Rep. Gregory Harris

Filed: 5/21/2020

 

 


 

 


 
10100SB2541ham001LRB101 18248 KTG 72312 a

1
AMENDMENT TO SENATE BILL 2541

2    AMENDMENT NO. ______. Amend Senate Bill 2541 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Administrative Procedure Act is
5amended by adding Section 5-45.1 as follows:
 
6    (5 ILCS 100/5-45.1 new)
7    Sec. 5-45.1. Emergency rulemaking. To provide for the
8expeditious and timely implementation of changes made to
9Articles 5, 5A, 12, and 14 of the Illinois Public Aid Code by
10this amendatory Act of the 101st General Assembly, emergency
11rules may be adopted in accordance with Section 5-45 by the
12respective Department. The 24-month limitation on the adoption
13of emergency rules does not apply to rules adopted under this
14Section. The adoption of emergency rules authorized by Section
155-45 and this Section is deemed to be necessary for the public
16interest, safety, and welfare.

 

 

10100SB2541ham001- 2 -LRB101 18248 KTG 72312 a

1    This Section is repealed on January 1, 2026.
 
2    (5 ILCS 100/5-46.3 rep.)
3    Section 10. The Illinois Administrative Procedure Act is
4amended by repealing Section 5-46.3.
 
5    Section 15. The Illinois Health Facilities Planning Act is
6amended by changing Sections 3 and 8.7 as follows:
 
7    (20 ILCS 3960/3)  (from Ch. 111 1/2, par. 1153)
8    (Section scheduled to be repealed on December 31, 2029)
9    Sec. 3. Definitions. As used in this Act:
10    "Health care facilities" means and includes the following
11facilities, organizations, and related persons:
12        (1) An ambulatory surgical treatment center required
13    to be licensed pursuant to the Ambulatory Surgical
14    Treatment Center Act.
15        (2) An institution, place, building, or agency
16    required to be licensed pursuant to the Hospital Licensing
17    Act.
18        (3) Skilled and intermediate long term care facilities
19    licensed under the Nursing Home Care Act.
20            (A) If a demonstration project under the Nursing
21        Home Care Act applies for a certificate of need to
22        convert to a nursing facility, it shall meet the
23        licensure and certificate of need requirements in

 

 

10100SB2541ham001- 3 -LRB101 18248 KTG 72312 a

1        effect as of the date of application.
2            (B) Except as provided in item (A) of this
3        subsection, this Act does not apply to facilities
4        granted waivers under Section 3-102.2 of the Nursing
5        Home Care Act.
6        (3.5) Skilled and intermediate care facilities
7    licensed under the ID/DD Community Care Act or the MC/DD
8    Act. No permit or exemption is required for a facility
9    licensed under the ID/DD Community Care Act or the MC/DD
10    Act prior to the reduction of the number of beds at a
11    facility. If there is a total reduction of beds at a
12    facility licensed under the ID/DD Community Care Act or the
13    MC/DD Act, this is a discontinuation or closure of the
14    facility. If a facility licensed under the ID/DD Community
15    Care Act or the MC/DD Act reduces the number of beds or
16    discontinues the facility, that facility must notify the
17    Board as provided in Section 14.1 of this Act.
18        (3.7) Facilities licensed under the Specialized Mental
19    Health Rehabilitation Act of 2013.
20        (4) Hospitals, nursing homes, ambulatory surgical
21    treatment centers, or kidney disease treatment centers
22    maintained by the State or any department or agency
23    thereof.
24        (5) Kidney disease treatment centers, including a
25    free-standing hemodialysis unit required to meet the
26    requirements of 42 CFR 494 in order to be certified for

 

 

10100SB2541ham001- 4 -LRB101 18248 KTG 72312 a

1    participation in Medicare and Medicaid under Titles XVIII
2    and XIX of the federal Social Security Act.
3            (A) This Act does not apply to a dialysis facility
4        that provides only dialysis training, support, and
5        related services to individuals with end stage renal
6        disease who have elected to receive home dialysis.
7            (B) This Act does not apply to a dialysis unit
8        located in a licensed nursing home that offers or
9        provides dialysis-related services to residents with
10        end stage renal disease who have elected to receive
11        home dialysis within the nursing home.
12            (C) The Board, however, may require dialysis
13        facilities and licensed nursing homes under items (A)
14        and (B) of this subsection to report statistical
15        information on a quarterly basis to the Board to be
16        used by the Board to conduct analyses on the need for
17        proposed kidney disease treatment centers.
18        (6) An institution, place, building, or room used for
19    the performance of outpatient surgical procedures that is
20    leased, owned, or operated by or on behalf of an
21    out-of-state facility.
22        (7) An institution, place, building, or room used for
23    provision of a health care category of service, including,
24    but not limited to, cardiac catheterization and open heart
25    surgery.
26        (8) An institution, place, building, or room housing

 

 

10100SB2541ham001- 5 -LRB101 18248 KTG 72312 a

1    major medical equipment used in the direct clinical
2    diagnosis or treatment of patients, and whose project cost
3    is in excess of the capital expenditure minimum.
4    "Health care facilities" does not include the following
5entities or facility transactions:
6        (1) Federally-owned facilities.
7        (2) Facilities used solely for healing by prayer or
8    spiritual means.
9        (3) An existing facility located on any campus facility
10    as defined in Section 5-5.8b of the Illinois Public Aid
11    Code, provided that the campus facility encompasses 30 or
12    more contiguous acres and that the new or renovated
13    facility is intended for use by a licensed residential
14    facility.
15        (4) Facilities licensed under the Supportive
16    Residences Licensing Act or the Assisted Living and Shared
17    Housing Act.
18        (5) Facilities designated as supportive living
19    facilities that are in good standing with the program
20    established under Section 5-5.01a of the Illinois Public
21    Aid Code.
22        (6) Facilities established and operating under the
23    Alternative Health Care Delivery Act as a children's
24    community-based health care center alternative health care
25    model demonstration program or as an Alzheimer's Disease
26    Management Center alternative health care model

 

 

10100SB2541ham001- 6 -LRB101 18248 KTG 72312 a

1    demonstration program.
2        (7) The closure of an entity or a portion of an entity
3    licensed under the Nursing Home Care Act, the Specialized
4    Mental Health Rehabilitation Act of 2013, the ID/DD
5    Community Care Act, or the MC/DD Act, with the exception of
6    facilities operated by a county or Illinois Veterans Homes,
7    that elect to convert, in whole or in part, to an assisted
8    living or shared housing establishment licensed under the
9    Assisted Living and Shared Housing Act and with the
10    exception of a facility licensed under the Specialized
11    Mental Health Rehabilitation Act of 2013 in connection with
12    a proposal to close a facility and re-establish the
13    facility in another location.
14        (8) Any change of ownership of a health care facility
15    that is licensed under the Nursing Home Care Act, the
16    Specialized Mental Health Rehabilitation Act of 2013, the
17    ID/DD Community Care Act, or the MC/DD Act, with the
18    exception of facilities operated by a county or Illinois
19    Veterans Homes. Changes of ownership of facilities
20    licensed under the Nursing Home Care Act must meet the
21    requirements set forth in Sections 3-101 through 3-119 of
22    the Nursing Home Care Act.
23        (9) (Blank). Any project the Department of Healthcare
24    and Family Services certifies was approved by the Hospital
25    Transformation Review Committee as a project subject to the
26    hospital's transformation under subsection (d-5) of

 

 

10100SB2541ham001- 7 -LRB101 18248 KTG 72312 a

1    Section 14-12 of the Illinois Public Aid Code, provided the
2    hospital shall submit the certification to the Board.
3    Nothing in this paragraph excludes a health care facility
4    from the requirements of this Act after the approved
5    transformation project is complete. All other requirements
6    under this Act continue to apply. Hospitals that are not
7    subject to this Act under this paragraph shall notify the
8    Health Facilities and Services Review Board within 30 days
9    of the dates that bed changes or service changes occur.
10    With the exception of those health care facilities
11specifically included in this Section, nothing in this Act
12shall be intended to include facilities operated as a part of
13the practice of a physician or other licensed health care
14professional, whether practicing in his individual capacity or
15within the legal structure of any partnership, medical or
16professional corporation, or unincorporated medical or
17professional group. Further, this Act shall not apply to
18physicians or other licensed health care professional's
19practices where such practices are carried out in a portion of
20a health care facility under contract with such health care
21facility by a physician or by other licensed health care
22professionals, whether practicing in his individual capacity
23or within the legal structure of any partnership, medical or
24professional corporation, or unincorporated medical or
25professional groups, unless the entity constructs, modifies,
26or establishes a health care facility as specifically defined

 

 

10100SB2541ham001- 8 -LRB101 18248 KTG 72312 a

1in this Section. This Act shall apply to construction or
2modification and to establishment by such health care facility
3of such contracted portion which is subject to facility
4licensing requirements, irrespective of the party responsible
5for such action or attendant financial obligation.
6    "Person" means any one or more natural persons, legal
7entities, governmental bodies other than federal, or any
8combination thereof.
9    "Consumer" means any person other than a person (a) whose
10major occupation currently involves or whose official capacity
11within the last 12 months has involved the providing,
12administering or financing of any type of health care facility,
13(b) who is engaged in health research or the teaching of
14health, (c) who has a material financial interest in any
15activity which involves the providing, administering or
16financing of any type of health care facility, or (d) who is or
17ever has been a member of the immediate family of the person
18defined by item (a), (b), or (c).
19    "State Board" or "Board" means the Health Facilities and
20Services Review Board.
21    "Construction or modification" means the establishment,
22erection, building, alteration, reconstruction, modernization,
23improvement, extension, discontinuation, change of ownership,
24of or by a health care facility, or the purchase or acquisition
25by or through a health care facility of equipment or service
26for diagnostic or therapeutic purposes or for facility

 

 

10100SB2541ham001- 9 -LRB101 18248 KTG 72312 a

1administration or operation, or any capital expenditure made by
2or on behalf of a health care facility which exceeds the
3capital expenditure minimum; however, any capital expenditure
4made by or on behalf of a health care facility for (i) the
5construction or modification of a facility licensed under the
6Assisted Living and Shared Housing Act or (ii) a conversion
7project undertaken in accordance with Section 30 of the Older
8Adult Services Act shall be excluded from any obligations under
9this Act.
10    "Establish" means the construction of a health care
11facility or the replacement of an existing facility on another
12site or the initiation of a category of service.
13    "Major medical equipment" means medical equipment which is
14used for the provision of medical and other health services and
15which costs in excess of the capital expenditure minimum,
16except that such term does not include medical equipment
17acquired by or on behalf of a clinical laboratory to provide
18clinical laboratory services if the clinical laboratory is
19independent of a physician's office and a hospital and it has
20been determined under Title XVIII of the Social Security Act to
21meet the requirements of paragraphs (10) and (11) of Section
221861(s) of such Act. In determining whether medical equipment
23has a value in excess of the capital expenditure minimum, the
24value of studies, surveys, designs, plans, working drawings,
25specifications, and other activities essential to the
26acquisition of such equipment shall be included.

 

 

10100SB2541ham001- 10 -LRB101 18248 KTG 72312 a

1    "Capital expenditure" means an expenditure: (A) made by or
2on behalf of a health care facility (as such a facility is
3defined in this Act); and (B) which under generally accepted
4accounting principles is not properly chargeable as an expense
5of operation and maintenance, or is made to obtain by lease or
6comparable arrangement any facility or part thereof or any
7equipment for a facility or part; and which exceeds the capital
8expenditure minimum.
9    For the purpose of this paragraph, the cost of any studies,
10surveys, designs, plans, working drawings, specifications, and
11other activities essential to the acquisition, improvement,
12expansion, or replacement of any plant or equipment with
13respect to which an expenditure is made shall be included in
14determining if such expenditure exceeds the capital
15expenditures minimum. Unless otherwise interdependent, or
16submitted as one project by the applicant, components of
17construction or modification undertaken by means of a single
18construction contract or financed through the issuance of a
19single debt instrument shall not be grouped together as one
20project. Donations of equipment or facilities to a health care
21facility which if acquired directly by such facility would be
22subject to review under this Act shall be considered capital
23expenditures, and a transfer of equipment or facilities for
24less than fair market value shall be considered a capital
25expenditure for purposes of this Act if a transfer of the
26equipment or facilities at fair market value would be subject

 

 

10100SB2541ham001- 11 -LRB101 18248 KTG 72312 a

1to review.
2    "Capital expenditure minimum" means $11,500,000 for
3projects by hospital applicants, $6,500,000 for applicants for
4projects related to skilled and intermediate care long-term
5care facilities licensed under the Nursing Home Care Act, and
6$3,000,000 for projects by all other applicants, which shall be
7annually adjusted to reflect the increase in construction costs
8due to inflation, for major medical equipment and for all other
9capital expenditures.
10    "Financial commitment" means the commitment of at least 33%
11of total funds assigned to cover total project cost, which
12occurs by the actual expenditure of 33% or more of the total
13project cost or the commitment to expend 33% or more of the
14total project cost by signed contracts or other legal means.
15    "Non-clinical service area" means an area (i) for the
16benefit of the patients, visitors, staff, or employees of a
17health care facility and (ii) not directly related to the
18diagnosis, treatment, or rehabilitation of persons receiving
19services from the health care facility. "Non-clinical service
20areas" include, but are not limited to, chapels; gift shops;
21news stands; computer systems; tunnels, walkways, and
22elevators; telephone systems; projects to comply with life
23safety codes; educational facilities; student housing;
24patient, employee, staff, and visitor dining areas;
25administration and volunteer offices; modernization of
26structural components (such as roof replacement and masonry

 

 

10100SB2541ham001- 12 -LRB101 18248 KTG 72312 a

1work); boiler repair or replacement; vehicle maintenance and
2storage facilities; parking facilities; mechanical systems for
3heating, ventilation, and air conditioning; loading docks; and
4repair or replacement of carpeting, tile, wall coverings,
5window coverings or treatments, or furniture. Solely for the
6purpose of this definition, "non-clinical service area" does
7not include health and fitness centers.
8    "Areawide" means a major area of the State delineated on a
9geographic, demographic, and functional basis for health
10planning and for health service and having within it one or
11more local areas for health planning and health service. The
12term "region", as contrasted with the term "subregion", and the
13word "area" may be used synonymously with the term "areawide".
14    "Local" means a subarea of a delineated major area that on
15a geographic, demographic, and functional basis may be
16considered to be part of such major area. The term "subregion"
17may be used synonymously with the term "local".
18    "Physician" means a person licensed to practice in
19accordance with the Medical Practice Act of 1987, as amended.
20    "Licensed health care professional" means a person
21licensed to practice a health profession under pertinent
22licensing statutes of the State of Illinois.
23    "Director" means the Director of the Illinois Department of
24Public Health.
25    "Agency" or "Department" means the Illinois Department of
26Public Health.

 

 

10100SB2541ham001- 13 -LRB101 18248 KTG 72312 a

1    "Alternative health care model" means a facility or program
2authorized under the Alternative Health Care Delivery Act.
3    "Out-of-state facility" means a person that is both (i)
4licensed as a hospital or as an ambulatory surgery center under
5the laws of another state or that qualifies as a hospital or an
6ambulatory surgery center under regulations adopted pursuant
7to the Social Security Act and (ii) not licensed under the
8Ambulatory Surgical Treatment Center Act, the Hospital
9Licensing Act, or the Nursing Home Care Act. Affiliates of
10out-of-state facilities shall be considered out-of-state
11facilities. Affiliates of Illinois licensed health care
12facilities 100% owned by an Illinois licensed health care
13facility, its parent, or Illinois physicians licensed to
14practice medicine in all its branches shall not be considered
15out-of-state facilities. Nothing in this definition shall be
16construed to include an office or any part of an office of a
17physician licensed to practice medicine in all its branches in
18Illinois that is not required to be licensed under the
19Ambulatory Surgical Treatment Center Act.
20    "Change of ownership of a health care facility" means a
21change in the person who has ownership or control of a health
22care facility's physical plant and capital assets. A change in
23ownership is indicated by the following transactions: sale,
24transfer, acquisition, lease, change of sponsorship, or other
25means of transferring control.
26    "Related person" means any person that: (i) is at least 50%

 

 

10100SB2541ham001- 14 -LRB101 18248 KTG 72312 a

1owned, directly or indirectly, by either the health care
2facility or a person owning, directly or indirectly, at least
350% of the health care facility; or (ii) owns, directly or
4indirectly, at least 50% of the health care facility.
5    "Charity care" means care provided by a health care
6facility for which the provider does not expect to receive
7payment from the patient or a third-party payer.
8    "Freestanding emergency center" means a facility subject
9to licensure under Section 32.5 of the Emergency Medical
10Services (EMS) Systems Act.
11    "Category of service" means a grouping by generic class of
12various types or levels of support functions, equipment, care,
13or treatment provided to patients or residents, including, but
14not limited to, classes such as medical-surgical, pediatrics,
15or cardiac catheterization. A category of service may include
16subcategories or levels of care that identify a particular
17degree or type of care within the category of service. Nothing
18in this definition shall be construed to include the practice
19of a physician or other licensed health care professional while
20functioning in an office providing for the care, diagnosis, or
21treatment of patients. A category of service that is subject to
22the Board's jurisdiction must be designated in rules adopted by
23the Board.
24    "State Board Staff Report" means the document that sets
25forth the review and findings of the State Board staff, as
26prescribed by the State Board, regarding applications subject

 

 

10100SB2541ham001- 15 -LRB101 18248 KTG 72312 a

1to Board jurisdiction.
2(Source: P.A. 100-518, eff. 6-1-18; 100-581, eff. 3-12-18;
3100-957, eff. 8-19-18; 101-81, eff. 7-12-19.)
 
