Partnership 10400SB3365ham001 -19- LRB104 18483 KTG 38682 a sponsors may prescribe reasonable additional qualifications for participation by medical providers, only with the prior written approval of the Illinois Department.

In order to ensure patient freedom of choice, the Illinois Department shall immediately promulgate SB3365 Enrolled - 19 - LRB104 18483 SSS 31925 b 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 Illinois Department shall require health care providers to make available, when authorized by the patient, in writing, 10400SB3365ham001 -20- LRB104 18483 KTG 38682 a 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 SB3365 Enrolled - 20 - LRB104 18483 SSS 31925 b assistance under this Code, in accordance with regulations promulgated by the Illinois Department.

Within 90 days after September 16, 1984 (the effective date of Public Act 83-1439), 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 10400SB3365ham001 -21- LRB104 18483 KTG 38682 a 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.

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), establish SB3365 Enrolled - 21 - LRB104 18483 SSS 31925 b procedures to permit skilled care facilities licensed under the Nursing Home Care Act to submit monthly billing claims for reimbursement purposes.

10400SB3365ham001 -22- LRB104 18483 KTG 38682 a 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, SB3365 Enrolled - 22 - LRB104 18483 SSS 31925 b institutions or other legal entities providing any form of health care services in this State under this Article.

10400SB3365ham001 -23- LRB104 18483 KTG 38682 a The Department has the discretion to limit the conditional enrollment period for vendors based upon the 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 SB3365 Enrolled - 23 - LRB104 18483 SSS 31925 b category of risk of the vendor.

To be eligible for payment consideration, a vendor's 10400SB3365ham001 -24- LRB104 18483 KTG 38682 a 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 SB3365 Enrolled - 24 - LRB104 18483 SSS 31925 b 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.

For claims for which the Illinois 10400SB3365ham001 -25- LRB104 18483 KTG 38682 a 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 120 calendar days of receipt by the facility of required prescreening information, new admissions with associated admission documents shall be submitted through the Medical SB3365 Enrolled - 25 - LRB104 18483 SSS 31925 b 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.

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 10400SB3365ham001 -26- LRB104 18483 KTG 38682 a necessary to perform eligibility and payment verifications and other Illinois Department functions.

the SB3365 Enrolled - 26 - LRB104 18483 SSS 31925 b National Practitioner Data Bank (NPDB);

and the Department of Financial and 10400SB3365ham001 -27- LRB104 18483 KTG 38682 a 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 SB3365 Enrolled - 27 - LRB104 18483 SSS 31925 b adjudication process through the utilization of:

Subject to prior approval, such 10400SB3365ham001 -28- LRB104 18483 KTG 38682 a 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.

Notwithstanding any provision of Section 5-5f to the contrary, the Department may, by rule, exempt certain replacement wheelchair parts from prior approval and, for wheelchairs, SB3365 Enrolled - 28 - LRB104 18483 SSS 31925 b wheelchair parts, wheelchair accessories, and related seating and positioning items, determine the wholesale price by methods other than actual acquisition costs.

In order to promote environmental responsibility, meet the needs of recipients and enrollees, and achieve significant cost savings, the Department, or a managed care organization under contract with the Department, may provide recipients or managed care enrollees who have a prescription or Certificate of Medical Necessity access to refurbished durable medical equipment under this Section (excluding prosthetic and orthotic devices as defined in the Orthotics, Prosthetics, and 10400SB3365ham001 -29- LRB104 18483 KTG 38682 a Pedorthics Practice Act and complex rehabilitation technology products and associated services) through the State's assistive technology program's reutilization program, using staff with the Assistive Technology Professional (ATP) Certification if the refurbished durable medical equipment:

SB3365 Enrolled - 29 - LRB104 18483 SSS 31925 b (iii) is able to withstand at least 3 years of use;

(i) intake procedures and common eligibility criteria for those persons who are receiving 10400SB3365ham001 -30- LRB104 18483 KTG 38682 a non-institutional services;

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 SB3365 Enrolled - 30 - LRB104 18483 SSS 31925 b community-based long term care;

10400SB3365ham001 -31- LRB104 18483 KTG 38682 a 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.

SB3365 Enrolled - 31 - LRB104 18483 SSS 31925 b 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:

The requirement for reporting to the General Assembly shall be satisfied by filing copies of the report as required by Section 3.1 of the General Assembly Organization Act, and filing such additional copies with the State Government Report Distribution Center for the General Assembly 10400SB3365ham001 -32- LRB104 18483 KTG 38682 a as is required under paragraph (t) of Section 7 of the State Library Act.

any purported rule not so adopted, for SB3365 Enrolled - 32 - LRB104 18483 SSS 31925 b whatever reason, is unauthorized.

Providers under this Section shall be prior approved and 10400SB3365ham001 -33- LRB104 18483 KTG 38682 a certified by the Department to perform kidney transplantation and the services under this Section shall be limited to services associated with kidney transplantation.

Notwithstanding any other provision of this Code to the contrary, on or after July 1, 2015, all FDA-approved forms of medication assisted treatment prescribed for the treatment of alcohol dependence or treatment of opioid dependence shall be SB3365 Enrolled - 33 - LRB104 18483 SSS 31925 b covered under both fee-for-service and managed care medical assistance programs for persons who are otherwise eligible for medical assistance under this Article and shall not be subject to any (1) utilization control, other than those established under the American Society of Addiction Medicine patient placement criteria, (2) prior authorization mandate, (3) lifetime restriction limit mandate, or (4) limitations on dosage.

As used in this Section, "opioid antagonist" means a drug that binds to opioid receptors and blocks or inhibits the effect of opioids acting on those receptors, including, but not limited to, naloxone hydrochloride or any other similarly acting drug 10400SB3365ham001 -34- LRB104 18483 KTG 38682 a approved by the U.S.

Upon federal approval, the Department shall provide coverage and reimbursement for all drugs that are approved for marketing by the federal Food and Drug Administration and that SB3365 Enrolled - 34 - LRB104 18483 SSS 31925 b are recommended by the federal Public Health Service or the United States Centers for Disease Control and Prevention for pre-exposure prophylaxis and related pre-exposure prophylaxis services, including, but not limited to, HIV and sexually transmitted infection screening, treatment for sexually transmitted infections, medical monitoring, assorted labs, and counseling to reduce the likelihood of HIV infection among individuals who are not infected with HIV but who are at high risk of HIV infection.

Within 90 days after October 8, 2021 (the effective date of Public Act 102-665), the Department shall seek federal 10400SB3365ham001 -35- LRB104 18483 KTG 38682 a approval of a State Plan amendment to expand coverage for family planning services that includes presumptive eligibility to individuals whose income is at or below 208% of the federal poverty level.

Subject to approval by the federal Centers for Medicare and Medicaid Services of a Title XIX State Plan amendment SB3365 Enrolled - 35 - LRB104 18483 SSS 31925 b electing the Program of All-Inclusive Care for the Elderly (PACE) as a State Medicaid option, as provided for by Subtitle I (commencing with Section 4801) of Title IV of the Balanced Budget Act of 1997 (Public Law 105-33) and Part 460 (commencing with Section 460.2) of Subchapter E of Title 42 of the Code of Federal Regulations, PACE program services shall become a covered benefit of the medical assistance program, subject to criteria established in accordance with all applicable laws.

Notwithstanding any other provision of this Code, within 12 months after June 2, 2022 (the effective date of Public Act 102-1037) and subject to federal approval, acupuncture services performed by an acupuncturist licensed under the Acupuncture Practice Act who is acting within the scope of his 10400SB3365ham001 -36- LRB104 18483 KTG 38682 a or her license shall be covered under the medical assistance program.

Notwithstanding any other provision of this Code, the medical assistance program shall, subject to federal approval, SB3365 Enrolled - 36 - LRB104 18483 SSS 31925 b reimburse hospitals for costs associated with a newborn screening test for the presence of metachromatic leukodystrophy, as required under the Newborn Metabolic Screening Act, at a rate not less than the fee charged by the Department of Public Health.

Notwithstanding any other provision of this Code, beginning on January 1, 2024, subject to federal approval, cognitive assessment and care planning services provided to a person who experiences signs or symptoms of cognitive 10400SB3365ham001 -37- LRB104 18483 KTG 38682 a impairment, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, shall be covered under the medical assistance program for persons who are otherwise eligible for medical assistance under this Article.

Notwithstanding any other provision of this Code, medically necessary reconstructive services that are intended to restore physical appearance shall be covered under the SB3365 Enrolled - 37 - LRB104 18483 SSS 31925 b medical assistance program for persons who are otherwise eligible for medical assistance under this Article.

10400SB3365ham001 -38- LRB104 18483 KTG 38682 a Section 6-5.

DISTRESSED HOSPITAL LOAN PROGRAM (305 ILCS 5/5J-1 new) SB3365 Enrolled - 38 - LRB104 18483 SSS 31925 b Sec.

10400SB3365ham001 -39- LRB104 18483 KTG 38682 a "Public hospital" means a hospital that is licensed by the Hospital Licensing Act and is either owned or operated by a governmental body in Illinois, excluding a State agency, a State university, or a county with a population of 3,000,000 or more.

(305 ILCS 5/5J-15 new) SB3365 Enrolled - 39 - LRB104 18483 SSS 31925 b Sec.

(2) Before issuing a loan under this Program, the 10400SB3365ham001 -40- LRB104 18483 KTG 38682 a Department shall review the plan submitted by an eligible hospital and make a determination both that the plan is viable and that there is a reasonable likelihood that the hospital will be able to regain financial viability, continue to operate as a hospital, and be able to repay the loan.

SB3365 Enrolled - 40 - LRB104 18483 SSS 31925 b (3) All funds loaned in accordance with this Article shall be used as described in the application approved by the Department, which shall be incorporated into any resulting loan agreement.

(a) In collaboration with the Governor's Office of Management and Budget and the Department of Public Health, the 10400SB3365ham001 -41- LRB104 18483 KTG 38682 a Department shall develop a methodology to evaluate a hospital's application for a loan through the Program.

whether the hospital is small, rural, a safety-net hospital, a critical access hospital, a trauma center, an urban hospital providing access SB3365 Enrolled - 41 - LRB104 18483 SSS 31925 b for an underserved area, a hospital that serves a disproportionate share of Medicaid patients, or serving a rural catchment area;

The Department maintains discretion to determine the amount of a loan approved for a hospital and 10400SB3365ham001 -42- LRB104 18483 KTG 38682 a may approve less than the amount requested by a hospital.

(1) Hospitals that belong to integrated health care systems with more than 3 separately licensed hospital SB3365 Enrolled - 42 - LRB104 18483 SSS 31925 b facilities.

10400SB3365ham001 -43- LRB104 18483 KTG 38682 a (f) The Department shall give preference to not-for-profit and public hospitals.

(g) The Department shall determine the application process, underwriting review, and methodology for approval and SB3365 Enrolled - 43 - LRB104 18483 SSS 31925 b distribution of the loans under the Program.

Terms must include, but are not limited to, monthly repayments of the loan beginning no later than 18 months after receipt of the loan and discharge of the loan within 36 months of the date 10400SB3365ham001 -44- LRB104 18483 KTG 38682 a of the loan.

The repayment agreement may provide for additional SB3365 Enrolled - 44 - LRB104 18483 SSS 31925 b security for any cash flow loans under this Article.

(d) Any unpaid loan under this Article shall become a lien 10400SB3365ham001 -45- LRB104 18483 KTG 38682 a upon the assets of the hospital that received the loan.

If any hospital provider, 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 hospital that is subject to the provisions of this Article, the seller or transferor shall pay the Department the amount of any loan, SB3365 Enrolled - 45 - LRB104 18483 SSS 31925 b penalty, and interest (if any) due from it under this Article up to the date of the sale or transfer.

(e) If a hospital provider fails to pay any monthly 10400SB3365ham001 -46- LRB104 18483 KTG 38682 a installment repayments, there shall, unless waived by the Department for reasonable cause, be added to the loan repayment obligation a penalty equal to the lesser of (i) 5% of the amount of the installment not paid on or before the due date plus 5% of the portion thereof remaining unpaid on the last day of each 30-day period thereafter or (ii) 100% of the installment amount not paid on or before the due date.

SB3365 Enrolled - 46 - LRB104 18483 SSS 31925 b (305 ILCS 5/5J-30 new) Sec.

(d) All moneys accruing to the Department under this Article from any source, including, but not limited to, all 10400SB3365ham001 -47- LRB104 18483 KTG 38682 a amounts repaid under the terms of any loan agreements, shall be deposited into the Fund.

Upon completion of the transfers, the Distressed SB3365 Enrolled - 47 - LRB104 18483 SSS 31925 b Hospital Loan Program Fund is dissolved and any outstanding obligations or liabilities of the Fund pass to the Healthcare Provider Relief Fund.

This Article is repealed on June 30, 10400SB3365ham001 -48- LRB104 18483 KTG 38682 a 2033.

SB3365 Enrolled - 48 - LRB104 18483 SSS 31925 b This Section is repealed June 30, 2033.

