housing Act
11		shall be subject to the provisions of this Act.
12		No facility established and operating under the
13		Alternative Health Care Delivery Act as a children's respite
14		care center alternative health care model demonstration
15		program or as an Alzheimer's Disease Management Center
16		alternative health care model demonstration program shall be
17		subject to the provisions of this Act.
18		A facility designated as a supportive living facility that
19		is in good standing with the program established under Section
20		5-5.01a of the Illinois Public Aid Code shall not be subject to
21		the provisions of this Act.
22		This Act does not apply to facilities granted waivers under
23		Section 3-102.2 of the Nursing Home Care Act. However, if a
24		demonstration project under that Act applies for a certificate
25		of need to convert to a nursing facility, it shall meet the
26		licensure and certificate of need requirements in effect as of

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1		the date of application.
2		This Act does not apply to a dialysis facility that
3		provides only dialysis training, support, and related services
4		to individuals with end stage renal disease who have elected to
5		receive home dialysis. This Act does not apply to a dialysis
6		unit located in a licensed nursing home that offers or provides
7		dialysis-related services to residents with end stage renal
8		disease who have elected to receive home dialysis within the
9		nursing home. The Board, however, may require these dialysis
10		facilities and licensed nursing homes to report statistical
11		information on a quarterly basis to the Board to be used by the
12		Board to conduct analyses on the need for proposed kidney
13		disease treatment centers.
14		This Act shall not apply to the closure of an entity or a
15		portion of an entity licensed under the Nursing Home Care Act,
16		the Specialized Mental Health Rehabilitation Act of 2013, or
17		the ID/DD Community Care Act, with the exceptions of facilities
18		operated by a county or Illinois Veterans Homes, that elects to
19		convert, in whole or in part, to an assisted living or shared
20		housing establishment licensed under the Assisted Living and
21		Shared Housing Act and with the exception of a facility
22		licensed under the Specialized Mental Health Rehabilitation
23		Act of 2013 in connection with a proposal to close a facility
24		and re-establish the facility in another location.
25		This Act does not apply to any change of ownership of a
26		healthcare facility that is licensed under the Nursing Home

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1		Care Act, the Specialized Mental Health Rehabilitation Act of
2		2013, or the ID/DD Community Care Act, with the exceptions of
3		facilities operated by a county or Illinois Veterans Homes.
4		Changes of ownership of facilities licensed under the Nursing
5		Home Care Act must meet the requirements set forth in Sections
6		3-101 through 3-119 of the Nursing Home Care Act.
7		With the exception of those health care facilities
8		specifically included in this Section, nothing in this Act
9		shall be intended to include facilities operated as a part of
10		the practice of a physician or other licensed health care
11		professional, whether practicing in his individual capacity or
12		within the legal structure of any partnership, medical or
13		professional corporation, or unincorporated medical or
14		professional group. Further, this Act shall not apply to
15		physicians or other licensed health care professional's
16		practices where such practices are carried out in a portion of
17		a health care facility under contract with such health care
18		facility by a physician or by other licensed health care
19		professionals, whether practicing in his individual capacity
20		or within the legal structure of any partnership, medical or
21		professional corporation, or unincorporated medical or
22		professional groups, unless the entity constructs, modifies,
23		or establishes a health care facility as specifically defined
24		in this Section. This Act shall apply to construction or
25		modification and to establishment by such health care facility
26		of such contracted portion which is subject to facility

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1		licensing requirements, irrespective of the party responsible
2		for such action or attendant financial obligation.
3		No permit or exemption is required for a facility licensed
4		under the ID/DD Community Care Act prior to the reduction of
5		the number of beds at a facility. If there is a total reduction
6		of beds at a facility licensed under the ID/DD Community Care
7		Act, this is a discontinuation or closure of the facility.
8		However, if a facility licensed under the ID/DD Community Care
9		Act reduces the number of beds or discontinues the facility,
10		that facility must notify the Board as provided in Section 14.1
11		of this Act.
12		"Person" means any one or more natural persons, legal
13		entities, governmental bodies other than federal, or any
14		combination thereof.
15		"Consumer" means any person other than a person (a) whose
16		major occupation currently involves or whose official capacity
17		within the last 12 months has involved the providing,
18		administering or financing of any type of health care facility,
19		(b) who is engaged in health research or the teaching of
20		health, (c) who has a material financial interest in any
21		activity which involves the providing, administering or
22		financing of any type of health care facility, or (d) who is or
23		ever has been a member of the immediate family of the person
24		defined by (a), (b), or (c).
25		"State Board" or "Board" means the Health Facilities and
26		Services Review Board.

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1		"Construction or modification" means the establishment,
2		erection, building, alteration, reconstruction, modernization,
3		improvement, extension, discontinuation, change of ownership,
4		of or by a health care facility, or the purchase or acquisition
5		by or through a health care facility of equipment or service
6		for diagnostic or therapeutic purposes or for facility
7		administration or operation, or any capital expenditure made by
8		or on behalf of a health care facility which exceeds the
9		capital expenditure minimum; however, any capital expenditure
10		made by or on behalf of a health care facility for (i) the
11		construction or modification of a facility licensed under the
12		Assisted Living and Shared Housing Act or (ii) a conversion
13		project undertaken in accordance with Section 30 of the Older
14		Adult Services Act shall be excluded from any obligations under
15		this Act.
16		"Establish" means the construction of a health care
17		facility or the replacement of an existing facility on another
18		site or the initiation of a category of service.
19		"Major medical equipment" means medical equipment which is
20		used for the provision of medical and other health services and
21		which costs in excess of the capital expenditure minimum,
22		except that such term does not include medical equipment
23		acquired by or on behalf of a clinical laboratory to provide
24		clinical laboratory services if the clinical laboratory is
25		independent of a physician's office and a hospital and it has
26		been determined under Title XVIII of the Social Security Act to

SB0741 Enrolled - 26 - LRB098 04975 KTG 35005 b
1		meet the requirements of paragraphs (10) and (11) of Section
2		1861(s) of such Act. In determining whether medical equipment
3		has a value in excess of the capital expenditure minimum, the
4		value of studies, surveys, designs, plans, working drawings,
5		specifications, and other activities essential to the
6		acquisition of such equipment shall be included.
7		"Capital Expenditure" means an expenditure: (A) made by or
8		on behalf of a health care facility (as such a facility is
9		defined in this Act); and (B) which under generally accepted
10		accounting principles is not properly chargeable as an expense
11		of operation and maintenance, or is made to obtain by lease or
12		comparable arrangement any facility or part thereof or any
13		equipment for a facility or part; and which exceeds the capital
14		expenditure minimum.
15		For the purpose of this paragraph, the cost of any studies,
16		surveys, designs, plans, working drawings, specifications, and
17		other activities essential to the acquisition, improvement,
18		expansion, or replacement of any plant or equipment with
19		respect to which an expenditure is made shall be included in
20		determining if such expenditure exceeds the capital
21		expenditures minimum. Unless otherwise interdependent, or
22		submitted as one project by the applicant, components of
23		construction or modification undertaken by means of a single
24		construction contract or financed through the issuance of a
25		single debt instrument shall not be grouped together as one
26		project. Donations of equipment or facilities to a health care

SB0741 Enrolled - 27 - LRB098 04975 KTG 35005 b
1		facility which if acquired directly by such facility would be
2		subject to review under this Act shall be considered capital
3		expenditures, and a transfer of equipment or facilities for
4		less than fair market value shall be considered a capital
5		expenditure for purposes of this Act if a transfer of the
6		equipment or facilities at fair market value would be subject
7		to review.
8		"Capital expenditure minimum" means $11,500,000 for
9		projects by hospital applicants, $6,500,000 for applicants for
10		projects related to skilled and intermediate care long-term
11		care facilities licensed under the Nursing Home Care Act, and
12		$3,000,000 for projects by all other applicants, which shall be
13		annually adjusted to reflect the increase in construction costs
14		due to inflation, for major medical equipment and for all other
15		capital expenditures.
16		"Non-clinical service area" means an area (i) for the
17		benefit of the patients, visitors, staff, or employees of a
18		health care facility and (ii) not directly related to the
19		diagnosis, treatment, or rehabilitation of persons receiving
20		services from the health care facility. "Non-clinical service
21		areas" include, but are not limited to, chapels; gift shops;
22		news stands; computer systems; tunnels, walkways, and
23		elevators; telephone systems; projects to comply with life
24		safety codes; educational facilities; student housing;
25		patient, employee, staff, and visitor dining areas;
26		administration and volunteer offices; modernization of

SB0741 Enrolled - 28 - LRB098 04975 KTG 35005 b
1		structural components (such as roof replacement and masonry
2		work); boiler repair or replacement; vehicle maintenance and
3		storage facilities; parking facilities; mechanical systems for
4		heating, ventilation, and air conditioning; loading docks; and
5		repair or replacement of carpeting, tile, wall coverings,
6		window coverings or treatments, or furniture. Solely for the
7		purpose of this definition, "non-clinical service area" does
8		not include health and fitness centers.
9		"Areawide" means a major area of the State delineated on a
10		geographic, demographic, and functional basis for health
11		planning and for health service and having within it one or
12		more local areas for health planning and health service. The
13		term "region", as contrasted with the term "subregion", and the
14		word "area" may be used synonymously with the term "areawide".
15		"Local" means a subarea of a delineated major area that on
16		a geographic, demographic, and functional basis may be
17		considered to be part of such major area. The term "subregion"
18		may be used synonymously with the term "local".
19		"Physician" means a person licensed to practice in
20		accordance with the Medical Practice Act of 1987, as amended.
21		"Licensed health care professional" means a person
22		licensed to practice a health profession under pertinent
23		licensing statutes of the State of Illinois.
24		"Director" means the Director of the Illinois Department of
25		Public Health.
26		"Agency" means the Illinois Department of Public Health.

SB0741 Enrolled - 29 - LRB098 04975 KTG 35005 b
1		"Alternative health care model" means a facility or program
2		authorized under the Alternative Health Care Delivery Act.
3		"Out-of-state facility" means a person that is both (i)
4		licensed as a hospital or as an ambulatory surgery center under
5		the laws of another state or that qualifies as a hospital or an
6		ambulatory surgery center under regulations adopted pursuant
7		to the Social Security Act and (ii) not licensed under the
8		Ambulatory Surgical Treatment Center Act, the Hospital
9		Licensing Act, or the Nursing Home Care Act. Affiliates of
10		out-of-state facilities shall be considered out-of-state
11		facilities. Affiliates of Illinois licensed health care
12		facilities 100% owned by an Illinois licensed health care
13		facility, its parent, or Illinois physicians licensed to
14		practice medicine in all its branches shall not be considered
15		out-of-state facilities. Nothing in this definition shall be
16		construed to include an office or any part of an office of a
17		physician licensed to practice medicine in all its branches in
18		Illinois that is not required to be licensed under the
19		Ambulatory Surgical Treatment Center Act.
20		"Change of ownership of a health care facility" means a
21		change in the person who has ownership or control of a health
22		care facility's physical plant and capital assets. A change in
23		ownership is indicated by the following transactions: sale,
24		transfer, acquisition, lease, change of sponsorship, or other
25		means of transferring control.
26		"Related person" means any person that: (i) is at least 50%

SB0741 Enrolled - 30 - LRB098 04975 KTG 35005 b
1		owned, directly or indirectly, by either the health care
2		facility or a person owning, directly or indirectly, at least
3		50% of the health care facility; or (ii) owns, directly or
4		indirectly, at least 50% of the health care facility.
5		"Charity care" means care provided by a health care
6		facility for which the provider does not expect to receive
7		payment from the patient or a third-party payer.
8		"Freestanding emergency center" means a facility subject
9		to licensure under Section 32.5 of the Emergency Medical
10		Services (EMS) Systems Act.
11		"Category of service" means a grouping by generic class of
12		various types or levels of support functions, equipment, care,
13		or treatment provided to patients or residents, including, but
14		not limited to, classes such as medical-surgical, pediatrics,
15		or cardiac catheterization. A category of service may include
16		subcategories or levels of care that identify a particular
17		degree or type of care within the category of service. Nothing
18		in this definition shall be construed to include the practice
19		of a physician or other licensed health care professional while
20		functioning in an office providing for the care, diagnosis, or
21		treatment of patients. A category of service that is subject to
22		the Board's jurisdiction must be designated in rules adopted by
23		the Board.
24		(Source: P.A. 97-38, eff. 6-28-11; 97-277, eff. 1-1-12; 97-813,
25		eff. 7-13-12; 97-980, eff. 8-17-12; 98-414, eff. 1-1-14.)

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1		(20 ILCS 3960/12) (from Ch. 111 1/2, par. 1162)
2		(Section scheduled to be repealed on December 31, 2019)
3		Sec. 12. Powers and duties of State Board. For purposes of
4		this Act, the State Board shall exercise the following powers
5		and duties:
6		(1) Prescribe rules, regulations, standards, criteria,
7		procedures or reviews which may vary according to the purpose
8		for which a particular review is being conducted or the type of
9		project reviewed and which are required to carry out the
10		provisions and purposes of this Act. Policies and procedures of
11		the State Board shall take into consideration the priorities
12		and needs of medically underserved areas and other health care
13		services identified through the comprehensive health planning
14		process, giving special consideration to the impact of projects
15		on access to safety net services.
16		(2) Adopt procedures for public notice and hearing on all
17		proposed rules, regulations, standards, criteria, and plans
18		required to carry out the provisions of this Act.
19		(3) (Blank).
20		(4) Develop criteria and standards for health care
21		facilities planning, conduct statewide inventories of health
22		care facilities, maintain an updated inventory on the Board's
23		web site reflecting the most recent bed and service changes and
24		updated need determinations when new census data become
25		available or new need formulae are adopted, and develop health
26		care facility plans which shall be utilized in the review of

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1		applications for permit under this Act. Such health facility
2		plans shall be coordinated by the Board with pertinent State
3		Plans. Inventories pursuant to this Section of skilled or
4		intermediate care facilities licensed under the Nursing Home
5		Care Act, skilled or intermediate care facilities licensed
6		under the ID/DD Community Care Act, facilities licensed under
7		the Specialized Mental Health Rehabilitation Act, or nursing
8		homes licensed under the Hospital Licensing Act shall be
9		conducted on an annual basis no later than July 1 of each year
10		and shall include among the information requested a list of all
11		services provided by a facility to its residents and to the
12		community at large and differentiate between active and
13		inactive beds.
14		In developing health care facility plans, the State Board
15		shall consider, but shall not be limited to, the following:
16		(a) The size, composition and growth of the population
17		of the area to be served;
18		(b) The number of existing and planned facilities
19		offering similar programs;
20		(c) The extent of utilization of existing facilities;
21		(d) The availability of facilities which may serve as
22		alternatives or substitutes;
23		(e) The availability of personnel necessary to the
24		operation of the facility;
25		(f) Multi-institutional planning and the establishment
26		of multi-institutional systems where feasible;

SB0741 Enrolled - 33 - LRB098 04975 KTG 35005 b
1		(g) The financial and economic feasibility of proposed
2		construction or modification; and
3		(h) In the case of health care facilities established
4		by a religious body or denomination, the needs of the
5		members of such religious body or denomination may be
6		considered to be public need.
7		The health care facility plans which are developed and
8		adopted in accordance with this Section shall form the basis
9		for the plan of the State to deal most effectively with
10		statewide health needs in regard to health care facilities.
11		(5) Coordinate with the Center for Comprehensive Health
12		Planning and other state agencies having responsibilities
13		affecting health care facilities, including those of licensure
14		and cost reporting. Beginning no later than January 1, 2013,
15		the Department of Public Health shall produce a written annual
16		report to the Governor and the General Assembly regarding the
17		development of the Center for Comprehensive Health Planning.
18		The Chairman of the State Board and the State Board
19		Administrator shall also receive a copy of the annual report.
20		(6) Solicit, accept, hold and administer on behalf of the
21		State any grants or bequests of money, securities or property
22		for use by the State Board or Center for Comprehensive Health
23		Planning in the administration of this Act; and enter into
24		contracts consistent with the appropriations for purposes
25		enumerated in this Act.
26		(7) The State Board shall prescribe procedures for review,

SB0741 Enrolled - 34 - LRB098 04975 KTG 35005 b
1		standards, and criteria which shall be utilized to make
2		periodic reviews and determinations of the appropriateness of
3		any existing health services being rendered by health care
4		facilities subject to the Act. The State Board shall consider
5		recommendations of the Board in making its determinations.
6		(8) Prescribe, in consultation with the Center for
7		Comprehensive Health Planning, rules, regulations, standards,
8		and criteria for the conduct of an expeditious review of
9		applications for permits for projects of construction or
10		modification of a health care facility, which projects are
11		classified as emergency, substantive, or non-substantive in
12		nature.
13		Six months after June 30, 2009 (the effective date of
14		Public Act 96-31), substantive projects shall include no more
15		than the following:
16		(a) Projects to construct (1) a new or replacement
17		facility located on a new site or (2) a replacement
18		facility located on the same site as the original facility
19		and the cost of the replacement facility exceeds the
20		capital expenditure minimum, which shall be reviewed by the
21		Board within 120 days;
22		(b) Projects proposing a (1) new service within an
23		existing healthcare facility or (2) discontinuation of a
24		service within an existing healthcare facility, which
25		shall be reviewed by the Board within 60 days; or
26		(c) Projects proposing a change in the bed capacity of

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1		a health care facility by an increase in the total number
2		of beds or by a redistribution of beds among various
3		categories of service or by a relocation of beds from one
4		physical facility or site to another by more than 20 beds
5		or more than 10% of total bed capacity, as defined by the
6		State Board, whichever is less, over a 2-year period.
7		The Chairman may approve applications for exemption that
8		meet the criteria set forth in rules or refer them to the full
9		Board. The Chairman may approve any unopposed application that
10		meets all of the review criteria or refer them to the full
11		Board.
12		Such rules shall not abridge the right of the Center for
13		Comprehensive Health Planning to make recommendations on the
14		classification and approval of projects, nor shall such rules
15		prevent the conduct of a public hearing upon the timely request
16		of an interested party. Such reviews shall not exceed 60 days
17		from the date the application is declared to be complete.
18		(9) Prescribe rules, regulations, standards, and criteria
19		pertaining to the granting of permits for construction and
20		modifications which are emergent in nature and must be
21		undertaken immediately to prevent or correct structural
22		deficiencies or hazardous conditions that may harm or injure
23		persons using the facility, as defined in the rules and
24		regulations of the State Board. This procedure is exempt from
25		public hearing requirements of this Act.
26		(10) Prescribe rules, regulations, standards and criteria

SB0741 Enrolled - 36 - LRB098 04975 KTG 35005 b
1		for the conduct of an expeditious review, not exceeding 60
2		days, of applications for permits for projects to construct or
3		modify health care facilities which are needed for the care and
4		treatment of persons who have acquired immunodeficiency
5		syndrome (AIDS) or related conditions.
6		(11) Issue written decisions upon request of the applicant
7		or an adversely affected party to the Board. Requests for a
8		written decision shall be made within 15 days after the Board
9		meeting in which a final decision has been made. A "final
10		decision" for purposes of this Act is the decision to approve
11		or deny an application, or take other actions permitted under
12		this Act, at the time and date of the meeting that such action
13		is scheduled by the Board. The staff of the Board shall prepare
14		a written copy of the final decision and the Board shall
15		approve a final copy for inclusion in the formal record. The
16		Board shall consider, for approval, the written draft of the
17		final decision no later than the next scheduled Board meeting.
18		The written decision shall identify the applicable criteria and
19		factors listed in this Act and the Board's regulations that
20		were taken into consideration by the Board when coming to a
21		final decision. If the Board denies or fails to approve an
22		application for permit or exemption, the Board shall include in
23		the final decision a detailed explanation as to why the
24		application was denied and identify what specific criteria or
25		standards the applicant did not fulfill.
26		(12) Require at least one of its members to participate in

SB0741 Enrolled - 37 - LRB098 04975 KTG 35005 b
1		any public hearing, after the appointment of a majority of the
2		members to the Board.
3		(13) Provide a mechanism for the public to comment on, and
4		request changes to, draft rules and standards.
5		(14) Implement public information campaigns to regularly
6		inform the general public about the opportunity for public
7		hearings and public hearing procedures.
8		(15) Establish a separate set of rules and guidelines for
9		long-term care that recognizes that nursing homes are a
10		different business line and service model from other regulated
11		facilities. An open and transparent process shall be developed
12		that considers the following: how skilled nursing fits in the
13		continuum of care with other care providers, modernization of
14		nursing homes, establishment of more private rooms,
15		development of alternative services, and current trends in
16		long-term care services. The Chairman of the Board shall
17		appoint a permanent Health Services Review Board Long-term Care
18		Facility Advisory Subcommittee that shall develop and
19		recommend to the Board the rules to be established by the Board
20		under this paragraph (15). The Subcommittee shall also provide
21		continuous review and commentary on policies and procedures
22		relative to long-term care and the review of related projects.
23		In consultation with other experts from the health field of
24		long-term care, the Board and the Subcommittee shall study new
25		approaches to the current bed need formula and Health Service
26		Area boundaries to encourage flexibility and innovation in

SB0741 Enrolled - 38 - LRB098 04975 KTG 35005 b
1		design models reflective of the changing long-term care
2		marketplace and consumer preferences. The Subcommittee shall
3		evaluate, and make recommendations to the State Board
4		regarding, the buying, selling, and exchange of beds between
5		long-term care facilities within a specified geographic area or
6		drive time. The Board shall file the proposed related
7		administrative rules for the separate rules and guidelines for
8		long-term care required by this paragraph (15) by no later than
9		September 30, 2011. The Subcommittee shall be provided a
10		reasonable and timely opportunity to review and comment on any
11		review, revision, or updating of the criteria, standards,
12		procedures, and rules used to evaluate project applications as
13		provided under Section 12.3 of this Act.
14		(16) Establish a separate set of rules and guidelines for
15		facilities licensed under the Specialized Mental Health
16		Rehabilitation Act of 2013. An application for the
17		re-establishment of a facility in connection with the
18		relocation of the facility shall not be granted unless the
19		applicant has a contractual relationship with at least one
20		hospital to provide emergency and inpatient mental health
21		services required by facility consumers, and at least one
22		community mental health agency to provide oversight and
23		assistance to facility consumers while living in the facility,
24		and appropriate services, including case management, to assist
25		them to prepare for discharge and reside stably in the
26		community thereafter. No new facilities licensed under the

SB0741 Enrolled - 39 - LRB098 04975 KTG 35005 b
1		Specialized Mental Health Rehabilitation Act of 2013 shall be
2		established after the effective date of this amendatory Act of
3		the 98th General Assembly except in connection with the
4		relocation of an existing facility to a new location. An
5		application for a new location shall not be approved unless
6		there are adequate community services accessible to the
7		consumers within a reasonable distance, or by use of public
8		transportation, so as to facilitate the goal of achieving
9		maximum individual self-care and independence. At no time shall
10		the total number of authorized beds under this Act in
11		facilities licensed under the Specialized Mental Health
12		Rehabilitation Act of 2013 exceed the number of authorized beds
13		on the effective date of this amendatory Act of the 98th
14		General Assembly.
15		(Source: P.A. 97-38, eff. 6-28-11; 97-227, eff. 1-1-12; 97-813,
16		eff. 7-13-12; 97-1045, eff. 8-21-13; 97-1115, eff. 8-27-12;
17		98-414, eff. 1-1-14; 98-463, eff. 8-16-13.)
18		Section 5-10. The Illinois Public Aid Code is amended by
19		changing Sections 5-5.12 and 5-30 and by adding Section 5-30.1
20		as follows:
21		(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
22		Sec. 5-5.12. Pharmacy payments.
23		(a) Every request submitted by a pharmacy for reimbursement
24		under this Article for prescription drugs provided to a

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1		recipient of aid under this Article shall include the name of
2		the prescriber or an acceptable identification number as
3		established by the Department.
4		(b) Pharmacies providing prescription drugs under this
5		Article shall be reimbursed at a rate which shall include a
6		professional dispensing fee as determined by the Illinois
7		Department, plus the current acquisition cost of the
8		prescription drug dispensed. The Illinois Department shall
9		update its information on the acquisition costs of all
10		prescription drugs no less frequently than every 30 days.
11		However, the Illinois Department may set the rate of
12		reimbursement for the acquisition cost, by rule, at a
13		percentage of the current average wholesale acquisition cost.
14		(c) (Blank).
15		(d) The Department shall review utilization of narcotic
16		medications in the medical assistance program and impose
17		utilization controls that protect against abuse.
18		(e) When making determinations as to which drugs shall be
19		on a prior approval list, the Department shall include as part
20		of the analysis for this determination, the degree to which a
21		drug may affect individuals in different ways based on factors
22		including the gender of the person taking the medication.
23		(f) The Department shall cooperate with the Department of
24		Public Health and the Department of Human Services Division of
25		Mental Health in identifying psychotropic medications that,
26		when given in a particular form, manner, duration, or frequency

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1		(including "as needed") in a dosage, or in conjunction with
2		other psychotropic medications to a nursing home resident or to
3		a resident of a facility licensed under the ID/DD Community
4		Care Act, may constitute a chemical restraint or an
5		"unnecessary drug" as defined by the Nursing Home Care Act or
6		Titles XVIII and XIX of the Social Security Act and the
7		implementing rules and regulations. The Department shall
8		require prior approval for any such medication prescribed for a
9		nursing home resident or to a resident of a facility licensed
10		under the ID/DD Community Care Act, that appears to be a
11		chemical restraint or an unnecessary drug. The Department shall
12		consult with the Department of Human Services Division of
13		Mental Health in developing a protocol and criteria for
14		deciding whether to grant such prior approval.
15		(g) The Department may by rule provide for reimbursement of
16		the dispensing of a 90-day supply of a generic or brand name,
17		non-narcotic maintenance medication in circumstances where it
18		is cost effective.
19		(g-5) On and after July 1, 2012, the Department may require
20		the dispensing of drugs to nursing home residents be in a 7-day
21		supply or other amount less than a 31-day supply. The
22		Department shall pay only one dispensing fee per 31-day supply.
23		(h) Effective July 1, 2011, the Department shall
24		discontinue coverage of select over-the-counter drugs,
25		including analgesics and cough and cold and allergy
26		medications.

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1		(h-5) On and after July 1, 2012, the Department shall
2		impose utilization controls, including, but not limited to,
3		prior approval on specialty drugs, oncolytic drugs, drugs for
4		the treatment of HIV or AIDS, immunosuppressant drugs, and
5		biological products in order to maximize savings on these
6		drugs. The Department may adjust payment methodologies for
7		non-pharmacy billed drugs in order to incentivize the selection
8		of lower-cost drugs. For drugs for the treatment of AIDS, the
9		Department shall take into consideration the potential for
10		non-adherence by certain populations, and shall develop
11		protocols with organizations or providers primarily serving
12		those with HIV/AIDS, as long as such measures intend to
13		maintain cost neutrality with other utilization management
14		controls such as prior approval. For hemophilia, the Department
15		shall develop a program of utilization review and control which
16		may include, in the discretion of the Department, prior
17		approvals. The Department may impose special standards on
18		providers that dispense blood factors which shall include, in
19		the discretion of the Department, staff training and education;
20		patient outreach and education; case management; in-home
21		patient assessments; assay management; maintenance of stock;
22		emergency dispensing timeframes; data collection and
23		reporting; dispensing of supplies related to blood factor
24		infusions; cold chain management and packaging practices; care
25		coordination; product recalls; and emergency clinical
26		consultation. The Department may require patients to receive a

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1		comprehensive examination annually at an appropriate provider
2		in order to be eligible to continue to receive blood factor.
3		(i) On and after July 1, 2012, the Department shall reduce
4		any rate of reimbursement for services or other payments or
5		alter any methodologies authorized by this Code to reduce any
6		rate of reimbursement for services or other payments in
7		accordance with Section 5-5e.
8		(j) On and after July 1, 2012, the Department shall impose
9		limitations on prescription drugs such that the Department
10		shall not provide reimbursement for more than 4 prescriptions,
11		including 3 brand name prescriptions, for distinct drugs in a
12		30-day period, unless prior approval is received for all
13		prescriptions in excess of the 4-prescription limit. Drugs in
14		the following therapeutic classes shall not be subject to prior
15		approval as a result of the 4-prescription limit:
16		immunosuppressant drugs, oncolytic drugs, and anti-retroviral
17		drugs, and, on or after July 1, 2014, antipsychotic drugs. On
18		or after July 1, 2014, the Department may exempt children with
19		complex medical needs enrolled in a care coordination entity
20		contracted with the Department to solely coordinate care for
21		such children, if the Department determines that the entity has
22		a comprehensive drug reconciliation program.
23		(k) No medication therapy management program implemented
24		by the Department shall be contrary to the provisions of the
25		Pharmacy Practice Act.
26		(l) Any provider enrolled with the Department that bills

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1		the Department for outpatient drugs and is eligible to enroll
2		in the federal Drug Pricing Program under Section 340B of the
3		federal Public Health Services Act shall enroll in that
4		program. No entity participating in the federal Drug Pricing
5		Program under Section 340B of the federal Public Health
6		Services Act may exclude Medicaid from their participation in
7		that program, although the Department may exclude entities
8		defined in Section 1905(l)(2)(B) of the Social Security Act
9		from this requirement.
10		(Source: P.A. 97-38, eff. 6-28-11; 97-74, eff. 6-30-11; 97-333,
11		eff. 8-12-11; 97-426, eff. 1-1-12; 97-689, eff. 6-14-12;
12		97-813, eff. 7-13-12; 98-463, eff. 8-16-13.)
13		(305 ILCS 5/5-30)
14		Sec. 5-30. Care coordination.
15		(a) At least 50% of recipients eligible for comprehensive
16		medical benefits in all medical assistance programs or other
17		health benefit programs administered by the Department,
18		including the Children's Health Insurance Program Act and the
19		Covering ALL KIDS Health Insurance Act, shall be enrolled in a
20		care coordination program by no later than January 1, 2015. For
21		purposes of this Section, "coordinated care" or "care
22		coordination" means delivery systems where recipients will
23		receive their care from providers who participate under
24		contract in integrated delivery systems that are responsible
25		for providing or arranging the majority of care, including

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1		primary care physician services, referrals from primary care
2		physicians, diagnostic and treatment services, behavioral
3		health services, in-patient and outpatient hospital services,
4		dental services, and rehabilitation and long-term care
5		services. The Department shall designate or contract for such
6		integrated delivery systems (i) to ensure enrollees have a
7		choice of systems and of primary care providers within such
8		systems; (ii) to ensure that enrollees receive quality care in
9		a culturally and linguistically appropriate manner; and (iii)
10		to ensure that coordinated care programs meet the diverse needs
11		of enrollees with developmental, mental health, physical, and
12		age-related disabilities.
13		(b) Payment for such coordinated care shall be based on
14		arrangements where the State pays for performance related to
15		health care outcomes, the use of evidence-based practices, the
16		use of primary care delivered through comprehensive medical
17		homes, the use of electronic medical records, and the
18		appropriate exchange of health information electronically made
19		either on a capitated basis in which a fixed monthly premium
20		per recipient is paid and full financial risk is assumed for
21		the delivery of services, or through other risk-based payment
22		arrangements.
23		(c) To qualify for compliance with this Section, the 50%
24		goal shall be achieved by enrolling medical assistance
25		enrollees from each medical assistance enrollment category,
26		including parents, children, seniors, and people with

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1		disabilities to the extent that current State Medicaid payment
2		laws would not limit federal matching funds for recipients in
3		care coordination programs. In addition, services must be more
4		comprehensively defined and more risk shall be assumed than in
5		the Department's primary care case management program as of the
6		effective date of this amendatory Act of the 96th General
7		Assembly.
8		(d) The Department shall report to the General Assembly in
9		a separate part of its annual medical assistance program
10		report, beginning April, 2012 until April, 2016, on the
11		progress and implementation of the care coordination program
12		initiatives established by the provisions of this amendatory
13		Act of the 96th General Assembly. The Department shall include
14		in its April 2011 report a full analysis of federal laws or
15		regulations regarding upper payment limitations to providers
16		and the necessary revisions or adjustments in rate
17		methodologies and payments to providers under this Code that
18		would be necessary to implement coordinated care with full
19		financial risk by a party other than the Department.
20		(e) Integrated Care Program for individuals with chronic
21		mental health conditions.
22		(1) The Integrated Care Program shall encompass
23		services administered to recipients of medical assistance
24		under this Article to prevent exacerbations and
25		complications using cost-effective, evidence-based
26		practice guidelines and mental health management

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1		strategies.
2		(2) The Department may utilize and expand upon existing
3		contractual arrangements with integrated care plans under
4		the Integrated Care Program for providing the coordinated
5		care provisions of this Section.
6		(3) Payment for such coordinated care shall be based on
7		arrangements where the State pays for performance related
8		to mental health outcomes on a capitated basis in which a
9		fixed monthly premium per recipient is paid and full
10		financial risk is assumed for the delivery of services, or
11		through other risk-based payment arrangements such as
12		provider-based care coordination.
13		(4) The Department shall examine whether chronic
14		mental health management programs and services for
15		recipients with specific chronic mental health conditions
16		do any or all of the following:
17		(A) Improve the patient's overall mental health in
18		a more expeditious and cost-effective manner.
19		(B) Lower costs in other aspects of the medical
20		assistance program, such as hospital admissions,
21		emergency room visits, or more frequent and
22		inappropriate psychotropic drug use.
23		(5) The Department shall work with the facilities and
24		any integrated care plan participating in the program to
25		identify and correct barriers to the successful
26		implementation of this subsection (e) prior to and during

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1		the implementation to best facilitate the goals and
2		objectives of this subsection (e).
3		(f) A hospital that is located in a county of the State in
4		which the Department mandates some or all of the beneficiaries
5		of the Medical Assistance Program residing in the county to
6		enroll in a Care Coordination Program, as set forth in Section
7		5-30 of this Code, shall not be eligible for any non-claims
8		based payments not mandated by Article V-A of this Code for
9		which it would otherwise be qualified to receive, unless the
10		hospital is a Coordinated Care Participating Hospital no later
11		than 60 days after the effective date of this amendatory Act of
12		the 97th General Assembly or 60 days after the first mandatory
13		enrollment of a beneficiary in a Coordinated Care program. For
14		purposes of this subsection, "Coordinated Care Participating
15		Hospital" means a hospital that meets one of the following
16		criteria:
17		(1) The hospital has entered into a contract to provide
18		hospital services with one or more MCOs to enrollees of the
19		care coordination program.
20		(2) The hospital has not been offered a contract by a
21		care coordination plan that the Department has determined
22		to be a good faith offer and that pays at least as much as
23		the Department would pay, on a fee-for-service basis, not
24		including disproportionate share hospital adjustment
25		payments or any other supplemental adjustment or add-on
26		payment to the base fee-for-service rate, except to the

SB0741 Enrolled - 49 - LRB098 04975 KTG 35005 b
1		extent such adjustments or add-on payments are
2		incorporated into the development of the applicable MCO
3		capitated rates.
4		As used in this subsection (f), "MCO" means any entity
5		which contracts with the Department to provide services where
6		payment for medical services is made on a capitated basis.
7		(g) No later than August 1, 2013, the Department shall
8		issue a purchase of care solicitation for Accountable Care
9		Entities (ACE) to serve any children and parents or caretaker
10		relatives of children eligible for medical assistance under
11		this Article. An ACE may be a single corporate structure or a
12		network of providers organized through contractual
13		relationships with a single corporate entity. The solicitation
14		shall require that:
15		(1) An ACE operating in Cook County be capable of
16		serving at least 40,000 eligible individuals in that
17		county; an ACE operating in Lake, Kane, DuPage, or Will
18		Counties be capable of serving at least 20,000 eligible
19		individuals in those counties and an ACE operating in other
20		regions of the State be capable of serving at least 10,000
21		eligible individuals in the region in which it operates.
22		During initial periods of mandatory enrollment, the
23		Department shall require its enrollment services
24		contractor to use a default assignment algorithm that
25		ensures if possible an ACE reaches the minimum enrollment
26		levels set forth in this paragraph.

