93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB4969

 

Introduced 02/05/04, by Rosemary Mulligan

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.02   from Ch. 23, par. 5-5.02

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning Medicaid rates for hospitals.


LRB093 18794 DRJ 44528 b

 

 

A BILL FOR

 

HB4969 LRB093 18794 DRJ 44528 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 Hospitals; July 1, 1992
9 through September 30, 1992. Notwithstanding any other
10 provisions of this Code or the Illinois Department's Rules
11 promulgated 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 of
22     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 by
28     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
32     critical care, as defined by the Illinois Department on

 

 

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1     June 30, 1992, the adjustment payment for the period July
2     1, 1992 through September 30, 1992, shall be 25% of the
3     annual adjustment payments calculated for each eligible
4     hospital, as of June 30, 1992. The Illinois Department
5     shall determine by rule the adjustment payments for
6     targeted access and critical care beginning October 1,
7     1992.
8         (3) For the purpose of calculating the inpatient
9     payment rate for each hospital eligible to receive
10     quarterly adjustment payments for uncompensated care, as
11     defined by the Illinois Department on June 30, 1992, the
12     adjustment payment for the period August 1, 1992 through
13     September 30, 1992, shall be one-sixth of the total
14     uncompensated care adjustment payments calculated for each
15     eligible hospital for the uncompensated care rate year, as
16     defined by the Illinois Department, ending on July 31,
17     1992. The Illinois Department shall determine by rule the
18     adjustment payments for uncompensated care beginning
19     October 1, 1992.
20     (b) Inpatient payments. For inpatient services provided on
21 or after October 1, 1993, in addition to rates paid for
22 hospital inpatient services pursuant to the Illinois Health
23 Finance Reform Act, as now or hereafter amended, or the
24 Illinois Department's prospective reimbursement methodology,
25 or any other methodology used by the Illinois Department for
26 inpatient services, the Illinois Department shall make
27 adjustment payments, in an amount calculated pursuant to the
28 methodology described in paragraph (c) of this Section, to
29 hospitals that the Illinois Department determines satisfy any
30 one of the following requirements:
31         (1) Hospitals that are described in Section 1923 of the
32     federal Social Security Act, as now or hereafter amended;
33     or
34         (2) Illinois hospitals that have a Medicaid inpatient
35     utilization rate which is at least one-half a standard
36     deviation above the mean Medicaid inpatient utilization

 

 

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1     rate for all hospitals in Illinois receiving Medicaid
2     payments from the Illinois Department; or
3         (3) Illinois hospitals that on July 1, 1991 had a
4     Medicaid inpatient utilization rate, as defined in
5     paragraph (h) of this Section, that was at least the mean
6     Medicaid inpatient utilization rate for all hospitals in
7     Illinois receiving Medicaid payments from the Illinois
8     Department and which were located in a planning area with
9     one-third or fewer excess beds as determined by the
10     Illinois Health Facilities Planning Board, and that, as of
11     June 30, 1992, were located in a federally designated
12     Health Manpower Shortage Area; or
13         (4) Illinois hospitals that:
14             (A) have a Medicaid inpatient utilization rate
15         that is at least equal to the mean Medicaid inpatient
16         utilization rate for all hospitals in Illinois
17         receiving Medicaid payments from the Department; and
18             (B) also have a Medicaid obstetrical inpatient
19         utilization rate that is at least one standard
20         deviation above the mean Medicaid obstetrical
21         inpatient utilization rate for all hospitals in
22         Illinois receiving Medicaid payments from the
23         Department for obstetrical services; or
24         (5) Any children's hospital, which means a hospital
25     devoted exclusively to caring for children. A hospital
26     which includes a facility devoted exclusively to caring for
27     children shall be considered a children's hospital to the
28     degree that the hospital's Medicaid care is provided to
29     children if either (i) the facility devoted exclusively to
30     caring for children is separately licensed as a hospital by
31     a municipality prior to September 30, 1998 or (ii) the
32     hospital has been designated by the State as a Level III
33     perinatal care facility, has a Medicaid Inpatient
34     Utilization rate greater than 55% for the rate year 2003
35     disproportionate share determination, and has more than
36     10,000 qualified children days as defined by the Department

 

 

