Human Services Committee

Filed: 5/27/2005

 

 


 

 


 
09400SB0157ham001 LRB094 07276 DRJ 47293 a

1
AMENDMENT TO SENATE BILL 157

2     AMENDMENT NO. ______. Amend Senate Bill 157 by replacing
3 everything after the enacting clause with the following:
 
4
"ARTICLE 5.

 
5     Section 5-1. Short title. This Article may be cited as the
6 Public Health Program Beneficiary Employer Disclosure Law.
7 References in this Article to "this Law" mean this Article.
 
8     Section 5-5. Definition. In this Law, "public health
9 program" means either of the following:
10         (1) The medical assistance program under Article V of
11     the Illinois Public Aid Code.
12         (2) The children's health insurance program under the
13     Children's Health Insurance Program Act.
 
14     Section 5-10. Disclosure of employer required. An
15 applicant for health care benefits under a public health
16 program, or a person requesting uncompensated care in a
17 hospital, may identify the employer or employers of the
18 proposed beneficiary of the health care benefits. If the
19 proposed public health program beneficiary is not employed, the
20 applicant may identify the employer or employers of any adult
21 who is responsible for providing all or some of the proposed
22 beneficiary's support.
 

 

 

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1     Section 5-15. Reporting of employer-provided health
2 insurance information.
3     (a) Hospitals required to report information on the
4 uncompensated care they provide pursuant to federal Medicare
5 cost reporting shall determine, from information that may be
6 provided by a person receiving uncompensated or charity care,
7 whether that person is employed, and if the person is employed
8 the identity of the employer. The hospital shall annually
9 submit to the Department a summary report of the employment
10 status information obtained from persons receiving
11 uncompensated or charity care, including available information
12 regarding the cost of the care provided and the number of
13 persons employed by each identified employer.
14     (b) Notwithstanding any other law to the contrary, the
15 Department of Public Aid or its successor agency, in
16 collaboration with the Department of Human Services and the
17 Department of Financial and Professional Regulation, shall
18 annually prepare a public health access program beneficiary
19 employer report to be submitted to the General Assembly. For
20 the purposes of this Section, a "public health access program
21 beneficiary" means a person who receives medical assistance
22 under Title XIX or XXI of the federal Social Security Act.
23     Subject to federal approval, the report shall provide the
24 following information for each employer who has more than 100
25 employees and 25 or more public health access program
26 beneficiaries:
27         (1) The name and address of the qualified employer.
28         (2) The number of public health access program
29     beneficiaries.
30         (3) The number of persons requesting uncompensated or
31     charity care from the hospitals required to report under
32     this Section and the cost of that care.
33         (4) The number of public health access program

 

 

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1     beneficiaries who are spouses or dependents of employees of
2     the employer.
3         (5) Information on whether the employer offers health
4     insurance benefits to employees and their dependents.
5         (6) Information on whether the employer receives
6     health insurance benefits through the company.
7         (7) Whether an employer offers health insurance
8     benefits, and, if so, information on the level of premium
9     subsidies for such health insurance.
10         (8) The cost to the State of Illinois of providing
11     public health access program benefits for the employer's
12     employees and enrolled dependents.
13     (c) The report shall not include the names of any
14 individual public health access program beneficiary and shall
15 be subject to privacy standards both in the Health Insurance
16 Portability and Accountability Act of 1996 and in Title XIX of
17 the federal Social Security Act.
18     (d) The first report shall be submitted on or before
19 October 1, 2006, and subsequent reports shall be submitted on
20 or before that date each year thereafter.
 
21     Section 5-90. Repeal. This Law is repealed on January 1,
22 2009.
 
23
ARTICLE 10.

 
24     Section 10-1. Short title. This Article may be cited as the
25 Illinois Adverse Health Care Events Reporting Law of 2005.
26 References in this Article to "this Law" mean this Article.
 
27     Section 10-5. Purpose. The sole purpose of this Law is to
28 establish an adverse health care event reporting system
29 designed to facilitate quality improvement in the health care
30 system through communication and collaboration between the

 

 

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1 Department and health care facilities. The reporting system
2 established under this Law shall not be designed or used to
3 punish errors or to investigate or take disciplinary action
4 against health care facilities, health care practitioners, or
5 health care facility employees.
 
6     Section 10-10. Definitions. As used in this Law, the
7 following terms have the following meanings:
8     "Adverse health care event" means any event described in
9 subsections (b) through (g) of Section 10-15.
10     "Department" means the Illinois Department of Public
11 Health.
12     "Health care facility" means a hospital maintained by the
13 State or any department or agency thereof where such department
14 or agency has authority under law to establish and enforce
15 standards for the hospital under its management and control, a
16 hospital maintained by any university or college established
17 under the laws of this State and supported principally by
18 public funds raised by taxation, a hospital licensed under the
19 Hospital Licensing Act, a hospital organized under the
20 University of Illinois Hospital Act, and an ambulatory surgical
21 treatment center licensed under the Ambulatory Surgical
22 Treatment Center Act.
 
23     Section 10-15. Health care facility requirements to
24 report, analyze, and correct.
25     (a) Reports of adverse health care events required. Each
26 health care facility shall report to the Department the
27 occurrence of any of the adverse health care events described
28 in subsections (b) through (g) no later than 30 days after
29 discovery of the event. The report shall be filed in a format
30 specified by the Department and shall identify the health care
31 facility, but shall not include any information identifying or
32 that tends to identify any of the health care professionals,

 

 

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1 employees, or patients involved.
2     (b) Surgical events. Events reportable under this
3 subsection are:
4         (1) Surgery performed on a wrong body part that is not
5     consistent with the documented informed consent for that
6     patient. Reportable events under this clause do not include
7     situations requiring prompt action that occur in the course
8     of surgery or situations whose urgency precludes obtaining
9     informed consent.
10         (2) Surgery performed on the wrong patient.
11         (3) The wrong surgical procedure performed on a patient
12     that is not consistent with the documented informed consent
13     for that patient. Reportable events under this clause do
14     not include situations requiring prompt action that occur
15     in the course of surgery or situations whose urgency
16     precludes obtaining informed consent.
17         (4) Retention of a foreign object in a patient after
18     surgery or other procedure, excluding objects
19     intentionally implanted as part of a planned intervention
20     and objects present prior to surgery that are intentionally
21     retained.
22         (5) Death during or immediately after surgery of a
23     normal, healthy patient who has no organic, physiologic,
24     biochemical, or psychiatric disturbance and for whom the
25     pathologic processes for which the operation is to be
26     performed are localized and do not entail a systemic
27     disturbance.
28     (c) Product or device events. Events reportable under this
29 subsection are:
30         (1) Patient death or serious disability associated
31     with the use of contaminated drugs, devices, or biologics
32     provided by the health care facility when the contamination
33     is the result of generally detectable contaminants in
34     drugs, devices, or biologics regardless of the source of

 

 

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1     the contamination or the product.
2         (2) Patient death or serious disability associated
3     with the use or function of a device in patient care in
4     which the device is used or functions other than as
5     intended. "Device" includes, but is not limited to,
6     catheters, drains, and other specialized tubes, infusion
7     pumps, and ventilators.
8         (3) Patient death or serious disability associated
9     with intravascular air embolism that occurs while being
10     cared for in a health care facility, excluding deaths
11     associated with neurosurgical procedures known to present
12     a high risk of intravascular air embolism.
13     (d) Patient protection events. Events reportable under
14 this subsection are:
15         (1) An infant discharged to the wrong person.
16         (2) Patient death or serious disability associated
17     with patient disappearance for more than 4 hours, excluding
18     events involving adults who have decision-making capacity.
19         (3) Patient suicide or attempted suicide resulting in
20     serious disability while being cared for in a health care
21     facility due to patient actions after admission to the
22     health care facility, excluding deaths resulting from
23     self-inflicted injuries that were the reason for admission
24     to the health care facility.
25     (e) Care management events. Events reportable under this
26 subsection are:
27         (1) Patient death or serious disability associated
28     with a medication error, including, but not limited to,
29     errors involving the wrong drug, the wrong dose, the wrong
30     patient, the wrong time, the wrong rate, the wrong
31     preparation, or the wrong route of administration,
32     excluding reasonable differences in clinical judgment on
33     drug selection and dose.
34         (2) Patient death or serious disability associated

 

 

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1     with a hemolytic reaction due to the administration of
2     ABO-incompatible blood or blood products.
3         (3) Maternal death or serious disability associated
4     with labor or delivery in a low-risk pregnancy while being
5     cared for in a health care facility, excluding deaths from
6     pulmonary or amniotic fluid embolism, acute fatty liver of
7     pregnancy, or cardiomyopathy.
8         (4) Patient death or serious disability directly
9     related to hypoglycemia, the onset of which occurs while
10     the patient is being cared for in a health care facility
11     for a condition unrelated to hypoglycemia.
12     (f) Environmental events. Events reportable under this
13 subsection are:
14         (1) Patient death or serious disability associated
15     with an electric shock while being cared for in a health
16     care facility, excluding events involving planned
17     treatments such as electric countershock.
18         (2) Any incident in which a line designated for oxygen
19     or other gas to be delivered to a patient contains the
20     wrong gas or is contaminated by toxic substances.
21         (3) Patient death or serious disability associated
22     with a burn incurred from any source while being cared for
23     in a health care facility that is not consistent with the
24     documented informed consent for that patient. Reportable
25     events under this clause do not include situations
26     requiring prompt action that occur in the course of surgery
27     or situations whose urgency precludes obtaining informed
28     consent.
29         (4) Patient death associated with a fall while being
30     cared for in a health care facility.
31         (5) Patient death or serious disability associated
32     with the use of restraints or bedrails while being cared
33     for in a health care facility.
34     (g) Physical security events. Events reportable under this

