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 “The COVID-19 pandemic has only heightened the nation’s critical
need for more equitable health care access and delivery,
particularly in Black and Brown communities and for those who are
uninsured or underinsured,” said Governor JB Pritzker. “These new
laws bring safety net hospitals over $250 million in additional
annual funding – to the tune of $3.8 billion in payments over the
life of the program – while simultaneously uplifting residents on an
individual basis through a more responsive Medicaid program, support
for increasing diversity in clinical trials, and expanded access to
affordable health insurance. I applaud the work of leaders in the
General Assembly and the bipartisan, bicameral Medicaid Working
Group for coming together to advance a vision of health care as a
right, not a privilege, for all of Illinois.”
THE HOSPITAL ASSESSMENT PROGRAM
The Hospital Assessment Program is a $3.8 billion program that will
bring in over $250 million additional federal dollars to the state.
The program consists of $450 million in additional funding for
hospitals since the last assessment four years ago.
The Illinois Department of Healthcare and Family Services (HFS)
worked with the General Assembly and stakeholders to distribute
funding in a manner that increased funding to all hospitals in
Illinois, while prioritizing hospitals that serve a high number of
Medicaid patients.
The legislation helps make the Medicaid program more responsive to
the needs of individual members on where to seek care. Funding is
also reserved to improve access to health care services, including
diagnostic and treatment services, in under resourced communities
across the state. Payments to hospitals will be more transparent and
the billing system will be simplified for some services like
laboratory tests performed by hospitals.
The Fixed Pool Structure:
Safety Net Hospitals (24): Funding increased $81.4 million
Critical Access Hospitals (51): Funding increased $14 million
Fixed Rate Structure:
High Medicaid Hospitals (30): Funding increased $86 million
General Acute Hospitals (69): Funding increased $62.1 million
Psych Hospital (10): Funding increased $2.4 million
Long Term Acute Care Hospitals (6): Funding increased $1.2 million
Rehab Hospitals (4): Funding increased $2.3 million
To ensure physicians are fairly compensated, the plan increases
rates for vital physician services to $150 million annually. The
legislation also clarifies rules and regulations for hospitals by
providing the following guidance:
Simplifying the hospital billing process;
Requiring HFS to publish all details of the assessment calculation
every year within 30 days of completing the calculation;
Granting HFS rules making authority;
An application to close a hospital is only complete if the hospital
provided 30 day written notice to the local community and local
governing bodies and officials;
If a for-profit general acute care hospital ceases to provide
hospital services prior to July 1, 2021 and within 12 months of
switching from not-for-profit to investor, they must reimburse HFS
for payments received.
"With this forward-looking program, we are advancing our focus on
better healthcare and greater health equity," said Illinois
Department of Healthcare and Family Services Director Theresa
Eagleson. "We are bringing in significant and vital new funding to
safety net hospitals and others that serve high percentages of
Medicaid members. This is crucial - especially in historically
under-served communities of color throughout our state. This renewed
program also shifts to more dynamic payments, which means more
resources going to the hospitals that our members are choosing for
their care. The heroes working in our hospitals and the patients and
neighborhoods they serve all need and deserve this critical
support."
“This is vitally important now for our hospitals that are struggling
valiantly against COVID-19,” said House Majority Leader Greg Harris.
“The assessment program will bring $3.9 billion into our Medicaid
system to support hospitals and healthcare, particularly
high-Medicaid hospitals, at a critical time, where we need as much
stability and support for our hospitals as we can get.”
“This new assessment program ensures needed rate increases for
health care providers, improves the long term viability of our
hospitals, and gives medical institutions the power and the funds to
repurpose facilities to better meet the needs of their communities,”
said State Senator Heather Steans. “I want to thank everyone who
worked to craft this legislation and the governor for signing it.”
"Given the public health challenges facing our state and country,
supporting providers in vulnerable and under-served communities was
a top priority for my colleagues and I," said State Senator Mattie
Hunter. "This assessment system takes a number of steps to bolster
the financial health of our hospitals and offers additional tools to
fund necessary transformation projects, while ensuring positive
gains for every hospital in the state."
“Hospitals serve as the cornerstone of our state’s communities,
providing critical care and treatment to Illinois residents in need.
Through the hospital assessment program, we can assure that
hospitals operating in low-income communities across the state have
access to the funding and support they need to continue offering
high quality care to every Illinoisan,” said State Senator Dave
Syverson.
“The new hospital assessment program will provide critical funds to
hospitals to ensure all Illinois residents receive the medical care
they need, no matter where they call home,” said State
Representative Camille Lilly. “I applaud Governor Pritzker for
championing this program and signing legislation into law that will
ensure hospitals that serve our state’s underserved communities
aren’t left behind.”
