Full Text of SB1573 100th General Assembly
SB1573enr 100TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Procurement Code is amended by | 5 | | changing Section 1-10 as follows:
| 6 | | (30 ILCS 500/1-10)
| 7 | | Sec. 1-10. Application.
| 8 | | (a) This Code applies only to procurements for which | 9 | | bidders, offerors, potential contractors, or contractors were | 10 | | first
solicited on or after July 1, 1998. This Code shall not | 11 | | be construed to affect
or impair any contract, or any provision | 12 | | of a contract, entered into based on a
solicitation prior to | 13 | | the implementation date of this Code as described in
Article | 14 | | 99, including but not limited to any covenant entered into with | 15 | | respect
to any revenue bonds or similar instruments.
All | 16 | | procurements for which contracts are solicited between the | 17 | | effective date
of Articles 50 and 99 and July 1, 1998 shall be | 18 | | substantially in accordance
with this Code and its intent.
| 19 | | (b) This Code shall apply regardless of the source of the | 20 | | funds with which
the contracts are paid, including federal | 21 | | assistance moneys. This Except as specifically provided in this | 22 | | Code, this
Code shall
not apply to:
| 23 | | (1) Contracts between the State and its political |
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| 1 | | subdivisions or other
governments, or between State | 2 | | governmental bodies , except as specifically provided in | 3 | | this Code .
| 4 | | (2) Grants, except for the filing requirements of | 5 | | Section 20-80.
| 6 | | (3) Purchase of care , except as provided in Section | 7 | | 5-30.6 of the Illinois Public Aid
Code and this Section .
| 8 | | (4) Hiring of an individual as employee and not as an | 9 | | independent
contractor, whether pursuant to an employment | 10 | | code or policy or by contract
directly with that | 11 | | individual.
| 12 | | (5) Collective bargaining contracts.
| 13 | | (6) Purchase of real estate, except that notice of this | 14 | | type of contract with a value of more than $25,000 must be | 15 | | published in the Procurement Bulletin within 10 calendar | 16 | | days after the deed is recorded in the county of | 17 | | jurisdiction. The notice shall identify the real estate | 18 | | purchased, the names of all parties to the contract, the | 19 | | value of the contract, and the effective date of the | 20 | | contract.
| 21 | | (7) Contracts necessary to prepare for anticipated | 22 | | litigation, enforcement
actions, or investigations, | 23 | | provided
that the chief legal counsel to the Governor shall | 24 | | give his or her prior
approval when the procuring agency is | 25 | | one subject to the jurisdiction of the
Governor, and | 26 | | provided that the chief legal counsel of any other |
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| 1 | | procuring
entity
subject to this Code shall give his or her | 2 | | prior approval when the procuring
entity is not one subject | 3 | | to the jurisdiction of the Governor.
| 4 | | (8) (Blank).
| 5 | | (9) Procurement expenditures by the Illinois | 6 | | Conservation Foundation
when only private funds are used.
| 7 | | (10) (Blank). | 8 | | (11) Public-private agreements entered into according | 9 | | to the procurement requirements of Section 20 of the | 10 | | Public-Private Partnerships for Transportation Act and | 11 | | design-build agreements entered into according to the | 12 | | procurement requirements of Section 25 of the | 13 | | Public-Private Partnerships for Transportation Act. | 14 | | (12) Contracts for legal, financial, and other | 15 | | professional and artistic services entered into on or | 16 | | before December 31, 2018 by the Illinois Finance Authority | 17 | | in which the State of Illinois is not obligated. Such | 18 | | contracts shall be awarded through a competitive process | 19 | | authorized by the Board of the Illinois Finance Authority | 20 | | and are subject to Sections 5-30, 20-160, 50-13, 50-20, | 21 | | 50-35, and 50-37 of this Code, as well as the final | 22 | | approval by the Board of the Illinois Finance Authority of | 23 | | the terms of the contract. | 24 | | (13) Contracts for services, commodities, and | 25 | | equipment to support the delivery of timely forensic | 26 | | science services in consultation with and subject to the |
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| 1 | | approval of the Chief Procurement Officer as provided in | 2 | | subsection (d) of Section 5-4-3a of the Unified Code of | 3 | | Corrections, except for the requirements of Sections | 4 | | 20-60, 20-65, 20-70, and 20-160 and Article 50 of this | 5 | | Code; however, the Chief Procurement Officer may, in | 6 | | writing with justification, waive any certification | 7 | | required under Article 50 of this Code. For any contracts | 8 | | for services which are currently provided by members of a | 9 | | collective bargaining agreement, the applicable terms of | 10 | | the collective bargaining agreement concerning | 11 | | subcontracting shall be followed. | 12 | | On and after January 1, 2019, this paragraph (13), | 13 | | except for this sentence, is inoperative. | 14 | | (14) Contracts for participation expenditures required | 15 | | by a domestic or international trade show or exhibition of | 16 | | an exhibitor, member, or sponsor. | 17 | | (15) Contracts with a railroad or utility that requires | 18 | | the State to reimburse the railroad or utilities for the | 19 | | relocation of utilities for construction or other public | 20 | | purpose. Contracts included within this paragraph (15) | 21 | | shall include, but not be limited to, those associated | 22 | | with: relocations, crossings, installations, and | 23 | | maintenance. For the purposes of this paragraph (15), | 24 | | "railroad" means any form of non-highway ground | 25 | | transportation that runs on rails or electromagnetic | 26 | | guideways and "utility" means: (1) public utilities as |