 

 

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1 subsection are:
2         (1) Any instance of care ordered by or provided by
3     someone impersonating a physician, nurse, pharmacist, or
4     other licensed health care provider.
5         (2) Abduction of a patient of any age.
6         (3) Sexual assault on a patient within or on the
7     grounds of a health care facility.
8         (4) Death or significant injury of a patient or staff
9     member resulting from a physical assault that occurs within
10     or on the grounds of a health care facility.
11     (h) Definitions. As used in this Section 10-15:
12     "Death" means patient death that would not have occurred
13 but for an event described in this Section.
14     "Serious disability" means a physical or mental impairment
15 that would not have occurred but for an event described in this
16 Section that substantially limits one or more of the major life
17 activities of an individual or a loss of bodily function, if
18 the impairment or loss lasts more than 7 days prior to
19 discharge or is still present at the time of discharge from an
20 inpatient health care facility.
 
21     Section 10-20. Root cause analysis; corrective action
22 plan. Following the occurrence of an adverse health care event,
23 the health care facility must conduct a root cause analysis of
24 the event. Following the analysis, the health care facility
25 must (i) implement a corrective action plan to address the
26 findings of the analysis or (ii) report to the Department any
27 reasons for not taking corrective action. A copy of the
28 findings of the root cause analysis and a copy of the
29 corrective action plan must be filed with the Department within
30 90 days after the submission of the report to the Department
31 under Section 10-15.
 
32     Section 10-25. Confidentiality. Other than the annual

 

 

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1 report required under paragraph (4) of Section 10-35 of this
2 Law, adverse health care event reports, findings of root cause
3 analyses, and corrective action plans filed by a health care
4 facility under this Law and records created or obtained by the
5 Department in reviewing or investigating these reports,
6 findings, and plans shall not be available to the public and
7 shall not be discoverable or admissible in any civil, criminal,
8 or administrative proceeding against a health care facility or
9 health care professional. No report or Department disclosure
10 under this Law may contain information identifying a patient,
11 employee, or licensed professional. Notwithstanding any other
12 provision of law, under no circumstances shall the Department
13 disclose information obtained from a health care facility that
14 is confidential under Part 21 of Article VIII of the Code of
15 Civil Procedure. Nothing in this Law shall preclude or alter
16 the reporting responsibilities of hospitals or ambulatory
17 surgical treatment centers under existing federal or State law.
 
18     Section 10-30. Establishment of reporting system.
19     (a) The Department shall establish an adverse health event
20 reporting system that will be fully operational by January 1,
21 2008 and designed to facilitate quality improvement in the
22 health care system through communication and collaboration
23 among the Department and health care facilities. The reporting
24 system shall not be designed or used to punish errors or
25 investigate or take disciplinary action against health care
26 facilities, health care practitioners, or health care facility
27 employees. The Department may not use the adverse health care
28 event reports, findings of the root cause analyses, and
29 corrective action plans filed under this Law for any purpose
30 not stated in this Law, including, but not limited to, using
31 such information for investigating possible violations of the
32 reporting health care facility's licensing act or its
33 regulations. The Department is not authorized to select from or

 

 

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1 between competing alternate health care treatments, services,
2 or practices.
3     (b) The reporting system shall consist of:
4         (1) Mandatory reporting by health care facilities of
5     adverse health care events.
6         (2) Mandatory completion of a root cause analysis and a
7     corrective action plan by the health care facility and
8     reporting of the findings of the analysis and the plan to
9     the Department or reporting of reasons for not taking
10     corrective action.
11         (3) Analysis of reported information by the Department
12     to determine patterns of systemic failure in the health
13     care system and successful methods to correct these
14     failures.
15         (4) Sanctions against health care facilities for
16     failure to comply with reporting system requirements.
17         (5) Communication from the Department to health care
18     facilities, to maximize the use of the reporting system to
19     improve health care quality.
20     (c) In establishing the adverse health event reporting
21 system, including the design of the reporting format and annual
22 report, the Department must consult with and seek input from
23 experts and organizations specializing in patient safety.
24     (d) The Department must design the reporting system so that
25 a health care facility may file by electronic means the reports
26 required under this Law. The Department shall encourage a
27 health care facility to use the electronic filing option when
28 that option is feasible for the health care facility.
29     (e) Nothing in this Section prohibits a health care
30 facility from taking any remedial action in response to the
31 occurrence of an adverse health care event.
 
32     Section 10-35. Analysis of reports; communication of
33 findings. The Department shall do the following:

 

 

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1         (1) Analyze adverse event reports, corrective action
2     plans, and findings of the root cause analyses to determine
3     patterns of systemic failure in the health care system and
4     successful methods to correct these failures.
5         (2) Communicate to individual health care facilities
6     the Department's conclusions, if any, regarding an adverse
7     event reported by the health care facility.
8         (3) Communicate to relevant health care facilities any
9     recommendations for corrective action resulting from the
10     Department's analysis of submissions from facilities.
11         (4) Publish an annual report that does the following:
12             (i) Describes, by institution, adverse health care
13         events reported.
14             (ii) Summarizes, in aggregate form, the types of
15         corrective action plans implemented by health care
16         facilities collectively.
17             (iii) Describes adopted recommendations for
18     quality improvement practices.
 
19     Section 10-40. Health Care Event Reporting Advisory
20 Committee. The Department shall appoint a 9-person Health Care
21 Event Reporting Advisory Committee with at least one member
22 from each of the following statewide organizations: one
23 representing hospitals; one representing ambulatory surgical
24 treatment centers; and one representing physicians licensed to
25 practice medicine in all its branches. The committee shall also
26 include other individuals who have expertise and experience in
27 system-based quality improvement and safety and shall include
28 one public member. At least 3 of the 9 members shall be
29 individuals who do not have a financial interest in, or a
30 business relationship with, hospitals or ambulatory surgical
31 treatment centers. The Health Care Event Reporting Advisory
32 Committee shall, when possible, make recommendations for
33 potential quality improvement practices and modifications to

 

 

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1 the list of reportable adverse health care events consistent
2 with national standards. Prior to adoption of any
3 recommendations, the committee shall conduct a public hearing
4 seeking input from health care facilities, health care
5 professionals, and the public.
 
6     Section 10-45. Testing period.
7     (a) Prior to the testing period in subsection (b), the
8 Department shall adopt rules for implementing this Law in
9 consultation with the Health Care Event Reporting Advisory
10 Committee and individuals who have experience and expertise in
11 devising and implementing adverse health care event or other
12 heath care quality reporting systems. The rules shall establish
13 the methodology and format for health care facilities reporting
14 information under this Law to the Department and shall be
15 finalized before the beginning of the testing period under
16 subsection (b).
17     (b) The Department shall conduct a testing period of at
18 least 6 months to test the reporting process to identify any
19 problems or deficiencies with the planned reporting process.
20     (c) None of the information reported and analyzed during
21 the testing period shall be used in any public report under
22 this Law.
23     (d) The Department must address problems or deficiencies
24 identified during the testing period before fully implementing
25 the reporting system.
26     (e) After the testing period, and after any corrections,
27 adjustments, or modifications are finalized, the Department
28 must give at least 30 days written notice to health care
29 facilities prior to full implementation of the reporting system
30 and collection of adverse event data that will be used in
31 public reports.
32     (f) Following the testing period, 4 calendar quarters of
33 data must be collected prior to the Department's publishing the

 

 

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1 annual report of adverse events to the public under paragraph
2 (4) of Section 10-35.
3     (g) The process described in subsections (a) through (e)
4 must be completed by the Department no later than July 1, 2007.
5     (h) Notwithstanding any other provision of law, the
6 Department may contract with an entity for receiving all
7 adverse health care event reports, root cause analysis
8 findings, and corrective action plans that must be reported to
9 the Department under this Law and for the compilation of the
10 information and the provision of quarterly and annual reports
11 to the Department describing such information according to the
12 rules adopted by the Department under this Law.
 
13     Section 10-50. Validity of public reports. None of the
14 information the Department discloses to the public may be made
15 available in any form or fashion unless such information is
16 shared with the health care facilities under review prior to
17 public dissemination of such information. Those health care
18 facilities shall have 30 days to make corrections and to add
19 helpful explanatory comments about the information before the
20 publication.
 
