Full Text of SB1370 99th General Assembly
SB1370 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 SB1370 Introduced 2/18/2015, by Sen. Napoleon Harris, III SYNOPSIS AS INTRODUCED: |
| 305 ILCS 5/5-5.02 | from Ch. 23, par. 5-5.02 |
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Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision concerning adjustment payments for inpatient services, adds Illinois acute care hospitals that have a Medicaid Inpatient Utilization rate that is at least 33% and that has total Medicaid inpatient days in excess of 30,000 as calculated by the Department in its annual determination for the Disproportionate Share Hospital (DSH), Medicaid High Volume Adjustment (MHVA), and Medicaid Percentage Adjustment (MPA) programs to the list of hospitals that shall receive such adjustment payments from the Department of Healthcare and Family Services.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 5-5.02 as follows:
| 6 | | (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
| 7 | | Sec. 5-5.02. Hospital reimbursements.
| 8 | | (a) Reimbursement to Hospitals; July 1, 1992 through | 9 | | September 30, 1992.
Notwithstanding any other provisions of | 10 | | this Code or the Illinois
Department's Rules promulgated under | 11 | | the Illinois Administrative Procedure
Act, reimbursement to | 12 | | hospitals for services provided during the period
July 1, 1992 | 13 | | through September 30, 1992, shall be as follows:
| 14 | | (1) For inpatient hospital services rendered, or if | 15 | | applicable, for
inpatient hospital discharges occurring, | 16 | | on or after July 1, 1992 and on
or before September 30, | 17 | | 1992, the Illinois Department shall reimburse
hospitals | 18 | | for inpatient services under the reimbursement | 19 | | methodologies in
effect for each hospital, and at the | 20 | | inpatient payment rate calculated for
each hospital, as of | 21 | | June 30, 1992. For purposes of this paragraph,
| 22 | | "reimbursement methodologies" means all reimbursement | 23 | | methodologies that
pertain to the provision of inpatient |
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| 1 | | hospital services, including, but not
limited to, any | 2 | | adjustments for disproportionate share, targeted access,
| 3 | | critical care access and uncompensated care, as defined by | 4 | | the Illinois
Department on June 30, 1992.
| 5 | | (2) For the purpose of calculating the inpatient | 6 | | payment rate for each
hospital eligible to receive | 7 | | quarterly adjustment payments for targeted
access and | 8 | | critical care, as defined by the Illinois Department on | 9 | | June 30,
1992, the adjustment payment for the period July | 10 | | 1, 1992 through September
30, 1992, shall be 25% of the | 11 | | annual adjustment payments calculated for
each eligible | 12 | | hospital, as of June 30, 1992. The Illinois Department | 13 | | shall
determine by rule the adjustment payments for | 14 | | targeted access and critical
care beginning October 1, | 15 | | 1992.
| 16 | | (3) For the purpose of calculating the inpatient | 17 | | payment rate for each
hospital eligible to receive | 18 | | quarterly adjustment payments for
uncompensated care, as | 19 | | defined by the Illinois Department on June 30, 1992,
the | 20 | | adjustment payment for the period August 1, 1992 through | 21 | | September 30,
1992, shall be one-sixth of the total | 22 | | uncompensated care adjustment payments
calculated for each | 23 | | eligible hospital for the uncompensated care rate year,
as | 24 | | defined by the Illinois Department, ending on July 31, | 25 | | 1992. The
Illinois Department shall determine by rule the | 26 | | adjustment payments for
uncompensated care beginning |
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| 1 | | October 1, 1992.
