Public Act 098-0651

SB0741 Enrolled LRB098 04975 KTG 35005 b

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois,

represented in the General Assembly:

Article 1

Section 1-5. The Illinois Public Aid Code is amended by

adding Article V-F as follows:

(305 ILCS 5/Art. V-F heading new)

ARTICLE V-F. MEDICARE-MEDICAID ALIGNMENT

INITIATIVE (MMAI) NURSING HOME

RESIDENTS' MANAGED CARE RIGHTS LAW

(305 ILCS 5/5F-1 new)

Sec. 5F-1. Short title. This Article may be referred to as

the Medicare-Medicaid Alignment Initiative (MMAI) Nursing Home

Residents' Managed Care Rights Law.

(305 ILCS 5/5F-5 new)

Sec. 5F-5. Findings. The General Assembly finds that

elderly Illinoisans residing in a nursing home have the right

to:

(1) quality health care regardless of the payer;

(2) receive medically necessary care prescribed by

their doctors;

(3) a simple appeal process when care is denied; and

(4) make decisions about their care and where they

receive it.

(305 ILCS 5/5F-10 new)

Sec. 5F-10. Scope. This Article applies to policies and

contracts amended, delivered, issued, or renewed on or after

the effective date of this amendatory Act of the 98th General

Assembly for the nursing home component of the

Medicare-Medicaid Alignment Initiative. This Article does not

diminish a managed care organization's duties and

responsibilities under other federal or State laws or rules

adopted under those laws and the 3-way Medicare-Medicaid

Alignment Initiative contract.

(305 ILCS 5/5F-15 new)

Sec. 5F-15. Definitions. As used in this Article:

"Appeal" means any of the procedures that deal with the

review of adverse organization determinations on the health

care services the enrollee believes he or she is entitled to

receive, including delay in providing, arranging for, or

approving the health care services, such that a delay would

adversely affect the health of the enrollee or on any amounts

the enrollee must pay for a service, as defined under 42 CFR

422.566(b). These procedures include reconsiderations by the

managed care organization and, if necessary, an independent

review entity as provided by the Health Carrier External Review

Act, hearings before administrative law judges, review by the

Medicare Appeals Council, and judicial review.

"Demonstration Project" means the nursing home component

of the Medicare-Medicaid Alignment Initiative Demonstration

Project.

"Department" means the Department of Healthcare and Family

Services.

"Enrollee" means an individual who resides in a nursing

home or is qualified to be admitted to a nursing home and is

enrolled with a managed care organization participating in the

Demonstration Project.

"Health care services" means the diagnosis, treatment, and

prevention of disease and includes medication, primary care,

nursing or medical care, mental health treatment, psychiatric

rehabilitation, memory loss services, physical, occupational,

and speech rehabilitation, enhanced care, medical supplies and

equipment and the repair of such equipment, and assistance with

activities of daily living.

"Managed care organization" or "MCO" means an entity that

meets the definition of health maintenance organization as

defined in the Health Maintenance Organization Act, is

licensed, regulated and in good standing with the Department of

Insurance, and is authorized to participate in the nursing home

component of the Medicare-Medicaid Alignment Initiative

Demonstration Project by a 3-way contract with the Department

of Healthcare and Family Services and the Centers for Medicare

and Medicaid Services.

"Medical professional" means a physician, physician

assistant, or nurse practitioner.

"Medically necessary" means health care services that a

medical professional, exercising prudent clinical judgment,

would provide to a patient for the purpose of preventing,

evaluating, diagnosing, or treating an illness, injury, or

disease or its symptoms, and that are: (i) in accordance with

the generally accepted standards of medical practice; (ii)

clinically appropriate, in terms of type, frequency, extent,

site, and duration, and considered effective for the patient's

illness, injury, or disease; and (iii) not primarily for the

convenience of the patient, a medical professional, other

health care provider, caregiver, family member, or other

interested party.

"Nursing home" means a facility licensed under the Nursing

Home Care Act.

"Nurse practitioner" means an individual properly licensed

as a nurse practitioner under the Nurse Practice Act.

"Physician" means an individual licensed to practice in all

branches of medicine under the Medical Practice Act of 1987.

"Physician assistant" means an individual properly

licensed under the Physician Assistant Practice Act of 1987.

"Resident" means an enrollee who is receiving personal or

medical care, including, but not limited to, mental health

treatment, psychiatric rehabilitation, physical

rehabilitation, and assistance with activities of daily

living, from a nursing home.

"RAI Manual" means the most recent Resident Assessment

Instrument Manual, published by the Centers for Medicare and

Medicaid Services.

"Resident's representative" means a person designated in

writing by a resident to be the resident's representative or

the resident's guardian, as described by the Nursing Home Care

Act.

"SNFist" means a medical professional specializing in the

care of individuals residing in nursing homes employed by or

under contract with a MCO.

"Transition period" means a period of time immediately

following enrollment into the Demonstration Project or an

enrollee's movement from one managed care organization to

another managed care organization or one care setting to

another care setting.

(305 ILCS 5/5F-20 new)

Sec. 5F-20. Network adequacy.

(a) Every managed care organization shall allow every

nursing home in its service area an opportunity to be a network

contracted facility at the plan's standard terms, conditions,

and rates. Either party may opt to limit the contract to

existing residents only.

(b) With the exception of subsection (c) of this Section, a

managed care organization shall only terminate or refuse to

renew a contract with a nursing home if the nursing home fails

to meet quality standards if the following conditions are met:

(1) the quality standards are made known to the nursing

home;

(2) the quality standards can be objectively measured

through data;

(3) the nursing home is measured on at least a year's

worth of performance;

(4) a nursing home that the MCO has determined did not

meet a quality standard has the opportunity to contest that

determination by challenging the accuracy or the

measurement of the data through an arbitration process

agreed to by contract; and

(5) the Department may attempt to mediate a dispute

prior to arbitration.

(c) A managed care organization may terminate or refuse to

renew a contract with a nursing home for a material breach of

the contract, including, but not limited to, failure to grant

reasonable and timely access to the MCO's care coordinators,

SNFists and other providers, termination from the Medicare or

Medicaid program, or revocation of license.

(305 ILCS 5/5F-25 new)

Sec. 5F-25. Care coordination. Care coordination provided

to all enrollees in the Demonstration Project shall conform to

the following requirements:

(1) care coordination services shall be

enrollee-driven and person-centered;

(2) all enrollees in the Demonstration Project shall

have the right to receive health care services in the care

setting of their choice, except as permitted by Part 4 of

Article III of the Nursing Home Care Act with respect to

involuntary transfers and discharges; and

(3) decisions shall be based on the enrollee's best

interests.

(305 ILCS 5/5F-30 new)

Sec. 5F-30. Continuity of care. When a nursing home

resident first transitions to a managed care organization from

the fee-for-service system or from another managed care

organization, the managed care organization shall honor the

existing care plan and any necessary changes to that care plan

until the MCO has completed a comprehensive assessment and new

care plan, to the extent such services are covered benefits

under the contract, which shall be consistent with the

requirements of the RAI Manual.

When an enrollee of a managed care organization is moving

from a community setting to a nursing home, and the MCO is

properly notified of the proposed admission by a network

nursing home, and the managed care organization fails to

participate in developing a care plan within the time frames

required by nursing home regulations, the MCO must honor a care

plan developed by the nursing home until the MCO has completed

a comprehensive assessment and a new care plan to the extent

such services are covered benefits under the contract,

consistent with the requirements of the RAI Manual.

A nursing home shall have the ability to refuse admission

of an enrollee for whom care is required that the nursing home

determines is outside the scope of its license and healthcare

capabilities.

(305 ILCS 5/5F-32 new)

Sec. 5F-32. Non-emergency prior approval and appeal.

(a) MCOs must have a method of receiving prior approval

requests 24 hours a day, 7 days a week, 365 days a year for

nursing home residents. If a response is not provided within 24

hours of the request and the nursing home is required by

regulation to provide a service because a physician ordered it,

the MCO must pay for the service if it is a covered service

under the MCO's contract in the Demonstration Project, provided

that the request is consistent with the policies and procedures

of the MCO.

In a non-emergency situation, notwithstanding any

provisions in State law to the contrary, in the event a

resident's physician orders a service, treatment, or test that

is not approved by the MCO, the physician and the provider may

utilize an expedited appeal to the MCO.

If an enrollee or provider requests an expedited appeal

pursuant to 42 CFR 438.410, the MCO shall notify the enrollee

or provider within 24 hours after the submission of the appeal

of all information from the enrollee or provider that the MCO

requires to evaluate the appeal. The MCO shall render a

decision on an expedited appeal within 24 hours after receipt

of the required information.

(b) While the appeal is pending or if the ordered service,

treatment, or test is denied after appeal, the Department of

Public Health may not cite the nursing home for failure to

provide the ordered service, treatment, or test. The nursing

home shall not be liable or responsible for an injury in any

regulatory proceeding for the following:

(1) failure to follow the appealed or denied order; or

(2) injury to the extent it was caused by the delay or

failure to perform the appealed or denied service,

treatment, or test.

Provided however, a nursing home shall continue to monitor,

document, and ensure the patient's safety. Nothing in this

subsection (b) is intended to otherwise change the nursing

home's existing obligations under State and federal law to

appropriately care for its residents.

(305 ILCS 5/5F-35 new)

Sec. 5F-35. Reimbursement. The Department shall provide

each managed care organization with the quarterly

facility-specific RUG-IV nursing component per diem along with

any add-ons for enhanced care services, support component per

diem, and capital component per diem effective for each nursing

home under contract with the managed care organization.

(305 ILCS 5/5F-40 new)

Sec. 5F-40. Contractual requirements.

(a) Every contract shall contain a clause for termination

consistent with the Managed Care Reform and Patient Rights Act

providing nursing homes the ability to terminate the contract.

(b) All changes to the contract by the MCO shall be

preceded by 30 days' written notice sent to the nursing home.

(305 ILCS 5/5F-45 new)

Sec. 5F-45. Prohibition. No managed care organization or

contract shall contain any provision, policy, or procedure that

limits, restricts, or waives any rights set forth in this

Article or is expressly prohibited by this Article. Any such

policy or procedure is void and unenforceable.

Section 1-10. The Health Maintenance Organization Act is

amended by changing Section 1-2 as follows:

(215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402)

Sec. 1-2. Definitions. As used in this Act, unless the

context otherwise requires, the following terms shall have the

meanings ascribed to them:

(1) "Advertisement" means any printed or published

material, audiovisual material and descriptive literature of

the health care plan used in direct mail, newspapers,

magazines, radio scripts, television scripts, billboards and

similar displays; and any descriptive literature or sales aids

of all kinds disseminated by a representative of the health

care plan for presentation to the public including, but not

limited to, circulars, leaflets, booklets, depictions,

illustrations, form letters and prepared sales presentations.

(2) "Director" means the Director of Insurance.

(3) "Basic health care services" means emergency care, and

inpatient hospital and physician care, outpatient medical

services, mental health services and care for alcohol and drug

abuse, including any reasonable deductibles and co-payments,

all of which are subject to the limitations described in

Section 4-20 of this Act and as determined by the Director

pursuant to rule.

(4) "Enrollee" means an individual who has been enrolled in

a health care plan.

(5) "Evidence of coverage" means any certificate,

agreement, or contract issued to an enrollee setting out the

coverage to which he is entitled in exchange for a per capita

prepaid sum.

(6) "Group contract" means a contract for health care

services which by its terms limits eligibility to members of a

specified group.

(7) "Health care plan" means any arrangement whereby any

organization undertakes to provide or arrange for and pay for

or reimburse the cost of basic health care services, excluding

any reasonable deductibles and copayments, from providers

selected by the Health Maintenance Organization and such

arrangement consists of arranging for or the provision of such

health care services, as distinguished from mere

indemnification against the cost of such services, except as

otherwise authorized by Section 2-3 of this Act, on a per

capita prepaid basis, through insurance or otherwise. A "health

care plan" also includes any arrangement whereby an

organization undertakes to provide or arrange for or pay for or

reimburse the cost of any health care service for persons who

are enrolled under Article V of the Illinois Public Aid Code or

under the Children's Health Insurance Program Act through

providers selected by the organization and the arrangement

consists of making provision for the delivery of health care

services, as distinguished from mere indemnification. A

"health care plan" also includes any arrangement pursuant to

Section 4-17. Nothing in this definition, however, affects the

total medical services available to persons eligible for

medical assistance under the Illinois Public Aid Code.

(8) "Health care services" means any services included in

the furnishing to any individual of medical or dental care, or

the hospitalization or incident to the furnishing of such care

or hospitalization as well as the furnishing to any person of

any and all other services for the purpose of preventing,

alleviating, curing or healing human illness or injury.

(9) "Health Maintenance Organization" means any

organization formed under the laws of this or another state to

provide or arrange for one or more health care plans under a

system which causes any part of the risk of health care

delivery to be borne by the organization or its providers.

(10) "Net worth" means admitted assets, as defined in

Section 1-3 of this Act, minus liabilities.

(11) "Organization" means any insurance company, a

nonprofit corporation authorized under the Dental Service Plan

Act or the Voluntary Health Services Plans Act, or a

corporation organized under the laws of this or another state

for the purpose of operating one or more health care plans and

doing no business other than that of a Health Maintenance

Organization or an insurance company. "Organization" shall

also mean the University of Illinois Hospital as defined in the

University of Illinois Hospital Act or a unit of local

government health system operating within a county with a

population of 3,000,000 or more.

(12) "Provider" means any physician, hospital facility,

facility licensed under the Nursing Home Care Act, or other

person which is licensed or otherwise authorized to furnish

health care services and also includes any other entity that

arranges for the delivery or furnishing of health care service.

(13) "Producer" means a person directly or indirectly

associated with a health care plan who engages in solicitation

or enrollment.

(14) "Per capita prepaid" means a basis of prepayment by

which a fixed amount of money is prepaid per individual or any

other enrollment unit to the Health Maintenance Organization or

for health care services which are provided during a definite

time period regardless of the frequency or extent of the

services rendered by the Health Maintenance Organization,

except for copayments and deductibles and except as provided in

subsection (f) of Section 5-3 of this Act.

(15) "Subscriber" means a person who has entered into a

contractual relationship with the Health Maintenance

Organization for the provision of or arrangement of at least

basic health care services to the beneficiaries of such

contract.

(Source: P.A. 97-1148, eff. 1-24-13.)

Section 1-15. The Managed Care Reform and Patient Rights

Act is amended by changing Section 10 as follows:

(215 ILCS 134/10)

Sec. 10. Definitions:

"Adverse determination" means a determination by a health

care plan under Section 45 or by a utilization review program

under Section 85 that a health care service is not medically

necessary.

"Clinical peer" means a health care professional who is in

the same profession and the same or similar specialty as the

health care provider who typically manages the medical

condition, procedures, or treatment under review.

"Department" means the Department of Insurance.

"Emergency medical condition" means a medical condition

manifesting itself by acute symptoms of sufficient severity

(including, but not limited to, severe pain) such that a

prudent layperson, who possesses an average knowledge of health

and medicine, could reasonably expect the absence of immediate

medical attention to result in:

(1) placing the health of the individual (or, with

respect to a pregnant woman, the health of the woman or her

unborn child) in serious jeopardy;

(2) serious impairment to bodily functions; or

(3) serious dysfunction of any bodily organ or part.

"Emergency medical screening examination" means a medical

screening examination and evaluation by a physician licensed to

practice medicine in all its branches, or to the extent

permitted by applicable laws, by other appropriately licensed

personnel under the supervision of or in collaboration with a

physician licensed to practice medicine in all its branches to

determine whether the need for emergency services exists.

"Emergency services" means, with respect to an enrollee of

a health care plan, transportation services, including but not

limited to ambulance services, and covered inpatient and

outpatient hospital services furnished by a provider qualified

to furnish those services that are needed to evaluate or

stabilize an emergency medical condition. "Emergency services"

does not refer to post-stabilization medical services.

"Enrollee" means any person and his or her dependents

enrolled in or covered by a health care plan.

"Health care plan" means a plan, including, but not limited

to, a health maintenance organization, a managed care community

network as defined in the Illinois Public Aid Code, or an

accountable care entity as defined in the Illinois Public Aid

Code that receives capitated payments to cover medical services

from the Department of Healthcare and Family Services, that

establishes, operates, or maintains a network of health care

providers that has entered into an agreement with the plan to

provide health care services to enrollees to whom the plan has

the ultimate obligation to arrange for the provision of or

payment for services through organizational arrangements for

ongoing quality assurance, utilization review programs, or

dispute resolution. Nothing in this definition shall be

construed to mean that an independent practice association or a

physician hospital organization that subcontracts with a

health care plan is, for purposes of that subcontract, a health

care plan.

For purposes of this definition, "health care plan" shall

not include the following:

(1) indemnity health insurance policies including

those using a contracted provider network;

(2) health care plans that offer only dental or only

vision coverage;

(3) preferred provider administrators, as defined in

Section 370g(g) of the Illinois Insurance Code;

(4) employee or employer self-insured health benefit

plans under the federal Employee Retirement Income

Security Act of 1974;

(5) health care provided pursuant to the Workers'

Compensation Act or the Workers' Occupational Diseases

Act; and

(6) not-for-profit voluntary health services plans

with health maintenance organization authority in

existence as of January 1, 1999 that are affiliated with a

union and that only extend coverage to union members and

their dependents.

"Health care professional" means a physician, a registered

professional nurse, or other individual appropriately licensed

or registered to provide health care services.

"Health care provider" means any physician, hospital

facility, facility licensed under the Nursing Home Care Act, or

other person that is licensed or otherwise authorized to

deliver health care services. Nothing in this Act shall be

construed to define Independent Practice Associations or

Physician-Hospital Organizations as health care providers.

"Health care services" means any services included in the

furnishing to any individual of medical care, or the

hospitalization incident to the furnishing of such care, as

well as the furnishing to any person of any and all other

services for the purpose of preventing, alleviating, curing, or

healing human illness or injury including home health and

pharmaceutical services and products.

"Medical director" means a physician licensed in any state

to practice medicine in all its branches appointed by a health

care plan.

"Person" means a corporation, association, partnership,

limited liability company, sole proprietorship, or any other

legal entity.

"Physician" means a person licensed under the Medical

Practice Act of 1987.

"Post-stabilization medical services" means health care

services provided to an enrollee that are furnished in a

licensed hospital by a provider that is qualified to furnish

such services, and determined to be medically necessary and

directly related to the emergency medical condition following

stabilization.

"Stabilization" means, with respect to an emergency

medical condition, to provide such medical treatment of the

condition as may be necessary to assure, within reasonable

medical probability, that no material deterioration of the

condition is likely to result.

"Utilization review" means the evaluation of the medical

necessity, appropriateness, and efficiency of the use of health

care services, procedures, and facilities.

"Utilization review program" means a program established

by a person to perform utilization review.

(Source: P.A. 91-617, eff. 1-1-00.)

Article 5

Section 5-5. The Illinois Health Facilities Planning Act is

amended by changing Sections 3 and 12 as follows:

(20 ILCS 3960/3) (from Ch. 111 1/2, par. 1153)

(Section scheduled to be repealed on December 31, 2019)

Sec. 3. Definitions. As used in this Act:

"Health care facilities" means and includes the following

facilities, organizations, and related persons:

1. An ambulatory surgical treatment center required to

be licensed pursuant to the Ambulatory Surgical Treatment

Center Act;

2. An institution, place, building, or agency required

to be licensed pursuant to the Hospital Licensing Act;

3. Skilled and intermediate long term care facilities

licensed under the Nursing Home Care Act;

3.5. Skilled and intermediate care facilities licensed

under the ID/DD Community Care Act;

3.7. Facilities licensed under the Specialized Mental

Health Rehabilitation Act of 2013;

4. Hospitals, nursing homes, ambulatory surgical

treatment centers, or kidney disease treatment centers

maintained by the State or any department or agency

thereof;

5. Kidney disease treatment centers, including a

free-standing hemodialysis unit required to be licensed

under the End Stage Renal Disease Facility Act;

6. An institution, place, building, or room used for

the performance of outpatient surgical procedures that is

leased, owned, or operated by or on behalf of an

out-of-state facility;

7. An institution, place, building, or room used for

provision of a health care category of service, including,

but not limited to, cardiac catheterization and open heart

surgery; and

8. An institution, place, building, or room used for

provision of major medical equipment used in the direct

clinical diagnosis or treatment of patients, and whose

project cost is in excess of the capital expenditure

minimum.

This Act shall not apply to the construction of any new

facility or the renovation of any existing facility located on

any campus facility as defined in Section 5-5.8b of the

Illinois Public Aid Code, provided that the campus facility

encompasses 30 or more contiguous acres and that the new or

renovated facility is intended for use by a licensed

residential facility.

No federally owned facility shall be subject to the

provisions of this Act, nor facilities used solely for healing

by prayer or spiritual means.

No facility licensed under the Supportive Residences

Licensing Act or the Assisted Living and Shared Housing Act

shall be subject to the provisions of this Act.

No facility established and operating under the

Alternative Health Care Delivery Act as a children's respite

care center alternative health care model demonstration

program or as an Alzheimer's Disease Management Center

alternative health care model demonstration program shall be

subject to the provisions of this Act.

A facility designated as a supportive living facility that

is in good standing with the program established under Section

5-5.01a of the Illinois Public Aid Code shall not be subject to

the provisions of this Act.

This Act does not apply to facilities granted waivers under

Section 3-102.2 of the Nursing Home Care Act. However, if a

demonstration project under that Act applies for a certificate

of need to convert to a nursing facility, it shall meet the

licensure and certificate of need requirements in effect as of

the date of application.

This Act does not apply to a dialysis facility that

provides only dialysis training, support, and related services

to individuals with end stage renal disease who have elected to

receive home dialysis. This Act does not apply to a dialysis

unit located in a licensed nursing home that offers or provides

dialysis-related services to residents with end stage renal

disease who have elected to receive home dialysis within the

nursing home. The Board, however, may require these dialysis

facilities and licensed nursing homes to report statistical

information on a quarterly basis to the Board to be used by the

Board to conduct analyses on the need for proposed kidney

disease treatment centers.

This Act shall not apply to the closure of an entity or a

portion of an entity licensed under the Nursing Home Care Act,

the Specialized Mental Health Rehabilitation Act of 2013, or

the ID/DD Community Care Act, with the exceptions of facilities

operated by a county or Illinois Veterans Homes, that elects to

convert, in whole or in part, to an assisted living or shared

housing establishment licensed under the Assisted Living and

Shared Housing Act and with the exception of a facility

licensed under the Specialized Mental Health Rehabilitation

Act of 2013 in connection with a proposal to close a facility

and re-establish the facility in another location.

This Act does not apply to any change of ownership of a

healthcare facility that is licensed under the Nursing Home

Care Act, the Specialized Mental Health Rehabilitation Act of

2013, or the ID/DD Community Care Act, with the exceptions of

facilities operated by a county or Illinois Veterans Homes.

Changes of ownership of facilities licensed under the Nursing

Home Care Act must meet the requirements set forth in Sections

3-101 through 3-119 of the Nursing Home Care Act.

With the exception of those health care facilities

specifically included in this Section, nothing in this Act

shall be intended to include facilities operated as a part of

the practice of a physician or other licensed health care

professional, whether practicing in his individual capacity or

within the legal structure of any partnership, medical or

professional corporation, or unincorporated medical or

professional group. Further, this Act shall not apply to

physicians or other licensed health care professional's

practices where such practices are carried out in a portion of

a health care facility under contract with such health care

facility by a physician or by other licensed health care

professionals, whether practicing in his individual capacity

or within the legal structure of any partnership, medical or

professional corporation, or unincorporated medical or

professional groups, unless the entity constructs, modifies,

or establishes a health care facility as specifically defined

in this Section. This Act shall apply to construction or

modification and to establishment by such health care facility

of such contracted portion which is subject to facility

licensing requirements, irrespective of the party responsible

for such action or attendant financial obligation.

No permit or exemption is required for a facility licensed

under the ID/DD Community Care Act prior to the reduction of

the number of beds at a facility. If there is a total reduction

of beds at a facility licensed under the ID/DD Community Care

Act, this is a discontinuation or closure of the facility.

However, if a facility licensed under the ID/DD Community Care

Act reduces the number of beds or discontinues the facility,

that facility must notify the Board as provided in Section 14.1

of this Act.

"Person" means any one or more natural persons, legal

entities, governmental bodies other than federal, or any

combination thereof.

"Consumer" means any person other than a person (a) whose

major occupation currently involves or whose official capacity

within the last 12 months has involved the providing,

administering or financing of any type of health care facility,

(b) who is engaged in health research or the teaching of

health, (c) who has a material financial interest in any

activity which involves the providing, administering or

financing of any type of health care facility, or (d) who is or

ever has been a member of the immediate family of the person

defined by (a), (b), or (c).

"State Board" or "Board" means the Health Facilities and

Services Review Board.

"Construction or modification" means the establishment,

erection, building, alteration, reconstruction, modernization,

improvement, extension, discontinuation, change of ownership,

of or by a health care facility, or the purchase or acquisition

by or through a health care facility of equipment or service

for diagnostic or therapeutic purposes or for facility

administration or operation, or any capital expenditure made by

or on behalf of a health care facility which exceeds the

capital expenditure minimum; however, any capital expenditure

made by or on behalf of a health care facility for (i) the

construction or modification of a facility licensed under the

Assisted Living and Shared Housing Act or (ii) a conversion

project undertaken in accordance with Section 30 of the Older

Adult Services Act shall be excluded from any obligations under

this Act.

"Establish" means the construction of a health care

facility or the replacement of an existing facility on another

site or the initiation of a category of service.

"Major medical equipment" means medical equipment which is

used for the provision of medical and other health services and

which costs in excess of the capital expenditure minimum,

except that such term does not include medical equipment

acquired by or on behalf of a clinical laboratory to provide

clinical laboratory services if the clinical laboratory is

independent of a physician's office and a hospital and it has

been determined under Title XVIII of the Social Security Act to

meet the requirements of paragraphs (10) and (11) of Section

1861(s) of such Act. In determining whether medical equipment

has a value in excess of the capital expenditure minimum, the

value of studies, surveys, designs, plans, working drawings,

specifications, and other activities essential to the

acquisition of such equipment shall be included.

"Capital Expenditure" means an expenditure: (A) made by or

on behalf of a health care facility (as such a facility is

defined in this Act); and (B) which under generally accepted

accounting principles is not properly chargeable as an expense

of operation and maintenance, or is made to obtain by lease or

comparable arrangement any facility or part thereof or any

equipment for a facility or part; and which exceeds the capital

expenditure minimum.

For the purpose of this paragraph, the cost of any studies,

surveys, designs, plans, working drawings, specifications, and

other activities essential to the acquisition, improvement,

expansion, or replacement of any plant or equipment with

respect to which an expenditure is made shall be included in

determining if such expenditure exceeds the capital

expenditures minimum. Unless otherwise interdependent, or

submitted as one project by the applicant, components of

construction or modification undertaken by means of a single

construction contract or financed through the issuance of a

single debt instrument shall not be grouped together as one

project. Donations of equipment or facilities to a health care

facility which if acquired directly by such facility would be

subject to review under this Act shall be considered capital

expenditures, and a transfer of equipment or facilities for

less than fair market value shall be considered a capital

expenditure for purposes of this Act if a transfer of the

equipment or facilities at fair market value would be subject

to review.

"Capital expenditure minimum" means $11,500,000 for

projects by hospital applicants, $6,500,000 for applicants for

projects related to skilled and intermediate care long-term

care facilities licensed under the Nursing Home Care Act, and

$3,000,000 for projects by all other applicants, which shall be

annually adjusted to reflect the increase in construction costs

due to inflation, for major medical equipment and for all other

capital expenditures.

"Non-clinical service area" means an area (i) for the

benefit of the patients, visitors, staff, or employees of a

health care facility and (ii) not directly related to the

diagnosis, treatment, or rehabilitation of persons receiving

services from the health care facility. "Non-clinical service

areas" include, but are not limited to, chapels; gift shops;

news stands; computer systems; tunnels, walkways, and

elevators; telephone systems; projects to comply with life

safety codes; educational facilities; student housing;

patient, employee, staff, and visitor dining areas;

administration and volunteer offices; modernization of

structural components (such as roof replacement and masonry

work); boiler repair or replacement; vehicle maintenance and

storage facilities; parking facilities; mechanical systems for

heating, ventilation, and air conditioning; loading docks; and

repair or replacement of carpeting, tile, wall coverings,

window coverings or treatments, or furniture. Solely for the

purpose of this definition, "non-clinical service area" does

not include health and fitness centers.

"Areawide" means a major area of the State delineated on a

geographic, demographic, and functional basis for health

planning and for health service and having within it one or

more local areas for health planning and health service. The

term "region", as contrasted with the term "subregion", and the

word "area" may be used synonymously with the term "areawide".

"Local" means a subarea of a delineated major area that on

a geographic, demographic, and functional basis may be

considered to be part of such major area. The term "subregion"

may be used synonymously with the term "local".

"Physician" means a person licensed to practice in

accordance with the Medical Practice Act of 1987, as amended.

"Licensed health care professional" means a person

licensed to practice a health profession under pertinent

licensing statutes of the State of Illinois.

"Director" means the Director of the Illinois Department of

Public Health.

"Agency" means the Illinois Department of Public Health.

"Alternative health care model" means a facility or program

authorized under the Alternative Health Care Delivery Act.

"Out-of-state facility" means a person that is both (i)

licensed as a hospital or as an ambulatory surgery center under

the laws of another state or that qualifies as a hospital or an

ambulatory surgery center under regulations adopted pursuant

to the Social Security Act and (ii) not licensed under the

Ambulatory Surgical Treatment Center Act, the Hospital

Licensing Act, or the Nursing Home Care Act. Affiliates of

out-of-state facilities shall be considered out-of-state

facilities. Affiliates of Illinois licensed health care

facilities 100% owned by an Illinois licensed health care

facility, its parent, or Illinois physicians licensed to

practice medicine in all its branches shall not be considered

out-of-state facilities. Nothing in this definition shall be

construed to include an office or any part of an office of a

physician licensed to practice medicine in all its branches in

Illinois that is not required to be licensed under the

Ambulatory Surgical Treatment Center Act.

"Change of ownership of a health care facility" means a

change in the person who has ownership or control of a health

care facility's physical plant and capital assets. A change in

ownership is indicated by the following transactions: sale,

transfer, acquisition, lease, change of sponsorship, or other

means of transferring control.

"Related person" means any person that: (i) is at least 50%

owned, directly or indirectly, by either the health care

facility or a person owning, directly or indirectly, at least

50% of the health care facility; or (ii) owns, directly or

indirectly, at least 50% of the health care facility.

"Charity care" means care provided by a health care

facility for which the provider does not expect to receive

payment from the patient or a third-party payer.

"Freestanding emergency center" means a facility subject

to licensure under Section 32.5 of the Emergency Medical

Services (EMS) Systems Act.