21
ARTICLE 90.

 
22     Section 90-5. The Ambulatory Surgical Treatment Center Act
23 is amended by changing Section 10d as follows:
 
24     (210 ILCS 5/10d)  (from Ch. 111 1/2, par. 157-8.10d)
25     Sec. 10d. Fines and penalties.
26     (a) When the Director determines that a facility has failed
27 to comply with this Act or the Illinois Adverse Health Care
28 Events Reporting Law of 2005 or any rule adopted under either
29 of those Acts hereunder, the Department may issue a notice of
30 fine assessment which shall specify the violations for which

 

 

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1 the fine is assessed. The Department may assess a fine of up to
2 $500 per violation per day commencing on the date the violation
3 was identified and ending on the date the violation is
4 corrected, or action is taken to suspend, revoke or deny
5 renewal of the license, whichever comes first.
6     (b) In determining whether a fine is to be assessed or the
7 amount of such fine, the Director shall consider the following
8 factors:
9         (1) The gravity of the violation, including the
10     probability that death or serious physical or mental harm
11     to a patient will result or has resulted, the severity of
12     the actual or potential harm, and the extent to which the
13     provisions of the applicable statutes or rules were
14     violated;
15         (2) The reasonable diligence exercised by the licensee
16     and efforts to correct violations;
17         (3) Any previous violations committed by the licensee;
18     and
19         (4) The financial benefit to the facility of committing
20     or continuing the violation.
21 (Source: P.A. 86-1292.)
 
22     Section 90-10. The Hospital Licensing Act is amended by
23 changing Section 7 as follows:
 
24     (210 ILCS 85/7)  (from Ch. 111 1/2, par. 148)
25     Sec. 7. (a) The Director after notice and opportunity for
26 hearing to the applicant or licensee may deny, suspend, or
27 revoke a permit to establish a hospital or deny, suspend, or
28 revoke a license to open, conduct, operate, and maintain a
29 hospital in any case in which he finds that there has been a
30 substantial failure to comply with the provisions of this Act,
31 or the Hospital Report Card Act, or the Illinois Adverse Health
32 Care Events Reporting Law of 2005 or the standards, rules, and

 

 

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1 regulations established by virtue of any either of those Acts.
2     (b) Such notice shall be effected by registered mail or by
3 personal service setting forth the particular reasons for the
4 proposed action and fixing a date, not less than 15 days from
5 the date of such mailing or service, at which time the
6 applicant or licensee shall be given an opportunity for a
7 hearing. Such hearing shall be conducted by the Director or by
8 an employee of the Department designated in writing by the
9 Director as Hearing Officer to conduct the hearing. On the
10 basis of any such hearing, or upon default of the applicant or
11 licensee, the Director shall make a determination specifying
12 his findings and conclusions. In case of a denial to an
13 applicant of a permit to establish a hospital, such
14 determination shall specify the subsection of Section 6 under
15 which the permit was denied and shall contain findings of fact
16 forming the basis of such denial. A copy of such determination
17 shall be sent by registered mail or served personally upon the
18 applicant or licensee. The decision denying, suspending, or
19 revoking a permit or a license shall become final 35 days after
20 it is so mailed or served, unless the applicant or licensee,
21 within such 35 day period, petitions for review pursuant to
22 Section 13.
23     (c) The procedure governing hearings authorized by this
24 Section shall be in accordance with rules promulgated by the
25 Department and approved by the Hospital Licensing Board. A full
26 and complete record shall be kept of all proceedings, including
27 the notice of hearing, complaint, and all other documents in
28 the nature of pleadings, written motions filed in the
29 proceedings, and the report and orders of the Director and
30 Hearing Officer. All testimony shall be reported but need not
31 be transcribed unless the decision is appealed pursuant to
32 Section 13. A copy or copies of the transcript may be obtained
33 by any interested party on payment of the cost of preparing
34 such copy or copies.

 

 

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1     (d) The Director or Hearing Officer shall upon his own
2 motion, or on the written request of any party to the
3 proceeding, issue subpoenas requiring the attendance and the
4 giving of testimony by witnesses, and subpoenas duces tecum
5 requiring the production of books, papers, records, or
6 memoranda. All subpoenas and subpoenas duces tecum issued under
7 the terms of this Act may be served by any person of full age.
8 The fees of witnesses for attendance and travel shall be the
9 same as the fees of witnesses before the Circuit Court of this
10 State, such fees to be paid when the witness is excused from
11 further attendance. When the witness is subpoenaed at the
12 instance of the Director, or Hearing Officer, such fees shall
13 be paid in the same manner as other expenses of the Department,
14 and when the witness is subpoenaed at the instance of any other
15 party to any such proceeding the Department may require that
16 the cost of service of the subpoena or subpoena duces tecum and
17 the fee of the witness be borne by the party at whose instance
18 the witness is summoned. In such case, the Department in its
19 discretion, may require a deposit to cover the cost of such
20 service and witness fees. A subpoena or subpoena duces tecum
21 issued as aforesaid shall be served in the same manner as a
22 subpoena issued out of a court.
23     (e) Any Circuit Court of this State upon the application of
24 the Director, or upon the application of any other party to the
25 proceeding, may, in its discretion, compel the attendance of
26 witnesses, the production of books, papers, records, or
27 memoranda and the giving of testimony before the Director or
28 Hearing Officer conducting an investigation or holding a
29 hearing authorized by this Act, by an attachment for contempt,
30 or otherwise, in the same manner as production of evidence may
31 be compelled before the court.
32     (f) The Director or Hearing Officer, or any party in an
33 investigation or hearing before the Department, may cause the
34 depositions of witnesses within the State to be taken in the

 

 

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1 manner prescribed by law for like depositions in civil actions
2 in courts of this State, and to that end compel the attendance
3 of witnesses and the production of books, papers, records, or
4 memoranda.
5 (Source: P.A. 93-563, eff. 1-1-04.)
 
6     Section 90-15. The Illinois Public Aid Code is amended by
7 changing Sections 5A-1, 5A-2, 5A-3, 5A-4, 5A-5, 5A-7, 5A-8,
8 5A-10, 5A-13, and 5A-14 and by adding Section 5A-12.1 as
9 follows:
 
10     (305 ILCS 5/5A-1)  (from Ch. 23, par. 5A-1)
11     Sec. 5A-1. Definitions. As used in this Article, unless
12 the context requires otherwise:
13     "Adjusted gross hospital revenue" shall be determined
14 separately for inpatient and outpatient services for each
15 hospital conducted, operated or maintained by a hospital
16 provider, and means the hospital provider's total gross
17 revenues less: (i) gross revenue attributable to non-hospital
18 based services including home dialysis services, durable
19 medical equipment, ambulance services, outpatient clinics and
20 any other non-hospital based services as determined by the
21 Illinois Department by rule; and (ii) gross revenues
22 attributable to the routine services provided to persons
23 receiving skilled or intermediate long-term care services
24 within the meaning of Title XVIII or XIX of the Social Security
25 Act; and (iii) Medicare gross revenue (excluding the Medicare
26 gross revenue attributable to clauses (i) and (ii) of this
27 paragraph and the Medicare gross revenue attributable to the
28 routine services provided to patients in a psychiatric
29 hospital, a rehabilitation hospital, a distinct part
30 psychiatric unit, a distinct part rehabilitation unit, or swing
31 beds). Adjusted gross hospital revenue shall be determined
32 using the most recent data available from each hospital's 2003

 

 

09400SB0157ham001 - 18 - LRB094 07276 DRJ 47293 a

1 Medicare cost report as contained in the Healthcare Cost Report
2 Information System file, for the quarter ending on December 31,
3 2004, without regard to any subsequent adjustments or changes
4 to such data. If a hospital's 2003 Medicare cost report is not
5 contained in the Healthcare Cost Report Information System, the
6 hospital provider shall furnish such cost report or the data
7 necessary to determine its adjusted gross hospital revenue as
8 required by rule by the Illinois Department.
9     "Fund" means the Hospital Provider Fund.
10     "Hospital" means an institution, place, building, or
11 agency located in this State that is subject to licensure by
12 the Illinois Department of Public Health under the Hospital
13 Licensing Act, whether public or private and whether organized
14 for profit or not-for-profit.
15     "Hospital provider" means a person licensed by the
16 Department of Public Health to conduct, operate, or maintain a
17 hospital, regardless of whether the person is a Medicaid
18 provider. For purposes of this paragraph, "person" means any
19 political subdivision of the State, municipal corporation,
20 individual, firm, partnership, corporation, company, limited
21 liability company, association, joint stock association, or
22 trust, or a receiver, executor, trustee, guardian, or other
23 representative appointed by order of any court.
24     "Occupied bed days" means the sum of the number of days
25 that each bed was occupied by a patient for all beds during
26 calendar year 2001. Occupied bed days shall be computed
27 separately for each hospital operated or maintained by a
28 hospital provider.
29     "Proration factor" means a fraction, the numerator of which
30 is 53 and the denominator of which is 365.
31 (Source: P.A. 93-659, eff. 2-3-04; 93-1066, eff. 1-15-05.)
 
