Public Act 0687 97TH GENERAL ASSEMBLY |
Public Act 097-0687 |
| HB5007 Enrolled | LRB097 18977 KTG 64216 b |
|
|
AN ACT concerning public aid.
|
Be it enacted by the People of the State of Illinois,
|
represented in the General Assembly:
|
Section 5. If and only if both Senate Bill 2840, AS |
AMENDED, of the 97th General Assembly and Senate Bill 3397, AS |
AMENDED, of
the 97th General Assembly become law, then the |
Illinois Public Aid Code is amended by changing Sections 5-1.4, |
5-2, 5-2.03, 15-1, 15-2, 15-5, and 15-11 as follows: |
(305 ILCS 5/5-1.4) |
Sec. 5-1.4. Moratorium on eligibility expansions. |
Beginning on January 25, 2011 (the effective date of Public Act |
96-1501) this amendatory Act of the 96th General Assembly, |
there shall be a 4-year 2-year moratorium on the expansion of |
eligibility through increasing financial eligibility |
standards, or through increasing income disregards, or through |
the creation of new programs which would add new categories of |
eligible individuals under the medical assistance program in |
addition to those categories covered on January 1, 2011 or |
above the level of any subsequent reduction in eligibility. |
This moratorium shall not apply to expansions required as a |
federal condition of State participation in the medical |
assistance program or to expansions approved by the federal |
government that are financed entirely by units of local |
|
government and federal matching funds. If the State of Illinois |
finds that the State has borne a cost related to such an |
expansion, the unit of local government shall reimburse the |
State. All federal funds associated with an expansion funded by |
a unit of local government shall be returned to the local |
government entity funding the expansion, pursuant to an |
intergovernmental agreement between the Department of |
Healthcare and Family Services and the local government entity. |
Within 10 calendar days of the effective date of this |
amendatory Act of the 97th General Assembly, the Department of |
Healthcare and Family Services shall formally advise the |
Centers for Medicare and Medicaid Services of the passage of |
this amendatory Act of the 97th General Assembly. The State is |
prohibited from submitting additional waiver requests that |
expand or allow for an increase in the classes of persons |
eligible for medical assistance under this Article to the |
federal government for its consideration beginning on the 20th |
calendar day following the effective date of this amendatory |
Act of the 97th General Assembly until January 25, 2015.
|
(Source: P.A. 96-1501, eff. 1-25-11.)
|
(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
|
Sec. 5-2. Classes of Persons Eligible. Medical assistance |
under this
Article shall be available to any of the following |
classes of persons in
respect to whom a plan for coverage has |
been submitted to the Governor
by the Illinois Department and |
|
approved by him:
|
1. Recipients of basic maintenance grants under |
Articles III and IV.
|
2. Persons otherwise eligible for basic maintenance |
under Articles
III and IV, excluding any eligibility |
requirements that are inconsistent with any federal law or |
federal regulation, as interpreted by the U.S. Department |
of Health and Human Services, but who fail to qualify |
thereunder on the basis of need or who qualify but are not |
receiving basic maintenance under Article IV, and
who have |
insufficient income and resources to meet the costs of
|
necessary medical care, including but not limited to the |
following:
|
(a) All persons otherwise eligible for basic |
maintenance under Article
III but who fail to qualify |
under that Article on the basis of need and who
meet |
either of the following requirements:
|
(i) their income, as determined by the |
Illinois Department in
accordance with any federal |
requirements, is equal to or less than 70% in
|
fiscal year 2001, equal to or less than 85% in |
fiscal year 2002 and until
a date to be determined |
by the Department by rule, and equal to or less
|
than 100% beginning on the date determined by the |
Department by rule, of the nonfarm income official |
poverty
line, as defined by the federal Office of |
|
Management and Budget and revised
annually in |
accordance with Section 673(2) of the Omnibus |
Budget Reconciliation
Act of 1981, applicable to |
families of the same size; or
|
(ii) their income, after the deduction of |
costs incurred for medical
care and for other types |
of remedial care, is equal to or less than 70% in
|
fiscal year 2001, equal to or less than 85% in |
fiscal year 2002 and until
a date to be determined |
by the Department by rule, and equal to or less
|
than 100% beginning on the date determined by the |
Department by rule, of the nonfarm income official |
poverty
line, as defined in item (i) of this |
subparagraph (a).
