Full Text of HB0217 94th General Assembly
HB0217 94TH GENERAL ASSEMBLY
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94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 HB0217
Introduced 1/13/2005, by Rep. Rosemary Mulligan SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning hospital access improvement payments.
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A BILL FOR
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HB0217 |
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LRB094 05457 DRJ 35502 b |
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Public Aid Code is amended by | 5 |
| changing Section 5A-12 as follows: | 6 |
| (305 ILCS 5/5A-12)
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| (Section scheduled to be repealed on July 1, 2005) | 8 |
| Sec. 5A-12. Hospital access improvement payments.
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| (a) To improve access to hospital services, for hospital | 10 |
| services rendered
on or
after June 1, 2004, the
the Department | 11 |
| of Public Aid shall make
payments
to hospitals as set forth in | 12 |
| this Section, except for hospitals described in
subsection (b) | 13 |
| of
Section 5A-3.
These payments shall be paid on a quarterly | 14 |
| basis. For State fiscal year 2004, if the effective date of the | 15 |
| approval of the payment methodology required under this Section | 16 |
| and the waiver granted under 42 CFR 433.68 by the Centers for | 17 |
| Medicare and Medicaid Services of the U.S. Department of Health | 18 |
| and Human Services is prior to July 1, 2004,
the
Department | 19 |
| shall pay the total amounts required for fiscal year 2004 under | 20 |
| this Section within 25 days of the latest notification. No | 21 |
| payment shall be made for State fiscal year 2004 if the | 22 |
| effective date of the approval is on or after July 1, 2004.
In | 23 |
| State fiscal year 2005,
the total
amounts required under this | 24 |
| Section shall be paid in 4 equal installments on or
before
July | 25 |
| 15, October 15, January 14, and April 15
of the year, except | 26 |
| that if the date of notification of the approval of the payment | 27 |
| methodologies required under this Section and the waiver | 28 |
| granted under 42 CFR 433.68 is on or after July 1, 2004, the | 29 |
| sum of amounts required under this Section prior to the date of | 30 |
| notification shall be paid within 25 days of the date of the | 31 |
| last notification. Payments under
this
Section are not due and | 32 |
| payable, however, until (i) the methodologies described
in
this
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HB0217 |
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LRB094 05457 DRJ 35502 b |
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| Section are approved by the federal government in an | 2 |
| appropriate State Plan
amendment,
(ii) the assessment imposed | 3 |
| under this Article is determined to be a
permissible tax under | 4 |
| Title XIX of the Social Security Act, and (iii) the
assessment | 5 |
| is in effect.
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| (b) High volume payment. In addition to rates paid for | 7 |
| inpatient hospital
services, the Department of Public Aid shall | 8 |
| pay, to each Illinois hospital
that provided
more than 20,000 | 9 |
| Medicaid inpatient days of care during State fiscal year 2001
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| (except
for hospitals
that qualify for adjustment payments | 11 |
| under Section 5-5.02 for the 12-month
period beginning on | 12 |
| October 1, 2002), $190 for each
Medicaid inpatient day
of care | 13 |
| provided during that fiscal year. A hospital that provided less | 14 |
| than
30,000 Medicaid inpatient days of
care during that period, | 15 |
| however, is not entitled to receive more than
$3,500,000 per | 16 |
| year
in such payments.
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| (c) Medicaid inpatient utilization rate adjustment. In | 18 |
| addition to rates
paid for
inpatient hospital services, the | 19 |
| Department of Public Aid shall pay each
Illinois hospital
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| (except for hospitals described in Section 5A-3), for each | 21 |
| Medicaid inpatient
day of
care provided
during State fiscal | 22 |
| year 2001, an amount equal to the product of $57.25
multiplied | 23 |
| by the
quotient of 1 divided by the greater of 1.6% or the | 24 |
| hospital's Medicaid
inpatient
utilization rate (as used to | 25 |
| determine eligibility for adjustment payments
under Section | 26 |
| 5-5.02 for the 12-month period beginning on October 1, 2002). | 27 |
| The
total payments under this
subsection to a
hospital may
not | 28 |
| exceed $10,500,000 annually.
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| (d) Psychiatric base rate adjustment.
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| (1) In addition to rates paid for
inpatient
psychiatric | 31 |
| services, the Department of Public Aid shall pay each | 32 |
| Illinois
general acute care hospital with a distinct | 33 |
| part-psychiatric unit, for
each Medicaid inpatient | 34 |
| psychiatric day of care provided in State fiscal year
2001, | 35 |
| an
amount equal
to $400 less the hospital's per-diem rate | 36 |
| for Medicaid inpatient psychiatric
services as in effect on |
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HB0217 |
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LRB094 05457 DRJ 35502 b |
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| October 1, 2003. In no
event, however, shall that amount be | 2 |
| less than zero.
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| (2) For distinct
part-psychiatric units of Illinois
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| general acute care hospitals, except for all hospitals | 5 |
| excluded in Section
5A-3,
whose inpatient per-diem rate as | 6 |
| in effect on
October 1, 2003 is greater than
$400, the
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| Department shall pay, in addition to any other amounts | 8 |
| authorized under this
Code, $25
for each Medicaid inpatient | 9 |
| psychiatric day of care provided in State fiscal
year 2001.