32     (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
33     (Section scheduled to be repealed on July 1, 2005)

 

 

09400SB0157ham001 - 19 - LRB094 07276 DRJ 47293 a

1     Sec. 5A-2. Assessment; no local authorization to tax.
2     (a) Subject to Sections 5A-3 and 5A-10, an annual
3 assessment on inpatient services is imposed on each hospital
4 provider in an amount equal to the hospital's occupied bed days
5 multiplied by $84.19 multiplied by the proration factor for
6 State fiscal year 2004 and the hospital's occupied bed days
7 multiplied by $84.19 for State fiscal year 2005.
8     The Department of Public Aid shall use the number of
9 occupied bed days as reported by each hospital on the Annual
10 Survey of Hospitals conducted by the Department of Public
11 Health to calculate the hospital's annual assessment. If the
12 sum of a hospital's occupied bed days is not reported on the
13 Annual Survey of Hospitals or if there are data errors in the
14 reported sum of a hospital's occupied bed days as determined by
15 the Department of Public Aid, then the Department of Public Aid
16 may obtain the sum of occupied bed days from any source
17 available, including, but not limited to, records maintained by
18 the hospital provider, which may be inspected at all times
19 during business hours of the day by the Department of Public
20 Aid or its duly authorized agents and employees.
21     Subject to Sections 5A-3 and 5A-10, for the privilege of
22 engaging in the occupation of hospital provider, beginning
23 August 1, 2005, an annual assessment is imposed on each
24 hospital provider for State fiscal years 2006, 2007, and 2008,
25 in an amount equal to 2.5835% of the hospital provider's
26 adjusted gross hospital revenue for inpatient services and
27 2.5835% of the hospital provider's adjusted gross hospital
28 revenue for outpatient services. If the hospital provider's
29 adjusted gross hospital revenue is not available, then the
30 Illinois Department may obtain the hospital provider's
31 adjusted gross hospital revenue from any source available,
32 including, but not limited to, records maintained by the
33 hospital provider, which may be inspected at all times during
34 business hours of the day by the Illinois Department or its

 

 

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1 duly authorized agents and employees.
2     (b) Nothing in this Article amendatory Act of the 93rd
3 General Assembly shall be construed to authorize any home rule
4 unit or other unit of local government to license for revenue
5 or to impose a tax or assessment upon hospital providers or the
6 occupation of hospital provider, or a tax or assessment
7 measured by the income or earnings of a hospital provider.
8     (c) As provided in Section 5A-14, this Section is repealed
9 on July 1, 2008 2005.
10 (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04;
11 93-1066, eff. 1-15-05.)
 
12     (305 ILCS 5/5A-3)  (from Ch. 23, par. 5A-3)
13     Sec. 5A-3. Exemptions.
14     (a) (Blank).
15     (b) A hospital provider that is a State agency, a State
16 university, or a county with a population of 3,000,000 or more
17 is exempt from the assessment imposed by Section 5A-2.
18     (b-2) A hospital provider that is a county with a
19 population of less than 3,000,000 or a township, municipality,
20 hospital district, or any other local governmental unit is
21 exempt from the assessment imposed by Section 5A-2.
22     (b-5) (Blank).
23     (b-10) For State fiscal years 2004 and 2005, a A hospital
24 provider whose hospital does not charge for its services is
25 exempt from the assessment imposed by Section 5A-2, unless the
26 exemption is adjudged to be unconstitutional or otherwise
27 invalid, in which case the hospital provider shall pay the
28 assessment imposed by Section 5A-2.
29     (b-15) For State fiscal years 2004 and 2005, a A hospital
30 provider whose hospital is licensed by the Department of Public
31 Health as a psychiatric hospital is exempt from the assessment
32 imposed by Section 5A-2, unless the exemption is adjudged to be
33 unconstitutional or otherwise invalid, in which case the

 

 

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1 hospital provider shall pay the assessment imposed by Section
2 5A-2.
3     (b-20) For State fiscal years 2004 and 2005, a A hospital
4 provider whose hospital is licensed by the Department of Public
5 Health as a rehabilitation hospital is exempt from the
6 assessment imposed by Section 5A-2, unless the exemption is
7 adjudged to be unconstitutional or otherwise invalid, in which
8 case the hospital provider shall pay the assessment imposed by
9 Section 5A-2.
10     (b-25) For State fiscal years 2004 and 2005, a A hospital
11 provider whose hospital (i) is not a psychiatric hospital,
12 rehabilitation hospital, or children's hospital and (ii) has an
13 average length of inpatient stay greater than 25 days is exempt
14 from the assessment imposed by Section 5A-2, unless the
15 exemption is adjudged to be unconstitutional or otherwise
16 invalid, in which case the hospital provider shall pay the
17 assessment imposed by Section 5A-2.
18     (c) (Blank).
19 (Source: P.A. 93-659, eff. 2-3-04.)
 
20     (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
21     Sec. 5A-4. Payment of assessment; penalty.
22     (a) The annual assessment imposed by Section 5A-2 for State
23 fiscal year 2004 shall be due and payable on June 18 of the
24 year. The assessment imposed by Section 5A-2 for State fiscal
25 year 2005 shall be due and payable in quarterly installments,
26 each equalling one-fourth of the assessment for the year, on
27 July 19, October 19, January 18, and April 19 of the year. The
28 assessment imposed by Section 5A-2 for State fiscal year 2006
29 and each subsequent State fiscal year shall be due and payable
30 in quarterly installments, each equaling one-fourth of the
31 assessment for the year, on the fourteenth State business day
32 of September, December, March, and May. No installment payment
33 of an assessment imposed by Section 5A-2 shall be due and

 

 

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1 payable, however, until after: (i) the hospital provider
2 receives written notice from the Department of Public Aid that
3 the payment methodologies to hospitals required under Section
4 5A-12 or Section 5A-12.1, whichever is applicable for that
5 fiscal year, have been approved by the Centers for Medicare and
6 Medicaid Services of the U.S. Department of Health and Human
7 Services and the waiver under 42 CFR 433.68 for the assessment
8 imposed by Section 5A-2, if necessary, has been granted by the
9 Centers for Medicare and Medicaid Services of the U.S.
10 Department of Health and Human Services; and (ii) the hospital
11 has received the payments required under Section 5A-12 or
12 Section 5A-12.1, whichever is applicable for that fiscal year.
13 Upon notification to the Department of approval of the payment
14 methodologies required under Section 5A-12 or Section 5A-12.1,
15 whichever is applicable for that fiscal year, and the waiver
16 granted under 42 CFR 433.68, all quarterly installments
17 otherwise due under Section 5A-2 prior to the date of
18 notification shall be due and payable to the Department upon
19 written direction from the Department and receipt of the
20 payments required under Section 5A-12.1.
21     (b) The Illinois Department is authorized to establish
22 delayed payment schedules for hospital providers that are
23 unable to make installment payments when due under this Section
24 due to financial difficulties, as determined by the Illinois
25 Department.
26     (c) If a hospital provider fails to pay the full amount of
27 an installment when due (including any extensions granted under
28 subsection (b)), there shall, unless waived by the Illinois
29 Department for reasonable cause, be added to the assessment
30 imposed by Section 5A-2 a penalty assessment equal to the
31 lesser of (i) 5% of the amount of the installment not paid on
32 or before the due date plus 5% of the portion thereof remaining
33 unpaid on the last day of each 30-day period thereafter or (ii)
34 100% of the installment amount not paid on or before the due

 

 

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1 date. For purposes of this subsection, payments will be
2 credited first to unpaid installment amounts (rather than to
3 penalty or interest), beginning with the most delinquent
4 installments.
5 (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04;
6 93-1066, eff. 1-15-05.)
 
7     (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
8     Sec. 5A-5. Notice; penalty; maintenance of records.
9     (a) The Department of Public Aid shall send a notice of
10 assessment to every hospital provider subject to assessment
11 under this Article. The notice of assessment shall notify the
12 hospital of its assessment and shall be sent after within 14
13 days of receipt by the Department of notification from the
14 Centers for Medicare and Medicaid Services of the U.S.
15 Department of Health and Human Services that the payment
16 methodologies required under Section 5A-12 or Section 5A-12.1,
17 whichever is applicable for that fiscal year, and, if
18 necessary, the waiver granted under 42 CFR 433.68 have been
19 approved. The notice shall be on a form prepared by the
20 Illinois Department and shall state the following:
21         (1) The name of the hospital provider.
22         (2) The address of the hospital provider's principal
23     place of business from which the provider engages in the
24     occupation of hospital provider in this State, and the name
25     and address of each hospital operated, conducted, or
26     maintained by the provider in this State.
27         (3) The occupied bed days or adjusted gross hospital
28     revenue of the hospital provider (whichever is
29     applicable), the amount of assessment imposed under
30     Section 5A-2 for the State fiscal year for which the notice
31     is sent, and the amount of each quarterly installment to be
32     paid during the State fiscal year.
33         (4) (Blank).