"Category of service" means a grouping by generic class of

various types or levels of support functions, equipment, care,

or treatment provided to patients or residents, including, but

not limited to, classes such as medical-surgical, pediatrics,

or cardiac catheterization. A category of service may include

subcategories or levels of care that identify a particular

degree or type of care within the category of service. Nothing

in this definition shall be construed to include the practice

of a physician or other licensed health care professional while

functioning in an office providing for the care, diagnosis, or

treatment of patients. A category of service that is subject to

the Board's jurisdiction must be designated in rules adopted by

the Board.

(Source: P.A. 97-38, eff. 6-28-11; 97-277, eff. 1-1-12; 97-813,

eff. 7-13-12; 97-980, eff. 8-17-12; 98-414, eff. 1-1-14.)

(20 ILCS 3960/12) (from Ch. 111 1/2, par. 1162)

(Section scheduled to be repealed on December 31, 2019)

Sec. 12. Powers and duties of State Board. For purposes of

this Act, the State Board shall exercise the following powers

and duties:

(1) Prescribe rules, regulations, standards, criteria,

procedures or reviews which may vary according to the purpose

for which a particular review is being conducted or the type of

project reviewed and which are required to carry out the

provisions and purposes of this Act. Policies and procedures of

the State Board shall take into consideration the priorities

and needs of medically underserved areas and other health care

services identified through the comprehensive health planning

process, giving special consideration to the impact of projects

on access to safety net services.

(2) Adopt procedures for public notice and hearing on all

proposed rules, regulations, standards, criteria, and plans

required to carry out the provisions of this Act.

(3) (Blank).

(4) Develop criteria and standards for health care

facilities planning, conduct statewide inventories of health

care facilities, maintain an updated inventory on the Board's

web site reflecting the most recent bed and service changes and

updated need determinations when new census data become

available or new need formulae are adopted, and develop health

care facility plans which shall be utilized in the review of

applications for permit under this Act. Such health facility

plans shall be coordinated by the Board with pertinent State

Plans. Inventories pursuant to this Section of skilled or

intermediate care facilities licensed under the Nursing Home

Care Act, skilled or intermediate care facilities licensed

under the ID/DD Community Care Act, facilities licensed under

the Specialized Mental Health Rehabilitation Act, or nursing

homes licensed under the Hospital Licensing Act shall be

conducted on an annual basis no later than July 1 of each year

and shall include among the information requested a list of all

services provided by a facility to its residents and to the

community at large and differentiate between active and

inactive beds.

In developing health care facility plans, the State Board

shall consider, but shall not be limited to, the following:

(a) The size, composition and growth of the population

of the area to be served;

(b) The number of existing and planned facilities

offering similar programs;

(c) The extent of utilization of existing facilities;

(d) The availability of facilities which may serve as

alternatives or substitutes;

(e) The availability of personnel necessary to the

operation of the facility;

(f) Multi-institutional planning and the establishment

of multi-institutional systems where feasible;

(g) The financial and economic feasibility of proposed

construction or modification; and

(h) In the case of health care facilities established

by a religious body or denomination, the needs of the

members of such religious body or denomination may be

considered to be public need.

The health care facility plans which are developed and

adopted in accordance with this Section shall form the basis

for the plan of the State to deal most effectively with

statewide health needs in regard to health care facilities.

(5) Coordinate with the Center for Comprehensive Health

Planning and other state agencies having responsibilities

affecting health care facilities, including those of licensure

and cost reporting. Beginning no later than January 1, 2013,

the Department of Public Health shall produce a written annual

report to the Governor and the General Assembly regarding the

development of the Center for Comprehensive Health Planning.

The Chairman of the State Board and the State Board

Administrator shall also receive a copy of the annual report.

(6) Solicit, accept, hold and administer on behalf of the

State any grants or bequests of money, securities or property

for use by the State Board or Center for Comprehensive Health

Planning in the administration of this Act; and enter into

contracts consistent with the appropriations for purposes

enumerated in this Act.

(7) The State Board shall prescribe procedures for review,

standards, and criteria which shall be utilized to make

periodic reviews and determinations of the appropriateness of

any existing health services being rendered by health care

facilities subject to the Act. The State Board shall consider

recommendations of the Board in making its determinations.

(8) Prescribe, in consultation with the Center for

Comprehensive Health Planning, rules, regulations, standards,

and criteria for the conduct of an expeditious review of

applications for permits for projects of construction or

modification of a health care facility, which projects are

classified as emergency, substantive, or non-substantive in

nature.

Six months after June 30, 2009 (the effective date of

Public Act 96-31), substantive projects shall include no more

than the following:

(a) Projects to construct (1) a new or replacement

facility located on a new site or (2) a replacement

facility located on the same site as the original facility

and the cost of the replacement facility exceeds the

capital expenditure minimum, which shall be reviewed by the

Board within 120 days;

(b) Projects proposing a (1) new service within an

existing healthcare facility or (2) discontinuation of a

service within an existing healthcare facility, which

shall be reviewed by the Board within 60 days; or

(c) Projects proposing a change in the bed capacity of

a health care facility by an increase in the total number

of beds or by a redistribution of beds among various

categories of service or by a relocation of beds from one

physical facility or site to another by more than 20 beds

or more than 10% of total bed capacity, as defined by the

State Board, whichever is less, over a 2-year period.

The Chairman may approve applications for exemption that

meet the criteria set forth in rules or refer them to the full

Board. The Chairman may approve any unopposed application that

meets all of the review criteria or refer them to the full

Board.

Such rules shall not abridge the right of the Center for

Comprehensive Health Planning to make recommendations on the

classification and approval of projects, nor shall such rules

prevent the conduct of a public hearing upon the timely request

of an interested party. Such reviews shall not exceed 60 days

from the date the application is declared to be complete.

(9) Prescribe rules, regulations, standards, and criteria

pertaining to the granting of permits for construction and

modifications which are emergent in nature and must be

undertaken immediately to prevent or correct structural

deficiencies or hazardous conditions that may harm or injure

persons using the facility, as defined in the rules and

regulations of the State Board. This procedure is exempt from

public hearing requirements of this Act.

(10) Prescribe rules, regulations, standards and criteria

for the conduct of an expeditious review, not exceeding 60

days, of applications for permits for projects to construct or

modify health care facilities which are needed for the care and

treatment of persons who have acquired immunodeficiency

syndrome (AIDS) or related conditions.

(11) Issue written decisions upon request of the applicant

or an adversely affected party to the Board. Requests for a

written decision shall be made within 15 days after the Board

meeting in which a final decision has been made. A "final

decision" for purposes of this Act is the decision to approve

or deny an application, or take other actions permitted under

this Act, at the time and date of the meeting that such action

is scheduled by the Board. The staff of the Board shall prepare

a written copy of the final decision and the Board shall

approve a final copy for inclusion in the formal record. The

Board shall consider, for approval, the written draft of the

final decision no later than the next scheduled Board meeting.

The written decision shall identify the applicable criteria and

factors listed in this Act and the Board's regulations that

were taken into consideration by the Board when coming to a

final decision. If the Board denies or fails to approve an

application for permit or exemption, the Board shall include in

the final decision a detailed explanation as to why the

application was denied and identify what specific criteria or

standards the applicant did not fulfill.

(12) Require at least one of its members to participate in

any public hearing, after the appointment of a majority of the

members to the Board.

(13) Provide a mechanism for the public to comment on, and

request changes to, draft rules and standards.

(14) Implement public information campaigns to regularly

inform the general public about the opportunity for public

hearings and public hearing procedures.

(15) Establish a separate set of rules and guidelines for

long-term care that recognizes that nursing homes are a

different business line and service model from other regulated

facilities. An open and transparent process shall be developed

that considers the following: how skilled nursing fits in the

continuum of care with other care providers, modernization of

nursing homes, establishment of more private rooms,

development of alternative services, and current trends in

long-term care services. The Chairman of the Board shall

appoint a permanent Health Services Review Board Long-term Care

Facility Advisory Subcommittee that shall develop and

recommend to the Board the rules to be established by the Board

under this paragraph (15). The Subcommittee shall also provide

continuous review and commentary on policies and procedures

relative to long-term care and the review of related projects.

In consultation with other experts from the health field of

long-term care, the Board and the Subcommittee shall study new

approaches to the current bed need formula and Health Service

Area boundaries to encourage flexibility and innovation in

design models reflective of the changing long-term care

marketplace and consumer preferences. The Subcommittee shall

evaluate, and make recommendations to the State Board

regarding, the buying, selling, and exchange of beds between

long-term care facilities within a specified geographic area or

drive time. The Board shall file the proposed related

administrative rules for the separate rules and guidelines for

long-term care required by this paragraph (15) by no later than

September 30, 2011. The Subcommittee shall be provided a

reasonable and timely opportunity to review and comment on any

review, revision, or updating of the criteria, standards,

procedures, and rules used to evaluate project applications as

provided under Section 12.3 of this Act.

(16) Establish a separate set of rules and guidelines for

facilities licensed under the Specialized Mental Health

Rehabilitation Act of 2013. An application for the

re-establishment of a facility in connection with the

relocation of the facility shall not be granted unless the

applicant has a contractual relationship with at least one

hospital to provide emergency and inpatient mental health

services required by facility consumers, and at least one

community mental health agency to provide oversight and

assistance to facility consumers while living in the facility,

and appropriate services, including case management, to assist

them to prepare for discharge and reside stably in the

community thereafter. No new facilities licensed under the

Specialized Mental Health Rehabilitation Act of 2013 shall be

established after the effective date of this amendatory Act of

the 98th General Assembly except in connection with the

relocation of an existing facility to a new location. An

application for a new location shall not be approved unless

there are adequate community services accessible to the

consumers within a reasonable distance, or by use of public

transportation, so as to facilitate the goal of achieving

maximum individual self-care and independence. At no time shall

the total number of authorized beds under this Act in

facilities licensed under the Specialized Mental Health

Rehabilitation Act of 2013 exceed the number of authorized beds

on the effective date of this amendatory Act of the 98th

General Assembly.

(Source: P.A. 97-38, eff. 6-28-11; 97-227, eff. 1-1-12; 97-813,

eff. 7-13-12; 97-1045, eff. 8-21-13; 97-1115, eff. 8-27-12;

98-414, eff. 1-1-14; 98-463, eff. 8-16-13.)

Section 5-10. The Illinois Public Aid Code is amended by

changing Sections 5-5.12 and 5-30 and by adding Section 5-30.1

as follows:

(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)

Sec. 5-5.12. Pharmacy payments.

(a) Every request submitted by a pharmacy for reimbursement

under this Article for prescription drugs provided to a

recipient of aid under this Article shall include the name of

the prescriber or an acceptable identification number as

established by the Department.

(b) Pharmacies providing prescription drugs under this

Article shall be reimbursed at a rate which shall include a

professional dispensing fee as determined by the Illinois

Department, plus the current acquisition cost of the

prescription drug dispensed. The Illinois Department shall

update its information on the acquisition costs of all

prescription drugs no less frequently than every 30 days.

However, the Illinois Department may set the rate of

reimbursement for the acquisition cost, by rule, at a

percentage of the current average wholesale acquisition cost.

(c) (Blank).

(d) The Department shall review utilization of narcotic

medications in the medical assistance program and impose

utilization controls that protect against abuse.

(e) When making determinations as to which drugs shall be

on a prior approval list, the Department shall include as part

of the analysis for this determination, the degree to which a

drug may affect individuals in different ways based on factors

including the gender of the person taking the medication.

(f) The Department shall cooperate with the Department of

Public Health and the Department of Human Services Division of

Mental Health in identifying psychotropic medications that,

when given in a particular form, manner, duration, or frequency

(including "as needed") in a dosage, or in conjunction with

other psychotropic medications to a nursing home resident or to

a resident of a facility licensed under the ID/DD Community

Care Act, may constitute a chemical restraint or an

"unnecessary drug" as defined by the Nursing Home Care Act or

Titles XVIII and XIX of the Social Security Act and the

implementing rules and regulations. The Department shall

require prior approval for any such medication prescribed for a

nursing home resident or to a resident of a facility licensed

under the ID/DD Community Care Act, that appears to be a

chemical restraint or an unnecessary drug. The Department shall

consult with the Department of Human Services Division of

Mental Health in developing a protocol and criteria for

deciding whether to grant such prior approval.

(g) The Department may by rule provide for reimbursement of

the dispensing of a 90-day supply of a generic or brand name,

non-narcotic maintenance medication in circumstances where it

is cost effective.

(g-5) On and after July 1, 2012, the Department may require

the dispensing of drugs to nursing home residents be in a 7-day

supply or other amount less than a 31-day supply. The

Department shall pay only one dispensing fee per 31-day supply.

(h) Effective July 1, 2011, the Department shall

discontinue coverage of select over-the-counter drugs,

including analgesics and cough and cold and allergy

medications.

(h-5) On and after July 1, 2012, the Department shall

impose utilization controls, including, but not limited to,

prior approval on specialty drugs, oncolytic drugs, drugs for

the treatment of HIV or AIDS, immunosuppressant drugs, and

biological products in order to maximize savings on these

drugs. The Department may adjust payment methodologies for

non-pharmacy billed drugs in order to incentivize the selection

of lower-cost drugs. For drugs for the treatment of AIDS, the

Department shall take into consideration the potential for

non-adherence by certain populations, and shall develop

protocols with organizations or providers primarily serving

those with HIV/AIDS, as long as such measures intend to

maintain cost neutrality with other utilization management

controls such as prior approval. For hemophilia, the Department

shall develop a program of utilization review and control which

may include, in the discretion of the Department, prior

approvals. The Department may impose special standards on

providers that dispense blood factors which shall include, in

the discretion of the Department, staff training and education;

patient outreach and education; case management; in-home

patient assessments; assay management; maintenance of stock;

emergency dispensing timeframes; data collection and

reporting; dispensing of supplies related to blood factor

infusions; cold chain management and packaging practices; care

coordination; product recalls; and emergency clinical

consultation. The Department may require patients to receive a

comprehensive examination annually at an appropriate provider

in order to be eligible to continue to receive blood factor.

(i) On and after July 1, 2012, the Department shall reduce

any rate of reimbursement for services or other payments or

alter any methodologies authorized by this Code to reduce any

rate of reimbursement for services or other payments in

accordance with Section 5-5e.

(j) On and after July 1, 2012, the Department shall impose

limitations on prescription drugs such that the Department

shall not provide reimbursement for more than 4 prescriptions,

including 3 brand name prescriptions, for distinct drugs in a

30-day period, unless prior approval is received for all

prescriptions in excess of the 4-prescription limit. Drugs in

the following therapeutic classes shall not be subject to prior

approval as a result of the 4-prescription limit:

immunosuppressant drugs, oncolytic drugs, and anti-retroviral

drugs, and, on or after July 1, 2014, antipsychotic drugs. On

or after July 1, 2014, the Department may exempt children with

complex medical needs enrolled in a care coordination entity

contracted with the Department to solely coordinate care for

such children, if the Department determines that the entity has

a comprehensive drug reconciliation program.

(k) No medication therapy management program implemented

by the Department shall be contrary to the provisions of the

Pharmacy Practice Act.

(l) Any provider enrolled with the Department that bills

the Department for outpatient drugs and is eligible to enroll

in the federal Drug Pricing Program under Section 340B of the

federal Public Health Services Act shall enroll in that

program. No entity participating in the federal Drug Pricing

Program under Section 340B of the federal Public Health

Services Act may exclude Medicaid from their participation in

that program, although the Department may exclude entities

defined in Section 1905(l)(2)(B) of the Social Security Act

from this requirement.

(Source: P.A. 97-38, eff. 6-28-11; 97-74, eff. 6-30-11; 97-333,

eff. 8-12-11; 97-426, eff. 1-1-12; 97-689, eff. 6-14-12;

97-813, eff. 7-13-12; 98-463, eff. 8-16-13.)

(305 ILCS 5/5-30)

Sec. 5-30. Care coordination.

(a) At least 50% of recipients eligible for comprehensive

medical benefits in all medical assistance programs or other

health benefit programs administered by the Department,

including the Children's Health Insurance Program Act and the

Covering ALL KIDS Health Insurance Act, shall be enrolled in a

care coordination program by no later than January 1, 2015. For

purposes of this Section, "coordinated care" or "care

coordination" means delivery systems where recipients will

receive their care from providers who participate under

contract in integrated delivery systems that are responsible

for providing or arranging the majority of care, including

primary care physician services, referrals from primary care

physicians, diagnostic and treatment services, behavioral

health services, in-patient and outpatient hospital services,

dental services, and rehabilitation and long-term care

services. The Department shall designate or contract for such

integrated delivery systems (i) to ensure enrollees have a

choice of systems and of primary care providers within such

systems; (ii) to ensure that enrollees receive quality care in

a culturally and linguistically appropriate manner; and (iii)

to ensure that coordinated care programs meet the diverse needs

of enrollees with developmental, mental health, physical, and

age-related disabilities.

(b) Payment for such coordinated care shall be based on

arrangements where the State pays for performance related to

health care outcomes, the use of evidence-based practices, the

use of primary care delivered through comprehensive medical

homes, the use of electronic medical records, and the

appropriate exchange of health information electronically made

either on a capitated basis in which a fixed monthly premium

per recipient is paid and full financial risk is assumed for

the delivery of services, or through other risk-based payment

arrangements.

(c) To qualify for compliance with this Section, the 50%

goal shall be achieved by enrolling medical assistance

enrollees from each medical assistance enrollment category,

including parents, children, seniors, and people with

disabilities to the extent that current State Medicaid payment

laws would not limit federal matching funds for recipients in

care coordination programs. In addition, services must be more

comprehensively defined and more risk shall be assumed than in

the Department's primary care case management program as of the

effective date of this amendatory Act of the 96th General

Assembly.

(d) The Department shall report to the General Assembly in

a separate part of its annual medical assistance program

report, beginning April, 2012 until April, 2016, on the

progress and implementation of the care coordination program

initiatives established by the provisions of this amendatory

Act of the 96th General Assembly. The Department shall include

in its April 2011 report a full analysis of federal laws or

regulations regarding upper payment limitations to providers

and the necessary revisions or adjustments in rate

methodologies and payments to providers under this Code that

would be necessary to implement coordinated care with full

financial risk by a party other than the Department.

(e) Integrated Care Program for individuals with chronic

mental health conditions.

(1) The Integrated Care Program shall encompass

services administered to recipients of medical assistance

under this Article to prevent exacerbations and

complications using cost-effective, evidence-based

practice guidelines and mental health management

strategies.

(2) The Department may utilize and expand upon existing

contractual arrangements with integrated care plans under

the Integrated Care Program for providing the coordinated

care provisions of this Section.

(3) Payment for such coordinated care shall be based on

arrangements where the State pays for performance related

to mental health outcomes on a capitated basis in which a

fixed monthly premium per recipient is paid and full

financial risk is assumed for the delivery of services, or

through other risk-based payment arrangements such as

provider-based care coordination.

(4) The Department shall examine whether chronic

mental health management programs and services for

recipients with specific chronic mental health conditions

do any or all of the following:

(A) Improve the patient's overall mental health in

a more expeditious and cost-effective manner.

(B) Lower costs in other aspects of the medical

assistance program, such as hospital admissions,

emergency room visits, or more frequent and

inappropriate psychotropic drug use.

(5) The Department shall work with the facilities and

any integrated care plan participating in the program to

identify and correct barriers to the successful

implementation of this subsection (e) prior to and during

the implementation to best facilitate the goals and

objectives of this subsection (e).

(f) A hospital that is located in a county of the State in

which the Department mandates some or all of the beneficiaries

of the Medical Assistance Program residing in the county to

enroll in a Care Coordination Program, as set forth in Section

5-30 of this Code, shall not be eligible for any non-claims

based payments not mandated by Article V-A of this Code for

which it would otherwise be qualified to receive, unless the

hospital is a Coordinated Care Participating Hospital no later

than 60 days after the effective date of this amendatory Act of

the 97th General Assembly or 60 days after the first mandatory

enrollment of a beneficiary in a Coordinated Care program. For

purposes of this subsection, "Coordinated Care Participating

Hospital" means a hospital that meets one of the following

criteria:

(1) The hospital has entered into a contract to provide

hospital services with one or more MCOs to enrollees of the

care coordination program.

(2) The hospital has not been offered a contract by a

care coordination plan that the Department has determined

to be a good faith offer and that pays at least as much as

the Department would pay, on a fee-for-service basis, not

including disproportionate share hospital adjustment

payments or any other supplemental adjustment or add-on

payment to the base fee-for-service rate, except to the

extent such adjustments or add-on payments are

incorporated into the development of the applicable MCO

capitated rates.

As used in this subsection (f), "MCO" means any entity

which contracts with the Department to provide services where

payment for medical services is made on a capitated basis.

(g) No later than August 1, 2013, the Department shall

issue a purchase of care solicitation for Accountable Care

Entities (ACE) to serve any children and parents or caretaker

relatives of children eligible for medical assistance under

this Article. An ACE may be a single corporate structure or a

network of providers organized through contractual

relationships with a single corporate entity. The solicitation

shall require that:

(1) An ACE operating in Cook County be capable of

serving at least 40,000 eligible individuals in that

county; an ACE operating in Lake, Kane, DuPage, or Will

Counties be capable of serving at least 20,000 eligible

individuals in those counties and an ACE operating in other

regions of the State be capable of serving at least 10,000

eligible individuals in the region in which it operates.

During initial periods of mandatory enrollment, the

Department shall require its enrollment services

contractor to use a default assignment algorithm that

ensures if possible an ACE reaches the minimum enrollment

levels set forth in this paragraph.

(2) An ACE must include at a minimum the following

types of providers: primary care, specialty care,

hospitals, and behavioral healthcare.

(3) An ACE shall have a governance structure that

includes the major components of the health care delivery

system, including one representative from each of the

groups listed in paragraph (2).

(4) An ACE must be an integrated delivery system,

including a network able to provide the full range of

services needed by Medicaid beneficiaries and system

capacity to securely pass clinical information across

participating entities and to aggregate and analyze that

data in order to coordinate care.

(5) An ACE must be capable of providing both care

coordination and complex case management, as necessary, to

beneficiaries. To be responsive to the solicitation, a

potential ACE must outline its care coordination and

complex case management model and plan to reduce the cost

of care.

(6) In the first 18 months of operation, unless the ACE

selects a shorter period, an ACE shall be paid care

coordination fees on a per member per month basis that are

projected to be cost neutral to the State during the term

of their payment and, subject to federal approval, be

eligible to share in additional savings generated by their

care coordination.

(7) In months 19 through 36 of operation, unless the

ACE selects a shorter period, an ACE shall be paid on a

pre-paid capitation basis for all medical assistance

covered services, under contract terms similar to Managed

Care Organizations (MCO), with the Department sharing the

risk through either stop-loss insurance for extremely high

cost individuals or corridors of shared risk based on the

overall cost of the total enrollment in the ACE. The ACE

shall be responsible for claims processing, encounter data

submission, utilization control, and quality assurance.

(8) In the fourth and subsequent years of operation, an

ACE shall convert to a Managed Care Community Network

(MCCN), as defined in this Article, or Health Maintenance

Organization pursuant to the Illinois Insurance Code,

accepting full-risk capitation payments.

The Department shall allow potential ACE entities 5 months

from the date of the posting of the solicitation to submit

proposals. After the solicitation is released, in addition to

the MCO rate development data available on the Department's

website, subject to federal and State confidentiality and

privacy laws and regulations, the Department shall provide 2

years of de-identified summary service data on the targeted

population, split between children and adults, showing the

historical type and volume of services received and the cost of

those services to those potential bidders that sign a data use

agreement. The Department may add up to 2 non-state government

employees with expertise in creating integrated delivery

systems to its review team for the purchase of care

solicitation described in this subsection. Any such

individuals must sign a no-conflict disclosure and

confidentiality agreement and agree to act in accordance with

all applicable State laws.

During the first 2 years of an ACE's operation, the

Department shall provide claims data to the ACE on its

enrollees on a periodic basis no less frequently than monthly.

Nothing in this subsection shall be construed to limit the

Department's mandate to enroll 50% of its beneficiaries into

care coordination systems by January 1, 2015, using all

available care coordination delivery systems, including Care

Coordination Entities (CCE), MCCNs, or MCOs, nor be construed

to affect the current CCEs, MCCNs, and MCOs selected to serve

seniors and persons with disabilities prior to that date.

Nothing in this subsection precludes the Department from

considering future proposals for new ACEs or expansion of

existing ACEs at the discretion of the Department.

(h) Department contracts with MCOs and other entities

reimbursed by risk based capitation shall have a minimum

medical loss ratio of 85%, shall require the MCO or other

entity to pay claims within 30 days of receiving a bill that

contains all the essential information needed to adjudicate the

bill, and shall require the entity to pay a penalty that is at

least equal to the penalty imposed under the Illinois Insurance

Code for any claims not paid within this time period shall

require the entity to establish an appeals and grievances

process for consumers and providers, and shall require the

entity to provide a quality assurance and utilization review

program. Entities contracted with the Department to coordinate

healthcare regardless of risk shall be measured utilizing the

same quality metrics. The quality metrics may be population

specific. Any contracted entity serving at least 5,000 seniors

or people with disabilities or 15,000 individuals in other

populations covered by the Medical Assistance Program that has

been receiving full-risk capitation for a year shall be

accredited by a national accreditation organization authorized

by the Department within 2 years after the date it is eligible

to become accredited. The requirements of this subsection shall

apply to contracts with MCOs entered into or renewed or

extended after June 1, 2013.

(h-5) The Department shall monitor and enforce compliance

by MCOs with agreements they have entered into with providers

on issues that include, but are not limited to, timeliness of

payment, payment rates, and processes for obtaining prior

approval. The Department may impose sanctions on MCOs for

violating provisions of those agreements that include, but are

not limited to, financial penalties, suspension of enrollment

of new enrollees, and termination of the MCO's contract with

the Department. As used in this subsection (h-5), "MCO" has the

meaning ascribed to that term in Section 5-30.1 of this Code.

(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)

(305 ILCS 5/5-30.1 new)

Sec. 5-30.1. Managed care protections.

(a) As used in this Section:

"Managed care organization" or "MCO" means any entity which

contracts with the Department to provide services where payment

for medical services is made on a capitated basis.

"Emergency services" include:

(1) emergency services, as defined by Section 10 of the

Managed Care Reform and Patient Rights Act;

(2) emergency medical screening examinations, as

defined by Section 10 of the Managed Care Reform and

Patient Rights Act;

(3) post-stabilization medical services, as defined by

Section 10 of the Managed Care Reform and Patient Rights

Act; and

(4) emergency medical conditions, as defined by

Section 10 of the Managed Care Reform and Patient Rights

Act.

(b) As provided by Section 5-16.12, managed care

organizations are subject to the provisions of the Managed Care

Reform and Patient Rights Act.

(c) An MCO shall pay any provider of emergency services

that does not have in effect a contract with the contracted

Medicaid MCO. The default rate of reimbursement shall be the

rate paid under Illinois Medicaid fee-for-service program

methodology, including all policy adjusters, including but not

limited to Medicaid High Volume Adjustments, Medicaid

Percentage Adjustments, Outpatient High Volume Adjustments,

and all outlier add-on adjustments to the extent such

adjustments are incorporated in the development of the

applicable MCO capitated rates.

(d) An MCO shall pay for all post-stabilization services as

a covered service in any of the following situations:

(1) the MCO authorized such services;

(2) such services were administered to maintain the

enrollee's stabilized condition within one hour after a

request to the MCO for authorization of further

post-stabilization services;

(3) the MCO did not respond to a request to authorize

such services within one hour;

(4) the MCO could not be contacted; or

(5) the MCO and the treating provider, if the treating

provider is a non-affiliated provider, could not reach an

agreement concerning the enrollee's care and an affiliated

provider was unavailable for a consultation, in which case

the MCO must pay for such services rendered by the treating

non-affiliated provider until an affiliated provider was

reached and either concurred with the treating

non-affiliated provider's plan of care or assumed

responsibility for the enrollee's care. Such payment shall

be made at the default rate of reimbursement paid under

Illinois Medicaid fee-for-service program methodology,

including all policy adjusters, including but not limited

to Medicaid High Volume Adjustments, Medicaid Percentage

Adjustments, Outpatient High Volume Adjustments and all

outlier add-on adjustments to the extent that such

adjustments are incorporated in the development of the

applicable MCO capitated rates.

(e) The following requirements apply to MCOs in determining

payment for all emergency services:

(1) MCOs shall not impose any requirements for prior

approval of emergency services.

(2) The MCO shall cover emergency services provided to

enrollees who are temporarily away from their residence and

outside the contracting area to the extent that the

enrollees would be entitled to the emergency services if

they still were within the contracting area.

(3) The MCO shall have no obligation to cover medical

services provided on an emergency basis that are not

covered services under the contract.

(4) The MCO shall not condition coverage for emergency

services on the treating provider notifying the MCO of the

enrollee's screening and treatment within 10 days after

presentation for emergency services.

(5) The determination of the attending emergency

physician, or the provider actually treating the enrollee,

of whether an enrollee is sufficiently stabilized for

discharge or transfer to another facility, shall be binding

on the MCO. The MCO shall cover emergency services for all

enrollees whether the emergency services are provided by an

affiliated or non-affiliated provider.

(6) The MCO's financial responsibility for

post-stabilization care services it has not pre-approved

ends when:

(A) a plan physician with privileges at the

treating hospital assumes responsibility for the

enrollee's care;

(B) a plan physician assumes responsibility for

the enrollee's care through transfer;

(C) a contracting entity representative and the

treating physician reach an agreement concerning the

enrollee's care; or

(D) the enrollee is discharged.

(f) Network adequacy.

(1) The Department shall:

(A) ensure that an adequate provider network is in

place, taking into consideration health professional

shortage areas and medically underserved areas;

(B) publicly release an explanation of its process

for analyzing network adequacy;

(C) periodically ensure that an MCO continues to

have an adequate network in place; and

(D) require MCOs to maintain an updated and public

list of network providers.

(g) Timely payment of claims.

(1) The MCO shall pay a claim within 30 days of

receiving a claim that contains all the essential

information needed to adjudicate the claim.

(2) The MCO shall notify the billing party of its

inability to adjudicate a claim within 30 days of receiving

that claim.

(3) The MCO shall pay a penalty that is at least equal

to the penalty imposed under the Illinois Insurance Code

for any claims not timely paid.

(4) The Department may establish a process for MCOs to

expedite payments to providers based on criteria

established by the Department.

(h) The Department shall not expand mandatory MCO

enrollment into new counties beyond those counties already

designated by the Department as of June 1, 2014 for the

individuals whose eligibility for medical assistance is not the

seniors or people with disabilities population until the

Department provides an opportunity for accountable care

entities and MCOs to participate in such newly designated

counties.

(i) The requirements of this Section apply to contracts

with accountable care entities and MCOs entered into, amended,

or renewed after the effective date of this amendatory Act of

the 98th General Assembly.

Article 10

Section 10-5. The Specialized Mental Health Rehabilitation

Act of 2013 is amended by changing Sections 1-101.5, 1-101.6,

1-102, 4-108, and 5-101 and by adding Section 4-108.5 as

follows:

(210 ILCS 49/1-101.5)

Sec. 1-101.5. Prior law.

