Illinois General Assembly - Full Text of HB4594
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Full Text of HB4594  102nd General Assembly




State of Illinois
2021 and 2022


Introduced 1/21/2022, by Rep. Greg Harris


305 ILCS 5/14-12

    Amends the Illinois Public Aid Code. Provides that effective for dates of service on or after January 1, 2023, the psychiatric standardized amount for psychiatric ambulatory services, categories of service 27 and 28, shall be no less than $402.92. Effective immediately.

LRB102 23229 KTG 32393 b





HB4594LRB102 23229 KTG 32393 b

1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 14-12 as follows:
6    (305 ILCS 5/14-12)
7    Sec. 14-12. Hospital rate reform payment system. The
8hospital payment system pursuant to Section 14-11 of this
9Article shall be as follows:
10    (a) Inpatient hospital services. Effective for discharges
11on and after July 1, 2014, reimbursement for inpatient general
12acute care services shall utilize the All Patient Refined
13Diagnosis Related Grouping (APR-DRG) software, version 30,
14distributed by 3MTM Health Information System.
15        (1) The Department shall establish Medicaid weighting
16    factors to be used in the reimbursement system established
17    under this subsection. Initial weighting factors shall be
18    the weighting factors as published by 3M Health
19    Information System, associated with Version 30.0 adjusted
20    for the Illinois experience.
21        (2) The Department shall establish a
22    statewide-standardized amount to be used in the inpatient
23    reimbursement system. The Department shall publish these



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1    amounts on its website no later than 10 calendar days
2    prior to their effective date.
3        (3) In addition to the statewide-standardized amount,
4    the Department shall develop adjusters to adjust the rate
5    of reimbursement for critical Medicaid providers or
6    services for trauma, transplantation services, perinatal
7    care, and Graduate Medical Education (GME).
8        (4) The Department shall develop add-on payments to
9    account for exceptionally costly inpatient stays,
10    consistent with Medicare outlier principles. Outlier fixed
11    loss thresholds may be updated to control for excessive
12    growth in outlier payments no more frequently than on an
13    annual basis, but at least once every 4 years. Upon
14    updating the fixed loss thresholds, the Department shall
15    be required to update base rates within 12 months.
16        (5) The Department shall define those hospitals or
17    distinct parts of hospitals that shall be exempt from the
18    APR-DRG reimbursement system established under this
19    Section. The Department shall publish these hospitals'
20    inpatient rates on its website no later than 10 calendar
21    days prior to their effective date.
22        (6) Beginning July 1, 2014 and ending on June 30,
23    2024, in addition to the statewide-standardized amount,
24    the Department shall develop an adjustor to adjust the
25    rate of reimbursement for safety-net hospitals defined in
26    Section 5-5e.1 of this Code excluding pediatric hospitals.



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1        (7) Beginning July 1, 2014, in addition to the
2    statewide-standardized amount, the Department shall
3    develop an adjustor to adjust the rate of reimbursement
4    for Illinois freestanding inpatient psychiatric hospitals
5    that are not designated as children's hospitals by the
6    Department but are primarily treating patients under the
7    age of 21.
8        (7.5) (Blank).
9        (8) Beginning July 1, 2018, in addition to the
10    statewide-standardized amount, the Department shall adjust
11    the rate of reimbursement for hospitals designated by the
12    Department of Public Health as a Perinatal Level II or II+
13    center by applying the same adjustor that is applied to
14    Perinatal and Obstetrical care cases for Perinatal Level
15    III centers, as of December 31, 2017.
16        (9) Beginning July 1, 2018, in addition to the
17    statewide-standardized amount, the Department shall apply
18    the same adjustor that is applied to trauma cases as of
19    December 31, 2017 to inpatient claims to treat patients
20    with burns, including, but not limited to, APR-DRGs 841,
21    842, 843, and 844.
22        (10) Beginning July 1, 2018, the
23    statewide-standardized amount for inpatient general acute
24    care services shall be uniformly increased so that base
25    claims projected reimbursement is increased by an amount
26    equal to the funds allocated in paragraph (1) of



