IL SB3374

Requires the Department of Healthcare and Family Services to establish reimbursement methodologies for hospitals when inpatient and emergency department stays are extended beyond medical necessity due to inability to find appropriate post-discharge placements.

Sets inpatient reimbursement rate effective January 1, 2025 equal to the statewide average daily rate including Medicaid High Volume Adjustment (MHVA) and Medicaid Percentage Adjustment (MPA) based on State Fiscal Year 2023 data, with annual updates thereafter.

Establishes hourly reimbursement for emergency department extended stays effective January 1, 2025 equal to one-twenty-fourth of the inpatient daily rate, paid for each hour the patient cannot be transferred to appropriate care.

Prohibits managed care organizations from restricting coverage due to delays in the Pre-Admission Screening and Resident Review process or authorization processing, and prevents MCOs from imposing more restrictive requirements than the fee-for-service program.

Authorizes the Department to impose sanctions on MCOs for noncompliance, including financial penalties, suspension of enrollment, or contract termination.