SB3762eng 96TH GENERAL ASSEMBLY

SB3762 Engrossed LRB096 20714 KTG 36441 b

AN ACT concerning regulation.

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 adding Section 12-4.40 as follows:

(305 ILCS 5/12-4.40 new)

Sec. 12-4.40. Medicaid Revenue Maximization.

(a) Purpose. The General Assembly finds that there is a need to make changes to the administration of services provided by State and local governments in order to maximize federal financial participation.

(b) Definitions. As used in this Section:

"Community Medicaid mental health services" means all mental health services outlined in Section 132 of Title 59 of the Illinois Administrative Code that are Medicaid funded and provided by a community-based provider.

"Community-based provider" means an entity enrolled as a provider pursuant to Sections 140.11 and 140.12 of Title 89 of the Illinois Administrative Code and certified to provide community Medicaid mental health services in accordance with Section 132 of Title 59 of the Illinois Administrative Code.

"CTA" means the Chicago Transit Authority.

"DCFS" means the Department of Children and Family Services.

"Department" means the Illinois Department of Healthcare and Family Services.

"Developmentally disabled care facility" means an intermediate care facility for the mentally retarded within the meaning of Title XIX of the Social Security Act, whether public or private and whether organized for profit or not-for-profit, but shall not include any facility operated by the State.

"Developmentally disabled care provider" means a person conducting, operating, or maintaining a developmentally disabled care facility. For purposes of this definition, "person" means any political subdivision of the State, municipal corporation, individual, firm, partnership, corporation, company, limited liability company, association, joint stock association, or trust, or a receiver, executor, trustee, guardian, or other representative appointed by order of any court.

"DHS" means the Illinois Department of Human Services.

"Hospital" means an institution, place, building, or agency located in this State that is licensed as a general acute hospital by the Illinois Department of Public Health under the Hospital Licensing Act, whether public or private and whether organized for profit or not-for-profit.

"Long term care facility" means (i) a skilled nursing or intermediate long term care facility, whether public or private and whether organized for profit or not-for-profit, that is subject to licensure by the Illinois Department of Public Health under the Nursing Home Care Act, including a county nursing home directed and maintained under Section 5-1005 of the Counties Code, and (ii) a part of a hospital in which skilled or intermediate long term care services within the meaning of Title XVIII or XIX of the Social Security Act are provided; except that the term "long term care facility" does not include a facility operated solely as an intermediate care facility for the mentally retarded within the meaning of Title XIX of the Social Security Act.

"Long term care provider" means (i) a person licensed by the Department of Public Health to operate and maintain a skilled nursing or intermediate long term care facility or (ii) a hospital provider that provides skilled or intermediate long term care services within the meaning of Title XVIII or XIX of the Social Security Act. For purposes of this definition, "person" means any political subdivision of the State, municipal corporation, individual, firm, partnership, corporation, company, limited liability company, association, joint stock association, or trust, or a receiver, executor, trustee, guardian, or other representative appointed by order of any court.

"State-operated developmentally disabled care facility" means an intermediate care facility for the mentally retarded within the meaning of Title XIX of the Social Security Act operated by the State.

(c) Administration and deposit of Revenues. The Department shall coordinate the implementation of changes required by this amendatory Act of the 96th General Assembly amongst the various State and local government bodies that administer programs referred to in this Section.

Revenues generated by program changes mandated by any provision in this Section, less reasonable administrative costs associated with the implementation of these program changes, shall be deposited into the Healthcare Provider Relief Fund.

To the extent practicable and permissible under federal law, all changes required by this Section shall be implemented no later than December 15, 2010.

The Department shall issue a report to the General Assembly detailing the implementation of this amendatory Act of the 96th General Assembly no later than March 31, 2011.

(d) Acceleration of administrative vouchers. The Department shall create all vouchers for long term care facilities and developmentally disabled care facilities for dates of service in November and December 2010 and shall, no later than December 15, 2010, submit these vouchers to the Comptroller for payment.

The Department of Human Services shall create the necessary documentation for State-operated developmentally disabled care facilities so that the necessary data for dates of service before January 1, 2011 can be adjudicated by the Department no later than December 15, 2010.

(e) Conversion of DHS grant programs to fee-for-service. After the effective date of this amendatory Act of the 96th General Assembly, community Medicaid mental health services provided by community-based providers shall no longer be included in contracts with DHS. Instead, community Medicaid mental health services provided by a community-based provider must be billed directly to the Department and must be separate from contracts between the Department of Human Services and community-based providers for all other mental health services.

Rates of reimbursement for community Medicaid mental health services shall be consistent with rates outlined in Section 132 of Title 59 of the Illinois Administrative Code.

(f) DCFS Medicaid services. The Department shall work with DCFS to identify existing programs, pending qualifying services, that can be converted in an economically feasible manner to Medicaid in order to secure federal financial revenue.

(g) Third Party Liability recoveries. The Department shall contract with a vendor to support the Department in coordinating benefits for Medicaid enrollees. The scope of work shall include, at a minimum, the identification of other insurance for Medicaid enrollees and the recovery of funds paid by the Department when another payer was liable. The vendor shall be paid a percentage of actual cash recovered when practical and subject to federal law.

(h) CTA transportation to Medical providers for service. The Department, working with the CTA, shall create a process to identify transportation services provided to Medicaid enrollees.

The Department shall assist the CTA in determining total costs associated with the provision of transportation services to Medicaid enrollees.

The Department shall determine and draw the maximum allowable federal matching dollars associated with the cost of CTA services provided to Medicaid enrollees.

(i) Public health departments. The Department shall identify unreimbursed costs for persons covered by Medicaid who are served by the Chicago Department of Public Health.

The Department shall assist the Chicago Department of Public Health in determining total unreimbursed costs associated with the provision of healthcare services to Medicaid enrollees.

The Department shall determine and draw the maximum allowable federal matching dollars associated with the cost of Chicago Department of Public Health services provided to Medicaid enrollees.

(j) Acceleration of hospital-based payments. The Department shall, by December 10, 2010, create vouchers for all State fiscal year 2011 hospital payments exempt from the prompt payment requirements of the American Recovery and Reinvestment Act of 2009. The Department shall, no later than December 15, 2010, submit these vouchers to the Comptroller for payment.

Section 10. The Community Services Act is amended by adding Section 4.8 as follows:

(405 ILCS 30/4.8 new)

Sec. 4.8. Payments for community Medicaid mental health services.

(a) After the effective date of this amendatory Act of the 96th General Assembly, community Medicaid mental health services provided by community-based providers shall no longer be included in contracts with the Department of Human Services. Instead, community Medicaid mental health services provided by a community-based provider must be billed directly to the Department of Healthcare and Family Services and must be separate from contracts between the Department of Human Services and community-based providers for all other mental health services. Rates of reimbursement for community Medicaid mental health services shall be consistent with rates outlined in Section 132 of Title 59 of the Illinois Administrative Code.

(b) For purposes of this Section:

"Community Medicaid mental health services" means all mental health services outlined in Section 132 of Title 59 of the Illinois Administrative Code that are Medicaid funded and provided by a community-based provider.

"Community-based provider" means an entity enrolled as a provider pursuant to Sections 140.11 and 140.12 of Title 89 of the Illinois Administrative Code and certified to provide community Medicaid mental health services in accordance with Section 132 of Title 59 of the Illinois Administrative Code.

Section 99. Effective date. This Act takes effect upon becoming law.