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1    subsection (b) of Section 5A-12.6, less the amount
2    allocated under paragraphs (8) and (9) of this subsection
3    and paragraphs (3) and (4) of subsection (b) multiplied by
4    40%.
5        (11) Beginning July 1, 2018, the reimbursement for
6    inpatient rehabilitation services shall be increased by
7    the addition of a $96 per day add-on.
8    (b) Outpatient hospital services. Effective for dates of
9service on and after July 1, 2014, reimbursement for
10outpatient services shall utilize the Enhanced Ambulatory
11Procedure Grouping (EAPG) software, version 3.7 distributed by
123MTM Health Information System.
13        (1) The Department shall establish Medicaid weighting
14    factors to be used in the reimbursement system established
15    under this subsection. The initial weighting factors shall
16    be the weighting factors as published by 3M Health
17    Information System, associated with Version 3.7.
18        (2) The Department shall establish service specific
19    statewide-standardized amounts to be used in the
20    reimbursement system.
21            (A) The initial statewide standardized amounts,
22        with the labor portion adjusted by the Calendar Year
23        2013 Medicare Outpatient Prospective Payment System
24        wage index with reclassifications, shall be published
25        by the Department on its website no later than 10
26        calendar days prior to their effective date.



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1            (B) The Department shall establish adjustments to
2        the statewide-standardized amounts for each Critical
3        Access Hospital, as designated by the Department of
4        Public Health in accordance with 42 CFR 485, Subpart
5        F. For outpatient services provided on or before June
6        30, 2018, the EAPG standardized amounts are determined
7        separately for each critical access hospital such that
8        simulated EAPG payments using outpatient base period
9        paid claim data plus payments under Section 5A-12.4 of
10        this Code net of the associated tax costs are equal to
11        the estimated costs of outpatient base period claims
12        data with a rate year cost inflation factor applied.
13        (3) In addition to the statewide-standardized amounts,
14    the Department shall develop adjusters to adjust the rate
15    of reimbursement for critical Medicaid hospital outpatient
16    providers or services, including outpatient high volume or
17    safety-net hospitals. Beginning July 1, 2018, the
18    outpatient high volume adjustor shall be increased to
19    increase annual expenditures associated with this adjustor
20    by $79,200,000, based on the State Fiscal Year 2015 base
21    year data and this adjustor shall apply to public
22    hospitals, except for large public hospitals, as defined
23    under 89 Ill. Adm. Code 148.25(a).
24        (4) Beginning July 1, 2018, in addition to the
25    statewide standardized amounts, the Department shall make
26    an add-on payment for outpatient expensive devices and



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1    drugs. This add-on payment shall at least apply to claim
2    lines that: (i) are assigned with one of the following
3    EAPGs: 490, 1001 to 1020, and coded with one of the
4    following revenue codes: 0274 to 0276, 0278; or (ii) are
5    assigned with one of the following EAPGs: 430 to 441, 443,
6    444, 460 to 465, 495, 496, 1090. The add-on payment shall
7    be calculated as follows: the claim line's covered charges
8    multiplied by the hospital's total acute cost to charge
9    ratio, less the claim line's EAPG payment plus $1,000,
10    multiplied by 0.8.
11        (5) Beginning July 1, 2018, the statewide-standardized
12    amounts for outpatient services shall be increased by a
13    uniform percentage so that base claims projected
14    reimbursement is increased by an amount equal to no less
15    than the funds allocated in paragraph (1) of subsection
16    (b) of Section 5A-12.6, less the amount allocated under
17    paragraphs (8) and (9) of subsection (a) and paragraphs
18    (3) and (4) of this subsection multiplied by 46%.
19        (6) Effective for dates of service on or after July 1,
20    2018, the Department shall establish adjustments to the
21    statewide-standardized amounts for each Critical Access
22    Hospital, as designated by the Department of Public Health
23    in accordance with 42 CFR 485, Subpart F, such that each
24    Critical Access Hospital's standardized amount for
25    outpatient services shall be increased by the applicable
26    uniform percentage determined pursuant to paragraph (5) of



