SB1851 Engrossed LRB100 10394 KTG 20591 b
1		AN ACT concerning public aid.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The Illinois Public Aid Code is amended by
5		changing Section 5-5.4h as follows:
6		(305 ILCS 5/5-5.4h)
7		Sec. 5-5.4h. Medicaid reimbursement for medically complex
8		for the developmentally disabled facilities long-term care
9		facilities for persons under 22 years of age.
10		(a) Facilities licensed as medically complex for the
11		developmentally disabled facilities long-term care facilities
12		for persons under 22 years of age that serve severely and
13		chronically ill pediatric patients shall have a specific
14		reimbursement system designed to recognize the characteristics
15		and needs of the patients they serve.
16		(b) For dates of services starting July 1, 2013 and until a
17		new reimbursement system is designed, medically complex for the
18		developmentally disabled facilities long-term care facilities
19		for persons under 22 years of age that meet the following
20		criteria:
21		(1) serve exceptional care patients; and
22		(2) have 30% or more of their patients receiving
23		ventilator care;

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

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