The Freedom of Information Act is amended by 10400SB3365ham001 -49- LRB104 18483 KTG 38682 a changing Section 7.5 as follows:

To the extent provided for by the statutes referenced below, the following shall be SB3365 Enrolled - 49 - LRB104 18483 SSS 31925 b exempt from inspection and copying:

10400SB3365ham001 -50- LRB104 18483 KTG 38682 a (e) Information the disclosure of which is exempted under Section 30 of the Radon Industry Licensing Act.

(g) Information the disclosure of which is restricted and exempted under Section 50 of the Illinois Prepaid SB3365 Enrolled - 50 - LRB104 18483 SSS 31925 b Tuition Act.

(l) Records and information provided to a residential 10400SB3365ham001 -51- LRB104 18483 KTG 38682 a health care facility resident sexual assault and death review team or the Executive Council under the Abuse Prevention Review Team Act.

SB3365 Enrolled - 51 - LRB104 18483 SSS 31925 b (n) Defense budgets and petitions for certification of compensation and expenses for court appointed trial counsel as provided under Sections 10 and 15 of the Capital Crimes Litigation Act (repealed).

Clair County Transit District under the Bi-State Transit Safety 10400SB3365ham001 -52- LRB104 18483 KTG 38682 a Act (repealed).

SB3365 Enrolled - 52 - LRB104 18483 SSS 31925 b (t) (Blank).

(w) Personally identifiable information which is exempted from disclosure under subsection (g) of Section 10400SB3365ham001 -53- LRB104 18483 KTG 38682 a 19.1 of the Toll Highway Act.

(y) Confidential information under the Adult Protective Services Act and its predecessor enabling statute, the Elder Abuse and Neglect Act, including SB3365 Enrolled - 53 - LRB104 18483 SSS 31925 b information about the identity and administrative finding against any caregiver of a verified and substantiated decision of abuse, neglect, or financial exploitation of an eligible adult maintained in the Registry established under Section 7.5 of the Adult Protective Services Act.

10400SB3365ham001 -54- LRB104 18483 KTG 38682 a (ee) Information that is exempted from disclosure under Section 30.1 of the Pharmacy Practice Act.

SB3365 Enrolled - 54 - LRB104 18483 SSS 31925 b (hh) Records that are exempt from disclosure under Section 1A-16.7 of the Election Code.

10400SB3365ham001 -55- LRB104 18483 KTG 38682 a (oo) Communications, notes, records, and reports arising out of a peer support counseling session prohibited from disclosure under the First Responders Suicide Prevention Act.

(pp) Names and all identifying information relating to an employee of an emergency services provider or law enforcement agency under the First Responders Suicide SB3365 Enrolled - 55 - LRB104 18483 SSS 31925 b Prevention Act.

10400SB3365ham001 -56- LRB104 18483 KTG 38682 a (xx) Information that is exempt from disclosure or information that shall not be made public under the Illinois Insurance Code.

SB3365 Enrolled - 56 - LRB104 18483 SSS 31925 b (aaa) Information prohibited from being disclosed under Section 1-167 of the Illinois Pension Code.

"ALPR information" means information gathered by 10400SB3365ham001 -57- LRB104 18483 KTG 38682 a an ALPR or created from the analysis of data generated by an ALPR.

(hhh) Information submitted to the Illinois State SB3365 Enrolled - 57 - LRB104 18483 SSS 31925 b Police in an affidavit or application for an assault weapon endorsement, assault weapon attachment endorsement, .50 caliber rifle endorsement, or .50 caliber cartridge endorsement under the Firearm Owners Identification Card Act.

(nnn) Materials received by the Department of Commerce and Economic Opportunity that are confidential under the 10400SB3365ham001 -58- LRB104 18483 KTG 38682 a Music and Musicians Tax Credit and Jobs Act.

SB3365 Enrolled - 58 - LRB104 18483 SSS 31925 b (rrr) Information prohibited from being disclosed under Section 4-2 of the Uniform Money Transmission Modernization Act.

revised 9-10-25.) 10400SB3365ham001 -59- LRB104 18483 KTG 38682 a (Text of Section after amendment by P.A.

(a) All information determined to be confidential SB3365 Enrolled - 59 - LRB104 18483 SSS 31925 b under Section 4002 of the Technology Advancement and Development Act.

10400SB3365ham001 -60- LRB104 18483 KTG 38682 a (f) Firm performance evaluations under Section 55 of the Architectural, Engineering, and Land Surveying Qualifications Based Selection Act.

(h) Information the disclosure of which is exempted SB3365 Enrolled - 60 - LRB104 18483 SSS 31925 b under the State Officials and Employees Ethics Act, and records of any lawfully created State or local inspector general's office that would be exempt if created or obtained by an Executive Inspector General's office under that Act.

(l) Records and information provided to a residential health care facility resident sexual assault and death review team or the Executive Council under the Abuse 10400SB3365ham001 -61- LRB104 18483 KTG 38682 a Prevention Review Team Act.

(n) Defense budgets and petitions for certification of compensation and expenses for court appointed trial SB3365 Enrolled - 61 - LRB104 18483 SSS 31925 b counsel as provided under Sections 10 and 15 of the Capital Crimes Litigation Act (repealed).

(q) Information prohibited from being disclosed by the 10400SB3365ham001 -62- LRB104 18483 KTG 38682 a Personnel Record Review Act.

(u) Records and information provided to an independent SB3365 Enrolled - 62 - LRB104 18483 SSS 31925 b team of experts under the Developmental Disability and Mental Health Safety Act (also known as Brian's Law).

(x) Information which is exempted from disclosure 10400SB3365ham001 -63- LRB104 18483 KTG 38682 a under Section 5-1014.3 of the Counties Code or Section 8-11-21 of the Illinois Municipal Code.

(y) Confidential information under the Adult Protective Services Act and its predecessor enabling statute, the Elder Abuse and Neglect Act, including information about the identity and administrative finding against any caregiver of a verified and substantiated SB3365 Enrolled - 63 - LRB104 18483 SSS 31925 b decision of abuse, neglect, or financial exploitation of an eligible adult maintained in the Registry established under Section 7.5 of the Adult Protective Services Act.

10400SB3365ham001 -64- LRB104 18483 KTG 38682 a (ff) Information that is exempted from disclosure under the Revised Uniform Unclaimed Property Act.

SB3365 Enrolled - 64 - LRB104 18483 SSS 31925 b (ii) Information which is exempted from disclosure under Section 2505-800 of the Department of Revenue Law of the Civil Administrative Code of Illinois.

(oo) Communications, notes, records, and reports arising out of a peer support counseling session 10400SB3365ham001 -65- LRB104 18483 KTG 38682 a prohibited from disclosure under the First Responders Suicide Prevention Act.

(qq) Information and records held by the Department of SB3365 Enrolled - 65 - LRB104 18483 SSS 31925 b Public Health and its authorized representatives collected under the Reproductive Health Act.

(xx) Information that is exempt from disclosure or information that shall not be made public under the 10400SB3365ham001 -66- LRB104 18483 KTG 38682 a Illinois Insurance Code.

SB3365 Enrolled - 66 - LRB104 18483 SSS 31925 b (bbb) Information that is prohibited from disclosure by the Illinois Police Training Act and the Illinois State Police Act.

This subsection (fff) is inoperative on and after 10400SB3365ham001 -67- LRB104 18483 KTG 38682 a July 1, 2028.

(hhh) Information submitted to the Illinois State Police in an affidavit or application for an assault weapon endorsement, assault weapon attachment endorsement, SB3365 Enrolled - 67 - LRB104 18483 SSS 31925 b .50 caliber rifle endorsement, or .50 caliber cartridge endorsement under the Firearm Owners Identification Card Act.

(ooo) Data or information provided pursuant to Section 10400SB3365ham001 -68- LRB104 18483 KTG 38682 a 20 of the Statewide Recycling Needs and Assessment Act.

(rrr) Information prohibited from being disclosed under Section 4-2 of the Uniform Money Transmission SB3365 Enrolled - 68 - LRB104 18483 SSS 31925 b Modernization Act.

10400SB3365ham001 -69- LRB104 18483 KTG 38682 a 104-417, eff.

SB3365 Enrolled - 69 - LRB104 18483 SSS 31925 b (a) All information determined to be confidential under Section 4002 of the Technology Advancement and Development Act.

(e) Information the disclosure of which is exempted 10400SB3365ham001 -70- LRB104 18483 KTG 38682 a under Section 30 of the Radon Industry Licensing Act.

SB3365 Enrolled - 70 - LRB104 18483 SSS 31925 b (h) Information the disclosure of which is exempted under the State Officials and Employees Ethics Act, and records of any lawfully created State or local inspector general's office that would be exempt if created or obtained by an Executive Inspector General's office under that Act.

(l) Records and information provided to a residential health care facility resident sexual assault and death 10400SB3365ham001 -71- LRB104 18483 KTG 38682 a review team or the Executive Council under the Abuse Prevention Review Team Act.

(n) Defense budgets and petitions for certification of SB3365 Enrolled - 71 - LRB104 18483 SSS 31925 b compensation and expenses for court appointed trial counsel as provided under Sections 10 and 15 of the Capital Crimes Litigation Act (repealed).

10400SB3365ham001 -72- LRB104 18483 KTG 38682 a (q) Information prohibited from being disclosed by the Personnel Record Review Act.

SB3365 Enrolled - 72 - LRB104 18483 SSS 31925 b (u) Records and information provided to an independent team of experts under the Developmental Disability and Mental Health Safety Act (also known as Brian's Law).

10400SB3365ham001 -73- LRB104 18483 KTG 38682 a (x) Information which is exempted from disclosure under Section 5-1014.3 of the Counties Code or Section 8-11-21 of the Illinois Municipal Code.

(y) Confidential information under the Adult Protective Services Act and its predecessor enabling statute, the Elder Abuse and Neglect Act, including information about the identity and administrative finding SB3365 Enrolled - 73 - LRB104 18483 SSS 31925 b against any caregiver of a verified and substantiated decision of abuse, neglect, or financial exploitation of an eligible adult maintained in the Registry established under Section 7.5 of the Adult Protective Services Act.

(ee) Information that is exempted from disclosure 10400SB3365ham001 -74- LRB104 18483 KTG 38682 a under Section 30.1 of the Pharmacy Practice Act.

(hh) Records that are exempt from disclosure under SB3365 Enrolled - 74 - LRB104 18483 SSS 31925 b Section 1A-16.7 of the Election Code.

(oo) Communications, notes, records, and reports 10400SB3365ham001 -75- LRB104 18483 KTG 38682 a arising out of a peer support counseling session prohibited from disclosure under the First Responders Suicide Prevention Act.

SB3365 Enrolled - 75 - LRB104 18483 SSS 31925 b (qq) Information and records held by the Department of Public Health and its authorized representatives collected under the Reproductive Health Act.

(xx) Information that is exempt from disclosure or 10400SB3365ham001 -76- LRB104 18483 KTG 38682 a information that shall not be made public under the Illinois Insurance Code.

(aaa) Information prohibited from being disclosed SB3365 Enrolled - 76 - LRB104 18483 SSS 31925 b under Section 1-167 of the Illinois Pension Code.

"ALPR information" means information gathered by an ALPR or created from the analysis of data generated by 10400SB3365ham001 -77- LRB104 18483 KTG 38682 a an ALPR.

(hhh) Information submitted to the Illinois State Police in an affidavit or application for an assault SB3365 Enrolled - 77 - LRB104 18483 SSS 31925 b weapon endorsement, assault weapon attachment endorsement, .50 caliber rifle endorsement, or .50 caliber cartridge endorsement under the Firearm Owners Identification Card Act.

10400SB3365ham001 -78- LRB104 18483 KTG 38682 a (ooo) Data or information provided pursuant to Section 20 of the Statewide Recycling Needs and Assessment Act.

(rrr) Information prohibited from being disclosed SB3365 Enrolled - 78 - LRB104 18483 SSS 31925 b under Section 4-2 of the Uniform Money Transmission Modernization Act.

103-592, 10400SB3365ham001 -79- LRB104 18483 KTG 38682 a eff.

revised 1-7-26.) SB3365 Enrolled - 79 - LRB104 18483 SSS 31925 b Section 6-75.

The changes made to this Act by this amendatory Act of the 96th General Assembly are intended to accomplish the following 10400SB3365ham001 -80- LRB104 18483 KTG 38682 a objectives:

to assure that the SB3365 Enrolled - 80 - LRB104 18483 SSS 31925 b reduction and closure of health care services or facilities is performed in an orderly and timely manner, and that these actions are deemed to be in the best interests of the public;

1163) 10400SB3365ham001 -81- LRB104 18483 KTG 38682 a (Section scheduled to be repealed on December 31, 2029) Sec.

The State Board shall make or cause to be made such investigations as it deems necessary in connection with an application for a permit, or in connection with a determination of whether or not construction or modification that has been commenced is in accord with the SB3365 Enrolled - 81 - LRB104 18483 SSS 31925 b permit issued by the State Board, or whether construction or modification has been commenced without a permit having been obtained.

Prior to collecting information from health facilities, the State Board shall make reasonable 10400SB3365ham001 -82- LRB104 18483 KTG 38682 a efforts through a public process to consult with health facilities and associations that represent them to determine whether data and information requests will result in useful information for health planning, whether sufficient information is available from other sources, and whether data requested is routinely collected by health facilities and is available without retrospective record review.