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1    this subsection. It is the intent of the General Assembly
2    that the adjustments required under this paragraph (6) by
3    Public Act 100-1181 shall be applied retroactively to
4    claims for dates of service provided on or after July 1,
5    2018.
6        (7) Effective for dates of service on or after March
7    8, 2019 (the effective date of Public Act 100-1181), the
8    Department shall recalculate and implement an updated
9    statewide-standardized amount for outpatient services
10    provided by hospitals that are not Critical Access
11    Hospitals to reflect the applicable uniform percentage
12    determined pursuant to paragraph (5).
13            (1) Any recalculation to the
14        statewide-standardized amounts for outpatient services
15        provided by hospitals that are not Critical Access
16        Hospitals shall be the amount necessary to achieve the
17        increase in the statewide-standardized amounts for
18        outpatient services increased by a uniform percentage,
19        so that base claims projected reimbursement is
20        increased by an amount equal to no less than the funds
21        allocated in paragraph (1) of subsection (b) of
22        Section 5A-12.6, less the amount allocated under
23        paragraphs (8) and (9) of subsection (a) and
24        paragraphs (3) and (4) of this subsection, for all
25        hospitals that are not Critical Access Hospitals,
26        multiplied by 46%.



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1            (2) It is the intent of the General Assembly that
2        the recalculations required under this paragraph (7)
3        by Public Act 100-1181 shall be applied prospectively
4        to claims for dates of service provided on or after
5        March 8, 2019 (the effective date of Public Act
6        100-1181) and that no recoupment or repayment by the
7        Department or an MCO of payments attributable to
8        recalculation under this paragraph (7), issued to the
9        hospital for dates of service on or after July 1, 2018
10        and before March 8, 2019 (the effective date of Public
11        Act 100-1181), shall be permitted.
12        (8) The Department shall ensure that all necessary
13    adjustments to the managed care organization capitation
14    base rates necessitated by the adjustments under
15    subparagraph (6) or (7) of this subsection are completed
16    and applied retroactively in accordance with Section
17    5-30.8 of this Code within 90 days of March 8, 2019 (the
18    effective date of Public Act 100-1181).
19        (9) Within 60 days after federal approval of the
20    change made to the assessment in Section 5A-2 by this
21    amendatory Act of the 101st General Assembly, the
22    Department shall incorporate into the EAPG system for
23    outpatient services those services performed by hospitals
24    currently billed through the Non-Institutional Provider
25    billing system.
26        (10) Effective for dates of service on or after



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1    January 1, 2023, the psychiatric standardized amount for
2    psychiatric ambulatory services, categories of service 27
3    and 28, shall be no less than $402.92.
4    (c) In consultation with the hospital community, the
5Department is authorized to replace 89 Ill. Admin. Code
6152.150 as published in 38 Ill. Reg. 4980 through 4986 within
712 months of June 16, 2014 (the effective date of Public Act
898-651). If the Department does not replace these rules within
912 months of June 16, 2014 (the effective date of Public Act
1098-651), the rules in effect for 152.150 as published in 38
11Ill. Reg. 4980 through 4986 shall remain in effect until
12modified by rule by the Department. Nothing in this subsection
13shall be construed to mandate that the Department file a
14replacement rule.
15    (d) Transition period. There shall be a transition period
16to the reimbursement systems authorized under this Section
17that shall begin on the effective date of these systems and
18continue until June 30, 2018, unless extended by rule by the
19Department. To help provide an orderly and predictable
20transition to the new reimbursement systems and to preserve
21and enhance access to the hospital services during this
22transition, the Department shall allocate a transitional
23hospital access pool of at least $290,000,000 annually so that
24transitional hospital access payments are made to hospitals.
25        (1) After the transition period, the Department may
26    begin incorporating the transitional hospital access pool



