SB2541 EnrolledLRB101 18248 KTG 67690 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois 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.
17    This Section is repealed on January 1, 2026.
 
18    (5 ILCS 100/5-46.3 rep.)
19    Section 10. The Illinois Administrative Procedure Act is
20amended by repealing Section 5-46.3.
 
21    Section 15. The Illinois Health Facilities Planning Act is

 

 

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1amended by changing Sections 3 and 8.7 as follows:
 
2    (20 ILCS 3960/3)  (from Ch. 111 1/2, par. 1153)
3    (Section scheduled to be repealed on December 31, 2029)
4    Sec. 3. Definitions. As used in this Act:
5    "Health care facilities" means and includes the following
6facilities, organizations, and related persons:
7        (1) An ambulatory surgical treatment center required
8    to be licensed pursuant to the Ambulatory Surgical
9    Treatment Center Act.
10        (2) An institution, place, building, or agency
11    required to be licensed pursuant to the Hospital Licensing
12    Act.
13        (3) Skilled and intermediate long term care facilities
14    licensed under the Nursing Home Care Act.
15            (A) If a demonstration project under the Nursing
16        Home Care Act applies for a certificate of need to
17        convert to a nursing facility, it shall meet the
18        licensure and certificate of need requirements in
19        effect as of the date of application.
20            (B) Except as provided in item (A) of this
21        subsection, this Act does not apply to facilities
22        granted waivers under Section 3-102.2 of the Nursing
23        Home Care Act.
24        (3.5) Skilled and intermediate care facilities
25    licensed under the ID/DD Community Care Act or the MC/DD

 

 

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1    Act. No permit or exemption is required for a facility
2    licensed under the ID/DD Community Care Act or the MC/DD
3    Act prior to the reduction of the number of beds at a
4    facility. If there is a total reduction of beds at a
5    facility licensed under the ID/DD Community Care Act or the
6    MC/DD Act, this is a discontinuation or closure of the
7    facility. If a facility licensed under the ID/DD Community
8    Care Act or the MC/DD Act reduces the number of beds or
9    discontinues the facility, that facility must notify the
10    Board as provided in Section 14.1 of this Act.
11        (3.7) Facilities licensed under the Specialized Mental
12    Health Rehabilitation Act of 2013.
13        (4) Hospitals, nursing homes, ambulatory surgical
14    treatment centers, or kidney disease treatment centers
15    maintained by the State or any department or agency
16    thereof.
17        (5) Kidney disease treatment centers, including a
18    free-standing hemodialysis unit required to meet the
19    requirements of 42 CFR 494 in order to be certified for
20    participation in Medicare and Medicaid under Titles XVIII
21    and XIX of the federal Social Security Act.
22            (A) This Act does not apply to a dialysis facility
23        that provides only dialysis training, support, and
24        related services to individuals with end stage renal
25        disease who have elected to receive home dialysis.
26            (B) This Act does not apply to a dialysis unit

 

 

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1        located in a licensed nursing home that offers or
2        provides dialysis-related services to residents with
3        end stage renal disease who have elected to receive
4        home dialysis within the nursing home.
5            (C) The Board, however, may require dialysis
6        facilities and licensed nursing homes under items (A)
7        and (B) of this subsection to report statistical
8        information on a quarterly basis to the Board to be
9        used by the Board to conduct analyses on the need for
10        proposed kidney disease treatment centers.
11        (6) An institution, place, building, or room used for
12    the performance of outpatient surgical procedures that is
13    leased, owned, or operated by or on behalf of an
14    out-of-state facility.
15        (7) An institution, place, building, or room used for
16    provision of a health care category of service, including,
17    but not limited to, cardiac catheterization and open heart
18    surgery.
19        (8) An institution, place, building, or room housing
20    major medical equipment used in the direct clinical
21    diagnosis or treatment of patients, and whose project cost
22    is in excess of the capital expenditure minimum.
23    "Health care facilities" does not include the following
24entities or facility transactions:
25        (1) Federally-owned facilities.
26        (2) Facilities used solely for healing by prayer or

 

 

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1    spiritual means.
2        (3) An existing facility located on any campus facility
3    as defined in Section 5-5.8b of the Illinois Public Aid
4    Code, provided that the campus facility encompasses 30 or
5    more contiguous acres and that the new or renovated
6    facility is intended for use by a licensed residential
7    facility.
8        (4) Facilities licensed under the Supportive
9    Residences Licensing Act or the Assisted Living and Shared
10    Housing Act.
11        (5) Facilities designated as supportive living
12    facilities that are in good standing with the program
13    established under Section 5-5.01a of the Illinois Public
14    Aid Code.
15        (6) Facilities established and operating under the
16    Alternative Health Care Delivery Act as a children's
17    community-based health care center alternative health care
18    model demonstration program or as an Alzheimer's Disease
19    Management Center alternative health care model
20    demonstration program.
21        (7) The closure of an entity or a portion of an entity
22    licensed under the Nursing Home Care Act, the Specialized
23    Mental Health Rehabilitation Act of 2013, the ID/DD
24    Community Care Act, or the MC/DD Act, with the exception of
25    facilities operated by a county or Illinois Veterans Homes,
26    that elect to convert, in whole or in part, to an assisted

 

 

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1    living or shared housing establishment licensed under the
2    Assisted Living and Shared Housing Act and with the
3    exception of a facility licensed under the Specialized
4    Mental Health Rehabilitation Act of 2013 in connection with
5    a proposal to close a facility and re-establish the
6    facility in another location.
7        (8) Any change of ownership of a health care facility
8    that is licensed under the Nursing Home Care Act, the
9    Specialized Mental Health Rehabilitation Act of 2013, the
10    ID/DD Community Care Act, or the MC/DD Act, with the
11    exception of facilities operated by a county or Illinois
12    Veterans Homes. Changes of ownership of facilities
13    licensed under the Nursing Home Care Act must meet the
14    requirements set forth in Sections 3-101 through 3-119 of
15    the Nursing Home Care Act.
16        (9) (Blank). Any project the Department of Healthcare
17    and Family Services certifies was approved by the Hospital
18    Transformation Review Committee as a project subject to the
19    hospital's transformation under subsection (d-5) of
20    Section 14-12 of the Illinois Public Aid Code, provided the
21    hospital shall submit the certification to the Board.
22    Nothing in this paragraph excludes a health care facility
23    from the requirements of this Act after the approved
24    transformation project is complete. All other requirements
25    under this Act continue to apply. Hospitals that are not
26    subject to this Act under this paragraph shall notify the

 

 

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1    Health Facilities and Services Review Board within 30 days
2    of the dates that bed changes or service changes occur.
3    With the exception of those health care facilities
4specifically included in this Section, nothing in this Act
5shall be intended to include facilities operated as a part of
6the practice of a physician or other licensed health care
7professional, whether practicing in his individual capacity or
8within the legal structure of any partnership, medical or
9professional corporation, or unincorporated medical or
10professional group. Further, this Act shall not apply to
11physicians or other licensed health care professional's
12practices where such practices are carried out in a portion of
13a health care facility under contract with such health care
14facility by a physician or by other licensed health care
15professionals, whether practicing in his individual capacity
16or within the legal structure of any partnership, medical or
17professional corporation, or unincorporated medical or
18professional groups, unless the entity constructs, modifies,
19or establishes a health care facility as specifically defined
20in this Section. This Act shall apply to construction or
21modification and to establishment by such health care facility
22of such contracted portion which is subject to facility
23licensing requirements, irrespective of the party responsible
24for such action or attendant financial obligation.
25    "Person" means any one or more natural persons, legal
26entities, governmental bodies other than federal, or any

 

 

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1combination thereof.
2    "Consumer" means any person other than a person (a) whose
3major occupation currently involves or whose official capacity
4within the last 12 months has involved the providing,
5administering or financing of any type of health care facility,
6(b) who is engaged in health research or the teaching of
7health, (c) who has a material financial interest in any
8activity which involves the providing, administering or
9financing of any type of health care facility, or (d) who is or
10ever has been a member of the immediate family of the person
11defined by item (a), (b), or (c).
12    "State Board" or "Board" means the Health Facilities and
13Services Review Board.
14    "Construction or modification" means the establishment,
15erection, building, alteration, reconstruction, modernization,
16improvement, extension, discontinuation, change of ownership,
17of or by a health care facility, or the purchase or acquisition
18by or through a health care facility of equipment or service
19for diagnostic or therapeutic purposes or for facility
20administration or operation, or any capital expenditure made by
21or on behalf of a health care facility which exceeds the
22capital expenditure minimum; however, any capital expenditure
23made by or on behalf of a health care facility for (i) the
24construction or modification of a facility licensed under the
25Assisted Living and Shared Housing Act or (ii) a conversion
26project undertaken in accordance with Section 30 of the Older

 

 

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1Adult Services Act shall be excluded from any obligations under
2this Act.
3    "Establish" means the construction of a health care
4facility or the replacement of an existing facility on another
5site or the initiation of a category of service.
6    "Major medical equipment" means medical equipment which is
7used for the provision of medical and other health services and
8which costs in excess of the capital expenditure minimum,
9except that such term does not include medical equipment
10acquired by or on behalf of a clinical laboratory to provide
11clinical laboratory services if the clinical laboratory is
12independent of a physician's office and a hospital and it has
13been determined under Title XVIII of the Social Security Act to
14meet the requirements of paragraphs (10) and (11) of Section
151861(s) of such Act. In determining whether medical equipment
16has a value in excess of the capital expenditure minimum, the
17value of studies, surveys, designs, plans, working drawings,
18specifications, and other activities essential to the
19acquisition of such equipment shall be included.
20    "Capital expenditure" means an expenditure: (A) made by or
21on behalf of a health care facility (as such a facility is
22defined in this Act); and (B) which under generally accepted
23accounting principles is not properly chargeable as an expense
24of operation and maintenance, or is made to obtain by lease or
25comparable arrangement any facility or part thereof or any
26equipment for a facility or part; and which exceeds the capital

 

 

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1expenditure minimum.
2    For the purpose of this paragraph, the cost of any studies,
3surveys, designs, plans, working drawings, specifications, and
4other activities essential to the acquisition, improvement,
5expansion, or replacement of any plant or equipment with
6respect to which an expenditure is made shall be included in
7determining if such expenditure exceeds the capital
8expenditures minimum. Unless otherwise interdependent, or
9submitted as one project by the applicant, components of
10construction or modification undertaken by means of a single
11construction contract or financed through the issuance of a
12single debt instrument shall not be grouped together as one
13project. Donations of equipment or facilities to a health care
14facility which if acquired directly by such facility would be
15subject to review under this Act shall be considered capital
16expenditures, and a transfer of equipment or facilities for
17less than fair market value shall be considered a capital
18expenditure for purposes of this Act if a transfer of the
19equipment or facilities at fair market value would be subject
20to review.
21    "Capital expenditure minimum" means $11,500,000 for
22projects by hospital applicants, $6,500,000 for applicants for
23projects related to skilled and intermediate care long-term
24care facilities licensed under the Nursing Home Care Act, and
25$3,000,000 for projects by all other applicants, which shall be
26annually adjusted to reflect the increase in construction costs

 

 

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1due to inflation, for major medical equipment and for all other
2capital expenditures.
3    "Financial commitment" means the commitment of at least 33%
4of total funds assigned to cover total project cost, which
5occurs by the actual expenditure of 33% or more of the total
6project cost or the commitment to expend 33% or more of the
7total project cost by signed contracts or other legal means.
8    "Non-clinical service area" means an area (i) for the
9benefit of the patients, visitors, staff, or employees of a
10health care facility and (ii) not directly related to the
11diagnosis, treatment, or rehabilitation of persons receiving
12services from the health care facility. "Non-clinical service
13areas" include, but are not limited to, chapels; gift shops;
14news stands; computer systems; tunnels, walkways, and
15elevators; telephone systems; projects to comply with life
16safety codes; educational facilities; student housing;
17patient, employee, staff, and visitor dining areas;
18administration and volunteer offices; modernization of
19structural components (such as roof replacement and masonry
20work); boiler repair or replacement; vehicle maintenance and
21storage facilities; parking facilities; mechanical systems for
22heating, ventilation, and air conditioning; loading docks; and
23repair or replacement of carpeting, tile, wall coverings,
24window coverings or treatments, or furniture. Solely for the
25purpose of this definition, "non-clinical service area" does
26not include health and fitness centers.

 

 

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1    "Areawide" means a major area of the State delineated on a
2geographic, demographic, and functional basis for health
3planning and for health service and having within it one or
4more local areas for health planning and health service. The
5term "region", as contrasted with the term "subregion", and the
6word "area" may be used synonymously with the term "areawide".
7    "Local" means a subarea of a delineated major area that on
8a geographic, demographic, and functional basis may be
9considered to be part of such major area. The term "subregion"
10may be used synonymously with the term "local".
11    "Physician" means a person licensed to practice in
12accordance with the Medical Practice Act of 1987, as amended.
13    "Licensed health care professional" means a person
14licensed to practice a health profession under pertinent
15licensing statutes of the State of Illinois.
16    "Director" means the Director of the Illinois Department of
17Public Health.
18    "Agency" or "Department" means the Illinois Department of
19Public Health.
20    "Alternative health care model" means a facility or program
21authorized under the Alternative Health Care Delivery Act.
22    "Out-of-state facility" means a person that is both (i)
23licensed as a hospital or as an ambulatory surgery center under
24the laws of another state or that qualifies as a hospital or an
25ambulatory surgery center under regulations adopted pursuant
26to the Social Security Act and (ii) not licensed under the

 

 

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1Ambulatory Surgical Treatment Center Act, the Hospital
2Licensing Act, or the Nursing Home Care Act. Affiliates of
3out-of-state facilities shall be considered out-of-state
4facilities. Affiliates of Illinois licensed health care
5facilities 100% owned by an Illinois licensed health care
6facility, its parent, or Illinois physicians licensed to
7practice medicine in all its branches shall not be considered
8out-of-state facilities. Nothing in this definition shall be
9construed to include an office or any part of an office of a
10physician licensed to practice medicine in all its branches in
11Illinois that is not required to be licensed under the
12Ambulatory Surgical Treatment Center Act.
13    "Change of ownership of a health care facility" means a
14change in the person who has ownership or control of a health
15care facility's physical plant and capital assets. A change in
16ownership is indicated by the following transactions: sale,
17transfer, acquisition, lease, change of sponsorship, or other
18means of transferring control.
19    "Related person" means any person that: (i) is at least 50%
20owned, directly or indirectly, by either the health care
21facility or a person owning, directly or indirectly, at least
2250% of the health care facility; or (ii) owns, directly or
23indirectly, at least 50% of the health care facility.
24    "Charity care" means care provided by a health care
25facility for which the provider does not expect to receive
26payment from the patient or a third-party payer.

 

 

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1    "Freestanding emergency center" means a facility subject
2to licensure under Section 32.5 of the Emergency Medical
3Services (EMS) Systems Act.
4    "Category of service" means a grouping by generic class of
5various types or levels of support functions, equipment, care,
6or treatment provided to patients or residents, including, but
7not limited to, classes such as medical-surgical, pediatrics,
8or cardiac catheterization. A category of service may include
9subcategories or levels of care that identify a particular
10degree or type of care within the category of service. Nothing
11in this definition shall be construed to include the practice
12of a physician or other licensed health care professional while
13functioning in an office providing for the care, diagnosis, or
14treatment of patients. A category of service that is subject to
15the Board's jurisdiction must be designated in rules adopted by
16the Board.
17    "State Board Staff Report" means the document that sets
18forth the review and findings of the State Board staff, as
19prescribed by the State Board, regarding applications subject
20to Board jurisdiction.
21(Source: P.A. 100-518, eff. 6-1-18; 100-581, eff. 3-12-18;
22100-957, eff. 8-19-18; 101-81, eff. 7-12-19.)
 
