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Gov. Pritzker renews Hospital Assessment Program, signs Health Care Affordability Act

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ROCKFORD, Ill. (WIFR) – Gov. Pritzker signed SB 2541, renewing the Hospital Assessment Program, and SB 1864, the Health Care Affordability Act, into law on Tuesday.

The Hospital Assessment Program is a $3.8 billion program that will bring in more than $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, according to a statement from Gov. Pritzker’s office.

“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,” Gov. Pritzker said. “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.”

SB 2541 takes effect immediately. 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

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.

The Health Care Affordability Act eliminates or loosens requirements on who can access Medicaid through the following actions, according to a statement from Gov. Pritzker’s office:

  • 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 Health Care Affordability Act requires the Department of Healthcare and Family Services, 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, according to a statement from Gov. Pritzker’s office.

SB 1864 takes effect immediately.

“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,” State Senator Mattie Hunter said. “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.”

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, according to a statement from Gov. Pritzker’s office.

Copyright 2020 WIFR. All rights reserved.

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