Sen. Heather A. Steans
Filed: 2/5/2013
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1 | AMENDMENT TO SENATE BILL 26
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2 | AMENDMENT NO. ______. Amend Senate Bill 26 as follows:
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3 | on page 2, line 7, by replacing "and 5-2" with "5-2, 5A-2, | ||||||
4 | 5A-4, 5A-5, 5A-8, and 5A-12.4"; and | ||||||
5 | on page 21, immediately below line 18, by inserting the | ||||||
6 | following: | ||||||
7 | "(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | ||||||
8 | (Section scheduled to be repealed on January 1, 2015) | ||||||
9 | Sec. 5A-2. Assessment.
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10 | (a)
Subject to Sections 5A-3 and 5A-10, for State fiscal | ||||||
11 | years 2009 through 2014, and from July 1, 2014 through December | ||||||
12 | 31, 2014, an annual assessment on inpatient services is imposed | ||||||
13 | on each hospital provider in an amount equal to $218.38 | ||||||
14 | multiplied by the difference of the hospital's occupied bed | ||||||
15 | days less the hospital's Medicare bed days. |
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1 | For State fiscal years 2009 through 2014, and after a | ||||||
2 | hospital's occupied bed days and Medicare bed days shall be | ||||||
3 | determined using the most recent data available from each | ||||||
4 | hospital's 2005 Medicare cost report as contained in the | ||||||
5 | Healthcare Cost Report Information System file, for the quarter | ||||||
6 | ending on December 31, 2006, without regard to any subsequent | ||||||
7 | adjustments or changes to such data. If a hospital's 2005 | ||||||
8 | Medicare cost report is not contained in the Healthcare Cost | ||||||
9 | Report Information System, then the Illinois Department may | ||||||
10 | obtain the hospital provider's occupied bed days and Medicare | ||||||
11 | bed days from any source available, including, but not limited | ||||||
12 | to, records maintained by the hospital provider, which may be | ||||||
13 | inspected at all times during business hours of the day by the | ||||||
14 | Illinois Department or its duly authorized agents and | ||||||
15 | employees. | ||||||
16 | (b) (Blank).
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17 | (b-5) Subject to Sections 5A-3 and 5A-10, for the portion | ||||||
18 | of State fiscal year 2012, beginning June 10, 2012 through June | ||||||
19 | 30, 2012, and for State fiscal years 2013 through 2014, and | ||||||
20 | July 1, 2014 through December 31, 2014, an annual assessment on | ||||||
21 | outpatient services is imposed on each hospital provider in an | ||||||
22 | amount equal to .008766 multiplied by the hospital's outpatient | ||||||
23 | gross revenue. For the period beginning June 10, 2012 through | ||||||
24 | June 30, 2012, the annual assessment on outpatient services | ||||||
25 | shall be prorated by multiplying the assessment amount by a | ||||||
26 | fraction, the numerator of which is 21 days and the denominator |
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1 | of which is 365 days. | ||||||
2 | For the portion of State fiscal year 2012, beginning June | ||||||
3 | 10, 2012 through June 30, 2012, and State fiscal years 2013 | ||||||
4 | through 2014, and July 1, 2014 through December 31, 2014, a | ||||||
5 | hospital's outpatient gross revenue shall be determined using | ||||||
6 | the most recent data available from each hospital's 2009 | ||||||
7 | Medicare cost report as contained in the Healthcare Cost Report | ||||||
8 | Information System file, for the quarter ending on June 30, | ||||||
9 | 2011, without regard to any subsequent adjustments or changes | ||||||
10 | to such data. If a hospital's 2009 Medicare cost report is not | ||||||
11 | contained in the Healthcare Cost Report Information System, | ||||||
12 | then the Department may obtain the hospital provider's | ||||||
13 | outpatient gross revenue from any source available, including, | ||||||
14 | but not limited to, records maintained by the hospital | ||||||
15 | provider, which may be inspected at all times during business | ||||||
16 | hours of the day by the Department or its duly authorized | ||||||
17 | agents and employees. | ||||||
18 | (c) (Blank).
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19 | (d) Notwithstanding any of the other provisions of this | ||||||
20 | Section, the Department is authorized to adopt rules to reduce | ||||||
21 | the rate of any annual assessment imposed under this Section, | ||||||
22 | as authorized by Section 5-46.2 of the Illinois Administrative | ||||||
23 | Procedure Act.