|
(b) All persons who, excluding any eligibility |
requirements that are inconsistent with any federal |
law or federal regulation, as interpreted by the U.S. |
Department of Health and Human Services, would be |
determined eligible for such basic
maintenance under |
Article IV by disregarding the maximum earned income
|
permitted by federal law.
|
3. Persons who would otherwise qualify for Aid to the |
Medically
Indigent under Article VII.
|
4. Persons not eligible under any of the preceding |
paragraphs who fall
sick, are injured, or die, not having |
sufficient money, property or other
resources to meet the |
|
costs of necessary medical care or funeral and burial
|
expenses.
|
5.(a) Women during pregnancy, after the fact
of |
pregnancy has been determined by medical diagnosis, and |
during the
60-day period beginning on the last day of the |
pregnancy, together with
their infants and children born |
after September 30, 1983,
whose income and
resources are |
insufficient to meet the costs of necessary medical care to
|
the maximum extent possible under Title XIX of the
Federal |
Social Security Act.
|
(b) The Illinois Department and the Governor shall |
provide a plan for
coverage of the persons eligible under |
paragraph 5(a) by April 1, 1990. Such
plan shall provide |
ambulatory prenatal care to pregnant women during a
|
presumptive eligibility period and establish an income |
eligibility standard
that is equal to 133%
of the nonfarm |
income official poverty line, as defined by
the federal |
Office of Management and Budget and revised annually in
|
accordance with Section 673(2) of the Omnibus Budget |
Reconciliation Act of
1981, applicable to families of the |
same size, provided that costs incurred
for medical care |
are not taken into account in determining such income
|
eligibility.
|
(c) The Illinois Department may conduct a |
demonstration in at least one
county that will provide |
medical assistance to pregnant women, together
with their |
|
infants and children up to one year of age,
where the |
income
eligibility standard is set up to 185% of the |
nonfarm income official
poverty line, as defined by the |
federal Office of Management and Budget.
The Illinois |
Department shall seek and obtain necessary authorization
|
provided under federal law to implement such a |
demonstration. Such
demonstration may establish resource |
standards that are not more
restrictive than those |
established under Article IV of this Code.
|
6. Persons under the age of 18 who fail to qualify as |
dependent under
Article IV and who have insufficient income |
and resources to meet the costs
of necessary medical care |
to the maximum extent permitted under Title XIX
of the |
Federal Social Security Act.
|
7. Persons who are under 21 years of age and would
|
qualify as
disabled as defined under the Federal |
Supplemental Security Income Program,
provided medical |
service for such persons would be eligible for Federal
|
Financial Participation, and provided the Illinois |
Department determines that:
|
(a) the person requires a level of care provided by |
a hospital, skilled
nursing facility, or intermediate |
care facility, as determined by a physician
licensed to |
practice medicine in all its branches;
|
(b) it is appropriate to provide such care outside |
of an institution, as
determined by a physician |
|
licensed to practice medicine in all its branches;
|
(c) the estimated amount which would be expended |
for care outside the
institution is not greater than |
the estimated amount which would be
expended in an |
institution.
|
8. Persons who become ineligible for basic maintenance |
assistance
under Article IV of this Code in programs |
administered by the Illinois
Department due to employment |
earnings and persons in
assistance units comprised of |
adults and children who become ineligible for
basic |
maintenance assistance under Article VI of this Code due to
|
employment earnings. The plan for coverage for this class |
of persons shall:
|
(a) extend the medical assistance coverage for up |
to 12 months following
termination of basic |
maintenance assistance; and
|
(b) offer persons who have initially received 6 |
months of the
coverage provided in paragraph (a) above, |
the option of receiving an
additional 6 months of |
coverage, subject to the following:
|
(i) such coverage shall be pursuant to |
provisions of the federal
Social Security Act;
|
(ii) such coverage shall include all services |
covered while the person
was eligible for basic |
maintenance assistance;
|
(iii) no premium shall be charged for such |
|
coverage; and
|
(iv) such coverage shall be suspended in the |
event of a person's
failure without good cause to |
file in a timely fashion reports required for
this |
coverage under the Social Security Act and |
coverage shall be reinstated
upon the filing of |
such reports if the person remains otherwise |
eligible.
