Full Text of SB3209 96th General Assembly
SB3209 96TH GENERAL ASSEMBLY
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96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010 SB3209
Introduced 2/9/2010, by Sen. Jeffrey M. Schoenberg SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning hospital access payments.
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A BILL FOR
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SB3209 |
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Public Aid Code is amended by | 5 |
| changing Section 5A-12.2 as follows: | 6 |
| (305 ILCS 5/5A-12.2) | 7 |
| (Section scheduled to be repealed on July 1, 2013) | 8 |
| Sec. 5A-12.2. Hospital access payments on or after July 1, | 9 |
| 2008. | 10 |
| (a) To preserve and improve access to hospital services, | 11 |
| for for hospital services rendered on or after July 1, 2008, | 12 |
| the Illinois Department shall, except for hospitals described | 13 |
| in subsection (b) of Section 5A-3, make payments to hospitals | 14 |
| as set forth in this Section. These payments shall be paid in | 15 |
| 12 equal installments on or before the seventh State business | 16 |
| day of each month, except that no payment shall be due within | 17 |
| 100 days after the later of the date of notification of federal | 18 |
| approval of the payment methodologies required under this | 19 |
| Section or any waiver required under 42 CFR 433.68, at which | 20 |
| time the sum of amounts required under this Section prior to | 21 |
| the date of notification is due and payable. Payments under | 22 |
| this Section are not due and payable, however, until (i) the | 23 |
| methodologies described in this Section are approved by the |
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| federal government in an appropriate State Plan amendment and | 2 |
| (ii) the assessment imposed under this Article is determined to | 3 |
| be a permissible tax under Title XIX of the Social Security | 4 |
| Act. | 5 |
| (a-5) The Illinois Department may, when practicable, | 6 |
| accelerate the schedule upon which payments authorized under | 7 |
| this Section are made. | 8 |
| (b) Across-the-board inpatient adjustment. | 9 |
| (1) In addition to rates paid for inpatient hospital | 10 |
| services, the Department shall pay to each Illinois general | 11 |
| acute care hospital an amount equal to 40% of the total | 12 |
| base inpatient payments paid to the hospital for services | 13 |
| provided in State fiscal year 2005. | 14 |
| (2) In addition to rates paid for inpatient hospital | 15 |
| services, the Department shall pay to each freestanding | 16 |
| Illinois specialty care hospital as defined in 89 Ill. Adm. | 17 |
| Code 149.50(c)(1), (2), or (4) an amount equal to 60% of | 18 |
| the total base inpatient payments paid to the hospital for | 19 |
| services provided in State fiscal year 2005. | 20 |
| (3) In addition to rates paid for inpatient hospital | 21 |
| services, the Department shall pay to each freestanding | 22 |
| Illinois rehabilitation or psychiatric hospital an amount | 23 |
| equal to $1,000 per Medicaid inpatient day multiplied by | 24 |
| the increase in the hospital's Medicaid inpatient | 25 |
| utilization ratio (determined using the positive | 26 |
| percentage change from the rate year 2005 Medicaid |
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| inpatient utilization ratio to the rate year 2007 Medicaid | 2 |
| inpatient utilization ratio, as calculated by the | 3 |
| Department for the disproportionate share determination). | 4 |
| (4) In addition to rates paid for inpatient hospital | 5 |
| services, the Department shall pay to each Illinois | 6 |
| children's hospital an amount equal to 20% of the total | 7 |
| base inpatient payments paid to the hospital for services | 8 |
| provided in State fiscal year 2005 and an additional amount | 9 |
| equal to 20% of the base inpatient payments paid to the | 10 |
| hospital for psychiatric services provided in State fiscal | 11 |
| year 2005. | 12 |
| (5) In addition to rates paid for inpatient hospital | 13 |