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24 | (e) Notwithstanding any other provision of this Section, | ||||||
25 | any plan providing for an assessment on a hospital provider as | ||||||
26 | a permissible tax under Title XIX of the federal Social |
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1 | Security Act and Medicaid-eligible payments to hospital | ||||||
2 | providers from the revenues derived from that assessment shall | ||||||
3 | be reviewed by the Illinois Department of Healthcare and Family | ||||||
4 | Services, as the Single State Medicaid Agency required by | ||||||
5 | federal law, to determine whether those assessments and | ||||||
6 | hospital provider payments meet federal Medicaid standards. If | ||||||
7 | the Department determines that the elements of the plan may | ||||||
8 | meet federal Medicaid standards and a related State Medicaid | ||||||
9 | Plan Amendment is prepared in a manner and form suitable for | ||||||
10 | submission, that State Plan Amendment shall be submitted in a | ||||||
11 | timely manner for review by the Centers for Medicare and | ||||||
12 | Medicaid Services of the United States Department of Health and | ||||||
13 | Human Services and subject to approval by the Centers for | ||||||
14 | Medicare and Medicaid Services of the United States Department | ||||||
15 | of Health and Human Services. No such plan shall become | ||||||
16 | effective without approval by the Illinois General Assembly by | ||||||
17 | the enactment into law of related legislation. Notwithstanding | ||||||
18 | any other provision of this Section, the Department is | ||||||
19 | authorized to adopt rules to reduce the rate of any annual | ||||||
20 | assessment imposed under this Section. Any such rules may be | ||||||
21 | adopted by the Department under Section 5-50 of the Illinois | ||||||
22 | Administrative Procedure Act. | ||||||
23 | (Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; | ||||||
24 | 97-689, eff. 6-14-12.)
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25 | (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) |
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1 | Sec. 5A-4. Payment of assessment; penalty.
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2 | (a) The assessment imposed by Section 5A-2 for State fiscal | ||||||
3 | year 2009 and each subsequent State fiscal year shall be due | ||||||
4 | and payable in monthly installments, each equaling one-twelfth | ||||||
5 | of the assessment for the year, on the fourteenth State | ||||||
6 | business day of each month.
No installment payment of an | ||||||
7 | assessment imposed by Section 5A-2 shall be due
and
payable, | ||||||
8 | however, until after the Comptroller has issued the payments | ||||||
9 | required under this Article.
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10 | Except as provided in subsection (a-5) of this Section, the | ||||||
11 | assessment imposed by subsection (b-5) of Section 5A-2 for the | ||||||
12 | portion of State fiscal year 2012 beginning June 10, 2012 | ||||||
13 | through June 30, 2012, and for State fiscal year 2013 and each | ||||||
14 | subsequent State fiscal year shall be due and payable in | ||||||
15 | monthly installments, each equaling one-twelfth of the | ||||||
16 | assessment for the year, on the 14th State business day of each | ||||||
17 | month. No installment payment of an assessment imposed by | ||||||
18 | subsection (b-5) of Section 5A-2 shall be due and payable, | ||||||
19 | however, until after: (i) the Department notifies the hospital | ||||||
20 | provider, in writing, that the payment methodologies to | ||||||
21 | hospitals required under Section 5A-12.4, have been approved by | ||||||
22 | the Centers for Medicare and Medicaid Services of the U.S. | ||||||
23 | Department of Health and Human Services, and the waiver under | ||||||
24 | 42 CFR 433.68 for the assessment imposed by subsection (b-5) of | ||||||
25 | Section 5A-2, if necessary, has been granted by the Centers for | ||||||
26 | Medicare and Medicaid Services of the U.S. Department of Health |
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1 | and Human Services; and (ii) the Comptroller has issued the | ||||||
2 | payments required under Section 5A-12.4. Upon notification to | ||||||
3 | the Department of approval of the payment methodologies | ||||||
4 | required under Section 5A-12.4 and the waiver granted under 42 | ||||||
5 | CFR 433.68, if necessary, all installments otherwise due under | ||||||
6 | subsection (b-5) of Section 5A-2 prior to the date of | ||||||
7 | notification shall be due and payable to the Department upon | ||||||
8 | written direction from the Department and issuance by the | ||||||
9 | Comptroller of the payments required under Section 5A-12.4. | ||||||
10 | (a-5) The Illinois Department may accelerate the schedule | ||||||
11 | upon which assessment installments are due and payable by | ||||||
12 | hospitals with a payment ratio greater than or equal to one. | ||||||
13 | Such acceleration of due dates for payment of the assessment | ||||||
14 | may be made only in conjunction with a corresponding | ||||||
15 | acceleration in access payments identified in Section 5A-12.2 | ||||||
16 | or Section 5A-12.4 to the same hospitals. For the purposes of | ||||||
17 | this subsection (a-5), a hospital's payment ratio is defined as | ||||||
18 | the quotient obtained by dividing the total payments for the | ||||||
19 | State fiscal year, as authorized under Section 5A-12.2 or | ||||||
20 | Section 5A-12.4, by the total assessment for the State fiscal | ||||||
21 | year imposed under Section 5A-2 or subsection (b-5) of Section | ||||||
22 | 5A-2. | ||||||
23 | (b) The Illinois Department is authorized to establish
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24 | delayed payment schedules for hospital providers that are | ||||||
25 | unable
to make installment payments when due under this Section | ||||||
26 | due to
financial difficulties, as determined by the Illinois |
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1 | Department.
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2 | (c) If a hospital provider fails to pay the full amount of
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3 | an installment when due (including any extensions granted under
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4 | subsection (b)), there shall, unless waived by the Illinois
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5 | Department for reasonable cause, be added to the assessment
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6 | imposed by Section 5A-2 a penalty
assessment equal to the | ||||||
7 | lesser of (i) 5% of the amount of the
installment not paid on | ||||||
8 | or before the due date plus 5% of the
portion thereof remaining | ||||||
9 | unpaid on the last day of each 30-day period
thereafter or (ii) | ||||||
10 | 100% of the installment amount not paid on or
before the due | ||||||
11 | date. For purposes of this subsection, payments
will be | ||||||
12 | credited first to unpaid installment amounts (rather than
to | ||||||
13 | penalty or interest), beginning with the most delinquent
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14 | installments.
