Public Act 096-1405
 
SB3762 EnrolledLRB096 20714 KTG 36441 b



    AN ACT concerning regulation.

 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:






 
    Section 5. The Illinois Public Aid Code is amended  by 
adding Section 12-4.40 as follows:
 
    (305 ILCS 5/12-4.40 new)
    Sec. 12-4.40. Medicaid Revenue Maximization.
    (a) Purpose. The General Assembly finds that there is a 
need to make changes to the administration of services provided 
by State and local governments in order to maximize federal 
financial participation. 
    (b) Definitions. As used in this Section: 
    "Community Medicaid mental health services" means all 
mental health services outlined in Section 132 of Title 59 of 
the Illinois Administrative Code that are funded through DHS, 
eligible for federal financial participation, and provided by a 
community-based provider. 
    "Community-based provider" means an entity enrolled as a 
provider pursuant to Sections 140.11 and 140.12 of Title 89 of 
the Illinois Administrative Code and certified to provide 
community Medicaid mental health services in accordance with 
Section 132 of Title 59 of the Illinois Administrative Code. 
    "DCFS" means the Department of Children and Family 
Services.
    "Department" means the Illinois Department of Healthcare 
and Family Services.
    "Developmentally disabled care facility" means an 
intermediate care facility for the mentally retarded within the 
meaning of Title XIX of the Social Security Act, whether public 
or private and whether organized for profit or not-for-profit, 
but shall not include any facility operated by the State.
    "Developmentally disabled care provider" means a person 
conducting, operating, or maintaining a developmentally 
disabled care facility. For purposes of this definition, 
"person" means any political subdivision of the State, 
municipal corporation, individual, firm, partnership, 
corporation, company, limited liability company, association, 
joint stock association, or trust, or a receiver, executor, 
trustee, guardian, or other representative appointed by order 
of any court.
    "DHS" means the Illinois Department of Human Services.
    "Hospital" means an institution, place, building, or 
agency located in this State that is licensed as a general 
acute hospital by the Illinois Department of Public Health 
under the Hospital Licensing Act, whether public or private and 
whether organized for profit or not-for-profit.
    "Long term care facility" means (i) a skilled nursing or 
intermediate long term care facility, whether public or private 
and whether organized for profit or not-for-profit, that is 
subject to licensure by the Illinois Department of Public 
Health under the Nursing Home Care Act, including a county 
nursing home directed and maintained under Section 5-1005 of 
the Counties Code, and (ii) a part of a hospital in which 
skilled or intermediate long term care services within the 
meaning of Title XVIII or XIX of the Social Security Act are 
provided; except that the term "long term care facility" does 
not include a facility operated solely as an intermediate care 
facility for the mentally retarded within the meaning of Title 
XIX of the Social Security Act.
    "Long term care provider" means (i) a person licensed by 
the Department of Public Health to operate and maintain a 
skilled nursing or intermediate long term care facility or (ii) 
a hospital provider that provides skilled or intermediate long 
term care services within the meaning of Title XVIII or XIX of 
the Social Security Act. For purposes of this definition, 
"person" means any political subdivision of the State, 
municipal corporation, individual, firm, partnership, 
corporation, company, limited liability company, association, 
joint stock association, or trust, or a receiver, executor, 
trustee, guardian, or other representative appointed by order 
of any court.
    "State-operated developmentally disabled care facility" 
means an intermediate care facility for the mentally retarded 
within the meaning of Title XIX of the Social Security Act 
operated by the State. 
    (c) Administration and deposit of Revenues. The Department 
shall coordinate the implementation of changes required by this 
amendatory Act of the 96th General Assembly amongst the various 
State and local government bodies that administer programs 
referred to in this Section.
    Revenues generated by program changes mandated by any 
provision in this Section, less reasonable administrative 
costs associated with the implementation of these program 
changes, shall be deposited into the Healthcare Provider Relief 
Fund. 
    The Department shall issue a report to the General Assembly 
detailing the implementation progress of this amendatory Act of 
the 96th General Assembly as a part of the Department's Medical 
Programs annual report for fiscal years 2010 and 2011. 
    (d) Acceleration of payment vouchers. To the  extent 
practicable and permissible under federal law, the Department 
shall create all vouchers for long term care facilities and 
developmentally disabled care facilities for dates of service 
in the month in which the enhanced federal medical assistance 
percentage (FMAP) originally set forth in the American Recovery 
and Reinvestment Act (ARRA) expires and for dates of service in 
the month prior to that month and shall, no later than the 15th 
of the month in which the enhanced FMAP expires, submit these 
vouchers to the Comptroller for payment. 
    The Department of Human Services shall create the necessary 
documentation for State-operated developmentally disabled care 
facilities so that the necessary data for all dates of service 
before the expiration of the enhanced FMAP originally set forth 
in the ARRA can be adjudicated by the Department no later than 
the 15th of the month in which the enhanced FMAP expires. 
    (e) Billing of DHS community Medicaid mental health 
services. No later than July 1, 2011, community Medicaid mental 
health services provided by a community-based provider must be 
billed directly to the Department. 
    (f) DCFS Medicaid services. The Department shall work with 
DCFS to identify existing programs, pending qualifying 
services, that can be converted in an economically feasible 
manner to  Medicaid in order to secure federal financial 
revenue. 
    (g) Third Party Liability recoveries. The Department shall 
contract with a vendor to support the Department in 
coordinating benefits for Medicaid enrollees.   The scope of work 
shall include, at a minimum, the identification of other 
insurance for Medicaid enrollees and the recovery of funds paid 
by the Department when another payer was liable. The vendor may 
be paid a percentage of actual cash recovered when practical 
and subject to federal law. 
    (h) Public health departments.
The Department shall 
identify unreimbursed costs for persons covered by Medicaid who 
are served by the Chicago Department of Public Health.
    The Department shall assist the Chicago Department of 
Public Health in determining total unreimbursed costs 
associated with the provision of healthcare services to 
Medicaid enrollees.
    The Department shall determine and draw the maximum 
allowable federal matching dollars associated with the cost of 
Chicago Department of Public Health services provided to 
Medicaid enrollees. 
    (i) Acceleration of hospital-based payments.
The 
Department shall, by the 10th day of the month in which the 
enhanced FMAP originally set forth in the ARRA expires, create 
vouchers for all State fiscal year 2011 hospital payments 
exempt from the prompt payment requirements of the ARRA.  The 
Department shall submit these vouchers to the Comptroller for 
payment. 
 
    Section 10. The Community Services Act is amended  by adding 
Section 4.8 as follows:
 
    (405 ILCS 30/4.8 new)
    Sec. 4.8. Payments for community Medicaid mental health 
services. 
    (a) No later than July 1, 2011, community Medicaid mental 
health services provided by a community-based provider must be 
billed directly to the Department of Healthcare and Family 
Services.
    (b) For purposes of this Section:
    "Community Medicaid mental health services" means all 
mental health services outlined in Section 132 of Title 59 of 
the Illinois Administrative Code that are funded through the 
Department of Human Services, eligible for federal financial 
participation, and provided by a community-based provider.
    "Community-based provider" means an entity enrolled as a 
provider pursuant to Sections 140.11 and 140.12 of Title 89 of 
the Illinois Administrative Code and certified to provide 
community Medicaid mental health services in accordance with 
Section 132 of Title 59 of the Illinois Administrative Code. 
 

    Section 99. Effective date. This Act takes effect upon 
becoming law.