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1 | | shall include the text of the
emergency rule and shall be |
2 | | published in the Illinois Register. Consent
orders or other |
3 | | court orders adopting settlements negotiated by an agency
may |
4 | | be adopted under this Section. Subject to applicable |
5 | | constitutional or
statutory provisions, an emergency rule |
6 | | becomes effective immediately upon
filing under Section 5-65 or |
7 | | at a stated date less than 10 days
thereafter. The agency's |
8 | | finding and a statement of the specific reasons
for the finding |
9 | | shall be filed with the rule. The agency shall take
reasonable |
10 | | and appropriate measures to make emergency rules known to the
|
11 | | persons who may be affected by them. |
12 | | (c) An emergency rule may be effective for a period of not |
13 | | longer than
150 days, but the agency's authority to adopt an |
14 | | identical rule under Section
5-40 is not precluded. No |
15 | | emergency rule may be adopted more
than once in any 24 month |
16 | | period, except that this limitation on the number
of emergency |
17 | | rules that may be adopted in a 24 month period does not apply
|
18 | | to (i) emergency rules that make additions to and deletions |
19 | | from the Drug
Manual under Section 5-5.16 of the Illinois |
20 | | Public Aid Code or the
generic drug formulary under Section |
21 | | 3.14 of the Illinois Food, Drug
and Cosmetic Act, (ii) |
22 | | emergency rules adopted by the Pollution Control
Board before |
23 | | July 1, 1997 to implement portions of the Livestock Management
|
24 | | Facilities Act, (iii) emergency rules adopted by the Illinois |
25 | | Department of Public Health under subsections (a) through (i) |
26 | | of Section 2 of the Department of Public Health Act when |
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1 | | necessary to protect the public's health, (iv) emergency rules |
2 | | adopted pursuant to subsection (n) of this Section, (v) |
3 | | emergency rules adopted pursuant to subsection (o) of this |
4 | | Section, or (vi) emergency rules adopted pursuant to subsection |
5 | | (c-5) of this Section. Two or more emergency rules having |
6 | | substantially the same
purpose and effect shall be deemed to be |
7 | | a single rule for purposes of this
Section. |
8 | | (c-5) To facilitate the maintenance of the program of group |
9 | | health benefits provided to annuitants, survivors, and retired |
10 | | employees under the State Employees Group Insurance Act of |
11 | | 1971, rules to alter the contributions to be paid by the State, |
12 | | annuitants, survivors, retired employees, or any combination |
13 | | of those entities, for that program of group health benefits, |
14 | | shall be adopted as emergency rules. The adoption of those |
15 | | rules shall be considered an emergency and necessary for the |
16 | | public interest, safety, and welfare. |
17 | | (d) In order to provide for the expeditious and timely |
18 | | implementation
of the State's fiscal year 1999 budget, |
19 | | emergency rules to implement any
provision of Public Act 90-587 |
20 | | or 90-588
or any other budget initiative for fiscal year 1999 |
21 | | may be adopted in
accordance with this Section by the agency |
22 | | charged with administering that
provision or initiative, |
23 | | except that the 24-month limitation on the adoption
of |
24 | | emergency rules and the provisions of Sections 5-115 and 5-125 |
25 | | do not apply
to rules adopted under this subsection (d). The |
26 | | adoption of emergency rules
authorized by this subsection (d) |
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1 | | shall be deemed to be necessary for the
public interest, |
2 | | safety, and welfare. |
3 | | (e) In order to provide for the expeditious and timely |
4 | | implementation
of the State's fiscal year 2000 budget, |
5 | | emergency rules to implement any
provision of Public Act 91-24 |
6 | | this amendatory Act of the 91st General Assembly
or any other |
7 | | budget initiative for fiscal year 2000 may be adopted in
|
8 | | accordance with this Section by the agency charged with |
9 | | administering that
provision or initiative, except that the |
10 | | 24-month limitation on the adoption
of emergency rules and the |
11 | | provisions of Sections 5-115 and 5-125 do not apply
to rules |
12 | | adopted under this subsection (e). The adoption of emergency |
13 | | rules
authorized by this subsection (e) shall be deemed to be |
14 | | necessary for the
public interest, safety, and welfare. |
15 | | (f) In order to provide for the expeditious and timely |
16 | | implementation
of the State's fiscal year 2001 budget, |
17 | | emergency rules to implement any
provision of Public Act 91-712 |
18 | | this amendatory Act of the 91st General Assembly
or any other |
19 | | budget initiative for fiscal year 2001 may be adopted in
|
20 | | accordance with this Section by the agency charged with |
21 | | administering that
provision or initiative, except that the |
22 | | 24-month limitation on the adoption
of emergency rules and the |
23 | | provisions of Sections 5-115 and 5-125 do not apply
to rules |
24 | | adopted under this subsection (f). The adoption of emergency |
25 | | rules
authorized by this subsection (f) shall be deemed to be |
26 | | necessary for the
public interest, safety, and welfare. |
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1 | | (g) In order to provide for the expeditious and timely |
2 | | implementation
of the State's fiscal year 2002 budget, |
3 | | emergency rules to implement any
provision of Public Act 92-10 |
4 | | this amendatory Act of the 92nd General Assembly
or any other |
5 | | budget initiative for fiscal year 2002 may be adopted in
|
6 | | accordance with this Section by the agency charged with |
7 | | administering that
provision or initiative, except that the |
8 | | 24-month limitation on the adoption
of emergency rules and the |
9 | | provisions of Sections 5-115 and 5-125 do not apply
to rules |
10 | | adopted under this subsection (g). The adoption of emergency |
11 | | rules
authorized by this subsection (g) shall be deemed to be |
12 | | necessary for the
public interest, safety, and welfare. |
13 | | (h) In order to provide for the expeditious and timely |
14 | | implementation
of the State's fiscal year 2003 budget, |
15 | | emergency rules to implement any
provision of Public Act 92-597 |
16 | | this amendatory Act of the 92nd General Assembly
or any other |
17 | | budget initiative for fiscal year 2003 may be adopted in
|
18 | | accordance with this Section by the agency charged with |
19 | | administering that
provision or initiative, except that the |
20 | | 24-month limitation on the adoption
of emergency rules and the |
21 | | provisions of Sections 5-115 and 5-125 do not apply
to rules |
22 | | adopted under this subsection (h). The adoption of emergency |
23 | | rules
authorized by this subsection (h) shall be deemed to be |
24 | | necessary for the
public interest, safety, and welfare. |
25 | | (i) In order to provide for the expeditious and timely |
26 | | implementation
of the State's fiscal year 2004 budget, |
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1 | | emergency rules to implement any
provision of Public Act 93-20 |
2 | | this amendatory Act of the 93rd General Assembly
or any other |
3 | | budget initiative for fiscal year 2004 may be adopted in
|
4 | | accordance with this Section by the agency charged with |
5 | | administering that
provision or initiative, except that the |
6 | | 24-month limitation on the adoption
of emergency rules and the |
7 | | provisions of Sections 5-115 and 5-125 do not apply
to rules |
8 | | adopted under this subsection (i). The adoption of emergency |
9 | | rules
authorized by this subsection (i) shall be deemed to be |
10 | | necessary for the
public interest, safety, and welfare. |
11 | | (j) In order to provide for the expeditious and timely |
12 | | implementation of the provisions of the State's fiscal year |
13 | | 2005 budget as provided under the Fiscal Year 2005 Budget |
14 | | Implementation (Human Services) Act, emergency rules to |
15 | | implement any provision of the Fiscal Year 2005 Budget |
16 | | Implementation (Human Services) Act may be adopted in |
17 | | accordance with this Section by the agency charged with |
18 | | administering that provision, except that the 24-month |
19 | | limitation on the adoption of emergency rules and the |
20 | | provisions of Sections 5-115 and 5-125 do not apply to rules |
21 | | adopted under this subsection (j). The Department of Public Aid |
22 | | may also adopt rules under this subsection (j) necessary to |
23 | | administer the Illinois Public Aid Code and the Children's |
24 | | Health Insurance Program Act. The adoption of emergency rules |
25 | | authorized by this subsection (j) shall be deemed to be |
26 | | necessary for the public interest, safety, and welfare.
