093_HB1587

                                     LRB093 04477 DRJ 04530 b

 1        AN ACT in relation to public aid.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 5. The Illinois Public Aid  Code  is  amended  by
 5    changing Section 5-5.02 as follows:

 6        (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
 7        Sec. 5-5.02. Hospital reimbursements.
 8        (a)  Reimbursement  to  Hospitals;  July  1, 1992 through
 9    September 30, 1992.  Notwithstanding any other provisions  of
10    this  Code  or  the  Illinois  Department's Rules promulgated
11    under   the   Illinois    Administrative    Procedure    Act,
12    reimbursement  to  hospitals for services provided during the
13    period July 1, 1992 through September 30, 1992, shall  be  as
14    follows:
15             (1)  For inpatient hospital services rendered, or if
16        applicable,  for inpatient hospital discharges occurring,
17        on or after July 1, 1992 and on or before  September  30,
18        1992,  the  Illinois Department shall reimburse hospitals
19        for   inpatient   services   under   the    reimbursement
20        methodologies  in  effect  for  each hospital, and at the
21        inpatient payment rate calculated for each  hospital,  as
22        of  June  30,  1992.   For  purposes  of  this paragraph,
23        "reimbursement  methodologies"  means  all  reimbursement
24        methodologies that pertain to the provision of  inpatient
25        hospital  services,  including,  but  not limited to, any
26        adjustments for disproportionate share, targeted  access,
27        critical  care  access and uncompensated care, as defined
28        by the Illinois Department on June 30, 1992.
29             (2)  For the purpose of  calculating  the  inpatient
30        payment  rate  for  each  hospital  eligible  to  receive
31        quarterly  adjustment  payments  for  targeted access and
 
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 1        critical care, as defined by the Illinois  Department  on
 2        June 30, 1992, the adjustment payment for the period July
 3        1,  1992  through September 30, 1992, shall be 25% of the
 4        annual adjustment payments calculated for  each  eligible
 5        hospital,  as  of June 30, 1992.  The Illinois Department
 6        shall determine  by  rule  the  adjustment  payments  for
 7        targeted  access  and  critical care beginning October 1,
 8        1992.
 9             (3)  For the purpose of  calculating  the  inpatient
10        payment  rate  for  each  hospital  eligible  to  receive
11        quarterly  adjustment payments for uncompensated care, as
12        defined by the Illinois Department on June 30, 1992,  the
13        adjustment  payment for the period August 1, 1992 through
14        September 30, 1992,  shall  be  one-sixth  of  the  total
15        uncompensated  care  adjustment  payments  calculated for
16        each eligible hospital for the  uncompensated  care  rate
17        year,  as  defined  by the Illinois Department, ending on
18        July 31, 1992.  The Illinois Department  shall  determine
19        by  rule  the  adjustment payments for uncompensated care
20        beginning October 1, 1992.
21        (b)  Inpatient payments.  For inpatient services provided
22    on or after October 1, 1993, in addition to  rates  paid  for
23    hospital  inpatient  services pursuant to the Illinois Health
24    Finance Reform Act, as  now  or  hereafter  amended,  or  the
25    Illinois  Department's prospective reimbursement methodology,
26    or any other methodology used by the Illinois Department  for
27    inpatient   services,  the  Illinois  Department  shall  make
28    adjustment payments, in an amount calculated pursuant to  the
29    methodology  described  in  paragraph (c) of this Section, to
30    hospitals that the Illinois Department determines satisfy any
31    one of the following requirements:
32             (1)  Hospitals that are described in Section 1923 of
33        the federal Social Security  Act,  as  now  or  hereafter
34        amended; or
 