 

 

09400SB0157ham001 - 24 - LRB094 07276 DRJ 47293 a

1         (5) Other reasonable information as determined by the
2     Illinois Department.
3     (b) If a hospital provider conducts, operates, or maintains
4 more than one hospital licensed by the Illinois Department of
5 Public Health, the provider shall pay the assessment for each
6 hospital separately.
7     (c) Notwithstanding any other provision in this Article, in
8 the case of a person who ceases to conduct, operate, or
9 maintain a hospital in respect of which the person is subject
10 to assessment under this Article as a hospital provider, the
11 assessment for the State fiscal year in which the cessation
12 occurs shall be adjusted by multiplying the assessment computed
13 under Section 5A-2 by a fraction, the numerator of which is the
14 number of days in the year during which the provider conducts,
15 operates, or maintains the hospital and the denominator of
16 which is 365. Immediately upon ceasing to conduct, operate, or
17 maintain a hospital, the person shall pay the assessment for
18 the year as so adjusted (to the extent not previously paid).
19     (d) Notwithstanding any other provision in this Article, a
20 provider who commences conducting, operating, or maintaining a
21 hospital, upon notice by the Illinois Department, shall pay the
22 assessment computed under Section 5A-2 and subsection (e) in
23 installments on the due dates stated in the notice and on the
24 regular installment due dates for the State fiscal year
25 occurring after the due dates of the initial notice.
26     (e) Notwithstanding any other provision in this Article,
27 for State fiscal years 2004 and 2005, in the case of a hospital
28 provider that did not conduct, operate, or maintain a hospital
29 throughout calendar year 2001, the assessment for that State
30 fiscal year shall be computed on the basis of hypothetical
31 occupied bed days for the full calendar year as determined by
32 the Illinois Department. Notwithstanding any other provision
33 in this Article, for State fiscal years after 2005, in the case
34 of a hospital provider that did not conduct, operate, or

 

 

09400SB0157ham001 - 25 - LRB094 07276 DRJ 47293 a

1 maintain a hospital in 2003, the assessment for that State
2 fiscal year shall be computed on the basis of hypothetical
3 adjusted gross hospital revenue for the hospital's first full
4 fiscal year as determined by the Illinois Department (which may
5 be based on annualization of the provider's actual revenues for
6 a portion of the year, or revenues of a comparable hospital for
7 the year, including revenues realized by a prior provider of
8 the same hospital during the year).
9     (f) Every hospital provider subject to assessment under
10 this Article shall keep sufficient records to permit the
11 determination of adjusted gross hospital revenue for the
12 hospital's fiscal year. All such records shall be kept in the
13 English language and shall, at all times during regular
14 business hours of the day, be subject to inspection by the
15 Illinois Department or its duly authorized agents and
16 employees. (Blank).
17     (g) The Illinois Department may, by rule, provide a
18 hospital provider a reasonable opportunity to request a
19 clarification or correction of any clerical or computational
20 errors contained in the calculation of its assessment, but such
21 corrections shall not extend to updating the cost report
22 information used to calculate the assessment. (Blank).
23     (h) (Blank).
24 (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
 
25     (305 ILCS 5/5A-7)  (from Ch. 23, par. 5A-7)
26     Sec. 5A-7. Administration; enforcement provisions.
27     (a) The Illinois Department shall establish and maintain a
28 listing of all hospital providers appearing in the licensing
29 records of the Illinois Department of Public Health, which
30 shall show each provider's name and principal place of business
31 and the name and address of each hospital operated, conducted,
32 or maintained by the provider in this State. The Illinois
33 Department shall administer and enforce this Article and

 

 

09400SB0157ham001 - 26 - LRB094 07276 DRJ 47293 a

1 collect the assessments and penalty assessments imposed under
2 this Article using procedures employed in its administration of
3 this Code generally. The Illinois Department, its Director, and
4 every hospital provider subject to assessment under this
5 Article measured by occupied bed days shall have the following
6 powers, duties, and rights:
7         (1) The Illinois Department may initiate either
8     administrative or judicial proceedings, or both, to
9     enforce provisions of this Article. Administrative
10     enforcement proceedings initiated hereunder shall be
11     governed by the Illinois Department's administrative
12     rules. Judicial enforcement proceedings initiated
13     hereunder shall be governed by the rules of procedure
14     applicable in the courts of this State.
15         (2) No proceedings for collection, refund, credit, or
16     other adjustment of an assessment amount shall be issued
17     more than 3 years after the due date of the assessment,
18     except in the case of an extended period agreed to in
19     writing by the Illinois Department and the hospital
20     provider before the expiration of this limitation period.
21         (3) Any unpaid assessment under this Article shall
22     become a lien upon the assets of the hospital upon which it
23     was assessed. If any hospital provider, outside the usual
24     course of its business, sells or transfers the major part
25     of any one or more of (A) the real property and
26     improvements, (B) the machinery and equipment, or (C) the
27     furniture or fixtures, of any hospital that is subject to
28     the provisions of this Article, the seller or transferor
29     shall pay the Illinois Department the amount of any
30     assessment, assessment penalty, and interest (if any) due
31     from it under this Article up to the date of the sale or
32     transfer. If the seller or transferor fails to pay any
33     assessment, assessment penalty, and interest (if any) due,
34     the purchaser or transferee of such asset shall be liable

 

 

09400SB0157ham001 - 27 - LRB094 07276 DRJ 47293 a

1     for the amount of the assessment, penalties, and interest
2     (if any) up to the amount of the reasonable value of the
3     property acquired by the purchaser or transferee. The
4     purchaser or transferee shall continue to be liable until
5     the purchaser or transferee pays the full amount of the
6     assessment, penalties, and interest (if any) up to the
7     amount of the reasonable value of the property acquired by
8     the purchaser or transferee or until the purchaser or
9     transferee receives from the Illinois Department a
10     certificate showing that such assessment, penalty, and
11     interest have been paid or a certificate from the Illinois
12     Department showing that no assessment, penalty, or
13     interest is due from the seller or transferor under this
14     Article.
15         (4) Payments under this Article are not subject to the
16     Illinois Prompt Payment Act. Credits or refunds shall not
17     bear interest.
18     (b) In addition to any other remedy provided for and
19 without sending a notice of assessment liability, the Illinois
20 Department may collect an unpaid assessment by withholding, as
21 payment of the assessment, reimbursements or other amounts
22 otherwise payable by the Illinois Department to the hospital
23 provider.
24 (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
 
25     (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
26     Sec. 5A-8. Hospital Provider Fund.
27     (a) There is created in the State Treasury the Hospital
28 Provider Fund. Interest earned by the Fund shall be credited to
29 the Fund. The Fund shall not be used to replace any moneys
30 appropriated to the Medicaid program by the General Assembly.
31     (b) The Fund is created for the purpose of receiving moneys
32 in accordance with Section 5A-6 and disbursing moneys only for
33 the following purposes, notwithstanding any other provision of

 

 

09400SB0157ham001 - 28 - LRB094 07276 DRJ 47293 a

1 law:
2         (1) For making payments to hospitals as required under
3     Articles V, VI, and XIV of this Code and under the
4     Children's Health Insurance Program Act.
5         (2) For the reimbursement of moneys collected by the
6     Illinois Department from hospitals or hospital providers
7     through error or mistake in performing the activities
8     authorized under this Article and Article V of this Code.
9         (3) For payment of administrative expenses incurred by
10     the Illinois Department or its agent in performing the
11     activities authorized by this Article.
12         (4) For payments of any amounts which are reimbursable
13     to the federal government for payments from this Fund which
14     are required to be paid by State warrant.
15         (5) For making transfers, as those transfers are
16     authorized in the proceedings authorizing debt under the
17     Short Term Borrowing Act, but transfers made under this
18     paragraph (5) shall not exceed the principal amount of debt
19     issued in anticipation of the receipt by the State of
20     moneys to be deposited into the Fund.
21         (6) For making transfers to any other fund in the State
22     treasury, but transfers made under this paragraph (6) shall
23     not exceed the amount transferred previously from that
24     other fund into the Hospital Provider Fund.
25         (7) For State fiscal years 2004 and 2005 for making
26     transfers to the Health and Human Services Medicaid Trust
27     Fund, including 20% of the moneys received from hospital
28     providers under Section 5A-4 and transferred into the
29     Hospital Provider Fund under Section 5A-6. For State fiscal
30     years 2006, 2007 and 2008 for making transfers to the
31     Health and Human Services Medicaid Trust Fund of up to
32     $130,000,000 per year of the moneys received from hospital
33     providers under Section 5A-4 and transferred into the
34     Hospital Provider Fund under Section 5A-6. Transfers under

 

 

09400SB0157ham001 - 29 - LRB094 07276 DRJ 47293 a

1     this paragraph shall be made within 7 days after the
2     payments have been received pursuant to the schedule of
3     payments provided in subsection (a) of Section 5A-4.
4         (8) For making refunds to hospital providers pursuant
5     to Section 5A-10.
6     Disbursements from the Fund, other than transfers
7 authorized under paragraphs (5) and (6) of this subsection,
8 shall be by warrants drawn by the State Comptroller upon
9 receipt of vouchers duly executed and certified by the Illinois
10 Department.
11     (c) The Fund shall consist of the following:
12         (1) All moneys collected or received by the Illinois
13     Department from the hospital provider assessment imposed
14     by this Article.
15         (2) All federal matching funds received by the Illinois
16     Department as a result of expenditures made by the Illinois
17     Department that are attributable to moneys deposited in the
18     Fund.
19         (3) Any interest or penalty levied in conjunction with
20     the administration of this Article.
21         (4) Moneys transferred from another fund in the State
22     treasury.
23         (5) All other moneys received for the Fund from any
24     other source, including interest earned thereon.
25     (d) (Blank).
26 (Source: P.A. 93-659, eff. 2-3-04.)
 