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1		(2) An ACE must include at a minimum the following
2		types of providers: primary care, specialty care,
3		hospitals, and behavioral healthcare.
4		(3) An ACE shall have a governance structure that
5		includes the major components of the health care delivery
6		system, including one representative from each of the
7		groups listed in paragraph (2).
8		(4) An ACE must be an integrated delivery system,
9		including a network able to provide the full range of
10		services needed by Medicaid beneficiaries and system
11		capacity to securely pass clinical information across
12		participating entities and to aggregate and analyze that
13		data in order to coordinate care.
14		(5) An ACE must be capable of providing both care
15		coordination and complex case management, as necessary, to
16		beneficiaries. To be responsive to the solicitation, a
17		potential ACE must outline its care coordination and
18		complex case management model and plan to reduce the cost
19		of care.
20		(6) In the first 18 months of operation, unless the ACE
21		selects a shorter period, an ACE shall be paid care
22		coordination fees on a per member per month basis that are
23		projected to be cost neutral to the State during the term
24		of their payment and, subject to federal approval, be
25		eligible to share in additional savings generated by their
26		care coordination.

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1		(7) In months 19 through 36 of operation, unless the
2		ACE selects a shorter period, an ACE shall be paid on a
3		pre-paid capitation basis for all medical assistance
4		covered services, under contract terms similar to Managed
5		Care Organizations (MCO), with the Department sharing the
6		risk through either stop-loss insurance for extremely high
7		cost individuals or corridors of shared risk based on the
8		overall cost of the total enrollment in the ACE. The ACE
9		shall be responsible for claims processing, encounter data
10		submission, utilization control, and quality assurance.
11		(8) In the fourth and subsequent years of operation, an
12		ACE shall convert to a Managed Care Community Network
13		(MCCN), as defined in this Article, or Health Maintenance
14		Organization pursuant to the Illinois Insurance Code,
15		accepting full-risk capitation payments.
16		The Department shall allow potential ACE entities 5 months
17		from the date of the posting of the solicitation to submit
18		proposals. After the solicitation is released, in addition to
19		the MCO rate development data available on the Department's
20		website, subject to federal and State confidentiality and
21		privacy laws and regulations, the Department shall provide 2
22		years of de-identified summary service data on the targeted
23		population, split between children and adults, showing the
24		historical type and volume of services received and the cost of
25		those services to those potential bidders that sign a data use
26		agreement. The Department may add up to 2 non-state government

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1		employees with expertise in creating integrated delivery
2		systems to its review team for the purchase of care
3		solicitation described in this subsection. Any such
4		individuals must sign a no-conflict disclosure and
5		confidentiality agreement and agree to act in accordance with
6		all applicable State laws.
7		During the first 2 years of an ACE's operation, the
8		Department shall provide claims data to the ACE on its
9		enrollees on a periodic basis no less frequently than monthly.
10		Nothing in this subsection shall be construed to limit the
11		Department's mandate to enroll 50% of its beneficiaries into
12		care coordination systems by January 1, 2015, using all
13		available care coordination delivery systems, including Care
14		Coordination Entities (CCE), MCCNs, or MCOs, nor be construed
15		to affect the current CCEs, MCCNs, and MCOs selected to serve
16		seniors and persons with disabilities prior to that date.
17		Nothing in this subsection precludes the Department from
18		considering future proposals for new ACEs or expansion of
19		existing ACEs at the discretion of the Department.
20		(h) Department contracts with MCOs and other entities
21		reimbursed by risk based capitation shall have a minimum
22		medical loss ratio of 85%, shall require the MCO or other
23		entity to pay claims within 30 days of receiving a bill that
24		contains all the essential information needed to adjudicate the
25		bill, and shall require the entity to pay a penalty that is at
26		least equal to the penalty imposed under the Illinois Insurance

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1		Code for any claims not paid within this time period shall
2		require the entity to establish an appeals and grievances
3		process for consumers and providers, and shall require the
4		entity to provide a quality assurance and utilization review
5		program. Entities contracted with the Department to coordinate
6		healthcare regardless of risk shall be measured utilizing the
7		same quality metrics. The quality metrics may be population
8		specific. Any contracted entity serving at least 5,000 seniors
9		or people with disabilities or 15,000 individuals in other
10		populations covered by the Medical Assistance Program that has
11		been receiving full-risk capitation for a year shall be
12		accredited by a national accreditation organization authorized
13		by the Department within 2 years after the date it is eligible
14		to become accredited. The requirements of this subsection shall
15		apply to contracts with MCOs entered into or renewed or
16		extended after June 1, 2013.
17		(h-5) The Department shall monitor and enforce compliance
18		by MCOs with agreements they have entered into with providers
19		on issues that include, but are not limited to, timeliness of
20		payment, payment rates, and processes for obtaining prior
21		approval. The Department may impose sanctions on MCOs for
22		violating provisions of those agreements that include, but are
23		not limited to, financial penalties, suspension of enrollment
24		of new enrollees, and termination of the MCO's contract with
25		the Department. As used in this subsection (h-5), "MCO" has the
26		meaning ascribed to that term in Section 5-30.1 of this Code.

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1		(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
2		(305 ILCS 5/5-30.1 new)
3		Sec. 5-30.1. Managed care protections.
4		(a) As used in this Section:
5		"Managed care organization" or "MCO" means any entity which
6		contracts with the Department to provide services where payment
7		for medical services is made on a capitated basis.
8		"Emergency services" include:
9		(1) emergency services, as defined by Section 10 of the
10		Managed Care Reform and Patient Rights Act;
11		(2) emergency medical screening examinations, as
12		defined by Section 10 of the Managed Care Reform and
13		Patient Rights Act;
14		(3) post-stabilization medical services, as defined by
15		Section 10 of the Managed Care Reform and Patient Rights
16		Act; and
17		(4) emergency medical conditions, as defined by
18		Section 10 of the Managed Care Reform and Patient Rights
19		Act.
20		(b) As provided by Section 5-16.12, managed care
21		organizations are subject to the provisions of the Managed Care
22		Reform and Patient Rights Act.
23		(c) An MCO shall pay any provider of emergency services
24		that does not have in effect a contract with the contracted
25		Medicaid MCO. The default rate of reimbursement shall be the

SB0741 Enrolled - 55 - LRB098 04975 KTG 35005 b
1		rate paid under Illinois Medicaid fee-for-service program
2		methodology, including all policy adjusters, including but not
3		limited to Medicaid High Volume Adjustments, Medicaid
4		Percentage Adjustments, Outpatient High Volume Adjustments,
5		and all outlier add-on adjustments to the extent such
6		adjustments are incorporated in the development of the
7		applicable MCO capitated rates.
8		(d) An MCO shall pay for all post-stabilization services as
9		a covered service in any of the following situations:
10		(1) the MCO authorized such services;
11		(2) such services were administered to maintain the
12		enrollee's stabilized condition within one hour after a
13		request to the MCO for authorization of further
14		post-stabilization services;
15		(3) the MCO did not respond to a request to authorize
16		such services within one hour;
17		(4) the MCO could not be contacted; or
18		(5) the MCO and the treating provider, if the treating
19		provider is a non-affiliated provider, could not reach an
20		agreement concerning the enrollee's care and an affiliated
21		provider was unavailable for a consultation, in which case
22		the MCO must pay for such services rendered by the treating
23		non-affiliated provider until an affiliated provider was
24		reached and either concurred with the treating
25		non-affiliated provider's plan of care or assumed
26		responsibility for the enrollee's care. Such payment shall

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1		be made at the default rate of reimbursement paid under
2		Illinois Medicaid fee-for-service program methodology,
3		including all policy adjusters, including but not limited
4		to Medicaid High Volume Adjustments, Medicaid Percentage
5		Adjustments, Outpatient High Volume Adjustments and all
6		outlier add-on adjustments to the extent that such
7		adjustments are incorporated in the development of the
8		applicable MCO capitated rates.
9		(e) The following requirements apply to MCOs in determining
10		payment for all emergency services:
11		(1) MCOs shall not impose any requirements for prior
12		approval of emergency services.
13		(2) The MCO shall cover emergency services provided to
14		enrollees who are temporarily away from their residence and
15		outside the contracting area to the extent that the
16		enrollees would be entitled to the emergency services if
17		they still were within the contracting area.
18		(3) The MCO shall have no obligation to cover medical
19		services provided on an emergency basis that are not
20		covered services under the contract.
21		(4) The MCO shall not condition coverage for emergency
22		services on the treating provider notifying the MCO of the
23		enrollee's screening and treatment within 10 days after
24		presentation for emergency services.
25		(5) The determination of the attending emergency
26		physician, or the provider actually treating the enrollee,

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1		of whether an enrollee is sufficiently stabilized for
2		discharge or transfer to another facility, shall be binding
3		on the MCO. The MCO shall cover emergency services for all
4		enrollees whether the emergency services are provided by an
5		affiliated or non-affiliated provider.
6		(6) The MCO's financial responsibility for
7		post-stabilization care services it has not pre-approved
8		ends when:
9		(A) a plan physician with privileges at the
10		treating hospital assumes responsibility for the
11		enrollee's care;
12		(B) a plan physician assumes responsibility for
13		the enrollee's care through transfer;
14		(C) a contracting entity representative and the
15		treating physician reach an agreement concerning the
16		enrollee's care; or
17		(D) the enrollee is discharged.
18		(f) Network adequacy.
19		(1) The Department shall:
20		(A) ensure that an adequate provider network is in
21		place, taking into consideration health professional
22		shortage areas and medically underserved areas;
23		(B) publicly release an explanation of its process
24		for analyzing network adequacy;
25		(C) periodically ensure that an MCO continues to
26		have an adequate network in place; and

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1		(D) require MCOs to maintain an updated and public
2		list of network providers.
3		(g) Timely payment of claims.
4		(1) The MCO shall pay a claim within 30 days of
5		receiving a claim that contains all the essential
6		information needed to adjudicate the claim.
7		(2) The MCO shall notify the billing party of its
8		inability to adjudicate a claim within 30 days of receiving
9		that claim.
10		(3) The MCO shall pay a penalty that is at least equal
11		to the penalty imposed under the Illinois Insurance Code
12		for any claims not timely paid.
13		(4) The Department may establish a process for MCOs to
14		expedite payments to providers based on criteria
15		established by the Department.
16		(h) The Department shall not expand mandatory MCO
17		enrollment into new counties beyond those counties already
18		designated by the Department as of June 1, 2014 for the
19		individuals whose eligibility for medical assistance is not the
20		seniors or people with disabilities population until the
21		Department provides an opportunity for accountable care
22		entities and MCOs to participate in such newly designated
23		counties.
24		(i) The requirements of this Section apply to contracts
25		with accountable care entities and MCOs entered into, amended,
26		or renewed after the effective date of this amendatory Act of

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1		the 98th General Assembly.
2		Article 10
3		Section 10-5. The Specialized Mental Health Rehabilitation
4		Act of 2013 is amended by changing Sections 1-101.5, 1-101.6,
5		1-102, 4-108, and 5-101 and by adding Section 4-108.5 as
6		follows:
7		(210 ILCS 49/1-101.5)
8		Sec. 1-101.5. Prior law.
9		(a) This Act provides for licensure of long term care
10		facilities that are federally designated as institutions for
11		the mentally diseased on the effective date of this Act and
12		specialize in providing services to individuals with a serious
13		mental illness. On and after the effective date of this Act,
14		these facilities shall be governed by this Act instead of the
15		Nursing Home Care Act.
16		(b) All consent decrees that apply to facilities federally
17		designated as institutions for the mentally diseased shall
18		continue to apply to facilities licensed under this Act.
19		(c) A facility licensed under this Act may voluntarily
20		close, and the facility may reopen in an underserved region of
21		the State, if the facility receives a certificate of need from
22		the Health Facilities and Services Review Board. At no time
23		shall the total number of licensed beds under this Act exceed

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1		the total number of licensed beds existing on July 22, 2013
2		(the effective date of Public Act 98-104).
3		(Source: P.A. 98-104, eff. 7-22-13.)
4		(210 ILCS 49/1-101.6)
5		Sec. 1-101.6. Mental health system planning. The General
6		Assembly finds the services contained in this Act are necessary
7		for the effective delivery of mental health services for the
8		citizens of the State of Illinois. The General Assembly also
9		finds that the mental health system in the State requires
10		further review to develop additional needed services. To ensure
11		the adequacy of community-based services and to offer choice to
12		all individuals with serious mental illness who choose to live
13		in the community, and for whom the community is the appropriate
14		setting, but are at risk of institutional care, the Governor
15		shall convene a working group to develop the process and
16		procedure for identifying needed services in the different
17		geographic regions of the State. The Governor shall include the
18		Division of Mental Health of the Department of Human Services,
19		the Department of Healthcare and Family Services, the
20		Department of Public Health, community mental health
21		providers, statewide associations of mental health providers,
22		mental health advocacy groups, and any other entity as deemed
23		appropriate for participation in the working group. The
24		Department of Human Services shall provide staff and support to
25		this working group.

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1		Before September 1, 2014, the State shall develop and
2		implement a service authorization system available 24 hours a
3		day, 7 days a week for approval of services in the following 3
4		levels of care under this Act: crisis stabilization; recovery
5		and rehabilitation supports; and transitional living units.
6		(Source: P.A. 98-104, eff. 7-22-13.)
7		(210 ILCS 49/1-102)
8		Sec. 1-102. Definitions. For the purposes of this Act,
9		unless the context otherwise requires:
10		"Abuse" means any physical or mental injury or sexual
11		assault inflicted on a consumer other than by accidental means
12		in a facility.
13		"Accreditation" means any of the following:
14		(1) the Joint Commission;
15		(2) the Commission on Accreditation of Rehabilitation
16		Facilities;
17		(3) the Healthcare Facilities Accreditation Program;
18		or
19		(4) any other national standards of care as approved by
20		the Department.
21		"Applicant" means any person making application for a
22		license or a provisional license under this Act.
23		"Consumer" means a person, 18 years of age or older,
24		admitted to a mental health rehabilitation facility for
25		evaluation, observation, diagnosis, treatment, stabilization,

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1		recovery, and rehabilitation.
2		"Consumer" does not mean any of the following:
3		(i) an individual requiring a locked setting;
4		(ii) an individual requiring psychiatric
5		hospitalization because of an acute psychiatric crisis;
6		(iii) an individual under 18 years of age;
7		(iv) an individual who is actively suicidal or violent
8		toward others;
9		(v) an individual who has been found unfit to stand
10		trial;
11		(vi) an individual who has been found not guilty by
12		reason of insanity based on committing a violent act, such
13		as sexual assault, assault with a deadly weapon, arson, or
14		murder;
15		(vii) an individual subject to temporary detention and
16		examination under Section 3-607 of the Mental Health and
17		Developmental Disabilities Code;
18		(viii) an individual deemed clinically appropriate for
19		inpatient admission in a State psychiatric hospital; and
20		(ix) an individual transferred by the Department of
21		Corrections pursuant to Section 3-8-5 of the Unified Code
22		of Corrections.
23		"Consumer record" means a record that organizes all
24		information on the care, treatment, and rehabilitation
25		services rendered to a consumer in a specialized mental health
26		rehabilitation facility.

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1		"Controlled drugs" means those drugs covered under the
2		federal Comprehensive Drug Abuse Prevention Control Act of
3		1970, as amended, or the Illinois Controlled Substances Act.
4		"Department" means the Department of Public Health.
5		"Discharge" means the full release of any consumer from a
6		facility.
7		"Drug administration" means the act in which a single dose
8		of a prescribed drug or biological is given to a consumer. The
9		complete act of administration entails removing an individual
10		dose from a container, verifying the dose with the prescriber's
11		orders, giving the individual dose to the consumer, and
12		promptly recording the time and dose given.
13		"Drug dispensing" means the act entailing the following of
14		a prescription order for a drug or biological and proper
15		selection, measuring, packaging, labeling, and issuance of the
16		drug or biological to a consumer.
17		"Emergency" means a situation, physical condition, or one
18		or more practices, methods, or operations which present
19		imminent danger of death or serious physical or mental harm to
20		consumers of a facility.
21		"Facility" means a specialized mental health
22		rehabilitation facility that provides at least one of the
23		following services: (1) triage center; (2) crisis
24		stabilization; (3) recovery and rehabilitation supports; or
25		(4) transitional living units for 3 or more persons. The
26		facility shall provide a 24-hour program that provides

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1		intensive support and recovery services designed to assist
2		persons, 18 years or older, with mental disorders to develop
3		the skills to become self-sufficient and capable of increasing
4		levels of independent functioning. It includes facilities that
5		meet the following criteria:
6		(1) 100% of the consumer population of the facility has
7		a diagnosis of serious mental illness;
8		(2) no more than 15% of the consumer population of the
9		facility is 65 years of age or older;
10		(3) none of the consumers are non-ambulatory;
11		(4) none of the consumers have a primary diagnosis of
12		moderate, severe, or profound intellectual disability; and
13		(5) the facility must have been licensed under the
14		Specialized Mental Health Rehabilitation Act or the
15		Nursing Home Care Act immediately preceding the effective
16		date of this Act and qualifies as a institute for mental
17		disease under the federal definition of the term.
18		"Facility" does not include the following:
19		(1) a home, institution, or place operated by the
20		federal government or agency thereof, or by the State of
21		Illinois;
22		(2) a hospital, sanitarium, or other institution whose
23		principal activity or business is the diagnosis, care, and
24		treatment of human illness through the maintenance and
25		operation as organized facilities therefor which is
26		required to be licensed under the Hospital Licensing Act;

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1		(3) a facility for child care as defined in the Child
2		Care Act of 1969;
3		(4) a community living facility as defined in the
4		Community Living Facilities Licensing Act;
5		(5) a nursing home or sanatorium operated solely by and
6		for persons who rely exclusively upon treatment by
7		spiritual means through prayer, in accordance with the
8		creed or tenets of any well-recognized church or religious
9		denomination; however, such nursing home or sanatorium
10		shall comply with all local laws and rules relating to
11		sanitation and safety;
12		(6) a facility licensed by the Department of Human
13		Services as a community-integrated living arrangement as
14		defined in the Community-Integrated Living Arrangements
15		Licensure and Certification Act;
16		(7) a supportive residence licensed under the
17		Supportive Residences Licensing Act;
18		(8) a supportive living facility in good standing with
19		the program established under Section 5-5.01a of the
20		Illinois Public Aid Code, except only for purposes of the
21		employment of persons in accordance with Section 3-206.01
22		of the Nursing Home Care Act;
23		(9) an assisted living or shared housing establishment
24		licensed under the Assisted Living and Shared Housing Act,
25		except only for purposes of the employment of persons in
26		accordance with Section 3-206.01 of the Nursing Home Care

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1		Act;
2		(10) an Alzheimer's disease management center
3		alternative health care model licensed under the
4		Alternative Health Care Delivery Act;
5		(11) a home, institution, or other place operated by or
6		under the authority of the Illinois Department of Veterans'
7		Affairs;
8		(12) a facility licensed under the ID/DD Community Care
9		Act; or
10		(13) a facility licensed under the Nursing Home Care
11		Act after the effective date of this Act.
12		"Executive director" means a person who is charged with the
13		general administration and supervision of a facility licensed
14		under this Act.
15		"Guardian" means a person appointed as a guardian of the
16		person or guardian of the estate, or both, of a consumer under
17		the Probate Act of 1975.
18		"Identified offender" means a person who meets any of the
19		following criteria:
20		(1) Has been convicted of, found guilty of, adjudicated
21		delinquent for, found not guilty by reason of insanity for,
22		or found unfit to stand trial for, any felony offense
23		listed in Section 25 of the Health Care Worker Background
24		Check Act, except for the following:
25		(i) a felony offense described in Section 10-5 of
26		the Nurse Practice Act;

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1		(ii) a felony offense described in Section 4, 5, 6,
2		8, or 17.02 of the Illinois Credit Card and Debit Card
3		Act;
4		(iii) a felony offense described in Section 5, 5.1,
5		5.2, 7, or 9 of the Cannabis Control Act;
6		(iv) a felony offense described in Section 401,
7		401.1, 404, 405, 405.1, 407, or 407.1 of the Illinois
8		Controlled Substances Act; and
9		(v) a felony offense described in the
10		Methamphetamine Control and Community Protection Act.
11		(2) Has been convicted of, adjudicated delinquent for,
12		found not guilty by reason of insanity for, or found unfit
13		to stand trial for, any sex offense as defined in
14		subsection (c) of Section 10 of the Sex Offender Management
15		Board Act.
16		"Transitional living units" are residential units within a
17		facility that have the purpose of assisting the consumer in
18		developing and reinforcing the necessary skills to live
19		independently outside of the facility. The duration of stay in
20		such a setting shall not exceed 120 days for each consumer.
21		Nothing in this definition shall be construed to be a
22		prerequisite for transitioning out of a facility.
23		"Licensee" means the person, persons, firm, partnership,
24		association, organization, company, corporation, or business
25		trust to which a license has been issued.
26		"Misappropriation of a consumer's property" means the

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1		deliberate misplacement, exploitation, or wrongful temporary
2		or permanent use of a consumer's belongings or money without
3		the consent of a consumer or his or her guardian.
4		"Neglect" means a facility's failure to provide, or willful
5		withholding of, adequate medical care, mental health
6		treatment, psychiatric rehabilitation, personal care, or
7		assistance that is necessary to avoid physical harm and mental
8		anguish of a consumer.
9		"Personal care" means assistance with meals, dressing,
10		movement, bathing, or other personal needs, maintenance, or
11		general supervision and oversight of the physical and mental
12		well-being of an individual who is incapable of maintaining a
13		private, independent residence or who is incapable of managing
14		his or her person, whether or not a guardian has been appointed
15		for such individual. "Personal care" shall not be construed to
16		confine or otherwise constrain a facility's pursuit to develop
17		the skills and abilities of a consumer to become
18		self-sufficient and capable of increasing levels of
19		independent functioning.
20		"Recovery and rehabilitation supports" means a program
21		that facilitates a consumer's longer-term symptom management
22		and stabilization while preparing the consumer for
23		transitional living units by improving living skills and
24		community socialization. The duration of stay in such a setting
25		shall be established by the Department by rule.
26		"Restraint" means:

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1		(i) a physical restraint that is any manual method or
2		physical or mechanical device, material, or equipment
3		attached or adjacent to a consumer's body that the consumer
4		cannot remove easily and restricts freedom of movement or
5		normal access to one's body; devices used for positioning,
6		including, but not limited to, bed rails, gait belts, and
7		cushions, shall not be considered to be restraints for
8		purposes of this Section; or
9		(ii) a chemical restraint that is any drug used for
10		discipline or convenience and not required to treat medical
11		symptoms; the Department shall, by rule, designate certain
12		devices as restraints, including at least all those devices
13		that have been determined to be restraints by the United
14		States Department of Health and Human Services in
15		interpretive guidelines issued for the purposes of
16		administering Titles XVIII and XIX of the federal Social
17		Security Act. For the purposes of this Act, restraint shall
18		be administered only after utilizing a coercive free
19		environment and culture.
20		"Self-administration of medication" means consumers shall
21		be responsible for the control, management, and use of their
22		own medication.
23		"Crisis stabilization" means a secure and separate unit
24		that provides short-term behavioral, emotional, or psychiatric
25		crisis stabilization as an alternative to hospitalization or
26		re-hospitalization for consumers from residential or community

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1		placement. The duration of stay in such a setting shall not
2		exceed 21 days for each consumer.
3		"Therapeutic separation" means the removal of a consumer
4		from the milieu to a room or area which is designed to aid in
5		the emotional or psychiatric stabilization of that consumer.
6		"Triage center" means a non-residential 23-hour center
7		that serves as an alternative to emergency room care,
8		hospitalization, or re-hospitalization for consumers in need
9		of short-term crisis stabilization. Consumers may access a
10		triage center from a number of referral sources, including
11		family, emergency rooms, hospitals, community behavioral
12		health providers, federally qualified health providers, or
13		schools, including colleges or universities. A triage center
14		may be located in a building separate from the licensed
15		location of a facility, but shall not be more than 1,000 feet
16		from the licensed location of the facility and must meet all of
17		the facility standards applicable to the licensed location. If
18		the triage center does operate in a separate building, safety
19		personnel shall be provided, on site, 24 hours per day and the
20		triage center shall meet all other staffing requirements
21		without counting any staff employed in the main facility
22		building.
23		(Source: P.A. 98-104, eff. 7-22-13.)
24		(210 ILCS 49/4-108)
25		Sec. 4-108. Surveys and inspections. The Department shall

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1		conduct surveys of licensed facilities and their certified
2		programs and services. The Department shall review the records
3		or premises, or both, as it deems appropriate for the purpose
4		of determining compliance with this Act and the rules
5		promulgated under this Act. The Department shall have access to
6		and may reproduce or photocopy any books, records, and other
7		documents maintained by the facility to the extent necessary to
8		carry out this Act and the rules promulgated under this Act.
9		The Department shall not divulge or disclose the contents of a
10		record under this Section as otherwise prohibited by this Act.
11		Any holder of a license or applicant for a license shall be
12		deemed to have given consent to any authorized officer,
13		employee, or agent of the Department to enter and inspect the
14		facility in accordance with this Article. Refusal to permit
15		such entry or inspection shall constitute grounds for denial,
16		suspension, or revocation of a license under this Act.
17		(1) The Department shall conduct surveys to determine
18		compliance and may conduct surveys to investigate
19		complaints.
20		(2) Determination of compliance with the service
21		requirements shall be based on a survey centered on
22		individuals that sample services being provided.
23		(3) Determination of compliance with the general
24		administrative requirements shall be based on a review of
25		facility records and observation of individuals and staff.
26		(4) The Department shall conduct surveys of licensed

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1		facilities and their certified programs and services to
2		determine the extent to which these facilities provide high
3		quality interventions, especially evidence-based
4		practices, appropriate to the assessed clinical needs of
5		individuals in the various levels of care.
6		(Source: P.A. 98-104, eff. 7-22-13.)
7		(210 ILCS 49/4-108.5 new)
8		Sec. 4-108.5. Provisional licensure period; surveys.
9		During the provisional licensure period, the Department shall
10		conduct surveys to determine compliance with timetables and
11		benchmarks with a facility's provisional licensure application
12		plan of operation. Timetables and benchmarks shall be
13		established in rule and shall include, but not be limited to,
14		the following: (1) training of new and existing staff; (2)
15		establishment of a data collection and reporting program for
16		the facility's Quality Assessment and Performance Improvement
17		Program; and (3) compliance with building environment
18		standards beyond compliance with Chapter 33 of the National
19		Fire Protection Association (NFPA) 101 Life Safety Code.
20		During the provisional licensure period, the Department
21		shall conduct State licensure surveys as well as a conformance
22		standard review to determine compliance with timetables and
23		benchmarks associated with the accreditation process.
24		Timetables and benchmarks shall be met in accordance with the
25		preferred accrediting organization conformance standards and

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1		recommendations and shall include, but not be limited to,
2		conducting a comprehensive facility self-evaluation in
3		accordance with an established national accreditation program.
4		The facility shall submit all data reporting and outcomes
5		required by accrediting organization to the Department of
6		Public Health for review to determine progress towards
7		accreditation. Accreditation status shall supplement but not
8		replace the State's licensure surveys of facilities licensed
9		under this Act and their certified programs and services to
10		determine the extent to which these facilities provide high
11		quality interventions, especially evidence-based practices,
12		appropriate to the assessed clinical needs of individuals in
13		the 4 certified levels of care.
14		Except for incidents involving the potential for harm,
15		serious harm, death, or substantial facility failure to address
16		a serious systemic issue within 60 days, findings of the
17		facility's root cause analysis of problems and the facility's
18		Quality Assessment and Performance Improvement program in
19		accordance with item (22) of Section 4-104 shall not be used as
20		a basis for non-compliance.
21		The Department shall have the authority to hire licensed
22		practitioners of the healing arts and qualified mental health
23		professionals to consult with and participate in survey and
24		inspection activities.
25		(210 ILCS 49/5-101)

