HB4978 Summary

• Department of Healthcare and Family Services must implement reimbursement methodology for inpatient hospital stays extended beyond medical necessity when discharge placement cannot be found, effective for dates of service July 1, 2019 and later.

• Department must implement separate reimbursement methodology for emergency department stays extended beyond medical necessity, effective January 1, 2025, using hourly rates equal to the inpatient daily rate divided by 24.

• Inpatient daily rates effective January 1, 2025 must equal statewide average rate per day including Medicaid High Volume Adjustment and Medicaid Percentage Adjustment for all Illinois hospitals based on State Fiscal Year 2023 data, with annual updates.

• Managed care organizations are prohibited from restricting coverage due to delays in Pre-Admission Screening and Resident Review process or authorization processing, and cannot impose requirements more restrictive than fee-for-service standards.

• Department must impose sanctions on MCOs for violations including financial penalties, suspension of enrollment, or contract termination.