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1 | | (k) In order to provide for the expeditious and timely |
2 | | implementation of the provisions of the State's fiscal year |
3 | | 2006 budget, emergency rules to implement any provision of |
4 | | Public Act 94-48 this amendatory Act of the 94th General |
5 | | Assembly or any other budget initiative for fiscal year 2006 |
6 | | may be adopted in accordance with this Section by the agency |
7 | | charged with administering that provision or initiative, |
8 | | except that the 24-month limitation on the adoption of |
9 | | emergency rules and the provisions of Sections 5-115 and 5-125 |
10 | | do not apply to rules adopted under this subsection (k). The |
11 | | Department of Healthcare and Family Services may also adopt |
12 | | rules under this subsection (k) necessary to administer the |
13 | | Illinois Public Aid Code, the Senior Citizens and Persons with |
14 | | Disabilities Property Tax Relief Act, the Senior Citizens and |
15 | | Disabled Persons Prescription Drug Discount Program Act (now |
16 | | the Illinois Prescription Drug Discount Program Act), and the |
17 | | Children's Health Insurance Program Act. The adoption of |
18 | | emergency rules authorized by this subsection (k) shall be |
19 | | deemed to be necessary for the public interest, safety, and |
20 | | welfare.
|
21 | | (l) In order to provide for the expeditious and timely |
22 | | implementation of the provisions of the
State's fiscal year |
23 | | 2007 budget, the Department of Healthcare and Family Services |
24 | | may adopt emergency rules during fiscal year 2007, including |
25 | | rules effective July 1, 2007, in
accordance with this |
26 | | subsection to the extent necessary to administer the |
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1 | | Department's responsibilities with respect to amendments to |
2 | | the State plans and Illinois waivers approved by the federal |
3 | | Centers for Medicare and Medicaid Services necessitated by the |
4 | | requirements of Title XIX and Title XXI of the federal Social |
5 | | Security Act. The adoption of emergency rules
authorized by |
6 | | this subsection (l) shall be deemed to be necessary for the |
7 | | public interest,
safety, and welfare.
|
8 | | (m) In order to provide for the expeditious and timely |
9 | | implementation of the provisions of the
State's fiscal year |
10 | | 2008 budget, the Department of Healthcare and Family Services |
11 | | may adopt emergency rules during fiscal year 2008, including |
12 | | rules effective July 1, 2008, in
accordance with this |
13 | | subsection to the extent necessary to administer the |
14 | | Department's responsibilities with respect to amendments to |
15 | | the State plans and Illinois waivers approved by the federal |
16 | | Centers for Medicare and Medicaid Services necessitated by the |
17 | | requirements of Title XIX and Title XXI of the federal Social |
18 | | Security Act. The adoption of emergency rules
authorized by |
19 | | this subsection (m) shall be deemed to be necessary for the |
20 | | public interest,
safety, and welfare.
|
21 | | (n) In order to provide for the expeditious and timely |
22 | | implementation of the provisions of the State's fiscal year |
23 | | 2010 budget, emergency rules to implement any provision of |
24 | | Public Act 96-45 this amendatory Act of the 96th General |
25 | | Assembly or any other budget initiative authorized by the 96th |
26 | | General Assembly for fiscal year 2010 may be adopted in |
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1 | | accordance with this Section by the agency charged with |
2 | | administering that provision or initiative. The adoption of |
3 | | emergency rules authorized by this subsection (n) shall be |
4 | | deemed to be necessary for the public interest, safety, and |
5 | | welfare. The rulemaking authority granted in this subsection |
6 | | (n) shall apply only to rules promulgated during Fiscal Year |
7 | | 2010. |
8 | | (o) In order to provide for the expeditious and timely |
9 | | implementation of the provisions of the State's fiscal year |
10 | | 2011 budget, emergency rules to implement any provision of |
11 | | Public Act 96-958 this amendatory Act of the 96th General |
12 | | Assembly or any other budget initiative authorized by the 96th |
13 | | General Assembly for fiscal year 2011 may be adopted in |
14 | | accordance with this Section by the agency charged with |
15 | | administering that provision or initiative. The adoption of |
16 | | emergency rules authorized by this subsection (o) is deemed to |
17 | | be necessary for the public interest, safety, and welfare. The |
18 | | rulemaking authority granted in this subsection (o) applies |
19 | | only to rules promulgated on or after the effective date of |
20 | | Public Act 96-958 this amendatory Act of the 96th General |
21 | | Assembly through June 30, 2011. |
22 | | (p) In order to provide for the expeditious and timely |
23 | | implementation of the provisions of Public Act 97-689, |
24 | | emergency rules to implement any provision of Public Act 97-689 |
25 | | may be adopted in accordance with this subsection (p) by the |
26 | | agency charged with administering that provision or |
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1 | | initiative. The 150-day limitation of the effective period of |
2 | | emergency rules does not apply to rules adopted under this |
3 | | subsection (p), and the effective period may continue through |
4 | | June 30, 2013. The 24-month limitation on the adoption of |
5 | | emergency rules does not apply to rules adopted under this |
6 | | subsection (p). The adoption of emergency rules authorized by |
7 | | this subsection (p) is deemed to be necessary for the public |
8 | | interest, safety, and welfare. |
9 | | (q) In order to provide for the expeditious and timely |
10 | | implementation of the provisions of Articles 7, 8, 9, 11, and |
11 | | 12 of Public Act 98-104 this amendatory Act of the 98th General |
12 | | Assembly , emergency rules to implement any provision of |
13 | | Articles 7, 8, 9, 11, and 12 of Public Act 98-104 this |
14 | | amendatory Act of the 98th General Assembly may be adopted in |
15 | | accordance with this subsection (q) by the agency charged with |
16 | | administering that provision or initiative. The 24-month |
17 | | limitation on the adoption of emergency rules does not apply to |
18 | | rules adopted under this subsection (q). The adoption of |
19 | | emergency rules authorized by this subsection (q) is deemed to |
20 | | be necessary for the public interest, safety, and welfare. |
21 | | (r) In order to provide for the expeditious and timely |
22 | | implementation of the provisions of Public Act 98-651 this |
23 | | amendatory Act of the 98th General Assembly , emergency rules to |
24 | | implement Public Act 98-651 this amendatory Act of the 98th |
25 | | General Assembly may be adopted in accordance with this |
26 | | subsection (r) by the Department of Healthcare and Family |
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1 | | Services. The 24-month limitation on the adoption of emergency |
2 | | rules does not apply to rules adopted under this subsection |
3 | | (r). The adoption of emergency rules authorized by this |
4 | | subsection (r) is deemed to be necessary for the public |
5 | | interest, safety, and welfare. |
6 | | (s) In order to provide for the expeditious and timely |
7 | | implementation of the provisions of Sections 5-5b.1 and 5A-2 of |
8 | | the Illinois Public Aid Code, emergency rules to implement any |
9 | | provision of Section 5-5b.1 or Section 5A-2 of the Illinois |
10 | | Public Aid Code may be adopted in accordance with this |
11 | | subsection (s) by the Department of Healthcare and Family |
12 | | Services. The rulemaking authority granted in this subsection |
13 | | (s) shall apply only to those rules adopted prior to July 1, |
14 | | 2015. Notwithstanding any other provision of this Section, any |
15 | | emergency rule adopted under this subsection (s) shall only |
16 | | apply to payments made for State fiscal year 2015. The adoption |
17 | | of emergency rules authorized by this subsection (s) is deemed |
18 | | to be necessary for the public interest, safety, and welfare. |
19 | | (t) In order to provide for the expeditious and timely |
20 | | implementation of the provisions of Article II of Public Act |
21 | | 99-6 this amendatory Act of the 99th General Assembly , |
22 | | emergency rules to implement the changes made by Article II of |
23 | | Public Act 99-6 this amendatory Act of the 99th General |
24 | | Assembly to the Emergency Telephone System Act may be adopted |
25 | | in accordance with this subsection (t) by the Department of |
26 | | State Police. The rulemaking authority granted in this |
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1 | | subsection (t) shall apply only to those rules adopted prior to |
2 | | July 1, 2016. The 24-month limitation on the adoption of |
3 | | emergency rules does not apply to rules adopted under this |
4 | | subsection (t). The adoption of emergency rules authorized by |
5 | | this subsection (t) is deemed to be necessary for the public |
6 | | interest, safety, and welfare. |
7 | | (u) (t) In order to provide for the expeditious and timely |
8 | | implementation of the provisions of the Burn Victims Relief |
9 | | Act, emergency rules to implement any provision of the Act may |
10 | | be adopted in accordance with this subsection (u) (t) by the |
