Sen. Jeffrey M. Schoenberg

Filed: 11/9/2011

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 774

2    AMENDMENT NO. ______. Amend Senate Bill 774 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5A-1, 5A-2, 5A-4, 5A-5, 5A-8, 5A-10, 5A-13,
6and 5A-14 and by adding Section 5A-12.4 as follows:
 
7    (305 ILCS 5/5A-1)  (from Ch. 23, par. 5A-1)
8    Sec. 5A-1. Definitions. As used in this Article, unless
9the context requires otherwise:
10    "Adjusted gross hospital revenue" shall be determined
11separately for inpatient and outpatient services for each
12hospital conducted, operated or maintained by a hospital
13provider, and means the hospital provider's total gross
14revenues less: (i) gross revenue attributable to non-hospital
15based services including home dialysis services, durable
16medical equipment, ambulance services, outpatient clinics and

 

 

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1any other non-hospital based services as determined by the
2Illinois Department by rule; and (ii) gross revenues
3attributable to the routine services provided to persons
4receiving skilled or intermediate long-term care services
5within the meaning of Title XVIII or XIX of the Social Security
6Act; and (iii) Medicare gross revenue (excluding the Medicare
7gross revenue attributable to clauses (i) and (ii) of this
8paragraph and the Medicare gross revenue attributable to the
9routine services provided to patients in a psychiatric
10hospital, a rehabilitation hospital, a distinct part
11psychiatric unit, a distinct part rehabilitation unit, or swing
12beds). Adjusted gross hospital revenue shall be determined
13using the most recent data available from each hospital's 2003
14Medicare cost report as contained in the Healthcare Cost Report
15Information System file, for the quarter ending on December 31,
162004, without regard to any subsequent adjustments or changes
17to such data. If a hospital's 2003 Medicare cost report is not
18contained in the Healthcare Cost Report Information System, the
19hospital provider shall furnish such cost report or the data
20necessary to determine its adjusted gross hospital revenue as
21required by rule by the Illinois Department.
22    "Fund" means the Hospital Provider Fund.
23    "Hospital" means an institution, place, building, or
24agency located in this State that is subject to licensure by
25the Illinois Department of Public Health under the Hospital
26Licensing Act, whether public or private and whether organized

 

 

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1for profit or not-for-profit.
2    "Hospital provider" means a person licensed by the
3Department of Public Health to conduct, operate, or maintain a
4hospital, regardless of whether the person is a Medicaid
5provider. For purposes of this paragraph, "person" means any
6political subdivision of the State, municipal corporation,
7individual, firm, partnership, corporation, company, limited
8liability company, association, joint stock association, or
9trust, or a receiver, executor, trustee, guardian, or other
10representative appointed by order of any court.
11    "Medicare bed days" means, for each hospital, the sum of
12the number of days that each bed was occupied by a patient who
13was covered by Title XVIII of the Social Security Act,
14excluding days attributable to the routine services provided to
15persons receiving skilled or intermediate long term care
16services. Medicare bed days shall be computed separately for
17each hospital operated or maintained by a hospital provider.
18    "Occupied bed days" means the sum of the number of days
19that each bed was occupied by a patient for all beds, excluding
20days attributable to the routine services provided to persons
21receiving skilled or intermediate long term care services.
22Occupied bed days shall be computed separately for each
23hospital operated or maintained by a hospital provider.
24    "Outpatient gross revenue" means, for each hospital, its
25total gross charges attributed to outpatient services as
26reported on the Medicare cost report at Worksheet C, Part I,

 

 

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1Column 7, line 101, less the sum of lines 45, 60, 63, 64, 65,
266, 67, and 68 (and any subsets of those lines).
3    "Proration factor" means a fraction, the numerator of which
4is 53 and the denominator of which is 365.
5(Source: P.A. 94-242, eff. 7-18-05; 95-859, eff. 8-19-08.)
 
6    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
7    (Section scheduled to be repealed on July 1, 2014)
8    Sec. 5A-2. Assessment.
9    (a) Subject to Sections 5A-3 and 5A-10, an annual
10assessment on inpatient services is imposed on each hospital
11provider in an amount equal to the hospital's occupied bed days
12multiplied by $84.19 multiplied by the proration factor for
13State fiscal year 2004 and the hospital's occupied bed days
14multiplied by $84.19 for State fiscal year 2005.
15    For State fiscal years 2004 and 2005, the Department of
16Healthcare and Family Services shall use the number of occupied
17bed days as reported by each hospital on the Annual Survey of
18Hospitals conducted by the Department of Public Health to
19calculate the hospital's annual assessment. If the sum of a
20hospital's occupied bed days is not reported on the Annual
21Survey of Hospitals or if there are data errors in the reported
22sum of a hospital's occupied bed days as determined by the
23Department of Healthcare and Family Services (formerly
24Department of Public Aid), then the Department of Healthcare
25and Family Services may obtain the sum of occupied bed days

 

 

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1from any source available, including, but not limited to,
2records maintained by the hospital provider, which may be
3inspected at all times during business hours of the day by the
4Department of Healthcare and Family Services or its duly
5authorized agents and employees.
6    Subject to Sections 5A-3 and 5A-10, for the privilege of
7engaging in the occupation of hospital provider, beginning
8August 1, 2005, an annual assessment is imposed on each
9hospital provider for State fiscal years 2006, 2007, and 2008,
10in an amount equal to 2.5835% of the hospital provider's
11adjusted gross hospital revenue for inpatient services and
122.5835% of the hospital provider's adjusted gross hospital
13revenue for outpatient services. If the hospital provider's
14adjusted gross hospital revenue is not available, then the
15Illinois Department may obtain the hospital provider's
16adjusted gross hospital revenue from any source available,
17including, but not limited to, records maintained by the
18hospital provider, which may be inspected at all times during
19business hours of the day by the Illinois Department or its
20duly authorized agents and employees.
21    Subject to Sections 5A-3 and 5A-10, for State fiscal years
222009 through 2014, an annual assessment on inpatient services
23is imposed on each hospital provider in an amount equal to
24$218.38 multiplied by the difference of the hospital's occupied
25bed days less the hospital's Medicare bed days.
26    For State fiscal years 2009 through 2014, a hospital's

