Full Text of HB0691 95th General Assembly
HB0691sam002 95TH GENERAL ASSEMBLY
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Sen. Donne E. Trotter
Filed: 8/14/2007
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LRB095 08369 WGH 38691 a |
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| AMENDMENT TO HOUSE BILL 691
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| AMENDMENT NO. ______. Amend House Bill 691, AS AMENDED, by | 3 |
| replacing everything after the enacting clause with the | 4 |
| following:
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| "Section 1. Short title. This Act may be cited as the FY08 | 6 |
| Human Services Budget Implementation Act. | 7 |
| Section 3. The State Employees Group Insurance Act of 1971 | 8 |
| is amended by changing Section 10 as follows:
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| (5 ILCS 375/10) (from Ch. 127, par. 530)
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| Sec. 10. Payments by State; premiums.
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| (a) The State shall pay the cost of basic non-contributory | 12 |
| group life
insurance and, subject to member paid contributions | 13 |
| set by the Department or
required by this Section, the basic | 14 |
| program of group health benefits on each
eligible member, | 15 |
| except a member, not otherwise
covered by this Act, who has |
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| retired as a participating member under Article 2
of the | 2 |
| Illinois Pension Code but is ineligible for the retirement | 3 |
| annuity under
Section 2-119 of the Illinois Pension Code, and | 4 |
| part of each eligible member's
and retired member's premiums | 5 |
| for health insurance coverage for enrolled
dependents as | 6 |
| provided by Section 9. The State shall pay the cost of the | 7 |
| basic
program of group health benefits only after benefits are | 8 |
| reduced by the amount
of benefits covered by Medicare for all | 9 |
| members and dependents
who are eligible for benefits under | 10 |
| Social Security or
the Railroad Retirement system or who had | 11 |
| sufficient Medicare-covered
government employment, except that | 12 |
| such reduction in benefits shall apply only
to those members | 13 |
| and dependents who (1) first become eligible
for such Medicare | 14 |
| coverage on or after July 1, 1992; or (2) are
Medicare-eligible | 15 |
| members or dependents of a local government unit which began
| 16 |
| participation in the program on or after July 1, 1992; or (3) | 17 |
| remain eligible
for, but no longer receive Medicare coverage | 18 |
| which they had been receiving on
or after July 1, 1992. The | 19 |
| Department may determine the aggregate level of the
State's | 20 |
| contribution on the basis of actual cost of medical services | 21 |
| adjusted
for age, sex or geographic or other demographic | 22 |
| characteristics which affect
the costs of such programs.
| 23 |
| The cost of participation in the basic program of group | 24 |
| health benefits
for the dependent or survivor of a living or | 25 |
| deceased retired employee who was
formerly employed by the | 26 |
| University of Illinois in the Cooperative Extension
Service and |
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| would be an annuitant but for the fact that he or she was made
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| ineligible to participate in the State Universities Retirement | 3 |
| System by clause
(4) of subsection (a) of Section 15-107 of the | 4 |
| Illinois Pension Code shall not
be greater than the cost of | 5 |
| participation that would otherwise apply to that
dependent or | 6 |
| survivor if he or she were the dependent or survivor of an
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| annuitant under the State Universities Retirement System.
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| (a-1) Beginning January 1, 1998, for each person who | 9 |
| becomes a new SERS
annuitant and participates in the basic | 10 |
| program of group health benefits, the
State shall contribute | 11 |
| toward the cost of the annuitant's
coverage under the basic | 12 |
| program of group health benefits an amount equal
to 5% of that | 13 |
| cost for each full year of creditable service upon which the
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| annuitant's retirement annuity is based, up to a maximum of | 15 |
| 100% for an
annuitant with 20 or more years of creditable | 16 |
| service.
The remainder of the cost of a new SERS annuitant's | 17 |
| coverage under the basic
program of group health benefits shall | 18 |
| be the responsibility of the
annuitant. In the case of a new | 19 |
| SERS annuitant who has elected to receive an alternative | 20 |
| retirement cancellation payment under Section 14-108.5 of the | 21 |
| Illinois Pension Code in lieu of an annuity, for the purposes | 22 |
| of this subsection the annuitant shall be deemed to be | 23 |
| receiving a retirement annuity based on the number of years of | 24 |
| creditable service that the annuitant had established at the | 25 |
| time of his or her termination of service under SERS.
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| (a-2) Beginning January 1, 1998, for each person who |
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| becomes a new SERS
survivor and participates in the basic | 2 |
| program of group health benefits, the
State shall contribute | 3 |
| toward the cost of the survivor's
coverage under the basic | 4 |
| program of group health benefits an amount equal
to 5% of that | 5 |
| cost for each full year of the deceased employee's or deceased
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| annuitant's creditable service in the State Employees' | 7 |
| Retirement System of
Illinois on the date of death, up to a | 8 |
| maximum of 100% for a survivor of an
employee or annuitant with | 9 |
| 20 or more years of creditable service. The
remainder of the | 10 |
| cost of the new SERS survivor's coverage under the basic
| 11 |
| program of group health benefits shall be the responsibility of | 12 |
| the survivor. In the case of a new SERS survivor who was the | 13 |
| dependent of an annuitant who elected to receive an alternative | 14 |
| retirement cancellation payment under Section 14-108.5 of the | 15 |
| Illinois Pension Code in lieu of an annuity, for the purposes | 16 |
| of this subsection the deceased annuitant's creditable service | 17 |
| shall be determined as of the date of termination of service | 18 |
| rather than the date of death.
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| (a-3) Beginning January 1, 1998, for each person who | 20 |
| becomes a new SURS
annuitant and participates in the basic | 21 |
| program of group health benefits, the
State shall contribute | 22 |
| toward the cost of the annuitant's
coverage under the basic | 23 |
| program of group health benefits an amount equal
to 5% of that | 24 |
| cost for each full year of creditable service upon which the
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| annuitant's retirement annuity is based, up to a maximum of | 26 |
| 100% for an
annuitant with 20 or more years of creditable |
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| service.
The remainder of the cost of a new SURS annuitant's | 2 |
| coverage under the basic
program of group health benefits shall | 3 |
| be the responsibility of the
annuitant.
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| (a-4) (Blank).
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| (a-5) Beginning January 1, 1998, for each person who | 6 |
| becomes a new SURS
survivor and participates in the basic | 7 |
| program of group health benefits, the
State shall contribute | 8 |
| toward the cost of the survivor's coverage under the
basic | 9 |
| program of group health benefits an amount equal to 5% of that | 10 |
| cost for
each full year of the deceased employee's or deceased | 11 |
| annuitant's creditable
service in the State Universities | 12 |
| Retirement System on the date of death, up to
a maximum of 100% | 13 |
| for a survivor of an
employee or annuitant with 20 or more | 14 |
| years of creditable service. The
remainder of the cost of the | 15 |
| new SURS survivor's coverage under the basic
program of group | 16 |
| health benefits shall be the responsibility of the survivor.
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| (a-6) Beginning July 1, 1998, for each person who becomes a | 18 |
| new TRS
State annuitant and participates in the basic program | 19 |
| of group health benefits,
the State shall contribute toward the | 20 |
| cost of the annuitant's coverage under
the basic program of | 21 |
| group health benefits an amount equal to 5% of that cost
for | 22 |
| each full year of creditable service
as a teacher as defined in | 23 |
| paragraph (2), (3), or (5) of Section 16-106 of the
Illinois | 24 |
| Pension Code
upon which the annuitant's retirement annuity is | 25 |
| based, up to a maximum of
100%;
except that
the State | 26 |
| contribution shall be 12.5% per year (rather than 5%) for each |
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| full
year of creditable service as a regional superintendent or | 2 |
| assistant regional
superintendent of schools. The
remainder of | 3 |
| the cost of a new TRS State annuitant's coverage under the | 4 |
| basic
program of group health benefits shall be the | 5 |
| responsibility of the
annuitant.
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| (a-7) Beginning July 1, 1998, for each person who becomes a | 7 |
| new TRS
State survivor and participates in the basic program of | 8 |
| group health benefits,
the State shall contribute toward the | 9 |
| cost of the survivor's coverage under the
basic program of | 10 |
| group health benefits an amount equal to 5% of that cost for
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| each full year of the deceased employee's or deceased | 12 |
| annuitant's creditable
service
as a teacher as defined in | 13 |
| paragraph (2), (3), or (5) of Section 16-106 of the
Illinois | 14 |
| Pension Code
on the date of death, up to a maximum of 100%;
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| except that the State contribution shall be 12.5% per year | 16 |
| (rather than 5%) for
each full year of the deceased employee's | 17 |
| or deceased annuitant's creditable
service as a regional | 18 |
| superintendent or assistant regional superintendent of
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| schools.