11 | | Department of Insurance. The rulemaking authority granted in |
12 | | this subsection (u) (t) shall apply only to those rules adopted |
13 | | prior to December 31, 2015. The adoption of emergency rules |
14 | | authorized by this subsection (u) (t) is deemed to be necessary |
15 | | for the public interest, safety, and welfare. |
16 | | (v) In order to provide for the expeditious and timely |
17 | | implementation of the provisions of this amendatory Act of the |
18 | | 99th General Assembly, emergency rules to implement this |
19 | | amendatory Act of the 99th General Assembly may be adopted in |
20 | | accordance with this subsection (v) by the Department of |
21 | | Healthcare and Family Services. The 24-month limitation on the |
22 | | adoption of emergency rules does not apply to rules adopted |
23 | | under this subsection (v). The adoption of emergency rules |
24 | | authorized by this subsection (v) is deemed to be necessary for |
25 | | the public interest, safety, and welfare. |
26 | | (Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13; |
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1 | | 98-651, eff. 6-16-14; 99-2, eff. 3-26-15; 99-6, eff. 1-1-16; |
2 | | 99-143, eff. 7-27-15; 99-455, eff. 1-1-16; revised 10-15-15.) |
3 | | Section 10. The State Finance Act is amended by changing |
4 | | Section 6z-81 as follows: |
5 | | (30 ILCS 105/6z-81) |
6 | | Sec. 6z-81. Healthcare Provider Relief Fund. |
7 | | (a) There is created in the State treasury a special fund |
8 | | to be known as the Healthcare Provider Relief Fund. |
9 | | (b) The Fund is created for the purpose of receiving and |
10 | | disbursing moneys in accordance with this Section. |
11 | | Disbursements from the Fund shall be made only as follows: |
12 | | (1) Subject to appropriation, for payment by the |
13 | | Department of Healthcare and
Family Services or by the |
14 | | Department of Human Services of medical bills and related |
15 | | expenses, including administrative expenses, for which the |
16 | | State is responsible under Titles XIX and XXI of the Social |
17 | | Security Act, the Illinois Public Aid Code, the Children's |
18 | | Health Insurance Program Act, the Covering ALL KIDS Health |
19 | | Insurance Act, and the Long Term Acute Care Hospital |
20 | | Quality Improvement Transfer Program Act. |
21 | | (2) For repayment of funds borrowed from other State
|
22 | | funds or from outside sources, including interest thereon. |
23 | | (3) For State fiscal years 2017 and 2018, for making |
24 | | payments to the human poison control center pursuant to |
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1 | | Section 12-4.105 of the Illinois Public Aid Code. |
2 | | (c) The Fund shall consist of the following: |
3 | | (1) Moneys received by the State from short-term
|
4 | | borrowing pursuant to the Short Term Borrowing Act on or |
5 | | after the effective date of this amendatory Act of the 96th |
6 | | General Assembly. |
7 | | (2) All federal matching funds received by the
Illinois |
8 | | Department of Healthcare and Family Services as a result of |
9 | | expenditures made by the Department that are attributable |
10 | | to moneys deposited in the Fund. |
11 | | (3) All federal matching funds received by the
Illinois |
12 | | Department of Healthcare and Family Services as a result of |
13 | | federal approval of Title XIX State plan amendment |
14 | | transmittal number 07-09. |
15 | | (4) All other moneys received for the Fund from any
|
16 | | other source, including interest earned thereon. |
17 | | (5) All federal matching funds received by the
Illinois |
18 | | Department of Healthcare and Family Services as a result of |
19 | | expenditures made by the Department for Medical Assistance |
20 | | from the General Revenue Fund, the Tobacco Settlement |
21 | | Recovery Fund, the Long-Term Care Provider Fund, and the |
22 | | Drug Rebate Fund related to individuals eligible for |
23 | | medical assistance pursuant to the Patient Protection and |
24 | | Affordable Care Act (P.L. 111-148) and Section 5-2 of the |
25 | | Illinois Public Aid Code. |
26 | | (d) In addition to any other transfers that may be provided |
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1 | | for by law, on the effective date of this amendatory Act of the |
2 | | 97th General Assembly, or as soon thereafter as practical, the |
3 | | State Comptroller shall direct and the State Treasurer shall |
4 | | transfer the sum of $365,000,000 from the General Revenue Fund |
5 | | into the Healthcare Provider Relief Fund.
|
6 | | (e) In addition to any other transfers that may be provided |
7 | | for by law, on July 1, 2011, or as soon thereafter as |
8 | | practical, the State Comptroller shall direct and the State |
9 | | Treasurer shall transfer the sum of $160,000,000 from the |
10 | | General Revenue Fund to the Healthcare Provider Relief Fund. |
11 | | (f) Notwithstanding any other State law to the contrary, |
12 | | and in addition to any other transfers that may be provided for |
13 | | by law, the State Comptroller shall order transferred and the |
14 | | State Treasurer shall transfer $500,000,000 to the Healthcare |
15 | | Provider Relief Fund from the General Revenue Fund in equal |
16 | | monthly installments of $100,000,000, with the first transfer |
17 | | to be made on July 1, 2012, or as soon thereafter as practical, |
18 | | and with each of the remaining transfers to be made on August |
19 | | 1, 2012, September 1, 2012, October 1, 2012, and November 1, |
20 | | 2012, or as soon thereafter as practical. This transfer may |
21 | | assist the Department of Healthcare and Family Services in |
22 | | improving Medical Assistance bill processing timeframes or in |
23 | | meeting the possible requirements of Senate Bill 3397, or other |
24 | | similar legislation, of the 97th General Assembly should it |
25 | | become law. |
26 | | (g) Notwithstanding any other State law to the contrary, |
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1 | | and in addition to any other transfers that may be provided for |
2 | | by law, on July 1, 2013, or as soon thereafter as may be |
3 | | practical, the State Comptroller shall direct and the State |
4 | | Treasurer shall transfer the sum of $601,000,000 from the |
5 | | General Revenue Fund to the Healthcare Provider Relief Fund. |
6 | | (Source: P.A. 97-44, eff. 6-28-11; 97-641, eff. 12-19-11; |
7 | | 97-689, eff. 6-14-12; 97-732, eff. 6-30-12; 98-24, eff. |
8 | | 6-19-13; 98-463, eff. 8-16-13.) |
9 | | Section 15. The Illinois Public Aid Code is amended by |
10 | | changing Sections 5A-2, 5A-8, 5A-12.2, and 5A-12.5 and by |
11 | | adding Section 12-4.105 as follows: |
12 | | (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) |
13 | | (Section scheduled to be repealed on July 1, 2018) |
14 | | Sec. 5A-2. Assessment.
|
15 | | (a) (1)
Subject to Sections 5A-3 and 5A-10, for State fiscal |
16 | | years 2009 through 2018, an annual assessment on inpatient |
17 | | services is imposed on each hospital provider in an amount |
18 | | equal to $218.38 multiplied by the difference of the hospital's |
19 | | occupied bed days less the hospital's Medicare bed days, |
20 | | provided, however, that the amount of $218.38 shall be |
21 | | increased by a uniform percentage to generate an amount equal |
22 | | to 75% of the State share of the payments authorized under |
23 | | Section 5A-12.5 Section 12-5 , with such increase only taking |
24 | | effect upon the date that a State share for such payments is |
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1 | | required under federal law. For the period of April through |
2 | | June 2015, the amount of $218.38 used to calculate the |
3 | | assessment under this paragraph shall, by emergency rule under |
4 | | subsection (s) of Section 5-45 of the Illinois Administrative |
5 | | Procedure Act, be increased by a uniform percentage to generate |
6 | | $20,250,000 in the aggregate for that period from all hospitals |
7 | | subject to the annual assessment under this paragraph. |
8 | | (2) In addition to any other assessments imposed under this |
9 | | Article, effective July 1, 2016 and semi-annually thereafter |
10 | | through June 2018, in addition to any federally required State |
11 | | share as authorized under paragraph (1), the amount of $218.38 |
12 | | shall be increased by a uniform percentage to generate an |
13 | | amount equal to 75% of the ACA Assessment Adjustment, as |
14 | | defined in subsection (b-6) of this Section. |
15 | | For State fiscal years 2009 through 2014 and after, a |
16 | | hospital's occupied bed days and Medicare bed days shall be |
17 | | determined using the most recent data available from each |
18 | | hospital's 2005 Medicare cost report as contained in the |
19 | | Healthcare Cost Report Information System file, for the quarter |
20 | | ending on December 31, 2006, without regard to any subsequent |
21 | | adjustments or changes to such data. If a hospital's 2005 |
22 | | Medicare cost report is not contained in the Healthcare Cost |
23 | | Report Information System, then the Illinois Department may |
24 | | obtain the hospital provider's occupied bed days and Medicare |
25 | | bed days from any source available, including, but not limited |
26 | | to, records maintained by the hospital provider, which may be |
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1 | | inspected at all times during business hours of the day by the |
2 | | Illinois Department or its duly authorized agents and |
3 | | employees. |
4 | | (b) (Blank).
