Full Text of SB2367 93rd General Assembly
SB2367ham003 93RD GENERAL ASSEMBLY
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Rep. Lee A. Daniels
Filed: 5/28/2004
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LRB093 19989 DRJ 51885 a |
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| AMENDMENT TO SENATE BILL 2367
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| AMENDMENT NO. ______. Amend Senate Bill 2367, AS AMENDED, | 3 |
| by replacing everything after the enacting clause with the | 4 |
| following:
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| "Section 5. The Department of Human Services Act is amended | 6 |
| by adding Sections 1-35, 1-36, and 1-40 as follows: | 7 |
| (20 ILCS 1305/1-35 new) | 8 |
| Sec. 1-35. Community-based services contracting pilot | 9 |
| project. | 10 |
| (a) The Department of Human Services may initiate a 2-year | 11 |
| pilot project aimed at the improvement of delivery of | 12 |
| community-based services by contract, which will increase the | 13 |
| number of service contracts open to a competitive selection | 14 |
| process and utilize performance-based contracts in the | 15 |
| provision of such services. Only contracts for community-based | 16 |
| services executed under this project shall be subject to a | 17 |
| competitive selection process and performance measurement. | 18 |
| Nothing in this Section prohibits the continuation of contracts | 19 |
| that were subject to requests for proposals and executed before | 20 |
| June 30, 2004. | 21 |
| If implemented, the pilot project authorized by this | 22 |
| Section shall be directed toward community-based services that | 23 |
| assist Illinois residents in achieving self-sufficiency, | 24 |
| independence and health to the maximum extent possible by |
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| providing integrated family-oriented services, promoting | 2 |
| prevention, and establishing measurable outcomes in | 3 |
| partnership with communities. | 4 |
| The 2-year pilot project must be implemented in a manner | 5 |
| that ensures the continuation of existing client and provider | 6 |
| relationships to the maximum extent possible in cases where | 7 |
| there is an ongoing plan of treatment. The pilot project shall | 8 |
| ensure that "critical access" providers of services, as defined | 9 |
| by rule, continue to provide essential services to the | 10 |
| communities serving persons who need such services. | 11 |
| (b) For the fiscal year beginning July 1, 2004, the | 12 |
| Department shall limit the total amount of expenditures for the | 13 |
| contracts issued under this project to $64,000,000 with respect | 14 |
| to no more than the following services:
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| (1) Mental Health: Screening and Support Services.
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| (2) Mental Health: Preadmission Assessment and | 17 |
| Screening.
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| (3) Rehabilitation Services: Extended Services | 19 |
| Programs.
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| (4) Alcoholism and Substance Abuse: HIV Counseling and | 21 |
| Testing.
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| (5) Alcoholism and Substance Abuse: Technical | 23 |
| Assistance.
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| (6) Developmental Disabilities: Self-Advocacy | 25 |
| Training.
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| (7) Developmental Disabilities: Enhanced Respite | 27 |
| Services in Underserved Areas.
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| (8) Community Health and Prevention: Abstinence Only | 29 |
| Education.
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| (9) Community Health and Prevention: Early | 31 |
| Intervention and Family Connections.
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| (10) Community Health and Prevention: Crossroads | 33 |
| Program.
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| (11) Community Health and Prevention: Family Planning.
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| (12) Human Capital Development: Temporary Assistance | 2 |
| for Needy Families (TANF) - Work First.
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| (13) Human Capital Development: Temporary Assistance | 4 |
| for Needy Families (TANF) - Job Placement with Retention.
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| (14) Human Capital Development: Food Stamp Employment | 6 |
| and Training with retention.
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| (15) Human Capital Development: Emergency Food | 8 |
| Program.
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| (16) Human Capital Development: Emergency Food and | 10 |
| Shelter Program.