| services, the Department shall pay to each Illinois | 14 |
| hospital eligible for a pediatric inpatient adjustment | 15 |
| payment under 89 Ill. Adm. Code 148.298, as in effect for | 16 |
| State fiscal year 2007, a supplemental pediatric inpatient | 17 |
| adjustment payment equal to: | 18 |
| (i) For freestanding children's hospitals as | 19 |
| defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5 | 20 |
| multiplied by the hospital's pediatric inpatient | 21 |
| adjustment payment required under 89 Ill. Adm. Code | 22 |
| 148.298, as in effect for State fiscal year 2008. | 23 |
| (ii) For hospitals other than freestanding | 24 |
| children's hospitals as defined in 89 Ill. Adm. Code | 25 |
| 149.50(c)(3)(B), 1.0 multiplied by the hospital's | 26 |
| pediatric inpatient adjustment payment required under |
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| 89 Ill. Adm. Code 148.298, as in effect for State | 2 |
| fiscal year 2008. | 3 |
| (c) Outpatient adjustment. | 4 |
| (1) In addition to the rates paid for outpatient | 5 |
| hospital services, the Department shall pay each Illinois | 6 |
| hospital an amount equal to 2.2 multiplied by the | 7 |
| hospital's ambulatory procedure listing payments for | 8 |
| categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code | 9 |
| 148.140(b), for State fiscal year 2005. | 10 |
| (2) In addition to the rates paid for outpatient | 11 |
| hospital services, the Department shall pay each Illinois | 12 |
| freestanding psychiatric hospital an amount equal to 3.25 | 13 |
| multiplied by the hospital's ambulatory procedure listing | 14 |
| payments for category 5b, as defined in 89 Ill. Adm. Code | 15 |
| 148.140(b)(1)(E), for State fiscal year 2005. | 16 |
| (d) Medicaid high volume adjustment. In addition to rates | 17 |
| paid for inpatient hospital services, the Department shall pay | 18 |
| to each Illinois general acute care hospital that provided more | 19 |
| than 20,500 Medicaid inpatient days of care in State fiscal | 20 |
| year 2005 amounts as follows: | 21 |
| (1) For hospitals with a case mix index equal to or | 22 |
| greater than the 85th percentile of hospital case mix | 23 |
| indices, $350 for each Medicaid inpatient day of care | 24 |
| provided during that period; and | 25 |
| (2) For hospitals with a case mix index less than the | 26 |
| 85th percentile of hospital case mix indices, $100 for each |
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| Medicaid inpatient day of care provided during that period. | 2 |
| (e) Capital adjustment. In addition to rates paid for | 3 |
| inpatient hospital services, the Department shall pay an | 4 |
| additional payment to each Illinois general acute care hospital | 5 |
| that has a Medicaid inpatient utilization rate of at least 10% | 6 |
| (as calculated by the Department for the rate year 2007 | 7 |
| disproportionate share determination) amounts as follows: | 8 |
| (1) For each Illinois general acute care hospital that | 9 |
| has a Medicaid inpatient utilization rate of at least 10% | 10 |
| and less than 36.94% and whose capital cost is less than | 11 |
| the 60th percentile of the capital costs of all Illinois | 12 |
| hospitals, the amount of such payment shall equal the | 13 |
| hospital's Medicaid inpatient days multiplied by the | 14 |
| difference between the capital costs at the 60th percentile | 15 |
| of the capital costs of all Illinois hospitals and the | 16 |
| hospital's capital costs. | 17 |
| (2) For each Illinois general acute care hospital that | 18 |
| has a Medicaid inpatient utilization rate of at least | 19 |
| 36.94% and whose capital cost is less than the 75th | 20 |
| percentile of the capital costs of all Illinois hospitals, | 21 |
| the amount of such payment shall equal the hospital's | 22 |
| Medicaid inpatient days multiplied by the difference | 23 |
| between the capital costs at the 75th percentile of the | 24 |
| capital costs of all Illinois hospitals and the hospital's | 25 |
| capital costs. | 26 |
| (f) Obstetrical care adjustment. |
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| (1) In addition to rates paid for inpatient hospital | 2 |