|
5 | | (b-5) (1) Subject to Sections 5A-3 and 5A-10, for the |
6 | | portion of State fiscal year 2012, beginning June 10, 2012 |
7 | | through June 30, 2012, and for State fiscal years 2013 through |
8 | | 2018, an annual assessment on outpatient services is imposed on |
9 | | each hospital provider in an amount equal to .008766 multiplied |
10 | | by the hospital's outpatient gross revenue, provided, however, |
11 | | that the amount of .008766 shall be increased by a uniform |
12 | | percentage to generate an amount equal to 25% of the State |
13 | | share of the payments authorized under Section 5A-12.5 Section |
14 | | 12-5 , with such increase only taking effect upon the date that |
15 | | a State share for such payments is required under federal law. |
16 | | For the period beginning June 10, 2012 through June 30, 2012, |
17 | | the annual assessment on outpatient services shall be prorated |
18 | | by multiplying the assessment amount by a fraction, the |
19 | | numerator of which is 21 days and the denominator of which is |
20 | | 365 days. For the period of April through June 2015, the amount |
21 | | of .008766 used to calculate the assessment under this |
22 | | paragraph shall, by emergency rule under subsection (s) of |
23 | | Section 5-45 of the Illinois Administrative Procedure Act, be |
24 | | increased by a uniform percentage to generate $6,750,000 in the |
25 | | aggregate for that period from all hospitals subject to the |
26 | | annual assessment under this paragraph. |
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1 | | (2) In addition to any other assessments imposed under this |
2 | | Article, effective July 1, 2016 and semi-annually thereafter |
3 | | through June 2018, in addition to any federally required State |
4 | | share as authorized under paragraph (1), the amount of .008766 |
5 | | shall be increased by a uniform percentage to generate an |
6 | | amount equal to 25% of the ACA Assessment Adjustment, as |
7 | | defined in subsection (b-6) of this Section. |
8 | | For the portion of State fiscal year 2012, beginning June |
9 | | 10, 2012 through June 30, 2012, and State fiscal years 2013 |
10 | | through 2018, a hospital's outpatient gross revenue shall be |
11 | | determined using the most recent data available from each |
12 | | hospital's 2009 Medicare cost report as contained in the |
13 | | Healthcare Cost Report Information System file, for the quarter |
14 | | ending on June 30, 2011, without regard to any subsequent |
15 | | adjustments or changes to such data. If a hospital's 2009 |
16 | | Medicare cost report is not contained in the Healthcare Cost |
17 | | Report Information System, then the Department may obtain the |
18 | | hospital provider's outpatient gross revenue from any source |
19 | | available, including, but not limited to, records maintained by |
20 | | the hospital provider, which may be inspected at all times |
21 | | during business hours of the day by the Department or its duly |
22 | | authorized agents and employees. |
23 | | (b-6)(1) As used in this Section, "ACA Assessment |
24 | | Adjustment" means: |
25 | | (A) For the period of July 1, 2016 through December 31, |
26 | | 2016, the product of .19125 multiplied by the sum of the |
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1 | | fee-for-service payments to hospitals as authorized under |
2 | | Section 5A-12.5 and the adjustments authorized under |
3 | | subsection (t) of Section 5A-12.2 to managed care |
4 | | organizations for hospital services due and payable in the |
5 | | month of April 2016 multiplied by 6. |
6 | | (B) For the period of January 1, 2017 through June 30, |
7 | | 2017, the product of .19125 multiplied by the sum of the |
8 | | fee-for-service payments to hospitals as authorized under |
9 | | Section 5A-12.5 and the adjustments authorized under |
10 | | subsection (t) of Section 5A-12.2 to managed care |
11 | | organizations for hospital services due and payable in the |
12 | | month of October 2016 multiplied by 6, except that the |
13 | | amount calculated under this subparagraph (B) shall be |
14 | | adjusted, either positively or negatively, to account for |
15 | | the difference between the actual payments issued under |
16 | | Section 5A-12.5 for the period beginning July 1, 2016 |
17 | | through December 31, 2016 and the estimated payments due |
18 | | and payable in the month of April 2016 multiplied by 6 as |
19 | | described in subparagraph (A). |
20 | | (C) For the period of July 1, 2017 through December 31, |
21 | | 2017, the product of .19125 multiplied by the sum of the |
22 | | fee-for-service payments to hospitals as authorized under |
23 | | Section 5A-12.5 and the adjustments authorized under |
24 | | subsection (t) of Section 5A-12.2 to managed care |
25 | | organizations for hospital services due and payable in the |
26 | | month of April 2017 multiplied by 6, except that the amount |
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1 | | calculated under this subparagraph (C) shall be adjusted, |
2 | | either positively or negatively, to account for the |
3 | | difference between the actual payments issued under |
4 | | Section 5A-12.5 for the period beginning January 1, 2017 |
5 | | through June 30, 2017 and the estimated payments due and |
6 | | payable in the month of October 2016 multiplied by 6 as |
7 | | described in subparagraph (B). |
8 | | (D) For the period of January 1, 2018 through June 30, |
9 | | 2018, the product of .19125 multiplied by the sum of the |
10 | | fee-for-service payments to hospitals as authorized under |
11 | | Section 5A-12.5 and the adjustments authorized under |
12 | | subsection (t) of Section 5A-12.2 to managed care |
13 | | organizations for hospital services due and payable in the |
14 | | month of October 2017 multiplied by 6, except that: |
15 | | (i) the amount calculated under this subparagraph |
16 | | (D) shall be adjusted, either positively or |
17 | | negatively, to account for the difference between the |
18 | | actual payments issued under Section 5A-12.5 for the |
19 | | period of July 1, 2017 through December 31, 2017 and |
20 | | the estimated payments due and payable in the month of |
21 | | April 2017 multiplied by 6 as described in subparagraph |
22 | | (C); and |
23 | | (ii) the amount calculated under this subparagraph |
24 | | (D) shall be adjusted to include the product of .19125 |
25 | | multiplied by the sum of the fee-for-service payments, |
26 | | if any, estimated to be paid to hospitals under |
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1 | | subsection (b) of Section 5A-12.5. |
2 | | (2) The Department shall complete and apply a final |
3 | | reconciliation of the ACA Assessment Adjustment prior to June |
4 | | 30, 2018 to account for: |
5 | | (A) any differences between the actual payments issued |
6 | | or scheduled to be issued prior to June 30, 2018 as |
7 | | authorized in Section 5A-12.5 for the period of January 1, |
8 | | 2018 through June 30, 2018 and the estimated payments due |
9 | | and payable in the month of October 2017 multiplied by 6 as |
10 | | described in subparagraph (D); and |
11 | | (B) any difference between the estimated |
12 | | fee-for-service payments under subsection (b) of Section |
13 | | 5A-12.5 and the amount of such payments that are actually |
14 | | scheduled to be paid. |
15 | | The Department shall notify hospitals of any additional |
16 | | amounts owed or reduction credits to be applied to the June |
17 | | 2018 ACA Assessment Adjustment. This is to be considered the |
18 | | final reconciliation for the ACA Assessment Adjustment. |
19 | | (3) Notwithstanding any other provision of this Section, if |
20 | | for any reason the scheduled payments under subsection (b) of |
21 | | Section 5A-12.5 are not issued in full by the final day of the |
22 | | period authorized under subsection (b) of Section 5A-12.5, |
23 | | funds collected from each hospital pursuant to subparagraph (D) |
24 | | of paragraph (1) and pursuant to paragraph (2), attributable to |
25 | | the scheduled payments authorized under subsection (b) of |
26 | | Section 5A-12.5 that are not issued in full by the final day of |
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1 | | the period attributable to each payment authorized under |
2 | | subsection (b) of Section 5A-12.5, shall be refunded. |
3 | | (4) The increases authorized under paragraph (2) of |
4 | | subsection (a) and paragraph (2) of subsection (b-5) shall be |
5 | | limited to the federally required State share of the total |
6 | | payments authorized under Section 5A-12.5 if the sum of such |
7 | | payments yields an annualized amount equal to or less than |
8 | | $450,000,000, or if the adjustments authorized under |
9 | | subsection (t) of Section 5A-12.2 are found not to be |
10 | | actuarially sound; however, this limitation shall not apply to |
11 | | the fee-for-service payments described in subsection (b) of |
12 | | Section 5A-12.5. |
13 | | (c) (Blank).
|
14 | | (d) Notwithstanding any of the other provisions of this |
15 | | Section, the Department is authorized to adopt rules to reduce |
16 | | the rate of any annual assessment imposed under this Section, |
17 | | as authorized by Section 5-46.2 of the Illinois Administrative |
18 | | Procedure Act.