(a) This Act provides for licensure of long term care

facilities that are federally designated as institutions for

the mentally diseased on the effective date of this Act and

specialize in providing services to individuals with a serious

mental illness. On and after the effective date of this Act,

these facilities shall be governed by this Act instead of the

Nursing Home Care Act.

(b) All consent decrees that apply to facilities federally

designated as institutions for the mentally diseased shall

continue to apply to facilities licensed under this Act.

(c) A facility licensed under this Act may voluntarily

close, and the facility may reopen in an underserved region of

the State, if the facility receives a certificate of need from

the Health Facilities and Services Review Board. At no time

shall the total number of licensed beds under this Act exceed

the total number of licensed beds existing on July 22, 2013

(the effective date of Public Act 98-104).

(Source: P.A. 98-104, eff. 7-22-13.)

(210 ILCS 49/1-101.6)

Sec. 1-101.6. Mental health system planning. The General

Assembly finds the services contained in this Act are necessary

for the effective delivery of mental health services for the

citizens of the State of Illinois. The General Assembly also

finds that the mental health system in the State requires

further review to develop additional needed services. To ensure

the adequacy of community-based services and to offer choice to

all individuals with serious mental illness who choose to live

in the community, and for whom the community is the appropriate

setting, but are at risk of institutional care, the Governor

shall convene a working group to develop the process and

procedure for identifying needed services in the different

geographic regions of the State. The Governor shall include the

Division of Mental Health of the Department of Human Services,

the Department of Healthcare and Family Services, the

Department of Public Health, community mental health

providers, statewide associations of mental health providers,

mental health advocacy groups, and any other entity as deemed

appropriate for participation in the working group. The

Department of Human Services shall provide staff and support to

this working group.

Before September 1, 2014, the State shall develop and

implement a service authorization system available 24 hours a

day, 7 days a week for approval of services in the following 3

levels of care under this Act: crisis stabilization; recovery

and rehabilitation supports; and transitional living units.

(Source: P.A. 98-104, eff. 7-22-13.)

(210 ILCS 49/1-102)

Sec. 1-102. Definitions. For the purposes of this Act,

unless the context otherwise requires:

"Abuse" means any physical or mental injury or sexual

assault inflicted on a consumer other than by accidental means

in a facility.

"Accreditation" means any of the following:

(1) the Joint Commission;

(2) the Commission on Accreditation of Rehabilitation

Facilities;

(3) the Healthcare Facilities Accreditation Program;

or

(4) any other national standards of care as approved by

the Department.

"Applicant" means any person making application for a

license or a provisional license under this Act.

"Consumer" means a person, 18 years of age or older,

admitted to a mental health rehabilitation facility for

evaluation, observation, diagnosis, treatment, stabilization,

recovery, and rehabilitation.

"Consumer" does not mean any of the following:

(i) an individual requiring a locked setting;

(ii) an individual requiring psychiatric

hospitalization because of an acute psychiatric crisis;

(iii) an individual under 18 years of age;

(iv) an individual who is actively suicidal or violent

toward others;

(v) an individual who has been found unfit to stand

trial;

(vi) an individual who has been found not guilty by

reason of insanity based on committing a violent act, such

as sexual assault, assault with a deadly weapon, arson, or

murder;

(vii) an individual subject to temporary detention and

examination under Section 3-607 of the Mental Health and

Developmental Disabilities Code;

(viii) an individual deemed clinically appropriate for

inpatient admission in a State psychiatric hospital; and

(ix) an individual transferred by the Department of

Corrections pursuant to Section 3-8-5 of the Unified Code

of Corrections.

"Consumer record" means a record that organizes all

information on the care, treatment, and rehabilitation

services rendered to a consumer in a specialized mental health

rehabilitation facility.

"Controlled drugs" means those drugs covered under the

federal Comprehensive Drug Abuse Prevention Control Act of

1970, as amended, or the Illinois Controlled Substances Act.

"Department" means the Department of Public Health.

"Discharge" means the full release of any consumer from a

facility.

"Drug administration" means the act in which a single dose

of a prescribed drug or biological is given to a consumer. The

complete act of administration entails removing an individual

dose from a container, verifying the dose with the prescriber's

orders, giving the individual dose to the consumer, and

promptly recording the time and dose given.

"Drug dispensing" means the act entailing the following of

a prescription order for a drug or biological and proper

selection, measuring, packaging, labeling, and issuance of the

drug or biological to a consumer.

"Emergency" means a situation, physical condition, or one

or more practices, methods, or operations which present

imminent danger of death or serious physical or mental harm to

consumers of a facility.

"Facility" means a specialized mental health

rehabilitation facility that provides at least one of the

following services: (1) triage center; (2) crisis

stabilization; (3) recovery and rehabilitation supports; or

(4) transitional living units for 3 or more persons. The

facility shall provide a 24-hour program that provides

intensive support and recovery services designed to assist

persons, 18 years or older, with mental disorders to develop

the skills to become self-sufficient and capable of increasing

levels of independent functioning. It includes facilities that

meet the following criteria:

(1) 100% of the consumer population of the facility has

a diagnosis of serious mental illness;

(2) no more than 15% of the consumer population of the

facility is 65 years of age or older;

(3) none of the consumers are non-ambulatory;

(4) none of the consumers have a primary diagnosis of

moderate, severe, or profound intellectual disability; and

(5) the facility must have been licensed under the

Specialized Mental Health Rehabilitation Act or the

Nursing Home Care Act immediately preceding the effective

date of this Act and qualifies as a institute for mental

disease under the federal definition of the term.

"Facility" does not include the following:

(1) a home, institution, or place operated by the

federal government or agency thereof, or by the State of

Illinois;

(2) a hospital, sanitarium, or other institution whose

principal activity or business is the diagnosis, care, and

treatment of human illness through the maintenance and

operation as organized facilities therefor which is

required to be licensed under the Hospital Licensing Act;

(3) a facility for child care as defined in the Child

Care Act of 1969;

(4) a community living facility as defined in the

Community Living Facilities Licensing Act;

(5) a nursing home or sanatorium operated solely by and

for persons who rely exclusively upon treatment by

spiritual means through prayer, in accordance with the

creed or tenets of any well-recognized church or religious

denomination; however, such nursing home or sanatorium

shall comply with all local laws and rules relating to

sanitation and safety;

(6) a facility licensed by the Department of Human

Services as a community-integrated living arrangement as

defined in the Community-Integrated Living Arrangements

Licensure and Certification Act;

(7) a supportive residence licensed under the

Supportive Residences Licensing Act;

(8) a supportive living facility in good standing with

the program established under Section 5-5.01a of the

Illinois Public Aid Code, except only for purposes of the

employment of persons in accordance with Section 3-206.01

of the Nursing Home Care Act;

(9) an assisted living or shared housing establishment

licensed under the Assisted Living and Shared Housing Act,

except only for purposes of the employment of persons in

accordance with Section 3-206.01 of the Nursing Home Care

Act;

(10) an Alzheimer's disease management center

alternative health care model licensed under the

Alternative Health Care Delivery Act;

(11) a home, institution, or other place operated by or

under the authority of the Illinois Department of Veterans'

Affairs;

(12) a facility licensed under the ID/DD Community Care

Act; or

(13) a facility licensed under the Nursing Home Care

Act after the effective date of this Act.

"Executive director" means a person who is charged with the

general administration and supervision of a facility licensed

under this Act.

"Guardian" means a person appointed as a guardian of the

person or guardian of the estate, or both, of a consumer under

the Probate Act of 1975.

"Identified offender" means a person who meets any of the

following criteria:

(1) Has been convicted of, found guilty of, adjudicated

delinquent for, found not guilty by reason of insanity for,

or found unfit to stand trial for, any felony offense

listed in Section 25 of the Health Care Worker Background

Check Act, except for the following:

(i) a felony offense described in Section 10-5 of

the Nurse Practice Act;

(ii) a felony offense described in Section 4, 5, 6,

8, or 17.02 of the Illinois Credit Card and Debit Card

Act;

(iii) a felony offense described in Section 5, 5.1,

5.2, 7, or 9 of the Cannabis Control Act;

(iv) a felony offense described in Section 401,

401.1, 404, 405, 405.1, 407, or 407.1 of the Illinois

Controlled Substances Act; and

(v) a felony offense described in the

Methamphetamine Control and Community Protection Act.

(2) Has been convicted of, adjudicated delinquent for,

found not guilty by reason of insanity for, or found unfit

to stand trial for, any sex offense as defined in

subsection (c) of Section 10 of the Sex Offender Management

Board Act.

"Transitional living units" are residential units within a

facility that have the purpose of assisting the consumer in

developing and reinforcing the necessary skills to live

independently outside of the facility. The duration of stay in

such a setting shall not exceed 120 days for each consumer.

Nothing in this definition shall be construed to be a

prerequisite for transitioning out of a facility.

"Licensee" means the person, persons, firm, partnership,

association, organization, company, corporation, or business

trust to which a license has been issued.

"Misappropriation of a consumer's property" means the

deliberate misplacement, exploitation, or wrongful temporary

or permanent use of a consumer's belongings or money without

the consent of a consumer or his or her guardian.

"Neglect" means a facility's failure to provide, or willful

withholding of, adequate medical care, mental health

treatment, psychiatric rehabilitation, personal care, or

assistance that is necessary to avoid physical harm and mental

anguish of a consumer.

"Personal care" means assistance with meals, dressing,

movement, bathing, or other personal needs, maintenance, or

general supervision and oversight of the physical and mental

well-being of an individual who is incapable of maintaining a

private, independent residence or who is incapable of managing

his or her person, whether or not a guardian has been appointed

for such individual. "Personal care" shall not be construed to

confine or otherwise constrain a facility's pursuit to develop

the skills and abilities of a consumer to become

self-sufficient and capable of increasing levels of

independent functioning.

"Recovery and rehabilitation supports" means a program

that facilitates a consumer's longer-term symptom management

and stabilization while preparing the consumer for

transitional living units by improving living skills and

community socialization. The duration of stay in such a setting

shall be established by the Department by rule.

"Restraint" means:

(i) a physical restraint that is any manual method or

physical or mechanical device, material, or equipment

attached or adjacent to a consumer's body that the consumer

cannot remove easily and restricts freedom of movement or

normal access to one's body; devices used for positioning,

including, but not limited to, bed rails, gait belts, and

cushions, shall not be considered to be restraints for

purposes of this Section; or

(ii) a chemical restraint that is any drug used for

discipline or convenience and not required to treat medical

symptoms; the Department shall, by rule, designate certain

devices as restraints, including at least all those devices

that have been determined to be restraints by the United

States Department of Health and Human Services in

interpretive guidelines issued for the purposes of

administering Titles XVIII and XIX of the federal Social

Security Act. For the purposes of this Act, restraint shall

be administered only after utilizing a coercive free

environment and culture.

"Self-administration of medication" means consumers shall

be responsible for the control, management, and use of their

own medication.

"Crisis stabilization" means a secure and separate unit

that provides short-term behavioral, emotional, or psychiatric

crisis stabilization as an alternative to hospitalization or

re-hospitalization for consumers from residential or community

placement. The duration of stay in such a setting shall not

exceed 21 days for each consumer.

"Therapeutic separation" means the removal of a consumer

from the milieu to a room or area which is designed to aid in

the emotional or psychiatric stabilization of that consumer.

"Triage center" means a non-residential 23-hour center

that serves as an alternative to emergency room care,

hospitalization, or re-hospitalization for consumers in need

of short-term crisis stabilization. Consumers may access a

triage center from a number of referral sources, including

family, emergency rooms, hospitals, community behavioral

health providers, federally qualified health providers, or

schools, including colleges or universities. A triage center

may be located in a building separate from the licensed

location of a facility, but shall not be more than 1,000 feet

from the licensed location of the facility and must meet all of

the facility standards applicable to the licensed location. If

the triage center does operate in a separate building, safety

personnel shall be provided, on site, 24 hours per day and the

triage center shall meet all other staffing requirements

without counting any staff employed in the main facility

building.

(Source: P.A. 98-104, eff. 7-22-13.)

(210 ILCS 49/4-108)

Sec. 4-108. Surveys and inspections. The Department shall

conduct surveys of licensed facilities and their certified

programs and services. The Department shall review the records

or premises, or both, as it deems appropriate for the purpose

of determining compliance with this Act and the rules

promulgated under this Act. The Department shall have access to

and may reproduce or photocopy any books, records, and other

documents maintained by the facility to the extent necessary to

carry out this Act and the rules promulgated under this Act.

The Department shall not divulge or disclose the contents of a

record under this Section as otherwise prohibited by this Act.

Any holder of a license or applicant for a license shall be

deemed to have given consent to any authorized officer,

employee, or agent of the Department to enter and inspect the

facility in accordance with this Article. Refusal to permit

such entry or inspection shall constitute grounds for denial,

suspension, or revocation of a license under this Act.

(1) The Department shall conduct surveys to determine

compliance and may conduct surveys to investigate

complaints.

(2) Determination of compliance with the service

requirements shall be based on a survey centered on

individuals that sample services being provided.

(3) Determination of compliance with the general

administrative requirements shall be based on a review of

facility records and observation of individuals and staff.

(4) The Department shall conduct surveys of licensed

facilities and their certified programs and services to

determine the extent to which these facilities provide high

quality interventions, especially evidence-based

practices, appropriate to the assessed clinical needs of

individuals in the various levels of care.

(Source: P.A. 98-104, eff. 7-22-13.)

(210 ILCS 49/4-108.5 new)

Sec. 4-108.5. Provisional licensure period; surveys.

During the provisional licensure period, the Department shall

conduct surveys to determine compliance with timetables and

benchmarks with a facility's provisional licensure application

plan of operation. Timetables and benchmarks shall be

established in rule and shall include, but not be limited to,

the following: (1) training of new and existing staff; (2)

establishment of a data collection and reporting program for

the facility's Quality Assessment and Performance Improvement

Program; and (3) compliance with building environment

standards beyond compliance with Chapter 33 of the National

Fire Protection Association (NFPA) 101 Life Safety Code.

During the provisional licensure period, the Department

shall conduct State licensure surveys as well as a conformance

standard review to determine compliance with timetables and

benchmarks associated with the accreditation process.

Timetables and benchmarks shall be met in accordance with the

preferred accrediting organization conformance standards and

recommendations and shall include, but not be limited to,

conducting a comprehensive facility self-evaluation in

accordance with an established national accreditation program.

The facility shall submit all data reporting and outcomes

required by accrediting organization to the Department of

Public Health for review to determine progress towards

accreditation. Accreditation status shall supplement but not

replace the State's licensure surveys of facilities licensed

under this Act and their certified programs and services to

determine the extent to which these facilities provide high

quality interventions, especially evidence-based practices,

appropriate to the assessed clinical needs of individuals in

the 4 certified levels of care.

Except for incidents involving the potential for harm,

serious harm, death, or substantial facility failure to address

a serious systemic issue within 60 days, findings of the

facility's root cause analysis of problems and the facility's

Quality Assessment and Performance Improvement program in

accordance with item (22) of Section 4-104 shall not be used as

a basis for non-compliance.

The Department shall have the authority to hire licensed

practitioners of the healing arts and qualified mental health

professionals to consult with and participate in survey and

inspection activities.

(210 ILCS 49/5-101)

Sec. 5-101. Managed care entity, coordinated care entity,

and accountable care entity payments. For facilities licensed

by the Department of Public Health under this Act, the payment

for services provided shall be determined by negotiation with

managed care entities, coordinated care entities, or

accountable care entities. However, for 3 years after the

effective date of this Act, in no event shall the reimbursement

rate paid to facilities licensed under this Act be less than

the rate in effect on June 30, 2013 less $7.07 times the number

of occupied bed days, as that term is defined in Article V-B of

the Illinois Public Aid Code, for each facility previously

licensed under the Nursing Home Care Act on June 30, 2013; or

the rate in effect on June 30, 2013 for each facility licensed

under the Specialized Mental Health Rehabilitation Act on June

30, 2013. Any adjustment in the support component or the

capital component for facilities licensed by the Department of

Public Health under the Nursing Home Care Act shall apply

equally to facilities licensed by the Department of Public

Health under this Act for the duration of the provisional

licensure period as defined in Section 4-105 of this Act.

The Department of Healthcare and Family Services shall

publish a reimbursement rate for triage, crisis stabilization,

and transitional living services by December 1, 2014.

(Source: P.A. 98-104, eff. 7-22-13.)

Article 15

Section 15-5. The Illinois Public Aid Code is amended by

changing Sections 5A-8 and 5A-12.2 as follows:

(305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)

Sec. 5A-8. Hospital Provider Fund.

(a) There is created in the State Treasury the Hospital

Provider Fund. Interest earned by the Fund shall be credited to

the Fund. The Fund shall not be used to replace any moneys

appropriated to the Medicaid program by the General Assembly.

(b) The Fund is created for the purpose of receiving moneys

in accordance with Section 5A-6 and disbursing moneys only for

the following purposes, notwithstanding any other provision of

law:

(1) For making payments to hospitals as required under

this Code, under the Children's Health Insurance Program

Act, under the Covering ALL KIDS Health Insurance Act, and

under the Long Term Acute Care Hospital Quality Improvement

Transfer Program Act.

(2) For the reimbursement of moneys collected by the

Illinois Department from hospitals or hospital providers

through error or mistake in performing the activities

authorized under this Code.

(3) For payment of administrative expenses incurred by

the Illinois Department or its agent in performing

activities under this Code, under the Children's Health

Insurance Program Act, under the Covering ALL KIDS Health

Insurance Act, and under the Long Term Acute Care Hospital

Quality Improvement Transfer Program Act.

(4) For payments of any amounts which are reimbursable

to the federal government for payments from this Fund which

are required to be paid by State warrant.

(5) For making transfers, as those transfers are

authorized in the proceedings authorizing debt under the

Short Term Borrowing Act, but transfers made under this

paragraph (5) shall not exceed the principal amount of debt

issued in anticipation of the receipt by the State of

moneys to be deposited into the Fund.

(6) For making transfers to any other fund in the State

treasury, but transfers made under this paragraph (6) shall

not exceed the amount transferred previously from that

other fund into the Hospital Provider Fund plus any

interest that would have been earned by that fund on the

monies that had been transferred.

(6.5) For making transfers to the Healthcare Provider

Relief Fund, except that transfers made under this

paragraph (6.5) shall not exceed $60,000,000 in the

aggregate.

(7) For making transfers not exceeding the following

amounts, related to in State fiscal years 2013 through 2018

and 2014, to the following designated funds:

Health and Human Services Medicaid Trust

Fund..............................$20,000,000

Long-Term Care Provider Fund..........$30,000,000

General Revenue Fund.................$80,000,000.

Transfers under this paragraph shall be made within 7 days

after the payments have been received pursuant to the

schedule of payments provided in subsection (a) of Section

5A-4.

(7.1) (Blank). For making transfers not exceeding the

following amounts, in State fiscal year 2015, to the

following designated funds:

Health and Human Services Medicaid Trust

Fund..............................$10,000,000

Long-Term Care Provider Fund..........$15,000,000

General Revenue Fund.................$40,000,000.

Transfers under this paragraph shall be made within 7 days

after the payments have been received pursuant to the

schedule of payments provided in subsection (a) of Section

5A-4.

(7.5) (Blank).

(7.8) (Blank).

(7.9) (Blank).

(7.10) For State fiscal year years 2013 and 2014, for

making transfers of the moneys resulting from the

assessment under subsection (b-5) of Section 5A-2 and

received from hospital providers under Section 5A-4 and

transferred into the Hospital Provider Fund under Section

5A-6 to the designated funds not exceeding the following

amounts in that State fiscal year:

Health Care Provider Relief Fund.....$100,000,000

$50,000,000

Transfers under this paragraph shall be made within 7

days after the payments have been received pursuant to the

schedule of payments provided in subsection (a) of Section

5A-4.

The additional amount of transfers in this paragraph

(7.10), authorized by this amendatory Act of the 98th

General Assembly, shall be made within 10 State business

days after the effective date of this amendatory Act of the

98th General Assembly. That authority shall remain in

effect even if this amendatory Act of the 98th General

Assembly does not become law until State fiscal year 2015.

(7.10a) For State fiscal years 2015 through 2018, for

making transfers of the moneys resulting from the

assessment under subsection (b-5) of Section 5A-2 and

received from hospital providers under Section 5A-4 and

transferred into the Hospital Provider Fund under Section

5A-6 to the designated funds not exceeding the following

amounts related to each State fiscal year:

Health Care Provider Relief

Fund .....................................$50,000,000

Transfers under this paragraph shall be made within 7

days after the payments have been received pursuant to the

schedule of payments provided in subsection (a) of Section

5A-4.

(7.11) (Blank). For State fiscal year 2015, for making

transfers of the moneys resulting from the assessment under

subsection (b-5) of Section 5A-2 and received from hospital

providers under Section 5A-4 and transferred into the

Hospital Provider Fund under Section 5A-6 to the designated

funds not exceeding the following amounts in that State

fiscal year:

Health Care Provider Relief Fund......$25,000,000

Transfers under this paragraph shall be made within 7

days after the payments have been received pursuant to the

schedule of payments provided in subsection (a) of Section

5A-4.

(7.12) For State fiscal year 2013, for increasing by

21/365ths the transfer of the moneys resulting from the

assessment under subsection (b-5) of Section 5A-2 and

received from hospital providers under Section 5A-4 for the

portion of State fiscal year 2012 beginning June 10, 2012

through June 30, 2012 and transferred into the Hospital

Provider Fund under Section 5A-6 to the designated funds

not exceeding the following amounts in that State fiscal

year:

Health Care Provider Relief Fund......$2,870,000

Since the federal Centers for Medicare and Medicaid

Services approval of the assessment authorized under

subsection (b-5) of Section 5A-2, received from hospital

providers under Section 5A-4 and the payment methodologies

to hospitals required under Section 5A-12.4 was not

received by the Department until State fiscal year 2014 and

since the Department made retroactive payments during

State fiscal year 2014 related to the referenced period of

June 2012, the transfer authority granted in this paragraph

(7.12) is extended through the date that is 10 State

business days after the effective date of this amendatory

Act of the 98th General Assembly.

(8) For making refunds to hospital providers pursuant

to Section 5A-10.

(9) For making payment to capitated managed care

organizations as described in subsections (s) and (t) of

Section 5A-12.2 of this Code.

Disbursements from the Fund, other than transfers

authorized under paragraphs (5) and (6) of this subsection,

shall be by warrants drawn by the State Comptroller upon

receipt of vouchers duly executed and certified by the Illinois

Department.

(c) The Fund shall consist of the following:

(1) All moneys collected or received by the Illinois

Department from the hospital provider assessment imposed

by this Article.

(2) All federal matching funds received by the Illinois

Department as a result of expenditures made by the Illinois

Department that are attributable to moneys deposited in the

Fund.

(3) Any interest or penalty levied in conjunction with

the administration of this Article.

(3.5) As applicable, proceeds from surety bond

payments payable to the Department as referenced in

subsection (s) of Section 5A-12.2 of this Code.

(4) Moneys transferred from another fund in the State

treasury.

(5) All other moneys received for the Fund from any

other source, including interest earned thereon.

(d) (Blank).

(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;

98-104, eff. 7-22-13; 98-463, eff. 8-16-13; revised 10-21-13.)

(305 ILCS 5/5A-12.2)

(Section scheduled to be repealed on January 1, 2015)

Sec. 5A-12.2. Hospital access payments on or after July 1,

2008.

(a) To preserve and improve access to hospital services,

for hospital services rendered on or after July 1, 2008, the

Illinois Department shall, except for hospitals described in

subsection (b) of Section 5A-3, make payments to hospitals as

set forth in this Section. These payments shall be paid in 12

equal installments on or before the seventh State business day

of each month, except that no payment shall be due within 100

days after the later of the date of notification of federal

approval of the payment methodologies required under this

Section or any waiver required under 42 CFR 433.68, at which

time the sum of amounts required under this Section prior to

the date of notification is due and payable. Payments under

this Section are not due and payable, however, until (i) the

methodologies described in this Section are approved by the

federal government in an appropriate State Plan amendment and

(ii) the assessment imposed under this Article is determined to

be a permissible tax under Title XIX of the Social Security

Act.

(a-5) The Illinois Department may, when practicable,

accelerate the schedule upon which payments authorized under

this Section are made.

(b) Across-the-board inpatient adjustment.

(1) In addition to rates paid for inpatient hospital

services, the Department shall pay to each Illinois general

acute care hospital an amount equal to 40% of the total

base inpatient payments paid to the hospital for services

provided in State fiscal year 2005.

(2) In addition to rates paid for inpatient hospital

services, the Department shall pay to each freestanding

Illinois specialty care hospital as defined in 89 Ill. Adm.

Code 149.50(c)(1), (2), or (4) an amount equal to 60% of

the total base inpatient payments paid to the hospital for

services provided in State fiscal year 2005.

(3) In addition to rates paid for inpatient hospital

services, the Department shall pay to each freestanding

Illinois rehabilitation or psychiatric hospital an amount

equal to $1,000 per Medicaid inpatient day multiplied by

the increase in the hospital's Medicaid inpatient

utilization ratio (determined using the positive

percentage change from the rate year 2005 Medicaid

inpatient utilization ratio to the rate year 2007 Medicaid

inpatient utilization ratio, as calculated by the

Department for the disproportionate share determination).

(4) In addition to rates paid for inpatient hospital

services, the Department shall pay to each Illinois

children's hospital an amount equal to 20% of the total

base inpatient payments paid to the hospital for services

provided in State fiscal year 2005 and an additional amount

equal to 20% of the base inpatient payments paid to the

hospital for psychiatric services provided in State fiscal

year 2005.

(5) In addition to rates paid for inpatient hospital

services, the Department shall pay to each Illinois

hospital eligible for a pediatric inpatient adjustment

payment under 89 Ill. Adm. Code 148.298, as in effect for

State fiscal year 2007, a supplemental pediatric inpatient

adjustment payment equal to:

(i) For freestanding children's hospitals as

defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5

multiplied by the hospital's pediatric inpatient

adjustment payment required under 89 Ill. Adm. Code

148.298, as in effect for State fiscal year 2008.

(ii) For hospitals other than freestanding

children's hospitals as defined in 89 Ill. Adm. Code

149.50(c)(3)(B), 1.0 multiplied by the hospital's

pediatric inpatient adjustment payment required under

89 Ill. Adm. Code 148.298, as in effect for State

fiscal year 2008.

(c) Outpatient adjustment.

(1) In addition to the rates paid for outpatient

hospital services, the Department shall pay each Illinois

hospital an amount equal to 2.2 multiplied by the

hospital's ambulatory procedure listing payments for

categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code

148.140(b), for State fiscal year 2005.

(2) In addition to the rates paid for outpatient

hospital services, the Department shall pay each Illinois

freestanding psychiatric hospital an amount equal to 3.25

multiplied by the hospital's ambulatory procedure listing

payments for category 5b, as defined in 89 Ill. Adm. Code

148.140(b)(1)(E), for State fiscal year 2005.

(d) Medicaid high volume adjustment. In addition to rates

paid for inpatient hospital services, the Department shall pay

to each Illinois general acute care hospital that provided more

than 20,500 Medicaid inpatient days of care in State fiscal

year 2005 amounts as follows:

(1) For hospitals with a case mix index equal to or

greater than the 85th percentile of hospital case mix

indices, $350 for each Medicaid inpatient day of care

provided during that period; and

(2) For hospitals with a case mix index less than the

85th percentile of hospital case mix indices, $100 for each

Medicaid inpatient day of care provided during that period.

(e) Capital adjustment. In addition to rates paid for

inpatient hospital services, the Department shall pay an

additional payment to each Illinois general acute care hospital

that has a Medicaid inpatient utilization rate of at least 10%

(as calculated by the Department for the rate year 2007

disproportionate share determination) amounts as follows:

(1) For each Illinois general acute care hospital that

has a Medicaid inpatient utilization rate of at least 10%

and less than 36.94% and whose capital cost is less than

the 60th percentile of the capital costs of all Illinois

hospitals, the amount of such payment shall equal the

hospital's Medicaid inpatient days multiplied by the

difference between the capital costs at the 60th percentile

of the capital costs of all Illinois hospitals and the

hospital's capital costs.

(2) For each Illinois general acute care hospital that

has a Medicaid inpatient utilization rate of at least

36.94% and whose capital cost is less than the 75th

percentile of the capital costs of all Illinois hospitals,

the amount of such payment shall equal the hospital's

Medicaid inpatient days multiplied by the difference

between the capital costs at the 75th percentile of the

capital costs of all Illinois hospitals and the hospital's

capital costs.

(f) Obstetrical care adjustment.

(1) In addition to rates paid for inpatient hospital

services, the Department shall pay $1,500 for each Medicaid

obstetrical day of care provided in State fiscal year 2005

by each Illinois rural hospital that had a Medicaid

obstetrical percentage (Medicaid obstetrical days divided

by Medicaid inpatient days) greater than 15% for State

fiscal year 2005.

(2) In addition to rates paid for inpatient hospital

services, the Department shall pay $1,350 for each Medicaid

obstetrical day of care provided in State fiscal year 2005

by each Illinois general acute care hospital that was

designated a level III perinatal center as of December 31,

2006, and that had a case mix index equal to or greater

than the 45th percentile of the case mix indices for all

level III perinatal centers.

(3) In addition to rates paid for inpatient hospital

services, the Department shall pay $900 for each Medicaid

obstetrical day of care provided in State fiscal year 2005

by each Illinois general acute care hospital that was

designated a level II or II+ perinatal center as of

December 31, 2006, and that had a case mix index equal to

or greater than the 35th percentile of the case mix indices

for all level II and II+ perinatal centers.

(g) Trauma adjustment.

(1) In addition to rates paid for inpatient hospital

services, the Department shall pay each Illinois general

acute care hospital designated as a trauma center as of

July 1, 2007, a payment equal to 3.75 multiplied by the

hospital's State fiscal year 2005 Medicaid capital

payments.

(2) In addition to rates paid for inpatient hospital

services, the Department shall pay $400 for each Medicaid

acute inpatient day of care provided in State fiscal year

2005 by each Illinois general acute care hospital that was

designated a level II trauma center, as defined in 89 Ill.

Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,

2007.

(3) In addition to rates paid for inpatient hospital

services, the Department shall pay $235 for each Illinois

Medicaid acute inpatient day of care provided in State

fiscal year 2005 by each level I pediatric trauma center

located outside of Illinois that had more than 8,000

Illinois Medicaid inpatient days in State fiscal year 2005.

(h) Supplemental tertiary care adjustment. In addition to

rates paid for inpatient services, the Department shall pay to

each Illinois hospital eligible for tertiary care adjustment

payments under 89 Ill. Adm. Code 148.296, as in effect for

State fiscal year 2007, a supplemental tertiary care adjustment

payment equal to the tertiary care adjustment payment required

under 89 Ill. Adm. Code 148.296, as in effect for State fiscal

year 2007.

(i) Crossover adjustment. In addition to rates paid for

inpatient services, the Department shall pay each Illinois

general acute care hospital that had a ratio of crossover days

to total inpatient days for medical assistance programs

administered by the Department (utilizing information from

2005 paid claims) greater than 50%, and a case mix index

greater than the 65th percentile of case mix indices for all

Illinois hospitals, a rate of $1,125 for each Medicaid

inpatient day including crossover days.