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| 1 | | defined in Section 3-105 of the Public Utilities Act, (2) | 2 | | telecommunications carriers as defined in Section 13-202 | 3 | | of the Public Utilities Act, (3) electric cooperatives as | 4 | | defined in Section 3.4 of the Electric Supplier Act, (4) | 5 | | telephone or telecommunications cooperatives as defined in | 6 | | Section 13-212 of the Public Utilities Act, (5) rural water | 7 | | or waste water systems with 10,000 connections or less, (6) | 8 | | a holder as defined in Section 21-201 of the Public | 9 | | Utilities Act, and (7) municipalities owning or operating | 10 | | utility systems consisting of public utilities as that term | 11 | | is defined in Section 11-117-2 of the Illinois Municipal | 12 | | Code. | 13 | | Notwithstanding any other provision of law, for contracts | 14 | | entered into on or after October 1, 2017 under an exemption | 15 | | provided in any paragraph of this subsection (b), except | 16 | | paragraph (1), (2), or (5), each State agency shall post to the | 17 | | appropriate procurement bulletin the name of the contractor, a | 18 | | description of the supply or service provided, the total amount | 19 | | of the contract, the term of the contract, and the exception to | 20 | | the Code utilized. The chief procurement officer shall submit a | 21 | | report to the Governor and General Assembly no later than | 22 | | November 1 of each year that shall include, at a minimum, an | 23 | | annual summary of the monthly information reported to the chief | 24 | | procurement officer. | 25 | | (c) This Code does not apply to the electric power | 26 | | procurement process provided for under Section 1-75 of the |
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| 1 | | Illinois Power Agency Act and Section 16-111.5 of the Public | 2 | | Utilities Act. | 3 | | (d) Except for Section 20-160 and Article 50 of this Code, | 4 | | and as expressly required by Section 9.1 of the Illinois | 5 | | Lottery Law, the provisions of this Code do not apply to the | 6 | | procurement process provided for under Section 9.1 of the | 7 | | Illinois Lottery Law. | 8 | | (e) This Code does not apply to the process used by the | 9 | | Capital Development Board to retain a person or entity to | 10 | | assist the Capital Development Board with its duties related to | 11 | | the determination of costs of a clean coal SNG brownfield | 12 | | facility, as defined by Section 1-10 of the Illinois Power | 13 | | Agency Act, as required in subsection (h-3) of Section 9-220 of | 14 | | the Public Utilities Act, including calculating the range of | 15 | | capital costs, the range of operating and maintenance costs, or | 16 | | the sequestration costs or monitoring the construction of clean | 17 | | coal SNG brownfield facility for the full duration of | 18 | | construction. | 19 | | (f) (Blank). | 20 | | (g) (Blank). | 21 | | (h) This Code does not apply to the process to procure or | 22 | | contracts entered into in accordance with Sections 11-5.2 and | 23 | | 11-5.3 of the Illinois Public Aid Code. | 24 | | (i) Each chief procurement officer may access records | 25 | | necessary to review whether a contract, purchase, or other | 26 | | expenditure is or is not subject to the provisions of this |
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| 1 | | Code, unless such records would be subject to attorney-client | 2 | | privilege. | 3 | | (j) This Code does not apply to the process used by the | 4 | | Capital Development Board to retain an artist or work or works | 5 | | of art as required in Section 14 of the Capital Development | 6 | | Board Act. | 7 | | (k) This Code does not apply to the process to procure | 8 | | contracts, or contracts entered into, by the State Board of | 9 | | Elections or the State Electoral Board for hearing officers | 10 | | appointed pursuant to the Election Code. | 11 | | (l) This Code does not apply to the processes used by the | 12 | | Illinois Student Assistance Commission to procure supplies and | 13 | | services paid for from the private funds of the Illinois | 14 | | Prepaid Tuition Fund. As used in this subsection (l), "private | 15 | | funds" means funds derived from deposits paid into the Illinois | 16 | | Prepaid Tuition Trust Fund and the earnings thereon. | 17 | | (Source: P.A. 99-801, eff. 1-1-17; 100-43, eff. 8-9-17.)
| 18 | | Section 10. The Illinois Insurance Code is amended by | 19 | | changing Section 35A-10 as follows:
| 20 | | (215 ILCS 5/35A-10)
| 21 | | Sec. 35A-10. RBC Reports.
| 22 | | (a) On or before each March 1 (the "filing date"), every | 23 | | domestic
insurer
shall prepare and submit to the Director a | 24 | | report of its RBC levels as of the
end of the previous calendar |
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| 1 | | year in the form and containing the information
required by the | 2 | | RBC Instructions. Every domestic insurer shall also file its
| 3 | | RBC Report with the NAIC in accordance with the RBC | 4 | | Instructions. In addition,
if requested in writing by the chief | 5 | | insurance regulatory official of any state
in which it
is | 6 | | authorized to do business, every domestic insurer shall file | 7 | | its RBC Report
with that official no later than the later of 15 | 8 | | days after the insurer
receives the written request
or the | 9 | | filing date.
| 10 | | (b) A life, health, or life and health insurer's or | 11 | | fraternal benefit society's RBC shall be
determined under the | 12 | | formula set
forth in the RBC Instructions. The formula shall | 13 | | take into account (and may
adjust for the covariance between):
| 14 | | (1) the risk with respect to the insurer's assets;
| 15 | | (2) the risk of adverse insurance experience with | 16 | | respect to the insurer's
liabilities and obligations;
| 17 | | (3) the interest rate risk with respect to the | 18 | | insurer's business; and
| 19 | | (4) all other business risks and other relevant risks | 20 | | set forth in the RBC
Instructions.