The remainder of
the cost of the new TRS State | 20 |
| survivor's coverage under the basic program of
group health | 21 |
| benefits shall be the responsibility of the survivor.
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| (a-8) A new SERS annuitant, new SERS survivor, new SURS
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| annuitant, new SURS survivor, new TRS State
annuitant, or new | 24 |
| TRS State survivor may waive or terminate coverage in
the | 25 |
| program of group health benefits. Any such annuitant or | 26 |
| survivor
who has waived or terminated coverage may enroll or |
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| re-enroll in the
program of group health benefits only during | 2 |
| the annual benefit choice period,
as determined by the | 3 |
| Director; except that in the event of termination of
coverage | 4 |
| due to nonpayment of premiums, the annuitant or survivor
may | 5 |
| not re-enroll in the program.
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| (a-9) No later than May 1 of each calendar year, the | 7 |
| Director
of Central Management Services shall certify in | 8 |
| writing to the Executive
Secretary of the State Employees' | 9 |
| Retirement System of Illinois the amounts
of the Medicare | 10 |
| supplement health care premiums and the amounts of the
health | 11 |
| care premiums for all other retirees who are not Medicare | 12 |
| eligible.
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| A separate calculation of the premiums based upon the | 14 |
| actual cost of each
health care plan shall be so certified.
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| The Director of Central Management Services shall provide | 16 |
| to the
Executive Secretary of the State Employees' Retirement | 17 |
| System of
Illinois such information, statistics, and other data | 18 |
| as he or she
may require to review the premium amounts | 19 |
| certified by the Director
of Central Management Services.
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| (b) State employees who become eligible for this program on | 21 |
| or after January
1, 1980 in positions normally requiring actual | 22 |
| performance of duty not less
than 1/2 of a normal work period | 23 |
| but not equal to that of a normal work period,
shall be given | 24 |
| the option of participating in the available program. If the
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| employee elects coverage, the State shall contribute on behalf | 26 |
| of such employee
to the cost of the employee's benefit and any |
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| applicable dependent supplement,
that sum which bears the same | 2 |
| percentage as that percentage of time the
employee regularly | 3 |
| works when compared to normal work period.
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| (c) The basic non-contributory coverage from the basic | 5 |
| program of
group health benefits shall be continued for each | 6 |
| employee not in pay status or
on active service by reason of | 7 |
| (1) leave of absence due to illness or injury,
(2) authorized | 8 |
| educational leave of absence or sabbatical leave, or (3)
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| military leave with pay and benefits. This coverage shall | 10 |
| continue until
expiration of authorized leave and return to | 11 |
| active service, but not to exceed
24 months for leaves under | 12 |
| item (1) or (2). This 24-month limitation and the
requirement | 13 |
| of returning to active service shall not apply to persons | 14 |
| receiving
ordinary or accidental disability benefits or | 15 |
| retirement benefits through the
appropriate State retirement | 16 |
| system or benefits under the Workers' Compensation
or | 17 |
| Occupational Disease Act.
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| (d) The basic group life insurance coverage shall continue, | 19 |
| with
full State contribution, where such person is (1) absent | 20 |
| from active
service by reason of disability arising from any | 21 |
| cause other than
self-inflicted, (2) on authorized educational | 22 |
| leave of absence or
sabbatical leave, or (3) on military leave | 23 |
| with pay and benefits.
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| (e) Where the person is in non-pay status for a period in | 25 |
| excess of
30 days or on leave of absence, other than by reason | 26 |
| of disability,
educational or sabbatical leave, or military |
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| leave with pay and benefits, such
person may continue coverage | 2 |
| only by making personal
payment equal to the amount normally | 3 |
| contributed by the State on such person's
behalf. Such payments | 4 |
| and coverage may be continued: (1) until such time as
the | 5 |
| person returns to a status eligible for coverage at State | 6 |
| expense, but not
to exceed 24 months, (2) until such person's | 7 |
| employment or annuitant status
with the State is terminated, or | 8 |
| (3) for a maximum period of 4 years for
members on military | 9 |
| leave with pay and benefits and military leave without pay
and | 10 |
| benefits (exclusive of any additional service imposed pursuant | 11 |
| to law).
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| (f) The Department shall establish by rule the extent to | 13 |
| which other
employee benefits will continue for persons in | 14 |
| non-pay status or who are
not in active service.
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| (g) The State shall not pay the cost of the basic | 16 |
| non-contributory
group life insurance, program of health | 17 |
| benefits and other employee benefits
for members who are | 18 |
| survivors as defined by paragraphs (1) and (2) of
subsection | 19 |
| (q) of Section 3 of this Act. The costs of benefits for these
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| survivors shall be paid by the survivors or by the University | 21 |
| of Illinois
Cooperative Extension Service, or any combination | 22 |
| thereof.
However, the State shall pay the amount of the | 23 |
| reduction in the cost of
participation, if any, resulting from | 24 |
| the amendment to subsection (a) made
by this amendatory Act of | 25 |
| the 91st General Assembly.
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| (h) Those persons occupying positions with any department |
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| as a result
of emergency appointments pursuant to Section 8b.8 | 2 |
| of the Personnel Code
who are not considered employees under | 3 |
| this Act shall be given the option
of participating in the | 4 |
| programs of group life insurance, health benefits and
other | 5 |
| employee benefits. Such persons electing coverage may | 6 |
| participate only
by making payment equal to the amount normally | 7 |
| contributed by the State for
similarly situated employees. Such | 8 |
| amounts shall be determined by the
Director. Such payments and | 9 |
| coverage may be continued until such time as the
person becomes | 10 |
| an employee pursuant to this Act or such person's appointment | 11 |
| is
terminated.
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| (i) Any unit of local government within the State of | 13 |
| Illinois
may apply to the Director to have its employees, | 14 |
| annuitants, and their
dependents provided group health | 15 |
| coverage under this Act on a non-insured
basis. To participate, | 16 |
| a unit of local government must agree to enroll
all of its | 17 |
| employees, who may select coverage under either the State group
| 18 |
| health benefits plan or a health maintenance organization that | 19 |
| has
contracted with the State to be available as a health care | 20 |
| provider for
employees as defined in this Act. A unit of local | 21 |
| government must remit the
entire cost of providing coverage | 22 |
| under the State group health benefits plan
or, for coverage | 23 |
| under a health maintenance organization, an amount determined
| 24 |
| by the Director based on an analysis of the sex, age, | 25 |
| geographic location, or
other relevant demographic variables | 26 |
| for its employees, except that the unit of
local government |
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| shall not be required to enroll those of its employees who are
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| covered spouses or dependents under this plan or another group | 3 |
| policy or plan
providing health benefits as long as (1) an | 4 |
| appropriate official from the unit
of local government attests | 5 |
| that each employee not enrolled is a covered spouse
or | 6 |
| dependent under this plan or another group policy or plan, and | 7 |
| (2) at least
85% of the employees are enrolled and the unit of | 8 |
| local government remits
the entire cost of providing coverage | 9 |
| to those employees, except that a
participating school district | 10 |
| must have enrolled at least 85% of its full-time
employees who | 11 |
| have not waived coverage under the district's group health
plan | 12 |
| by participating in a component of the district's cafeteria | 13 |
| plan. A
participating school district is not required to enroll | 14 |
| a full-time employee
who has waived coverage under the | 15 |
| district's health plan, provided that an
appropriate official | 16 |
| from the participating school district attests that the
| 17 |
| full-time employee has waived coverage by participating in a | 18 |
| component of the
district's cafeteria plan. For the purposes of | 19 |
| this subsection, "participating
school district" includes a | 20 |
| unit of local government whose primary purpose is
education as | 21 |
| defined by the Department's rules.
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| Employees of a participating unit of local government who | 23 |
| are not enrolled
due to coverage under another group health | 24 |
| policy or plan may enroll in
the event of a qualifying change | 25 |
| in status, special enrollment, special
circumstance as defined | 26 |
| by the Director, or during the annual Benefit Choice
Period. A |
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| participating unit of local government may also elect to cover | 2 |
| its
annuitants. Dependent coverage shall be offered on an | 3 |
| optional basis, with the
costs paid by the unit of local | 4 |
| government, its employees, or some combination
of the two as | 5 |
| determined by the unit of local government. The unit of local
| 6 |
| government shall be responsible for timely collection and | 7 |
| transmission of
dependent premiums.
| 8 |
| The Director shall annually determine monthly rates of | 9 |
| payment, subject
to the following constraints:
| 10 |
| (1) In the first year of coverage, the rates shall be | 11 |
| equal to the
amount normally charged to State employees for | 12 |
| elected optional coverages
or for enrolled dependents | 13 |
| coverages or other contributory coverages, or
contributed | 14 |
| by the State for basic insurance coverages on behalf of its
| 15 |
| employees, adjusted for differences between State | 16 |
| employees and employees
of the local government in age, | 17 |
| sex, geographic location or other relevant
demographic | 18 |
| variables, plus an amount sufficient to pay for the | 19 |
| additional
administrative costs of providing coverage to | 20 |
| employees of the unit of
local government and their | 21 |
| dependents.