4    (20 ILCS 3960/8.7)
5    (Section scheduled to be repealed on December 31, 2029)
6    Sec. 8.7. Application for permit for discontinuation of a
7health care facility or category of service; public notice and
8public hearing.
9    (a) Upon a finding that an application to close a health
10care facility or discontinue a category of service is complete,
11the State Board shall publish a legal notice on 3 consecutive
12days in a newspaper of general circulation in the area or
13community to be affected and afford the public an opportunity
14to request a hearing. If the application is for a facility
15located in a Metropolitan Statistical Area, an additional legal
16notice shall be published in a newspaper of limited
17circulation, if one exists, in the area in which the facility
18is located. If the newspaper of limited circulation is
19published on a daily basis, the additional legal notice shall
20be published on 3 consecutive days. The legal notice shall also
21be posted on the Health Facilities and Services Review Board's
22website and sent to the State Representative and State Senator
23of the district in which the health care facility is located.
24In addition, the health care facility shall provide notice of
25closure to the local media that the health care facility would

 

 

10100SB2541ham001- 16 -LRB101 18248 KTG 72312 a

1routinely notify about facility events.
2    An application to close a health care facility shall only
3be deemed complete if it includes evidence that the health care
4facility provided written notice at least 30 days prior to
5filing the application of its intent to do so to the
6municipality in which it is located, the State Representative
7and State Senator of the district in which the health care
8facility is located, the State Board, the Director of Public
9Health, and the Director of Healthcare and Family Services. The
10changes made to this subsection by this amendatory Act of the
11101st General Assembly shall apply to all applications
12submitted after the effective date of this amendatory Act of
13the 101st General Assembly.
14    (b) No later than 30 days after issuance of a permit to
15close a health care facility or discontinue a category of
16service, the permit holder shall give written notice of the
17closure or discontinuation to the State Senator and State
18Representative serving the legislative district in which the
19health care facility is located.
20    (c) If there is a pending lawsuit that challenges an
21application to discontinue a health care facility that either
22names the Board as a party or alleges fraud in the filing of
23the application, the Board may defer action on the application
24for up to 6 months after the date of the initial deferral of
25the application.
26    (d) The changes made to this Section by this amendatory Act

 

 

10100SB2541ham001- 17 -LRB101 18248 KTG 72312 a

1of the 101st General Assembly shall apply to all applications
2submitted after the effective date of this amendatory Act of
3the 101st General Assembly.
4(Source: P.A. 101-83, eff. 7-15-19.)
 
5    Section 20. The State Finance Act is amended by changing
6Section 6z-81 as follows:
 
7    (30 ILCS 105/6z-81)
8    Sec. 6z-81. Healthcare Provider Relief Fund.
9    (a) There is created in the State treasury a special fund
10to be known as the Healthcare Provider Relief Fund.
11    (b) The Fund is created for the purpose of receiving and
12disbursing moneys in accordance with this Section.
13Disbursements from the Fund shall be made only as follows:
14        (1) Subject to appropriation, for payment by the
15    Department of Healthcare and Family Services or by the
16    Department of Human Services of medical bills and related
17    expenses, including administrative expenses, for which the
18    State is responsible under Titles XIX and XXI of the Social
19    Security Act, the Illinois Public Aid Code, the Children's
20    Health Insurance Program Act, the Covering ALL KIDS Health
21    Insurance Act, and the Long Term Acute Care Hospital
22    Quality Improvement Transfer Program Act.
23        (2) For repayment of funds borrowed from other State
24    funds or from outside sources, including interest thereon.

 

 

10100SB2541ham001- 18 -LRB101 18248 KTG 72312 a

1        (3) For State fiscal years 2017, 2018, and 2019, for
2    making payments to the human poison control center pursuant
3    to Section 12-4.105 of the Illinois Public Aid Code.
4    (c) The Fund shall consist of the following:
5        (1) Moneys received by the State from short-term
6    borrowing pursuant to the Short Term Borrowing Act on or
7    after the effective date of Public Act 96-820.
8        (2) All federal matching funds received by the Illinois
9    Department of Healthcare and Family Services as a result of
10    expenditures made by the Department that are attributable
11    to moneys deposited in the Fund.
12        (3) All federal matching funds received by the Illinois
13    Department of Healthcare and Family Services as a result of
14    federal approval of Title XIX State plan amendment
15    transmittal number 07-09.
16        (3.5) Proceeds from the assessment authorized under
17    Article V-H of the Illinois Public Aid Code.
18        (4) All other moneys received for the Fund from any
19    other source, including interest earned thereon.
20        (5) All federal matching funds received by the Illinois
21    Department of Healthcare and Family Services as a result of
22    expenditures made by the Department for Medical Assistance
23    from the General Revenue Fund, the Tobacco Settlement
24    Recovery Fund, the Long-Term Care Provider Fund, and the
25    Drug Rebate Fund related to individuals eligible for
26    medical assistance pursuant to the Patient Protection and

 

 

10100SB2541ham001- 19 -LRB101 18248 KTG 72312 a

1    Affordable Care Act (P.L. 111-148) and Section 5-2 of the
2    Illinois Public Aid Code.
3    (d) In addition to any other transfers that may be provided
4for by law, on the effective date of Public Act 97-44, or as
5soon thereafter as practical, the State Comptroller shall
6direct and the State Treasurer shall transfer the sum of
7$365,000,000 from the General Revenue Fund into the Healthcare
8Provider Relief Fund.
9    (e) In addition to any other transfers that may be provided
10for by law, on July 1, 2011, or as soon thereafter as
11practical, the State Comptroller shall direct and the State
12Treasurer shall transfer the sum of $160,000,000 from the
13General Revenue Fund to the Healthcare Provider Relief Fund.
14    (f) Notwithstanding any other State law to the contrary,
15and in addition to any other transfers that may be provided for
16by law, the State Comptroller shall order transferred and the
17State Treasurer shall transfer $500,000,000 to the Healthcare
18Provider Relief Fund from the General Revenue Fund in equal
19monthly installments of $100,000,000, with the first transfer
20to be made on July 1, 2012, or as soon thereafter as practical,
21and with each of the remaining transfers to be made on August
221, 2012, September 1, 2012, October 1, 2012, and November 1,
232012, or as soon thereafter as practical. This transfer may
24assist the Department of Healthcare and Family Services in
25improving Medical Assistance bill processing timeframes or in
26meeting the possible requirements of Senate Bill 3397, or other

 

 

10100SB2541ham001- 20 -LRB101 18248 KTG 72312 a

1similar legislation, of the 97th General Assembly should it
2become law.
3    (g) Notwithstanding any other State law to the contrary,
4and in addition to any other transfers that may be provided for
5by law, on July 1, 2013, or as soon thereafter as may be
6practical, the State Comptroller shall direct and the State
7Treasurer shall transfer the sum of $601,000,000 from the
8General Revenue Fund to the Healthcare Provider Relief Fund.
9(Source: P.A. 100-587, eff. 6-4-18; 101-9, eff. 6-5-19; revised
107-17-19.)
 
11    Section 25. The Emergency Medical Services (EMS) Systems
12Act is amended by changing Section 32.5 as follows:
 
13    (210 ILCS 50/32.5)
14    Sec. 32.5. Freestanding Emergency Center.
15    (a) The Department shall issue an annual Freestanding
16Emergency Center (FEC) license to any facility that has
17received a permit from the Health Facilities and Services
18Review Board to establish a Freestanding Emergency Center by
19January 1, 2015, and:
20        (1) is located: (A) in a municipality with a population
21    of 50,000 or fewer inhabitants; (B) within 50 miles of the
22    hospital that owns or controls the FEC; and (C) within 50
23    miles of the Resource Hospital affiliated with the FEC as
24    part of the EMS System;

 

 

10100SB2541ham001- 21 -LRB101 18248 KTG 72312 a

1        (2) is wholly owned or controlled by an Associate or
2    Resource Hospital, but is not a part of the hospital's
3    physical plant;
4        (3) meets the standards for licensed FECs, adopted by
5    rule of the Department, including, but not limited to:
6            (A) facility design, specification, operation, and
7        maintenance standards;
8            (B) equipment standards; and
9            (C) the number and qualifications of emergency
10        medical personnel and other staff, which must include
11        at least one board certified emergency physician
12        present at the FEC 24 hours per day.
13        (4) limits its participation in the EMS System strictly
14    to receiving a limited number of patients by ambulance: (A)
15    according to the FEC's 24-hour capabilities; (B) according
16    to protocols developed by the Resource Hospital within the
17    FEC's designated EMS System; and (C) as pre-approved by
18    both the EMS Medical Director and the Department;
19        (5) provides comprehensive emergency treatment
20    services, as defined in the rules adopted by the Department
21    pursuant to the Hospital Licensing Act, 24 hours per day,
22    on an outpatient basis;
23        (6) provides an ambulance and maintains on site
24    ambulance services staffed with paramedics 24 hours per
25    day;
26        (7) (blank);

 

 

10100SB2541ham001- 22 -LRB101 18248 KTG 72312 a

1        (8) complies with all State and federal patient rights
2    provisions, including, but not limited to, the Emergency
3    Medical Treatment Act and the federal Emergency Medical
4    Treatment and Active Labor Act;
5        (9) maintains a communications system that is fully
6    integrated with its Resource Hospital within the FEC's
7    designated EMS System;
8        (10) reports to the Department any patient transfers
9    from the FEC to a hospital within 48 hours of the transfer
10    plus any other data determined to be relevant by the
11    Department;
12        (11) submits to the Department, on a quarterly basis,
13    the FEC's morbidity and mortality rates for patients
14    treated at the FEC and other data determined to be relevant
15    by the Department;
16        (12) does not describe itself or hold itself out to the
17    general public as a full service hospital or hospital
18    emergency department in its advertising or marketing
19    activities;
20        (13) complies with any other rules adopted by the
21    Department under this Act that relate to FECs;
22        (14) passes the Department's site inspection for
23    compliance with the FEC requirements of this Act;
24        (15) submits a copy of the permit issued by the Health
25    Facilities and Services Review Board indicating that the
26    facility has complied with the Illinois Health Facilities

 

 

10100SB2541ham001- 23 -LRB101 18248 KTG 72312 a

1    Planning Act with respect to the health services to be
2    provided at the facility;
3        (16) submits an application for designation as an FEC
4    in a manner and form prescribed by the Department by rule;
5    and
6        (17) pays the annual license fee as determined by the
7    Department by rule.
8    (a-5) Notwithstanding any other provision of this Section,
9the Department may issue an annual FEC license to a facility
10that is located in a county that does not have a licensed
11general acute care hospital if the facility's application for a
12permit from the Illinois Health Facilities Planning Board has
13been deemed complete by the Department of Public Health by
14January 1, 2014 and if the facility complies with the
15requirements set forth in paragraphs (1) through (17) of
16subsection (a).
17    (a-10) Notwithstanding any other provision of this
18Section, the Department may issue an annual FEC license to a
19facility if the facility has, by January 1, 2014, filed a
20letter of intent to establish an FEC and if the facility
21complies with the requirements set forth in paragraphs (1)
22through (17) of subsection (a).
23    (a-15) Notwithstanding any other provision of this
24Section, the Department shall issue an annual FEC license to a
25facility if the facility: (i) discontinues operation as a
26hospital within 180 days after December 4, 2015 (the effective

 

 

10100SB2541ham001- 24 -LRB101 18248 KTG 72312 a

1date of Public Act 99-490) this amendatory Act of the 99th
2General Assembly with a Health Facilities and Services Review
3Board project number of E-017-15; (ii) has an application for a
4permit to establish an FEC from the Health Facilities and
5Services Review Board that is deemed complete by January 1,
62017; and (iii) complies with the requirements set forth in
7paragraphs (1) through (17) of subsection (a) of this Section.
8    (a-20) Notwithstanding any other provision of this
9Section, the Department shall issue an annual FEC license to a
10facility if:
11        (1) the facility is a hospital that has discontinued
12    inpatient hospital services;
13        (2) the Department of Healthcare and Family Services
14    has approved certified the conversion to an FEC was
15    approved by the Hospital Transformation Review Committee
16    as a project subject to the hospital's transformation under
17    subsection (d-5) of Section 14-12 of the Illinois Public
18    Aid Code;
19        (3) the facility complies with the requirements set
20    forth in paragraphs (1) through (17), provided however that
21    the FEC may be located in a municipality with a population
22    greater than 50,000 inhabitants and shall not be subject to
23    the requirements of the Illinois Health Facilities
24    Planning Act that are applicable to the conversion to an
25    FEC if the Department of Healthcare and Family Services
26    Service has approved certified the conversion to an FEC was

 

 

10100SB2541ham001- 25 -LRB101 18248 KTG 72312 a

1    approved by the Hospital Transformation Review Committee
2    as a project subject to the hospital's transformation under
3    subsection (d-5) of Section 14-12 of the Illinois Public
4    Aid Code; and
5        (4) the facility is located at the same physical
6    location where the facility served as a hospital.
7    (b) The Department shall:
8        (1) annually inspect facilities of initial FEC
9    applicants and licensed FECs, and issue annual licenses to
10    or annually relicense FECs that satisfy the Department's
11    licensure requirements as set forth in subsection (a);
12        (2) suspend, revoke, refuse to issue, or refuse to
13    renew the license of any FEC, after notice and an
14    opportunity for a hearing, when the Department finds that
15    the FEC has failed to comply with the standards and
16    requirements of the Act or rules adopted by the Department
17    under the Act;
18        (3) issue an Emergency Suspension Order for any FEC
19    when the Director or his or her designee has determined
20    that the continued operation of the FEC poses an immediate
21    and serious danger to the public health, safety, and
22    welfare. An opportunity for a hearing shall be promptly
23    initiated after an Emergency Suspension Order has been
24    issued; and
25        (4) adopt rules as needed to implement this Section.
26(Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16;

 

 

10100SB2541ham001- 26 -LRB101 18248 KTG 72312 a

1100-581, eff. 3-12-18; revised 7-23-19.)
 
2    Section 30. The Illinois Public Aid Code is amended by
3changing Sections 5-5e.1, 5A-2, 5A-4, 5A-8, 5A-10, 5A-13,
45A-14, 12-4.105, and 14-12 and by adding Sections 5-5.05c,
55A-12.7, 5A-12.8, and 5A-17 as follows:
 
6    (305 ILCS 5/5-5.05c new)
7    Sec. 5-5.05c. Access to physician services. The Department
8shall increase rates of reimbursement for physician services to
9as close to 60% of Medicare rates in effect as of January 1,
102020 utilizing the rates of Illinois Locality 99 facility
11rates.
 
12    (305 ILCS 5/5-5e.1)
13    Sec. 5-5e.1. Safety-Net Hospitals.
14    (a) A Safety-Net Hospital is an Illinois hospital that:
15        (1) is licensed by the Department of Public Health as a
16    general acute care or pediatric hospital; and
17        (2) is a disproportionate share hospital, as described
18    in Section 1923 of the federal Social Security Act, as
19    determined by the Department; and
20        (3) meets one of the following:
21            (A) has a MIUR of at least 40% and a charity
22        percent of at least 4%; or
23            (B) has a MIUR of at least 50%.

 

 

10100SB2541ham001- 27 -LRB101 18248 KTG 72312 a

1    (b) Definitions. As used in this Section:
2        (1) "Charity percent" means the ratio of (i) the
3    hospital's charity charges for services provided to
4    individuals without health insurance or another source of
5    third party coverage to (ii) the Illinois total hospital
6    charges, each as reported on the hospital's OBRA form.
7        (2) "MIUR" means Medicaid Inpatient Utilization Rate
8    and is defined as a fraction, the numerator of which is the
9    number of a hospital's inpatient days provided in the
10    hospital's fiscal year ending 3 years prior to the rate
11    year, to patients who, for such days, were eligible for
12    Medicaid under Title XIX of the federal Social Security
13    Act, 42 USC 1396a et seq., excluding those persons eligible
14    for medical assistance pursuant to 42 U.S.C.
15    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
16    Section 5-2 of this Article, and the denominator of which
17    is the total number of the hospital's inpatient days in
18    that same period, excluding those persons eligible for
19    medical assistance pursuant to 42 U.S.C.
20    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
21    Section 5-2 of this Article.
22        (3) "OBRA form" means form HFS-3834, OBRA '93 data
23    collection form, for the rate year.
24        (4) "Rate year" means the 12-month period beginning on
25    October 1.
26    (c) Beginning July 1, 2012 and ending on December 31, 2022

 

 

10100SB2541ham001- 28 -LRB101 18248 KTG 72312 a

1June 30, 2020, a hospital that would have qualified for the
2rate year beginning October 1, 2011, shall be a Safety-Net
3Hospital.
4    (d) No later than August 15 preceding the rate year, each
5hospital shall submit the OBRA form to the Department. Prior to
6October 1, the Department shall notify each hospital whether it
7has qualified as a Safety-Net Hospital.
8    (e) The Department may promulgate rules in order to
9implement this Section.
10    (f) Nothing in this Section shall be construed as limiting
11the ability of the Department to include the Safety-Net
12Hospitals in the hospital rate reform mandated by Section 14-11
13of this Code and implemented under Section 14-12 of this Code
14and by administrative rulemaking.
15(Source: P.A. 100-581, eff. 3-12-18.)
 