| services, the Department shall pay $1,500 for each Medicaid | 3 |
| obstetrical day of care provided in State fiscal year 2005 | 4 |
| by each Illinois rural hospital that had a Medicaid | 5 |
| obstetrical percentage (Medicaid obstetrical days divided | 6 |
| by Medicaid inpatient days) greater than 15% for State | 7 |
| fiscal year 2005. | 8 |
| (2) In addition to rates paid for inpatient hospital | 9 |
| services, the Department shall pay $1,350 for each Medicaid | 10 |
| obstetrical day of care provided in State fiscal year 2005 | 11 |
| by each Illinois general acute care hospital that was | 12 |
| designated a level III perinatal center as of December 31, | 13 |
| 2006, and that had a case mix index equal to or greater | 14 |
| than the 45th percentile of the case mix indices for all | 15 |
| level III perinatal centers. | 16 |
| (3) In addition to rates paid for inpatient hospital | 17 |
| services, the Department shall pay $900 for each Medicaid | 18 |
| obstetrical day of care provided in State fiscal year 2005 | 19 |
| by each Illinois general acute care hospital that was | 20 |
| designated a level II or II+ perinatal center as of | 21 |
| December 31, 2006, and that had a case mix index equal to | 22 |
| or greater than the 35th percentile of the case mix indices | 23 |
| for all level II and II+ perinatal centers. | 24 |
| (g) Trauma adjustment. | 25 |
| (1) In addition to rates paid for inpatient hospital | 26 |
| services, the Department shall pay each Illinois general |
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| acute care hospital designated as a trauma center as of | 2 |
| July 1, 2007, a payment equal to 3.75 multiplied by the | 3 |
| hospital's State fiscal year 2005 Medicaid capital | 4 |
| payments. | 5 |
| (2) In addition to rates paid for inpatient hospital | 6 |
| services, the Department shall pay $400 for each Medicaid | 7 |
| acute inpatient day of care provided in State fiscal year | 8 |
| 2005 by each Illinois general acute care hospital that was | 9 |
| designated a level II trauma center, as defined in 89 Ill. | 10 |
| Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1, | 11 |
| 2007. | 12 |
| (3) In addition to rates paid for inpatient hospital | 13 |
| services, the Department shall pay $235 for each Illinois | 14 |
| Medicaid acute inpatient day of care provided in State | 15 |
| fiscal year 2005 by each level I pediatric trauma center | 16 |
| located outside of Illinois that had more than 8,000 | 17 |
| Illinois Medicaid inpatient days in State fiscal year 2005. | 18 |
| (h) Supplemental tertiary care adjustment. In addition to | 19 |
| rates paid for inpatient services, the Department shall pay to | 20 |
| each Illinois hospital eligible for tertiary care adjustment | 21 |
| payments under 89 Ill. Adm. Code 148.296, as in effect for | 22 |
| State fiscal year 2007, a supplemental tertiary care adjustment | 23 |
| payment equal to the tertiary care adjustment payment required | 24 |
| under 89 Ill. Adm. Code 148.296, as in effect for State fiscal | 25 |
| year 2007. | 26 |
| (i) Crossover adjustment. In addition to rates paid for |
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| inpatient services, the Department shall pay each Illinois | 2 |
| general acute care hospital that had a ratio of crossover days | 3 |
| to total inpatient days for medical assistance programs | 4 |
| administered by the Department (utilizing information from | 5 |
| 2005 paid claims) greater than 50%, and a case mix index | 6 |
| greater than the 65th percentile of case mix indices for all | 7 |
| Illinois hospitals, a rate of $1,125 for each Medicaid | 8 |
| inpatient day including crossover days. | 9 |
| (j) Magnet hospital adjustment. In addition to rates paid | 10 |
| for inpatient hospital services, the Department shall pay to | 11 |
| each Illinois general acute care hospital and each Illinois | 12 |
| freestanding children's hospital that, as of February 1, 2008, | 13 |
| was recognized as a Magnet hospital by the American Nurses | 14 |