 

 

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1occupied bed days and Medicare bed days shall be determined
2using the most recent data available from each hospital's 2005
3Medicare cost report as contained in the Healthcare Cost Report
4Information System file, for the quarter ending on December 31,
52006, without regard to any subsequent adjustments or changes
6to such data. If a hospital's 2005 Medicare cost report is not
7contained in the Healthcare Cost Report Information System,
8then the Illinois Department may obtain the hospital provider's
9occupied bed days and Medicare bed days from any source
10available, including, but not limited to, records maintained by
11the hospital provider, which may be inspected at all times
12during business hours of the day by the Illinois Department or
13its duly authorized agents and employees.
14    (b) (Blank).
15    (b-5) Subject to Sections 5A-3 and 5A-10, for State fiscal
16years 2012 through 2014, an annual assessment on outpatient
17services is imposed on each hospital provider in an amount
18equal to .007236 multiplied by the hospital's outpatient gross
19revenue. For State fiscal year 2012, the amount of the
20assessment shall be prorated based on the portion of the fiscal
21year for which it and the payments authorized under Section
225A-12.4 are in effect.
23    For State fiscal years 2012 through 2014, a hospital's
24outpatient gross revenue shall be determined using the most
25recent data available from each hospital's 2009 Medicare cost
26report as contained in the Healthcare Cost Report Information

 

 

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1System file, for the quarter ending on June 30, 2011, without
2regard to any subsequent adjustments or changes to such data.
3If a hospital's 2009 Medicare cost report is not contained in
4the Healthcare Cost Report Information System, then the
5Department may obtain the hospital provider's outpatient gross
6revenue from any source available, including, but not limited
7to, records maintained by the hospital provider, which may be
8inspected at all times during business hours of the day by the
9Department or its duly authorized agents and employees.
10    (c) (Blank).
11    (d) Notwithstanding any of the other provisions of this
12Section, the Department is authorized, during this 94th General
13Assembly, to adopt rules to reduce the rate of any annual
14assessment imposed under this Section, as authorized by Section
155-46.2 of the Illinois Administrative Procedure Act.
16    (e) Notwithstanding any other provision of this Section,
17any plan providing for an assessment on a hospital provider as
18a permissible tax under Title XIX of the federal Social
19Security Act and Medicaid-eligible payments to hospital
20providers from the revenues derived from that assessment shall
21be reviewed by the Illinois Department of Healthcare and Family
22Services, as the Single State Medicaid Agency required by
23federal law, to determine whether those assessments and
24hospital provider payments meet federal Medicaid standards. If
25the Department determines that the elements of the plan may
26meet federal Medicaid standards and a related State Medicaid

 

 

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1Plan Amendment is prepared in a manner and form suitable for
2submission, that State Plan Amendment shall be submitted in a
3timely manner for review by the Centers for Medicare and
4Medicaid Services of the United States Department of Health and
5Human Services and subject to approval by the Centers for
6Medicare and Medicaid Services of the United States Department
7of Health and Human Services. No such plan shall become
8effective without approval by the Illinois General Assembly by
9the enactment into law of related legislation. Notwithstanding
10any other provision of this Section, the Department is
11authorized to adopt rules to reduce the rate of any annual
12assessment imposed under this Section. Any such rules may be
13adopted by the Department under Section 5-50 of the Illinois
14Administrative Procedure Act.
15(Source: P.A. 95-859, eff. 8-19-08; 96-1530, eff. 2-16-11.)
 
16    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
17    Sec. 5A-4. Payment of assessment; penalty.
18    (a) The annual assessment imposed by Section 5A-2 for State
19fiscal year 2004 shall be due and payable on June 18 of the
20year. The assessment imposed by Section 5A-2 for State fiscal
21year 2005 shall be due and payable in quarterly installments,
22each equalling one-fourth of the assessment for the year, on
23July 19, October 19, January 18, and April 19 of the year. The
24assessment imposed by Section 5A-2 for State fiscal years 2006
25through 2008 shall be due and payable in quarterly

 

 

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1installments, each equaling one-fourth of the assessment for
2the year, on the fourteenth State business day of September,
3December, March, and May. Except as provided in subsection
4(a-5) of this Section, the assessment imposed by Section 5A-2
5for State fiscal year 2009 and each subsequent State fiscal
6year shall be due and payable in monthly installments, each
7equaling one-twelfth of the assessment for the year, on the
8fourteenth State business day of each month. No installment
9payment of an assessment imposed by Section 5A-2 shall be due
10and payable, however, until after: (i) the Department notifies
11the hospital provider, in writing, that the payment
12methodologies to hospitals required under Section 5A-12,
13Section 5A-12.1, or Section 5A-12.2, whichever is applicable
14for that fiscal year, have been approved by the Centers for
15Medicare and Medicaid Services of the U.S. Department of Health
16and Human Services and the waiver under 42 CFR 433.68 for the
17assessment imposed by Section 5A-2, if necessary, has been
18granted by the Centers for Medicare and Medicaid Services of
19the U.S. Department of Health and Human Services; and (ii) the
20Comptroller has issued the payments required under Section
215A-12, Section 5A-12.1, or Section 5A-12.2, whichever is
22applicable for that fiscal year. Upon notification to the
23Department of approval of the payment methodologies required
24under Section 5A-12, Section 5A-12.1, or Section 5A-12.2,
25whichever is applicable for that fiscal year, and the waiver
26granted under 42 CFR 433.68, all installments otherwise due