(j) Magnet hospital adjustment. In addition to rates paid

for inpatient hospital services, the Department shall pay to

each Illinois general acute care hospital and each Illinois

freestanding children's hospital that, as of February 1, 2008,

was recognized as a Magnet hospital by the American Nurses

Credentialing Center and that had a case mix index greater than

the 75th percentile of case mix indices for all Illinois

hospitals amounts as follows:

(1) For hospitals located in a county whose eligibility

growth factor is greater than the mean, $450 multiplied by

the eligibility growth factor for the county in which the

hospital is located for each Medicaid inpatient day of care

provided by the hospital during State fiscal year 2005.

(2) For hospitals located in a county whose eligibility

growth factor is less than or equal to the mean, $225

multiplied by the eligibility growth factor for the county

in which the hospital is located for each Medicaid

inpatient day of care provided by the hospital during State

fiscal year 2005.

For purposes of this subsection, "eligibility growth

factor" means the percentage by which the number of Medicaid

recipients in the county increased from State fiscal year 1998

to State fiscal year 2005.

(k) For purposes of this Section, a hospital that is

enrolled to provide Medicaid services during State fiscal year

2005 shall have its utilization and associated reimbursements

annualized prior to the payment calculations being performed

under this Section.

(l) For purposes of this Section, the terms "Medicaid

days", "ambulatory procedure listing services", and

"ambulatory procedure listing payments" do not include any

days, charges, or services for which Medicare or a managed care

organization reimbursed on a capitated basis was liable for

payment, except where explicitly stated otherwise in this

Section.

(m) For purposes of this Section, in determining the

percentile ranking of an Illinois hospital's case mix index or

capital costs, hospitals described in subsection (b) of Section

5A-3 shall be excluded from the ranking.

(n) Definitions. Unless the context requires otherwise or

unless provided otherwise in this Section, the terms used in

this Section for qualifying criteria and payment calculations

shall have the same meanings as those terms have been given in

the Illinois Department's administrative rules as in effect on

March 1, 2008. Other terms shall be defined by the Illinois

Department by rule.

As used in this Section, unless the context requires

otherwise:

"Base inpatient payments" means, for a given hospital, the

sum of base payments for inpatient services made on a per diem

or per admission (DRG) basis, excluding those portions of per

admission payments that are classified as capital payments.

Disproportionate share hospital adjustment payments, Medicaid

Percentage Adjustments, Medicaid High Volume Adjustments, and

outlier payments, as defined by rule by the Department as of

January 1, 2008, are not base payments.

"Capital costs" means, for a given hospital, the total

capital costs determined using the most recent 2005 Medicare

cost report as contained in the Healthcare Cost Report

Information System file, for the quarter ending on December 31,

2006, divided by the total inpatient days from the same cost

report to calculate a capital cost per day. The resulting

capital cost per day is inflated to the midpoint of State

fiscal year 2009 utilizing the national hospital market price

proxies (DRI) hospital cost index. If a hospital's 2005

Medicare cost report is not contained in the Healthcare Cost

Report Information System, the Department may obtain the data

necessary to compute the hospital's capital costs from any

source available, including, but not limited to, records

maintained by the hospital provider, which may be inspected at

all times during business hours of the day by the Illinois

Department or its duly authorized agents and employees.

"Case mix index" means, for a given hospital, the sum of

the DRG relative weighting factors in effect on January 1,

2005, for all general acute care admissions for State fiscal

year 2005, excluding Medicare crossover admissions and

transplant admissions reimbursed under 89 Ill. Adm. Code

148.82, divided by the total number of general acute care

admissions for State fiscal year 2005, excluding Medicare

crossover admissions and transplant admissions reimbursed

under 89 Ill. Adm. Code 148.82.

"Medicaid inpatient day" means, for a given hospital, the

sum of days of inpatient hospital days provided to recipients

of medical assistance under Title XIX of the federal Social

Security Act, excluding days for individuals eligible for

Medicare under Title XVIII of that Act (Medicaid/Medicare

crossover days), as tabulated from the Department's paid claims

data for admissions occurring during State fiscal year 2005

that was adjudicated by the Department through March 23, 2007.

"Medicaid obstetrical day" means, for a given hospital, the

sum of days of inpatient hospital days grouped by the

Department to DRGs of 370 through 375 provided to recipients of

medical assistance under Title XIX of the federal Social

Security Act, excluding days for individuals eligible for

Medicare under Title XVIII of that Act (Medicaid/Medicare

crossover days), as tabulated from the Department's paid claims

data for admissions occurring during State fiscal year 2005

that was adjudicated by the Department through March 23, 2007.

"Outpatient ambulatory procedure listing payments" means,

for a given hospital, the sum of payments for ambulatory

procedure listing services, as described in 89 Ill. Adm. Code

148.140(b), provided to recipients of medical assistance under

Title XIX of the federal Social Security Act, excluding

payments for individuals eligible for Medicare under Title

XVIII of the Act (Medicaid/Medicare crossover days), as

tabulated from the Department's paid claims data for services

occurring in State fiscal year 2005 that were adjudicated by

the Department through March 23, 2007.

(o) The Department may adjust payments made under this

Section 5A-12.2 to comply with federal law or regulations

regarding hospital-specific payment limitations on

government-owned or government-operated hospitals.

(p) Notwithstanding any of the other provisions of this

Section, the Department is authorized to adopt rules that

change the hospital access improvement payments specified in

this Section, but only to the extent necessary to conform to

any federally approved amendment to the Title XIX State plan.

Any such rules shall be adopted by the Department as authorized

by Section 5-50 of the Illinois Administrative Procedure Act.

Notwithstanding any other provision of law, any changes

implemented as a result of this subsection (p) shall be given

retroactive effect so that they shall be deemed to have taken

effect as of the effective date of this Section.

(q) (Blank).

(r) On and after July 1, 2012, the Department shall reduce

any rate of reimbursement for services or other payments or

alter any methodologies authorized by this Code to reduce any

rate of reimbursement for services or other payments in

accordance with Section 5-5e.

(s) On or after July 1, 2014, but no later than October 1,

2014, and no less than annually thereafter, the Department may

increase capitation payments to capitated managed care

organizations (MCOs) to equal the aggregate reduction of

payments made in this Section and in Section 5A-12.4 by a

uniform percentage on a regional basis to preserve access to

hospital services for recipients under the Illinois Medical

Assistance Program. The aggregate amount of all increased

capitation payments to all MCOs for a fiscal year shall be the

amount needed to avoid reduction in payments authorized under

Section 5A-15. Payments to MCOs under this Section shall be

consistent with actuarial certification and shall be published

by the Department each year. Each MCO shall only expend the

increased capitation payments it receives under this Section to

support the availability of hospital services and to ensure

access to hospital services, with such expenditures being made

within 15 calendar days from when the MCO receives the

increased capitation payment. The Department shall make

available, on a monthly basis, a report of the capitation

payments that are made to each MCO pursuant to this subsection,

including the number of enrollees for which such payment is

made, the per enrollee amount of the payment, and any

adjustments that have been made. Payments made under this

subsection shall be guaranteed by a surety bond obtained by the

MCO in an amount established by the Department to approximate

one month's liability of payments authorized under this

subsection. The Department may advance the payments guaranteed

by the surety bond. Payments to MCOs that would be paid

consistent with actuarial certification and enrollment in the

absence of the increased capitation payments under this Section

shall not be reduced as a consequence of payments made under

this subsection.

As used in this subsection, "MCO" means an entity which

contracts with the Department to provide services where payment

for medical services is made on a capitated basis.

(t) On or after July 1, 2014, the Department may increase

capitation payments to capitated managed care organizations

(MCOs) to equal the aggregate reduction of payments made in

Section 5A-12.5 to preserve access to hospital services for

recipients under the Illinois Medical Assistance Program.

Payments to MCOs under this Section shall be consistent with

actuarial certification and shall be published by the

Department each year. Each MCO shall only expend the increased

capitation payments it receives under this Section to support

the availability of hospital services and to ensure access to

hospital services, with such expenditures being made within 15

calendar days from when the MCO receives the increased

capitation payment. The Department may advance the payments to

hospitals under this subsection, in the event the MCO fails to

make such payments. The Department shall make available, on a

monthly basis, a report of the capitation payments that are

made to each MCO pursuant to this subsection, including the

number of enrollees for which such payment is made, the per

enrollee amount of the payment, and any adjustments that have

been made. Payments to MCOs that would be paid consistent with

actuarial certification and enrollment in the absence of the

increased capitation payments under this subsection shall not

be reduced as a consequence of payments made under this

subsection.

As used in this subsection, "MCO" means an entity which

contracts with the Department to provide services where payment

for medical services is made on a capitated basis.

(Source: P.A. 96-821, eff. 11-20-09; 97-689, eff. 6-14-12.)

Article 20

Section 20-5. The Illinois Administrative Procedure Act is

amended by changing Section 5-45 as follows:

(5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)

Sec. 5-45. Emergency rulemaking.

(a) "Emergency" means the existence of any situation that

any agency finds reasonably constitutes a threat to the public

interest, safety, or welfare.

(b) If any agency finds that an emergency exists that

requires adoption of a rule upon fewer days than is required by

Section 5-40 and states in writing its reasons for that

finding, the agency may adopt an emergency rule without prior

notice or hearing upon filing a notice of emergency rulemaking

with the Secretary of State under Section 5-70. The notice

shall include the text of the emergency rule and shall be

published in the Illinois Register. Consent orders or other

court orders adopting settlements negotiated by an agency may

be adopted under this Section. Subject to applicable

constitutional or statutory provisions, an emergency rule

becomes effective immediately upon filing under Section 5-65 or

at a stated date less than 10 days thereafter. The agency's

finding and a statement of the specific reasons for the finding

shall be filed with the rule. The agency shall take reasonable

and appropriate measures to make emergency rules known to the

persons who may be affected by them.

(c) An emergency rule may be effective for a period of not

longer than 150 days, but the agency's authority to adopt an

identical rule under Section 5-40 is not precluded. No

emergency rule may be adopted more than once in any 24 month

period, except that this limitation on the number of emergency

rules that may be adopted in a 24 month period does not apply

to (i) emergency rules that make additions to and deletions

from the Drug Manual under Section 5-5.16 of the Illinois

Public Aid Code or the generic drug formulary under Section

3.14 of the Illinois Food, Drug and Cosmetic Act, (ii)

emergency rules adopted by the Pollution Control Board before

July 1, 1997 to implement portions of the Livestock Management

Facilities Act, (iii) emergency rules adopted by the Illinois

Department of Public Health under subsections (a) through (i)

of Section 2 of the Department of Public Health Act when

necessary to protect the public's health, (iv) emergency rules

adopted pursuant to subsection (n) of this Section, (v)

emergency rules adopted pursuant to subsection (o) of this

Section, or (vi) emergency rules adopted pursuant to subsection

(c-5) of this Section. Two or more emergency rules having

substantially the same purpose and effect shall be deemed to be

a single rule for purposes of this Section.

(c-5) To facilitate the maintenance of the program of group

health benefits provided to annuitants, survivors, and retired

employees under the State Employees Group Insurance Act of

1971, rules to alter the contributions to be paid by the State,

annuitants, survivors, retired employees, or any combination

of those entities, for that program of group health benefits,

shall be adopted as emergency rules. The adoption of those

rules shall be considered an emergency and necessary for the

public interest, safety, and welfare.

(d) In order to provide for the expeditious and timely

implementation of the State's fiscal year 1999 budget,

emergency rules to implement any provision of Public Act 90-587

or 90-588 or any other budget initiative for fiscal year 1999

may be adopted in accordance with this Section by the agency

charged with administering that provision or initiative,

except that the 24-month limitation on the adoption of

emergency rules and the provisions of Sections 5-115 and 5-125

do not apply to rules adopted under this subsection (d). The

adoption of emergency rules authorized by this subsection (d)

shall be deemed to be necessary for the public interest,

safety, and welfare.

(e) In order to provide for the expeditious and timely

implementation of the State's fiscal year 2000 budget,

emergency rules to implement any provision of this amendatory

Act of the 91st General Assembly or any other budget initiative

for fiscal year 2000 may be adopted in accordance with this

Section by the agency charged with administering that provision

or initiative, except that the 24-month limitation on the

adoption of emergency rules and the provisions of Sections

5-115 and 5-125 do not apply to rules adopted under this

subsection (e). The adoption of emergency rules authorized by

this subsection (e) shall be deemed to be necessary for the

public interest, safety, and welfare.

(f) In order to provide for the expeditious and timely

implementation of the State's fiscal year 2001 budget,

emergency rules to implement any provision of this amendatory

Act of the 91st General Assembly or any other budget initiative

for fiscal year 2001 may be adopted in accordance with this

Section by the agency charged with administering that provision

or initiative, except that the 24-month limitation on the

adoption of emergency rules and the provisions of Sections

5-115 and 5-125 do not apply to rules adopted under this

subsection (f). The adoption of emergency rules authorized by

this subsection (f) shall be deemed to be necessary for the

public interest, safety, and welfare.

(g) In order to provide for the expeditious and timely

implementation of the State's fiscal year 2002 budget,

emergency rules to implement any provision of this amendatory

Act of the 92nd General Assembly or any other budget initiative

for fiscal year 2002 may be adopted in accordance with this

Section by the agency charged with administering that provision

or initiative, except that the 24-month limitation on the

adoption of emergency rules and the provisions of Sections

5-115 and 5-125 do not apply to rules adopted under this

subsection (g). The adoption of emergency rules authorized by

this subsection (g) shall be deemed to be necessary for the

public interest, safety, and welfare.

(h) In order to provide for the expeditious and timely

implementation of the State's fiscal year 2003 budget,

emergency rules to implement any provision of this amendatory

Act of the 92nd General Assembly or any other budget initiative

for fiscal year 2003 may be adopted in accordance with this

Section by the agency charged with administering that provision

or initiative, except that the 24-month limitation on the

adoption of emergency rules and the provisions of Sections

5-115 and 5-125 do not apply to rules adopted under this

subsection (h). The adoption of emergency rules authorized by

this subsection (h) shall be deemed to be necessary for the

public interest, safety, and welfare.

(i) In order to provide for the expeditious and timely

implementation of the State's fiscal year 2004 budget,

emergency rules to implement any provision of this amendatory

Act of the 93rd General Assembly or any other budget initiative

for fiscal year 2004 may be adopted in accordance with this

Section by the agency charged with administering that provision

or initiative, except that the 24-month limitation on the

adoption of emergency rules and the provisions of Sections

5-115 and 5-125 do not apply to rules adopted under this

subsection (i). The adoption of emergency rules authorized by

this subsection (i) shall be deemed to be necessary for the

public interest, safety, and welfare.

(j) In order to provide for the expeditious and timely

implementation of the provisions of the State's fiscal year

2005 budget as provided under the Fiscal Year 2005 Budget

Implementation (Human Services) Act, emergency rules to

implement any provision of the Fiscal Year 2005 Budget

Implementation (Human Services) Act may be adopted in

accordance with this Section by the agency charged with

administering that provision, except that the 24-month

limitation on the adoption of emergency rules and the

provisions of Sections 5-115 and 5-125 do not apply to rules

adopted under this subsection (j). The Department of Public Aid

may also adopt rules under this subsection (j) necessary to

administer the Illinois Public Aid Code and the Children's

Health Insurance Program Act. The adoption of emergency rules

authorized by this subsection (j) shall be deemed to be

necessary for the public interest, safety, and welfare.

(k) In order to provide for the expeditious and timely

implementation of the provisions of the State's fiscal year

2006 budget, emergency rules to implement any provision of this

amendatory Act of the 94th General Assembly or any other budget

initiative for fiscal year 2006 may be adopted in accordance

with this Section by the agency charged with administering that

provision or initiative, except that the 24-month limitation on

the adoption of emergency rules and the provisions of Sections

5-115 and 5-125 do not apply to rules adopted under this

subsection (k). The Department of Healthcare and Family

Services may also adopt rules under this subsection (k)

necessary to administer the Illinois Public Aid Code, the

Senior Citizens and Disabled Persons Property Tax Relief Act,

the Senior Citizens and Disabled Persons Prescription Drug

Discount Program Act (now the Illinois Prescription Drug

Discount Program Act), and the Children's Health Insurance

Program Act. The adoption of emergency rules authorized by this

subsection (k) shall be deemed to be necessary for the public

interest, safety, and welfare.

(l) In order to provide for the expeditious and timely

implementation of the provisions of the State's fiscal year

2007 budget, the Department of Healthcare and Family Services

may adopt emergency rules during fiscal year 2007, including

rules effective July 1, 2007, in accordance with this

subsection to the extent necessary to administer the

Department's responsibilities with respect to amendments to

the State plans and Illinois waivers approved by the federal

Centers for Medicare and Medicaid Services necessitated by the

requirements of Title XIX and Title XXI of the federal Social

Security Act. The adoption of emergency rules authorized by

this subsection (l) shall be deemed to be necessary for the

public interest, safety, and welfare.

(m) In order to provide for the expeditious and timely

implementation of the provisions of the State's fiscal year

2008 budget, the Department of Healthcare and Family Services

may adopt emergency rules during fiscal year 2008, including

rules effective July 1, 2008, in accordance with this

subsection to the extent necessary to administer the

Department's responsibilities with respect to amendments to

the State plans and Illinois waivers approved by the federal

Centers for Medicare and Medicaid Services necessitated by the

requirements of Title XIX and Title XXI of the federal Social

Security Act. The adoption of emergency rules authorized by

this subsection (m) shall be deemed to be necessary for the

public interest, safety, and welfare.

(n) In order to provide for the expeditious and timely

implementation of the provisions of the State's fiscal year

2010 budget, emergency rules to implement any provision of this

amendatory Act of the 96th General Assembly or any other budget

initiative authorized by the 96th General Assembly for fiscal

year 2010 may be adopted in accordance with this Section by the

agency charged with administering that provision or

initiative. The adoption of emergency rules authorized by this

subsection (n) shall be deemed to be necessary for the public

interest, safety, and welfare. The rulemaking authority

granted in this subsection (n) shall apply only to rules

promulgated during Fiscal Year 2010.

(o) In order to provide for the expeditious and timely

implementation of the provisions of the State's fiscal year

2011 budget, emergency rules to implement any provision of this

amendatory Act of the 96th General Assembly or any other budget

initiative authorized by the 96th General Assembly for fiscal

year 2011 may be adopted in accordance with this Section by the

agency charged with administering that provision or

initiative. The adoption of emergency rules authorized by this

subsection (o) is deemed to be necessary for the public

interest, safety, and welfare. The rulemaking authority

granted in this subsection (o) applies only to rules

promulgated on or after the effective date of this amendatory

Act of the 96th General Assembly through June 30, 2011.

(p) In order to provide for the expeditious and timely

implementation of the provisions of Public Act 97-689,

emergency rules to implement any provision of Public Act 97-689

may be adopted in accordance with this subsection (p) by the

agency charged with administering that provision or

initiative. The 150-day limitation of the effective period of

emergency rules does not apply to rules adopted under this

subsection (p), and the effective period may continue through

June 30, 2013. The 24-month limitation on the adoption of

emergency rules does not apply to rules adopted under this

subsection (p). The adoption of emergency rules authorized by

this subsection (p) is deemed to be necessary for the public

interest, safety, and welfare.

(q) In order to provide for the expeditious and timely

implementation of the provisions of Articles 7, 8, 9, 11, and

12 of this amendatory Act of the 98th General Assembly,

emergency rules to implement any provision of Articles 7, 8, 9,

11, and 12 of this amendatory Act of the 98th General Assembly

may be adopted in accordance with this subsection (q) by the

agency charged with administering that provision or

initiative. The 24-month limitation on the adoption of

emergency rules does not apply to rules adopted under this

subsection (q). The adoption of emergency rules authorized by

this subsection (q) is deemed to be necessary for the public

interest, safety, and welfare.

(r) In order to provide for the expeditious and timely

implementation of the provisions of this amendatory Act of the

98th General Assembly, emergency rules to implement this

amendatory Act of the 98th General Assembly may be adopted in

accordance with this subsection (r) by the Department of

Healthcare and Family Services. The 24-month limitation on the

adoption of emergency rules does not apply to rules adopted

under this subsection (r). The adoption of emergency rules

authorized by this subsection (r) is deemed to be necessary for

the public interest, safety, and welfare.

(Source: P.A. 97-689, eff. 6-14-12; 97-695, eff. 7-1-12;

98-104, eff. 7-22-13; 98-463, eff. 8-16-13.)

Section 20-10. The Children's Health Insurance Program Act

is amended by changing Section 7 as follows:

(215 ILCS 106/7)

Sec. 7. Eligibility verification. Notwithstanding any

other provision of this Act, with respect to applications for

benefits provided under the Program, eligibility shall be

determined in a manner that ensures program integrity and that

complies with federal law and regulations while minimizing

unnecessary barriers to enrollment. To this end, as soon as

practicable, and unless the Department receives written denial

from the federal government, this Section shall be implemented:

(a) The Department of Healthcare and Family Services or its

designees shall:

(1) By no later than July 1, 2011, require verification

of, at a minimum, one month's income from all sources

required for determining the eligibility of applicants to

the Program. Such verification shall take the form of pay

stubs, business or income and expense records for

self-employed persons, letters from employers, and any

other valid documentation of income including data

obtained electronically by the Department or its designees

from other sources as described in subsection (b) of this

Section.

(2) By no later than October 1, 2011, require

verification of, at a minimum, one month's income from all

sources required for determining the continued eligibility

of recipients at their annual review of eligibility under

the Program. Such verification shall take the form of pay

stubs, business or income and expense records for

self-employed persons, letters from employers, and any

other valid documentation of income including data

obtained electronically by the Department or its designees

from other sources as described in subsection (b) of this

Section. The Department shall send a notice to the

recipient at least 60 days prior to the end of the period

of eligibility that informs them of the requirements for

continued eligibility. If a recipient does not fulfill the

requirements for continued eligibility by the deadline

established in the notice, a notice of cancellation shall

be issued to the recipient and coverage shall end on the

last day of the eligibility period. A recipient's

eligibility may be reinstated without requiring a new

application if the recipient fulfills the requirements for

continued eligibility prior to the end of the third month

following the last date of coverage (or longer period if

required by federal regulations). Nothing in this Section

shall prevent an individual whose coverage has been

cancelled from reapplying for health benefits at any time.

(3) By no later than July 1, 2011, require verification

of Illinois residency.

(b) The Department shall establish or continue cooperative

arrangements with the Social Security Administration, the

Illinois Secretary of State, the Department of Human Services,

the Department of Revenue, the Department of Employment

Security, and any other appropriate entity to gain electronic

access, to the extent allowed by law, to information available

to those entities that may be appropriate for electronically

verifying any factor of eligibility for benefits under the

Program. Data relevant to eligibility shall be provided for no

other purpose than to verify the eligibility of new applicants

or current recipients of health benefits under the Program.

Data will be requested or provided for any new applicant or

current recipient only insofar as that individual's

circumstances are relevant to that individual's or another

individual's eligibility.

(c) Within 90 days of the effective date of this amendatory

Act of the 96th General Assembly, the Department of Healthcare

and Family Services shall send notice to current recipients

informing them of the changes regarding their eligibility

verification.

(Source: P.A. 96-1501, eff. 1-25-11.)

Section 20-15. The Covering ALL KIDS Health Insurance Act

is amended by changing Sections 7 and 20 as follows:

(215 ILCS 170/7)

(Section scheduled to be repealed on July 1, 2016)

Sec. 7. Eligibility verification. Notwithstanding any

other provision of this Act, with respect to applications for

benefits provided under the Program, eligibility shall be

determined in a manner that ensures program integrity and that

complies with federal law and regulations while minimizing

unnecessary barriers to enrollment. To this end, as soon as

practicable, and unless the Department receives written denial

from the federal government, this Section shall be implemented:

(a) The Department of Healthcare and Family Services or its

designees shall:

(1) By July 1, 2011, require verification of, at a

minimum, one month's income from all sources required for

determining the eligibility of applicants to the Program.

Such verification shall take the form of pay stubs,

business or income and expense records for self-employed

persons, letters from employers, and any other valid

documentation of income including data obtained

electronically by the Department or its designees from

other sources as described in subsection (b) of this

Section.

(2) By October 1, 2011, require verification of, at a

minimum, one month's income from all sources required for

determining the continued eligibility of recipients at

their annual review of eligibility under the Program. Such

verification shall take the form of pay stubs, business or

income and expense records for self-employed persons,

letters from employers, and any other valid documentation

of income including data obtained electronically by the

Department or its designees from other sources as described

in subsection (b) of this Section. The Department shall

send a notice to recipients at least 60 days prior to the

end of their period of eligibility that informs them of the

requirements for continued eligibility. If a recipient

does not fulfill the requirements for continued

eligibility by the deadline established in the notice, a

notice of cancellation shall be issued to the recipient and

coverage shall end on the last day of the eligibility

period. A recipient's eligibility may be reinstated

without requiring a new application if the recipient

fulfills the requirements for continued eligibility prior

to the end of the third month following the last date of

coverage (or longer period if required by federal

regulations). Nothing in this Section shall prevent an

individual whose coverage has been cancelled from

reapplying for health benefits at any time.

(3) By July 1, 2011, require verification of Illinois

residency.

(b) The Department shall establish or continue cooperative

arrangements with the Social Security Administration, the

Illinois Secretary of State, the Department of Human Services,

the Department of Revenue, the Department of Employment

Security, and any other appropriate entity to gain electronic

access, to the extent allowed by law, to information available

to those entities that may be appropriate for electronically

verifying any factor of eligibility for benefits under the

Program. Data relevant to eligibility shall be provided for no

other purpose than to verify the eligibility of new applicants

or current recipients of health benefits under the Program.

Data will be requested or provided for any new applicant or

current recipient only insofar as that individual's

circumstances are relevant to that individual's or another

individual's eligibility.

(c) Within 90 days of the effective date of this amendatory

Act of the 96th General Assembly, the Department of Healthcare

and Family Services shall send notice to current recipients

informing them of the changes regarding their eligibility

verification.

(Source: P.A. 96-1501, eff. 1-25-11.)

(215 ILCS 170/20)

(Section scheduled to be repealed on July 1, 2016)

Sec. 20. Eligibility.

(a) To be eligible for the Program, a person must be a

child:

(1) who is a resident of the State of Illinois;

(2) who is ineligible for medical assistance under the

Illinois Public Aid Code or benefits under the Children's

Health Insurance Program Act;

(3) who either (i) effective July 1, 2014, who has in

accordance with 42 CFR 457.805 (78 FR 42313, July 15, 2013)

or any other federal requirement necessary to obtain

federal financial participation for expenditures made

under this Act, has been without health insurance coverage

for 90 days; 12 months, (ii) whose parent has lost

employment that made available affordable dependent health

insurance coverage, until such time as affordable

employer-sponsored dependent health insurance coverage is

again available for the child as set forth by the

Department in rules, (iii) (ii) who is a newborn whose

responsible relative does not have available affordable

private or employer-sponsored health insurance; or (iii) ,

or (iv) who, within one year of applying for coverage under

this Act, lost medical benefits under the Illinois Public

Aid Code or the Children's Health Insurance Program Act;

and

(3.5) whose household income, as determined, effective

October 1, 2013, by the Department, is at or below 300% of

the federal poverty level as determined in compliance with

42 U.S.C. 1397bb(b)(1)(B)(v) and applicable federal

regulations. This item (3.5) is effective July 1, 2011.

An entity that provides health insurance coverage (as

defined in Section 2 of the Comprehensive Health Insurance Plan

Act) to Illinois residents shall provide health insurance data

match to the Department of Healthcare and Family Services as

provided by and subject to Section 5.5 of the Illinois

Insurance Code. The Department of Healthcare and Family

Services may impose an administrative penalty as provided under

Section 12-4.45 of the Illinois Public Aid Code on entities

that have established a pattern of failure to provide the

information required under this Section.

The Department of Healthcare and Family Services, in

collaboration with the Department of Insurance, shall adopt

rules governing the exchange of information under this Section.

The rules shall be consistent with all laws relating to the

confidentiality or privacy of personal information or medical

records, including provisions under the Federal Health

Insurance Portability and Accountability Act (HIPAA).

(b) The Department shall monitor the availability and

retention of employer-sponsored dependent health insurance

coverage and shall modify the period described in subdivision

(a)(3) if necessary to promote retention of private or

employer-sponsored health insurance and timely access to

healthcare services, but at no time shall the period described

in subdivision (a)(3) be less than 6 months.

(c) The Department, at its discretion, may take into

account the affordability of dependent health insurance when

determining whether employer-sponsored dependent health

insurance coverage is available upon reemployment of a child's

parent as provided in subdivision (a)(3).

(d) A child who is determined to be eligible for the

Program shall remain eligible for 12 months, provided that the

child maintains his or her residence in this State, has not yet

attained 19 years of age, and is not excluded under subsection

(e).

(e) A child is not eligible for coverage under the Program

if:

(1) the premium required under Section 40 has not been

timely paid; if the required premiums are not paid, the

liability of the Program shall be limited to benefits

incurred under the Program for the time period for which

premiums have been paid; re-enrollment shall be completed

before the next covered medical visit, and the first

month's required premium shall be paid in advance of the

next covered medical visit; or

(2) the child is an inmate of a public institution or

an institution for mental diseases.

(f) The Department may adopt rules, including, but not

limited to: rules regarding annual renewals of eligibility for

the Program in conformance with Section 7 of this Act; rules

providing for re-enrollment, grace periods, notice

requirements, and hearing procedures under subdivision (e)(1)

of this Section; and rules regarding what constitutes

availability and affordability of private or

employer-sponsored health insurance, with consideration of

such factors as the percentage of income needed to purchase

children or family health insurance, the availability of

employer subsidies, and other relevant factors.

(g) Each child enrolled in the Program as of July 1, 2011

whose family income, as established by the Department, exceeds

300% of the federal poverty level may remain enrolled in the

Program for 12 additional months commencing July 1, 2011.

Continued enrollment pursuant to this subsection shall be

available only if the child continues to meet all eligibility

criteria established under the Program as of the effective date

of this amendatory Act of the 96th General Assembly without a

break in coverage. Nothing contained in this subsection shall

prevent a child from qualifying for any other health benefits

program operated by the Department.

(Source: P.A. 98-130, eff. 8-2-13.)

Section 20-20. The Illinois Public Aid Code is amended by

changing Sections 5-2.1a and 11-5.1 as follows:

(305 ILCS 5/5-2.1a)

Sec. 5-2.1a. Treatment of trust amounts. To the extent

required by federal law, the Department of Healthcare and

Family Services Illinois Department shall provide by rule for

the consideration of trusts and similar legal instruments or

devices established by a person in the Illinois Department's

determination of the person's eligibility for and the amount of

assistance provided under this Article. This Section shall be

enforced by the Department of Human Services, acting as

successor to the Department of Public Aid under the Department

of Human Services Act.

(Source: P.A. 88-554, eff. 7-26-94; 89-507, eff. 7-1-97.)

