Full Text of SB0026 98th General Assembly
SB0026sam001 98TH GENERAL ASSEMBLY | Sen. Heather A. Steans Filed: 2/5/2013
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| 1 | | AMENDMENT TO SENATE BILL 26
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 26 as follows:
| 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inserting the | 6 | | following: | 7 | | "(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | 8 | | (Section scheduled to be repealed on January 1, 2015) | 9 | | Sec. 5A-2.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.
| 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).
| 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).
| 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.
| 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.)
| 25 | | (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) |
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| 1 | | Sec. 5A-4. Payment of assessment; penalty.
| 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.
| 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
| 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.
| 2 | | (c) If a hospital provider fails to pay the full amount of
| 3 | | an installment when due (including any extensions granted under
| 4 | | subsection (b)), there shall, unless waived by the Illinois
| 5 | | Department for reasonable cause, be added to the assessment
| 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
| 14 | | installments.
| 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
| 10 | | prepared by the Illinois Department and shall state the | 11 | | following:
| 12 | | (1) The name of the hospital provider.
| 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.
| 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
| 24 | | installment to be paid during the State fiscal year.
| 25 | | (4) (Blank).
| 26 | | (5) Other reasonable information as determined by the |
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| 1 | | Illinois
Department.
| 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.
| 6 | | (c) Notwithstanding any other provision in this Article, in
| 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).
| 18 | | (d) Notwithstanding any other provision in this Article, a
| 19 | | provider who commences conducting, operating, or maintaining a
| 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.
| 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.
| 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.
| 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.
| 3 | | (h) (Blank).
| 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.)
| 6 | | (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
| 7 | | Sec. 5A-8. Hospital Provider Fund.
| 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.
| 12 | | (b) The Fund is created for the purpose of receiving moneys
| 13 | | in accordance with Section 5A-6 and disbursing moneys only for | 14 | | the following
purposes, notwithstanding any other provision of | 15 | | law:
| 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.
| 21 | | (2) For the reimbursement of moneys collected by the
| 22 | | Illinois Department from hospitals or hospital providers | 23 | | through error or
mistake in performing the
activities | 24 | | authorized under this Code.
| 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.
| 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.
| 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.
| 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.
| 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.
| 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.
| 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.
| 14 | | (c) The Fund shall consist of the following:
| 15 | | (1) All moneys collected or received by the Illinois
| 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
| 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.
| 24 | | (4) Moneys transferred from another fund in the State | 25 | | treasury.
| 26 | | (5) All other moneys received for the Fund from any |
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| 1 | | other
source, including interest earned thereon.
| 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.)
| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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, |
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| 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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