Data and SB3365 Enrolled - 82 - LRB104 18483 SSS 31925 b information requests shall not impose undue paperwork burdens on health care facilities and personnel.

10400SB3365ham001 -83- LRB104 18483 KTG 38682 a These questionnaires shall be conducted on an annual basis and compiled by the State Board.

For health care facilities licensed under the Nursing Home Care Act or the Specialized Mental Health Rehabilitation Act of 2013, these reports shall include, but not be limited to, the identification of specialty services provided by the facility to patients, residents, and the community at SB3365 Enrolled - 83 - LRB104 18483 SSS 31925 b large.

For purposes of this paragraph, "long term care beds" means beds (i) licensed under the Nursing Home Care Act, (ii) licensed under the ID/DD Community Care Act, (iii) licensed under the MC/DD Act, (iv) licensed under 10400SB3365ham001 -84- LRB104 18483 KTG 38682 a the Hospital Licensing Act, or (v) licensed under the Specialized Mental Health Rehabilitation Act of 2013 and certified as skilled nursing or nursing facility beds under Medicaid or Medicare.

For health care facilities licensed under the Hospital Licensing Act, the health care facilities operating in this State shall report the following financial and SB3365 Enrolled - 84 - LRB104 18483 SSS 31925 b utilization data annually:

The transmission of the financial and utilization data shall be due to the 10400SB3365ham001 -85- LRB104 18483 KTG 38682 a State Board within 90 days after the effective date of this amendatory Act of the 104th General Assembly, and thereafter, the data shall be due annually on the regular schedule set by the State Board for questionnaires.

The State Board, in coordination with the Department of Healthcare and Family Services and the Department of Public Health, shall administer the collection of the SB3365 Enrolled - 85 - LRB104 18483 SSS 31925 b financial and utilization data submitted under this Section.

The financial and utilization data shall remain confidential, is not subject to subpoena, is not subject to discovery or admissible as evidence in private civil litigation, is not subject to disclosure under the Freedom of 10400SB3365ham001 -86- LRB104 18483 KTG 38682 a Information Act, and must not be made public at any time or used by the State Board or any other person, except as provided in subparagraphs (B), (D), and (E) of this paragraph (2).

(i) share the financial and utilization data SB3365 Enrolled - 86 - LRB104 18483 SSS 31925 b submitted under this Section with other State agencies;

(D) Notwithstanding the confidentiality 10400SB3365ham001 -87- LRB104 18483 KTG 38682 a requirements of this Section or otherwise imposed by State law, relevant State agencies may make public financial and utilization data submitted under this Section in an aggregated format that does not disclose information or data attributed to any specific facility.

(E) Notwithstanding the confidentiality SB3365 Enrolled - 87 - LRB104 18483 SSS 31925 b requirements of this Section, a State agency may disclose the financial and utilization data submitted under this Section with the written consent of the hospital that submitted the report.

Any hospital licensed under this Act that has outstanding debts to the State in the form of tax arrears or that maintains debt through the Distressed Hospital Loan Program or other Medicaid advance payments shall submit to the Department a hospital emergency and financial contingency plan for the rapid and orderly resolution of finances and operations in the event of 10400SB3365ham001 -88- LRB104 18483 KTG 38682 a material financial distress.

Potential events precipitating SB3365 Enrolled - 88 - LRB104 18483 SSS 31925 b closure or suspended services that shall be addressed in the plan, include, but are not limited to:

Any hospital licensed by the Department under Section 4.5 of this Act and required to submit a hospital emergency and financial contingency plan shall submit a hospital emergency and financial contingency plan as outlined in subsection (a) considering each location, campus, or facility administered 10400SB3365ham001 -89- LRB104 18483 KTG 38682 a under the license that could reasonably be affected.

Hospital emergency and financial contingency plans, or annual affirmations of previously filed hospital emergency and financial contingency SB3365 Enrolled - 89 - LRB104 18483 SSS 31925 b plans, as outlined in this Section shall be submitted on an annual basis as determined by the Department through administrative rule.

Such payments shall be paid in 10400SB3365ham001 -90- LRB104 18483 KTG 38682 a addition to the base Medicaid reimbursement rate and add-on payment rates per service unit.

SB3365 Enrolled - 90 - LRB104 18483 SSS 31925 b (A) The Medicaid total payment rate for individual therapy provided by a qualified mental health professional shall be increased by no less than $9 per service unit.

The Medicaid total payment rate for assertive community treatment services shall increase by no less than $8 per 10400SB3365ham001 -91- LRB104 18483 KTG 38682 a service unit.

This subsection does not prevent the Department from making payments in future State fiscal years to correct errors or omissions made in State Fiscal Year 2023 through State SB3365 Enrolled - 91 - LRB104 18483 SSS 31925 b Fiscal Year 2026 payments.

10400SB3365ham001 -92- LRB104 18483 KTG 38682 a (B) (ii) As used in this subparagraph, "user" means an individual who received at least 200 units of community support team services (H2016) during the base year.

(2) (B) For each State fiscal year, a monthly directed payment shall be paid to each community mental health provider of assertive community treatment services based SB3365 Enrolled - 92 - LRB104 18483 SSS 31925 b on the number of Medicaid users of assertive community treatment services documented by Medicaid fee-for-service and managed care encounter claims delivered by the provider in the base year.

For the State fiscal year 10400SB3365ham001 -93- LRB104 18483 KTG 38682 a beginning on July 1, 2024, and for every State fiscal year thereafter, the base year shall be the calendar year that ended 18 months prior to the start of the State fiscal year in which payments are made.

(b-5) (b) Subject to federal approval, a one-time directed payment must be made in calendar year 2023 for community mental health services provided by community mental health SB3365 Enrolled - 93 - LRB104 18483 SSS 31925 b providers.

10400SB3365ham001 -94- LRB104 18483 KTG 38682 a (1) Assertive Community Treatment, $10,600,000;

(1) Subject to federal approval, beginning on January 1, 2024, the Department shall introduce rate increases to behavioral health services no less than by the following targeted pool for the specified services provided by SB3365 Enrolled - 94 - LRB104 18483 SSS 31925 b community mental health centers:

10400SB3365ham001 -95- LRB104 18483 KTG 38682 a (d) Rate simplification for team-based services.

Subject to federal SB3365 Enrolled - 95 - LRB104 18483 SSS 31925 b approval, the redesigned rates shall seek to introduce bundled payment systems that minimize provider claiming activities while transitioning the focus of treatment towards metrics and outcomes.

10400SB3365ham001 -96- LRB104 18483 KTG 38682 a (Source:

SB3365 Enrolled - 96 - LRB104 18483 SSS 31925 b (30 ILCS 105/5.945) Sec.

10400SB3365ham001 -97- LRB104 18483 KTG 38682 a (305 ILCS 75/185-5) Sec.

SB3365 Enrolled - 97 - LRB104 18483 SSS 31925 b means mental health and substance use disorder providers.

"Social determinants of health" means any conditions that impact an individual's health, including, but not limited to, access to healthy food, safety, education, and housing 10400SB3365ham001 -98- LRB104 18483 KTG 38682 a stability.

4-27-21.) (305 ILCS 75/185-15) SB3365 Enrolled - 98 - LRB104 18483 SSS 31925 b Sec.

The Medicaid Technical Assistance Center shall undertake efforts to identify and engage community-based providers offering services to customers funded by the Department, including, but not limited to, behavioral health services and or services addressing the social determinants of health, especially those predominantly serving communities of color or those operating within or near service deserts, for the purpose 10400SB3365ham001 -99- LRB104 18483 KTG 38682 a of offering training and technical assistance to them through the Medicaid Technical Assistance Center.

The Medicaid Technical Assistance Center shall provide SB3365 Enrolled - 99 - LRB104 18483 SSS 31925 b in-person and web-based trainings.

The Medicaid Technical Assistance Center shall host regional learning 10400SB3365ham001 -100- LRB104 18483 KTG 38682 a collaboratives that will supplement the Medicaid Technical Assistance Center training curriculum to bring together groups of stakeholders to share issues and best practices, and to escalate issues.

Using reports and data SB3365 Enrolled - 100 - LRB104 18483 SSS 31925 b provided by the Department's External Quality Review Organization on adequacy reports:

The Medicaid Technical 10400SB3365ham001 -101- LRB104 18483 KTG 38682 a Assistance Center is committed to the principle that all Medicaid recipients have accessible and equitable physical and mental health care services.

All providers served through the Medicaid Technical Assistance Center shall deliver services notwithstanding the patient's race, color, gender, gender identity, age, ancestry, marital status, military status, religion, national origin, SB3365 Enrolled - 101 - LRB104 18483 SSS 31925 b disability status, sexual orientation, order of protection status, as defined under Section 1-103 of the Illinois Human Rights Act, or immigration status.

10400SB3365ham001 -102- LRB104 18483 KTG 38682 a (a) The following service shall no longer be a covered service available under this Code:

(i) the Department shall limit SB3365 Enrolled - 102 - LRB104 18483 SSS 31925 b adult eyeglasses to one pair every 2 years;

(v) the Department shall limit adult dental services to 10400SB3365ham001 -103- LRB104 18483 KTG 38682 a emergencies;

(C) extractions and dentures necessary as a SB3365 Enrolled - 103 - LRB104 18483 SSS 31925 b result of cancer treatment;

10400SB3365ham001 -104- LRB104 18483 KTG 38682 a (c) The Department shall require prior approval of the following services:

Providers may not break SB3365 Enrolled - 104 - LRB104 18483 SSS 31925 b wheelchair repairs into separate claims for purposes of staying under the $750 threshold for requiring prior approval.

In the instance of readmissions, the Department shall adopt policies and rates of reimbursement for services and other 10400SB3365ham001 -105- LRB104 18483 KTG 38682 a payments provided under this Code to ensure that, by June 30, 2013, expenditures to hospitals are reduced by, at a minimum, $40,000,000.

SB3365 Enrolled - 105 - LRB104 18483 SSS 31925 b (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 10400SB3365ham001 -106- LRB104 18483 KTG 38682 a not pay for services related to an other provider-preventable condition.

SB3365 Enrolled - 106 - LRB104 18483 SSS 31925 b "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.

5-13-22.) 10400SB3365ham001 -107- LRB104 18483 KTG 38682 a ARTICLE 25.

The SB3365 Enrolled - 107 - LRB104 18483 SSS 31925 b hospital payment system pursuant to Section 14-11 of this Article shall be as follows:

Effective on and after the effective date of this amendatory Act of the 104th General Assembly, reimbursement for inpatient general acute care services shall utilize the All Patient Refined Diagnosis TM Related Grouping (APR-DRG) software distributed by Solventum TM TM previously known as 3M3MTM Health Information System.

Solventum TM shall be the exclusive provider of this software unless the TM Department determines that Solventum TM is unable to meet the required operational or contractual terms.

10400SB3365ham001 -108- LRB104 18483 KTG 38682 a (2) The Department shall establish a statewide-standardized amount to be used in the inpatient reimbursement system.

(3) In addition to the statewide-standardized amount, the Department shall develop adjusters to adjust the rate SB3365 Enrolled - 108 - LRB104 18483 SSS 31925 b of reimbursement for critical Medicaid providers or services for trauma, transplantation services, perinatal care, and Graduate Medical Education (GME).

(6) Beginning July 1, 2014 and ending on December 31, 2023, in addition to the statewide-standardized amount, 10400SB3365ham001 -109- LRB104 18483 KTG 38682 a 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, 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 SB3365 Enrolled - 109 - LRB104 18483 SSS 31925 b that are not designated as children's hospitals by the Department but are primarily treating patients under the age of 21.

(10) Beginning July 1, 2018, the statewide-standardized amount for inpatient general acute 10400SB3365ham001 -110- LRB104 18483 KTG 38682 a care services shall be uniformly increased so that base claims projected reimbursement is increased by an amount equal to the funds allocated in paragraph (1) of subsection (b) of Section 5A-12.6, less the amount allocated under paragraphs (8) and (9) of this subsection and paragraphs (3) and (4) of subsection (b) multiplied by 40%.

SB3365 Enrolled - 110 - LRB104 18483 SSS 31925 b (11) Beginning July 1, 2018, the reimbursement for inpatient rehabilitation services shall be increased by the addition of a $96 per day add-on.

Effective on and after the effective date of this amendatory Act of the 104th General Assembly, reimbursement for outpatient services shall utilize the Enhanced Ambulatory Procedure Grouping (EAPG) software TM TM distributed by Solventum TM previously known as 3M Health TM Health Information System.

Solventum TM shall be the exclusive provider of this software unless the Agency determines that TM Solventum is unable to meet the required operational or contractual terms.

(2) The Department shall establish service specific 10400SB3365ham001 -111- LRB104 18483 KTG 38682 a 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 SB3365 Enrolled - 111 - LRB104 18483 SSS 31925 b calendar days prior to their effective date.

Beginning July 1, 2018, the outpatient high volume adjustor shall be increased to 10400SB3365ham001 -112- LRB104 18483 KTG 38682 a increase annual expenditures associated with this adjustor by $79,200,000, based on the State Fiscal Year 2015 base year data and this adjustor shall apply to public hospitals, except for large public hospitals, as defined under 89 Ill.