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15 | (d) Any assessment amount that is due and payable to the | ||||||
16 | Illinois Department more frequently than once per calendar | ||||||
17 | quarter shall be remitted to the Illinois Department by the | ||||||
18 | hospital provider by means of electronic funds transfer. The | ||||||
19 | Illinois Department may provide for remittance by other means | ||||||
20 | if (i) the amount due is less than $10,000 or (ii) electronic | ||||||
21 | funds transfer is unavailable for this purpose. | ||||||
22 | (Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12; | ||||||
23 | 97-689, eff. 6-14-12.) | ||||||
24 | (305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5) | ||||||
25 | Sec. 5A-5. Notice; penalty; maintenance of records.
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1 | (a)
The Illinois Department shall send a
notice of | ||||||
2 | assessment to every hospital provider subject
to assessment | ||||||
3 | under this Article. The notice of assessment shall notify the | ||||||
4 | hospital of its assessment and shall be sent after receipt by | ||||||
5 | the Department of notification from the Centers for Medicare | ||||||
6 | and Medicaid Services of the U.S. Department of Health and | ||||||
7 | Human Services that the payment methodologies required under | ||||||
8 | this Article and, if necessary, the waiver granted under 42 CFR | ||||||
9 | 433.68 have been approved. The notice
shall be on a form
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10 | prepared by the Illinois Department and shall state the | ||||||
11 | following:
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12 | (1) The name of the hospital provider.
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13 | (2) The address of the hospital provider's principal | ||||||
14 | place
of business from which the provider engages in the | ||||||
15 | occupation of hospital
provider in this State, and the name | ||||||
16 | and address of each hospital
operated, conducted, or | ||||||
17 | maintained by the provider in this State.
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18 | (3) The occupied bed days, occupied bed days less | ||||||
19 | Medicare days, adjusted gross hospital revenue, or | ||||||
20 | outpatient gross revenue of the
hospital
provider | ||||||
21 | (whichever is applicable), the amount of
assessment | ||||||
22 | imposed under Section 5A-2 for the State fiscal year
for | ||||||
23 | which the notice is sent, and the amount of
each
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24 | installment to be paid during the State fiscal year.
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25 | (4) (Blank).
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26 | (5) Other reasonable information as determined by the |
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1 | Illinois
Department.
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2 | (b) If a hospital provider conducts, operates, or
maintains | ||||||
3 | more than one hospital licensed by the Illinois
Department of | ||||||
4 | Public Health, the provider shall pay the
assessment for each | ||||||
5 | hospital separately.
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6 | (c) Notwithstanding any other provision in this Article, in
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7 | the case of a person who ceases to conduct, operate, or | ||||||
8 | maintain a
hospital in respect of which the person is subject | ||||||
9 | to assessment
under this Article as a hospital provider, the | ||||||
10 | assessment for the State
fiscal year in which the cessation | ||||||
11 | occurs shall be adjusted by
multiplying the assessment computed | ||||||
12 | under Section 5A-2 by a
fraction, the numerator of which is the | ||||||
13 | number of days in the
year during which the provider conducts, | ||||||
14 | operates, or maintains
the hospital and the denominator of | ||||||
15 | which is 365. Immediately
upon ceasing to conduct, operate, or | ||||||
16 | maintain a hospital, the person
shall pay the assessment
for | ||||||
17 | the year as so adjusted (to the extent not previously paid).
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18 | (d) Notwithstanding any other provision in this Article, a
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19 | provider who commences conducting, operating, or maintaining a
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20 | hospital, upon notice by the Illinois Department,
shall pay the | ||||||
21 | assessment computed under Section 5A-2 and
subsection (e) in | ||||||
22 | installments on the due dates stated in the
notice and on the | ||||||
23 | regular installment due dates for the State
fiscal year | ||||||
24 | occurring after the due dates of the initial
notice.
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25 | (e)
Notwithstanding any other provision in this Article, | ||||||
26 | for State fiscal years 2009 through 2014 2015 , in the case of a |
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1 | hospital provider that did not conduct, operate, or maintain a | ||||||
2 | hospital in 2005, the assessment for that State fiscal year | ||||||
3 | shall be computed on the basis of hypothetical occupied bed | ||||||
4 | days for the full calendar year as determined by the Illinois | ||||||
5 | Department. Notwithstanding any other provision in this | ||||||
6 | Article, for the portion of State fiscal year 2012 beginning | ||||||
7 | June 10, 2012 through June 30, 2012, and for State fiscal years | ||||||
8 | 2013 through 2014, and for July 1, 2014 through December 31, | ||||||
9 | 2014, in the case of a hospital provider that did not conduct, | ||||||
10 | operate, or maintain a hospital in 2009, the assessment under | ||||||
11 | subsection (b-5) of Section 5A-2 for that State fiscal year | ||||||
12 | shall be computed on the basis of hypothetical gross outpatient | ||||||
13 | revenue for the full calendar year as determined by the | ||||||
14 | Illinois Department.