16    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
17    (Section scheduled to be repealed on July 1, 2020)
18    Sec. 5A-2. Assessment.
19    (a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
20years 2009 through 2018, or as long as continued under Section
215A-16, an annual assessment on inpatient services is imposed on
22each hospital provider in an amount equal to $218.38 multiplied
23by the difference of the hospital's occupied bed days less the
24hospital's Medicare bed days, provided, however, that the
25amount of $218.38 shall be increased by a uniform percentage to

 

 

10100SB2541ham001- 29 -LRB101 18248 KTG 72312 a

1generate an amount equal to 75% of the State share of the
2payments authorized under Section 5A-12.5, with such increase
3only taking effect upon the date that a State share for such
4payments is required under federal law. For the period of April
5through June 2015, the amount of $218.38 used to calculate the
6assessment under this paragraph shall, by emergency rule under
7subsection (s) of Section 5-45 of the Illinois Administrative
8Procedure Act, be increased by a uniform percentage to generate
9$20,250,000 in the aggregate for that period from all hospitals
10subject to the annual assessment under this paragraph.
11    (2) In addition to any other assessments imposed under this
12Article, effective July 1, 2016 and semi-annually thereafter
13through June 2018, or as provided in Section 5A-16, in addition
14to any federally required State share as authorized under
15paragraph (1), the amount of $218.38 shall be increased by a
16uniform percentage to generate an amount equal to 75% of the
17ACA Assessment Adjustment, as defined in subsection (b-6) of
18this Section.
19    For State fiscal years 2009 through 2018, or as provided in
20Section 5A-16, a hospital's occupied bed days and Medicare bed
21days shall be determined using the most recent data available
22from each hospital's 2005 Medicare cost report as contained in
23the Healthcare Cost Report Information System file, for the
24quarter ending on December 31, 2006, without regard to any
25subsequent adjustments or changes to such data. If a hospital's
262005 Medicare cost report is not contained in the Healthcare

 

 

10100SB2541ham001- 30 -LRB101 18248 KTG 72312 a

1Cost Report Information System, then the Illinois Department
2may obtain the hospital provider's occupied bed days and
3Medicare bed days from any source available, including, but not
4limited to, records maintained by the hospital provider, which
5may be inspected at all times during business hours of the day
6by the Illinois Department or its duly authorized agents and
7employees.
8    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
9fiscal years 2019 and 2020, an annual assessment on inpatient
10services is imposed on each hospital provider in an amount
11equal to $197.19 multiplied by the difference of the hospital's
12occupied bed days less the hospital's Medicare bed days;
13however, for State fiscal year 2021, the amount of $197.19
14shall be increased by a uniform percentage to generate an
15additional $6,250,000 in the aggregate for that period from all
16hospitals subject to the annual assessment under this
17paragraph. For State fiscal years 2019 and 2020, a hospital's
18occupied bed days and Medicare bed days shall be determined
19using the most recent data available from each hospital's 2015
20Medicare cost report as contained in the Healthcare Cost Report
21Information System file, for the quarter ending on March 31,
222017, without regard to any subsequent adjustments or changes
23to such data. If a hospital's 2015 Medicare cost report is not
24contained in the Healthcare Cost Report Information System,
25then the Illinois Department may obtain the hospital provider's
26occupied bed days and Medicare bed days from any source

 

 

10100SB2541ham001- 31 -LRB101 18248 KTG 72312 a

1available, including, but not limited to, records maintained by
2the hospital provider, which may be inspected at all times
3during business hours of the day by the Illinois Department or
4its duly authorized agents and employees. Notwithstanding any
5other provision in this Article, for a hospital provider that
6did not have a 2015 Medicare cost report, but paid an
7assessment in State fiscal year 2018 on the basis of
8hypothetical data, that assessment amount shall be used for
9State fiscal years 2019 and 2020; however, for State fiscal
10year 2021, the assessment amount shall be increased by the
11proportion that it represents of the total annual assessment
12that is generated from all hospitals in order to generate
13$6,250,000 in the aggregate for that period from all hospitals
14subject to the annual assessment under this paragraph.
15    (4) Subject to Sections 5A-3 and 5A-10, for the period of
16July 1, 2020 through December 31, 2020 and calendar State
17fiscal years 2021 and 2022 through 2024, an annual assessment
18on inpatient services is imposed on each hospital provider in
19an amount equal to $221.50 $197.19 multiplied by the difference
20of the hospital's occupied bed days less the hospital's
21Medicare bed days, provided however: for the period of July 1,
222020 through December 31, 2020, (i) the assessment shall be
23equal to 50% of the annual amount; and (ii) the amount of
24$221.50 shall be retroactively adjusted by a uniform percentage
25to generate an amount equal to 50% of the Assessment
26Adjustment, as defined in subsection (b-7) , that the amount of

 

 

10100SB2541ham001- 32 -LRB101 18248 KTG 72312 a

1$197.19 used to calculate the assessment under this paragraph
2shall, by rule, be adjusted by a uniform percentage to generate
3the same total annual assessment that was generated in State
4fiscal year 2020 from all hospitals subject to the annual
5assessment under this paragraph plus $6,250,000. For the period
6of July 1, 2020 through December 31, 2020 and calendar State
7fiscal years 2021 and 2022, a hospital's occupied bed days and
8Medicare bed days shall be determined using the most recent
9data available from each hospital's 2015 2017 Medicare cost
10report as contained in the Healthcare Cost Report Information
11System file, for the quarter ending on March 31, 2017 2019,
12without regard to any subsequent adjustments or changes to such
13data. If a hospital's 2015 Medicare cost report is not
14contained in the Healthcare Cost Report Information System,
15then the Illinois Department may obtain the hospital provider's
16occupied bed days and Medicare bed days from any source
17available, including, but not limited to, records maintained by
18the hospital provider, which may be inspected at all times
19during business hours of the day by the Illinois Department or
20its duly authorized agents and employees. Should the change in
21the assessment methodology for fiscal years 2021 through
22December 31, 2022 not be approved on or before June 30, 2020,
23the assessment and payments under this Article in effect for
24fiscal year 2020 shall remain in place until the new assessment
25is approved. If the assessment methodology for July 1, 2020
26through December 31, 2022, is approved on or after July 1,

 

 

10100SB2541ham001- 33 -LRB101 18248 KTG 72312 a

12020, it shall be retroactive to July 1, 2020, subject to
2federal approval and provided that the payments authorized
3under Section 5A-12.7 have the same effective date as the new
4assessment methodology. In giving retroactive effect to the
5assessment approved after June 30, 2020, credit toward the new
6assessment shall be given for any payments of the previous
7assessment for periods after June 30, 2020. Notwithstanding any
8other provision of this Article, for a hospital provider that
9did not have a 2015 Medicare cost report, but paid an
10assessment in State Fiscal Year 2020 on the basis of
11hypothetical data, the data that was the basis for the 2020
12assessment shall be used to calculate the assessment under this
13paragraph. For State fiscal years 2023 and 2024, a hospital's
14occupied bed days and Medicare bed days shall be determined
15using the most recent data available from each hospital's 2019
16Medicare cost report as contained in the Healthcare Cost Report
17Information System file, for the quarter ending on March 31,
182021, without regard to any subsequent adjustments or changes
19to such data.
20    (b) (Blank).
21    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
22portion of State fiscal year 2012, beginning June 10, 2012
23through June 30, 2012, and for State fiscal years 2013 through
242018, or as provided in Section 5A-16, an annual assessment on
25outpatient services is imposed on each hospital provider in an
26amount equal to .008766 multiplied by the hospital's outpatient

 

 

10100SB2541ham001- 34 -LRB101 18248 KTG 72312 a

1gross revenue, provided, however, that the amount of .008766
2shall be increased by a uniform percentage to generate an
3amount equal to 25% of the State share of the payments
4authorized under Section 5A-12.5, with such increase only
5taking effect upon the date that a State share for such
6payments is required under federal law. For the period
7beginning June 10, 2012 through June 30, 2012, the annual
8assessment on outpatient services shall be prorated by
9multiplying the assessment amount by a fraction, the numerator
10of which is 21 days and the denominator of which is 365 days.
11For the period of April through June 2015, the amount of
12.008766 used to calculate the assessment under this paragraph
13shall, by emergency rule under subsection (s) of Section 5-45
14of the Illinois Administrative Procedure Act, be increased by a
15uniform percentage to generate $6,750,000 in the aggregate for
16that period from all hospitals subject to the annual assessment
17under this paragraph.
18    (2) In addition to any other assessments imposed under this
19Article, effective July 1, 2016 and semi-annually thereafter
20through June 2018, in addition to any federally required State
21share as authorized under paragraph (1), the amount of .008766
22shall be increased by a uniform percentage to generate an
23amount equal to 25% of the ACA Assessment Adjustment, as
24defined in subsection (b-6) of this Section.
25    For the portion of State fiscal year 2012, beginning June
2610, 2012 through June 30, 2012, and State fiscal years 2013

 

 

10100SB2541ham001- 35 -LRB101 18248 KTG 72312 a

1through 2018, or as provided in Section 5A-16, a hospital's
2outpatient gross revenue shall be determined using the most
3recent data available from each hospital's 2009 Medicare cost
4report as contained in the Healthcare Cost Report Information
5System file, for the quarter ending on June 30, 2011, without
6regard to any subsequent adjustments or changes to such data.
7If a hospital's 2009 Medicare cost report is not contained in
8the Healthcare Cost Report Information System, then the
9Department may obtain the hospital provider's outpatient gross
10revenue from any source available, including, but not limited
11to, records maintained by the hospital provider, which may be
12inspected at all times during business hours of the day by the
13Department or its duly authorized agents and employees.
14    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
15fiscal years 2019 and 2020, an annual assessment on outpatient
16services is imposed on each hospital provider in an amount
17equal to .01358 multiplied by the hospital's outpatient gross
18revenue; however, for State fiscal year 2021, the amount of
19.01358 shall be increased by a uniform percentage to generate
20an additional $6,250,000 in the aggregate for that period from
21all hospitals subject to the annual assessment under this
22paragraph. For State fiscal years 2019 and 2020, a hospital's
23outpatient gross revenue shall be determined using the most
24recent data available from each hospital's 2015 Medicare cost
25report as contained in the Healthcare Cost Report Information
26System file, for the quarter ending on March 31, 2017, without

 

 

10100SB2541ham001- 36 -LRB101 18248 KTG 72312 a

1regard to any subsequent adjustments or changes to such data.
2If a hospital's 2015 Medicare cost report is not contained in
3the Healthcare Cost Report Information System, then the
4Department may obtain the hospital provider's outpatient gross
5revenue from any source available, including, but not limited
6to, records maintained by the hospital provider, which may be
7inspected at all times during business hours of the day by the
8Department or its duly authorized agents and employees.
9Notwithstanding any other provision in this Article, for a
10hospital provider that did not have a 2015 Medicare cost
11report, but paid an assessment in State fiscal year 2018 on the
12basis of hypothetical data, that assessment amount shall be
13used for State fiscal years 2019 and 2020; however, for State
14fiscal year 2021, the assessment amount shall be increased by
15the proportion that it represents of the total annual
16assessment that is generated from all hospitals in order to
17generate $6,250,000 in the aggregate for that period from all
18hospitals subject to the annual assessment under this
19paragraph.
20    (4) Subject to Sections 5A-3 and 5A-10, for the period of
21July 1, 2020 through December 31, 2020 and calendar State
22fiscal years 2021 and 2022 through 2024, an annual assessment
23on outpatient services is imposed on each hospital provider in
24an amount equal to .01525 .01358 multiplied by the hospital's
25outpatient gross revenue, provided however: (i) for the period
26of July 1, 2020 through December 31, 2020, the assessment shall

 

 

10100SB2541ham001- 37 -LRB101 18248 KTG 72312 a

1be equal to 50% of the annual amount; and (ii) the amount of
2.01525 shall be retroactively adjusted by a uniform percentage
3to generate an amount equal to 50% of the Assessment
4Adjustment, as defined in subsection (b-7) , that the amount of
5.01358 used to calculate the assessment under this paragraph
6shall, by rule, be adjusted by a uniform percentage to generate
7the same total annual assessment that was generated in State
8fiscal year 2020 from all hospitals subject to the annual
9assessment under this paragraph plus $6,250,000. For the period
10of July 1, 2020 through December 31, 2020 and calendar State
11fiscal years 2021 and 2022, a hospital's outpatient gross
12revenue shall be determined using the most recent data
13available from each hospital's 2015 2017 Medicare cost report
14as contained in the Healthcare Cost Report Information System
15file, for the quarter ending on March 31, 2017 2019, without
16regard to any subsequent adjustments or changes to such data.
17If a hospital's 2015 Medicare cost report is not contained in
18the Healthcare Cost Report Information System, then the
19Illinois Department may obtain the hospital provider's
20outpatient revenue data from any source available, including,
21but not limited to, records maintained by the hospital
22provider, which may be inspected at all times during business
23hours of the day by the Illinois Department or its duly
24authorized agents and employees. Should the change in the
25assessment methodology above for fiscal years 2021 through
26calendar year 2022 not be approved prior to July 1, 2020, the

 

 

10100SB2541ham001- 38 -LRB101 18248 KTG 72312 a

1assessment and payments under this Article in effect for fiscal
2year 2020 shall remain in place until the new assessment is
3approved. If the change in the assessment methodology above for
4July 1, 2020 through December 31, 2022, is approved after June
530, 2020, it shall have a retroactive effective date of July 1,
62020, subject to federal approval and provided that the
7payments authorized under Section 12A-7 have the same effective
8date as the new assessment methodology. In giving retroactive
9effect to the assessment approved after June 30, 2020, credit
10toward the new assessment shall be given for any payments of
11the previous assessment for periods after June 30, 2020.
12Notwithstanding any other provision of this Article, for a
13hospital provider that did not have a 2015 Medicare cost
14report, but paid an assessment in State Fiscal Year 2020 on the
15basis of hypothetical data, the data that was the basis for the
162020 assessment shall be used to calculate the assessment under
17this paragraph. For State fiscal years 2023 and 2024, a
18hospital's outpatient gross revenue shall be determined using
19the most recent data available from each hospital's 2019
20Medicare cost report as contained in the Healthcare Cost Report
21Information System file, for the quarter ending on March 31,
222021, without regard to any subsequent adjustments or changes
23to such data.
24    (b-6)(1) As used in this Section, "ACA Assessment
25Adjustment" means:
26        (A) For the period of July 1, 2016 through December 31,

 

 

10100SB2541ham001- 39 -LRB101 18248 KTG 72312 a

1    2016, the product of .19125 multiplied by the sum of the
2    fee-for-service payments to hospitals as authorized under
3    Section 5A-12.5 and the adjustments authorized under
4    subsection (t) of Section 5A-12.2 to managed care
5    organizations for hospital services due and payable in the
6    month of April 2016 multiplied by 6.
7        (B) For the period of January 1, 2017 through June 30,
8    2017, the product of .19125 multiplied by the sum of the
9    fee-for-service payments to hospitals as authorized under
10    Section 5A-12.5 and the adjustments authorized under
11    subsection (t) of Section 5A-12.2 to managed care
12    organizations for hospital services due and payable in the
13    month of October 2016 multiplied by 6, except that the
14    amount calculated under this subparagraph (B) shall be
15    adjusted, either positively or negatively, to account for
16    the difference between the actual payments issued under
17    Section 5A-12.5 for the period beginning July 1, 2016
18    through December 31, 2016 and the estimated payments due
19    and payable in the month of April 2016 multiplied by 6 as
20    described in subparagraph (A).
21        (C) For the period of July 1, 2017 through December 31,
22    2017, the product of .19125 multiplied by the sum of the
23    fee-for-service payments to hospitals as authorized under
24    Section 5A-12.5 and the adjustments authorized under
25    subsection (t) of Section 5A-12.2 to managed care
26    organizations for hospital services due and payable in the

 

 

10100SB2541ham001- 40 -LRB101 18248 KTG 72312 a

1    month of April 2017 multiplied by 6, except that the amount
2    calculated under this subparagraph (C) shall be adjusted,
3    either positively or negatively, to account for the
4    difference between the actual payments issued under
5    Section 5A-12.5 for the period beginning January 1, 2017
6    through June 30, 2017 and the estimated payments due and
7    payable in the month of October 2016 multiplied by 6 as
8    described in subparagraph (B).
9        (D) For the period of January 1, 2018 through June 30,
10    2018, the product of .19125 multiplied by the sum of the
11    fee-for-service payments to hospitals as authorized under
12    Section 5A-12.5 and the adjustments authorized under
13    subsection (t) of Section 5A-12.2 to managed care
14    organizations for hospital services due and payable in the
15    month of October 2017 multiplied by 6, except that:
16            (i) the amount calculated under this subparagraph
17        (D) shall be adjusted, either positively or
18        negatively, to account for the difference between the
19        actual payments issued under Section 5A-12.5 for the
20        period of July 1, 2017 through December 31, 2017 and
21        the estimated payments due and payable in the month of
22        April 2017 multiplied by 6 as described in subparagraph
23        (C); and
24            (ii) the amount calculated under this subparagraph
25        (D) shall be adjusted to include the product of .19125
26        multiplied by the sum of the fee-for-service payments,

 

 

10100SB2541ham001- 41 -LRB101 18248 KTG 72312 a

1        if any, estimated to be paid to hospitals under
2        subsection (b) of Section 5A-12.5.
3    (2) The Department shall complete and apply a final
4reconciliation of the ACA Assessment Adjustment prior to June
530, 2018 to account for:
6        (A) any differences between the actual payments issued
7    or scheduled to be issued prior to June 30, 2018 as
8    authorized in Section 5A-12.5 for the period of January 1,
9    2018 through June 30, 2018 and the estimated payments due
10    and payable in the month of October 2017 multiplied by 6 as
11    described in subparagraph (D); and
12        (B) any difference between the estimated
13    fee-for-service payments under subsection (b) of Section
14    5A-12.5 and the amount of such payments that are actually
15    scheduled to be paid.
16    The Department shall notify hospitals of any additional
17amounts owed or reduction credits to be applied to the June
182018 ACA Assessment Adjustment. This is to be considered the
19final reconciliation for the ACA Assessment Adjustment.
20    (3) Notwithstanding any other provision of this Section, if
21for any reason the scheduled payments under subsection (b) of
22Section 5A-12.5 are not issued in full by the final day of the
23period authorized under subsection (b) of Section 5A-12.5,
24funds collected from each hospital pursuant to subparagraph (D)
25of paragraph (1) and pursuant to paragraph (2), attributable to
26the scheduled payments authorized under subsection (b) of