23    (20 ILCS 3960/8.7)
24    (Section scheduled to be repealed on December 31, 2029)
25    Sec. 8.7. Application for permit for discontinuation of a

 

 

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1health care facility or category of service; public notice and
2public hearing.
3    (a) Upon a finding that an application to close a health
4care facility or discontinue a category of service is complete,
5the State Board shall publish a legal notice on 3 consecutive
6days in a newspaper of general circulation in the area or
7community to be affected and afford the public an opportunity
8to request a hearing. If the application is for a facility
9located in a Metropolitan Statistical Area, an additional legal
10notice shall be published in a newspaper of limited
11circulation, if one exists, in the area in which the facility
12is located. If the newspaper of limited circulation is
13published on a daily basis, the additional legal notice shall
14be published on 3 consecutive days. The legal notice shall also
15be posted on the Health Facilities and Services Review Board's
16website and sent to the State Representative and State Senator
17of the district in which the health care facility is located.
18In addition, the health care facility shall provide notice of
19closure to the local media that the health care facility would
20routinely notify about facility events.
21    An application to close a health care facility shall only
22be deemed complete if it includes evidence that the health care
23facility provided written notice at least 30 days prior to
24filing the application of its intent to do so to the
25municipality in which it is located, the State Representative
26and State Senator of the district in which the health care

 

 

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1facility is located, the State Board, the Director of Public
2Health, and the Director of Healthcare and Family Services. The
3changes made to this subsection by this amendatory Act of the
4101st General Assembly shall apply to all applications
5submitted after the effective date of this amendatory Act of
6the 101st General Assembly.
7    (b) No later than 30 days after issuance of a permit to
8close a health care facility or discontinue a category of
9service, the permit holder shall give written notice of the
10closure or discontinuation to the State Senator and State
11Representative serving the legislative district in which the
12health care facility is located.
13    (c) If there is a pending lawsuit that challenges an
14application to discontinue a health care facility that either
15names the Board as a party or alleges fraud in the filing of
16the application, the Board may defer action on the application
17for up to 6 months after the date of the initial deferral of
18the application.
19    (d) The changes made to this Section by this amendatory Act
20of the 101st General Assembly shall apply to all applications
21submitted after the effective date of this amendatory Act of
22the 101st General Assembly.
23(Source: P.A. 101-83, eff. 7-15-19.)
 
24    Section 20. The State Finance Act is amended by changing
25Section 6z-81 as follows:
 

 

 

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1    (30 ILCS 105/6z-81)
2    Sec. 6z-81. Healthcare Provider Relief Fund.
3    (a) There is created in the State treasury a special fund
4to be known as the Healthcare Provider Relief Fund.
5    (b) The Fund is created for the purpose of receiving and
6disbursing moneys in accordance with this Section.
7Disbursements from the Fund shall be made only as follows:
8        (1) Subject to appropriation, for payment by the
9    Department of Healthcare and Family Services or by the
10    Department of Human Services of medical bills and related
11    expenses, including administrative expenses, for which the
12    State is responsible under Titles XIX and XXI of the Social
13    Security Act, the Illinois Public Aid Code, the Children's
14    Health Insurance Program Act, the Covering ALL KIDS Health
15    Insurance Act, and the Long Term Acute Care Hospital
16    Quality Improvement Transfer Program Act.
17        (2) For repayment of funds borrowed from other State
18    funds or from outside sources, including interest thereon.
19        (3) For State fiscal years 2017, 2018, and 2019, for
20    making payments to the human poison control center pursuant
21    to Section 12-4.105 of the Illinois Public Aid Code.
22    (c) The Fund shall consist of the following:
23        (1) Moneys received by the State from short-term
24    borrowing pursuant to the Short Term Borrowing Act on or
25    after the effective date of Public Act 96-820.

 

 

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1        (2) All federal matching funds received by the Illinois
2    Department of Healthcare and Family Services as a result of
3    expenditures made by the Department that are attributable
4    to moneys deposited in the Fund.
5        (3) All federal matching funds received by the Illinois
6    Department of Healthcare and Family Services as a result of
7    federal approval of Title XIX State plan amendment
8    transmittal number 07-09.
9        (3.5) Proceeds from the assessment authorized under
10    Article V-H of the Illinois Public Aid Code.
11        (4) All other moneys received for the Fund from any
12    other source, including interest earned thereon.
13        (5) All federal matching funds received by the Illinois
14    Department of Healthcare and Family Services as a result of
15    expenditures made by the Department for Medical Assistance
16    from the General Revenue Fund, the Tobacco Settlement
17    Recovery Fund, the Long-Term Care Provider Fund, and the
18    Drug Rebate Fund related to individuals eligible for
19    medical assistance pursuant to the Patient Protection and
20    Affordable Care Act (P.L. 111-148) and Section 5-2 of the
21    Illinois Public Aid Code.
22    (d) In addition to any other transfers that may be provided
23for by law, on the effective date of Public Act 97-44, or as
24soon thereafter as practical, the State Comptroller shall
25direct and the State Treasurer shall transfer the sum of
26$365,000,000 from the General Revenue Fund into the Healthcare

 

 

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1Provider Relief Fund.
2    (e) In addition to any other transfers that may be provided
3for by law, on July 1, 2011, or as soon thereafter as
4practical, the State Comptroller shall direct and the State
5Treasurer shall transfer the sum of $160,000,000 from the
6General Revenue Fund to the Healthcare Provider Relief Fund.
7    (f) Notwithstanding any other State law to the contrary,
8and in addition to any other transfers that may be provided for
9by law, the State Comptroller shall order transferred and the
10State Treasurer shall transfer $500,000,000 to the Healthcare
11Provider Relief Fund from the General Revenue Fund in equal
12monthly installments of $100,000,000, with the first transfer
13to be made on July 1, 2012, or as soon thereafter as practical,
14and with each of the remaining transfers to be made on August
151, 2012, September 1, 2012, October 1, 2012, and November 1,
162012, or as soon thereafter as practical. This transfer may
17assist the Department of Healthcare and Family Services in
18improving Medical Assistance bill processing timeframes or in
19meeting the possible requirements of Senate Bill 3397, or other
20similar legislation, of the 97th General Assembly should it
21become law.
22    (g) Notwithstanding any other State law to the contrary,
23and in addition to any other transfers that may be provided for
24by law, on July 1, 2013, or as soon thereafter as may be
25practical, the State Comptroller shall direct and the State
26Treasurer shall transfer the sum of $601,000,000 from the

 

 

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1General Revenue Fund to the Healthcare Provider Relief Fund.
2(Source: P.A. 100-587, eff. 6-4-18; 101-9, eff. 6-5-19; revised
37-17-19.)
 
4    Section 25. The Emergency Medical Services (EMS) Systems
5Act is amended by changing Section 32.5 as follows:
 
6    (210 ILCS 50/32.5)
7    Sec. 32.5. Freestanding Emergency Center.
8    (a) The Department shall issue an annual Freestanding
9Emergency Center (FEC) license to any facility that has
10received a permit from the Health Facilities and Services
11Review Board to establish a Freestanding Emergency Center by
12January 1, 2015, and:
13        (1) is located: (A) in a municipality with a population
14    of 50,000 or fewer inhabitants; (B) within 50 miles of the
15    hospital that owns or controls the FEC; and (C) within 50
16    miles of the Resource Hospital affiliated with the FEC as
17    part of the EMS System;
18        (2) is wholly owned or controlled by an Associate or
19    Resource Hospital, but is not a part of the hospital's
20    physical plant;
21        (3) meets the standards for licensed FECs, adopted by
22    rule of the Department, including, but not limited to:
23            (A) facility design, specification, operation, and
24        maintenance standards;

 

 

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1            (B) equipment standards; and
2            (C) the number and qualifications of emergency
3        medical personnel and other staff, which must include
4        at least one board certified emergency physician
5        present at the FEC 24 hours per day.
6        (4) limits its participation in the EMS System strictly
7    to receiving a limited number of patients by ambulance: (A)
8    according to the FEC's 24-hour capabilities; (B) according
9    to protocols developed by the Resource Hospital within the
10    FEC's designated EMS System; and (C) as pre-approved by
11    both the EMS Medical Director and the Department;
12        (5) provides comprehensive emergency treatment
13    services, as defined in the rules adopted by the Department
14    pursuant to the Hospital Licensing Act, 24 hours per day,
15    on an outpatient basis;
16        (6) provides an ambulance and maintains on site
17    ambulance services staffed with paramedics 24 hours per
18    day;
19        (7) (blank);
20        (8) complies with all State and federal patient rights
21    provisions, including, but not limited to, the Emergency
22    Medical Treatment Act and the federal Emergency Medical
23    Treatment and Active Labor Act;
24        (9) maintains a communications system that is fully
25    integrated with its Resource Hospital within the FEC's
26    designated EMS System;

 

 

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1        (10) reports to the Department any patient transfers
2    from the FEC to a hospital within 48 hours of the transfer
3    plus any other data determined to be relevant by the
4    Department;
5        (11) submits to the Department, on a quarterly basis,
6    the FEC's morbidity and mortality rates for patients
7    treated at the FEC and other data determined to be relevant
8    by the Department;
9        (12) does not describe itself or hold itself out to the
10    general public as a full service hospital or hospital
11    emergency department in its advertising or marketing
12    activities;
13        (13) complies with any other rules adopted by the
14    Department under this Act that relate to FECs;
15        (14) passes the Department's site inspection for
16    compliance with the FEC requirements of this Act;
17        (15) submits a copy of the permit issued by the Health
18    Facilities and Services Review Board indicating that the
19    facility has complied with the Illinois Health Facilities
20    Planning Act with respect to the health services to be
21    provided at the facility;
22        (16) submits an application for designation as an FEC
23    in a manner and form prescribed by the Department by rule;
24    and
25        (17) pays the annual license fee as determined by the
26    Department by rule.

 

 

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1    (a-5) Notwithstanding any other provision of this Section,
2the Department may issue an annual FEC license to a facility
3that is located in a county that does not have a licensed
4general acute care hospital if the facility's application for a
5permit from the Illinois Health Facilities Planning Board has
6been deemed complete by the Department of Public Health by
7January 1, 2014 and if the facility complies with the
8requirements set forth in paragraphs (1) through (17) of
9subsection (a).
10    (a-10) Notwithstanding any other provision of this
11Section, the Department may issue an annual FEC license to a
12facility if the facility has, by January 1, 2014, filed a
13letter of intent to establish an FEC and if the facility
14complies with the requirements set forth in paragraphs (1)
15through (17) of subsection (a).
16    (a-15) Notwithstanding any other provision of this
17Section, the Department shall issue an annual FEC license to a
18facility if the facility: (i) discontinues operation as a
19hospital within 180 days after December 4, 2015 (the effective
20date of Public Act 99-490) this amendatory Act of the 99th
21General Assembly with a Health Facilities and Services Review
22Board project number of E-017-15; (ii) has an application for a
23permit to establish an FEC from the Health Facilities and
24Services Review Board that is deemed complete by January 1,
252017; and (iii) complies with the requirements set forth in
26paragraphs (1) through (17) of subsection (a) of this Section.

 

 

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1    (a-20) Notwithstanding any other provision of this
2Section, the Department shall issue an annual FEC license to a
3facility if:
4        (1) the facility is a hospital that has discontinued
5    inpatient hospital services;
6        (2) the Department of Healthcare and Family Services
7    has approved certified the conversion to an FEC was
8    approved by the Hospital Transformation Review Committee
9    as a project subject to the hospital's transformation under
10    subsection (d-5) of Section 14-12 of the Illinois Public
11    Aid Code;
12        (3) the facility complies with the requirements set
13    forth in paragraphs (1) through (17), provided however that
14    the FEC may be located in a municipality with a population
15    greater than 50,000 inhabitants and shall not be subject to
16    the requirements of the Illinois Health Facilities
17    Planning Act that are applicable to the conversion to an
18    FEC if the Department of Healthcare and Family Services
19    Service has approved certified the conversion to an FEC was
20    approved by the Hospital Transformation Review Committee
21    as a project subject to the hospital's transformation under
22    subsection (d-5) of Section 14-12 of the Illinois Public
23    Aid Code; and
24        (4) the facility is located at the same physical
25    location where the facility served as a hospital.
26    (b) The Department shall:

 

 

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1        (1) annually inspect facilities of initial FEC
2    applicants and licensed FECs, and issue annual licenses to
3    or annually relicense FECs that satisfy the Department's
4    licensure requirements as set forth in subsection (a);
5        (2) suspend, revoke, refuse to issue, or refuse to
6    renew the license of any FEC, after notice and an
7    opportunity for a hearing, when the Department finds that
8    the FEC has failed to comply with the standards and
9    requirements of the Act or rules adopted by the Department
10    under the Act;
11        (3) issue an Emergency Suspension Order for any FEC
12    when the Director or his or her designee has determined
13    that the continued operation of the FEC poses an immediate
14    and serious danger to the public health, safety, and
15    welfare. An opportunity for a hearing shall be promptly
16    initiated after an Emergency Suspension Order has been
17    issued; and
18        (4) adopt rules as needed to implement this Section.
19(Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16;
20100-581, eff. 3-12-18; revised 7-23-19.)
 
21    Section 30. The Illinois Public Aid Code is amended by
22changing Sections 5-5e.1, 5A-2, 5A-4, 5A-8, 5A-10, 5A-13,
235A-14, 12-4.105, and 14-12 and by adding Sections 5-5.05c,
245A-12.7, 5A-12.8, and 5A-17 as follows:
 

 

 

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1    (305 ILCS 5/5-5.05c new)
2    Sec. 5-5.05c. Access to physician services. The Department
3shall increase rates of reimbursement for physician services to
4as close to 60% of Medicare rates in effect as of January 1,
52020 utilizing the rates of Illinois Locality 99 facility
6rates.
 
7    (305 ILCS 5/5-5e.1)
8    Sec. 5-5e.1. Safety-Net Hospitals.
9    (a) A Safety-Net Hospital is an Illinois hospital that:
10        (1) is licensed by the Department of Public Health as a
11    general acute care or pediatric hospital; and
12        (2) is a disproportionate share hospital, as described
13    in Section 1923 of the federal Social Security Act, as
14    determined by the Department; and
15        (3) meets one of the following:
16            (A) has a MIUR of at least 40% and a charity
17        percent of at least 4%; or
18            (B) has a MIUR of at least 50%.
19    (b) Definitions. As used in this Section:
20        (1) "Charity percent" means the ratio of (i) the
21    hospital's charity charges for services provided to
22    individuals without health insurance or another source of
23    third party coverage to (ii) the Illinois total hospital
24    charges, each as reported on the hospital's OBRA form.
25        (2) "MIUR" means Medicaid Inpatient Utilization Rate

 

 

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1    and is defined as a fraction, the numerator of which is the
2    number of a hospital's inpatient days provided in the
3    hospital's fiscal year ending 3 years prior to the rate
4    year, to patients who, for such days, were eligible for
5    Medicaid under Title XIX of the federal Social Security
6    Act, 42 USC 1396a et seq., excluding those persons eligible
7    for medical assistance pursuant to 42 U.S.C.
8    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
9    Section 5-2 of this Article, and the denominator of which
10    is the total number of the hospital's inpatient days in
11    that same period, excluding those persons eligible for
12    medical assistance pursuant to 42 U.S.C.
13    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
14    Section 5-2 of this Article.
15        (3) "OBRA form" means form HFS-3834, OBRA '93 data
16    collection form, for the rate year.
17        (4) "Rate year" means the 12-month period beginning on
18    October 1.
19    (c) Beginning July 1, 2012 and ending on December 31, 2022
20June 30, 2020, a hospital that would have qualified for the
21rate year beginning October 1, 2011, shall be a Safety-Net
22Hospital.
23    (d) No later than August 15 preceding the rate year, each
24hospital shall submit the OBRA form to the Department. Prior to
25October 1, the Department shall notify each hospital whether it
26has qualified as a Safety-Net Hospital.

 

 

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1    (e) The Department may promulgate rules in order to
2implement this Section.
3    (f) Nothing in this Section shall be construed as limiting
4the ability of the Department to include the Safety-Net
5Hospitals in the hospital rate reform mandated by Section 14-11
6of this Code and implemented under Section 14-12 of this Code
7and by administrative rulemaking.
8(Source: P.A. 100-581, eff. 3-12-18.)
 