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1    into the base rate structure; however, the transitional
2    hospital access payments in effect on June 30, 2018 shall
3    continue to be paid, if continued under Section 5A-16.
4        (2) After the transition period, if the Department
5    reduces payments from the transitional hospital access
6    pool, it shall increase base rates, develop new adjustors,
7    adjust current adjustors, develop new hospital access
8    payments based on updated information, or any combination
9    thereof by an amount equal to the decreases proposed in
10    the transitional hospital access pool payments, ensuring
11    that the entire transitional hospital access pool amount
12    shall continue to be used for hospital payments.
13    (d-5) Hospital and health care transformation program. The
14Department shall develop a hospital and health care
15transformation program to provide financial assistance to
16hospitals in transforming their services and care models to
17better align with the needs of the communities they serve. The
18payments authorized in this Section shall be subject to
19approval by the federal government.
20        (1) Phase 1. In State fiscal years 2019 through 2020,
21    the Department shall allocate funds from the transitional
22    access hospital pool to create a hospital transformation
23    pool of at least $262,906,870 annually and make hospital
24    transformation payments to hospitals. Subject to Section
25    5A-16, in State fiscal years 2019 and 2020, an Illinois
26    hospital that received either a transitional hospital



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1    access payment under subsection (d) or a supplemental
2    payment under subsection (f) of this Section in State
3    fiscal year 2018, shall receive a hospital transformation
4    payment as follows:
5            (A) If the hospital's Rate Year 2017 Medicaid
6        inpatient utilization rate is equal to or greater than
7        45%, the hospital transformation payment shall be
8        equal to 100% of the sum of its transitional hospital
9        access payment authorized under subsection (d) and any
10        supplemental payment authorized under subsection (f).
11            (B) If the hospital's Rate Year 2017 Medicaid
12        inpatient utilization rate is equal to or greater than
13        25% but less than 45%, the hospital transformation
14        payment shall be equal to 75% of the sum of its
15        transitional hospital access payment authorized under
16        subsection (d) and any supplemental payment authorized
17        under subsection (f).
18            (C) If the hospital's Rate Year 2017 Medicaid
19        inpatient utilization rate is less than 25%, the
20        hospital transformation payment shall be equal to 50%
21        of the sum of its transitional hospital access payment
22        authorized under subsection (d) and any supplemental
23        payment authorized under subsection (f).
24        (2) Phase 2.
25            (A) The funding amount from phase one shall be
26        incorporated into directed payment and pass-through



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1        payment methodologies described in Section 5A-12.7.
2            (B) Because there are communities in Illinois that
3        experience significant health care disparities due to
4        systemic racism, as recently emphasized by the
5        COVID-19 pandemic, aggravated by social determinants
6        of health and a lack of sufficiently allocated
7        healthcare resources, particularly community-based
8        services, preventive care, obstetric care, chronic
9        disease management, and specialty care, the Department
10        shall establish a health care transformation program
11        that shall be supported by the transformation funding
12        pool. It is the intention of the General Assembly that
13        innovative partnerships funded by the pool must be
14        designed to establish or improve integrated health
15        care delivery systems that will provide significant
16        access to the Medicaid and uninsured populations in
17        their communities, as well as improve health care
18        equity. It is also the intention of the General
19        Assembly that partnerships recognize and address the
20        disparities revealed by the COVID-19 pandemic, as well
21        as the need for post-COVID care. During State fiscal
22        years 2021 through 2027, the hospital and health care
23        transformation program shall be supported by an annual
24        transformation funding pool of up to $150,000,000,
25        pending federal matching funds, to be allocated during
26        the specified fiscal years for the purpose of