|
9. Persons with acquired immunodeficiency syndrome |
(AIDS) or with
AIDS-related conditions with respect to whom |
there has been a determination
that but for home or |
community-based services such individuals would
require |
the level of care provided in an inpatient hospital, |
skilled
nursing facility or intermediate care facility the |
cost of which is
reimbursed under this Article. Assistance |
shall be provided to such
persons to the maximum extent |
permitted under Title
XIX of the Federal Social Security |
Act.
|
10. Participants in the long-term care insurance |
partnership program
established under the Illinois |
Long-Term Care Partnership Program Act who meet the
|
qualifications for protection of resources described in |
Section 15 of that
Act.
|
11. Persons with disabilities who are employed and |
eligible for Medicaid,
pursuant to Section |
1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, |
|
subject to federal approval, persons with a medically |
improved disability who are employed and eligible for |
Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of |
the Social Security Act, as
provided by the Illinois |
Department by rule. In establishing eligibility standards |
under this paragraph 11, the Department shall, subject to |
federal approval: |
(a) set the income eligibility standard at not |
lower than 350% of the federal poverty level; |
(b) exempt retirement accounts that the person |
cannot access without penalty before the age
of 59 1/2, |
and medical savings accounts established pursuant to |
26 U.S.C. 220; |
(c) allow non-exempt assets up to $25,000 as to |
those assets accumulated during periods of eligibility |
under this paragraph 11; and
|
(d) continue to apply subparagraphs (b) and (c) in |
determining the eligibility of the person under this |
Article even if the person loses eligibility under this |
paragraph 11.
|
12. Subject to federal approval, persons who are |
eligible for medical
assistance coverage under applicable |
provisions of the federal Social Security
Act and the |
federal Breast and Cervical Cancer Prevention and |
Treatment Act of
2000. Those eligible persons are defined |
to include, but not be limited to,
the following persons:
|
|
(1) persons who have been screened for breast or |
cervical cancer under
the U.S. Centers for Disease |
Control and Prevention Breast and Cervical Cancer
|
Program established under Title XV of the federal |
Public Health Services Act in
accordance with the |
requirements of Section 1504 of that Act as |
administered by
the Illinois Department of Public |
Health; and
|
(2) persons whose screenings under the above |
program were funded in whole
or in part by funds |
appropriated to the Illinois Department of Public |
Health
for breast or cervical cancer screening.
|
"Medical assistance" under this paragraph 12 shall be |
identical to the benefits
provided under the State's |
approved plan under Title XIX of the Social Security
Act. |
The Department must request federal approval of the |
coverage under this
paragraph 12 within 30 days after the |
effective date of this amendatory Act of
the 92nd General |
Assembly.
|
In addition to the persons who are eligible for medical |
assistance pursuant to subparagraphs (1) and (2) of this |
paragraph 12, and to be paid from funds appropriated to the |
Department for its medical programs, any uninsured person |
as defined by the Department in rules residing in Illinois |
who is younger than 65 years of age, who has been screened |
for breast and cervical cancer in accordance with standards |
|
and procedures adopted by the Department of Public Health |
for screening, and who is referred to the Department by the |
Department of Public Health as being in need of treatment |
for breast or cervical cancer is eligible for medical |
assistance benefits that are consistent with the benefits |
provided to those persons described in subparagraphs (1) |
and (2). Medical assistance coverage for the persons who |
are eligible under the preceding sentence is not dependent |
on federal approval, but federal moneys may be used to pay |
for services provided under that coverage upon federal |
approval. |
13. Subject to appropriation and to federal approval, |
persons living with HIV/AIDS who are not otherwise eligible |
under this Article and who qualify for services covered |
under Section 5-5.04 as provided by the Illinois Department |
by rule.
|
14. Subject to the availability of funds for this |
purpose, the Department may provide coverage under this |
Article to persons who reside in Illinois who are not |
eligible under any of the preceding paragraphs and who meet |
the income guidelines of paragraph 2(a) of this Section and |
(i) have an application for asylum pending before the |
federal Department of Homeland Security or on appeal before |
a court of competent jurisdiction and are represented |
either by counsel or by an advocate accredited by the |
federal Department of Homeland Security and employed by a |
|
not-for-profit organization in regard to that application |
or appeal, or (ii) are receiving services through a |
federally funded torture treatment center. Medical |
coverage under this paragraph 14 may be provided for up to |
24 continuous months from the initial eligibility date so |
long as an individual continues to satisfy the criteria of |
this paragraph 14. If an individual has an appeal pending |
regarding an application for asylum before the Department |
of Homeland Security, eligibility under this paragraph 14 |
may be extended until a final decision is rendered on the |
appeal. The Department may adopt rules governing the |
implementation of this paragraph 14.