 

 

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1under Section 5A-2 prior to the date of notification shall be
2due and payable to the Department upon written direction from
3the Department and issuance by the Comptroller of the payments
4required under Section 5A-12.1 or Section 5A-12.2, whichever is
5applicable for that fiscal year.
6    Except as provided in subsection (a-5) of this Section, the
7assessment imposed by subsection (b-5) of Section 5A-2 for
8State fiscal year 2012 and each subsequent State fiscal year
9shall be due and payable in monthly installments, each equaling
10one-twelfth of the assessment for the year, on the 14th State
11business day of each month. No installment payment of an
12assessment imposed by subsection (b-5) of Section 5A-2 shall be
13due and payable, however, until after: (i) the Department
14notifies the hospital provider, in writing, that the payment
15methodologies to hospitals required under Section 5A-12.4,
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 subsection (b-5) of Section 5A-2, if necessary, has been
20granted by the Centers for Medicare and Medicaid Services of
21the U.S. Department of Health and Human Services; and (ii) the
22Comptroller has issued the payments required under Section
235A-12.4. Upon notification to the Department of approval of the
24payment methodologies required under Section 5A-12.4 and the
25waiver granted under 42 CFR 433.68, if necessary, all
26installments otherwise due under subsection (b-5) of Section

 

 

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15A-2 prior to the date of notification shall be due and payable
2to the Department upon written direction from the Department
3and issuance by the Comptroller of the payments required under
4Section 5A-12.4.
5    (a-5) The Illinois Department may, for the purpose of
6maximizing federal revenue, accelerate the schedule upon which
7assessment installments are due and payable by hospitals with a
8payment ratio greater than or equal to one. Such acceleration
9of due dates for payment of the assessment may be made only in
10conjunction with a corresponding acceleration in access
11payments identified in Section 5A-12.2 or Section 5A-12.4 to
12the same hospitals. For the purposes of this subsection (a-5),
13a hospital's payment ratio is defined as the quotient obtained
14by dividing the total payments for the State fiscal year, as
15authorized under Section 5A-12.2 or Section 5A-12.4, by the
16total assessment for the State fiscal year imposed under
17Section 5A-2 or subsection (b-5) of Section 5A-2.
18    (b) The Illinois Department is authorized to establish
19delayed payment schedules for hospital providers that are
20unable to make installment payments when due under this Section
21due to financial difficulties, as determined by the Illinois
22Department.
23    (c) If a hospital provider fails to pay the full amount of
24an installment when due (including any extensions granted under
25subsection (b)), there shall, unless waived by the Illinois
26Department for reasonable cause, be added to the assessment

 

 

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1imposed by Section 5A-2 a penalty assessment equal to the
2lesser of (i) 5% of the amount of the installment not paid on
3or before the due date plus 5% of the portion thereof remaining
4unpaid on the last day of each 30-day period thereafter or (ii)
5100% of the installment amount not paid on or before the due
6date. For purposes of this subsection, payments will be
7credited first to unpaid installment amounts (rather than to
8penalty or interest), beginning with the most delinquent
9installments.
10    (d) Any assessment amount that is due and payable to the
11Illinois Department more frequently than once per calendar
12quarter shall be remitted to the Illinois Department by the
13hospital provider by means of electronic funds transfer. The
14Illinois Department may provide for remittance by other means
15if (i) the amount due is less than $10,000 or (ii) electronic
16funds transfer is unavailable for this purpose.
17(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08;
1896-821, eff. 11-20-09.)
 
19    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
20    Sec. 5A-5. Notice; penalty; maintenance of records.
21    (a) The Department of Healthcare and Family Services shall
22send a notice of assessment to every hospital provider subject
23to assessment under this Article. The notice of assessment
24shall notify the hospital of its assessment and shall be sent
25after receipt by the Department of notification from the

 

 

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1Centers for Medicare and Medicaid Services of the U.S.
2Department of Health and Human Services that the payment
3methodologies required under Section 5A-12, Section 5A-12.1,
4or Section 5A-12.2, or Section 5A-12.4, whichever is applicable
5for that fiscal year, and, if necessary, the waiver granted
6under 42 CFR 433.68 have been approved. The notice shall be on
7a form prepared by the Illinois Department and shall state the
8following:
9        (1) The name of the hospital provider.
10        (2) The address of the hospital provider's principal
11    place of business from which the provider engages in the
12    occupation of hospital provider in this State, and the name
13    and address of each hospital operated, conducted, or
14    maintained by the provider in this State.
15        (3) The occupied bed days, occupied bed days less
16    Medicare days, or adjusted gross hospital revenue, or
17    outpatient gross revenue of the hospital provider
18    (whichever is applicable), the amount of assessment
19    imposed under Section 5A-2 for the State fiscal year for
20    which the notice is sent, and the amount of each
21    installment to be paid during the State fiscal year.
22        (4) (Blank).
23        (5) Other reasonable information as determined by the
24    Illinois Department.
25    (b) If a hospital provider conducts, operates, or maintains
26more than one hospital licensed by the Illinois Department of

 

 

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

 

 

