Bill
HB 2558
Illinois must study Medicaid private duty nursing rates for medically fragile/MFTD children by 12/31/2025 to align payments with costs and guide future rate decisions.
Status / key dates
- Bill filed/introduced: early February 2025 (introduced by Rep. Maura Hirschauer).
- Chief co-sponsor added: Rep. Elizabeth “Lisa” Hernandez (April 2, 2025).
- Major floor activity: committee hearings and reports in March–April 2025; House passage recorded April 29, 2025.
- Statutory location: amends Illinois Public Aid Code (305 ILCS 5/5‑2b).
- Effective date: the Act takes effect upon becoming law. The required study must be completed by December 31, 2025.
Purpose / intent
- To evaluate the adequacy and soundness of Medicaid reimbursement rates paid for private duty nursing services provided to medically fragile and technology‑dependent (MFTD) children. The goal is to inform rate-setting and ensure rates reflect costs and program objectives.
Key provisions
- Rate evaluation requirement: By December 31, 2025, the Illinois Department of Healthcare and Family Services (HFS or “the Department”) must conduct a rate evaluation of private duty nursing services paid under Medicaid for MFTD children.
- Contractor engagement: HFS shall either contract with an outside entity to conduct the study or use one of its existing contractors.
- Provider consultation: The contractor must consult with HFS‑enrolled private duty nursing providers while the study is being developed to help ensure accuracy.
- Minimum study elements: At a minimum the study must include:
- A comparison of rates paid by other states for comparable private duty nursing services.
- An analysis of the cost of providing comparable care in an institutional setting (i.e., cost‑comparison to institutional care).
- Context in statute: The same section contains statutory rate adjustments enacted earlier — notably a 20% increase (effective Jan 1, 2024) and a 7% increase (effective Jan 1, 2025) for certain provider categories — which provide background to the current study requirement.
Who is affected
- Primary: Medicaid‑enrolled medically fragile and technology‑dependent children who receive private duty nursing services, and the private duty nursing providers who deliver that care.
- Secondary: HFS (for potential future rate changes), state budget and appropriations entities (if study findings prompt reimbursement changes), and institutional care providers (as a comparison point).
Potential impact
- The study’s findings can guide HFS and the General Assembly in future rate‑setting decisions (increasing, decreasing, or restructuring payments), with potential budgetary implications for state Medicaid spending and providers’ financial sustainability.
- Improved alignment of rates with costs could affect provider availability, access to home‑based care vs. institutional placements, and family/community supports for MFTD children.
Procedural notes
- The bill directs a firm deadline (Dec 31, 2025) for completion of the evaluation and requires direct engagement with enrolled providers. Implementation will depend on HFS contracting and the study’s findings; any subsequent reimbursement changes would follow regular administrative and appropriations processes.
Compiled from official sources — confirm details with the bill’s official record.
Sign in to ask a question.