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| (17) Human Capital Development: Donated Funds | 12 |
| Initiative Employability Development Service (EDS). | 13 |
| The amount of the contracts to be issued and the programs | 14 |
| affected for subsequent fiscal years shall be established by | 15 |
| rule, which must be proposed by March 1 of each year. | 16 |
| (c) The Department must track real outcomes and | 17 |
| achievements that improve the quality of life for people. | 18 |
| Prospective bidders must provide affirmative statements in the | 19 |
| proposals submitted regarding the services to be provided and | 20 |
| the outcomes expected. Performance measurements must be | 21 |
| incorporated into the requests-for-proposals. Deliverables | 22 |
| must demonstrate performance and actual outcomes achieved. | 23 |
| Under the performance-based contracting system, providers must | 24 |
| be measured on the indicators set forth in the proposals | 25 |
| submitted and the contracts formally executed. Under this pilot | 26 |
| project, the Department shall not re-bid all of the community | 27 |
| service contracts under its jurisdiction. The Department may | 28 |
| only issue requests-for-proposals where an improved system is | 29 |
| expected to result. The Department may execute multi-year | 30 |
| agreements, when applicable, with annual renewals. | 31 |
| (d) Contracts under this Section shall include provisions | 32 |
| for (i) adequate and timely notice to a provider of any | 33 |
| determination by the Department that the provider is not in | 34 |
| compliance with the contract or any standards of performance |
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| and (ii) an opportunity for the provider to take corrective | 2 |
| action. A contract may be terminated if the provider fails to | 3 |
| take corrective action. In the event of a contract termination, | 4 |
| the Department must ensure that eligible persons receiving | 5 |
| services under the contract will otherwise continue to receive | 6 |
| necessary services in the community.
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| (e) Additional procedures, supplementary payments, or | 8 |
| special rates may be adopted and implemented by the Department | 9 |
| to ensure that unique circumstances of local areas, as defined | 10 |
| by rule, can be met, including but not limited to circumstances | 11 |
| in which there are not sufficient services available to meet | 12 |
| basic needs or in which there is a need for specialty care.
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| (f) The Department must consult with stakeholders and | 14 |
| consumers in the implementation of this pilot project. The | 15 |
| Department must periodically conduct regional focus group | 16 |
| discussions with stakeholders (including consumers and | 17 |
| providers), legislators, foundations, trade associations, and | 18 |
| advocacy groups in the administration of and evaluation of this | 19 |
| system. The Department must implement a system using internet | 20 |
| technology under which concerned individuals will be able to | 21 |
| submit inquiries and receive responses about the system. The | 22 |
| Department must issue quarterly reports and post on its | 23 |
| internet website information about this project, information | 24 |
| about roundtable discussions with stakeholders, the content | 25 |
| and postings regarding the request-for-proposal process, the | 26 |
| Department's work with foundations and other experts in | 27 |
| grant-making, the evaluation of the request-for-proposal | 28 |
| processes, and the Department's work with stakeholders in | 29 |
| establishing criteria that will govern the determination of | 30 |
| future additional program areas that may be included in the | 31 |
| request-for-proposal process. | 32 |
| (g) The Department must establish an "ombudsman" system | 33 |
| that will enable providers and consumers to resolve problems | 34 |
| and disputes. |
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| (h) The pilot project must be evaluated by an independent | 2 |
| contractor with expertise in such matters, and a preliminary | 3 |
| report on the progress and results of the project must be | 4 |
| submitted to the Governor and General Assembly by March 1, 2005 | 5 |
| and a final report March 1, 2006. The General Assembly may | 6 |
| authorize an expansion of this pilot project by adoption of a | 7 |
| joint resolution.