27     (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
28     Sec. 5A-10. Applicability.
29     (a) The assessment imposed by Section 5A-2 shall not take
30 effect or shall cease to be imposed, and any moneys remaining
31 in the Fund shall be refunded to hospital providers in
32 proportion to the amounts paid by them, if:
33         (1) the sum of the appropriations for State fiscal

 

 

09400SB0157ham001 - 30 - LRB094 07276 DRJ 47293 a

1     years 2004 and 2005 from the General Revenue Fund for
2     hospital payments under the medical assistance program is
3     less than $4,500,000,000 or the appropriation for each of
4     State fiscal years 2006, 2007 and 2008 from the General
5     Revenue Fund for hospital payments under the medical
6     assistance program is less than $2,500,000,000 increased
7     annually to reflect any increase in the number of
8     recipients; or
9         (2) the Department of Public Aid makes changes in its
10     rules that reduce the hospital inpatient or outpatient
11     payment rates, including adjustment payment rates, in
12     effect on October 1, 2004 2003, except for hospitals
13     described in subsection (b) of Section 5A-3 and except for
14     changes in the methodology for calculating outlier
15     payments to hospitals for exceptionally costly stays and
16     except for changes in outpatient payment rates made to
17     comply with the federal Health Insurance Portability and
18     Accountability Act, so long as those changes do not reduce
19     aggregate expenditures below the amount expended in State
20     fiscal year 2005 2003 for such services; or
21         (3) the payments to hospitals required under Section
22     5A-12 are changed or are not eligible for federal matching
23     funds under Title XIX or XXI of the Social Security Act.
24     (b) The assessment imposed by Section 5A-2 shall not take
25 effect or shall cease to be imposed if the assessment is
26 determined to be an impermissible tax under Title XIX of the
27 Social Security Act. Moneys in the Hospital Provider Fund
28 derived from assessments imposed prior thereto shall be
29 disbursed in accordance with Section 5A-8 to the extent federal
30 matching is not reduced due to the impermissibility of the
31 assessments, and any remaining moneys shall be refunded to
32 hospital providers in proportion to the amounts paid by them.
33 (Source: P.A. 93-659, eff. 2-3-04.)
 

 

 

09400SB0157ham001 - 31 - LRB094 07276 DRJ 47293 a

1     (305 ILCS 5/5A-12.1 new)
2     Sec. 5A-12.1. Hospital access improvement payments.
3     (a) To preserve and improve access to hospital services,
4 for hospital services rendered on or after August 1, 2005, the
5 Department of Public Aid shall make payments to hospitals as
6 set forth in this Section, except for hospitals described in
7 subsection (b) of Section 5A-3. These payments shall be paid on
8 a quarterly basis. For State fiscal year 2006, once the
9 approval of the payment methodology required under this Section
10 and any waiver required under 42 CFR 433.68 by the Centers for
11 Medicare and Medicaid Services of the U.S. Department of Health
12 and Human Services is received, the Department shall pay the
13 total amounts required for fiscal year 2006 under this Section
14 within 100 days of the latest notification. In State fiscal
15 years 2007 and 2008, the total amounts required under this
16 Section shall be paid in 4 equal installments on or before the
17 seventh State business day of September, December, March, and
18 May, except that if the date of notification of the approval of
19 the payment methodologies required under this Section and any
20 waiver required under 42 CFR 433.68 is on or after July 1,
21 2006, the sum of amounts required under this Section prior to
22 the date of notification shall be paid within 100 days of the
23 date of the last notification. Payments under this Section are
24 not due and payable, however, until (i) the methodologies
25 described in this Section are approved by the federal
26 government in an appropriate State Plan amendment, (ii) the
27 assessment imposed under this Article is determined to be a
28 permissible tax under Title XIX of the Social Security Act, and
29 (iii) the assessment is in effect.
30     (b) Medicaid eligibility payment. In addition to amounts
31 paid for inpatient hospital services, the Department shall pay
32 each Illinois hospital (except for hospitals described in
33 Section 5A-3) for each inpatient Medicaid admission in State
34 fiscal year 2003, $430 multiplied by the percentage by which

 

 

09400SB0157ham001 - 32 - LRB094 07276 DRJ 47293 a

1 the number of Medicaid recipients in the county in which the
2 hospital is located increased from State fiscal year 1998 to
3 State fiscal year 2003.
4     (c) Medicaid high volume adjustment.
5         (1) In addition to rates paid for inpatient hospital
6     services, the Department shall pay to each Illinois
7     hospital (except for hospitals that qualify for Medicaid
8     Percentage Adjustment payments under 89 Ill. Adm. Code
9     148.122 for the 12-month period beginning on October 1,
10     2004) that provided more than 10,000 Medicaid inpatient
11     days of care (determined using the hospital's fiscal year
12     2002 Medicaid cost report on file with the Department on
13     July 1, 2004) amounts as follows:
14             (i) for hospitals that provided more than 10,000
15         Medicaid inpatient days of care but less than or equal
16         to 14,500 Medicaid inpatient days of care, $90 for each
17         Medicaid inpatient day of care provided during that
18         period; and
19             (ii) for hospitals that provided more than 14,500
20         Medicaid inpatient days of care but less than or equal
21         to 18,500 Medicaid inpatient days of care, $135 for
22         each Medicaid inpatient day of care provided during
23         that period; and
24             (iii) for hospitals that provided more than 18,500
25         Medicaid inpatient days of care but less than or equal
26         to 20,000 Medicaid inpatient days of care, $225 for
27         each Medicaid inpatient day of care provided during
28         that period; and
29             (iv) for hospitals that provided more than 20,000
30         Medicaid inpatient days of care, $900 for each Medicaid
31         inpatient day of care provided during that period.
32         Provided, however, that no hospital shall receive more
33     than $19,000,000 per year in such payments under
34     subparagraphs (i), (ii), (iii), and (iv).

 

 

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1         (2) In addition to rates paid for inpatient hospital
2     services, the Department shall pay to each Illinois general
3     acute care hospital that as of October 1, 2004, qualified
4     for Medicaid percentage adjustment payments under 89 Ill.
5     Adm. Code 148.122 and provided more than 21,000 Medicaid
6     inpatient days of care (determined using the hospital's
7     fiscal year 2002 Medicaid cost report on file with the
8     Department on July 1, 2004) $35 for each Medicaid inpatient
9     day of care provided during that period. Provided, however,
10     that no hospital shall receive more than $1,200,000 per
11     year in such payments.
12     (d) Intensive care adjustment. In addition to rates paid
13 for inpatient services, the Department shall pay an adjustment
14 payment to each Illinois general acute care hospital located in
15 a large urban area that, based on the hospital's fiscal year
16 2002 Medicaid cost report, had a ratio of Medicaid intensive
17 care unit days to total Medicaid days greater than 19%. If such
18 ratio for the hospital is less than 30%, the hospital shall be
19 paid an adjustment payment for each Medicaid inpatient day of
20 care provided equal to $1,000 multiplied by the hospital's
21 ratio of Medicaid intensive care days to total Medicaid days.
22 If such ratio for the hospital is equal to or greater than 30%,
23 the hospital shall be paid an adjustment payment for each
24 Medicaid inpatient day of care provided equal to $2,800
25 multiplied by the hospital's ratio of Medicaid intensive care
26 days to total Medicaid days.
27     (e) Trauma center adjustments.
28         (1) In addition to rates paid for inpatient hospital
29     services, the Department shall pay to each Illinois general
30     acute care hospital that as of January 1, 2005, was
31     designated as a Level I trauma center and is either located
32     in a large urban area or is located in an other urban area
33     and as of October 1, 2004 qualified for Medicaid percentage
34     adjustment payments under 89 Ill. Adm. Code 148.122, a

 

 

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1     payment equal to $800 multiplied by the hospital's Medicaid
2     intensive care unit days (excluding Medicare crossover
3     days). This payment shall be calculated based on data from
4     the hospital's 2002 cost report on file with the Department
5     on July 1, 2004. For hospitals located in large urban areas
6     outside of a city with a population in excess of 1,000,000
7     people, the payment required under this subsection shall be
8     multiplied by 4.5. For hospitals located in other urban
9     areas, the payment required under this subsection shall be
10     multiplied by 8.5.
11         (2) In addition to rates paid for inpatient hospital
12     services, the Department shall pay an additional payment to
13     each Illinois general acute care hospital that as of
14     January 1, 2005, was designated as a Level II trauma center
15     and is located in a county with a population in excess of
16     3,000,000 people. The payment shall equal $4,000 per day
17     for the first 500 Medicaid inpatient days, $2,000 per day
18     for the Medicaid inpatient days between 501 and 1,500, and
19     $100 per day for any Medicaid inpatient day in excess of
20     1,500. This payment shall be calculated based on data from
21     the hospital's 2002 cost report on file with the Department
22     on July 1, 2004.
23         (3) In addition to rates paid for inpatient hospital
24     services, the Department shall pay an additional payment to
25     each Illinois general acute care hospital that as of
26     January 1, 2005, was designated as a Level II trauma
27     center, is located in a large urban area outside of a
28     county with a population in excess of 3,000,000 people, and
29     as of January 1, 2005, was designated a Level III perinatal
30     center or designated a Level II or II+ prenatal center that
31     has a ratio of Medicaid intensive care unit days to total
32     Medicaid days greater than 5%. The payment shall equal
33     $4,000 per day for the first 500 Medicaid inpatient days,
34     $2,000 per day for the Medicaid inpatient days between 501