9    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
10    (Section scheduled to be repealed on July 1, 2020)
11    Sec. 5A-2. Assessment.
12    (a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
13years 2009 through 2018, or as long as continued under Section
145A-16, an annual assessment on inpatient services is imposed on
15each hospital provider in an amount equal to $218.38 multiplied
16by the difference of the hospital's occupied bed days less the
17hospital's Medicare bed days, provided, however, that the
18amount of $218.38 shall be increased by a uniform percentage to
19generate an amount equal to 75% of the State share of the
20payments authorized under Section 5A-12.5, with such increase
21only taking effect upon the date that a State share for such
22payments is required under federal law. For the period of April
23through June 2015, the amount of $218.38 used to calculate the
24assessment under this paragraph shall, by emergency rule under
25subsection (s) of Section 5-45 of the Illinois Administrative

 

 

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1Procedure Act, be increased by a uniform percentage to generate
2$20,250,000 in the aggregate for that period from all hospitals
3subject to the annual assessment under this paragraph.
4    (2) In addition to any other assessments imposed under this
5Article, effective July 1, 2016 and semi-annually thereafter
6through June 2018, or as provided in Section 5A-16, in addition
7to any federally required State share as authorized under
8paragraph (1), the amount of $218.38 shall be increased by a
9uniform percentage to generate an amount equal to 75% of the
10ACA Assessment Adjustment, as defined in subsection (b-6) of
11this Section.
12    For State fiscal years 2009 through 2018, or as provided in
13Section 5A-16, a hospital's occupied bed days and Medicare bed
14days shall be determined using the most recent data available
15from each hospital's 2005 Medicare cost report as contained in
16the Healthcare Cost Report Information System file, for the
17quarter ending on December 31, 2006, without regard to any
18subsequent adjustments or changes to such data. If a hospital's
192005 Medicare cost report is not contained in the Healthcare
20Cost Report Information System, then the Illinois Department
21may obtain the hospital provider's occupied bed days and
22Medicare bed days from any source available, including, but not
23limited to, records maintained by the hospital provider, which
24may be inspected at all times during business hours of the day
25by the Illinois Department or its duly authorized agents and
26employees.

 

 

SB2541 Enrolled- 30 -LRB101 18248 KTG 67690 b

1    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
2fiscal years 2019 and 2020, an annual assessment on inpatient
3services is imposed on each hospital provider in an amount
4equal to $197.19 multiplied by the difference of the hospital's
5occupied bed days less the hospital's Medicare bed days;
6however, for State fiscal year 2021, the amount of $197.19
7shall be increased by a uniform percentage to generate an
8additional $6,250,000 in the aggregate for that period from all
9hospitals subject to the annual assessment under this
10paragraph. For State fiscal years 2019 and 2020, a hospital's
11occupied bed days and Medicare bed days shall be determined
12using the most recent data available from each hospital's 2015
13Medicare cost report as contained in the Healthcare Cost Report
14Information System file, for the quarter ending on March 31,
152017, without regard to any subsequent adjustments or changes
16to such data. If a hospital's 2015 Medicare cost report is not
17contained in the Healthcare Cost Report Information System,
18then the Illinois Department may obtain the hospital provider's
19occupied bed days and Medicare bed days from any source
20available, including, but not limited to, records maintained by
21the hospital provider, which may be inspected at all times
22during business hours of the day by the Illinois Department or
23its duly authorized agents and employees. Notwithstanding any
24other provision in this Article, for a hospital provider that
25did not have a 2015 Medicare cost report, but paid an
26assessment in State fiscal year 2018 on the basis of

 

 

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1hypothetical data, that assessment amount shall be used for
2State fiscal years 2019 and 2020; however, for State fiscal
3year 2021, the assessment amount shall be increased by the
4proportion that it represents of the total annual assessment
5that is generated from all hospitals in order to generate
6$6,250,000 in the aggregate for that period from all hospitals
7subject to the annual assessment under this paragraph.
8    (4) Subject to Sections 5A-3 and 5A-10, for the period of
9July 1, 2020 through December 31, 2020 and calendar State
10fiscal years 2021 and 2022 through 2024, an annual assessment
11on inpatient services is imposed on each hospital provider in
12an amount equal to $221.50 $197.19 multiplied by the difference
13of the hospital's occupied bed days less the hospital's
14Medicare bed days, provided however: for the period of July 1,
152020 through December 31, 2020, (i) the assessment shall be
16equal to 50% of the annual amount; and (ii) the amount of
17$221.50 shall be retroactively adjusted by a uniform percentage
18to generate an amount equal to 50% of the Assessment
19Adjustment, as defined in subsection (b-7) , that the amount of
20$197.19 used to calculate the assessment under this paragraph
21shall, by rule, be adjusted by a uniform percentage to generate
22the same total annual assessment that was generated in State
23fiscal year 2020 from all hospitals subject to the annual
24assessment under this paragraph plus $6,250,000. For the period
25of July 1, 2020 through December 31, 2020 and calendar State
26fiscal years 2021 and 2022, a hospital's occupied bed days and

 

 

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1Medicare bed days shall be determined using the most recent
2data available from each hospital's 2015 2017 Medicare cost
3report as contained in the Healthcare Cost Report Information
4System file, for the quarter ending on March 31, 2017 2019,
5without regard to any subsequent adjustments or changes to such
6data. If a hospital's 2015 Medicare cost report is not
7contained in the Healthcare Cost Report Information System,
8then the Illinois Department may obtain the hospital provider's
9occupied bed days and Medicare bed days from any source
10available, including, but not limited to, records maintained by
11the hospital provider, which may be inspected at all times
12during business hours of the day by the Illinois Department or
13its duly authorized agents and employees. Should the change in
14the assessment methodology for fiscal years 2021 through
15December 31, 2022 not be approved on or before June 30, 2020,
16the assessment and payments under this Article in effect for
17fiscal year 2020 shall remain in place until the new assessment
18is approved. If the assessment methodology for July 1, 2020
19through December 31, 2022, is approved on or after July 1,
202020, it shall be retroactive to July 1, 2020, subject to
21federal approval and provided that the payments authorized
22under Section 5A-12.7 have the same effective date as the new
23assessment methodology. In giving retroactive effect to the
24assessment approved after June 30, 2020, credit toward the new
25assessment shall be given for any payments of the previous
26assessment for periods after June 30, 2020. Notwithstanding any

 

 

SB2541 Enrolled- 33 -LRB101 18248 KTG 67690 b

1other provision of this Article, for a hospital provider that
2did not have a 2015 Medicare cost report, but paid an
3assessment in State Fiscal Year 2020 on the basis of
4hypothetical data, the data that was the basis for the 2020
5assessment shall be used to calculate the assessment under this
6paragraph. For State fiscal years 2023 and 2024, a hospital's
7occupied bed days and Medicare bed days shall be determined
8using the most recent data available from each hospital's 2019
9Medicare cost report as contained in the Healthcare Cost Report
10Information System file, for the quarter ending on March 31,
112021, without regard to any subsequent adjustments or changes
12to such data.
13    (b) (Blank).
14    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
15portion of State fiscal year 2012, beginning June 10, 2012
16through June 30, 2012, and for State fiscal years 2013 through
172018, or as provided in Section 5A-16, an annual assessment on
18outpatient services is imposed on each hospital provider in an
19amount equal to .008766 multiplied by the hospital's outpatient
20gross revenue, provided, however, that the amount of .008766
21shall be increased by a uniform percentage to generate an
22amount equal to 25% of the State share of the payments
23authorized under Section 5A-12.5, with such increase only
24taking effect upon the date that a State share for such
25payments is required under federal law. For the period
26beginning June 10, 2012 through June 30, 2012, the annual

 

 

SB2541 Enrolled- 34 -LRB101 18248 KTG 67690 b

1assessment on outpatient services shall be prorated by
2multiplying the assessment amount by a fraction, the numerator
3of which is 21 days and the denominator of which is 365 days.
4For the period of April through June 2015, the amount of
5.008766 used to calculate the assessment under this paragraph
6shall, by emergency rule under subsection (s) of Section 5-45
7of the Illinois Administrative Procedure Act, be increased by a
8uniform percentage to generate $6,750,000 in the aggregate for
9that period from all hospitals subject to the annual assessment
10under 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, in addition to any federally required State
14share as authorized under paragraph (1), the amount of .008766
15shall be increased by a uniform percentage to generate an
16amount equal to 25% of the ACA Assessment Adjustment, as
17defined in subsection (b-6) of this Section.
18    For the portion of State fiscal year 2012, beginning June
1910, 2012 through June 30, 2012, and State fiscal years 2013
20through 2018, or as provided in Section 5A-16, a hospital's
21outpatient gross revenue shall be determined using the most
22recent data available from each hospital's 2009 Medicare cost
23report as contained in the Healthcare Cost Report Information
24System file, for the quarter ending on June 30, 2011, without
25regard to any subsequent adjustments or changes to such data.
26If a hospital's 2009 Medicare cost report is not contained in

 

 

SB2541 Enrolled- 35 -LRB101 18248 KTG 67690 b

1the Healthcare Cost Report Information System, then the
2Department may obtain the hospital provider's outpatient gross
3revenue from any source available, including, but not limited
4to, records maintained by the hospital provider, which may be
5inspected at all times during business hours of the day by the
6Department or its duly authorized agents and employees.
7    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
8fiscal years 2019 and 2020, an annual assessment on outpatient
9services is imposed on each hospital provider in an amount
10equal to .01358 multiplied by the hospital's outpatient gross
11revenue; however, for State fiscal year 2021, the amount of
12.01358 shall be increased by a uniform percentage to generate
13an additional $6,250,000 in the aggregate for that period from
14all hospitals subject to the annual assessment under this
15paragraph. For State fiscal years 2019 and 2020, a hospital's
16outpatient gross revenue shall be determined using the most
17recent data available from each hospital's 2015 Medicare cost
18report as contained in the Healthcare Cost Report Information
19System file, for the quarter ending on March 31, 2017, without
20regard to any subsequent adjustments or changes to such data.
21If a hospital's 2015 Medicare cost report is not contained in
22the Healthcare Cost Report Information System, then the
23Department may obtain the hospital provider's outpatient gross
24revenue from any source available, including, but not limited
25to, records maintained by the hospital provider, which may be
26inspected at all times during business hours of the day by the

 

 

SB2541 Enrolled- 36 -LRB101 18248 KTG 67690 b

1Department or its duly authorized agents and employees.
2Notwithstanding any other provision in this Article, for a
3hospital provider that did not have a 2015 Medicare cost
4report, but paid an assessment in State fiscal year 2018 on the
5basis of hypothetical data, that assessment amount shall be
6used for State fiscal years 2019 and 2020; however, for State
7fiscal year 2021, the assessment amount shall be increased by
8the proportion that it represents of the total annual
9assessment that is generated from all hospitals in order to
10generate $6,250,000 in the aggregate for that period from all
11hospitals subject to the annual assessment under this
12paragraph.
13    (4) Subject to Sections 5A-3 and 5A-10, for the period of
14July 1, 2020 through December 31, 2020 and calendar State
15fiscal years 2021 and 2022 through 2024, an annual assessment
16on outpatient services is imposed on each hospital provider in
17an amount equal to .01525 .01358 multiplied by the hospital's
18outpatient gross revenue, provided however: (i) for the period
19of July 1, 2020 through December 31, 2020, the assessment shall
20be equal to 50% of the annual amount; and (ii) the amount of
21.01525 shall be retroactively adjusted by a uniform percentage
22to generate an amount equal to 50% of the Assessment
23Adjustment, as defined in subsection (b-7) , that the amount of
24.01358 used to calculate the assessment under this paragraph
25shall, by rule, be adjusted by a uniform percentage to generate
26the same total annual assessment that was generated in State

 

 

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1fiscal year 2020 from all hospitals subject to the annual
2assessment under this paragraph plus $6,250,000. For the period
3of July 1, 2020 through December 31, 2020 and calendar State
4fiscal years 2021 and 2022, a hospital's outpatient gross
5revenue shall be determined using the most recent data
6available from each hospital's 2015 2017 Medicare cost report
7as contained in the Healthcare Cost Report Information System
8file, for the quarter ending on March 31, 2017 2019, without
9regard to any subsequent adjustments or changes to such data.
10If a hospital's 2015 Medicare cost report is not contained in
11the Healthcare Cost Report Information System, then the
12Illinois Department may obtain the hospital provider's
13outpatient revenue data from any source available, including,
14but not limited to, records maintained by the hospital
15provider, which may be inspected at all times during business
16hours of the day by the Illinois Department or its duly
17authorized agents and employees. Should the change in the
18assessment methodology above for fiscal years 2021 through
19calendar year 2022 not be approved prior to July 1, 2020, the
20assessment and payments under this Article in effect for fiscal
21year 2020 shall remain in place until the new assessment is
22approved. If the change in the assessment methodology above for
23July 1, 2020 through December 31, 2022, is approved after June
2430, 2020, it shall have a retroactive effective date of July 1,
252020, subject to federal approval and provided that the
26payments authorized under Section 12A-7 have the same effective

 

 

SB2541 Enrolled- 38 -LRB101 18248 KTG 67690 b

1date as the new assessment methodology. In giving retroactive
2effect to the assessment approved after June 30, 2020, credit
3toward the new assessment shall be given for any payments of
4the previous assessment for periods after June 30, 2020.
5Notwithstanding any other provision of this Article, for a
6hospital provider that did not have a 2015 Medicare cost
7report, but paid an assessment in State Fiscal Year 2020 on the
8basis of hypothetical data, the data that was the basis for the
92020 assessment shall be used to calculate the assessment under
10this paragraph. For State fiscal years 2023 and 2024, a
11hospital's outpatient gross revenue shall be determined using
12the most recent data available from each hospital's 2019
13Medicare cost report as contained in the Healthcare Cost Report
14Information System file, for the quarter ending on March 31,
152021, without regard to any subsequent adjustments or changes
16to such data.
17    (b-6)(1) As used in this Section, "ACA Assessment
18Adjustment" means:
19        (A) For the period of July 1, 2016 through December 31,
20    2016, the product of .19125 multiplied by the sum of the
21    fee-for-service payments to hospitals as authorized under
22    Section 5A-12.5 and the adjustments authorized under
23    subsection (t) of Section 5A-12.2 to managed care
24    organizations for hospital services due and payable in the
25    month of April 2016 multiplied by 6.
26        (B) For the period of January 1, 2017 through June 30,

 

 

SB2541 Enrolled- 39 -LRB101 18248 KTG 67690 b

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

 

 

SB2541 Enrolled- 40 -LRB101 18248 KTG 67690 b

1    described in subparagraph (B).
2        (D) For the period of January 1, 2018 through June 30,
3    2018, the product of .19125 multiplied by the sum of the
4    fee-for-service payments to hospitals as authorized under
5    Section 5A-12.5 and the adjustments authorized under
6    subsection (t) of Section 5A-12.2 to managed care
7    organizations for hospital services due and payable in the
8    month of October 2017 multiplied by 6, except that:
9            (i) the amount calculated under this subparagraph
10        (D) shall be adjusted, either positively or
11        negatively, to account for the difference between the
12        actual payments issued under Section 5A-12.5 for the
13        period of July 1, 2017 through December 31, 2017 and
14        the estimated payments due and payable in the month of
15        April 2017 multiplied by 6 as described in subparagraph
16        (C); and
17            (ii) the amount calculated under this subparagraph
18        (D) shall be adjusted to include the product of .19125
19        multiplied by the sum of the fee-for-service payments,
20        if any, estimated to be paid to hospitals under
21        subsection (b) of Section 5A-12.5.
22    (2) The Department shall complete and apply a final
23reconciliation of the ACA Assessment Adjustment prior to June
2430, 2018 to account for:
25        (A) any differences between the actual payments issued
26    or scheduled to be issued prior to June 30, 2018 as

 

 