(4) Beginning July 1, 2018, in addition to the statewide standardized amounts, the Department shall make SB3365 Enrolled - 112 - LRB104 18483 SSS 31925 b an add-on payment for outpatient expensive devices and drugs.

10400SB3365ham001 -113- LRB104 18483 KTG 38682 a (6) Effective for dates of service on or after July 1, 2018, 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, such that each Critical Access Hospital's standardized amount for outpatient services shall be increased by the applicable SB3365 Enrolled - 113 - LRB104 18483 SSS 31925 b uniform percentage determined pursuant to paragraph (5) of this subsection.

(1) Any recalculation to the statewide-standardized amounts for outpatient services provided by hospitals that are not Critical Access Hospitals shall be the amount necessary to achieve the increase in the statewide-standardized amounts for outpatient services increased by a uniform percentage, 10400SB3365ham001 -114- LRB104 18483 KTG 38682 a so that base claims projected reimbursement is increased by an amount equal to no less than the funds allocated in paragraph (1) of subsection (b) of Section 5A-12.6, less the amount allocated under paragraphs (8) and (9) of subsection (a) and paragraphs (3) and (4) of this subsection, for all hospitals that are not Critical Access Hospitals, SB3365 Enrolled - 114 - LRB104 18483 SSS 31925 b multiplied by 46%.

10400SB3365ham001 -115- LRB104 18483 KTG 38682 a (9) Within 60 days after federal approval of the change made to the assessment in Section 5A-2 by Public Act 101-650, the Department shall incorporate into the EAPG system for outpatient services those services performed by hospitals currently billed through the Non-Institutional Provider billing system.

(b-5) Notwithstanding any other provision of this Section, SB3365 Enrolled - 115 - LRB104 18483 SSS 31925 b beginning with dates of service on and after January 1, 2023, any general acute care hospital with more than 500 outpatient psychiatric Medicaid services to persons under 19 years of age in any calendar year shall be paid the outpatient add-on payment of no less than $113.

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 10400SB3365ham001 -116- LRB104 18483 KTG 38682 a Department.

(1) After the transition period, the Department may SB3365 Enrolled - 116 - LRB104 18483 SSS 31925 b begin incorporating the transitional hospital access pool into the base rate structure;

The payments authorized in this Section shall be subject to 10400SB3365ham001 -117- LRB104 18483 KTG 38682 a approval by the federal government.

Subject to Section 5A-16, in State fiscal years 2019 and 2020, an Illinois SB3365 Enrolled - 117 - LRB104 18483 SSS 31925 b hospital that received either a transitional hospital access payment under subsection (d) or a supplemental payment under subsection (f) of this Section in State fiscal year 2018, shall receive a hospital transformation payment as follows:

(C) If the hospital's Rate Year 2017 Medicaid 10400SB3365ham001 -118- LRB104 18483 KTG 38682 a inpatient utilization rate is less than 25%, the hospital transformation payment shall be equal to 50% of the sum of its transitional hospital access payment authorized under subsection (d) and any supplemental payment authorized under subsection (f).

(A) The funding amount from phase one shall be SB3365 Enrolled - 118 - LRB104 18483 SSS 31925 b incorporated into directed payment and pass-through payment methodologies described in Section 5A-12.7.

It is also the intention of the General 10400SB3365ham001 -119- LRB104 18483 KTG 38682 a Assembly that partnerships recognize and address the disparities revealed by the COVID-19 pandemic, as well as the need for post-COVID care.

During State fiscal years 2021 through 2027, the hospital and health care transformation program shall be supported by an annual transformation funding pool of up to $150,000,000, pending federal matching funds, to be allocated during SB3365 Enrolled - 119 - LRB104 18483 SSS 31925 b the specified fiscal years for the purpose of facilitating hospital and health care transformation.

The Department shall convene, within 30 days after March 12, 2021 (the effective date of Public Act 101-655), a workgroup that includes subject matter experts on health care disparities and stakeholders 10400SB3365ham001 -120- LRB104 18483 KTG 38682 a from distressed communities, which could be a subcommittee of the Medicaid Advisory Committee, to review and provide recommendations on how Department policy, including health care transformation, can improve health disparities and the impact on communities disproportionately affected by COVID-19.

The workgroup shall consider and make recommendations SB3365 Enrolled - 120 - LRB104 18483 SSS 31925 b on the following issues:

To be eligible for such 10400SB3365ham001 -121- LRB104 18483 KTG 38682 a a conversion, the hospital must submit to the Department of Public Health approval from the Department that the project is a part of the hospital's transformation.

SB3365 Enrolled - 121 - LRB104 18483 SSS 31925 b (i) the proposal shall be designed based on community needs assessment completed by either a University partner or other qualified entity with significant community input;

(iv) the proposal shall have specific measurable metrics related to disparities that will be tracked by the Department and made public 10400SB3365ham001 -122- LRB104 18483 KTG 38682 a by the Department;

SB3365 Enrolled - 122 - LRB104 18483 SSS 31925 b (F) Entities eligible to be funded.

safety-net hospitals, critical access hospitals, the campuses of hospitals that have closed since January 1, 2018, or other health care providers designed to address specific health care disparities, including the impact of COVID-19 on individuals and the 10400SB3365ham001 -123- LRB104 18483 KTG 38682 a community and the need for post-COVID care.

$30,000,000 of SB3365 Enrolled - 123 - LRB104 18483 SSS 31925 b transformation funds to projects that are a collaboration between a safety-net hospital, particularly community safety-net hospitals, and other providers and designed to address specific health care disparities, $20,000,000 of transformation funds to collaborations between safety-net hospitals and a larger hospital partner that increases specialty care in distressed communities, $30,000,000 of transformation funds to projects that are a collaboration between hospitals and other providers in distressed areas of the State designed to address specific health care disparities, $15,000,000 to collaborations between critical access hospitals and other providers designed to address specific health care disparities, and $15,000,000 to cross-provider collaborations designed to address specific health care disparities, and $5,000,000 to collaborations that focus on workforce development.

10400SB3365ham001 -124- LRB104 18483 KTG 38682 a (iv) The Department may allocate up to $5,000,000 for planning, racial equity analysis, or consulting resources for the Department or entities without the resources to develop a plan to meet the criteria of this Section.

Any contract for consulting services issued by the Department under this subparagraph shall comply with the SB3365 Enrolled - 124 - LRB104 18483 SSS 31925 b provisions of Section 5-45 of the State Officials and Employees Ethics Act.

The Department shall post any proposal received on the Department's website for at least 2 weeks for public comment, and any such public comment shall also be considered in the review 10400SB3365ham001 -125- LRB104 18483 KTG 38682 a process.

(i) A detailed description of how the project intends to affect the goals outlined in this SB3365 Enrolled - 125 - LRB104 18483 SSS 31925 b subsection, describing new interventions, new technology, new structures, and other changes to the health care delivery system planned.

10400SB3365ham001 -126- LRB104 18483 KTG 38682 a (iv) A description of any new entities formed or other legal relationships between collaborating entities and how funds will be allocated among participants.

(v) A timeline showing the evolution of sites and specific services of the project over a 5-year period, including services available to the SB3365 Enrolled - 126 - LRB104 18483 SSS 31925 b community by site.

(viii) If the community study utilized is not the study commissioned and published by the Department, the applicant must define the methodology used, including documentation of clear 10400SB3365ham001 -127- LRB104 18483 KTG 38682 a community participation.

SB3365 Enrolled - 127 - LRB104 18483 SSS 31925 b (x) Documentation of a community input process in the community served, including links to proposal materials on public websites.

10400SB3365ham001 -128- LRB104 18483 KTG 38682 a (xiv) An explanation of how the proposal will address the existing disparities that exacerbated the impact of COVID-19 and the need for post-COVID care in the community, if applicable.

SB3365 Enrolled - 128 - LRB104 18483 SSS 31925 b (H) The Department shall evaluate proposals for compliance with the criteria listed under subparagraph (G).

Agreements shall specify the terms and conditions under which a health care facility that receives funds under a purchase of care agreement and closes in violation of the terms of the agreement must 10400SB3365ham001 -129- LRB104 18483 KTG 38682 a pay an early closure fee no greater than 50% of the funds it received under the agreement, prior to the Health Facilities and Services Review Board considering an application for closure of the facility.

Any project that is funded shall be required to provide quarterly written progress reports, in a form prescribed by the Department, and at a minimum SB3365 Enrolled - 129 - LRB104 18483 SSS 31925 b shall include the progress made in achieving any milestones or metrics or Business Enterprise Program commitments in its plan.

To the extent that fiscal year funding is not adequate to fund all eligible projects that apply, the Department shall prioritize 10400SB3365ham001 -130- LRB104 18483 KTG 38682 a applications that most comprehensively and effectively address the criteria listed under subparagraph (G).

No later than 30 days after March 12, 2018 (the effective date of Public SB3365 Enrolled - 130 - LRB104 18483 SSS 31925 b Act 100-581), the 4 legislative leaders shall each appoint 3 members;

The Committee 10400SB3365ham001 -131- LRB104 18483 KTG 38682 a shall perform the functions described in this Section and advise and consult with the Director in the administration of this Section.

In addition to reviewing and approving the policies, procedures, and rules for the hospital and health care transformation program, the Committee shall consider and make recommendations related to qualifying criteria and payment methodologies related to safety-net SB3365 Enrolled - 131 - LRB104 18483 SSS 31925 b hospitals and children's hospitals.

Any supplemental payments authorized under 89 Illinois Administrative Code 148 effective January 1, 2014 and that 10400SB3365ham001 -132- LRB104 18483 KTG 38682 a 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 that is in effect on December 31, 2017 remains in effect.

(g) Notwithstanding subsections (a) through (f) of this Section and notwithstanding the changes authorized under Section 5-5b.1, any updates to the system shall not result in SB3365 Enrolled - 132 - LRB104 18483 SSS 31925 b any diminishment of the overall effective rates of reimbursement as of the implementation date of the new system (July 1, 2014).

(i) Except for subsections (g) and (h) of this Section, 10400SB3365ham001 -133- LRB104 18483 KTG 38682 a 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:

SB3365 Enrolled - 133 - LRB104 18483 SSS 31925 b Reg.

10400SB3365ham001 -134- LRB104 18483 KTG 38682 a (k-5) The Department shall adopt amended rules, in advance of the development of annual Calendar Year 2027 hospital rates, to address the standardized process and time frame for updates to the reimbursement components described in subsections (a) and (b), including, but not limited to, the definition of "excessive growth" in paragraph (4) of subsection (a), in consultation with a statewide association SB3365 Enrolled - 134 - LRB104 18483 SSS 31925 b representing a majority of hospitals, to be undertaken prior to initiating rulemaking in accordance with the Illinois Administrative Procedure Act.

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 10400SB3365ham001 -135- LRB104 18483 KTG 38682 a 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 SB3365 Enrolled - 135 - LRB104 18483 SSS 31925 b 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, other State agencies or departments, 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.

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 10400SB3365ham001 -136- LRB104 18483 KTG 38682 a 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 SB3365 Enrolled - 136 - LRB104 18483 SSS 31925 b 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) separate from those disbursements allowed under items (4) and (5), for payment of contingency fees to third-party entities that the Office of Inspector General authorizes to conduct audits under Sections 12-4.25 and 12-4.40, or any similar audits required by State or federal law, (7) 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 (8) (7) for payments to State universities, other State agencies or 10400SB3365ham001 -137- LRB104 18483 KTG 38682 a departments, 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 SB3365 Enrolled - 137 - LRB104 18483 SSS 31925 b Illinois Department of Public Aid).

10400SB3365ham001 -138- LRB104 18483 KTG 38682 a (305 ILCS 5/5-5.4) (from Ch.

SB3365 Enrolled - 138 - LRB104 18483 SSS 31925 b (1) Provide for the determination of a facility's payment for nursing facility or ICF/DD services on a prospective basis.

The changes made by Public Act 93-841 extending the duration of the prohibition 10400SB3365ham001 -139- LRB104 18483 KTG 38682 a against a rate increase or update for inflation are effective retroactive to July 1, 2004.

For facilities licensed SB3365 Enrolled - 139 - LRB104 18483 SSS 31925 b by the Department of Public Health under the Nursing Home Care Act as Skilled Nursing facilities or Intermediate Care facilities, the rates taking effect on July 1, 1998 shall include an increase of 3% plus $1.10 per resident-day, as defined by the Department.

For facilities licensed by the Department of Public Health under the ID/DD Community Care Act as ID/DD Facilities the rates taking effect within 30 days after July 6, 2017 (the effective date of Public Act 100-23) shall include an increase sufficient to provide a 10400SB3365ham001 -140- LRB104 18483 KTG 38682 a $0.75 per hour wage increase for non-executive staff.

For facilities licensed by the Department of Public Health under the ID/DD Community Care Act as ID/DD Facilities and under the MC/DD Act as MC/DD Facilities, the rates taking SB3365 Enrolled - 140 - LRB104 18483 SSS 31925 b effect within 30 days after June 5, 2019 (the effective date of Public Act 101-10) shall include an increase sufficient to provide a $0.50 per hour wage increase for non-executive frontline personnel, including, but not limited to, direct support persons, aides, frontline supervisors, qualified intellectual disabilities professionals, nurses, and non-administrative support staff.

