Full Text of HB2199 97th General Assembly
HB2199 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 HB2199 Introduced , by Rep. Tom Cross SYNOPSIS AS INTRODUCED: | | 305 ILCS 5/5-5.02 | from Ch. 23, par. 5-5.02 |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section
concerning Medicaid rates for hospitals.
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| | 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
the Illinois
Department's Rules promulgated | 11 | | under the Illinois Administrative Procedure
Act, reimbursement | 12 | | to hospitals for services provided during the period
July 1, | 13 | | 1992 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 | | or
| 16 | | (2) Illinois hospitals that have a Medicaid inpatient | 17 | | utilization
rate which is at least one-half a standard | 18 | | deviation above the mean Medicaid
inpatient utilization | 19 | | rate for all hospitals in Illinois receiving Medicaid
| 20 | | payments from the Illinois Department; or
| 21 | | (3) Illinois hospitals that on July 1, 1991 had a | 22 | | Medicaid inpatient
utilization rate, as defined in | 23 | | paragraph (h) of this Section,
that was at least the mean | 24 | | Medicaid inpatient utilization rate for all
hospitals in | 25 | | Illinois receiving Medicaid payments from the Illinois
| 26 | | Department and which were located in a planning area with |
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| 1 | | one-third or
fewer excess beds as determined by the Health | 2 | | Facilities and Services Review Board, and that, as of June | 3 | | 30, 1992, were located in a federally
designated Health | 4 | | Manpower Shortage Area; or
| 5 | | (4) Illinois hospitals that:
| 6 | | (A) have a Medicaid inpatient utilization rate | 7 | | that is at least
equal to the mean Medicaid inpatient | 8 | | utilization rate for all hospitals in
Illinois | 9 | | receiving Medicaid payments from the Department; and
| 10 | | (B) also have a Medicaid obstetrical inpatient | 11 | | utilization
rate that is at least one standard | 12 | | deviation above the mean Medicaid
obstetrical | 13 | | inpatient utilization rate for all hospitals in | 14 | | Illinois
receiving Medicaid payments from the | 15 | | Department for obstetrical services; or
| 16 | | (5) Any children's hospital, which means a hospital | 17 | | devoted exclusively
to caring for children. A hospital | 18 | | which includes a facility devoted
exclusively to caring for | 19 | | children shall be considered a
children's hospital to the | 20 | | degree that the hospital's Medicaid care is
provided to | 21 | | children
if either (i) the facility devoted exclusively to | 22 | | caring for children is
separately licensed as a hospital by | 23 | | a municipality prior to
September
30, 1998 or
(ii) the | 24 | | hospital has been
designated
by the State
as a Level III | 25 | | perinatal care facility, has a Medicaid Inpatient
| 26 | | Utilization rate
greater than 55% for the rate year 2003 |
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| 1 | | disproportionate share determination,
and has more than | 2 | | 10,000 qualified children days as defined by
the
Department | 3 | | in rulemaking.
| 4 | | (c) Inpatient adjustment payments. The adjustment payments | 5 | | required by
paragraph (b) shall be calculated based upon the | 6 | | hospital's Medicaid
inpatient utilization rate as follows:
| 7 | | (1) hospitals with a Medicaid inpatient utilization | 8 | | rate below the mean
shall receive a per day adjustment | 9 | | payment equal to $25;
| 10 | | (2) hospitals with a Medicaid inpatient utilization | 11 | | rate
that is equal to or greater than the mean Medicaid | 12 | | inpatient utilization rate
but less than one standard | 13 | | deviation above the mean Medicaid inpatient
utilization | 14 | | rate shall receive a per day adjustment payment
equal to | 15 | | the sum of $25 plus $1 for each one percent that the | 16 | | hospital's
Medicaid inpatient utilization rate exceeds the | 17 | | mean Medicaid inpatient
utilization rate;
| 18 | | (3) hospitals with a Medicaid inpatient utilization | 19 | | rate that is equal
to or greater than one standard | 20 | | deviation above the mean Medicaid inpatient
utilization | 21 | | rate but less than 1.5 standard deviations above the mean | 22 | | Medicaid
inpatient utilization rate shall receive a per day | 23 | | adjustment payment equal to
the sum of $40 plus $7 for each | 24 | | one percent that the hospital's Medicaid
inpatient | 25 | | utilization rate exceeds one standard deviation above the | 26 | | mean
Medicaid inpatient utilization rate; and
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| 1 | | (4) hospitals with a Medicaid inpatient utilization | 2 | | rate that is equal
to or greater than 1.5 standard | 3 | | deviations above the mean Medicaid inpatient
utilization | 4 | | rate shall receive a per day adjustment payment equal to | 5 | | the sum of
$90 plus $2 for each one percent that the | 6 | | hospital's Medicaid inpatient
utilization rate exceeds 1.5 | 7 | | standard deviations above the mean Medicaid
inpatient | 8 | | utilization rate.