| Credentialing Center and that had a case mix index greater than | 15 |
| the 75th percentile of case mix indices for all Illinois | 16 |
| hospitals amounts as follows: | 17 |
| (1) For hospitals located in a county whose eligibility | 18 |
| growth factor is greater than the mean, $450 multiplied by | 19 |
| the eligibility growth factor for the county in which the | 20 |
| hospital is located for each Medicaid inpatient day of care | 21 |
| provided by the hospital during State fiscal year 2005. | 22 |
| (2) For hospitals located in a county whose eligibility | 23 |
| growth factor is less than or equal to the mean, $225 | 24 |
| multiplied by the eligibility growth factor for the county | 25 |
| in which the hospital is located for each Medicaid | 26 |
| inpatient day of care provided by the hospital during State |
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| fiscal year 2005. | 2 |
| For purposes of this subsection, "eligibility growth | 3 |
| factor" means the percentage by which the number of Medicaid | 4 |
| recipients in the county increased from State fiscal year 1998 | 5 |
| to State fiscal year 2005. | 6 |
| (k) For purposes of this Section, a hospital that is | 7 |
| enrolled to provide Medicaid services during State fiscal year | 8 |
| 2005 shall have its utilization and associated reimbursements | 9 |
| annualized prior to the payment calculations being performed | 10 |
| under this Section. | 11 |
| (l) For purposes of this Section, the terms "Medicaid | 12 |
| days", "ambulatory procedure listing services", and | 13 |
| "ambulatory procedure listing payments" do not include any | 14 |
| days, charges, or services for which Medicare or a managed care | 15 |
| organization reimbursed on a capitated basis was liable for | 16 |
| payment, except where explicitly stated otherwise in this | 17 |
| Section. | 18 |
| (m) For purposes of this Section, in determining the | 19 |
| percentile ranking of an Illinois hospital's case mix index or | 20 |
| capital costs, hospitals described in subsection (b) of Section | 21 |
| 5A-3 shall be excluded from the ranking. | 22 |
| (n) Definitions. Unless the context requires otherwise or | 23 |
| unless provided otherwise in this Section, the terms used in | 24 |
| this Section for qualifying criteria and payment calculations | 25 |
| shall have the same meanings as those terms have been given in | 26 |
| the Illinois Department's administrative rules as in effect on |
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| March 1, 2008. Other terms shall be defined by the Illinois | 2 |
| Department by rule. | 3 |
| As used in this Section, unless the context requires | 4 |
| otherwise: | 5 |
| "Base inpatient payments" means, for a given hospital, the | 6 |
| sum of base payments for inpatient services made on a per diem | 7 |
| or per admission (DRG) basis, excluding those portions of per | 8 |
| admission payments that are classified as capital payments. | 9 |
| Disproportionate share hospital adjustment payments, Medicaid | 10 |
| Percentage Adjustments, Medicaid High Volume Adjustments, and | 11 |
| outlier payments, as defined by rule by the Department as of | 12 |
| January 1, 2008, are not base payments. | 13 |
| "Capital costs" means, for a given hospital, the total | 14 |
| capital costs determined using the most recent 2005 Medicare | 15 |
| cost report as contained in the Healthcare Cost Report | 16 |
| Information System file, for the quarter ending on December 31, | 17 |
| 2006, divided by the total inpatient days from the same cost | 18 |
| report to calculate a capital cost per day. The resulting | 19 |
| capital cost per day is inflated to the midpoint of State | 20 |
| fiscal year 2009 utilizing the national hospital market price | 21 |
| proxies (DRI) hospital cost index. If a hospital's 2005 | 22 |
| Medicare cost report is not contained in the Healthcare Cost | 23 |
| Report Information System, the Department may obtain the data | 24 |
| necessary to compute the hospital's capital costs from any | 25 |
| source available, including, but not limited to, records | 26 |
| maintained by the hospital provider, which may be inspected at |