 

 

10100SB2541ham001- 42 -LRB101 18248 KTG 72312 a

1Section 5A-12.5 that are not issued in full by the final day of
2the period attributable to each payment authorized under
3subsection (b) of Section 5A-12.5, shall be refunded.
4    (4) The increases authorized under paragraph (2) of
5subsection (a) and paragraph (2) of subsection (b-5) shall be
6limited to the federally required State share of the total
7payments authorized under Section 5A-12.5 if the sum of such
8payments yields an annualized amount equal to or less than
9$450,000,000, or if the adjustments authorized under
10subsection (t) of Section 5A-12.2 are found not to be
11actuarially sound; however, this limitation shall not apply to
12the fee-for-service payments described in subsection (b) of
13Section 5A-12.5.
14    (b-7)(1) As used in this Section, "Assessment Adjustment"
15means:
16        (A) For the period of July 1, 2020 through December 31,
17    2020, the product of .3853 multiplied by the total of the
18    actual payments made under subsections (c) through (k) of
19    Section 5A-12.7 attributable to the period, less the total
20    of the assessment imposed under subsections (a) and (b-5)
21    of this Section for the period.
22        (B) For each calendar quarter beginning on and after
23    January 1, 2021, the product of .3853 multiplied by the
24    total of the actual payments made under subsections (c)
25    through (k) of Section 5A-12.7 attributable to the period,
26    less the total of the assessment imposed under subsections

 

 

10100SB2541ham001- 43 -LRB101 18248 KTG 72312 a

1    (a) and (b-5) of this Section for the period.
2    (2) The Department shall calculate and notify each hospital
3of the total Assessment Adjustment and any additional
4assessment owed by the hospital or refund owed to the hospital
5on either a semi-annual or annual basis. Such notice shall be
6issued at least 30 days prior to any period in which the
7assessment will be adjusted. Any additional assessment owed by
8the hospital or refund owed to the hospital shall be uniformly
9applied to the assessment owed by the hospital in monthly
10installments for the subsequent semi-annual period or calendar
11year. If no assessment is owed in the subsequent year, any
12amount owed by the hospital or refund due to the hospital,
13shall be paid in a lump sum.
14    (3) The Department shall publish all details of the
15Assessment Adjustment calculation performed each year on its
16website within 30 days of completing the calculation, and also
17submit the details of the Assessment Adjustment calculation as
18part of the Department's annual report to the General Assembly.
19    (c) (Blank).
20    (d) Notwithstanding any of the other provisions of this
21Section, the Department is authorized to adopt rules to reduce
22the rate of any annual assessment imposed under this Section,
23as authorized by Section 5-46.2 of the Illinois Administrative
24Procedure Act.
25    (e) Notwithstanding any other provision of this Section,
26any plan providing for an assessment on a hospital provider as

 

 

10100SB2541ham001- 44 -LRB101 18248 KTG 72312 a

1a permissible tax under Title XIX of the federal Social
2Security Act and Medicaid-eligible payments to hospital
3providers from the revenues derived from that assessment shall
4be reviewed by the Illinois Department of Healthcare and Family
5Services, as the Single State Medicaid Agency required by
6federal law, to determine whether those assessments and
7hospital provider payments meet federal Medicaid standards. If
8the Department determines that the elements of the plan may
9meet federal Medicaid standards and a related State Medicaid
10Plan Amendment is prepared in a manner and form suitable for
11submission, that State Plan Amendment shall be submitted in a
12timely manner for review by the Centers for Medicare and
13Medicaid Services of the United States Department of Health and
14Human Services and subject to approval by the Centers for
15Medicare and Medicaid Services of the United States Department
16of Health and Human Services. No such plan shall become
17effective without approval by the Illinois General Assembly by
18the enactment into law of related legislation. Notwithstanding
19any other provision of this Section, the Department is
20authorized to adopt rules to reduce the rate of any annual
21assessment imposed under this Section. Any such rules may be
22adopted by the Department under Section 5-50 of the Illinois
23Administrative Procedure Act.
24(Source: P.A. 100-581, eff. 3-12-18; 101-10, eff. 6-5-19.)
 
25    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)

 

 

10100SB2541ham001- 45 -LRB101 18248 KTG 72312 a

1    Sec. 5A-4. Payment of assessment; penalty.
2    (a) The assessment imposed by Section 5A-2 for State fiscal
3year 2009 through State fiscal year 2018 or as provided in
4Section 5A-16, shall be due and payable in monthly
5installments, each equaling one-twelfth of the assessment for
6the year, on the fourteenth State business day of each month.
7No installment payment of an assessment imposed by Section 5A-2
8shall be due and payable, however, until after the Comptroller
9has issued the payments required under this Article.
10    Except as provided in subsection (a-5) of this Section, the
11assessment imposed by subsection (b-5) of Section 5A-2 for the
12portion of State fiscal year 2012 beginning June 10, 2012
13through June 30, 2012, and for State fiscal year 2013 through
14State fiscal year 2018 or as provided in Section 5A-16, shall
15be due and payable in monthly installments, each equaling
16one-twelfth of the assessment for the year, on the 17th State
17business day of each month. No installment payment of an
18assessment imposed by subsection (b-5) of Section 5A-2 shall be
19due and payable, however, until after: (i) the Department
20notifies the hospital provider, in writing, that the payment
21methodologies to hospitals required under Section 5A-12.4,
22have been approved by the Centers for Medicare and Medicaid
23Services of the U.S. Department of Health and Human Services,
24and the waiver under 42 CFR 433.68 for the assessment imposed
25by subsection (b-5) of Section 5A-2, if necessary, has been
26granted by the Centers for Medicare and Medicaid Services of

 

 

10100SB2541ham001- 46 -LRB101 18248 KTG 72312 a

1the U.S. Department of Health and Human Services; and (ii) the
2Comptroller has issued the payments required under Section
35A-12.4. Upon notification to the Department of approval of the
4payment methodologies required under Section 5A-12.4 and the
5waiver granted under 42 CFR 433.68, if necessary, all
6installments otherwise due under subsection (b-5) of Section
75A-2 prior to the date of notification shall be due and payable
8to the Department upon written direction from the Department
9and issuance by the Comptroller of the payments required under
10Section 5A-12.4.
11    Except as provided in subsection (a-5) of this Section, the
12assessment imposed under Section 5A-2 for State fiscal year
132019 and each subsequent State fiscal year shall be due and
14payable in monthly installments, each equaling one-twelfth of
15the assessment for the year, on the 17th State business day of
16each month. The Department has discretion to establish a later
17date due to delays in payments being made to hospitals as
18required under Section 5A-12.7. No installment payment of an
19assessment imposed by Section 5A-2 shall be due and payable,
20however, until after: (i) the Department notifies the hospital
21provider, in writing, that the payment methodologies to
22hospitals required under Section 5A-12.6 or 5A-12.7 have been
23approved by the Centers for Medicare and Medicaid Services of
24the U.S. Department of Health and Human Services, and the
25waiver under 42 CFR 433.68 for the assessment imposed by
26Section 5A-2, if necessary, has been granted by the Centers for

 

 

10100SB2541ham001- 47 -LRB101 18248 KTG 72312 a

1Medicare and Medicaid Services of the U.S. Department of Health
2and Human Services; and (ii) the Comptroller and managed care
3organizations have has issued the payments required under
4Section 5A-12.6 or 5A-12.7. Upon notification to the Department
5of approval of the payment methodologies required under Section
65A-12.6 or 5A-12.7 and the waiver granted under 42 CFR 433.68,
7if necessary, all installments otherwise due under Section 5A-2
8prior to the date of notification shall be due and payable to
9the Department upon written direction from the Department and
10issuance by the Comptroller and managed care organizations of
11the payments required under Section 5A-12.6 or 5A-12.7.
12    (a-5) The Illinois Department may accelerate the schedule
13upon which assessment installments are due and payable by
14hospitals with a payment ratio greater than or equal to one.
15Such acceleration of due dates for payment of the assessment
16may be made only in conjunction with a corresponding
17acceleration in access payments identified in Section 5A-12.2,
18Section 5A-12.4, or Section 5A-12.6, or Section 5A-12.7 to the
19same hospitals. For the purposes of this subsection (a-5), a
20hospital's payment ratio is defined as the quotient obtained by
21dividing the total payments for the State fiscal year, as
22authorized under Section 5A-12.2, Section 5A-12.4, or Section
235A-12.6, or Section 5A-12.7, by the total assessment for the
24State fiscal year imposed under Section 5A-2 or subsection
25(b-5) of Section 5A-2.
26    (b) The Illinois Department is authorized to establish

 

 

10100SB2541ham001- 48 -LRB101 18248 KTG 72312 a

1delayed payment schedules for hospital providers that are
2unable to make installment payments when due under this Section
3due to financial difficulties, as determined by the Illinois
4Department.
5    (c) If a hospital provider fails to pay the full amount of
6an installment when due (including any extensions granted under
7subsection (b)), there shall, unless waived by the Illinois
8Department for reasonable cause, be added to the assessment
9imposed by Section 5A-2 a penalty assessment equal to the
10lesser of (i) 5% of the amount of the installment not paid on
11or before the due date plus 5% of the portion thereof remaining
12unpaid on the last day of each 30-day period thereafter or (ii)
13100% of the installment amount not paid on or before the due
14date. For purposes of this subsection, payments will be
15credited first to unpaid installment amounts (rather than to
16penalty or interest), beginning with the most delinquent
17installments.
18    (d) Any assessment amount that is due and payable to the
19Illinois Department more frequently than once per calendar
20quarter shall be remitted to the Illinois Department by the
21hospital provider by means of electronic funds transfer. The
22Illinois Department may provide for remittance by other means
23if (i) the amount due is less than $10,000 or (ii) electronic
24funds transfer is unavailable for this purpose.
25(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
26101-209, eff. 8-5-19.)
 

 

 

10100SB2541ham001- 49 -LRB101 18248 KTG 72312 a

1    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
2    Sec. 5A-8. Hospital Provider Fund.
3    (a) There is created in the State Treasury the Hospital
4Provider Fund. Interest earned by the Fund shall be credited to
5the Fund. The Fund shall not be used to replace any moneys
6appropriated to the Medicaid program by the General Assembly.
7    (b) The Fund is created for the purpose of receiving moneys
8in accordance with Section 5A-6 and disbursing moneys only for
9the following purposes, notwithstanding any other provision of
10law:
11        (1) For making payments to hospitals as required under
12    this Code, under the Children's Health Insurance Program
13    Act, under the Covering ALL KIDS Health Insurance Act, and
14    under the Long Term Acute Care Hospital Quality Improvement
15    Transfer Program Act.
16        (2) For the reimbursement of moneys collected by the
17    Illinois Department from hospitals or hospital providers
18    through error or mistake in performing the activities
19    authorized under this Code.
20        (3) For payment of administrative expenses incurred by
21    the Illinois Department or its agent in performing
22    activities under this Code, under the Children's Health
23    Insurance Program Act, under the Covering ALL KIDS Health
24    Insurance Act, and under the Long Term Acute Care Hospital
25    Quality Improvement Transfer Program Act.

 

 

10100SB2541ham001- 50 -LRB101 18248 KTG 72312 a

1        (4) For payments of any amounts which are reimbursable
2    to the federal government for payments from this Fund which
3    are required to be paid by State warrant.
4        (5) For making transfers, as those transfers are
5    authorized in the proceedings authorizing debt under the
6    Short Term Borrowing Act, but transfers made under this
7    paragraph (5) shall not exceed the principal amount of debt
8    issued in anticipation of the receipt by the State of
9    moneys to be deposited into the Fund.
10        (6) For making transfers to any other fund in the State
11    treasury, but transfers made under this paragraph (6) shall
12    not exceed the amount transferred previously from that
13    other fund into the Hospital Provider Fund plus any
14    interest that would have been earned by that fund on the
15    monies that had been transferred.
16        (6.5) For making transfers to the Healthcare Provider
17    Relief Fund, except that transfers made under this
18    paragraph (6.5) shall not exceed $60,000,000 in the
19    aggregate.
20        (7) For making transfers not exceeding the following
21    amounts, related to State fiscal years 2013 through 2018,
22    to the following designated funds:
23            Health and Human Services Medicaid Trust
24                Fund..............................$20,000,000
25            Long-Term Care Provider Fund..........$30,000,000
26            General Revenue Fund.................$80,000,000.

 

 

10100SB2541ham001- 51 -LRB101 18248 KTG 72312 a

1    Transfers under this paragraph shall be made within 7 days
2    after the payments have been received pursuant to the
3    schedule of payments provided in subsection (a) of Section
4    5A-4.
5        (7.1) (Blank).
6        (7.5) (Blank).
7        (7.8) (Blank).
8        (7.9) (Blank).
9        (7.10) For State fiscal year 2014, for making transfers
10    of the moneys resulting from the assessment under
11    subsection (b-5) of Section 5A-2 and received from hospital
12    providers under Section 5A-4 and transferred into the
13    Hospital Provider Fund under Section 5A-6 to the designated
14    funds not exceeding the following amounts in that State
15    fiscal year:
16            Healthcare Provider Relief Fund......$100,000,000
17        Transfers under this paragraph shall be made within 7
18    days after the payments have been received pursuant to the
19    schedule of payments provided in subsection (a) of Section
20    5A-4.
21        The additional amount of transfers in this paragraph
22    (7.10), authorized by Public Act 98-651, shall be made
23    within 10 State business days after June 16, 2014 (the
24    effective date of Public Act 98-651). That authority shall
25    remain in effect even if Public Act 98-651 does not become
26    law until State fiscal year 2015.

 

 

10100SB2541ham001- 52 -LRB101 18248 KTG 72312 a

1        (7.10a) For State fiscal years 2015 through 2018, for
2    making transfers of the moneys resulting from the
3    assessment under subsection (b-5) of Section 5A-2 and
4    received from hospital providers under Section 5A-4 and
5    transferred into the Hospital Provider Fund under Section
6    5A-6 to the designated funds not exceeding the following
7    amounts related to each State fiscal year:
8            Healthcare Provider Relief Fund......$50,000,000
9        Transfers under this paragraph shall be made within 7
10    days after the payments have been received pursuant to the
11    schedule of payments provided in subsection (a) of Section
12    5A-4.
13        (7.11) (Blank).
14        (7.12) For State fiscal year 2013, for increasing by
15    21/365ths the transfer of the moneys resulting from the
16    assessment under subsection (b-5) of Section 5A-2 and
17    received from hospital providers under Section 5A-4 for the
18    portion of State fiscal year 2012 beginning June 10, 2012
19    through June 30, 2012 and transferred into the Hospital
20    Provider Fund under Section 5A-6 to the designated funds
21    not exceeding the following amounts in that State fiscal
22    year:
23            Healthcare Provider Relief Fund.......$2,870,000
24        Since the federal Centers for Medicare and Medicaid
25    Services approval of the assessment authorized under
26    subsection (b-5) of Section 5A-2, received from hospital

 

 

10100SB2541ham001- 53 -LRB101 18248 KTG 72312 a

1    providers under Section 5A-4 and the payment methodologies
2    to hospitals required under Section 5A-12.4 was not
3    received by the Department until State fiscal year 2014 and
4    since the Department made retroactive payments during
5    State fiscal year 2014 related to the referenced period of
6    June 2012, the transfer authority granted in this paragraph
7    (7.12) is extended through the date that is 10 State
8    business days after June 16, 2014 (the effective date of
9    Public Act 98-651).
10        (7.13) In addition to any other transfers authorized
11    under this Section, for State fiscal years 2017 and 2018,
12    for making transfers to the Healthcare Provider Relief Fund
13    of moneys collected from the ACA Assessment Adjustment
14    authorized under subsections (a) and (b-5) of Section 5A-2
15    and paid by hospital providers under Section 5A-4 into the
16    Hospital Provider Fund under Section 5A-6 for each State
17    fiscal year. Timing of transfers to the Healthcare Provider
18    Relief Fund under this paragraph shall be at the discretion
19    of the Department, but no less frequently than quarterly.
20        (7.14) For making transfers not exceeding the
21    following amounts, related to State fiscal years 2019 and
22    2020 through 2024, to the following designated funds:
23            Health and Human Services Medicaid Trust
24                Fund..............................$20,000,000
25            Long-Term Care Provider Fund..........$30,000,000
26            Healthcare Health Care Provider Relief Fund

 

 

10100SB2541ham001- 54 -LRB101 18248 KTG 72312 a

1.......        $325,000,000.
2        Transfers under this paragraph shall be made within 7
3    days after the payments have been received pursuant to the
4    schedule of payments provided in subsection (a) of Section
5    5A-4.
6        (7.15) For making transfers not exceeding the
7    following amounts, related to State fiscal years 2021 and
8    2022, to the following designated funds:
9            Health and Human Services Medicaid Trust
10                Fund..............................$20,000,000
11            Long-Term Care Provider Fund..........$30,000,000
12            Healthcare Provider Relief Fund......$365,000,000
13        (7.16) For making transfers not exceeding the
14    following amounts, related to July 1, 2022 to December 31,
15    2022, to the following designated funds:
16            Health and Human Services Medicaid Trust
17                Fund..............................$10,000,000
18            Long-Term Care Provider Fund..........$15,000,000
19            Healthcare Provider Relief Fund......$182,500,000
20        (8) For making refunds to hospital providers pursuant
21    to Section 5A-10.
22        (9) For making payment to capitated managed care
23    organizations as described in subsections (s) and (t) of
24    Section 5A-12.2, and subsection (r) of Section 5A-12.6, and
25    Section 5A-12.7 of this Code.
26    Disbursements from the Fund, other than transfers

 

 

10100SB2541ham001- 55 -LRB101 18248 KTG 72312 a

1authorized under paragraphs (5) and (6) of this subsection,
2shall be by warrants drawn by the State Comptroller upon
3receipt of vouchers duly executed and certified by the Illinois
4Department.
5    (c) The Fund shall consist of the following:
6        (1) All moneys collected or received by the Illinois
7    Department from the hospital provider assessment imposed
8    by this Article.
9        (2) All federal matching funds received by the Illinois
10    Department as a result of expenditures made by the Illinois
11    Department that are attributable to moneys deposited in the
12    Fund.
13        (3) Any interest or penalty levied in conjunction with
14    the administration of this Article.
15        (3.5) As applicable, proceeds from surety bond
16    payments payable to the Department as referenced in
17    subsection (s) of Section 5A-12.2 of this Code.
18        (4) Moneys transferred from another fund in the State
19    treasury.
20        (5) All other moneys received for the Fund from any
21    other source, including interest earned thereon.
22    (d) (Blank).
23(Source: P.A. 99-78, eff. 7-20-15; 99-516, eff. 6-30-16;
2499-933, eff. 1-27-17; 100-581, eff. 3-12-18; 100-863, eff.
258-14-19; revised 7-12-19.)
 