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1    authorized in Section 5A-12.5 for the period of January 1,
2    2018 through June 30, 2018 and the estimated payments due
3    and payable in the month of October 2017 multiplied by 6 as
4    described in subparagraph (D); and
5        (B) any difference between the estimated
6    fee-for-service payments under subsection (b) of Section
7    5A-12.5 and the amount of such payments that are actually
8    scheduled to be paid.
9    The Department shall notify hospitals of any additional
10amounts owed or reduction credits to be applied to the June
112018 ACA Assessment Adjustment. This is to be considered the
12final reconciliation for the ACA Assessment Adjustment.
13    (3) Notwithstanding any other provision of this Section, if
14for any reason the scheduled payments under subsection (b) of
15Section 5A-12.5 are not issued in full by the final day of the
16period authorized under subsection (b) of Section 5A-12.5,
17funds collected from each hospital pursuant to subparagraph (D)
18of paragraph (1) and pursuant to paragraph (2), attributable to
19the scheduled payments authorized under subsection (b) of
20Section 5A-12.5 that are not issued in full by the final day of
21the period attributable to each payment authorized under
22subsection (b) of Section 5A-12.5, shall be refunded.
23    (4) The increases authorized under paragraph (2) of
24subsection (a) and paragraph (2) of subsection (b-5) shall be
25limited to the federally required State share of the total
26payments authorized under Section 5A-12.5 if the sum of such

 

 

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1payments yields an annualized amount equal to or less than
2$450,000,000, or if the adjustments authorized under
3subsection (t) of Section 5A-12.2 are found not to be
4actuarially sound; however, this limitation shall not apply to
5the fee-for-service payments described in subsection (b) of
6Section 5A-12.5.
7    (b-7)(1) As used in this Section, "Assessment Adjustment"
8means:
9        (A) For the period of July 1, 2020 through December 31,
10    2020, the product of .3853 multiplied by the total of the
11    actual payments made under subsections (c) through (k) of
12    Section 5A-12.7 attributable to the period, less the total
13    of the assessment imposed under subsections (a) and (b-5)
14    of this Section for the period.
15        (B) For each calendar quarter beginning on and after
16    January 1, 2021, the product of .3853 multiplied by the
17    total of the actual payments made under subsections (c)
18    through (k) of Section 5A-12.7 attributable to the period,
19    less the total of the assessment imposed under subsections
20    (a) and (b-5) of this Section for the period.
21    (2) The Department shall calculate and notify each hospital
22of the total Assessment Adjustment and any additional
23assessment owed by the hospital or refund owed to the hospital
24on either a semi-annual or annual basis. Such notice shall be
25issued at least 30 days prior to any period in which the
26assessment will be adjusted. Any additional assessment owed by

 

 

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1the hospital or refund owed to the hospital shall be uniformly
2applied to the assessment owed by the hospital in monthly
3installments for the subsequent semi-annual period or calendar
4year. If no assessment is owed in the subsequent year, any
5amount owed by the hospital or refund due to the hospital,
6shall be paid in a lump sum.
7    (3) The Department shall publish all details of the
8Assessment Adjustment calculation performed each year on its
9website within 30 days of completing the calculation, and also
10submit the details of the Assessment Adjustment calculation as
11part of the Department's annual report to the General Assembly.
12    (c) (Blank).
13    (d) Notwithstanding any of the other provisions of this
14Section, the Department is authorized to adopt rules to reduce
15the rate of any annual assessment imposed under this Section,
16as authorized by Section 5-46.2 of the Illinois Administrative
17Procedure Act.
18    (e) Notwithstanding any other provision of this Section,
19any plan providing for an assessment on a hospital provider as
20a permissible tax under Title XIX of the federal Social
21Security Act and Medicaid-eligible payments to hospital
22providers from the revenues derived from that assessment shall
23be reviewed by the Illinois Department of Healthcare and Family
24Services, as the Single State Medicaid Agency required by
25federal law, to determine whether those assessments and
26hospital provider payments meet federal Medicaid standards. If

 

 

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1the Department determines that the elements of the plan may
2meet federal Medicaid standards and a related State Medicaid
3Plan Amendment is prepared in a manner and form suitable for
4submission, that State Plan Amendment shall be submitted in a
5timely manner for review by the Centers for Medicare and
6Medicaid Services of the United States Department of Health and
7Human Services and subject to approval by the Centers for
8Medicare and Medicaid Services of the United States Department
9of Health and Human Services. No such plan shall become
10effective without approval by the Illinois General Assembly by
11the enactment into law of related legislation. Notwithstanding
12any other provision of this Section, the Department is
13authorized to adopt rules to reduce the rate of any annual
14assessment imposed under this Section. Any such rules may be
15adopted by the Department under Section 5-50 of the Illinois
16Administrative Procedure Act.
17(Source: P.A. 100-581, eff. 3-12-18; 101-10, eff. 6-5-19.)
 
18    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
19    Sec. 5A-4. Payment of assessment; penalty.
20    (a) The assessment imposed by Section 5A-2 for State fiscal
21year 2009 through State fiscal year 2018 or as provided in
22Section 5A-16, shall be due and payable in monthly
23installments, each equaling one-twelfth of the assessment for
24the year, on the fourteenth State business day of each month.
25No installment payment of an assessment imposed by Section 5A-2

 

 

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1shall be due and payable, however, until after the Comptroller
2has issued the payments required under this Article.
3    Except as provided in subsection (a-5) of this Section, the
4assessment imposed by subsection (b-5) of Section 5A-2 for the
5portion of State fiscal year 2012 beginning June 10, 2012
6through June 30, 2012, and for State fiscal year 2013 through
7State fiscal year 2018 or as provided in Section 5A-16, shall
8be due and payable in monthly installments, each equaling
9one-twelfth of the assessment for the year, on the 17th State
10business day of each month. No installment payment of an
11assessment imposed by subsection (b-5) of Section 5A-2 shall be
12due and payable, however, until after: (i) the Department
13notifies the hospital provider, in writing, that the payment
14methodologies to hospitals required under Section 5A-12.4,
15have been approved by the Centers for Medicare and Medicaid
16Services of the U.S. Department of Health and Human Services,
17and the waiver under 42 CFR 433.68 for the assessment imposed
18by subsection (b-5) of Section 5A-2, if necessary, has been
19granted by the Centers for Medicare and Medicaid Services of
20the U.S. Department of Health and Human Services; and (ii) the
21Comptroller has issued the payments required under Section
225A-12.4. Upon notification to the Department of approval of the
23payment methodologies required under Section 5A-12.4 and the
24waiver granted under 42 CFR 433.68, if necessary, all
25installments otherwise due under subsection (b-5) of Section
265A-2 prior to the date of notification shall be due and payable

 

 

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1to the Department upon written direction from the Department
2and issuance by the Comptroller of the payments required under
3Section 5A-12.4.
4    Except as provided in subsection (a-5) of this Section, the
5assessment imposed under Section 5A-2 for State fiscal year
62019 and each subsequent State fiscal year shall be due and
7payable in monthly installments, each equaling one-twelfth of
8the assessment for the year, on the 17th State business day of
9each month. The Department has discretion to establish a later
10date due to delays in payments being made to hospitals as
11required under Section 5A-12.7. No installment payment of an
12assessment imposed by Section 5A-2 shall be due and payable,
13however, until after: (i) the Department notifies the hospital
14provider, in writing, that the payment methodologies to
15hospitals required under Section 5A-12.6 or 5A-12.7 have been
16approved by the Centers for Medicare and Medicaid Services of
17the U.S. Department of Health and Human Services, and the
18waiver under 42 CFR 433.68 for the assessment imposed by
19Section 5A-2, if necessary, has been granted by the Centers for
20Medicare and Medicaid Services of the U.S. Department of Health
21and Human Services; and (ii) the Comptroller and managed care
22organizations have has issued the payments required under
23Section 5A-12.6 or 5A-12.7. Upon notification to the Department
24of approval of the payment methodologies required under Section
255A-12.6 or 5A-12.7 and the waiver granted under 42 CFR 433.68,
26if necessary, all installments otherwise due under Section 5A-2

 

 

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1prior to the date of notification shall be due and payable to
2the Department upon written direction from the Department and
3issuance by the Comptroller and managed care organizations of
4the payments required under Section 5A-12.6 or 5A-12.7.
5    (a-5) The Illinois Department may accelerate the schedule
6upon which assessment installments are due and payable by
7hospitals with a payment ratio greater than or equal to one.
8Such acceleration of due dates for payment of the assessment
9may be made only in conjunction with a corresponding
10acceleration in access payments identified in Section 5A-12.2,
11Section 5A-12.4, or Section 5A-12.6, or Section 5A-12.7 to the
12same hospitals. For the purposes of this subsection (a-5), a
13hospital's payment ratio is defined as the quotient obtained by
14dividing the total payments for the State fiscal year, as
15authorized under Section 5A-12.2, Section 5A-12.4, or Section
165A-12.6, or Section 5A-12.7, by the total assessment for the
17State fiscal year imposed under Section 5A-2 or subsection
18(b-5) of Section 5A-2.
19    (b) The Illinois Department is authorized to establish
20delayed payment schedules for hospital providers that are
21unable to make installment payments when due under this Section
22due to financial difficulties, as determined by the Illinois
23Department.
24    (c) If a hospital provider fails to pay the full amount of
25an installment when due (including any extensions granted under
26subsection (b)), there shall, unless waived by the Illinois

 

 

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1Department for reasonable cause, be added to the assessment
2imposed by Section 5A-2 a penalty assessment equal to the
3lesser of (i) 5% of the amount of the installment not paid on
4or before the due date plus 5% of the portion thereof remaining
5unpaid on the last day of each 30-day period thereafter or (ii)
6100% of the installment amount not paid on or before the due
7date. For purposes of this subsection, payments will be
8credited first to unpaid installment amounts (rather than to
9penalty or interest), beginning with the most delinquent
10installments.
11    (d) Any assessment amount that is due and payable to the
12Illinois Department more frequently than once per calendar
13quarter shall be remitted to the Illinois Department by the
14hospital provider by means of electronic funds transfer. The
15Illinois Department may provide for remittance by other means
16if (i) the amount due is less than $10,000 or (ii) electronic
17funds transfer is unavailable for this purpose.
18(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
19101-209, eff. 8-5-19.)
 
20    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
21    Sec. 5A-8. Hospital Provider Fund.
22    (a) There is created in the State Treasury the Hospital
23Provider Fund. Interest earned by the Fund shall be credited to
24the Fund. The Fund shall not be used to replace any moneys
25appropriated to the Medicaid program by the General Assembly.

 

 

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1    (b) The Fund is created for the purpose of receiving moneys
2in accordance with Section 5A-6 and disbursing moneys only for
3the following purposes, notwithstanding any other provision of
4law:
5        (1) For making payments to hospitals as required under
6    this Code, under the Children's Health Insurance Program
7    Act, under the Covering ALL KIDS Health Insurance Act, and
8    under the Long Term Acute Care Hospital Quality Improvement
9    Transfer Program Act.
10        (2) For the reimbursement of moneys collected by the
11    Illinois Department from hospitals or hospital providers
12    through error or mistake in performing the activities
13    authorized under this Code.
14        (3) For payment of administrative expenses incurred by
15    the Illinois Department or its agent in performing
16    activities under this Code, under the Children's Health
17    Insurance Program Act, under the Covering ALL KIDS Health
18    Insurance Act, and under the Long Term Acute Care Hospital
19    Quality Improvement Transfer Program Act.
20        (4) For payments of any amounts which are reimbursable
21    to the federal government for payments from this Fund which
22    are required to be paid by State warrant.
23        (5) For making transfers, as those transfers are
24    authorized in the proceedings authorizing debt under the
25    Short Term Borrowing Act, but transfers made under this
26    paragraph (5) shall not exceed the principal amount of debt

 

 

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1    issued in anticipation of the receipt by the State of
2    moneys to be deposited into the Fund.
3        (6) For making transfers to any other fund in the State
4    treasury, but transfers made under this paragraph (6) shall
5    not exceed the amount transferred previously from that
6    other fund into the Hospital Provider Fund plus any
7    interest that would have been earned by that fund on the
8    monies that had been transferred.
9        (6.5) For making transfers to the Healthcare Provider
10    Relief Fund, except that transfers made under this
11    paragraph (6.5) shall not exceed $60,000,000 in the
12    aggregate.
13        (7) For making transfers not exceeding the following
14    amounts, related to State fiscal years 2013 through 2018,
15    to the following designated funds:
16            Health and Human Services Medicaid Trust
17                Fund..............................$20,000,000
18            Long-Term Care Provider Fund..........$30,000,000
19            General Revenue Fund.................$80,000,000.
20    Transfers under this paragraph shall be made within 7 days
21    after the payments have been received pursuant to the
22    schedule of payments provided in subsection (a) of Section
23    5A-4.
24        (7.1) (Blank).
25        (7.5) (Blank).
26        (7.8) (Blank).

 

 

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1        (7.9) (Blank).
2        (7.10) For State fiscal year 2014, for making transfers
3    of the moneys resulting from the assessment under
4    subsection (b-5) of Section 5A-2 and received from hospital
5    providers under Section 5A-4 and transferred into the
6    Hospital Provider Fund under Section 5A-6 to the designated
7    funds not exceeding the following amounts in that State
8    fiscal year:
9            Healthcare Provider Relief Fund......$100,000,000
10        Transfers under this paragraph shall be made within 7
11    days after the payments have been received pursuant to the
12    schedule of payments provided in subsection (a) of Section
13    5A-4.
14        The additional amount of transfers in this paragraph
15    (7.10), authorized by Public Act 98-651, shall be made
16    within 10 State business days after June 16, 2014 (the
17    effective date of Public Act 98-651). That authority shall
18    remain in effect even if Public Act 98-651 does not become
19    law until State fiscal year 2015.
20        (7.10a) For State fiscal years 2015 through 2018, for
21    making transfers of the moneys resulting from the
22    assessment under subsection (b-5) of Section 5A-2 and
23    received from hospital providers under Section 5A-4 and
24    transferred into the Hospital Provider Fund under Section
25    5A-6 to the designated funds not exceeding the following
26    amounts related to each State fiscal year:

 

 

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1            Healthcare Provider Relief Fund......$50,000,000
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        (7.11) (Blank).
7        (7.12) For State fiscal year 2013, for increasing by
8    21/365ths the transfer of the moneys resulting from the
9    assessment under subsection (b-5) of Section 5A-2 and
10    received from hospital providers under Section 5A-4 for the
11    portion of State fiscal year 2012 beginning June 10, 2012
12    through June 30, 2012 and transferred into the Hospital
13    Provider Fund under Section 5A-6 to the designated funds
14    not exceeding the following amounts in that State fiscal
15    year:
16            Healthcare Provider Relief Fund.......$2,870,000
17        Since the federal Centers for Medicare and Medicaid
18    Services approval of the assessment authorized under
19    subsection (b-5) of Section 5A-2, received from hospital
20    providers under Section 5A-4 and the payment methodologies
21    to hospitals required under Section 5A-12.4 was not
22    received by the Department until State fiscal year 2014 and
23    since the Department made retroactive payments during
24    State fiscal year 2014 related to the referenced period of
25    June 2012, the transfer authority granted in this paragraph
26    (7.12) is extended through the date that is 10 State

 

 

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1    business days after June 16, 2014 (the effective date of
2    Public Act 98-651).
3        (7.13) In addition to any other transfers authorized
4    under this Section, for State fiscal years 2017 and 2018,
5    for making transfers to the Healthcare Provider Relief Fund
6    of moneys collected from the ACA Assessment Adjustment
7    authorized under subsections (a) and (b-5) of Section 5A-2
8    and paid by hospital providers under Section 5A-4 into the
9    Hospital Provider Fund under Section 5A-6 for each State
10    fiscal year. Timing of transfers to the Healthcare Provider
11    Relief Fund under this paragraph shall be at the discretion
12    of the Department, but no less frequently than quarterly.
13        (7.14) For making transfers not exceeding the
14    following amounts, related to State fiscal years 2019 and
15    2020 through 2024, to the following designated funds:
16            Health and Human Services Medicaid Trust
17                Fund..............................$20,000,000
18            Long-Term Care Provider Fund..........$30,000,000
19            Healthcare Health Care Provider Relief Fund
20.......        $325,000,000.
21        Transfers under this paragraph shall be made within 7
22    days after the payments have been received pursuant to the
23    schedule of payments provided in subsection (a) of Section
24    5A-4.
25        (7.15) For making transfers not exceeding the
26    following amounts, related to State fiscal years 2021 and

 

 

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1    2022, to the following designated funds:
2            Health and Human Services Medicaid Trust
3                Fund..............................$20,000,000
4            Long-Term Care Provider Fund..........$30,000,000
5            Healthcare Provider Relief Fund......$365,000,000
6        (7.16) For making transfers not exceeding the
7    following amounts, related to July 1, 2022 to December 31,
8    2022, to the following designated funds:
9            Health and Human Services Medicaid Trust
10                Fund..............................$10,000,000
11            Long-Term Care Provider Fund..........$15,000,000
12            Healthcare Provider Relief Fund......$182,500,000
13        (8) For making refunds to hospital providers pursuant
14    to Section 5A-10.
15        (9) For making payment to capitated managed care
16    organizations as described in subsections (s) and (t) of
17    Section 5A-12.2, and subsection (r) of Section 5A-12.6, and
18    Section 5A-12.7 of this Code.
19    Disbursements from the Fund, other than transfers
20authorized under paragraphs (5) and (6) of this subsection,
21shall be by warrants drawn by the State Comptroller upon
22receipt of vouchers duly executed and certified by the Illinois
23Department.
24    (c) The Fund shall consist of the following:
25        (1) All moneys collected or received by the Illinois
26    Department from the hospital provider assessment imposed

 

 

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1    by this Article.
2        (2) All federal matching funds received by the Illinois
3    Department as a result of expenditures made by the Illinois
4    Department that are attributable to moneys deposited in the
5    Fund.
6        (3) Any interest or penalty levied in conjunction with
7    the administration of this Article.
8        (3.5) As applicable, proceeds from surety bond
9    payments payable to the Department as referenced in
10    subsection (s) of Section 5A-12.2 of this Code.
11        (4) Moneys transferred from another fund in the State
12    treasury.
13        (5) All other moneys received for the Fund from any
14    other source, including interest earned thereon.
15    (d) (Blank).
16(Source: P.A. 99-78, eff. 7-20-15; 99-516, eff. 6-30-16;
1799-933, eff. 1-27-17; 100-581, eff. 3-12-18; 100-863, eff.
188-14-19; revised 7-12-19.)
 