| 21 | | These risks shall be determined in each case by applying
the | 22 | | factors in the
manner set forth in the RBC Instructions. | 23 | | Notwithstanding the foregoing, and notwithstanding the RBC | 24 | | Instructions, health maintenance organizations operating as | 25 | | Medicaid managed care plans under contract with the Department | 26 | | of Healthcare and Family Services shall not be required to |
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| 1 | | include in its RBC calculations any capitation revenue | 2 | | identified by Medicaid managed care plans as authorized under | 3 | | Section 5A-12.6(r) of the Illinois Public Aid Code.
| 4 | | (c) A property and casualty insurer's RBC shall be | 5 | | determined in
accordance
with the formula set forth in the RBC | 6 | | Instructions. The formula shall take
into account (and may | 7 | | adjust for the covariance between):
| 8 | | (1) asset risk;
| 9 | | (2) credit risk;
| 10 | | (3) underwriting risk; and
| 11 | | (4) all other business risks and other relevant risks | 12 | | set
forth in the RBC Instructions.
| 13 | | These risks shall be determined in each case by applying the | 14 | | factors in the
manner
set forth in the RBC Instructions.
| 15 | | (d) A health organization's RBC shall be determined in | 16 | | accordance with the
formula set forth in the RBC Instructions. | 17 | | The formula shall take the
following into account (and may | 18 | | adjust for the covariance between):
| 19 | | (1) asset risk;
| 20 | | (2) credit risk;
| 21 | | (3) underwriting risk; and
| 22 | | (4) all other business risks and other relevant risks | 23 | | set forth in the RBC
Instructions.
| 24 | | These risks shall be determined in each case by applying the | 25 | | factors in the
manner set forth in the RBC Instructions.
| 26 | | (e) An excess of capital over the amount produced by the
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| 1 | | risk-based
capital requirements contained in this Code and the | 2 | | formulas, schedules, and
instructions referenced in this Code | 3 | | is desirable in the business of insurance.
Accordingly, | 4 | | insurers should seek to maintain capital above the RBC levels
| 5 | | required by this Code. Additional capital is used and useful in | 6 | | the insurance
business and helps to secure an insurer against | 7 | | various risks inherent in, or
affecting, the business of | 8 | | insurance and not accounted for or only partially
measured by | 9 | | the risk-based capital requirements contained in this Code.
| 10 | | (f) If a domestic insurer files an RBC Report that, in the
| 11 | | judgment of the
Director, is inaccurate, the Director shall | 12 | | adjust the RBC Report to correct
the inaccuracy and shall | 13 | | notify the insurer of the adjustment. The notice
shall contain | 14 | | a statement of the reason for the adjustment.
| 15 | | (Source: P.A. 98-157, eff. 8-2-13.)
| 16 | | Section 15. The Illinois Public Aid Code is amended by | 17 | | changing Sections 5-5.02, 5-30.1, and 5A-15 and by adding | 18 | | Sections 5-30.6 and 5-30.7 as follows:
| 19 | | (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
| 20 | | Sec. 5-5.02. Hospital reimbursements.
| 21 | | (a) Reimbursement to Hospitals; July 1, 1992 through | 22 | | September 30, 1992.
Notwithstanding any other provisions of | 23 | | this Code or the Illinois
Department's Rules promulgated under | 24 | | the Illinois Administrative Procedure
Act, reimbursement to |
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| 1 | | hospitals for services provided during the period
July 1, 1992 | 2 | | through September 30, 1992, shall be as follows:
| 3 | | (1) For inpatient hospital services rendered, or if | 4 | | applicable, for
inpatient hospital discharges occurring, | 5 | | on or after July 1, 1992 and on
or before September 30, | 6 | | 1992, the Illinois Department shall reimburse
hospitals | 7 | | for inpatient services under the reimbursement | 8 | | methodologies in
effect for each hospital, and at the | 9 | | inpatient payment rate calculated for
each hospital, as of | 10 | | June 30, 1992. For purposes of this paragraph,
| 11 | | "reimbursement methodologies" means all reimbursement | 12 | | methodologies that
pertain to the provision of inpatient | 13 | | hospital services, including, but not
limited to, any | 14 | | adjustments for disproportionate share, targeted access,
| 15 | | critical care access and uncompensated care, as defined by | 16 | | the Illinois
Department on June 30, 1992.
| 17 | | (2) For the purpose of calculating the inpatient | 18 | | payment rate for each
hospital eligible to receive | 19 | | quarterly adjustment payments for targeted
access and | 20 | | critical care, as defined by the Illinois Department on | 21 | | June 30,
1992, the adjustment payment for the period July | 22 | | 1, 1992 through September
30, 1992, shall be 25% of the | 23 | | annual adjustment payments calculated for
each eligible | 24 | | hospital, as of June 30, 1992. The Illinois Department | 25 | | shall
determine by rule the adjustment payments for | 26 | | targeted access and critical
care beginning October 1, |
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| 1 | | 1992.
| 2 | | (3) For the purpose of calculating the inpatient | 3 | | payment rate for each
hospital eligible to receive | 4 | | quarterly adjustment payments for
uncompensated care, as | 5 | | defined by the Illinois Department on June 30, 1992,
the | 6 | | adjustment payment for the period August 1, 1992 through | 7 | | September 30,
1992, shall be one-sixth of the total | 8 | | uncompensated care adjustment payments
calculated for each | 9 | | eligible hospital for the uncompensated care rate year,
as | 10 | | defined by the Illinois Department, ending on July 31, | 11 | | 1992. The
Illinois Department shall determine by rule the | 12 | | adjustment payments for
uncompensated care beginning | 13 | | October 1, 1992.
