Tuesday, May 28, 2013

Illinois Senate Bill 26 - MEDICAID-HEALTH BENEFITS SERVICE ; passes legislator, Gov Quinn to sign

PRESS RELEASE May 28, 2013
OFFICE OF GOV. QUINN
STATE OF ILLINOS

Statement from Governor Pat Quinn on Senate Passage of Senate Bill 26
Historic Legislation to Advance President Obama’s Affordable Care Act is Headed to the Governor’s Desk

SPRINGFIELD
– Governor Pat Quinn released the following statement on today’s final passage by the Illinois Senate of Senate Bill 26, which increases access to health coverage for the uninsured under President Obama’s Affordable Care Act. The bill was one of Governor Quinn’s legislative priorities in his 2013 State of the State address:

“I applaud Senate sponsor Heather Steans, House sponsor Sara Feigenholtz and all the members of the General Assembly who voted to pass Senate Bill 26 and fully embrace President Barack Obama’s Affordable Care Act.

“All people deserve access to decent health care. This bill will not only expand access to health care for the uninsured, it will also strengthen our efforts to transform Illinois’ health care sector into a wellness system that focuses on preventative services and provides better quality treatment when people do become sick.

“This bill will improve the health of the people of Illinois and create thousands of good jobs in the health care field.

“I look forward to signing this legislation and making the promise of the Affordable Care Act a reality in Illinois.”

http://www3.illinois.gov/PressReleases/PressReleasesListShow.cfm?RecNum=11221

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From the Illinois General Assembly website...

Bill Status of SB0026 98th General Assembly
Short Description: MEDICAID-HEALTH BENEFITS SRVCE

Last Action
Date Chamber Action

5/28/2013 Senate Passed Both Houses

Synopsis As Introduced
Amends the Medical Assistance Article of the Illinois Public Aid Code. Beginning January 1, 2014, extends benefits under the State's medical assistance program to persons aged 19 or older, but younger than 65, who are not otherwise eligible for medical assistance under the Code, who qualify for medical assistance under specified provisions of the Social Security Act, and who have income at or below 133% of the federal poverty level plus 5% for the applicable family size. Provides that the 4-year moratorium on the expansion of medical assistance eligibility through increasing financial eligibility standards shall not apply to this new class of persons. Provides that such persons shall receive coverage for the Health Benefits Service Package. Defines "Health Benefits Service Package". Provides that if Illinois' federal medical assistance percentage (FMAP) is reduced below 90% for persons eligible for medical assistance under the specified provisions, medical assistance eligibility for this new class of persons shall cease no later than the end of the third month following the month in which the reduction in FMAP takes effect. Effective immediately.

Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Provides that an annual assessment on outpatient services shall be imposed on each hospital provider in a specified amount for the portion of State fiscal year 2012, beginning June 10, 2012 through June 30, 2012, and for State fiscal years 2013 through 2014, and July 1, 2014 through December 31, 2014 (rather than for State fiscal years 2013 through 2014, and July 1, 2014 through December 31, 2014). Provides that for the period beginning June 10, 2012 through June 30, 2012, the annual assessment on outpatient services shall be prorated by multiplying the assessment amount by a fraction, the numerator of which is 21 days and the denominator of which is 365 days. Provides that for the portion of State fiscal year 2012, beginning June 10, 2012 through June 30, 2012, and State fiscal years 2013 through 2014, and July 1, 2014 through December 31, 2014 (rather than for State fiscal years 2013 through 2014, and July 1, 2014 through December 31, 2014), a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2009 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on June 30, 2011, without regard to any subsequent adjustments or changes to such data. Provides that certain assessments on outpatient services for the portion of State fiscal year 2012 beginning June 10, 2012 through June 30, 2012, and for State fiscal year 2013 and each subsequent State fiscal year (rather than for State fiscal year 2013 and each subsequent State fiscal year) shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the 14th State business day of each month. In a provision concerning disbursements from the Hospital Provider Fund, provides that moneys shall be disbursed from the Fund for State fiscal year 2013, for the purpose of increasing by 21/365ths the transfer of the moneys resulting from the assessment for outpatient services and received from hospital providers for the portion of State fiscal year 2012 beginning June 10, 2012 through June 30, 2012 and transferred into the Hospital Provider Fund to the Health Care Provider Relief Fund not exceeding $2,870,000 in that State fiscal year. Makes other changes.