 

 

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1     and 1,500, and $100 per day for any Medicaid inpatient day
2     in excess of 1,500. This payment shall be calculated based
3     on data from the hospital's 2002 cost report on file with
4     the Department on July 1, 2004.
5         (4) In addition to rates paid for inpatient hospital
6     services, the Department shall pay an additional payment to
7     each Illinois children's hospital that as of January 1,
8     2005, was designated a Level I pediatric trauma center that
9     had more than 30,000 Medicaid days in State fiscal year
10     2003 and to each Level I pediatric trauma center located
11     outside of Illinois and that had more than 700 Illinois
12     Medicaid cases in State fiscal year 2003. The amount of
13     such payment shall equal $325 multiplied by the hospital's
14     Medicaid intensive care unit days, and this payment shall
15     be multiplied by 2.25 for hospitals located outside of
16     Illinois. This payment shall be calculated based on data
17     from the hospital's 2002 cost report on file with the
18     Department on July 1, 2004.
19         (5) Notwithstanding any other provision of this
20     subsection, a children's hospital, as defined in 89 Ill.
21     Adm. Code 149.50(c)(3)(B), is not eligible for the payments
22     described in paragraphs (1), (2), and (3) of this
23     subsection.
24     (f) Psychiatric rate adjustment.
25         (1) In addition to rates paid for inpatient psychiatric
26     services, the Department shall pay each Illinois
27     psychiatric hospital and general acute care hospital with a
28     distinct part psychiatric unit, for each Medicaid
29     inpatient psychiatric day of care provided in State fiscal
30     year 2003, an amount equal to $420 less the hospital's per
31     diem rate for Medicaid inpatient psychiatric services as in
32     effect on July 1, 2002. In no event, however, shall that
33     amount be less than zero.
34         (2) For Illinois psychiatric hospitals and distinct

 

 

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1     part psychiatric units of Illinois general acute care
2     hospitals whose inpatient per diem rate as in effect on
3     July 1, 2002 is greater than $420, the Department shall
4     pay, in addition to any other amounts authorized under this
5     Code, $40 for each Medicaid inpatient psychiatric day of
6     care provided in State fiscal year 2003.
7         (3) In addition to rates paid for inpatient psychiatric
8     services, for Illinois psychiatric hospitals located in a
9     county with a population in excess of 3,000,000 people that
10     did not qualify for Medicaid percentage adjustment
11     payments under 89 Ill. Adm. Code 148.122 for the 12-month
12     period beginning on October 1, 2004, the Illinois
13     Department shall make an adjustment payment of $150 for
14     each Medicaid inpatient psychiatric day of care provided by
15     the hospital in State fiscal year 2003. In addition to
16     rates paid for inpatient psychiatric services, for
17     Illinois psychiatric hospitals located in a county with a
18     population in excess of 3,000,000 people, but outside of a
19     city with a population in excess of 1,000,000 people, that
20     did qualify for Medicaid percentage adjustment payments
21     under 89 Ill. Adm. Code 148.122 for the 12-month period
22     beginning on October 1, 2004, the Illinois Department shall
23     make an adjustment payment of $20 for each Medicaid
24     inpatient psychiatric day of care provided by the hospital
25     in State fiscal year 2003.
26     (g) Rehabilitation adjustment.
27         (1) In addition to rates paid for inpatient
28     rehabilitation services, the Department shall pay each
29     Illinois general acute care hospital with a distinct part
30     rehabilitation unit that had at least 40 beds as reported
31     on the hospital's 2003 Medicaid cost report on file with
32     the Department as of March 31, 2005, for each Medicaid
33     inpatient day of care provided during State fiscal year
34     2003, an amount equal to $230.

 

 

09400SB0157ham001 - 37 - LRB094 07276 DRJ 47293 a

1         (2) In addition to rates paid for inpatient
2     rehabilitation services, for Illinois rehabilitation
3     hospitals that did not qualify for Medicaid percentage
4     adjustment payments under 89 Ill. Adm. Code 148.122 for the
5     12-month period beginning on October 1, 2004, the Illinois
6     Department shall make an adjustment payment of $200 for
7     each Medicaid inpatient day of care provided during State
8     fiscal year 2003.
9     (h) Supplemental tertiary care adjustment. In addition to
10 rates paid for inpatient services, the Department shall pay to
11 each Illinois hospital eligible for tertiary care adjustment
12 payments under 89 Ill. Adm. Code 148.296, as in effect for
13 State fiscal year 2005, a supplemental tertiary care adjustment
14 payment equal to 2.5 multiplied by the tertiary care adjustment
15 payment required under 89 Ill. Adm. Code 148.296, as in effect
16 for State fiscal year 2005.
17     (i) Crossover percentage adjustment. In addition to rates
18 paid for inpatient services, the Department shall pay each
19 Illinois general acute care hospital, excluding any hospital
20 defined as a cancer center hospital in rules by the Department,
21 located in an urban area that provided over 500 days of
22 inpatient care to Medicaid recipients, that had a ratio of
23 crossover days to total Medicaid days, utilizing information
24 used for the Medicaid percentage adjustment determination
25 described in 84 Ill. Adm. Code 148.122, effective October 1,
26 2004, of greater than 40%, and that does not qualify for
27 Medicaid percentage adjustment payments under 89 Ill. Adm. Code
28 148.122, on October 1, 2004, an amount as follows:
29         (1) for hospitals located in an other urban area, $140
30     per Medicaid inpatient day (including crossover days);
31         (2) for hospitals located in a large urban area whose
32     ratio of crossover days to total Medicaid days is less than
33     55%, $350 per Medicaid inpatient day (including crossover
34     days);

 

 

09400SB0157ham001 - 38 - LRB094 07276 DRJ 47293 a

1         (3) for hospitals located in a large urban area whose
2     ratio of crossover days to total Medicaid days is equal to
3     or greater than 55%, $ 1,400 per Medicaid inpatient day
4     (including crossover days).
5     The term "Medicaid days" in paragraphs (1), (2), and (3) of
6 this subsection (i) means the Medicaid days utilized for the
7 Medicaid percentage adjustment determination described in 89
8 Ill. Adm. Code 148.122 for the October 1, 2004 determination.
9     (j) Long term acute care hospital adjustment. In addition
10 to rates paid for inpatient services, the Department shall pay
11 each Illinois long term acute care hospital that, as of October
12 1, 2004, qualified for a Medicaid percentage adjustment under
13 89 Ill. Adm. Code 148.122, $125 for each Medicaid inpatient day
14 of care provided in State fiscal year 2003. In addition to
15 rates paid for inpatient services, the Department shall pay
16 each long term acute care hospital that, as of October 1, 2004,
17 did not qualify for a Medicaid percentage adjustment under 89
18 Ill. Adm. Code 148.122, $1,250 for each Medicaid inpatient day
19 of care provided in State fiscal year 2003. For purposes of
20 this subsection, "long term acute care hospital" means a
21 hospital that (i) is not a psychiatric hospital, rehabilitation
22 hospital, or children's hospital and (ii) has an average length
23 of inpatient stay greater than 25 days.
24     (k) Obstetrical care adjustments.
25         (1) In addition to rates paid for inpatient services,
26     the Department shall pay each Illinois hospital an amount
27     equal to $550 multiplied by each Medicaid obstetrical day
28     of care provided by the hospital in State fiscal year 2003.
29         (2) In addition to rates paid for inpatient services,
30     the Department shall pay each Illinois hospital that
31     qualified as a Medicaid disproportionate share hospital
32     under 89 Ill. Adm. Code 148.120 as of October 1, 2004, and
33     that had a Medicaid obstetrical percentage greater than 10%
34     and a Medicaid emergency care percentage greater than 40%,

 

 

09400SB0157ham001 - 39 - LRB094 07276 DRJ 47293 a

1     an amount equal to $650 multiplied by each Medicaid
2     obstetrical day of care provided by the hospital in State
3     fiscal year 2003.
4         (3) In addition to rates paid for inpatient services,
5     the Department shall pay each Illinois hospital that is
6     located in the St. Louis metropolitan statistical area and
7     that provided more than 500 Medicaid obstetrical days of
8     care in State fiscal year 2003, an amount equal to $1,800
9     multiplied by each Medicaid obstetrical day of care
10     provided by the hospital in State fiscal year 2003.
11         (4) In addition to rates paid for inpatient services,
12     the Department shall pay $600 for each Medicaid obstetrical
13     day of care provided in State fiscal year 2003 by each
14     Illinois hospital that (i) is located in a large urban
15     area, (ii) is located in a county whose number of Medicaid
16     recipients increased from State fiscal year 1998 to State
17     fiscal year 2003 by more than 60%, and (iii) that had a
18     Medicaid obstetrical percentage used for the October 1,
19     2004, Medicaid percentage adjustment determination
20     described in 89 Ill. Adm. Code 148.122 greater than 25%.
21         (5) In addition to rates paid for inpatient services,
22     the Department shall pay $400 for each Medicaid obstetrical
23     day of care provided in State fiscal year 2003 by each
24     Illinois rural hospital that (i) was designated a Level II
25     perinatal center as of January 1, 2005, (ii) had a Medicaid
26     inpatient utilization rate greater than 34% in State fiscal
27     year 2002, and (iii) had a Medicaid obstetrical percentage
28     used for the October 1, 2004, Medicaid percentage
29     adjustment determination described in 89 Ill. Adm. Code
30     148.122 greater than 15%.
31     (l) Outpatient access payments. In addition to the rates
32 paid for outpatient hospital services, the Department shall pay
33 each Illinois hospital (except for hospitals described in
34 Section 5A-3), an amount equal to 2.38 multiplied by the