| 14 | | (b) Inpatient payments. For inpatient services provided on | 15 | | or after October
1, 1993, in addition to rates paid for | 16 | | hospital inpatient services pursuant to
the Illinois Health | 17 | | Finance Reform Act, as now or hereafter amended, or the
| 18 | | Illinois Department's prospective reimbursement methodology, | 19 | | or any other
methodology used by the Illinois Department for | 20 | | inpatient services, the
Illinois Department shall make | 21 | | adjustment payments, in an amount calculated
pursuant to the | 22 | | methodology described in paragraph (c) of this Section, to
| 23 | | hospitals that the Illinois Department determines satisfy any | 24 | | one of the
following requirements:
| 25 | | (1) Hospitals that are described in Section 1923 of the | 26 | | federal Social
Security Act, as now or hereafter amended, |
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| 1 | | except that for rate year 2015 and after a hospital | 2 | | described in Section 1923(b)(1)(B) of the federal Social | 3 | | Security Act and qualified for the payments described in | 4 | | subsection (c) of this Section for rate year 2014 provided | 5 | | the hospital continues to meet the description in Section | 6 | | 1923(b)(1)(B) in the current determination year; or
| 7 | | (2) Illinois hospitals that have a Medicaid inpatient | 8 | | utilization
rate which is at least one-half a standard | 9 | | deviation above the mean Medicaid
inpatient utilization | 10 | | rate for all hospitals in Illinois receiving Medicaid
| 11 | | payments from the Illinois Department; or
| 12 | | (3) Illinois hospitals that on July 1, 1991 had a | 13 | | Medicaid inpatient
utilization rate, as defined in | 14 | | paragraph (h) of this Section,
that was at least the mean | 15 | | Medicaid inpatient utilization rate for all
hospitals in | 16 | | Illinois receiving Medicaid payments from the Illinois
| 17 | | Department and which were located in a planning area with | 18 | | one-third or
fewer excess beds as determined by the Health | 19 | | Facilities and Services Review Board, and that, as of June | 20 | | 30, 1992, were located in a federally
designated Health | 21 | | Manpower Shortage Area; or
| 22 | | (4) Illinois hospitals that:
| 23 | | (A) have a Medicaid inpatient utilization rate | 24 | | that is at least
equal to the mean Medicaid inpatient | 25 | | utilization rate for all hospitals in
Illinois | 26 | | receiving Medicaid payments from the Department; and
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| 1 | | (B) also have a Medicaid obstetrical inpatient | 2 | | utilization
rate that is at least one standard | 3 | | deviation above the mean Medicaid
obstetrical | 4 | | inpatient utilization rate for all hospitals in | 5 | | Illinois
receiving Medicaid payments from the | 6 | | Department for obstetrical services; or
| 7 | | (5) Any children's hospital, which means a hospital | 8 | | devoted exclusively
to caring for children. A hospital | 9 | | which includes a facility devoted
exclusively to caring for | 10 | | children shall be considered a
children's hospital to the | 11 | | degree that the hospital's Medicaid care is
provided to | 12 | | children
if either (i) the facility devoted exclusively to | 13 | | caring for children is
separately licensed as a hospital by | 14 | | a municipality prior to February 28, 2013 ;
or
(ii) the | 15 | | hospital has been
designated
by the State
as a Level III | 16 | | perinatal care facility, has a Medicaid Inpatient
| 17 | | Utilization rate
greater than 55% for the rate year 2003 | 18 | | disproportionate share determination,
and has more than | 19 | | 10,000 qualified children days as defined by
the
Department | 20 | | in rulemaking ; (iii) the hospital has been designated as a | 21 | | Perinatal Level III center by the State as of December 1, | 22 | | 2017, is a Pediatric Critical Care Center designated by the | 23 | | State as of December 1, 2017 and has a 2017 Medicaid | 24 | | inpatient utilization rate equal to or greater than 45%; or | 25 | | (iv) the hospital has been designated as a Perinatal Level | 26 | | II center by the State as of December 1, 2017, has a 2017 |
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| 1 | | Medicaid Inpatient Utilization Rate greater than 70%, and | 2 | | has at least 10 pediatric beds as listed on the IDPH 2015 | 3 | | calendar year hospital profile .
