Rep. Lee A. Daniels
Filed: 3/30/2004
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1 | AMENDMENT TO HOUSE BILL 5000
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2 | AMENDMENT NO. ______. Amend House Bill 5000, AS AMENDED, in | ||||||
3 | Section 5, Sec. 1-36, by replacing subsections (b) through (f) | ||||||
4 | with the following: | ||||||
5 | " (b) Contracts must ensure that the transition to a | ||||||
6 | fee-for-service payment methodology beginning July 1, 2003 | ||||||
7 | will not cause any person receiving services to become | ||||||
8 | ineligible or the level or quality of their service to be | ||||||
9 | diminished, nor cause any person to be denied necessary | ||||||
10 | services if the person is eligible for services. | ||||||
11 | (c) The Department of Human Services, in consultation with | ||||||
12 | the departments of Public Aid, Public Health, and Children and | ||||||
13 | Family Services and the Department on Aging, if applicable to | ||||||
14 | the services under contract, shall adopt rules establishing the | ||||||
15 | criteria, standards, and procedures for issuing the | ||||||
16 | fee-for-service contracts, including but not limited to the | ||||||
17 | fees to be paid for the services. | ||||||
18 | (d) In developing rules establishing conditions of | ||||||
19 | participation and in developing performance standards, the | ||||||
20 | Department shall provide an opportunity for public review and | ||||||
21 | comment and for consultation with stakeholders before | ||||||
22 | publishing and adopting those rules and performance standards. | ||||||
23 | (e) For the fiscal year beginning July 1, 2004, approved | ||||||
24 | claims for payments for community services by grants, or | ||||||
25 | payments by reimbursements for services billed under | ||||||
26 | fee-for-service contracts, shall be paid in 12 monthly payments |
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1 | equal to 1/12 of the grant amount or as prospective payments of | ||||||
2 | estimated bills, and these payments must be received no later | ||||||
3 | than the 8th calendar day of each month. The Department may | ||||||
4 | adjust the amount of payments for errors or improper payments | ||||||
5 | and for the reconciliation of estimated and actual billings | ||||||
6 | that shall be determined quarterly. The Department may revise | ||||||
7 | the schedule of payments after July 1, 2005 by rule. | ||||||
8 | (f) For the fiscal year beginning July 1, 2004, to ensure | ||||||
9 | continuity of services for recipients of community services | ||||||
10 | administered by the Department, and to ensure a smooth | ||||||
11 | transition from any payment methodology not based on | ||||||
12 | fee-for-service contracts, the Department shall provide an | ||||||
13 | aggregate amount of funding through a combination of grants and | ||||||
14 | contracts that will at least maintain the same level of | ||||||
15 | services in effect for the prior fiscal year beginning July 1, | ||||||
16 | 2003. Individuals, organizations, or agencies who were | ||||||
17 | providers of community services in the fiscal year beginning | ||||||
18 | July 1, 2003, who are willing to comply with conditions of | ||||||
19 | participation, and who meet performance standards established | ||||||
20 | by the Department, shall be eligible as providers of services | ||||||
21 | after July 1, 2004 for contracts under this Section that | ||||||
22 | include terms that will enable them to at least maintain the | ||||||
23 | same service capacity that they were providing in that prior | ||||||
24 | fiscal year. | ||||||
25 | (g) Contracts under this Section shall include provisions | ||||||
26 | for (i) adequate and timely notice to a provider of any | ||||||
27 | determination by the Department that the provider is not in | ||||||
28 | compliance with the contract or any standards of performance | ||||||
29 | and (ii) an opportunity for the provider to take corrective | ||||||
30 | action. A contract may be terminated if the provider fails to | ||||||
31 | take corrective action. In the event of a contract termination, | ||||||
32 | the Department must ensure that eligible persons receiving | ||||||
33 | services under the contract will otherwise continue to receive | ||||||
34 | necessary services in the community.
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1 | (h) The Department shall implement policies and procedures | ||||||
2 | for recipients and providers of services to submit inquiries | ||||||
3 | and resolve disputes with regard to the community services | ||||||
4 | subject to contracts under this Section.
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5 | (i) Additional procedures, supplementary payments, or | ||||||
6 | special rates may be adopted and implemented by the Department | ||||||
7 | to ensure that unique circumstances of local areas, as defined | ||||||
8 | by rule, can be met, including but not limited to circumstances | ||||||
9 | in which there are not sufficient services available to meet | ||||||
10 | basic needs or in which there is a need for specialty care. | ||||||
11 | (j) The Department shall require cost reports from | ||||||
12 | providers of community services, as prescribed by rule, for the | ||||||
13 | community services for which it will contract on a | ||||||
14 | fee-for-service basis under this Section to determine the cost | ||||||
15 | of services and other factors upon which the rates of payment | ||||||
16 | shall be based. The Department, by rule, shall set rates to be | ||||||
17 | paid for the various types of community services based on the | ||||||
18 | cost reports. In developing rules establishing rates under this | ||||||
19 | Section, the Department shall provide an opportunity for public | ||||||
20 | review and comment and consultation with stakeholders before | ||||||
21 | publishing and adopting those rules. Before adopting the rules, | ||||||
22 | the Department shall obtain an evaluation and opinion by an | ||||||
23 | independent certified public accountant comparing reported | ||||||
24 | costs and proposed rates. ".
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