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“This bill will support and protect access to healthcare for millions of
Illinoisans. It’s the product of months of bipartisan effort, and shows a shared
commitment to healthcare for many diverse communities across the state. I thank
Gov. Pritzker for signing this critical bill today, and I appreciate the
collaborative process that led us to this point,” said State Representative Tom
Demmer.
“On the occasion of Governor Pritzker signing SB2541 into law, we applaud his
leadership in ensuring that the state's safety net and community hospitals
receive an increase in Medicaid funding during this time of health crisis," said
Greg Kelley, President of SEIU Healthcare Illinois Indiana. "SB 2541 is a
crucial step forward in making the formula for allocating Medicaid funding more
equitable for the financially-vulnerable hospitals which serve the urban and
rural communities with the greatest unmet need for healthcare. The extreme
vulnerabilities of these hospitals and especially of the patient populations
they serve have been exposed by our current pandemic, with debilitating and
often fatal consequences. It is our hope that this first step--vital as it
is--is soon followed by additional measures to secure these crucial facilities
so that they can better serve the healthcare needs of Illinois' most vulnerable
communities."
“The Illinois hospital community commends Governor Pritzker and his
administration, including Healthcare and Family Services Director Theresa
Eagleson, as well as members of the Legislative Medicaid Work Group, for their
outstanding leadership in enacting this bipartisan legislation to provide
critically needed healthcare in this very challenging, unprecedented time,” said
Illinois Health and Hospital Association President & CEO A.J. Wilhelmi. “The
Hospital Assessment Program is a vital source of funding for patients, the
healthcare delivery system and community hospitals and health systems. Most
importantly, this program helps ensure that Illinoisans – especially the most
vulnerable who face health disparities that have been starkly exposed during the
COVID-19 pandemic – have access to quality healthcare services that will improve
their health and their lives.”
“As safety-net hospitals, we serve as the frontline healthcare providers for
low-income and minority communities across our state,” said George Miller, CEO
of Loretto Hospital, Board Member of the Association of Safety-Net Community
Hospitals. “We know that now, more than ever, it’s critical that our hospitals
have the proper resources so they can provide the highest quality care to those
who often have no other place to turn. We want to thank Governor Pritzker, the
Black and Latino Caucus’, Leader Harris, Senator Steans and the Legislative
Medicaid Working Group for their work in ensuring that safety-net hospitals
receive the proper funding so that we can continue to make new improvements,
upgrades to our infrastructure, equipment and technology, and help create new
opportunities in many disadvantaged communities.
Many residents of Illinois rely on our hospitals and providers as their only
sources of care, and by increasing their resources and ability to serve, we can
build a stronger and healthier Illinois.”
The new assessment plan is scheduled to begin July 1, 2020 and continue through
December 31, 2022.
SB 2541 takes effect immediately.
HEALTH CARE AFFORDABLILTY ACT
The Health Care Affordability Act helps expand access to quality and affordable
health care in response to health and economic inequities and challenges
heightened by the COVID-19 pandemic. Specifically, the legislation eliminates or
loosens requirements on who can access Medicaid through the following actions:
Provides HFS with the authority to accept an applicant’s or recipient’s
attestation of income, incurred medical expenses, residency, and insured status
when electronic verification is not available;
Eliminates resource tests for some eligibility determinations;
Suspends redeterminations;
Suspends changes that would adversely affect an applicant’s or recipient’s
eligibility;
Allows phone or verbal approval by an applicant to submit an application in lieu
of applicant signature;
Allows adult presumptive eligibility;
Allows presumptive eligibility for children, pregnant women, and adults as often
as twice per calendar year; and,
Suspends premium and co-payment requirements.
The legislation also recognizes that families have experienced unique challenges
as a result of the pandemic, and helps families enroll and maintain coverage
through the Children’s Health Insurance Program (CHIP) and the ALL KIDS Act.
The Health Care Affordability Act also helps address longstanding disparities in
health care access and delivery by requiring the Department of Healthcare and
Family Services (HFS), in consultation with the Department of Insurance, to
explore options to make health insurance more affordable for low-income and
middle-income residents. This work will be compiled into a study due to the
General Assembly by February 15, 2021.
The new law also supports clinical trials by requiring Medicaid to cover routine
care costs for members who participate in medical trials. In addition, the
legislation helps expand access to and affordability of home health care and
mental and behavioral health care.
“We know that African-Americans are significantly underrepresented among those
who participate in clinical trials, meaning we lose out on life-saving
opportunities and unanswered questions then remain on the effectiveness of these
medications for Blacks,” said State Senator Mattie Hunter. “Because Medicaid
recipients are much more diverse, this law will help reduce that disparity for
black patients and for low-income white residents, while advancing the overall
fight against cancer.”
SB 1864 takes effect immediately.
[Office of the Governor JB Pritzker] |