Senate Floor Amendment No. 2
In a provision concerning assessments imposed on hospital providers that did not conduct, operate, or maintain a hospital in 2005, provides that for State fiscal years 2009 through 2015 (rather than for State fiscal years 2009 through 2014) the assessment for that State fiscal year shall be computed on the basis of hypothetical occupied bed days for the full calendar year as determined by the Department of Healthcare and Family Services. Restores language concerning monetary transfers from the Hospital Provider Fund to other specified funds in State fiscal years 2013 and 2014 in each State fiscal year during which an annual assessment for inpatient services is imposed. Provides that for State fiscal year 2013, hospital access improvement payments shall be increased by 21/365ths; and that the funding source for these additional payments shall be from a specific increased assessment on outpatient services that was received from hospital providers for the portion of State fiscal year 2012 beginning June 10, 2012 through June 30, 2012. Removes language requiring the Department of Healthcare and Family Services to submit a State Medicaid Plan Amendment to the Centers of Medicare and Medicaid Services to implement certain payments within 30 says of June 14, 2012 and instead provides that the Department of Healthcare and Family Services must submit a State Medicaid Plan Amendment to the Centers of Medicare and Medicaid Services to implement certain payments.

Replaces everything after the enacting clause. Reinserts the provisions of the engrossed bill with the following changes and additions. Deletes a provision of the engrossed bill concerning findings. Creates the Specialized Mental Health Rehabilitation Act of 2013 concerning the licensing and operation of specialized mental health rehabilitation facilities. Repeals the Specialized Mental Health Rehabilitation Act. Changes references from the Specialized Mental Health Rehabilitation Act to the Specialized Mental Health Rehabilitation Act of 2013 or deletes references to the Specialized Mental Health Rehabilitation Act in various Acts. Amends the Community-Integrated Living Arrangements Licensure and Certification Act by providing that the Division of Mental Health of the Department of Human Services shall oversee the creation of comparable programs for the services contained in the Specialized Mental Health Rehabilitation Act of 2013 for community-based providers to provide certain services. Amends the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act by providing that determinations of eligibility shall be made in accordance with specified federal laws and regulations and by making other changes. Amends the Illinois Public Aid Code by making various changes concerning: medical assistance eligibility; hospital provider assessments; exemption of property in Aid to the Aged, Blind, or Disabled eligibility determinations; eligibility of children with a disability who are medically fragile and technology dependent; medical services; rates of reimbursement; Safety-Net Hospitals; use of vendors to verify eligibility for medical assistance; hospitals dedicated to medical research and medical education; creation of the Medicaid Research and Education Support Fund; Medicaid enhancement payments to certain academic medical centers; Accountable Care Entities serve any children and parents or caretaker relatives of children eligible for medical assistance; hospital reimbursements; and other matters. Amends the Veterans' Health Insurance Program Act of 2008 to provide that the operation of the Veterans' Health Insurance Program may be changed to simplify its administration and to take advantage of health insurance coverage that may be available to veterans under the Patient Protection and Affordable Care Act. Amends the Renal Disease Treatment Act and the Hemophilia Care Act by providing that coverage under the Acts shall be coordinated with the requirements of the Patient Protection and Affordable Care Act and by making other changes. Amends the Illinois Administrative Procedure Act by authorizing adoption of emergency rules to implement specified provisions. Amends the Workers' Compensation Act. Provides that, if payment is made by the employee, the employee's health benefit plan, or the Department of Healthcare and Family Services for medical services that should be a compensable medical benefit, the payments made by the employee, the employee's health benefit plan, or the Department of Healthcare and Family Services shall be reimbursed by the employer or workers' compensation insurer. Provides that the Illinois Workers' Compensation Commission shall establish a program to provide limited workers' compensation case information to the Department of Healthcare and Family Services and to health benefit plans providing accident, health, or disability insurance benefits to residents of the State, sets forth components of the program, and authorizes the Commission to provide a limited set of workers' compensation case record elements to a participating health benefit plan. Amends the Personnel Code in relation to partial exemptions of certain positions in State service from jurisdictions A, B, and C. Inserts an Article with the short title of the Resident First Act. Amends the Nursing Home Care Act. Provides that before a licensee enters into a contract with a resident or prospective resident, it shall provide the resident or prospective resident and his or her guardian, if any, with a copy of the licensee's policy regarding the assignment of Social Security representative payee status as a condition of the contract when the resident's or prospective resident's care is being funded under Medicaid. Requires the Department of Public Health to implement a single survey process that includes an enhanced complaint investigation initiative. Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to establish procedures under the Medical Assistance program to permit skilled care facilities licensed under the Nursing Home Care Act to initiate monthly billing claims. Requires the Departments of Human Services and Healthcare and Family Services and the Department on Aging to establish an expedited long term care eligibility determination system. Amends the Mental Health and Developmental Disabilities Code. Provides that the Division of Mental Health of the Department of Human Services shall oversee the creation of comparable programs for the services contained in the Specialized Mental Health Rehabilitation Act of 2013 for community-based providers to provide specified services. Makes other changes. Effective immediately.