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| (2) In subsequent years, a further adjustment shall be | 23 |
| made to reflect
the actual prior years' claims experience | 24 |
| of the employees of the unit of
local government.
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| In the case of coverage of local government employees under | 26 |
| a health
maintenance organization, the Director shall annually |
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| determine for each
participating unit of local government the | 2 |
| maximum monthly amount the unit
may contribute toward that | 3 |
| coverage, based on an analysis of (i) the age,
sex, geographic | 4 |
| location, and other relevant demographic variables of the
| 5 |
| unit's employees and (ii) the cost to cover those employees | 6 |
| under the State
group health benefits plan. The Director may | 7 |
| similarly determine the
maximum monthly amount each unit of | 8 |
| local government may contribute toward
coverage of its | 9 |
| employees' dependents under a health maintenance organization.
| 10 |
| Monthly payments by the unit of local government or its | 11 |
| employees for
group health benefits plan or health maintenance | 12 |
| organization coverage shall
be deposited in the Local | 13 |
| Government Health Insurance Reserve Fund.
| 14 |
| The Local Government Health Insurance Reserve Fund is | 15 |
| hereby created as a nonappropriated trust fund to be held | 16 |
| outside the State Treasury, with the State Treasurer as | 17 |
| custodian. The Local Government Health Insurance Reserve Fund | 18 |
| shall be a continuing
fund not subject to fiscal year | 19 |
| limitations. All revenues arising from the administration of | 20 |
| the health benefits program established under this Section | 21 |
| shall be deposited into the Local Government Health Insurance | 22 |
| Reserve Fund. Any interest earned on moneys in the Local | 23 |
| Government Health Insurance Reserve Fund shall be deposited | 24 |
| into the Fund. All expenditures from this Fund
shall be used | 25 |
| for payments for health care benefits for local government and | 26 |
| rehabilitation facility
employees, annuitants, and dependents, |
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| and to reimburse the Department or
its administrative service | 2 |
| organization for all expenses incurred in the
administration of | 3 |
| benefits. No other State funds may be used for these
purposes.
| 4 |
| A local government employer's participation or desire to | 5 |
| participate
in a program created under this subsection shall | 6 |
| not limit that employer's
duty to bargain with the | 7 |
| representative of any collective bargaining unit
of its | 8 |
| employees.
| 9 |
| (j) Any rehabilitation facility within the State of | 10 |
| Illinois may apply
to the Director to have its employees, | 11 |
| annuitants, and their eligible
dependents provided group | 12 |
| health coverage under this Act on a non-insured
basis. To | 13 |
| participate, a rehabilitation facility must agree to enroll all
| 14 |
| of its employees and remit the entire cost of providing such | 15 |
| coverage for
its employees, except that the rehabilitation | 16 |
| facility shall not be
required to enroll those of its employees | 17 |
| who are covered spouses or
dependents under this plan or | 18 |
| another group policy or plan providing health
benefits as long | 19 |
| as (1) an appropriate official from the rehabilitation
facility | 20 |
| attests that each employee not enrolled is a covered spouse or
| 21 |
| dependent under this plan or another group policy or plan, and | 22 |
| (2) at least
85% of the employees are enrolled and the | 23 |
| rehabilitation facility remits
the entire cost of providing | 24 |
| coverage to those employees. Employees of a
participating | 25 |
| rehabilitation facility who are not enrolled due to coverage
| 26 |
| under another group health policy or plan may enroll
in the |
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| event of a qualifying change in status, special enrollment, | 2 |
| special
circumstance as defined by the Director, or during the | 3 |
| annual Benefit Choice
Period. A participating rehabilitation | 4 |
| facility may also elect
to cover its annuitants. Dependent | 5 |
| coverage shall be offered on an optional
basis, with the costs | 6 |
| paid by the rehabilitation facility, its employees, or
some | 7 |
| combination of the 2 as determined by the rehabilitation | 8 |
| facility. The
rehabilitation facility shall be responsible for | 9 |
| timely collection and
transmission of dependent premiums.
| 10 |
| The Director shall annually determine quarterly rates of | 11 |
| payment, subject
to the following constraints:
| 12 |
| (1) In the first year of coverage, the rates shall be | 13 |
| equal to the amount
normally charged to State employees for | 14 |
| elected optional coverages or for
enrolled dependents | 15 |
| coverages or other contributory coverages on behalf of
its | 16 |
| employees, adjusted for differences between State | 17 |
| employees and
employees of the rehabilitation facility in | 18 |
| age, sex, geographic location
or other relevant | 19 |
| demographic variables, plus an amount sufficient to pay
for | 20 |
| the additional administrative costs of providing coverage | 21 |
| to employees
of the rehabilitation facility and their | 22 |
| dependents.
| 23 |
| (2) In subsequent years, a further adjustment shall be | 24 |
| made to reflect
the actual prior years' claims experience | 25 |
| of the employees of the
rehabilitation facility.
| 26 |
| Monthly payments by the rehabilitation facility or its |
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| employees for
group health benefits shall be deposited in the | 2 |
| Local Government Health
Insurance Reserve Fund.
| 3 |
| (k) Any domestic violence shelter or service within the | 4 |
| State of Illinois
may apply to the Director to have its | 5 |
| employees, annuitants, and their
dependents provided group | 6 |
| health coverage under this Act on a non-insured
basis. To | 7 |
| participate, a domestic violence shelter or service must agree | 8 |
| to
enroll all of its employees and pay the entire cost of | 9 |
| providing such coverage
for its employees. A participating | 10 |
| domestic violence shelter may also elect
to cover its | 11 |
| annuitants. Dependent coverage shall be offered on an optional
| 12 |
| basis, with
employees, or some combination of the 2 as | 13 |
| determined by the domestic violence
shelter or service. The | 14 |
| domestic violence shelter or service shall be
responsible for | 15 |
| timely collection and transmission of dependent premiums.
| 16 |
| The Director shall annually determine rates of payment,
| 17 |
| subject to the following constraints:
| 18 |
| (1) In the first year of coverage, the rates shall be | 19 |
| equal to the
amount normally charged to State employees for | 20 |
| elected optional coverages
or for enrolled dependents | 21 |
| coverages or other contributory coverages on
behalf of its | 22 |
| employees, adjusted for differences between State | 23 |
| employees and
employees of the domestic violence shelter or | 24 |
| service in age, sex, geographic
location or other relevant | 25 |
| demographic variables, plus an amount sufficient
to pay for | 26 |
| the additional administrative costs of providing coverage |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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| 1 |
| to
employees of the domestic violence shelter or service | 2 |
| and their dependents.
| 3 |
| (2) In subsequent years, a further adjustment shall be | 4 |
| made to reflect
the actual prior years' claims experience | 5 |
| of the employees of the domestic
violence shelter or | 6 |
| service.
| 7 |
| Monthly payments by the domestic violence shelter or | 8 |
| service or its employees
for group health insurance shall be | 9 |
| deposited in the Local Government Health
Insurance Reserve | 10 |
| Fund.
| 11 |
| (l) A public community college or entity organized pursuant | 12 |
| to the
Public Community College Act may apply to the Director | 13 |
| initially to have
only annuitants not covered prior to July 1, | 14 |
| 1992 by the district's health
plan provided health coverage | 15 |
| under this Act on a non-insured basis. The
community college | 16 |
| must execute a 2-year contract to participate in the
Local | 17 |
| Government Health Plan.