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1     in rulemaking.
2     (c) Inpatient adjustment payments. The adjustment payments
3 required by paragraph (b) shall be calculated based upon the
4 hospital's Medicaid inpatient utilization rate as follows:
5         (1) hospitals with a Medicaid inpatient utilization
6     rate below the mean shall receive a per day adjustment
7     payment equal to $25;
8         (2) hospitals with a Medicaid inpatient utilization
9     rate that is equal to or greater than the mean Medicaid
10     inpatient utilization rate but less than one standard
11     deviation above the mean Medicaid inpatient utilization
12     rate shall receive a per day adjustment payment equal to
13     the sum of $25 plus $1 for each one percent that the
14     hospital's Medicaid inpatient utilization rate exceeds the
15     mean Medicaid inpatient utilization rate;
16         (3) hospitals with a Medicaid inpatient utilization
17     rate that is equal to or greater than one standard
18     deviation above the mean Medicaid inpatient utilization
19     rate but less than 1.5 standard deviations above the mean
20     Medicaid inpatient utilization rate shall receive a per day
21     adjustment payment equal to the sum of $40 plus $7 for each
22     one percent that the hospital's Medicaid inpatient
23     utilization rate exceeds one standard deviation above the
24     mean Medicaid inpatient utilization rate; and
25         (4) hospitals with a Medicaid inpatient utilization
26     rate that is equal to or greater than 1.5 standard
27     deviations above the mean Medicaid inpatient utilization
28     rate shall receive a per day adjustment payment equal to
29     the sum of $90 plus $2 for each one percent that the
30     hospital's Medicaid inpatient utilization rate exceeds 1.5
31     standard deviations above the mean Medicaid inpatient
32     utilization rate.
33     (d) Supplemental adjustment payments. In addition to the
34 adjustment payments described in paragraph (c), hospitals as
35 defined in clauses (1) through (5) of paragraph (b), excluding
36 county hospitals (as defined in subsection (c) of Section 15-1

 

 

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1 of this Code) and a hospital organized under the University of
2 Illinois Hospital Act, shall be paid supplemental inpatient
3 adjustment payments of $60 per day. For purposes of Title XIX
4 of the federal Social Security Act, these supplemental
5 adjustment payments shall not be classified as adjustment
6 payments to disproportionate share hospitals.
7     (e) The inpatient adjustment payments described in
8 paragraphs (c) and (d) shall be increased on October 1, 1993
9 and annually thereafter by a percentage equal to the lesser of
10 (i) the increase in the DRI hospital cost index for the most
11 recent 12 month period for which data are available, or (ii)
12 the percentage increase in the statewide average hospital
13 payment rate over the previous year's statewide average
14 hospital payment rate. The sum of the inpatient adjustment
15 payments under paragraphs (c) and (d) to a hospital, other than
16 a county hospital (as defined in subsection (c) of Section 15-1
17 of this Code) or a hospital organized under the University of
18 Illinois Hospital Act, however, shall not exceed $275 per day;
19 that limit shall be increased on October 1, 1993 and annually
20 thereafter by a percentage equal to the lesser of (i) the
21 increase in the DRI hospital cost index for the most recent
22 12-month period for which data are available or (ii) the
23 percentage increase in the statewide average hospital payment
24 rate over the previous year's statewide average hospital
25 payment rate.
26     (f) Children's hospital inpatient adjustment payments. For
27 children's hospitals, as defined in clause (5) of paragraph
28 (b), the adjustment payments required pursuant to paragraphs
29 (c) and (d) shall be multiplied by 2.0.
30     (g) County hospital inpatient adjustment payments. For
31 county hospitals, as defined in subsection (c) of Section 15-1
32 of this Code, there shall be an adjustment payment as
33 determined by rules issued by the Illinois Department.
34     (h) For the purposes of this Section the following terms
35 shall be defined as follows:
36         (1) "Medicaid inpatient utilization rate" means a

 

 

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1     fraction, the numerator of which is the number of a
2     hospital's inpatient days provided in a given 12-month
3     period to patients who, for such days, were eligible for
4     Medicaid under Title XIX of the federal Social Security
5     Act, and the denominator of which is the total number of
6     the hospital's inpatient days in that same period.
7         (2) "Mean Medicaid inpatient utilization rate" means
8     the total number of Medicaid inpatient days provided by all
9     Illinois Medicaid-participating hospitals divided by the
10     total number of inpatient days provided by those same
11     hospitals.
12         (3) "Medicaid obstetrical inpatient utilization rate"
13     means the ratio of Medicaid obstetrical inpatient days to
14     total Medicaid inpatient days for all Illinois hospitals
15     receiving Medicaid payments from the Illinois Department.
16     (i) Inpatient adjustment payment limit. In order to meet
17 the limits of Public Law 102-234 and Public Law 103-66, the
18 Illinois Department shall by rule adjust disproportionate
19 share adjustment payments.
20     (j) University of Illinois Hospital inpatient adjustment
21 payments. For hospitals organized under the University of
22 Illinois Hospital Act, there shall be an adjustment payment as
23 determined by rules adopted by the Illinois Department.
24     (k) The Illinois Department may by rule establish criteria
25 for and develop methodologies for adjustment payments to
26 hospitals participating under this Article.
27 (Source: P.A. 93-40, eff. 6-27-03.)