Sen. Jeffrey M. Schoenberg

Filed: 5/24/2011

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 2934

2    AMENDMENT NO. ______. Amend House Bill 2934 as follows:
 
3on page 3, immediately below line 13, by inserting the
4following:
 
5    "Section 20. The Illinois Public Aid Code is amended by
6changing Sections 5A-4 and 5A-12.2 as follows:
 
7    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
8    Sec. 5A-4. Payment of assessment; penalty.
9    (a) The annual assessment imposed by Section 5A-2 for State
10fiscal year 2004 shall be due and payable on June 18 of the
11year. The assessment imposed by Section 5A-2 for State fiscal
12year 2005 shall be due and payable in quarterly installments,
13each equalling one-fourth of the assessment for the year, on
14July 19, October 19, January 18, and April 19 of the year. The
15assessment imposed by Section 5A-2 for State fiscal years 2006

 

 

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1through 2008 shall be due and payable in quarterly
2installments, each equaling one-fourth of the assessment for
3the year, on the fourteenth State business day of September,
4December, March, and May. Except as provided in subsection
5(a-5) of this Section, the assessment imposed by Section 5A-2
6for State fiscal year 2009 and each subsequent State fiscal
7year, with the exception of State fiscal year 2012, shall be
8due and payable in monthly installments, each equaling
9one-twelfth of the assessment for the year, on the fourteenth
10State business day of each month. No installment payment of an
11assessment imposed by Section 5A-2 shall be due and payable,
12however, until after: (i) the Department notifies the hospital
13provider, in writing, that the payment methodologies to
14hospitals required under Section 5A-12, Section 5A-12.1, or
15Section 5A-12.2, whichever is applicable for that fiscal year,
16have been approved by the Centers for Medicare and Medicaid
17Services of the U.S. Department of Health and Human Services
18and the waiver under 42 CFR 433.68 for the assessment imposed
19by Section 5A-2, if necessary, has been granted by the Centers
20for Medicare and Medicaid Services of the U.S. Department of
21Health and Human Services; and (ii) the Comptroller has issued
22the payments required under Section 5A-12, Section 5A-12.1, or
23Section 5A-12.2, whichever is applicable for that fiscal year.
24Upon notification to the Department of approval of the payment
25methodologies required under Section 5A-12, Section 5A-12.1,
26or Section 5A-12.2, whichever is applicable for that fiscal

 

 

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1year, and the waiver granted under 42 CFR 433.68, all
2installments otherwise due under Section 5A-2 prior to the date
3of notification shall be due and payable to the Department upon
4written direction from the Department and issuance by the
5Comptroller of the payments required under Section 5A-12.1 or
6Section 5A-12.2, whichever is applicable for that fiscal year.
7    (a-5) The Illinois Department may, for the purpose of
8maximizing federal revenue, accelerate the schedule upon which
9assessment installments are due and payable by hospitals with a
10payment ratio greater than or equal to one. Such acceleration
11of due dates for payment of the assessment may be made only in
12conjunction with a corresponding acceleration in access
13payments identified in Section 5A-12.2 to the same hospitals.
14For the purposes of this subsection (a-5), a hospital's payment
15ratio is defined as the quotient obtained by dividing the total
16payments for the State fiscal year, as authorized under Section
175A-12.2, by the total assessment for the State fiscal year
18imposed under Section 5A-2.
19    (a-10) During State fiscal year 2012, the assessment
20imposed by Section 5A-2 shall be due and payable by hospitals
21with a payment ratio greater than or equal to one in 6 monthly
22installments, each equaling one-sixth of the assessment for the
23year, on the 14th State business day of each month from July
242011 to December 2011. For the purposes of this subsection
25(a-10), a hospital's payment ratio is defined as the quotient
26obtained by dividing the total payments for the State fiscal

 

 

