98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB3286

 

Introduced , by Rep. Naomi D. Jakobsson

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5e
305 ILCS 5/5-5e.1

    Amends the Medical Assistance Article of the Illinois Public Aid Code. In addition to other specified criteria, provides that a Safety-Net Hospital is an Illinois hospital that is licensed by the Department of Public Health as a general acute care, psychiatric, or pediatric hospital (rather than a general acute care or pediatric hospital). Includes psychiatric hospitals to the types of hospitals that shall experience a 3.5% reduction in rates or payments for hospital services. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-5e and 5-5e.1 as follows:
 
6    (305 ILCS 5/5-5e)
7    Sec. 5-5e. Adjusted rates of reimbursement.
8    (a) Rates or payments for services in effect on June 30,
92012 shall be adjusted and services shall be affected as
10required by any other provision of this amendatory Act of the
1197th General Assembly. In addition, the Department shall do the
12following:
13        (1) Delink the per diem rate paid for supportive living
14    facility services from the per diem rate paid for nursing
15    facility services, effective for services provided on or
16    after May 1, 2011.
17        (2) Cease payment for bed reserves in nursing
18    facilities, specialized mental health rehabilitation
19    facilities, and, except in the instance of residents who
20    are under 21 years of age, intermediate care facilities for
21    persons with developmental disabilities.
22        (3) Cease payment of the $10 per day add-on payment to
23    nursing facilities for certain residents with

 

 

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1    developmental disabilities.
2    (b) After the application of subsection (a),
3notwithstanding any other provision of this Code to the
4contrary and to the extent permitted by federal law, on and
5after July 1, 2012, the rates of reimbursement for services and
6other payments provided under this Code shall further be
7reduced as follows:
8        (1) Rates or payments for physician services, dental
9    services, or community health center services reimbursed
10    through an encounter rate, and services provided under the
11    Medicaid Rehabilitation Option of the Illinois Title XIX
12    State Plan shall not be further reduced.
13        (2) Rates or payments, or the portion thereof, paid to
14    a provider that is operated by a unit of local government
15    or State University that provides the non-federal share of
16    such services shall not be further reduced.
17        (3) Rates or payments for hospital services delivered
18    by a hospital defined as a Safety-Net Hospital under
19    Section 5-5e.1 of this Code shall not be further reduced.
20        (4) Rates or payments for hospital services delivered
21    by a Critical Access Hospital, which is an Illinois
22    hospital designated as a critical care hospital by the
23    Department of Public Health in accordance with 42 CFR 485,
24    Subpart F, shall not be further reduced.
25        (5) Rates or payments for Nursing Facility Services
26    shall only be further adjusted pursuant to Section 5-5.2 of

 

 

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1    this Code.
2        (6) Rates or payments for services delivered by long
3    term care facilities licensed under the ID/DD Community
4    Care Act and developmental training services shall not be
5    further reduced.
6        (7) Rates or payments for services provided under
7    capitation rates shall be adjusted taking into
8    consideration the rates reduction and covered services
9    required by this amendatory Act of the 97th General
10    Assembly.
11        (8) For hospitals not previously described in this
12    subsection or for a psychiatric hospital defined as a
13    Safety-Net Hospital under Section 5-5e.1 of this Code, the
14    rates or payments for hospital services shall be further
15    reduced by 3.5%, except for payments authorized under
16    Section 5A-12.4 of this Code.
17        (9) For all other rates or payments for services
18    delivered by providers not specifically referenced in
19    paragraphs (1) through (8), rates or payments shall be
20    further reduced by 2.7%.
21    (c) Any assessment imposed by this Code shall continue and
22nothing in this Section shall be construed to cause it to
23cease.
24(Source: P.A. 97-689, eff. 6-14-12.)
 
25    (305 ILCS 5/5-5e.1)

 

 

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1    Sec. 5-5e.1. Safety-Net Hospitals.
2    (a) A Safety-Net Hospital is an Illinois hospital that:
3        (1) is licensed by the Department of Public Health as a
4    general acute care, psychiatric, or pediatric hospital;
5    and
6        (2) is a disproportionate share hospital, as described
7    in Section 1923 of the federal Social Security Act, as
8    determined by the Department; and
9        (3) meets one of the following:
10            (A) has a MIUR of at least 40% and a charity
11        percent of at least 4%; or
12            (B) has a MIUR of at least 50%.
13    (b) Definitions. As used in this Section:
14        (1) "Charity percent" means the ratio of (i) the
15    hospital's charity charges for services provided to
16    individuals without health insurance or another source of
17    third party coverage to (ii) the Illinois total hospital
18    charges, each as reported on the hospital's OBRA form.
19        (2) "MIUR" means Medicaid Inpatient Utilization Rate
20    and is defined as a fraction, the numerator of which is the
21    number of a hospital's inpatient days provided in the
22    hospital's fiscal year ending 3 years prior to the rate
23    year, to patients who, for such days, were eligible for
24    Medicaid under Title XIX of the federal Social Security
25    Act, 42 USC 1396a et seq., and the denominator of which is
26    the total number of the hospital's inpatient days in that

 

 

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1    same period.
2        (3) "OBRA form" means form HFS-3834, OBRA '93 data
3    collection form, for the rate year.
4        (4) "Rate year" means the 12-month period beginning on
5    October 1.
6    (c) For the 27-month period beginning July 1, 2012, a
7hospital that would have qualified for the rate year beginning
8October 1, 2011, shall be a Safety-Net Hospital.
9    (d) No later than August 15 preceding the rate year, each
10hospital shall submit the OBRA form to the Department. Prior to
11October 1, the Department shall notify each hospital whether it
12has qualified as a Safety-Net Hospital.
13    (e) The Department may promulgate rules in order to
14implement this Section.
15(Source: P.A. 97-689, eff. 6-14-12.)
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.