98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB2653

 

Introduced 2/21/2013, by Rep. Fred Crespo

 

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

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a hospital which includes a facility devoted exclusively to caring for children shall be considered a children's hospital to the degree that the hospital's Medicaid care is provided to children if either (i) the facility devoted exclusively to caring for children is separately licensed as a hospital by a municipality prior to February 28, 2013 (rather than prior to September 30, 1998) or (ii) as otherwise specified. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.02 as follows:
 
6    (305 ILCS 5/5-5.02)  (from Ch. 23, par. 5-5.02)
7    Sec. 5-5.02. Hospital reimbursements.
8    (a) Reimbursement to Hospitals; July 1, 1992 through
9September 30, 1992. Notwithstanding any other provisions of
10this Code or the Illinois Department's Rules promulgated under
11the Illinois Administrative Procedure Act, reimbursement to
12hospitals for services provided during the period July 1, 1992
13through September 30, 1992, shall be as follows:
14        (1) For inpatient hospital services rendered, or if
15    applicable, for inpatient hospital discharges occurring,
16    on or after July 1, 1992 and on or before September 30,
17    1992, the Illinois Department shall reimburse hospitals
18    for inpatient services under the reimbursement
19    methodologies in effect for each hospital, and at the
20    inpatient payment rate calculated for each hospital, as of
21    June 30, 1992. For purposes of this paragraph,
22    "reimbursement methodologies" means all reimbursement
23    methodologies that pertain to the provision of inpatient

 

 

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1    hospital services, including, but not limited to, any
2    adjustments for disproportionate share, targeted access,
3    critical care access and uncompensated care, as defined by
4    the Illinois Department on June 30, 1992.
5        (2) For the purpose of calculating the inpatient
6    payment rate for each hospital eligible to receive
7    quarterly adjustment payments for targeted access and
8    critical care, as defined by the Illinois Department on
9    June 30, 1992, the adjustment payment for the period July
10    1, 1992 through September 30, 1992, shall be 25% of the
11    annual adjustment payments calculated for each eligible
12    hospital, as of June 30, 1992. The Illinois Department
13    shall determine by rule the adjustment payments for
14    targeted access and critical care beginning October 1,
15    1992.
16        (3) For the purpose of calculating the inpatient
17    payment rate for each hospital eligible to receive
18    quarterly adjustment payments for uncompensated care, as
19    defined by the Illinois Department on June 30, 1992, the
20    adjustment payment for the period August 1, 1992 through
21    September 30, 1992, shall be one-sixth of the total
22    uncompensated care adjustment payments calculated for each
23    eligible hospital for the uncompensated care rate year, as
24    defined by the Illinois Department, ending on July 31,
25    1992. The Illinois Department shall determine by rule the
26    adjustment payments for uncompensated care beginning

 

 

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1    October 1, 1992.
2    (b) Inpatient payments. For inpatient services provided on
3or after October 1, 1993, in addition to rates paid for
4hospital inpatient services pursuant to the Illinois Health
5Finance Reform Act, as now or hereafter amended, or the
6Illinois Department's prospective reimbursement methodology,
7or any other methodology used by the Illinois Department for
8inpatient services, the Illinois Department shall make
9adjustment payments, in an amount calculated pursuant to the
10methodology described in paragraph (c) of this Section, to
11hospitals that the Illinois Department determines satisfy any
12one of the following requirements:
13        (1) Hospitals that are described in Section 1923 of the
14    federal Social Security Act, as now or hereafter amended;
15    or
16        (2) Illinois hospitals that have a Medicaid inpatient
17    utilization rate which is at least one-half a standard
18    deviation above the mean Medicaid inpatient utilization
19    rate for all hospitals in Illinois receiving Medicaid
20    payments from the Illinois Department; or
21        (3) Illinois hospitals that on July 1, 1991 had a
22    Medicaid inpatient utilization rate, as defined in
23    paragraph (h) of this Section, that was at least the mean
24    Medicaid inpatient utilization rate for all hospitals in
25    Illinois receiving Medicaid payments from the Illinois
26    Department and which were located in a planning area with

 

 

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1    one-third or fewer excess beds as determined by the Health
2    Facilities and Services Review Board, and that, as of June
3    30, 1992, were located in a federally designated Health
4    Manpower Shortage Area; or
5        (4) Illinois hospitals that:
6            (A) have a Medicaid inpatient utilization rate
7        that is at least equal to the mean Medicaid inpatient
8        utilization rate for all hospitals in Illinois
9        receiving Medicaid payments from the Department; and
10            (B) also have a Medicaid obstetrical inpatient
11        utilization rate that is at least one standard
12        deviation above the mean Medicaid obstetrical
13        inpatient utilization rate for all hospitals in
14        Illinois receiving Medicaid payments from the
15        Department for obstetrical services; or
16        (5) Any children's hospital, which means a hospital
17    devoted exclusively to caring for children. A hospital
18    which includes a facility devoted exclusively to caring for
19    children shall be considered a children's hospital to the
20    degree that the hospital's Medicaid care is provided to
21    children if either (i) the facility devoted exclusively to
22    caring for children is separately licensed as a hospital by
23    a municipality prior to February 28, 2013 September 30,
24    1998 or (ii) the hospital has been designated by the State
25    as a Level III perinatal care facility, has a Medicaid
26    Inpatient Utilization rate greater than 55% for the rate

