Gov. Pritzker signs Hospital Assessment Legislation and Health Care Affordability Act

30
information provided by the Office of the Governor

SPRINGFIELD, Ill. (July 11, 2020) – On Tuesday, July 7, Governor JB Pritzker signed SB 2541, renewing the Hospital Assessment Program, and SB 1864, the Health Care Affordability Act, into law.

“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 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.”

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.

The new assessment plan is scheduled to begin July 1, 2020, and continue through December 31, 2022.

SB 2541 took effect immediately on July 7 when it was signed.

The Health Care Affordability 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.

SB 1864 took effect immediately when it was signed on July 7.