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1		Sec. 5-101. Managed care entity, coordinated care entity,
2		and accountable care entity payments. For facilities licensed
3		by the Department of Public Health under this Act, the payment
4		for services provided shall be determined by negotiation with
5		managed care entities, coordinated care entities, or
6		accountable care entities. However, for 3 years after the
7		effective date of this Act, in no event shall the reimbursement
8		rate paid to facilities licensed under this Act be less than
9		the rate in effect on June 30, 2013 less $7.07 times the number
10		of occupied bed days, as that term is defined in Article V-B of
11		the Illinois Public Aid Code, for each facility previously
12		licensed under the Nursing Home Care Act on June 30, 2013; or
13		the rate in effect on June 30, 2013 for each facility licensed
14		under the Specialized Mental Health Rehabilitation Act on June
15		30, 2013. Any adjustment in the support component or the
16		capital component for facilities licensed by the Department of
17		Public Health under the Nursing Home Care Act shall apply
18		equally to facilities licensed by the Department of Public
19		Health under this Act for the duration of the provisional
20		licensure period as defined in Section 4-105 of this Act.
21		The Department of Healthcare and Family Services shall
22		publish a reimbursement rate for triage, crisis stabilization,
23		and transitional living services by December 1, 2014.
24		(Source: P.A. 98-104, eff. 7-22-13.)
25		Article 15

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1		Section 15-5. The Illinois Public Aid Code is amended by
2		changing Sections 5A-8 and 5A-12.2 as follows:
3		(305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
4		Sec. 5A-8. Hospital Provider Fund.
5		(a) There is created in the State Treasury the Hospital
6		Provider Fund. Interest earned by the Fund shall be credited to
7		the Fund. The Fund shall not be used to replace any moneys
8		appropriated to the Medicaid program by the General Assembly.
9		(b) The Fund is created for the purpose of receiving moneys
10		in accordance with Section 5A-6 and disbursing moneys only for
11		the following purposes, notwithstanding any other provision of
12		law:
13		(1) For making payments to hospitals as required under
14		this Code, under the Children's Health Insurance Program
15		Act, under the Covering ALL KIDS Health Insurance Act, and
16		under the Long Term Acute Care Hospital Quality Improvement
17		Transfer Program Act.
18		(2) For the reimbursement of moneys collected by the
19		Illinois Department from hospitals or hospital providers
20		through error or mistake in performing the activities
21		authorized under this Code.
22		(3) For payment of administrative expenses incurred by
23		the Illinois Department or its agent in performing
24		activities under this Code, under the Children's Health

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1		Insurance Program Act, under the Covering ALL KIDS Health
2		Insurance Act, and under the Long Term Acute Care Hospital
3		Quality Improvement Transfer Program Act.
4		(4) For payments of any amounts which are reimbursable
5		to the federal government for payments from this Fund which
6		are required to be paid by State warrant.
7		(5) For making transfers, as those transfers are
8		authorized in the proceedings authorizing debt under the
9		Short Term Borrowing Act, but transfers made under this
10		paragraph (5) shall not exceed the principal amount of debt
11		issued in anticipation of the receipt by the State of
12		moneys to be deposited into the Fund.
13		(6) For making transfers to any other fund in the State
14		treasury, but transfers made under this paragraph (6) shall
15		not exceed the amount transferred previously from that
16		other fund into the Hospital Provider Fund plus any
17		interest that would have been earned by that fund on the
18		monies that had been transferred.
19		(6.5) For making transfers to the Healthcare Provider
20		Relief Fund, except that transfers made under this
21		paragraph (6.5) shall not exceed $60,000,000 in the
22		aggregate.
23		(7) For making transfers not exceeding the following
24		amounts, related to in State fiscal years 2013 through 2018
25		and 2014, to the following designated funds:
26		Health and Human Services Medicaid Trust

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1		Fund..............................$20,000,000
2		Long-Term Care Provider Fund..........$30,000,000
3		General Revenue Fund.................$80,000,000.
4		Transfers under this paragraph shall be made within 7 days
5		after the payments have been received pursuant to the
6		schedule of payments provided in subsection (a) of Section
7		5A-4.
8		(7.1) (Blank). For making transfers not exceeding the
9		following amounts, in State fiscal year 2015, to the
10		following designated funds:
11		Health and Human Services Medicaid Trust
12		Fund..............................$10,000,000
13		Long-Term Care Provider Fund..........$15,000,000
14		General Revenue Fund.................$40,000,000.
15		Transfers under this paragraph shall be made within 7 days
16		after the payments have been received pursuant to the
17		schedule of payments provided in subsection (a) of Section
18		5A-4.
19		(7.5) (Blank).
20		(7.8) (Blank).
21		(7.9) (Blank).
22		(7.10) For State fiscal year years 2013 and 2014, for
23		making transfers of the moneys resulting from the
24		assessment under subsection (b-5) of Section 5A-2 and
25		received from hospital providers under Section 5A-4 and
26		transferred into the Hospital Provider Fund under Section

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1		5A-6 to the designated funds not exceeding the following
2		amounts in that State fiscal year:
3		Health Care Provider Relief Fund.....$100,000,000
4		$50,000,000
5		Transfers under this paragraph shall be made within 7
6		days after the payments have been received pursuant to the
7		schedule of payments provided in subsection (a) of Section
8		5A-4.
9		The additional amount of transfers in this paragraph
10		(7.10), authorized by this amendatory Act of the 98th
11		General Assembly, shall be made within 10 State business
12		days after the effective date of this amendatory Act of the
13		98th General Assembly. That authority shall remain in
14		effect even if this amendatory Act of the 98th General
15		Assembly does not become law until State fiscal year 2015.
16		(7.10a) For State fiscal years 2015 through 2018, for
17		making transfers of the moneys resulting from the
18		assessment under subsection (b-5) of Section 5A-2 and
19		received from hospital providers under Section 5A-4 and
20		transferred into the Hospital Provider Fund under Section
21		5A-6 to the designated funds not exceeding the following
22		amounts related to each State fiscal year:
23		Health Care Provider Relief
24		Fund .....................................$50,000,000
25		Transfers under this paragraph shall be made within 7
26		days after the payments have been received pursuant to the

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1		schedule of payments provided in subsection (a) of Section
2		5A-4.
3		(7.11) (Blank). For State fiscal year 2015, for making
4		transfers of the moneys resulting from the assessment under
5		subsection (b-5) of Section 5A-2 and received from hospital
6		providers under Section 5A-4 and transferred into the
7		Hospital Provider Fund under Section 5A-6 to the designated
8		funds not exceeding the following amounts in that State
9		fiscal year:
10		Health Care Provider Relief Fund......$25,000,000
11		Transfers under this paragraph shall be made within 7
12		days after the payments have been received pursuant to the
13		schedule of payments provided in subsection (a) of Section
14		5A-4.
15		(7.12) For State fiscal year 2013, for increasing by
16		21/365ths the transfer of the moneys resulting from the
17		assessment under subsection (b-5) of Section 5A-2 and
18		received from hospital providers under Section 5A-4 for the
19		portion of State fiscal year 2012 beginning June 10, 2012
20		through June 30, 2012 and transferred into the Hospital
21		Provider Fund under Section 5A-6 to the designated funds
22		not exceeding the following amounts in that State fiscal
23		year:
24		Health Care Provider Relief Fund......$2,870,000
25		Since the federal Centers for Medicare and Medicaid
26		Services approval of the assessment authorized under

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1		subsection (b-5) of Section 5A-2, received from hospital
2		providers under Section 5A-4 and the payment methodologies
3		to hospitals required under Section 5A-12.4 was not
4		received by the Department until State fiscal year 2014 and
5		since the Department made retroactive payments during
6		State fiscal year 2014 related to the referenced period of
7		June 2012, the transfer authority granted in this paragraph
8		(7.12) is extended through the date that is 10 State
9		business days after the effective date of this amendatory
10		Act of the 98th General Assembly.
11		(8) For making refunds to hospital providers pursuant
12		to Section 5A-10.
13		(9) For making payment to capitated managed care
14		organizations as described in subsections (s) and (t) of
15		Section 5A-12.2 of this Code.
16		Disbursements from the Fund, other than transfers
17		authorized under paragraphs (5) and (6) of this subsection,
18		shall be by warrants drawn by the State Comptroller upon
19		receipt of vouchers duly executed and certified by the Illinois
20		Department.
21		(c) The Fund shall consist of the following:
22		(1) All moneys collected or received by the Illinois
23		Department from the hospital provider assessment imposed
24		by this Article.
25		(2) All federal matching funds received by the Illinois
26		Department as a result of expenditures made by the Illinois

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1		Department that are attributable to moneys deposited in the
2		Fund.
3		(3) Any interest or penalty levied in conjunction with
4		the administration of this Article.
5		(3.5) As applicable, proceeds from surety bond
6		payments payable to the Department as referenced in
7		subsection (s) of Section 5A-12.2 of this Code.
8		(4) Moneys transferred from another fund in the State
9		treasury.
10		(5) All other moneys received for the Fund from any
11		other source, including interest earned thereon.
12		(d) (Blank).
13		(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
14		98-104, eff. 7-22-13; 98-463, eff. 8-16-13; revised 10-21-13.)
15		(305 ILCS 5/5A-12.2)
16		(Section scheduled to be repealed on January 1, 2015)
17		Sec. 5A-12.2. Hospital access payments on or after July 1,
18		2008.
19		(a) To preserve and improve access to hospital services,
20		for hospital services rendered on or after July 1, 2008, the
21		Illinois Department shall, except for hospitals described in
22		subsection (b) of Section 5A-3, make payments to hospitals as
23		set forth in this Section. These payments shall be paid in 12
24		equal installments on or before the seventh State business day
25		of each month, except that no payment shall be due within 100

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1		days after the later of the date of notification of federal
2		approval of the payment methodologies required under this
3		Section or any waiver required under 42 CFR 433.68, at which
4		time the sum of amounts required under this Section prior to
5		the date of notification is due and payable. Payments under
6		this Section are not due and payable, however, until (i) the
7		methodologies described in this Section are approved by the
8		federal government in an appropriate State Plan amendment and
9		(ii) the assessment imposed under this Article is determined to
10		be a permissible tax under Title XIX of the Social Security
11		Act.
12		(a-5) The Illinois Department may, when practicable,
13		accelerate the schedule upon which payments authorized under
14		this Section are made.
15		(b) Across-the-board inpatient adjustment.
16		(1) In addition to rates paid for inpatient hospital
17		services, the Department shall pay to each Illinois general
18		acute care hospital an amount equal to 40% of the total
19		base inpatient payments paid to the hospital for services
20		provided in State fiscal year 2005.
21		(2) In addition to rates paid for inpatient hospital
22		services, the Department shall pay to each freestanding
23		Illinois specialty care hospital as defined in 89 Ill. Adm.
24		Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
25		the total base inpatient payments paid to the hospital for
26		services provided in State fiscal year 2005.

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1		(3) In addition to rates paid for inpatient hospital
2		services, the Department shall pay to each freestanding
3		Illinois rehabilitation or psychiatric hospital an amount
4		equal to $1,000 per Medicaid inpatient day multiplied by
5		the increase in the hospital's Medicaid inpatient
6		utilization ratio (determined using the positive
7		percentage change from the rate year 2005 Medicaid
8		inpatient utilization ratio to the rate year 2007 Medicaid
9		inpatient utilization ratio, as calculated by the
10		Department for the disproportionate share determination).
11		(4) In addition to rates paid for inpatient hospital
12		services, the Department shall pay to each Illinois
13		children's hospital an amount equal to 20% of the total
14		base inpatient payments paid to the hospital for services
15		provided in State fiscal year 2005 and an additional amount
16		equal to 20% of the base inpatient payments paid to the
17		hospital for psychiatric services provided in State fiscal
18		year 2005.
19		(5) In addition to rates paid for inpatient hospital
20		services, the Department shall pay to each Illinois
21		hospital eligible for a pediatric inpatient adjustment
22		payment under 89 Ill. Adm. Code 148.298, as in effect for
23		State fiscal year 2007, a supplemental pediatric inpatient
24		adjustment payment equal to:
25		(i) For freestanding children's hospitals as
26		defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5

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1		multiplied by the hospital's pediatric inpatient
2		adjustment payment required under 89 Ill. Adm. Code
3		148.298, as in effect for State fiscal year 2008.
4		(ii) For hospitals other than freestanding
5		children's hospitals as defined in 89 Ill. Adm. Code
6		149.50(c)(3)(B), 1.0 multiplied by the hospital's
7		pediatric inpatient adjustment payment required under
8		89 Ill. Adm. Code 148.298, as in effect for State
9		fiscal year 2008.
10		(c) Outpatient adjustment.
11		(1) In addition to the rates paid for outpatient
12		hospital services, the Department shall pay each Illinois
13		hospital an amount equal to 2.2 multiplied by the
14		hospital's ambulatory procedure listing payments for
15		categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
16		148.140(b), for State fiscal year 2005.
17		(2) In addition to the rates paid for outpatient
18		hospital services, the Department shall pay each Illinois
19		freestanding psychiatric hospital an amount equal to 3.25
20		multiplied by the hospital's ambulatory procedure listing
21		payments for category 5b, as defined in 89 Ill. Adm. Code
22		148.140(b)(1)(E), for State fiscal year 2005.
23		(d) Medicaid high volume adjustment. In addition to rates
24		paid for inpatient hospital services, the Department shall pay
25		to each Illinois general acute care hospital that provided more
26		than 20,500 Medicaid inpatient days of care in State fiscal

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1		year 2005 amounts as follows:
2		(1) For hospitals with a case mix index equal to or
3		greater than the 85th percentile of hospital case mix
4		indices, $350 for each Medicaid inpatient day of care
5		provided during that period; and
6		(2) For hospitals with a case mix index less than the
7		85th percentile of hospital case mix indices, $100 for each
8		Medicaid inpatient day of care provided during that period.
9		(e) Capital adjustment. In addition to rates paid for
10		inpatient hospital services, the Department shall pay an
11		additional payment to each Illinois general acute care hospital
12		that has a Medicaid inpatient utilization rate of at least 10%
13		(as calculated by the Department for the rate year 2007
14		disproportionate share determination) amounts as follows:
15		(1) For each Illinois general acute care hospital that
16		has a Medicaid inpatient utilization rate of at least 10%
17		and less than 36.94% and whose capital cost is less than
18		the 60th percentile of the capital costs of all Illinois
19		hospitals, the amount of such payment shall equal the
20		hospital's Medicaid inpatient days multiplied by the
21		difference between the capital costs at the 60th percentile
22		of the capital costs of all Illinois hospitals and the
23		hospital's capital costs.
24		(2) For each Illinois general acute care hospital that
25		has a Medicaid inpatient utilization rate of at least
26		36.94% and whose capital cost is less than the 75th

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1		percentile of the capital costs of all Illinois hospitals,
2		the amount of such payment shall equal the hospital's
3		Medicaid inpatient days multiplied by the difference
4		between the capital costs at the 75th percentile of the
5		capital costs of all Illinois hospitals and the hospital's
6		capital costs.
7		(f) Obstetrical care adjustment.
8		(1) In addition to rates paid for inpatient hospital
9		services, the Department shall pay $1,500 for each Medicaid
10		obstetrical day of care provided in State fiscal year 2005
11		by each Illinois rural hospital that had a Medicaid
12		obstetrical percentage (Medicaid obstetrical days divided
13		by Medicaid inpatient days) greater than 15% for State
14		fiscal year 2005.
15		(2) In addition to rates paid for inpatient hospital
16		services, the Department shall pay $1,350 for each Medicaid
17		obstetrical day of care provided in State fiscal year 2005
18		by each Illinois general acute care hospital that was
19		designated a level III perinatal center as of December 31,
20		2006, and that had a case mix index equal to or greater
21		than the 45th percentile of the case mix indices for all
22		level III perinatal centers.
23		(3) In addition to rates paid for inpatient hospital
24		services, the Department shall pay $900 for each Medicaid
25		obstetrical day of care provided in State fiscal year 2005
26		by each Illinois general acute care hospital that was

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1		designated a level II or II+ perinatal center as of
2		December 31, 2006, and that had a case mix index equal to
3		or greater than the 35th percentile of the case mix indices
4		for all level II and II+ perinatal centers.
5		(g) Trauma adjustment.
6		(1) In addition to rates paid for inpatient hospital
7		services, the Department shall pay each Illinois general
8		acute care hospital designated as a trauma center as of
9		July 1, 2007, a payment equal to 3.75 multiplied by the
10		hospital's State fiscal year 2005 Medicaid capital
11		payments.
12		(2) In addition to rates paid for inpatient hospital
13		services, the Department shall pay $400 for each Medicaid
14		acute inpatient day of care provided in State fiscal year
15		2005 by each Illinois general acute care hospital that was
16		designated a level II trauma center, as defined in 89 Ill.
17		Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
18		2007.
19		(3) In addition to rates paid for inpatient hospital
20		services, the Department shall pay $235 for each Illinois
21		Medicaid acute inpatient day of care provided in State
22		fiscal year 2005 by each level I pediatric trauma center
23		located outside of Illinois that had more than 8,000
24		Illinois Medicaid inpatient days in State fiscal year 2005.
25		(h) Supplemental tertiary care adjustment. In addition to
26		rates paid for inpatient services, the Department shall pay to

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1		each Illinois hospital eligible for tertiary care adjustment
2		payments under 89 Ill. Adm. Code 148.296, as in effect for
3		State fiscal year 2007, a supplemental tertiary care adjustment
4		payment equal to the tertiary care adjustment payment required
5		under 89 Ill. Adm. Code 148.296, as in effect for State fiscal
6		year 2007.
7		(i) Crossover adjustment. In addition to rates paid for
8		inpatient services, the Department shall pay each Illinois
9		general acute care hospital that had a ratio of crossover days
10		to total inpatient days for medical assistance programs
11		administered by the Department (utilizing information from
12		2005 paid claims) greater than 50%, and a case mix index
13		greater than the 65th percentile of case mix indices for all
14		Illinois hospitals, a rate of $1,125 for each Medicaid
15		inpatient day including crossover days.
16		(j) Magnet hospital adjustment. In addition to rates paid
17		for inpatient hospital services, the Department shall pay to
18		each Illinois general acute care hospital and each Illinois
19		freestanding children's hospital that, as of February 1, 2008,
20		was recognized as a Magnet hospital by the American Nurses
21		Credentialing Center and that had a case mix index greater than
22		the 75th percentile of case mix indices for all Illinois
23		hospitals amounts as follows:
24		(1) For hospitals located in a county whose eligibility
25		growth factor is greater than the mean, $450 multiplied by
26		the eligibility growth factor for the county in which the

SB0741 Enrolled - 89 - LRB098 04975 KTG 35005 b
1		hospital is located for each Medicaid inpatient day of care
2		provided by the hospital during State fiscal year 2005.
3		(2) For hospitals located in a county whose eligibility
4		growth factor is less than or equal to the mean, $225
5		multiplied by the eligibility growth factor for the county
6		in which the hospital is located for each Medicaid
7		inpatient day of care provided by the hospital during State
8		fiscal year 2005.
9		For purposes of this subsection, "eligibility growth
10		factor" means the percentage by which the number of Medicaid
11		recipients in the county increased from State fiscal year 1998
12		to State fiscal year 2005.
13		(k) For purposes of this Section, a hospital that is
14		enrolled to provide Medicaid services during State fiscal year
15		2005 shall have its utilization and associated reimbursements
16		annualized prior to the payment calculations being performed
17		under this Section.
18		(l) For purposes of this Section, the terms "Medicaid
19		days", "ambulatory procedure listing services", and
20		"ambulatory procedure listing payments" do not include any
21		days, charges, or services for which Medicare or a managed care
22		organization reimbursed on a capitated basis was liable for
23		payment, except where explicitly stated otherwise in this
24		Section.
25		(m) For purposes of this Section, in determining the
26		percentile ranking of an Illinois hospital's case mix index or

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1		capital costs, hospitals described in subsection (b) of Section
2		5A-3 shall be excluded from the ranking.
3		(n) Definitions. Unless the context requires otherwise or
4		unless provided otherwise in this Section, the terms used in
5		this Section for qualifying criteria and payment calculations
6		shall have the same meanings as those terms have been given in
7		the Illinois Department's administrative rules as in effect on
8		March 1, 2008. Other terms shall be defined by the Illinois
9		Department by rule.
10		As used in this Section, unless the context requires
11		otherwise:
12		"Base inpatient payments" means, for a given hospital, the
13		sum of base payments for inpatient services made on a per diem
14		or per admission (DRG) basis, excluding those portions of per
15		admission payments that are classified as capital payments.
16		Disproportionate share hospital adjustment payments, Medicaid
17		Percentage Adjustments, Medicaid High Volume Adjustments, and
18		outlier payments, as defined by rule by the Department as of
19		January 1, 2008, are not base payments.
20		"Capital costs" means, for a given hospital, the total
21		capital costs determined using the most recent 2005 Medicare
22		cost report as contained in the Healthcare Cost Report
23		Information System file, for the quarter ending on December 31,
24		2006, divided by the total inpatient days from the same cost
25		report to calculate a capital cost per day. The resulting
26		capital cost per day is inflated to the midpoint of State

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1		fiscal year 2009 utilizing the national hospital market price
2		proxies (DRI) hospital cost index. If a hospital's 2005
3		Medicare cost report is not contained in the Healthcare Cost
4		Report Information System, the Department may obtain the data
5		necessary to compute the hospital's capital costs from any
6		source available, including, but not limited to, records
7		maintained by the hospital provider, which may be inspected at
8		all times during business hours of the day by the Illinois
9		Department or its duly authorized agents and employees.
10		"Case mix index" means, for a given hospital, the sum of
11		the DRG relative weighting factors in effect on January 1,
12		2005, for all general acute care admissions for State fiscal
13		year 2005, excluding Medicare crossover admissions and
14		transplant admissions reimbursed under 89 Ill. Adm. Code
15		148.82, divided by the total number of general acute care
16		admissions for State fiscal year 2005, excluding Medicare
17		crossover admissions and transplant admissions reimbursed
18		under 89 Ill. Adm. Code 148.82.
19		"Medicaid inpatient day" means, for a given hospital, the
20		sum of days of inpatient hospital days provided to recipients
21		of medical assistance under Title XIX of the federal Social
22		Security Act, excluding days for individuals eligible for
23		Medicare under Title XVIII of that Act (Medicaid/Medicare
24		crossover days), as tabulated from the Department's paid claims
25		data for admissions occurring during State fiscal year 2005
26		that was adjudicated by the Department through March 23, 2007.

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1		"Medicaid obstetrical day" means, for a given hospital, the
2		sum of days of inpatient hospital days grouped by the
3		Department to DRGs of 370 through 375 provided to recipients of
4		medical assistance under Title XIX of the federal Social
5		Security Act, excluding days for individuals eligible for
6		Medicare under Title XVIII of that Act (Medicaid/Medicare
7		crossover days), as tabulated from the Department's paid claims
8		data for admissions occurring during State fiscal year 2005
9		that was adjudicated by the Department through March 23, 2007.
10		"Outpatient ambulatory procedure listing payments" means,
11		for a given hospital, the sum of payments for ambulatory
12		procedure listing services, as described in 89 Ill. Adm. Code
13		148.140(b), provided to recipients of medical assistance under
14		Title XIX of the federal Social Security Act, excluding
15		payments for individuals eligible for Medicare under Title
16		XVIII of the Act (Medicaid/Medicare crossover days), as
17		tabulated from the Department's paid claims data for services
18		occurring in State fiscal year 2005 that were adjudicated by
19		the Department through March 23, 2007.
20		(o) The Department may adjust payments made under this
21		Section 5A-12.2 to comply with federal law or regulations
22		regarding hospital-specific payment limitations on
23		government-owned or government-operated hospitals.
24		(p) Notwithstanding any of the other provisions of this
25		Section, the Department is authorized to adopt rules that
26		change the hospital access improvement payments specified in

SB0741 Enrolled - 93 - LRB098 04975 KTG 35005 b
1		this Section, but only to the extent necessary to conform to
2		any federally approved amendment to the Title XIX State plan.
3		Any such rules shall be adopted by the Department as authorized
4		by Section 5-50 of the Illinois Administrative Procedure Act.
5		Notwithstanding any other provision of law, any changes
6		implemented as a result of this subsection (p) shall be given
7		retroactive effect so that they shall be deemed to have taken
8		effect as of the effective date of this Section.
9		(q) (Blank).
10		(r) On and after July 1, 2012, the Department shall reduce
11		any rate of reimbursement for services or other payments or
12		alter any methodologies authorized by this Code to reduce any
13		rate of reimbursement for services or other payments in
14		accordance with Section 5-5e.
15		(s) On or after July 1, 2014, but no later than October 1,
16		2014, and no less than annually thereafter, the Department may
17		increase capitation payments to capitated managed care
18		organizations (MCOs) to equal the aggregate reduction of
19		payments made in this Section and in Section 5A-12.4 by a
20		uniform percentage on a regional basis to preserve access to
21		hospital services for recipients under the Illinois Medical
22		Assistance Program. The aggregate amount of all increased
23		capitation payments to all MCOs for a fiscal year shall be the
24		amount needed to avoid reduction in payments authorized under
25		Section 5A-15. Payments to MCOs under this Section shall be
26		consistent with actuarial certification and shall be published

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1		by the Department each year. Each MCO shall only expend the
2		increased capitation payments it receives under this Section to
3		support the availability of hospital services and to ensure
4		access to hospital services, with such expenditures being made
5		within 15 calendar days from when the MCO receives the
6		increased capitation payment. The Department shall make
7		available, on a monthly basis, a report of the capitation
8		payments that are made to each MCO pursuant to this subsection,
9		including the number of enrollees for which such payment is
10		made, the per enrollee amount of the payment, and any
11		adjustments that have been made. Payments made under this
12		subsection shall be guaranteed by a surety bond obtained by the
13		MCO in an amount established by the Department to approximate
14		one month's liability of payments authorized under this
15		subsection. The Department may advance the payments guaranteed
16		by the surety bond. Payments to MCOs that would be paid
17		consistent with actuarial certification and enrollment in the
18		absence of the increased capitation payments under this Section
19		shall not be reduced as a consequence of payments made under
20		this subsection.
21		As used in this subsection, "MCO" means an entity which
22		contracts with the Department to provide services where payment
23		for medical services is made on a capitated basis.
24		(t) On or after July 1, 2014, the Department may increase
25		capitation payments to capitated managed care organizations
26		(MCOs) to equal the aggregate reduction of payments made in

SB0741 Enrolled - 95 - LRB098 04975 KTG 35005 b
1		Section 5A-12.5 to preserve access to hospital services for
2		recipients under the Illinois Medical Assistance Program.
3		Payments to MCOs under this Section shall be consistent with
4		actuarial certification and shall be published by the
5		Department each year. Each MCO shall only expend the increased
6		capitation payments it receives under this Section to support
7		the availability of hospital services and to ensure access to
8		hospital services, with such expenditures being made within 15
9		calendar days from when the MCO receives the increased
10		capitation payment. The Department may advance the payments to
11		hospitals under this subsection, in the event the MCO fails to
12		make such payments. The Department shall make available, on a
13		monthly basis, a report of the capitation payments that are
14		made to each MCO pursuant to this subsection, including the
15		number of enrollees for which such payment is made, the per
16		enrollee amount of the payment, and any adjustments that have
17		been made. Payments to MCOs that would be paid consistent with
18		actuarial certification and enrollment in the absence of the
19		increased capitation payments under this subsection shall not
20		be reduced as a consequence of payments made under this
21		subsection.
22		As used in this subsection, "MCO" means an entity which
23		contracts with the Department to provide services where payment
24		for medical services is made on a capitated basis.
25		(Source: P.A. 96-821, eff. 11-20-09; 97-689, eff. 6-14-12.)

SB0741 Enrolled - 96 - LRB098 04975 KTG 35005 b
1		Article 20
2		Section 20-5. The Illinois Administrative Procedure Act is
3		amended by changing Section 5-45 as follows:
4		(5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
5		Sec. 5-45. Emergency rulemaking.
6		(a) "Emergency" means the existence of any situation that
7		any agency finds reasonably constitutes a threat to the public
8		interest, safety, or welfare.
9		(b) If any agency finds that an emergency exists that
10		requires adoption of a rule upon fewer days than is required by
11		Section 5-40 and states in writing its reasons for that
12		finding, the agency may adopt an emergency rule without prior
13		notice or hearing upon filing a notice of emergency rulemaking
14		with the Secretary of State under Section 5-70. The notice
15		shall include the text of the emergency rule and shall be
16		published in the Illinois Register. Consent orders or other
17		court orders adopting settlements negotiated by an agency may
18		be adopted under this Section. Subject to applicable
19		constitutional or statutory provisions, an emergency rule
20		becomes effective immediately upon filing under Section 5-65 or
21		at a stated date less than 10 days thereafter. The agency's
22		finding and a statement of the specific reasons for the finding
23		shall be filed with the rule. The agency shall take reasonable
24		and appropriate measures to make emergency rules known to the

SB0741 Enrolled - 97 - LRB098 04975 KTG 35005 b
1		persons who may be affected by them.
2		(c) An emergency rule may be effective for a period of not
3		longer than 150 days, but the agency's authority to adopt an
4		identical rule under Section 5-40 is not precluded. No
5		emergency rule may be adopted more than once in any 24 month
6		period, except that this limitation on the number of emergency
7		rules that may be adopted in a 24 month period does not apply
8		to (i) emergency rules that make additions to and deletions
9		from the Drug Manual under Section 5-5.16 of the Illinois
10		Public Aid Code or the generic drug formulary under Section
11		3.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
12		emergency rules adopted by the Pollution Control Board before
13		July 1, 1997 to implement portions of the Livestock Management
14		Facilities Act, (iii) emergency rules adopted by the Illinois
15		Department of Public Health under subsections (a) through (i)
16		of Section 2 of the Department of Public Health Act when
17		necessary to protect the public's health, (iv) emergency rules
18		adopted pursuant to subsection (n) of this Section, (v)
19		emergency rules adopted pursuant to subsection (o) of this
20		Section, or (vi) emergency rules adopted pursuant to subsection
21		(c-5) of this Section. Two or more emergency rules having
22		substantially the same purpose and effect shall be deemed to be
23		a single rule for purposes of this Section.
24		(c-5) To facilitate the maintenance of the program of group
25		health benefits provided to annuitants, survivors, and retired
26		employees under the State Employees Group Insurance Act of

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1		1971, rules to alter the contributions to be paid by the State,
2		annuitants, survivors, retired employees, or any combination
3		of those entities, for that program of group health benefits,
4		shall be adopted as emergency rules. The adoption of those
5		rules shall be considered an emergency and necessary for the
6		public interest, safety, and welfare.
7		(d) In order to provide for the expeditious and timely
8		implementation of the State's fiscal year 1999 budget,
9		emergency rules to implement any provision of Public Act 90-587
10		or 90-588 or any other budget initiative for fiscal year 1999
11		may be adopted in accordance with this Section by the agency
12		charged with administering that provision or initiative,
13		except that the 24-month limitation on the adoption of
14		emergency rules and the provisions of Sections 5-115 and 5-125
15		do not apply to rules adopted under this subsection (d). The
16		adoption of emergency rules authorized by this subsection (d)
17		shall be deemed to be necessary for the public interest,
18		safety, and welfare.
19		(e) In order to provide for the expeditious and timely
20		implementation of the State's fiscal year 2000 budget,
21		emergency rules to implement any provision of this amendatory
22		Act of the 91st General Assembly or any other budget initiative
23		for fiscal year 2000 may be adopted in accordance with this
24		Section by the agency charged with administering that provision
25		or initiative, except that the 24-month limitation on the
26		adoption of emergency rules and the provisions of Sections

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1		5-115 and 5-125 do not apply to rules adopted under this
2		subsection (e). The adoption of emergency rules authorized by
3		this subsection (e) shall be deemed to be necessary for the
4		public interest, safety, and welfare.
5		(f) In order to provide for the expeditious and timely
6		implementation of the State's fiscal year 2001 budget,
7		emergency rules to implement any provision of this amendatory
8		Act of the 91st General Assembly or any other budget initiative
9		for fiscal year 2001 may be adopted in accordance with this
10		Section by the agency charged with administering that provision
11		or initiative, except that the 24-month limitation on the
12		adoption of emergency rules and the provisions of Sections
13		5-115 and 5-125 do not apply to rules adopted under this
14		subsection (f). The adoption of emergency rules authorized by
15		this subsection (f) shall be deemed to be necessary for the
16		public interest, safety, and welfare.
17		(g) In order to provide for the expeditious and timely
18		implementation of the State's fiscal year 2002 budget,
19		emergency rules to implement any provision of this amendatory
20		Act of the 92nd General Assembly or any other budget initiative
21		for fiscal year 2002 may be adopted in accordance with this
22		Section by the agency charged with administering that provision
23		or initiative, except that the 24-month limitation on the
24		adoption of emergency rules and the provisions of Sections
25		5-115 and 5-125 do not apply to rules adopted under this
26		subsection (g). The adoption of emergency rules authorized by

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1		this subsection (g) shall be deemed to be necessary for the
2		public interest, safety, and welfare.
3		(h) In order to provide for the expeditious and timely
4		implementation of the State's fiscal year 2003 budget,
5		emergency rules to implement any provision of this amendatory
6		Act of the 92nd General Assembly or any other budget initiative
7		for fiscal year 2003 may be adopted in accordance with this
8		Section by the agency charged with administering that provision
9		or initiative, except that the 24-month limitation on the
10		adoption of emergency rules and the provisions of Sections
11		5-115 and 5-125 do not apply to rules adopted under this
12		subsection (h). The adoption of emergency rules authorized by
13		this subsection (h) shall be deemed to be necessary for the
14		public interest, safety, and welfare.
15		(i) In order to provide for the expeditious and timely
16		implementation of the State's fiscal year 2004 budget,
17		emergency rules to implement any provision of this amendatory
18		Act of the 93rd General Assembly or any other budget initiative
19		for fiscal year 2004 may be adopted in accordance with this
20		Section by the agency charged with administering that provision
21		or initiative, except that the 24-month limitation on the
22		adoption of emergency rules and the provisions of Sections
23		5-115 and 5-125 do not apply to rules adopted under this
24		subsection (i). The adoption of emergency rules authorized by
25		this subsection (i) shall be deemed to be necessary for the
26		public interest, safety, and welfare.