| 4 | | (c) Inpatient adjustment payments. The adjustment payments | 5 | | required by
paragraph (b) shall be calculated based upon the | 6 | | hospital's Medicaid
inpatient utilization rate as follows:
| 7 | | (1) hospitals with a Medicaid inpatient utilization | 8 | | rate below the mean
shall receive a per day adjustment | 9 | | payment equal to $25;
| 10 | | (2) hospitals with a Medicaid inpatient utilization | 11 | | rate
that is equal to or greater than the mean Medicaid | 12 | | inpatient utilization rate
but less than one standard | 13 | | deviation above the mean Medicaid inpatient
utilization | 14 | | rate shall receive a per day adjustment payment
equal to | 15 | | the sum of $25 plus $1 for each one percent that the | 16 | | hospital's
Medicaid inpatient utilization rate exceeds the | 17 | | mean Medicaid inpatient
utilization rate;
| 18 | | (3) hospitals with a Medicaid inpatient utilization | 19 | | rate that is equal
to or greater than one standard | 20 | | deviation above the mean Medicaid inpatient
utilization | 21 | | rate but less than 1.5 standard deviations above the mean | 22 | | Medicaid
inpatient utilization rate shall receive a per day | 23 | | adjustment payment equal to
the sum of $40 plus $7 for each | 24 | | one percent that the hospital's Medicaid
inpatient | 25 | | utilization rate exceeds one standard deviation above the | 26 | | mean
Medicaid inpatient utilization rate; and
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| 1 | | (4) hospitals with a Medicaid inpatient utilization | 2 | | rate that is equal
to or greater than 1.5 standard | 3 | | deviations above the mean Medicaid inpatient
utilization | 4 | | rate shall receive a per day adjustment payment equal to | 5 | | the sum of
$90 plus $2 for each one percent that the | 6 | | hospital's Medicaid inpatient
utilization rate exceeds 1.5 | 7 | | standard deviations above the mean Medicaid
inpatient | 8 | | utilization rate.
| 9 | | (d) Supplemental adjustment payments. In addition to the | 10 | | adjustment
payments described in paragraph (c), hospitals as | 11 | | defined in clauses
(1) through (5) of paragraph (b), excluding | 12 | | county hospitals (as defined in
subsection (c) of Section 15-1 | 13 | | of this Code) and a hospital organized under the
University of | 14 | | Illinois Hospital Act, shall be paid supplemental inpatient
| 15 | | adjustment payments of $60 per day. For purposes of Title XIX | 16 | | of the federal
Social Security Act, these supplemental | 17 | | adjustment payments shall not be
classified as adjustment | 18 | | payments to disproportionate share hospitals.
| 19 | | (e) The inpatient adjustment payments described in | 20 | | paragraphs (c) and (d)
shall be increased on October 1, 1993 | 21 | | and annually thereafter by a percentage
equal to the lesser of | 22 | | (i) the increase in the DRI hospital cost index for the
most | 23 | | recent 12 month period for which data are available, or (ii) | 24 | | the
percentage increase in the statewide average hospital | 25 | | payment rate over the
previous year's statewide average | 26 | | hospital payment rate. The sum of the
inpatient adjustment |
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| 1 | | payments under paragraphs (c) and (d) to a hospital, other
than | 2 | | a county hospital (as defined in subsection (c) of Section 15-1 | 3 | | of this
Code) or a hospital organized under the University of | 4 | | Illinois Hospital Act,
however, shall not exceed $275 per day; | 5 | | that limit shall be increased on
October 1, 1993 and annually | 6 | | thereafter by a percentage equal to the lesser of
(i) the | 7 | | increase in the DRI hospital cost index for the most recent | 8 | | 12-month
period for which data are available or (ii) the | 9 | | percentage increase in the
statewide average hospital payment | 10 | | rate over the previous year's statewide
average hospital | 11 | | payment rate.
| 12 | | (f) Children's hospital inpatient adjustment payments. For | 13 | | children's
hospitals, as defined in clause (5) of paragraph | 14 | | (b), the adjustment payments
required pursuant to paragraphs | 15 | | (c) and (d) shall be multiplied by 2.0.
| 16 | | (g) County hospital inpatient adjustment payments. For | 17 | | county hospitals,
as defined in subsection (c) of Section 15-1 | 18 | | of this Code, there shall be an
adjustment payment as | 19 | | determined by rules issued by the Illinois Department.
| 20 | | (h) For the purposes of this Section the following terms | 21 | | shall be defined
as follows:
| 22 | | (1) "Medicaid inpatient utilization rate" means a | 23 | | fraction, the numerator
of which is the number of a | 24 | | hospital's inpatient days provided in a given
12-month | 25 | | period to patients who, for such days, were eligible for | 26 | | Medicaid
under Title XIX of the federal Social Security |
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| 1 | | Act, and the denominator of
which is the total number of | 2 | | the hospital's inpatient days in that same period.
| 3 | | (2) "Mean Medicaid inpatient utilization rate" means | 4 | | the total number
of Medicaid inpatient days provided by all | 5 | | Illinois Medicaid-participating
hospitals divided by the | 6 | | total number of inpatient days provided by those same
| 7 | | hospitals.
| 8 | | (3) "Medicaid obstetrical inpatient utilization rate" | 9 | | means the
ratio of Medicaid obstetrical inpatient days to | 10 | | total Medicaid inpatient
days for all Illinois hospitals | 11 | | receiving Medicaid payments from the
Illinois Department.
| 12 | | (i) Inpatient adjustment payment limit. In order to meet | 13 | | the limits
of Public Law 102-234 and Public Law 103-66, the
| 14 | | Illinois Department shall by rule adjust
disproportionate | 15 | | share adjustment payments.
| 16 | | (j) University of Illinois Hospital inpatient adjustment | 17 | | payments. For
hospitals organized under the University of | 18 | | Illinois Hospital Act, there shall
be an adjustment payment as | 19 | | determined by rules adopted by the Illinois
Department.
| 20 | | (k) The Illinois Department may by rule establish criteria | 21 | | for and develop
methodologies for adjustment payments to | 22 | | hospitals participating under this
Article.