| 2 | | (b) Inpatient payments. For inpatient services provided on | 3 | | or after October
1, 1993, in addition to rates paid for | 4 | | hospital inpatient services pursuant to
the Illinois Health | 5 | | Finance Reform Act, as now or hereafter amended, or the
| 6 | | Illinois Department's prospective reimbursement methodology, | 7 | | or any other
methodology used by the Illinois Department for | 8 | | inpatient services, the
Illinois Department shall make | 9 | | adjustment payments, in an amount calculated
pursuant to the | 10 | | methodology described in paragraph (c) of this Section, to
| 11 | | hospitals that the Illinois Department determines satisfy any | 12 | | one of the
following requirements:
| 13 | | (1) Hospitals that are described in Section 1923 of the | 14 | | federal Social
Security Act, as now or hereafter amended, | 15 | | except that for rate year 2015 and after a hospital | 16 | | described in Section 1923(b)(1)(B) of the federal Social | 17 | | Security Act and qualified for the payments described in | 18 | | subsection (c) of this Section for rate year 2014 provided | 19 | | the hospital continues to meet the description in Section | 20 | | 1923(b)(1)(B) in the current determination year; or
| 21 | | (2) Illinois hospitals that have a Medicaid inpatient | 22 | | utilization
rate which is at least one-half a standard | 23 | | deviation above the mean Medicaid
inpatient utilization | 24 | | rate for all hospitals in Illinois receiving Medicaid
| 25 | | payments from the Illinois Department; or
| 26 | | (3) Illinois hospitals that on July 1, 1991 had a |
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| 1 | | Medicaid inpatient
utilization rate, as defined in | 2 | | paragraph (h) of this Section,
that was at least the mean | 3 | | Medicaid inpatient utilization rate for all
hospitals in | 4 | | Illinois receiving Medicaid payments from the Illinois
| 5 | | Department and which were located in a planning area with | 6 | | one-third or
fewer excess beds as determined by the Health | 7 | | Facilities and Services Review Board, and that, as of June | 8 | | 30, 1992, were located in a federally
designated Health | 9 | | Manpower Shortage Area; or
| 10 | | (4) Illinois hospitals that:
| 11 | | (A) have a Medicaid inpatient utilization rate | 12 | | that is at least
equal to the mean Medicaid inpatient | 13 | | utilization rate for all hospitals in
Illinois | 14 | | receiving Medicaid payments from the Department; and
| 15 | | (B) also have a Medicaid obstetrical inpatient | 16 | | utilization
rate that is at least one standard | 17 | | deviation above the mean Medicaid
obstetrical | 18 | | inpatient utilization rate for all hospitals in | 19 | | Illinois
receiving Medicaid payments from the | 20 | | Department for obstetrical services; or
| 21 | | (5) Any children's hospital, which means a hospital | 22 | | devoted exclusively
to caring for children. A hospital | 23 | | which includes a facility devoted
exclusively to caring for | 24 | | children shall be considered a
children's hospital to the | 25 | | degree that the hospital's Medicaid care is
provided to | 26 | | children
if either (i) the facility devoted exclusively to |
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| 1 | | caring for children is
separately licensed as a hospital by | 2 | | a municipality prior to February 28, 2013
or
(ii) the | 3 | | hospital has been
designated
by the State
as a Level III | 4 | | perinatal care facility, has a Medicaid Inpatient
| 5 | | Utilization rate
greater than 55% for the rate year 2003 | 6 | | disproportionate share determination,
and has more than | 7 | | 10,000 qualified children days as defined by
the
Department | 8 | | in rulemaking.
| 9 | | (6) Any Illinois acute care hospital that has a | 10 | | Medicaid Inpatient Utilization rate that is at least 33% | 11 | | and that has total Medicaid inpatient days in excess of | 12 | | 30,000 as calculated by the Department in its annual | 13 | | determination for the Disproportionate Share Hospital | 14 | | (DSH), Medicaid High Volume Adjustment (MHVA), and | 15 | | Medicaid Percentage Adjustment (MPA) programs. | 16 | | (c) Inpatient adjustment payments. The adjustment payments | 17 | | required by
paragraph (b) shall be calculated based upon the | 18 | | hospital's Medicaid
inpatient utilization rate as follows:
| 19 | | (1) hospitals with a Medicaid inpatient utilization | 20 | | rate below the mean
shall receive a per day adjustment | 21 | | payment equal to $25;
| 22 | | (2) hospitals with a Medicaid inpatient utilization | 23 | | rate
that is equal to or greater than the mean Medicaid | 24 | | inpatient utilization rate
but less than one standard | 25 | | deviation above the mean Medicaid inpatient
utilization | 26 | | rate shall receive a per day adjustment payment
equal to |
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| 1 | | the sum of $25 plus $1 for each one percent that the | 2 | | hospital's
Medicaid inpatient utilization rate exceeds the | 3 | | mean Medicaid inpatient
utilization rate;
| 4 | | (3) hospitals with a Medicaid inpatient utilization | 5 | | rate that is equal
to or greater than one standard | 6 | | deviation above the mean Medicaid inpatient
utilization | 7 | | rate but less than 1.5 standard deviations above the mean | 8 | | Medicaid
inpatient utilization rate shall receive a per day | 9 | | adjustment payment equal to
the sum of $40 plus $7 for each | 10 | | one percent that the hospital's Medicaid
inpatient | 11 | | utilization rate exceeds one standard deviation above the | 12 | | mean
Medicaid inpatient utilization rate; and
| 13 | | (4) hospitals with a Medicaid inpatient utilization | 14 | | rate that is equal
to or greater than 1.5 standard | 15 | | deviations above the mean Medicaid inpatient
utilization | 16 | | rate shall receive a per day adjustment payment equal to | 17 | | the sum of
$90 plus $2 for each one percent that the | 18 | | hospital's Medicaid inpatient
utilization rate exceeds 1.5 | 19 | | standard deviations above the mean Medicaid
inpatient | 20 | | utilization rate.