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1		(j) In order to provide for the expeditious and timely
2		implementation of the provisions of the State's fiscal year
3		2005 budget as provided under the Fiscal Year 2005 Budget
4		Implementation (Human Services) Act, emergency rules to
5		implement any provision of the Fiscal Year 2005 Budget
6		Implementation (Human Services) Act may be adopted in
7		accordance with this Section by the agency charged with
8		administering that provision, except that the 24-month
9		limitation on the adoption of emergency rules and the
10		provisions of Sections 5-115 and 5-125 do not apply to rules
11		adopted under this subsection (j). The Department of Public Aid
12		may also adopt rules under this subsection (j) necessary to
13		administer the Illinois Public Aid Code and the Children's
14		Health Insurance Program Act. The adoption of emergency rules
15		authorized by this subsection (j) shall be deemed to be
16		necessary for the public interest, safety, and welfare.
17		(k) In order to provide for the expeditious and timely
18		implementation of the provisions of the State's fiscal year
19		2006 budget, emergency rules to implement any provision of this
20		amendatory Act of the 94th General Assembly or any other budget
21		initiative for fiscal year 2006 may be adopted in accordance
22		with this Section by the agency charged with administering that
23		provision or initiative, except that the 24-month limitation on
24		the adoption of emergency rules and the provisions of Sections
25		5-115 and 5-125 do not apply to rules adopted under this
26		subsection (k). The Department of Healthcare and Family

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1		Services may also adopt rules under this subsection (k)
2		necessary to administer the Illinois Public Aid Code, the
3		Senior Citizens and Disabled Persons Property Tax Relief Act,
4		the Senior Citizens and Disabled Persons Prescription Drug
5		Discount Program Act (now the Illinois Prescription Drug
6		Discount Program Act), and the Children's Health Insurance
7		Program Act. The adoption of emergency rules authorized by this
8		subsection (k) shall be deemed to be necessary for the public
9		interest, safety, and welfare.
10		(l) In order to provide for the expeditious and timely
11		implementation of the provisions of the State's fiscal year
12		2007 budget, the Department of Healthcare and Family Services
13		may adopt emergency rules during fiscal year 2007, including
14		rules effective July 1, 2007, in accordance with this
15		subsection to the extent necessary to administer the
16		Department's responsibilities with respect to amendments to
17		the State plans and Illinois waivers approved by the federal
18		Centers for Medicare and Medicaid Services necessitated by the
19		requirements of Title XIX and Title XXI of the federal Social
20		Security Act. The adoption of emergency rules authorized by
21		this subsection (l) shall be deemed to be necessary for the
22		public interest, safety, and welfare.
23		(m) In order to provide for the expeditious and timely
24		implementation of the provisions of the State's fiscal year
25		2008 budget, the Department of Healthcare and Family Services
26		may adopt emergency rules during fiscal year 2008, including

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1		rules effective July 1, 2008, in accordance with this
2		subsection to the extent necessary to administer the
3		Department's responsibilities with respect to amendments to
4		the State plans and Illinois waivers approved by the federal
5		Centers for Medicare and Medicaid Services necessitated by the
6		requirements of Title XIX and Title XXI of the federal Social
7		Security Act. The adoption of emergency rules authorized by
8		this subsection (m) shall be deemed to be necessary for the
9		public interest, safety, and welfare.
10		(n) In order to provide for the expeditious and timely
11		implementation of the provisions of the State's fiscal year
12		2010 budget, emergency rules to implement any provision of this
13		amendatory Act of the 96th General Assembly or any other budget
14		initiative authorized by the 96th General Assembly for fiscal
15		year 2010 may be adopted in accordance with this Section by the
16		agency charged with administering that provision or
17		initiative. The adoption of emergency rules authorized by this
18		subsection (n) shall be deemed to be necessary for the public
19		interest, safety, and welfare. The rulemaking authority
20		granted in this subsection (n) shall apply only to rules
21		promulgated during Fiscal Year 2010.
22		(o) In order to provide for the expeditious and timely
23		implementation of the provisions of the State's fiscal year
24		2011 budget, emergency rules to implement any provision of this
25		amendatory Act of the 96th General Assembly or any other budget
26		initiative authorized by the 96th General Assembly for fiscal

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1		year 2011 may be adopted in accordance with this Section by the
2		agency charged with administering that provision or
3		initiative. The adoption of emergency rules authorized by this
4		subsection (o) is deemed to be necessary for the public
5		interest, safety, and welfare. The rulemaking authority
6		granted in this subsection (o) applies only to rules
7		promulgated on or after the effective date of this amendatory
8		Act of the 96th General Assembly through June 30, 2011.
9		(p) In order to provide for the expeditious and timely
10		implementation of the provisions of Public Act 97-689,
11		emergency rules to implement any provision of Public Act 97-689
12		may be adopted in accordance with this subsection (p) by the
13		agency charged with administering that provision or
14		initiative. The 150-day limitation of the effective period of
15		emergency rules does not apply to rules adopted under this
16		subsection (p), and the effective period may continue through
17		June 30, 2013. The 24-month limitation on the adoption of
18		emergency rules does not apply to rules adopted under this
19		subsection (p). The adoption of emergency rules authorized by
20		this subsection (p) is deemed to be necessary for the public
21		interest, safety, and welfare.
22		(q) In order to provide for the expeditious and timely
23		implementation of the provisions of Articles 7, 8, 9, 11, and
24		12 of this amendatory Act of the 98th General Assembly,
25		emergency rules to implement any provision of Articles 7, 8, 9,
26		11, and 12 of this amendatory Act of the 98th General Assembly

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1		may be adopted in accordance with this subsection (q) by the
2		agency charged with administering that provision or
3		initiative. The 24-month limitation on the adoption of
4		emergency rules does not apply to rules adopted under this
5		subsection (q). The adoption of emergency rules authorized by
6		this subsection (q) is deemed to be necessary for the public
7		interest, safety, and welfare.
8		(r) In order to provide for the expeditious and timely
9		implementation of the provisions of this amendatory Act of the
10		98th General Assembly, emergency rules to implement this
11		amendatory Act of the 98th General Assembly may be adopted in
12		accordance with this subsection (r) by the Department of
13		Healthcare and Family Services. The 24-month limitation on the
14		adoption of emergency rules does not apply to rules adopted
15		under this subsection (r). The adoption of emergency rules
16		authorized by this subsection (r) is deemed to be necessary for
17		the public interest, safety, and welfare.
18		(Source: P.A. 97-689, eff. 6-14-12; 97-695, eff. 7-1-12;
19		98-104, eff. 7-22-13; 98-463, eff. 8-16-13.)
20		Section 20-10. The Children's Health Insurance Program Act
21		is amended by changing Section 7 as follows:
22		(215 ILCS 106/7)
23		Sec. 7. Eligibility verification. Notwithstanding any
24		other provision of this Act, with respect to applications for

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1		benefits provided under the Program, eligibility shall be
2		determined in a manner that ensures program integrity and that
3		complies with federal law and regulations while minimizing
4		unnecessary barriers to enrollment. To this end, as soon as
5		practicable, and unless the Department receives written denial
6		from the federal government, this Section shall be implemented:
7		(a) The Department of Healthcare and Family Services or its
8		designees shall:
9		(1) By no later than July 1, 2011, require verification
10		of, at a minimum, one month's income from all sources
11		required for determining the eligibility of applicants to
12		the Program. Such verification shall take the form of pay
13		stubs, business or income and expense records for
14		self-employed persons, letters from employers, and any
15		other valid documentation of income including data
16		obtained electronically by the Department or its designees
17		from other sources as described in subsection (b) of this
18		Section.
19		(2) By no later than October 1, 2011, require
20		verification of, at a minimum, one month's income from all
21		sources required for determining the continued eligibility
22		of recipients at their annual review of eligibility under
23		the Program. Such verification shall take the form of pay
24		stubs, business or income and expense records for
25		self-employed persons, letters from employers, and any
26		other valid documentation of income including data

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1		obtained electronically by the Department or its designees
2		from other sources as described in subsection (b) of this
3		Section. The Department shall send a notice to the
4		recipient at least 60 days prior to the end of the period
5		of eligibility that informs them of the requirements for
6		continued eligibility. If a recipient does not fulfill the
7		requirements for continued eligibility by the deadline
8		established in the notice, a notice of cancellation shall
9		be issued to the recipient and coverage shall end on the
10		last day of the eligibility period. A recipient's
11		eligibility may be reinstated without requiring a new
12		application if the recipient fulfills the requirements for
13		continued eligibility prior to the end of the third month
14		following the last date of coverage (or longer period if
15		required by federal regulations). Nothing in this Section
16		shall prevent an individual whose coverage has been
17		cancelled from reapplying for health benefits at any time.
18		(3) By no later than July 1, 2011, require verification
19		of Illinois residency.
20		(b) The Department shall establish or continue cooperative
21		arrangements with the Social Security Administration, the
22		Illinois Secretary of State, the Department of Human Services,
23		the Department of Revenue, the Department of Employment
24		Security, and any other appropriate entity to gain electronic
25		access, to the extent allowed by law, to information available
26		to those entities that may be appropriate for electronically

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1		verifying any factor of eligibility for benefits under the
2		Program. Data relevant to eligibility shall be provided for no
3		other purpose than to verify the eligibility of new applicants
4		or current recipients of health benefits under the Program.
5		Data will be requested or provided for any new applicant or
6		current recipient only insofar as that individual's
7		circumstances are relevant to that individual's or another
8		individual's eligibility.
9		(c) Within 90 days of the effective date of this amendatory
10		Act of the 96th General Assembly, the Department of Healthcare
11		and Family Services shall send notice to current recipients
12		informing them of the changes regarding their eligibility
13		verification.
14		(Source: P.A. 96-1501, eff. 1-25-11.)
15		Section 20-15. The Covering ALL KIDS Health Insurance Act
16		is amended by changing Sections 7 and 20 as follows:
17		(215 ILCS 170/7)
18		(Section scheduled to be repealed on July 1, 2016)
19		Sec. 7. Eligibility verification. Notwithstanding any
20		other provision of this Act, with respect to applications for
21		benefits provided under the Program, eligibility shall be
22		determined in a manner that ensures program integrity and that
23		complies with federal law and regulations while minimizing
24		unnecessary barriers to enrollment. To this end, as soon as

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1		practicable, and unless the Department receives written denial
2		from the federal government, this Section shall be implemented:
3		(a) The Department of Healthcare and Family Services or its
4		designees shall:
5		(1) By July 1, 2011, require verification of, at a
6		minimum, one month's income from all sources required for
7		determining the eligibility of applicants to the Program.
8		Such verification shall take the form of pay stubs,
9		business or income and expense records for self-employed
10		persons, letters from employers, and any other valid
11		documentation of income including data obtained
12		electronically by the Department or its designees from
13		other sources as described in subsection (b) of this
14		Section.
15		(2) By October 1, 2011, require verification of, at a
16		minimum, one month's income from all sources required for
17		determining the continued eligibility of recipients at
18		their annual review of eligibility under the Program. Such
19		verification shall take the form of pay stubs, business or
20		income and expense records for self-employed persons,
21		letters from employers, and any other valid documentation
22		of income including data obtained electronically by the
23		Department or its designees from other sources as described
24		in subsection (b) of this Section. The Department shall
25		send a notice to recipients at least 60 days prior to the
26		end of their period of eligibility that informs them of the

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1		requirements for continued eligibility. If a recipient
2		does not fulfill the requirements for continued
3		eligibility by the deadline established in the notice, a
4		notice of cancellation shall be issued to the recipient and
5		coverage shall end on the last day of the eligibility
6		period. A recipient's eligibility may be reinstated
7		without requiring a new application if the recipient
8		fulfills the requirements for continued eligibility prior
9		to the end of the third month following the last date of
10		coverage (or longer period if required by federal
11		regulations). Nothing in this Section shall prevent an
12		individual whose coverage has been cancelled from
13		reapplying for health benefits at any time.
14		(3) By July 1, 2011, require verification of Illinois
15		residency.
16		(b) The Department shall establish or continue cooperative
17		arrangements with the Social Security Administration, the
18		Illinois Secretary of State, the Department of Human Services,
19		the Department of Revenue, the Department of Employment
20		Security, and any other appropriate entity to gain electronic
21		access, to the extent allowed by law, to information available
22		to those entities that may be appropriate for electronically
23		verifying any factor of eligibility for benefits under the
24		Program. Data relevant to eligibility shall be provided for no
25		other purpose than to verify the eligibility of new applicants
26		or current recipients of health benefits under the Program.

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1		Data will be requested or provided for any new applicant or
2		current recipient only insofar as that individual's
3		circumstances are relevant to that individual's or another
4		individual's eligibility.
5		(c) Within 90 days of the effective date of this amendatory
6		Act of the 96th General Assembly, the Department of Healthcare
7		and Family Services shall send notice to current recipients
8		informing them of the changes regarding their eligibility
9		verification.
10		(Source: P.A. 96-1501, eff. 1-25-11.)
11		(215 ILCS 170/20)
12		(Section scheduled to be repealed on July 1, 2016)
13		Sec. 20. Eligibility.
14		(a) To be eligible for the Program, a person must be a
15		child:
16		(1) who is a resident of the State of Illinois;
17		(2) who is ineligible for medical assistance under the
18		Illinois Public Aid Code or benefits under the Children's
19		Health Insurance Program Act;
20		(3) who either (i) effective July 1, 2014, who has in
21		accordance with 42 CFR 457.805 (78 FR 42313, July 15, 2013)
22		or any other federal requirement necessary to obtain
23		federal financial participation for expenditures made
24		under this Act, has been without health insurance coverage
25		for 90 days; 12 months, (ii) whose parent has lost

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1		employment that made available affordable dependent health
2		insurance coverage, until such time as affordable
3		employer-sponsored dependent health insurance coverage is
4		again available for the child as set forth by the
5		Department in rules, (iii) (ii) who is a newborn whose
6		responsible relative does not have available affordable
7		private or employer-sponsored health insurance; or (iii) ,
8		or (iv) who, within one year of applying for coverage under
9		this Act, lost medical benefits under the Illinois Public
10		Aid Code or the Children's Health Insurance Program Act;
11		and
12		(3.5) whose household income, as determined, effective
13		October 1, 2013, by the Department, is at or below 300% of
14		the federal poverty level as determined in compliance with
15		42 U.S.C. 1397bb(b)(1)(B)(v) and applicable federal
16		regulations. This item (3.5) is effective July 1, 2011.
17		An entity that provides health insurance coverage (as
18		defined in Section 2 of the Comprehensive Health Insurance Plan
19		Act) to Illinois residents shall provide health insurance data
20		match to the Department of Healthcare and Family Services as
21		provided by and subject to Section 5.5 of the Illinois
22		Insurance Code. The Department of Healthcare and Family
23		Services may impose an administrative penalty as provided under
24		Section 12-4.45 of the Illinois Public Aid Code on entities
25		that have established a pattern of failure to provide the
26		information required under this Section.

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1		The Department of Healthcare and Family Services, in
2		collaboration with the Department of Insurance, shall adopt
3		rules governing the exchange of information under this Section.
4		The rules shall be consistent with all laws relating to the
5		confidentiality or privacy of personal information or medical
6		records, including provisions under the Federal Health
7		Insurance Portability and Accountability Act (HIPAA).
8		(b) The Department shall monitor the availability and
9		retention of employer-sponsored dependent health insurance
10		coverage and shall modify the period described in subdivision
11		(a)(3) if necessary to promote retention of private or
12		employer-sponsored health insurance and timely access to
13		healthcare services, but at no time shall the period described
14		in subdivision (a)(3) be less than 6 months.
15		(c) The Department, at its discretion, may take into
16		account the affordability of dependent health insurance when
17		determining whether employer-sponsored dependent health
18		insurance coverage is available upon reemployment of a child's
19		parent as provided in subdivision (a)(3).
20		(d) A child who is determined to be eligible for the
21		Program shall remain eligible for 12 months, provided that the
22		child maintains his or her residence in this State, has not yet
23		attained 19 years of age, and is not excluded under subsection
24		(e).
25		(e) A child is not eligible for coverage under the Program
26		if:

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1		(1) the premium required under Section 40 has not been
2		timely paid; if the required premiums are not paid, the
3		liability of the Program shall be limited to benefits
4		incurred under the Program for the time period for which
5		premiums have been paid; re-enrollment shall be completed
6		before the next covered medical visit, and the first
7		month's required premium shall be paid in advance of the
8		next covered medical visit; or
9		(2) the child is an inmate of a public institution or
10		an institution for mental diseases.
11		(f) The Department may adopt rules, including, but not
12		limited to: rules regarding annual renewals of eligibility for
13		the Program in conformance with Section 7 of this Act; rules
14		providing for re-enrollment, grace periods, notice
15		requirements, and hearing procedures under subdivision (e)(1)
16		of this Section; and rules regarding what constitutes
17		availability and affordability of private or
18		employer-sponsored health insurance, with consideration of
19		such factors as the percentage of income needed to purchase
20		children or family health insurance, the availability of
21		employer subsidies, and other relevant factors.
22		(g) Each child enrolled in the Program as of July 1, 2011
23		whose family income, as established by the Department, exceeds
24		300% of the federal poverty level may remain enrolled in the
25		Program for 12 additional months commencing July 1, 2011.
26		Continued enrollment pursuant to this subsection shall be

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1		available only if the child continues to meet all eligibility
2		criteria established under the Program as of the effective date
3		of this amendatory Act of the 96th General Assembly without a
4		break in coverage. Nothing contained in this subsection shall
5		prevent a child from qualifying for any other health benefits
6		program operated by the Department.
7		(Source: P.A. 98-130, eff. 8-2-13.)
8		Section 20-20. The Illinois Public Aid Code is amended by
9		changing Sections 5-2.1a and 11-5.1 as follows:
10		(305 ILCS 5/5-2.1a)
11		Sec. 5-2.1a. Treatment of trust amounts. To the extent
12		required by federal law, the Department of Healthcare and
13		Family Services Illinois Department shall provide by rule for
14		the consideration of trusts and similar legal instruments or
15		devices established by a person in the Illinois Department's
16		determination of the person's eligibility for and the amount of
17		assistance provided under this Article. This Section shall be
18		enforced by the Department of Human Services, acting as
19		successor to the Department of Public Aid under the Department
20		of Human Services Act.
21		(Source: P.A. 88-554, eff. 7-26-94; 89-507, eff. 7-1-97.)
22		(305 ILCS 5/11-5.1)
23		Sec. 11-5.1. Eligibility verification. Notwithstanding any

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1		other provision of this Code, with respect to applications for
2		medical assistance provided under Article V of this Code,
3		eligibility shall be determined in a manner that ensures
4		program integrity and complies with federal laws and
5		regulations while minimizing unnecessary barriers to
6		enrollment. To this end, as soon as practicable, and unless the
7		Department receives written denial from the federal
8		government, this Section shall be implemented:
9		(a) The Department of Healthcare and Family Services or its
10		designees shall:
11		(1) By no later than July 1, 2011, require verification
12		of, at a minimum, one month's income from all sources
13		required for determining the eligibility of applicants for
14		medical assistance under this Code. Such verification
15		shall take the form of pay stubs, business or income and
16		expense records for self-employed persons, letters from
17		employers, and any other valid documentation of income
18		including data obtained electronically by the Department
19		or its designees from other sources as described in
20		subsection (b) of this Section.
21		(2) By no later than October 1, 2011, require
22		verification of, at a minimum, one month's income from all
23		sources required for determining the continued eligibility
24		of recipients at their annual review of eligibility for
25		medical assistance under this Code. Such verification
26		shall take the form of pay stubs, business or income and

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1		expense records for self-employed persons, letters from
2		employers, and any other valid documentation of income
3		including data obtained electronically by the Department
4		or its designees from other sources as described in
5		subsection (b) of this Section. The Department shall send a
6		notice to recipients at least 60 days prior to the end of
7		their period of eligibility that informs them of the
8		requirements for continued eligibility. If a recipient
9		does not fulfill the requirements for continued
10		eligibility by the deadline established in the notice a
11		notice of cancellation shall be issued to the recipient and
12		coverage shall end on the last day of the eligibility
13		period. A recipient's eligibility may be reinstated
14		without requiring a new application if the recipient
15		fulfills the requirements for continued eligibility prior
16		to the end of the third month following the last date of
17		coverage (or longer period if required by federal
18		regulations). Nothing in this Section shall prevent an
19		individual whose coverage has been cancelled from
20		reapplying for health benefits at any time.
21		(3) By no later than July 1, 2011, require verification
22		of Illinois residency.
23		(b) The Department shall establish or continue cooperative
24		arrangements with the Social Security Administration, the
25		Illinois Secretary of State, the Department of Human Services,
26		the Department of Revenue, the Department of Employment

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1		Security, and any other appropriate entity to gain electronic
2		access, to the extent allowed by law, to information available
3		to those entities that may be appropriate for electronically
4		verifying any factor of eligibility for benefits under the
5		Program. Data relevant to eligibility shall be provided for no
6		other purpose than to verify the eligibility of new applicants
7		or current recipients of health benefits under the Program.
8		Data shall be requested or provided for any new applicant or
9		current recipient only insofar as that individual's
10		circumstances are relevant to that individual's or another
11		individual's eligibility.
12		(c) Within 90 days of the effective date of this amendatory
13		Act of the 96th General Assembly, the Department of Healthcare
14		and Family Services shall send notice to current recipients
15		informing them of the changes regarding their eligibility
16		verification.
17		(Source: P.A. 96-1501, eff. 1-25-11.)
18		Article 25
19		Section 25-5. The State Finance Act is amended by changing
20		Section 6z-30 as follows:
21		(30 ILCS 105/6z-30)
22		Sec. 6z-30. University of Illinois Hospital Services Fund.
23		(a) The University of Illinois Hospital Services Fund is

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1		created as a special fund in the State Treasury. The following
2		moneys shall be deposited into the Fund:
3		(1) As soon as possible after the beginning of fiscal
4		year 2010, and in no event later than July 30, the State
5		Comptroller and the State Treasurer shall automatically
6		transfer $30,000,000 from the General Revenue Fund to the
7		University of Illinois Hospital Services Fund.
8		(1.5) Starting in fiscal year 2011, as soon as possible
9		after the beginning of each fiscal year, and in no event
10		later than July 30, the State Comptroller and the State
11		Treasurer shall automatically transfer $45,000,000 from
12		the General Revenue Fund to the University of Illinois
13		Hospital Services Fund; except that, in fiscal year 2012
14		only, the State Comptroller and the State Treasurer shall
15		transfer $90,000,000 from the General Revenue Fund to the
16		University of Illinois Hospital Services Fund under this
17		paragraph, and, in fiscal year 2013 only, the State
18		Comptroller and the State Treasurer shall transfer no
19		amounts from the General Revenue Fund to the University of
20		Illinois Hospital Services Fund under this paragraph.
21		(2) All intergovernmental transfer payments to the
22		Department of Healthcare and Family Services by the
23		University of Illinois made pursuant to an
24		intergovernmental agreement under subsection (b) or (c) of
25		Section 5A-3 of the Illinois Public Aid Code.
26		(3) All federal matching funds received by the

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1		Department of Healthcare and Family Services (formerly
2		Illinois Department of Public Aid) as a result of
3		expenditures made by the Department that are attributable
4		to moneys that were deposited in the Fund.
5		(4) All other moneys received for the Fund from any
6		other source, including interest earned thereon.
7		(b) Moneys in the fund may be used by the Department of
8		Healthcare and Family Services, subject to appropriation and to
9		an interagency agreement between that Department and the Board
10		of Trustees of the University of Illinois, to reimburse the
11		University of Illinois Hospital for hospital and pharmacy
12		services, to reimburse practitioners who are employed by the
13		University of Illinois, to reimburse other health care
14		facilities and health plans operated by the University of
15		Illinois, and to pass through to the University of Illinois
16		federal financial participation earned by the State as a result
17		of expenditures made by the University of Illinois.
18		(c) (Blank).
19		(Source: P.A. 96-45, eff. 7-15-09; 96-959, eff. 7-1-10; 97-732,
20		eff. 6-30-12.)
21		Section 25-10. The Illinois Public Aid Code is amended by
22		changing Section 12-9 as follows:
23		(305 ILCS 5/12-9) (from Ch. 23, par. 12-9)
24		Sec. 12-9. Public Aid Recoveries Trust Fund; uses. The

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1		Public Aid Recoveries Trust Fund shall consist of (1)
2		recoveries by the Department of Healthcare and Family Services
3		(formerly Illinois Department of Public Aid) authorized by this
4		Code in respect to applicants or recipients under Articles III,
5		IV, V, and VI, including recoveries made by the Department of
6		Healthcare and Family Services (formerly Illinois Department
7		of Public Aid) from the estates of deceased recipients, (2)
8		recoveries made by the Department of Healthcare and Family
9		Services (formerly Illinois Department of Public Aid) in
10		respect to applicants and recipients under the Children's
11		Health Insurance Program Act, and the Covering ALL KIDS Health
12		Insurance Act, (2.5) recoveries made by the Department of
13		Healthcare and Family Services in connection with the
14		imposition of an administrative penalty as provided under
15		Section 12-4.45, (3) federal funds received on behalf of and
16		earned by State universities and local governmental entities
17		for services provided to applicants or recipients covered under
18		this Code, the Children's Health Insurance Program Act, and the
19		Covering ALL KIDS Health Insurance Act, (3.5) federal financial
20		participation revenue related to eligible disbursements made
21		by the Department of Healthcare and Family Services from
22		appropriations required by this Section, and (4) all other
23		moneys received to the Fund, including interest thereon. The
24		Fund shall be held as a special fund in the State Treasury.
25		Disbursements from this Fund shall be only (1) for the
26		reimbursement of claims collected by the Department of

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1		Healthcare and Family Services (formerly Illinois Department
2		of Public Aid) through error or mistake, (2) for payment to
3		persons or agencies designated as payees or co-payees on any
4		instrument, whether or not negotiable, delivered to the
5		Department of Healthcare and Family Services (formerly
6		Illinois Department of Public Aid) as a recovery under this
7		Section, such payment to be in proportion to the respective
8		interests of the payees in the amount so collected, (3) for
9		payments to the Department of Human Services for collections
10		made by the Department of Healthcare and Family Services
11		(formerly Illinois Department of Public Aid) on behalf of the
12		Department of Human Services under this Code, the Children's
13		Health Insurance Program Act, and the Covering ALL KIDS Health
14		Insurance Act, (4) for payment of administrative expenses
15		incurred in performing the activities authorized under this
16		Code, the Children's Health Insurance Program Act, and the
17		Covering ALL KIDS Health Insurance Act, (5) for payment of fees
18		to persons or agencies in the performance of activities
19		pursuant to the collection of monies owed the State that are
20		collected under this Code, the Children's Health Insurance
21		Program Act, and the Covering ALL KIDS Health Insurance Act,
22		(6) for payments of any amounts which are reimbursable to the
23		federal government which are required to be paid by State
24		warrant by either the State or federal government, and (7) for
25		payments to State universities and local governmental entities
26		of federal funds for services provided to applicants or

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1		recipients covered under this Code, the Children's Health
2		Insurance Program Act, and the Covering ALL KIDS Health
3		Insurance Act. Disbursements from this Fund for purposes of
4		items (4) and (5) of this paragraph shall be subject to
5		appropriations from the Fund to the Department of Healthcare
6		and Family Services (formerly Illinois Department of Public
7		Aid).
8		The balance in this Fund on the first day of each calendar
9		quarter, after payment therefrom of any amounts reimbursable to
10		the federal government, and minus the amount reasonably
11		anticipated to be needed to make the disbursements during that
12		quarter authorized by this Section during the current and
13		following 3 calendar months, shall be certified by the Director
14		of Healthcare and Family Services and transferred by the State
15		Comptroller to the Drug Rebate Fund or the Healthcare Provider
16		Relief Fund in the State Treasury, as appropriate, on at least
17		an annual basis by June 30th of each fiscal year within 30 days
18		of the first day of each calendar quarter. The Director of
19		Healthcare and Family Services may certify and the State
20		Comptroller shall transfer to the Drug Rebate Fund or the
21		Healthcare Provider Relief Fund amounts on a more frequent
22		basis.
23		On July 1, 1999, the State Comptroller shall transfer the
24		sum of $5,000,000 from the Public Aid Recoveries Trust Fund
25		(formerly the Public Assistance Recoveries Trust Fund) into the
26		DHS Recoveries Trust Fund.