 

 

10100SB2541ham001- 56 -LRB101 18248 KTG 72312 a

1    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
2    Sec. 5A-10. Applicability.
3    (a) The assessment imposed by subsection (a) of Section
45A-2 shall cease to be imposed and the Department's obligation
5to make payments shall immediately cease, and any moneys
6remaining in the Fund shall be refunded to hospital providers
7in proportion to the amounts paid by them, if:
8        (1) The payments to hospitals required under this
9    Article are not eligible for federal matching funds under
10    Title XIX or XXI of the Social Security Act;
11        (2) For State fiscal years 2009 through 2018, and as
12    provided in Section 5A-16, the Department of Healthcare and
13    Family Services adopts any administrative rule change to
14    reduce payment rates or alters any payment methodology that
15    reduces any payment rates made to operating hospitals under
16    the approved Title XIX or Title XXI State plan in effect
17    January 1, 2008 except for:
18            (A) any changes for hospitals described in
19        subsection (b) of Section 5A-3;
20            (B) any rates for payments made under this Article
21        V-A;
22            (C) any changes proposed in State plan amendment
23        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
24        08-07;
25            (D) in relation to any admissions on or after
26        January 1, 2011, a modification in the methodology for

 

 

10100SB2541ham001- 57 -LRB101 18248 KTG 72312 a

1        calculating outlier payments to hospitals for
2        exceptionally costly stays, for hospitals reimbursed
3        under the diagnosis-related grouping methodology in
4        effect on July 1, 2011; provided that the Department
5        shall be limited to one such modification during the
6        36-month period after the effective date of this
7        amendatory Act of the 96th General Assembly;
8            (E) any changes affecting hospitals authorized by
9        Public Act 97-689;
10        (F) any changes authorized by Section 14-12 of this
11        Code, or for any changes authorized under Section 5A-15
12        of this Code; or
13            (G) any changes authorized under Section 5-5b.1.
14    (b) The assessment imposed by Section 5A-2 shall not take
15effect or shall cease to be imposed, and the Department's
16obligation to make payments shall immediately cease, if the
17assessment is determined to be an impermissible tax under Title
18XIX of the Social Security Act. Moneys in the Hospital Provider
19Fund derived from assessments imposed prior thereto shall be
20disbursed in accordance with Section 5A-8 to the extent federal
21financial participation is not reduced due to the
22impermissibility of the assessments, and any remaining moneys
23shall be refunded to hospital providers in proportion to the
24amounts paid by them.
25    (c) The assessments imposed by subsection (b-5) of Section
265A-2 shall not take effect or shall cease to be imposed, the

 

 

10100SB2541ham001- 58 -LRB101 18248 KTG 72312 a

1Department's obligation to make payments shall immediately
2cease, and any moneys remaining in the Fund shall be refunded
3to hospital providers in proportion to the amounts paid by
4them, if the payments to hospitals required under Section
55A-12.4 or Section 5A-12.6 are not eligible for federal
6matching funds under Title XIX of the Social Security Act.
7    (d) The assessments imposed by Section 5A-2 shall not take
8effect or shall cease to be imposed, the Department's
9obligation to make payments shall immediately cease, and any
10moneys remaining in the Fund shall be refunded to hospital
11providers in proportion to the amounts paid by them, if:
12        (1) for State fiscal years 2013 through 2018, and as
13    provided in Section 5A-16, the Department reduces any
14    payment rates to hospitals as in effect on May 1, 2012, or
15    alters any payment methodology as in effect on May 1, 2012,
16    that has the effect of reducing payment rates to hospitals,
17    except for any changes affecting hospitals authorized in
18    Public Act 97-689 and any changes authorized by Section
19    14-12 of this Code, and except for any changes authorized
20    under Section 5A-15, and except for any changes authorized
21    under Section 5-5b.1;
22        (2) for State fiscal years 2013 through 2018, and as
23    provided in Section 5A-16, the Department reduces any
24    supplemental payments made to hospitals below the amounts
25    paid for services provided in State fiscal year 2011 as
26    implemented by administrative rules adopted and in effect

 

 

10100SB2541ham001- 59 -LRB101 18248 KTG 72312 a

1    on or prior to June 30, 2011, except for any changes
2    affecting hospitals authorized in Public Act 97-689 and any
3    changes authorized by Section 14-12 of this Code, and
4    except for any changes authorized under Section 5A-15, and
5    except for any changes authorized under Section 5-5b.1; or
6        (3) for State fiscal years 2015 through 2018, and as
7    provided in Section 5A-16, the Department reduces the
8    overall effective rate of reimbursement to hospitals below
9    the level authorized under Section 14-12 of this Code,
10    except for any changes under Section 14-12 or Section 5A-15
11    of this Code, and except for any changes authorized under
12    Section 5-5b.1.
13    (e) In Beginning in State fiscal year 2019 through State
14fiscal year 2020, the assessments imposed under Section 5A-2
15shall not take effect or shall cease to be imposed, the
16Department's obligation to make payments shall immediately
17cease, and any moneys remaining in the Fund shall be refunded
18to hospital providers in proportion to the amounts paid by
19them, if:
20        (1) the payments to hospitals required under Section
21    5A12.6 are not eligible for federal matching funds under
22    Title XIX of the Social Security Act; or
23        (2) the Department reduces the overall effective rate
24    of reimbursement to hospitals below the level authorized
25    under Section 14-12 of this Code, as in effect on December
26    31, 2017, except for any changes authorized under Sections

 

 

10100SB2541ham001- 60 -LRB101 18248 KTG 72312 a

1    14-12 or Section 5A-15 of this Code, and except for any
2    changes authorized under changes to Sections 5A-12.2,
3    5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by Public Act
4    100-581 this amendatory Act of the 100th General Assembly.
5    (f) Beginning in State Fiscal Year 2021, the assessments
6imposed under Section 5A-2 shall not take effect or shall cease
7to be imposed, the Department's obligation to make payments
8shall immediately cease, and any moneys remaining in the Fund
9shall be refunded to hospital providers in proportion to the
10amounts paid by them, if:
11        (1) the payments to hospitals required under Section
12    5A-12.7 are not eligible for federal matching funds under
13    Title XIX of the Social Security Act; or
14        (2) the Department reduces the overall effective rate
15    of reimbursement to hospitals below the level authorized
16    under Section 14-12, as in effect on December 31, 2019,
17    except for any changes authorized under Sections 14-12 or
18    5A-15, and except for any changes authorized under changes
19    to Sections 5A-12.7 and 14-12 made by this amendatory Act
20    of the 101st General Assembly.
21(Source: P.A. 99-2, eff. 3-26-15; 100-581, eff. 3-12-18.)
 
22    (305 ILCS 5/5A-12.7 new)
23    Sec. 5A-12.7. Continuation of hospital access payments on
24and after July 1, 2020.
25    (a) To preserve and improve access to hospital services,

 

 

10100SB2541ham001- 61 -LRB101 18248 KTG 72312 a

1for hospital services rendered on and after July 1, 2020, the
2Department shall, except for hospitals described in subsection
3(b) of Section 5A-3, make payments to hospitals or require
4capitated managed care organizations to make payments as set
5forth in this Section. Payments under this Section are not due
6and payable, however, until: (i) the methodologies described in
7this Section are approved by the federal government in an
8appropriate State Plan amendment or directed payment preprint;
9and (ii) the assessment imposed under this Article is
10determined to be a permissible tax under Title XIX of the
11Social Security Act. In determining the hospital access
12payments authorized under subsection (g) of this Section, if a
13hospital ceases to qualify for payments from the pool, the
14payments for all hospitals continuing to qualify for payments
15from such pool shall be uniformly adjusted to fully expend the
16aggregate net amount of the pool, with such adjustment being
17effective on the first day of the second month following the
18date the hospital ceases to receive payments from such pool.
19    (b) Amounts moved into claims-based rates and distributed
20in accordance with Section 14-12 shall remain in those
21claims-based rates.
22    (c) Graduate medical education.
23        (1) The calculation of graduate medical education
24    payments shall be based on the hospital's Medicare cost
25    report ending in Calendar Year 2018, as reported in the
26    Healthcare Cost Report Information System file, release

 

 

10100SB2541ham001- 62 -LRB101 18248 KTG 72312 a

1    date September 30, 2019. An Illinois hospital reporting
2    intern and resident cost on its Medicare cost report shall
3    be eligible for graduate medical education payments.
4        (2) Each hospital's annualized Medicaid Intern
5    Resident Cost is calculated using annualized intern and
6    resident total costs obtained from Worksheet B Part I,
7    Columns 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
8    96-98, and 105-112 multiplied by the percentage that the
9    hospital's Medicaid days (Worksheet S3 Part I, Column 7,
10    Lines 2, 3, 4, 14, 16-18, and 32) comprise of the
11    hospital's total days (Worksheet S3 Part I, Column 8, Lines
12    14, 16-18, and 32).
13        (3) An annualized Medicaid indirect medical education
14    (IME) payment is calculated for each hospital using its IME
15    payments (Worksheet E Part A, Line 29, Column 1) multiplied
16    by the percentage that its Medicaid days (Worksheet S3 Part
17    I, Column 7, Lines 2, 3, 4, 14, 16-18, and 32) comprise of
18    its Medicare days (Worksheet S3 Part I, Column 6, Lines 2,
19    3, 4, 14, and 16-18).
20        (4) For each hospital, its annualized Medicaid Intern
21    Resident Cost and its annualized Medicaid IME payment are
22    summed, and, except as capped at 120% of the average cost
23    per intern and resident for all qualifying hospitals as
24    calculated under this paragraph, is multiplied by 22.6% to
25    determine the hospital's final graduate medical education
26    payment. Each hospital's average cost per intern and

 

 

10100SB2541ham001- 63 -LRB101 18248 KTG 72312 a

1    resident shall be calculated by summing its total
2    annualized Medicaid Intern Resident Cost plus its
3    annualized Medicaid IME payment and dividing that amount by
4    the hospital's total Full Time Equivalent Residents and
5    Interns. If the hospital's average per intern and resident
6    cost is greater than 120% of the same calculation for all
7    qualifying hospitals, the hospital's per intern and
8    resident cost shall be capped at 120% of the average cost
9    for all qualifying hospitals.
10    (d) Fee-for-service supplemental payments. Each Illinois
11hospital shall receive an annual payment equal to the amounts
12below, to be paid in 12 equal installments on or before the
13seventh State business day of each month, except that no
14payment shall be due within 30 days after the later of the date
15of notification of federal approval of the payment
16methodologies required under this Section or any waiver
17required under 42 CFR 433.68, at which time the sum of amounts
18required under this Section prior to the date of notification
19is due and payable.
20        (1) For critical access hospitals, $385 per covered
21    inpatient day contained in paid fee-for-service claims and
22    $530 per paid fee-for-service outpatient claim for dates of
23    service in Calendar Year 2019 in the Department's
24    Enterprise Data Warehouse as of May 11, 2020.
25        (2) For safety-net hospitals, $960 per covered
26    inpatient day contained in paid fee-for-service claims and

 

 

10100SB2541ham001- 64 -LRB101 18248 KTG 72312 a

1    $625 per paid fee-for-service outpatient claim for dates of
2    service in Calendar Year 2019 in the Department's
3    Enterprise Data Warehouse as of May 11, 2020.
4        (3) For long term acute care hospitals, $295 per
5    covered inpatient day contained in paid fee-for-service
6    claims for dates of service in Calendar Year 2019 in the
7    Department's Enterprise Data Warehouse as of May 11, 2020.
8        (4) For freestanding psychiatric hospitals, $125 per
9    covered inpatient day contained in paid fee-for-service
10    claims and $130 per paid fee-for-service outpatient claim
11    for dates of service in Calendar Year 2019 in the
12    Department's Enterprise Data Warehouse as of May 11, 2020.
13        (5) For freestanding rehabilitation hospitals, $355
14    per covered inpatient day contained in paid
15    fee-for-service claims for dates of service in Calendar
16    Year 2019 in the Department's Enterprise Data Warehouse as
17    of May 11, 2020.
18        (6) For all general acute care hospitals and high
19    Medicaid hospitals as defined in subsection (f), $350 per
20    covered inpatient day for dates of service in Calendar Year
21    2019 contained in paid fee-for-service claims and $620 per
22    paid fee-for-service outpatient claim in the Department's
23    Enterprise Data Warehouse as of May 11, 2020.
24        (7) Alzheimer's treatment access payment. Each
25    Illinois academic medical center or teaching hospital, as
26    defined in Section 5-5e.2 of this Code, that is identified

 

 

10100SB2541ham001- 65 -LRB101 18248 KTG 72312 a

1    as the primary hospital affiliate of one of the Regional
2    Alzheimer's Disease Assistance Centers, as designated by
3    the Alzheimer's Disease Assistance Act and identified in
4    the Department of Public Health's Alzheimer's Disease
5    State Plan dated December 2016, shall be paid an
6    Alzheimer's treatment access payment equal to the product
7    of the qualifying hospital's State Fiscal Year 2018 total
8    inpatient fee-for-service days multiplied by the
9    applicable Alzheimer's treatment rate of $226.30 for
10    hospitals located in Cook County and $116.21 for hospitals
11    located outside Cook County.
12    (e) The Department shall require managed care
13organizations (MCOs) to make directed payments and
14pass-through payments according to this Section. Each calendar
15year, the Department shall require MCOs to pay the maximum
16amount out of these funds as allowed as pass-through payments
17under federal regulations. The Department shall require MCOs to
18make such pass-through payments as specified in this Section.
19The Department shall require the MCOs to pay the remaining
20amounts as directed Payments as specified in this Section. The
21Department shall issue payments to the Comptroller by the
22seventh business day of each month for all MCOs that are
23sufficient for MCOs to make the directed payments and
24pass-through payments according to this Section. The
25Department shall require the MCOs to make pass-through payments
26and directed payments using electronic funds transfers (EFT),

 

 

10100SB2541ham001- 66 -LRB101 18248 KTG 72312 a

1if the hospital provides the information necessary to process
2such EFTs, in accordance with directions provided monthly by
3the Department, within 7 business days of the date the funds
4are paid to the MCOs, as indicated by the "Paid Date" on the
5website of the Office of the Comptroller if the funds are paid
6by EFT and the MCOs have received directed payment
7instructions. If funds are not paid through the Comptroller by
8EFT, payment must be made within 7 business days of the date
9actually received by the MCO. The MCO will be considered to
10have paid the pass-through payments when the payment remittance
11number is generated or the date the MCO sends the check to the
12hospital, if EFT information is not supplied. If an MCO is late
13in paying a pass-through payment or directed payment as
14required under this Section (including any extensions granted
15by the Department), it shall pay a penalty, unless waived by
16the Department for reasonable cause, to the Department equal to
175% of the amount of the pass-through payment or directed
18payment not paid on or before the due date plus 5% of the
19portion thereof remaining unpaid on the last day of each 30-day
20period thereafter. Payments to MCOs that would be paid
21consistent with actuarial certification and enrollment in the
22absence of the increased capitation payments under this Section
23shall not be reduced as a consequence of payments made under
24this subsection. The Department shall publish and maintain on
25its website for a period of no less than 8 calendar quarters,
26the quarterly calculation of directed payments and

 

 

10100SB2541ham001- 67 -LRB101 18248 KTG 72312 a

1pass-through payments owed to each hospital from each MCO. All
2calculations and reports shall be posted no later than the
3first day of the quarter for which the payments are to be
4issued.
5    (f)(1) For purposes of allocating the funds included in
6capitation payments to MCOs, Illinois hospitals shall be
7divided into the following classes as defined in administrative
8rules:
9        (A) Critical access hospitals.
10        (B) Safety-net hospitals, except that stand-alone
11    children's hospitals that are not specialty children's
12    hospitals will not be included.
13        (C) Long term acute care hospitals.
14        (D) Freestanding psychiatric hospitals.
15        (E) Freestanding rehabilitation hospitals.
16        (F) High Medicaid hospitals. As used in this Section,
17    "high Medicaid hospital" means a general acute care
18    hospital that is not a safety-net hospital or critical
19    access hospital and that has a Medicaid Inpatient
20    Utilization Rate above 30% or a hospital that had over
21    35,000 inpatient Medicaid days during the applicable
22    period. For the period July 1, 2020 through December 31,
23    2020, the applicable period for the Medicaid Inpatient
24    Utilization Rate (MIUR) is the rate year 2020 MIUR and for
25    the number of inpatient days it is State fiscal year 2018.
26    Beginning in calendar year 2021, the Department shall use

 

 