19    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
20    Sec. 5A-10. Applicability.
21    (a) The assessment imposed by subsection (a) of Section
225A-2 shall cease to be imposed and the Department's obligation
23to make payments shall immediately cease, and any moneys
24remaining in the Fund shall be refunded to hospital providers
25in proportion to the amounts paid by them, if:

 

 

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1        (1) The payments to hospitals required under this
2    Article are not eligible for federal matching funds under
3    Title XIX or XXI of the Social Security Act;
4        (2) For State fiscal years 2009 through 2018, and as
5    provided in Section 5A-16, the Department of Healthcare and
6    Family Services adopts any administrative rule change to
7    reduce payment rates or alters any payment methodology that
8    reduces any payment rates made to operating hospitals under
9    the approved Title XIX or Title XXI State plan in effect
10    January 1, 2008 except for:
11            (A) any changes for hospitals described in
12        subsection (b) of Section 5A-3;
13            (B) any rates for payments made under this Article
14        V-A;
15            (C) any changes proposed in State plan amendment
16        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
17        08-07;
18            (D) in relation to any admissions on or after
19        January 1, 2011, a modification in the methodology for
20        calculating outlier payments to hospitals for
21        exceptionally costly stays, for hospitals reimbursed
22        under the diagnosis-related grouping methodology in
23        effect on July 1, 2011; provided that the Department
24        shall be limited to one such modification during the
25        36-month period after the effective date of this
26        amendatory Act of the 96th General Assembly;

 

 

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1            (E) any changes affecting hospitals authorized by
2        Public Act 97-689;
3        (F) any changes authorized by Section 14-12 of this
4        Code, or for any changes authorized under Section 5A-15
5        of this Code; or
6            (G) any changes authorized under Section 5-5b.1.
7    (b) The assessment imposed by Section 5A-2 shall not take
8effect or shall cease to be imposed, and the Department's
9obligation to make payments shall immediately cease, if the
10assessment is determined to be an impermissible tax under Title
11XIX of the Social Security Act. Moneys in the Hospital Provider
12Fund derived from assessments imposed prior thereto shall be
13disbursed in accordance with Section 5A-8 to the extent federal
14financial participation is not reduced due to the
15impermissibility of the assessments, and any remaining moneys
16shall be refunded to hospital providers in proportion to the
17amounts paid by them.
18    (c) The assessments imposed by subsection (b-5) of Section
195A-2 shall not take effect or shall cease to be imposed, the
20Department's obligation to make payments shall immediately
21cease, and any moneys remaining in the Fund shall be refunded
22to hospital providers in proportion to the amounts paid by
23them, if the payments to hospitals required under Section
245A-12.4 or Section 5A-12.6 are not eligible for federal
25matching funds under Title XIX of the Social Security Act.
26    (d) The assessments imposed by Section 5A-2 shall not take

 

 

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1effect or shall cease to be imposed, the Department's
2obligation to make payments shall immediately cease, and any
3moneys remaining in the Fund shall be refunded to hospital
4providers in proportion to the amounts paid by them, if:
5        (1) for State fiscal years 2013 through 2018, and as
6    provided in Section 5A-16, the Department reduces any
7    payment rates to hospitals as in effect on May 1, 2012, or
8    alters any payment methodology as in effect on May 1, 2012,
9    that has the effect of reducing payment rates to hospitals,
10    except for any changes affecting hospitals authorized in
11    Public Act 97-689 and any changes authorized by Section
12    14-12 of this Code, and except for any changes authorized
13    under Section 5A-15, and except for any changes authorized
14    under Section 5-5b.1;
15        (2) for State fiscal years 2013 through 2018, and as
16    provided in Section 5A-16, the Department reduces any
17    supplemental payments made to hospitals below the amounts
18    paid for services provided in State fiscal year 2011 as
19    implemented by administrative rules adopted and in effect
20    on or prior to June 30, 2011, except for any changes
21    affecting hospitals authorized in Public Act 97-689 and any
22    changes authorized by Section 14-12 of this Code, and
23    except for any changes authorized under Section 5A-15, and
24    except for any changes authorized under Section 5-5b.1; or
25        (3) for State fiscal years 2015 through 2018, and as
26    provided in Section 5A-16, the Department reduces the

 

 

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1    overall effective rate of reimbursement to hospitals below
2    the level authorized under Section 14-12 of this Code,
3    except for any changes under Section 14-12 or Section 5A-15
4    of this Code, and except for any changes authorized under
5    Section 5-5b.1.
6    (e) In Beginning in State fiscal year 2019 through State
7fiscal year 2020, the assessments imposed under Section 5A-2
8shall not take effect or shall cease to be imposed, the
9Department's obligation to make payments shall immediately
10cease, and any moneys remaining in the Fund shall be refunded
11to hospital providers in proportion to the amounts paid by
12them, if:
13        (1) the payments to hospitals required under Section
14    5A12.6 are not eligible for federal matching funds under
15    Title XIX of the Social Security Act; or
16        (2) the Department reduces the overall effective rate
17    of reimbursement to hospitals below the level authorized
18    under Section 14-12 of this Code, as in effect on December
19    31, 2017, except for any changes authorized under Sections
20    14-12 or Section 5A-15 of this Code, and except for any
21    changes authorized under changes to Sections 5A-12.2,
22    5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by Public Act
23    100-581 this amendatory Act of the 100th General Assembly.
24    (f) Beginning in State Fiscal Year 2021, the assessments
25imposed under Section 5A-2 shall not take effect or shall cease
26to be imposed, the Department's obligation to make payments

 

 

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1shall immediately cease, and any moneys remaining in the Fund
2shall be refunded to hospital providers in proportion to the
3amounts paid by them, if:
4        (1) the payments to hospitals required under Section
5    5A-12.7 are not eligible for federal matching funds under
6    Title XIX of the Social Security Act; or
7        (2) the Department reduces the overall effective rate
8    of reimbursement to hospitals below the level authorized
9    under Section 14-12, as in effect on December 31, 2019,
10    except for any changes authorized under Sections 14-12 or
11    5A-15, and except for any changes authorized under changes
12    to Sections 5A-12.7 and 14-12 made by this amendatory Act
13    of the 101st General Assembly.
14(Source: P.A. 99-2, eff. 3-26-15; 100-581, eff. 3-12-18.)
 
15    (305 ILCS 5/5A-12.7 new)
16    Sec. 5A-12.7. Continuation of hospital access payments on
17and after July 1, 2020.
18    (a) To preserve and improve access to hospital services,
19for hospital services rendered on and after July 1, 2020, the
20Department shall, except for hospitals described in subsection
21(b) of Section 5A-3, make payments to hospitals or require
22capitated managed care organizations to make payments as set
23forth in this Section. Payments under this Section are not due
24and payable, however, until: (i) the methodologies described in
25this Section are approved by the federal government in an

 

 

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1appropriate State Plan amendment or directed payment preprint;
2and (ii) the assessment imposed under this Article is
3determined to be a permissible tax under Title XIX of the
4Social Security Act. In determining the hospital access
5payments authorized under subsection (g) of this Section, if a
6hospital ceases to qualify for payments from the pool, the
7payments for all hospitals continuing to qualify for payments
8from such pool shall be uniformly adjusted to fully expend the
9aggregate net amount of the pool, with such adjustment being
10effective on the first day of the second month following the
11date the hospital ceases to receive payments from such pool.
12    (b) Amounts moved into claims-based rates and distributed
13in accordance with Section 14-12 shall remain in those
14claims-based rates.
15    (c) Graduate medical education.
16        (1) The calculation of graduate medical education
17    payments shall be based on the hospital's Medicare cost
18    report ending in Calendar Year 2018, as reported in the
19    Healthcare Cost Report Information System file, release
20    date September 30, 2019. An Illinois hospital reporting
21    intern and resident cost on its Medicare cost report shall
22    be eligible for graduate medical education payments.
23        (2) Each hospital's annualized Medicaid Intern
24    Resident Cost is calculated using annualized intern and
25    resident total costs obtained from Worksheet B Part I,
26    Columns 21 and 22 the sum of Lines 30-43, 50-76, 90-93,

 

 

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1    96-98, and 105-112 multiplied by the percentage that the
2    hospital's Medicaid days (Worksheet S3 Part I, Column 7,
3    Lines 2, 3, 4, 14, 16-18, and 32) comprise of the
4    hospital's total days (Worksheet S3 Part I, Column 8, Lines
5    14, 16-18, and 32).
6        (3) An annualized Medicaid indirect medical education
7    (IME) payment is calculated for each hospital using its IME
8    payments (Worksheet E Part A, Line 29, Column 1) multiplied
9    by the percentage that its Medicaid days (Worksheet S3 Part
10    I, Column 7, Lines 2, 3, 4, 14, 16-18, and 32) comprise of
11    its Medicare days (Worksheet S3 Part I, Column 6, Lines 2,
12    3, 4, 14, and 16-18).
13        (4) For each hospital, its annualized Medicaid Intern
14    Resident Cost and its annualized Medicaid IME payment are
15    summed, and, except as capped at 120% of the average cost
16    per intern and resident for all qualifying hospitals as
17    calculated under this paragraph, is multiplied by 22.6% to
18    determine the hospital's final graduate medical education
19    payment. Each hospital's average cost per intern and
20    resident shall be calculated by summing its total
21    annualized Medicaid Intern Resident Cost plus its
22    annualized Medicaid IME payment and dividing that amount by
23    the hospital's total Full Time Equivalent Residents and
24    Interns. If the hospital's average per intern and resident
25    cost is greater than 120% of the same calculation for all
26    qualifying hospitals, the hospital's per intern and

 

 

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1    resident cost shall be capped at 120% of the average cost
2    for all qualifying hospitals.
3    (d) Fee-for-service supplemental payments. Each Illinois
4hospital shall receive an annual payment equal to the amounts
5below, to be paid in 12 equal installments on or before the
6seventh State business day of each month, except that no
7payment shall be due within 30 days after the later of the date
8of notification of federal approval of the payment
9methodologies required under this Section or any waiver
10required under 42 CFR 433.68, at which time the sum of amounts
11required under this Section prior to the date of notification
12is due and payable.
13        (1) For critical access hospitals, $385 per covered
14    inpatient day contained in paid fee-for-service claims and
15    $530 per paid fee-for-service outpatient claim for dates of
16    service in Calendar Year 2019 in the Department's
17    Enterprise Data Warehouse as of May 11, 2020.
18        (2) For safety-net hospitals, $960 per covered
19    inpatient day contained in paid fee-for-service claims and
20    $625 per paid fee-for-service outpatient claim for dates of
21    service in Calendar Year 2019 in the Department's
22    Enterprise Data Warehouse as of May 11, 2020.
23        (3) For long term acute care hospitals, $295 per
24    covered inpatient day contained in paid fee-for-service
25    claims for dates of service in Calendar Year 2019 in the
26    Department's Enterprise Data Warehouse as of May 11, 2020.

 

 

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1        (4) For freestanding psychiatric hospitals, $125 per
2    covered inpatient day contained in paid fee-for-service
3    claims and $130 per paid fee-for-service outpatient claim
4    for dates of service in Calendar Year 2019 in the
5    Department's Enterprise Data Warehouse as of May 11, 2020.
6        (5) For freestanding rehabilitation hospitals, $355
7    per covered inpatient day contained in paid
8    fee-for-service claims for dates of service in Calendar
9    Year 2019 in the Department's Enterprise Data Warehouse as
10    of May 11, 2020.
11        (6) For all general acute care hospitals and high
12    Medicaid hospitals as defined in subsection (f), $350 per
13    covered inpatient day for dates of service in Calendar Year
14    2019 contained in paid fee-for-service claims and $620 per
15    paid fee-for-service outpatient claim in the Department's
16    Enterprise Data Warehouse as of May 11, 2020.
17        (7) Alzheimer's treatment access payment. Each
18    Illinois academic medical center or teaching hospital, as
19    defined in Section 5-5e.2 of this Code, that is identified
20    as the primary hospital affiliate of one of the Regional
21    Alzheimer's Disease Assistance Centers, as designated by
22    the Alzheimer's Disease Assistance Act and identified in
23    the Department of Public Health's Alzheimer's Disease
24    State Plan dated December 2016, shall be paid an
25    Alzheimer's treatment access payment equal to the product
26    of the qualifying hospital's State Fiscal Year 2018 total

 

 

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1    inpatient fee-for-service days multiplied by the
2    applicable Alzheimer's treatment rate of $226.30 for
3    hospitals located in Cook County and $116.21 for hospitals
4    located outside Cook County.
5    (e) The Department shall require managed care
6organizations (MCOs) to make directed payments and
7pass-through payments according to this Section. Each calendar
8year, the Department shall require MCOs to pay the maximum
9amount out of these funds as allowed as pass-through payments
10under federal regulations. The Department shall require MCOs to
11make such pass-through payments as specified in this Section.
12The Department shall require the MCOs to pay the remaining
13amounts as directed Payments as specified in this Section. The
14Department shall issue payments to the Comptroller by the
15seventh business day of each month for all MCOs that are
16sufficient for MCOs to make the directed payments and
17pass-through payments according to this Section. The
18Department shall require the MCOs to make pass-through payments
19and directed payments using electronic funds transfers (EFT),
20if the hospital provides the information necessary to process
21such EFTs, in accordance with directions provided monthly by
22the Department, within 7 business days of the date the funds
23are paid to the MCOs, as indicated by the "Paid Date" on the
24website of the Office of the Comptroller if the funds are paid
25by EFT and the MCOs have received directed payment
26instructions. If funds are not paid through the Comptroller by

 

 

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1EFT, payment must be made within 7 business days of the date
2actually received by the MCO. The MCO will be considered to
3have paid the pass-through payments when the payment remittance
4number is generated or the date the MCO sends the check to the
5hospital, if EFT information is not supplied. If an MCO is late
6in paying a pass-through payment or directed payment as
7required under this Section (including any extensions granted
8by the Department), it shall pay a penalty, unless waived by
9the Department for reasonable cause, to the Department equal to
105% of the amount of the pass-through payment or directed
11payment not paid on or before the due date plus 5% of the
12portion thereof remaining unpaid on the last day of each 30-day
13period thereafter. Payments to MCOs that would be paid
14consistent with actuarial certification and enrollment in the
15absence of the increased capitation payments under this Section
16shall not be reduced as a consequence of payments made under
17this subsection. The Department shall publish and maintain on
18its website for a period of no less than 8 calendar quarters,
19the quarterly calculation of directed payments and
20pass-through payments owed to each hospital from each MCO. All
21calculations and reports shall be posted no later than the
22first day of the quarter for which the payments are to be
23issued.
24    (f)(1) For purposes of allocating the funds included in
25capitation payments to MCOs, Illinois hospitals shall be
26divided into the following classes as defined in administrative

 

 

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1rules:
2        (A) Critical access hospitals.
3        (B) Safety-net hospitals, except that stand-alone
4    children's hospitals that are not specialty children's
5    hospitals will not be included.
6        (C) Long term acute care hospitals.
7        (D) Freestanding psychiatric hospitals.
8        (E) Freestanding rehabilitation hospitals.
9        (F) High Medicaid hospitals. As used in this Section,
10    "high Medicaid hospital" means a general acute care
11    hospital that is not a safety-net hospital or critical
12    access hospital and that has a Medicaid Inpatient
13    Utilization Rate above 30% or a hospital that had over
14    35,000 inpatient Medicaid days during the applicable
15    period. For the period July 1, 2020 through December 31,
16    2020, the applicable period for the Medicaid Inpatient
17    Utilization Rate (MIUR) is the rate year 2020 MIUR and for
18    the number of inpatient days it is State fiscal year 2018.
19    Beginning in calendar year 2021, the Department shall use
20    the most recently determined MIUR, as defined in subsection
21    (h) of Section 5-5.02, and for the inpatient day threshold,
22    the State fiscal year ending 18 months prior to the
23    beginning of the calendar year. For purposes of calculating
24    MIUR under this Section, children's hospitals and
25    affiliated general acute care hospitals shall be
26    considered a single hospital.