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1		(Source: P.A. 97-647, eff. 1-1-12; 97-689, eff. 6-14-12;
2		98-130, eff. 8-2-13.)
3		Article 30
4		Section 30-5. The Illinois Public Aid Code is amended by
5		adding Section 5A-12.5 as follows:
6		(305 ILCS 5/5A-12.5 new)
7		Sec. 5A-12.5. Affordable Care Act adults; hospital access
8		payments. The Department shall, subject to federal approval,
9		mirror the Medical Assistance hospital reimbursement
10		methodology, including hospital access payments as defined in
11		Section 5A-12.2 of this Article and hospital access improvement
12		payments as defined in Section 5A-12.4 of this Article, in
13		compliance with the equivalent rate provisions of the
14		Affordable Care Act.
15		As used in this Section, "Affordable Care Act" is the
16		collective term for the Patient Protection and Affordable Care
17		Act (Pub. L. 111-148) and the Health Care and Education
18		Reconciliation Act of 2010 (Pub. L. 111-152).
19		Article 35
20		Section 35-5. The Hospital Licensing Act is amended by
21		changing Section 6.09 as follows:

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1		(210 ILCS 85/6.09) (from Ch. 111 1/2, par. 147.09)
2		Sec. 6.09. (a) In order to facilitate the orderly
3		transition of aged and disabled patients from hospitals to
4		post-hospital care, whenever a patient who qualifies for the
5		federal Medicare program is hospitalized, the patient shall be
6		notified of discharge at least 24 hours prior to discharge from
7		the hospital. With regard to pending discharges to a skilled
8		nursing facility, the hospital must notify the case
9		coordination unit, as defined in 89 Ill. Adm. Code 240.260, at
10		least 24 hours prior to discharge. When the assessment is
11		completed in the hospital, the case coordination unit shall
12		provide the discharge planner with a copy of the prescreening
13		information and accompanying materials, which the discharge
14		planner shall transmit when the patient is discharged to a
15		skilled nursing facility. If or, if home health services are
16		ordered, the hospital must inform its designated case
17		coordination unit, as defined in 89 Ill. Adm. Code 240.260, of
18		the pending discharge and must provide the patient with the
19		case coordination unit's telephone number and other contact
20		information.
21		(b) Every hospital shall develop procedures for a physician
22		with medical staff privileges at the hospital or any
23		appropriate medical staff member to provide the discharge
24		notice prescribed in subsection (a) of this Section. The
25		procedures must include prohibitions against discharging or

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1		referring a patient to any of the following if unlicensed,
2		uncertified, or unregistered: (i) a board and care facility, as
3		defined in the Board and Care Home Act; (ii) an assisted living
4		and shared housing establishment, as defined in the Assisted
5		Living and Shared Housing Act; (iii) a facility licensed under
6		the Nursing Home Care Act, the Specialized Mental Health
7		Rehabilitation Act of 2013, or the ID/DD Community Care Act;
8		(iv) a supportive living facility, as defined in Section
9		5-5.01a of the Illinois Public Aid Code; or (v) a free-standing
10		hospice facility licensed under the Hospice Program Licensing
11		Act if licensure, certification, or registration is required.
12		The Department of Public Health shall annually provide
13		hospitals with a list of licensed, certified, or registered
14		board and care facilities, assisted living and shared housing
15		establishments, nursing homes, supportive living facilities,
16		facilities licensed under the ID/DD Community Care Act or the
17		Specialized Mental Health Rehabilitation Act of 2013, and
18		hospice facilities. Reliance upon this list by a hospital shall
19		satisfy compliance with this requirement. The procedure may
20		also include a waiver for any case in which a discharge notice
21		is not feasible due to a short length of stay in the hospital
22		by the patient, or for any case in which the patient
23		voluntarily desires to leave the hospital before the expiration
24		of the 24 hour period.
25		(c) At least 24 hours prior to discharge from the hospital,
26		the patient shall receive written information on the patient's

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1		right to appeal the discharge pursuant to the federal Medicare
2		program, including the steps to follow to appeal the discharge
3		and the appropriate telephone number to call in case the
4		patient intends to appeal the discharge.
5		(d) Before transfer of a patient to a long term care
6		facility licensed under the Nursing Home Care Act where elderly
7		persons reside, a hospital shall as soon as practicable
8		initiate a name-based criminal history background check by
9		electronic submission to the Department of State Police for all
10		persons between the ages of 18 and 70 years; provided, however,
11		that a hospital shall be required to initiate such a background
12		check only with respect to patients who:
13		(1) are transferring to a long term care facility for
14		the first time;
15		(2) have been in the hospital more than 5 days;
16		(3) are reasonably expected to remain at the long term
17		care facility for more than 30 days;
18		(4) have a known history of serious mental illness or
19		substance abuse; and
20		(5) are independently ambulatory or mobile for more
21		than a temporary period of time.
22		A hospital may also request a criminal history background
23		check for a patient who does not meet any of the criteria set
24		forth in items (1) through (5).
25		A hospital shall notify a long term care facility if the
26		hospital has initiated a criminal history background check on a

SB0741 Enrolled - 128 - LRB098 04975 KTG 35005 b
1		patient being discharged to that facility. In all circumstances
2		in which the hospital is required by this subsection to
3		initiate the criminal history background check, the transfer to
4		the long term care facility may proceed regardless of the
5		availability of criminal history results. Upon receipt of the
6		results, the hospital shall promptly forward the results to the
7		appropriate long term care facility. If the results of the
8		background check are inconclusive, the hospital shall have no
9		additional duty or obligation to seek additional information
10		from, or about, the patient.
11		(Source: P.A. 97-38, eff. 6-28-11; 97-227, eff. 1-1-12; 97-813,
12		eff. 7-13-12; 98-104, eff. 7-22-13.)
13		Section 35-10. The Illinois Public Aid Code is amended by
14		changing Section 11-5.4 as follows:
15		(305 ILCS 5/11-5.4)
16		Sec. 11-5.4. Expedited long-term care eligibility
17		determination and enrollment.
18		(a) An expedited long-term care eligibility determination
19		and enrollment system shall be established to reduce long-term
20		care determinations to 90 days or fewer by July 1, 2014 and
21		streamline the long-term care enrollment process.
22		Establishment of the system shall be a joint venture of the
23		Department of Human Services and Healthcare and Family Services
24		and the Department on Aging. The Governor shall name a lead

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1		agency no later than 30 days after the effective date of this
2		amendatory Act of the 98th General Assembly to assume
3		responsibility for the full implementation of the
4		establishment and maintenance of the system. Project outcomes
5		shall include an enhanced eligibility determination tracking
6		system accessible to providers and a centralized application
7		review and eligibility determination with all applicants
8		reviewed within 90 days of receipt by the State of a complete
9		application. If the Department of Healthcare and Family
10		Services' Office of the Inspector General determines that there
11		is a likelihood that a non-allowable transfer of assets has
12		occurred, and the facility in which the applicant resides is
13		notified, an extension of up to 90 days shall be permissible.
14		On or before December 31, 2015, a streamlined application and
15		enrollment process shall be put in place based on the following
16		principles:
17		(1) Minimize the burden on applicants by collecting
18		only the data necessary to determine eligibility for
19		medical services, long-term care services, and spousal
20		impoverishment offset.
21		(2) Integrate online data sources to simplify the
22		application process by reducing the amount of information
23		needed to be entered and to expedite eligibility
24		verification.
25		(3) Provide online prompts to alert the applicant that
26		information is missing or not complete.

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1		(b) The Department shall, on or before July 1, 2014, assess
2		the feasibility of incorporating all information needed to
3		determine eligibility for long-term care services, including
4		asset transfer and spousal impoverishment financials, into the
5		State's integrated eligibility system identifying all
6		resources needed and reasonable timeframes for achieving the
7		specified integration.
8		(c) The lead agency shall file interim reports with the
9		Chairs and Minority Spokespersons of the House and Senate Human
10		Services Committees no later than September 1, 2013 and on
11		February 1, 2014. The Department of Healthcare and Family
12		Services shall include in the annual Medicaid report for State
13		Fiscal Year 2014 and every fiscal year thereafter information
14		concerning implementation of the provisions of this Section.
15		(d) No later than August 1, 2014, the Auditor General shall
16		report to the General Assembly concerning the extent to which
17		the timeframes specified in this Section have been met and the
18		extent to which State staffing levels are adequate to meet the
19		requirements of this Section.
20		(e) The Department of Healthcare and Family Services, the
21		Department of Human Services, and the Department on Aging shall
22		take the following steps to achieve federally established
23		timeframes for eligibility determinations for Medicaid and
24		long-term care benefits and shall work toward the federal goal
25		of real time determinations:
26		(1) The Departments shall review, in collaboration

SB0741 Enrolled - 131 - LRB098 04975 KTG 35005 b
1		with representatives of affected providers, all forms and
2		procedures currently in use, federal guidelines either
3		suggested or mandated, and staff deployment by September
4		30, 2014 to identify additional measures that can improve
5		long-term care eligibility processing and make adjustments
6		where possible.
7		(2) No later than June 30, 2014, the Department of
8		Healthcare and Family Services shall issue vouchers for
9		advance payments not to exceed $50,000,000 to nursing
10		facilities with significant outstanding Medicaid liability
11		associated with services provided to residents with
12		Medicaid applications pending and residents facing the
13		greatest delays. Each facility with an advance payment
14		shall state in writing whether its own recoupment schedule
15		will be in 3 or 6 equal monthly installments, as long as
16		all advances are recouped by June 30, 2015.
17		(3) The Department of Healthcare and Family Services'
18		Office of Inspector General and the Department of Human
19		Services shall immediately forgo resource review and
20		review of transfers during the relevant look-back period
21		for applications that were submitted prior to September 1,
22		2013. An applicant who applied prior to September 1, 2013,
23		who was denied for failure to cooperate in providing
24		required information, and whose application was
25		incorrectly reviewed under the wrong look-back period
26		rules may request review and correction of the denial based

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1		on this subsection. If found eligible upon review, such
2		applicants shall be retroactively enrolled.
3		(4) As soon as practicable, the Department of
4		Healthcare and Family Services shall implement policies
5		and promulgate rules to simplify financial eligibility
6		verification in the following instances: (A) for
7		applicants or recipients who are receiving Supplemental
8		Security Income payments or who had been receiving such
9		payments at the time they were admitted to a nursing
10		facility and (B) for applicants or recipients with verified
11		income at or below 100% of the federal poverty level when
12		the declared value of their countable resources is no
13		greater than the allowable amounts pursuant to Section 5-2
14		of this Code for classes of eligible persons for whom a
15		resource limit applies. Such simplified verification
16		policies shall apply to community cases as well as
17		long-term care cases.
18		(5) As soon as practicable, but not later than July 1,
19		2014, the Department of Healthcare and Family Services and
20		the Department of Human Services shall jointly begin a
21		special enrollment project by using simplified eligibility
22		verification policies and by redeploying caseworkers
23		trained to handle long-term care cases to prioritize those
24		cases, until the backlog is eliminated and processing time
25		is within 90 days. This project shall apply to applications
26		for long-term care received by the State on or before May

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1		15, 2014.
2		(6) As soon as practicable, but not later than
3		September 1, 2014, the Department on Aging shall make
4		available to long-term care facilities and community
5		providers upon request, through an electronic method, the
6		information contained within the Interagency Certification
7		of Screening Results completed by the pre-screener, in a
8		form and manner acceptable to the Department of Human
9		Services.
10		(7) Effective 30 days after the completion of 3
11		regionally based trainings, nursing facilities shall
12		submit all applications for medical assistance online via
13		the Application for Benefits Eligibility (ABE) website.
14		This requirement shall extend to scanning and uploading
15		with the online application any required additional forms
16		such as the Long Term Care Facility Notification and the
17		Additional Financial Information for Long Term Care
18		Applicants as well as scanned copies of any supporting
19		documentation. Long-term care facility admission documents
20		must be submitted as required in Section 5-5 of this Code.
21		No local Department of Human Services office shall refuse
22		to accept an electronically filed application.
23		(8) Notwithstanding any other provision of this Code,
24		the Department of Human Services and the Department of
25		Healthcare and Family Services' Office of the Inspector
26		General shall, upon request, allow an applicant additional

SB0741 Enrolled - 134 - LRB098 04975 KTG 35005 b
1		time to submit information and documents needed as part of
2		a review of available resources or resources transferred
3		during the look-back period. The initial extension shall
4		not exceed 30 days. A second extension of 30 days may be
5		granted upon request. Any request for information issued by
6		the State to an applicant shall include the following: an
7		explanation of the information required and the date by
8		which the information must be submitted; a statement that
9		failure to respond in a timely manner can result in denial
10		of the application; a statement that the applicant or the
11		facility in the name of the applicant may seek an
12		extension; and the name and contact information of a
13		caseworker in case of questions. Any such request for
14		information shall also be sent to the facility. In deciding
15		whether to grant an extension, the Department of Human
16		Services or the Department of Healthcare and Family
17		Services' Office of the Inspector General shall take into
18		account what is in the best interest of the applicant. The
19		time limits for processing an application shall be tolled
20		during the period of any extension granted under this
21		subsection.
22		(9) The Department of Human Services and the Department
23		of Healthcare and Family Services must jointly compile data
24		on pending applications and post a monthly report on each
25		Department's website for the purposes of monitoring
26		long-term care eligibility processing. The report must

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1		specify the number of applications pending long-term care
2		eligibility determination and admission in the following
3		categories:
4		(A) Length of time application is pending - 0 to 90
5		days, 91 days to 180 days, 181 days to 12 months, over
6		12 months to 18 months, over 18 months to 24 months,
7		and over 24 months.
8		(B) Percentage of applications pending in the
9		Department of Human Services' Family Community
10		Resource Centers, in the Department of Human Services'
11		long-term care hubs, with the Department of Healthcare
12		and Family Services' Office of Inspector General, and
13		those applications which are being tolled due to
14		requests for extension of time for additional
15		information.
16		(C) Status of pending applications.
17		(Source: P.A. 98-104, eff. 7-22-13.)
18		Article 40
19		Section 40-5. The Illinois Public Aid Code is amended by
20		changing Sections 5A-2, 5A-5, 5A-10, and 5A-14 as follows:
21		(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
22		(Section scheduled to be repealed on January 1, 2015)
23		Sec. 5A-2. Assessment.

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1		(a) Subject to Sections 5A-3 and 5A-10, for State fiscal
2		years 2009 through 2018 2014, and from July 1, 2014 through
3		December 31, 2014, an annual assessment on inpatient services
4		is imposed on each hospital provider in an amount equal to
5		$218.38 multiplied by the difference of the hospital's occupied
6		bed days less the hospital's Medicare bed days, provided,
7		however, that the amount of $218.38 shall be increased by a
8		uniform percentage to generate an amount equal to 75% of the
9		State share of the payments authorized under Section 12-5, with
10		such increase only taking effect upon the date that a State
11		share for such payments is required under federal law.
12		For State fiscal years 2009 through 2014, and after, a
13		hospital's occupied bed days and Medicare bed days shall be
14		determined using the most recent data available from each
15		hospital's 2005 Medicare cost report as contained in the
16		Healthcare Cost Report Information System file, for the quarter
17		ending on December 31, 2006, without regard to any subsequent
18		adjustments or changes to such data. If a hospital's 2005
19		Medicare cost report is not contained in the Healthcare Cost
20		Report Information System, then the Illinois Department may
21		obtain the hospital provider's occupied bed days and Medicare
22		bed days from any source available, including, but not limited
23		to, records maintained by the hospital provider, which may be
24		inspected at all times during business hours of the day by the
25		Illinois Department or its duly authorized agents and
26		employees.

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1		(b) (Blank).
2		(b-5) Subject to Sections 5A-3 and 5A-10, for the portion
3		of State fiscal year 2012, beginning June 10, 2012 through June
4		30, 2012, and for State fiscal years 2013 through 2018 2014,
5		and July 1, 2014 through December 31, 2014, an annual
6		assessment on outpatient services is imposed on each hospital
7		provider in an amount equal to .008766 multiplied by the
8		hospital's outpatient gross revenue, provided, however, that
9		the amount of .008766 shall be increased by a uniform
10		percentage to generate an amount equal to 25% of the State
11		share of the payments authorized under Section 12-5, with such
12		increase only taking effect upon the date that a State share
13		for such payments is required under federal law. For the period
14		beginning June 10, 2012 through June 30, 2012, the annual
15		assessment on outpatient services shall be prorated by
16		multiplying the assessment amount by a fraction, the numerator
17		of which is 21 days and the denominator of which is 365 days.
18		For the portion of State fiscal year 2012, beginning June
19		10, 2012 through June 30, 2012, and State fiscal years 2013
20		through 2018 2014, and July 1, 2014 through December 31, 2014,
21		a hospital's outpatient gross revenue shall be determined using
22		the most recent data available from each hospital's 2009
23		Medicare cost report as contained in the Healthcare Cost Report
24		Information System file, for the quarter ending on June 30,
25		2011, without regard to any subsequent adjustments or changes
26		to such data. If a hospital's 2009 Medicare cost report is not

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1		contained in the Healthcare Cost Report Information System,
2		then the Department may obtain the hospital provider's
3		outpatient gross revenue from any source available, including,
4		but not limited to, records maintained by the hospital
5		provider, which may be inspected at all times during business
6		hours of the day by the Department or its duly authorized
7		agents and employees.
8		(c) (Blank).
9		(d) Notwithstanding any of the other provisions of this
10		Section, the Department is authorized to adopt rules to reduce
11		the rate of any annual assessment imposed under this Section,
12		as authorized by Section 5-46.2 of the Illinois Administrative
13		Procedure Act.
14		(e) Notwithstanding any other provision of this Section,
15		any plan providing for an assessment on a hospital provider as
16		a permissible tax under Title XIX of the federal Social
17		Security Act and Medicaid-eligible payments to hospital
18		providers from the revenues derived from that assessment shall
19		be reviewed by the Illinois Department of Healthcare and Family
20		Services, as the Single State Medicaid Agency required by
21		federal law, to determine whether those assessments and
22		hospital provider payments meet federal Medicaid standards. If
23		the Department determines that the elements of the plan may
24		meet federal Medicaid standards and a related State Medicaid
25		Plan Amendment is prepared in a manner and form suitable for
26		submission, that State Plan Amendment shall be submitted in a

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1		timely manner for review by the Centers for Medicare and
2		Medicaid Services of the United States Department of Health and
3		Human Services and subject to approval by the Centers for
4		Medicare and Medicaid Services of the United States Department
5		of Health and Human Services. No such plan shall become
6		effective without approval by the Illinois General Assembly by
7		the enactment into law of related legislation. Notwithstanding
8		any other provision of this Section, the Department is
9		authorized to adopt rules to reduce the rate of any annual
10		assessment imposed under this Section. Any such rules may be
11		adopted by the Department under Section 5-50 of the Illinois
12		Administrative Procedure Act.
13		(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
14		98-104, eff. 7-22-13.)
15		(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)
16		Sec. 5A-5. Notice; penalty; maintenance of records.
17		(a) The Illinois Department shall send a notice of
18		assessment to every hospital provider subject to assessment
19		under this Article. The notice of assessment shall notify the
20		hospital of its assessment and shall be sent after receipt by
21		the Department of notification from the Centers for Medicare
22		and Medicaid Services of the U.S. Department of Health and
23		Human Services that the payment methodologies required under
24		this Article and, if necessary, the waiver granted under 42 CFR
25		433.68 have been approved. The notice shall be on a form

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1		prepared by the Illinois Department and shall state the
2		following:
3		(1) The name of the hospital provider.
4		(2) The address of the hospital provider's principal
5		place of business from which the provider engages in the
6		occupation of hospital provider in this State, and the name
7		and address of each hospital operated, conducted, or
8		maintained by the provider in this State.
9		(3) The occupied bed days, occupied bed days less
10		Medicare days, adjusted gross hospital revenue, or
11		outpatient gross revenue of the hospital provider
12		(whichever is applicable), the amount of assessment
13		imposed under Section 5A-2 for the State fiscal year for
14		which the notice is sent, and the amount of each
15		installment to be paid during the State fiscal year.
16		(4) (Blank).
17		(5) Other reasonable information as determined by the
18		Illinois Department.
19		(b) If a hospital provider conducts, operates, or maintains
20		more than one hospital licensed by the Illinois Department of
21		Public Health, the provider shall pay the assessment for each
22		hospital separately.
23		(c) Notwithstanding any other provision in this Article, in
24		the case of a person who ceases to conduct, operate, or
25		maintain a hospital in respect of which the person is subject
26		to assessment under this Article as a hospital provider, the

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1		assessment for the State fiscal year in which the cessation
2		occurs shall be adjusted by multiplying the assessment computed
3		under Section 5A-2 by a fraction, the numerator of which is the
4		number of days in the year during which the provider conducts,
5		operates, or maintains the hospital and the denominator of
6		which is 365. Immediately upon ceasing to conduct, operate, or
7		maintain a hospital, the person shall pay the assessment for
8		the year as so adjusted (to the extent not previously paid).
9		(d) Notwithstanding any other provision in this Article, a
10		provider who commences conducting, operating, or maintaining a
11		hospital, upon notice by the Illinois Department, shall pay the
12		assessment computed under Section 5A-2 and subsection (e) in
13		installments on the due dates stated in the notice and on the
14		regular installment due dates for the State fiscal year
15		occurring after the due dates of the initial notice.
16		(e) Notwithstanding any other provision in this Article,
17		for State fiscal years 2009 through 2018 2014, in the case of a
18		hospital provider that did not conduct, operate, or maintain a
19		hospital in 2005, the assessment for that State fiscal year
20		shall be computed on the basis of hypothetical occupied bed
21		days for the full calendar year as determined by the Illinois
22		Department. Notwithstanding any other provision in this
23		Article, for the portion of State fiscal year 2012 beginning
24		June 10, 2012 through June 30, 2012, and for State fiscal years
25		2013 through 2018 2014, and for July 1, 2014 through December
26		31, 2014, in the case of a hospital provider that did not

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1		conduct, operate, or maintain a hospital in 2009, the
2		assessment under subsection (b-5) of Section 5A-2 for that
3		State fiscal year shall be computed on the basis of
4		hypothetical gross outpatient revenue for the full calendar
5		year as determined by the Illinois Department.
6		(f) Every hospital provider subject to assessment under
7		this Article shall keep sufficient records to permit the
8		determination of adjusted gross hospital revenue for the
9		hospital's fiscal year. All such records shall be kept in the
10		English language and shall, at all times during regular
11		business hours of the day, be subject to inspection by the
12		Illinois Department or its duly authorized agents and
13		employees.
14		(g) The Illinois Department may, by rule, provide a
15		hospital provider a reasonable opportunity to request a
16		clarification or correction of any clerical or computational
17		errors contained in the calculation of its assessment, but such
18		corrections shall not extend to updating the cost report
19		information used to calculate the assessment.
20		(h) (Blank).
21		(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
22		98-104, eff. 7-22-13; 98-463, eff. 8-16-13; revised 10-21-13.)
23		(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
24		Sec. 5A-10. Applicability.
25		(a) The assessment imposed by subsection (a) of Section

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1		5A-2 shall cease to be imposed and the Department's obligation
2		to make payments shall immediately cease, and any moneys
3		remaining in the Fund shall be refunded to hospital providers
4		in proportion to the amounts paid by them, if:
5		(1) The payments to hospitals required under this
6		Article are not eligible for federal matching funds under
7		Title XIX or XXI of the Social Security Act;
8		(2) For State fiscal years 2009 through 2018 2014, and
9		July 1, 2014 through December 31, 2014, the Department of
10		Healthcare and Family Services adopts any administrative
11		rule change to reduce payment rates or alters any payment
12		methodology that reduces any payment rates made to
13		operating hospitals under the approved Title XIX or Title
14		XXI State plan in effect January 1, 2008 except for:
15		(A) any changes for hospitals described in
16		subsection (b) of Section 5A-3;
17		(B) any rates for payments made under this Article
18		V-A;
19		(C) any changes proposed in State plan amendment
20		transmittal numbers 08-01, 08-02, 08-04, 08-06, and
21		08-07;
22		(D) in relation to any admissions on or after
23		January 1, 2011, a modification in the methodology for
24		calculating outlier payments to hospitals for
25		exceptionally costly stays, for hospitals reimbursed
26		under the diagnosis-related grouping methodology in

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1		effect on July 1, 2011; provided that the Department
2		shall be limited to one such modification during the
3		36-month period after the effective date of this
4		amendatory Act of the 96th General Assembly; or
5		(E) any changes affecting hospitals authorized by
6		Public Act 97-689; or .
7		(F) any changes authorized by Section 14-12 of this
8		Code, or for any changes authorized under Section 5A-15
9		of this Code.
10		(b) The assessment imposed by Section 5A-2 shall not take
11		effect or shall cease to be imposed, and the Department's
12		obligation to make payments shall immediately cease, if the
13		assessment is determined to be an impermissible tax under Title
14		XIX of the Social Security Act. Moneys in the Hospital Provider
15		Fund derived from assessments imposed prior thereto shall be
16		disbursed in accordance with Section 5A-8 to the extent federal
17		financial participation is not reduced due to the
18		impermissibility of the assessments, and any remaining moneys
19		shall be refunded to hospital providers in proportion to the
20		amounts paid by them.
21		(c) The assessments imposed by subsection (b-5) of Section
22		5A-2 shall not take effect or shall cease to be imposed, the
23		Department's obligation to make payments shall immediately
24		cease, and any moneys remaining in the Fund shall be refunded
25		to hospital providers in proportion to the amounts paid by
26		them, if the payments to hospitals required under Section

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1		5A-12.4 are not eligible for federal matching funds under Title
2		XIX of the Social Security Act.
3		(d) The assessments imposed by Section 5A-2 shall not take
4		effect or shall cease to be imposed, the Department's
5		obligation to make payments shall immediately cease, and any
6		moneys remaining in the Fund shall be refunded to hospital
7		providers in proportion to the amounts paid by them, if:
8		(1) for State fiscal years 2013 through 2018 2014, and
9		July 1, 2014 through December 31, 2014, the Department
10		reduces any payment rates to hospitals as in effect on May
11		1, 2012, or alters any payment methodology as in effect on
12		May 1, 2012, that has the effect of reducing payment rates
13		to hospitals, except for any changes affecting hospitals
14		authorized in Public Act 97-689 and any changes authorized
15		by Section 14-12 of this Code, and except for any changes
16		authorized under Section 5A-15; or
17		(2) for State fiscal years 2013 through 2018 2014, and
18		July 1, 2014 through December 31, 2014, the Department
19		reduces any supplemental payments made to hospitals below
20		the amounts paid for services provided in State fiscal year
21		2011 as implemented by administrative rules adopted and in
22		effect on or prior to June 30, 2011, except for any changes
23		affecting hospitals authorized in Public Act 97-689 and any
24		changes authorized by Section 14-12 of this Code, and
25		except for any changes authorized under Section 5A-15; or .
26		(3) for State fiscal years 2015 through 2018, the

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1		Department reduces the overall effective rate of
2		reimbursement to hospitals below the level authorized
3		under Section 14-12 of this Code, except for any changes
4		under Section 14-12 or Section 5A-15 of this Code.
5		(Source: P.A. 97-72, eff. 7-1-11; 97-74, eff. 6-30-11; 97-688,
6		eff. 6-14-12; 97-689, eff. 6-14-12; 98-463, eff. 8-16-13.)
7		(305 ILCS 5/5A-14)
8		Sec. 5A-14. Repeal of assessments and disbursements.
9		(a) Section 5A-2 is repealed on July 1, 2018 January 1,
10		2015.
11		(b) Section 5A-12 is repealed on July 1, 2005.
12		(c) Section 5A-12.1 is repealed on July 1, 2008.
13		(d) Section 5A-12.2 and Section 5A-12.4 are repealed on
14		July 1, 2018 January 1, 2015.
15		(e) Section 5A-12.3 is repealed on July 1, 2011.
16		(Source: P.A. 96-821, eff. 11-20-09; 96-1530, eff. 2-16-11;
17		97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
18		Article 45
19		Section 45-5. The Illinois Public Aid Code is amended by
20		changing Section 14-8 and by adding Section 14-12 as follows:
21		(305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
22		Sec. 14-8. Disbursements to Hospitals.

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1		(a) For inpatient hospital services rendered on and after
2		September 1, 1991, the Illinois Department shall reimburse
3		hospitals for inpatient services at an inpatient payment rate
4		calculated for each hospital based upon the Medicare
5		Prospective Payment System as set forth in Sections 1886(b),
6		(d), (g), and (h) of the federal Social Security Act, and the
7		regulations, policies, and procedures promulgated thereunder,
8		except as modified by this Section. Payment rates for inpatient
9		hospital services rendered on or after September 1, 1991 and on
10		or before September 30, 1992 shall be calculated using the
11		Medicare Prospective Payment rates in effect on September 1,
12		1991. Payment rates for inpatient hospital services rendered on
13		or after October 1, 1992 and on or before March 31, 1994 shall
14		be calculated using the Medicare Prospective Payment rates in
15		effect on September 1, 1992. Payment rates for inpatient
16		hospital services rendered on or after April 1, 1994 shall be
17		calculated using the Medicare Prospective Payment rates
18		(including the Medicare grouping methodology and weighting
19		factors as adjusted pursuant to paragraph (1) of this
20		subsection) in effect 90 days prior to the date of admission.
21		For services rendered on or after July 1, 1995, the
22		reimbursement methodology implemented under this subsection
23		shall not include those costs referred to in Sections
24		1886(d)(5)(B) and 1886(h) of the Social Security Act. The
25		additional payment amounts required under Section
26		1886(d)(5)(F) of the Social Security Act, for hospitals serving

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1		a disproportionate share of low-income or indigent patients,
2		are not required under this Section. For hospital inpatient
3		services rendered on or after July 1, 1995 and on or before
4		June 30, 2014, the Illinois Department shall reimburse
5		hospitals using the relative weighting factors and the base
6		payment rates calculated for each hospital that were in effect
7		on June 30, 1995, less the portion of such rates attributed by
8		the Illinois Department to the cost of medical education.
9		(1) The weighting factors established under Section
10		1886(d)(4) of the Social Security Act shall not be used in
11		the reimbursement system established under this Section.
12		Rather, the Illinois Department shall establish by rule
13		Medicaid weighting factors to be used in the reimbursement
14		system established under this Section.
15		(2) The Illinois Department shall define by rule those
16		hospitals or distinct parts of hospitals that shall be
17		exempt from the reimbursement system established under
18		this Section. In defining such hospitals, the Illinois
19		Department shall take into consideration those hospitals
20		exempt from the Medicare Prospective Payment System as of
21		September 1, 1991. For hospitals defined as exempt under
22		this subsection, the Illinois Department shall by rule
23		establish a reimbursement system for payment of inpatient
24		hospital services rendered on and after September 1, 1991.
25		For all hospitals that are children's hospitals as defined
26		in Section 5-5.02 of this Code, the reimbursement

SB0741 Enrolled - 149 - LRB098 04975 KTG 35005 b
1		methodology shall, through June 30, 1992, net of all
2		applicable fees, at least equal each children's hospital
3		1990 ICARE payment rates, indexed to the current year by
4		application of the DRI hospital cost index from 1989 to the
5		year in which payments are made. Excepting county providers
6		as defined in Article XV of this Code, hospitals licensed
7		under the University of Illinois Hospital Act, and
8		facilities operated by the Department of Mental Health and
9		Developmental Disabilities (or its successor, the
10		Department of Human Services) for hospital inpatient
11		services rendered on or after July 1, 1995 and on or before
12		June 30, 2014, the Illinois Department shall reimburse
13		children's hospitals, as defined in 89 Illinois
14		Administrative Code Section 149.50(c)(3), at the rates in
15		effect on June 30, 1995, and shall reimburse all other
16		hospitals at the rates in effect on June 30, 1995, less the
17		portion of such rates attributed by the Illinois Department
18		to the cost of medical education. For inpatient hospital
19		services provided on or after August 1, 1998, the Illinois
20		Department may establish by rule a means of adjusting the
21		rates of children's hospitals, as defined in 89 Illinois
22		Administrative Code Section 149.50(c)(3), that did not
23		meet that definition on June 30, 1995, in order for the
24		inpatient hospital rates of such hospitals to take into
25		account the average inpatient hospital rates of those
26		children's hospitals that did meet the definition of

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1		children's hospitals on June 30, 1995.
2		(3) (Blank).
3		(4) Notwithstanding any other provision of this
4		Section, hospitals that on August 31, 1991, have a contract
5		with the Illinois Department under Section 3-4 of the
6		Illinois Health Finance Reform Act may elect to continue to
7		be reimbursed at rates stated in such contracts for general
8		and specialty care.
9		(5) In addition to any payments made under this
10		subsection (a), the Illinois Department shall make the
11		adjustment payments required by Section 5-5.02 of this
12		Code; provided, that in the case of any hospital reimbursed
13		under a per case methodology, the Illinois Department shall
14		add an amount equal to the product of the hospital's
15		average length of stay, less one day, multiplied by 20, for
16		inpatient hospital services rendered on or after September
17		1, 1991 and on or before September 30, 1992.
18		(b) (Blank).
19		(b-5) Excepting county providers as defined in Article XV
20		of this Code, hospitals licensed under the University of
21		Illinois Hospital Act, and facilities operated by the Illinois
22		Department of Mental Health and Developmental Disabilities (or
23		its successor, the Department of Human Services), for
24		outpatient services rendered on or after July 1, 1995 and
25		before July 1, 1998 the Illinois Department shall reimburse
26		children's hospitals, as defined in the Illinois