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1        facilitating hospital and health care transformation.
2        No disbursement of moneys for transformation projects
3        from the transformation funding pool described under
4        this Section shall be considered an award, a grant, or
5        an expenditure of grant funds. Funding agreements made
6        in accordance with the transformation program shall be
7        considered purchases of care under the Illinois
8        Procurement Code, and funds shall be expended by the
9        Department in a manner that maximizes federal funding
10        to expend the entire allocated amount.
11            The Department shall convene, within 30 days after
12        the effective date of this amendatory Act of the 101st
13        General Assembly, a workgroup that includes subject
14        matter experts on healthcare disparities and
15        stakeholders from distressed communities, which could
16        be a subcommittee of the Medicaid Advisory Committee,
17        to review and provide recommendations on how
18        Department policy, including health care
19        transformation, can improve health disparities and the
20        impact on communities disproportionately affected by
21        COVID-19. The workgroup shall consider and make
22        recommendations on the following issues: a community
23        safety-net designation of certain hospitals, racial
24        equity, and a regional partnership to bring additional
25        specialty services to communities.
26            (C) As provided in paragraph (9) of Section 3 of



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1        the Illinois Health Facilities Planning Act, any
2        hospital participating in the transformation program
3        may be excluded from the requirements of the Illinois
4        Health Facilities Planning Act for those projects
5        related to the hospital's transformation. To be
6        eligible, the hospital must submit to the Health
7        Facilities and Services Review Board approval from the
8        Department that the project is a part of the
9        hospital's transformation.
10            (D) As provided in subsection (a-20) of Section
11        32.5 of the Emergency Medical Services (EMS) Systems
12        Act, a hospital that received hospital transformation
13        payments under this Section may convert to a
14        freestanding emergency center. To be eligible for such
15        a conversion, the hospital must submit to the
16        Department of Public Health approval from the
17        Department that the project is a part of the
18        hospital's transformation.
19            (E) Criteria for proposals. To be eligible for
20        funding under this Section, a transformation proposal
21        shall meet all of the following criteria:
22                (i) the proposal shall be designed based on
23            community needs assessment completed by either a
24            University partner or other qualified entity with
25            significant community input;
26                (ii) the proposal shall be a collaboration



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1            among providers across the care and community
2            spectrum, including preventative care, primary
3            care specialty care, hospital services, mental
4            health and substance abuse services, as well as
5            community-based entities that address the social
6            determinants of health;
7                (iii) the proposal shall be specifically
8            designed to improve healthcare outcomes and reduce
9            healthcare disparities, and improve the
10            coordination, effectiveness, and efficiency of
11            care delivery;
12                (iv) the proposal shall have specific
13            measurable metrics related to disparities that
14            will be tracked by the Department and made public
15            by the Department;
16                (v) the proposal shall include a commitment to
17            include Business Enterprise Program certified
18            vendors or other entities controlled and managed
19            by minorities or women; and
20                (vi) the proposal shall specifically increase
21            access to primary, preventive, or specialty care.
22            (F) Entities eligible to be funded.
23                (i) Proposals for funding should come from
24            collaborations operating in one of the most
25            distressed communities in Illinois as determined
26            by the U.S. Centers for Disease Control and



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1            Prevention's Social Vulnerability Index for
2            Illinois and areas disproportionately impacted by
3            COVID-19 or from rural areas of Illinois.
4                (ii) The Department shall prioritize
5            partnerships from distressed communities, which
6            include Business Enterprise Program certified
7            vendors or other entities controlled and managed
8            by minorities or women and also include one or
9            more of the following: safety-net hospitals,
10            critical access hospitals, the campuses of
11            hospitals that have closed since January 1, 2018,
12            or other healthcare providers designed to address
13            specific healthcare disparities, including the
14            impact of COVID-19 on individuals and the
15            community and the need for post-COVID care. All
16            funded proposals must include specific measurable
17            goals and metrics related to improved outcomes and
18            reduced disparities which shall be tracked by the
19            Department.
20                (iii) The Department should target the funding
21            in the following ways: $30,000,000 of
22            transformation funds to projects that are a
23            collaboration between a safety-net hospital,
24            particularly community safety-net hospitals, and
25            other providers and designed to address specific
26            healthcare disparities, $20,000,000 of