10100SB2541ham001- 68 -LRB101 18248 KTG 72312 a

1    the most recently determined MIUR, as defined in subsection
2    (h) of Section 5-5.02, and for the inpatient day threshold,
3    the State fiscal year ending 18 months prior to the
4    beginning of the calendar year. For purposes of calculating
5    MIUR under this Section, children's hospitals and
6    affiliated general acute care hospitals shall be
7    considered a single hospital.
8        (G) General acute care hospitals. As used under this
9    Section, "general acute care hospitals" means all other
10    Illinois hospitals not identified in subparagraphs (A)
11    through (F).
12    (2) Hospitals' qualification for each class shall be
13assessed prior to the beginning of each calendar year and the
14new class designation shall be effective January 1 of the next
15year. The Department shall publish by rule the process for
16establishing class determination.
17    (g) Fixed pool directed payments. Beginning July 1, 2020,
18the Department shall issue payments to MCOs which shall be used
19to issue directed payments to qualified Illinois safety-net
20hospitals and critical access hospitals on a monthly basis in
21accordance with this subsection. Prior to the beginning of each
22Payout Quarter beginning July 1, 2020, the Department shall use
23encounter claims data from the Determination Quarter, accepted
24by the Department's Medicaid Management Information System for
25inpatient and outpatient services rendered by safety-net
26hospitals and critical access hospitals to determine a

 

 

10100SB2541ham001- 69 -LRB101 18248 KTG 72312 a

1quarterly uniform per unit add-on for each hospital class.
2        (1) Inpatient per unit add-on. A quarterly uniform per
3    diem add-on shall be derived by dividing the quarterly
4    Inpatient Directed Payments Pool amount allocated to the
5    applicable hospital class by the total inpatient days
6    contained on all encounter claims received during the
7    Determination Quarter, for all hospitals in the class.
8            (A) Each hospital in the class shall have a
9        quarterly inpatient directed payment calculated that
10        is equal to the product of the number of inpatient days
11        attributable to the hospital used in the calculation of
12        the quarterly uniform class per diem add-on,
13        multiplied by the calculated applicable quarterly
14        uniform class per diem add-on of the hospital class.
15            (B) Each hospital shall be paid 1/3 of its
16        quarterly inpatient directed payment in each of the 3
17        months of the Payout Quarter, in accordance with
18        directions provided to each MCO by the Department.
19        (2) Outpatient per unit add-on. A quarterly uniform per
20    claim add-on shall be derived by dividing the quarterly
21    Outpatient Directed Payments Pool amount allocated to the
22    applicable hospital class by the total outpatient
23    encounter claims received during the Determination
24    Quarter, for all hospitals in the class.
25            (A) Each hospital in the class shall have a
26        quarterly outpatient directed payment calculated that

 

 

10100SB2541ham001- 70 -LRB101 18248 KTG 72312 a

1        is equal to the product of the number of outpatient
2        encounter claims attributable to the hospital used in
3        the calculation of the quarterly uniform class per
4        claim add-on, multiplied by the calculated applicable
5        quarterly uniform class per claim add-on of the
6        hospital class.
7            (B) Each hospital shall be paid 1/3 of its
8        quarterly outpatient directed payment in each of the 3
9        months of the Payout Quarter, in accordance with
10        directions provided to each MCO by the Department.
11        (3) Each MCO shall pay each hospital the Monthly
12    Directed Payment as identified by the Department on its
13    quarterly determination report.
14        (4) Definitions. As used in this subsection:
15            (A) "Payout Quarter" means each 3 month calendar
16        quarter, beginning July 1, 2020.
17            (B) "Determination Quarter" means each 3 month
18        calendar quarter, which ends 3 months prior to the
19        first day of each Payout Quarter.
20        (5) For the period July 1, 2020 through December 2020,
21    the following amounts shall be allocated to the following
22    hospital class directed payment pools for the quarterly
23    development of a uniform per unit add-on:
24            (A) $2,894,500 for hospital inpatient services for
25        critical access hospitals.
26            (B) $4,294,374 for hospital outpatient services

 

 

10100SB2541ham001- 71 -LRB101 18248 KTG 72312 a

1        for critical access hospitals.
2            (C) $29,109,330 for hospital inpatient services
3        for safety-net hospitals.
4            (D) $35,041,218 for hospital outpatient services
5        for safety-net hospitals.
6    (h) Fixed rate directed payments. Effective July 1, 2020,
7the Department shall issue payments to MCOs which shall be used
8to issue directed payments to Illinois hospitals not identified
9in paragraph (g) on a monthly basis. Prior to the beginning of
10each Payout Quarter beginning July 1, 2020, the Department
11shall use encounter claims data from the Determination Quarter,
12accepted by the Department's Medicaid Management Information
13System for inpatient and outpatient services rendered by
14hospitals in each hospital class identified in paragraph (f)
15and not identified in paragraph (g). For the period July 1,
162020 through December 2020, the Department shall direct MCOs to
17make payments as follows:
18        (1) For general acute care hospitals an amount equal to
19    $1,750 multiplied by the hospital's category of service 20
20    case mix index for the determination quarter multiplied by
21    the hospital's total number of inpatient admissions for
22    category of service 20 for the determination quarter.
23        (2) For general acute care hospitals an amount equal to
24    $160 multiplied by the hospital's category of service 21
25    case mix index for the determination quarter multiplied by
26    the hospital's total number of inpatient admissions for

 

 

10100SB2541ham001- 72 -LRB101 18248 KTG 72312 a

1    category of service 21 for the determination quarter.
2        (3) For general acute care hospitals an amount equal to
3    $80 multiplied by the hospital's category of service 22
4    case mix index for the determination quarter multiplied by
5    the hospital's total number of inpatient admissions for
6    category of service 22 for the determination quarter.
7        (4) For general acute care hospitals an amount equal to
8    $375 multiplied by the hospital's category of service 24
9    case mix index for the determination quarter multiplied by
10    the hospital's total number of category of service 24 paid
11    EAPG (EAPGs) for the determination quarter.
12        (5) For general acute care hospitals an amount equal to
13    $240 multiplied by the hospital's category of service 27
14    and 28 case mix index for the determination quarter
15    multiplied by the hospital's total number of category of
16    service 27 and 28 paid EAPGs for the determination quarter.
17        (6) For general acute care hospitals an amount equal to
18    $290 multiplied by the hospital's category of service 29
19    case mix index for the determination quarter multiplied by
20    the hospital's total number of category of service 29 paid
21    EAPGs for the determination quarter.
22        (7) For high Medicaid hospitals an amount equal to
23    $1,800 multiplied by the hospital's category of service 20
24    case mix index for the determination quarter multiplied by
25    the hospital's total number of inpatient admissions for
26    category of service 20 for the determination quarter.

 

 

10100SB2541ham001- 73 -LRB101 18248 KTG 72312 a

1        (8) For high Medicaid hospitals an amount equal to $160
2    multiplied by the hospital's category of service 21 case
3    mix index for the determination quarter multiplied by the
4    hospital's total number of inpatient admissions for
5    category of service 21 for the determination quarter.
6        (9) For high Medicaid hospitals an amount equal to $80
7    multiplied by the hospital's category of service 22 case
8    mix index for the determination quarter multiplied by the
9    hospital's total number of inpatient admissions for
10    category of service 22 for the determination quarter.
11        (10) For high Medicaid hospitals an amount equal to
12    $400 multiplied by the hospital's category of service 24
13    case mix index for the determination quarter multiplied by
14    the hospital's total number of category of service 24 paid
15    EAPG outpatient claims for the determination quarter.
16        (11) For high Medicaid hospitals an amount equal to
17    $240 multiplied by the hospital's category of service 27
18    and 28 case mix index for the determination quarter
19    multiplied by the hospital's total number of category of
20    service 27 and 28 paid EAPGs for the determination quarter.
21        (12) For high Medicaid hospitals an amount equal to
22    $290 multiplied by the hospital's category of service 29
23    case mix index for the determination quarter multiplied by
24    the hospital's total number of category of service 29 paid
25    EAPGs for the determination quarter.
26        (13) For long term acute care hospitals the amount of

 

 

10100SB2541ham001- 74 -LRB101 18248 KTG 72312 a

1    $495 multiplied by the hospital's total number of inpatient
2    days for the determination quarter.
3        (14) For psychiatric hospitals the amount of $210
4    multiplied by the hospital's total number of inpatient days
5    for category of service 21 for the determination quarter.
6        (15) For psychiatric hospitals the amount of $250
7    multiplied by the hospital's total number of outpatient
8    claims for category of service 27 and 28 for the
9    determination quarter.
10        (16) For rehabilitation hospitals the amount of $410
11    multiplied by the hospital's total number of inpatient days
12    for category of service 22 for the determination quarter.
13        (17) For rehabilitation hospitals the amount of $100
14    multiplied by the hospital's total number of outpatient
15    claims for category of service 29 for the determination
16    quarter.
17        (18) Each hospital shall be paid 1/3 of their quarterly
18    inpatient and outpatient directed payment in each of the 3
19    months of the Payout Quarter, in accordance with directions
20    provided to each MCO by the Department.
21        (19) Each MCO shall pay each hospital the Monthly
22    Directed Payment amount as identified by the Department on
23    its quarterly determination report.
24    Notwithstanding any other provision of this subsection, if
25the Department determines that the actual total hospital
26utilization data that is used to calculate the fixed rate

 

 

10100SB2541ham001- 75 -LRB101 18248 KTG 72312 a

1directed payments is substantially different than anticipated
2when the rates in this subsection were initially determined
3(for unforeseeable circumstances such as the COVID-19
4pandemic), the Department may adjust the rates specified in
5this subsection so that the total directed payments approximate
6the total spending amount anticipated when the rates were
7initially established.
8    Definitions. As used in this subsection:
9            (A) "Payout Quarter" means each calendar quarter,
10        beginning July 1, 2020.
11            (B) "Determination Quarter" means each calendar
12        quarter which ends 3 months prior to the first day of
13        each Payout Quarter.
14            (C) "Case mix index" means a hospital specific
15        calculation. For inpatient claims the case mix index is
16        calculated each quarter by summing the relative weight
17        of all inpatient Diagnosis-Related Group (DRG) claims
18        for a category of service in the applicable
19        Determination Quarter and dividing the sum by the
20        number of sum total of all inpatient DRG admissions for
21        the category of service for the associated claims. The
22        case mix index for outpatient claims is calculated each
23        quarter by summing the relative weight of all paid
24        EAPGs in the applicable Determination Quarter and
25        dividing the sum by the sum total of paid EAPGs for the
26        associated claims.

 

 

10100SB2541ham001- 76 -LRB101 18248 KTG 72312 a

1    (i) Beginning January 1, 2021, the rates for directed
2payments shall be recalculated in order to spend the additional
3funds for directed payments that result from reduction in the
4amount of pass-through payments allowed under federal
5regulations. The additional funds for directed payments shall
6be allocated proportionally to each class of hospitals based on
7that class' proportion of services.
8    (j) Pass-through payments.
9        (1) For the period July 1, 2020 through December 31,
10    2020, the Department shall assign quarterly pass-through
11    payments to each class of hospitals equal to one-fourth of
12    the following annual allocations:
13            (A) $390,487,095 to safety-net hospitals.
14            (B) $62,553,886 to critical access hospitals.
15            (C) $345,021,438 to high Medicaid hospitals.
16            (D) $551,429,071 to general acute care hospitals.
17            (E) $27,283,870 to long term acute care hospitals.
18            (F) $40,825,444 to freestanding psychiatric
19        hospitals.
20            (G) $9,652,108 to freestanding rehabilitation
21        hospitals.
22        (2) The pass-through payments shall at a minimum ensure
23    hospitals receive a total amount of monthly payments under
24    this Section as received in calendar year 2019 in
25    accordance with this Article and paragraph (1) of
26    subsection (d-5) of Section 14-12, exclusive of amounts

 

 

10100SB2541ham001- 77 -LRB101 18248 KTG 72312 a

1    received through payments referenced in subsection (b).
2        (3) For the calendar year beginning January 1, 2021,
3    and each calendar year thereafter, each hospital's
4    pass-through payment amount shall be reduced
5    proportionally to the reduction of all pass-through
6    payments required by federal regulations.
7    (k) At least 30 days prior to each calendar year, the
8Department shall notify each hospital of changes to the payment
9methodologies in this Section, including, but not limited to,
10changes in the fixed rate directed payment rates, the aggregate
11pass-through payment amount for all hospitals, and the
12hospital's pass-through payment amount for the upcoming
13calendar year.
14    (l) Notwithstanding any other provisions of this Section,
15the Department may adopt rules to change the methodology for
16directed and pass-through payments as set forth in this
17Section, but only to the extent necessary to obtain federal
18approval of a necessary State Plan amendment or Directed
19Payment Preprint or to otherwise conform to federal law or
20federal regulation.
21    (m) As used in this subsection, "managed care organization"
22or "MCO" means an entity which contracts with the Department to
23provide services where payment for medical services is made on
24a capitated basis, excluding contracted entities for dual
25eligible or Department of Children and Family Services youth
26populations.
 

 

 

10100SB2541ham001- 78 -LRB101 18248 KTG 72312 a

1    (305 ILCS 5/5A-12.8 new)
2    Sec. 5A-12.8. Report to the General Assembly. In order to
3facilitate transparency, accountability, and future policy
4development by the General Assembly, the Department shall
5provide the reports and information specified in this Section.
6By February 1, 2022, the Department shall provide a report to
7the General Assembly that includes, but is not limited to, the
8following:
9        (1) information on the total payments made under
10    Section 5A-12.7 through December 1, 2021 broken out by
11    payment type; and
12        (2) after consulting the hospital community and other
13    interested parties, information that summarizes and
14    identifies options and stakeholder suggestions on the
15    following:
16            (A) policies and practices to improve access to
17        care, improve health, and reduce health disparities in
18        vulnerable communities;
19            (B) analysis of charity care by hospital;
20            (C) revisions to the payment methodology for
21        graduate medical education;
22            (D) revisions to the directed payment
23        methodologies, including the opportunity for hospitals
24        to shift from the fixed pool to the fixed rate directed
25        payments;

 

 

10100SB2541ham001- 79 -LRB101 18248 KTG 72312 a

1            (E) the definitions of and criteria to qualify as a
2        safety-net hospital, a high Medicaid hospital, or a
3        children's hospital; and
4            (F) options to revise the methodology for
5        calculating the assessment under Section 5A-2.
 
6    (305 ILCS 5/5A-13)
7    Sec. 5A-13. Emergency rulemaking.
8    (a) The Department of Healthcare and Family Services
9(formerly Department of Public Aid) may adopt rules necessary
10to implement this amendatory Act of the 94th General Assembly
11through the use of emergency rulemaking in accordance with
12Section 5-45 of the Illinois Administrative Procedure Act. For
13purposes of that Act, the General Assembly finds that the
14adoption of rules to implement this amendatory Act of the 94th
15General Assembly is deemed an emergency and necessary for the
16public interest, safety, and welfare.
17    (b) The Department of Healthcare and Family Services may
18adopt rules necessary to implement this amendatory Act of the
1997th General Assembly through the use of emergency rulemaking
20in accordance with Section 5-45 of the Illinois Administrative
21Procedure Act. For purposes of that Act, the General Assembly
22finds that the adoption of rules to implement this amendatory
23Act of the 97th General Assembly is deemed an emergency and
24necessary for the public interest, safety, and welfare.
25    (c) The Department of Healthcare and Family Services may

 

 

10100SB2541ham001- 80 -LRB101 18248 KTG 72312 a

1adopt rules necessary to initially implement the changes to
2Articles 5, 5A, 12, and 14 of this Code under this amendatory
3Act of the 100th General Assembly through the use of emergency
4rulemaking in accordance with subsection (aa) of Section 5-45
5of the Illinois Administrative Procedure Act. For purposes of
6that Act, the General Assembly finds that the adoption of rules
7to implement the changes to Articles 5, 5A, 12, and 14 of this
8Code under this amendatory Act of the 100th General Assembly is
9deemed an emergency and necessary for the public interest,
10safety, and welfare. The 24-month limitation on the adoption of
11emergency rules does not apply to rules adopted to initially
12implement the changes to Articles 5, 5A, 12, and 14 of this
13Code under this amendatory Act of the 100th General Assembly.
14For purposes of this subsection, "initially" means any
15emergency rules necessary to immediately implement the changes
16authorized to Articles 5, 5A, 12, and 14 of this Code under
17this amendatory Act of the 100th General Assembly; however,
18emergency rulemaking authority shall not be used to make
19changes that could otherwise be made following the process
20established in the Illinois Administrative Procedure Act.
21    (d) The Department of Healthcare and Family Services may on
22a one-time-only basis adopt rules necessary to initially
23implement the changes to Articles 5A and 14 of this Code under
24this amendatory Act of the 100th General Assembly through the
25use of emergency rulemaking in accordance with subsection (ee)
26of Section 5-45 of the Illinois Administrative Procedure Act.

 

 

10100SB2541ham001- 81 -LRB101 18248 KTG 72312 a

1For purposes of that Act, the General Assembly finds that the
2adoption of rules on a one-time-only basis to implement the
3changes to Articles 5A and 14 of this Code under this
4amendatory Act of the 100th General Assembly is deemed an
5emergency and necessary for the public interest, safety, and
6welfare. The 24-month limitation on the adoption of emergency
7rules does not apply to rules adopted to initially implement
8the changes to Articles 5A and 14 of this Code under this
9amendatory Act of the 100th General Assembly.
10    (e) The Department of Healthcare and Family Services may
11adopt rules necessary to implement the changes made to Articles
125, 5A, 12, and 14 of this Code by this amendatory Act of the
13101st General Assembly through the use of emergency rulemaking
14in accordance with Section 5-45.1 of the Illinois
15Administrative Procedure Act. The 24-month limitation on the
16adoption of emergency rules does not apply to rules adopted
17under this Section. The General Assembly finds that the
18adoption of rules to implement the changes made to Articles 5,
195A, 12, and 14 of this Code by this amendatory Act of the 101st
20General Assembly is deemed an emergency and necessary for the
21public interest, safety, and welfare.
22(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19.)
 