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1		Administrative Code Section 149.50(c)(3), at the rates in
2		effect on June 30, 1995, less that portion of such rates
3		attributed by the Illinois Department to the outpatient
4		indigent volume adjustment and shall reimburse all other
5		hospitals at the rates in effect on June 30, 1995, less the
6		portions of such rates attributed by the Illinois Department to
7		the cost of medical education and attributed by the Illinois
8		Department to the outpatient indigent volume adjustment. For
9		outpatient services provided on or after July 1, 1998 and on or
10		before June 30, 2014, reimbursement rates shall be established
11		by rule.
12		(c) In addition to any other payments under this Code, the
13		Illinois Department shall develop a hospital disproportionate
14		share reimbursement methodology that, effective July 1, 1991,
15		through September 30, 1992, shall reimburse hospitals
16		sufficiently to expend the fee monies described in subsection
17		(b) of Section 14-3 of this Code and the federal matching funds
18		received by the Illinois Department as a result of expenditures
19		made by the Illinois Department as required by this subsection
20		(c) and Section 14-2 that are attributable to fee monies
21		deposited in the Fund, less amounts applied to adjustment
22		payments under Section 5-5.02.
23		(d) Critical Care Access Payments.
24		(1) In addition to any other payments made under this
25		Code, the Illinois Department shall develop a
26		reimbursement methodology that shall reimburse Critical

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1		Care Access Hospitals for the specialized services that
2		qualify them as Critical Care Access Hospitals. No
3		adjustment payments shall be made under this subsection on
4		or after July 1, 1995.
5		(2) "Critical Care Access Hospitals" includes, but is
6		not limited to, hospitals that meet at least one of the
7		following criteria:
8		(A) Hospitals located outside of a metropolitan
9		statistical area that are designated as Level II
10		Perinatal Centers and that provide a disproportionate
11		share of perinatal services to recipients; or
12		(B) Hospitals that are designated as Level I Trauma
13		Centers (adult or pediatric) and certain Level II
14		Trauma Centers as determined by the Illinois
15		Department; or
16		(C) Hospitals located outside of a metropolitan
17		statistical area and that provide a disproportionate
18		share of obstetrical services to recipients.
19		(e) Inpatient high volume adjustment. For hospital
20		inpatient services, effective with rate periods beginning on or
21		after October 1, 1993, in addition to rates paid for inpatient
22		services by the Illinois Department, the Illinois Department
23		shall make adjustment payments for inpatient services
24		furnished by Medicaid high volume hospitals. The Illinois
25		Department shall establish by rule criteria for qualifying as a
26		Medicaid high volume hospital and shall establish by rule a

SB0741 Enrolled - 153 - LRB098 04975 KTG 35005 b
1		reimbursement methodology for calculating these adjustment
2		payments to Medicaid high volume hospitals. No adjustment
3		payment shall be made under this subsection for services
4		rendered on or after July 1, 1995.
5		(f) The Illinois Department shall modify its current rules
6		governing adjustment payments for targeted access, critical
7		care access, and uncompensated care to classify those
8		adjustment payments as not being payments to disproportionate
9		share hospitals under Title XIX of the federal Social Security
10		Act. Rules adopted under this subsection shall not be effective
11		with respect to services rendered on or after July 1, 1995. The
12		Illinois Department has no obligation to adopt or implement any
13		rules or make any payments under this subsection for services
14		rendered on or after July 1, 1995.
15		(f-5) The State recognizes that adjustment payments to
16		hospitals providing certain services or incurring certain
17		costs may be necessary to assure that recipients of medical
18		assistance have adequate access to necessary medical services.
19		These adjustments include payments for teaching costs and
20		uncompensated care, trauma center payments, rehabilitation
21		hospital payments, perinatal center payments, obstetrical care
22		payments, targeted access payments, Medicaid high volume
23		payments, and outpatient indigent volume payments. On or before
24		April 1, 1995, the Illinois Department shall issue
25		recommendations regarding (i) reimbursement mechanisms or
26		adjustment payments to reflect these costs and services,

SB0741 Enrolled - 154 - LRB098 04975 KTG 35005 b
1		including methods by which the payments may be calculated and
2		the method by which the payments may be financed, and (ii)
3		reimbursement mechanisms or adjustment payments to reflect
4		costs and services of federally qualified health centers with
5		respect to recipients of medical assistance.
6		(g) If one or more hospitals file suit in any court
7		challenging any part of this Article XIV, payments to hospitals
8		under this Article XIV shall be made only to the extent that
9		sufficient monies are available in the Fund and only to the
10		extent that any monies in the Fund are not prohibited from
11		disbursement under any order of the court.
12		(h) Payments under the disbursement methodology described
13		in this Section are subject to approval by the federal
14		government in an appropriate State plan amendment.
15		(i) The Illinois Department may by rule establish criteria
16		for and develop methodologies for adjustment payments to
17		hospitals participating under this Article.
18		(j) Hospital Residing Long Term Care Services. In addition
19		to any other payments made under this Code, the Illinois
20		Department may by rule establish criteria and develop
21		methodologies for payments to hospitals for Hospital Residing
22		Long Term Care Services.
23		(k) Critical Access Hospital outpatient payments. In
24		addition to any other payments authorized under this Code, the
25		Illinois Department shall reimburse critical access hospitals,
26		as designated by the Illinois Department of Public Health in

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1		accordance with 42 CFR 485, Subpart F, for outpatient services
2		at an amount that is no less than the cost of providing such
3		services, based on Medicare cost principles. Payments under
4		this subsection shall be subject to appropriation.
5		(l) On and after July 1, 2012, the Department shall reduce
6		any rate of reimbursement for services or other payments or
7		alter any methodologies authorized by this Code to reduce any
8		rate of reimbursement for services or other payments in
9		accordance with Section 5-5e.
10		(Source: P.A. 97-689, eff. 6-14-12; 98-463, eff. 8-16-13.)
11		(305 ILCS 5/14-12 new)
12		Sec. 14-12. Hospital rate reform payment system. The
13		hospital payment system pursuant to Section 14-11 of this
14		Article shall be as follows:
15		(a) Inpatient hospital services. Effective for discharges
16		on and after July 1, 2014, reimbursement for inpatient general
17		acute care services shall utilize the All Patient Refined
18		Diagnosis Related Grouping (APR-DRG) software, version 30,
19		distributed by 3MTM Health Information System.
20		(1) The Department shall establish Medicaid weighting
21		factors to be used in the reimbursement system established
22		under this subsection. Initial weighting factors shall be
23		the weighting factors as published by 3M Health Information
24		System, associated with Version 30.0 adjusted for the
25		Illinois experience.

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1		(2) The Department shall establish a
2		statewide-standardized amount to be used in the inpatient
3		reimbursement system. The Department shall publish these
4		amounts on its website no later than 10 calendar days prior
5		to their effective date.
6		(3) In addition to the statewide-standardized amount,
7		the Department shall develop adjusters to adjust the rate
8		of reimbursement for critical Medicaid providers or
9		services for trauma, transplantation services, perinatal
10		care, and Graduate Medical Education (GME).
11		(4) The Department shall develop add-on payments to
12		account for exceptionally costly inpatient stays,
13		consistent with Medicare outlier principles. Outlier fixed
14		loss thresholds may be updated to control for excessive
15		growth in outlier payments no more frequently than on an
16		annual basis, but at least triennially. Upon updating the
17		fixed loss thresholds, the Department shall be required to
18		update base rates within 12 months.
19		(5) The Department shall define those hospitals or
20		distinct parts of hospitals that shall be exempt from the
21		APR-DRG reimbursement system established under this
22		Section. The Department shall publish these hospitals'
23		inpatient rates on its website no later than 10 calendar
24		days prior to their effective date.
25		(6) Beginning July 1, 2014 and ending on June 30, 2018,
26		in addition to the statewide-standardized amount, the

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1		Department shall develop an adjustor to adjust the rate of
2		reimbursement for safety-net hospitals defined in Section
3		5-5e.1 of this Code excluding pediatric hospitals.
4		(7) Beginning July 1, 2014 and ending on June 30, 2018,
5		in addition to the statewide-standardized amount, the
6		Department shall develop an adjustor to adjust the rate of
7		reimbursement for Illinois freestanding inpatient
8		psychiatric hospitals that are not designated as
9		children's hospitals by the Department but are primarily
10		treating patients under the age of 21.
11		(b) Outpatient hospital services. Effective for dates of
12		service on and after July 1, 2014, reimbursement for outpatient
13		services shall utilize the Enhanced Ambulatory Procedure
14		Grouping (E-APG) software, version 3.7 distributed by 3MTM
15		Health Information System.
16		(1) The Department shall establish Medicaid weighting
17		factors to be used in the reimbursement system established
18		under this subsection. The initial weighting factors shall
19		be the weighting factors as published by 3M Health
20		Information System, associated with Version 3.7.
21		(2) The Department shall establish service specific
22		statewide-standardized amounts to be used in the
23		reimbursement system.
24		(A) The initial statewide standardized amounts,
25		with the labor portion adjusted by the Calendar Year
26		2013 Medicare Outpatient Prospective Payment System

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1		wage index with reclassifications, shall be published
2		by the Department on its website no later than 10
3		calendar days prior to their effective date.
4		(B) The Department shall establish adjustments to
5		the statewide-standardized amounts for each Critical
6		Access Hospital, as designated by the Department of
7		Public Health in accordance with 42 CFR 485, Subpart F.
8		The EAPG standardized amounts are determined
9		separately for each critical access hospital such that
10		simulated EAPG payments using outpatient base period
11		paid claim data plus payments under Section 5A-12.4 of
12		this Code net of the associated tax costs are equal to
13		the estimated costs of outpatient base period claims
14		data with a rate year cost inflation factor applied.
15		(3) In addition to the statewide-standardized amounts,
16		the Department shall develop adjusters to adjust the rate
17		of reimbursement for critical Medicaid hospital outpatient
18		providers or services, including outpatient high volume or
19		safety-net hospitals.
20		(c) In consultation with the hospital community, the
21		Department is authorized to replace 89 Ill. Admin. Code 152.150
22		as published in 38 Ill. Reg. 4980 through 4986 within 12 months
23		of the effective date of this amendatory Act of the 98th
24		General Assembly. If the Department does not replace these
25		rules within 12 months of the effective date of this amendatory
26		Act of the 98th General Assembly, the rules in effect for

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1		152.150 as published in 38 Ill. Reg. 4980 through 4986 shall
2		remain in effect until modified by rule by the Department.
3		Nothing in this subsection shall be construed to mandate that
4		the Department file a replacement rule.
5		(d) Transition period. There shall be a transition period
6		to the reimbursement systems authorized under this Section that
7		shall begin on the effective date of these systems and continue
8		until June 30, 2018, unless extended by rule by the Department.
9		To help provide an orderly and predictable transition to the
10		new reimbursement systems and to preserve and enhance access to
11		the hospital services during this transition, the Department
12		shall allocate a transitional hospital access pool of at least
13		$290,000,000 annually so that transitional hospital access
14		payments are made to hospitals.
15		(1) After the transition period, the Department may
16		begin incorporating the transitional hospital access pool
17		into the base rate structure.
18		(2) After the transition period, if the Department
19		reduces payments from the transitional hospital access
20		pool, it shall increase base rates, develop new adjustors,
21		adjust current adjustors, develop new hospital access
22		payments based on updated information, or any combination
23		thereof by an amount equal to the decreases proposed in the
24		transitional hospital access pool payments, ensuring that
25		the entire transitional hospital access pool amount shall
26		continue to be used for hospital payments.

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1		(e) Beginning 36 months after initial implementation, the
2		Department shall update the reimbursement components in
3		subsections (a) and (b), including standardized amounts and
4		weighting factors, and at least triennially and no more
5		frequently than annually thereafter. The Department shall
6		publish these updates on its website no later than 30 calendar
7		days prior to their effective date.
8		(f) Continuation of supplemental payments. Any
9		supplemental payments authorized under Illinois Administrative
10		Code 148 effective January 1, 2014 and that continue during the
11		period of July 1, 2014 through December 31, 2014 shall remain
12		in effect as long as the assessment imposed by Section 5A-2 is
13		in effect.
14		(g) Notwithstanding subsections (a) through (f) of this
15		Section, any updates to the system shall not result in any
16		diminishment of the overall effective rates of reimbursement as
17		of the implementation date of the new system (July 1, 2014).
18		These updates shall not preclude variations in any individual
19		component of the system or hospital rate variations. Nothing in
20		this Section shall prohibit the Department from increasing the
21		rates of reimbursement or developing payments to ensure access
22		to hospital services. Nothing in this Section shall be
23		construed to guarantee a minimum amount of spending in the
24		aggregate or per hospital as spending may be impacted by
25		factors including but not limited to the number of individuals
26		in the medical assistance program and the severity of illness

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1		of the individuals.
2		(h) The Department shall have the authority to modify by
3		rulemaking any changes to the rates or methodologies in this
4		Section as required by the federal government to obtain federal
5		financial participation for expenditures made under this
6		Section.
7		(i) Except for subsections (g) and (h) of this Section, the
8		Department shall, pursuant to subsection (c) of Section 5-40 of
9		the Illinois Administrative Procedure Act, provide for
10		presentation at the June 2014 hearing of the Joint Committee on
11		Administrative Rules (JCAR) additional written notice to JCAR
12		of the following rules in order to commence the second notice
13		period for the following rules: rules published in the Illinois
14		Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
15		(Medical Payment), 4628 (Specialized Health Care Delivery
16		Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
17		Grouping (DRG) Prospective Payment System (PPS)), and 4977
18		(Hospital Reimbursement Changes), and published in the
19		Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
20		(Specialized Health Care Delivery Systems) and 6505 (Hospital
21		Services).
22		Article 50
23		Section 50-5. The Specialized Mental Health Rehabilitation
24		Act of 2013 is amended by changing Sections 3-116 and 3-205 as

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1		follows:
2		(210 ILCS 49/3-116)
3		Sec. 3-116. Experimental research. No consumer shall be
4		subjected to experimental research or treatment without first
5		obtaining his or her informed, written consent. The conduct of
6		any experimental research or treatment shall be authorized and
7		monitored by an institutional review board appointed by the
8		Director of the Department executive director. The membership,
9		operating procedures and review criteria for the institutional
10		review board shall be prescribed under rules and regulations of
11		the Department and shall comply with the requirements for
12		institutional review boards established by the federal Food and
13		Drug Administration. No person who has received compensation in
14		the prior 3 years from an entity that manufactures,
15		distributes, or sells pharmaceuticals, biologics, or medical
16		devices may serve on the institutional review board.
17		No facility shall permit experimental research or
18		treatment to be conducted on a consumer, or give access to any
19		person or person's records for a retrospective study about the
20		safety or efficacy of any care or treatment, without the prior
21		written approval of the institutional review board. No
22		executive director, or person licensed by the State to provide
23		medical care or treatment to any person, may assist or
24		participate in any experimental research on or treatment of a
25		consumer, including a retrospective study, that does not have

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1		the prior written approval of the board. Such conduct shall be
2		grounds for professional discipline by the Department of
3		Financial and Professional Regulation.
4		The institutional review board may exempt from ongoing
5		review research or treatment initiated on a consumer before the
6		individual's admission to a facility and for which the board
7		determines there is adequate ongoing oversight by another
8		institutional review board. Nothing in this Section shall
9		prevent a facility, any facility employee, or any other person
10		from assisting or participating in any experimental research on
11		or treatment of a consumer, if the research or treatment began
12		before the person's admission to a facility, until the board
13		has reviewed the research or treatment and decided to grant or
14		deny approval or to exempt the research or treatment from
15		ongoing review.
16		(Source: P.A. 98-104, eff. 7-22-13.)
17		(210 ILCS 49/3-205)
18		Sec. 3-205. Disclosure of information to public. Standards
19		for the disclosure of information to the public shall be
20		established by rule. These information disclosure standards
21		shall include, but are not limited to, the following: staffing
22		and personnel levels, licensure and inspection information,
23		national accreditation information, consumer charges cost and
24		reimbursement information, and consumer complaint information.
25		Rules for the public disclosure of information shall be in

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1		accordance with the provisions for inspection and copying of
2		public records in the Freedom of Information Act. The
3		Department of Healthcare and Family Services shall make
4		facility cost reports available on its website.
5		(Source: P.A. 98-104, eff. 7-22-13.)
6		Article 55
7		Section 55-5. The State Finance Act is amended by adding
8		Section 5.855 as follows:
9		(30 ILCS 105/5.855 new)
10		Sec. 5.855. The Supportive Living Facility Fund.
11		Section 55-10. The Specialized Mental Health
12		Rehabilitation Act of 2013 is amended by adding Section 5-102
13		as follows:
14		(210 ILCS 49/5-102 new)
15		Sec. 5-102. Transition payments. In addition to payments
16		already required by law, the Department of Healthcare and
17		Family Services shall make payments to facilities licensed
18		under this Act in the amount of $29.43 per licensed bed, per
19		day, for the period beginning June 1, 2014 and ending June 30,
20		2014.

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1		Section 55-15. The Illinois Public Aid Code is amended by
2		changing Sections 5-5, 5-5.01a, 5-5.2, 5-5.4h, 5-5e, 5-5e.1,
3		5-5f, 5B-1, 5C-1, 5C-2, and 5C-7 and by adding Section 5C-10
4		and Article V-G as follows:
5		(305 ILCS 5/5-5) (from Ch. 23, par. 5-5)
6		Sec. 5-5. Medical services. The Illinois Department, by
7		rule, shall determine the quantity and quality of and the rate
8		of reimbursement for the medical assistance for which payment
9		will be authorized, and the medical services to be provided,
10		which may include all or part of the following: (1) inpatient
11		hospital services; (2) outpatient hospital services; (3) other
12		laboratory and X-ray services; (4) skilled nursing home
13		services; (5) physicians' services whether furnished in the
14		office, the patient's home, a hospital, a skilled nursing home,
15		or elsewhere; (6) medical care, or any other type of remedial
16		care furnished by licensed practitioners; (7) home health care
17		services; (8) private duty nursing service; (9) clinic
18		services; (10) dental services, including prevention and
19		treatment of periodontal disease and dental caries disease for
20		pregnant women, provided by an individual licensed to practice
21		dentistry or dental surgery; for purposes of this item (10),
22		"dental services" means diagnostic, preventive, or corrective
23		procedures provided by or under the supervision of a dentist in
24		the practice of his or her profession; (11) physical therapy
25		and related services; (12) prescribed drugs, dentures, and

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1		prosthetic devices; and eyeglasses prescribed by a physician
2		skilled in the diseases of the eye, or by an optometrist,
3		whichever the person may select; (13) other diagnostic,
4		screening, preventive, and rehabilitative services, including
5		to ensure that the individual's need for intervention or
6		treatment of mental disorders or substance use disorders or
7		co-occurring mental health and substance use disorders is
8		determined using a uniform screening, assessment, and
9		evaluation process inclusive of criteria, for children and
10		adults; for purposes of this item (13), a uniform screening,
11		assessment, and evaluation process refers to a process that
12		includes an appropriate evaluation and, as warranted, a
13		referral; "uniform" does not mean the use of a singular
14		instrument, tool, or process that all must utilize; (14)
15		transportation and such other expenses as may be necessary;
16		(15) medical treatment of sexual assault survivors, as defined
17		in Section 1a of the Sexual Assault Survivors Emergency
18		Treatment Act, for injuries sustained as a result of the sexual
19		assault, including examinations and laboratory tests to
20		discover evidence which may be used in criminal proceedings
21		arising from the sexual assault; (16) the diagnosis and
22		treatment of sickle cell anemia; and (17) any other medical
23		care, and any other type of remedial care recognized under the
24		laws of this State, but not including abortions, or induced
25		miscarriages or premature births, unless, in the opinion of a
26		physician, such procedures are necessary for the preservation

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1		of the life of the woman seeking such treatment, or except an
2		induced premature birth intended to produce a live viable child
3		and such procedure is necessary for the health of the mother or
4		her unborn child. The Illinois Department, by rule, shall
5		prohibit any physician from providing medical assistance to
6		anyone eligible therefor under this Code where such physician
7		has been found guilty of performing an abortion procedure in a
8		wilful and wanton manner upon a woman who was not pregnant at
9		the time such abortion procedure was performed. The term "any
10		other type of remedial care" shall include nursing care and
11		nursing home service for persons who rely on treatment by
12		spiritual means alone through prayer for healing.
13		Notwithstanding any other provision of this Section, a
14		comprehensive tobacco use cessation program that includes
15		purchasing prescription drugs or prescription medical devices
16		approved by the Food and Drug Administration shall be covered
17		under the medical assistance program under this Article for
18		persons who are otherwise eligible for assistance under this
19		Article.
20		Notwithstanding any other provision of this Code, the
21		Illinois Department may not require, as a condition of payment
22		for any laboratory test authorized under this Article, that a
23		physician's handwritten signature appear on the laboratory
24		test order form. The Illinois Department may, however, impose
25		other appropriate requirements regarding laboratory test order
26		documentation.

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1		Upon receipt of federal approval of an amendment to the
2		Illinois Title XIX State Plan for this purpose, the Department
3		shall authorize the Chicago Public Schools (CPS) to procure a
4		vendor or vendors to manufacture eyeglasses for individuals
5		enrolled in a school within the CPS system. CPS shall ensure
6		that its vendor or vendors are enrolled as providers in the
7		medical assistance program and in any capitated Medicaid
8		managed care entity (MCE) serving individuals enrolled in a
9		school within the CPS system. Under any contract procured under
10		this provision, the vendor or vendors must serve only
11		individuals enrolled in a school within the CPS system. Claims
12		for services provided by CPS's vendor or vendors to recipients
13		of benefits in the medical assistance program under this Code,
14		the Children's Health Insurance Program, or the Covering ALL
15		KIDS Health Insurance Program shall be submitted to the
16		Department or the MCE in which the individual is enrolled for
17		payment and shall be reimbursed at the Department's or the
18		MCE's established rates or rate methodologies for eyeglasses.
19		On and after July 1, 2012, the Department of Healthcare and
20		Family Services may provide the following services to persons
21		eligible for assistance under this Article who are
22		participating in education, training or employment programs
23		operated by the Department of Human Services as successor to
24		the Department of Public Aid:
25		(1) dental services provided by or under the
26		supervision of a dentist; and

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1		(2) eyeglasses prescribed by a physician skilled in the
2		diseases of the eye, or by an optometrist, whichever the
3		person may select.
4		Notwithstanding any other provision of this Code and
5		subject to federal approval, the Department may adopt rules to
6		allow a dentist who is volunteering his or her service at no
7		cost to render dental services through an enrolled
8		not-for-profit health clinic without the dentist personally
9		enrolling as a participating provider in the medical assistance
10		program. A not-for-profit health clinic shall include a public
11		health clinic or Federally Qualified Health Center or other
12		enrolled provider, as determined by the Department, through
13		which dental services covered under this Section are performed.
14		The Department shall establish a process for payment of claims
15		for reimbursement for covered dental services rendered under
16		this provision.
17		The Illinois Department, by rule, may distinguish and
18		classify the medical services to be provided only in accordance
19		with the classes of persons designated in Section 5-2.
20		The Department of Healthcare and Family Services must
21		provide coverage and reimbursement for amino acid-based
22		elemental formulas, regardless of delivery method, for the
23		diagnosis and treatment of (i) eosinophilic disorders and (ii)
24		short bowel syndrome when the prescribing physician has issued
25		a written order stating that the amino acid-based elemental
26		formula is medically necessary.

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1		The Illinois Department shall authorize the provision of,
2		and shall authorize payment for, screening by low-dose
3		mammography for the presence of occult breast cancer for women
4		35 years of age or older who are eligible for medical
5		assistance under this Article, as follows:
6		(A) A baseline mammogram for women 35 to 39 years of
7		age.
8		(B) An annual mammogram for women 40 years of age or
9		older.
10		(C) A mammogram at the age and intervals considered
11		medically necessary by the woman's health care provider for
12		women under 40 years of age and having a family history of
13		breast cancer, prior personal history of breast cancer,
14		positive genetic testing, or other risk factors.
15		(D) A comprehensive ultrasound screening of an entire
16		breast or breasts if a mammogram demonstrates
17		heterogeneous or dense breast tissue, when medically
18		necessary as determined by a physician licensed to practice
19		medicine in all of its branches.
20		All screenings shall include a physical breast exam,
21		instruction on self-examination and information regarding the
22		frequency of self-examination and its value as a preventative
23		tool. For purposes of this Section, "low-dose mammography"
24		means the x-ray examination of the breast using equipment
25		dedicated specifically for mammography, including the x-ray
26		tube, filter, compression device, and image receptor, with an

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1		average radiation exposure delivery of less than one rad per
2		breast for 2 views of an average size breast. The term also
3		includes digital mammography.
4		On and after January 1, 2012, providers participating in a
5		quality improvement program approved by the Department shall be
6		reimbursed for screening and diagnostic mammography at the same
7		rate as the Medicare program's rates, including the increased
8		reimbursement for digital mammography.
9		The Department shall convene an expert panel including
10		representatives of hospitals, free-standing mammography
11		facilities, and doctors, including radiologists, to establish
12		quality standards.
13		Subject to federal approval, the Department shall
14		establish a rate methodology for mammography at federally
15		qualified health centers and other encounter-rate clinics.
16		These clinics or centers may also collaborate with other
17		hospital-based mammography facilities.
18		The Department shall establish a methodology to remind
19		women who are age-appropriate for screening mammography, but
20		who have not received a mammogram within the previous 18
21		months, of the importance and benefit of screening mammography.
22		The Department shall establish a performance goal for
23		primary care providers with respect to their female patients
24		over age 40 receiving an annual mammogram. This performance
25		goal shall be used to provide additional reimbursement in the
26		form of a quality performance bonus to primary care providers

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1		who meet that goal.
2		The Department shall devise a means of case-managing or
3		patient navigation for beneficiaries diagnosed with breast
4		cancer. This program shall initially operate as a pilot program
5		in areas of the State with the highest incidence of mortality
6		related to breast cancer. At least one pilot program site shall
7		be in the metropolitan Chicago area and at least one site shall
8		be outside the metropolitan Chicago area. An evaluation of the
9		pilot program shall be carried out measuring health outcomes
10		and cost of care for those served by the pilot program compared
11		to similarly situated patients who are not served by the pilot
12		program.
13		Any medical or health care provider shall immediately
14		recommend, to any pregnant woman who is being provided prenatal
15		services and is suspected of drug abuse or is addicted as
16		defined in the Alcoholism and Other Drug Abuse and Dependency
17		Act, referral to a local substance abuse treatment provider
18		licensed by the Department of Human Services or to a licensed
19		hospital which provides substance abuse treatment services.
20		The Department of Healthcare and Family Services shall assure
21		coverage for the cost of treatment of the drug abuse or
22		addiction for pregnant recipients in accordance with the
23		Illinois Medicaid Program in conjunction with the Department of
24		Human Services.
25		All medical providers providing medical assistance to
26		pregnant women under this Code shall receive information from

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1		the Department on the availability of services under the Drug
2		Free Families with a Future or any comparable program providing
3		case management services for addicted women, including
4		information on appropriate referrals for other social services
5		that may be needed by addicted women in addition to treatment
6		for addiction.
7		The Illinois Department, in cooperation with the
8		Departments of Human Services (as successor to the Department
9		of Alcoholism and Substance Abuse) and Public Health, through a
10		public awareness campaign, may provide information concerning
11		treatment for alcoholism and drug abuse and addiction, prenatal
12		health care, and other pertinent programs directed at reducing
13		the number of drug-affected infants born to recipients of
14		medical assistance.
15		Neither the Department of Healthcare and Family Services
16		nor the Department of Human Services shall sanction the
17		recipient solely on the basis of her substance abuse.
18		The Illinois Department shall establish such regulations
19		governing the dispensing of health services under this Article
20		as it shall deem appropriate. The Department should seek the
21		advice of formal professional advisory committees appointed by
22		the Director of the Illinois Department for the purpose of
23		providing regular advice on policy and administrative matters,
24		information dissemination and educational activities for
25		medical and health care providers, and consistency in
26		procedures to the Illinois Department.

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1		The Illinois Department may develop and contract with
2		Partnerships of medical providers to arrange medical services
3		for persons eligible under Section 5-2 of this Code.
4		Implementation of this Section may be by demonstration projects
5		in certain geographic areas. The Partnership shall be
6		represented by a sponsor organization. The Department, by rule,
7		shall develop qualifications for sponsors of Partnerships.
8		Nothing in this Section shall be construed to require that the
9		sponsor organization be a medical organization.
10		The sponsor must negotiate formal written contracts with
11		medical providers for physician services, inpatient and
12		outpatient hospital care, home health services, treatment for
13		alcoholism and substance abuse, and other services determined
14		necessary by the Illinois Department by rule for delivery by
15		Partnerships. Physician services must include prenatal and
16		obstetrical care. The Illinois Department shall reimburse
17		medical services delivered by Partnership providers to clients
18		in target areas according to provisions of this Article and the
19		Illinois Health Finance Reform Act, except that:
20		(1) Physicians participating in a Partnership and
21		providing certain services, which shall be determined by
22		the Illinois Department, to persons in areas covered by the
23		Partnership may receive an additional surcharge for such
24		services.
25		(2) The Department may elect to consider and negotiate
26		financial incentives to encourage the development of

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1		Partnerships and the efficient delivery of medical care.
2		(3) Persons receiving medical services through
3		Partnerships may receive medical and case management
4		services above the level usually offered through the
5		medical assistance program.
6		Medical providers shall be required to meet certain
7		qualifications to participate in Partnerships to ensure the
8		delivery of high quality medical services. These
9		qualifications shall be determined by rule of the Illinois
10		Department and may be higher than qualifications for
11		participation in the medical assistance program. Partnership
12		sponsors may prescribe reasonable additional qualifications
13		for participation by medical providers, only with the prior
14		written approval of the Illinois Department.
15		Nothing in this Section shall limit the free choice of
16		practitioners, hospitals, and other providers of medical
17		services by clients. In order to ensure patient freedom of
18		choice, the Illinois Department shall immediately promulgate
19		all rules and take all other necessary actions so that provided
20		services may be accessed from therapeutically certified
21		optometrists to the full extent of the Illinois Optometric
22		Practice Act of 1987 without discriminating between service
23		providers.
24		The Department shall apply for a waiver from the United
25		States Health Care Financing Administration to allow for the
26		implementation of Partnerships under this Section.

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1		The Illinois Department shall require health care
2		providers to maintain records that document the medical care
3		and services provided to recipients of Medical Assistance under
4		this Article. Such records must be retained for a period of not
5		less than 6 years from the date of service or as provided by
6		applicable State law, whichever period is longer, except that
7		if an audit is initiated within the required retention period
8		then the records must be retained until the audit is completed
9		and every exception is resolved. The Illinois Department shall
10		require health care providers to make available, when
11		authorized by the patient, in writing, the medical records in a
12		timely fashion to other health care providers who are treating
13		or serving persons eligible for Medical Assistance under this
14		Article. All dispensers of medical services shall be required
15		to maintain and retain business and professional records
16		sufficient to fully and accurately document the nature, scope,
17		details and receipt of the health care provided to persons
18		eligible for medical assistance under this Code, in accordance
19		with regulations promulgated by the Illinois Department. The
20		rules and regulations shall require that proof of the receipt
21		of prescription drugs, dentures, prosthetic devices and
22		eyeglasses by eligible persons under this Section accompany
23		each claim for reimbursement submitted by the dispenser of such
24		medical services. No such claims for reimbursement shall be
25		approved for payment by the Illinois Department without such
26		proof of receipt, unless the Illinois Department shall have put

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1		into effect and shall be operating a system of post-payment
2		audit and review which shall, on a sampling basis, be deemed
3		adequate by the Illinois Department to assure that such drugs,
4		dentures, prosthetic devices and eyeglasses for which payment
5		is being made are actually being received by eligible
6		recipients. Within 90 days after the effective date of this
7		amendatory Act of 1984, the Illinois Department shall establish
8		a current list of acquisition costs for all prosthetic devices
9		and any other items recognized as medical equipment and
10		supplies reimbursable under this Article and shall update such
11		list on a quarterly basis, except that the acquisition costs of
12		all prescription drugs shall be updated no less frequently than
13		every 30 days as required by Section 5-5.12.
14		The rules and regulations of the Illinois Department shall
15		require that a written statement including the required opinion
16		of a physician shall accompany any claim for reimbursement for
17		abortions, or induced miscarriages or premature births. This
18		statement shall indicate what procedures were used in providing
19		such medical services.
20		Notwithstanding any other law to the contrary, the Illinois
21		Department shall, within 365 days after July 22, 2013, the
22		effective date of Public Act 98-104 this amendatory Act of the
23		98th General Assembly, establish procedures to permit skilled
24		care facilities licensed under the Nursing Home Care Act to
25		submit monthly billing claims for reimbursement purposes.
26		Following development of these procedures, the Department

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1		shall have an additional 365 days to test the viability of the
2		new system and to ensure that any necessary operational or
3		structural changes to its information technology platforms are
4		implemented.
5		The Illinois Department shall require all dispensers of
6		medical services, other than an individual practitioner or
7		group of practitioners, desiring to participate in the Medical
8		Assistance program established under this Article to disclose
9		all financial, beneficial, ownership, equity, surety or other
10		interests in any and all firms, corporations, partnerships,
11		associations, business enterprises, joint ventures, agencies,
12		institutions or other legal entities providing any form of
13		health care services in this State under this Article.
14		The Illinois Department may require that all dispensers of
15		medical services desiring to participate in the medical
16		assistance program established under this Article disclose,
17		under such terms and conditions as the Illinois Department may
18		by rule establish, all inquiries from clients and attorneys
19		regarding medical bills paid by the Illinois Department, which
20		inquiries could indicate potential existence of claims or liens
21		for the Illinois Department.
22		Enrollment of a vendor shall be subject to a provisional
23		period and shall be conditional for one year. During the period
24		of conditional enrollment, the Department may terminate the
25		vendor's eligibility to participate in, or may disenroll the
26		vendor from, the medical assistance program without cause.

