Illinois House Bill 4978

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Spectrum: Partisan Bill (Democrat 2-0)
Status: Introduced on February 7 2024 - 25% progression
Action: 2024-04-05 - Committee/3rd Reading Deadline Extended-Rule May 24, 2024
Pending: House Medicaid & Managed Care Committee
Text: Latest bill text (Introduced) [HTML]

Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to by rule implement a methodology to reimburse hospitals for inpatient stays extended beyond medical necessity due to the inability of the Department, the managed care organization (MCO) in which a medical assistance recipient is enrolled in, or the hospital discharge planner to find an appropriate placement after discharge from the hospital to the next level of care. Requires the Department to by rule implement a methodology effective for dates of service January 1, 2025 and later to reimburse hospitals for emergency department stays extended beyond medical necessity due to the inability of the Department, the MCO, or the hospital discharge planner to find an appropriate placement after discharge from the hospital setting to the next appropriate level of care. Provides that both methodologies shall provide reasonable compensation for the services provided attributable to the hours of the extended stay for which the prevailing rate methodology provides no reimbursement. Contains provisions concerning the rate for inpatient days of care; hourly rates of reimbursement for emergency department stays; a prohibition on MCOs restricting coverage due to delays caused by the Department or the MCOs in completing the pre-admission screening and resident review process; a prohibition on MCOs imposing authorization or documentation requirements and other conditions of reimbursement that are more restrictive than standards under the fee-for-service medical assistance program; sanctions on MCOs for noncompliance; and administrative rules. Effective immediately.

DHFS-EXTENDED HOSP STAYS

Rep. Robyn Gabel [D]

Rep. Dagmara Avelar [D]

Date	Chamber	Action
2024-04-05	House	Committee/3rd Reading Deadline Extended-Rule May 24, 2024
2024-04-04	House	To Medicaid & Managed Care Subcommittee
2024-03-06	House	Added Co-Sponsor Rep. Dagmara Avelar
2024-02-28	House	Assigned to Appropriations-Health & Human Services Committee
2024-02-08	House	Referred to Rules Committee
2024-02-08	House	First Reading
2024-02-07	House	Filed with the Clerk by Rep. Robyn Gabel

Chapter	Article	Section	Citation Type	Statute Text
305	5	14-13	Amended Code	Citation Text

Type	Source
Summary	https://www.ilga.gov/legislation/BillStatus.asp?DocNum=4978&GAID=17&DocTypeID=HB&SessionID=112&GA=103
Text	https://www.ilga.gov/legislation/103/HB/10300HB4978.htm