Sec. 40. Reimbursement rules.
350 words·~2 min read·
/il/chapter-210/act-42/40A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Sec. 40. Reimbursement rules. The Secretary of Human Services and the Director of Healthcare and Family Services shall:
(1)ensure that reimbursement utilizing federal and State resources for services
provided to eligible beneficiaries through a continuum of care facility comports with the following requirements:
(A)such services shall be reimbursed in a budget-neutral manner such that
reimbursement for services provided by the facility constituent elements of a continuum of care licensee shall be neither greater nor lesser than the reimbursement received for such services provided by that facility constituent element prior to the licensing of the continuum of care facility, adjusted to take into account any subsequent changes in reimbursement for such similar services, or, if the facility constituent element is a new facility reimbursement for the services provided by the new facility shall be no less than the reimbursement received for such services by a comparable facility constituent element of that continuum of care facility; and
(B)a continuum of care licensee shall enter into a single provider agreement with
the Director of Healthcare and Family Services or the Secretary of Human Services; changes that may occur from time to time in the facility constituent elements under the continuum of care license shall be addressed as may be required by applicable requirements of law through amendments to the provider agreement; the Director of Healthcare and Family Services shall make all reasonable efforts to ensure that all facility constituent elements that are approved parts of a continuum of care license remain qualified for reimbursement under relevant State and federal programs including Title XIX of the federal Social Security Act; and
(2)in cooperation with interested stakeholders, develop an alternative payment
methodology for a continuum of care facility; the initial methodology shall produce payments that are budget neutral as compared to the services provided by the licensee prior to the implementation of the continuum of care license; the effectiveness of the methodology and corresponding rate levels shall be evaluated 18 months following the implementation of the methodology and every 12 months thereafter and shall be adjusted as necessary, subject to appropriation.