For facilities licensed by the Department of Public Health under the Nursing Home Care Act as Skilled Nursing facilities or Intermediate Care facilities, the rates taking effect on July 1, 1999 shall 10400SB3365ham001 -141- LRB104 18483 KTG 38682 a include an increase of 1.6% and, for services provided on or after October 1, 1999, shall be increased by $4.00 per resident-day, as defined by the Department.

For facilities licensed by the Department of Public Health under the Nursing Home Care Act as Intermediate Care for the Developmentally Disabled facilities or Long Term Care for Under Age 22 facilities, the rates taking effect on July 1, SB3365 Enrolled - 141 - LRB104 18483 SSS 31925 b 2000 shall include an increase of 2.5% per resident-day, as defined by the Department.

A 10400SB3365ham001 -142- LRB104 18483 KTG 38682 a transition period from the payment methodology in effect on June 30, 2003 to the payment methodology in effect on July 1, 2003 shall be provided for a period not exceeding 3 years and 184 days after implementation of the new payment methodology as follows:

(A) For a facility that would receive a lower nursing component rate per patient day under the new system than SB3365 Enrolled - 142 - LRB104 18483 SSS 31925 b the facility received effective on the date immediately preceding the date that the Department implements the new payment methodology, the nursing component rate per patient day for the facility shall be held at the level in effect on the date immediately preceding the date that the Department implements the new payment methodology until a higher nursing component rate of reimbursement is achieved by that facility.

10400SB3365ham001 -143- LRB104 18483 KTG 38682 a For facilities licensed by the Department of Public Health under the Nursing Home Care Act as Intermediate Care for the Developmentally Disabled facilities or Long Term Care for Under Age 22 facilities, the rates taking effect on March 1, 2001 shall include a statewide increase of 7.85%, as defined by the Department.

Notwithstanding any other provision of this Section, for SB3365 Enrolled - 143 - LRB104 18483 SSS 31925 b facilities licensed by the Department of Public Health under the Nursing Home Care Act as skilled nursing facilities or intermediate care facilities, except facilities participating in the Department's demonstration program pursuant to the provisions of Title 77, Part 300, Subpart T of the Illinois Administrative Code, the numerator of the ratio used by the Department of Healthcare and Family Services to compute the rate payable under this Section using the Minimum Data Set (MDS) methodology shall incorporate the following annual amounts as the additional funds appropriated to the Department specifically to pay for rates based on the MDS nursing component methodology in excess of the funding in effect on December 31, 2006:

10400SB3365ham001 -144- LRB104 18483 KTG 38682 a (iv) For rates taking effect April 1, 2011, or the first day of the month that begins at least 45 days after February 16, 2011 (the effective date of Public Act 96-1530), $416,500,000 or an amount as may be necessary to complete the transition to the MDS methodology for the nursing component of the rate.

Increased payments under this item (iv) are not due and payable, however, until (i) SB3365 Enrolled - 144 - LRB104 18483 SSS 31925 b the methodologies described in this paragraph are approved by the federal government in an appropriate State Plan amendment and (ii) the assessment imposed by Section 5B-2 of this Code is determined to be a permissible tax under Title XIX of the Social Security Act.

10400SB3365ham001 -145- LRB104 18483 KTG 38682 a beginning July 1, 2002 these rates are reduced to the level of the rates in effect on March 31, 2002, as defined by the Department.

For facilities licensed by the Department of Public Health under the Nursing Home Care Act as skilled nursing facilities or intermediate care facilities, the rates taking effect on July 1, 2001 shall be computed using the most recent cost SB3365 Enrolled - 145 - LRB104 18483 SSS 31925 b reports on file with the Department of Public Aid no later than April 1, 2000, updated for inflation to January 1, 2001.

Notwithstanding any other provision of this Section, for facilities licensed by the Department of Public Health under the Nursing Home Care Act as skilled nursing facilities or intermediate care facilities, if the payment methodologies required under Section 5A-12 and the waiver granted under 42 CFR 433.68 are approved by the United States Centers for Medicare and Medicaid Services, the rates taking effect on 10400SB3365ham001 -146- LRB104 18483 KTG 38682 a July 1, 2004 shall be 3.0% greater than the rates in effect on June 30, 2004.

Notwithstanding any other provisions of this Section, for facilities licensed by the Department of Public Health under the Nursing Home Care Act as skilled nursing facilities or SB3365 Enrolled - 146 - LRB104 18483 SSS 31925 b intermediate care facilities, the rates taking effect on January 1, 2005 shall be 3% more than the rates in effect on December 31, 2004.

Notwithstanding any other provisions of this Section, for facilities licensed by the Department of Public Health under the Nursing Home Care Act as intermediate care facilities that are federally defined as Institutions for Mental Disease, or facilities licensed by the Department of Public Health under 10400SB3365ham001 -147- LRB104 18483 KTG 38682 a the Specialized Mental Health Rehabilitation Act of 2013, a socio-development component rate equal to 6.6% of the facility's nursing component rate as of January 1, 2006 shall be established and paid effective July 1, 2006.

The socio-development component of the rate shall be increased by a factor of 2.53 on the first day of the month that begins at least 45 days after January 11, 2008 (the effective date of SB3365 Enrolled - 147 - LRB104 18483 SSS 31925 b Public Act 95-707).

For facilities licensed by the Department of Public Health under the Nursing Home Care Act as Intermediate Care for the Developmentally Disabled facilities or as long-term care facilities for residents under 22 years of age, the rates 10400SB3365ham001 -148- LRB104 18483 KTG 38682 a taking effect on July 1, 2003 shall include a statewide increase of 4%, as defined by the Department.

For facilities licensed by the Department of Public Health under the Nursing Home Care Act as Intermediate Care for the Developmentally Disabled facilities or Long Term Care for Under Age 22 facilities, the rates taking effect on the first day of the month that begins at least 45 days after January 11, SB3365 Enrolled - 148 - LRB104 18483 SSS 31925 b 2008 (the effective date of Public Act 95-707) shall include a statewide increase of 2.5%, as defined by the Department.

Such rates will be based upon the rates calculated for 10400SB3365ham001 -149- LRB104 18483 KTG 38682 a the year beginning July 1, 1990, and for subsequent years thereafter until June 30, 2001 shall be based on the facility cost reports for the facility fiscal year ending at any point in time during the previous calendar year, updated to the midpoint of the rate year.

Should the cost report not be on file by April 1, the SB3365 Enrolled - 149 - LRB104 18483 SSS 31925 b Department shall base the rate on the latest cost report filed by each skilled care facility and intermediate care facility, updated to the midpoint of the current rate year.

10400SB3365ham001 -150- LRB104 18483 KTG 38682 a Department of Health and Human Services pursuant to Title XIX of the Social Security Act.

The Department of Healthcare and Family Services shall develop precise standards for payments to reimburse nursing facilities for any utilization of appropriate rehabilitative personnel for the provision of rehabilitative services which is authorized by federal regulations, including reimbursement SB3365 Enrolled - 150 - LRB104 18483 SSS 31925 b for services provided by qualified therapists or qualified assistants, and which is in accordance with accepted professional practices.

10400SB3365ham001 -151- LRB104 18483 KTG 38682 a Beginning January 1, 2014 the methodologies for reimbursement of nursing facility services as provided under this Section 5-5.4 shall no longer be applicable for services provided on or after January 1, 2014.

No payment increase under this Section for the MDS methodology, exceptional care residents, or the socio-development component rate established by Public Act SB3365 Enrolled - 151 - LRB104 18483 SSS 31925 b 96-1530 of the 96th General Assembly and funded by the assessment imposed under Section 5B-2 of this Code shall be due and payable until after the Department notifies the long-term care providers, in writing, that the payment methodologies to long-term care providers required under this Section have been approved by the Centers for Medicare and Medicaid Services of the U.S.

On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter 10400SB3365ham001 -152- LRB104 18483 KTG 38682 a any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e.

For facilities licensed by the Department of Public Health under the ID/DD Community Care Act as ID/DD Facilities and under the MC/DD Act as MC/DD Facilities, subject to federal approval, the rates taking effect for services delivered on or SB3365 Enrolled - 152 - LRB104 18483 SSS 31925 b after August 1, 2019 shall be increased by 3.5% over the rates in effect on June 30, 2019.

10400SB3365ham001 -153- LRB104 18483 KTG 38682 a For facilities licensed by the Department of Public Health under the ID/DD Community Care Act as ID/DD Facilities and under the MC/DD Act as MC/DD Facilities, subject to federal approval of the State Plan Amendment and the Waiver Amendment for the home and community-based services settings, the rates taking effect for the services delivered on or after July 1, 2020 shall include an increase sufficient to provide a $1.00 SB3365 Enrolled - 153 - LRB104 18483 SSS 31925 b per hour wage increase for non-executive staff.

For facilities licensed by the Department of Public Health under the ID/DD Community Care Act as ID/DD Facilities and under the 10400SB3365ham001 -154- LRB104 18483 KTG 38682 a MC/DD Act as MC/DD Facilities, subject to federal approval of the State Plan Amendment, the rates taking effect for the residential services delivered on or after January 1, 2022 shall include an increase sufficient to provide a $1.00 per hour increase for aides in the rate methodology.

In addition, for residential services delivered on or after January 1, 2022 such rates shall include an increase sufficient to provide SB3365 Enrolled - 154 - LRB104 18483 SSS 31925 b wages for all residential non-executive direct care staff, excluding aides, at the federal Department of Labor, Bureau of Labor Statistics' average wage as defined in rule by the Department.

For facilities licensed by the Department of Public Health under the ID/DD Community Care Act as ID/DD facilities and under the MC/DD Act as MC/DD facilities, subject to federal approval of the State Plan Amendment, the rates taking effect for services delivered on or after January 1, 2023, shall include a $1.00 per hour wage increase for all direct support personnel and all other frontline personnel who are not subject to the Bureau of Labor Statistics' average wage increases, who work in residential and community day services settings, with at least $0.50 of those funds to be provided as a direct increase to all aide base wages, with the remaining $0.50 to be used flexibly for base wage increases to the rate 10400SB3365ham001 -155- LRB104 18483 KTG 38682 a methodology for aides.

Also, for services delivered on or after January 1, 2023, the rates will SB3365 Enrolled - 155 - LRB104 18483 SSS 31925 b include adjustments to employment-related expenses as defined in rule by the Department.

In addition, for residential 10400SB3365ham001 -156- LRB104 18483 KTG 38682 a services delivered on or after January 1, 2024, the rates shall include an increase sufficient to provide wages for all residential non-executive direct care staff, excluding aides, at the federal Department of Labor, Bureau of Labor Statistics' average wage as determined by the Department.

Also, for services delivered on or after January 1, 2024, the rates will include adjustments to employment-related expenses SB3365 Enrolled - 156 - LRB104 18483 SSS 31925 b as defined in rule by the Department.

In addition, for residential services delivered on 10400SB3365ham001 -157- LRB104 18483 KTG 38682 a or after January 1, 2025, the rates shall include an increase sufficient to provide wages for all residential non-executive direct care staff, excluding aides, at the federal Department of Labor, Bureau of Labor Statistics' average wage as determined by the Department.

Also, for services delivered on or after January 1, 2025, the rates will include adjustments to employment-related expenses as defined in rule by the SB3365 Enrolled - 157 - LRB104 18483 SSS 31925 b Department.

In addition, for residential services delivered on 10400SB3365ham001 -158- LRB104 18483 KTG 38682 a or after January 1, 2026, the rates shall include an increase sufficient to provide wages for all residential non-executive direct care staff, excluding aides, at the federal Department of Labor, Bureau of Labor Statistics' average wage as determined by the Department.

Also, for services delivered on or after January 1, 2026, the rates will include adjustments to employment-related expenses as defined in rule by the SB3365 Enrolled - 158 - LRB104 18483 SSS 31925 b Department.

Nothing in this Section shall prohibit 10400SB3365ham001 -159- LRB104 18483 KTG 38682 a the Department of Healthcare and Family Services from paying more than the rates specified in this Section.

6-16-25.) SB3365 Enrolled - 159 - LRB104 18483 SSS 31925 b ARTICLE 40.

(1) "Charity percent" means the ratio of (i) the 10400SB3365ham001 -160- LRB104 18483 KTG 38682 a 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 SB3365 Enrolled - 160 - LRB104 18483 SSS 31925 b 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.

(c) Beginning July 1, 2012 and ending on December 31, 2028 2026, a hospital that would have qualified for the rate year beginning October 1, 2011 or October 1, 2012 shall be a 10400SB3365ham001 -161- LRB104 18483 KTG 38682 a Safety-Net Hospital.

(d) No later than August 15 preceding the rate year, each SB3365 Enrolled - 161 - LRB104 18483 SSS 31925 b hospital shall submit the OBRA form to the Department.

147.09) 10400SB3365ham001 -162- LRB104 18483 KTG 38682 a Sec.

With regard to pending discharges to a skilled nursing facility, the hospital must SB3365 Enrolled - 162 - LRB104 18483 SSS 31925 b notify the case coordination unit, as defined in 89 Ill.

Nothing in this subsection shall preclude federal requirements for a pre-admission 10400SB3365ham001 -163- LRB104 18483 KTG 38682 a screening/mental health (PAS/MH) as required under Section 2-201.5 of the Nursing Home Care Act or State or federal law or regulation.