Any annuitant may enroll in the event | 18 |
| of a qualifying change in status, special
enrollment, special | 19 |
| circumstance as defined by the Director, or during the
annual | 20 |
| Benefit Choice Period.
| 21 |
| The Director shall annually determine monthly rates of | 22 |
| payment subject to
the following constraints: for those | 23 |
| community colleges with annuitants
only enrolled, first year | 24 |
| rates shall be equal to the average cost to cover
claims for a | 25 |
| State member adjusted for demographics, Medicare
| 26 |
| participation, and other factors; and in the second year, a |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| further adjustment
of rates shall be made to reflect the actual | 2 |
| first year's claims experience
of the covered annuitants.
| 3 |
| (l-5) The provisions of subsection (l) become inoperative | 4 |
| on July 1, 1999.
| 5 |
| (m) The Director shall adopt any rules deemed necessary for
| 6 |
| implementation of this amendatory Act of 1989 (Public Act | 7 |
| 86-978).
| 8 |
| (n) Any child advocacy center within the State of Illinois | 9 |
| may apply to the Director to have its employees, annuitants, | 10 |
| and their dependants provided group health coverage under this | 11 |
| Act on a non-insured basis. To participate, a child advocacy | 12 |
| center must agree to enroll all of its employees and pay the | 13 |
| entire cost of providing coverage for its employees. A | 14 |
| participating child advocacy center may also elect to cover its | 15 |
| annuitants. Dependent coverage shall be offered on an optional | 16 |
| basis, with the costs paid by the child advocacy center, its | 17 |
| employees, or some combination of the 2 as determined by the | 18 |
| child advocacy center. The child advocacy center shall be | 19 |
| responsible for timely collection and transmission of | 20 |
| dependent premiums. | 21 |
| The Director shall annually determine rates of payment, | 22 |
| subject to the following constraints: | 23 |
| (1) In the first year of coverage, the rates shall be | 24 |
| equal to the amount normally charged to State employees for | 25 |
| elected optional coverages or for enrolled dependents | 26 |
| coverages or other contributory coverages on behalf of its |
|
|
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|
| 1 |
| employees, adjusted for differences between State | 2 |
| employees and employees of the child advocacy center in | 3 |
| age, sex, geographic location, or other relevant | 4 |
| demographic variables, plus an amount sufficient to pay for | 5 |
| the additional administrative costs of providing coverage | 6 |
| to employees of the child advocacy center and their | 7 |
| dependents. | 8 |
| (2) In subsequent years, a further adjustment shall be | 9 |
| made to reflect the actual prior years' claims experience | 10 |
| of the employees of the child advocacy center. | 11 |
| Monthly payments by the child advocacy center or its | 12 |
| employees for group health insurance shall be deposited into | 13 |
| the Local Government Health Insurance Reserve Fund. | 14 |
| (Source: P.A. 93-839, eff. 7-30-04; 94-839, eff. 6-6-06; | 15 |
| 94-860, eff. 6-16-06; revised 8-3-06.)
| 16 |
| Section 5. The Mental Health and Developmental | 17 |
| Disabilities Administrative Act is amended by changing Section | 18 |
| 18.5 as follows: | 19 |
| (20 ILCS 1705/18.5) | 20 |
| Sec. 18.5. Community Developmental Disability Services | 21 |
| Medicaid Trust Fund; reimbursement. | 22 |
| (a) The Community Developmental Disability Services | 23 |
| Medicaid Trust Fund is hereby created in the State treasury.
| 24 |
| (b) Except as provided in subsection (b-5), any
Any funds |
|
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| 1 |
| in excess of $16,700,000 in any fiscal year paid to the State | 2 |
| by the federal government under Title XIX or Title XXI of the | 3 |
| Social Security Act for services delivered by community | 4 |
| developmental disability services providers for services | 5 |
| relating to Developmental Training and Community Integrated | 6 |
| Living Arrangements as a result of the conversion of such | 7 |
| providers from a grant payment methodology to a fee-for-service | 8 |
| payment methodology, or any other funds paid to the State for | 9 |
| any subsequent revenue maximization initiatives performed by | 10 |
| such providers, and any interest earned thereon, shall be | 11 |
| deposited directly into the Community Developmental Disability | 12 |
| Services Medicaid Trust Fund. One-third of this amount shall be | 13 |
| used only to pay for Medicaid-reimbursed community | 14 |
| developmental disability services provided to eligible | 15 |
| individuals, and the remainder shall be transferred to the | 16 |
| General Revenue Fund. | 17 |
| (b-5) Beginning in State fiscal year 2008, any funds paid | 18 |
| to the State by the federal government under Title XIX or Title | 19 |
| XXI of the Social Security Act for services delivered through | 20 |
| the Children's Residential Waiver and the Children's In-Home | 21 |
| Support Waiver shall be deposited directly into the Community | 22 |
| Developmental Disability Services Medicaid Trust Fund and | 23 |
| shall not be subject to the transfer provisions of subsection | 24 |
| (b).
| 25 |
| (c) For purposes of this Section: | 26 |
| "Medicaid-reimbursed developmental disability services" |
|
|
|
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LRB095 08369 WGH 38691 a |
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| 1 |
| means services provided by a community developmental | 2 |
| disability provider under an agreement with the Department that | 3 |
| is eligible for reimbursement under the federal Title XIX | 4 |
| program or Title XXI program. | 5 |
| "Provider" means a qualified entity as defined in the | 6 |
| State's Home and
Community-Based Services Waiver for Persons | 7 |
| with Developmental Disabilities that is funded by the | 8 |
| Department to provide a Medicaid-reimbursed service. | 9 |
| "Revenue maximization alternatives" do not include | 10 |
| increases in
funds paid to the State as a result of growth in | 11 |
| spending through service expansion or
rate increases.
| 12 |
| (Source: P.A. 93-841, eff. 7-30-04.) | 13 |
| Section 7. The State Finance Act is amended by adding | 14 |
| Sections 5.675 and 6z-69 and changing Section 8.27 as follows: | 15 |
| (30 ILCS 105/5.675 new) | 16 |
| Sec. 5.675. The Priority Capital Grant Program Fund. | 17 |
| (30 ILCS 105/6z-69 new)
| 18 |
| Sec. 6z-69. Priority Capital Grant Program Fund. The | 19 |
| Priority Capital Grant Program Fund is created as a special | 20 |
| fund in the State treasury. Subject to appropriation, the | 21 |
| Department of Human Services shall use moneys in the Fund to | 22 |
| make grants to the Illinois Facilities Fund, a not-for-profit | 23 |
| corporation, to make long term below market rate loans and |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| grants to assist nonprofit human service providers working | 2 |
| under contract to the State of Illinois to assist those | 3 |
| providers in meeting their capital needs. The loans or grants | 4 |
| shall be for the purpose of such capital needs, including but | 5 |
| not limited to special use facilities, requirements for serving | 6 |
| the disabled, mentally ill, or substance abusers, and medical | 7 |
| and technology equipment. Loan repayments shall be deposited | 8 |
| into the Priority Capital Grant Program Fund. Interest income | 9 |
| may be used to cover expenses of the program.
| 10 |
| (30 ILCS 105/8.27) (from Ch. 127, par. 144.27)
| 11 |
| Sec. 8.27. All receipts from federal financial | 12 |
| participation in the
Foster Care and Adoption Services program | 13 |
| under Title IV-E of the federal
Social Security Act, including | 14 |
| receipts
for related indirect costs,
shall be deposited in the | 15 |
| DCFS Children's Services Fund.
| 16 |
| Eighty percent of the federal funds received by the | 17 |
| Illinois Department
of Human Services under the Title IV-A | 18 |
| Emergency Assistance program as
reimbursement for expenditures | 19 |
| made from the Illinois Department of Children
and Family | 20 |
| Services appropriations for the costs of services in behalf of
| 21 |
| Department of Children and Family Services clients shall be | 22 |
| deposited into
the DCFS Children's Services Fund.
| 23 |
| All receipts from federal financial participation in the | 24 |
| Child Welfare
Services program under Title IV-B of the federal | 25 |
| Social Security Act,
including receipts for related indirect |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| costs, shall be deposited into the
DCFS Children's Services | 2 |
| Fund for those moneys received as reimbursement for
services | 3 |
| provided on or after July 1, 1994.
| 4 |
| In addition, as soon as may be practicable after the first | 5 |
| day of November,
1994, the Department of Children and Family | 6 |
| Services shall request the
Comptroller to order transferred and | 7 |
| the Treasurer shall transfer the
unexpended balance of the | 8 |
| Child Welfare Services Fund to the DCFS Children's
Services | 9 |
| Fund. Upon completion of the transfer, the Child Welfare | 10 |
| Services
Fund will be considered dissolved and any outstanding | 11 |
| obligations or
liabilities of that fund will pass to the DCFS | 12 |
| Children's Services Fund.
| 13 |
| For services provided on or after July 1, 2007, all federal | 14 |
| funds received pursuant to the John H. Chafee Foster Care | 15 |
| Independence Program shall be deposited into the DCFS | 16 |
| Children's Services Fund.
| 17 |
| Monies in the Fund may be used by the Department, pursuant | 18 |
| to
appropriation by the General Assembly, for the ordinary and | 19 |
| contingent
expenses of the Department.