 

 

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1        (G) General acute care hospitals. As used under this
2    Section, "general acute care hospitals" means all other
3    Illinois hospitals not identified in subparagraphs (A)
4    through (F).
5    (2) Hospitals' qualification for each class shall be
6assessed prior to the beginning of each calendar year and the
7new class designation shall be effective January 1 of the next
8year. The Department shall publish by rule the process for
9establishing class determination.
10    (g) Fixed pool directed payments. Beginning July 1, 2020,
11the Department shall issue payments to MCOs which shall be used
12to issue directed payments to qualified Illinois safety-net
13hospitals and critical access hospitals on a monthly basis in
14accordance with this subsection. Prior to the beginning of each
15Payout Quarter beginning July 1, 2020, the Department shall use
16encounter claims data from the Determination Quarter, accepted
17by the Department's Medicaid Management Information System for
18inpatient and outpatient services rendered by safety-net
19hospitals and critical access hospitals to determine a
20quarterly uniform per unit add-on for each hospital class.
21        (1) Inpatient per unit add-on. A quarterly uniform per
22    diem add-on shall be derived by dividing the quarterly
23    Inpatient Directed Payments Pool amount allocated to the
24    applicable hospital class by the total inpatient days
25    contained on all encounter claims received during the
26    Determination Quarter, for all hospitals in the class.

 

 

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

 

 

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1        quarterly outpatient directed payment in each of the 3
2        months of the Payout Quarter, in accordance with
3        directions provided to each MCO by the Department.
4        (3) Each MCO shall pay each hospital the Monthly
5    Directed Payment as identified by the Department on its
6    quarterly determination report.
7        (4) Definitions. As used in this subsection:
8            (A) "Payout Quarter" means each 3 month calendar
9        quarter, beginning July 1, 2020.
10            (B) "Determination Quarter" means each 3 month
11        calendar quarter, which ends 3 months prior to the
12        first day of each Payout Quarter.
13        (5) For the period July 1, 2020 through December 2020,
14    the following amounts shall be allocated to the following
15    hospital class directed payment pools for the quarterly
16    development of a uniform per unit add-on:
17            (A) $2,894,500 for hospital inpatient services for
18        critical access hospitals.
19            (B) $4,294,374 for hospital outpatient services
20        for critical access hospitals.
21            (C) $29,109,330 for hospital inpatient services
22        for safety-net hospitals.
23            (D) $35,041,218 for hospital outpatient services
24        for safety-net hospitals.
25    (h) Fixed rate directed payments. Effective July 1, 2020,
26the Department shall issue payments to MCOs which shall be used

 

 

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1to issue directed payments to Illinois hospitals not identified
2in paragraph (g) on a monthly basis. Prior to the beginning of
3each Payout Quarter beginning July 1, 2020, the Department
4shall use encounter claims data from the Determination Quarter,
5accepted by the Department's Medicaid Management Information
6System for inpatient and outpatient services rendered by
7hospitals in each hospital class identified in paragraph (f)
8and not identified in paragraph (g). For the period July 1,
92020 through December 2020, the Department shall direct MCOs to
10make payments as follows:
11        (1) For general acute care hospitals an amount equal to
12    $1,750 multiplied by the hospital's category of service 20
13    case mix index for the determination quarter multiplied by
14    the hospital's total number of inpatient admissions for
15    category of service 20 for the determination quarter.
16        (2) For general acute care hospitals an amount equal to
17    $160 multiplied by the hospital's category of service 21
18    case mix index for the determination quarter multiplied by
19    the hospital's total number of inpatient admissions for
20    category of service 21 for the determination quarter.
21        (3) For general acute care hospitals an amount equal to
22    $80 multiplied by the hospital's category of service 22
23    case mix index for the determination quarter multiplied by
24    the hospital's total number of inpatient admissions for
25    category of service 22 for the determination quarter.
26        (4) For general acute care hospitals an amount equal to

 

 

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1    $375 multiplied by the hospital's category of service 24
2    case mix index for the determination quarter multiplied by
3    the hospital's total number of category of service 24 paid
4    EAPG (EAPGs) for the determination quarter.
5        (5) For general acute care hospitals an amount equal to
6    $240 multiplied by the hospital's category of service 27
7    and 28 case mix index for the determination quarter
8    multiplied by the hospital's total number of category of
9    service 27 and 28 paid EAPGs for the determination quarter.
10        (6) For general acute care hospitals an amount equal to
11    $290 multiplied by the hospital's category of service 29
12    case mix index for the determination quarter multiplied by
13    the hospital's total number of category of service 29 paid
14    EAPGs for the determination quarter.
15        (7) For high Medicaid hospitals an amount equal to
16    $1,800 multiplied by the hospital's category of service 20
17    case mix index for the determination quarter multiplied by
18    the hospital's total number of inpatient admissions for
19    category of service 20 for the determination quarter.
20        (8) For high Medicaid hospitals an amount equal to $160
21    multiplied by the hospital's category of service 21 case
22    mix index for the determination quarter multiplied by the
23    hospital's total number of inpatient admissions for
24    category of service 21 for the determination quarter.
25        (9) For high Medicaid hospitals an amount equal to $80
26    multiplied by the hospital's category of service 22 case

 

 

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1    mix index for the determination quarter multiplied by the
2    hospital's total number of inpatient admissions for
3    category of service 22 for the determination quarter.
4        (10) For high Medicaid hospitals an amount equal to
5    $400 multiplied by the hospital's category of service 24
6    case mix index for the determination quarter multiplied by
7    the hospital's total number of category of service 24 paid
8    EAPG outpatient claims for the determination quarter.
9        (11) For high Medicaid hospitals an amount equal to
10    $240 multiplied by the hospital's category of service 27
11    and 28 case mix index for the determination quarter
12    multiplied by the hospital's total number of category of
13    service 27 and 28 paid EAPGs for the determination quarter.
14        (12) For high Medicaid hospitals an amount equal to
15    $290 multiplied by the hospital's category of service 29
16    case mix index for the determination quarter multiplied by
17    the hospital's total number of category of service 29 paid
18    EAPGs for the determination quarter.
19        (13) For long term acute care hospitals the amount of
20    $495 multiplied by the hospital's total number of inpatient
21    days for the determination quarter.
22        (14) For psychiatric hospitals the amount of $210
23    multiplied by the hospital's total number of inpatient days
24    for category of service 21 for the determination quarter.
25        (15) For psychiatric hospitals the amount of $250
26    multiplied by the hospital's total number of outpatient

 

 

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1    claims for category of service 27 and 28 for the
2    determination quarter.
3        (16) For rehabilitation hospitals the amount of $410
4    multiplied by the hospital's total number of inpatient days
5    for category of service 22 for the determination quarter.
6        (17) For rehabilitation hospitals the amount of $100
7    multiplied by the hospital's total number of outpatient
8    claims for category of service 29 for the determination
9    quarter.
10        (18) Each hospital shall be paid 1/3 of their quarterly
11    inpatient and outpatient directed payment in each of the 3
12    months of the Payout Quarter, in accordance with directions
13    provided to each MCO by the Department.
14        (19) Each MCO shall pay each hospital the Monthly
15    Directed Payment amount as identified by the Department on
16    its quarterly determination report.
17    Notwithstanding any other provision of this subsection, if
18the Department determines that the actual total hospital
19utilization data that is used to calculate the fixed rate
20directed payments is substantially different than anticipated
21when the rates in this subsection were initially determined
22(for unforeseeable circumstances such as the COVID-19
23pandemic), the Department may adjust the rates specified in
24this subsection so that the total directed payments approximate
25the total spending amount anticipated when the rates were
26initially established.

 

 

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1    Definitions. As used in this subsection:
2            (A) "Payout Quarter" means each calendar quarter,
3        beginning July 1, 2020.
4            (B) "Determination Quarter" means each calendar
5        quarter which ends 3 months prior to the first day of
6        each Payout Quarter.
7            (C) "Case mix index" means a hospital specific
8        calculation. For inpatient claims the case mix index is
9        calculated each quarter by summing the relative weight
10        of all inpatient Diagnosis-Related Group (DRG) claims
11        for a category of service in the applicable
12        Determination Quarter and dividing the sum by the
13        number of sum total of all inpatient DRG admissions for
14        the category of service for the associated claims. The
15        case mix index for outpatient claims is calculated each
16        quarter by summing the relative weight of all paid
17        EAPGs in the applicable Determination Quarter and
18        dividing the sum by the sum total of paid EAPGs for the
19        associated claims.
20    (i) Beginning January 1, 2021, the rates for directed
21payments shall be recalculated in order to spend the additional
22funds for directed payments that result from reduction in the
23amount of pass-through payments allowed under federal
24regulations. The additional funds for directed payments shall
25be allocated proportionally to each class of hospitals based on
26that class' proportion of services.

 

 

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1    (j) Pass-through payments.
2        (1) For the period July 1, 2020 through December 31,
3    2020, the Department shall assign quarterly pass-through
4    payments to each class of hospitals equal to one-fourth of
5    the following annual allocations:
6            (A) $390,487,095 to safety-net hospitals.
7            (B) $62,553,886 to critical access hospitals.
8            (C) $345,021,438 to high Medicaid hospitals.
9            (D) $551,429,071 to general acute care hospitals.
10            (E) $27,283,870 to long term acute care hospitals.
11            (F) $40,825,444 to freestanding psychiatric
12        hospitals.
13            (G) $9,652,108 to freestanding rehabilitation
14        hospitals.
15        (2) The pass-through payments shall at a minimum ensure
16    hospitals receive a total amount of monthly payments under
17    this Section as received in calendar year 2019 in
18    accordance with this Article and paragraph (1) of
19    subsection (d-5) of Section 14-12, exclusive of amounts
20    received through payments referenced in subsection (b).
21        (3) For the calendar year beginning January 1, 2021,
22    and each calendar year thereafter, each hospital's
23    pass-through payment amount shall be reduced
24    proportionally to the reduction of all pass-through
25    payments required by federal regulations.
26    (k) At least 30 days prior to each calendar year, the

 

 

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1Department shall notify each hospital of changes to the payment
2methodologies in this Section, including, but not limited to,
3changes in the fixed rate directed payment rates, the aggregate
4pass-through payment amount for all hospitals, and the
5hospital's pass-through payment amount for the upcoming
6calendar year.
7    (l) Notwithstanding any other provisions of this Section,
8the Department may adopt rules to change the methodology for
9directed and pass-through payments as set forth in this
10Section, but only to the extent necessary to obtain federal
11approval of a necessary State Plan amendment or Directed
12Payment Preprint or to otherwise conform to federal law or
13federal regulation.
14    (m) As used in this subsection, "managed care organization"
15or "MCO" means an entity which contracts with the Department to
16provide services where payment for medical services is made on
17a capitated basis, excluding contracted entities for dual
18eligible or Department of Children and Family Services youth
19populations.
 
20    (305 ILCS 5/5A-12.8 new)
21    Sec. 5A-12.8. Report to the General Assembly. In order to
22facilitate transparency, accountability, and future policy
23development by the General Assembly, the Department shall
24provide the reports and information specified in this Section.
25By February 1, 2022, the Department shall provide a report to

 

 

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1the General Assembly that includes, but is not limited to, the
2following:
3        (1) information on the total payments made under
4    Section 5A-12.7 through December 1, 2021 broken out by
5    payment type; and
6        (2) after consulting the hospital community and other
7    interested parties, information that summarizes and
8    identifies options and stakeholder suggestions on the
9    following:
10            (A) policies and practices to improve access to
11        care, improve health, and reduce health disparities in
12        vulnerable communities;
13            (B) analysis of charity care by hospital;
14            (C) revisions to the payment methodology for
15        graduate medical education;
16            (D) revisions to the directed payment
17        methodologies, including the opportunity for hospitals
18        to shift from the fixed pool to the fixed rate directed
19        payments;
20            (E) the definitions of and criteria to qualify as a
21        safety-net hospital, a high Medicaid hospital, or a
22        children's hospital; and
23            (F) options to revise the methodology for
24        calculating the assessment under Section 5A-2.
 
25    (305 ILCS 5/5A-13)

 

 

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1    Sec. 5A-13. Emergency rulemaking.
2    (a) The Department of Healthcare and Family Services
3(formerly Department of Public Aid) may adopt rules necessary
4to implement this amendatory Act of the 94th General Assembly
5through the use of emergency rulemaking in accordance with
6Section 5-45 of the Illinois Administrative Procedure Act. For
7purposes of that Act, the General Assembly finds that the
8adoption of rules to implement this amendatory Act of the 94th
9General Assembly is deemed an emergency and necessary for the
10public interest, safety, and welfare.
11    (b) The Department of Healthcare and Family Services may
12adopt rules necessary to implement this amendatory Act of the
1397th General Assembly through the use of emergency rulemaking
14in accordance with Section 5-45 of the Illinois Administrative
15Procedure Act. For purposes of that Act, the General Assembly
16finds that the adoption of rules to implement this amendatory
17Act of the 97th General Assembly is deemed an emergency and
18necessary for the public interest, safety, and welfare.
19    (c) The Department of Healthcare and Family Services may
20adopt rules necessary to initially implement the changes to
21Articles 5, 5A, 12, and 14 of this Code under this amendatory
22Act of the 100th General Assembly through the use of emergency
23rulemaking in accordance with subsection (aa) of Section 5-45
24of the Illinois Administrative Procedure Act. For purposes of
25that Act, the General Assembly finds that the adoption of rules
26to implement the changes to Articles 5, 5A, 12, and 14 of this

 

 

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

 

 

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1the changes to Articles 5A and 14 of this Code under this
2amendatory Act of the 100th General Assembly.
3    (e) The Department of Healthcare and Family Services may
4adopt rules necessary to implement the changes made to Articles
55, 5A, 12, and 14 of this Code by this amendatory Act of the
6101st General Assembly through the use of emergency rulemaking
7in accordance with Section 5-45.1 of the Illinois
8Administrative Procedure Act. The 24-month limitation on the
9adoption of emergency rules does not apply to rules adopted
10under this Section. The General Assembly finds that the
11adoption of rules to implement the changes made to Articles 5,
125A, 12, and 14 of this Code by this amendatory Act of the 101st
13General Assembly is deemed an emergency and necessary for the
14public interest, safety, and welfare.
15(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19.)
 