| 23 | | (l) On and after July 1, 2012, the Department shall reduce | 24 | | any rate of reimbursement for services or other payments or | 25 | | alter any methodologies authorized by this Code to reduce any | 26 | | rate of reimbursement for services or other payments in |
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| 1 | | accordance with Section 5-5e. | 2 | | (Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
| 3 | | (305 ILCS 5/5-30.1) | 4 | | Sec. 5-30.1. Managed care protections. | 5 | | (a) As used in this Section: | 6 | | "Managed care organization" or "MCO" means any entity which | 7 | | contracts with the Department to provide services where payment | 8 | | for medical services is made on a capitated basis. | 9 | | "Emergency services" include: | 10 | | (1) emergency services, as defined by Section 10 of the | 11 | | Managed Care Reform and Patient Rights Act; | 12 | | (2) emergency medical screening examinations, as | 13 | | defined by Section 10 of the Managed Care Reform and | 14 | | Patient Rights Act; | 15 | | (3) post-stabilization medical services, as defined by | 16 | | Section 10 of the Managed Care Reform and Patient Rights | 17 | | Act; and | 18 | | (4) emergency medical conditions, as defined by
| 19 | | Section 10 of the Managed Care Reform and Patient Rights
| 20 | | Act. | 21 | | (b) As provided by Section 5-16.12, managed care | 22 | | organizations are subject to the provisions of the Managed Care | 23 | | Reform and Patient Rights Act. | 24 | | (c) An MCO shall pay any provider of emergency services | 25 | | that does not have in effect a contract with the contracted |
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| 1 | | Medicaid MCO. The default rate of reimbursement shall be the | 2 | | rate paid under Illinois Medicaid fee-for-service program | 3 | | methodology, including all policy adjusters, including but not | 4 | | limited to Medicaid High Volume Adjustments, Medicaid | 5 | | Percentage Adjustments, Outpatient High Volume Adjustments, | 6 | | and all outlier add-on adjustments to the extent such | 7 | | adjustments are incorporated in the development of the | 8 | | applicable MCO capitated rates. | 9 | | (d) An MCO shall pay for all post-stabilization services as | 10 | | a covered service in any of the following situations: | 11 | | (1) the MCO authorized such services; | 12 | | (2) such services were administered to maintain the | 13 | | enrollee's stabilized condition within one hour after a | 14 | | request to the MCO for authorization of further | 15 | | post-stabilization services; | 16 | | (3) the MCO did not respond to a request to authorize | 17 | | such services within one hour; | 18 | | (4) the MCO could not be contacted; or | 19 | | (5) the MCO and the treating provider, if the treating | 20 | | provider is a non-affiliated provider, could not reach an | 21 | | agreement concerning the enrollee's care and an affiliated | 22 | | provider was unavailable for a consultation, in which case | 23 | | the MCO
must pay for such services rendered by the treating | 24 | | non-affiliated provider until an affiliated provider was | 25 | | reached and either concurred with the treating | 26 | | non-affiliated provider's plan of care or assumed |
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| 1 | | responsibility for the enrollee's care. Such payment shall | 2 | | be made at the default rate of reimbursement paid under | 3 | | Illinois Medicaid fee-for-service program methodology, | 4 | | including all policy adjusters, including but not limited | 5 | | to Medicaid High Volume Adjustments, Medicaid Percentage | 6 | | Adjustments, Outpatient High Volume Adjustments and all | 7 | | outlier add-on adjustments to the extent that such | 8 | | adjustments are incorporated in the development of the | 9 | | applicable MCO capitated rates. | 10 | | (e) The following requirements apply to MCOs in determining | 11 | | payment for all emergency services: | 12 | | (1) MCOs shall not impose any requirements for prior | 13 | | approval of emergency services. | 14 | | (2) The MCO shall cover emergency services provided to | 15 | | enrollees who are temporarily away from their residence and | 16 | | outside the contracting area to the extent that the | 17 | | enrollees would be entitled to the emergency services if | 18 | | they still were within the contracting area. | 19 | | (3) The MCO shall have no obligation to cover medical | 20 | | services provided on an emergency basis that are not | 21 | | covered services under the contract. | 22 | | (4) The MCO shall not condition coverage for emergency | 23 | | services on the treating provider notifying the MCO of the | 24 | | enrollee's screening and treatment within 10 days after | 25 | | presentation for emergency services. | 26 | | (5) The determination of the attending emergency |
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| 1 | | physician, or the provider actually treating the enrollee, | 2 | | of whether an enrollee is sufficiently stabilized for | 3 | | discharge or transfer to another facility, shall be binding | 4 | | on the MCO. The MCO shall cover emergency services for all | 5 | | enrollees whether the emergency services are provided by an | 6 | | affiliated or non-affiliated provider. | 7 | | (6) The MCO's financial responsibility for | 8 | | post-stabilization care services it has not pre-approved | 9 | | ends when: | 10 | | (A) a plan physician with privileges at the | 11 | | treating hospital assumes responsibility for the | 12 | | enrollee's care; | 13 | | (B) a plan physician assumes responsibility for | 14 | | the enrollee's care through transfer; | 15 | | (C) a contracting entity representative and the | 16 | | treating physician reach an agreement concerning the | 17 | | enrollee's care; or | 18 | | (D) the enrollee is discharged. | 19 | | (f) Network adequacy and transparency. | 20 | | (1) The Department shall: | 21 | | (A) ensure that an adequate provider network is in | 22 | | place, taking into consideration health professional | 23 | | shortage areas and medically underserved areas; | 24 | | (B) publicly release an explanation of its process | 25 | | for analyzing network adequacy; | 26 | | (C) periodically ensure that an MCO continues to |