SB3365 Enrolled - 163 - LRB104 18483 SSS 31925 b (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 Department of Public Health shall annually provide hospitals with a list of licensed, certified, or registered board and care facilities, assisted 10400SB3365ham001 -164- LRB104 18483 KTG 38682 a living and shared housing establishments, nursing homes, supportive living facilities, facilities licensed under the ID/DD Community Care Act, the MC/DD Act, or the Specialized Mental Health Rehabilitation Act of 2013, and hospice facilities.

The procedure may also include a waiver for any case in which a discharge notice SB3365 Enrolled - 164 - LRB104 18483 SSS 31925 b 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.

(1) are transferring to a long term care facility for 10400SB3365ham001 -165- LRB104 18483 KTG 38682 a the first time;

and (5) are independently ambulatory or mobile for more SB3365 Enrolled - 165 - LRB104 18483 SSS 31925 b than a temporary period of time.

1-1-24.) 10400SB3365ham001 -166- LRB104 18483 KTG 38682 a ARTICLE 50.

SB3365 Enrolled - 166 - LRB104 18483 SSS 31925 b (a) The Department of Healthcare and Family Services may provide reimbursement under this Article for all prenatal and perinatal health care services that are provided for the purpose of preventing low-birthweight infants, reducing the need for neonatal intensive care hospital services, and promoting perinatal and maternal health.

On 10400SB3365ham001 -167- LRB104 18483 KTG 38682 a or before January 1, 2006 and every 2 years thereafter, the Department shall report to the General Assembly concerning the effectiveness of prenatal and perinatal health care services reimbursed under this Section in preventing low-birthweight infants and reducing the need for neonatal intensive care hospital services.

Each such report shall include an evaluation of how the ratio of expenditures for treating SB3365 Enrolled - 167 - LRB104 18483 SSS 31925 b low-birthweight infants compared with the investment in promoting healthy births and infants in local community areas throughout Illinois relates to healthy infant development in those areas.

10400SB3365ham001 -168- LRB104 18483 KTG 38682 a (i) Diagnostic labs and imaging, including level II ultrasounds.

(v) Any other outpatient or inpatient service relating SB3365 Enrolled - 168 - LRB104 18483 SSS 31925 b to pregnancy or the 12 months following childbirth or fetal loss.

(3) In cases where a managed care organization must pay 10400SB3365ham001 -169- LRB104 18483 KTG 38682 a for preventive prenatal services, perinatal healthcare services, and postpartum services rendered by a non-affiliated provider, the requirements under paragraph (2) shall not apply if the services were not emergency services, as defined in Section 5-30.1, and:

(A) the non-affiliated provider is a perinatal hospital and has, within the 12 months preceding the date SB3365 Enrolled - 169 - LRB104 18483 SSS 31925 b of service, rejected a contract that was offered in good faith by the health plan as determined by the Department;

(4) For dates of service on and after January 1, 2026, the medical assistance program shall provide coverage, without 10400SB3365ham001 -170- LRB104 18483 KTG 38682 a imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement, for preeclampsia biomarker testing for predictive screening in asymptomatic individuals, or for diagnosis and management when symptoms are present.

SB3365 Enrolled - 170 - LRB104 18483 SSS 31925 b Section 55-5.

specifically, the Department shall establish 10400SB3365ham001 -171- LRB104 18483 KTG 38682 a staffing ratios for facilities which shall specify the number of staff hours per consumer of care that are needed for each level of care offered within the facility;

SB3365 Enrolled - 171 - LRB104 18483 SSS 31925 b (4) a program for adequate maintenance of physical plant and equipment;

A minimum of 3 feet of clearance at the foot and one 10400SB3365ham001 -172- LRB104 18483 KTG 38682 a side of each bed shall be provided.

(c) A facility licensed under this Act shall not accept SB3365 Enrolled - 172 - LRB104 18483 SSS 31925 b any person experiencing an acute medical condition liable to cause death, severe injury, or serious illness.

(3) All medical treatment and procedures shall be 10400SB3365ham001 -173- LRB104 18483 KTG 38682 a administered as ordered by a physician.

According to rules adopted by the Department, every woman consumer of child bearing age shall receive routine obstetrical and gynecological SB3365 Enrolled - 173 - LRB104 18483 SSS 31925 b evaluations as well as necessary prenatal care.

10400SB3365ham001 -174- LRB104 18483 KTG 38682 a (Source:

SB3365 Enrolled - 174 - LRB104 18483 SSS 31925 b (305 ILCS 5/5-5.25a new) Sec.

(b) All seizure detection devices covered under this Section shall be approved for use by individuals, provided 10400SB3365ham001 -175- LRB104 18483 KTG 38682 a that the device has been prescribed and determined to be medically necessary.

(c) Any individual who has been prescribed a seizure detection device shall not be required to obtain prior authorization for coverage for a seizure detection device, and SB3365 Enrolled - 175 - LRB104 18483 SSS 31925 b coverage shall be continuous once the seizure detection device is prescribed.

(210 ILCS 135/13.3) 10400SB3365ham001 -176- LRB104 18483 KTG 38682 a Sec.

As used in this Section, "medical absence" means a situation in which a resident is temporarily absent from a community-integrated living arrangement to receive medical treatment or for other reasons that have been recommended by third-party medical personnel, including, but not limited to, hospitalizations, placements in short-term SB3365 Enrolled - 176 - LRB104 18483 SSS 31925 b stabilization homes or State-operated facilities, stays in nursing facilities, rehabilitation in long-term care facilities, or other absences for legitimate medical reasons.

The per diem reimbursement shall be in addition to the existing occupancy 10400SB3365ham001 -177- LRB104 18483 KTG 38682 a factor policy set by the Division of Developmental Disabilities.

SB3365 Enrolled - 177 - LRB104 18483 SSS 31925 b (Source:

(1) For inpatient hospital services rendered, or if applicable, for inpatient hospital discharges occurring, on or after July 1, 1992 and on or before September 30, 1992, the Illinois Department shall reimburse hospitals 10400SB3365ham001 -178- LRB104 18483 KTG 38682 a for inpatient services under the reimbursement methodologies in effect for each hospital, and at the inpatient payment rate calculated for each hospital, as of June 30, 1992.

For purposes of this paragraph, "reimbursement methodologies" means all reimbursement methodologies that pertain to the provision of inpatient hospital services, including, but not limited to, any SB3365 Enrolled - 178 - LRB104 18483 SSS 31925 b adjustments for disproportionate share, targeted access, critical care access and uncompensated care, as defined by the Illinois Department on June 30, 1992.

(3) For the purpose of calculating the inpatient payment rate for each hospital eligible to receive quarterly adjustment payments for uncompensated care, as defined by the Illinois Department on June 30, 1992, the adjustment payment for the period August 1, 1992 through 10400SB3365ham001 -179- LRB104 18483 KTG 38682 a September 30, 1992, shall be one-sixth of the total uncompensated care adjustment payments calculated for each eligible hospital for the uncompensated care rate year, as defined by the Illinois Department, ending on July 31, 1992.

SB3365 Enrolled - 179 - LRB104 18483 SSS 31925 b (b) Inpatient payments.

(1) Hospitals that are described in Section 1923 of the federal Social Security Act, as now or hereafter amended, except that for rate year 2015 and after a hospital described in Section 1923(b)(1)(B) of the federal Social Security Act and qualified for the payments described in subsection (c) of this Section for rate year 2014 provided the hospital continues to meet the description in Section 1923(b)(1)(B) in the current 10400SB3365ham001 -180- LRB104 18483 KTG 38682 a determination year;

or (3) Illinois hospitals that on July 1, 1991 had a SB3365 Enrolled - 180 - LRB104 18483 SSS 31925 b Medicaid inpatient utilization rate, as defined in paragraph (h) of this Section, that was at least the mean Medicaid inpatient utilization rate for all hospitals in Illinois receiving Medicaid payments from the Illinois Department and which were located in a planning area with one-third or fewer excess beds as determined by the Health Facilities and Services Review Board, and that, as of June 30, 1992, were located in a federally designated Health Manpower Shortage Area;

and (B) also have a Medicaid obstetrical inpatient utilization rate that is at least one standard deviation above the mean Medicaid obstetrical inpatient utilization rate for all hospitals in Illinois receiving Medicaid payments from the 10400SB3365ham001 -181- LRB104 18483 KTG 38682 a Department for obstetrical services;

A hospital which includes a facility devoted exclusively to caring for children shall be considered a children's hospital to the degree that the hospital's Medicaid care is provided to children if either (i) the facility devoted exclusively SB3365 Enrolled - 181 - LRB104 18483 SSS 31925 b to caring for children is separately licensed as a hospital by a municipality prior to February 28, 2013;

or (6) A hospital that reopens a previously closed hospital facility within 4 calendar years of the hospital 10400SB3365ham001 -182- LRB104 18483 KTG 38682 a facility's closure, if the previously closed hospital facility qualified for payments under paragraph (c) at the time of closure, until utilization data for the new facility is available for the Medicaid inpatient utilization rate calculation.

For purposes of this clause, a "closed hospital facility" shall include hospitals that have been terminated from participation in the medical SB3365 Enrolled - 182 - LRB104 18483 SSS 31925 b assistance program in accordance with Section 12-4.25 of this Code.

(3) hospitals with a Medicaid inpatient utilization rate that is equal to or greater than one standard deviation above the mean Medicaid inpatient utilization 10400SB3365ham001 -183- LRB104 18483 KTG 38682 a rate but less than 1.5 standard deviations above the mean Medicaid inpatient utilization rate shall receive a per day adjustment payment equal to the sum of $40 plus $7 for each one percent that the hospital's Medicaid inpatient utilization rate exceeds one standard deviation above the mean Medicaid inpatient utilization rate;

(4) hospitals with a Medicaid inpatient utilization SB3365 Enrolled - 183 - LRB104 18483 SSS 31925 b rate that is equal to or greater than 1.5 standard deviations above the mean Medicaid inpatient utilization rate shall receive a per day adjustment payment equal to the sum of $90 plus $2 for each one percent that the hospital's Medicaid inpatient utilization rate exceeds 1.5 standard deviations above the mean Medicaid inpatient utilization rate;

Department of Veterans Affairs at a hospital approved to conduct its operations from more than one location within contiguous 10400SB3365ham001 -184- LRB104 18483 KTG 38682 a counties under a single license, if at the time of its licensing application the hospital was located in a county with fewer than 125,000 inhabitants and the hospital's second facility is located in a contiguous county with fewer than 235,000 inhabitants.

SB3365 Enrolled - 184 - LRB104 18483 SSS 31925 b (d) Supplemental adjustment payments.

The sum of the inpatient adjustment payments under paragraphs (c) and (d) to a hospital, other 10400SB3365ham001 -185- LRB104 18483 KTG 38682 a than a county hospital (as defined in subsection (c) of Section 15-1 of this Code) or a hospital organized under the University of Illinois Hospital Act, however, shall not exceed $275 per day;

that limit shall be increased on October 1, 1993 and annually thereafter by a percentage equal to the lesser of (i) the increase in the DRI hospital cost index for the most recent 12-month period for which data are available or (ii) SB3365 Enrolled - 185 - LRB104 18483 SSS 31925 b the percentage increase in the statewide average hospital payment rate over the previous year's statewide average hospital payment rate.

(1) "Medicaid inpatient utilization rate" means a fraction, the numerator of which is the number of a hospital's inpatient days provided in a given 12-month period to patients who, for such days, were eligible for Medicaid under Title XIX of the federal Social Security Act, and the denominator of which is the total number of 10400SB3365ham001 -186- LRB104 18483 KTG 38682 a the hospital's inpatient days in that same period.

(3) "Medicaid obstetrical inpatient utilization rate" SB3365 Enrolled - 186 - LRB104 18483 SSS 31925 b means the ratio of Medicaid obstetrical inpatient days to total Medicaid inpatient days for all Illinois hospitals receiving Medicaid payments from the Illinois Department.

10400SB3365ham001 -187- LRB104 18483 KTG 38682 a (m) The Department shall establish a cost-based reimbursement methodology for determining payments to hospitals for approved graduate medical education (GME) programs for dates of service on and after July 1, 2018.

(1) As used in this subsection, "hospitals" means the University of Illinois Hospital as defined in the University of Illinois Hospital Act and a county hospital SB3365 Enrolled - 187 - LRB104 18483 SSS 31925 b in a county of over 3,000,000 inhabitants.

(3) The Department shall make all GME payments directly to hospitals including such costs in support of 10400SB3365ham001 -188- LRB104 18483 KTG 38682 a clients enrolled in Medicaid managed care entities.

SB3365 Enrolled - 188 - LRB104 18483 SSS 31925 b (5) As used in this subsection, "managed care days" means costs associated with services rendered to enrollees of Medicaid managed care entities.

10400SB3365ham001 -189- LRB104 18483 KTG 38682 a 102-886, eff.

SB3365 Enrolled - 189 - LRB104 18483 SSS 31925 b (20 ILCS 105/4.02) Sec.