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1occupied bed days for the full calendar year as determined by
2the Illinois Department. Notwithstanding any other provision
3in this Article, for State fiscal years 2006 through 2008, in
4the case of a hospital provider that did not conduct, operate,
5or maintain a hospital in 2003, the assessment for that State
6fiscal year shall be computed on the basis of hypothetical
7adjusted gross hospital revenue for the hospital's first full
8fiscal year as determined by the Illinois Department (which may
9be based on annualization of the provider's actual revenues for
10a portion of the year, or revenues of a comparable hospital for
11the year, including revenues realized by a prior provider of
12the same hospital during the year). Notwithstanding any other
13provision in this Article, for State fiscal years 2009 through
142014, in the case of a hospital provider that did not conduct,
15operate, or maintain a hospital in 2005, the assessment for
16that State fiscal year shall be computed on the basis of
17hypothetical occupied bed days for the full calendar year as
18determined by the Illinois Department. Notwithstanding any
19other provision in this Article, for State fiscal years 2012
20through 2014, in the case of a hospital provider that did not
21conduct, operate, or maintain a hospital in 2009, the
22assessment under subsection (b-5) of Section 5A-2 for that
23State fiscal year shall be computed on the basis of
24hypothetical gross outpatient revenue for the full calendar
25year as determined by the Illinois Department.
26    (f) Every hospital provider subject to assessment under

 

 

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1this Article shall keep sufficient records to permit the
2determination of adjusted gross hospital revenue for the
3hospital's fiscal year. All such records shall be kept in the
4English language and shall, at all times during regular
5business hours of the day, be subject to inspection by the
6Illinois Department or its duly authorized agents and
7employees.
8    (g) The Illinois Department may, by rule, provide a
9hospital provider a reasonable opportunity to request a
10clarification or correction of any clerical or computational
11errors contained in the calculation of its assessment, but such
12corrections shall not extend to updating the cost report
13information used to calculate the assessment.
14    (h) (Blank).
15(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08;
1696-1530, eff. 2-16-11.)
 
17    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
18    Sec. 5A-8. Hospital Provider Fund.
19    (a) There is created in the State Treasury the Hospital
20Provider Fund. Interest earned by the Fund shall be credited to
21the Fund. The Fund shall not be used to replace any moneys
22appropriated to the Medicaid program by the General Assembly.
23    (b) The Fund is created for the purpose of receiving moneys
24in accordance with Section 5A-6 and disbursing moneys only for
25the following purposes, notwithstanding any other provision of

 

 

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1law:
2        (1) For making payments to hospitals as required under
3    Articles V, V-A, VI, and XIV of this Code, under the
4    Children's Health Insurance Program Act, under the
5    Covering ALL KIDS Health Insurance Act, and under the
6    Senior Citizens and Disabled Persons Property Tax Relief
7    and Pharmaceutical Assistance Act.
8        (2) For the reimbursement of moneys collected by the
9    Illinois Department from hospitals or hospital providers
10    through error or mistake in performing the activities
11    authorized under this Article and Article V of this Code.
12        (3) For payment of administrative expenses incurred by
13    the Illinois Department or its agent in performing the
14    activities authorized by this Article.
15        (4) For payments of any amounts which are reimbursable
16    to the federal government for payments from this Fund which
17    are required to be paid by State warrant.
18        (5) For making transfers, as those transfers are
19    authorized in the proceedings authorizing debt under the
20    Short Term Borrowing Act, but transfers made under this
21    paragraph (5) shall not exceed the principal amount of debt
22    issued in anticipation of the receipt by the State of
23    moneys to be deposited into the Fund.
24        (6) For making transfers to any other fund in the State
25    treasury, but transfers made under this paragraph (6) shall
26    not exceed the amount transferred previously from that

 

 

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1    other fund into the Hospital Provider Fund.
2        (6.5) For making transfers to the Healthcare Provider
3    Relief Fund, except that transfers made under this
4    paragraph (6.5) shall not exceed $60,000,000 in the
5    aggregate.
6        (7) For State fiscal years 2004 and 2005 for making
7    transfers to the Health and Human Services Medicaid Trust
8    Fund, including 20% of the moneys received from hospital
9    providers under Section 5A-4 and transferred into the
10    Hospital Provider Fund under Section 5A-6. For State fiscal
11    year 2006 for making transfers to the Health and Human
12    Services Medicaid Trust Fund of up to $130,000,000 per year
13    of the moneys received from hospital providers under
14    Section 5A-4 and transferred into the Hospital Provider
15    Fund under Section 5A-6. Transfers under this paragraph
16    shall be made within 7 days after the payments have been
17    received pursuant to the schedule of payments provided in
18    subsection (a) of Section 5A-4.
19        (7.5) For State fiscal year 2007 for making transfers
20    of the moneys received from hospital providers under
21    Section 5A-4 and transferred into the Hospital Provider
22    Fund under Section 5A-6 to the designated funds not
23    exceeding the following amounts in that State fiscal year:
24        Health and Human Services
25            Medicaid Trust Fund................. $20,000,000
26        Long-Term Care Provider Fund............ $30,000,000

 

 