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15 | (f) Every hospital provider subject to assessment under | ||||||
16 | this Article shall keep sufficient records to permit the | ||||||
17 | determination of adjusted gross hospital revenue for the | ||||||
18 | hospital's fiscal year. All such records shall be kept in the | ||||||
19 | English language and shall, at all times during regular | ||||||
20 | business hours of the day, be subject to inspection by the | ||||||
21 | Illinois Department or its duly authorized agents and | ||||||
22 | employees.
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23 | (g) The Illinois Department may, by rule, provide a | ||||||
24 | hospital provider a reasonable opportunity to request a | ||||||
25 | clarification or correction of any clerical or computational | ||||||
26 | errors contained in the calculation of its assessment, but such |
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1 | corrections shall not extend to updating the cost report | ||||||
2 | information used to calculate the assessment.
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3 | (h) (Blank).
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4 | (Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; | ||||||
5 | 97-689, eff. 6-14-12; revised 10-17-12.)
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6 | (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
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7 | Sec. 5A-8. Hospital Provider Fund.
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8 | (a) There is created in the State Treasury the Hospital | ||||||
9 | Provider Fund.
Interest earned by the Fund shall be credited to | ||||||
10 | the Fund. The
Fund shall not be used to replace any moneys | ||||||
11 | appropriated to the
Medicaid program by the General Assembly.
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12 | (b) The Fund is created for the purpose of receiving moneys
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13 | in accordance with Section 5A-6 and disbursing moneys only for | ||||||
14 | the following
purposes, notwithstanding any other provision of | ||||||
15 | law:
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16 | (1) For making payments to hospitals as required under | ||||||
17 | this Code, under the Children's Health Insurance Program | ||||||
18 | Act, under the Covering ALL KIDS Health Insurance Act, and | ||||||
19 | under the Long Term Acute Care Hospital Quality Improvement | ||||||
20 | Transfer Program Act.
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21 | (2) For the reimbursement of moneys collected by the
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22 | Illinois Department from hospitals or hospital providers | ||||||
23 | through error or
mistake in performing the
activities | ||||||
24 | authorized under this Code.
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25 | (3) For payment of administrative expenses incurred by |
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1 | the
Illinois Department or its agent in performing | ||||||
2 | activities
under this Code, under the Children's Health | ||||||
3 | Insurance Program Act, under the Covering ALL KIDS Health | ||||||
4 | Insurance Act, and under the Long Term Acute Care Hospital | ||||||
5 | Quality Improvement Transfer Program Act.
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6 | (4) For payments of any amounts which are reimbursable | ||||||
7 | to
the federal government for payments from this Fund which | ||||||
8 | are
required to be paid by State warrant.
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9 | (5) For making transfers, as those transfers are | ||||||
10 | authorized
in the proceedings authorizing debt under the | ||||||
11 | Short Term Borrowing Act,
but transfers made under this | ||||||
12 | paragraph (5) shall not exceed the
principal amount of debt | ||||||
13 | issued in anticipation of the receipt by
the State of | ||||||
14 | moneys to be deposited into the Fund.
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15 | (6) For making transfers to any other fund in the State | ||||||
16 | treasury, but
transfers made under this paragraph (6) shall | ||||||
17 | not exceed the amount transferred
previously from that | ||||||
18 | other fund into the Hospital Provider Fund plus any | ||||||
19 | interest that would have been earned by that fund on the | ||||||
20 | monies that had been transferred.
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21 | (6.5) For making transfers to the Healthcare Provider | ||||||
22 | Relief Fund, except that transfers made under this | ||||||
23 | paragraph (6.5) shall not exceed $60,000,000 in the | ||||||
24 | aggregate. | ||||||
25 | (7) For making transfers not exceeding the following | ||||||
26 | amounts, in State fiscal years 2013 and 2014 in each State |
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1 | fiscal year during which an assessment is imposed pursuant | ||||||
2 | to Section 5A-2 , to the following designated funds: | ||||||
3 | Health and Human Services Medicaid Trust | ||||||
4 | Fund ..............................$20,000,000 | ||||||
5 | Long-Term Care Provider Fund ..........$30,000,000 | ||||||
6 | General Revenue Fund .................$80,000,000. | ||||||
7 | Transfers under this paragraph shall be made within 7 days | ||||||
8 | after the payments have been received pursuant to the | ||||||
9 | schedule of payments provided in subsection (a) of Section | ||||||
10 | 5A-4. | ||||||
11 | (7.1) For making transfers not exceeding the following | ||||||
12 | amounts, in State fiscal year 2015, to the following | ||||||
13 | designated funds: | ||||||
14 | Health and Human Services Medicaid Trust | ||||||
15 | Fund ..............................$10,000,000 | ||||||
16 | Long-Term Care Provider Fund ..........$15,000,000 | ||||||
17 | General Revenue Fund .................$40,000,000. | ||||||
18 | Transfers under this paragraph shall be made within 7 days | ||||||
19 | after the payments have been received pursuant to the | ||||||
20 | schedule of payments provided in subsection (a) of Section | ||||||
21 | 5A-4.