10400SB3365ham001 -190- LRB104 18483 KTG 38682 a (i) adult day health services;

SB3365 Enrolled - 190 - LRB104 18483 SSS 31925 b (l) other nonmedical social services that may enable the person to become self-supporting;

The Department shall, in conjunction with the Department 10400SB3365ham001 -191- LRB104 18483 KTG 38682 a of Public Aid (now Department of Healthcare and Family Services), seek appropriate amendments under Sections 1915 and 1924 of the Social Security Act.

The purpose of the amendments shall be to extend eligibility for home and community based services under Sections 1915 and 1924 of the Social Security Act to persons who transfer to or for the benefit of a spouse those amounts of income and resources allowed under Section SB3365 Enrolled - 191 - LRB104 18483 SSS 31925 b 1924 of the Social Security Act.

The services shall be provided to eligible persons age 60 and older to the extent that the cost of the services together with the other personal maintenance expenses of the persons are reasonably related to the standards established for care in a group 10400SB3365ham001 -192- LRB104 18483 KTG 38682 a facility appropriate to the person's condition.

The Departments of Human Services, Healthcare and Family Services, Public Health, Veterans' Affairs, and Commerce and Economic Opportunity and SB3365 Enrolled - 192 - LRB104 18483 SSS 31925 b other appropriate agencies of State, federal, and local governments shall cooperate with the Department on Aging in the establishment and development of the noninstitutional services.

On 10400SB3365ham001 -193- LRB104 18483 KTG 38682 a and after July 1, 1996, all nursing home prescreenings for individuals 60 years of age or older shall be conducted by the Department.

As part of the Department on Aging's routine training of case managers and case manager supervisors, the Department may include information on family futures planning for persons who are age 60 or older and who are caregivers of their adult SB3365 Enrolled - 193 - LRB104 18483 SSS 31925 b children with developmental disabilities.

The Department, or the Department's authorized representative, may recover the amount of moneys expended for services provided to or in behalf of a person under this Section by a claim against the person's estate or against the estate of the person's surviving spouse, but no recovery may be had until after the death of the surviving spouse, if any, and then only at such time when there is no surviving child who 10400SB3365ham001 -194- LRB104 18483 KTG 38682 a is under age 21 or blind or who has a permanent and total disability.

provided that such recovery shall not be enforced against any real estate while it is occupied as a homestead by the surviving spouse or other SB3365 Enrolled - 194 - LRB104 18483 SSS 31925 b dependent, if no claims by other creditors have been filed against the estate, or, if such claims have been filed, they remain dormant for failure of prosecution or failure of the claimant to compel administration of the estate for the purpose of payment.

10400SB3365ham001 -195- LRB104 18483 KTG 38682 a (2) ensuring that care plans contain the services that eligible participants need based on the number of days in a month, not limited to specific blocks of time, as identified by the comprehensive assessment tool selected by the Department for use statewide, not to exceed the total monthly service cost maximum allowed for each service;

the Department shall develop administrative rules SB3365 Enrolled - 195 - LRB104 18483 SSS 31925 b to implement this item (2);

(6) ensuring that homemaker program vendors are not restricted from hiring homemakers who are family members 10400SB3365ham001 -196- LRB104 18483 KTG 38682 a of clients or recommended by clients;

(7) ensuring that the State may access maximum federal matching funds by seeking approval for the Centers for Medicare and Medicaid Services for modifications to the SB3365 Enrolled - 196 - LRB104 18483 SSS 31925 b State's home and community based services waiver and additional waiver opportunities, including applying for enrollment in the Balance Incentive Payment Program by May 1, 2013, in order to maximize federal matching funds;

10400SB3365ham001 -197- LRB104 18483 KTG 38682 a (10) working in conjunction with Care Coordination Units, the Department of Healthcare and Family Services, the Department of Human Services, Community Care Program providers, and other stakeholders to make improvements to the Medicaid claiming processes and the Medicaid enrollment procedures or requirements as needed, including, but not limited to, specific policy changes or SB3365 Enrolled - 197 - LRB104 18483 SSS 31925 b rules to improve the up-front enrollment of participants in the Medicaid program and specific policy changes or rules to ensure insure more prompt submission of bills to the federal government to secure maximum federal matching dollars as promptly as possible;

10400SB3365ham001 -198- LRB104 18483 KTG 38682 a By January 1, 2009 or as soon after the end of the Cash and Counseling Demonstration Project as is practicable, the Department may, based on its evaluation of the demonstration project, promulgate rules concerning personal assistant services, to include, but need not be limited to, qualifications, employment screening, rights under fair labor standards, training, fiduciary agent, and supervision SB3365 Enrolled - 198 - LRB104 18483 SSS 31925 b requirements.

Persons engaged in the program authorized by this Section before the effective date of this amendatory Act of 1991 shall be issued a certificate of all 10400SB3365ham001 -199- LRB104 18483 KTG 38682 a pre-service and in-service training from his or her employer upon submitting the necessary information.

In addition, the employing agency is responsible for the issuance of SB3365 Enrolled - 199 - LRB104 18483 SSS 31925 b certifications of in-service training completed to its their employees.

The Committee shall meet on a bi-monthly basis and shall serve to 10400SB3365ham001 -200- LRB104 18483 KTG 38682 a identify and advise the Department on present and potential issues affecting the service delivery network, the program's clients, and the Department and to recommend solution strategies.

The Director shall appoint members to SB3365 Enrolled - 200 - LRB104 18483 SSS 31925 b the Committee to represent provider, advocacy, policy research, and other constituencies committed to the delivery of high quality home and community-based services to older adults.

10400SB3365ham001 -201- LRB104 18483 KTG 38682 a Committee members' terms of appointment shall be for 4 years with one-quarter of the appointees' terms expiring each year.

The Director shall designate Department staff to provide technical SB3365 Enrolled - 201 - LRB104 18483 SSS 31925 b assistance and staff support to the committee.

10400SB3365ham001 -202- LRB104 18483 KTG 38682 a Those persons previously found eligible for receiving noninstitutional services whose services were discontinued under the Emergency Budget Act of Fiscal Year 1992, and who do not meet the eligibility standards in effect on or after July 1, 1992, shall remain ineligible on and after July 1, 1992.

Those persons previously not required to cost-share and who were required to cost-share effective March 1, 1992, shall SB3365 Enrolled - 202 - LRB104 18483 SSS 31925 b continue to meet cost-share requirements on and after July 1, 1992.

The Department may authorize Community Care Program services until an applicant is determined eligible for medical 10400SB3365ham001 -203- LRB104 18483 KTG 38682 a assistance under Article V of the Illinois Public Aid Code.

In regard to community care providers, failure to comply SB3365 Enrolled - 203 - LRB104 18483 SSS 31925 b with Department on Aging policies shall be cause for disciplinary action, including, but not limited to, disqualification from serving Community Care Program clients.

The Department shall review the enhanced rate as part of its process to rebase 10400SB3365ham001 -204- LRB104 18483 KTG 38682 a in-home service provider reimbursement rates pursuant to federal waiver requirements.

Subject to federal approval, on and after January 1, 2024, SB3365 Enrolled - 204 - LRB104 18483 SSS 31925 b rates for homemaker services shall be increased to $28.07 to sustain a minimum wage of $17 per hour for direct service workers.

Fringe 10400SB3365ham001 -205- LRB104 18483 KTG 38682 a benefits, including, but not limited to, paid time off and payment for training, health insurance, travel, or transportation, shall not be reduced in relation to the rate increases described in this paragraph.

Subject to and upon federal approval, on and after January 1, 2026, rates for homemaker services shall be increased to $30.80 to sustain a minimum wage of $18.75 per hour for direct SB3365 Enrolled - 205 - LRB104 18483 SSS 31925 b service workers.

The Department on Aging shall establish and implement a Community 10400SB3365ham001 -206- LRB104 18483 KTG 38682 a Care Program Medicaid Initiative.

and (iii) establish requirements for State agencies to make enrollment SB3365 Enrolled - 206 - LRB104 18483 SSS 31925 b in the State's Medical Assistance program easier for seniors.

10400SB3365ham001 -207- LRB104 18483 KTG 38682 a (5) One individual from a non-governmental statewide organization that advocates for seniors, appointed by the Director of Aging.

(7) One individual from a statewide association dedicated to Alzheimer's care, support, and research, SB3365 Enrolled - 207 - LRB104 18483 SSS 31925 b appointed by the Director of Aging.

(14) One individual appointed by a labor organization 10400SB3365ham001 -208- LRB104 18483 KTG 38682 a representing frontline employees at the Department of Human Services.

(A) the number of Illinois residents, categorized by planning and SB3365 Enrolled - 208 - LRB104 18483 SSS 31925 b service area, who are receiving services under the Community Care Program and are enrolled in the State's Medical Assistance Program;

The Department on Aging shall enroll in the State's Medical Assistance Program those Illinois residents who receive services under the Community Care Program and are eligible for medical assistance benefits but are not enrolled 10400SB3365ham001 -209- LRB104 18483 KTG 38682 a in the State's Medical Medicaid Assistance Program.

The Department on Aging, with the involvement of the Subcommittee, shall collaborate with the Department of Human Services and the Department of Healthcare and Family Services on how best to achieve the responsibilities of the Community SB3365 Enrolled - 209 - LRB104 18483 SSS 31925 b Care Program Medicaid Initiative.

On and after July 1, 2019, care coordination units shall receive no less than $200 per completed application, which rate may be included in a bundled rate for initial intake 10400SB3365ham001 -210- LRB104 18483 KTG 38682 a services when Medicaid application assistance is provided in conjunction with the initial intake process for new program participants.

SB3365 Enrolled - 210 - LRB104 18483 SSS 31925 b Effective July 1, 2023, subject to federal approval, the Department on Aging shall reimburse Care Coordination Units at the following rates for case management services:

8-15-25.) 10400SB3365ham001 -211- LRB104 18483 KTG 38682 a ARTICLE 145.

SB3365 Enrolled - 211 - LRB104 18483 SSS 31925 b (a) Notwithstanding any other provision of this Code, the hospital rates of reimbursement authorized under Sections 5-5.05, 14-12, and 14-13 of this Code shall be adjusted in accordance with the provisions of this Section.

(B) For all general acute care hospitals that are 10400SB3365ham001 -212- LRB104 18483 KTG 38682 a not safety-net hospitals, the inpatient psychiatric care per diem rates in effect January 1, 2023 shall be increased by 10%, except that all rates shall be at least 90% of the minimum inpatient psychiatric care per diem rate for safety-net hospitals as authorized in subsection (b-5) of Section 5-5.05 of this Code including the adjustments authorized in this Section.

SB3365 Enrolled - 212 - LRB104 18483 SSS 31925 b The statewide default per diem rate for a hospital opening a new psychiatric distinct part unit, shall be set at 90% of the minimum inpatient psychiatric care per diem rate for safety-net hospitals as authorized in subsection (b-5) of Section 5-5.05 of this Code, including the adjustment authorized in this Section.

10400SB3365ham001 -213- LRB104 18483 KTG 38682 a (3) For inpatient rehabilitative services, all hospital specific per diem rates in effect January 1, 2023, shall be increased by 10%.

SB3365 Enrolled - 213 - LRB104 18483 SSS 31925 b (4) The statewide-standardized amount for outpatient general acute care services in effect January 1, 2023, shall be increased by 10%.

(8) For services provided on and after January 1, 2024 through June 30, 2024, and on and after January 1, 2029 2027, subject to federal approval, in addition to the statewide standardized amount, an add-on payment of at least $210 shall be paid for each inpatient General Acute and Psychiatric day of care, excluding Medicare-Medicaid dual eligible crossover days, for all safety-net hospitals 10400SB3365ham001 -214- LRB104 18483 KTG 38682 a defined in Section 5-5e.1 of this Code.

SB3365 Enrolled - 214 - LRB104 18483 SSS 31925 b (B) If the add-on adjustment is added to the hospital specific psychiatric per diem rate to operationalize payment, the Department shall provide a rate sheet to each safety-net hospital, which identifies the hospital psychiatric per diem rate before and after the adjustment.

10400SB3365ham001 -215- LRB104 18483 KTG 38682 a (A) if the safety-net hospital's Medicaid inpatient utilization rate, as calculated under Section 5-5e.1 of this Code, is equal to or greater than 70%, the add-on payment shall be $425;

(B) if the safety-net hospital's Medicaid inpatient utilization rate, as calculated under Section 5-5e.1 of this Code, is equal to or greater SB3365 Enrolled - 215 - LRB104 18483 SSS 31925 b than 50% and less than 70%, the add-on payment shall be $300;

Rates described in subparagraphs (A) through (C) shall be adjusted annually beginning January 1, 2026 by applying a uniform factor to each rate to spend an approximate 10400SB3365ham001 -216- LRB104 18483 KTG 38682 a amount of $50,000,000 annually per year using State fiscal year 2024 days as a basis for calendar year 2026 rates.

(10) For services provided on and after July 1, 2024, and on or before December 31, 2028 2026, subject to SB3365 Enrolled - 216 - LRB104 18483 SSS 31925 b federal approval, in addition to the statewide standardized amount and any other payments authorized under this Code, a safety-net hospital low volume add-on payment of the lesser of $200 or the annually recalculated amount described below shall be paid for each inpatient General Acute and Psychiatric day of care, excluding Medicare-Medicaid dual eligible crossover days, for any safety-net hospital as defined in Section 5-5e.1 that provided less than 11,000 Medicaid inpatient days of care, excluding Medicare-Medicaid dual eligible crossover days, in the base period.