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| (20 ILCS 1305/1-36 new)
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| Sec. 1-36. Fee-for-service contracts. | 10 |
| (a) The Illinois Department of Human Services shall | 11 |
| implement policies and procedures for the procurement of | 12 |
| community services under its jurisdiction in a manner that will | 13 |
| ensure the maximum amount of federal financial participation in | 14 |
| the cost of such services. For the community services that may | 15 |
| be eligible for federal financial participation, the | 16 |
| Department of Human Services may issue and execute contracts | 17 |
| that include provisions for payment on a fee-for-service basis | 18 |
| after January 1, 2005 under the terms and conditions set forth | 19 |
| in this Section. The Department may implement, prior to January | 20 |
| 1, 2005, demonstrations of a payment system based on | 21 |
| fee-for-service contracts that will include any of the | 22 |
| categories of community services (alcoholism and substance | 23 |
| abuse, developmental disabilities, and mental health) for | 24 |
| which a memorandum of understanding has been issued under | 25 |
| subsection (d) of this Section. | 26 |
| (b) Contracts must ensure that the transition to a | 27 |
| fee-for-service payment methodology will not cause any person | 28 |
| receiving services to become ineligible or the level or quality | 29 |
| of their service to be diminished, nor cause any person to be | 30 |
| denied necessary services if the person is eligible for | 31 |
| services.
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| (c) The Department of Human Services, in consultation with | 33 |
| the departments of Public Aid, Public Health, and Children and |
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| Family Services and the Department on Aging, if applicable to | 2 |
| the services under contract, shall adopt rules establishing the | 3 |
| criteria, standards, and procedures for issuing the | 4 |
| fee-for-service contracts, including but not limited to the | 5 |
| conditions of participation, performance standards, fees to be | 6 |
| paid for the service, the schedule for payment of bills and | 7 |
| reimbursement of claims, and the methodology for reconciling | 8 |
| advance payments. The Department may adopt emergency rules for | 9 |
| the immediate implementation of the demonstrations authorized | 10 |
| by subsection (a) of this Section.
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| (d) The Department shall develop and issue a separate | 12 |
| memorandum of understanding in cooperation with community | 13 |
| providers of alcoholism and substance abuse services, | 14 |
| developmental disabilities services, and mental health | 15 |
| services. The memorandum shall delineate the criteria, | 16 |
| standards, and procedures agreed upon to be covered by the | 17 |
| rules. The Department may not issue any contracts under this | 18 |
| Section until it issues the memorandum.
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| (e) To ensure continuity of services for recipients of | 20 |
| community services administered by the Department, and to | 21 |
| ensure a smooth transition from any payment methodology not | 22 |
| based on fee-for-service contracts, the Department shall, | 23 |
| subject to appropriation, provide an aggregate amount of | 24 |
| funding through a combination of grants and contracts that will | 25 |
| at least maintain the same level of services in effect for the | 26 |
| prior fiscal year beginning July 1, 2003.
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| (f) The Department shall implement policies and procedures | 28 |
| for recipients and providers of services to submit inquiries | 29 |
| and resolve disputes with regard to the community services | 30 |
| subject to contracts under this Section.
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| (g) The Department shall require cost reports from | 32 |
| providers of community services, as prescribed by rule, for the | 33 |
| community services for which the Department of Human Services | 34 |
| will contract under this Section to determine the cost of |
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| services and other factors upon which the rates of payment | 2 |
| shall be based. The Department shall obtain an evaluation and | 3 |
| opinion by an independent certified public accountant | 4 |
| comparing reported costs and any proposed rates. | 5 |
| (h) The Department, in cooperation with representatives of | 6 |
| the providers of services through the Department's divisions of | 7 |
| Developmental Disabilities, Alcohol and Substance Abuse, and | 8 |
| Mental Health, shall, subject to the availability of funding, | 9 |
| conduct a comprehensive review of the methodology, used in | 10 |
| determining rates to be paid for community services after July | 11 |
| 1, 2004, that is in effect on the effective date of this | 12 |
| amendatory Act of the 93rd General Assembly. The Department | 13 |
| shall complete this review by November 1, 2004.