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1year, as authorized under Section 5A-12.2, by the total
2assessment for the State fiscal year imposed under Section
35A-2.
4    (b) The Illinois Department is authorized to establish
5delayed payment schedules for hospital providers that are
6unable to make installment payments when due under this Section
7due to financial difficulties, as determined by the Illinois
8Department.
9    (c) If a hospital provider fails to pay the full amount of
10an installment when due (including any extensions granted under
11subsection (b)), there shall, unless waived by the Illinois
12Department for reasonable cause, be added to the assessment
13imposed by Section 5A-2 a penalty assessment equal to the
14lesser of (i) 5% of the amount of the installment not paid on
15or before the due date plus 5% of the portion thereof remaining
16unpaid on the last day of each 30-day period thereafter or (ii)
17100% of the installment amount not paid on or before the due
18date. For purposes of this subsection, payments will be
19credited first to unpaid installment amounts (rather than to
20penalty or interest), beginning with the most delinquent
21installments.
22    (d) Any assessment amount that is due and payable to the
23Illinois Department more frequently than once per calendar
24quarter shall be remitted to the Illinois Department by the
25hospital provider by means of electronic funds transfer. The
26Illinois Department may provide for remittance by other means

 

 

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1if (i) the amount due is less than $10,000 or (ii) electronic
2funds transfer is unavailable for this purpose.
3(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08;
496-821, eff. 11-20-09.)
 
5    (305 ILCS 5/5A-12.2)
6    (Section scheduled to be repealed on July 1, 2013)
7    Sec. 5A-12.2. Hospital access payments on or after July 1,
82008.
9    (a) To preserve and improve access to hospital services,
10for hospital services rendered on or after July 1, 2008, the
11Illinois Department shall, except for hospitals described in
12subsection (b) of Section 5A-3, make payments to hospitals as
13set forth in this Section. These payments shall be paid in 12
14equal installments on or before the seventh State business day
15of each month, except that no payment shall be due within 100
16days after the later of the date of notification of federal
17approval of the payment methodologies required under this
18Section or any waiver required under 42 CFR 433.68, at which
19time the sum of amounts required under this Section prior to
20the date of notification is due and payable. Payments under
21this Section are not due and payable, however, until (i) the
22methodologies described in this Section are approved by the
23federal government in an appropriate State Plan amendment and
24(ii) the assessment imposed under this Article is determined to
25be a permissible tax under Title XIX of the Social Security

 

 

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1Act.
2    (a-5) The Illinois Department may, when practicable,
3accelerate the schedule upon which payments authorized under
4this Section are made.
5    (a-10) During State fiscal year 2012 only, the payments set
6forth in this Section shall be paid in 6 monthly installments,
7each equaling one-sixth of the amount due for the year, on or
8before the 7th State business day of each month from July 2011
9to December 2011.
10    (b) Across-the-board inpatient adjustment.
11        (1) In addition to rates paid for inpatient hospital
12    services, the Department shall pay to each Illinois general
13    acute care hospital an amount equal to 40% of the total
14    base inpatient payments paid to the hospital for services
15    provided in State fiscal year 2005.
16        (2) In addition to rates paid for inpatient hospital
17    services, the Department shall pay to each freestanding
18    Illinois specialty care hospital as defined in 89 Ill. Adm.
19    Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
20    the total base inpatient payments paid to the hospital for
21    services provided in State fiscal year 2005.
22        (3) In addition to rates paid for inpatient hospital
23    services, the Department shall pay to each freestanding
24    Illinois rehabilitation or psychiatric hospital an amount
25    equal to $1,000 per Medicaid inpatient day multiplied by
26    the increase in the hospital's Medicaid inpatient

 

 

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1    utilization ratio (determined using the positive
2    percentage change from the rate year 2005 Medicaid
3    inpatient utilization ratio to the rate year 2007 Medicaid
4    inpatient utilization ratio, as calculated by the
5    Department for the disproportionate share determination).
6        (4) In addition to rates paid for inpatient hospital
7    services, the Department shall pay to each Illinois
8    children's hospital an amount equal to 20% of the total
9    base inpatient payments paid to the hospital for services
10    provided in State fiscal year 2005 and an additional amount
11    equal to 20% of the base inpatient payments paid to the
12    hospital for psychiatric services provided in State fiscal
13    year 2005.
14        (5) In addition to rates paid for inpatient hospital
15    services, the Department shall pay to each Illinois
16    hospital eligible for a pediatric inpatient adjustment
17    payment under 89 Ill. Adm. Code 148.298, as in effect for
18    State fiscal year 2007, a supplemental pediatric inpatient
19    adjustment payment equal to:
20            (i) For freestanding children's hospitals as
21        defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5
22        multiplied by the hospital's pediatric inpatient
23        adjustment payment required under 89 Ill. Adm. Code
24        148.298, as in effect for State fiscal year 2008.
25            (ii) For hospitals other than freestanding
26        children's hospitals as defined in 89 Ill. Adm. Code