The low volume add-on payment amount of $200 shall 10400SB3365ham001 -217- LRB104 18483 KTG 38682 a be adjusted annually beginning January 1, 2027 if projected overall payment exceeds $30,000,000 by setting a rate to spend an approximate amount of $30,000,000 annually using the most recent complete State fiscal year inpatient General Acute and Psychiatric day of care data, excluding Medicare-Medicaid dual eligible crossover days for qualifying hospitals.

State Fiscal Year 2025 data SB3365 Enrolled - 217 - LRB104 18483 SSS 31925 b shall be used as the basis for the Calendar Year 2027 rate, and State Fiscal Year 2026 data shall be used as the basis for the Calendar Year 2028 rate.

The 10400SB3365ham001 -218- LRB104 18483 KTG 38682 a General Assembly finds that the adoption of rules to implement the changes made by Public Act 103-102 and this amendatory Act of the 103rd General Assembly is deemed an emergency and necessary for the public interest, safety, and welfare.

(e) The Department shall ensure that all necessary adjustments to the managed care organization capitation base rates necessitated by the adjustments in this Section are SB3365 Enrolled - 218 - LRB104 18483 SSS 31925 b completed, published, and applied in accordance with Section 5-30.8 of this Code 90 days prior to the implementation date of the changes required under Public Act 103-102 and this amendatory Act of the 103rd General Assembly.

6-7-24.) ARTICLE 175.170.

Section 170-5.

The Illinois Public Aid Code is amended by changing Section 1-8.5 as follows:

(305 ILCS 5/1-8.5) Sec.

1-8.5.

Eligibility for medical assistance during periods of incarceration or detention.

10400SB3365ham001 -219- LRB104 18483 KTG 38682 a (a) To the extent permitted by federal law and notwithstanding any other provision of this Code, the Department of Healthcare and Family Services shall not cancel a person's eligibility for medical assistance, nor shall the Department deny a person's application for medical assistance, solely because that person has become or is an inmate of a public institution, including, but not limited to, a county jail, juvenile detention center, or State correctional facility.

The person may be and remain enrolled for medical assistance as long as all other eligibility criteria are met.

(b) The Department may adopt rules to permit a person to apply for medical assistance while he or she is an inmate of a public institution as described in subsection (a).

The rules may limit applications to persons who would be likely to qualify for medical assistance if they resided in the community.

Any such person who is not already enrolled for medical assistance may apply for medical assistance prior to the date of scheduled release or discharge from a penal institution or county jail or similar status.

(c) Except as provided under Section 17 of the County Jail Act, the Department shall not be responsible to provide medical assistance under this Code for any medical care, services, or supplies provided to a person while he or she is an inmate of a public institution as described in subsection (a).

The responsibility for providing medical care shall remain as otherwise provided by law with the Department of 10400SB3365ham001 -220- LRB104 18483 KTG 38682 a Corrections, county, or other arresting authority.

The Department may seek federal financial participation, to the extent that it is available and with the cooperation of the Department of Juvenile Justice, the Department of Corrections, or the relevant county, for the costs of those services.

(c-1) Notwithstanding subsection (c), the Department may provide medical assistance under this Code for medical care, services, and supplies provided to a person while he or she is an inmate of a public institution as described in subsection (a) to the extent authorized under a federally approved 1115 Waiver or other federal authority.

The medical care, services, and supplies covered, and any other standards, limitations, or conditions for coverage, shall be established by rule by the Department in accordance with the federal authority obtained.

(d) To the extent permitted under State and federal law, the Department shall develop procedures to expedite required periodic reviews of continued eligibility for persons described in subsection (a).

(e) Counties, the Department of Juvenile Justice, the Department of Human Services, and the Department of Corrections shall cooperate with the Department in administering this Section.

That cooperation shall include managing eligibility processing and sharing information sufficient to inform the Department, in a manner established by the Department, that a person enrolled in the medical assistance program has been detained or incarcerated.

10400SB3365ham001 -221- LRB104 18483 KTG 38682 a (f) The Department shall resume responsibility for providing medical assistance upon release of the person to the community as long as all of the following apply:

(1) The person is enrolled for medical assistance at the time of release.

(2) Neither a county, the Department of Juvenile Justice, the Department of Corrections, nor any other criminal justice authority continues to bear responsibility for the person's medical care.

(3) The county, the Department of Juvenile Justice, or the Department of Corrections provides timely notice of the date of release in a manner established by the Department.

(g) This Section applies on and after December 31, 2011.

(Source:

P.A.

98-139, eff.

1-1-14;

99-415, eff.

8-20-15.) ARTICLE 175.

"Managed care organization" or "MCO" means any entity which contracts with the Department to provide services where 10400SB3365ham001 -222- LRB104 18483 KTG 38682 a payment for medical services is made on a capitated basis.

"Emergency services" include inpatient SB3365 Enrolled - 219 - LRB104 18483 SSS 31925 b stabilization services furnished during the inpatient stabilization period.

or (B) a transfer to another hospital may pose a threat to the health or safety of the woman or unborn 10400SB3365ham001 -223- LRB104 18483 KTG 38682 a child.

"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 SB3365 Enrolled - 220 - LRB104 18483 SSS 31925 b 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.

"Post-stabilization medical services" means health care services provided to an enrollee that are furnished in a hospital by a provider that is qualified to furnish such 10400SB3365ham001 -224- LRB104 18483 KTG 38682 a services and determined to be medically necessary by the provider and directly related to the emergency medical condition following stabilization.

"Provider" means a facility or individual who is actively enrolled in the medical assistance program and licensed or SB3365 Enrolled - 221 - LRB104 18483 SSS 31925 b otherwise authorized to order, prescribe, refer, or render health care services in this State.

"Service authorization request" means a request by a provider to a service authorization program to determine whether a health care service meets the reimbursement eligibility requirements for medically necessary, clinically appropriate care, resulting in the issuance of a service 10400SB3365ham001 -225- LRB104 18483 KTG 38682 a authorization determination.

"Utilization review organization" or "URO" means an MCO's utilization review department or a peer review organization or quality improvement organization that contracts with an MCO to administer a service authorization program and make service SB3365 Enrolled - 222 - LRB104 18483 SSS 31925 b authorization determinations.

10400SB3365ham001 -226- LRB104 18483 KTG 38682 a (1) The MCO shall not impose any service authorization program requirements for emergency services, including, but not limited to, prior authorization, prior approval, pre-certification, certification of admission, concurrent review, or retrospective review.

SB3365 Enrolled - 223 - LRB104 18483 SSS 31925 b (A) Notification period:

(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 10400SB3365ham001 -227- LRB104 18483 KTG 38682 a 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 emergency services provided on an emergency basis that are not covered services under the contract between the MCO SB3365 Enrolled - 224 - LRB104 18483 SSS 31925 b and the Department.

10400SB3365ham001 -228- LRB104 18483 KTG 38682 a (6) The MCO's financial responsibility for post-stabilization medical services it has not pre-approved ends when:

(A) a plan physician with privileges at the treating hospital assumes responsibility for the SB3365 Enrolled - 225 - LRB104 18483 SSS 31925 b enrollee's care;

or (5) the MCO or its URO and the treating provider, if the treating provider is a non-affiliated provider, could not reach an agreement concerning the enrollee's care and 10400SB3365ham001 -229- LRB104 18483 KTG 38682 a 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 SB3365 Enrolled - 226 - LRB104 18483 SSS 31925 b assumed responsibility for the enrollee's care.

10400SB3365ham001 -230- LRB104 18483 KTG 38682 a (E) require MCOs to ensure that any Medicaid-certified provider under contract with an MCO and previously submitted on a roster on the date of service is paid for any medically necessary, Medicaid-covered, and authorized service rendered to SB3365 Enrolled - 227 - LRB104 18483 SSS 31925 b any of the MCO's enrollees, regardless of inclusion on the MCO's published and publicly available directory of available providers;

(2) Each MCO shall confirm its receipt of information submitted specific to physician or dentist additions or physician or dentist deletions from the MCO's provider network within 3 days after receiving all required information from contracted physicians or dentists, and electronic physician and dental directories must be updated consistent with current rules as published by the 10400SB3365ham001 -231- LRB104 18483 KTG 38682 a Centers for Medicare and Medicaid Services or its successor agency.

(1) The MCO shall pay a claim within 30 days of receiving a claim that contains all the essential SB3365 Enrolled - 228 - LRB104 18483 SSS 31925 b information needed to adjudicate the claim.

(4)(A) The Department shall require MCOs to expedite payments to providers identified on the Department's 10400SB3365ham001 -232- LRB104 18483 KTG 38682 a expedited provider list, determined in accordance with 89 Ill.

(B) Compliance with the expedited provider requirement SB3365 Enrolled - 229 - LRB104 18483 SSS 31925 b may be satisfied by an MCO through the use of a Periodic Interim Payment (PIP) program that has been mutually agreed to and documented between the MCO and the provider, if the PIP program ensures that any expedited provider receives regular and periodic payments based on prior period payment experience from that MCO.

(1) in no instance shall a medically necessary covered service rendered in good faith, based upon eligibility information documented by the provider, be denied coverage or diminished in payment amount if the eligibility or coverage information available at the time the service was rendered is later found to be inaccurate in the assignment 10400SB3365ham001 -233- LRB104 18483 KTG 38682 a of coverage responsibility between MCOs or the fee-for-service system, except for instances when an individual is deemed to have not been eligible for coverage under the Illinois Medicaid program;

and (2) the Department shall, by December 31, 2016, adopt SB3365 Enrolled - 230 - LRB104 18483 SSS 31925 b rules establishing policies that shall be included in the Medicaid managed care policy and procedures manual addressing payment resolutions in situations in which a provider renders services based upon information obtained after verifying a patient's eligibility and coverage plan through either the Department's current enrollment system or a system operated by the coverage plan identified by the patient presenting for services:

The rules on payment resolutions shall include, but 10400SB3365ham001 -234- LRB104 18483 KTG 38682 a not be limited to:

and (C) guaranteed minimum payment rate of no less than the current, as of the date of service, SB3365 Enrolled - 231 - LRB104 18483 SSS 31925 b fee-for-service rate, plus all applicable add-ons, when the resulting service relationship is out of network.

and 10400SB3365ham001 -235- LRB104 18483 KTG 38682 a (G) member and provider customer service.

(3) The metrics shall be developed in consultation SB3365 Enrolled - 232 - LRB104 18483 SSS 31925 b with industry representatives of the Medicaid managed care health plans and representatives of associations representing the majority of providers within the identified industry.

10400SB3365ham001 -236- LRB104 18483 KTG 38682 a An unresolved dispute means an MCO's decision that denies in whole or in part a claim for reimbursement to a provider for health care services rendered by the provider to an enrollee of the MCO with which the provider disagrees.

Disputes shall not be submitted to the portal until the provider has availed SB3365 Enrolled - 233 - LRB104 18483 SSS 31925 b itself of the MCO's internal dispute resolution process.

If the dispute remains unresolved at the end of this time frame or the provider is not satisfied with the MCO's written proposal to resolve the dispute, the provider may, within 30 days, request the Department to review the dispute and make a final 10400SB3365ham001 -237- LRB104 18483 KTG 38682 a determination.

SB3365 Enrolled - 234 - LRB104 18483 SSS 31925 b Within 30 days of receiving the relevant information on the dispute, or the lapse of the period for submitting such information, the Department shall issue a written decision on the dispute based on contractual terms between the provider and the MCO, contractual terms between the MCO and the Department of Healthcare and Family Services and applicable Medicaid policy.

10400SB3365ham001 -238- LRB104 18483 KTG 38682 a (iii) Other claim payments.

SB3365 Enrolled - 235 - LRB104 18483 SSS 31925 b (2) The medical loss ratio shall be calculated consistent with federal law and regulation following a claims runout period determined by the Department.

(2) The standardized roster form may be submitted to the MCO at the same time that the provider submits an enrollment 10400SB3365ham001 -239- LRB104 18483 KTG 38682 a application to the Department through IMPACT.

(3) By October 1, 2019, the Department shall require all MCOs to update their provider directory with information for new practitioners of existing contracted providers within 30 days of receipt of a complete and accurate standardized roster SB3365 Enrolled - 236 - LRB104 18483 SSS 31925 b template in the format approved by the Department provided that the provider is effective in the Department's provider enrollment subsystem within the IMPACT system.

(g-12) Notwithstanding any other provision of law, if the Department or an MCO requires submission of a claim for payment in a non-electronic format, a provider shall always be 10400SB3365ham001 -240- LRB104 18483 KTG 38682 a afforded a period of no less than 90 business days, as a correction period, following any notification of rejection by either the Department or the MCO to correct errors or omissions in the original submission.

Under no circumstances, either by an MCO or under the SB3365 Enrolled - 237 - LRB104 18483 SSS 31925 b State's fee-for-service system, shall a provider be denied payment for failure to comply with any timely submission requirements under this Code or under any existing contract, unless the non-electronic format claim submission occurs after the initial 180 days following the latest date of service on the claim, or after the 90 business days correction period following notification to the provider of rejection or denial of payment.