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| 1 | | have an adequate network in place; and | 2 | | (D) require MCOs, including Medicaid Managed Care | 3 | | Entities as defined in Section 5-30.2, to meet provider | 4 | | directory requirements under Section 5-30.3. | 5 | | (2) Each MCO shall confirm its receipt of information | 6 | | submitted specific to physician additions or physician | 7 | | deletions from the MCO's provider network within 3 days | 8 | | after receiving all required information from contracted | 9 | | physicians, and electronic physician directories must be | 10 | | updated consistent with current rules as published by the | 11 | | Centers for Medicare and Medicaid Services or its successor | 12 | | agency. | 13 | | (g) Timely payment of claims. | 14 | | (1) The MCO shall pay a claim within 30 days of | 15 | | receiving a claim that contains all the essential | 16 | | information needed to adjudicate the claim. | 17 | | (2) The MCO shall notify the billing party of its | 18 | | inability to adjudicate a claim within 30 days of receiving | 19 | | that claim. | 20 | | (3) The MCO shall pay a penalty that is at least equal | 21 | | to the penalty imposed under the Illinois Insurance Code | 22 | | for any claims not timely paid. | 23 | | (4) The Department may establish a process for MCOs to | 24 | | expedite payments to providers based on criteria | 25 | | established by the Department. | 26 | | (g-5) Recognizing that the rapid transformation of the |
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| 1 | | Illinois Medicaid program may have unintended operational | 2 | | challenges for both payers and providers: | 3 | | (1) in no instance shall a medically necessary covered | 4 | | service rendered in good faith, based upon eligibility | 5 | | information documented by the provider, be denied coverage | 6 | | or diminished in payment amount if the eligibility or | 7 | | coverage information available at the time the service was | 8 | | rendered is later found to be inaccurate; and | 9 | | (2) the Department shall, by December 31, 2016, adopt | 10 | | rules establishing policies that shall be included in the | 11 | | Medicaid managed care policy and procedures manual | 12 | | addressing payment resolutions in situations in which a | 13 | | provider renders services based upon information obtained | 14 | | after verifying a patient's eligibility and coverage plan | 15 | | through either the Department's current enrollment system | 16 | | or a system operated by the coverage plan identified by the | 17 | | patient presenting for services: | 18 | | (A) such medically necessary covered services | 19 | | shall be considered rendered in good faith; | 20 | | (B) such policies and procedures shall be | 21 | | developed in consultation with industry | 22 | | representatives of the Medicaid managed care health | 23 | | plans and representatives of provider associations | 24 | | representing the majority of providers within the | 25 | | identified provider industry; and | 26 | | (C) such rules shall be published for a review and |
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| 1 | | comment period of no less than 30 days on the | 2 | | Department's website with final rules remaining | 3 | | available on the Department's website. | 4 | | (3) The rules on payment resolutions shall include, but | 5 | | not be limited to: | 6 | | (A) the extension of the timely filing period; | 7 | | (B) retroactive prior authorizations; and | 8 | | (C) guaranteed minimum payment rate of no less than | 9 | | the current, as of the date of service, fee-for-service | 10 | | rate, plus all applicable add-ons, when the resulting | 11 | | service relationship is out of network. | 12 | | (4) The rules shall be applicable for both MCO coverage | 13 | | and fee-for-service coverage. | 14 | | (g-6) MCO Performance Metrics Report. | 15 | | (1) The Department shall publish, on at least a | 16 | | quarterly basis, each MCO's operational performance, | 17 | | including, but not limited to, the following categories of | 18 | | metrics: | 19 | | (A) claims payment, including timeliness and | 20 | | accuracy; | 21 | | (B) prior authorizations; | 22 | | (C) grievance and appeals; | 23 | | (D) utilization statistics; | 24 | | (E) provider disputes; | 25 | | (F) provider credentialing; and | 26 | | (G) member and provider customer service. |
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| 1 | | (2) The Department shall ensure that the metrics report | 2 | | is accessible to providers online by January 1, 2017. | 3 | | (3) The metrics shall be developed in consultation with | 4 | | industry representatives of the Medicaid managed care | 5 | | health plans and representatives of associations | 6 | | representing the majority of providers within the | 7 | | identified industry. | 8 | | (4) Metrics shall be defined and incorporated into the | 9 | | applicable Managed Care Policy Manual issued by the | 10 | | Department. | 11 | | (g-7) MCO claims processing and performance analysis. In | 12 | | order to monitor MCO payments to hospital providers, pursuant | 13 | | to this amendatory Act of the 100th General Assembly, the | 14 | | Department shall post an analysis of MCO claims processing and | 15 | | payment performance on its website every 6 months. Such | 16 | | analysis shall include a review and evaluation of a | 17 | | representative sample of hospital claims that are rejected and | 18 | | denied for clean and unclean claims and the top 5 reasons for | 19 | | such actions and timeliness of claims adjudication, which | 20 | | identifies the percentage of claims adjudicated within 30, 60, | 21 | | 90, and over 90 days, and the dollar amounts associated with | 22 | | those claims. The Department shall post the contracted claims | 23 | | report required by HealthChoice Illinois on its website every 3 | 24 | | months. | 25 | | (h) The Department shall not expand mandatory MCO | 26 | | enrollment into new counties beyond those counties already |
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| 1 | | designated by the Department as of June 1, 2014 for the | 2 | | individuals whose eligibility for medical assistance is not the | 3 | | seniors or people with disabilities population until the | 4 | | Department provides an opportunity for accountable care | 5 | | entities and MCOs to participate in such newly designated | 6 | | counties. | 7 | | (i) The requirements of this Section apply to contracts | 8 | | with accountable care entities and MCOs entered into, amended, | 9 | | or renewed after June 16, 2014 (the effective date of Public | 10 | | Act 98-651).