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| (e) Supplemental tertiary care adjustment. In addition to | 11 |
| rates paid for
inpatient
services, the Department of Public Aid | 12 |
| shall pay to each Illinois hospital
eligible for
tertiary care | 13 |
| adjustment payments under 89 Ill. Adm. Code 148.296, as in | 14 |
| effect
for State fiscal year
2003, a supplemental tertiary care | 15 |
| adjustment payment equal to
the tertiary
care adjustment | 16 |
| payment required under 89 Ill. Adm. Code 148.296, as in effect
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| for State fiscal year
2003.
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| (f) Medicaid outpatient utilization rate adjustment. In | 19 |
| addition to rates
paid for
outpatient hospital services, the | 20 |
| Department of Public Aid shall pay each
Illinois hospital
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| (except for hospitals described in Section 5A-3), an amount | 22 |
| equal to the
product of 2.45%
multiplied by the hospital's | 23 |
| Medicaid outpatient charges multiplied by the
quotient of 1
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| divided by the greater of 1.6% or the hospital's Medicaid | 25 |
| outpatient
utilization rate. The
total payments under this | 26 |
| subsection to a hospital may not exceed $6,750,000
annually.
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| For purposes of this subsection:
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| "Medicaid outpatient charges" means the charges for | 29 |
| outpatient services
provided to Medicaid patients for State | 30 |
| fiscal year 2001 as submitted by the
hospital on the UB-92 | 31 |
| billing form or under the ambulatory procedure listing
and
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| adjudicated by the Department of Public Aid on or before | 33 |
| September 12, 2003.
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| "Medicaid outpatient utilization rate" means a fraction, | 35 |
| the numerator of
which is the hospital's Medicaid outpatient | 36 |
| charges and the denominator of
which
is the total number of the |
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LRB094 05457 DRJ 35502 b |
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| hospital's charges for outpatient services for the
hospital's | 2 |
| fiscal year ending in 2001.
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| (g) State outpatient service adjustment. In addition to | 4 |
| rates paid for
outpatient
hospital services, the Department of | 5 |
| Public Aid shall pay each Illinois
hospital an amount
equal to | 6 |
| the product of 75.5% multiplied by the hospital's Medicaid | 7 |
| outpatient
services
submitted to
the Department on the UB-92 | 8 |
| billing form for State fiscal year 2001 multiplied
by the
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| hospital's outpatient access fraction.
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| For purposes of this subsection,
"outpatient access
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| fraction" means a fraction, the numerator of which is the | 12 |
| hospital's Medicaid
payments
for outpatient services for | 13 |
| ambulatory procedure listing services submitted to
the | 14 |
| Department on the UB-92 billing form
for State
fiscal year | 15 |
| 2001, and the denominator of which is the hospital's Medicaid
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| outpatient
services submitted to the Department on the UB-92 | 17 |
| billing form for State fiscal
year
2001.
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| The total payments under this subsection to a hospital may | 19 |
| not exceed
$3,000,000
annually.
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| (h) Rural hospital outpatient adjustment. In addition to | 21 |
| rates paid for
outpatient
hospital services, the Department of | 22 |
| Public Aid shall pay each Illinois rural
hospital an
amount | 23 |
| equal to the product of $14,500,000 multiplied by the rural | 24 |
| hospital
outpatient
adjustment fraction.
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| For purposes of this subsection, "rural hospital
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| outpatient
adjustment fraction" means a fraction, the | 27 |
| numerator of which is the hospital's
Medicaid
visits for | 28 |
| outpatient services for
ambulatory procedure listing services
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| submitted to the Department on the UB-92 billing
form for
State | 30 |
| fiscal year 2001, and the denominator of which is the total | 31 |
| Medicaid
visits for
outpatient services for ambulatory | 32 |
| procedure listing services for all Illinois
rural hospitals | 33 |
| submitted to the
Department on the UB-92 billing form for State | 34 |
| fiscal year 2001.
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| For purposes
of this subsection, "rural
hospital" has the | 36 |
| same meaning as in 89 Ill. Adm. Code 148.25, as in effect on
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LRB094 05457 DRJ 35502 b |
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| September
30, 2003.
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| (i) Merged/closed hospital adjustment. If any hospital | 3 |
| files a
combined Medicaid cost report with another hospital | 4 |
| after January 1, 2001, and
if
that hospital subsequently | 5 |
| closes, then except for the payments
described in
subsection | 6 |
| (e), all payments described in the various subsections of this
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| Section shall, before the application of the annual limitation | 8 |
| amount specified
in each such subsection, be multiplied by a | 9 |
| fraction, the numerator of which is
the number
of occupied bed | 10 |
| days attributable to the open hospital and the denominator of
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| which is the sum of the number of occupied bed days of each | 12 |
| open hospital and
each
closed hospital. For purposes of this | 13 |
| subsection, "occupied bed
days" has the same meaning as the | 14 |
| term is defined in subsection (a) of
Section 5A-2.
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| (j) For purposes of this Section, the terms "Medicaid | 16 |
| days", "Medicaid
charges", and "Medicaid services" do not | 17 |
| include any days, charges, or services
for which Medicare was | 18 |
| liable for payment.
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| (k) As provided in Section 5A-14, this Section is repealed | 20 |
| on July 1,
2005.
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| (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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