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1		Unless otherwise specified, such termination of eligibility or
2		disenrollment is not subject to the Department's hearing
3		process. However, a disenrolled vendor may reapply without
4		penalty.
5		The Department has the discretion to limit the conditional
6		enrollment period for vendors based upon category of risk of
7		the vendor.
8		Prior to enrollment and during the conditional enrollment
9		period in the medical assistance program, all vendors shall be
10		subject to enhanced oversight, screening, and review based on
11		the risk of fraud, waste, and abuse that is posed by the
12		category of risk of the vendor. The Illinois Department shall
13		establish the procedures for oversight, screening, and review,
14		which may include, but need not be limited to: criminal and
15		financial background checks; fingerprinting; license,
16		certification, and authorization verifications; unscheduled or
17		unannounced site visits; database checks; prepayment audit
18		reviews; audits; payment caps; payment suspensions; and other
19		screening as required by federal or State law.
20		The Department shall define or specify the following: (i)
21		by provider notice, the "category of risk of the vendor" for
22		each type of vendor, which shall take into account the level of
23		screening applicable to a particular category of vendor under
24		federal law and regulations; (ii) by rule or provider notice,
25		the maximum length of the conditional enrollment period for
26		each category of risk of the vendor; and (iii) by rule, the

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1		hearing rights, if any, afforded to a vendor in each category
2		of risk of the vendor that is terminated or disenrolled during
3		the conditional enrollment period.
4		To be eligible for payment consideration, a vendor's
5		payment claim or bill, either as an initial claim or as a
6		resubmitted claim following prior rejection, must be received
7		by the Illinois Department, or its fiscal intermediary, no
8		later than 180 days after the latest date on the claim on which
9		medical goods or services were provided, with the following
10		exceptions:
11		(1) In the case of a provider whose enrollment is in
12		process by the Illinois Department, the 180-day period
13		shall not begin until the date on the written notice from
14		the Illinois Department that the provider enrollment is
15		complete.
16		(2) In the case of errors attributable to the Illinois
17		Department or any of its claims processing intermediaries
18		which result in an inability to receive, process, or
19		adjudicate a claim, the 180-day period shall not begin
20		until the provider has been notified of the error.
21		(3) In the case of a provider for whom the Illinois
22		Department initiates the monthly billing process.
23		(4) In the case of a provider operated by a unit of
24		local government with a population exceeding 3,000,000
25		when local government funds finance federal participation
26		for claims payments.

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1		For claims for services rendered during a period for which
2		a recipient received retroactive eligibility, claims must be
3		filed within 180 days after the Department determines the
4		applicant is eligible. For claims for which the Illinois
5		Department is not the primary payer, claims must be submitted
6		to the Illinois Department within 180 days after the final
7		adjudication by the primary payer.
8		In the case of long term care facilities, within 5 days of
9		receipt by the facility of required prescreening information,
10		data for new admissions shall be entered into the Medical
11		Electronic Data Interchange (MEDI) or the Recipient
12		Eligibility Verification (REV) System or successor system, and
13		within 15 days of receipt by the facility of required
14		prescreening information, admission documents shall be
15		submitted within 30 days of an admission to the facility
16		through MEDI or REV the Medical Electronic Data Interchange
17		(MEDI) or the Recipient Eligibility Verification (REV) System,
18		or shall be submitted directly to the Department of Human
19		Services using required admission forms. Effective September
20		1, 2014, admission documents, including all prescreening
21		information, must be submitted through MEDI or REV.
22		Confirmation numbers assigned to an accepted transaction shall
23		be retained by a facility to verify timely submittal. Once an
24		admission transaction has been completed, all resubmitted
25		claims following prior rejection are subject to receipt no
26		later than 180 days after the admission transaction has been

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1		completed.
2		Claims that are not submitted and received in compliance
3		with the foregoing requirements shall not be eligible for
4		payment under the medical assistance program, and the State
5		shall have no liability for payment of those claims.
6		To the extent consistent with applicable information and
7		privacy, security, and disclosure laws, State and federal
8		agencies and departments shall provide the Illinois Department
9		access to confidential and other information and data necessary
10		to perform eligibility and payment verifications and other
11		Illinois Department functions. This includes, but is not
12		limited to: information pertaining to licensure;
13		certification; earnings; immigration status; citizenship; wage
14		reporting; unearned and earned income; pension income;
15		employment; supplemental security income; social security
16		numbers; National Provider Identifier (NPI) numbers; the
17		National Practitioner Data Bank (NPDB); program and agency
18		exclusions; taxpayer identification numbers; tax delinquency;
19		corporate information; and death records.
20		The Illinois Department shall enter into agreements with
21		State agencies and departments, and is authorized to enter into
22		agreements with federal agencies and departments, under which
23		such agencies and departments shall share data necessary for
24		medical assistance program integrity functions and oversight.
25		The Illinois Department shall develop, in cooperation with
26		other State departments and agencies, and in compliance with

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1		applicable federal laws and regulations, appropriate and
2		effective methods to share such data. At a minimum, and to the
3		extent necessary to provide data sharing, the Illinois
4		Department shall enter into agreements with State agencies and
5		departments, and is authorized to enter into agreements with
6		federal agencies and departments, including but not limited to:
7		the Secretary of State; the Department of Revenue; the
8		Department of Public Health; the Department of Human Services;
9		and the Department of Financial and Professional Regulation.
10		Beginning in fiscal year 2013, the Illinois Department
11		shall set forth a request for information to identify the
12		benefits of a pre-payment, post-adjudication, and post-edit
13		claims system with the goals of streamlining claims processing
14		and provider reimbursement, reducing the number of pending or
15		rejected claims, and helping to ensure a more transparent
16		adjudication process through the utilization of: (i) provider
17		data verification and provider screening technology; and (ii)
18		clinical code editing; and (iii) pre-pay, pre- or
19		post-adjudicated predictive modeling with an integrated case
20		management system with link analysis. Such a request for
21		information shall not be considered as a request for proposal
22		or as an obligation on the part of the Illinois Department to
23		take any action or acquire any products or services.
24		The Illinois Department shall establish policies,
25		procedures, standards and criteria by rule for the acquisition,
26		repair and replacement of orthotic and prosthetic devices and

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1		durable medical equipment. Such rules shall provide, but not be
2		limited to, the following services: (1) immediate repair or
3		replacement of such devices by recipients; and (2) rental,
4		lease, purchase or lease-purchase of durable medical equipment
5		in a cost-effective manner, taking into consideration the
6		recipient's medical prognosis, the extent of the recipient's
7		needs, and the requirements and costs for maintaining such
8		equipment. Subject to prior approval, such rules shall enable a
9		recipient to temporarily acquire and use alternative or
10		substitute devices or equipment pending repairs or
11		replacements of any device or equipment previously authorized
12		for such recipient by the Department.
13		The Department shall execute, relative to the nursing home
14		prescreening project, written inter-agency agreements with the
15		Department of Human Services and the Department on Aging, to
16		effect the following: (i) intake procedures and common
17		eligibility criteria for those persons who are receiving
18		non-institutional services; and (ii) the establishment and
19		development of non-institutional services in areas of the State
20		where they are not currently available or are undeveloped; and
21		(iii) notwithstanding any other provision of law, subject to
22		federal approval, on and after July 1, 2012, an increase in the
23		determination of need (DON) scores from 29 to 37 for applicants
24		for institutional and home and community-based long term care;
25		if and only if federal approval is not granted, the Department
26		may, in conjunction with other affected agencies, implement

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1		utilization controls or changes in benefit packages to
2		effectuate a similar savings amount for this population; and
3		(iv) no later than July 1, 2013, minimum level of care
4		eligibility criteria for institutional and home and
5		community-based long term care; and (v) no later than October
6		1, 2013, establish procedures to permit long term care
7		providers access to eligibility scores for individuals with an
8		admission date who are seeking or receiving services from the
9		long term care provider. In order to select the minimum level
10		of care eligibility criteria, the Governor shall establish a
11		workgroup that includes affected agency representatives and
12		stakeholders representing the institutional and home and
13		community-based long term care interests. This Section shall
14		not restrict the Department from implementing lower level of
15		care eligibility criteria for community-based services in
16		circumstances where federal approval has been granted.
17		The Illinois Department shall develop and operate, in
18		cooperation with other State Departments and agencies and in
19		compliance with applicable federal laws and regulations,
20		appropriate and effective systems of health care evaluation and
21		programs for monitoring of utilization of health care services
22		and facilities, as it affects persons eligible for medical
23		assistance under this Code.
24		The Illinois Department shall report annually to the
25		General Assembly, no later than the second Friday in April of
26		1979 and each year thereafter, in regard to:

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1		(a) actual statistics and trends in utilization of
2		medical services by public aid recipients;
3		(b) actual statistics and trends in the provision of
4		the various medical services by medical vendors;
5		(c) current rate structures and proposed changes in
6		those rate structures for the various medical vendors; and
7		(d) efforts at utilization review and control by the
8		Illinois Department.
9		The period covered by each report shall be the 3 years
10		ending on the June 30 prior to the report. The report shall
11		include suggested legislation for consideration by the General
12		Assembly. The filing of one copy of the report with the
13		Speaker, one copy with the Minority Leader and one copy with
14		the Clerk of the House of Representatives, one copy with the
15		President, one copy with the Minority Leader and one copy with
16		the Secretary of the Senate, one copy with the Legislative
17		Research Unit, and such additional copies with the State
18		Government Report Distribution Center for the General Assembly
19		as is required under paragraph (t) of Section 7 of the State
20		Library Act shall be deemed sufficient to comply with this
21		Section.
22		Rulemaking authority to implement Public Act 95-1045, if
23		any, is conditioned on the rules being adopted in accordance
24		with all provisions of the Illinois Administrative Procedure
25		Act and all rules and procedures of the Joint Committee on
26		Administrative Rules; any purported rule not so adopted, for

SB0741 Enrolled - 187 - LRB098 04975 KTG 35005 b
1		whatever reason, is unauthorized.
2		On and after July 1, 2012, the Department shall reduce any
3		rate of reimbursement for services or other payments or alter
4		any methodologies authorized by this Code to reduce any rate of
5		reimbursement for services or other payments in accordance with
6		Section 5-5e.
7		Because kidney transplantation can be an appropriate, cost
8		effective alternative to renal dialysis when medically
9		necessary and notwithstanding the provisions of Section 1-11 of
10		this Code, beginning October 1, 2014, the Department shall
11		cover kidney transplantation for noncitizens with end-stage
12		renal disease who are not eligible for comprehensive medical
13		benefits, who meet the residency requirements of Section 5-3 of
14		this Code, and who would otherwise meet the financial
15		requirements of the appropriate class of eligible persons under
16		Section 5-2 of this Code. To qualify for coverage of kidney
17		transplantation, such person must be receiving emergency renal
18		dialysis services covered by the Department. Providers under
19		this Section shall be prior approved and certified by the
20		Department to perform kidney transplantation and the services
21		under this Section shall be limited to services associated with
22		kidney transplantation.
23		(Source: P.A. 97-48, eff. 6-28-11; 97-638, eff. 1-1-12; 97-689,
24		eff. 6-14-12; 97-1061, eff. 8-24-12; 98-104, Article 9, Section
25		9-5, eff. 7-22-13; 98-104, Article 12, Section 12-20, eff.
26		7-22-13; 98-303, eff. 8-9-13; 98-463, eff. 8-16-13; revised

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1		9-19-13.)
2		(305 ILCS 5/5-5.01a)
3		Sec. 5-5.01a. Supportive living facilities program. The
4		Department shall establish and provide oversight for a program
5		of supportive living facilities that seek to promote resident
6		independence, dignity, respect, and well-being in the most
7		cost-effective manner.
8		A supportive living facility is either a free-standing
9		facility or a distinct physical and operational entity within a
10		nursing facility. A supportive living facility integrates
11		housing with health, personal care, and supportive services and
12		is a designated setting that offers residents their own
13		separate, private, and distinct living units.
14		Sites for the operation of the program shall be selected by
15		the Department based upon criteria that may include the need
16		for services in a geographic area, the availability of funding,
17		and the site's ability to meet the standards.
18		Beginning July 1, 2014, subject to federal approval, the
19		Medicaid rates for supportive living facilities shall be equal
20		to the supportive living facility Medicaid rate effective on
21		June 30, 2014 increased by 8.85%. Once the assessment imposed
22		at Article V-G of this Code is determined to be a permissible
23		tax under Title XIX of the Social Security Act, the Department
24		shall increase the Medicaid rates for supportive living
25		facilities effective on July 1, 2014 by 9.09%. The Department

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1		shall apply this increase retroactively to coincide with the
2		imposition of the assessment in Article V-G of this Code in
3		accordance with the approval for federal financial
4		participation by the Centers for Medicare and Medicaid
5		Services.
6		The Department may adopt rules to implement this Section.
7		Rules that establish or modify the services, standards, and
8		conditions for participation in the program shall be adopted by
9		the Department in consultation with the Department on Aging,
10		the Department of Rehabilitation Services, and the Department
11		of Mental Health and Developmental Disabilities (or their
12		successor agencies).
13		Facilities or distinct parts of facilities which are
14		selected as supportive living facilities and are in good
15		standing with the Department's rules are exempt from the
16		provisions of the Nursing Home Care Act and the Illinois Health
17		Facilities Planning Act.
18		(Source: P.A. 94-342, eff. 7-26-05.)
19		(305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
20		Sec. 5-5.2. Payment.
21		(a) All nursing facilities that are grouped pursuant to
22		Section 5-5.1 of this Act shall receive the same rate of
23		payment for similar services.
24		(b) It shall be a matter of State policy that the Illinois
25		Department shall utilize a uniform billing cycle throughout the

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1		State for the long-term care providers.
2		(c) Notwithstanding any other provisions of this Code, the
3		methodologies for reimbursement of nursing services as
4		provided under this Article shall no longer be applicable for
5		bills payable for nursing services rendered on or after a new
6		reimbursement system based on the Resource Utilization Groups
7		(RUGs) has been fully operationalized, which shall take effect
8		for services provided on or after January 1, 2014.
9		(d) The new nursing services reimbursement methodology
10		utilizing RUG-IV 48 grouper model, which shall be referred to
11		as the RUGs reimbursement system, taking effect January 1,
12		2014, shall be based on the following:
13		(1) The methodology shall be resident-driven,
14		facility-specific, and cost-based.
15		(2) Costs shall be annually rebased and case mix index
16		quarterly updated. The nursing services methodology will
17		be assigned to the Medicaid enrolled residents on record as
18		of 30 days prior to the beginning of the rate period in the
19		Department's Medicaid Management Information System (MMIS)
20		as present on the last day of the second quarter preceding
21		the rate period.
22		(3) Regional wage adjustors based on the Health Service
23		Areas (HSA) groupings and adjusters in effect on April 30,
24		2012 shall be included.
25		(4) Case mix index shall be assigned to each resident
26		class based on the Centers for Medicare and Medicaid

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1		Services staff time measurement study in effect on July 1,
2		2013, utilizing an index maximization approach.
3		(5) The pool of funds available for distribution by
4		case mix and the base facility rate shall be determined
5		using the formula contained in subsection (d-1).
6		(d-1) Calculation of base year Statewide RUG-IV nursing
7		base per diem rate.
8		(1) Base rate spending pool shall be:
9		(A) The base year resident days which are
10		calculated by multiplying the number of Medicaid
11		residents in each nursing home as indicated in the MDS
12		data defined in paragraph (4) by 365.
13		(B) Each facility's nursing component per diem in
14		effect on July 1, 2012 shall be multiplied by
15		subsection (A).
16		(C) Thirteen million is added to the product of
17		subparagraph (A) and subparagraph (B) to adjust for the
18		exclusion of nursing homes defined in paragraph (5).
19		(2) For each nursing home with Medicaid residents as
20		indicated by the MDS data defined in paragraph (4),
21		weighted days adjusted for case mix and regional wage
22		adjustment shall be calculated. For each home this
23		calculation is the product of:
24		(A) Base year resident days as calculated in
25		subparagraph (A) of paragraph (1).
26		(B) The nursing home's regional wage adjustor

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1		based on the Health Service Areas (HSA) groupings and
2		adjustors in effect on April 30, 2012.
3		(C) Facility weighted case mix which is the number
4		of Medicaid residents as indicated by the MDS data
5		defined in paragraph (4) multiplied by the associated
6		case weight for the RUG-IV 48 grouper model using
7		standard RUG-IV procedures for index maximization.
8		(D) The sum of the products calculated for each
9		nursing home in subparagraphs (A) through (C) above
10		shall be the base year case mix, rate adjusted weighted
11		days.
12		(3) The Statewide RUG-IV nursing base per diem rate:
13		(A) on January 1, 2014 shall be the quotient of the
14		paragraph (1) divided by the sum calculated under
15		subparagraph (D) of paragraph (2); and .
16		(B) on and after July 1, 2014, shall be the amount
17		calculated under subparagraph (A) of this paragraph
18		(3) plus $1.76.
19		(4) Minimum Data Set (MDS) comprehensive assessments
20		for Medicaid residents on the last day of the quarter used
21		to establish the base rate.
22		(5) Nursing facilities designated as of July 1, 2012 by
23		the Department as "Institutions for Mental Disease" shall
24		be excluded from all calculations under this subsection.
25		The data from these facilities shall not be used in the
26		computations described in paragraphs (1) through (4) above

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1		to establish the base rate.
2		(e) Beginning July 1, 2014, the Department shall allocate
3		funding in the amount up to $10,000,000 for per diem add-ons to
4		the RUGS methodology for dates of service on and after July 1,
5		2014:
6		(1) $0.63 for each resident who scores in I4200
7		Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
8		(2) $2.67 for each resident who scores either a "1" or
9		"2" in any items S1200A through S1200I and also scores in
10		RUG groups PA1, PA2, BA1, or BA2.
11		Notwithstanding any other provision of this Code, the
12		Department shall by rule develop a reimbursement methodology
13		reflective of the intensity of care and services requirements
14		of low need residents in the lowest RUG IV groupers and
15		corresponding regulations. Only that portion of the RUGs
16		Reimbursement System spending pool described in subsection
17		(d-1) attributed to the groupers as of July 1, 2013 for which
18		the methodology in this Section is developed may be diverted
19		for this purpose. The Department shall submit the rules no
20		later than January 1, 2014 for an implementation date no later
21		than January 1, 2015.
22		If the Department does not implement this reimbursement
23		methodology by the required date, the nursing component per
24		diem on January 1, 2015 for residents classified in RUG-IV
25		groups PA1, PA2, BA1, and BA2 shall be the blended rate of the
26		calculated RUG-IV nursing component per diem and the nursing

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1		component per diem in effect on July 1, 2012. This blended rate
2		shall be applied only to nursing homes whose resident
3		population is greater than or equal to 70% of the total
4		residents served and whose RUG-IV nursing component per diem
5		rate is less than the nursing component per diem in effect on
6		July 1, 2012. This blended rate shall be in effect until the
7		reimbursement methodology is implemented or until July 1, 2019,
8		whichever is sooner.
9		(e-1) (Blank). Notwithstanding any other provision of this
10		Article, rates established pursuant to this subsection shall
11		not apply to any and all nursing facilities designated by the
12		Department as "Institutions for Mental Disease" and shall be
13		excluded from the RUGs Reimbursement System applicable to
14		facilities not designated as "Institutions for the Mentally
15		Diseased" by the Department.
16		(e-2) For dates of services beginning January 1, 2014, the
17		RUG-IV nursing component per diem for a nursing home shall be
18		the product of the statewide RUG-IV nursing base per diem rate,
19		the facility average case mix index, and the regional wage
20		adjustor. Transition rates for services provided between
21		January 1, 2014 and December 31, 2014 shall be as follows:
22		(1) The transition RUG-IV per diem nursing rate for
23		nursing homes whose rate calculated in this subsection
24		(e-2) is greater than the nursing component rate in effect
25		July 1, 2012 shall be paid the sum of:
26		(A) The nursing component rate in effect July 1,

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1		2012; plus
2		(B) The difference of the RUG-IV nursing component
3		per diem calculated for the current quarter minus the
4		nursing component rate in effect July 1, 2012
5		multiplied by 0.88.
6		(2) The transition RUG-IV per diem nursing rate for
7		nursing homes whose rate calculated in this subsection
8		(e-2) is less than the nursing component rate in effect
9		July 1, 2012 shall be paid the sum of:
10		(A) The nursing component rate in effect July 1,
11		2012; plus
12		(B) The difference of the RUG-IV nursing component
13		per diem calculated for the current quarter minus the
14		nursing component rate in effect July 1, 2012
15		multiplied by 0.13.
16		(f) Notwithstanding any other provision of this Code, on
17		and after July 1, 2012, reimbursement rates associated with the
18		nursing or support components of the current nursing facility
19		rate methodology shall not increase beyond the level effective
20		May 1, 2011 until a new reimbursement system based on the RUGs
21		IV 48 grouper model has been fully operationalized.
22		(g) Notwithstanding any other provision of this Code, on
23		and after July 1, 2012, for facilities not designated by the
24		Department of Healthcare and Family Services as "Institutions
25		for Mental Disease", rates effective May 1, 2011 shall be
26		adjusted as follows:

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1		(1) Individual nursing rates for residents classified
2		in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
3		ending March 31, 2012 shall be reduced by 10%;
4		(2) Individual nursing rates for residents classified
5		in all other RUG IV groups shall be reduced by 1.0%;
6		(3) Facility rates for the capital and support
7		components shall be reduced by 1.7%.
8		(h) Notwithstanding any other provision of this Code, on
9		and after July 1, 2012, nursing facilities designated by the
10		Department of Healthcare and Family Services as "Institutions
11		for Mental Disease" and "Institutions for Mental Disease" that
12		are facilities licensed under the Specialized Mental Health
13		Rehabilitation Act of 2013 shall have the nursing,
14		socio-developmental, capital, and support components of their
15		reimbursement rate effective May 1, 2011 reduced in total by
16		2.7%.
17		(i) On and after July 1, 2014, the reimbursement rates for
18		the support component of the nursing facility rate for
19		facilities licensed under the Nursing Home Care Act as skilled
20		or intermediate care facilities shall be the rate in effect on
21		June 30, 2014 increased by 8.17%.
22		(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section
23		6-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff.
24		7-22-13; revised 9-19-13.)
25		(305 ILCS 5/5-5.4h)

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1		Sec. 5-5.4h. Medicaid reimbursement for long-term care
2		facilities for persons under 22 years of age pediatric skilled
3		nursing facilities.
4		(a) Facilities licensed as long-term care facilities for
5		persons under 22 years of age uniquely licensed as pediatric
6		skilled nursing facilities that serve severely and chronically
7		ill pediatric patients shall have a specific reimbursement
8		system designed to recognize the characteristics and needs of
9		the patients they serve.
10		(b) For dates of services starting July 1, 2013 and until a
11		new reimbursement system is designed, long-term care
12		facilities for persons under 22 years of age pediatric skilled
13		nursing facilities that meet the following criteria:
14		(1) serve exceptional care patients; and
15		(2) have 30% or more of their patients receiving
16		ventilator care;
17		shall receive Medicaid reimbursement on a 30-day expedited
18		schedule.
19		(c) Subject to federal approval of changes to the Title XIX
20		State Plan, for dates of services starting July 1, 2014 and
21		until a new reimbursement system is designed, long-term care
22		facilities for persons under 22 years of age which meet the
23		criteria in subsection (b) of this Section shall receive a per
24		diem rate for clinically complex residents of $304. Clinically
25		complex residents on a ventilator shall receive a per diem rate
26		of $669.

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1		(d) To qualify for the per diem rate of $669 for clinically
2		complex residents on a ventilator pursuant to subsection (c),
3		facilities shall have a policy documenting their method of
4		routine assessment of a resident's weaning potential with
5		interventions implemented noted in the resident's record.
6		(e) For the purposes of this Section, a resident is
7		considered clinically complex if the resident requires at least
8		one of the following medical services:
9		(1) Tracheostomy care with dependence on mechanical
10		ventilation for a minimum of 6 hours each day.
11		(2) Tracheostomy care requiring suctioning at least
12		every 6 hours, room air mist or oxygen as needed, and
13		dependence on one of the treatment procedures listed under
14		paragraph (4) excluding the procedure listed in
15		subparagraph (A) of paragraph (4).
16		(3) Total parenteral nutrition or other intravenous
17		nutritional support and one of the treatment procedures
18		listed under paragraph (4).
19		(4) The following treatment procedures apply to the
20		conditions in paragraphs (2) and (3) of this subsection:
21		(A) Intermittent suctioning at least every 8 hours
22		and room air mist or oxygen as needed.
23		(B) Continuous intravenous therapy including
24		administration of therapeutic agents necessary for
25		hydration or of intravenous pharmaceuticals; or
26		intravenous pharmaceutical administration of more than

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1		one agent via a peripheral or central line, without
2		continuous infusion.
3		(C) Peritoneal dialysis treatments requiring at
4		least 4 exchanges every 24 hours.
5		(D) Tube feeding via nasogastric or gastrostomy
6		tube.
7		(E) Other medical technologies required
8		continuously, which in the opinion of the attending
9		physician require the services of a professional
10		nurse.
11		(Source: P.A. 98-104, eff. 7-22-13.)
12		(305 ILCS 5/5-5e)
13		Sec. 5-5e. Adjusted rates of reimbursement.
14		(a) Rates or payments for services in effect on June 30,
15		2012 shall be adjusted and services shall be affected as
16		required by any other provision of this amendatory Act of the
17		97th General Assembly. In addition, the Department shall do the
18		following:
19		(1) Delink the per diem rate paid for supportive living
20		facility services from the per diem rate paid for nursing
21		facility services, effective for services provided on or
22		after May 1, 2011.
23		(2) Cease payment for bed reserves in nursing
24		facilities and specialized mental health rehabilitation
25		facilities.

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1		(2.5) Cease payment for bed reserves for purposes of
2		inpatient hospitalizations to intermediate care facilities
3		for persons with development disabilities, except in the
4		instance of residents who are under 21 years of age.
5		(3) Cease payment of the $10 per day add-on payment to
6		nursing facilities for certain residents with
7		developmental disabilities.
8		(b) After the application of subsection (a),
9		notwithstanding any other provision of this Code to the
10		contrary and to the extent permitted by federal law, on and
11		after July 1, 2012, the rates of reimbursement for services and
12		other payments provided under this Code shall further be
13		reduced as follows:
14		(1) Rates or payments for physician services, dental
15		services, or community health center services reimbursed
16		through an encounter rate, and services provided under the
17		Medicaid Rehabilitation Option of the Illinois Title XIX
18		State Plan shall not be further reduced.
19		(2) Rates or payments, or the portion thereof, paid to
20		a provider that is operated by a unit of local government
21		or State University that provides the non-federal share of
22		such services shall not be further reduced.
23		(3) Rates or payments for hospital services delivered
24		by a hospital defined as a Safety-Net Hospital under
25		Section 5-5e.1 of this Code shall not be further reduced.
26		(4) Rates or payments for hospital services delivered

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1		by a Critical Access Hospital, which is an Illinois
2		hospital designated as a critical care hospital by the
3		Department of Public Health in accordance with 42 CFR 485,
4		Subpart F, shall not be further reduced.
5		(5) Rates or payments for Nursing Facility Services
6		shall only be further adjusted pursuant to Section 5-5.2 of
7		this Code.
8		(6) Rates or payments for services delivered by long
9		term care facilities licensed under the ID/DD Community
10		Care Act and developmental training services shall not be
11		further reduced.
12		(7) Rates or payments for services provided under
13		capitation rates shall be adjusted taking into
14		consideration the rates reduction and covered services
15		required by this amendatory Act of the 97th General
16		Assembly.
17		(8) For hospitals not previously described in this
18		subsection, the rates or payments for hospital services
19		shall be further reduced by 3.5%, except for payments
20		authorized under Section 5A-12.4 of this Code.
21		(9) For all other rates or payments for services
22		delivered by providers not specifically referenced in
23		paragraphs (1) through (8), rates or payments shall be
24		further reduced by 2.7%.
25		(c) Any assessment imposed by this Code shall continue and
26		nothing in this Section shall be construed to cause it to

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1		cease.
2		(d) Notwithstanding any other provision of this Code to the
3		contrary, subject to federal approval under Title XIX of the
4		Social Security Act, for dates of service on and after July 1,
5		2014, rates or payments for services provided for the purpose
6		of transitioning children from a hospital to home placement or
7		other appropriate setting by a children's community-based
8		health care center authorized under the Alternative Health Care
9		Delivery Act shall be $683 per day.
10		(e) Notwithstanding any other provision of this Code to the
11		contrary, subject to federal approval under Title XIX of the
12		Social Security Act, for dates of service on and after July 1,
13		2014, rates or payments for home health visits shall be $72.
14		(f) Notwithstanding any other provision of this Code to the
15		contrary, subject to federal approval under Title XIX of the
16		Social Security Act, for dates of service on and after July 1,
17		2014, rates or payments for the certified nursing assistant
18		component of the home health agency rate shall be $20.
19		(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
20		(305 ILCS 5/5-5e.1)
21		Sec. 5-5e.1. Safety-Net Hospitals.
22		(a) A Safety-Net Hospital is an Illinois hospital that:
23		(1) is licensed by the Department of Public Health as a
24		general acute care or pediatric hospital; and
25		(2) is a disproportionate share hospital, as described

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1		in Section 1923 of the federal Social Security Act, as
2		determined by the Department; and
3		(3) meets one of the following:
4		(A) has a MIUR of at least 40% and a charity
5		percent of at least 4%; or
6		(B) has a MIUR of at least 50%.
7		(b) Definitions. As used in this Section:
8		(1) "Charity percent" means the ratio of (i) the
9		hospital's charity charges for services provided to
10		individuals without health insurance or another source of
11		third party coverage to (ii) the Illinois total hospital
12		charges, each as reported on the hospital's OBRA form.
13		(2) "MIUR" means Medicaid Inpatient Utilization Rate
14		and is defined as a fraction, the numerator of which is the
15		number of a hospital's inpatient days provided in the
16		hospital's fiscal year ending 3 years prior to the rate
17		year, to patients who, for such days, were eligible for
18		Medicaid under Title XIX of the federal Social Security
19		Act, 42 USC 1396a et seq., excluding those persons eligible
20		for medical assistance pursuant to 42 U.S.C.
21		1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
22		Section 5-2 of this Article, and the denominator of which
23		is the total number of the hospital's inpatient days in
24		that same period, excluding those persons eligible for
25		medical assistance pursuant to 42 U.S.C.
26		1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of