 

 

09400SB0157ham001 - 40 - LRB094 07276 DRJ 47293 a

1 hospital's outpatient ambulatory procedure listing payments
2 for services provided during State fiscal year 2003 multiplied
3 by the percentage by which the number of Medicaid recipients in
4 the county in which the hospital is located increased from
5 State fiscal year 1998 to State fiscal year 2003.
6     (m) Outpatient utilization payment.
7         (1) In addition to the rates paid for outpatient
8     hospital services, the Department shall pay each Illinois
9     rural hospital, an amount equal to 1.7 multiplied by the
10     hospital's outpatient ambulatory procedure listing
11     payments for services provided during State fiscal year
12     2003.
13         (2) In addition to the rates paid for outpatient
14     hospital services, the Department shall pay each Illinois
15     hospital located in an urban area, an amount equal to 0.45
16     multiplied by the hospital's outpatient ambulatory
17     procedure listing payments received for services provided
18     during State fiscal year 2003.
19     (n) Outpatient complexity of care adjustment. In addition
20 to the rates paid for outpatient hospital services, the
21 Department shall pay each Illinois hospital located in an urban
22 area an amount equal to 2.55 multiplied by the hospital's
23 emergency care percentage multiplied by the hospital's
24 outpatient ambulatory procedure listing payments received for
25 services provided during State fiscal year 2003. For children's
26 hospitals with an inpatient utilization rate used for the
27 October 1, 2004, Medicaid percentage adjustment determination
28 described in 89 Ill. Adm. Code 148.122 greater than 90%, this
29 adjustment shall be multiplied by 2. For cancer center
30 hospitals, this adjustment shall be multiplied by 3.
31     (o) Rehabilitation hospital adjustment. In addition to the
32 rates paid for outpatient hospital services, the Department
33 shall pay each Illinois freestanding rehabilitation hospital
34 that does not qualify for a Medicaid percentage adjustment

 

 

09400SB0157ham001 - 41 - LRB094 07276 DRJ 47293 a

1 under 89 Ill. Adm. Code 148.122 as of October 1, 2004, an
2 amount equal to 3 multiplied by the hospital's outpatient
3 ambulatory procedure listing payments for Group 6A services
4 provided during State fiscal year 2003.
5     (p) Perinatal outpatient adjustment. In addition to the
6 rates paid for outpatient hospital services, the Department
7 shall pay an adjustment payment to each large urban general
8 acute care hospital that is designated as a perinatal center as
9 of January 1, 2005, has a Medicaid obstetrical percentage of at
10 least 10% used for the October 1, 2004, Medicaid percentage
11 adjustment determination described in 89 Ill. Adm. Code
12 148.122, has a Medicaid intensive care unit percentage of at
13 least 3%, and has a ratio of ambulatory procedure listing Level
14 3 services to total ambulatory procedure listing services of at
15 least 50%. The amount of the adjustment payment under this
16 subsection shall be $550 multiplied by the hospital's
17 outpatient ambulatory procedure listing Level 3A services
18 provided in State fiscal year 2003. If the hospital, as of
19 January 1, 2005, was designated a Level III or II+ perinatal
20 center, the adjustment payments required by this subsection
21 shall be multiplied by 4.
22     (q) Supplemental psychiatric adjustment payments. In
23 addition to rates paid for inpatient services, the Department
24 shall pay to each Illinois hospital that does not qualify for
25 Medicaid percentage adjustments described in 89 Ill. Adm. Code
26 148.122 but is eligible for psychiatric adjustment payments
27 under 89 Ill. Adm. Code 148.105 for State fiscal year 2005, a
28 supplemental psychiatric adjustment payment equal to 0.7
29 multiplied by the psychiatric adjustment payment required
30 under 89 Ill. Adm. Code 148.105, as in effect for State fiscal
31 year 2005.
32     (r) Outpatient community access adjustment. In addition to
33 the rates paid for outpatient hospital services, the Department
34 shall pay an adjustment payment to each general acute care

 

 

09400SB0157ham001 - 42 - LRB094 07276 DRJ 47293 a

1 hospital that is designated as a perinatal center as of January
2 1, 2005, that had a Medicaid obstetrical percentage used for
3 the October 1, 2004, Medicaid percentage adjustment
4 determination described in 89 Ill. Adm. Code 148.122 of at
5 least 12.5%, that had a ratio of crossover days to total
6 Medicaid days utilizing information used for the Medicaid
7 percentage adjustment described in 89 Ill. Adm. Code 148.122
8 determination effective October 1, 2004, of greater than or
9 equal to 25%, and that qualified for the Medicaid percentage
10 adjustment payments under 89 Ill. Adm. Code 148.122 on October
11 1, 2004, an amount equal to $100 multiplied by the hospital's
12 outpatient ambulatory procedure listing services provided
13 during State fiscal year 2003.
14     (s) Definitions. Unless the context requires otherwise or
15 unless provided otherwise in this Section, the terms used in
16 this Section for qualifying criteria and payment calculations
17 shall have the same meanings as those terms have been given in
18 the Illinois Department's administrative rules as in effect on
19 May 1, 2005. Other terms shall be defined by the Illinois
20 Department by rule.
21     As used in this Section, unless the context requires
22 otherwise:
23     "Emergency care percentage" means a fraction, the
24 numerator of which is the total Group 3 ambulatory procedure
25 listing services provided by the hospital in State fiscal year
26 2003, and the denominator of which is the total ambulatory
27 procedure listing services provided by the hospital in State
28 fiscal year 2003.
29     "Large urban area" means an area located within a
30 metropolitan statistical area, as defined by the U.S. Office of
31 Management and Budget in OMB Bulletin 04-03, dated February 18,
32 2004, with a population in excess of 1,000,000.
33     "Medicaid intensive care unit days" means the number of
34 hospital inpatient days during which Medicaid recipients

 

 

09400SB0157ham001 - 43 - LRB094 07276 DRJ 47293 a

1 received intensive care services from the hospital, as
2 determined from the hospital's 2002 Medicaid cost report that
3 was on file with the Department as of July 1, 2004.
4     "Other urban area" means an area located within a
5 metropolitan statistical area, as defined by the U.S. Office of
6 Management and Budget in OMB Bulletin 04-03, dated February 18,
7 2004, with a city with a population in excess of 50,000 or a
8 total population in excess of 100,000.
9     (t) For purposes of this Section, a hospital that enrolled
10 to provide Medicaid services during State fiscal year 2003
11 shall have its utilization and associated reimbursements
12 annualized prior to the payment calculations being performed
13 under this Section.
14     (u) For purposes of this Section, the terms "Medicaid
15 days", "ambulatory procedure listing services", and
16 "ambulatory procedure listing payments" do not include any
17 days, charges, or services for which Medicare was liable for
18 payment, except where explicitly stated otherwise in this
19 Section.
20     (v) As provided in Section 5A-14, this Section is repealed
21 on July 1, 2008.
 
22     (305 ILCS 5/5A-13)
23     Sec. 5A-13. Emergency rulemaking. The Department of Public
24 Aid may adopt rules necessary to implement this amendatory Act
25 of the 94th 93rd General Assembly through the use of emergency
26 rulemaking in accordance with Section 5-45 of the Illinois
27 Administrative Procedure Act. For purposes of that Act, the
28 General Assembly finds that the adoption of rules to implement
29 this amendatory Act of the 94th 93rd General Assembly is deemed
30 an emergency and necessary for the public interest, safety, and
31 welfare.
32 (Source: P.A. 93-659, eff. 2-3-04.)
 

 

 

09400SB0157ham001 - 44 - LRB094 07276 DRJ 47293 a

1     (305 ILCS 5/5A-14)
2     Sec. 5A-14. Repeal of assessments and disbursements.
3     (a) Section 5A-2 is repealed on July 1, 2008 2005.
4     (b) Section 5A-12 is repealed on July 1, 2005.
5     (c) Section 5A-12.1 is repealed on July 1, 2008.
6 (Source: P.A. 93-659, eff. 2-3-04.)
 
7     Section 90-97. Severability. The provisions of this Act are
8 severable under Section 1.31 of the Statute on Statutes.
 
9     Section 90-99. Effective date. This Act takes effect upon
10 becoming law.".