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1        General Revenue Fund................... $80,000,000.
2        Transfers under this paragraph shall be made within 7
3    days after the payments have been received pursuant to the
4    schedule of payments provided in subsection (a) of Section
5    5A-4.
6        (7.8) For State fiscal year 2008, for making transfers
7    of the moneys received from hospital providers under
8    Section 5A-4 and transferred into the Hospital Provider
9    Fund under Section 5A-6 to the designated funds not
10    exceeding the following amounts in that State fiscal year:
11        Health and Human Services
12            Medicaid Trust Fund..................$40,000,000
13        Long-Term Care Provider Fund..............$60,000,000
14        General Revenue Fund...................$160,000,000.
15        Transfers under this paragraph shall be made within 7
16    days after the payments have been received pursuant to the
17    schedule of payments provided in subsection (a) of Section
18    5A-4.
19        (7.9) For State fiscal years 2009 through 2014, for
20    making transfers of the moneys received from hospital
21    providers under Section 5A-4 and transferred into the
22    Hospital Provider Fund under Section 5A-6 to the designated
23    funds not exceeding the following amounts in that State
24    fiscal year:
25        Health and Human Services
26            Medicaid Trust Fund...................$20,000,000

 

 

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1        Long Term Care Provider Fund..............$30,000,000
2        General Revenue Fund.....................$80,000,000.
3        Except as provided under this paragraph, transfers
4    under this paragraph shall be made within 7 business days
5    after the payments have been received pursuant to the
6    schedule of payments provided in subsection (a) of Section
7    5A-4. For State fiscal year 2009, transfers to the General
8    Revenue Fund under this paragraph shall be made on or
9    before June 30, 2009, as sufficient funds become available
10    in the Hospital Provider Fund to both make the transfers
11    and continue hospital payments.
12        (7.10) For State fiscal year 2012, for making transfers
13    of the moneys resulting from the assessment under
14    subsection (b-5) of Section 5A-2 and received from hospital
15    providers under Section 5A-4 and transferred into the
16    Hospital Provider Fund under Section 5A-6 to the designated
17    funds not exceeding the following amounts in that State
18    fiscal year:
19            Health Care Provider Relief Fund......$10,000,000
20        Transfers under this paragraph shall be made within 7
21    days after the payments have been received pursuant to the
22    schedule of payments provided in subsection (a) of Section
23    5A-4.
24        (7.11) For State fiscal years 2013 and 2014, for making
25    transfers of the moneys resulting from the assessment under
26    subsection (b-5) of Section 5A-2 and received from hospital

 

 

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1    providers under Section 5A-4 and transferred into the
2    Hospital Provider Fund under Section 5A-6 to the designated
3    funds not exceeding the following amounts in that State
4    fiscal year:
5            Health Care Provider Relief Fund......$20,000,000
6        Transfers under this paragraph shall be made within 7
7    days after the payments have been received pursuant to the
8    schedule of payments provided in subsection (a) of Section
9    5A-4.
10        (8) For making refunds to hospital providers pursuant
11    to Section 5A-10.
12    Disbursements from the Fund, other than transfers
13authorized under paragraphs (5) and (6) of this subsection,
14shall be by warrants drawn by the State Comptroller upon
15receipt of vouchers duly executed and certified by the Illinois
16Department.
17    (c) The Fund shall consist of the following:
18        (1) All moneys collected or received by the Illinois
19    Department from the hospital provider assessment imposed
20    by this Article.
21        (2) All federal matching funds received by the Illinois
22    Department as a result of expenditures made by the Illinois
23    Department that are attributable to moneys deposited in the
24    Fund.
25        (3) Any interest or penalty levied in conjunction with
26    the administration of this Article.

 

 

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1        (4) Moneys transferred from another fund in the State
2    treasury.
3        (5) All other moneys received for the Fund from any
4    other source, including interest earned thereon.
5    (d) (Blank).
6(Source: P.A. 95-707, eff. 1-11-08; 95-859, eff. 8-19-08; 96-3,
7eff. 2-27-09; 96-45, eff. 7-15-09; 96-821, eff. 11-20-09;
896-1530, eff. 2-16-11.)
 
9    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
10    Sec. 5A-10. Applicability.
11    (a) The assessment imposed by subsection (a) of Section
125A-2 shall not take effect or shall cease to be imposed, and
13any moneys remaining in the Fund shall be refunded to hospital
14providers in proportion to the amounts paid by them, if:
15        (1) The sum of the appropriations for State fiscal
16    years 2004 and 2005 from the General Revenue Fund for
17    hospital payments under the medical assistance program is
18    less than $4,500,000,000 or the appropriation for each of
19    State fiscal years 2006, 2007 and 2008 from the General
20    Revenue Fund for hospital payments under the medical
21    assistance program is less than $2,500,000,000 increased
22    annually to reflect any increase in the number of
23    recipients, or the annual appropriation for State fiscal
24    years 2009, 2010, 2011, 2013, and 2014, from the General
25    Revenue Fund combined with the Hospital Provider Fund as

 

 

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1    authorized in Section 5A-8 for hospital payments under the
2    medical assistance program, is less than the amount
3    appropriated for State fiscal year 2009, adjusted annually
4    to reflect any change in the number of recipients,
5    excluding State fiscal year 2009 supplemental
6    appropriations made necessary by the enactment of the
7    American Recovery and Reinvestment Act of 2009; or
8        (2) For State fiscal years prior to State fiscal year
9    2009, the Department of Healthcare and Family Services
10    (formerly Department of Public Aid) makes changes in its
11    rules that reduce the hospital inpatient or outpatient
12    payment rates, including adjustment payment rates, in
13    effect on October 1, 2004, except for hospitals described
14    in subsection (b) of Section 5A-3 and except for changes in
15    the methodology for calculating outlier payments to
16    hospitals for exceptionally costly stays, so long as those
17    changes do not reduce aggregate expenditures below the
18    amount expended in State fiscal year 2005 for such
19    services; or
20        (2.1) For State fiscal years 2009 through 2014, the
21    Department of Healthcare and Family Services adopts any
22    administrative rule change to reduce payment rates or
23    alters any payment methodology that reduces any payment
24    rates made to operating hospitals under the approved Title
25    XIX or Title XXI State plan in effect January 1, 2008
26    except for:

 

 

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1            (A) any changes for hospitals described in
2        subsection (b) of Section 5A-3; or
3            (B) any rates for payments made under this Article
4        V-A; or
5            (C) any changes proposed in State plan amendment
6        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
7        08-07; or
8            (D) in relation to any admissions on or after
9        January 1, 2011, a modification in the methodology for
10        calculating outlier payments to hospitals for
11        exceptionally costly stays, for hospitals reimbursed
12        under the diagnosis-related grouping methodology;
13        provided that the Department shall be limited to one
14        such modification during the 36-month period after the
15        effective date of this amendatory Act of the 96th
16        General Assembly; or
17        (3) The payments to hospitals required under Section
18    5A-12 or Section 5A-12.2 are changed or are not eligible
19    for federal matching funds under Title XIX or XXI of the
20    Social Security Act.
21    (b) The assessment imposed by Section 5A-2 shall not take
22effect or shall cease to be imposed if the assessment is
23determined to be an impermissible tax under Title XIX of the
24Social Security Act. Moneys in the Hospital Provider Fund
25derived from assessments imposed prior thereto shall be
26disbursed in accordance with Section 5A-8 to the extent federal

 

 

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1financial participation is not reduced due to the
2impermissibility of the assessments, and any remaining moneys
3shall be refunded to hospital providers in proportion to the
4amounts paid by them.
5    (c) The assessments imposed by subsection (b-5) of Section
65A-2 shall not take effect or shall cease to be imposed, and
7any moneys remaining in the Fund shall be refunded to hospital
8providers in proportion to the amounts paid by them, if the
9payments to hospitals required under Section 5A-12.4 are
10changed or are not eligible for federal matching funds under
11Title XIX of the Social Security Act.
12    (d) The assessments imposed by Section 5A-2 shall not take
13effect or shall cease to be imposed, and any moneys remaining
14in the Fund shall be refunded to hospital providers in
15proportion to the amounts paid by them, if:
16        (1) for State fiscal years 2012 through 2014, the
17    Department reduces any payment rates to hospitals as in
18    effect on November 1, 2011, or alters any payment
19    methodology as in effect on November 1, 2011, that has the
20    effect of reducing payment rates to hospitals; or
21        (2) for State fiscal years 2012 through 2014, the
22    Department reduces any supplemental payments made to
23    hospitals below the amounts paid for services provided in
24    State fiscal year 2011 as implemented by administrative
25    rules adopted and in effect on or prior to June 30, 2011.
26    (e) If the payments under Section 5A-12.4 are reduced

 

 

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1pursuant to subsection (p) of Section 5A-12.4, then the
2assessment rate imposed under subsection (b-5) of Section 5A-2
3shall be reduced such that the aggregate assessment is reduced
4by 50% of the amount of any reduction in payments pursuant to
5subsection (p) of Section 5A-12.4.
6(Source: P.A. 96-8, eff. 4-28-09; 96-1530, eff. 2-16-11; 97-72,
7eff. 7-1-11; 97-74, eff. 6-30-11.)
 
8    (305 ILCS 5/5A-12.4 new)
9    Sec. 5A-12.4. Hospital access improvement payments on or
10after January 1, 2012.
11    (a) Hospital access improvement payments. To preserve and
12improve access to hospital services, for hospital and physician
13services rendered on or after January 1, 2012, the Illinois
14Department shall, except for hospitals described in subsection
15(b) of Section 5A-3, make payments to hospitals as set forth in
16this Section. These payments shall be paid in 12 equal
17installments on or before the 7th State business day of each
18month, except that no payment shall be due within 100 days
19after the later of the date of notification of federal approval
20of the payment methodologies required under this Section or any
21waiver required under 42 CFR 433.68, at which time the sum of
22amounts required under this Section prior to the date of
23notification is due and payable. Payments under this Section
24are not due and payable, however, until (i) the methodologies
25described in this Section are approved by the federal

 

 

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1government in an appropriate State Plan amendment and (ii) the
2assessment imposed under subsection (b-5) of Section 5A-2 of
3this Article is determined to be a permissible tax under Title
4XIX of the Social Security Act. For State fiscal year 2012, the
5amount of the payments shall be prorated based on the portion
6of the fiscal year for which they and the assessment authorized
7under subsection (b-5) of Section 5A-2 are in effect.
8    (a-5) Accelerated schedule. The Illinois Department may,
9when practicable, accelerate the schedule upon which payments
10authorized under this Section are made.
11    (b) Magnet and perinatal hospital adjustment. In addition
12to rates paid for inpatient hospital services, the Department
13shall pay to each Illinois general acute care hospital that, as
14of August 25, 2011, was recognized as a Magnet hospital by the
15American Nurses Credentialing Center and that, as of September
1614, 2011, was designated as a level III perinatal center
17amounts as follows:
18        (1) For hospitals with a case mix index equal to or
19    greater than the 80th percentile of case mix indices for
20    all Illinois hospitals, $380 for each Medicaid general
21    acute care inpatient day of care provided by the hospital
22    during State fiscal year 2009.
23        (2) For all other hospitals, $200 for each Medicaid
24    general acute care inpatient day of care provided by the
25    hospital during State fiscal year 2009.
26    (c) Trauma level II adjustment. In addition to rates paid

 

 