|
19 | | (e) Notwithstanding any other provision of this Section, |
20 | | any plan providing for an assessment on a hospital provider as |
21 | | a permissible tax under Title XIX of the federal Social |
22 | | Security Act and Medicaid-eligible payments to hospital |
23 | | providers from the revenues derived from that assessment shall |
24 | | be reviewed by the Illinois Department of Healthcare and Family |
25 | | Services, as the Single State Medicaid Agency required by |
26 | | federal law, to determine whether those assessments and |
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1 | | hospital provider payments meet federal Medicaid standards. If |
2 | | the Department determines that the elements of the plan may |
3 | | meet federal Medicaid standards and a related State Medicaid |
4 | | Plan Amendment is prepared in a manner and form suitable for |
5 | | submission, that State Plan Amendment shall be submitted in a |
6 | | timely manner for review by the Centers for Medicare and |
7 | | Medicaid Services of the United States Department of Health and |
8 | | Human Services and subject to approval by the Centers for |
9 | | Medicare and Medicaid Services of the United States Department |
10 | | of Health and Human Services. No such plan shall become |
11 | | effective without approval by the Illinois General Assembly by |
12 | | the enactment into law of related legislation. Notwithstanding |
13 | | any other provision of this Section, the Department is |
14 | | authorized to adopt rules to reduce the rate of any annual |
15 | | assessment imposed under this Section. Any such rules may be |
16 | | adopted by the Department under Section 5-50 of the Illinois |
17 | | Administrative Procedure Act. |
18 | | (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2, |
19 | | eff. 3-26-15.)
|
20 | | (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
|
21 | | Sec. 5A-8. Hospital Provider Fund.
|
22 | | (a) There is created in the State Treasury the Hospital |
23 | | Provider Fund.
Interest earned by the Fund shall be credited to |
24 | | the Fund. The
Fund shall not be used to replace any moneys |
25 | | appropriated to the
Medicaid program by the General Assembly.
|
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1 | | (b) The Fund is created for the purpose of receiving moneys
|
2 | | in accordance with Section 5A-6 and disbursing moneys only for |
3 | | the following
purposes, notwithstanding any other provision of |
4 | | law:
|
5 | | (1) For making payments to hospitals as required under |
6 | | this Code, under the Children's Health Insurance Program |
7 | | Act, under the Covering ALL KIDS Health Insurance Act, and |
8 | | under the Long Term Acute Care Hospital Quality Improvement |
9 | | Transfer Program Act.
|
10 | | (2) For the reimbursement of moneys collected by the
|
11 | | Illinois Department from hospitals or hospital providers |
12 | | through error or
mistake in performing the
activities |
13 | | authorized under this Code.
|
14 | | (3) For payment of administrative expenses incurred by |
15 | | the
Illinois Department or its agent in performing |
16 | | activities
under this Code, under the Children's Health |
17 | | Insurance Program Act, under the Covering ALL KIDS Health |
18 | | Insurance Act, and under the Long Term Acute Care Hospital |
19 | | Quality Improvement Transfer Program Act.
|
20 | | (4) For payments of any amounts which are reimbursable |
21 | | to
the federal government for payments from this Fund which |
22 | | are
required to be paid by State warrant.
|
23 | | (5) For making transfers, as those transfers are |
24 | | authorized
in the proceedings authorizing debt under the |
25 | | Short Term Borrowing Act,
but transfers made under this |
26 | | paragraph (5) shall not exceed the
principal amount of debt |
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1 | | issued in anticipation of the receipt by
the State of |
2 | | moneys to be deposited into the Fund.
|
3 | | (6) For making transfers to any other fund in the State |
4 | | treasury, but
transfers made under this paragraph (6) shall |
5 | | not exceed the amount transferred
previously from that |
6 | | other fund into the Hospital Provider Fund plus any |
7 | | interest that would have been earned by that fund on the |
8 | | monies that had been transferred.
|
9 | | (6.5) For making transfers to the Healthcare Provider |
10 | | Relief Fund, except that transfers made under this |
11 | | paragraph (6.5) shall not exceed $60,000,000 in the |
12 | | aggregate. |
13 | | (7) For making transfers not exceeding the following |
14 | | amounts, related to State fiscal years 2013 through 2018, |
15 | | to the following designated funds: |
16 | | Health and Human Services Medicaid Trust |
17 | | Fund ..............................$20,000,000 |
18 | | Long-Term Care Provider Fund ..........$30,000,000 |
19 | | General Revenue Fund .................$80,000,000. |
20 | | Transfers under this paragraph shall be made within 7 days |
21 | | after the payments have been received pursuant to the |
22 | | schedule of payments provided in subsection (a) of Section |
23 | | 5A-4. |
24 | | (7.1) (Blank).
|
25 | | (7.5) (Blank). |
26 | | (7.8) (Blank). |
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1 | | (7.9) (Blank). |
2 | | (7.10) For State fiscal year 2014, for making transfers |
3 | | of the moneys resulting from the assessment under |
4 | | subsection (b-5) of Section 5A-2 and received from hospital |
5 | | providers under Section 5A-4 and transferred into the |
6 | | Hospital Provider Fund under Section 5A-6 to the designated |
7 | | funds not exceeding the following amounts in that State |
8 | | fiscal year: |
9 | | Health Care Provider Relief Fund .....$100,000,000 |
10 | | Transfers under this paragraph shall be made within 7 |
11 | | days after the payments have been received pursuant to the |
12 | | schedule of payments provided in subsection (a) of Section |
13 | | 5A-4. |
14 | | The additional amount of transfers in this paragraph |
15 | | (7.10), authorized by Public Act 98-651, shall be made |
16 | | within 10 State business days after June 16, 2014 (the |
17 | | effective date of Public Act 98-651). That authority shall |
18 | | remain in effect even if Public Act 98-651 does not become |
19 | | law until State fiscal year 2015. |
20 | | (7.10a) For State fiscal years 2015 through 2018, for |
21 | | making transfers of the moneys resulting from the |
22 | | assessment under subsection (b-5) of Section 5A-2 and |
23 | | received from hospital providers under Section 5A-4 and |
24 | | transferred into the Hospital Provider Fund under Section |
25 | | 5A-6 to the designated funds not exceeding the following |
26 | | amounts related to each State fiscal year: |
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1 | | Health Care Provider Relief Fund ....$50,000,000 |
2 | | Transfers under this paragraph shall be made within 7 |
3 | | days after the payments have been received pursuant to the |
4 | | schedule of payments provided in subsection (a) of Section |
5 | | 5A-4. |
6 | | (7.11) (Blank). |
7 | | (7.12) For State fiscal year 2013, for increasing by |
8 | | 21/365ths the transfer of the moneys resulting from the |
9 | | assessment under subsection (b-5) of Section 5A-2 and |
10 | | received from hospital providers under Section 5A-4 for the |
11 | | portion of State fiscal year 2012 beginning June 10, 2012 |
12 | | through June 30, 2012 and transferred into the Hospital |
13 | | Provider Fund under Section 5A-6 to the designated funds |
14 | | not exceeding the following amounts in that State fiscal |
15 | | year: |
16 | | Health Care Provider Relief Fund ......$2,870,000 |
17 | | Since the federal Centers for Medicare and Medicaid |
18 | | Services approval of the assessment authorized under |
19 | | subsection (b-5) of Section 5A-2, received from hospital |
20 | | providers under Section 5A-4 and the payment methodologies |
21 | | to hospitals required under Section 5A-12.4 was not |
22 | | received by the Department until State fiscal year 2014 and |
23 | | since the Department made retroactive payments during |
24 | | State fiscal year 2014 related to the referenced period of |
25 | | June 2012, the transfer authority granted in this paragraph |
26 | | (7.12) is extended through the date that is 10 State |
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1 | | business days after June 16, 2014 (the effective date of |
2 | | Public Act 98-651). |
3 | | (7.13) In addition to any other transfers authorized |
4 | | under this Section, for State fiscal years 2017 and 2018, |
5 | | for making transfers to the Healthcare Provider Relief Fund |
6 | | of moneys collected from the ACA Assessment Adjustment |
7 | | authorized under subsections (a) and (b-5) of Section 5A-2 |
8 | | and paid by hospital providers under Section 5A-4 into the |
9 | | Hospital Provider Fund under Section 5A-6 for each State |
10 | | fiscal year. Timing of transfers to the Healthcare Provider |
11 | | Relief Fund under this paragraph shall be at the discretion |
12 | | of the Department, but no less frequently than quarterly. |
13 | | (8) For making refunds to hospital providers pursuant |
14 | | to Section 5A-10.
|
15 | | (9) For making payment to capitated managed care |
16 | | organizations as described in subsections (s) and (t) of |
17 | | Section 5A-12.2 of this Code. |
18 | | Disbursements from the Fund, other than transfers |
19 | | authorized under
paragraphs (5) and (6) of this subsection, |
20 | | shall be by
warrants drawn by the State Comptroller upon |
21 | | receipt of vouchers
duly executed and certified by the Illinois |
22 | | Department.