(305 ILCS 5/11-5.1)

Sec. 11-5.1. Eligibility verification. Notwithstanding any

other provision of this Code, with respect to applications for

medical assistance provided under Article V of this Code,

eligibility shall be determined in a manner that ensures

program integrity and complies with federal laws and

regulations while minimizing unnecessary barriers to

enrollment. To this end, as soon as practicable, and unless the

Department receives written denial from the federal

government, this Section shall be implemented:

(a) The Department of Healthcare and Family Services or its

designees shall:

(1) By no later than July 1, 2011, require verification

of, at a minimum, one month's income from all sources

required for determining the eligibility of applicants for

medical assistance under this Code. Such verification

shall take the form of pay stubs, business or income and

expense records for self-employed persons, letters from

employers, and any other valid documentation of income

including data obtained electronically by the Department

or its designees from other sources as described in

subsection (b) of this Section.

(2) By no later than October 1, 2011, require

verification of, at a minimum, one month's income from all

sources required for determining the continued eligibility

of recipients at their annual review of eligibility for

medical assistance under this Code. Such verification

shall take the form of pay stubs, business or income and

expense records for self-employed persons, letters from

employers, and any other valid documentation of income

including data obtained electronically by the Department

or its designees from other sources as described in

subsection (b) of this Section. The Department shall send a

notice to recipients at least 60 days prior to the end of

their period of eligibility that informs them of the

requirements for continued eligibility. If a recipient

does not fulfill the requirements for continued

eligibility by the deadline established in the notice a

notice of cancellation shall be issued to the recipient and

coverage shall end on the last day of the eligibility

period. A recipient's eligibility may be reinstated

without requiring a new application if the recipient

fulfills the requirements for continued eligibility prior

to the end of the third month following the last date of

coverage (or longer period if required by federal

regulations). Nothing in this Section shall prevent an

individual whose coverage has been cancelled from

reapplying for health benefits at any time.

(3) By no later than July 1, 2011, require verification

of Illinois residency.

(b) The Department shall establish or continue cooperative

arrangements with the Social Security Administration, the

Illinois Secretary of State, the Department of Human Services,

the Department of Revenue, the Department of Employment

Security, and any other appropriate entity to gain electronic

access, to the extent allowed by law, to information available

to those entities that may be appropriate for electronically

verifying any factor of eligibility for benefits under the

Program. Data relevant to eligibility shall be provided for no

other purpose than to verify the eligibility of new applicants

or current recipients of health benefits under the Program.

Data shall be requested or provided for any new applicant or

current recipient only insofar as that individual's

circumstances are relevant to that individual's or another

individual's eligibility.

(c) Within 90 days of the effective date of this amendatory

Act of the 96th General Assembly, the Department of Healthcare

and Family Services shall send notice to current recipients

informing them of the changes regarding their eligibility

verification.

(Source: P.A. 96-1501, eff. 1-25-11.)

Article 25

Section 25-5. The State Finance Act is amended by changing

Section 6z-30 as follows:

(30 ILCS 105/6z-30)

Sec. 6z-30. University of Illinois Hospital Services Fund.

(a) The University of Illinois Hospital Services Fund is

created as a special fund in the State Treasury. The following

moneys shall be deposited into the Fund:

(1) As soon as possible after the beginning of fiscal

year 2010, and in no event later than July 30, the State

Comptroller and the State Treasurer shall automatically

transfer $30,000,000 from the General Revenue Fund to the

University of Illinois Hospital Services Fund.

(1.5) Starting in fiscal year 2011, as soon as possible

after the beginning of each fiscal year, and in no event

later than July 30, the State Comptroller and the State

Treasurer shall automatically transfer $45,000,000 from

the General Revenue Fund to the University of Illinois

Hospital Services Fund; except that, in fiscal year 2012

only, the State Comptroller and the State Treasurer shall

transfer $90,000,000 from the General Revenue Fund to the

University of Illinois Hospital Services Fund under this

paragraph, and, in fiscal year 2013 only, the State

Comptroller and the State Treasurer shall transfer no

amounts from the General Revenue Fund to the University of

Illinois Hospital Services Fund under this paragraph.

(2) All intergovernmental transfer payments to the

Department of Healthcare and Family Services by the

University of Illinois made pursuant to an

intergovernmental agreement under subsection (b) or (c) of

Section 5A-3 of the Illinois Public Aid Code.

(3) All federal matching funds received by the

Department of Healthcare and Family Services (formerly

Illinois Department of Public Aid) as a result of

expenditures made by the Department that are attributable

to moneys that were deposited in the Fund.

(4) All other moneys received for the Fund from any

other source, including interest earned thereon.

(b) Moneys in the fund may be used by the Department of

Healthcare and Family Services, subject to appropriation and to

an interagency agreement between that Department and the Board

of Trustees of the University of Illinois, to reimburse the

University of Illinois Hospital for hospital and pharmacy

services, to reimburse practitioners who are employed by the

University of Illinois, to reimburse other health care

facilities and health plans operated by the University of

Illinois, and to pass through to the University of Illinois

federal financial participation earned by the State as a result

of expenditures made by the University of Illinois.

(c) (Blank).

(Source: P.A. 96-45, eff. 7-15-09; 96-959, eff. 7-1-10; 97-732,

eff. 6-30-12.)

Section 25-10. The Illinois Public Aid Code is amended by

changing Section 12-9 as follows:

(305 ILCS 5/12-9) (from Ch. 23, par. 12-9)

Sec. 12-9. Public Aid Recoveries Trust Fund; uses. The

Public Aid Recoveries Trust Fund shall consist of (1)

recoveries by the Department of Healthcare and Family Services

(formerly Illinois Department of Public Aid) authorized by this

Code in respect to applicants or recipients under Articles III,

IV, V, and VI, including recoveries made by the Department of

Healthcare and Family Services (formerly Illinois Department

of Public Aid) from the estates of deceased recipients, (2)

recoveries made by the Department of Healthcare and Family

Services (formerly Illinois Department of Public Aid) in

respect to applicants and recipients under the Children's

Health Insurance Program Act, and the Covering ALL KIDS Health

Insurance Act, (2.5) recoveries made by the Department of

Healthcare and Family Services in connection with the

imposition of an administrative penalty as provided under

Section 12-4.45, (3) federal funds received on behalf of and

earned by State universities and local governmental entities

for services provided to applicants or recipients covered under

this Code, the Children's Health Insurance Program Act, and the

Covering ALL KIDS Health Insurance Act, (3.5) federal financial

participation revenue related to eligible disbursements made

by the Department of Healthcare and Family Services from

appropriations required by this Section, and (4) all other

moneys received to the Fund, including interest thereon. The

Fund shall be held as a special fund in the State Treasury.

Disbursements from this Fund shall be only (1) for the

reimbursement of claims collected by the Department of

Healthcare and Family Services (formerly Illinois Department

of Public Aid) through error or mistake, (2) for payment to

persons or agencies designated as payees or co-payees on any

instrument, whether or not negotiable, delivered to the

Department of Healthcare and Family Services (formerly

Illinois Department of Public Aid) as a recovery under this

Section, such payment to be in proportion to the respective

interests of the payees in the amount so collected, (3) for

payments to the Department of Human Services for collections

made by the Department of Healthcare and Family Services

(formerly Illinois Department of Public Aid) on behalf of the

Department of Human Services under this Code, the Children's

Health Insurance Program Act, and the Covering ALL KIDS Health

Insurance Act, (4) for payment of administrative expenses

incurred in performing the activities authorized under this

Code, the Children's Health Insurance Program Act, and the

Covering ALL KIDS Health Insurance Act, (5) for payment of fees

to persons or agencies in the performance of activities

pursuant to the collection of monies owed the State that are

collected under this Code, the Children's Health Insurance

Program Act, and the Covering ALL KIDS Health Insurance Act,

(6) for payments of any amounts which are reimbursable to the

federal government which are required to be paid by State

warrant by either the State or federal government, and (7) for

payments to State universities and local governmental entities

of federal funds for services provided to applicants or

recipients covered under this Code, the Children's Health

Insurance Program Act, and the Covering ALL KIDS Health

Insurance Act. Disbursements from this Fund for purposes of

items (4) and (5) of this paragraph shall be subject to

appropriations from the Fund to the Department of Healthcare

and Family Services (formerly Illinois Department of Public

Aid).

The balance in this Fund on the first day of each calendar

quarter, after payment therefrom of any amounts reimbursable to

the federal government, and minus the amount reasonably

anticipated to be needed to make the disbursements during that

quarter authorized by this Section during the current and

following 3 calendar months, shall be certified by the Director

of Healthcare and Family Services and transferred by the State

Comptroller to the Drug Rebate Fund or the Healthcare Provider

Relief Fund in the State Treasury, as appropriate, on at least

an annual basis by June 30th of each fiscal year within 30 days

of the first day of each calendar quarter. The Director of

Healthcare and Family Services may certify and the State

Comptroller shall transfer to the Drug Rebate Fund or the

Healthcare Provider Relief Fund amounts on a more frequent

basis.

On July 1, 1999, the State Comptroller shall transfer the

sum of $5,000,000 from the Public Aid Recoveries Trust Fund

(formerly the Public Assistance Recoveries Trust Fund) into the

DHS Recoveries Trust Fund.

(Source: P.A. 97-647, eff. 1-1-12; 97-689, eff. 6-14-12;

98-130, eff. 8-2-13.)

Article 30

Section 30-5. The Illinois Public Aid Code is amended by

adding Section 5A-12.5 as follows:

(305 ILCS 5/5A-12.5 new)

Sec. 5A-12.5. Affordable Care Act adults; hospital access

payments. The Department shall, subject to federal approval,

mirror the Medical Assistance hospital reimbursement

methodology, including hospital access payments as defined in

Section 5A-12.2 of this Article and hospital access improvement

payments as defined in Section 5A-12.4 of this Article, in

compliance with the equivalent rate provisions of the

Affordable Care Act.

As used in this Section, "Affordable Care Act" is the

collective term for the Patient Protection and Affordable Care

Act (Pub. L. 111-148) and the Health Care and Education

Reconciliation Act of 2010 (Pub. L. 111-152).

Article 35

Section 35-5. The Hospital Licensing Act is amended by

changing Section 6.09 as follows:

(210 ILCS 85/6.09) (from Ch. 111 1/2, par. 147.09)

Sec. 6.09. (a) In order to facilitate the orderly

transition of aged and disabled patients from hospitals to

post-hospital care, whenever a patient who qualifies for the

federal Medicare program is hospitalized, the patient shall be

notified of discharge at least 24 hours prior to discharge from

the hospital. With regard to pending discharges to a skilled

nursing facility, the hospital must notify the case

coordination unit, as defined in 89 Ill. Adm. Code 240.260, at

least 24 hours prior to discharge. When the assessment is

completed in the hospital, the case coordination unit shall

provide the discharge planner with a copy of the prescreening

information and accompanying materials, which the discharge

planner shall transmit when the patient is discharged to a

skilled nursing facility. If or, if home health services are

ordered, the hospital must inform its designated case

coordination unit, as defined in 89 Ill. Adm. Code 240.260, of

the pending discharge and must provide the patient with the

case coordination unit's telephone number and other contact

information.

(b) Every hospital shall develop procedures for a physician

with medical staff privileges at the hospital or any

appropriate medical staff member to provide the discharge

notice prescribed in subsection (a) of this Section. The

procedures must include prohibitions against discharging or

referring a patient to any of the following if unlicensed,

uncertified, or unregistered: (i) a board and care facility, as

defined in the Board and Care Home Act; (ii) an assisted living

and shared housing establishment, as defined in the Assisted

Living and Shared Housing Act; (iii) a facility licensed under

the Nursing Home Care Act, the Specialized Mental Health

Rehabilitation Act of 2013, or the ID/DD Community Care Act;

(iv) a supportive living facility, as defined in Section

5-5.01a of the Illinois Public Aid Code; or (v) a free-standing

hospice facility licensed under the Hospice Program Licensing

Act if licensure, certification, or registration is required.

The Department of Public Health shall annually provide

hospitals with a list of licensed, certified, or registered

board and care facilities, assisted living and shared housing

establishments, nursing homes, supportive living facilities,

facilities licensed under the ID/DD Community Care Act or the

Specialized Mental Health Rehabilitation Act of 2013, and

hospice facilities. Reliance upon this list by a hospital shall

satisfy compliance with this requirement. The procedure may

also include a waiver for any case in which a discharge notice

is not feasible due to a short length of stay in the hospital

by the patient, or for any case in which the patient

voluntarily desires to leave the hospital before the expiration

of the 24 hour period.

(c) At least 24 hours prior to discharge from the hospital,

the patient shall receive written information on the patient's

right to appeal the discharge pursuant to the federal Medicare

program, including the steps to follow to appeal the discharge

and the appropriate telephone number to call in case the

patient intends to appeal the discharge.

(d) Before transfer of a patient to a long term care

facility licensed under the Nursing Home Care Act where elderly

persons reside, a hospital shall as soon as practicable

initiate a name-based criminal history background check by

electronic submission to the Department of State Police for all

persons between the ages of 18 and 70 years; provided, however,

that a hospital shall be required to initiate such a background

check only with respect to patients who:

(1) are transferring to a long term care facility for

the first time;

(2) have been in the hospital more than 5 days;

(3) are reasonably expected to remain at the long term

care facility for more than 30 days;

(4) have a known history of serious mental illness or

substance abuse; and

(5) are independently ambulatory or mobile for more

than a temporary period of time.

A hospital may also request a criminal history background

check for a patient who does not meet any of the criteria set

forth in items (1) through (5).

A hospital shall notify a long term care facility if the

hospital has initiated a criminal history background check on a

patient being discharged to that facility. In all circumstances

in which the hospital is required by this subsection to

initiate the criminal history background check, the transfer to

the long term care facility may proceed regardless of the

availability of criminal history results. Upon receipt of the

results, the hospital shall promptly forward the results to the

appropriate long term care facility. If the results of the

background check are inconclusive, the hospital shall have no

additional duty or obligation to seek additional information

from, or about, the patient.

(Source: P.A. 97-38, eff. 6-28-11; 97-227, eff. 1-1-12; 97-813,

eff. 7-13-12; 98-104, eff. 7-22-13.)

Section 35-10. The Illinois Public Aid Code is amended by

changing Section 11-5.4 as follows:

(305 ILCS 5/11-5.4)

Sec. 11-5.4. Expedited long-term care eligibility

determination and enrollment.

(a) An expedited long-term care eligibility determination

and enrollment system shall be established to reduce long-term

care determinations to 90 days or fewer by July 1, 2014 and

streamline the long-term care enrollment process.

Establishment of the system shall be a joint venture of the

Department of Human Services and Healthcare and Family Services

and the Department on Aging. The Governor shall name a lead

agency no later than 30 days after the effective date of this

amendatory Act of the 98th General Assembly to assume

responsibility for the full implementation of the

establishment and maintenance of the system. Project outcomes

shall include an enhanced eligibility determination tracking

system accessible to providers and a centralized application

review and eligibility determination with all applicants

reviewed within 90 days of receipt by the State of a complete

application. If the Department of Healthcare and Family

Services' Office of the Inspector General determines that there

is a likelihood that a non-allowable transfer of assets has

occurred, and the facility in which the applicant resides is

notified, an extension of up to 90 days shall be permissible.

On or before December 31, 2015, a streamlined application and

enrollment process shall be put in place based on the following

principles:

(1) Minimize the burden on applicants by collecting

only the data necessary to determine eligibility for

medical services, long-term care services, and spousal

impoverishment offset.

(2) Integrate online data sources to simplify the

application process by reducing the amount of information

needed to be entered and to expedite eligibility

verification.

(3) Provide online prompts to alert the applicant that

information is missing or not complete.

(b) The Department shall, on or before July 1, 2014, assess

the feasibility of incorporating all information needed to

determine eligibility for long-term care services, including

asset transfer and spousal impoverishment financials, into the

State's integrated eligibility system identifying all

resources needed and reasonable timeframes for achieving the

specified integration.

(c) The lead agency shall file interim reports with the

Chairs and Minority Spokespersons of the House and Senate Human

Services Committees no later than September 1, 2013 and on

February 1, 2014. The Department of Healthcare and Family

Services shall include in the annual Medicaid report for State

Fiscal Year 2014 and every fiscal year thereafter information

concerning implementation of the provisions of this Section.

(d) No later than August 1, 2014, the Auditor General shall

report to the General Assembly concerning the extent to which

the timeframes specified in this Section have been met and the

extent to which State staffing levels are adequate to meet the

requirements of this Section.

(e) The Department of Healthcare and Family Services, the

Department of Human Services, and the Department on Aging shall

take the following steps to achieve federally established

timeframes for eligibility determinations for Medicaid and

long-term care benefits and shall work toward the federal goal

of real time determinations:

(1) The Departments shall review, in collaboration

with representatives of affected providers, all forms and

procedures currently in use, federal guidelines either

suggested or mandated, and staff deployment by September

30, 2014 to identify additional measures that can improve

long-term care eligibility processing and make adjustments

where possible.

(2) No later than June 30, 2014, the Department of

Healthcare and Family Services shall issue vouchers for

advance payments not to exceed $50,000,000 to nursing

facilities with significant outstanding Medicaid liability

associated with services provided to residents with

Medicaid applications pending and residents facing the

greatest delays. Each facility with an advance payment

shall state in writing whether its own recoupment schedule

will be in 3 or 6 equal monthly installments, as long as

all advances are recouped by June 30, 2015.

(3) The Department of Healthcare and Family Services'

Office of Inspector General and the Department of Human

Services shall immediately forgo resource review and

review of transfers during the relevant look-back period

for applications that were submitted prior to September 1,

2013. An applicant who applied prior to September 1, 2013,

who was denied for failure to cooperate in providing

required information, and whose application was

incorrectly reviewed under the wrong look-back period

rules may request review and correction of the denial based

on this subsection. If found eligible upon review, such

applicants shall be retroactively enrolled.

(4) As soon as practicable, the Department of

Healthcare and Family Services shall implement policies

and promulgate rules to simplify financial eligibility

verification in the following instances: (A) for

applicants or recipients who are receiving Supplemental

Security Income payments or who had been receiving such

payments at the time they were admitted to a nursing

facility and (B) for applicants or recipients with verified

income at or below 100% of the federal poverty level when

the declared value of their countable resources is no

greater than the allowable amounts pursuant to Section 5-2

of this Code for classes of eligible persons for whom a

resource limit applies. Such simplified verification

policies shall apply to community cases as well as

long-term care cases.

(5) As soon as practicable, but not later than July 1,

2014, the Department of Healthcare and Family Services and

the Department of Human Services shall jointly begin a

special enrollment project by using simplified eligibility

verification policies and by redeploying caseworkers

trained to handle long-term care cases to prioritize those

cases, until the backlog is eliminated and processing time

is within 90 days. This project shall apply to applications

for long-term care received by the State on or before May

15, 2014.

(6) As soon as practicable, but not later than

September 1, 2014, the Department on Aging shall make

available to long-term care facilities and community

providers upon request, through an electronic method, the

information contained within the Interagency Certification

of Screening Results completed by the pre-screener, in a

form and manner acceptable to the Department of Human

Services.

(7) Effective 30 days after the completion of 3

regionally based trainings, nursing facilities shall

submit all applications for medical assistance online via

the Application for Benefits Eligibility (ABE) website.

This requirement shall extend to scanning and uploading

with the online application any required additional forms

such as the Long Term Care Facility Notification and the

Additional Financial Information for Long Term Care

Applicants as well as scanned copies of any supporting

documentation. Long-term care facility admission documents

must be submitted as required in Section 5-5 of this Code.

No local Department of Human Services office shall refuse

to accept an electronically filed application.

(8) Notwithstanding any other provision of this Code,

the Department of Human Services and the Department of

Healthcare and Family Services' Office of the Inspector

General shall, upon request, allow an applicant additional

time to submit information and documents needed as part of

a review of available resources or resources transferred

during the look-back period. The initial extension shall

not exceed 30 days. A second extension of 30 days may be

granted upon request. Any request for information issued by

the State to an applicant shall include the following: an

explanation of the information required and the date by

which the information must be submitted; a statement that

failure to respond in a timely manner can result in denial

of the application; a statement that the applicant or the

facility in the name of the applicant may seek an

extension; and the name and contact information of a

caseworker in case of questions. Any such request for

information shall also be sent to the facility. In deciding

whether to grant an extension, the Department of Human

Services or the Department of Healthcare and Family

Services' Office of the Inspector General shall take into

account what is in the best interest of the applicant. The

time limits for processing an application shall be tolled

during the period of any extension granted under this

subsection.

(9) The Department of Human Services and the Department

of Healthcare and Family Services must jointly compile data

on pending applications and post a monthly report on each

Department's website for the purposes of monitoring

long-term care eligibility processing. The report must

specify the number of applications pending long-term care

eligibility determination and admission in the following

categories:

(A) Length of time application is pending - 0 to 90

days, 91 days to 180 days, 181 days to 12 months, over

12 months to 18 months, over 18 months to 24 months,

and over 24 months.

(B) Percentage of applications pending in the

Department of Human Services' Family Community

Resource Centers, in the Department of Human Services'

long-term care hubs, with the Department of Healthcare

and Family Services' Office of Inspector General, and

those applications which are being tolled due to

requests for extension of time for additional

information.

(C) Status of pending applications.

(Source: P.A. 98-104, eff. 7-22-13.)

Article 40

Section 40-5. The Illinois Public Aid Code is amended by

changing Sections 5A-2, 5A-5, 5A-10, and 5A-14 as follows:

(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)

(Section scheduled to be repealed on January 1, 2015)

Sec. 5A-2. Assessment.

(a) Subject to Sections 5A-3 and 5A-10, for State fiscal

years 2009 through 2018 2014, and from July 1, 2014 through

December 31, 2014, an annual assessment on inpatient services

is imposed on each hospital provider in an amount equal to

$218.38 multiplied by the difference of the hospital's occupied

bed days less the hospital's Medicare bed days, provided,

however, that the amount of $218.38 shall be increased by a

uniform percentage to generate an amount equal to 75% of the

State share of the payments authorized under Section 12-5, with

such increase only taking effect upon the date that a State

share for such payments is required under federal law.

For State fiscal years 2009 through 2014, and after, a

hospital's occupied bed days and Medicare bed days shall be

determined using the most recent data available from each

hospital's 2005 Medicare cost report as contained in the

Healthcare Cost Report Information System file, for the quarter

ending on December 31, 2006, without regard to any subsequent

adjustments or changes to such data. If a hospital's 2005

Medicare cost report is not contained in the Healthcare Cost

Report Information System, then the Illinois Department may

obtain the hospital provider's occupied bed days and Medicare

bed days from any source available, including, but not limited

to, records maintained by the hospital provider, which may be

inspected at all times during business hours of the day by the

Illinois Department or its duly authorized agents and

employees.

(b) (Blank).

(b-5) Subject to Sections 5A-3 and 5A-10, for the portion

of State fiscal year 2012, beginning June 10, 2012 through June

30, 2012, and for State fiscal years 2013 through 2018 2014,

and July 1, 2014 through December 31, 2014, an annual

assessment on outpatient services is imposed on each hospital

provider in an amount equal to .008766 multiplied by the

hospital's outpatient gross revenue, provided, however, that

the amount of .008766 shall be increased by a uniform

percentage to generate an amount equal to 25% of the State

share of the payments authorized under Section 12-5, with such

increase only taking effect upon the date that a State share

for such payments is required under federal law. For the period

beginning June 10, 2012 through June 30, 2012, the annual

assessment on outpatient services shall be prorated by

multiplying the assessment amount by a fraction, the numerator

of which is 21 days and the denominator of which is 365 days.

For the portion of State fiscal year 2012, beginning June

10, 2012 through June 30, 2012, and State fiscal years 2013

through 2018 2014, and July 1, 2014 through December 31, 2014,

a hospital's outpatient gross revenue shall be determined using

the most recent data available from each hospital's 2009

Medicare cost report as contained in the Healthcare Cost Report

Information System file, for the quarter ending on June 30,

2011, without regard to any subsequent adjustments or changes

to such data. If a hospital's 2009 Medicare cost report is not

contained in the Healthcare Cost Report Information System,

then the Department may obtain the hospital provider's

outpatient gross revenue from any source available, including,

but not limited to, records maintained by the hospital

provider, which may be inspected at all times during business

hours of the day by the Department or its duly authorized

agents and employees.

(c) (Blank).

(d) Notwithstanding any of the other provisions of this

Section, the Department is authorized to adopt rules to reduce

the rate of any annual assessment imposed under this Section,

as authorized by Section 5-46.2 of the Illinois Administrative

Procedure Act.

(e) Notwithstanding any other provision of this Section,

any plan providing for an assessment on a hospital provider as

a permissible tax under Title XIX of the federal Social

Security Act and Medicaid-eligible payments to hospital

providers from the revenues derived from that assessment shall

be reviewed by the Illinois Department of Healthcare and Family

Services, as the Single State Medicaid Agency required by

federal law, to determine whether those assessments and

hospital provider payments meet federal Medicaid standards. If

the Department determines that the elements of the plan may

meet federal Medicaid standards and a related State Medicaid

Plan Amendment is prepared in a manner and form suitable for

submission, that State Plan Amendment shall be submitted in a

timely manner for review by the Centers for Medicare and

Medicaid Services of the United States Department of Health and

Human Services and subject to approval by the Centers for

Medicare and Medicaid Services of the United States Department

of Health and Human Services. No such plan shall become

effective without approval by the Illinois General Assembly by

the enactment into law of related legislation. Notwithstanding

any other provision of this Section, the Department is

authorized to adopt rules to reduce the rate of any annual

assessment imposed under this Section. Any such rules may be

adopted by the Department under Section 5-50 of the Illinois

Administrative Procedure Act.

(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;

98-104, eff. 7-22-13.)

(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)

Sec. 5A-5. Notice; penalty; maintenance of records.

(a) The Illinois Department shall send a notice of

assessment to every hospital provider subject to assessment

under this Article. The notice of assessment shall notify the

hospital of its assessment and shall be sent after receipt by

the Department of notification from the Centers for Medicare

and Medicaid Services of the U.S. Department of Health and

Human Services that the payment methodologies required under

this Article and, if necessary, the waiver granted under 42 CFR

433.68 have been approved. The notice shall be on a form

prepared by the Illinois Department and shall state the

following:

(1) The name of the hospital provider.

(2) The address of the hospital provider's principal

place of business from which the provider engages in the

occupation of hospital provider in this State, and the name

and address of each hospital operated, conducted, or

maintained by the provider in this State.

(3) The occupied bed days, occupied bed days less

Medicare days, adjusted gross hospital revenue, or

outpatient gross revenue of the hospital provider

(whichever is applicable), the amount of assessment

imposed under Section 5A-2 for the State fiscal year for

which the notice is sent, and the amount of each

installment to be paid during the State fiscal year.

(4) (Blank).

(5) Other reasonable information as determined by the

Illinois Department.

(b) If a hospital provider conducts, operates, or maintains

more than one hospital licensed by the Illinois Department of

Public Health, the provider shall pay the assessment for each

hospital separately.

(c) Notwithstanding any other provision in this Article, in

the case of a person who ceases to conduct, operate, or

maintain a hospital in respect of which the person is subject

to assessment under this Article as a hospital provider, the

assessment for the State fiscal year in which the cessation

occurs shall be adjusted by multiplying the assessment computed

under Section 5A-2 by a fraction, the numerator of which is the

number of days in the year during which the provider conducts,

operates, or maintains the hospital and the denominator of

which is 365. Immediately upon ceasing to conduct, operate, or

maintain a hospital, the person shall pay the assessment for

the year as so adjusted (to the extent not previously paid).

(d) Notwithstanding any other provision in this Article, a

provider who commences conducting, operating, or maintaining a

hospital, upon notice by the Illinois Department, shall pay the

assessment computed under Section 5A-2 and subsection (e) in

installments on the due dates stated in the notice and on the

regular installment due dates for the State fiscal year

occurring after the due dates of the initial notice.

(e) Notwithstanding any other provision in this Article,

for State fiscal years 2009 through 2018 2014, in the case of a

hospital provider that did not conduct, operate, or maintain a

hospital in 2005, the assessment for that State fiscal year

shall be computed on the basis of hypothetical occupied bed

days for the full calendar year as determined by the Illinois

Department. Notwithstanding any other provision in this

Article, for the portion of State fiscal year 2012 beginning

June 10, 2012 through June 30, 2012, and for State fiscal years

2013 through 2018 2014, and for July 1, 2014 through December

31, 2014, in the case of a hospital provider that did not

conduct, operate, or maintain a hospital in 2009, the

assessment under subsection (b-5) of Section 5A-2 for that

State fiscal year shall be computed on the basis of

hypothetical gross outpatient revenue for the full calendar

year as determined by the Illinois Department.

(f) Every hospital provider subject to assessment under

this Article shall keep sufficient records to permit the

determination of adjusted gross hospital revenue for the

hospital's fiscal year. All such records shall be kept in the

English language and shall, at all times during regular

business hours of the day, be subject to inspection by the

Illinois Department or its duly authorized agents and

employees.

(g) The Illinois Department may, by rule, provide a

hospital provider a reasonable opportunity to request a

clarification or correction of any clerical or computational

errors contained in the calculation of its assessment, but such

corrections shall not extend to updating the cost report

information used to calculate the assessment.

(h) (Blank).

(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;

98-104, eff. 7-22-13; 98-463, eff. 8-16-13; revised 10-21-13.)

(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)

Sec. 5A-10. Applicability.

(a) The assessment imposed by subsection (a) of Section

5A-2 shall cease to be imposed and the Department's obligation

to make payments shall immediately cease, and any moneys

remaining in the Fund shall be refunded to hospital providers

in proportion to the amounts paid by them, if:

(1) The payments to hospitals required under this

Article are not eligible for federal matching funds under

Title XIX or XXI of the Social Security Act;

(2) For State fiscal years 2009 through 2018 2014, and

July 1, 2014 through December 31, 2014, the Department of

Healthcare and Family Services adopts any administrative

rule change to reduce payment rates or alters any payment

methodology that reduces any payment rates made to

operating hospitals under the approved Title XIX or Title

XXI State plan in effect January 1, 2008 except for:

(A) any changes for hospitals described in

subsection (b) of Section 5A-3;

(B) any rates for payments made under this Article

V-A;

(C) any changes proposed in State plan amendment

transmittal numbers 08-01, 08-02, 08-04, 08-06, and

08-07;

(D) in relation to any admissions on or after

January 1, 2011, a modification in the methodology for

calculating outlier payments to hospitals for

exceptionally costly stays, for hospitals reimbursed

under the diagnosis-related grouping methodology in

effect on July 1, 2011; provided that the Department

shall be limited to one such modification during the

36-month period after the effective date of this

amendatory Act of the 96th General Assembly; or

(E) any changes affecting hospitals authorized by

Public Act 97-689; or .

(F) any changes authorized by Section 14-12 of this

Code, or for any changes authorized under Section 5A-15

of this Code.