23    (305 ILCS 5/5A-14)
24    Sec. 5A-14. Repeal of assessments and disbursements.
25    (a) Section 5A-2 is repealed on December 31, 2022 July 1,

 

 

10100SB2541ham001- 82 -LRB101 18248 KTG 72312 a

12020.
2    (b) Section 5A-12 is repealed on July 1, 2005.
3    (c) Section 5A-12.1 is repealed on July 1, 2008.
4    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
5July 1, 2018, subject to Section 5A-16.
6    (e) Section 5A-12.3 is repealed on July 1, 2011.
7    (f) Section 5A-12.6 is repealed on July 1, 2020.
8    (g) Section 5A-12.7 is repealed on December 31, 2022.
9(Source: P.A. 100-581, eff. 3-12-18.)
 
10    (305 ILCS 5/5A-17 new)
11    Sec. 5A-17. Recovery of payments; liens.
12    (a) As a condition of receiving payments pursuant to
13subsections (d) and (k) of Section 5A-12.7 for State Fiscal
14Year 2021, a for-profit general acute care hospital that ceases
15to provide hospital services before July 1, 2021 and within 12
16months of a change in the hospital's ownership status from
17not-for-profit to investor owned, shall be obligated to pay to
18the Department an amount equal to the payments received
19pursuant to subsections (d) and (k) of Section 5A-12.7 since
20the change in ownership status to the cessation of hospital
21services. The obligated amount shall be due immediately and
22must be paid to the Department within 10 days of ceasing to
23provide services or pursuant to a payment plan approved by the
24Department unless the hospital requests a hearing under
25paragraph (d) of this Section. The obligation under this

 

 

10100SB2541ham001- 83 -LRB101 18248 KTG 72312 a

1Section shall not apply to a hospital that ceases to provide
2services under circumstances that include: implementation of a
3transformation project approved by the Department under
4subsection (d-5) of Section 14-12; emergencies as declared by
5federal, State, or local government; actions approved or
6required by federal, State, or local government; actions taken
7in compliance with the Illinois Health Facilities Planning Act;
8or other circumstances beyond the control of the hospital
9provider or for the benefit of the community previously served
10by the hospital, as determined on a case-by-case basis by the
11Department.
12    (b) The Illinois Department shall administer and enforce
13this Section and collect the obligations imposed under this
14Section using procedures employed in its administration of this
15Code generally. The Illinois Department, its Director, and
16every hospital provider subject to this Section shall have the
17following powers, duties, and rights:
18        (1) The Illinois Department may initiate either
19    administrative or judicial proceedings, or both, to
20    enforce the provisions of this Section. Administrative
21    enforcement proceedings initiated hereunder shall be
22    governed by the Illinois Department's administrative
23    rules. Judicial enforcement proceedings initiated in
24    accordance with this Section shall be governed by the rules
25    of procedure applicable in the courts of this State.
26        (2) No proceedings for collection, refund, credit, or

 

 

10100SB2541ham001- 84 -LRB101 18248 KTG 72312 a

1    other adjustment of an amount payable under this Section
2    shall be issued more than 3 years after the due date of the
3    obligation, except in the case of an extended period agreed
4    to in writing by the Illinois Department and the hospital
5    provider before the expiration of this limitation period.
6        (3) Any unpaid obligation under this Section shall
7    become a lien upon the assets of the hospital. If any
8    hospital provider sells or transfers the major part of any
9    one or more of (i) the real property and improvements, (ii)
10    the machinery and equipment, or (iii) the furniture or
11    fixtures of any hospital that is subject to the provisions
12    of this Section, the seller or transferor shall pay the
13    Illinois Department the amount of any obligation due from
14    it under this Section up to the date of the sale or
15    transfer. If the seller or transferor fails to pay any
16    amount due under this Section, the purchaser or transferee
17    of such asset shall be liable for the amount of the
18    obligation up to the amount of the reasonable value of the
19    property acquired by the purchaser or transferee. The
20    purchaser or transferee shall continue to be liable until
21    the purchaser or transferee pays the full amount of the
22    obligation up to the amount of the reasonable value of the
23    property acquired by the purchaser or transferee or until
24    the purchaser or transferee receives from the Illinois
25    Department a certificate showing that such assessment,
26    penalty, and interest have been paid or a certificate from

 

 

10100SB2541ham001- 85 -LRB101 18248 KTG 72312 a

1    the Illinois Department showing that no amount is due from
2    the seller or transferor under this Section.
3    (c) In addition to any other remedy provided for, the
4Illinois Department may collect an unpaid obligation by
5withholding, as payment of the amount due, reimbursements or
6other amounts otherwise payable by the Illinois Department to
7the hospital provider.
 
8    (305 ILCS 5/12-4.105)
9    Sec. 12-4.105. Human poison control center; payment
10program. Subject to funding availability resulting from
11transfers made from the Hospital Provider Fund to the
12Healthcare Provider Relief Fund as authorized under this Code,
13for State fiscal year 2017 and State fiscal year 2018, and for
14each State fiscal year thereafter in which the assessment under
15Section 5A-2 is imposed, the Department of Healthcare and
16Family Services shall pay to the human poison control center
17designated under the Poison Control System Act an amount of not
18less than $3,000,000 for each of those State fiscal years 2017
19through 2020, and for State fiscal year 2021 and 2022 an amount
20of not less than $3,750,000 and for the period July 1, 2022
21through December 31, 2022 an amount of not less than
22$1,875,000, if that the human poison control center is in
23operation.
24(Source: P.A. 99-516, eff. 6-30-16; 100-581, eff. 3-12-18.)
 

 

 

10100SB2541ham001- 86 -LRB101 18248 KTG 72312 a

1    (305 ILCS 5/14-12)
2    Sec. 14-12. Hospital rate reform payment system. The
3hospital payment system pursuant to Section 14-11 of this
4Article shall be as follows:
5    (a) Inpatient hospital services. Effective for discharges
6on and after July 1, 2014, reimbursement for inpatient general
7acute care services shall utilize the All Patient Refined
8Diagnosis Related Grouping (APR-DRG) software, version 30,
9distributed by 3MTM Health Information System.
10        (1) The Department shall establish Medicaid weighting
11    factors to be used in the reimbursement system established
12    under this subsection. Initial weighting factors shall be
13    the weighting factors as published by 3M Health Information
14    System, associated with Version 30.0 adjusted for the
15    Illinois experience.
16        (2) The Department shall establish a
17    statewide-standardized amount to be used in the inpatient
18    reimbursement system. The Department shall publish these
19    amounts on its website no later than 10 calendar days prior
20    to their effective date.
21        (3) In addition to the statewide-standardized amount,
22    the Department shall develop adjusters to adjust the rate
23    of reimbursement for critical Medicaid providers or
24    services for trauma, transplantation services, perinatal
25    care, and Graduate Medical Education (GME).
26        (4) The Department shall develop add-on payments to

 

 

10100SB2541ham001- 87 -LRB101 18248 KTG 72312 a

1    account for exceptionally costly inpatient stays,
2    consistent with Medicare outlier principles. Outlier fixed
3    loss thresholds may be updated to control for excessive
4    growth in outlier payments no more frequently than on an
5    annual basis, but at least triennially. Upon updating the
6    fixed loss thresholds, the Department shall be required to
7    update base rates within 12 months.
8        (5) The Department shall define those hospitals or
9    distinct parts of hospitals that shall be exempt from the
10    APR-DRG reimbursement system established under this
11    Section. The Department shall publish these hospitals'
12    inpatient rates on its website no later than 10 calendar
13    days prior to their effective date.
14        (6) Beginning July 1, 2014 and ending on June 30, 2024,
15    in addition to the statewide-standardized amount, the
16    Department shall develop an adjustor to adjust the rate of
17    reimbursement for safety-net hospitals defined in Section
18    5-5e.1 of this Code excluding pediatric hospitals.
19        (7) Beginning July 1, 2014 and ending on June 30, 2020,
20    or upon implementation of inpatient psychiatric rate
21    increases as described in subsection (n) of Section
22    5A-12.6, in addition to the statewide-standardized amount,
23    the Department shall develop an adjustor to adjust the rate
24    of reimbursement for Illinois freestanding inpatient
25    psychiatric hospitals that are not designated as
26    children's hospitals by the Department but are primarily

 

 

10100SB2541ham001- 88 -LRB101 18248 KTG 72312 a

1    treating patients under the age of 21.
2        (7.5) (Blank). Beginning July 1, 2020, the
3    reimbursement for inpatient psychiatric services shall be
4    so that base claims projected reimbursement is increased by
5    an amount equal to the funds allocated in paragraph (2) of
6    subsection (b) of Section 5A-12.6, less the amount
7    allocated under paragraphs (8) and (9) of this subsection
8    and paragraphs (3) and (4) of subsection (b) multiplied by
9    13%. Beginning July 1, 2022, the reimbursement for
10    inpatient psychiatric services shall be so that base claims
11    projected reimbursement is increased by an amount equal to
12    the funds allocated in paragraph (3) of subsection (b) of
13    Section 5A-12.6, less the amount allocated under
14    paragraphs (8) and (9) of this subsection and paragraphs
15    (3) and (4) of subsection (b) multiplied by 13%. Beginning
16    July 1, 2024, the reimbursement for inpatient psychiatric
17    services shall be so that base claims projected
18    reimbursement is increased by an amount equal to the funds
19    allocated in paragraph (4) of subsection (b) of Section
20    5A-12.6, less the amount allocated under paragraphs (8) and
21    (9) of this subsection and paragraphs (3) and (4) of
22    subsection (b) multiplied by 13%.
23        (8) Beginning July 1, 2018, in addition to the
24    statewide-standardized amount, the Department shall adjust
25    the rate of reimbursement for hospitals designated by the
26    Department of Public Health as a Perinatal Level II or II+

 

 

10100SB2541ham001- 89 -LRB101 18248 KTG 72312 a

1    center by applying the same adjustor that is applied to
2    Perinatal and Obstetrical care cases for Perinatal Level
3    III centers, as of December 31, 2017.
4        (9) Beginning July 1, 2018, in addition to the
5    statewide-standardized amount, the Department shall apply
6    the same adjustor that is applied to trauma cases as of
7    December 31, 2017 to inpatient claims to treat patients
8    with burns, including, but not limited to, APR-DRGs 841,
9    842, 843, and 844.
10        (10) Beginning July 1, 2018, the
11    statewide-standardized amount for inpatient general acute
12    care services shall be uniformly increased so that base
13    claims projected reimbursement is increased by an amount
14    equal to the funds allocated in paragraph (1) of subsection
15    (b) of Section 5A-12.6, less the amount allocated under
16    paragraphs (8) and (9) of this subsection and paragraphs
17    (3) and (4) of subsection (b) multiplied by 40%. Beginning
18    July 1, 2020, the statewide-standardized amount for
19    inpatient general acute care services shall be uniformly
20    increased so that base claims projected reimbursement is
21    increased by an amount equal to the funds allocated in
22    paragraph (2) of subsection (b) of Section 5A-12.6, less
23    the amount allocated under paragraphs (8) and (9) of this
24    subsection and paragraphs (3) and (4) of subsection (b)
25    multiplied by 40%. Beginning July 1, 2022, the
26    statewide-standardized amount for inpatient general acute

 

 

10100SB2541ham001- 90 -LRB101 18248 KTG 72312 a

1    care services shall be uniformly increased so that base
2    claims projected reimbursement is increased by an amount
3    equal to the funds allocated in paragraph (3) of subsection
4    (b) of Section 5A-12.6, less the amount allocated under
5    paragraphs (8) and (9) of this subsection and paragraphs
6    (3) and (4) of subsection (b) multiplied by 40%. Beginning
7    July 1, 2023 the statewide-standardized amount for
8    inpatient general acute care services shall be uniformly
9    increased so that base claims projected reimbursement is
10    increased by an amount equal to the funds allocated in
11    paragraph (4) of subsection (b) of Section 5A-12.6, less
12    the amount allocated under paragraphs (8) and (9) of this
13    subsection and paragraphs (3) and (4) of subsection (b)
14    multiplied by 40%.
15        (11) Beginning July 1, 2018, the reimbursement for
16    inpatient rehabilitation services shall be increased by
17    the addition of a $96 per day add-on.
18        Beginning July 1, 2020, the reimbursement for
19    inpatient rehabilitation services shall be uniformly
20    increased so that the $96 per day add-on is increased by an
21    amount equal to the funds allocated in paragraph (2) of
22    subsection (b) of Section 5A-12.6, less the amount
23    allocated under paragraphs (8) and (9) of this subsection
24    and paragraphs (3) and (4) of subsection (b) multiplied by
25    0.9%.
26        Beginning July 1, 2022, the reimbursement for

 

 

10100SB2541ham001- 91 -LRB101 18248 KTG 72312 a

1    inpatient rehabilitation services shall be uniformly
2    increased so that the $96 per day add-on as adjusted by the
3    July 1, 2020 increase, is increased by an amount equal to
4    the funds allocated in paragraph (3) of subsection (b) of
5    Section 5A-12.6, less the amount allocated under
6    paragraphs (8) and (9) of this subsection and paragraphs
7    (3) and (4) of subsection (b) multiplied by 0.9%.
8        Beginning July 1, 2023, the reimbursement for
9    inpatient rehabilitation services shall be uniformly
10    increased so that the $96 per day add-on as adjusted by the
11    July 1, 2022 increase, is increased by an amount equal to
12    the funds allocated in paragraph (4) of subsection (b) of
13    Section 5A-12.6, less the amount allocated under
14    paragraphs (8) and (9) of this subsection and paragraphs
15    (3) and (4) of subsection (b) multiplied by 0.9%.
16    (b) Outpatient hospital services. Effective for dates of
17service on and after July 1, 2014, reimbursement for outpatient
18services shall utilize the Enhanced Ambulatory Procedure
19Grouping (EAPG) software, version 3.7 distributed by 3MTM
20Health Information System.
21        (1) The Department shall establish Medicaid weighting
22    factors to be used in the reimbursement system established
23    under this subsection. The initial weighting factors shall
24    be the weighting factors as published by 3M Health
25    Information System, associated with Version 3.7.
26        (2) The Department shall establish service specific

 

 

10100SB2541ham001- 92 -LRB101 18248 KTG 72312 a

1    statewide-standardized amounts to be used in the
2    reimbursement system.
3            (A) The initial statewide standardized amounts,
4        with the labor portion adjusted by the Calendar Year
5        2013 Medicare Outpatient Prospective Payment System
6        wage index with reclassifications, shall be published
7        by the Department on its website no later than 10
8        calendar days prior to their effective date.
9            (B) The Department shall establish adjustments to
10        the statewide-standardized amounts for each Critical
11        Access Hospital, as designated by the Department of
12        Public Health in accordance with 42 CFR 485, Subpart F.
13        For outpatient services provided on or before June 30,
14        2018, the EAPG standardized amounts are determined
15        separately for each critical access hospital such that
16        simulated EAPG payments using outpatient base period
17        paid claim data plus payments under Section 5A-12.4 of
18        this Code net of the associated tax costs are equal to
19        the estimated costs of outpatient base period claims
20        data with a rate year cost inflation factor applied.
21        (3) In addition to the statewide-standardized amounts,
22    the Department shall develop adjusters to adjust the rate
23    of reimbursement for critical Medicaid hospital outpatient
24    providers or services, including outpatient high volume or
25    safety-net hospitals. Beginning July 1, 2018, the
26    outpatient high volume adjustor shall be increased to

 

 

10100SB2541ham001- 93 -LRB101 18248 KTG 72312 a

1    increase annual expenditures associated with this adjustor
2    by $79,200,000, based on the State Fiscal Year 2015 base
3    year data and this adjustor shall apply to public
4    hospitals, except for large public hospitals, as defined
5    under 89 Ill. Adm. Code 148.25(a).
6        (4) Beginning July 1, 2018, in addition to the
7    statewide standardized amounts, the Department shall make
8    an add-on payment for outpatient expensive devices and
9    drugs. This add-on payment shall at least apply to claim
10    lines that: (i) are assigned with one of the following
11    EAPGs: 490, 1001 to 1020, and coded with one of the
12    following revenue codes: 0274 to 0276, 0278; or (ii) are
13    assigned with one of the following EAPGs: 430 to 441, 443,
14    444, 460 to 465, 495, 496, 1090. The add-on payment shall
15    be calculated as follows: the claim line's covered charges
16    multiplied by the hospital's total acute cost to charge
17    ratio, less the claim line's EAPG payment plus $1,000,
18    multiplied by 0.8.
19        (5) Beginning July 1, 2018, the statewide-standardized
20    amounts for outpatient services shall be increased by a
21    uniform percentage so that base claims projected
22    reimbursement is increased by an amount equal to no less
23    than the funds allocated in paragraph (1) of subsection (b)
24    of Section 5A-12.6, less the amount allocated under
25    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
26    and (4) of this subsection multiplied by 46%. Beginning

 

 