|
23 | | (c) The Fund shall consist of the following:
|
24 | | (1) All moneys collected or received by the Illinois
|
25 | | Department from the hospital provider assessment imposed |
26 | | by this
Article.
|
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1 | | (2) All federal matching funds received by the Illinois
|
2 | | Department as a result of expenditures made by the Illinois
|
3 | | Department that are attributable to moneys deposited in the |
4 | | Fund.
|
5 | | (3) Any interest or penalty levied in conjunction with |
6 | | the
administration of this Article.
|
7 | | (3.5) As applicable, proceeds from surety bond |
8 | | payments payable to the Department as referenced in |
9 | | subsection (s) of Section 5A-12.2 of this Code. |
10 | | (4) Moneys transferred from another fund in the State |
11 | | treasury.
|
12 | | (5) All other moneys received for the Fund from any |
13 | | other
source, including interest earned thereon.
|
14 | | (d) (Blank).
|
15 | | (Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13; |
16 | | 98-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff. |
17 | | 7-20-15.)
|
18 | | (305 ILCS 5/5A-12.2) |
19 | | (Section scheduled to be repealed on July 1, 2018) |
20 | | Sec. 5A-12.2. Hospital access payments on or after July 1, |
21 | | 2008. |
22 | | (a) To preserve and improve access to hospital services, |
23 | | for hospital services rendered on or after July 1, 2008, the |
24 | | Illinois Department shall, except for hospitals described in |
25 | | subsection (b) of Section 5A-3, make payments to hospitals as |
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1 | | set forth in this Section. These payments shall be paid in 12 |
2 | | equal installments on or before the seventh State business day |
3 | | of each month, except that no payment shall be due within 100 |
4 | | days after the later of the date of notification of federal |
5 | | approval of the payment methodologies required under this |
6 | | Section or any waiver required under 42 CFR 433.68, at which |
7 | | time the sum of amounts required under this Section prior to |
8 | | the date of notification is due and payable. Payments under |
9 | | this Section are not due and payable, however, until (i) the |
10 | | methodologies described in this Section are approved by the |
11 | | federal government in an appropriate State Plan amendment and |
12 | | (ii) the assessment imposed under this Article is determined to |
13 | | be a permissible tax under Title XIX of the Social Security |
14 | | Act. |
15 | | (a-5) The Illinois Department may, when practicable, |
16 | | accelerate the schedule upon which payments authorized under |
17 | | this Section are made. |
18 | | (b) Across-the-board inpatient adjustment. |
19 | | (1) In addition to rates paid for inpatient hospital |
20 | | services, the Department shall pay to each Illinois general |
21 | | acute care hospital an amount equal to 40% of the total |
22 | | base inpatient payments paid to the hospital for services |
23 | | provided in State fiscal year 2005. |
24 | | (2) In addition to rates paid for inpatient hospital |
25 | | services, the Department shall pay to each freestanding |
26 | | Illinois specialty care hospital as defined in 89 Ill. Adm. |
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1 | | Code 149.50(c)(1), (2), or (4) an amount equal to 60% of |
2 | | the total base inpatient payments paid to the hospital for |
3 | | services provided in State fiscal year 2005. |
4 | | (3) In addition to rates paid for inpatient hospital |
5 | | services, the Department shall pay to each freestanding |
6 | | Illinois rehabilitation or psychiatric hospital an amount |
7 | | equal to $1,000 per Medicaid inpatient day multiplied by |
8 | | the increase in the hospital's Medicaid inpatient |
9 | | utilization ratio (determined using the positive |
10 | | percentage change from the rate year 2005 Medicaid |
11 | | inpatient utilization ratio to the rate year 2007 Medicaid |
12 | | inpatient utilization ratio, as calculated by the |
13 | | Department for the disproportionate share determination). |
14 | | (4) In addition to rates paid for inpatient hospital |
15 | | services, the Department shall pay to each Illinois |
16 | | children's hospital an amount equal to 20% of the total |
17 | | base inpatient payments paid to the hospital for services |
18 | | provided in State fiscal year 2005 and an additional amount |
19 | | equal to 20% of the base inpatient payments paid to the |
20 | | hospital for psychiatric services provided in State fiscal |
21 | | year 2005. |
22 | | (5) In addition to rates paid for inpatient hospital |
23 | | services, the Department shall pay to each Illinois |
24 | | hospital eligible for a pediatric inpatient adjustment |
25 | | payment under 89 Ill. Adm. Code 148.298, as in effect for |
26 | | State fiscal year 2007, a supplemental pediatric inpatient |
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1 | | adjustment payment equal to: |
2 | | (i) For freestanding children's hospitals as |
3 | | defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5 |
4 | | multiplied by the hospital's pediatric inpatient |
5 | | adjustment payment required under 89 Ill. Adm. Code |
6 | | 148.298, as in effect for State fiscal year 2008. |
7 | | (ii) For hospitals other than freestanding |
8 | | children's hospitals as defined in 89 Ill. Adm. Code |
9 | | 149.50(c)(3)(B), 1.0 multiplied by the hospital's |
10 | | pediatric inpatient adjustment payment required under |
11 | | 89 Ill. Adm. Code 148.298, as in effect for State |
12 | | fiscal year 2008. |
13 | | (c) Outpatient adjustment. |
14 | | (1) In addition to the rates paid for outpatient |
15 | | hospital services, the Department shall pay each Illinois |
16 | | hospital an amount equal to 2.2 multiplied by the |
17 | | hospital's ambulatory procedure listing payments for |
18 | | categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code |
19 | | 148.140(b), for State fiscal year 2005. |
20 | | (2) In addition to the rates paid for outpatient |
21 | | hospital services, the Department shall pay each Illinois |
22 | | freestanding psychiatric hospital an amount equal to 3.25 |
23 | | multiplied by the hospital's ambulatory procedure listing |
24 | | payments for category 5b, as defined in 89 Ill. Adm. Code |
25 | | 148.140(b)(1)(E), for State fiscal year 2005. |
26 | | (d) Medicaid high volume adjustment. In addition to rates |
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1 | | paid for inpatient hospital services, the Department shall pay |
2 | | to each Illinois general acute care hospital that provided more |
3 | | than 20,500 Medicaid inpatient days of care in State fiscal |
4 | | year 2005 amounts as follows: |
5 | | (1) For hospitals with a case mix index equal to or |
6 | | greater than the 85th percentile of hospital case mix |
7 | | indices, $350 for each Medicaid inpatient day of care |
8 | | provided during that period; and |
9 | | (2) For hospitals with a case mix index less than the |
10 | | 85th percentile of hospital case mix indices, $100 for each |
11 | | Medicaid inpatient day of care provided during that period. |
12 | | (e) Capital adjustment. In addition to rates paid for |
13 | | inpatient hospital services, the Department shall pay an |
14 | | additional payment to each Illinois general acute care hospital |
15 | | that has a Medicaid inpatient utilization rate of at least 10% |
16 | | (as calculated by the Department for the rate year 2007 |
17 | | disproportionate share determination) amounts as follows: |
18 | | (1) For each Illinois general acute care hospital that |
19 | | has a Medicaid inpatient utilization rate of at least 10% |
20 | | and less than 36.94% and whose capital cost is less than |
21 | | the 60th percentile of the capital costs of all Illinois |
22 | | hospitals, the amount of such payment shall equal the |
23 | | hospital's Medicaid inpatient days multiplied by the |
24 | | difference between the capital costs at the 60th percentile |
25 | | of the capital costs of all Illinois hospitals and the |
26 | | hospital's capital costs. |
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1 | | (2) For each Illinois general acute care hospital that |
2 | | has a Medicaid inpatient utilization rate of at least |
3 | | 36.94% and whose capital cost is less than the 75th |
4 | | percentile of the capital costs of all Illinois hospitals, |
5 | | the amount of such payment shall equal the hospital's |
6 | | Medicaid inpatient days multiplied by the difference |
7 | | between the capital costs at the 75th percentile of the |
8 | | capital costs of all Illinois hospitals and the hospital's |
9 | | capital costs. |
10 | | (f) Obstetrical care adjustment. |
11 | | (1) In addition to rates paid for inpatient hospital |
12 | | services, the Department shall pay $1,500 for each Medicaid |
13 | | obstetrical day of care provided in State fiscal year 2005 |
14 | | by each Illinois rural hospital that had a Medicaid |
15 | | obstetrical percentage (Medicaid obstetrical days divided |
16 | | by Medicaid inpatient days) greater than 15% for State |
17 | | fiscal year 2005. |
18 | | (2) In addition to rates paid for inpatient hospital |
19 | | services, the Department shall pay $1,350 for each Medicaid |
20 | | obstetrical day of care provided in State fiscal year 2005 |
21 | | by each Illinois general acute care hospital that was |
22 | | designated a level III perinatal center as of December 31, |
23 | | 2006, and that had a case mix index equal to or greater |