| 20 |
| In fiscal year 1988 and in each fiscal year thereafter | 21 |
| through fiscal
year 2000, the Comptroller
shall order | 22 |
| transferred and the Treasurer shall transfer an amount of
| 23 |
| $16,100,000 from the DCFS Children's Services Fund to the | 24 |
| General Revenue
Fund in the following manner: As soon as may be | 25 |
| practicable after the 15th
day of September, December, March | 26 |
| and June, the Comptroller shall order
transferred and the |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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| 1 |
| Treasurer shall transfer, to the extent that funds are
| 2 |
| available, 1/4 of $16,100,000, plus any cumulative | 3 |
| deficiencies in such
transfers for prior transfer dates during | 4 |
| such fiscal year. In no event
shall any such transfer reduce | 5 |
| the available balance in the DCFS Children's
Services Fund | 6 |
| below $350,000.
| 7 |
| In accordance with subsection (q) of Section 5 of the | 8 |
| Children and Family
Services Act, disbursements from | 9 |
| individual children's accounts shall be
deposited into the DCFS | 10 |
| Children's Services Fund.
| 11 |
| Receipts from public and unsolicited private grants, fees | 12 |
| for training, and royalties earned from the publication of | 13 |
| materials owned by or licensed to the Department of Children | 14 |
| and Family Services shall be deposited into the DCFS Children's | 15 |
| Services Fund. | 16 |
| As soon as may be practical after September 1, 2005, upon | 17 |
| the request of the Department of Children and Family Services, | 18 |
| the Comptroller shall order transferred and the Treasurer shall | 19 |
| transfer the unexpended balance of the Department of Children | 20 |
| and Family Services Training Fund into the DCFS Children's | 21 |
| Services Fund. Upon completion of the transfer, the Department | 22 |
| of Children and Family Services Training Fund is dissolved and | 23 |
| any outstanding obligations or liabilities of that Fund pass to | 24 |
| the DCFS Children's Services Fund.
| 25 |
| (Source: P.A. 94-91, eff. 7-1-05.)
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| Section 9. The Hospital Licensing Act is amended by | 2 |
| changing Section 8 as follows:
| 3 |
| (210 ILCS 85/8) (from Ch. 111 1/2, par. 149)
| 4 |
| Sec. 8. Facility plan review; fees.
| 5 |
| (a) Before commencing construction of new facilities or | 6 |
| specified types
of alteration or additions to an existing | 7 |
| hospital involving major
construction, as defined by rule by | 8 |
| the Department, with an estimated
cost greater than $100,000, | 9 |
| architectural plans and
specifications therefor shall be | 10 |
| submitted by the licensee to the
Department for review and | 11 |
| approval.
A hospital may submit architectural drawings and | 12 |
| specifications for other
construction projects for Department | 13 |
| review according to subsection (b) that
shall not be subject to | 14 |
| fees under subsection (d).
The Department must give a hospital | 15 |
| that is planning to submit a construction
project for review | 16 |
| the opportunity to discuss its plans and specifications with
| 17 |
| the Department before the hospital formally submits the plans | 18 |
| and
specifications for Department review.
Review of drawings | 19 |
| and specifications shall be conducted by an employee of
the | 20 |
| Department meeting the qualifications established by the | 21 |
| Department of
Central Management Services class specifications | 22 |
| for such an individual's
position or by a person contracting | 23 |
| with the Department who meets those class
specifications.
Final | 24 |
| approval of the plans and specifications for compliance
with | 25 |
| design and construction standards shall be obtained from the
|
|
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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| 1 |
| Department before the alteration, addition, or new | 2 |
| construction is begun. Subject to this Section 8, and prior to | 3 |
| January 1, 2012, the Department shall consider the re-licensing | 4 |
| of an existing hospital structure according to the standards | 5 |
| for an existing hospital, as set forth in the Department's | 6 |
| rules. Re-licensing under this provision shall occur only if | 7 |
| that facility operated as a licensed hospital on July 1, 2005, | 8 |
| has had no intervening use as other than a hospital, and exists | 9 |
| in a county with a population of less than 20,000 that does not | 10 |
| have another licensed hospital on the effective date of this | 11 |
| amendatory Act of the 95th General Assembly.
| 12 |
| (b) The Department shall inform an applicant in writing | 13 |
| within 10 working
days after receiving drawings and | 14 |
| specifications and the required fee, if any,
from the applicant | 15 |
| whether the applicant's submission is complete or
incomplete. | 16 |
| Failure to provide the applicant with this notice within 10
| 17 |
| working days shall result in the submission being deemed | 18 |
| complete for purposes
of initiating the 60-day review period | 19 |
| under this Section. If the submission
is incomplete, the | 20 |
| Department shall inform the applicant of the deficiencies
with | 21 |
| the submission in writing. If the submission is complete and | 22 |
| the required
fee, if any, has been paid,
the Department shall | 23 |
| approve or disapprove drawings and specifications
submitted to | 24 |
| the Department no later than 60 days following receipt by the
| 25 |
| Department. The drawings and specifications shall be of | 26 |
| sufficient detail, as
provided by Department rule, to
enable |
|
|
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LRB095 08369 WGH 38691 a |
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| 1 |
| the Department to
render a determination of compliance with | 2 |
| design and construction standards
under this Act.
If the | 3 |
| Department finds that the drawings are not of sufficient detail | 4 |
| for it
to render a determination of compliance, the plans shall | 5 |
| be determined to be
incomplete and shall not be considered for | 6 |
| purposes of initiating the 60 day
review period.
If a | 7 |
| submission of drawings and specifications is incomplete, the | 8 |
| applicant
may submit additional information. The 60-day review | 9 |
| period shall not commence
until the Department determines that | 10 |
| a submission of drawings and
specifications is complete or the | 11 |
| submission is deemed complete.
If the Department has not | 12 |
| approved or disapproved the
drawings and specifications within | 13 |
| 60 days, the construction, major alteration,
or addition shall | 14 |
| be deemed approved. If the drawings and specifications are
| 15 |
| disapproved, the Department shall state in writing, with | 16 |
| specificity, the
reasons for the disapproval. The entity | 17 |
| submitting the drawings and
specifications may submit | 18 |
| additional information in response to the written
comments from | 19 |
| the Department or request a reconsideration of the disapproval.
| 20 |
| A final decision of approval or disapproval shall be made | 21 |
| within 45 days of the
receipt of the additional information or | 22 |
| reconsideration request. If denied,
the Department shall state | 23 |
| the specific reasons for the denial
and the applicant may elect | 24 |
| to seek dispute resolution pursuant to Section
25 of the | 25 |
| Illinois Building Commission Act, which the Department must
| 26 |
| participate in.
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| (c) The Department shall provide written approval for | 2 |
| occupancy pursuant
to subsection (g) and shall not issue a | 3 |
| violation to a facility as a result of
a licensure or complaint | 4 |
| survey based upon the facility's physical structure
if:
| 5 |
| (1) the Department reviewed and approved or deemed | 6 |
| approved the drawing
and specifications for compliance | 7 |
| with design and construction standards;
| 8 |
| (2) the construction, major alteration, or addition | 9 |
| was built as
submitted;
| 10 |
| (3) the law or rules have not been amended since the | 11 |
| original approval;
and
| 12 |
| (4) the conditions at the facility indicate that there | 13 |
| is a reasonable
degree of safety provided for the patients.
| 14 |
| (c-5) The Department shall not issue a violation to a | 15 |
| facility if the
inspected aspects of the facility were | 16 |
| previously found to be in compliance
with applicable standards, | 17 |
| the relevant law or rules have not been amended,
conditions at | 18 |
| the facility
reasonably protect the safety of its patients, and | 19 |
| alterations or new hazards
have not been
identified.
| 20 |
| (d) The Department shall charge the following fees in | 21 |
| connection with its
reviews conducted before June 30, 2004 | 22 |
| under this Section:
| 23 |
| (1) (Blank).
| 24 |
| (2) (Blank).
| 25 |
| (3) If the estimated dollar value of the major
| 26 |
| construction is greater than $500,000, the fee shall be
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| established by the Department pursuant to rules that | 2 |
| reflect the reasonable
and
direct cost of the Department in | 3 |
| conducting the architectural reviews required
under this | 4 |
| Section. The estimated dollar value of the major | 5 |
| construction
subject to review under this Section shall be | 6 |
| annually readjusted to
reflect the
increase in | 7 |
| construction costs due to inflation.
| 8 |
| The fees provided in this subsection (d) shall not apply to | 9 |
| major
construction projects involving facility changes that | 10 |
| are required by
Department rule amendments or to projects | 11 |
| related to homeland security.
| 12 |
| The fees provided in this subsection (d) shall also not | 13 |
| apply to major
construction projects if 51% or more of the | 14 |
| estimated cost of the project is
attributed to capital | 15 |
| equipment. For major construction projects where 51% or
more of | 16 |
| the estimated cost of the project is attributed to capital | 17 |
| equipment,
the Department shall by rule establish a fee that is | 18 |
| reasonably related to the
cost of reviewing the project.
| 19 |
| Disproportionate share hospitals and rural hospitals shall | 20 |
| only pay
one-half of the fees
required in this subsection (d).
| 21 |
| For the purposes of this subsection (d),
(i) "disproportionate | 22 |
| share hospital" means a hospital described in items (1)
through | 23 |
| (5) of subsection (b) of Section 5-5.02 of the Illinois Public | 24 |
| Aid
Code and (ii)
"rural hospital" means a hospital that
is (A) | 25 |
| located
outside a metropolitan statistical area or (B) located | 26 |
| 15 miles or less from a
county that is
outside a metropolitan |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| statistical area and is licensed to perform
medical/surgical or
| 2 |
| obstetrical services and has a combined total bed capacity of | 3 |
| 75 or fewer beds
in these 2
service categories as of July 14, | 4 |
| 1993, as determined by the Department.
| 5 |
| The Department shall not commence the facility plan review | 6 |
| process under this
Section until the applicable fee has been | 7 |
| paid.
| 8 |
| (e) All fees received by the Department under this Section | 9 |
| shall be
deposited into the Health Facility Plan Review Fund, a | 10 |
| special fund created in
the State treasury.