|
15. Family Care Eligibility. |
(a) Through December 31, 2013, a caretaker |
relative who is 19 years of age or older when countable |
income is at or below 185% of the Federal Poverty Level |
Guidelines, as published annually in the Federal |
Register, for the appropriate family size. Beginning |
January 1, 2014, a caretaker relative who is 19 years |
of age or older when countable income is at or below |
133% of the Federal Poverty Level Guidelines, as |
published annually in the Federal Register, for the |
appropriate family size. A person may not spend down to |
become eligible under this paragraph 15. |
(b) Eligibility shall be reviewed annually. |
(c) Caretaker relatives enrolled under this |
|
paragraph 15 in families with countable income above |
150% and at or below 185% of the Federal Poverty Level |
Guidelines shall be counted as family members and pay |
premiums as established under the Children's Health |
Insurance Program Act. |
(d) Premiums shall be billed by and payable to the |
Department or its authorized agent, on a monthly basis. |
(e) The premium due date is the last day of the |
month preceding the month of coverage. |
(f) Individuals shall have a grace period through |
60 days of coverage to pay the premium. |
(g) Failure to pay the full monthly premium by the |
last day of the grace period shall result in |
termination of coverage. |
(h) Partial premium payments shall not be |
refunded. |
(i) Following termination of an individual's |
coverage under this paragraph 15, the following action |
is required before the individual can be re-enrolled: |
(1) A new application must be completed and the |
individual must be determined otherwise eligible. |
(2) There must be full payment of premiums due |
under this Code, the Children's Health Insurance |
Program Act, the Covering ALL KIDS Health |
Insurance Act, or any other healthcare program |
administered by the Department for periods in |
|
which a premium was owed and not paid for the |
individual. |
(3) The first month's premium must be paid if |
there was an unpaid premium on the date the |
individual's previous coverage was canceled. |
The Department is authorized to implement the |
provisions of this amendatory Act of the 95th General |
Assembly by adopting the medical assistance rules in effect |
as of October 1, 2007, at 89 Ill. Admin. Code 125, and at |
89 Ill. Admin. Code 120.32 along with only those changes |
necessary to conform to federal Medicaid requirements, |
federal laws, and federal regulations, including but not |
limited to Section 1931 of the Social Security Act (42 |
U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department |
of Health and Human Services, and the countable income |
eligibility standard authorized by this paragraph 15. The |
Department may not otherwise adopt any rule to implement |
this increase except as authorized by law, to meet the |
eligibility standards authorized by the federal government |
in the Medicaid State Plan or the Title XXI Plan, or to |
meet an order from the federal government or any court. |
16. Subject to appropriation, uninsured persons who |
are not otherwise eligible under this Section who have been |
certified and referred by the Department of Public Health |
as having been screened and found to need diagnostic |
evaluation or treatment, or both diagnostic evaluation and |
|
treatment, for prostate or testicular cancer. For the |
purposes of this paragraph 16, uninsured persons are those |
who do not have creditable coverage, as defined under the |
Health Insurance Portability and Accountability Act, or |
have otherwise exhausted any insurance benefits they may |
have had, for prostate or testicular cancer diagnostic |
evaluation or treatment, or both diagnostic evaluation and |
treatment.
To be eligible, a person must furnish a Social |
Security number.
A person's assets are exempt from |
consideration in determining eligibility under this |
paragraph 16.
Such persons shall be eligible for medical |
assistance under this paragraph 16 for so long as they need |
treatment for the cancer. A person shall be considered to |
need treatment if, in the opinion of the person's treating |
physician, the person requires therapy directed toward |
cure or palliation of prostate or testicular cancer, |
including recurrent metastatic cancer that is a known or |
presumed complication of prostate or testicular cancer and |
complications resulting from the treatment modalities |
themselves. Persons who require only routine monitoring |
services are not considered to need treatment.
"Medical |
assistance" under this paragraph 16 shall be identical to |
the benefits provided under the State's approved plan under |
Title XIX of the Social Security Act.