24 | | than the 45th percentile of the case mix indices for all |
25 | | level III perinatal centers. |
26 | | (3) In addition to rates paid for inpatient hospital |
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1 | | services, the Department shall pay $900 for each Medicaid |
2 | | obstetrical day of care provided in State fiscal year 2005 |
3 | | by each Illinois general acute care hospital that was |
4 | | designated a level II or II+ perinatal center as of |
5 | | December 31, 2006, and that had a case mix index equal to |
6 | | or greater than the 35th percentile of the case mix indices |
7 | | for all level II and II+ perinatal centers. |
8 | | (g) Trauma adjustment. |
9 | | (1) In addition to rates paid for inpatient hospital |
10 | | services, the Department shall pay each Illinois general |
11 | | acute care hospital designated as a trauma center as of |
12 | | July 1, 2007, a payment equal to 3.75 multiplied by the |
13 | | hospital's State fiscal year 2005 Medicaid capital |
14 | | payments. |
15 | | (2) In addition to rates paid for inpatient hospital |
16 | | services, the Department shall pay $400 for each Medicaid |
17 | | acute inpatient day of care provided in State fiscal year |
18 | | 2005 by each Illinois general acute care hospital that was |
19 | | designated a level II trauma center, as defined in 89 Ill. |
20 | | Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1, |
21 | | 2007. |
22 | | (3) In addition to rates paid for inpatient hospital |
23 | | services, the Department shall pay $235 for each Illinois |
24 | | Medicaid acute inpatient day of care provided in State |
25 | | fiscal year 2005 by each level I pediatric trauma center |
26 | | located outside of Illinois that had more than 8,000 |
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1 | | Illinois Medicaid inpatient days in State fiscal year 2005. |
2 | | (h) Supplemental tertiary care adjustment. In addition to |
3 | | rates paid for inpatient services, the Department shall pay to |
4 | | each Illinois hospital eligible for tertiary care adjustment |
5 | | payments under 89 Ill. Adm. Code 148.296, as in effect for |
6 | | State fiscal year 2007, a supplemental tertiary care adjustment |
7 | | payment equal to the tertiary care adjustment payment required |
8 | | under 89 Ill. Adm. Code 148.296, as in effect for State fiscal |
9 | | year 2007. |
10 | | (i) Crossover adjustment. In addition to rates paid for |
11 | | inpatient services, the Department shall pay each Illinois |
12 | | general acute care hospital that had a ratio of crossover days |
13 | | to total inpatient days for medical assistance programs |
14 | | administered by the Department (utilizing information from |
15 | | 2005 paid claims) greater than 50%, and a case mix index |
16 | | greater than the 65th percentile of case mix indices for all |
17 | | Illinois hospitals, a rate of $1,125 for each Medicaid |
18 | | inpatient day including crossover days. |
19 | | (j) Magnet hospital adjustment. In addition to rates paid |
20 | | for inpatient hospital services, the Department shall pay to |
21 | | each Illinois general acute care hospital and each Illinois |
22 | | freestanding children's hospital that, as of February 1, 2008, |
23 | | was recognized as a Magnet hospital by the American Nurses |
24 | | Credentialing Center and that had a case mix index greater than |
25 | | the 75th percentile of case mix indices for all Illinois |
26 | | hospitals amounts as follows: |
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1 | | (1) For hospitals located in a county whose eligibility |
2 | | growth factor is greater than the mean, $450 multiplied by |
3 | | the eligibility growth factor for the county in which the |
4 | | hospital is located for each Medicaid inpatient day of care |
5 | | provided by the hospital during State fiscal year 2005. |
6 | | (2) For hospitals located in a county whose eligibility |
7 | | growth factor is less than or equal to the mean, $225 |
8 | | multiplied by the eligibility growth factor for the county |
9 | | in which the hospital is located for each Medicaid |
10 | | inpatient day of care provided by the hospital during State |
11 | | fiscal year 2005. |
12 | | For purposes of this subsection, "eligibility growth |
13 | | factor" means the percentage by which the number of Medicaid |
14 | | recipients in the county increased from State fiscal year 1998 |
15 | | to State fiscal year 2005. |
16 | | (k) For purposes of this Section, a hospital that is |
17 | | enrolled to provide Medicaid services during State fiscal year |
18 | | 2005 shall have its utilization and associated reimbursements |
19 | | annualized prior to the payment calculations being performed |
20 | | under this Section. |
21 | | (l) For purposes of this Section, the terms "Medicaid |
22 | | days", "ambulatory procedure listing services", and |
23 | | "ambulatory procedure listing payments" do not include any |
24 | | days, charges, or services for which Medicare or a managed care |
25 | | organization reimbursed on a capitated basis was liable for |
26 | | payment, except where explicitly stated otherwise in this |
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1 | | Section. |
2 | | (m) For purposes of this Section, in determining the |
3 | | percentile ranking of an Illinois hospital's case mix index or |
4 | | capital costs, hospitals described in subsection (b) of Section |
5 | | 5A-3 shall be excluded from the ranking. |
6 | | (n) 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 | | March 1, 2008. 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 | | "Base inpatient payments" means, for a given hospital, the |
16 | | sum of base payments for inpatient services made on a per diem |
17 | | or per admission (DRG) basis, excluding those portions of per |
18 | | admission payments that are classified as capital payments. |
19 | | Disproportionate share hospital adjustment payments, Medicaid |
20 | | Percentage Adjustments, Medicaid High Volume Adjustments, and |
21 | | outlier payments, as defined by rule by the Department as of |
22 | | January 1, 2008, are not base payments. |
23 | | "Capital costs" means, for a given hospital, the total |
24 | | capital costs determined using the most recent 2005 Medicare |
25 | | cost report as contained in the Healthcare Cost Report |
26 | | Information System file, for the quarter ending on December 31, |
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1 | | 2006, divided by the total inpatient days from the same cost |
2 | | report to calculate a capital cost per day. The resulting |
3 | | capital cost per day is inflated to the midpoint of State |
4 | | fiscal year 2009 utilizing the national hospital market price |
5 | | proxies (DRI) hospital cost index. If a hospital's 2005 |
6 | | Medicare cost report is not contained in the Healthcare Cost |
7 | | Report Information System, the Department may obtain the data |
8 | | necessary to compute the hospital's capital costs from any |
9 | | source available, including, but not limited to, records |
10 | | maintained by the hospital provider, which may be inspected at |
11 | | all times during business hours of the day by the Illinois |
12 | | Department or its duly authorized agents and employees. |
13 | | "Case mix index" means, for a given hospital, the sum of |
14 | | the DRG relative weighting factors in effect on January 1, |
15 | | 2005, for all general acute care admissions for State fiscal |
16 | | year 2005, excluding Medicare crossover admissions and |
17 | | transplant admissions reimbursed under 89 Ill. Adm. Code |
18 | | 148.82, divided by the total number of general acute care |
19 | | admissions for State fiscal year 2005, excluding Medicare |
20 | | crossover admissions and transplant admissions reimbursed |
21 | | under 89 Ill. Adm. Code 148.82. |
22 | | "Medicaid inpatient day" means, for a given hospital, the |
23 | | sum of days of inpatient hospital days provided to recipients |
24 | | of medical assistance under Title XIX of the federal Social |
25 | | Security Act, excluding days for individuals eligible for |
26 | | Medicare under Title XVIII of that Act (Medicaid/Medicare |
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1 | | crossover days), as tabulated from the Department's paid claims |
2 | | data for admissions occurring during State fiscal year 2005 |
3 | | that was adjudicated by the Department through March 23, 2007. |
4 | | "Medicaid obstetrical day" means, for a given hospital, the |
5 | | sum of days of inpatient hospital days grouped by the |
6 | | Department to DRGs of 370 through 375 provided to recipients of |
7 | | 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 2005 |
12 | | that was adjudicated by the Department through March 23, 2007. |
13 | | "Outpatient ambulatory procedure listing payments" means, |
14 | | for a given hospital, the sum of payments for ambulatory |
15 | | procedure listing services, as described in 89 Ill. Adm. Code |
16 | | 148.140(b), provided to recipients of medical assistance under |
17 | | Title XIX of the federal Social Security Act, excluding |
18 | | payments for individuals eligible for Medicare under Title |
19 | | XVIII of the Act (Medicaid/Medicare crossover days), as |
20 | | tabulated from the Department's paid claims data for services |
21 | | occurring in State fiscal year 2005 that were adjudicated by |
22 | | the Department through March 23, 2007. |
23 | | (o) The Department may adjust payments made under this |
24 | | Section 5A-12.2 to comply with federal law or regulations |