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1            transformation funds to collaborations between
2            safety-net hospitals and a larger hospital partner
3            that increases specialty care in distressed
4            communities, $30,000,000 of transformation funds
5            to projects that are a collaboration between
6            hospitals and other providers in distressed areas
7            of the State designed to address specific
8            healthcare disparities, $15,000,000 to
9            collaborations between critical access hospitals
10            and other providers designed to address specific
11            healthcare disparities, and $15,000,000 to
12            cross-provider collaborations designed to address
13            specific healthcare disparities, and $5,000,000 to
14            collaborations that focus on workforce
15            development.
16                (iv) The Department may allocate up to
17            $5,000,000 for planning, racial equity analysis,
18            or consulting resources for the Department or
19            entities without the resources to develop a plan
20            to meet the criteria of this Section. Any contract
21            for consulting services issued by the Department
22            under this subparagraph shall comply with the
23            provisions of Section 5-45 of the State Officials
24            and Employees Ethics Act. Based on availability of
25            federal funding, the Department may directly
26            procure consulting services or provide funding to



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1            the collaboration. The provision of resources
2            under this subparagraph is not a guarantee that a
3            project will be approved.
4                (v) The Department shall take steps to ensure
5            that safety-net hospitals operating in
6            under-resourced communities receive priority
7            access to hospital and healthcare transformation
8            funds, including consulting funds, as provided
9            under this Section.
10            (G) Process for submitting and approving projects
11        for distressed communities. The Department shall issue
12        a template for application. The Department shall post
13        any proposal received on the Department's website for
14        at least 2 weeks for public comment, and any such
15        public comment shall also be considered in the review
16        process. Applicants may request that proprietary
17        financial information be redacted from publicly posted
18        proposals and the Department in its discretion may
19        agree. Proposals for each distressed community must
20        include all of the following:
21                (i) A detailed description of how the project
22            intends to affect the goals outlined in this
23            subsection, describing new interventions, new
24            technology, new structures, and other changes to
25            the healthcare delivery system planned.
26                (ii) A detailed description of the racial and



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1            ethnic makeup of the entities' board and
2            leadership positions and the salaries of the
3            executive staff of entities in the partnership
4            that is seeking to obtain funding under this
5            Section.
6                (iii) A complete budget, including an overall
7            timeline and a detailed pathway to sustainability
8            within a 5-year period, specifying other sources
9            of funding, such as in-kind, cost-sharing, or
10            private donations, particularly for capital needs.
11            There is an expectation that parties to the
12            transformation project dedicate resources to the
13            extent they are able and that these expectations
14            are delineated separately for each entity in the
15            proposal.
16                (iv) A description of any new entities formed
17            or other legal relationships between collaborating
18            entities and how funds will be allocated among
19            participants.
20                (v) A timeline showing the evolution of sites
21            and specific services of the project over a 5-year
22            period, including services available to the
23            community by site.
24                (vi) Clear milestones indicating progress
25            toward the proposed goals of the proposal as
26            checkpoints along the way to continue receiving



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1            funding. The Department is authorized to refine
2            these milestones in agreements, and is authorized
3            to impose reasonable penalties, including
4            repayment of funds, for substantial lack of
5            progress.
6                (vii) A clear statement of the level of
7            commitment the project will include for minorities
8            and women in contracting opportunities, including
9            as equity partners where applicable, or as
10            subcontractors and suppliers in all phases of the
11            project.
12                (viii) If the community study utilized is not
13            the study commissioned and published by the
14            Department, the applicant must define the
15            methodology used, including documentation of clear
16            community participation.
17                (ix) A description of the process used in
18            collaborating with all levels of government in the
19            community served in the development of the
20            project, including, but not limited to,
21            legislators and officials of other units of local
22            government.
23                (x) Documentation of a community input process
24            in the community served, including links to
25            proposal materials on public websites.
26                (xi) Verifiable project milestones and quality