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22 | (7.5) (Blank). | ||||||
23 | (7.8) (Blank). | ||||||
24 | (7.9) (Blank). | ||||||
25 | (7.10) For State fiscal years 2013 and 2014, for making | ||||||
26 | transfers of the moneys resulting from the assessment under |
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1 | subsection (b-5) of Section 5A-2 and received from hospital | ||||||
2 | providers under Section 5A-4 and transferred into the | ||||||
3 | Hospital Provider Fund under Section 5A-6 to the designated | ||||||
4 | funds not exceeding the following amounts in that State | ||||||
5 | fiscal year: | ||||||
6 | Health Care Provider Relief Fund ......$50,000,000 | ||||||
7 | Transfers under this paragraph shall be made within 7 | ||||||
8 | days after the payments have been received pursuant to the | ||||||
9 | schedule of payments provided in subsection (a) of Section | ||||||
10 | 5A-4. | ||||||
11 | (7.11) For State fiscal year 2015, for making transfers | ||||||
12 | of the moneys resulting from the assessment under | ||||||
13 | subsection (b-5) of Section 5A-2 and received from hospital | ||||||
14 | providers under Section 5A-4 and transferred into the | ||||||
15 | Hospital Provider Fund under Section 5A-6 to the designated | ||||||
16 | funds not exceeding the following amounts in that State | ||||||
17 | fiscal year: | ||||||
18 | Health Care Provider Relief Fund .....$25,000,000 | ||||||
19 | Transfers under this paragraph shall be made within 7 | ||||||
20 | days after the payments have been received pursuant to the | ||||||
21 | schedule of payments provided in subsection (a) of Section | ||||||
22 | 5A-4. | ||||||
23 | (7.12) For State fiscal year 2013, for increasing by | ||||||
24 | 21/365ths the transfer of the moneys resulting from the | ||||||
25 | assessment under subsection (b-5) of Section 5A-2 and | ||||||
26 | received from hospital providers under Section 5A-4 for the |
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1 | portion of State fiscal year 2012 beginning June 10, 2012 | ||||||
2 | through June 30, 2012 and transferred into the Hospital | ||||||
3 | Provider Fund under Section 5A-6 to the designated funds | ||||||
4 | not exceeding the following amounts in that State fiscal | ||||||
5 | year: | ||||||
6 | Health Care Provider Relief Fund .......$2,870,000 | ||||||
7 | (8) For making refunds to hospital providers pursuant | ||||||
8 | to Section 5A-10.
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9 | Disbursements from the Fund, other than transfers | ||||||
10 | authorized under
paragraphs (5) and (6) of this subsection, | ||||||
11 | shall be by
warrants drawn by the State Comptroller upon | ||||||
12 | receipt of vouchers
duly executed and certified by the Illinois | ||||||
13 | Department.
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14 | (c) The Fund shall consist of the following:
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15 | (1) All moneys collected or received by the Illinois
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16 | Department from the hospital provider assessment imposed | ||||||
17 | by this
Article.
| ||||||
18 | (2) All federal matching funds received by the Illinois
| ||||||
19 | Department as a result of expenditures made by the Illinois
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20 | Department that are attributable to moneys deposited in the | ||||||
21 | Fund.
| ||||||
22 | (3) Any interest or penalty levied in conjunction with | ||||||
23 | the
administration of this Article.
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24 | (4) Moneys transferred from another fund in the State | ||||||
25 | treasury.
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26 | (5) All other moneys received for the Fund from any |
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1 | other
source, including interest earned thereon.
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2 | (d) (Blank).
| ||||||
3 | (Source: P.A. 96-3, eff. 2-27-09; 96-45, eff. 7-15-09; 96-821, | ||||||
4 | eff. 11-20-09; 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; | ||||||
5 | 97-689, eff. 6-14-12; revised 10-17-12.)
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6 | (305 ILCS 5/5A-12.4) | ||||||
7 | (Section scheduled to be repealed on January 1, 2015) | ||||||
8 | Sec. 5A-12.4. Hospital access improvement payments on or | ||||||
9 | after June 10, 2012 July 1, 2012 . | ||||||
10 | (a) Hospital access improvement payments. To preserve and | ||||||
11 | improve access to hospital services, for hospital and physician | ||||||
12 | services rendered on or after June 10, 2012 July 1, 2012 , the | ||||||
13 | Illinois Department shall, except for hospitals described in | ||||||
14 | subsection (b) of Section 5A-3, make payments to hospitals as | ||||||
15 | set forth in this Section. These payments shall be paid in 12 | ||||||
16 | equal installments on or before the 7th State business day of | ||||||
17 | each month, except that no payment shall be due within 100 days | ||||||
18 | after the later of the date of notification of federal approval | ||||||
19 | of the payment methodologies required under this Section or any | ||||||
20 | waiver required under 42 CFR 433.68, at which time the sum of | ||||||
21 | amounts required under this Section prior to the date of | ||||||
22 | notification is due and payable. Payments under this Section | ||||||
23 | are not due and payable, however, until (i) the methodologies | ||||||
