Illinois Code § 5-2b

§ 5-2b.

Medically fragile and technology dependent children eligibility and program; provider reimbursement rates. (a) Notwithstanding any other provision of law except as provided in Section 5-30a, on and after September 1, 2012, subject to federal approval, medical assistance under this Article shall be available to children who qualify as persons with a disability, as defined under the federal Supplemental Security Income program and who are medically fragile and technology dependent. The program shall allow eligible children to receive the medical assistance provided under this Article in the community and must maximize, to the fullest extent permissible under federal law, federal reimbursement and family cost-sharing, including co-pays, premiums, or any other family contributions, except that the Department shall be permitted to incentivize the utilization of selected services through the use of cost-sharing adjustments. The Department shall establish the policies, procedures, standards, services, and criteria for this program by rule. (b) Notwithstanding any other provision of this Code, subject to federal approval, on and after January 1, 2024, the reimbursement rates for nursing paid through Nursing and Personal Care Services for non-waiver customers and to providers of private duty nursing services for children eligible for medical assistance under this Section shall be 20% higher than the reimbursement rates in effect for nursing services on December 31, 2023. (c) Notwithstanding any other provision of this Code, subject to federal approval, on and after January 1, 2025, the reimbursement rates for nursing paid through Nursing and Personal Care Services for non-waiver customers and to providers of private duty nursing services for children eligible for medical assistance under this Section shall be 7% higher than the reimbursement rates in effect for nursing services on December 31, 2024. (d) The Department shall conduct an evaluation to study the program, including service provision and design, waiver operations, and methodologies and policies for setting rates and reimbursements for services and supports that are provided to (i) individuals under the age of 21 who are approved by the Department for in-home shift nursing services and (ii) individuals over the age of 21 who are receiving in-home shift nursing services under the Home and Community-Based Services Waiver for Medically Fragile and Technology Dependent Children, including, but not limited to, in-home shift nursing services and related home and community-based services and supports, made to nursing agencies for such services. As needed, the Department shall consult with Department-enrolled providers of in-home shift nursing services to ensure accurate information is considered in the evaluation, and the Department may, to the extent it deems necessary and appropriate, contract with an outside entity to assist or provide further analysis in the support of the evaluation. (Source: P.A. 103-102, eff. 1-1-24; 103-593, eff. 6-7-24; 104-9, eff. 6-16-25.)