Notwithstanding any |
other provision of law, the Department (i) does not have a |
claim against the estate of a deceased recipient of |
|
services under this paragraph 16 and (ii) does not have a |
lien against any homestead property or other legal or |
equitable real property interest owned by a recipient of |
services under this paragraph 16. |
17. Persons who, pursuant to a waiver approved by the |
Secretary of the U.S. Department of Health and Human |
Services, are eligible for medical assistance under Title |
XIX or XXI of the federal Social Security Act. |
Notwithstanding any other provision of this Code and |
consistent with the terms of the approved waiver, the |
Illinois Department, may by rule: |
(a) Limit the geographic areas in which the waiver |
program operates. |
(b) Determine the scope, quantity, duration, and |
quality, and the rate and method of reimbursement, of |
the medical services to be provided, which may differ |
from those for other classes of persons eligible for |
assistance under this Article. |
(c) Restrict the persons' freedom in choice of |
providers. |
In implementing the provisions of Public Act 96-20, the |
Department is authorized to adopt only those rules necessary, |
including emergency rules. Nothing in Public Act 96-20 permits |
the Department to adopt rules or issue a decision that expands |
eligibility for the FamilyCare Program to a person whose income |
exceeds 185% of the Federal Poverty Level as determined from |
|
time to time by the U.S. Department of Health and Human |
Services, unless the Department is provided with express |
statutory authority. |
The Illinois Department and the Governor shall provide a |
plan for
coverage of the persons eligible under paragraph 7 as |
soon as possible after
July 1, 1984.
|
The eligibility of any such person for medical assistance |
under this
Article is not affected by the payment of any grant |
under the Senior
Citizens and Disabled Persons Property Tax |
Relief and Pharmaceutical
Assistance Act or any distributions |
or items of income described under
subparagraph (X) of
|
paragraph (2) of subsection (a) of Section 203 of the Illinois |
Income Tax
Act. The Department shall by rule establish the |
amounts of
assets to be disregarded in determining eligibility |
for medical assistance,
which shall at a minimum equal the |
amounts to be disregarded under the
Federal Supplemental |
Security Income Program. The amount of assets of a
single |
person to be disregarded
shall not be less than $2,000, and the |
amount of assets of a married couple
to be disregarded shall |
not be less than $3,000.
|
To the extent permitted under federal law, any person found |
guilty of a
second violation of Article VIIIA
shall be |
ineligible for medical assistance under this Article, as |
provided
in Section 8A-8.
|
The eligibility of any person for medical assistance under |
this Article
shall not be affected by the receipt by the person |
|
of donations or benefits
from fundraisers held for the person |
in cases of serious illness,
as long as neither the person nor |
members of the person's family
have actual control over the |
donations or benefits or the disbursement
of the donations or |
benefits.
|
Notwithstanding any other provision of this Code, if the |
United States Supreme Court holds Title II, Subtitle A, Section |
2001(a) of Public Law 111-148 to be unconstitutional, or if a |
holding of Public Law 111-148 makes Medicaid eligibility |
allowed under Section 2001(a) inoperable, the State or a unit |
of local government shall be prohibited from enrolling |
individuals in the Medical Assistance Program as the result of |
federal approval of a State Medicaid waiver on or after the |
effective date of this amendatory Act of the 97th General |
Assembly, and any individuals enrolled in the Medical |
Assistance Program pursuant to eligibility permitted as a |
result of such a State Medicaid waiver shall become immediately |
ineligible. |
Notwithstanding any other provision of this Code, if an Act |
of Congress that becomes a Public Law eliminates Section |
2001(a) of Public Law 111-148, the State or a unit of local |
government shall be prohibited from enrolling individuals in |
the Medical Assistance Program as the result of federal |
approval of a State Medicaid waiver on or after the effective |
date of this amendatory Act of the 97th General Assembly, and |
any individuals enrolled in the Medical Assistance Program |
|
pursuant to eligibility permitted as a result of such a State |
Medicaid waiver shall become immediately ineligible. |
(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; |
96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. |
7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, |
eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; |
revised 10-4-11.)