16    (305 ILCS 5/5A-14)
17    Sec. 5A-14. Repeal of assessments and disbursements.
18    (a) Section 5A-2 is repealed on December 31, 2022 July 1,
192020.
20    (b) Section 5A-12 is repealed on July 1, 2005.
21    (c) Section 5A-12.1 is repealed on July 1, 2008.
22    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
23July 1, 2018, subject to Section 5A-16.
24    (e) Section 5A-12.3 is repealed on July 1, 2011.
25    (f) Section 5A-12.6 is repealed on July 1, 2020.

 

 

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1    (g) Section 5A-12.7 is repealed on December 31, 2022.
2(Source: P.A. 100-581, eff. 3-12-18.)
 
3    (305 ILCS 5/5A-17 new)
4    Sec. 5A-17. Recovery of payments; liens.
5    (a) As a condition of receiving payments pursuant to
6subsections (d) and (k) of Section 5A-12.7 for State Fiscal
7Year 2021, a for-profit general acute care hospital that ceases
8to provide hospital services before July 1, 2021 and within 12
9months of a change in the hospital's ownership status from
10not-for-profit to investor owned, shall be obligated to pay to
11the Department an amount equal to the payments received
12pursuant to subsections (d) and (k) of Section 5A-12.7 since
13the change in ownership status to the cessation of hospital
14services. The obligated amount shall be due immediately and
15must be paid to the Department within 10 days of ceasing to
16provide services or pursuant to a payment plan approved by the
17Department unless the hospital requests a hearing under
18paragraph (d) of this Section. The obligation under this
19Section shall not apply to a hospital that ceases to provide
20services under circumstances that include: implementation of a
21transformation project approved by the Department under
22subsection (d-5) of Section 14-12; emergencies as declared by
23federal, State, or local government; actions approved or
24required by federal, State, or local government; actions taken
25in compliance with the Illinois Health Facilities Planning Act;

 

 

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1or other circumstances beyond the control of the hospital
2provider or for the benefit of the community previously served
3by the hospital, as determined on a case-by-case basis by the
4Department.
5    (b) The Illinois Department shall administer and enforce
6this Section and collect the obligations imposed under this
7Section using procedures employed in its administration of this
8Code generally. The Illinois Department, its Director, and
9every hospital provider subject to this Section shall have the
10following powers, duties, and rights:
11        (1) The Illinois Department may initiate either
12    administrative or judicial proceedings, or both, to
13    enforce the provisions of this Section. Administrative
14    enforcement proceedings initiated hereunder shall be
15    governed by the Illinois Department's administrative
16    rules. Judicial enforcement proceedings initiated in
17    accordance with this Section shall be governed by the rules
18    of procedure applicable in the courts of this State.
19        (2) No proceedings for collection, refund, credit, or
20    other adjustment of an amount payable under this Section
21    shall be issued more than 3 years after the due date of the
22    obligation, except in the case of an extended period agreed
23    to in writing by the Illinois Department and the hospital
24    provider before the expiration of this limitation period.
25        (3) Any unpaid obligation under this Section shall
26    become a lien upon the assets of the hospital. If any

 

 

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1    hospital provider sells or transfers the major part of any
2    one or more of (i) the real property and improvements, (ii)
3    the machinery and equipment, or (iii) the furniture or
4    fixtures of any hospital that is subject to the provisions
5    of this Section, the seller or transferor shall pay the
6    Illinois Department the amount of any obligation due from
7    it under this Section up to the date of the sale or
8    transfer. If the seller or transferor fails to pay any
9    amount due under this Section, the purchaser or transferee
10    of such asset shall be liable for the amount of the
11    obligation up to the amount of the reasonable value of the
12    property acquired by the purchaser or transferee. The
13    purchaser or transferee shall continue to be liable until
14    the purchaser or transferee pays the full amount of the
15    obligation up to the amount of the reasonable value of the
16    property acquired by the purchaser or transferee or until
17    the purchaser or transferee receives from the Illinois
18    Department a certificate showing that such assessment,
19    penalty, and interest have been paid or a certificate from
20    the Illinois Department showing that no amount is due from
21    the seller or transferor under this Section.
22    (c) In addition to any other remedy provided for, the
23Illinois Department may collect an unpaid obligation by
24withholding, as payment of the amount due, reimbursements or
25other amounts otherwise payable by the Illinois Department to
26the hospital provider.
 

 

 

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1    (305 ILCS 5/12-4.105)
2    Sec. 12-4.105. Human poison control center; payment
3program. Subject to funding availability resulting from
4transfers made from the Hospital Provider Fund to the
5Healthcare Provider Relief Fund as authorized under this Code,
6for State fiscal year 2017 and State fiscal year 2018, and for
7each State fiscal year thereafter in which the assessment under
8Section 5A-2 is imposed, the Department of Healthcare and
9Family Services shall pay to the human poison control center
10designated under the Poison Control System Act an amount of not
11less than $3,000,000 for each of those State fiscal years 2017
12through 2020, and for State fiscal year 2021 and 2022 an amount
13of not less than $3,750,000 and for the period July 1, 2022
14through December 31, 2022 an amount of not less than
15$1,875,000, if that the human poison control center is in
16operation.
17(Source: P.A. 99-516, eff. 6-30-16; 100-581, eff. 3-12-18.)
 
18    (305 ILCS 5/14-12)
19    Sec. 14-12. Hospital rate reform payment system. The
20hospital payment system pursuant to Section 14-11 of this
21Article shall be as follows:
22    (a) Inpatient hospital services. Effective for discharges
23on and after July 1, 2014, reimbursement for inpatient general
24acute care services shall utilize the All Patient Refined

 

 

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1Diagnosis Related Grouping (APR-DRG) software, version 30,
2distributed by 3MTM Health Information System.
3        (1) The Department shall establish Medicaid weighting
4    factors to be used in the reimbursement system established
5    under this subsection. Initial weighting factors shall be
6    the weighting factors as published by 3M Health Information
7    System, associated with Version 30.0 adjusted for the
8    Illinois experience.
9        (2) The Department shall establish a
10    statewide-standardized amount to be used in the inpatient
11    reimbursement system. The Department shall publish these
12    amounts on its website no later than 10 calendar days prior
13    to their effective date.
14        (3) In addition to the statewide-standardized amount,
15    the Department shall develop adjusters to adjust the rate
16    of reimbursement for critical Medicaid providers or
17    services for trauma, transplantation services, perinatal
18    care, and Graduate Medical Education (GME).
19        (4) The Department shall develop add-on payments to
20    account for exceptionally costly inpatient stays,
21    consistent with Medicare outlier principles. Outlier fixed
22    loss thresholds may be updated to control for excessive
23    growth in outlier payments no more frequently than on an
24    annual basis, but at least triennially. Upon updating the
25    fixed loss thresholds, the Department shall be required to
26    update base rates within 12 months.

 

 

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1        (5) The Department shall define those hospitals or
2    distinct parts of hospitals that shall be exempt from the
3    APR-DRG reimbursement system established under this
4    Section. The Department shall publish these hospitals'
5    inpatient rates on its website no later than 10 calendar
6    days prior to their effective date.
7        (6) Beginning July 1, 2014 and ending on June 30, 2024,
8    in addition to the statewide-standardized amount, the
9    Department shall develop an adjustor to adjust the rate of
10    reimbursement for safety-net hospitals defined in Section
11    5-5e.1 of this Code excluding pediatric hospitals.
12        (7) Beginning July 1, 2014 and ending on June 30, 2020,
13    or upon implementation of inpatient psychiatric rate
14    increases as described in subsection (n) of Section
15    5A-12.6, in addition to the statewide-standardized amount,
16    the Department shall develop an adjustor to adjust the rate
17    of reimbursement for Illinois freestanding inpatient
18    psychiatric hospitals that are not designated as
19    children's hospitals by the Department but are primarily
20    treating patients under the age of 21.
21        (7.5) (Blank). Beginning July 1, 2020, the
22    reimbursement for inpatient psychiatric services shall be
23    so that base claims projected reimbursement is increased by
24    an amount equal to the funds allocated in paragraph (2) of
25    subsection (b) of Section 5A-12.6, less the amount
26    allocated under paragraphs (8) and (9) of this subsection

 

 

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1    and paragraphs (3) and (4) of subsection (b) multiplied by
2    13%. Beginning July 1, 2022, the reimbursement for
3    inpatient psychiatric services shall be so that base claims
4    projected reimbursement is increased by an amount equal to
5    the funds allocated in paragraph (3) of subsection (b) of
6    Section 5A-12.6, less the amount allocated under
7    paragraphs (8) and (9) of this subsection and paragraphs
8    (3) and (4) of subsection (b) multiplied by 13%. Beginning
9    July 1, 2024, the reimbursement for inpatient psychiatric
10    services shall be so that base claims projected
11    reimbursement is increased by an amount equal to the funds
12    allocated in paragraph (4) of subsection (b) of Section
13    5A-12.6, less the amount allocated under paragraphs (8) and
14    (9) of this subsection and paragraphs (3) and (4) of
15    subsection (b) multiplied by 13%.
16        (8) Beginning July 1, 2018, in addition to the
17    statewide-standardized amount, the Department shall adjust
18    the rate of reimbursement for hospitals designated by the
19    Department of Public Health as a Perinatal Level II or II+
20    center by applying the same adjustor that is applied to
21    Perinatal and Obstetrical care cases for Perinatal Level
22    III centers, as of December 31, 2017.
23        (9) Beginning July 1, 2018, in addition to the
24    statewide-standardized amount, the Department shall apply
25    the same adjustor that is applied to trauma cases as of
26    December 31, 2017 to inpatient claims to treat patients

 

 

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1    with burns, including, but not limited to, APR-DRGs 841,
2    842, 843, and 844.
3        (10) Beginning July 1, 2018, the
4    statewide-standardized amount for inpatient general acute
5    care services shall be uniformly increased so that base
6    claims projected reimbursement is increased by an amount
7    equal to the funds allocated in paragraph (1) of subsection
8    (b) of Section 5A-12.6, less the amount allocated under
9    paragraphs (8) and (9) of this subsection and paragraphs
10    (3) and (4) of subsection (b) multiplied by 40%. Beginning
11    July 1, 2020, the statewide-standardized amount for
12    inpatient general acute care services shall be uniformly
13    increased so that base claims projected reimbursement is
14    increased by an amount equal to the funds allocated in
15    paragraph (2) of subsection (b) of Section 5A-12.6, less
16    the amount allocated under paragraphs (8) and (9) of this
17    subsection and paragraphs (3) and (4) of subsection (b)
18    multiplied by 40%. Beginning July 1, 2022, the
19    statewide-standardized amount for inpatient general acute
20    care services shall be uniformly increased so that base
21    claims projected reimbursement is increased by an amount
22    equal to the funds allocated in paragraph (3) of subsection
23    (b) of Section 5A-12.6, less the amount allocated under
24    paragraphs (8) and (9) of this subsection and paragraphs
25    (3) and (4) of subsection (b) multiplied by 40%. Beginning
26    July 1, 2023 the statewide-standardized amount for

 

 

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

 

 

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1        Beginning July 1, 2023, the reimbursement for
2    inpatient rehabilitation services shall be uniformly
3    increased so that the $96 per day add-on as adjusted by the
4    July 1, 2022 increase, is increased by an amount equal to
5    the funds allocated in paragraph (4) of subsection (b) of
6    Section 5A-12.6, less the amount allocated under
7    paragraphs (8) and (9) of this subsection and paragraphs
8    (3) and (4) of subsection (b) multiplied by 0.9%.
9    (b) Outpatient hospital services. Effective for dates of
10service on and after July 1, 2014, reimbursement for outpatient
11services shall utilize the Enhanced Ambulatory Procedure
12Grouping (EAPG) software, version 3.7 distributed by 3MTM
13Health Information System.
14        (1) The Department shall establish Medicaid weighting
15    factors to be used in the reimbursement system established
16    under this subsection. The initial weighting factors shall
17    be the weighting factors as published by 3M Health
18    Information System, associated with Version 3.7.
19        (2) The Department shall establish service specific
20    statewide-standardized amounts to be used in the
21    reimbursement system.
22            (A) The initial statewide standardized amounts,
23        with the labor portion adjusted by the Calendar Year
24        2013 Medicare Outpatient Prospective Payment System
25        wage index with reclassifications, shall be published
26        by the Department on its website no later than 10

 

 

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1        calendar days prior to their effective date.
2            (B) The Department shall establish adjustments to
3        the statewide-standardized amounts for each Critical
4        Access Hospital, as designated by the Department of
5        Public Health in accordance with 42 CFR 485, Subpart F.
6        For outpatient services provided on or before June 30,
7        2018, the EAPG standardized amounts are determined
8        separately for each critical access hospital such that
9        simulated EAPG payments using outpatient base period
10        paid claim data plus payments under Section 5A-12.4 of
11        this Code net of the associated tax costs are equal to
12        the estimated costs of outpatient base period claims
13        data with a rate year cost inflation factor applied.
14        (3) In addition to the statewide-standardized amounts,
15    the Department shall develop adjusters to adjust the rate
16    of reimbursement for critical Medicaid hospital outpatient
17    providers or services, including outpatient high volume or
18    safety-net hospitals. Beginning July 1, 2018, the
19    outpatient high volume adjustor shall be increased to
20    increase annual expenditures associated with this adjustor
21    by $79,200,000, based on the State Fiscal Year 2015 base
22    year data and this adjustor shall apply to public
23    hospitals, except for large public hospitals, as defined
24    under 89 Ill. Adm. Code 148.25(a).
25        (4) Beginning July 1, 2018, in addition to the
26    statewide standardized amounts, the Department shall make

 

 

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1    an add-on payment for outpatient expensive devices and
2    drugs. This add-on payment shall at least apply to claim
3    lines that: (i) are assigned with one of the following
4    EAPGs: 490, 1001 to 1020, and coded with one of the
5    following revenue codes: 0274 to 0276, 0278; or (ii) are
6    assigned with one of the following EAPGs: 430 to 441, 443,
7    444, 460 to 465, 495, 496, 1090. The add-on payment shall
8    be calculated as follows: the claim line's covered charges
9    multiplied by the hospital's total acute cost to charge
10    ratio, less the claim line's EAPG payment plus $1,000,
11    multiplied by 0.8.
12        (5) Beginning July 1, 2018, the statewide-standardized
13    amounts for outpatient services shall be increased by a
14    uniform percentage so that base claims projected
15    reimbursement is increased by an amount equal to no less
16    than the funds allocated in paragraph (1) of subsection (b)
17    of Section 5A-12.6, less the amount allocated under
18    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
19    and (4) of this subsection multiplied by 46%. Beginning
20    July 1, 2020, the statewide-standardized amounts for
21    outpatient services shall be increased by a uniform
22    percentage so that base claims projected reimbursement is
23    increased by an amount equal to no less than the funds
24    allocated in paragraph (2) of subsection (b) of Section
25    5A-12.6, less the amount allocated under paragraphs (8) and
26    (9) of subsection (a) and paragraphs (3) and (4) of this

 

 

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1    subsection multiplied by 46%. Beginning July 1, 2022, the
2    statewide-standardized amounts for outpatient services
3    shall be increased by a uniform percentage so that base
4    claims projected reimbursement is increased by an amount
5    equal to the funds allocated in paragraph (3) of subsection
6    (b) of Section 5A-12.6, less the amount allocated under
7    paragraphs (8) and (9) of subsection (a) and paragraphs (3)
8    and (4) of this subsection multiplied by 46%. Beginning
9    July 1, 2023, the statewide-standardized amounts for
10    outpatient services shall be increased by a uniform
11    percentage so that base claims projected reimbursement is
12    increased by an amount equal to no less than the funds
13    allocated in paragraph (4) of subsection (b) of Section
14    5A-12.6, less the amount allocated under paragraphs (8) and
15    (9) of subsection (a) and paragraphs (3) and (4) of this
16    subsection multiplied by 46%.
17        (6) Effective for dates of service on or after July 1,
18    2018, the Department shall establish adjustments to the
19    statewide-standardized amounts for each Critical Access
20    Hospital, as designated by the Department of Public Health
21    in accordance with 42 CFR 485, Subpart F, such that each
22    Critical Access Hospital's standardized amount for
23    outpatient services shall be increased by the applicable
24    uniform percentage determined pursuant to paragraph (5) of
25    this subsection. It is the intent of the General Assembly
26    that the adjustments required under this paragraph (6) by