(b) The assessment imposed by Section 5A-2 shall not take

effect or shall cease to be imposed, and the Department's

obligation to make payments shall immediately cease, if the

assessment is determined to be an impermissible tax under Title

XIX of the Social Security Act. Moneys in the Hospital Provider

Fund derived from assessments imposed prior thereto shall be

disbursed in accordance with Section 5A-8 to the extent federal

financial participation is not reduced due to the

impermissibility of the assessments, and any remaining moneys

shall be refunded to hospital providers in proportion to the

amounts paid by them.

(c) The assessments imposed by subsection (b-5) of Section

5A-2 shall not take effect or shall cease to be imposed, the

Department's obligation to make payments shall immediately

cease, and any moneys remaining in the Fund shall be refunded

to hospital providers in proportion to the amounts paid by

them, if the payments to hospitals required under Section

5A-12.4 are not eligible for federal matching funds under Title

XIX of the Social Security Act.

(d) The assessments imposed by Section 5A-2 shall not take

effect or shall cease to be imposed, the Department's

obligation to make payments shall immediately cease, and any

moneys remaining in the Fund shall be refunded to hospital

providers in proportion to the amounts paid by them, if:

(1) for State fiscal years 2013 through 2018 2014, and

July 1, 2014 through December 31, 2014, the Department

reduces any payment rates to hospitals as in effect on May

1, 2012, or alters any payment methodology as in effect on

May 1, 2012, that has the effect of reducing payment rates

to hospitals, except for any changes affecting hospitals

authorized in Public Act 97-689 and any changes authorized

by Section 14-12 of this Code, and except for any changes

authorized under Section 5A-15; or

(2) for State fiscal years 2013 through 2018 2014, and

July 1, 2014 through December 31, 2014, the Department

reduces any supplemental payments made to hospitals below

the amounts paid for services provided in State fiscal year

2011 as implemented by administrative rules adopted and in

effect on or prior to June 30, 2011, except for any changes

affecting hospitals authorized in Public Act 97-689 and any

changes authorized by Section 14-12 of this Code, and

except for any changes authorized under Section 5A-15; or .

(3) for State fiscal years 2015 through 2018, the

Department reduces the overall effective rate of

reimbursement to hospitals below the level authorized

under Section 14-12 of this Code, except for any changes

under Section 14-12 or Section 5A-15 of this Code.

(Source: P.A. 97-72, eff. 7-1-11; 97-74, eff. 6-30-11; 97-688,

eff. 6-14-12; 97-689, eff. 6-14-12; 98-463, eff. 8-16-13.)

(305 ILCS 5/5A-14)

Sec. 5A-14. Repeal of assessments and disbursements.

(a) Section 5A-2 is repealed on July 1, 2018 January 1,

2015.

(b) Section 5A-12 is repealed on July 1, 2005.

(c) Section 5A-12.1 is repealed on July 1, 2008.

(d) Section 5A-12.2 and Section 5A-12.4 are repealed on

July 1, 2018 January 1, 2015.

(e) Section 5A-12.3 is repealed on July 1, 2011.

(Source: P.A. 96-821, eff. 11-20-09; 96-1530, eff. 2-16-11;

97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)

Article 45

Section 45-5. The Illinois Public Aid Code is amended by

changing Section 14-8 and by adding Section 14-12 as follows:

(305 ILCS 5/14-8) (from Ch. 23, par. 14-8)

Sec. 14-8. Disbursements to Hospitals.

(a) For inpatient hospital services rendered on and after

September 1, 1991, the Illinois Department shall reimburse

hospitals for inpatient services at an inpatient payment rate

calculated for each hospital based upon the Medicare

Prospective Payment System as set forth in Sections 1886(b),

(d), (g), and (h) of the federal Social Security Act, and the

regulations, policies, and procedures promulgated thereunder,

except as modified by this Section. Payment rates for inpatient

hospital services rendered on or after September 1, 1991 and on

or before September 30, 1992 shall be calculated using the

Medicare Prospective Payment rates in effect on September 1,

1991. Payment rates for inpatient hospital services rendered on

or after October 1, 1992 and on or before March 31, 1994 shall

be calculated using the Medicare Prospective Payment rates in

effect on September 1, 1992. Payment rates for inpatient

hospital services rendered on or after April 1, 1994 shall be

calculated using the Medicare Prospective Payment rates

(including the Medicare grouping methodology and weighting

factors as adjusted pursuant to paragraph (1) of this

subsection) in effect 90 days prior to the date of admission.

For services rendered on or after July 1, 1995, the

reimbursement methodology implemented under this subsection

shall not include those costs referred to in Sections

1886(d)(5)(B) and 1886(h) of the Social Security Act. The

additional payment amounts required under Section

1886(d)(5)(F) of the Social Security Act, for hospitals serving

a disproportionate share of low-income or indigent patients,

are not required under this Section. For hospital inpatient

services rendered on or after July 1, 1995 and on or before

June 30, 2014, the Illinois Department shall reimburse

hospitals using the relative weighting factors and the base

payment rates calculated for each hospital that were in effect

on June 30, 1995, less the portion of such rates attributed by

the Illinois Department to the cost of medical education.

(1) The weighting factors established under Section

1886(d)(4) of the Social Security Act shall not be used in

the reimbursement system established under this Section.

Rather, the Illinois Department shall establish by rule

Medicaid weighting factors to be used in the reimbursement

system established under this Section.

(2) The Illinois Department shall define by rule those

hospitals or distinct parts of hospitals that shall be

exempt from the reimbursement system established under

this Section. In defining such hospitals, the Illinois

Department shall take into consideration those hospitals

exempt from the Medicare Prospective Payment System as of

September 1, 1991. For hospitals defined as exempt under

this subsection, the Illinois Department shall by rule

establish a reimbursement system for payment of inpatient

hospital services rendered on and after September 1, 1991.

For all hospitals that are children's hospitals as defined

in Section 5-5.02 of this Code, the reimbursement

methodology shall, through June 30, 1992, net of all

applicable fees, at least equal each children's hospital

1990 ICARE payment rates, indexed to the current year by

application of the DRI hospital cost index from 1989 to the

year in which payments are made. Excepting county providers

as defined in Article XV of this Code, hospitals licensed

under the University of Illinois Hospital Act, and

facilities operated by the Department of Mental Health and

Developmental Disabilities (or its successor, the

Department of Human Services) for hospital inpatient

services rendered on or after July 1, 1995 and on or before

June 30, 2014, the Illinois Department shall reimburse

children's hospitals, as defined in 89 Illinois

Administrative Code Section 149.50(c)(3), at the rates in

effect on June 30, 1995, and shall reimburse all other

hospitals at the rates in effect on June 30, 1995, less the

portion of such rates attributed by the Illinois Department

to the cost of medical education. For inpatient hospital

services provided on or after August 1, 1998, the Illinois

Department may establish by rule a means of adjusting the

rates of children's hospitals, as defined in 89 Illinois

Administrative Code Section 149.50(c)(3), that did not

meet that definition on June 30, 1995, in order for the

inpatient hospital rates of such hospitals to take into

account the average inpatient hospital rates of those

children's hospitals that did meet the definition of

children's hospitals on June 30, 1995.

(3) (Blank).

(4) Notwithstanding any other provision of this

Section, hospitals that on August 31, 1991, have a contract

with the Illinois Department under Section 3-4 of the

Illinois Health Finance Reform Act may elect to continue to

be reimbursed at rates stated in such contracts for general

and specialty care.

(5) In addition to any payments made under this

subsection (a), the Illinois Department shall make the

adjustment payments required by Section 5-5.02 of this

Code; provided, that in the case of any hospital reimbursed

under a per case methodology, the Illinois Department shall

add an amount equal to the product of the hospital's

average length of stay, less one day, multiplied by 20, for

inpatient hospital services rendered on or after September

1, 1991 and on or before September 30, 1992.

(b) (Blank).

(b-5) Excepting county providers as defined in Article XV

of this Code, hospitals licensed under the University of

Illinois Hospital Act, and facilities operated by the Illinois

Department of Mental Health and Developmental Disabilities (or

its successor, the Department of Human Services), for

outpatient services rendered on or after July 1, 1995 and

before July 1, 1998 the Illinois Department shall reimburse

children's hospitals, as defined in the Illinois

Administrative Code Section 149.50(c)(3), at the rates in

effect on June 30, 1995, less that portion of such rates

attributed by the Illinois Department to the outpatient

indigent volume adjustment and shall reimburse all other

hospitals at the rates in effect on June 30, 1995, less the

portions of such rates attributed by the Illinois Department to

the cost of medical education and attributed by the Illinois

Department to the outpatient indigent volume adjustment. For

outpatient services provided on or after July 1, 1998 and on or

before June 30, 2014, reimbursement rates shall be established

by rule.

(c) In addition to any other payments under this Code, the

Illinois Department shall develop a hospital disproportionate

share reimbursement methodology that, effective July 1, 1991,

through September 30, 1992, shall reimburse hospitals

sufficiently to expend the fee monies described in subsection

(b) of Section 14-3 of this Code and the federal matching funds

received by the Illinois Department as a result of expenditures

made by the Illinois Department as required by this subsection

(c) and Section 14-2 that are attributable to fee monies

deposited in the Fund, less amounts applied to adjustment

payments under Section 5-5.02.

(d) Critical Care Access Payments.

(1) In addition to any other payments made under this

Code, the Illinois Department shall develop a

reimbursement methodology that shall reimburse Critical

Care Access Hospitals for the specialized services that

qualify them as Critical Care Access Hospitals. No

adjustment payments shall be made under this subsection on

or after July 1, 1995.

(2) "Critical Care Access Hospitals" includes, but is

not limited to, hospitals that meet at least one of the

following criteria:

(A) Hospitals located outside of a metropolitan

statistical area that are designated as Level II

Perinatal Centers and that provide a disproportionate

share of perinatal services to recipients; or

(B) Hospitals that are designated as Level I Trauma

Centers (adult or pediatric) and certain Level II

Trauma Centers as determined by the Illinois

Department; or

(C) Hospitals located outside of a metropolitan

statistical area and that provide a disproportionate

share of obstetrical services to recipients.

(e) Inpatient high volume adjustment. For hospital

inpatient services, effective with rate periods beginning on or

after October 1, 1993, in addition to rates paid for inpatient

services by the Illinois Department, the Illinois Department

shall make adjustment payments for inpatient services

furnished by Medicaid high volume hospitals. The Illinois

Department shall establish by rule criteria for qualifying as a

Medicaid high volume hospital and shall establish by rule a

reimbursement methodology for calculating these adjustment

payments to Medicaid high volume hospitals. No adjustment

payment shall be made under this subsection for services

rendered on or after July 1, 1995.

(f) The Illinois Department shall modify its current rules

governing adjustment payments for targeted access, critical

care access, and uncompensated care to classify those

adjustment payments as not being payments to disproportionate

share hospitals under Title XIX of the federal Social Security

Act. Rules adopted under this subsection shall not be effective

with respect to services rendered on or after July 1, 1995. The

Illinois Department has no obligation to adopt or implement any

rules or make any payments under this subsection for services

rendered on or after July 1, 1995.

(f-5) The State recognizes that adjustment payments to

hospitals providing certain services or incurring certain

costs may be necessary to assure that recipients of medical

assistance have adequate access to necessary medical services.

These adjustments include payments for teaching costs and

uncompensated care, trauma center payments, rehabilitation

hospital payments, perinatal center payments, obstetrical care

payments, targeted access payments, Medicaid high volume

payments, and outpatient indigent volume payments. On or before

April 1, 1995, the Illinois Department shall issue

recommendations regarding (i) reimbursement mechanisms or

adjustment payments to reflect these costs and services,

including methods by which the payments may be calculated and

the method by which the payments may be financed, and (ii)

reimbursement mechanisms or adjustment payments to reflect

costs and services of federally qualified health centers with

respect to recipients of medical assistance.

(g) If one or more hospitals file suit in any court

challenging any part of this Article XIV, payments to hospitals

under this Article XIV shall be made only to the extent that

sufficient monies are available in the Fund and only to the

extent that any monies in the Fund are not prohibited from

disbursement under any order of the court.

(h) Payments under the disbursement methodology described

in this Section are subject to approval by the federal

government in an appropriate State plan amendment.

(i) The Illinois Department may by rule establish criteria

for and develop methodologies for adjustment payments to

hospitals participating under this Article.

(j) Hospital Residing Long Term Care Services. In addition

to any other payments made under this Code, the Illinois

Department may by rule establish criteria and develop

methodologies for payments to hospitals for Hospital Residing

Long Term Care Services.

(k) Critical Access Hospital outpatient payments. In

addition to any other payments authorized under this Code, the

Illinois Department shall reimburse critical access hospitals,

as designated by the Illinois Department of Public Health in

accordance with 42 CFR 485, Subpart F, for outpatient services

at an amount that is no less than the cost of providing such

services, based on Medicare cost principles. Payments under

this subsection shall be subject to appropriation.

(l) On and after July 1, 2012, the Department shall reduce

any rate of reimbursement for services or other payments or

alter any methodologies authorized by this Code to reduce any

rate of reimbursement for services or other payments in

accordance with Section 5-5e.

(Source: P.A. 97-689, eff. 6-14-12; 98-463, eff. 8-16-13.)

(305 ILCS 5/14-12 new)

Sec. 14-12. Hospital rate reform payment system. The

hospital payment system pursuant to Section 14-11 of this

Article shall be as follows:

(a) Inpatient hospital services. Effective for discharges

on and after July 1, 2014, reimbursement for inpatient general

acute care services shall utilize the All Patient Refined

Diagnosis Related Grouping (APR-DRG) software, version 30,

distributed by 3MTM Health Information System.

(1) The Department shall establish Medicaid weighting

factors to be used in the reimbursement system established

under this subsection. Initial weighting factors shall be

the weighting factors as published by 3M Health Information

System, associated with Version 30.0 adjusted for the

Illinois experience.

(2) The Department shall establish a

statewide-standardized amount to be used in the inpatient

reimbursement system. The Department shall publish these

amounts on its website no later than 10 calendar days prior

to their effective date.

(3) In addition to the statewide-standardized amount,

the Department shall develop adjusters to adjust the rate

of reimbursement for critical Medicaid providers or

services for trauma, transplantation services, perinatal

care, and Graduate Medical Education (GME).

(4) The Department shall develop add-on payments to

account for exceptionally costly inpatient stays,

consistent with Medicare outlier principles. Outlier fixed

loss thresholds may be updated to control for excessive

growth in outlier payments no more frequently than on an

annual basis, but at least triennially. Upon updating the

fixed loss thresholds, the Department shall be required to

update base rates within 12 months.

(5) The Department shall define those hospitals or

distinct parts of hospitals that shall be exempt from the

APR-DRG reimbursement system established under this

Section. The Department shall publish these hospitals'

inpatient rates on its website no later than 10 calendar

days prior to their effective date.

(6) Beginning July 1, 2014 and ending on June 30, 2018,

in addition to the statewide-standardized amount, the

Department shall develop an adjustor to adjust the rate of

reimbursement for safety-net hospitals defined in Section

5-5e.1 of this Code excluding pediatric hospitals.

(7) Beginning July 1, 2014 and ending on June 30, 2018,

in addition to the statewide-standardized amount, the

Department shall develop an adjustor to adjust the rate of

reimbursement for Illinois freestanding inpatient

psychiatric hospitals that are not designated as

children's hospitals by the Department but are primarily

treating patients under the age of 21.

(b) Outpatient hospital services. Effective for dates of

service on and after July 1, 2014, reimbursement for outpatient

services shall utilize the Enhanced Ambulatory Procedure

Grouping (E-APG) software, version 3.7 distributed by 3MTM

Health Information System.

(1) The Department shall establish Medicaid weighting

factors to be used in the reimbursement system established

under this subsection. The initial weighting factors shall

be the weighting factors as published by 3M Health

Information System, associated with Version 3.7.

(2) The Department shall establish service specific

statewide-standardized amounts to be used in the

reimbursement system.

(A) The initial statewide standardized amounts,

with the labor portion adjusted by the Calendar Year

2013 Medicare Outpatient Prospective Payment System

wage index with reclassifications, shall be published

by the Department on its website no later than 10

calendar days prior to their effective date.

(B) The Department shall establish adjustments to

the statewide-standardized amounts for each Critical

Access Hospital, as designated by the Department of

Public Health in accordance with 42 CFR 485, Subpart F.

The EAPG standardized amounts are determined

separately for each critical access hospital such that

simulated EAPG payments using outpatient base period

paid claim data plus payments under Section 5A-12.4 of

this Code net of the associated tax costs are equal to

the estimated costs of outpatient base period claims

data with a rate year cost inflation factor applied.

(3) In addition to the statewide-standardized amounts,

the Department shall develop adjusters to adjust the rate

of reimbursement for critical Medicaid hospital outpatient

providers or services, including outpatient high volume or

safety-net hospitals.

(c) In consultation with the hospital community, the

Department is authorized to replace 89 Ill. Admin. Code 152.150

as published in 38 Ill. Reg. 4980 through 4986 within 12 months

of the effective date of this amendatory Act of the 98th

General Assembly. If the Department does not replace these

rules within 12 months of the effective date of this amendatory

Act of the 98th General Assembly, the rules in effect for

152.150 as published in 38 Ill. Reg. 4980 through 4986 shall

remain in effect until modified by rule by the Department.

Nothing in this subsection shall be construed to mandate that

the Department file a replacement rule.

(d) Transition period. There shall be a transition period

to the reimbursement systems authorized under this Section that

shall begin on the effective date of these systems and continue

until June 30, 2018, unless extended by rule by the Department.

To help provide an orderly and predictable transition to the

new reimbursement systems and to preserve and enhance access to

the hospital services during this transition, the Department

shall allocate a transitional hospital access pool of at least

$290,000,000 annually so that transitional hospital access

payments are made to hospitals.

(1) After the transition period, the Department may

begin incorporating the transitional hospital access pool

into the base rate structure.

(2) After the transition period, if the Department

reduces payments from the transitional hospital access

pool, it shall increase base rates, develop new adjustors,

adjust current adjustors, develop new hospital access

payments based on updated information, or any combination

thereof by an amount equal to the decreases proposed in the

transitional hospital access pool payments, ensuring that

the entire transitional hospital access pool amount shall

continue to be used for hospital payments.

(e) Beginning 36 months after initial implementation, the

Department shall update the reimbursement components in

subsections (a) and (b), including standardized amounts and

weighting factors, and at least triennially and no more

frequently than annually thereafter. The Department shall

publish these updates on its website no later than 30 calendar

days prior to their effective date.

(f) Continuation of supplemental payments. Any

supplemental payments authorized under Illinois Administrative

Code 148 effective January 1, 2014 and that continue during the

period of July 1, 2014 through December 31, 2014 shall remain

in effect as long as the assessment imposed by Section 5A-2 is

in effect.

(g) Notwithstanding subsections (a) through (f) of this

Section, any updates to the system shall not result in any

diminishment of the overall effective rates of reimbursement as

of the implementation date of the new system (July 1, 2014).

These updates shall not preclude variations in any individual

component of the system or hospital rate variations. Nothing in

this Section shall prohibit the Department from increasing the

rates of reimbursement or developing payments to ensure access

to hospital services. Nothing in this Section shall be

construed to guarantee a minimum amount of spending in the

aggregate or per hospital as spending may be impacted by

factors including but not limited to the number of individuals

in the medical assistance program and the severity of illness

of the individuals.

(h) The Department shall have the authority to modify by

rulemaking any changes to the rates or methodologies in this

Section as required by the federal government to obtain federal

financial participation for expenditures made under this

Section.

(i) Except for subsections (g) and (h) of this Section, the

Department shall, pursuant to subsection (c) of Section 5-40 of

the Illinois Administrative Procedure Act, provide for

presentation at the June 2014 hearing of the Joint Committee on

Administrative Rules (JCAR) additional written notice to JCAR

of the following rules in order to commence the second notice

period for the following rules: rules published in the Illinois

Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559

(Medical Payment), 4628 (Specialized Health Care Delivery

Systems), 4640 (Hospital Services), 4932 (Diagnostic Related

Grouping (DRG) Prospective Payment System (PPS)), and 4977

(Hospital Reimbursement Changes), and published in the

Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499

(Specialized Health Care Delivery Systems) and 6505 (Hospital

Services).

Article 50

Section 50-5. The Specialized Mental Health Rehabilitation

Act of 2013 is amended by changing Sections 3-116 and 3-205 as

follows:

(210 ILCS 49/3-116)

Sec. 3-116. Experimental research. No consumer shall be

subjected to experimental research or treatment without first

obtaining his or her informed, written consent. The conduct of

any experimental research or treatment shall be authorized and

monitored by an institutional review board appointed by the

Director of the Department executive director. The membership,

operating procedures and review criteria for the institutional

review board shall be prescribed under rules and regulations of

the Department and shall comply with the requirements for

institutional review boards established by the federal Food and

Drug Administration. No person who has received compensation in

the prior 3 years from an entity that manufactures,

distributes, or sells pharmaceuticals, biologics, or medical

devices may serve on the institutional review board.

No facility shall permit experimental research or

treatment to be conducted on a consumer, or give access to any

person or person's records for a retrospective study about the

safety or efficacy of any care or treatment, without the prior

written approval of the institutional review board. No

executive director, or person licensed by the State to provide

medical care or treatment to any person, may assist or

participate in any experimental research on or treatment of a

consumer, including a retrospective study, that does not have

the prior written approval of the board. Such conduct shall be

grounds for professional discipline by the Department of

Financial and Professional Regulation.

The institutional review board may exempt from ongoing

review research or treatment initiated on a consumer before the

individual's admission to a facility and for which the board

determines there is adequate ongoing oversight by another

institutional review board. Nothing in this Section shall

prevent a facility, any facility employee, or any other person

from assisting or participating in any experimental research on

or treatment of a consumer, if the research or treatment began

before the person's admission to a facility, until the board

has reviewed the research or treatment and decided to grant or

deny approval or to exempt the research or treatment from

ongoing review.

(Source: P.A. 98-104, eff. 7-22-13.)

(210 ILCS 49/3-205)

Sec. 3-205. Disclosure of information to public. Standards

for the disclosure of information to the public shall be

established by rule. These information disclosure standards

shall include, but are not limited to, the following: staffing

and personnel levels, licensure and inspection information,

national accreditation information, consumer charges cost and

reimbursement information, and consumer complaint information.

Rules for the public disclosure of information shall be in

accordance with the provisions for inspection and copying of

public records in the Freedom of Information Act. The

Department of Healthcare and Family Services shall make

facility cost reports available on its website.

(Source: P.A. 98-104, eff. 7-22-13.)

Article 55

Section 55-5. The State Finance Act is amended by adding

Section 5.855 as follows:

(30 ILCS 105/5.855 new)

Sec. 5.855. The Supportive Living Facility Fund.

Section 55-10. The Specialized Mental Health

Rehabilitation Act of 2013 is amended by adding Section 5-102

as follows:

(210 ILCS 49/5-102 new)

Sec. 5-102. Transition payments. In addition to payments

already required by law, the Department of Healthcare and

Family Services shall make payments to facilities licensed

under this Act in the amount of $29.43 per licensed bed, per

day, for the period beginning June 1, 2014 and ending June 30,

2014.

Section 55-15. The Illinois Public Aid Code is amended by

changing Sections 5-5, 5-5.01a, 5-5.2, 5-5.4h, 5-5e, 5-5e.1,

5-5f, 5B-1, 5C-1, 5C-2, and 5C-7 and by adding Section 5C-10

and Article V-G as follows:

(305 ILCS 5/5-5) (from Ch. 23, par. 5-5)

Sec. 5-5. Medical services. The Illinois Department, by

rule, shall determine the quantity and quality of and the rate

of reimbursement for the medical assistance for which payment

will be authorized, and the medical services to be provided,

which may include all or part of the following: (1) inpatient

hospital services; (2) outpatient hospital services; (3) other

laboratory and X-ray services; (4) skilled nursing home

services; (5) physicians' services whether furnished in the

office, the patient's home, a hospital, a skilled nursing home,

or elsewhere; (6) medical care, or any other type of remedial

care furnished by licensed practitioners; (7) home health care

services; (8) private duty nursing service; (9) clinic

services; (10) dental services, including prevention and

treatment of periodontal disease and dental caries disease for

pregnant women, provided by an individual licensed to practice

dentistry or dental surgery; for purposes of this item (10),

"dental services" means diagnostic, preventive, or corrective

procedures provided by or under the supervision of a dentist in

the practice of his or her profession; (11) physical therapy

and related services; (12) prescribed drugs, dentures, and

prosthetic devices; and eyeglasses prescribed by a physician

skilled in the diseases of the eye, or by an optometrist,

whichever the person may select; (13) other diagnostic,

screening, preventive, and rehabilitative services, including

to ensure that the individual's need for intervention or

treatment of mental disorders or substance use disorders or

co-occurring mental health and substance use disorders is

determined using a uniform screening, assessment, and

evaluation process inclusive of criteria, for children and

adults; for purposes of this item (13), a uniform screening,

assessment, and evaluation process refers to a process that

includes an appropriate evaluation and, as warranted, a

referral; "uniform" does not mean the use of a singular

instrument, tool, or process that all must utilize; (14)

transportation and such other expenses as may be necessary;

(15) medical treatment of sexual assault survivors, as defined

in Section 1a of the Sexual Assault Survivors Emergency

Treatment Act, for injuries sustained as a result of the sexual

assault, including examinations and laboratory tests to

discover evidence which may be used in criminal proceedings

arising from the sexual assault; (16) the diagnosis and

treatment of sickle cell anemia; and (17) any other medical

care, and any other type of remedial care recognized under the

laws of this State, but not including abortions, or induced

miscarriages or premature births, unless, in the opinion of a

physician, such procedures are necessary for the preservation

of the life of the woman seeking such treatment, or except an

induced premature birth intended to produce a live viable child

and such procedure is necessary for the health of the mother or

her unborn child. The Illinois Department, by rule, shall

prohibit any physician from providing medical assistance to

anyone eligible therefor under this Code where such physician

has been found guilty of performing an abortion procedure in a

wilful and wanton manner upon a woman who was not pregnant at

the time such abortion procedure was performed. The term "any

other type of remedial care" shall include nursing care and

nursing home service for persons who rely on treatment by

spiritual means alone through prayer for healing.

Notwithstanding any other provision of this Section, a

comprehensive tobacco use cessation program that includes

purchasing prescription drugs or prescription medical devices

approved by the Food and Drug Administration shall be covered

under the medical assistance program under this Article for

persons who are otherwise eligible for assistance under this

Article.

Notwithstanding any other provision of this Code, the

Illinois Department may not require, as a condition of payment

for any laboratory test authorized under this Article, that a

physician's handwritten signature appear on the laboratory

test order form. The Illinois Department may, however, impose

other appropriate requirements regarding laboratory test order

documentation.

Upon receipt of federal approval of an amendment to the

Illinois Title XIX State Plan for this purpose, the Department

shall authorize the Chicago Public Schools (CPS) to procure a

vendor or vendors to manufacture eyeglasses for individuals

enrolled in a school within the CPS system. CPS shall ensure

that its vendor or vendors are enrolled as providers in the

medical assistance program and in any capitated Medicaid

managed care entity (MCE) serving individuals enrolled in a

school within the CPS system. Under any contract procured under

this provision, the vendor or vendors must serve only

individuals enrolled in a school within the CPS system. Claims

for services provided by CPS's vendor or vendors to recipients

of benefits in the medical assistance program under this Code,

the Children's Health Insurance Program, or the Covering ALL

KIDS Health Insurance Program shall be submitted to the

Department or the MCE in which the individual is enrolled for

payment and shall be reimbursed at the Department's or the

MCE's established rates or rate methodologies for eyeglasses.

On and after July 1, 2012, the Department of Healthcare and

Family Services may provide the following services to persons

eligible for assistance under this Article who are

participating in education, training or employment programs

operated by the Department of Human Services as successor to

the Department of Public Aid:

(1) dental services provided by or under the

supervision of a dentist; and

(2) eyeglasses prescribed by a physician skilled in the

diseases of the eye, or by an optometrist, whichever the

person may select.

Notwithstanding any other provision of this Code and

subject to federal approval, the Department may adopt rules to

allow a dentist who is volunteering his or her service at no

cost to render dental services through an enrolled

not-for-profit health clinic without the dentist personally

enrolling as a participating provider in the medical assistance

program. A not-for-profit health clinic shall include a public

health clinic or Federally Qualified Health Center or other

enrolled provider, as determined by the Department, through

which dental services covered under this Section are performed.

The Department shall establish a process for payment of claims

for reimbursement for covered dental services rendered under

this provision.

The Illinois Department, by rule, may distinguish and

classify the medical services to be provided only in accordance

with the classes of persons designated in Section 5-2.

The Department of Healthcare and Family Services must

provide coverage and reimbursement for amino acid-based

elemental formulas, regardless of delivery method, for the

diagnosis and treatment of (i) eosinophilic disorders and (ii)

short bowel syndrome when the prescribing physician has issued

a written order stating that the amino acid-based elemental

formula is medically necessary.

The Illinois Department shall authorize the provision of,

and shall authorize payment for, screening by low-dose

mammography for the presence of occult breast cancer for women

35 years of age or older who are eligible for medical

assistance under this Article, as follows:

(A) A baseline mammogram for women 35 to 39 years of

age.

(B) An annual mammogram for women 40 years of age or

older.

(C) A mammogram at the age and intervals considered

medically necessary by the woman's health care provider for

women under 40 years of age and having a family history of

breast cancer, prior personal history of breast cancer,

positive genetic testing, or other risk factors.

(D) A comprehensive ultrasound screening of an entire

breast or breasts if a mammogram demonstrates

heterogeneous or dense breast tissue, when medically

necessary as determined by a physician licensed to practice

medicine in all of its branches.

All screenings shall include a physical breast exam,

instruction on self-examination and information regarding the

frequency of self-examination and its value as a preventative

tool. For purposes of this Section, "low-dose mammography"

means the x-ray examination of the breast using equipment

dedicated specifically for mammography, including the x-ray

tube, filter, compression device, and image receptor, with an

average radiation exposure delivery of less than one rad per

breast for 2 views of an average size breast. The term also

includes digital mammography.

On and after January 1, 2012, providers participating in a

quality improvement program approved by the Department shall be

reimbursed for screening and diagnostic mammography at the same

rate as the Medicare program's rates, including the increased

reimbursement for digital mammography.

The Department shall convene an expert panel including

representatives of hospitals, free-standing mammography

facilities, and doctors, including radiologists, to establish

quality standards.

Subject to federal approval, the Department shall

establish a rate methodology for mammography at federally

qualified health centers and other encounter-rate clinics.

These clinics or centers may also collaborate with other

hospital-based mammography facilities.

The Department shall establish a methodology to remind

women who are age-appropriate for screening mammography, but

who have not received a mammogram within the previous 18

months, of the importance and benefit of screening mammography.

The Department shall establish a performance goal for

primary care providers with respect to their female patients

over age 40 receiving an annual mammogram. This performance

goal shall be used to provide additional reimbursement in the

form of a quality performance bonus to primary care providers

who meet that goal.