All fees paid by | 11 |
| hospitals under subsection (d) shall be used only to cover
the | 12 |
| direct and reasonable costs relating to the Department's review | 13 |
| of hospital
projects under this
Section.
Moneys shall be | 14 |
| appropriated from that Fund to the
Department only to pay the | 15 |
| costs of conducting reviews under this Section.
None of the | 16 |
| moneys in the Health Facility Plan Review Fund shall be used to
| 17 |
| reduce the amount of General Revenue Fund moneys appropriated | 18 |
| to the Department
for facility plan reviews conducted pursuant | 19 |
| to this Section.
| 20 |
| (f) (Blank).
| 21 |
| (g) The Department shall conduct an on-site inspection of | 22 |
| the completed
project no later than 15 business days after | 23 |
| notification from the
applicant that the
project has been | 24 |
| completed and all certifications required by the Department
| 25 |
| have been received and accepted by the Department. The | 26 |
| Department may extend
this deadline only if a federally |
|
|
|
09500HB0691sam002 |
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| 1 |
| mandated survey time frame takes
precedence. The Department | 2 |
| shall
provide written approval for occupancy to the applicant | 3 |
| within 5 working days
of the Department's final inspection, | 4 |
| provided the applicant has demonstrated
substantial compliance | 5 |
| as defined by Department rule.
Occupancy of new major | 6 |
| construction is prohibited until Department approval is
| 7 |
| received, unless the Department has not acted within the time | 8 |
| frames provided
in this subsection (g), in which case the | 9 |
| construction shall be deemed
approved. Occupancy shall be | 10 |
| authorized after any
required health inspection by the | 11 |
| Department has been conducted.
| 12 |
| (h) The Department shall establish, by rule, a procedure to | 13 |
| conduct interim
on-site review of large or complex construction | 14 |
| projects.
| 15 |
| (i) The Department shall establish, by rule, an expedited | 16 |
| process for
emergency repairs or replacement of like equipment.
| 17 |
| (j) Nothing in this Section shall be construed to apply to | 18 |
| maintenance,
upkeep, or renovation that does not affect the | 19 |
| structural integrity of the
building, does not add beds or | 20 |
| services over the number for which the facility
is licensed, | 21 |
| and provides a reasonable degree of safety for the patients.
| 22 |
| (Source: P.A. 92-563, eff. 6-24-02; 92-803, eff. 8-16-02; | 23 |
| 93-41, eff.
6-27-03.)
| 24 |
| Section 10. The Illinois Public Aid Code is amended by | 25 |
| changing Sections 5-5.4 and 5B-8 and adding Section 5-27 as |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| follows: | 2 |
| (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
| 3 |
| Sec. 5-5.4. Standards of Payment - Department of Healthcare | 4 |
| and Family Services.
The Department of Healthcare and Family | 5 |
| Services shall develop standards of payment of skilled
nursing | 6 |
| and intermediate care services in facilities providing such | 7 |
| services
under this Article which:
| 8 |
| (1) Provide for the determination of a facility's payment
| 9 |
| for skilled nursing and intermediate care services on a | 10 |
| prospective basis.
The amount of the payment rate for all | 11 |
| nursing facilities certified by the
Department of Public Health | 12 |
| under the Nursing Home Care Act as Intermediate
Care for the | 13 |
| Developmentally Disabled facilities, Long Term Care for Under | 14 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate | 15 |
| Care facilities
under the
medical assistance program shall be | 16 |
| prospectively established annually on the
basis of historical, | 17 |
| financial, and statistical data reflecting actual costs
from | 18 |
| prior years, which shall be applied to the current rate year | 19 |
| and updated
for inflation, except that the capital cost element | 20 |
| for newly constructed
facilities shall be based upon projected | 21 |
| budgets. The annually established
payment rate shall take | 22 |
| effect on July 1 in 1984 and subsequent years. No rate
increase | 23 |
| and no
update for inflation shall be provided on or after July | 24 |
| 1, 1994 and before
July 1, 2008, unless specifically provided | 25 |
| for in this
Section.
The changes made by Public Act 93-841
|
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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| 1 |
| extending the duration of the prohibition against a rate | 2 |
| increase or update for inflation are effective retroactive to | 3 |
| July 1, 2004.
| 4 |
| For facilities licensed by the Department of Public Health | 5 |
| under the Nursing
Home Care Act as Intermediate Care for the | 6 |
| Developmentally Disabled facilities
or Long Term Care for Under | 7 |
| Age 22 facilities, the rates taking effect on July
1, 1998 | 8 |
| shall include an increase of 3%. For facilities licensed by the
| 9 |
| Department of Public Health under the Nursing Home Care Act as | 10 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 11 |
| the rates taking effect on July 1,
1998 shall include an | 12 |
| increase of 3% plus $1.10 per resident-day, as defined by
the | 13 |
| Department. For facilities licensed by the Department of Public | 14 |
| Health under the Nursing Home Care Act as Intermediate Care | 15 |
| Facilities for the Developmentally Disabled or Long Term Care | 16 |
| for Under Age 22 facilities, the rates taking effect on January | 17 |
| 1, 2006 shall include an increase of 3%.
| 18 |
| For facilities licensed by the Department of Public Health | 19 |
| under the
Nursing Home Care Act as Intermediate Care for the | 20 |
| Developmentally Disabled
facilities or Long Term Care for Under | 21 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 | 22 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, | 23 |
| as defined by the Department. For facilities licensed by the
| 24 |
| Department of Public Health under the Nursing Home Care Act as | 25 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 26 |
| the rates taking effect on July 1,
1999 shall include an |
|
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09500HB0691sam002 |
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| 1 |
| increase of 1.6% and, for services provided on or after
October | 2 |
| 1, 1999, shall be increased by $4.00 per resident-day, as | 3 |
| defined by
the Department.
| 4 |
| For facilities licensed by the Department of Public Health | 5 |
| under the
Nursing Home Care Act as Intermediate Care for the | 6 |
| Developmentally Disabled
facilities or Long Term Care for Under | 7 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 | 8 |
| shall include an increase of 2.5% per resident-day,
as defined | 9 |
| by the Department. For facilities licensed by the Department of
| 10 |
| Public Health under the Nursing Home Care Act as Skilled | 11 |
| Nursing facilities or
Intermediate Care facilities, the rates | 12 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% | 13 |
| per resident-day, as defined by the Department.
| 14 |
| For facilities licensed by the Department of Public Health | 15 |
| under the
Nursing Home Care Act as skilled nursing facilities | 16 |
| or intermediate care
facilities, a new payment methodology must | 17 |
| be implemented for the nursing
component of the rate effective | 18 |
| July 1, 2003. The Department of Public Aid
(now Healthcare and | 19 |
| Family Services) shall develop the new payment methodology | 20 |
| using the Minimum Data Set
(MDS) as the instrument to collect | 21 |
| information concerning nursing home
resident condition | 22 |
| necessary to compute the rate. The Department
shall develop the | 23 |
| new payment methodology to meet the unique needs of
Illinois | 24 |
| nursing home residents while remaining subject to the | 25 |
| appropriations
provided by the General Assembly.