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1		Section 5-2 of this Article.
2		(3) "OBRA form" means form HFS-3834, OBRA '93 data
3		collection form, for the rate year.
4		(4) "Rate year" means the 12-month period beginning on
5		October 1.
6		(c) Beginning July 1, 2012 and ending on June 30, 2018, For
7		the 27-month period beginning July 1, 2012, a hospital that
8		would have qualified for the rate year beginning October 1,
9		2011, shall be a Safety-Net Hospital.
10		(d) No later than August 15 preceding the rate year, each
11		hospital shall submit the OBRA form to the Department. Prior to
12		October 1, the Department shall notify each hospital whether it
13		has qualified as a Safety-Net Hospital.
14		(e) The Department may promulgate rules in order to
15		implement this Section.
16		(f) Nothing in this Section shall be construed as limiting
17		the ability of the Department to include the Safety-Net
18		Hospitals in the hospital rate reform mandated by Section 14-11
19		of this Code and implemented under Section 14-12 of this Code
20		and by administrative rulemaking.
21		(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
22		(305 ILCS 5/5-5f)
23		Sec. 5-5f. Elimination and limitations of medical
24		assistance services. Notwithstanding any other provision of
25		this Code to the contrary, on and after July 1, 2012:

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1		(a) The following services shall no longer be a covered
2		service available under this Code: group psychotherapy for
3		residents of any facility licensed under the Nursing Home Care
4		Act or the Specialized Mental Health Rehabilitation Act of
5		2013; and adult chiropractic services.
6		(b) The Department shall place the following limitations on
7		services: (i) the Department shall limit adult eyeglasses to
8		one pair every 2 years; (ii) the Department shall set an annual
9		limit of a maximum of 20 visits for each of the following
10		services: adult speech, hearing, and language therapy
11		services, adult occupational therapy services, and physical
12		therapy services; on or after October 1, 2014, the annual
13		maximum limit of 20 visits shall expire but the Department
14		shall require prior approval for all individuals for speech,
15		hearing, and language therapy services, occupational therapy
16		services, and physical therapy services; (iii) the Department
17		shall limit adult podiatry services to individuals with
18		diabetes; on or after October 1, 2014, podiatry services shall
19		not be limited to individuals with diabetes; (iv) the
20		Department shall pay for caesarean sections at the normal
21		vaginal delivery rate unless a caesarean section was medically
22		necessary; (v) the Department shall limit adult dental services
23		to emergencies; beginning July 1, 2013, the Department shall
24		ensure that the following conditions are recognized as
25		emergencies: (A) dental services necessary for an individual in
26		order for the individual to be cleared for a medical procedure,

SB0741 Enrolled - 206 - LRB098 04975 KTG 35005 b
1		such as a transplant; (B) extractions and dentures necessary
2		for a diabetic to receive proper nutrition; (C) extractions and
3		dentures necessary as a result of cancer treatment; and (D)
4		dental services necessary for the health of a pregnant woman
5		prior to delivery of her baby; on or after July 1, 2014, adult
6		dental services shall no longer be limited to emergencies, and
7		dental services necessary for the health of a pregnant woman
8		prior to delivery of her baby shall continue to be covered; and
9		(vi) effective July 1, 2012, the Department shall place
10		limitations and require concurrent review on every inpatient
11		detoxification stay to prevent repeat admissions to any
12		hospital for detoxification within 60 days of a previous
13		inpatient detoxification stay. The Department shall convene a
14		workgroup of hospitals, substance abuse providers, care
15		coordination entities, managed care plans, and other
16		stakeholders to develop recommendations for quality standards,
17		diversion to other settings, and admission criteria for
18		patients who need inpatient detoxification, which shall be
19		published on the Department's website no later than September
20		1, 2013.
21		(c) The Department shall require prior approval of the
22		following services: wheelchair repairs costing more than $400,
23		coronary artery bypass graft, and bariatric surgery consistent
24		with Medicare standards concerning patient responsibility.
25		Wheelchair repair prior approval requests shall be adjudicated
26		within one business day of receipt of complete supporting

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1		documentation. Providers may not break wheelchair repairs into
2		separate claims for purposes of staying under the $400
3		threshold for requiring prior approval. The wholesale price of
4		manual and power wheelchairs, durable medical equipment and
5		supplies, and complex rehabilitation technology products and
6		services shall be defined as actual acquisition cost including
7		all discounts.
8		(d) The Department shall establish benchmarks for
9		hospitals to measure and align payments to reduce potentially
10		preventable hospital readmissions, inpatient complications,
11		and unnecessary emergency room visits. In doing so, the
12		Department shall consider items, including, but not limited to,
13		historic and current acuity of care and historic and current
14		trends in readmission. The Department shall publish
15		provider-specific historical readmission data and anticipated
16		potentially preventable targets 60 days prior to the start of
17		the program. In the instance of readmissions, the Department
18		shall adopt policies and rates of reimbursement for services
19		and other payments provided under this Code to ensure that, by
20		June 30, 2013, expenditures to hospitals are reduced by, at a
21		minimum, $40,000,000.
22		(e) The Department shall establish utilization controls
23		for the hospice program such that it shall not pay for other
24		care services when an individual is in hospice.
25		(f) For home health services, the Department shall require
26		Medicare certification of providers participating in the

SB0741 Enrolled - 208 - LRB098 04975 KTG 35005 b
1		program and implement the Medicare face-to-face encounter
2		rule. The Department shall require providers to implement
3		auditable electronic service verification based on global
4		positioning systems or other cost-effective technology.
5		(g) For the Home Services Program operated by the
6		Department of Human Services and the Community Care Program
7		operated by the Department on Aging, the Department of Human
8		Services, in cooperation with the Department on Aging, shall
9		implement an electronic service verification based on global
10		positioning systems or other cost-effective technology.
11		(h) Effective with inpatient hospital admissions on or
12		after July 1, 2012, the Department shall reduce the payment for
13		a claim that indicates the occurrence of a provider-preventable
14		condition during the admission as specified by the Department
15		in rules. The Department shall not pay for services related to
16		an other provider-preventable condition.
17		As used in this subsection (h):
18		"Provider-preventable condition" means a health care
19		acquired condition as defined under the federal Medicaid
20		regulation found at 42 CFR 447.26 or an other
21		provider-preventable condition.
22		"Other provider-preventable condition" means a wrong
23		surgical or other invasive procedure performed on a patient, a
24		surgical or other invasive procedure performed on the wrong
25		body part, or a surgical procedure or other invasive procedure
26		performed on the wrong patient.

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1		(i) The Department shall implement cost savings
2		initiatives for advanced imaging services, cardiac imaging
3		services, pain management services, and back surgery. Such
4		initiatives shall be designed to achieve annual costs savings.
5		(j) The Department shall ensure that beneficiaries with a
6		diagnosis of epilepsy or seizure disorder in Department records
7		will not require prior approval for anticonvulsants.
8		(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section
9		6-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff.
10		7-22-13; revised 9-19-13.)
11		(305 ILCS 5/5B-1) (from Ch. 23, par. 5B-1)
12		Sec. 5B-1. Definitions. As used in this Article, unless the
13		context requires otherwise:
14		"Fund" means the Long-Term Care Provider Fund.
15		"Long-term care facility" means (i) a nursing facility,
16		whether public or private and whether organized for profit or
17		not-for-profit, that is subject to licensure by the Illinois
18		Department of Public Health under the Nursing Home Care Act or
19		the ID/DD Community Care Act, including a county nursing home
20		directed and maintained under Section 5-1005 of the Counties
21		Code, and (ii) a part of a hospital in which skilled or
22		intermediate long-term care services within the meaning of
23		Title XVIII or XIX of the Social Security Act are provided;
24		except that the term "long-term care facility" does not include
25		a facility operated by a State agency or operated solely as an

SB0741 Enrolled - 210 - LRB098 04975 KTG 35005 b
1		intermediate care facility for the mentally retarded within the
2		meaning of Title XIX of the Social Security Act.
3		"Long-term care provider" means (i) a person licensed by
4		the Department of Public Health to operate and maintain a
5		skilled nursing or intermediate long-term care facility or (ii)
6		a hospital provider that provides skilled or intermediate
7		long-term care services within the meaning of Title XVIII or
8		XIX of the Social Security Act. For purposes of this paragraph,
9		"person" means any political subdivision of the State,
10		municipal corporation, individual, firm, partnership,
11		corporation, company, limited liability company, association,
12		joint stock association, or trust, or a receiver, executor,
13		trustee, guardian, or other representative appointed by order
14		of any court. "Hospital provider" means a person licensed by
15		the Department of Public Health to conduct, operate, or
16		maintain a hospital.
17		"Occupied bed days" shall be computed separately for each
18		long-term care facility operated or maintained by a long-term
19		care provider, and means the sum for all beds of the number of
20		days during the month on which each bed was occupied by a
21		resident, other than a resident for whom Medicare Part A is the
22		primary payer. For a resident whose care is covered by the
23		Medicare Medicaid Alignment initiative demonstration, Medicare
24		Part A is considered the primary payer.
25		(Source: P.A. 96-339, eff. 7-1-10; 96-1530, eff. 2-16-11;
26		97-38, eff. 6-28-11; 97-227, eff. 1-1-12; 97-813, eff.

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1		7-13-12.)
2		(305 ILCS 5/5C-1) (from Ch. 23, par. 5C-1)
3		Sec. 5C-1. Definitions. As used in this Article, unless the
4		context requires otherwise:
5		"Fund" means the Care Provider Fund for Persons with a
6		Developmental Disability.
7		"Developmentally disabled care facility" means an
8		intermediate care facility for the intellectually disabled
9		within the meaning of Title XIX of the Social Security Act,
10		whether public or private and whether organized for profit or
11		not-for-profit, but shall not include any facility operated by
12		the State.
13		"Developmentally disabled care provider" means a person
14		conducting, operating, or maintaining a developmentally
15		disabled care facility. For this purpose, "person" means any
16		political subdivision of the State, municipal corporation,
17		individual, firm, partnership, corporation, company, limited
18		liability company, association, joint stock association, or
19		trust, or a receiver, executor, trustee, guardian or other
20		representative appointed by order of any court.
21		"Adjusted gross developmentally disabled care revenue"
22		shall be computed separately for each developmentally disabled
23		care facility conducted, operated, or maintained by a
24		developmentally disabled care provider, and means the
25		developmentally disabled care provider's total revenue for

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1		inpatient residential services less contractual allowances and
2		discounts on patients' accounts, but does not include
3		non-patient revenue from sources such as contributions,
4		donations or bequests, investments, day training services,
5		television and telephone service, and rental of facility space.
6		"Long-term care facility for persons under 22 years of age
7		serving clinically complex residents" means a facility
8		licensed by the Department of Public Health as a long-term care
9		facility for persons under 22 meeting the qualifications of
10		Section 5-5.4h of this Code.
11		(Source: P.A. 97-227, eff. 1-1-12; 98-463, eff. 8-16-13.)
12		(305 ILCS 5/5C-2) (from Ch. 23, par. 5C-2)
13		Sec. 5C-2. Assessment; no local authorization to tax.
14		(a) For the privilege of engaging in the occupation of
15		developmentally disabled care provider, an assessment is
16		imposed upon each developmentally disabled care provider in an
17		amount equal to 6%, or the maximum allowed under federal
18		regulation, whichever is less, of its adjusted gross
19		developmentally disabled care revenue for the prior State
20		fiscal year. Notwithstanding any provision of any other Act to
21		the contrary, this assessment shall be construed as a tax, but
22		may not be added to the charges of an individual's nursing home
23		care that is paid for in whole, or in part, by a federal,
24		State, or combined federal-state medical care program, except
25		those individuals receiving Medicare Part B benefits solely.

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1		(b) Nothing in this amendatory Act of 1995 shall be
2		construed to authorize any home rule unit or other unit of
3		local government to license for revenue or impose a tax or
4		assessment upon a developmentally disabled care provider or the
5		occupation of developmentally disabled care provider, or a tax
6		or assessment measured by the income or earnings of a
7		developmentally disabled care provider.
8		(c) Effective July 1, 2013, for the privilege of engaging
9		in the occupation of long-term care facility for persons under
10		22 years of age serving clinically complex residents provider,
11		an assessment is imposed upon each long-term care facility for
12		persons under 22 years of age serving clinically complex
13		residents provider in the same amount and upon the same
14		conditions and requirements as imposed in Article V-B of this
15		Code and a license fee is imposed in the same amount and upon
16		the same conditions and requirements as imposed in Article V-E
17		of this Code. Notwithstanding any provision of any other Act to
18		the contrary, the assessment and license fee imposed by this
19		subsection (c) shall be construed as a tax, but may not be
20		added to the charges of an individual's nursing home care that
21		is paid for in whole, or in part, by a federal, State, or
22		combined federal-State medical care program, except for those
23		individuals receiving Medicare Part B benefits solely.
24		(Source: P.A. 95-707, eff. 1-11-08.)
25		(305 ILCS 5/5C-7) (from Ch. 23, par. 5C-7)

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1		Sec. 5C-7. Care Provider Fund for Persons with a
2		Developmental Disability.
3		(a) There is created in the State Treasury the Care
4		Provider Fund for Persons with a Developmental Disability.
5		Interest earned by the Fund shall be credited to the Fund. The
6		Fund shall not be used to replace any moneys appropriated to
7		the Medicaid program by the General Assembly.
8		(b) The Fund is created for the purpose of receiving and
9		disbursing assessment moneys in accordance with this Article.
10		Disbursements from the Fund shall be made only as follows:
11		(1) For payments to intermediate care facilities for
12		the developmentally disabled under Title XIX of the Social
13		Security Act and Article V of this Code.
14		(2) For the reimbursement of moneys collected by the
15		Illinois Department through error or mistake, and to make
16		required payments under Section 5-4.28(a)(1) of this Code
17		if there are no moneys available for such payments in the
18		Medicaid Developmentally Disabled Provider Participation
19		Fee Trust Fund.
20		(3) For payment of administrative expenses incurred by
21		the Department of Human Services or its agent or the
22		Illinois Department or its agent in performing the
23		activities authorized by this Article.
24		(4) For payments of any amounts which are reimbursable
25		to the federal government for payments from this Fund which
26		are required to be paid by State warrant.

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1		(5) For making transfers to the General Obligation Bond
2		Retirement and Interest Fund as those transfers are
3		authorized in the proceedings authorizing debt under the
4		Short Term Borrowing Act, but transfers made under this
5		paragraph (5) shall not exceed the principal amount of debt
6		issued in anticipation of the receipt by the State of
7		moneys to be deposited into the Fund.
8		(6) For making refunds as required under Section 5C-10
9		of this Article.
10		Disbursements from the Fund, other than transfers to the
11		General Obligation Bond Retirement and Interest Fund, shall be
12		by warrants drawn by the State Comptroller upon receipt of
13		vouchers duly executed and certified by the Illinois
14		Department.
15		(c) The Fund shall consist of the following:
16		(1) All moneys collected or received by the Illinois
17		Department from the developmentally disabled care provider
18		assessment imposed by this Article.
19		(2) All federal matching funds received by the Illinois
20		Department as a result of expenditures made by the Illinois
21		Department that are attributable to moneys deposited in the
22		Fund.
23		(3) Any interest or penalty levied in conjunction with
24		the administration of this Article.
25		(4) Any balance in the Medicaid Developmentally
26		Disabled Care Provider Participation Fee Trust Fund in the

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1		State Treasury. The balance shall be transferred to the
2		Fund upon certification by the Illinois Department to the
3		State Comptroller that all of the disbursements required by
4		Section 5-4.21(b) of this Code have been made.
5		(5) All other moneys received for the Fund from any
6		other source, including interest earned thereon.
7		(Source: P.A. 98-463, eff. 8-16-13.)
8		(305 ILCS 5/5C-10 new)
9		Sec. 5C-10. Adjustments. For long-term care facilities for
10		persons under 22 years of age serving clinically complex
11		residents previously classified as developmentally disabled
12		care facilities under this Article, the Department shall refund
13		any amounts paid under this Article in State fiscal year 2014
14		by the end of State fiscal year 2015 with at least half the
15		refund amount being made prior to December 31, 2014. The
16		amounts refunded shall be based on amounts paid by the
17		facilities to the Department as the assessment under subsection
18		(a) of Section 5C-2 less any assessment and license fee due for
19		State fiscal year 2014.
20		(305 ILCS 5/Art. V-G heading new)
21		ARTICLE V-G. SUPPORTIVE LIVING FACILITY FUNDING.
22		(305 ILCS 5/5G-5 new)
23		Sec. 5G-5. Definitions. As used in this Article, unless the

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1		context requires otherwise:
2		"Care days" shall be computed separately for each
3		supportive living facility, and means the sum for all apartment
4		units, the number of days during the month which each apartment
5		unit was occupied by a resident.
6		"Department" means the Department of Healthcare and Family
7		Services.
8		"Fund" means the Supportive Living Facility Fund.
9		"Supportive living facility" means an enrolled supportive
10		living site as described under Section 5-5.01a of this Code
11		that meets the participation requirements under Section
12		146.215 of Title 89 of the Illinois Administrative Code.
13		(305 ILCS 5/5G-10 new)
14		Sec. 5G-10. Assessment.
15		(a) Subject to Section 5G-45, beginning July 1, 2014, an
16		annual assessment on health care services is imposed on each
17		supportive living facility in an amount equal to $2.30
18		multiplied by the supportive living facility's care days. This
19		assessment shall not be billed or passed on to any resident of
20		a supportive living facility.
21		(b) Nothing in this Section shall be construed to authorize
22		any home rule unit or other unit of local government to license
23		for revenue or impose a tax or assessment upon supportive
24		living facilities or the occupation of operating a supportive
25		living facility, or a tax or assessment measured by the income

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1		or earnings or care days of a supportive living facility.
2		(c) The assessment imposed by this Section shall not be due
3		and payable, however, until after the Department notifies the
4		supportive living facilities, in writing, that the payment
5		methodologies to supportive living facilities required under
6		Section 5-5.01a of this Code have been approved by the Centers
7		for Medicare and Medicaid Services of the U.S. Department of
8		Health and Human Services and the waivers under 42 CFR 433.68
9		for the assessment imposed by this Section, if necessary, have
10		been granted by the Centers for Medicare and Medicaid Services
11		of the U.S. Department of Health and Human Services.
12		(305 ILCS 5/5G-15 new)
13		Sec. 5G-15. Payment of assessment; penalty.
14		(a) The assessment imposed by Section 5G-10 shall be due
15		and payable in monthly installments on the last State business
16		day of the month for care days reported for the preceding third
17		month prior to the month in which the assessment is payable and
18		due. A facility that has delayed payment due to the State's
19		failure to reimburse for services rendered may request an
20		extension on the due date for payment pursuant to subsection
21		(c) and shall pay the assessment within 30 days of
22		reimbursement by the Department.
23		(b) The Department shall provide for an electronic
24		submission process for each supportive living facility to
25		report at a minimum the number of care days of the supportive

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1		living facility for the reporting period and other reasonable
2		information the Department requires for the administration of
3		its responsibilities under this Code. The Department shall
4		prepare an assessment bill stating the amount due and payable
5		each month and submit it to each supportive living facility via
6		an electronic process. To the extent practicable, the
7		Department shall coordinate the assessment reporting
8		requirements with other reporting required of supportive
9		living facilities.
10		(c) The Department is authorized to establish delayed
11		payment schedules for supportive living facilities that are
12		unable to make assessment payments when due under this Section
13		due to financial difficulties, as determined by the Department.
14		The Department may not deny a request for delay of payment of
15		the assessment imposed under this Article if the supportive
16		living facility has not been paid for services provided during
17		the month in which the assessment is levied.
18		(d) If a supportive living facility fails to pay the full
19		amount of an assessment payment when due (including any
20		extensions granted under subsection (c)), there shall, unless
21		waived by the Department for reasonable cause, be added to the
22		assessment imposed by Section 5G-10 a penalty assessment equal
23		to the lesser of (i) 1% of the amount of the assessment payment
24		not paid on or before the due date plus 1% of the portion
25		thereof remaining unpaid on the last day of each month
26		thereafter or (ii) 100% of the assessment payment amount not

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1		paid on or before the due date. For purposes of this
2		subsection, payments will be credited first to unpaid
3		assessment payment amounts (rather than to penalty or
4		interest), beginning with the most delinquent assessment
5		payments. Payment cycles of longer than 30 days shall be one
6		factor the Director takes into account in granting a waiver
7		under this Section.
8		(e) No installment of the assessment imposed by Section
9		5G-10 shall be due and payable until after the Department
10		notifies the supportive living facilities, in writing, that the
11		payment methodologies to supportive living facilities required
12		under Section 5-5.01a of this Code have been approved by the
13		Centers for Medicare and Medicaid Services of the U.S.
14		Department of Health and Human Services and the waivers under
15		42 CFR 433.68 for the assessment imposed by this Section, if
16		necessary, have been granted by the Centers for Medicare and
17		Medicaid Services of the U.S. Department of Health and Human
18		Services. Upon notification to the Department of approval of
19		the payment methodologies required under Section 5-5.01a of
20		this Code and the waivers granted under 42 CFR 433.68, all
21		installments otherwise due under this Section prior to the date
22		of notification shall be due and payable to the Department upon
23		written direction from the Department within 90 days after
24		issuance by the Comptroller of the payments required under
25		Section 5-5.01a of this Code.

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1		(305 ILCS 5/5G-20 new)
2		Sec. 5G-20. Reporting; penalty; maintenance of records.
3		(a) Every supportive living facility subject to assessment
4		under this Article shall report the number care days of the
5		supportive living facility for the reporting period on or
6		before the last business day of the month following the
7		reporting period. Each supportive living facility shall ensure
8		that an accurate e-mail address is on file with the Department
9		in order for the Department to prepare and send an electronic
10		bill to the supportive living facility.
11		(b) If a supportive living facility fails to file its
12		monthly report with the Department when due, there shall,
13		unless waived by the Illinois Department for reasonable cause,
14		be added to the assessment due a penalty assessment equal to
15		25% of the assessment due.
16		(c) Every supportive living facility subject to assessment
17		under this Article shall keep records and books that will
18		permit the determination of care days on a calendar year basis.
19		All such books and records shall be kept in the English
20		language and shall, at all times during business hours of the
21		day, be subject to inspection by the Department or its duly
22		authorized agents and employees.
23		(d) Notwithstanding any other provision of this Article, a
24		facility that commences operating or maintaining a supportive
25		living facility that was under a prior ownership and remained
26		enrolled as a Medicaid facility by the Department shall notify

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1		the Department of the change in ownership and shall be
2		responsible to immediately pay any prior amounts owed by the
3		facility.
4		(e) The Department shall develop a procedure for sharing
5		with a potential buyer of a facility information regarding
6		outstanding assessments and penalties owed by that facility.
7		(305 ILCS 5/5G-25 new)
8		Sec. 5G-25. Disposition of proceeds. The Department shall
9		pay all moneys received from supportive living facilities under
10		this Article into the Supportive Living Facility Fund. Upon
11		certification by the Department to the State Comptroller of its
12		intent to withhold from a facility under Section 5G-30(b), the
13		State Comptroller shall draw a warrant on the treasury or other
14		fund held by the State Treasurer, as appropriate. The warrant
15		shall state the amount for which the facility is entitled to a
16		warrant, the amount of the deduction, and the reason therefor
17		and shall direct the State Treasurer to pay the balance to the
18		facility, all in accordance with Section 10.05 of the State
19		Comptroller Act. The warrant also shall direct the State
20		Treasurer to transfer the amount of the deduction so ordered
21		from the treasury or other fund into the Supportive Living
22		Facility Fund.
23		(305 ILCS 5/5G-30 new)
24		Sec. 5G-30. Administration; enforcement provisions.

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1		(a) The Department shall administer and enforce this
2		Article and collect the assessments and penalty assessments
3		imposed under this Article using procedures employed in its
4		administration of this Code generally and as follows:
5		(1) The Department may initiate either administrative
6		or judicial proceedings, or both, to enforce provisions of
7		this Article. Administrative enforcement proceedings
8		initiated hereunder shall be governed by the Department's
9		administrative rules. Judicial enforcement proceedings
10		initiated hereunder shall be governed by the rules of
11		procedure applicable in the courts of this State.
12		(2) No proceedings for collection, refund, credit, or
13		other adjustment of an assessment amount shall be issued
14		more than 3 years after the due date of the assessment,
15		except in the case of an extended period agreed to in
16		writing by the Department and the supportive living
17		facility before the expiration of this limitation period.
18		(3) Any unpaid assessment under this Article shall
19		become a lien upon the assets of the supportive living
20		facility upon which it was assessed. If any supportive
21		living facility, outside the usual course of its business,
22		sells or transfers the major part of any one or more of (A)
23		the real property and improvements, (B) the machinery and
24		equipment, or (C) the furniture or fixtures, of any
25		supportive living facility that is subject to the
26		provisions of this Article, the seller or transferor shall

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1		pay the Department the amount of any assessment, assessment
2		penalty, and interest (if any) due from it under this
3		Article up to the date of the sale or transfer. If the
4		seller or transferor fails to pay any assessment,
5		assessment penalty, and interest (if any) due, the
6		purchaser or transferee of such asset shall be liable for
7		the amount of the assessment, penalty, and interest (if
8		any) up to the amount of the reasonable value of the
9		property acquired by the purchaser or transferee. The
10		purchaser or transferee shall continue to be liable until
11		the purchaser or transferee pays the full amount of the
12		assessment, penalty, and interest (if any) up to the amount
13		of the reasonable value of the property acquired by the
14		purchaser or transferee or until the purchaser or
15		transferee receives from the Department a certificate
16		showing that such assessment, penalty, and interest have
17		been paid or a certificate from the Department showing that
18		no assessment, penalty, or interest is due from the seller
19		or transferor under this Article.
20		(b) In addition to any other remedy provided for and
21		without sending a notice of assessment liability, the
22		Department may collect an unpaid assessment by withholding, as
23		payment of the assessment, reimbursements or other amounts
24		otherwise payable by the Department to the supportive living
25		facility.

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1		(305 ILCS 5/5G-35 new)
2		Sec. 5G-35. Supportive Living Facility Fund.
3		(a) There is created in the State treasury the Supportive
4		Living Facility Fund. Interest earned by the Fund shall be
5		credited to the Fund. The Fund shall not be used to replace any
6		moneys appropriated to the Medicaid program by the General
7		Assembly.
8		(b) The Fund is created for the purpose of receiving and
9		disbursing moneys in accordance with this Article.
10		Disbursements from the Fund, other than transfers authorized
11		under paragraphs (5) and (6) of this subsection, shall be by
12		warrants drawn by the State Comptroller upon receipt of
13		vouchers duly executed and certified by the Department.
14		Disbursements from the Fund shall be made only as follows:
15		(1) For making payments to supportive living
16		facilities as required under this Code, under the
17		Children's Health Insurance Program Act, under the
18		Covering ALL KIDS Health Insurance Act, and under the Long
19		Term Acute Care Hospital Quality Improvement Transfer
20		Program Act.
21		(2) For the reimbursement of moneys collected by the
22		Department from supportive living facilities through error
23		or mistake in performing the activities authorized under
24		this Code.
25		(3) For payment of administrative expenses incurred by
26		the Department or its agent in performing administrative

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1		oversight activities for the supportive living program or
2		review of new supportive living facility applications.
3		(4) For payments of any amounts which are reimbursable
4		to the federal government for payments from this Fund which
5		are required to be paid by State warrant.
6		(5) For making transfers, as those transfers are
7		authorized in the proceedings authorizing debt under the
8		Short Term Borrowing Act, but transfers made under this
9		paragraph (5) shall not exceed the principal amount of debt
10		issued in anticipation of the receipt by the State of
11		moneys to be deposited into the Fund.
12		(6) For making transfers to any other fund in the State
13		treasury, but transfers made under this paragraph (6) shall
14		not exceed the amount transferred previously from that
15		other fund into the Supportive Living Facility Fund plus
16		any interest that would have been earned by that fund on
17		the money that had been transferred.
18		(c) The Fund shall consist of the following:
19		(1) All moneys collected or received by the Department
20		from the supportive living facility assessment imposed by
21		this Article.
22		(2) All moneys collected or received by the Department
23		from the supportive living facility certification fee
24		imposed by this Article.
25		(3) All federal matching funds received by the
26		Department as a result of expenditures made by the

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1		Department that are attributable to moneys deposited in the
2		Fund.
3		(4) Any interest or penalty levied in conjunction with
4		the administration of this Article.
5		(5) Moneys transferred from another fund in the State
6		treasury.
7		(6) All other moneys received for the Fund from any
8		other source, including interest earned thereon.
9		(305 ILCS 5/5G-40 new)
10		Sec. 5G-40. Certification fee.
11		(a) The Department shall collect an annual certification
12		fee of $100 per each operational or approved supportive living
13		facility for the purposes of funding the administrative process
14		of reviewing new supportive living facility applications and
15		administrative oversight of the health care services delivered
16		by supportive living facilities.
17		(b) The certification fee shall be deposited into the
18		Supportive Living Facility Fund. The Department shall maintain
19		a separate accounting of amounts collected under this Section.
20		(305 ILCS 5/5G-45 new)
21		Sec. 5G-45. Applicability.
22		(a) The Department must submit any necessary documentation
23		to the Centers for Medicare and Medicaid Services which allows
24		for an effective date of July 1, 2014 for the requirements of

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1		this Article. The documents shall include any necessary
2		documents that satisfy federal public notice requirements,
3		Medicaid state plan amendments, and any Medicaid waiver
4		amendments.
5		(b) The assessment imposed by Section 5G-10 shall cease to
6		be imposed if the amount of matching federal funds under Title
7		XIX of the Social Security Act is eliminated or significantly
8		reduced on account of the assessment. Any remaining assessments
9		shall be refunded to supportive living facilities in proportion
10		to the amounts of the assessments paid by them.
11		(c) The certification fee imposed by Section 5G-40 shall
12		cease to be imposed if the amount of matching federal funds
13		under Title XIX of the Social Security Act is eliminated or
14		significantly reduced on account of the certification fee.
15		Section 55-20. The Immunization Data Registry Act is
16		amended by changing Section 20 as follows:
17		(410 ILCS 527/20)
18		Sec. 20. Confidentiality of information; release of
19		information; statistics; panel on expanding access.
20		(a) Records maintained as part of the immunization data
21		registry are confidential.
22		(b) The Department may release an individual's
23		confidential information to the individual or to the
24		individual's parent or guardian if the individual is less than

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1		18 years of age.
2		(c) Subject to subsection (d) of this Section, the
3		Department may release information in the immunization data
4		registry concerning an individual to the following entities:
5		(1) The immunization data registry of another state.
6		(2) A health care provider or a health care provider's
7		designee.
8		(3) A local health department.
9		(4) An elementary or secondary school that is attended
10		by the individual.
11		(5) A licensed child care center in which the
12		individual is enrolled.
13		(6) A licensed child-placing agency.
14		(7) A college or university that is attended by the
15		individual.
16		(8) The Department of Healthcare and Family Services or
17		a managed care entity contracted with the Department of
18		Healthcare and Family Services to coordinate the provision
19		of medical care to enrollees of the medical assistance
20		program.
21		(d) Before immunization data may be released to an entity,
22		the entity must enter into an agreement with the Department
23		that provides that information that identifies a patient will
24		not be released to any other person without the written consent
25		of the patient.
26		(e) The Department may release summary statistics

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1		regarding information in the immunization data registry if the
2		summary statistics do not reveal the identity of an individual.
3		(Source: P.A. 97-117, eff. 7-14-11.)
4		Article 60
5		Section 60-5. The Lead Poisoning Prevention Act is amended
6		by adding Section 15.1 as follows:
7		(410 ILCS 45/15.1 new)
8		Sec. 15.1. Funding. Beginning July 1, 2014 and ending June
9		30, 2018, a hospital satisfying the definition, as of July 1,
10		2014, of Section 5-5e.1 of the Illinois Public Aid Code and
11		located in DuPage County shall pay the sum of $2,000,000
12		annually in 4 equal quarterly installments to the human poison
13		control center in existence as of July 1, 2014 and established
14		under the authority of this Act.
15		Article 99
16		Section 99-1. Severability. If any clause, sentence,
17		Section, exemption, provision, or part of this Act or the
18		application thereof to any person or circumstance shall be
19		adjudged to be unconstitutional or otherwise invalid, the
20		remainder of this Act or its application to persons or
21		circumstances other than those to which it is held invalid

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1		shall not be affected thereby and to this end the provisions of
2		this Act are declared to be severable.
3		Section 99-2. Any action required by this Act to occur
4		prior to or on June 30, 2014 shall be completed within 30 days
5		after the effective date of this Act.