25 | | regarding hospital-specific payment limitations on |
26 | | government-owned or government-operated hospitals. |
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1 | | (p) Notwithstanding any of the other provisions of this |
2 | | Section, the Department is authorized to adopt rules that |
3 | | change the hospital access improvement payments specified in |
4 | | this Section, but only to the extent necessary to conform to |
5 | | any federally approved amendment to the Title XIX State plan. |
6 | | Any such rules shall be adopted by the Department as authorized |
7 | | by Section 5-50 of the Illinois Administrative Procedure Act. |
8 | | Notwithstanding any other provision of law, any changes |
9 | | implemented as a result of this subsection (p) shall be given |
10 | | retroactive effect so that they shall be deemed to have taken |
11 | | effect as of the effective date of this Section. |
12 | | (q) (Blank). |
13 | | (r) On and after July 1, 2012, the Department shall reduce |
14 | | any rate of reimbursement for services or other payments or |
15 | | alter any methodologies authorized by this Code to reduce any |
16 | | rate of reimbursement for services or other payments in |
17 | | accordance with Section 5-5e. |
18 | | (s) On or after January 1, 2016 July 1, 2014, but no later |
19 | | than October 1, 2014 , and no less than annually thereafter, the |
20 | | Department shall may increase capitation payments to capitated |
21 | | managed care organizations (MCOs) to equal the aggregate |
22 | | reduction of payments made in this Section and in Section |
23 | | 5A-12.4 by a uniform percentage on a regional basis to preserve |
24 | | access to hospital services for recipients under the Illinois |
25 | | Medical Assistance Program. The aggregate amount of all |
26 | | increased capitation payments to all MCOs for a fiscal year |
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1 | | shall be the amount needed to avoid reduction in payments |
2 | | authorized under Section 5A-15. Payments to MCOs under this |
3 | | Section shall be consistent with actuarial certification and |
4 | | shall be published by the Department each year. Each MCO shall |
5 | | only expend the increased capitation payments it receives under |
6 | | this Section to support the availability of hospital services |
7 | | and to ensure access to hospital services, with such |
8 | | expenditures being made within 15 calendar days from when the |
9 | | MCO receives the increased capitation payment. The Department |
10 | | shall make available, on a monthly basis, a report of the |
11 | | capitation payments that are made to each MCO pursuant to this |
12 | | subsection, including the number of enrollees for which such |
13 | | payment is made, the per enrollee amount of the payment, and |
14 | | any adjustments that have been made. Payments made under this |
15 | | subsection shall be guaranteed by a surety bond obtained by the |
16 | | MCO in an amount established by the Department to approximate |
17 | | one month's liability of payments authorized under this |
18 | | subsection. The Department may advance the payments guaranteed |
19 | | by the surety bond. Payments to MCOs that would be paid |
20 | | consistent with actuarial certification and enrollment in the |
21 | | absence of the increased capitation payments under this Section |
22 | | shall not be reduced as a consequence of payments made under |
23 | | this subsection. |
24 | | As used in this subsection, "MCO" means an entity which |
25 | | contracts with the Department to provide services where payment |
26 | | for medical services is made on a capitated basis. |
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1 | | (t) On or after July 1, 2014, the Department may increase |
2 | | capitation payments to capitated managed care organizations |
3 | | (MCOs) to equal the aggregate reduction of payments made in |
4 | | Section 5A-12.5 to preserve access to hospital services for |
5 | | recipients under the Illinois Medical Assistance Program. |
6 | | Effective January 1, 2016, the Department shall increase |
7 | | capitation payments to MCOs to include the payments authorized |
8 | | under Section 5A-12.5 to preserve access to hospital services |
9 | | for recipients under the Illinois Medical Assistance Program by |
10 | | ensuring that the reimbursement provided for Affordable Care |
11 | | Act adults enrolled in a MCO is equivalent to the reimbursement |
12 | | provided for Affordable Care Act adults enrolled in a |
13 | | fee-for-service program. Payments to MCOs under this Section |
14 | | shall be consistent with actuarial certification and federal |
15 | | approval (which may be retrospectively determined) and shall be |
16 | | published by the Department each year. Each MCO shall only |
17 | | expend the increased capitation payments it receives under this |
18 | | Section to support the availability of hospital services and to |
19 | | ensure access to hospital services, with such expenditures |
20 | | being made within 15 calendar days from when the MCO receives |
21 | | the increased capitation payment. Payments made under this |
22 | | subsection may be guaranteed by a surety bond obtained by the |
23 | | MCO in an amount established by the Department to approximate |
24 | | one month's liability of payments authorized under this |
25 | | subsection. The Department may advance the payments to |
26 | | hospitals under this subsection, in the event the MCO fails to |
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1 | | make such payments. The Department shall make available, on a |
2 | | monthly basis, a report of the capitation payments that are |
3 | | made to each MCO pursuant to this subsection, including the |
4 | | number of enrollees for which such payment is made, the per |
5 | | enrollee amount of the payment, and any adjustments that have |
6 | | been made. Payments to MCOs that would be paid consistent with |
7 | | actuarial certification and enrollment in the absence of the |
8 | | increased capitation payments under this subsection shall not |
9 | | be reduced as a consequence of payments made under this |
10 | | subsection. |
11 | | As used in this subsection, "MCO" means an entity which |
12 | | contracts with the Department to provide services where payment |
13 | | for medical services is made on a capitated basis. |
14 | | (Source: P.A. 97-689, eff. 6-14-12; 98-651, eff. 6-16-14.) |
15 | | (305 ILCS 5/5A-12.5) |
16 | | Sec. 5A-12.5. Affordable Care Act adults; hospital access |
17 | | payments. |
18 | | (a) The Department shall, subject to federal approval, |
19 | | mirror the Medical Assistance hospital reimbursement |
20 | | methodology for Affordable Care Act adults who are enrolled |
21 | | under a fee-for-service or capitated managed care program , |
22 | | including hospital access payments as defined in Section |
23 | | 5A-12.2 of this Article and hospital access improvement |
24 | | payments as defined in Section 5A-12.4 of this Article, in |
25 | | compliance with the equivalent rate provisions of the |
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1 | | Affordable Care Act. |
2 | | (b) If the fee-for-service payments authorized under this |
3 | | Section are deemed to be increases to payments for a prior |
4 | | period, the Department shall seek federal approval to issue |
5 | | such increases for the payments made through the period ending |
6 | | on June 30, 2018, even if such increases are paid out during an |
7 | | extended payment period beyond such date. Payment of such |
8 | | increases beyond such date is subject to federal approval. |
9 | | (c) As used in this Section, "Affordable Care Act" is the |
10 | | collective term for the Patient Protection and Affordable Care |
11 | | Act (Pub. L. 111-148) and the Health Care and Education |
12 | | Reconciliation Act of 2010 (Pub. L. 111-152).
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13 | | (Source: P.A. 98-651, eff. 6-16-14.) |
14 | | (305 ILCS 5/12-4.105 new) |
15 | | Sec. 12-4.105. Human poison control center; payment |
16 | | program. Subject to funding availability resulting from |
17 | | transfers made from the Hospital Provider Fund to the |
18 | | Healthcare Provider Relief Fund as authorized under this Code, |
19 | | for State fiscal year 2017 and State fiscal year 2018, the |
20 | | Department of Healthcare and Family Services shall pay to the |
21 | | human poison control center designated under the Poison Control |
22 | | System Act an amount of not less than $3,000,000 for each of |
23 | | those State fiscal years that the human poison control center |
24 | | is in operation. |
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1 | | Section 20. The Lead Poisoning Prevention Act is amended by |
2 | | changing Section 15.1 as follows: |
3 | | (410 ILCS 45/15.1) |
4 | | Sec. 15.1. Funding. Beginning July 1, 2014 and ending June |
5 | | 30, 2015 2018 , a hospital satisfying the definition, as of July |
6 | | 1, 2014, of Section 5-5e.1 of the Illinois Public Aid Code and |
7 | | located in DuPage County shall pay the sum of $2,000,000 |
8 | | annually in 4 equal quarterly installments to the human poison |
9 | | control center in existence as of July 1, 2014 and established |
10 | | under the authority of this Act.
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11 | | (Source: P.A. 98-651, eff. 6-16-14.)
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12 | | Section 99. Effective date. This Act takes effect upon |
13 | | becoming law.".
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