In the Specialized Mental Health Rehabilitation Act of 2013, created under House Amendment No.1, makes the following changes: (i) defines "abuse" to mean any physical or mental injury or sexual assault inflicted on a consumer other than by accidental means in a facility; defines "identified offender"; (ii) provides that the Department of Public Health is empowered to promulgate any rules necessary to ensure proper implementation and administration of the Act; adds provisions concerning screening prior to admission and criminal history reports; (iii) provides that informed consent shall be required for restraints consistent with the requirements contained in the Nursing Home Care Act; (iv) in a provision concerning abuse or neglect, provides that it is the duty of any facility employee or agent who becomes aware of such abuse or neglect to report it "to the Department within 24 hours"; (v) changes all references to "triage" and "triage units" to "triage center" and provides that consumers shall be free to leave a triage center at any time; if a consumer in a triage center expresses a desire to contact a third party for any purpose, the facility staff shall contact that third party on behalf of the consumer; (vi) provides that the Department shall by rule establish criteria, hearings, and procedures for involuntary discharge; (vii) adds provisions providing that (a) no consumer shall be subjected to experimental research or treatment without first obtaining his or her informed, written consent; (b) no facility shall permit experimental research or treatment to be conducted on a consumer, or give access to any person or person's records for a retrospective study about the safety or efficacy of any care or treatment, without the prior written approval of the institutional review board; and (c) the institutional review board may exempt from ongoing review research or treatment initiated on a consumer before the individual's admission to a facility and for which the board determines there is adequate ongoing oversight by another institutional review board. In a provision concerning surveys and inspections, provides that the Department shall conduct surveys (rather than scheduled surveys) to determine compliance and may conduct surveys (rather than unscheduled surveys) to investigate complaints; provides that the Department shall review the records or premises, or both, as it deems appropriate for the purpose of determining compliance with this Act and the rules promulgated under the Act (rather than with the Act only); and that the Department shall have access to and may reproduce or photocopy any books, records, and other documents maintained by the facility to the extent necessary to carry out this Act and the rules promulgated under the Act. Provides that notwithstanding the existence or pursuit of any other remedy, the Department Director may, in the manner provider by law, upon the advice of the Attorney General who shall represent the Department Director in the proceedings, maintain an action in the name of the State for injunction or other process against any person or governmental unit to restrain or prevent the establishment of a facility without a license issued pursuant to the Act, or to restrain or prevent the opening, conduction, operating, or maintaining of a facility without a license issued pursuant to the Act. Changes references to "standards" to "Act and the rules promulgated under this Act". Makes other technical changes. Further amends the Illinois Public Aid Code. Provides that facilities uniquely licensed as pediatric skilled nursing facilities that serve severely and chronically ill pediatric patients shall have a specific reimbursement system designed to recognize the characteristics and needs of the patients they serve. Provides that for dates of services starting July 1, 2013 and until a new reimbursement system is designed, pediatric skilled nursing facilities that (1) serve exceptional care patients and (2) have 30% or more of their patients receiving ventilator care shall receive Medicaid reimbursement on a 30-day expedited schedule. In a provision concerning expedited long-term care eligibility determination and enrollment, provides that the lead agency shall file interim reports with the Chairs and Minority Spokespersons of the House and Senate Human Services Committees no later than September 1, 2013 (rather than September 1, 2014) and on February 1, 2014 (rather than February 1, 2015). Further amends the Nursing Home Care Act. In a provision concerning inspections of nursing facilities for possible violations, provides that violations shall be determined no later than 75 (rather than 60) days after completion of each inspection, survey, and evaluation. Provides that to meet the requirement of a single survey process, the portions of the health and life safety survey associated with federal certification and State licensure surveys must be started within 7 working days of each other, with certain exceptions (rather than the federal certification and State licensure surveys and health and life safety survey must each be started within 5 working days). Deletes the provisions amending the Workers' Compensation Act.

http://www.ilga.gov/legislation/billstatus.asp?DocNum=26&GAID=12&GA=98&DocTypeID=SB&LegID=68456&SessionID=85

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