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| (20 ILCS 1305/1-40 new)
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| Sec. 1-40. Reserve of funding prohibited. Neither the | 16 |
| Governor nor the Governor's Office of Management and Budget, | 17 |
| nor anyone acting on behalf of either of those, shall direct or | 18 |
| require the reserve or impoundment, or otherwise prohibit the | 19 |
| expenditure, of moneys appropriated to the Department for the | 20 |
| purpose of funding services provided through the Department's | 21 |
| divisions of Developmental Disabilities, Alcohol and Substance | 22 |
| Abuse, and Mental Health, provided that any such expenditure is | 23 |
| made pursuant to the Department's powers and duties as provided | 24 |
| by law. | 25 |
| Section 10. The Mental Health and Developmental | 26 |
| Disabilities Administrative
Act is amended by adding Section | 27 |
| 18.5 as follows: | 28 |
| (20 ILCS 1705/18.5 new)
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| Sec. 18.5. Community Developmental Disability Services | 30 |
| Medicaid Trust Fund;
reimbursement.
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| (a) Any funds paid to the State by the federal government |
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| under Title XIX or
Title
XXI of the Social Security Act for | 2 |
| services delivered by community
developmental
disability | 3 |
| services providers, and any interest earned thereon, shall be
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| deposited directly
into the Community Developmental Disability | 5 |
| Services Medicaid Trust Fund.
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| (b) Moneys in the Community Developmental Disability | 7 |
| Services Medicaid Trust Fund, subject to annual appropriation, | 8 |
| shall be used to pay for Medicaid-reimbursed community | 9 |
| developmental disability services provided to eligible | 10 |
| individuals and chosen by the individual or his or her legal | 11 |
| guardian from available community services options. Once the | 12 |
| individual or legal guardian chooses the desired services, the | 13 |
| services are approved by the Department of Human Services, and | 14 |
| the provision of services is initiated, the Department shall | 15 |
| make payment to the community developmental disability | 16 |
| services provider. Prior to choosing a service or services, an | 17 |
| eligible individual or his or her legal guardian shall be fully | 18 |
| informed by the independent service coordination agency and the | 19 |
| provider of all available community services options.
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| (c) Funds spent under this Section shall not supplant other | 21 |
| funds appropriated from the General Revenue Fund for | 22 |
| community-based developmental disability services.
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| (d) For the purposes of this Section:
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| "Medicaid-reimbursed developmental disability services" | 25 |
| means services
provided by a community developmental | 26 |
| disability provider under an agreement
with the
Department that | 27 |
| is eligible for reimbursement under the federal Title XIX
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| program or
Title XXI program.
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| "Provider" means a community agency that is funded by the | 30 |
| Department to
provide a Medicaid-reimbursed service.
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| (20 ILCS 1705/18.1 rep.)
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| Section 11. The Mental Health and Developmental | 33 |
| Disabilities Administrative
Act is amended by repealing |
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| Section 18.1.
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| Section 15. The State Prompt Payment Act is amended by | 3 |
| changing Section 1 and adding Section 8 as follows:
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| (30 ILCS 540/1) (from Ch. 127, par. 132.401)
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| Sec. 1. This Act applies to any State official or agency | 6 |
| authorized to
provide for payment from State funds, by virtue | 7 |
| of any appropriation of the
General Assembly, for goods or | 8 |
| services furnished to the State.
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| For purposes of this Act, "goods or
services furnished to | 10 |
| the State" include but are not limited to covered health
care | 11 |
| provided to eligible members and their covered dependents in | 12 |
| accordance
with the State Employees Group Insurance Act of | 13 |
| 1971, including coverage
through a physician-owned health | 14 |
| maintenance organization under Section 6.1 of
that Act.
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| For the purposes of this Act, "appropriate State official | 16 |
| or agency" is
defined as the Director or Chief Executive or his | 17 |
| designee of that State
agency or department or facility of such | 18 |
| agency or department.
