(210 ILCS 155/15)
Sec. 15.
Qualifying Hospitals.
(a) Beginning October 1, 2010, the Department shall establish the Long Term Acute Care Hospital Quality Improvement Transfer Program. Any hospital may participate in the program if it meets the requirements of this Section as determined by the Department.
(b) To participate in the program a hospital must do the following:
(1) Operate as an LTAC hospital.
(2) Employ one‑half of an FTE (designated for case
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| management) for every 15 patients admitted to the hospital. |
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(3) Maintain on‑site physician coverage 24 hours a |
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(4) Maintain on‑site respiratory therapy coverage 24 |
| hours a day, 7 days a week. |
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(c) A hospital must also execute a program participation |
| agreement with the Department. The agreement must include: |
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(1) An attestation that the hospital complies with |
| the criteria in subsection (b) of this Section. |
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(2) A process for the hospital to report its |
| continuing compliance with subsection (b) of this Section. The hospital must submit a compliance report at least annually. |
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(3) A requirement that the hospital complete and |
| submit to the Department the CARE tool (the most currently available version or an equivalent tool designated and approved for use by the Department) for each patient no later than 7 calendar days after discharge. |
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(4) A requirement that the hospital use a patient |
| satisfaction survey specifically designed for LTAC hospital settings. The hospital must submit survey results data to the Department at least annually. |
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(5) A requirement that the hospital accept all |
| clinically approved patients for admission or transfer from a STAC hospital with the exception of STAC hospitals identified in paragraphs (1) and (2) under subsection (a) of Section 25 of this Act. The patient must be evaluated using LTAC hospital criteria approved by the Department for use in this program and meet the appropriate criteria. |
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(6) A requirement that the hospital report quality |
| and outcome measurement data, as described in Section 20 of this Act, to the Department at least annually. |
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(7) A requirement that the hospital provide the |
| Department full access to patient data and other data maintained by the hospital. Access must be in compliance with State and federal law. |
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(8) A requirement that the hospital use LTAC hospital |
| criteria to evaluate patients that are admitted to the hospital to determine that the patient is in the most appropriate setting. |
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(Source: P.A. 96‑1130, eff. 7‑20‑10.) |
(210 ILCS 155/20)
Sec. 20.
Quality and outcome measurement data.
(a) For proper evaluation and monitoring of the program, each LTAC hospital must provide quality and outcome measurement data ("measures") as specified in subsections (c) through (h) of this Section to the Department for patients treated under this program. The Department may develop measures in addition to the minimum measures required under this Section.
(b) Two sets of measures must be calculated. The first set should only use data for medical assistance patients, and the second set should include all patients of the LTAC hospital regardless of payer.
(c) Average LTAC hospital length of stay for patients discharged during the reporting period.
(d) Adverse outcomes rates: Percent of patients who
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| expired or whose condition worsens and requires treatment in a STAC hospital. |
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(e) Ventilator weaning rate: Percent of patients |
| discharged during the reporting period who have been successfully weaned off invasive mechanical ventilation. |
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(f) Central Line Infection Rate per 1000 central line |
| days: Number of patients discharged from an LTAC hospital during the reporting period that had a central line in place and developed a bloodstream infection 48 hours or more after admission to the LTAC hospital. |
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(g) Acquired pressure ulcers per 1000 patient days.
(h) Falls with injury per 1000 patient days: Number of |
| falls among discharged LTAC hospital patients discharged during the reporting period, who fell during the LTAC hospital stay, regardless of distance fallen, that required an ancillary or surgical procedure (i.e. x‑ray, MRI, sutures, surgery, etc.) |
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(Source: P.A. 96‑1130, eff. 7‑20‑10.) |
(210 ILCS 155/25)
Sec. 25.
Quality improvement transfer program.
(a) The Department may exempt the following STAC hospitals from the requirements in this Section:
(1) A hospital operated by a county with a population
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(2) A hospital operated by a State agency or a State |
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(b) STAC hospitals may transfer patients who meet |
| criteria in the LTAC hospital criteria and are medically stable for discharge from the STAC hospital. |
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(c) A patient in a STAC hospital may be exempt from a |
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(1) The patient's physician does not issue an order |
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(2) The patient or the individual legally authorized |
| to make medical decisions for the patient refuses the transfer; or |
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(3) The patient's care is primarily paid for by |
| Medicare or another third party. The exemption in this paragraph (3) of subsection (c) does not apply to a patient who has exhausted his or her Medicare benefits resulting in the Department becoming the primary payer. |
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(Source: P.A. 96‑1130, eff. 7‑20‑10.) |
(210 ILCS 155/35)
Sec. 35.
LTAC supplemental per diem rate.