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| all times during business hours of the day by the Illinois | 2 |
| Department or its duly authorized agents and employees. | 3 |
| "Case mix index" means, for a given hospital, the sum of | 4 |
| the DRG relative weighting factors in effect on January 1, | 5 |
| 2005, for all general acute care admissions for State fiscal | 6 |
| year 2005, excluding Medicare crossover admissions and | 7 |
| transplant admissions reimbursed under 89 Ill. Adm. Code | 8 |
| 148.82, divided by the total number of general acute care | 9 |
| admissions for State fiscal year 2005, excluding Medicare | 10 |
| crossover admissions and transplant admissions reimbursed | 11 |
| under 89 Ill. Adm. Code 148.82. | 12 |
| "Medicaid inpatient day" means, for a given hospital, the | 13 |
| sum of days of inpatient hospital days provided to recipients | 14 |
| of medical assistance under Title XIX of the federal Social | 15 |
| Security Act, excluding days for individuals eligible for | 16 |
| Medicare under Title XVIII of that Act (Medicaid/Medicare | 17 |
| crossover days), as tabulated from the Department's paid claims | 18 |
| data for admissions occurring during State fiscal year 2005 | 19 |
| that was adjudicated by the Department through March 23, 2007. | 20 |
| "Medicaid obstetrical day" means, for a given hospital, the | 21 |
| sum of days of inpatient hospital days grouped by the | 22 |
| Department to DRGs of 370 through 375 provided to recipients of | 23 |
| medical assistance under Title XIX of the federal Social | 24 |
| Security Act, excluding days for individuals eligible for | 25 |
| Medicare under Title XVIII of that Act (Medicaid/Medicare | 26 |
| crossover days), as tabulated from the Department's paid claims |
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| data for admissions occurring during State fiscal year 2005 | 2 |
| that was adjudicated by the Department through March 23, 2007. | 3 |
| "Outpatient ambulatory procedure listing payments" means, | 4 |
| for a given hospital, the sum of payments for ambulatory | 5 |
| procedure listing services, as described in 89 Ill. Adm. Code | 6 |
| 148.140(b), provided to recipients of medical assistance under | 7 |
| Title XIX of the federal Social Security Act, excluding | 8 |
| payments for individuals eligible for Medicare under Title | 9 |
| XVIII of the Act (Medicaid/Medicare crossover days), as | 10 |
| tabulated from the Department's paid claims data for services | 11 |
| occurring in State fiscal year 2005 that were adjudicated by | 12 |
| the Department through March 23, 2007. | 13 |
| (o) The Department may adjust payments made under this | 14 |
| Section 12.2 to comply with federal law or regulations | 15 |
| regarding hospital-specific payment limitations on | 16 |
| government-owned or government-operated hospitals. | 17 |
| (p) Notwithstanding any of the other provisions of this | 18 |
| Section, the Department is authorized to adopt rules that | 19 |
| change the hospital access improvement payments specified in | 20 |
| this Section, but only to the extent necessary to conform to | 21 |
| any federally approved amendment to the Title XIX State plan. | 22 |
| Any such rules shall be adopted by the Department as authorized | 23 |
| by Section 5-50 of the Illinois Administrative Procedure Act. | 24 |
| Notwithstanding any other provision of law, any changes | 25 |
| implemented as a result of this subsection (p) shall be given | 26 |
| retroactive effect so that they shall be deemed to have taken |
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| effect as of the effective date of this Section. | 2 |
| (q) For State fiscal years 2012 and 2013, the Department | 3 |
| may make recommendations to the General Assembly regarding the | 4 |
| use of more recent data for purposes of calculating the | 5 |
| assessment authorized under Section 5A-2 and the payments | 6 |
| authorized under this Section 5A-12.2. | 7 |
| (Source: P.A. 95-859, eff. 8-19-08; 96-821, eff. 11-20-09.)
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