SB2529 101ST GENERAL ASSEMBLY

LRB101 15149 KTG 64294 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB2529

Introduced 1/28/2020, by Sen. Michael E. Hastings

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.4k new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that on or after July 1, 2020, to receive the additional Long-Acting Injectable for Mental Health or Addiction Medicaid payment, a hospital shall submit a separate professional claim specifying "place of service 21 – Inpatient Hospital". Provides that the professional claim shall include the hospital as the billing provider and list the practitioner performing the procedure as the rendering provider. Requires the hospital to use the appropriate Healthcare Common Procedure Coding System Level II procedure code and the National Drug Code. Requires facilities participating in the federal 340B Drug Pricing Program to continue to bill the 340B actual acquisition cost for the medication. Provides that long-acting injectable medications for mental health or addiction shall not be subject to prior authorization under the medical assistance program or under any Medicaid managed-care plans when initiated at an inpatient hospital setting or when continued at an outpatient treatment facility.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by changing Section 5-5.4k as follows:

(305 ILCS 5/5-5.4k new)

Sec. 5-5.4k. Payments for long-acting injectable medications for mental health or addiction. Notwithstanding any other provision of this Code, on or after July 1, 2020, to receive the additional Long-Acting Injectable for Mental Health or Addiction Medicaid payment, a hospital shall submit a separate professional claim specifying "place of service 21 – Inpatient Hospital". The professional claim shall include the hospital as the billing provider and list the practitioner performing the procedure as the rendering provider. The hospital shall use the appropriate Healthcare Common Procedure Coding System Level II procedure code and the National Drug Code. Facilities participating in the federal 340B Drug Pricing Program shall continue to bill the 340B actual acquisition cost for the medication. Long-acting injectable medications for mental health or addiction shall not be subject to prior authorization under the medical assistance program or under any Medicaid managed-care plans when initiated at an inpatient hospital setting or when continued at an outpatient treatment facility.