| 9 | | (d) Supplemental adjustment payments. In addition to the | 10 | | adjustment
payments described in paragraph (c), hospitals as | 11 | | defined in clauses
(1) through (5) of paragraph (b), excluding | 12 | | county hospitals (as defined in
subsection (c) of Section 15-1 | 13 | | of this Code) and a hospital organized under the
University of | 14 | | Illinois Hospital Act, shall be paid supplemental inpatient
| 15 | | adjustment payments of $60 per day. For purposes of Title XIX | 16 | | of the federal
Social Security Act, these supplemental | 17 | | adjustment payments shall not be
classified as adjustment | 18 | | payments to disproportionate share hospitals.
| 19 | | (e) The inpatient adjustment payments described in | 20 | | paragraphs (c) and (d)
shall be increased on October 1, 1993 | 21 | | and annually thereafter by a percentage
equal to the lesser of | 22 | | (i) the increase in the DRI hospital cost index for the
most | 23 | | recent 12 month period for which data are available, or (ii) | 24 | | the
percentage increase in the statewide average hospital | 25 | | payment rate over the
previous year's statewide average | 26 | | hospital payment rate. The sum of the
inpatient adjustment |
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| 1 | | payments under paragraphs (c) and (d) to a hospital, other
than | 2 | | a county hospital (as defined in subsection (c) of Section 15-1 | 3 | | of this
Code) or a hospital organized under the University of | 4 | | Illinois Hospital Act,
however, shall not exceed $275 per day; | 5 | | that limit shall be increased on
October 1, 1993 and annually | 6 | | thereafter by a percentage equal to the lesser of
(i) the | 7 | | increase in the DRI hospital cost index for the most recent | 8 | | 12-month
period for which data are available or (ii) the | 9 | | percentage increase in the
statewide average hospital payment | 10 | | rate over the previous year's statewide
average hospital | 11 | | payment rate.
| 12 | | (f) Children's hospital inpatient adjustment payments. For | 13 | | children's
hospitals, as defined in clause (5) of paragraph | 14 | | (b), the adjustment payments
required pursuant to paragraphs | 15 | | (c) and (d) shall be multiplied by 2.0.
| 16 | | (g) County hospital inpatient adjustment payments. For | 17 | | county hospitals,
as defined in subsection (c) of Section 15-1 | 18 | | of this Code, there shall be an
adjustment payment as | 19 | | determined by rules issued by the Illinois Department.
| 20 | | (h) For the purposes of this Section the following terms | 21 | | shall be defined
as follows:
| 22 | | (1) "Medicaid inpatient utilization rate" means a | 23 | | fraction, the numerator
of which is the number of a | 24 | | hospital's inpatient days provided in a given
12-month | 25 | | period to patients who, for such days, were eligible for | 26 | | Medicaid
under Title XIX of the federal Social Security |
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| 1 | | Act, and the denominator of
which is the total number of | 2 | | the hospital's inpatient days in that same period.
| 3 | | (2) "Mean Medicaid inpatient utilization rate" means | 4 | | the total number
of Medicaid inpatient days provided by all | 5 | | Illinois Medicaid-participating
hospitals divided by the | 6 | | total number of inpatient days provided by those same
| 7 | | hospitals.
| 8 | | (3) "Medicaid obstetrical inpatient utilization rate" | 9 | | means the
ratio of Medicaid obstetrical inpatient days to | 10 | | total Medicaid inpatient
days for all Illinois hospitals | 11 | | receiving Medicaid payments from the
Illinois Department.
| 12 | | (i) Inpatient adjustment payment limit. In order to meet | 13 | | the limits
of Public Law 102-234 and Public Law 103-66, the
| 14 | | Illinois Department shall by rule adjust
disproportionate | 15 | | share adjustment payments.
| 16 | | (j) University of Illinois Hospital inpatient adjustment | 17 | | payments. For
hospitals organized under the University of | 18 | | Illinois Hospital Act, there shall
be an adjustment payment as | 19 | | determined by rules adopted by the Illinois
Department.
| 20 | | (k) The Illinois Department may by rule establish criteria | 21 | | for and develop
methodologies for adjustment payments to | 22 | | hospitals participating under this
Article.
| 23 | | (Source: P.A. 96-31, eff. 6-30-09.)
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