Full Text of HB5000 93rd General Assembly
HB5000ham004 93RD GENERAL ASSEMBLY
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Rep. Lee A. Daniels
Filed: 3/31/2004
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09300HB5000ham004 |
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LRB093 16715 DRJ 49437 a |
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| AMENDMENT TO HOUSE BILL 5000
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| 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, 2004 | 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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LRB093 16715 DRJ 49437 a |
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| 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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LRB093 16715 DRJ 49437 a |
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| (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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| (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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