With respect to covered health care | 19 |
| provided to eligible members and
their dependents in accordance | 20 |
| with the State Employees Group Insurance Act
of 1971, | 21 |
| "appropriate State official or agency" also includes an
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| administrator of a program of health benefits under that Act.
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| As used in this Act, "eligible member" means a member who | 24 |
| is eligible for
health benefits under the State Employees Group | 25 |
| Insurance Act of 1971, and
"member" and "dependent" have the | 26 |
| meanings ascribed to those terms in that Act.
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| As used in this Act, "a proper bill or invoice" means a | 28 |
| bill or invoice
that
includes the
information necessary for | 29 |
| processing the payment as may be specified by a State
agency | 30 |
| and in rules adopted in accordance with this Act.
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| As used in this Act, "payment" means a payment of a | 32 |
| vendor's bill or invoice or a payment of a grant award, whether |
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| in whole or in part.
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| (Source: P.A. 91-266, eff. 7-23-99; 92-384, eff. 7-1-02.)
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| (30 ILCS 540/8 new)
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| Sec. 8. Priority of payment.
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| (a) Definition. As used in this Section, "qualified | 6 |
| provider" means a
not-for-profit
organization that provides | 7 |
| non-residential services for the mentally ill or
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| developmentally disabled and is reimbursed or
otherwise paid
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| for providing those services by
the Illinois Department of | 10 |
| Human Services. A "qualified provider" does not
include
a | 11 |
| hospital licensed under the Hospital Licensing
Act,
a long-term | 12 |
| care facility licensed under the Nursing Home Care Act only | 13 |
| with
respect to services provided in the licensed facility to | 14 |
| residents, or a
local governmental unit or university.
A | 15 |
| "qualified provider" also includes an entity licensed under the
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| Community-Integrated Living Arrangements Licensure and | 17 |
| Certification Act, but
only with respect to the services | 18 |
| provided for a community-integrated living
arrangement.
The | 19 |
| Department of Human Services shall make the determination of | 20 |
| who is a
"qualified
provider".
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| (b) Processing by official or agency. Except as provided in | 22 |
| subsection (d),
a bill or invoice for goods or
services
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| furnished to the State submitted by a qualified provider
and a | 24 |
| grant award payment to a qualified provider
must
be given
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| priority in processing. Any bill or invoice and any grant award | 26 |
| payment meeting
these criteria that is
submitted to an
official | 27 |
| or agency must be processed and forwarded for payment before
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| any other bill, invoice,
or grant award payment
is
processed or | 29 |
| forwarded for payment.
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| (c) A properly prepared voucher request to the Office of | 31 |
| the Comptroller for payment to a qualified provider, as defined | 32 |
| in this Section, shall be given priority by the Comptroller for | 33 |
| processing and warrant issuance after debt service obligations |
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| and payroll obligations of the State have been met unless the | 2 |
| Comptroller deems that other obligations of the State must be | 3 |
| satisfied prior to these categories of payment. If at any time | 4 |
| the Comptroller determines that there are insufficient funds | 5 |
| available to process priority payments as required under this | 6 |
| Section, then vouchers shall be processed and paid out in a | 7 |
| first-in, first-out manner as corresponding funds become | 8 |
| available.
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| Section 20. The Community Services Act is amended by adding | 10 |
| Section 4.4 as follows: | 11 |
| (405 ILCS 30/4.4 new) | 12 |
| Sec. 4.4. Medicaid recipients; separate billing. The | 13 |
| Department of Human Services must bill the Department of Public | 14 |
| Aid separately for services provided to recipients of medical | 15 |
| assistance under Article V of the Illinois Public Aid Code | 16 |
| through the Division of Mental Health and for services provided | 17 |
| to such recipients through the Division of Developmental | 18 |
| Disabilities.
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| Section 99. Effective date. This Act takes effect upon | 20 |
| becoming law.".
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