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1for inpatient hospital services, the Department shall pay to
2each Illinois general acute care hospital that, as of July 1,
32011, was designated as a level II trauma center amounts as
4follows:
5        (1) For hospitals with a case mix index equal to or
6    greater than the 50th percentile of case mix indices for
7    all Illinois hospitals, $380 for each Medicaid general
8    acute care inpatient day of care provided by the hospital
9    during State fiscal year 2009.
10        (2) For all other hospitals, $135 for each Medicaid
11    general acute care inpatient day of care provided by the
12    hospital during State fiscal year 2009.
13        (3) For the purposes of this adjustment, hospitals
14    located in the same city that alternate their trauma center
15    designation as defined in 89 Ill. Adm. Code 148.295(a)(2)
16    shall have the adjustment provided under this section
17    divided between the 2 hospitals.
18    (d) Dual eligible adjustment. In addition to rates paid for
19inpatient services, the Department shall pay each Illinois
20general acute care hospital that had a ratio of crossover days
21to total inpatient days for programs under Title XIX of the
22Social Security Act administered by the Department (utilizing
23information from 2009 paid claims) greater than 50%, and a case
24mix index equal to or greater than the 75th percentile of case
25mix indices for all Illinois hospitals, a rate of $380 for each
26Medicaid inpatient day during State fiscal year 2009 including

 

 

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1crossover days.
2    (e) Medicaid volume adjustment. In addition to rates paid
3for inpatient hospital services, the Department shall pay to
4each Illinois general acute care hospital that provided more
5than 10,000 Medicaid inpatient days of care in State fiscal
6year 2009, has a Medicaid inpatient utilization rate of at
7least 29.05% as calculated by the Department for the Rate Year
82011 Disproportionate Share determination, and is not eligible
9for Medicaid Percentage Adjustment payments in rate year 2011
10an amount equal to $75 for each Medicaid inpatient day of care
11provided during State fiscal year 2009.
12    (f) Outpatient service adjustment. In addition to the rates
13paid for outpatient hospital services, the Department shall pay
14each Illinois hospital an amount at least equal to $100
15multiplied by the hospital's outpatient ambulatory procedure
16listing services (excluding categories 3B and 3C) and by the
17hospital's end stage renal disease treatment services provided
18for State fiscal year 2009.
19    (g) Care coordination adjustment.
20        (1) In addition to the rates paid for outpatient
21    hospital services provided in the emergency department,
22    the Department shall pay each Illinois hospital an amount
23    equal to $100 multiplied by the hospital's outpatient
24    ambulatory procedure listing services for categories 3A,
25    3B, and 3C for State fiscal year 2009.
26        (2) In addition to the rates paid for outpatient

 

 

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1    hospital services, the Department shall pay each Illinois
2    freestanding psychiatric hospital an amount equal to $100
3    multiplied by the hospital's ambulatory procedure listing
4    services for category 5A for State fiscal year 2009.
5        (3) In order to incentivize better coordination of care
6    for patients receiving emergency room services and
7    services related to behavioral health and substance abuse,
8    the Department may seek to have the care coordination
9    activities that are developed in consultation with a
10    statewide association representing hospitals and that are
11    supported by these adjustment payments considered under
12    Section 2703 of the Affordable Care Act.
13    (h) Specialty hospital adjustment. In addition to the rates
14paid for outpatient hospital services, the Department shall pay
15each Illinois long term acute care hospital and each Illinois
16hospital devoted exclusively to the treatment of cancer, an
17amount equal to $715 multiplied by the hospital's outpatient
18ambulatory procedure listing services and by the hospital's end
19stage renal disease treatment services (including services
20provided to individuals eligible for both Medicaid and
21Medicare) provided for State fiscal year 2009.
22    (i) Physician supplemental adjustment. In addition to the
23rates paid for physician services, the Department shall make an
24adjustment payment for services provided by physicians as
25follows:
26        (1) Physician services eligible for the adjustment

 

 

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1    payment are those provided by physicians employed by or who
2    have an exclusive contract to provide services to patients
3    of the following hospitals: (i) Illinois general acute care
4    hospitals that provided at least 17,000 Medicaid inpatient
5    days of care in State fiscal year 2009 and had a Medicaid
6    inpatient utilization rate of at least 19.23% as calculated
7    by the Department for the Rate Year 2011 Disproportionate
8    Share determination; and (ii) Illinois freestanding
9    children's hospitals, as defined in 89 Ill. Adm. Code
10    149.50(c)(3)(A).
11        (2) The amount of the adjustment for each eligible
12    hospital under this subsection (i) shall be determined by
13    rule by the Department to spend a total pool of at least
14    $22,000,000 annually. This pool shall be allocated among
15    the eligible hospitals based on the difference between the
16    upper payment limit for what could have been paid under
17    Medicaid for physician services provided during State
18    fiscal year 2009 by physicians employed by or who had an
19    exclusive contract with the hospital and the amount that
20    was paid under Medicaid for such services, provided
21    however, that in no event shall physicians at any
22    individual hospital collectively receive an annual,
23    aggregate adjustment in excess of $1,000,000. Any amount
24    that is not distributed to a hospital because of the upper
25    payment limit shall be reallocated among the remaining
26    eligible hospitals that are below the upper payment

 

 

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1    limitation, on a proportionate basis.
2    (j) For purposes of this Section, a hospital that is
3enrolled to provide Medicaid services during State fiscal year
42009 shall have its utilization and associated reimbursements
5annualized prior to the payment calculations being performed
6under this Section.
7    (k) For purposes of this Section, the terms "Medicaid
8days", "ambulatory procedure listing services", and
9"ambulatory procedure listing payments" do not include any
10days, charges, or services for which Medicare or a managed care
11organization reimbursed on a capitated basis was liable for
12payment, except where explicitly stated otherwise in this
13Section.
14    (l) Definitions. Unless the context requires otherwise or
15unless provided otherwise in this Section, the terms used in
16this Section for qualifying criteria and payment calculations
17shall have the same meanings as those terms have been given in
18the Illinois Department's administrative rules as in effect on
19October 1, 2011. Other terms shall be defined by the Illinois
20Department by rule.
21    As used in this Section, unless the context requires
22otherwise:
23    "Case mix index" means, for a given hospital, the sum of
24the per admission (DRG) relative weighting factors in effect on
25January 1, 2005, for all general acute care admissions for
26State fiscal year 2009, excluding Medicare crossover