 

 

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1    year 2003 disproportionate share determination, and has
2    more than 10,000 qualified children days as defined by the
3    Department in rulemaking.
4    (c) Inpatient adjustment payments. The adjustment payments
5required by paragraph (b) shall be calculated based upon the
6hospital's Medicaid inpatient utilization rate as follows:
7        (1) hospitals with a Medicaid inpatient utilization
8    rate below the mean shall receive a per day adjustment
9    payment equal to $25;
10        (2) hospitals with a Medicaid inpatient utilization
11    rate that is equal to or greater than the mean Medicaid
12    inpatient utilization rate but less than one standard
13    deviation above the mean Medicaid inpatient utilization
14    rate shall receive a per day adjustment payment equal to
15    the sum of $25 plus $1 for each one percent that the
16    hospital's Medicaid inpatient utilization rate exceeds the
17    mean Medicaid inpatient utilization rate;
18        (3) hospitals with a Medicaid inpatient utilization
19    rate that is equal to or greater than one standard
20    deviation above the mean Medicaid inpatient utilization
21    rate but less than 1.5 standard deviations above the mean
22    Medicaid inpatient utilization rate shall receive a per day
23    adjustment payment equal to the sum of $40 plus $7 for each
24    one percent that the hospital's Medicaid inpatient
25    utilization rate exceeds one standard deviation above the
26    mean Medicaid inpatient utilization rate; and

 

 

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1        (4) hospitals with a Medicaid inpatient utilization
2    rate that is equal to or greater than 1.5 standard
3    deviations above the mean Medicaid inpatient utilization
4    rate shall receive a per day adjustment payment equal to
5    the sum of $90 plus $2 for each one percent that the
6    hospital's Medicaid inpatient utilization rate exceeds 1.5
7    standard deviations above the mean Medicaid inpatient
8    utilization rate.
9    (d) Supplemental adjustment payments. In addition to the
10adjustment payments described in paragraph (c), hospitals as
11defined in clauses (1) through (5) of paragraph (b), excluding
12county hospitals (as defined in subsection (c) of Section 15-1
13of this Code) and a hospital organized under the University of
14Illinois Hospital Act, shall be paid supplemental inpatient
15adjustment payments of $60 per day. For purposes of Title XIX
16of the federal Social Security Act, these supplemental
17adjustment payments shall not be classified as adjustment
18payments to disproportionate share hospitals.
19    (e) The inpatient adjustment payments described in
20paragraphs (c) and (d) shall be increased on October 1, 1993
21and annually thereafter by a percentage equal to the lesser of
22(i) the increase in the DRI hospital cost index for the most
23recent 12 month period for which data are available, or (ii)
24the percentage increase in the statewide average hospital
25payment rate over the previous year's statewide average
26hospital payment rate. The sum of the inpatient adjustment

 

 

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

 

 

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1    Act, and the denominator of which is the total number of
2    the hospital's inpatient days in that same period.
3        (2) "Mean Medicaid inpatient utilization rate" means
4    the total number of Medicaid inpatient days provided by all
5    Illinois Medicaid-participating hospitals divided by the
6    total number of inpatient days provided by those same
7    hospitals.
8        (3) "Medicaid obstetrical inpatient utilization rate"
9    means the ratio of Medicaid obstetrical inpatient days to
10    total Medicaid inpatient days for all Illinois hospitals
11    receiving Medicaid payments from the Illinois Department.
12    (i) Inpatient adjustment payment limit. In order to meet
13the limits of Public Law 102-234 and Public Law 103-66, the
14Illinois Department shall by rule adjust disproportionate
15share adjustment payments.
16    (j) University of Illinois Hospital inpatient adjustment
17payments. For hospitals organized under the University of
18Illinois Hospital Act, there shall be an adjustment payment as
19determined by rules adopted by the Illinois Department.
20    (k) The Illinois Department may by rule establish criteria
21for and develop methodologies for adjustment payments to
22hospitals participating under this Article.
23    (l) On and after July 1, 2012, the Department shall reduce
24any rate of reimbursement for services or other payments or
25alter any methodologies authorized by this Code to reduce any
26rate of reimbursement for services or other payments in

 

 

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1accordance with Section 5-5e.
2(Source: P.A. 96-31, eff. 6-30-09; 97-689, eff. 6-14-12.)
 
3    Section 99. Effective date. This Act takes effect upon
4becoming law.