The Department shall devise a means of case-managing or

patient navigation for beneficiaries diagnosed with breast

cancer. This program shall initially operate as a pilot program

in areas of the State with the highest incidence of mortality

related to breast cancer. At least one pilot program site shall

be in the metropolitan Chicago area and at least one site shall

be outside the metropolitan Chicago area. An evaluation of the

pilot program shall be carried out measuring health outcomes

and cost of care for those served by the pilot program compared

to similarly situated patients who are not served by the pilot

program.

Any medical or health care provider shall immediately

recommend, to any pregnant woman who is being provided prenatal

services and is suspected of drug abuse or is addicted as

defined in the Alcoholism and Other Drug Abuse and Dependency

Act, referral to a local substance abuse treatment provider

licensed by the Department of Human Services or to a licensed

hospital which provides substance abuse treatment services.

The Department of Healthcare and Family Services shall assure

coverage for the cost of treatment of the drug abuse or

addiction for pregnant recipients in accordance with the

Illinois Medicaid Program in conjunction with the Department of

Human Services.

All medical providers providing medical assistance to

pregnant women under this Code shall receive information from

the Department on the availability of services under the Drug

Free Families with a Future or any comparable program providing

case management services for addicted women, including

information on appropriate referrals for other social services

that may be needed by addicted women in addition to treatment

for addiction.

The Illinois Department, in cooperation with the

Departments of Human Services (as successor to the Department

of Alcoholism and Substance Abuse) and Public Health, through a

public awareness campaign, may provide information concerning

treatment for alcoholism and drug abuse and addiction, prenatal

health care, and other pertinent programs directed at reducing

the number of drug-affected infants born to recipients of

medical assistance.

Neither the Department of Healthcare and Family Services

nor the Department of Human Services shall sanction the

recipient solely on the basis of her substance abuse.

The Illinois Department shall establish such regulations

governing the dispensing of health services under this Article

as it shall deem appropriate. The Department should seek the

advice of formal professional advisory committees appointed by

the Director of the Illinois Department for the purpose of

providing regular advice on policy and administrative matters,

information dissemination and educational activities for

medical and health care providers, and consistency in

procedures to the Illinois Department.

The Illinois Department may develop and contract with

Partnerships of medical providers to arrange medical services

for persons eligible under Section 5-2 of this Code.

Implementation of this Section may be by demonstration projects

in certain geographic areas. The Partnership shall be

represented by a sponsor organization. The Department, by rule,

shall develop qualifications for sponsors of Partnerships.

Nothing in this Section shall be construed to require that the

sponsor organization be a medical organization.

The sponsor must negotiate formal written contracts with

medical providers for physician services, inpatient and

outpatient hospital care, home health services, treatment for

alcoholism and substance abuse, and other services determined

necessary by the Illinois Department by rule for delivery by

Partnerships. Physician services must include prenatal and

obstetrical care. The Illinois Department shall reimburse

medical services delivered by Partnership providers to clients

in target areas according to provisions of this Article and the

Illinois Health Finance Reform Act, except that:

(1) Physicians participating in a Partnership and

providing certain services, which shall be determined by

the Illinois Department, to persons in areas covered by the

Partnership may receive an additional surcharge for such

services.

(2) The Department may elect to consider and negotiate

financial incentives to encourage the development of

Partnerships and the efficient delivery of medical care.

(3) Persons receiving medical services through

Partnerships may receive medical and case management

services above the level usually offered through the

medical assistance program.

Medical providers shall be required to meet certain

qualifications to participate in Partnerships to ensure the

delivery of high quality medical services. These

qualifications shall be determined by rule of the Illinois

Department and may be higher than qualifications for

participation in the medical assistance program. Partnership

sponsors may prescribe reasonable additional qualifications

for participation by medical providers, only with the prior

written approval of the Illinois Department.

Nothing in this Section shall limit the free choice of

practitioners, hospitals, and other providers of medical

services by clients. In order to ensure patient freedom of

choice, the Illinois Department shall immediately promulgate

all rules and take all other necessary actions so that provided

services may be accessed from therapeutically certified

optometrists to the full extent of the Illinois Optometric

Practice Act of 1987 without discriminating between service

providers.

The Department shall apply for a waiver from the United

States Health Care Financing Administration to allow for the

implementation of Partnerships under this Section.

The Illinois Department shall require health care

providers to maintain records that document the medical care

and services provided to recipients of Medical Assistance under

this Article. Such records must be retained for a period of not

less than 6 years from the date of service or as provided by

applicable State law, whichever period is longer, except that

if an audit is initiated within the required retention period

then the records must be retained until the audit is completed

and every exception is resolved. The Illinois Department shall

require health care providers to make available, when

authorized by the patient, in writing, the medical records in a

timely fashion to other health care providers who are treating

or serving persons eligible for Medical Assistance under this

Article. All dispensers of medical services shall be required

to maintain and retain business and professional records

sufficient to fully and accurately document the nature, scope,

details and receipt of the health care provided to persons

eligible for medical assistance under this Code, in accordance

with regulations promulgated by the Illinois Department. The

rules and regulations shall require that proof of the receipt

of prescription drugs, dentures, prosthetic devices and

eyeglasses by eligible persons under this Section accompany

each claim for reimbursement submitted by the dispenser of such

medical services. No such claims for reimbursement shall be

approved for payment by the Illinois Department without such

proof of receipt, unless the Illinois Department shall have put

into effect and shall be operating a system of post-payment

audit and review which shall, on a sampling basis, be deemed

adequate by the Illinois Department to assure that such drugs,

dentures, prosthetic devices and eyeglasses for which payment

is being made are actually being received by eligible

recipients. Within 90 days after the effective date of this

amendatory Act of 1984, the Illinois Department shall establish

a current list of acquisition costs for all prosthetic devices

and any other items recognized as medical equipment and

supplies reimbursable under this Article and shall update such

list on a quarterly basis, except that the acquisition costs of

all prescription drugs shall be updated no less frequently than

every 30 days as required by Section 5-5.12.

The rules and regulations of the Illinois Department shall

require that a written statement including the required opinion

of a physician shall accompany any claim for reimbursement for

abortions, or induced miscarriages or premature births. This

statement shall indicate what procedures were used in providing

such medical services.

Notwithstanding any other law to the contrary, the Illinois

Department shall, within 365 days after July 22, 2013, the

effective date of Public Act 98-104 this amendatory Act of the

98th General Assembly, establish procedures to permit skilled

care facilities licensed under the Nursing Home Care Act to

submit monthly billing claims for reimbursement purposes.

Following development of these procedures, the Department

shall have an additional 365 days to test the viability of the

new system and to ensure that any necessary operational or

structural changes to its information technology platforms are

implemented.

The Illinois Department shall require all dispensers of

medical services, other than an individual practitioner or

group of practitioners, desiring to participate in the Medical

Assistance program established under this Article to disclose

all financial, beneficial, ownership, equity, surety or other

interests in any and all firms, corporations, partnerships,

associations, business enterprises, joint ventures, agencies,

institutions or other legal entities providing any form of

health care services in this State under this Article.

The Illinois Department may require that all dispensers of

medical services desiring to participate in the medical

assistance program established under this Article disclose,

under such terms and conditions as the Illinois Department may

by rule establish, all inquiries from clients and attorneys

regarding medical bills paid by the Illinois Department, which

inquiries could indicate potential existence of claims or liens

for the Illinois Department.

Enrollment of a vendor shall be subject to a provisional

period and shall be conditional for one year. During the period

of conditional enrollment, the Department may terminate the

vendor's eligibility to participate in, or may disenroll the

vendor from, the medical assistance program without cause.

Unless otherwise specified, such termination of eligibility or

disenrollment is not subject to the Department's hearing

process. However, a disenrolled vendor may reapply without

penalty.

The Department has the discretion to limit the conditional

enrollment period for vendors based upon category of risk of

the vendor.

Prior to enrollment and during the conditional enrollment

period in the medical assistance program, all vendors shall be

subject to enhanced oversight, screening, and review based on

the risk of fraud, waste, and abuse that is posed by the

category of risk of the vendor. The Illinois Department shall

establish the procedures for oversight, screening, and review,

which may include, but need not be limited to: criminal and

financial background checks; fingerprinting; license,

certification, and authorization verifications; unscheduled or

unannounced site visits; database checks; prepayment audit

reviews; audits; payment caps; payment suspensions; and other

screening as required by federal or State law.

The Department shall define or specify the following: (i)

by provider notice, the "category of risk of the vendor" for

each type of vendor, which shall take into account the level of

screening applicable to a particular category of vendor under

federal law and regulations; (ii) by rule or provider notice,

the maximum length of the conditional enrollment period for

each category of risk of the vendor; and (iii) by rule, the

hearing rights, if any, afforded to a vendor in each category

of risk of the vendor that is terminated or disenrolled during

the conditional enrollment period.

To be eligible for payment consideration, a vendor's

payment claim or bill, either as an initial claim or as a

resubmitted claim following prior rejection, must be received

by the Illinois Department, or its fiscal intermediary, no

later than 180 days after the latest date on the claim on which

medical goods or services were provided, with the following

exceptions:

(1) In the case of a provider whose enrollment is in

process by the Illinois Department, the 180-day period

shall not begin until the date on the written notice from

the Illinois Department that the provider enrollment is

complete.

(2) In the case of errors attributable to the Illinois

Department or any of its claims processing intermediaries

which result in an inability to receive, process, or

adjudicate a claim, the 180-day period shall not begin

until the provider has been notified of the error.

(3) In the case of a provider for whom the Illinois

Department initiates the monthly billing process.

(4) In the case of a provider operated by a unit of

local government with a population exceeding 3,000,000

when local government funds finance federal participation

for claims payments.

For claims for services rendered during a period for which

a recipient received retroactive eligibility, claims must be

filed within 180 days after the Department determines the

applicant is eligible. For claims for which the Illinois

Department is not the primary payer, claims must be submitted

to the Illinois Department within 180 days after the final

adjudication by the primary payer.

In the case of long term care facilities, within 5 days of

receipt by the facility of required prescreening information,

data for new admissions shall be entered into the Medical

Electronic Data Interchange (MEDI) or the Recipient

Eligibility Verification (REV) System or successor system, and

within 15 days of receipt by the facility of required

prescreening information, admission documents shall be

submitted within 30 days of an admission to the facility

through MEDI or REV the Medical Electronic Data Interchange

(MEDI) or the Recipient Eligibility Verification (REV) System,

or shall be submitted directly to the Department of Human

Services using required admission forms. Effective September

1, 2014, admission documents, including all prescreening

information, must be submitted through MEDI or REV.

Confirmation numbers assigned to an accepted transaction shall

be retained by a facility to verify timely submittal. Once an

admission transaction has been completed, all resubmitted

claims following prior rejection are subject to receipt no

later than 180 days after the admission transaction has been

completed.

Claims that are not submitted and received in compliance

with the foregoing requirements shall not be eligible for

payment under the medical assistance program, and the State

shall have no liability for payment of those claims.

To the extent consistent with applicable information and

privacy, security, and disclosure laws, State and federal

agencies and departments shall provide the Illinois Department

access to confidential and other information and data necessary

to perform eligibility and payment verifications and other

Illinois Department functions. This includes, but is not

limited to: information pertaining to licensure;

certification; earnings; immigration status; citizenship; wage

reporting; unearned and earned income; pension income;

employment; supplemental security income; social security

numbers; National Provider Identifier (NPI) numbers; the

National Practitioner Data Bank (NPDB); program and agency

exclusions; taxpayer identification numbers; tax delinquency;

corporate information; and death records.

The Illinois Department shall enter into agreements with

State agencies and departments, and is authorized to enter into

agreements with federal agencies and departments, under which

such agencies and departments shall share data necessary for

medical assistance program integrity functions and oversight.

The Illinois Department shall develop, in cooperation with

other State departments and agencies, and in compliance with

applicable federal laws and regulations, appropriate and

effective methods to share such data. At a minimum, and to the

extent necessary to provide data sharing, the Illinois

Department shall enter into agreements with State agencies and

departments, and is authorized to enter into agreements with

federal agencies and departments, including but not limited to:

the Secretary of State; the Department of Revenue; the

Department of Public Health; the Department of Human Services;

and the Department of Financial and Professional Regulation.

Beginning in fiscal year 2013, the Illinois Department

shall set forth a request for information to identify the

benefits of a pre-payment, post-adjudication, and post-edit

claims system with the goals of streamlining claims processing

and provider reimbursement, reducing the number of pending or

rejected claims, and helping to ensure a more transparent

adjudication process through the utilization of: (i) provider

data verification and provider screening technology; and (ii)

clinical code editing; and (iii) pre-pay, pre- or

post-adjudicated predictive modeling with an integrated case

management system with link analysis. Such a request for

information shall not be considered as a request for proposal

or as an obligation on the part of the Illinois Department to

take any action or acquire any products or services.

The Illinois Department shall establish policies,

procedures, standards and criteria by rule for the acquisition,

repair and replacement of orthotic and prosthetic devices and

durable medical equipment. Such rules shall provide, but not be

limited to, the following services: (1) immediate repair or

replacement of such devices by recipients; and (2) rental,

lease, purchase or lease-purchase of durable medical equipment

in a cost-effective manner, taking into consideration the

recipient's medical prognosis, the extent of the recipient's

needs, and the requirements and costs for maintaining such

equipment. Subject to prior approval, such rules shall enable a

recipient to temporarily acquire and use alternative or

substitute devices or equipment pending repairs or

replacements of any device or equipment previously authorized

for such recipient by the Department.

The Department shall execute, relative to the nursing home

prescreening project, written inter-agency agreements with the

Department of Human Services and the Department on Aging, to

effect the following: (i) intake procedures and common

eligibility criteria for those persons who are receiving

non-institutional services; and (ii) the establishment and

development of non-institutional services in areas of the State

where they are not currently available or are undeveloped; and

(iii) notwithstanding any other provision of law, subject to

federal approval, on and after July 1, 2012, an increase in the

determination of need (DON) scores from 29 to 37 for applicants

for institutional and home and community-based long term care;

if and only if federal approval is not granted, the Department

may, in conjunction with other affected agencies, implement

utilization controls or changes in benefit packages to

effectuate a similar savings amount for this population; and

(iv) no later than July 1, 2013, minimum level of care

eligibility criteria for institutional and home and

community-based long term care; and (v) no later than October

1, 2013, establish procedures to permit long term care

providers access to eligibility scores for individuals with an

admission date who are seeking or receiving services from the

long term care provider. In order to select the minimum level

of care eligibility criteria, the Governor shall establish a

workgroup that includes affected agency representatives and

stakeholders representing the institutional and home and

community-based long term care interests. This Section shall

not restrict the Department from implementing lower level of

care eligibility criteria for community-based services in

circumstances where federal approval has been granted.

The Illinois Department shall develop and operate, in

cooperation with other State Departments and agencies and in

compliance with applicable federal laws and regulations,

appropriate and effective systems of health care evaluation and

programs for monitoring of utilization of health care services

and facilities, as it affects persons eligible for medical

assistance under this Code.

The Illinois Department shall report annually to the

General Assembly, no later than the second Friday in April of

1979 and each year thereafter, in regard to:

(a) actual statistics and trends in utilization of

medical services by public aid recipients;

(b) actual statistics and trends in the provision of

the various medical services by medical vendors;

(c) current rate structures and proposed changes in

those rate structures for the various medical vendors; and

(d) efforts at utilization review and control by the

Illinois Department.

The period covered by each report shall be the 3 years

ending on the June 30 prior to the report. The report shall

include suggested legislation for consideration by the General

Assembly. The filing of one copy of the report with the

Speaker, one copy with the Minority Leader and one copy with

the Clerk of the House of Representatives, one copy with the

President, one copy with the Minority Leader and one copy with

the Secretary of the Senate, one copy with the Legislative

Research Unit, and such additional copies with the State

Government Report Distribution Center for the General Assembly

as is required under paragraph (t) of Section 7 of the State

Library Act shall be deemed sufficient to comply with this

Section.

Rulemaking authority to implement Public Act 95-1045, if

any, is conditioned on the rules being adopted in accordance

with all provisions of the Illinois Administrative Procedure

Act and all rules and procedures of the Joint Committee on

Administrative Rules; any purported rule not so adopted, for

whatever reason, is unauthorized.

On and after July 1, 2012, the Department shall reduce any

rate of reimbursement for services or other payments or alter

any methodologies authorized by this Code to reduce any rate of

reimbursement for services or other payments in accordance with

Section 5-5e.

Because kidney transplantation can be an appropriate, cost

effective alternative to renal dialysis when medically

necessary and notwithstanding the provisions of Section 1-11 of

this Code, beginning October 1, 2014, the Department shall

cover kidney transplantation for noncitizens with end-stage

renal disease who are not eligible for comprehensive medical

benefits, who meet the residency requirements of Section 5-3 of

this Code, and who would otherwise meet the financial

requirements of the appropriate class of eligible persons under

Section 5-2 of this Code. To qualify for coverage of kidney

transplantation, such person must be receiving emergency renal

dialysis services covered by the Department. Providers under

this Section shall be prior approved and certified by the

Department to perform kidney transplantation and the services

under this Section shall be limited to services associated with

kidney transplantation.

(Source: P.A. 97-48, eff. 6-28-11; 97-638, eff. 1-1-12; 97-689,

eff. 6-14-12; 97-1061, eff. 8-24-12; 98-104, Article 9, Section

9-5, eff. 7-22-13; 98-104, Article 12, Section 12-20, eff.

7-22-13; 98-303, eff. 8-9-13; 98-463, eff. 8-16-13; revised

9-19-13.)

(305 ILCS 5/5-5.01a)

Sec. 5-5.01a. Supportive living facilities program. The

Department shall establish and provide oversight for a program

of supportive living facilities that seek to promote resident

independence, dignity, respect, and well-being in the most

cost-effective manner.

A supportive living facility is either a free-standing

facility or a distinct physical and operational entity within a

nursing facility. A supportive living facility integrates

housing with health, personal care, and supportive services and

is a designated setting that offers residents their own

separate, private, and distinct living units.

Sites for the operation of the program shall be selected by

the Department based upon criteria that may include the need

for services in a geographic area, the availability of funding,

and the site's ability to meet the standards.

Beginning July 1, 2014, subject to federal approval, the

Medicaid rates for supportive living facilities shall be equal

to the supportive living facility Medicaid rate effective on

June 30, 2014 increased by 8.85%. Once the assessment imposed

at Article V-G of this Code is determined to be a permissible

tax under Title XIX of the Social Security Act, the Department

shall increase the Medicaid rates for supportive living

facilities effective on July 1, 2014 by 9.09%. The Department

shall apply this increase retroactively to coincide with the

imposition of the assessment in Article V-G of this Code in

accordance with the approval for federal financial

participation by the Centers for Medicare and Medicaid

Services.

The Department may adopt rules to implement this Section.

Rules that establish or modify the services, standards, and

conditions for participation in the program shall be adopted by

the Department in consultation with the Department on Aging,

the Department of Rehabilitation Services, and the Department

of Mental Health and Developmental Disabilities (or their

successor agencies).

Facilities or distinct parts of facilities which are

selected as supportive living facilities and are in good

standing with the Department's rules are exempt from the

provisions of the Nursing Home Care Act and the Illinois Health

Facilities Planning Act.

(Source: P.A. 94-342, eff. 7-26-05.)

(305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)

Sec. 5-5.2. Payment.

(a) All nursing facilities that are grouped pursuant to

Section 5-5.1 of this Act shall receive the same rate of

payment for similar services.

(b) It shall be a matter of State policy that the Illinois

Department shall utilize a uniform billing cycle throughout the

State for the long-term care providers.

(c) Notwithstanding any other provisions of this Code, the

methodologies for reimbursement of nursing services as

provided under this Article shall no longer be applicable for

bills payable for nursing services rendered on or after a new

reimbursement system based on the Resource Utilization Groups

(RUGs) has been fully operationalized, which shall take effect

for services provided on or after January 1, 2014.

(d) The new nursing services reimbursement methodology

utilizing RUG-IV 48 grouper model, which shall be referred to

as the RUGs reimbursement system, taking effect January 1,

2014, shall be based on the following:

(1) The methodology shall be resident-driven,

facility-specific, and cost-based.

(2) Costs shall be annually rebased and case mix index

quarterly updated. The nursing services methodology will

be assigned to the Medicaid enrolled residents on record as

of 30 days prior to the beginning of the rate period in the

Department's Medicaid Management Information System (MMIS)

as present on the last day of the second quarter preceding

the rate period.

(3) Regional wage adjustors based on the Health Service

Areas (HSA) groupings and adjusters in effect on April 30,

2012 shall be included.

(4) Case mix index shall be assigned to each resident

class based on the Centers for Medicare and Medicaid

Services staff time measurement study in effect on July 1,

2013, utilizing an index maximization approach.

(5) The pool of funds available for distribution by

case mix and the base facility rate shall be determined

using the formula contained in subsection (d-1).

(d-1) Calculation of base year Statewide RUG-IV nursing

base per diem rate.

(1) Base rate spending pool shall be:

(A) The base year resident days which are

calculated by multiplying the number of Medicaid

residents in each nursing home as indicated in the MDS

data defined in paragraph (4) by 365.

(B) Each facility's nursing component per diem in

effect on July 1, 2012 shall be multiplied by

subsection (A).

(C) Thirteen million is added to the product of

subparagraph (A) and subparagraph (B) to adjust for the

exclusion of nursing homes defined in paragraph (5).

(2) For each nursing home with Medicaid residents as

indicated by the MDS data defined in paragraph (4),

weighted days adjusted for case mix and regional wage

adjustment shall be calculated. For each home this

calculation is the product of:

(A) Base year resident days as calculated in

subparagraph (A) of paragraph (1).

(B) The nursing home's regional wage adjustor

based on the Health Service Areas (HSA) groupings and

adjustors in effect on April 30, 2012.

(C) Facility weighted case mix which is the number

of Medicaid residents as indicated by the MDS data

defined in paragraph (4) multiplied by the associated

case weight for the RUG-IV 48 grouper model using

standard RUG-IV procedures for index maximization.

(D) The sum of the products calculated for each

nursing home in subparagraphs (A) through (C) above

shall be the base year case mix, rate adjusted weighted

days.

(3) The Statewide RUG-IV nursing base per diem rate:

(A) on January 1, 2014 shall be the quotient of the

paragraph (1) divided by the sum calculated under

subparagraph (D) of paragraph (2); and .

(B) on and after July 1, 2014, shall be the amount

calculated under subparagraph (A) of this paragraph

(3) plus $1.76.

(4) Minimum Data Set (MDS) comprehensive assessments

for Medicaid residents on the last day of the quarter used

to establish the base rate.

(5) Nursing facilities designated as of July 1, 2012 by

the Department as "Institutions for Mental Disease" shall

be excluded from all calculations under this subsection.

The data from these facilities shall not be used in the

computations described in paragraphs (1) through (4) above

to establish the base rate.

(e) Beginning July 1, 2014, the Department shall allocate

funding in the amount up to $10,000,000 for per diem add-ons to

the RUGS methodology for dates of service on and after July 1,

2014:

(1) $0.63 for each resident who scores in I4200

Alzheimer's Disease or I4800 non-Alzheimer's Dementia.

(2) $2.67 for each resident who scores either a "1" or

"2" in any items S1200A through S1200I and also scores in

RUG groups PA1, PA2, BA1, or BA2.

Notwithstanding any other provision of this Code, the

Department shall by rule develop a reimbursement methodology

reflective of the intensity of care and services requirements

of low need residents in the lowest RUG IV groupers and

corresponding regulations. Only that portion of the RUGs

Reimbursement System spending pool described in subsection

(d-1) attributed to the groupers as of July 1, 2013 for which

the methodology in this Section is developed may be diverted

for this purpose. The Department shall submit the rules no

later than January 1, 2014 for an implementation date no later

than January 1, 2015.

If the Department does not implement this reimbursement

methodology by the required date, the nursing component per

diem on January 1, 2015 for residents classified in RUG-IV

groups PA1, PA2, BA1, and BA2 shall be the blended rate of the

calculated RUG-IV nursing component per diem and the nursing

component per diem in effect on July 1, 2012. This blended rate

shall be applied only to nursing homes whose resident

population is greater than or equal to 70% of the total

residents served and whose RUG-IV nursing component per diem

rate is less than the nursing component per diem in effect on

July 1, 2012. This blended rate shall be in effect until the

reimbursement methodology is implemented or until July 1, 2019,

whichever is sooner.

(e-1) (Blank). Notwithstanding any other provision of this

Article, rates established pursuant to this subsection shall

not apply to any and all nursing facilities designated by the

Department as "Institutions for Mental Disease" and shall be

excluded from the RUGs Reimbursement System applicable to

facilities not designated as "Institutions for the Mentally

Diseased" by the Department.

(e-2) For dates of services beginning January 1, 2014, the

RUG-IV nursing component per diem for a nursing home shall be

the product of the statewide RUG-IV nursing base per diem rate,

the facility average case mix index, and the regional wage

adjustor. Transition rates for services provided between

January 1, 2014 and December 31, 2014 shall be as follows:

(1) The transition RUG-IV per diem nursing rate for

nursing homes whose rate calculated in this subsection

(e-2) is greater than the nursing component rate in effect

July 1, 2012 shall be paid the sum of:

(A) The nursing component rate in effect July 1,

2012; plus

(B) The difference of the RUG-IV nursing component

per diem calculated for the current quarter minus the

nursing component rate in effect July 1, 2012

multiplied by 0.88.

(2) The transition RUG-IV per diem nursing rate for

nursing homes whose rate calculated in this subsection

(e-2) is less than the nursing component rate in effect

July 1, 2012 shall be paid the sum of:

(A) The nursing component rate in effect July 1,

2012; plus

(B) The difference of the RUG-IV nursing component

per diem calculated for the current quarter minus the

nursing component rate in effect July 1, 2012

multiplied by 0.13.

(f) Notwithstanding any other provision of this Code, on

and after July 1, 2012, reimbursement rates associated with the

nursing or support components of the current nursing facility

rate methodology shall not increase beyond the level effective

May 1, 2011 until a new reimbursement system based on the RUGs

IV 48 grouper model has been fully operationalized.

(g) Notwithstanding any other provision of this Code, on

and after July 1, 2012, for facilities not designated by the

Department of Healthcare and Family Services as "Institutions

for Mental Disease", rates effective May 1, 2011 shall be

adjusted as follows:

(1) Individual nursing rates for residents classified

in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter

ending March 31, 2012 shall be reduced by 10%;

(2) Individual nursing rates for residents classified

in all other RUG IV groups shall be reduced by 1.0%;

(3) Facility rates for the capital and support

components shall be reduced by 1.7%.

(h) Notwithstanding any other provision of this Code, on

and after July 1, 2012, nursing facilities designated by the

Department of Healthcare and Family Services as "Institutions

for Mental Disease" and "Institutions for Mental Disease" that

are facilities licensed under the Specialized Mental Health

Rehabilitation Act of 2013 shall have the nursing,

socio-developmental, capital, and support components of their

reimbursement rate effective May 1, 2011 reduced in total by

2.7%.

(i) On and after July 1, 2014, the reimbursement rates for

the support component of the nursing facility rate for

facilities licensed under the Nursing Home Care Act as skilled

or intermediate care facilities shall be the rate in effect on

June 30, 2014 increased by 8.17%.

(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section

6-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff.

7-22-13; revised 9-19-13.)

(305 ILCS 5/5-5.4h)

Sec. 5-5.4h. Medicaid reimbursement for long-term care

facilities for persons under 22 years of age pediatric skilled

nursing facilities.

(a) Facilities licensed as long-term care facilities for

persons under 22 years of age uniquely licensed as pediatric

skilled nursing facilities that serve severely and chronically

ill pediatric patients shall have a specific reimbursement

system designed to recognize the characteristics and needs of

the patients they serve.

(b) For dates of services starting July 1, 2013 and until a

new reimbursement system is designed, long-term care

facilities for persons under 22 years of age pediatric skilled

nursing facilities that meet the following criteria:

(1) serve exceptional care patients; and

(2) have 30% or more of their patients receiving

ventilator care;

shall receive Medicaid reimbursement on a 30-day expedited

schedule.

(c) Subject to federal approval of changes to the Title XIX

State Plan, for dates of services starting July 1, 2014 and

until a new reimbursement system is designed, long-term care

facilities for persons under 22 years of age which meet the

criteria in subsection (b) of this Section shall receive a per

diem rate for clinically complex residents of $304. Clinically

complex residents on a ventilator shall receive a per diem rate

of $669.

(d) To qualify for the per diem rate of $669 for clinically

complex residents on a ventilator pursuant to subsection (c),

facilities shall have a policy documenting their method of

routine assessment of a resident's weaning potential with

interventions implemented noted in the resident's record.

(e) For the purposes of this Section, a resident is

considered clinically complex if the resident requires at least

one of the following medical services:

(1) Tracheostomy care with dependence on mechanical

ventilation for a minimum of 6 hours each day.

(2) Tracheostomy care requiring suctioning at least

every 6 hours, room air mist or oxygen as needed, and

dependence on one of the treatment procedures listed under

paragraph (4) excluding the procedure listed in

subparagraph (A) of paragraph (4).

(3) Total parenteral nutrition or other intravenous

nutritional support and one of the treatment procedures

listed under paragraph (4).

(4) The following treatment procedures apply to the

conditions in paragraphs (2) and (3) of this subsection:

(A) Intermittent suctioning at least every 8 hours

and room air mist or oxygen as needed.

(B) Continuous intravenous therapy including

administration of therapeutic agents necessary for

hydration or of intravenous pharmaceuticals; or

intravenous pharmaceutical administration of more than

one agent via a peripheral or central line, without

continuous infusion.

(C) Peritoneal dialysis treatments requiring at

least 4 exchanges every 24 hours.

(D) Tube feeding via nasogastric or gastrostomy

tube.

(E) Other medical technologies required

continuously, which in the opinion of the attending

physician require the services of a professional

nurse.

(Source: P.A. 98-104, eff. 7-22-13.)

(305 ILCS 5/5-5e)

Sec. 5-5e. Adjusted rates of reimbursement.

(a) Rates or payments for services in effect on June 30,

2012 shall be adjusted and services shall be affected as

required by any other provision of this amendatory Act of the

97th General Assembly. In addition, the Department shall do the

following:

(1) Delink the per diem rate paid for supportive living

facility services from the per diem rate paid for nursing

facility services, effective for services provided on or

after May 1, 2011.

(2) Cease payment for bed reserves in nursing

facilities and specialized mental health rehabilitation

facilities.

(2.5) Cease payment for bed reserves for purposes of

inpatient hospitalizations to intermediate care facilities

for persons with development disabilities, except in the

instance of residents who are under 21 years of age.

(3) Cease payment of the $10 per day add-on payment to

nursing facilities for certain residents with

developmental disabilities.

(b) After the application of subsection (a),

notwithstanding any other provision of this Code to the

contrary and to the extent permitted by federal law, on and

after July 1, 2012, the rates of reimbursement for services and

other payments provided under this Code shall further be

reduced as follows:

(1) Rates or payments for physician services, dental

services, or community health center services reimbursed

through an encounter rate, and services provided under the

Medicaid Rehabilitation Option of the Illinois Title XIX

State Plan shall not be further reduced.

(2) Rates or payments, or the portion thereof, paid to

a provider that is operated by a unit of local government

or State University that provides the non-federal share of

such services shall not be further reduced.