A transition | 26 |
| period from the payment methodology in effect on June 30, 2003
|
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| to the payment methodology in effect on July 1, 2003 shall be | 2 |
| provided for a
period not exceeding 3 years and 184 days after | 3 |
| implementation of the new payment
methodology as follows:
| 4 |
| (A) For a facility that would receive a lower
nursing | 5 |
| component rate per patient day under the new system than | 6 |
| the facility
received
effective on the date immediately | 7 |
| preceding the date that the Department
implements the new | 8 |
| payment methodology, the nursing component rate per | 9 |
| patient
day for the facility
shall be held at
the level in | 10 |
| effect on the date immediately preceding the date that the
| 11 |
| Department implements the new payment methodology until a | 12 |
| higher nursing
component rate of
reimbursement is achieved | 13 |
| by that
facility.
| 14 |
| (B) For a facility that would receive a higher nursing | 15 |
| component rate per
patient day under the payment | 16 |
| methodology in effect on July 1, 2003 than the
facility | 17 |
| received effective on the date immediately preceding the | 18 |
| date that the
Department implements the new payment | 19 |
| methodology, the nursing component rate
per patient day for | 20 |
| the facility shall be adjusted.
| 21 |
| (C) Notwithstanding paragraphs (A) and (B), the | 22 |
| nursing component rate per
patient day for the facility | 23 |
| shall be adjusted subject to appropriations
provided by the | 24 |
| General Assembly.
| 25 |
| Notwithstanding any other provision of this Section, for | 26 |
| facilities licensed by the Department of Public Health under |
|
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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| 1 |
| the
Nursing Home Care Act as skilled nursing facilities or | 2 |
| intermediate care
facilities, the numerator of the ratio used | 3 |
| by the Department of Healthcare and Family Services to compute | 4 |
| the rate payable under this Section using the Minimum Data Set | 5 |
| (MDS) methodology shall incorporate the following annual | 6 |
| amounts as the additional funds appropriated to the Department | 7 |
| specifically to pay for rates based on the MDS nursing | 8 |
| component methodology in excess of the funding in effect on | 9 |
| December 31, 2006: | 10 |
| (i) For rates taking effect January 1, 2007, | 11 |
| $60,000,000. | 12 |
| (ii) For rates taking effect October 1, 2007, | 13 |
| $110,000,000. | 14 |
| Notwithstanding any other provision of this Section, for | 15 |
| facilities licensed by the Department of Public Health under | 16 |
| the Nursing Home Care Act as skilled nursing facilities or | 17 |
| intermediate care facilities, the support component of the | 18 |
| rates taking effect on October 1, 2007 shall be computed using | 19 |
| the most recent cost reports on file with the Department of | 20 |
| Healthcare and Family Services no later than April 1, 2005, | 21 |
| updated for inflation to January 1, 2006.
| 22 |
| For facilities licensed by the Department of Public Health | 23 |
| under the
Nursing Home Care Act as Intermediate Care for the | 24 |
| Developmentally Disabled
facilities or Long Term Care for Under | 25 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 | 26 |
| shall include a statewide increase of 7.85%, as
defined by the |
|
|
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LRB095 08369 WGH 38691 a |
|
| 1 |
| Department.
| 2 |
| For facilities licensed by the Department of Public Health | 3 |
| under the
Nursing Home Care Act as Intermediate Care for the | 4 |
| Developmentally Disabled
facilities or Long Term Care for Under | 5 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 | 6 |
| shall include a statewide increase of 2.0%, as
defined by the | 7 |
| Department.
This increase terminates on July 1, 2002;
beginning | 8 |
| July 1, 2002 these rates are reduced to the level of the rates
| 9 |
| in effect on March 31, 2002, as defined by the Department.
| 10 |
| For facilities licensed by the Department of Public Health | 11 |
| under the
Nursing Home Care Act as skilled nursing facilities | 12 |
| or intermediate care
facilities, the rates taking effect on | 13 |
| July 1, 2001 shall be computed using the most recent cost | 14 |
| reports
on file with the Department of Public Aid no later than | 15 |
| April 1, 2000,
updated for inflation to January 1, 2001. For | 16 |
| rates effective July 1, 2001
only, rates shall be the greater | 17 |
| of the rate computed for July 1, 2001
or the rate effective on | 18 |
| June 30, 2001.
| 19 |
| Notwithstanding any other provision of this Section, for | 20 |
| facilities
licensed by the Department of Public Health under | 21 |
| the Nursing Home Care Act
as skilled nursing facilities or | 22 |
| intermediate care facilities, the Illinois
Department shall | 23 |
| determine by rule the rates taking effect on July 1, 2002,
| 24 |
| which shall be 5.9% less than the rates in effect on June 30, | 25 |
| 2002.
| 26 |
| Notwithstanding any other provision of this Section, for |
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| facilities
licensed by the Department of Public Health under | 2 |
| the Nursing Home Care Act as
skilled nursing
facilities or | 3 |
| intermediate care facilities, if the payment methodologies | 4 |
| required under Section 5A-12 and the waiver granted under 42 | 5 |
| CFR 433.68 are approved by the United States Centers for | 6 |
| Medicare and Medicaid Services, the rates taking effect on July | 7 |
| 1, 2004 shall be 3.0% greater than the rates in effect on June | 8 |
| 30, 2004. These rates shall take
effect only upon approval and
| 9 |
| implementation of the payment methodologies required under | 10 |
| Section 5A-12.
| 11 |
| Notwithstanding any other provisions of this Section, for | 12 |
| facilities licensed by the Department of Public Health under | 13 |
| the Nursing Home Care Act as skilled nursing facilities or | 14 |
| intermediate care facilities, the rates taking effect on | 15 |
| January 1, 2005 shall be 3% more than the rates in effect on | 16 |
| December 31, 2004.
| 17 |
| Notwithstanding any other provisions of this Section, for | 18 |
| facilities licensed by the Department of Public Health under | 19 |
| the Nursing Home Care Act as intermediate care facilities that | 20 |
| are federally defined as Institutions for Mental Disease, a | 21 |
| socio-development component rate equal to 6.6% of the | 22 |
| facility's nursing component rate as of January 1, 2006 shall | 23 |
| be established and paid effective July 1, 2006. The | 24 |
| socio-development component of the rate as of July 1, 2007 | 25 |
| shall be increased by a factor of 2.53. The Illinois Department | 26 |
| may by rule adjust these socio-development component rates, but |
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
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| 1 |
| in no case may such rates be diminished.
| 2 |
| For facilities
licensed
by the
Department of Public Health | 3 |
| under the Nursing Home Care Act as Intermediate
Care for
the | 4 |
| Developmentally Disabled facilities or as long-term care | 5 |
| facilities for
residents under 22 years of age, the rates | 6 |
| taking effect on July 1,
2003 shall
include a statewide | 7 |
| increase of 4%, as defined by the Department.
| 8 |
| For facilities licensed by the Department of Public Health | 9 |
| under the
Nursing Home Care Act as Intermediate Care for the | 10 |
| Developmentally Disabled
facilities or Long Term Care for Under | 11 |
| Age 22 facilities, the rates taking
effect on October 1, 2007 | 12 |
| shall include a statewide increase of 2.5%, as
defined by the | 13 |
| Department.
| 14 |
| Notwithstanding any other provision of this Section, for | 15 |
| facilities licensed by the Department of Public Health under | 16 |
| the Nursing Home Care Act as skilled nursing facilities or | 17 |
| intermediate care facilities, effective January 1, 2005, | 18 |
| facility rates shall be increased by the difference between (i) | 19 |
| a facility's per diem property, liability, and malpractice | 20 |
| insurance costs as reported in the cost report filed with the | 21 |
| Department of Public Aid and used to establish rates effective | 22 |
| July 1, 2001 and (ii) those same costs as reported in the | 23 |
| facility's 2002 cost report. These costs shall be passed | 24 |
| through to the facility without caps or limitations, except for | 25 |
| adjustments required under normal auditing procedures.
| 26 |
| Rates established effective each July 1 shall govern |
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| payment
for services rendered throughout that fiscal year, | 2 |
| except that rates
established on July 1, 1996 shall be | 3 |
| increased by 6.8% for services
provided on or after January 1, | 4 |
| 1997. Such rates will be based
upon the rates calculated for | 5 |
| the year beginning July 1, 1990, and for
subsequent years | 6 |
| thereafter until June 30, 2001 shall be based on the
facility | 7 |
| cost reports
for the facility fiscal year ending at any point | 8 |
| in time during the previous
calendar year, updated to the | 9 |
| midpoint of the rate year. The cost report
shall be on file | 10 |
| with the Department no later than April 1 of the current
rate | 11 |
| year. Should the cost report not be on file by April 1, the | 12 |
| Department
shall base the rate on the latest cost report filed | 13 |
| by each skilled care
facility and intermediate care facility, | 14 |
| updated to the midpoint of the
current rate year. In | 15 |
| determining rates for services rendered on and after
July 1, | 16 |
| 1985, fixed time shall not be computed at less than zero. The
| 17 |
| Department shall not make any alterations of regulations which | 18 |
| would reduce
any component of the Medicaid rate to a level | 19 |
| below what that component would
have been utilizing in the rate | 20 |
| effective on July 1, 1984.