24 | described in this Section are approved by the federal | ||||||
25 | government in an appropriate State Plan amendment and (ii) the |
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1 | assessment imposed under subsection (b-5) of Section 5A-2 of | ||||||
2 | this Article is determined to be a permissible tax under Title | ||||||
3 | XIX of the Social Security Act. The Illinois Department shall | ||||||
4 | take all actions necessary to implement the payments under this | ||||||
5 | Section effective June 10, 2012 July 1, 2012 , including but not | ||||||
6 | limited to providing public notice pursuant to federal | ||||||
7 | requirements, the filing of a State Plan amendment, and the | ||||||
8 | adoption of administrative rules. For State fiscal year 2013, | ||||||
9 | payments under this Section shall be increased by 21/365ths of | ||||||
10 | the moneys resulting from the assessment under subsection (b-5) | ||||||
11 | of Section 5A-2 and received from hospital providers under | ||||||
12 | Section 5A-4 for the portion of State fiscal year 2012 | ||||||
13 | beginning June 10, 2012 through June 30, 2012. | ||||||
14 | (a-5) Accelerated schedule. The Illinois Department may, | ||||||
15 | when practicable, accelerate the schedule upon which payments | ||||||
16 | authorized under this Section are made. | ||||||
17 | (b) Magnet and perinatal hospital adjustment. In addition | ||||||
18 | to rates paid for inpatient hospital services, the Department | ||||||
19 | shall pay to each Illinois general acute care hospital that, as | ||||||
20 | of August 25, 2011, was recognized as a Magnet hospital by the | ||||||
21 | American Nurses Credentialing Center and that, as of September | ||||||
22 | 14, 2011, was designated as a level III perinatal center | ||||||
23 | amounts as follows: | ||||||
24 | (1) For hospitals with a case mix index equal to or | ||||||
25 | greater than the 80th percentile of case mix indices for | ||||||
26 | all Illinois hospitals, $470 for each Medicaid general |
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1 | acute care inpatient day of care provided by the hospital | ||||||
2 | during State fiscal year 2009. | ||||||
3 | (2) For all other hospitals, $170 for each Medicaid | ||||||
4 | general acute care inpatient day of care provided by the | ||||||
5 | hospital during State fiscal year 2009. | ||||||
6 | (c) Trauma level II adjustment. In addition to rates paid | ||||||
7 | for inpatient hospital services, the Department shall pay to | ||||||
8 | each Illinois general acute care hospital that, as of July 1, | ||||||
9 | 2011, was designated as a level II trauma center amounts as | ||||||
10 | follows: | ||||||
11 | (1) For hospitals with a case mix index equal to or | ||||||
12 | greater than the 50th percentile of case mix indices for | ||||||
13 | all Illinois hospitals, $470 for each Medicaid general | ||||||
14 | acute care inpatient day of care provided by the hospital | ||||||
15 | during State fiscal year 2009. | ||||||
16 | (2) For all other hospitals, $170 for each Medicaid | ||||||
17 | general acute care inpatient day of care provided by the | ||||||
18 | hospital during State fiscal year 2009. | ||||||
19 | (3) For the purposes of this adjustment, hospitals | ||||||
20 | located in the same city that alternate their trauma center | ||||||
21 | designation as defined in 89 Ill. Adm. Code 148.295(a)(2) | ||||||
22 | shall have the adjustment provided under this Section | ||||||
23 | divided between the 2 hospitals. | ||||||
24 | (d) Dual-eligible adjustment. In addition to rates paid for | ||||||
25 | inpatient services, the Department shall pay each Illinois | ||||||
26 | general acute care hospital that had a ratio of crossover days |
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1 | to total inpatient days for programs under Title XIX of the | ||||||
2 | Social Security Act administered by the Department (utilizing | ||||||
3 | information from 2009 paid claims) greater than 50%, and a case | ||||||
4 | mix index equal to or greater than the 75th percentile of case | ||||||
5 | mix indices for all Illinois hospitals, a rate of $400 for each | ||||||
6 | Medicaid inpatient day during State fiscal year 2009 including | ||||||
7 | crossover days. | ||||||
8 | (e) Medicaid volume adjustment. In addition to rates paid | ||||||
9 | for inpatient hospital services, the Department shall pay to | ||||||
10 | each Illinois general acute care hospital that provided more | ||||||
11 | than 10,000 Medicaid inpatient days of care in State fiscal | ||||||
12 | year 2009, has a Medicaid inpatient utilization rate of at | ||||||
13 | least 29.05% as calculated by the Department for the Rate Year | ||||||
14 | 2011 Disproportionate Share determination, and is not eligible | ||||||
15 | for Medicaid Percentage Adjustment payments in rate year 2011 | ||||||
16 | an amount equal to $135 for each Medicaid inpatient day of care | ||||||
17 | provided during State fiscal year 2009. | ||||||
18 | (f) Outpatient service adjustment. In addition to the rates | ||||||
19 | paid for outpatient hospital services, the Department shall pay | ||||||
20 | each Illinois hospital an amount at least equal to $100 | ||||||
21 | multiplied by the hospital's outpatient ambulatory procedure | ||||||
22 | listing services (excluding categories 3B and 3C) and by the | ||||||
23 | hospital's end stage renal disease treatment services provided | ||||||