| 11 | | (Source: P.A. 99-725, eff. 8-5-16; 99-751, eff. 8-5-16; | 12 | | 100-201, eff. 8-18-17.) | 13 | | (305 ILCS 5/5-30.6 new) | 14 | | Sec. 5-30.6. Managed care organization contracts | 15 | | procurement requirement. Beginning on the effective date of | 16 | | this amendatory Act of the 100th General Assembly, any new | 17 | | contract between the Department and a managed care organization | 18 | | as defined in Section 5-30.1 shall be procured in accordance | 19 | | with the Illinois Procurement Code. | 20 | | (a) Application. | 21 | | (1) This Section does not apply to the State of | 22 | | Illinois Medicaid Managed Care Organization Request for | 23 | | Proposals (2018-24-001) or any agreement, regardless of | 24 | | what it may be called, related to or arising from this | 25 | | procurement, including, but not limited to, contracts, |
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| 1 | | renewals, renegotiated contracts, amendments, and change | 2 | | orders. | 3 | | (2) This Section does not apply to Medicare-Medicaid | 4 | | Alignment Initiative contracts executed under Article V-F | 5 | | of this Code. | 6 | | (b) In the event any provision of this Section or of the | 7 | | Illinois Procurement Code is inconsistent with applicable | 8 | | federal law or would have the effect of foreclosing the use, | 9 | | potential use, or receipt of federal financial participation, | 10 | | the applicable federal law or funding condition shall prevail, | 11 | | but only to the extent of such inconsistency. | 12 | | (305 ILCS 5/5-30.7 new) | 13 | | Sec. 5-30.7. Encounter data guidelines; provider fee | 14 | | schedule. | 15 | | (a) No later than 60 days after the effective date of this | 16 | | amendatory Act of the 100th General Assembly, the Department | 17 | | shall publish on its website comprehensive written guidance on | 18 | | the submission of encounter data by managed care organizations. | 19 | | This information shall be updated and published as needed, but | 20 | | at least quarterly. The Department shall inform providers and | 21 | | managed care organizations of any updates via provider notices. | 22 | | (b) The Department shall publish on its website provider | 23 | | fee schedules on both a portable document format (PDF) and | 24 | | EXCEL format. The portable document format shall serve as the | 25 | | ultimate source if there is a discrepancy. |
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| 1 | | (305 ILCS 5/5A-15) | 2 | | Sec. 5A-15. Protection of federal revenue. | 3 | | (a) If the federal Centers for Medicare and Medicaid | 4 | | Services finds that any federal upper payment limit applicable | 5 | | to the payments under this Article is exceeded then: | 6 | | (1) the payments under this Article that exceed the | 7 | | applicable federal upper payment limit shall be reduced | 8 | | uniformly to the extent necessary to comply with the | 9 | | applicable federal upper payment limit; and | 10 | | (2) any assessment rate imposed under this Article | 11 | | shall be reduced such that the aggregate assessment is | 12 | | reduced by the same percentage reduction applied in | 13 | | paragraph (1); and | 14 | | (3) any transfers from the Hospital Provider Fund under | 15 | | Section 5A-8 shall be reduced by the same percentage | 16 | | reduction applied in paragraph (1). | 17 | | (b) Any payment reductions made under the authority granted | 18 | | in this Section are exempt from the requirements and actions | 19 | | under Section 5A-10.
| 20 | | (c) If any payments made as a result of the requirements of | 21 | | this Article are subject to a disallowance, deferral, or | 22 | | adjustment of federal matching funds then: | 23 | | (1) the Department shall recoup the payments related to | 24 | | those federal matching funds paid by the Department from | 25 | | the parties paid by the Department; |
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| 1 | | (2) if the payments that are subject to a disallowance, | 2 | | deferral, or adjustment of federal matching funds were made | 3 | | to MCOs, the Department shall recoup the payments related | 4 | | to the disallowance, deferral, or adjustment from the MCOs | 5 | | no sooner than the Department is required to remit federal | 6 | | matching funds to the Centers for Medicare and Medicaid | 7 | | Services or any other federal agency, and hospitals that | 8 | | received payments from the MCOs that were made with such | 9 | | disallowed, deferred, or adjusted federal matching funds | 10 | | must return those payments to the MCOs at least 10 business | 11 | | days before the MCOs are required to remit such payments to | 12 | | the Department; and | 13 | | (3) any assessment paid to the Department by hospitals | 14 | | under this Article that is attributable to the payments | 15 | | that are subject to a disallowance, deferral, or adjustment | 16 | | of federal matching funds, shall be refunded to the | 17 | | hospitals by the Department. | 18 | | If an MCO is unable to recoup funds from a hospital for any | 19 | | reason, then the Department, upon written notice from an MCO, | 20 | | shall work in good faith with the MCO to mitigate losses | 21 | | associated with the lack of recoupment. Losses by an MCO shall | 22 | | not exceed 1% of the total payments distributed by the MCO to | 23 | | hospitals pursuant to the Hospital Assessment Program. | 24 | | (Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
| 25 | | Section 99. Effective date. This Act takes effect upon | 26 | | becoming law, but this Act does not take effect at all unless |
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| 1 | | Senate Bill 1773 of the 100th General Assembly, as amended, | 2 | | becomes law.
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