 

 

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1        149.50(c)(3)(B), 1.0 multiplied by the hospital's
2        pediatric inpatient adjustment payment required under
3        89 Ill. Adm. Code 148.298, as in effect for State
4        fiscal year 2008.
5    (c) Outpatient adjustment.
6        (1) In addition to the rates paid for outpatient
7    hospital services, the Department shall pay each Illinois
8    hospital an amount equal to 2.2 multiplied by the
9    hospital's ambulatory procedure listing payments for
10    categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
11    148.140(b), for State fiscal year 2005.
12        (2) In addition to the rates paid for outpatient
13    hospital services, the Department shall pay each Illinois
14    freestanding psychiatric hospital an amount equal to 3.25
15    multiplied by the hospital's ambulatory procedure listing
16    payments for category 5b, as defined in 89 Ill. Adm. Code
17    148.140(b)(1)(E), for State fiscal year 2005.
18    (d) Medicaid high volume adjustment. In addition to rates
19paid for inpatient hospital services, the Department shall pay
20to each Illinois general acute care hospital that provided more
21than 20,500 Medicaid inpatient days of care in State fiscal
22year 2005 amounts as follows:
23        (1) For hospitals with a case mix index equal to or
24    greater than the 85th percentile of hospital case mix
25    indices, $350 for each Medicaid inpatient day of care
26    provided during that period; and

 

 

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1        (2) For hospitals with a case mix index less than the
2    85th percentile of hospital case mix indices, $100 for each
3    Medicaid inpatient day of care provided during that period.
4    (e) Capital adjustment. In addition to rates paid for
5inpatient hospital services, the Department shall pay an
6additional payment to each Illinois general acute care hospital
7that has a Medicaid inpatient utilization rate of at least 10%
8(as calculated by the Department for the rate year 2007
9disproportionate share determination) amounts as follows:
10        (1) For each Illinois general acute care hospital that
11    has a Medicaid inpatient utilization rate of at least 10%
12    and less than 36.94% and whose capital cost is less than
13    the 60th percentile of the capital costs of all Illinois
14    hospitals, the amount of such payment shall equal the
15    hospital's Medicaid inpatient days multiplied by the
16    difference between the capital costs at the 60th percentile
17    of the capital costs of all Illinois hospitals and the
18    hospital's capital costs.
19        (2) For each Illinois general acute care hospital that
20    has a Medicaid inpatient utilization rate of at least
21    36.94% and whose capital cost is less than the 75th
22    percentile of the capital costs of all Illinois hospitals,
23    the amount of such payment shall equal the hospital's
24    Medicaid inpatient days multiplied by the difference
25    between the capital costs at the 75th percentile of the
26    capital costs of all Illinois hospitals and the hospital's

 

 

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1    capital costs.
2    (f) Obstetrical care adjustment.
3        (1) In addition to rates paid for inpatient hospital
4    services, the Department shall pay $1,500 for each Medicaid
5    obstetrical day of care provided in State fiscal year 2005
6    by each Illinois rural hospital that had a Medicaid
7    obstetrical percentage (Medicaid obstetrical days divided
8    by Medicaid inpatient days) greater than 15% for State
9    fiscal year 2005.
10        (2) In addition to rates paid for inpatient hospital
11    services, the Department shall pay $1,350 for each Medicaid
12    obstetrical day of care provided in State fiscal year 2005
13    by each Illinois general acute care hospital that was
14    designated a level III perinatal center as of December 31,
15    2006, and that had a case mix index equal to or greater
16    than the 45th percentile of the case mix indices for all
17    level III perinatal centers.
18        (3) In addition to rates paid for inpatient hospital
19    services, the Department shall pay $900 for each Medicaid
20    obstetrical day of care provided in State fiscal year 2005
21    by each Illinois general acute care hospital that was
22    designated a level II or II+ perinatal center as of
23    December 31, 2006, and that had a case mix index equal to
24    or greater than the 35th percentile of the case mix indices
25    for all level II and II+ perinatal centers.
26    (g) Trauma adjustment.