24 | for State fiscal year 2009. | ||||||
25 | (g) Ambulatory service adjustment. | ||||||
26 | (1) In addition to the rates paid for outpatient |
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1 | hospital services provided in the emergency department, | ||||||
2 | the Department shall pay each Illinois hospital an amount | ||||||
3 | equal to $105 multiplied by the hospital's outpatient | ||||||
4 | ambulatory procedure listing services for categories 3A, | ||||||
5 | 3B, and 3C for State fiscal year 2009. | ||||||
6 | (2) In addition to the rates paid for outpatient | ||||||
7 | hospital services, the Department shall pay each Illinois | ||||||
8 | freestanding psychiatric hospital an amount equal to $200 | ||||||
9 | multiplied by the hospital's ambulatory procedure listing | ||||||
10 | services for category 5A for State fiscal year 2009. | ||||||
11 | (h) Specialty hospital adjustment. In addition to the rates | ||||||
12 | paid for outpatient hospital services, the Department shall pay | ||||||
13 | each Illinois long term acute care hospital and each Illinois | ||||||
14 | hospital devoted exclusively to the treatment of cancer, an | ||||||
15 | amount equal to $700 multiplied by the hospital's outpatient | ||||||
16 | ambulatory procedure listing services and by the hospital's end | ||||||
17 | stage renal disease treatment services (including services | ||||||
18 | provided to individuals eligible for both Medicaid and | ||||||
19 | Medicare) provided for State fiscal year 2009. | ||||||
20 | (h-1) ER Safety Net Payments. In addition to rates paid for | ||||||
21 | outpatient services, the Department shall pay to each Illinois | ||||||
22 | general acute care hospital with an emergency room ratio equal | ||||||
23 | to or greater than 55%, that is not eligible for Medicaid | ||||||
24 | percentage adjustments payments in rate year 2011, with a case | ||||||
25 | mix index equal to or greater than the 20th percentile, and | ||||||
26 | that is not designated as a trauma center by the Illinois |
| |||||||
| |||||||
1 | Department of Public Health on July 1, 2011, as follows: | ||||||
2 | (1) Each hospital with an emergency room ratio equal to | ||||||
3 | or greater than 74% shall receive a rate of $225 for each | ||||||
4 | outpatient ambulatory procedure listing and end-stage | ||||||
5 | renal disease treatment service provided for State fiscal | ||||||
6 | year 2009. | ||||||
7 | (2) For all other hospitals, $65 shall be paid for each | ||||||
8 | outpatient ambulatory procedure listing and end-stage | ||||||
9 | renal disease treatment service provided for State fiscal | ||||||
10 | year 2009. | ||||||
11 | (i) Physician supplemental adjustment. In addition to the | ||||||
12 | rates paid for physician services, the Department shall make an | ||||||
13 | adjustment payment for services provided by physicians as | ||||||
14 | follows: | ||||||
15 | (1) Physician services eligible for the adjustment | ||||||
16 | payment are those provided by physicians employed by or who | ||||||
17 | have a contract to provide services to patients of the | ||||||
18 | following hospitals: (i) Illinois general acute care | ||||||
19 | hospitals that provided at least 17,000 Medicaid inpatient | ||||||
20 | days of care in State fiscal year 2009 and are eligible for | ||||||
21 | Medicaid Percentage Adjustment Payments in rate year 2011; | ||||||
22 | and (ii) Illinois freestanding children's hospitals, as | ||||||
23 | defined in 89 Ill. Adm. Code 149.50(c)(3)(A). | ||||||
24 | (2) The amount of the adjustment for each eligible | ||||||
25 | hospital under this subsection (i) shall be determined by | ||||||
26 | rule by the Department to spend a total pool of at least |
| |||||||
| |||||||
1 | $6,960,000 annually. This pool shall be allocated among the | ||||||
2 | eligible hospitals based on the difference between the | ||||||
3 | upper payment limit for what could have been paid under | ||||||
4 | Medicaid for physician services provided during State | ||||||
5 | fiscal year 2009 by physicians employed by or who had a | ||||||
6 | contract with the hospital and the amount that was paid | ||||||
7 | under Medicaid for such services, provided however, that in | ||||||
8 | no event shall physicians at any individual hospital | ||||||
9 | collectively receive an annual, aggregate adjustment in | ||||||
10 | excess of $435,000, except that any amount that is not | ||||||
11 | distributed to a hospital because of the upper payment | ||||||
12 | limit shall be reallocated among the remaining eligible | ||||||
13 | hospitals that are below the upper payment limitation, on a | ||||||
14 | proportionate basis. | ||||||
15 | (i-5) For any children's hospital which did not charge for | ||||||
16 | its services during the base period, the Department shall use | ||||||
17 | data supplied by the hospital to determine payments using | ||||||
18 | similar methodologies for freestanding children's hospitals | ||||||
19 | under this Section or Section 5A-12.2 12.2 . | ||||||
20 | (j) For purposes of this Section, a hospital that is | ||||||
21 | enrolled to provide Medicaid services during State fiscal year | ||||||
22 | 2009 shall have its utilization and associated reimbursements | ||||||
23 | annualized prior to the payment calculations being performed | ||||||
24 | under this Section. | ||||||
25 | (k) For purposes of this Section, the terms "Medicaid | ||||||
26 | days", "ambulatory procedure listing services", and |
| |||||||
| |||||||