 

 

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1admissions and transplant admissions reimbursed under 89 Ill.
2Adm. Code 148.82, divided by the total number of general acute
3care admissions for State fiscal year 2009, excluding Medicare
4crossover admissions and transplant admissions reimbursed
5under 89 Ill. Adm. Code 148.82.
6    "Medicaid inpatient day" means, for a given hospital, the
7sum of days of inpatient hospital days provided to recipients
8of medical assistance under Title XIX of the federal Social
9Security Act, excluding days for individuals eligible for
10Medicare under Title XVIII of that Act (Medicaid/Medicare
11crossover days), as tabulated from the Department's paid claims
12data for admissions occurring during State fiscal year 2009
13that was adjudicated by the Department through June 30, 2010.
14    "Outpatient ambulatory procedure listing services" means,
15for a given hospital, ambulatory procedure listing services, as
16described in 89 Ill. Adm. Code 148.140(b), provided to
17recipients of medical assistance under Title XIX of the federal
18Social Security Act, excluding services for individuals
19eligible for Medicare under Title XVIII of the Act
20(Medicaid/Medicare crossover days), as tabulated from the
21Department's paid claims data for services occurring in State
22fiscal year 2009 that were adjudicated by the Department
23through September 2, 2010.
24    "Outpatient end-stage renal disease treatment services"
25means, for a given hospital, the services, as described in 89
26Ill. Adm. Code 148.140(c), provided to recipients of medical

 

 

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1assistance under Title XIX of the federal Social Security Act,
2excluding payments for individuals eligible for Medicare under
3Title XVIII of the Act (Medicaid/Medicare crossover days), as
4tabulated from the Department's paid claims data for services
5occurring in State fiscal year 2009 that were adjudicated by
6the Department through September 2, 2010.
7    (m) The Department may adjust payments made under this
8Section 5A-12.4 to comply with federal law or regulations
9regarding hospital-specific payment limitations on
10government-owned or government-operated hospitals.
11    (n) Notwithstanding any of the other provisions of this
12Section, the Department is authorized to adopt rules that
13change the hospital access improvement payments specified in
14this Section, but only to the extent necessary to conform to
15any federally approved amendment to the Title XIX State plan.
16Any such rules shall be adopted by the Department as authorized
17by Section 5-50 of the Illinois Administrative Procedure Act.
18Notwithstanding any other provision of law, any changes
19implemented as a result of this subsection (n) shall be given
20retroactive effect so that they shall be deemed to have taken
21effect as of the effective date of this Section.
22    (o) The Department of Healthcare and Family Services must
23submit a State Medicaid Plan Amendment to the Centers of
24Medicare and Medicaid Services to implement the payments under
25this Section within 30 days of the effective date of this Act.
26    (p) If any of the federal upper payment limits applicable

 

 

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1to the payments under this Section are exceeded due to an
2expansion of the number of recipients enrolled in
3fully-capitated, risk-based managed care arrangements prior to
4the dates set forth in subsections (a) and (d) of Section
55A-14, the payments under this Section that exceed the
6applicable federal upper payment limits may be reduced
7uniformly to the extent necessary to comply with the applicable
8federal upper payment limit.
 
9    (305 ILCS 5/5A-13)
10    Sec. 5A-13. Emergency rulemaking. The Department of
11Healthcare and Family Services (formerly Department of Public
12Aid) may adopt rules necessary to implement this amendatory Act
13of the 94th General Assembly through the use of emergency
14rulemaking in accordance with Section 5-45 of the Illinois
15Administrative Procedure Act. For purposes of that Act, the
16General Assembly finds that the adoption of rules to implement
17this amendatory Act of the 94th General Assembly is deemed an
18emergency and necessary for the public interest, safety, and
19welfare.
20    The Department of Healthcare and Family Services may adopt
21rules necessary to implement this amendatory Act of the 97th
22General Assembly through the use of emergency rulemaking in
23accordance with Section 5-45 of the Illinois Administrative
24Procedure Act. For purposes of that Act, the General Assembly
25finds that the adoption of rules to implement this amendatory

 

 

09700SB0774sam001- 36 -LRB097 04507 KTG 59749 a

1Act of the 97th General Assembly is deemed an emergency and
2necessary for the public interest, safety, and welfare.
3(Source: P.A. 94-242, eff. 7-18-05; 95-331, eff. 8-21-07.)
 
4    (305 ILCS 5/5A-14)
5    Sec. 5A-14. Repeal of assessments and disbursements.
6    (a) Section 5A-2 is repealed on July 1, 2014.
7    (b) Section 5A-12 is repealed on July 1, 2005.
8    (c) Section 5A-12.1 is repealed on July 1, 2008.
9    (d) Section 5A-12.2 and Section 5A-12.4 are is repealed on
10July 1, 2014.
11    (e) Section 5A-12.3 is repealed on July 1, 2011.
12(Source: P.A. 95-859, eff. 8-19-08; 96-821, eff. 11-20-09;
1396-1530, eff. 2-16-11.)
 
14    Section 99. Effective date. This Act takes effect upon
15becoming law.".