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 1             (2)  Illinois   hospitals   that   have  a  Medicaid
 2        inpatient utilization rate which is at least  one-half  a
 3        standard  deviation  above  the  mean  Medicaid inpatient
 4        utilization rate for all hospitals in Illinois  receiving
 5        Medicaid payments from the Illinois Department; or
 6             (3)  Illinois  hospitals  that on July 1, 1991 had a
 7        Medicaid  inpatient  utilization  rate,  as  defined   in
 8        paragraph (h) of this Section, that was at least the mean
 9        Medicaid  inpatient utilization rate for all hospitals in
10        Illinois receiving Medicaid payments  from  the  Illinois
11        Department and which were located in a planning area with
12        one-third  or  fewer  excess  beds  as  determined by the
13        Illinois Health Facilities Planning Board, and  that,  as
14        of  June 30, 1992, were located in a federally designated
15        Health Manpower Shortage Area; or
16             (4)  Illinois hospitals that:
17                  (A)  have a Medicaid inpatient utilization rate
18             that  is  at  least  equal  to  the  mean   Medicaid
19             inpatient  utilization  rate  for  all  hospitals in
20             Illinois  receiving  Medicaid  payments   from   the
21             Department; and
22                  (B)  also have a Medicaid obstetrical inpatient
23             utilization  rate  that  is  at  least  one standard
24             deviation  above  the  mean   Medicaid   obstetrical
25             inpatient  utilization  rate  for  all  hospitals in
26             Illinois  receiving  Medicaid  payments   from   the
27             Department for obstetrical services; or
28             (5)  Any children's hospital, which means a hospital
29        devoted  exclusively  to caring for children.  A hospital
30        which includes a facility devoted exclusively  to  caring
31        for children that is separately licensed as a hospital by
32        a  municipality  prior  to  September  30,  1998 shall be
33        considered a children's hospital to the degree  that  the
34        hospital's Medicaid care is provided to children; or.
 
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 1             (6) Any Illinois hospital located in a county with a
 2        population  determined by the 1990 decennial census to be
 3        over 250,000 and under 300,000 that borders another state
 4        which is within 25 miles of at least  2  hospitals  which
 5        receive  disproportionate  share payments under Title XIX
 6        of the Social Security Act and Article V of this Code.
 7        (c)  Inpatient  adjustment  payments.    The   adjustment
 8    payments  required by paragraph (b) shall be calculated based
 9    upon the hospital's Medicaid inpatient  utilization  rate  as
10    follows:
11             (1)  hospitals with a Medicaid inpatient utilization
12        rate  below  the  mean shall receive a per day adjustment
13        payment equal to $25;
14             (2)   hospitals   with    a    Medicaid    inpatient
15        utilization  rate  that  is  equal to or greater than the
16        mean Medicaid inpatient utilization rate  but  less  than
17        one  standard deviation above the mean Medicaid inpatient
18        utilization rate  shall  receive  a  per  day  adjustment
19        payment  equal  to  the  sum  of $25 plus $1 for each one
20        percent   that   the   hospital's   Medicaid    inpatient
21        utilization  rate  exceeds  the  mean  Medicaid inpatient
22        utilization rate;
23             (3)   hospitals   with    a    Medicaid    inpatient
24        utilization  rate  that  is  equal to or greater than one
25        standard deviation  above  the  mean  Medicaid  inpatient
26        utilization  rate  but  less than 1.5 standard deviations
27        above the mean Medicaid inpatient utilization rate  shall
28        receive  a per day adjustment payment equal to the sum of
29        $40 plus $7 for each  one  percent  that  the  hospital's
30        Medicaid  inpatient utilization rate exceeds one standard
31        deviation above the mean Medicaid  inpatient  utilization
32        rate; and
33             (4)   hospitals    with    a    Medicaid   inpatient
34        utilization rate that is equal to  or  greater  than  1.5
 