(3) Rates or payments for hospital services delivered

by a hospital defined as a Safety-Net Hospital under

Section 5-5e.1 of this Code shall not be further reduced.

(4) Rates or payments for hospital services delivered

by a Critical Access Hospital, which is an Illinois

hospital designated as a critical care hospital by the

Department of Public Health in accordance with 42 CFR 485,

Subpart F, shall not be further reduced.

(5) Rates or payments for Nursing Facility Services

shall only be further adjusted pursuant to Section 5-5.2 of

this Code.

(6) Rates or payments for services delivered by long

term care facilities licensed under the ID/DD Community

Care Act and developmental training services shall not be

further reduced.

(7) Rates or payments for services provided under

capitation rates shall be adjusted taking into

consideration the rates reduction and covered services

required by this amendatory Act of the 97th General

Assembly.

(8) For hospitals not previously described in this

subsection, the rates or payments for hospital services

shall be further reduced by 3.5%, except for payments

authorized under Section 5A-12.4 of this Code.

(9) For all other rates or payments for services

delivered by providers not specifically referenced in

paragraphs (1) through (8), rates or payments shall be

further reduced by 2.7%.

(c) Any assessment imposed by this Code shall continue and

nothing in this Section shall be construed to cause it to

cease.

(d) Notwithstanding any other provision of this Code to the

contrary, subject to federal approval under Title XIX of the

Social Security Act, for dates of service on and after July 1,

2014, rates or payments for services provided for the purpose

of transitioning children from a hospital to home placement or

other appropriate setting by a children's community-based

health care center authorized under the Alternative Health Care

Delivery Act shall be $683 per day.

(e) Notwithstanding any other provision of this Code to the

contrary, subject to federal approval under Title XIX of the

Social Security Act, for dates of service on and after July 1,

2014, rates or payments for home health visits shall be $72.

(f) Notwithstanding any other provision of this Code to the

contrary, subject to federal approval under Title XIX of the

Social Security Act, for dates of service on and after July 1,

2014, rates or payments for the certified nursing assistant

component of the home health agency rate shall be $20.

(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)

(305 ILCS 5/5-5e.1)

Sec. 5-5e.1. Safety-Net Hospitals.

(a) A Safety-Net Hospital is an Illinois hospital that:

(1) is licensed by the Department of Public Health as a

general acute care or pediatric hospital; and

(2) is a disproportionate share hospital, as described

in Section 1923 of the federal Social Security Act, as

determined by the Department; and

(3) meets one of the following:

(A) has a MIUR of at least 40% and a charity

percent of at least 4%; or

(B) has a MIUR of at least 50%.

(b) Definitions. As used in this Section:

(1) "Charity percent" means the ratio of (i) the

hospital's charity charges for services provided to

individuals without health insurance or another source of

third party coverage to (ii) the Illinois total hospital

charges, each as reported on the hospital's OBRA form.

(2) "MIUR" means Medicaid Inpatient Utilization Rate

and is defined as a fraction, the numerator of which is the

number of a hospital's inpatient days provided in the

hospital's fiscal year ending 3 years prior to the rate

year, to patients who, for such days, were eligible for

Medicaid under Title XIX of the federal Social Security

Act, 42 USC 1396a et seq., excluding those persons eligible

for medical assistance pursuant to 42 U.S.C.

1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of

Section 5-2 of this Article, and the denominator of which

is the total number of the hospital's inpatient days in

that same period, excluding those persons eligible for

medical assistance pursuant to 42 U.S.C.

1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of

Section 5-2 of this Article.

(3) "OBRA form" means form HFS-3834, OBRA '93 data

collection form, for the rate year.

(4) "Rate year" means the 12-month period beginning on

October 1.

(c) Beginning July 1, 2012 and ending on June 30, 2018, For

the 27-month period beginning July 1, 2012, a hospital that

would have qualified for the rate year beginning October 1,

2011, shall be a Safety-Net Hospital.

(d) No later than August 15 preceding the rate year, each

hospital shall submit the OBRA form to the Department. Prior to

October 1, the Department shall notify each hospital whether it

has qualified as a Safety-Net Hospital.

(e) The Department may promulgate rules in order to

implement this Section.

(f) Nothing in this Section shall be construed as limiting

the ability of the Department to include the Safety-Net

Hospitals in the hospital rate reform mandated by Section 14-11

of this Code and implemented under Section 14-12 of this Code

and by administrative rulemaking.

(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)

(305 ILCS 5/5-5f)

Sec. 5-5f. Elimination and limitations of medical

assistance services. Notwithstanding any other provision of

this Code to the contrary, on and after July 1, 2012:

(a) The following services shall no longer be a covered

service available under this Code: group psychotherapy for

residents of any facility licensed under the Nursing Home Care

Act or the Specialized Mental Health Rehabilitation Act of

2013; and adult chiropractic services.

(b) The Department shall place the following limitations on

services: (i) the Department shall limit adult eyeglasses to

one pair every 2 years; (ii) the Department shall set an annual

limit of a maximum of 20 visits for each of the following

services: adult speech, hearing, and language therapy

services, adult occupational therapy services, and physical

therapy services; on or after October 1, 2014, the annual

maximum limit of 20 visits shall expire but the Department

shall require prior approval for all individuals for speech,

hearing, and language therapy services, occupational therapy

services, and physical therapy services; (iii) the Department

shall limit adult podiatry services to individuals with

diabetes; on or after October 1, 2014, podiatry services shall

not be limited to individuals with diabetes; (iv) the

Department shall pay for caesarean sections at the normal

vaginal delivery rate unless a caesarean section was medically

necessary; (v) the Department shall limit adult dental services

to emergencies; beginning July 1, 2013, the Department shall

ensure that the following conditions are recognized as

emergencies: (A) dental services necessary for an individual in

order for the individual to be cleared for a medical procedure,

such as a transplant; (B) extractions and dentures necessary

for a diabetic to receive proper nutrition; (C) extractions and

dentures necessary as a result of cancer treatment; and (D)

dental services necessary for the health of a pregnant woman

prior to delivery of her baby; on or after July 1, 2014, adult

dental services shall no longer be limited to emergencies, and

dental services necessary for the health of a pregnant woman

prior to delivery of her baby shall continue to be covered; and

(vi) effective July 1, 2012, the Department shall place

limitations and require concurrent review on every inpatient

detoxification stay to prevent repeat admissions to any

hospital for detoxification within 60 days of a previous

inpatient detoxification stay. The Department shall convene a

workgroup of hospitals, substance abuse providers, care

coordination entities, managed care plans, and other

stakeholders to develop recommendations for quality standards,

diversion to other settings, and admission criteria for

patients who need inpatient detoxification, which shall be

published on the Department's website no later than September

1, 2013.

(c) The Department shall require prior approval of the

following services: wheelchair repairs costing more than $400,

coronary artery bypass graft, and bariatric surgery consistent

with Medicare standards concerning patient responsibility.

Wheelchair repair prior approval requests shall be adjudicated

within one business day of receipt of complete supporting

documentation. Providers may not break wheelchair repairs into

separate claims for purposes of staying under the $400

threshold for requiring prior approval. The wholesale price of

manual and power wheelchairs, durable medical equipment and

supplies, and complex rehabilitation technology products and

services shall be defined as actual acquisition cost including

all discounts.

(d) The Department shall establish benchmarks for

hospitals to measure and align payments to reduce potentially

preventable hospital readmissions, inpatient complications,

and unnecessary emergency room visits. In doing so, the

Department shall consider items, including, but not limited to,

historic and current acuity of care and historic and current

trends in readmission. The Department shall publish

provider-specific historical readmission data and anticipated

potentially preventable targets 60 days prior to the start of

the program. In the instance of readmissions, the Department

shall adopt policies and rates of reimbursement for services

and other payments provided under this Code to ensure that, by

June 30, 2013, expenditures to hospitals are reduced by, at a

minimum, $40,000,000.

(e) The Department shall establish utilization controls

for the hospice program such that it shall not pay for other

care services when an individual is in hospice.

(f) For home health services, the Department shall require

Medicare certification of providers participating in the

program and implement the Medicare face-to-face encounter

rule. The Department shall require providers to implement

auditable electronic service verification based on global

positioning systems or other cost-effective technology.

(g) For the Home Services Program operated by the

Department of Human Services and the Community Care Program

operated by the Department on Aging, the Department of Human

Services, in cooperation with the Department on Aging, shall

implement an electronic service verification based on global

positioning systems or other cost-effective technology.

(h) Effective with inpatient hospital admissions on or

after July 1, 2012, the Department shall reduce the payment for

a claim that indicates the occurrence of a provider-preventable

condition during the admission as specified by the Department

in rules. The Department shall not pay for services related to

an other provider-preventable condition.

As used in this subsection (h):

"Provider-preventable condition" means a health care

acquired condition as defined under the federal Medicaid

regulation found at 42 CFR 447.26 or an other

provider-preventable condition.

"Other provider-preventable condition" means a wrong

surgical or other invasive procedure performed on a patient, a

surgical or other invasive procedure performed on the wrong

body part, or a surgical procedure or other invasive procedure

performed on the wrong patient.

(i) The Department shall implement cost savings

initiatives for advanced imaging services, cardiac imaging

services, pain management services, and back surgery. Such

initiatives shall be designed to achieve annual costs savings.

(j) The Department shall ensure that beneficiaries with a

diagnosis of epilepsy or seizure disorder in Department records

will not require prior approval for anticonvulsants.

(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section

6-240, eff. 7-22-13; 98-104, Article 9, Section 9-5, eff.

7-22-13; revised 9-19-13.)

(305 ILCS 5/5B-1) (from Ch. 23, par. 5B-1)

Sec. 5B-1. Definitions. As used in this Article, unless the

context requires otherwise:

"Fund" means the Long-Term Care Provider Fund.

"Long-term care facility" means (i) a nursing 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 or

the ID/DD Community 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 by a State agency or 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 paragraph,

"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. "Hospital provider" means a person licensed by

the Department of Public Health to conduct, operate, or

maintain a hospital.

"Occupied bed days" shall be computed separately for each

long-term care facility operated or maintained by a long-term

care provider, and means the sum for all beds of the number of

days during the month on which each bed was occupied by a

resident, other than a resident for whom Medicare Part A is the

primary payer. For a resident whose care is covered by the

Medicare Medicaid Alignment initiative demonstration, Medicare

Part A is considered the primary payer.

(Source: P.A. 96-339, eff. 7-1-10; 96-1530, eff. 2-16-11;

97-38, eff. 6-28-11; 97-227, eff. 1-1-12; 97-813, eff.

7-13-12.)

(305 ILCS 5/5C-1) (from Ch. 23, par. 5C-1)

Sec. 5C-1. Definitions. As used in this Article, unless the

context requires otherwise:

"Fund" means the Care Provider Fund for Persons with a

Developmental Disability.

"Developmentally disabled care facility" means an

intermediate care facility for the intellectually disabled

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 this purpose, "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.

"Adjusted gross developmentally disabled care revenue"

shall be computed separately for each developmentally disabled

care facility conducted, operated, or maintained by a

developmentally disabled care provider, and means the

developmentally disabled care provider's total revenue for

inpatient residential services less contractual allowances and

discounts on patients' accounts, but does not include

non-patient revenue from sources such as contributions,

donations or bequests, investments, day training services,

television and telephone service, and rental of facility space.

"Long-term care facility for persons under 22 years of age

serving clinically complex residents" means a facility

licensed by the Department of Public Health as a long-term care

facility for persons under 22 meeting the qualifications of

Section 5-5.4h of this Code.

(Source: P.A. 97-227, eff. 1-1-12; 98-463, eff. 8-16-13.)

(305 ILCS 5/5C-2) (from Ch. 23, par. 5C-2)

Sec. 5C-2. Assessment; no local authorization to tax.

(a) For the privilege of engaging in the occupation of

developmentally disabled care provider, an assessment is

imposed upon each developmentally disabled care provider in an

amount equal to 6%, or the maximum allowed under federal

regulation, whichever is less, of its adjusted gross

developmentally disabled care revenue for the prior State

fiscal year. Notwithstanding any provision of any other Act to

the contrary, this assessment shall be construed as a tax, but

may not be added to the charges of an individual's nursing home

care that is paid for in whole, or in part, by a federal,

State, or combined federal-state medical care program, except

those individuals receiving Medicare Part B benefits solely.

(b) Nothing in this amendatory Act of 1995 shall be

construed to authorize any home rule unit or other unit of

local government to license for revenue or impose a tax or

assessment upon a developmentally disabled care provider or the

occupation of developmentally disabled care provider, or a tax

or assessment measured by the income or earnings of a

developmentally disabled care provider.

(c) Effective July 1, 2013, for the privilege of engaging

in the occupation of long-term care facility for persons under

22 years of age serving clinically complex residents provider,

an assessment is imposed upon each long-term care facility for

persons under 22 years of age serving clinically complex

residents provider in the same amount and upon the same

conditions and requirements as imposed in Article V-B of this

Code and a license fee is imposed in the same amount and upon

the same conditions and requirements as imposed in Article V-E

of this Code. Notwithstanding any provision of any other Act to

the contrary, the assessment and license fee imposed by this

subsection (c) shall be construed as a tax, but may not be

added to the charges of an individual's nursing home care that

is paid for in whole, or in part, by a federal, State, or

combined federal-State medical care program, except for those

individuals receiving Medicare Part B benefits solely.

(Source: P.A. 95-707, eff. 1-11-08.)

(305 ILCS 5/5C-7) (from Ch. 23, par. 5C-7)

Sec. 5C-7. Care Provider Fund for Persons with a

Developmental Disability.

(a) There is created in the State Treasury the Care

Provider Fund for Persons with a Developmental Disability.

Interest earned by the Fund shall be credited to the Fund. The

Fund shall not be used to replace any moneys appropriated to

the Medicaid program by the General Assembly.

(b) The Fund is created for the purpose of receiving and

disbursing assessment moneys in accordance with this Article.

Disbursements from the Fund shall be made only as follows:

(1) For payments to intermediate care facilities for

the developmentally disabled under Title XIX of the Social

Security Act and Article V of this Code.

(2) For the reimbursement of moneys collected by the

Illinois Department through error or mistake, and to make

required payments under Section 5-4.28(a)(1) of this Code

if there are no moneys available for such payments in the

Medicaid Developmentally Disabled Provider Participation

Fee Trust Fund.

(3) For payment of administrative expenses incurred by

the Department of Human Services or its agent or the

Illinois Department or its agent in performing the

activities authorized by this Article.

(4) For payments of any amounts which are reimbursable

to the federal government for payments from this Fund which

are required to be paid by State warrant.

(5) For making transfers to the General Obligation Bond

Retirement and Interest Fund as those transfers are

authorized in the proceedings authorizing debt under the

Short Term Borrowing Act, but transfers made under this

paragraph (5) shall not exceed the principal amount of debt

issued in anticipation of the receipt by the State of

moneys to be deposited into the Fund.

(6) For making refunds as required under Section 5C-10

of this Article.

Disbursements from the Fund, other than transfers to the

General Obligation Bond Retirement and Interest Fund, shall be

by warrants drawn by the State Comptroller upon receipt of

vouchers duly executed and certified by the Illinois

Department.

(c) The Fund shall consist of the following:

(1) All moneys collected or received by the Illinois

Department from the developmentally disabled care provider

assessment imposed by this Article.

(2) All federal matching funds received by the Illinois

Department as a result of expenditures made by the Illinois

Department that are attributable to moneys deposited in the

Fund.

(3) Any interest or penalty levied in conjunction with

the administration of this Article.

(4) Any balance in the Medicaid Developmentally

Disabled Care Provider Participation Fee Trust Fund in the

State Treasury. The balance shall be transferred to the

Fund upon certification by the Illinois Department to the

State Comptroller that all of the disbursements required by

Section 5-4.21(b) of this Code have been made.

(5) All other moneys received for the Fund from any

other source, including interest earned thereon.

(Source: P.A. 98-463, eff. 8-16-13.)

(305 ILCS 5/5C-10 new)

Sec. 5C-10. Adjustments. For long-term care facilities for

persons under 22 years of age serving clinically complex

residents previously classified as developmentally disabled

care facilities under this Article, the Department shall refund

any amounts paid under this Article in State fiscal year 2014

by the end of State fiscal year 2015 with at least half the

refund amount being made prior to December 31, 2014. The

amounts refunded shall be based on amounts paid by the

facilities to the Department as the assessment under subsection

(a) of Section 5C-2 less any assessment and license fee due for

State fiscal year 2014.

(305 ILCS 5/Art. V-G heading new)

ARTICLE V-G. SUPPORTIVE LIVING FACILITY FUNDING.

(305 ILCS 5/5G-5 new)

Sec. 5G-5. Definitions. As used in this Article, unless the

context requires otherwise:

"Care days" shall be computed separately for each

supportive living facility, and means the sum for all apartment

units, the number of days during the month which each apartment

unit was occupied by a resident.

"Department" means the Department of Healthcare and Family

Services.

"Fund" means the Supportive Living Facility Fund.

"Supportive living facility" means an enrolled supportive

living site as described under Section 5-5.01a of this Code

that meets the participation requirements under Section

146.215 of Title 89 of the Illinois Administrative Code.

(305 ILCS 5/5G-10 new)

Sec. 5G-10. Assessment.

(a) Subject to Section 5G-45, beginning July 1, 2014, an

annual assessment on health care services is imposed on each

supportive living facility in an amount equal to $2.30

multiplied by the supportive living facility's care days. This

assessment shall not be billed or passed on to any resident of

a supportive living facility.

(b) Nothing in this Section shall be construed to authorize

any home rule unit or other unit of local government to license

for revenue or impose a tax or assessment upon supportive

living facilities or the occupation of operating a supportive

living facility, or a tax or assessment measured by the income

or earnings or care days of a supportive living facility.

(c) The assessment imposed by this Section shall not be due

and payable, however, until after the Department notifies the

supportive living facilities, in writing, that the payment

methodologies to supportive living facilities required under

Section 5-5.01a of this Code have been approved by the Centers

for Medicare and Medicaid Services of the U.S. Department of

Health and Human Services and the waivers under 42 CFR 433.68

for the assessment imposed by this Section, if necessary, have

been granted by the Centers for Medicare and Medicaid Services

of the U.S. Department of Health and Human Services.

(305 ILCS 5/5G-15 new)

Sec. 5G-15. Payment of assessment; penalty.

(a) The assessment imposed by Section 5G-10 shall be due

and payable in monthly installments on the last State business

day of the month for care days reported for the preceding third

month prior to the month in which the assessment is payable and

due. A facility that has delayed payment due to the State's

failure to reimburse for services rendered may request an

extension on the due date for payment pursuant to subsection

(c) and shall pay the assessment within 30 days of

reimbursement by the Department.

(b) The Department shall provide for an electronic

submission process for each supportive living facility to

report at a minimum the number of care days of the supportive

living facility for the reporting period and other reasonable

information the Department requires for the administration of

its responsibilities under this Code. The Department shall

prepare an assessment bill stating the amount due and payable

each month and submit it to each supportive living facility via

an electronic process. To the extent practicable, the

Department shall coordinate the assessment reporting

requirements with other reporting required of supportive

living facilities.

(c) The Department is authorized to establish delayed

payment schedules for supportive living facilities that are

unable to make assessment payments when due under this Section

due to financial difficulties, as determined by the Department.

The Department may not deny a request for delay of payment of

the assessment imposed under this Article if the supportive

living facility has not been paid for services provided during

the month in which the assessment is levied.

(d) If a supportive living facility fails to pay the full

amount of an assessment payment when due (including any

extensions granted under subsection (c)), there shall, unless

waived by the Department for reasonable cause, be added to the

assessment imposed by Section 5G-10 a penalty assessment equal

to the lesser of (i) 1% of the amount of the assessment payment

not paid on or before the due date plus 1% of the portion

thereof remaining unpaid on the last day of each month

thereafter or (ii) 100% of the assessment payment amount not

paid on or before the due date. For purposes of this

subsection, payments will be credited first to unpaid

assessment payment amounts (rather than to penalty or

interest), beginning with the most delinquent assessment

payments. Payment cycles of longer than 30 days shall be one

factor the Director takes into account in granting a waiver

under this Section.

(e) No installment of the assessment imposed by Section

5G-10 shall be due and payable until after the Department

notifies the supportive living facilities, in writing, that the

payment methodologies to supportive living facilities required

under Section 5-5.01a of this Code have been approved by the

Centers for Medicare and Medicaid Services of the U.S.

Department of Health and Human Services and the waivers under

42 CFR 433.68 for the assessment imposed by this Section, if

necessary, have been granted by the Centers for Medicare and

Medicaid Services of the U.S. Department of Health and Human

Services. Upon notification to the Department of approval of

the payment methodologies required under Section 5-5.01a of

this Code and the waivers granted under 42 CFR 433.68, all

installments otherwise due under this Section prior to the date

of notification shall be due and payable to the Department upon

written direction from the Department within 90 days after

issuance by the Comptroller of the payments required under

Section 5-5.01a of this Code.

(305 ILCS 5/5G-20 new)

Sec. 5G-20. Reporting; penalty; maintenance of records.

(a) Every supportive living facility subject to assessment

under this Article shall report the number care days of the

supportive living facility for the reporting period on or

before the last business day of the month following the

reporting period. Each supportive living facility shall ensure

that an accurate e-mail address is on file with the Department

in order for the Department to prepare and send an electronic

bill to the supportive living facility.

(b) If a supportive living facility fails to file its

monthly report with the Department when due, there shall,

unless waived by the Illinois Department for reasonable cause,

be added to the assessment due a penalty assessment equal to

25% of the assessment due.

(c) Every supportive living facility subject to assessment

under this Article shall keep records and books that will

permit the determination of care days on a calendar year basis.

All such books and records shall be kept in the English

language and shall, at all times during business hours of the

day, be subject to inspection by the Department or its duly

authorized agents and employees.

(d) Notwithstanding any other provision of this Article, a

facility that commences operating or maintaining a supportive

living facility that was under a prior ownership and remained

enrolled as a Medicaid facility by the Department shall notify

the Department of the change in ownership and shall be

responsible to immediately pay any prior amounts owed by the

facility.

(e) The Department shall develop a procedure for sharing

with a potential buyer of a facility information regarding

outstanding assessments and penalties owed by that facility.

(305 ILCS 5/5G-25 new)

Sec. 5G-25. Disposition of proceeds. The Department shall

pay all moneys received from supportive living facilities under

this Article into the Supportive Living Facility Fund. Upon

certification by the Department to the State Comptroller of its

intent to withhold from a facility under Section 5G-30(b), the

State Comptroller shall draw a warrant on the treasury or other

fund held by the State Treasurer, as appropriate. The warrant

shall state the amount for which the facility is entitled to a

warrant, the amount of the deduction, and the reason therefor

and shall direct the State Treasurer to pay the balance to the

facility, all in accordance with Section 10.05 of the State

Comptroller Act. The warrant also shall direct the State

Treasurer to transfer the amount of the deduction so ordered

from the treasury or other fund into the Supportive Living

Facility Fund.

(305 ILCS 5/5G-30 new)

Sec. 5G-30. Administration; enforcement provisions.

(a) The Department shall administer and enforce this

Article and collect the assessments and penalty assessments

imposed under this Article using procedures employed in its

administration of this Code generally and as follows:

(1) The Department may initiate either administrative

or judicial proceedings, or both, to enforce provisions of

this Article. Administrative enforcement proceedings

initiated hereunder shall be governed by the Department's

administrative rules. Judicial enforcement proceedings

initiated hereunder shall be governed by the rules of

procedure applicable in the courts of this State.

(2) No proceedings for collection, refund, credit, or

other adjustment of an assessment amount shall be issued

more than 3 years after the due date of the assessment,

except in the case of an extended period agreed to in

writing by the Department and the supportive living

facility before the expiration of this limitation period.

(3) Any unpaid assessment under this Article shall

become a lien upon the assets of the supportive living

facility upon which it was assessed. If any supportive

living facility, outside the usual course of its business,

sells or transfers the major part of any one or more of (A)

the real property and improvements, (B) the machinery and

equipment, or (C) the furniture or fixtures, of any

supportive living facility that is subject to the

provisions of this Article, the seller or transferor shall

pay the Department the amount of any assessment, assessment

penalty, and interest (if any) due from it under this

Article up to the date of the sale or transfer. If the

seller or transferor fails to pay any assessment,

assessment penalty, and interest (if any) due, the

purchaser or transferee of such asset shall be liable for

the amount of the assessment, penalty, and interest (if

any) up to the amount of the reasonable value of the

property acquired by the purchaser or transferee. The

purchaser or transferee shall continue to be liable until

the purchaser or transferee pays the full amount of the

assessment, penalty, and interest (if any) up to the amount

of the reasonable value of the property acquired by the

purchaser or transferee or until the purchaser or

transferee receives from the Department a certificate

showing that such assessment, penalty, and interest have

been paid or a certificate from the Department showing that

no assessment, penalty, or interest is due from the seller

or transferor under this Article.

(b) In addition to any other remedy provided for and

without sending a notice of assessment liability, the

Department may collect an unpaid assessment by withholding, as

payment of the assessment, reimbursements or other amounts

otherwise payable by the Department to the supportive living

facility.

(305 ILCS 5/5G-35 new)

Sec. 5G-35. Supportive Living Facility Fund.

(a) There is created in the State treasury the Supportive

Living Facility Fund. Interest earned by the Fund shall be

credited to the Fund. The Fund shall not be used to replace any

moneys appropriated to the Medicaid program by the General

Assembly.

(b) The Fund is created for the purpose of receiving and

disbursing moneys in accordance with this Article.

Disbursements from the Fund, other than transfers authorized

under paragraphs (5) and (6) of this subsection, shall be by

warrants drawn by the State Comptroller upon receipt of

vouchers duly executed and certified by the Department.

Disbursements from the Fund shall be made only as follows:

(1) For making payments to supportive living

facilities as required under this Code, under the

Children's Health Insurance Program Act, under the

Covering ALL KIDS Health Insurance Act, and under the Long

Term Acute Care Hospital Quality Improvement Transfer

Program Act.

(2) For the reimbursement of moneys collected by the

Department from supportive living facilities through error

or mistake in performing the activities authorized under

this Code.

(3) For payment of administrative expenses incurred by

the Department or its agent in performing administrative

oversight activities for the supportive living program or

review of new supportive living facility applications.

(4) For payments of any amounts which are reimbursable

to the federal government for payments from this Fund which

are required to be paid by State warrant.

(5) For making transfers, as those transfers are

authorized in the proceedings authorizing debt under the

Short Term Borrowing Act, but transfers made under this

paragraph (5) shall not exceed the principal amount of debt

issued in anticipation of the receipt by the State of

moneys to be deposited into the Fund.

(6) For making transfers to any other fund in the State

treasury, but transfers made under this paragraph (6) shall

not exceed the amount transferred previously from that

other fund into the Supportive Living Facility Fund plus

any interest that would have been earned by that fund on

the money that had been transferred.

(c) The Fund shall consist of the following:

(1) All moneys collected or received by the Department

from the supportive living facility assessment imposed by

this Article.

(2) All moneys collected or received by the Department

from the supportive living facility certification fee

imposed by this Article.

(3) All federal matching funds received by the

Department as a result of expenditures made by the

Department that are attributable to moneys deposited in the

Fund.

(4) Any interest or penalty levied in conjunction with

the administration of this Article.

(5) Moneys transferred from another fund in the State

treasury.

(6) All other moneys received for the Fund from any

other source, including interest earned thereon.

(305 ILCS 5/5G-40 new)

Sec. 5G-40. Certification fee.

(a) The Department shall collect an annual certification

fee of $100 per each operational or approved supportive living

facility for the purposes of funding the administrative process

of reviewing new supportive living facility applications and

administrative oversight of the health care services delivered

by supportive living facilities.

(b) The certification fee shall be deposited into the

Supportive Living Facility Fund. The Department shall maintain

a separate accounting of amounts collected under this Section.

(305 ILCS 5/5G-45 new)

Sec. 5G-45. Applicability.

(a) The Department must submit any necessary documentation

to the Centers for Medicare and Medicaid Services which allows

for an effective date of July 1, 2014 for the requirements of

this Article. The documents shall include any necessary

documents that satisfy federal public notice requirements,

Medicaid state plan amendments, and any Medicaid waiver

amendments.

(b) The assessment imposed by Section 5G-10 shall cease to

be imposed if the amount of matching federal funds under Title

XIX of the Social Security Act is eliminated or significantly

reduced on account of the assessment. Any remaining assessments

shall be refunded to supportive living facilities in proportion

to the amounts of the assessments paid by them.

(c) The certification fee imposed by Section 5G-40 shall

cease to be imposed if the amount of matching federal funds

under Title XIX of the Social Security Act is eliminated or

significantly reduced on account of the certification fee.

Section 55-20. The Immunization Data Registry Act is

amended by changing Section 20 as follows:

(410 ILCS 527/20)

Sec. 20. Confidentiality of information; release of

information; statistics; panel on expanding access.

(a) Records maintained as part of the immunization data

registry are confidential.

(b) The Department may release an individual's

confidential information to the individual or to the

individual's parent or guardian if the individual is less than

18 years of age.

(c) Subject to subsection (d) of this Section, the

Department may release information in the immunization data

registry concerning an individual to the following entities:

(1) The immunization data registry of another state.

(2) A health care provider or a health care provider's

designee.

(3) A local health department.

(4) An elementary or secondary school that is attended

by the individual.

(5) A licensed child care center in which the

individual is enrolled.

(6) A licensed child-placing agency.

(7) A college or university that is attended by the

individual.

(8) The Department of Healthcare and Family Services or

a managed care entity contracted with the Department of

Healthcare and Family Services to coordinate the provision

of medical care to enrollees of the medical assistance

program.

(d) Before immunization data may be released to an entity,

the entity must enter into an agreement with the Department

that provides that information that identifies a patient will

not be released to any other person without the written consent

of the patient.

(e) The Department may release summary statistics

regarding information in the immunization data registry if the

summary statistics do not reveal the identity of an individual.

(Source: P.A. 97-117, eff. 7-14-11.)

Article 60

Section 60-5. The Lead Poisoning Prevention Act is amended

by adding Section 15.1 as follows:

(410 ILCS 45/15.1 new)

Sec. 15.1. Funding. Beginning July 1, 2014 and ending June

30, 2018, a hospital satisfying the definition, as of July 1,

2014, of Section 5-5e.1 of the Illinois Public Aid Code and

located in DuPage County shall pay the sum of $2,000,000

annually in 4 equal quarterly installments to the human poison

control center in existence as of July 1, 2014 and established

under the authority of this Act.

Article 99

Section 99-1. Severability. If any clause, sentence,

Section, exemption, provision, or part of this Act or the

application thereof to any person or circumstance shall be

adjudged to be unconstitutional or otherwise invalid, the

remainder of this Act or its application to persons or

circumstances other than those to which it is held invalid

shall not be affected thereby and to this end the provisions of

this Act are declared to be severable.

Section 99-2. Any action required by this Act to occur

prior to or on June 30, 2014 shall be completed within 30 days

after the effective date of this Act.