10100SB2541ham001- 94 -LRB101 18248 KTG 72312 a

1    July 1, 2020, the statewide-standardized amounts for
2    outpatient services shall be increased by a uniform
3    percentage so that base claims projected reimbursement is
4    increased by an amount equal to no less than the funds
5    allocated in paragraph (2) of subsection (b) of Section
6    5A-12.6, less the amount allocated under paragraphs (8) and
7    (9) of subsection (a) and paragraphs (3) and (4) of this
8    subsection multiplied by 46%. Beginning July 1, 2022, the
9    statewide-standardized amounts for outpatient services
10    shall be increased by a uniform percentage so that base
11    claims projected reimbursement is increased by an amount
12    equal to the funds allocated in paragraph (3) of subsection
13    (b) of Section 5A-12.6, less the amount allocated under
14    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
15    and (4) of this subsection multiplied by 46%. Beginning
16    July 1, 2023, the statewide-standardized amounts for
17    outpatient services shall be increased by a uniform
18    percentage so that base claims projected reimbursement is
19    increased by an amount equal to no less than the funds
20    allocated in paragraph (4) of subsection (b) of Section
21    5A-12.6, less the amount allocated under paragraphs (8) and
22    (9) of subsection (a) and paragraphs (3) and (4) of this
23    subsection multiplied by 46%.
24        (6) Effective for dates of service on or after July 1,
25    2018, the Department shall establish adjustments to the
26    statewide-standardized amounts for each Critical Access

 

 

10100SB2541ham001- 95 -LRB101 18248 KTG 72312 a

1    Hospital, as designated by the Department of Public Health
2    in accordance with 42 CFR 485, Subpart F, such that each
3    Critical Access Hospital's standardized amount for
4    outpatient services shall be increased by the applicable
5    uniform percentage determined pursuant to paragraph (5) of
6    this subsection. It is the intent of the General Assembly
7    that the adjustments required under this paragraph (6) by
8    Public Act 100-1181 this amendatory Act of the 100th
9    General Assembly shall be applied retroactively to claims
10    for dates of service provided on or after July 1, 2018.
11        (7) Effective for dates of service on or after March 8,
12    2019 (the effective date of Public Act 100-1181) this
13    amendatory Act of the 100th General Assembly, the
14    Department shall recalculate and implement an updated
15    statewide-standardized amount for outpatient services
16    provided by hospitals that are not Critical Access
17    Hospitals to reflect the applicable uniform percentage
18    determined pursuant to paragraph (5).
19            (1) Any recalculation to the
20        statewide-standardized amounts for outpatient services
21        provided by hospitals that are not Critical Access
22        Hospitals shall be the amount necessary to achieve the
23        increase in the statewide-standardized amounts for
24        outpatient services increased by a uniform percentage,
25        so that base claims projected reimbursement is
26        increased by an amount equal to no less than the funds

 

 

10100SB2541ham001- 96 -LRB101 18248 KTG 72312 a

1        allocated in paragraph (1) of subsection (b) of Section
2        5A-12.6, less the amount allocated under paragraphs
3        (8) and (9) of subsection (a) and paragraphs (3) and
4        (4) of this subsection, for all hospitals that are not
5        Critical Access Hospitals, multiplied by 46%.
6            (2) It is the intent of the General Assembly that
7        the recalculations required under this paragraph (7)
8        by Public Act 100-1181 this amendatory Act of the 100th
9        General Assembly shall be applied prospectively to
10        claims for dates of service provided on or after March
11        8, 2019 (the effective date of Public Act 100-1181)
12        this amendatory Act of the 100th General Assembly and
13        that no recoupment or repayment by the Department or an
14        MCO of payments attributable to recalculation under
15        this paragraph (7), issued to the hospital for dates of
16        service on or after July 1, 2018 and before March 8,
17        2019 (the effective date of Public Act 100-1181) this
18        amendatory Act of the 100th General Assembly, shall be
19        permitted.
20        (8) The Department shall ensure that all necessary
21    adjustments to the managed care organization capitation
22    base rates necessitated by the adjustments under
23    subparagraph (6) or (7) of this subsection are completed
24    and applied retroactively in accordance with Section
25    5-30.8 of this Code within 90 days of March 8, 2019 (the
26    effective date of Public Act 100-1181) this amendatory Act

 

 

10100SB2541ham001- 97 -LRB101 18248 KTG 72312 a

1    of the 100th General Assembly.
2        (9) Within 60 days after federal approval of the change
3    made to the assessment in Section 5A-2 by this amendatory
4    Act of the 101st General Assembly, the Department shall
5    incorporate into the EAPG system for outpatient services
6    those services performed by hospitals currently billed
7    through the Non-Institutional Provider billing system.
8    (c) In consultation with the hospital community, the
9Department is authorized to replace 89 Ill. Admin. Code 152.150
10as published in 38 Ill. Reg. 4980 through 4986 within 12 months
11of June 16, 2014 (the effective date of Public Act 98-651). If
12the Department does not replace these rules within 12 months of
13June 16, 2014 (the effective date of Public Act 98-651), the
14rules in effect for 152.150 as published in 38 Ill. Reg. 4980
15through 4986 shall remain in effect until modified by rule by
16the Department. Nothing in this subsection shall be construed
17to mandate that the Department file a replacement rule.
18    (d) Transition period. There shall be a transition period
19to the reimbursement systems authorized under this Section that
20shall begin on the effective date of these systems and continue
21until June 30, 2018, unless extended by rule by the Department.
22To help provide an orderly and predictable transition to the
23new reimbursement systems and to preserve and enhance access to
24the hospital services during this transition, the Department
25shall allocate a transitional hospital access pool of at least
26$290,000,000 annually so that transitional hospital access

 

 

10100SB2541ham001- 98 -LRB101 18248 KTG 72312 a

1payments are made to hospitals.
2        (1) After the transition period, the Department may
3    begin incorporating the transitional hospital access pool
4    into the base rate structure; however, the transitional
5    hospital access payments in effect on June 30, 2018 shall
6    continue to be paid, if continued under Section 5A-16.
7        (2) After the transition period, if the Department
8    reduces payments from the transitional hospital access
9    pool, it shall increase base rates, develop new adjustors,
10    adjust current adjustors, develop new hospital access
11    payments based on updated information, or any combination
12    thereof by an amount equal to the decreases proposed in the
13    transitional hospital access pool payments, ensuring that
14    the entire transitional hospital access pool amount shall
15    continue to be used for hospital payments.
16    (d-5) Hospital and health care transformation program. The
17Department, in conjunction with the Hospital Transformation
18Review Committee created under subsection (d-5), shall develop
19a hospital and health care transformation program to provide
20financial assistance to hospitals in transforming their
21services and care models to better align with the needs of the
22communities they serve. The payments authorized in this Section
23shall be subject to approval by the federal government.
24        (1) Phase 1. In State fiscal years 2019 through 2020,
25    the Department shall allocate funds from the transitional
26    access hospital pool to create a hospital transformation

 

 

10100SB2541ham001- 99 -LRB101 18248 KTG 72312 a

1    pool of at least $262,906,870 annually and make hospital
2    transformation payments to hospitals. Subject to Section
3    5A-16, in State fiscal years 2019 and 2020, an Illinois
4    hospital that received either a transitional hospital
5    access payment under subsection (d) or a supplemental
6    payment under subsection (f) of this Section in State
7    fiscal year 2018, shall receive a hospital transformation
8    payment as follows:
9            (A) If the hospital's Rate Year 2017 Medicaid
10        inpatient utilization rate is equal to or greater than
11        45%, the hospital transformation payment shall be
12        equal to 100% of the sum of its transitional hospital
13        access payment authorized under subsection (d) and any
14        supplemental payment authorized under subsection (f).
15            (B) If the hospital's Rate Year 2017 Medicaid
16        inpatient utilization rate is equal to or greater than
17        25% but less than 45%, the hospital transformation
18        payment shall be equal to 75% of the sum of its
19        transitional hospital access payment authorized under
20        subsection (d) and any supplemental payment authorized
21        under subsection (f).
22            (C) If the hospital's Rate Year 2017 Medicaid
23        inpatient utilization rate is less than 25%, the
24        hospital transformation payment shall be equal to 50%
25        of the sum of its transitional hospital access payment
26        authorized under subsection (d) and any supplemental

 

 

10100SB2541ham001- 100 -LRB101 18248 KTG 72312 a

1        payment authorized under subsection (f).
2        (2) Phase 2.
3            (A) The funding amount from phase one shall be
4        incorporated into directed payment and pass-through
5        payment methodologies described in Section 5A-12.7.
6        During State fiscal years 2021 and 2022, the Department
7        shall allocate funds from the transitional access
8        hospital pool to create a hospital transformation pool
9        annually and make hospital transformation payments to
10        hospitals participating in the transformation program.
11        Any hospital may seek transformation funding in Phase
12        2. Any hospital that seeks transformation funding in
13        Phase 2 to update or repurpose the hospital's physical
14        structure to transition to a new delivery model, must
15        submit to the Department in writing a transformation
16        plan, based on the Department's guidelines, that
17        describes the desired delivery model with projections
18        of patient volumes by service lines and projected
19        revenues, expenses, and net income that correspond to
20        the new delivery model. In Phase 2, subject to the
21        approval of rules, the Department may use the hospital
22        transformation pool to increase base rates, develop
23        new adjustors, adjust current adjustors, or develop
24        new access payments in order to support and incentivize
25        hospitals to pursue such transformation. In developing
26        such methodologies, the Department shall ensure that

 

 

10100SB2541ham001- 101 -LRB101 18248 KTG 72312 a

1        the entire hospital transformation pool continues to
2        be expended to ensure access to hospital services or to
3        support organizations that had received hospital
4        transformation payments under this Section.
5            (B) Whereas there are communities in Illinois that
6        suffer from significant health care disparities
7        aggravated by social determinants of health and a lack
8        of sufficiently allocated healthcare resources,
9        particularly community-based services and preventive
10        care, there is established a new hospital and health
11        care transformation program, which shall be supported
12        by a transformation funding pool. An application for
13        funding from the hospital and health care
14        transformation program may incorporate the campus of a
15        hospital closed after January 1, 2018 or a hospital
16        that has provided notice of its intent to close
17        pursuant to Section 8.7 of the Illinois Health
18        Facilities Planning Act. During State Fiscal Years
19        2021 through 2023, the hospital and health care
20        transformation program shall be supported by an annual
21        transformation funding pool of at least $150,000,000
22        to be allocated during the specified fiscal years for
23        the purpose of facilitating hospital and health care
24        transformation. The Department shall not allocate
25        funds associated with the hospital and health care
26        transformation pool as established in this

 

 

10100SB2541ham001- 102 -LRB101 18248 KTG 72312 a

1        subparagraph until the General Assembly has
2        established in law or resolution, further criteria for
3        dispersal or allocation of those funds after the
4        effective date of this amendatory Act of 101st General
5        Assembly.
6            (A) Any hospital participating in the hospital
7        transformation program shall provide an opportunity
8        for public input by local community groups, hospital
9        workers, and healthcare professionals and assist in
10        facilitating discussions about any transformations or
11        changes to the hospital.
12            (C) (B) As provided in paragraph (9) of Section 3
13        of the Illinois Health Facilities Planning Act, any
14        hospital participating in the transformation program
15        may be excluded from the requirements of the Illinois
16        Health Facilities Planning Act for those projects
17        related to the hospital's transformation. To be
18        eligible, the hospital must submit to the Health
19        Facilities and Services Review Board approval from
20        certification from the Department, approved by the
21        Hospital Transformation Review Committee, that the
22        project is a part of the hospital's transformation.
23            (D) (C) As provided in subsection (a-20) of Section
24        32.5 of the Emergency Medical Services (EMS) Systems
25        Act, a hospital that received hospital transformation
26        payments under this Section may convert to a

 

 

10100SB2541ham001- 103 -LRB101 18248 KTG 72312 a

1        freestanding emergency center. To be eligible for such
2        a conversion, the hospital must submit to the
3        Department of Public Health approval certification
4        from the Department, approved by the Hospital
5        Transformation Review Committee, that the project is a
6        part of the hospital's transformation.
7        (3) (Blank). By April 1, 2019 March 12, 2018 (Public
8    Act 100-581) the Department, in conjunction with the
9    Hospital Transformation Review Committee, shall develop
10    and file as an administrative rule with the Secretary of
11    State the goals, objectives, policies, standards, payment
12    models, or criteria to be applied in Phase 2 of the program
13    to allocate the hospital transformation funds. The goals,
14    objectives, and policies to be considered may include, but
15    are not limited to, achieving unmet needs of a community
16    that a hospital serves such as behavioral health services,
17    outpatient services, or drug rehabilitation services;
18    attaining certain quality or patient safety benchmarks for
19    health care services; or improving the coordination,
20    effectiveness, and efficiency of care delivery.
21    Notwithstanding any other provision of law, any rule
22    adopted in accordance with this subsection (d-5) may be
23    submitted to the Joint Committee on Administrative Rules
24    for approval only if the rule has first been approved by 9
25    of the 14 members of the Hospital Transformation Review
26    Committee.

 

 

10100SB2541ham001- 104 -LRB101 18248 KTG 72312 a

1        (4) Hospital Transformation Review Committee. There is
2    created the Hospital Transformation Review Committee. The
3    Committee shall consist of 14 members. No later than 30
4    days after March 12, 2018 (the effective date of Public Act
5    100-581), the 4 legislative leaders shall each appoint 3
6    members; the Governor shall appoint the Director of
7    Healthcare and Family Services, or his or her designee, as
8    a member; and the Director of Healthcare and Family
9    Services shall appoint one member. Any vacancy shall be
10    filled by the applicable appointing authority within 15
11    calendar days. The members of the Committee shall select a
12    Chair and a Vice-Chair from among its members, provided
13    that the Chair and Vice-Chair cannot be appointed by the
14    same appointing authority and must be from different
15    political parties. The Chair shall have the authority to
16    establish a meeting schedule and convene meetings of the
17    Committee, and the Vice-Chair shall have the authority to
18    convene meetings in the absence of the Chair. The Committee
19    may establish its own rules with respect to meeting
20    schedule, notice of meetings, and the disclosure of
21    documents; however, the Committee shall not have the power
22    to subpoena individuals or documents and any rules must be
23    approved by 9 of the 14 members. The Committee shall
24    perform the functions described in this Section and advise
25    and consult with the Director in the administration of this
26    Section. In addition to reviewing and approving the

 

 

10100SB2541ham001- 105 -LRB101 18248 KTG 72312 a

1    policies, procedures, and rules for the hospital and health
2    care transformation program, the Committee shall consider
3    and make recommendations related to qualifying criteria
4    and payment methodologies related to safety-net hospitals
5    and children's hospitals. Members of the Committee
6    appointed by the legislative leaders shall be subject to
7    the jurisdiction of the Legislative Ethics Commission, not
8    the Executive Ethics Commission, and all requests under the
9    Freedom of Information Act shall be directed to the
10    applicable Freedom of Information officer for the General
11    Assembly. The Department shall provide operational support
12    to the Committee as necessary. The Committee is dissolved
13    on April 1, 2019.
14    (e) Beginning 36 months after initial implementation, the
15Department shall update the reimbursement components in
16subsections (a) and (b), including standardized amounts and
17weighting factors, and at least triennially and no more
18frequently than annually thereafter. The Department shall
19publish these updates on its website no later than 30 calendar
20days prior to their effective date.
21    (f) Continuation of supplemental payments. Any
22supplemental payments authorized under Illinois Administrative
23Code 148 effective January 1, 2014 and that continue during the
24period of July 1, 2014 through December 31, 2014 shall remain
25in effect as long as the assessment imposed by Section 5A-2
26that is in effect on December 31, 2017 remains in effect.

 

 

10100SB2541ham001- 106 -LRB101 18248 KTG 72312 a

1    (g) Notwithstanding subsections (a) through (f) of this
2Section and notwithstanding the changes authorized under
3Section 5-5b.1, any updates to the system shall not result in
4any diminishment of the overall effective rates of
5reimbursement as of the implementation date of the new system
6(July 1, 2014). These updates shall not preclude variations in
7any individual component of the system or hospital rate
8variations. Nothing in this Section shall prohibit the
9Department from increasing the rates of reimbursement or
10developing payments to ensure access to hospital services.
11Nothing in this Section shall be construed to guarantee a
12minimum amount of spending in the aggregate or per hospital as
13spending may be impacted by factors, including, but not limited
14to, the number of individuals in the medical assistance program
15and the severity of illness of the individuals.
16    (h) The Department shall have the authority to modify by
17rulemaking any changes to the rates or methodologies in this
18Section as required by the federal government to obtain federal
19financial participation for expenditures made under this
20Section.
21    (i) Except for subsections (g) and (h) of this Section, the
22Department shall, pursuant to subsection (c) of Section 5-40 of
23the Illinois Administrative Procedure Act, provide for
24presentation at the June 2014 hearing of the Joint Committee on
25Administrative Rules (JCAR) additional written notice to JCAR
26of the following rules in order to commence the second notice

 

 

10100SB2541ham001- 107 -LRB101 18248 KTG 72312 a

1period for the following rules: rules published in the Illinois
2Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
3(Medical Payment), 4628 (Specialized Health Care Delivery
4Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
5Grouping (DRG) Prospective Payment System (PPS)), and 4977
6(Hospital Reimbursement Changes), and published in the
7Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
8(Specialized Health Care Delivery Systems) and 6505 (Hospital
9Services).
10    (j) Out-of-state hospitals. Beginning July 1, 2018, for
11purposes of determining for State fiscal years 2019 and 2020
12and subsequent fiscal years the hospitals eligible for the
13payments authorized under subsections (a) and (b) of this
14Section, the Department shall include out-of-state hospitals
15that are designated a Level I pediatric trauma center or a
16Level I trauma center by the Department of Public Health as of
17December 1, 2017.
18    (k) The Department shall notify each hospital and managed
19care organization, in writing, of the impact of the updates
20under this Section at least 30 calendar days prior to their
21effective date.
22(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
23101-81, eff. 7-12-19; revised 7-29-19.)
 
24    Section 97. Severability. If any provision of this Act or
25application thereof to any person or circumstance is held

 

 

10100SB2541ham001- 108 -LRB101 18248 KTG 72312 a

1invalid, such invalidity does not affect other provisions or
2applications of this Act which can be given effect without the
3invalid application or provision, and to this end the
4provisions of this Act are declared to be severable.
 
5    Section 99. Effective date. This Act takes effect upon
6becoming law.".