| 21 | | (d) Supplemental adjustment payments. In addition to the | 22 | | adjustment
payments described in paragraph (c), hospitals as | 23 | | defined in clauses
(1) through (5) of paragraph (b), excluding | 24 | | county hospitals (as defined in
subsection (c) of Section 15-1 | 25 | | of this Code) and a hospital organized under the
University of | 26 | | Illinois Hospital Act, shall be paid supplemental inpatient
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| 1 | | adjustment payments of $60 per day. For purposes of Title XIX | 2 | | of the federal
Social Security Act, these supplemental | 3 | | adjustment payments shall not be
classified as adjustment | 4 | | payments to disproportionate share hospitals.
| 5 | | (e) The inpatient adjustment payments described in | 6 | | paragraphs (c) and (d)
shall be increased on October 1, 1993 | 7 | | and annually thereafter by a percentage
equal to the lesser of | 8 | | (i) the increase in the DRI hospital cost index for the
most | 9 | | recent 12 month period for which data are available, or (ii) | 10 | | the
percentage increase in the statewide average hospital | 11 | | payment rate over the
previous year's statewide average | 12 | | hospital payment rate. The sum of the
inpatient adjustment | 13 | | payments under paragraphs (c) and (d) to a hospital, other
than | 14 | | a county hospital (as defined in subsection (c) of Section 15-1 | 15 | | of this
Code) or a hospital organized under the University of | 16 | | Illinois Hospital Act,
however, shall not exceed $275 per day; | 17 | | that limit shall be increased on
October 1, 1993 and annually | 18 | | thereafter by a percentage equal to the lesser of
(i) the | 19 | | increase in the DRI hospital cost index for the most recent | 20 | | 12-month
period for which data are available or (ii) the | 21 | | percentage increase in the
statewide average hospital payment | 22 | | rate over the previous year's statewide
average hospital | 23 | | payment rate.
| 24 | | (f) Children's hospital inpatient adjustment payments. For | 25 | | children's
hospitals, as defined in clause (5) of paragraph | 26 | | (b), the adjustment payments
required pursuant to paragraphs |
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| 1 | | (c) and (d) shall be multiplied by 2.0.
| 2 | | (g) County hospital inpatient adjustment payments. For | 3 | | county hospitals,
as defined in subsection (c) of Section 15-1 | 4 | | of this Code, there shall be an
adjustment payment as | 5 | | determined by rules issued by the Illinois Department.
| 6 | | (h) For the purposes of this Section the following terms | 7 | | shall be defined
as follows:
| 8 | | (1) "Medicaid inpatient utilization rate" means a | 9 | | fraction, the numerator
of which is the number of a | 10 | | hospital's inpatient days provided in a given
12-month | 11 | | period to patients who, for such days, were eligible for | 12 | | Medicaid
under Title XIX of the federal Social Security | 13 | | Act, and the denominator of
which is the total number of | 14 | | the hospital's inpatient days in that same period.
| 15 | | (2) "Mean Medicaid inpatient utilization rate" means | 16 | | the total number
of Medicaid inpatient days provided by all | 17 | | Illinois Medicaid-participating
hospitals divided by the | 18 | | total number of inpatient days provided by those same
| 19 | | hospitals.
| 20 | | (3) "Medicaid obstetrical inpatient utilization rate" | 21 | | means the
ratio of Medicaid obstetrical inpatient days to | 22 | | total Medicaid inpatient
days for all Illinois hospitals | 23 | | receiving Medicaid payments from the
Illinois Department.
| 24 | | (i) Inpatient adjustment payment limit. In order to meet | 25 | | the limits
of Public Law 102-234 and Public Law 103-66, the
| 26 | | Illinois Department shall by rule adjust
disproportionate |
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| 1 | | share adjustment payments.
| 2 | | (j) University of Illinois Hospital inpatient adjustment | 3 | | payments. For
hospitals organized under the University of | 4 | | Illinois Hospital Act, there shall
be an adjustment payment as | 5 | | determined by rules adopted by the Illinois
Department.
| 6 | | (k) The Illinois Department may by rule establish criteria | 7 | | for and develop
methodologies for adjustment payments to | 8 | | hospitals participating under this
Article.
| 9 | | (l) On and after July 1, 2012, the Department shall reduce | 10 | | any rate of reimbursement for services or other payments or | 11 | | alter any methodologies authorized by this Code to reduce any | 12 | | rate of reimbursement for services or other payments in | 13 | | accordance with Section 5-5e. | 14 | | (Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
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