|
(305 ILCS 5/5-2.03) |
Sec. 5-2.03. Presumptive eligibility. Beginning on the |
effective date of this amendatory Act of the 96th General |
Assembly and except where federal law requires presumptive |
eligibility, no adult may be presumed eligible for medical |
assistance under this Code and the Department may not cover any |
service rendered to an adult unless the adult has completed an |
application for benefits, all required verifications have been |
received, and the Department or its designee has found the |
adult eligible for the date on which that service was provided. |
Nothing in this Section shall apply to pregnant women or to |
persons enrolled under the medical assistance program due to |
expansions approved by the federal government that are financed |
entirely by units of local government and federal matching |
funds.
|
(Source: P.A. 96-1501, eff. 1-25-11.)
|
(305 ILCS 5/15-1) (from Ch. 23, par. 15-1)
|
|
Sec. 15-1. Definitions. As used in this Article, unless the |
context
requires otherwise:
|
(a) (Blank). "Base amount" means $108,800,000 multiplied |
by a
fraction, the numerator of which is the number of days |
represented by the
payments in question and the denominator of |
which is 365.
|
(a-5) "County provider" means a health care provider that |
is, or is
operated by, a county with a population greater than |
3,000,000.
|
(b) "Fund" means the County Provider Trust Fund.
|
(c) "Hospital" or "County hospital" means a hospital, as |
defined in Section
14-1 of this Code, which is a county |
hospital located in a county of over
3,000,000 population.
|
(Source: P.A. 87-13; 88-85; 88-554, eff. 7-26-94.)
|
(305 ILCS 5/15-2) (from Ch. 23, par. 15-2)
|
Sec. 15-2. County Provider Trust Fund.
|
(a) There is created in the State Treasury the County |
Provider
Trust Fund. Interest earned by the Fund shall be |
credited to the Fund.
The Fund shall not be used to replace any |
funds appropriated to the
Medicaid program by the General |
Assembly.
|
(b) The Fund is created solely for the purposes of |
receiving, investing,
and distributing monies in accordance |
with this Article XV. The Fund shall
consist of:
|
(1) All monies collected or received by the Illinois |
|
Department under
Section 15-3 of this Code;
|
(2) All federal financial participation monies |
received by the Illinois
Department pursuant to Title XIX |
of the Social Security Act, 42 U.S.C.
1396b, attributable |
to eligible expenditures made by the Illinois Department
|
pursuant to Section 15-5 of this Code;
|
(3) All federal moneys received by the
Illinois |
Department pursuant to Title XXI of the Social Security Act
|
attributable to eligible expenditures made by the Illinois |
Department
pursuant to Section 15-5 of this Code; and
|
(4) All other monies received by the Fund from any |
source, including
interest thereon.
|
(c) Disbursements from the Fund shall be by warrants drawn |
by the State
Comptroller upon receipt of vouchers duly executed |
and certified by the
Illinois Department and shall be made |
only:
|
(1) For hospital inpatient care, hospital outpatient |
care, care
provided by other outpatient facilities |
operated by a county, and
disproportionate share hospital |
adjustment payments made under Title XIX of the Social
|
Security Act and Article V of this Code as required by |
Section 15-5 of this
Code;
|
(1.5) For services provided or purchased by county |
providers pursuant to Section
5-11 of this Code;
|
(2) For the reimbursement of administrative expenses |
incurred by county
providers on behalf of the Illinois |
|
Department as permitted by Section 15-4 of
this Code;
|
(3) For the reimbursement of monies received by the |
Fund through
error or mistake;
|
(4) For the payment of administrative expenses |
necessarily incurred by the
Illinois Department or its |
agent in performing the activities required by this
Article |
XV;
|
(5) For the payment of any amounts that are |
reimbursable to the federal
government, attributable |
solely to the Fund, and required to be paid by State
|
warrant; and
|
(6) For hospital inpatient care, hospital outpatient |
care, care provided
by other outpatient facilities |
operated by a county, and disproportionate
share hospital |
adjustment payments made under Title XXI of the Social |
Security Act,
pursuant to Section 15-5 of this Code; and .
|
(7) For medical care and related services provided |
pursuant to a contract with a county. |
(Source: P.A. 95-859, eff. 8-19-08.)
|
(305 ILCS 5/15-5) (from Ch. 23, par. 15-5)
|
Sec. 15-5. Disbursements from the Fund.