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1            metrics that will be impacted by transformation.
2            These project milestones and quality metrics must
3            be identified with improvement targets that must
4            be met.
5                (xii) Data on the number of existing employees
6            by various job categories and wage levels by the
7            zip code of the employees' residence and
8            benchmarks for the continued maintenance and
9            improvement of these levels. The proposal must
10            also describe any retraining or other workforce
11            development planned for the new project.
12                (xiii) If a new entity is created by the
13            project, a description of how the board will be
14            reflective of the community served by the
15            proposal.
16                (xiv) An explanation of how the proposal will
17            address the existing disparities that exacerbated
18            the impact of COVID-19 and the need for post-COVID
19            care in the community, if applicable.
20                (xv) An explanation of how the proposal is
21            designed to increase access to care, including
22            specialty care based upon the community's needs.
23            (H) The Department shall evaluate proposals for
24        compliance with the criteria listed under subparagraph
25        (G). Proposals meeting all of the criteria may be
26        eligible for funding with the areas of focus



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1        prioritized as described in item (ii) of subparagraph
2        (F). Based on the funds available, the Department may
3        negotiate funding agreements with approved applicants
4        to maximize federal funding. Nothing in this
5        subsection requires that an approved project be funded
6        to the level requested. Agreements shall specify the
7        amount of funding anticipated annually, the
8        methodology of payments, the limit on the number of
9        years such funding may be provided, and the milestones
10        and quality metrics that must be met by the projects in
11        order to continue to receive funding during each year
12        of the program. Agreements shall specify the terms and
13        conditions under which a health care facility that
14        receives funds under a purchase of care agreement and
15        closes in violation of the terms of the agreement must
16        pay an early closure fee no greater than 50% of the
17        funds it received under the agreement, prior to the
18        Health Facilities and Services Review Board
19        considering an application for closure of the
20        facility. Any project that is funded shall be required
21        to provide quarterly written progress reports, in a
22        form prescribed by the Department, and at a minimum
23        shall include the progress made in achieving any
24        milestones or metrics or Business Enterprise Program
25        commitments in its plan. The Department may reduce or
26        end payments, as set forth in transformation plans, if



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1        milestones or metrics or Business Enterprise Program
2        commitments are not achieved. The Department shall
3        seek to make payments from the transformation fund in
4        a manner that is eligible for federal matching funds.
5            In reviewing the proposals, the Department shall
6        take into account the needs of the community, data
7        from the study commissioned by the Department from the
8        University of Illinois-Chicago if applicable, feedback
9        from public comment on the Department's website, as
10        well as how the proposal meets the criteria listed
11        under subparagraph (G). Alignment with the
12        Department's overall strategic initiatives shall be an
13        important factor. To the extent that fiscal year
14        funding is not adequate to fund all eligible projects
15        that apply, the Department shall prioritize
16        applications that most comprehensively and effectively
17        address the criteria listed under subparagraph (G).
18        (3) (Blank).
19        (4) Hospital Transformation Review Committee. There is
20    created the Hospital Transformation Review Committee. The
21    Committee shall consist of 14 members. No later than 30
22    days after March 12, 2018 (the effective date of Public
23    Act 100-581), the 4 legislative leaders shall each appoint
24    3 members; the Governor shall appoint the Director of
25    Healthcare and Family Services, or his or her designee, as
26    a member; and the Director of Healthcare and Family



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1    Services shall appoint one member. Any vacancy shall be
2    filled by the applicable appointing authority within 15
3    calendar days. The members of the Committee shall select a
4    Chair and a Vice-Chair from among its members, provided
5    that the Chair and Vice-Chair cannot be appointed by the
6    same appointing authority and must be from different
7    political parties. The Chair shall have the authority to
8    establish a meeting schedule and convene meetings of the
9    Committee, and the Vice-Chair shall have the authority to
10    convene meetings in the absence of the Chair. The
11    Committee may establish its own rules with respect to
12    meeting schedule, notice of meetings, and the disclosure
13    of documents; however, the Committee shall not have the
14    power to subpoena individuals or documents and any rules
15    must be approved by 9 of the 14 members. The Committee
16    shall perform the functions described in this Section and
17    advise and consult with the Director in the administration
18    of this Section. In addition to reviewing and approving
19    the policies, procedures, and rules for the hospital and
20    health care transformation program, the Committee shall
21    consider and make recommendations related to qualifying
22    criteria and payment methodologies related to safety-net
23    hospitals and children's hospitals. Members of the
24    Committee appointed by the legislative leaders shall be
25    subject to the jurisdiction of the Legislative Ethics
26    Commission, not the Executive Ethics Commission, and all



