Full Text of HB5179 102nd General Assembly
HB5179 102ND GENERAL ASSEMBLY |
| | 102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022 HB5179 Introduced 1/27/2022, by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED: |
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Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in light of the heightened risk of overdose if a
patient is discharged and not linked to treatment and recovery
supports, and the need for appropriate access to the treatment
and services available via community-based substance use
disorder and mental health providers, the Department of Healthcare and Family Services and each hospital shall ensure
coordination of care and treatment for each patient with
community-based mental health and substance use disorder
treatment providers. Requires hospitals to coordinate and
collaborate with community-based providers by: (i) providing a warm handoff of patients in need of
treatment and recovery support services to community-based
providers; (ii) collaborating with community-based providers on
the provision of 24/7 access to transitioning patients
prior to discharge from the hospital; (iii) working with community-based providers on fully
implementing substance use disorder treatment and recovery supports through existing and new hospital-located
community-based provider projects; and (iv) engaging in such other programs established by the
Department to prioritize treatment within the
community-based system to the extent such treatment is
deemed to best serve a patient, is considered medically
necessary, and is fiscally prudent. Provides that if a hospital fails to address these requirements prior to discharging a patient, the provider
shall forgo reimbursement for any observation or admission
services provided to the patient.
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| | A BILL FOR |
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| | | HB5179 | | LRB102 24822 KTG 34067 b |
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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 Public Aid Code is amended by | 5 | | changing Section 5-41 as follows: | 6 | | (305 ILCS 5/5-41) | 7 | | Sec. 5-41. Inpatient hospitalization for opioid-related | 8 | | overdose or withdrawal patients. | 9 | | (a) Due to the disproportionately high opioid-related | 10 | | fatality rates among African Americans in under-resourced | 11 | | communities in Illinois, the lack of community resources, the | 12 | | comorbidities experienced by these patients, and the high rate | 13 | | of hospital inpatient recidivism associated with this | 14 | | population when improperly treated, the Department shall | 15 | | ensure that patients, whether enrolled under the Medical | 16 | | Assistance Fee For Service program or enrolled with a Medicaid | 17 | | Managed Care Organization, experiencing opioid-related | 18 | | overdose or withdrawal are admitted on an inpatient status and | 19 | | the provider shall be reimbursed accordingly, when deemed | 20 | | medically necessary, as determined by either the patient's | 21 | | primary care physician, or the physician or other practitioner | 22 | | responsible for the patient's care at the hospital to which | 23 | | the patient presents, using criteria established by the |
| | | HB5179 | - 2 - | LRB102 24822 KTG 34067 b |
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| 1 | | American Society of Addiction Medicine. If it is determined by | 2 | | the physician or other practitioner responsible for the | 3 | | patient's care at the hospital to which the patient presents, | 4 | | that a patient does not meet medical necessity criteria for | 5 | | the admission, then the patient may be treated via observation | 6 | | and the provider shall seek reimbursement accordingly. Nothing | 7 | | in this Section shall diminish the requirements of a provider | 8 | | to document medical necessity in the patient's record.
| 9 | | (b) In light of the heightened risk of overdose if a | 10 | | patient is discharged and not linked to
treatment and recovery | 11 | | supports, and the need for appropriate access to the treatment | 12 | | and
services available via community-based substance use | 13 | | disorder and mental health providers,
notwithstanding | 14 | | subsection (a), the Department and each hospital shall ensure | 15 | | coordination of care and treatment for each patient with | 16 | | community-based mental health and substance use
disorder | 17 | | treatment providers. Hospitals shall coordinate and | 18 | | collaborate with community-based
providers by: | 19 | | (1) providing a warm handoff of patients in need of | 20 | | treatment and recovery
support services to community-based | 21 | | providers; | 22 | | (2) collaborating with community-based
providers on | 23 | | the provision of 24/7 access to transitioning patients | 24 | | prior to discharge from the
hospital; | 25 | | (3) working with community-based providers on fully | 26 | | implementing substance use
disorder treatment and recovery |
| | | HB5179 | - 3 - | LRB102 24822 KTG 34067 b |
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| 1 | | supports through existing and new hospital-located
| 2 | | community-based provider projects; and | 3 | | (4) engaging in such other programs established by
the | 4 | | Department to prioritize treatment within the | 5 | | community-based system to the extent
such treatment is | 6 | | deemed to best serve a patient, is considered medically | 7 | | necessary, and is fiscally prudent. | 8 | | (c) If a hospital fails to address the requirements of | 9 | | subsection (b) prior to discharging a patient, the provider | 10 | | shall forgo reimbursement for any observation or admission | 11 | | services provided
to the patient. | 12 | | (Source: P.A. 102-43, eff. 7-6-21.)
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