|
(a) The monies in the Fund shall be disbursed only as |
provided in
Section 15-2 of this Code and as follows:
|
(1) To the extent that such costs are reimbursable |
under federal law, to pay the county hospitals' inpatient |
|
reimbursement rates based on
actual costs incurred, |
trended forward annually by an inflation index.
|
(2) To the extent that such costs are reimbursable |
under federal law, to pay county hospitals and county |
operated outpatient
facilities for outpatient services |
based on a federally approved
methodology to cover the |
maximum allowable costs.
|
(3) To pay the county hospitals disproportionate share |
hospital adjustment payments as may be specified in the |
Illinois Title XIX State plan.
|
(3.5) To pay county providers for services provided or |
purchased pursuant to Section
5-11 of this Code.
|
(4) To reimburse the county providers for expenses
|
contractually
assumed pursuant to Section 15-4 of this |
Code.
|
(5) To pay the Illinois Department its necessary |
administrative
expenses relative to the Fund and other |
amounts agreed to, if any, by the
county providers in the |
agreement provided for in subsection
(c).
|
(6) To pay the county providers any other amount due |
according to a federally approved State plan, including
but |
not limited to payments made under the provisions of |
Section
701(d)(3)(B) of the federal Medicare, Medicaid, |
and SCHIP Benefits Improvement
and Protection Act of
2000. |
Intergovernmental transfers supporting payments under this |
paragraph
(6) shall not be subject to the
computation |
|
described in subsection (a) of Section 15-3 of this Code, |
but
shall be computed as the difference between
the total |
of such payments made by the Illinois Department to county
|
providers less any amount of federal
financial |
participation due the Illinois Department under Titles XIX |
and XXI
of the Social Security Act as a
result of such |
payments to county providers.
|
(b) The Illinois Department shall promptly seek all |
appropriate
amendments to the Illinois Title XIX State Plan to |
maximize reimbursement, including disproportionate share |
hospital adjustment payments, to the county providers.
|
(c) (Blank).
|
(d) The payments provided for herein are intended to cover |
services
rendered on and after July 1, 1991, and any agreement |
executed between a
qualifying county and the Illinois |
Department pursuant to this Section may
relate back to that |
date, provided the Illinois Department obtains federal
|
approval. Any changes in payment rates resulting from the |
provisions of
Article 3 of this amendatory Act of 1992 are |
intended to apply to services
rendered on or after October 1, |
1992, and any agreement executed between a
qualifying county |
and the Illinois Department pursuant to this Section may
be |
effective as of that date.
|
(e) If one or more hospitals file suit in any court |
challenging any part
of this Article XV, payments to hospitals |
from the Fund under this Article
XV shall be made only to the |
|
extent that sufficient monies are available in
the Fund and |
only to the extent that any monies in the Fund are not
|
prohibited from disbursement and may be disbursed under any |
order of the court.
|
(f) All payments under this Section are contingent upon |
federal
approval of changes to the Title XIX State plan, if |
that approval is required.
|
(Source: P.A. 95-859, eff. 8-19-08.)
|
(305 ILCS 5/15-11) |
Sec. 15-11. Uses of State funds. |
(a) At any point, if State revenues referenced in |
subsection (b) or (c) of Section 15-10 or additional State |
grants are disbursed to the Cook County Health and Hospitals |
System, all funds may be used only for the following: |
(1) medical services provided at hospitals or clinics |
owned and operated by the Cook County Health and Hospitals |
System Bureau of Health Services; or |
(2) information technology to enhance billing |
capabilities for medical claiming and reimbursement; or . |
(3) services purchased by county providers pursuant to |
Section 5-11 of this Code. |
(b) State funds may not be used for the following: |
(1) non-clinical services, except services that may be |
required by accreditation bodies or State or federal |
regulatory or licensing authorities; |
|
(2) non-clinical support staff, except as pursuant to |
paragraph (1) of this subsection; or |
(3) capital improvements, other than investments in |
medical technology, except for capital improvements that |
may be required by accreditation bodies or State or federal |
regulatory or licensing authorities.
|
(Source: P.A. 95-859, eff. 8-19-08.)
|
Section 99. Effective date. This Act takes effect upon |
becoming law; however, no part of this Act takes effect until |
both Senate Bill 2840, AS AMENDED, of the 97th
General Assembly |
and Senate Bill 3397, AS AMENDED, of the 97th
General Assembly |
have become law.
|
Effective Date: 06/14/2012