| 21 |
| (2) Shall take into account the actual costs incurred by | 22 |
| facilities
in providing services for recipients of skilled | 23 |
| nursing and intermediate
care services under the medical | 24 |
| assistance program.
| 25 |
| (3) Shall take into account the medical and psycho-social
| 26 |
| characteristics and needs of the patients.
|
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| (4) Shall take into account the actual costs incurred by | 2 |
| facilities in
meeting licensing and certification standards | 3 |
| imposed and prescribed by the
State of Illinois, any of its | 4 |
| political subdivisions or municipalities and by
the U.S. | 5 |
| Department of Health and Human Services pursuant to Title XIX | 6 |
| of the
Social Security Act.
| 7 |
| The Department of Healthcare and Family Services
shall | 8 |
| develop precise standards for
payments to reimburse nursing | 9 |
| facilities for any utilization of
appropriate rehabilitative | 10 |
| personnel for the provision of rehabilitative
services which is | 11 |
| authorized by federal regulations, including
reimbursement for | 12 |
| services provided by qualified therapists or qualified
| 13 |
| assistants, and which is in accordance with accepted | 14 |
| professional
practices. Reimbursement also may be made for | 15 |
| utilization of other
supportive personnel under appropriate | 16 |
| supervision.
| 17 |
| (Source: P.A. 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697, | 18 |
| eff. 11-21-05; 94-838, eff. 6-6-06; 94-964, eff. 6-28-06; | 19 |
| 95-12, eff. 7-2-07.)
| 20 |
| (305 ILCS 5/5-27 new)
| 21 |
| Sec. 5-27. Pilot mandatory managed care program. To | 22 |
| determine the potential for savings and improved quality of | 23 |
| care in the Medicaid program, the Department shall implement in | 24 |
| State fiscal year 2008 a pilot mandatory managed care program | 25 |
| requiring recipients to enroll with a Managed Care Entity (MCE) |
|
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LRB095 08369 WGH 38691 a |
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| 1 |
| meeting the requirements of Section 1932 of the Social Security | 2 |
| Act and under contract with the Department. The program shall | 3 |
| be implemented in at least 2 contiguous counties with not less | 4 |
| than 200,000 inhabitants and not more than 2,000,000 | 5 |
| inhabitants. The program shall have the following features: | 6 |
| (1) All recipients in the selected counties who do not | 7 |
| have eligibility through the spend-down program and who are | 8 |
| not excluded from State plan based mandatory managed care | 9 |
| by the Social Security Act shall be enrolled in the | 10 |
| program. | 11 |
| (2) Only the following services may be excluded from | 12 |
| the program and shall be delivered to eligible recipients | 13 |
| through the fee-for-service system: nursing facility and | 14 |
| assisted living long term care services, services provided | 15 |
| through waivers granted pursuant to Sections 1115 and 1915 | 16 |
| of the Social Security Act, and pharmacy services. | 17 |
| (3) Up to 3 Managed Care Entities shall be selected for | 18 |
| the program. | 19 |
| (4) The Department must use the following criteria in | 20 |
| selecting MCEs to participate in the pilot program: (A) | 21 |
| network adequacy ensuring availability and access to care; | 22 |
| (B) provider payment levels; (C) quality assurance plans | 23 |
| including utilization management and peer review; (D) past | 24 |
| performance on quality outcome measures (for example, the | 25 |
| Health Plan Employer Data and Information Set (HEDIS)); (E) | 26 |
| plan for care management; (F) data system adequacy, member |
|
|
|
09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| enrollment, and communication plan; and (G) any other | 2 |
| criteria that the Department determines appropriate. | 3 |
| (5) The Department shall require that the MCEs in the | 4 |
| pilot counties keep case-specific data under the pilot | 5 |
| program and produce periodic and final reports based on | 6 |
| that data of, at a minimum, the types and frequency of care | 7 |
| provided to enrollees and the types and frequency of | 8 |
| specialty and hospital care provided. The Department shall | 9 |
| require case-specific data in a manner that does not | 10 |
| violate applicable privacy laws. | 11 |
| (6) The Department shall perform an annual analysis of | 12 |
| healthcare outcomes for the population served under the | 13 |
| pilot program compared to healthcare outcomes for the | 14 |
| medical assistance population enrolled in the primary care | 15 |
| case management program under this Article. The Department | 16 |
| shall present this analysis to the General Assembly no | 17 |
| later than 60 days after the end of the month for which | 18 |
| HEDIS measures are reported for the calendar year.
| 19 |
| (305 ILCS 5/5B-8) (from Ch. 23, par. 5B-8)
| 20 |
| Sec. 5B-8. Long-Term Care Provider Fund.
| 21 |
| (a) There is created in the State Treasury the Long-Term
| 22 |
| Care Provider Fund. Interest earned by the Fund shall be
| 23 |
| credited to the Fund. The Fund shall not be used to replace any
| 24 |
| moneys appropriated to the Medicaid program by the General | 25 |
| Assembly.
|
|
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09500HB0691sam002 |
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|
| 1 |
| (b) The Fund is created for the purpose of receiving and
| 2 |
| disbursing moneys in accordance with this Article. | 3 |
| Disbursements
from the Fund shall be made only as follows:
| 4 |
| (1) For payments to skilled or intermediate nursing
| 5 |
| facilities, including county nursing facilities but | 6 |
| excluding
State-operated facilities, under Title XIX of | 7 |
| the Social Security
Act and Article V of this Code.
| 8 |
| (2) For the reimbursement of moneys collected by the
| 9 |
| Illinois Department through error or mistake, and for | 10 |
| making
required payments under Section 5-4.38(a)(1) if | 11 |
| there are no
moneys available for such payments in the | 12 |
| Medicaid Long Term Care
Provider Participation Fee Trust | 13 |
| Fund.
| 14 |
| (3) For payment of administrative expenses incurred by | 15 |
| the
Illinois Department or its agent in performing the | 16 |
| activities
authorized by this Article.
| 17 |
| (3.5) For reimbursement of expenses incurred by | 18 |
| long-term care facilities, and payment of administrative | 19 |
| expenses incurred by the Department of Public Health, in | 20 |
| relation to the conduct and analysis of background checks | 21 |
| for identified offenders under the Nursing Home Care Act.
| 22 |
| (4) For payments of any amounts that are reimbursable | 23 |
| to the
federal government for payments from this Fund that | 24 |
| are required
to be paid by State warrant.
| 25 |
| (5) For making transfers to the General Obligation Bond
| 26 |
| Retirement and Interest Fund, as those transfers are |
|
|
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09500HB0691sam002 |
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LRB095 08369 WGH 38691 a |
|
| 1 |
| authorized
in the proceedings authorizing debt under the | 2 |
| Short Term Borrowing Act,
but transfers made under this | 3 |
| paragraph (5) shall not exceed the
principal amount of debt | 4 |
| issued in anticipation of the receipt by
the State of | 5 |
| moneys to be deposited into the Fund.
| 6 |
| Disbursements from the Fund, other than transfers to the
| 7 |
| General Obligation Bond Retirement and Interest Fund, shall be | 8 |
| by
warrants drawn by the State Comptroller upon receipt of | 9 |
| vouchers
duly executed and certified by the Illinois | 10 |
| Department.
| 11 |
| (c) The Fund shall consist of the following:
| 12 |
| (1) All moneys collected or received by the Illinois
| 13 |
| Department from the long-term care provider assessment | 14 |
| imposed by
this Article.
| 15 |
| (2) All federal matching funds received by the Illinois
| 16 |
| Department as a result of expenditures made by the Illinois
| 17 |
| Department that are attributable to moneys deposited in the | 18 |
| Fund.
| 19 |
| (3) Any interest or penalty levied in conjunction with | 20 |
| the
administration of this Article.
| 21 |
| (4) Any balance in the Medicaid Long Term Care Provider | 22 |
| Participation
Fee Fund in the State Treasury. The balance | 23 |
| shall be transferred to the
Fund upon certification by the | 24 |
| Illinois Department to the State Comptroller
that all of | 25 |
| the disbursements required by Section 5-4.31(b) of this | 26 |
| Code
have been made.
|
|
|
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09500HB0691sam002 |
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|
| 1 |
| (5) All other monies received for the Fund from any | 2 |
| other source,
including interest earned thereon.
| 3 |
| (Source: P.A. 89-626, eff. 8-9-96.)
| 4 |
| Section 99. Effective date. This Act takes effect upon | 5 |
| becoming law.".
|
|