(a) The Department must pay an LTAC supplemental per diem rate calculated under this Section to LTAC hospitals that meet the requirements of Section 15 of this Act for patients:
(1) who upon admission to the LTAC hospital meet LTAC
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(2) whose care is primarily paid for by the |
| Department under Title XIX of the Social Security Act or whose care is primarily paid for by the Department after the patient has exhausted his or her benefits under Medicare. |
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(b) The Department must not pay the LTAC supplemental per diem rate calculated under this Section if any of the following conditions are met:
(1) the LTAC hospital no longer meets the |
| requirements under Section 15 of this Act or terminates the agreement specified under Section 15 of this Act; |
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(2) the patient does not meet the LTAC hospital |
| criteria upon admission; or |
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(3) the patient's care is primarily paid for by |
| Medicare and the patient has not exhausted his or her Medicare benefits, resulting in the Department becoming the primary payer. |
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(c) The Department may adjust the LTAC supplemental per diem rate calculated under this Section based only on the conditions and requirements described under Section 40 and Section 45 of this Act.
(d) The LTAC supplemental per diem rate shall be calculated using the LTAC hospital's inflated cost per diem, defined in subsection (f) of this Section, and subtracting the following:
(1) The LTAC hospital's Medicaid per diem inpatient |
| rate as calculated under 89 Ill. Adm. Code 148.270(c)(4). |
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(2) The LTAC hospital's disproportionate share (DSH) |
| rate as calculated under 89 Ill. Adm. Code 148.120. |
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(3) The LTAC hospital's Medicaid Percentage |
| Adjustment (MPA) rate as calculated under 89 Ill. Adm. Code 148.122. |
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(4) The LTAC hospital's Medicaid High Volume |
| Adjustment (MHVA) rate as calculated under 89 Ill. Adm. Code 148.290(d). |
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(e) LTAC supplemental per diem rates are effective for 12 |
| months beginning on October 1 of each year and must be updated every 12 months. |
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(f) For the purposes of this Section, "inflated cost per |
| diem" means the quotient resulting from dividing the hospital's inpatient Medicaid costs by the hospital's Medicaid inpatient days and inflating it to the most current period using methodologies consistent with the calculation of the rates described in paragraphs (2), (3), and (4) of subsection (d). The data is obtained from the LTAC hospital's most recent cost report submitted to the Department as mandated under 89 Ill. Adm. Code 148.210. |
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(Source: P.A. 96‑1130, eff. 7‑20‑10.) |
(210 ILCS 155/50)
Sec. 50.
Duties of the Department.
(a) The Department is responsible for implementing, monitoring, and evaluating the program. This includes but is not limited to:
(1) Collecting data required under Section 15 and
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| data necessary to calculate the measures under Section 20 of this Act. |
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(2) Setting annual benchmarks or targets for the |
| measures in Section 20 of this Act or other measures beyond the minimum required under Section 20. The Department must consult participating LTAC hospitals when setting these benchmarks and targets. |
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(3) Monitoring compliance with all requirements of |
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(b) The Department shall include specific information on the Program in its annual medical programs report.
(c) The Department must establish monitoring procedures |
| that ensure the LTAC supplemental payment is only paid for patients who upon admission meet the LTAC hospital criteria. The Department must notify qualified LTAC hospitals of the procedures and establish an appeals process as part of those procedures. The Department must recoup any LTAC supplemental payments that are identified as being paid for patients who do not meet the LTAC hospital criteria. |
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(d) The Department must implement the program by October |
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(e) The Department must create and distribute to LTAC |
| hospitals the agreement required under subsection (c) of Section 15 no later than September 1, 2010. |
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(f) The Department must notify Illinois hospitals which |
| LTAC hospital criteria are approved for use under the program. The Department may limit LTAC hospital criteria to the most strict criteria that meet the definitions of this Act. |
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(g) The Department must identify discharge tools that are |
| considered equivalent to the CARE tool and approved for use under the program. The Department must notify LTAC hospitals which tools are approved for use under the program. |
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(h) The Department must notify Illinois LTAC hospitals of |
| the program and inform them how to apply for qualification and what the qualification requirements are as described under Section 15 of this Act. |
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(i) The Department must notify Illinois STAC hospitals |
| about the operation and implementation of the program established by this Act. The Department must also notify LTAC hospitals that accepting transfers from the STAC hospitals identified in paragraphs (1) and (2) under subsection (a) of Section 25 of this Act are not required under paragraph (5) of subsection (c) of Section 15 of this Act. The Department must notify LTAC hospitals that accepting transfers from the STAC hospitals identified in paragraphs (1) and (2) under subsection (a) of Section 25 of this Act shall negatively impact the savings calculations under the Program evaluation required by Section 40 of this Act and shall in turn require the Department to initiate the penalty described in subsection (d) of Section 40 of this Act. |
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(j) The Department shall deem LTAC hospitals qualified under Section 15 of this Act as qualifying for expedited payments.
(k) The Department may use up to $500,000 of funds |
| contained in the Public Aid Recoveries Trust Fund per State fiscal year to operate the program under this Act. The Department may expand existing contracts, issue new contracts, issue personal service contracts, or purchase other services, supplies, or equipment. |
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(l) The Department may promulgate rules as allowed by the Illinois Administrative Procedure Act to implement this Act; however, the requirements under this Act shall be implemented by the Department even if the Department's proposed rules are not yet adopted by the implementation date of October 1, 2010.
(Source: P.A. 96‑1130, eff. 7‑20‑10.) |