 

 

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1        (1) In addition to rates paid for inpatient hospital
2    services, the Department shall pay each Illinois general
3    acute care hospital designated as a trauma center as of
4    July 1, 2007, a payment equal to 3.75 multiplied by the
5    hospital's State fiscal year 2005 Medicaid capital
6    payments.
7        (2) In addition to rates paid for inpatient hospital
8    services, the Department shall pay $400 for each Medicaid
9    acute inpatient day of care provided in State fiscal year
10    2005 by each Illinois general acute care hospital that was
11    designated a level II trauma center, as defined in 89 Ill.
12    Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
13    2007.
14        (3) In addition to rates paid for inpatient hospital
15    services, the Department shall pay $235 for each Illinois
16    Medicaid acute inpatient day of care provided in State
17    fiscal year 2005 by each level I pediatric trauma center
18    located outside of Illinois that had more than 8,000
19    Illinois Medicaid inpatient days in State fiscal year 2005.
20    (h) Supplemental tertiary care adjustment. In addition to
21rates paid for inpatient services, the Department shall pay to
22each Illinois hospital eligible for tertiary care adjustment
23payments under 89 Ill. Adm. Code 148.296, as in effect for
24State fiscal year 2007, a supplemental tertiary care adjustment
25payment equal to the tertiary care adjustment payment required
26under 89 Ill. Adm. Code 148.296, as in effect for State fiscal

 

 

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1year 2007.
2    (i) Crossover adjustment. In addition to rates paid for
3inpatient services, the Department shall pay each Illinois
4general acute care hospital that had a ratio of crossover days
5to total inpatient days for medical assistance programs
6administered by the Department (utilizing information from
72005 paid claims) greater than 50%, and a case mix index
8greater than the 65th percentile of case mix indices for all
9Illinois hospitals, a rate of $1,125 for each Medicaid
10inpatient day including crossover days.
11    (j) Magnet hospital adjustment. In addition to rates paid
12for inpatient hospital services, the Department shall pay to
13each Illinois general acute care hospital and each Illinois
14freestanding children's hospital that, as of February 1, 2008,
15was recognized as a Magnet hospital by the American Nurses
16Credentialing Center and that had a case mix index greater than
17the 75th percentile of case mix indices for all Illinois
18hospitals amounts as follows:
19        (1) For hospitals located in a county whose eligibility
20    growth factor is greater than the mean, $450 multiplied by
21    the eligibility growth factor for the county in which the
22    hospital is located for each Medicaid inpatient day of care
23    provided by the hospital during State fiscal year 2005.
24        (2) For hospitals located in a county whose eligibility
25    growth factor is less than or equal to the mean, $225
26    multiplied by the eligibility growth factor for the county

 

 

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1    in which the hospital is located for each Medicaid
2    inpatient day of care provided by the hospital during State
3    fiscal year 2005.
4    For purposes of this subsection, "eligibility growth
5factor" means the percentage by which the number of Medicaid
6recipients in the county increased from State fiscal year 1998
7to State fiscal year 2005.
8    (k) For purposes of this Section, a hospital that is
9enrolled to provide Medicaid services during State fiscal year
102005 shall have its utilization and associated reimbursements
11annualized prior to the payment calculations being performed
12under this Section.
13    (l) For purposes of this Section, the terms "Medicaid
14days", "ambulatory procedure listing services", and
15"ambulatory procedure listing payments" do not include any
16days, charges, or services for which Medicare or a managed care
17organization reimbursed on a capitated basis was liable for
18payment, except where explicitly stated otherwise in this
19Section.
20    (m) For purposes of this Section, in determining the
21percentile ranking of an Illinois hospital's case mix index or
22capital costs, hospitals described in subsection (b) of Section
235A-3 shall be excluded from the ranking.
24    (n) Definitions. Unless the context requires otherwise or
25unless provided otherwise in this Section, the terms used in
26this Section for qualifying criteria and payment calculations

 

 