1 | "ambulatory procedure listing payments" do not include any | ||||||
2 | days, charges, or services for which Medicare or a managed care | ||||||
3 | organization reimbursed on a capitated basis was liable for | ||||||
4 | payment, except where explicitly stated otherwise in this | ||||||
5 | Section. | ||||||
6 | (l) Definitions. Unless the context requires otherwise or | ||||||
7 | unless provided otherwise in this Section, the terms used in | ||||||
8 | this Section for qualifying criteria and payment calculations | ||||||
9 | shall have the same meanings as those terms have been given in | ||||||
10 | the Illinois Department's administrative rules as in effect on | ||||||
11 | October 1, 2011. Other terms shall be defined by the Illinois | ||||||
12 | Department by rule. | ||||||
13 | As used in this Section, unless the context requires | ||||||
14 | otherwise: | ||||||
15 | "Case mix index" means, for a given hospital, the sum of
| ||||||
16 | the per admission (DRG) relative weighting factors in effect on | ||||||
17 | January 1, 2005, for all general acute care admissions for | ||||||
18 | State fiscal year 2009, excluding Medicare crossover | ||||||
19 | admissions and transplant admissions reimbursed under 89 Ill. | ||||||
20 | Adm. Code 148.82, divided by the total number of general acute | ||||||
21 | care admissions for State fiscal year 2009, excluding Medicare | ||||||
22 | crossover admissions and transplant admissions reimbursed | ||||||
23 | under 89 Ill. Adm. Code 148.82. | ||||||
24 | "Emergency room ratio" means, for a given hospital, a | ||||||
25 | fraction, the denominator of which is the number of the | ||||||
26 | hospital's outpatient ambulatory procedure listing and |
| |||||||
| |||||||
1 | end-stage renal disease treatment services provided for State | ||||||
2 | fiscal year 2009 and the numerator of which is the hospital's | ||||||
3 | outpatient ambulatory procedure listing services for | ||||||
4 | categories 3A, 3B, and 3C for State fiscal year 2009. | ||||||
5 | "Medicaid inpatient day" means, for a given hospital, the
| ||||||
6 | sum of days of inpatient hospital days provided to recipients | ||||||
7 | of medical assistance under Title XIX of the federal Social | ||||||
8 | Security Act, excluding days for individuals eligible for | ||||||
9 | Medicare under Title XVIII of that Act (Medicaid/Medicare | ||||||
10 | crossover days), as tabulated from the Department's paid claims | ||||||
11 | data for admissions occurring during State fiscal year 2009 | ||||||
12 | that was adjudicated by the Department through June 30, 2010. | ||||||
13 | "Outpatient ambulatory procedure listing services" means, | ||||||
14 | for a given hospital, ambulatory procedure listing services, as | ||||||
15 | described in 89 Ill. Adm. Code 148.140(b), provided to | ||||||
16 | recipients of medical assistance under Title XIX of the federal | ||||||
17 | Social Security Act, excluding services for individuals | ||||||
18 | eligible for Medicare under Title XVIII of the Act | ||||||
19 | (Medicaid/Medicare crossover days), as tabulated from the | ||||||
20 | Department's paid claims data for services occurring in State | ||||||
21 | fiscal year 2009 that were adjudicated by the Department | ||||||
22 | through September 2, 2010. | ||||||
23 | "Outpatient end-stage renal disease treatment services" | ||||||
24 | means, for a given hospital, the services, as described in 89 | ||||||
25 | Ill. Adm. Code 148.140(c), provided to recipients of medical | ||||||
26 | assistance under Title XIX of the federal Social Security Act, |
| |||||||
| |||||||
1 | excluding payments for individuals eligible for Medicare under | ||||||
2 | Title XVIII of the Act (Medicaid/Medicare crossover days), as | ||||||
3 | tabulated from the Department's paid claims data for services | ||||||
4 | occurring in State fiscal year 2009 that were adjudicated by | ||||||
5 | the Department through September 2, 2010. | ||||||
6 | (m) The Department may adjust payments made under this | ||||||
7 | Section 5A-12.4 to comply with federal law or regulations | ||||||
8 | regarding hospital-specific payment limitations on | ||||||
9 | government-owned or government-operated hospitals. | ||||||
10 | (n) Notwithstanding any of the other provisions of this | ||||||
11 | Section, the Department is authorized to adopt rules that | ||||||
12 | change the hospital access improvement payments specified in | ||||||
13 | this Section, but only to the extent necessary to conform to | ||||||
14 | any federally approved amendment to the Title XIX State plan. | ||||||
15 | Any such rules shall be adopted by the Department as authorized | ||||||
16 | by Section 5-50 of the Illinois Administrative Procedure Act. | ||||||
17 | Notwithstanding any other provision of law, any changes | ||||||
18 | implemented as a result of this subsection (n) shall be given | ||||||
19 | retroactive effect so that they shall be deemed to have taken | ||||||
20 | effect as of the effective date of this Section. | ||||||
21 | (o) The Department of Healthcare and Family Services must | ||||||
22 | submit a State Medicaid Plan Amendment to the Centers of | ||||||
23 | Medicare and Medicaid Services to implement the payments under | ||||||
24 | this Section within 30 days of June 14, 2012 ( the effective | ||||||
25 | date of Public Act 97-688) this Act .
| ||||||
26 | (Source: P.A. 97-688, eff. 6-14-12; revised 8-3-12.)".
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