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 1        standard  deviations  above  the  mean Medicaid inpatient
 2        utilization rate  shall  receive  a  per  day  adjustment
 3        payment  equal  to  the  sum  of $90 plus $2 for each one
 4        percent   that   the   hospital's   Medicaid    inpatient
 5        utilization  rate  exceeds  1.5 standard deviations above
 6        the mean Medicaid inpatient utilization rate.
 7        (d)  Supplemental adjustment payments.   In  addition  to
 8    the adjustment payments described in paragraph (c), hospitals
 9    as  defined  in  clauses  (1)  through  (5) of paragraph (b),
10    excluding county hospitals (as defined in subsection  (c)  of
11    Section 15-1 of this Code) and a hospital organized under the
12    University   of   Illinois   Hospital   Act,  shall  be  paid
13    supplemental inpatient adjustment payments of  $60  per  day.
14    For purposes of Title XIX of the federal Social Security Act,
15    these   supplemental   adjustment   payments   shall  not  be
16    classified as adjustment payments to  disproportionate  share
17    hospitals.
18        (e)  The   inpatient  adjustment  payments  described  in
19    paragraphs (c) and (d) shall be increased on October 1,  1993
20    and  annually  thereafter by a percentage equal to the lesser
21    of (i) the increase in the DRI hospital cost  index  for  the
22    most  recent 12 month period for which data are available, or
23    (ii)  the  percentage  increase  in  the  statewide   average
24    hospital  payment  rate  over  the  previous year's statewide
25    average hospital payment rate.   The  sum  of  the  inpatient
26    adjustment  payments  under  paragraphs  (c)  and  (d)  to  a
27    hospital,  other  than  a  county  hospital  (as  defined  in
28    subsection  (c)  of  Section 15-1 of this Code) or a hospital
29    organized under the  University  of  Illinois  Hospital  Act,
30    however,  shall  not exceed $275 per day; that limit shall be
31    increased on October 1, 1993 and  annually  thereafter  by  a
32    percentage equal to the lesser of (i) the increase in the DRI
33    hospital  cost  index for the most recent 12-month period for
34    which data are available or (ii) the percentage  increase  in
 
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 1    the statewide average hospital payment rate over the previous
 2    year's statewide average hospital payment rate.
 3        (f)   Children's  hospital inpatient adjustment payments.
 4    For  children's  hospitals,  as  defined  in  clause  (5)  of
 5    paragraph (b), the adjustment payments required  pursuant  to
 6    paragraphs (c) and (d) shall be multiplied by 2.0.
 7        (g)   County hospital inpatient adjustment payments.  For
 8    county  hospitals,  as  defined  in subsection (c) of Section
 9    15-1 of this Code, there shall be an  adjustment  payment  as
10    determined by rules issued by the Illinois Department.
11        (h)   For  the  purposes  of  this  Section the following
12    terms shall be defined as follows:
13             (1)  "Medicaid inpatient utilization rate"  means  a
14        fraction,  the  numerator  of  which  is  the number of a
15        hospital's inpatient days provided in  a  given  12-month
16        period  to patients who, for such days, were eligible for
17        Medicaid under Title XIX of the federal  Social  Security
18        Act,  and the denominator of which is the total number of
19        the hospital's inpatient days in that same period.
20             (2)  "Mean  Medicaid  inpatient  utilization   rate"
21        means   the  total  number  of  Medicaid  inpatient  days
22        provided by all Illinois Medicaid-participating hospitals
23        divided by the total number of inpatient days provided by
24        those same hospitals.
25             (3)  "Medicaid  obstetrical  inpatient   utilization
26        rate"  means  the ratio of Medicaid obstetrical inpatient
27        days to total Medicaid inpatient days  for  all  Illinois
28        hospitals  receiving  Medicaid payments from the Illinois
29        Department.
30        (i)   Inpatient adjustment payment limit.   In  order  to
31    meet  the limits of Public Law 102-234 and Public Law 103-66,
32    the Illinois Department shall by rule adjust disproportionate
33    share adjustment payments.
34        (j)  University of Illinois Hospital inpatient adjustment
 
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 1    payments.  For hospitals organized under  the  University  of
 2    Illinois  Hospital  Act, there shall be an adjustment payment
 3    as determined by rules adopted by the Illinois Department.
 4        (k)  The  Illinois  Department  may  by  rule   establish
 5    criteria   for   and  develop  methodologies  for  adjustment
 6    payments to hospitals participating under this Article.
 7    (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)