 

 

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1    Public Act 100-1181 this amendatory Act of the 100th
2    General Assembly shall be applied retroactively to claims
3    for dates of service provided on or after July 1, 2018.
4        (7) Effective for dates of service on or after March 8,
5    2019 (the effective date of Public Act 100-1181) this
6    amendatory Act of the 100th General Assembly, the
7    Department shall recalculate and implement an updated
8    statewide-standardized amount for outpatient services
9    provided by hospitals that are not Critical Access
10    Hospitals to reflect the applicable uniform percentage
11    determined pursuant to paragraph (5).
12            (1) Any recalculation to the
13        statewide-standardized amounts for outpatient services
14        provided by hospitals that are not Critical Access
15        Hospitals shall be the amount necessary to achieve the
16        increase in the statewide-standardized amounts for
17        outpatient services increased by a uniform percentage,
18        so that base claims projected reimbursement is
19        increased by an amount equal to no less than the funds
20        allocated in paragraph (1) of subsection (b) of Section
21        5A-12.6, less the amount allocated under paragraphs
22        (8) and (9) of subsection (a) and paragraphs (3) and
23        (4) of this subsection, for all hospitals that are not
24        Critical Access Hospitals, multiplied by 46%.
25            (2) It is the intent of the General Assembly that
26        the recalculations required under this paragraph (7)

 

 

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1        by Public Act 100-1181 this amendatory Act of the 100th
2        General Assembly shall be applied prospectively to
3        claims for dates of service provided on or after March
4        8, 2019 (the effective date of Public Act 100-1181)
5        this amendatory Act of the 100th General Assembly and
6        that no recoupment or repayment by the Department or an
7        MCO of payments attributable to recalculation under
8        this paragraph (7), issued to the hospital for dates of
9        service on or after July 1, 2018 and before March 8,
10        2019 (the effective date of Public Act 100-1181) this
11        amendatory Act of the 100th General Assembly, shall be
12        permitted.
13        (8) The Department shall ensure that all necessary
14    adjustments to the managed care organization capitation
15    base rates necessitated by the adjustments under
16    subparagraph (6) or (7) of this subsection are completed
17    and applied retroactively in accordance with Section
18    5-30.8 of this Code within 90 days of March 8, 2019 (the
19    effective date of Public Act 100-1181) this amendatory Act
20    of the 100th General Assembly.
21        (9) Within 60 days after federal approval of the change
22    made to the assessment in Section 5A-2 by this amendatory
23    Act of the 101st General Assembly, the Department shall
24    incorporate into the EAPG system for outpatient services
25    those services performed by hospitals currently billed
26    through the Non-Institutional Provider billing system.

 

 

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1    (c) In consultation with the hospital community, the
2Department is authorized to replace 89 Ill. Admin. Code 152.150
3as published in 38 Ill. Reg. 4980 through 4986 within 12 months
4of June 16, 2014 (the effective date of Public Act 98-651). If
5the Department does not replace these rules within 12 months of
6June 16, 2014 (the effective date of Public Act 98-651), the
7rules in effect for 152.150 as published in 38 Ill. Reg. 4980
8through 4986 shall remain in effect until modified by rule by
9the Department. Nothing in this subsection shall be construed
10to mandate that the Department file a replacement rule.
11    (d) Transition period. There shall be a transition period
12to the reimbursement systems authorized under this Section that
13shall begin on the effective date of these systems and continue
14until June 30, 2018, unless extended by rule by the Department.
15To help provide an orderly and predictable transition to the
16new reimbursement systems and to preserve and enhance access to
17the hospital services during this transition, the Department
18shall allocate a transitional hospital access pool of at least
19$290,000,000 annually so that transitional hospital access
20payments are made to hospitals.
21        (1) After the transition period, the Department may
22    begin incorporating the transitional hospital access pool
23    into the base rate structure; however, the transitional
24    hospital access payments in effect on June 30, 2018 shall
25    continue to be paid, if continued under Section 5A-16.
26        (2) After the transition period, if the Department

 

 

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1    reduces payments from the transitional hospital access
2    pool, it shall increase base rates, develop new adjustors,
3    adjust current adjustors, develop new hospital access
4    payments based on updated information, or any combination
5    thereof by an amount equal to the decreases proposed in the
6    transitional hospital access pool payments, ensuring that
7    the entire transitional hospital access pool amount shall
8    continue to be used for hospital payments.
9    (d-5) Hospital and health care transformation program. The
10Department, in conjunction with the Hospital Transformation
11Review Committee created under subsection (d-5), shall develop
12a hospital and health care transformation program to provide
13financial assistance to hospitals in transforming their
14services and care models to better align with the needs of the
15communities they serve. The payments authorized in this Section
16shall be subject to approval by the federal government.
17        (1) Phase 1. In State fiscal years 2019 through 2020,
18    the Department shall allocate funds from the transitional
19    access hospital pool to create a hospital transformation
20    pool of at least $262,906,870 annually and make hospital
21    transformation payments to hospitals. Subject to Section
22    5A-16, in State fiscal years 2019 and 2020, an Illinois
23    hospital that received either a transitional hospital
24    access payment under subsection (d) or a supplemental
25    payment under subsection (f) of this Section in State
26    fiscal year 2018, shall receive a hospital transformation

 

 

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1    payment as follows:
2            (A) If the hospital's Rate Year 2017 Medicaid
3        inpatient utilization rate is equal to or greater than
4        45%, the hospital transformation payment shall be
5        equal to 100% of the sum of its transitional hospital
6        access payment authorized under subsection (d) and any
7        supplemental payment authorized under subsection (f).
8            (B) If the hospital's Rate Year 2017 Medicaid
9        inpatient utilization rate is equal to or greater than
10        25% but less than 45%, the hospital transformation
11        payment shall be equal to 75% of the sum of its
12        transitional hospital access payment authorized under
13        subsection (d) and any supplemental payment authorized
14        under subsection (f).
15            (C) If the hospital's Rate Year 2017 Medicaid
16        inpatient utilization rate is less than 25%, the
17        hospital transformation payment shall be equal to 50%
18        of the sum of its transitional hospital access payment
19        authorized under subsection (d) and any supplemental
20        payment authorized under subsection (f).
21        (2) Phase 2.
22            (A) The funding amount from phase one shall be
23        incorporated into directed payment and pass-through
24        payment methodologies described in Section 5A-12.7.
25        During State fiscal years 2021 and 2022, the Department
26        shall allocate funds from the transitional access

 

 

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1        hospital pool to create a hospital transformation pool
2        annually and make hospital transformation payments to
3        hospitals participating in the transformation program.
4        Any hospital may seek transformation funding in Phase
5        2. Any hospital that seeks transformation funding in
6        Phase 2 to update or repurpose the hospital's physical
7        structure to transition to a new delivery model, must
8        submit to the Department in writing a transformation
9        plan, based on the Department's guidelines, that
10        describes the desired delivery model with projections
11        of patient volumes by service lines and projected
12        revenues, expenses, and net income that correspond to
13        the new delivery model. In Phase 2, subject to the
14        approval of rules, the Department may use the hospital
15        transformation pool to increase base rates, develop
16        new adjustors, adjust current adjustors, or develop
17        new access payments in order to support and incentivize
18        hospitals to pursue such transformation. In developing
19        such methodologies, the Department shall ensure that
20        the entire hospital transformation pool continues to
21        be expended to ensure access to hospital services or to
22        support organizations that had received hospital
23        transformation payments under this Section.
24            (B) Whereas there are communities in Illinois that
25        suffer from significant health care disparities
26        aggravated by social determinants of health and a lack

 

 

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1        of sufficiently allocated healthcare resources,
2        particularly community-based services and preventive
3        care, there is established a new hospital and health
4        care transformation program, which shall be supported
5        by a transformation funding pool. An application for
6        funding from the hospital and health care
7        transformation program may incorporate the campus of a
8        hospital closed after January 1, 2018 or a hospital
9        that has provided notice of its intent to close
10        pursuant to Section 8.7 of the Illinois Health
11        Facilities Planning Act. During State Fiscal Years
12        2021 through 2023, the hospital and health care
13        transformation program shall be supported by an annual
14        transformation funding pool of at least $150,000,000
15        to be allocated during the specified fiscal years for
16        the purpose of facilitating hospital and health care
17        transformation. The Department shall not allocate
18        funds associated with the hospital and health care
19        transformation pool as established in this
20        subparagraph until the General Assembly has
21        established in law or resolution, further criteria for
22        dispersal or allocation of those funds after the
23        effective date of this amendatory Act of 101st General
24        Assembly.
25            (A) Any hospital participating in the hospital
26        transformation program shall provide an opportunity

 

 

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1        for public input by local community groups, hospital
2        workers, and healthcare professionals and assist in
3        facilitating discussions about any transformations or
4        changes to the hospital.
5            (C) (B) As provided in paragraph (9) of Section 3
6        of the Illinois Health Facilities Planning Act, any
7        hospital participating in the transformation program
8        may be excluded from the requirements of the Illinois
9        Health Facilities Planning Act for those projects
10        related to the hospital's transformation. To be
11        eligible, the hospital must submit to the Health
12        Facilities and Services Review Board approval from
13        certification from the Department, approved by the
14        Hospital Transformation Review Committee, that the
15        project is a part of the hospital's transformation.
16            (D) (C) As provided in subsection (a-20) of Section
17        32.5 of the Emergency Medical Services (EMS) Systems
18        Act, a hospital that received hospital transformation
19        payments under this Section may convert to a
20        freestanding emergency center. To be eligible for such
21        a conversion, the hospital must submit to the
22        Department of Public Health approval certification
23        from the Department, approved by the Hospital
24        Transformation Review Committee, that the project is a
25        part of the hospital's transformation.
26        (3) (Blank). By April 1, 2019 March 12, 2018 (Public

 

 

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1    Act 100-581) the Department, in conjunction with the
2    Hospital Transformation Review Committee, shall develop
3    and file as an administrative rule with the Secretary of
4    State the goals, objectives, policies, standards, payment
5    models, or criteria to be applied in Phase 2 of the program
6    to allocate the hospital transformation funds. The goals,
7    objectives, and policies to be considered may include, but
8    are not limited to, achieving unmet needs of a community
9    that a hospital serves such as behavioral health services,
10    outpatient services, or drug rehabilitation services;
11    attaining certain quality or patient safety benchmarks for
12    health care services; or improving the coordination,
13    effectiveness, and efficiency of care delivery.
14    Notwithstanding any other provision of law, any rule
15    adopted in accordance with this subsection (d-5) may be
16    submitted to the Joint Committee on Administrative Rules
17    for approval only if the rule has first been approved by 9
18    of the 14 members of the Hospital Transformation Review
19    Committee.
20        (4) Hospital Transformation Review Committee. There is
21    created the Hospital Transformation Review Committee. The
22    Committee shall consist of 14 members. No later than 30
23    days after March 12, 2018 (the effective date of Public Act
24    100-581), the 4 legislative leaders shall each appoint 3
25    members; the Governor shall appoint the Director of
26    Healthcare and Family Services, or his or her designee, as

 

 

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1    a member; and the Director of Healthcare and Family
2    Services shall appoint one member. Any vacancy shall be
3    filled by the applicable appointing authority within 15
4    calendar days. The members of the Committee shall select a
5    Chair and a Vice-Chair from among its members, provided
6    that the Chair and Vice-Chair cannot be appointed by the
7    same appointing authority and must be from different
8    political parties. The Chair shall have the authority to
9    establish a meeting schedule and convene meetings of the
10    Committee, and the Vice-Chair shall have the authority to
11    convene meetings in the absence of the Chair. The Committee
12    may establish its own rules with respect to meeting
13    schedule, notice of meetings, and the disclosure of
14    documents; however, the Committee shall not have the power
15    to subpoena individuals or documents and any rules must be
16    approved by 9 of the 14 members. The Committee shall
17    perform the functions described in this Section and advise
18    and consult with the Director in the administration of this
19    Section. In addition to reviewing and approving the
20    policies, procedures, and rules for the hospital and health
21    care transformation program, the Committee shall consider
22    and make recommendations related to qualifying criteria
23    and payment methodologies related to safety-net hospitals
24    and children's hospitals. Members of the Committee
25    appointed by the legislative leaders shall be subject to
26    the jurisdiction of the Legislative Ethics Commission, not

 

 

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1    the Executive Ethics Commission, and all requests under the
2    Freedom of Information Act shall be directed to the
3    applicable Freedom of Information officer for the General
4    Assembly. The Department shall provide operational support
5    to the Committee as necessary. The Committee is dissolved
6    on April 1, 2019.
7    (e) Beginning 36 months after initial implementation, the
8Department shall update the reimbursement components in
9subsections (a) and (b), including standardized amounts and
10weighting factors, and at least triennially and no more
11frequently than annually thereafter. The Department shall
12publish these updates on its website no later than 30 calendar
13days prior to their effective date.
14    (f) Continuation of supplemental payments. Any
15supplemental payments authorized under Illinois Administrative
16Code 148 effective January 1, 2014 and that continue during the
17period of July 1, 2014 through December 31, 2014 shall remain
18in effect as long as the assessment imposed by Section 5A-2
19that is in effect on December 31, 2017 remains in effect.
20    (g) Notwithstanding subsections (a) through (f) of this
21Section and notwithstanding the changes authorized under
22Section 5-5b.1, any updates to the system shall not result in
23any diminishment of the overall effective rates of
24reimbursement as of the implementation date of the new system
25(July 1, 2014). These updates shall not preclude variations in
26any individual component of the system or hospital rate

 

 

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1variations. Nothing in this Section shall prohibit the
2Department from increasing the rates of reimbursement or
3developing payments to ensure access to hospital services.
4Nothing in this Section shall be construed to guarantee a
5minimum amount of spending in the aggregate or per hospital as
6spending may be impacted by factors, including, but not limited
7to, the number of individuals in the medical assistance program
8and the severity of illness of the individuals.
9    (h) The Department shall have the authority to modify by
10rulemaking any changes to the rates or methodologies in this
11Section as required by the federal government to obtain federal
12financial participation for expenditures made under this
13Section.
14    (i) Except for subsections (g) and (h) of this Section, the
15Department shall, pursuant to subsection (c) of Section 5-40 of
16the Illinois Administrative Procedure Act, provide for
17presentation at the June 2014 hearing of the Joint Committee on
18Administrative Rules (JCAR) additional written notice to JCAR
19of the following rules in order to commence the second notice
20period for the following rules: rules published in the Illinois
21Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
22(Medical Payment), 4628 (Specialized Health Care Delivery
23Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
24Grouping (DRG) Prospective Payment System (PPS)), and 4977
25(Hospital Reimbursement Changes), and published in the
26Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499

 

 

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1(Specialized Health Care Delivery Systems) and 6505 (Hospital
2Services).
3    (j) Out-of-state hospitals. Beginning July 1, 2018, for
4purposes of determining for State fiscal years 2019 and 2020
5and subsequent fiscal years the hospitals eligible for the
6payments authorized under subsections (a) and (b) of this
7Section, the Department shall include out-of-state hospitals
8that are designated a Level I pediatric trauma center or a
9Level I trauma center by the Department of Public Health as of
10December 1, 2017.
11    (k) The Department shall notify each hospital and managed
12care organization, in writing, of the impact of the updates
13under this Section at least 30 calendar days prior to their
14effective date.
15(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
16101-81, eff. 7-12-19; revised 7-29-19.)
 
17    Section 97. Severability. If any provision of this Act or
18application thereof to any person or circumstance is held
19invalid, such invalidity does not affect other provisions or
20applications of this Act which can be given effect without the
21invalid application or provision, and to this end the
22provisions of this Act are declared to be severable.
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.