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1shall have the same meanings as those terms have been given in
2the Illinois Department's administrative rules as in effect on
3March 1, 2008. Other terms shall be defined by the Illinois
4Department by rule.
5    As used in this Section, unless the context requires
6otherwise:
7    "Base inpatient payments" means, for a given hospital, the
8sum of base payments for inpatient services made on a per diem
9or per admission (DRG) basis, excluding those portions of per
10admission payments that are classified as capital payments.
11Disproportionate share hospital adjustment payments, Medicaid
12Percentage Adjustments, Medicaid High Volume Adjustments, and
13outlier payments, as defined by rule by the Department as of
14January 1, 2008, are not base payments.
15    "Capital costs" means, for a given hospital, the total
16capital costs determined using the most recent 2005 Medicare
17cost report as contained in the Healthcare Cost Report
18Information System file, for the quarter ending on December 31,
192006, divided by the total inpatient days from the same cost
20report to calculate a capital cost per day. The resulting
21capital cost per day is inflated to the midpoint of State
22fiscal year 2009 utilizing the national hospital market price
23proxies (DRI) hospital cost index. If a hospital's 2005
24Medicare cost report is not contained in the Healthcare Cost
25Report Information System, the Department may obtain the data
26necessary to compute the hospital's capital costs from any

 

 

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1source available, including, but not limited to, records
2maintained by the hospital provider, which may be inspected at
3all times during business hours of the day by the Illinois
4Department or its duly authorized agents and employees.
5    "Case mix index" means, for a given hospital, the sum of
6the DRG relative weighting factors in effect on January 1,
72005, for all general acute care admissions for State fiscal
8year 2005, excluding Medicare crossover admissions and
9transplant admissions reimbursed under 89 Ill. Adm. Code
10148.82, divided by the total number of general acute care
11admissions for State fiscal year 2005, excluding Medicare
12crossover admissions and transplant admissions reimbursed
13under 89 Ill. Adm. Code 148.82.
14    "Medicaid inpatient day" means, for a given hospital, the
15sum of days of inpatient hospital days provided to recipients
16of medical assistance under Title XIX of the federal Social
17Security Act, excluding days for individuals eligible for
18Medicare under Title XVIII of that Act (Medicaid/Medicare
19crossover days), as tabulated from the Department's paid claims
20data for admissions occurring during State fiscal year 2005
21that was adjudicated by the Department through March 23, 2007.
22    "Medicaid obstetrical day" means, for a given hospital, the
23sum of days of inpatient hospital days grouped by the
24Department to DRGs of 370 through 375 provided to recipients of
25medical assistance under Title XIX of the federal Social
26Security Act, excluding days for individuals eligible for

 

 

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1Medicare under Title XVIII of that Act (Medicaid/Medicare
2crossover days), as tabulated from the Department's paid claims
3data for admissions occurring during State fiscal year 2005
4that was adjudicated by the Department through March 23, 2007.
5    "Outpatient ambulatory procedure listing payments" means,
6for a given hospital, the sum of payments for ambulatory
7procedure listing services, as described in 89 Ill. Adm. Code
8148.140(b), provided to recipients of medical assistance under
9Title XIX of the federal Social Security Act, excluding
10payments for individuals eligible for Medicare under Title
11XVIII of the Act (Medicaid/Medicare crossover days), as
12tabulated from the Department's paid claims data for services
13occurring in State fiscal year 2005 that were adjudicated by
14the Department through March 23, 2007.
15    (o) The Department may adjust payments made under this
16Section 12.2 to comply with federal law or regulations
17regarding hospital-specific payment limitations on
18government-owned or government-operated hospitals.
19    (p) Notwithstanding any of the other provisions of this
20Section, the Department is authorized to adopt rules that
21change the hospital access improvement payments specified in
22this Section, but only to the extent necessary to conform to
23any federally approved amendment to the Title XIX State plan.
24Any such rules shall be adopted by the Department as authorized
25by Section 5-50 of the Illinois Administrative Procedure Act.
26Notwithstanding any other provision of law, any changes

 

 

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1implemented as a result of this subsection (p) shall be given
2retroactive effect so that they shall be deemed to have taken
3effect as of the effective date of this Section.
4    (q) For State fiscal years 2012 and 2013, the Department
5may make recommendations to the General Assembly regarding the
6use of more recent data for purposes of calculating the
7assessment authorized under Section 5A-2 and the payments
8authorized under this Section 5A-12.2.
9(Source: P.A. 95-859, eff. 8-19-08; 96-821, eff. 11-20-09.)".