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1    requests under the Freedom of Information Act shall be
2    directed to the applicable Freedom of Information officer
3    for the General Assembly. The Department shall provide
4    operational support to the Committee as necessary. The
5    Committee is dissolved on April 1, 2019.
6    (e) Beginning 36 months after initial implementation, the
7Department shall update the reimbursement components in
8subsections (a) and (b), including standardized amounts and
9weighting factors, and at least once every 4 years and no more
10frequently than annually thereafter. The Department shall
11publish these updates on its website no later than 30 calendar
12days prior to their effective date.
13    (f) Continuation of supplemental payments. Any
14supplemental payments authorized under Illinois Administrative
15Code 148 effective January 1, 2014 and that continue during
16the period of July 1, 2014 through December 31, 2014 shall
17remain in effect as long as the assessment imposed by Section
185A-2 that is in effect on December 31, 2017 remains in effect.
19    (g) Notwithstanding subsections (a) through (f) of this
20Section and notwithstanding the changes authorized under
21Section 5-5b.1, any updates to the system shall not result in
22any diminishment of the overall effective rates of
23reimbursement as of the implementation date of the new system
24(July 1, 2014). These updates shall not preclude variations in
25any individual component of the system or hospital rate
26variations. Nothing in this Section shall prohibit the



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1Department from increasing the rates of reimbursement or
2developing payments to ensure access to hospital services.
3Nothing in this Section shall be construed to guarantee a
4minimum amount of spending in the aggregate or per hospital as
5spending may be impacted by factors, including, but not
6limited to, the number of individuals in the medical
7assistance program and the severity of illness of the
9    (h) The Department shall have the authority to modify by
10rulemaking any changes to the rates or methodologies in this
11Section as required by the federal government to obtain
12federal financial participation for expenditures made under
13this Section.
14    (i) Except for subsections (g) and (h) of this Section,
15the Department shall, pursuant to subsection (c) of Section
165-40 of the Illinois Administrative Procedure Act, provide for
17presentation at the June 2014 hearing of the Joint Committee
18on Administrative Rules (JCAR) additional written notice to
19JCAR of the following rules in order to commence the second
20notice period for the following rules: rules published in the
21Illinois Register, rule dated February 21, 2014 at 38 Ill.
22Reg. 4559 (Medical Payment), 4628 (Specialized Health Care
23Delivery Systems), 4640 (Hospital Services), 4932 (Diagnostic
24Related Grouping (DRG) Prospective Payment System (PPS)), and
254977 (Hospital Reimbursement Changes), and published in the
26Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499



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1(Specialized Health Care Delivery Systems) and 6505 (Hospital
3    (j) Out-of-state hospitals. Beginning July 1, 2018, for
4purposes of determining for State fiscal years 2019 and 2020
5and subsequent fiscal years the hospitals eligible for the
6payments authorized under subsections (a) and (b) of this
7Section, the Department shall include out-of-state hospitals
8that are designated a Level I pediatric trauma center or a
9Level I trauma center by the Department of Public Health as of
10December 1, 2017.
11    (k) The Department shall notify each hospital and managed
12care organization, in writing, of the impact of the updates
13under this Section at least 30 calendar days prior to their
14effective date.
15(Source: P.A. 101-81, eff. 7-12-19; 101-650, eff. 7-7-20;
16101-655, eff. 3-12-21; 102-682, eff. 12-10-21.)
17    Section 99. Effective date. This Act takes effect upon
18becoming law.