Full Text of HB4678 099th General Assembly
HB4678enr 99TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning State government.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Administrative Procedure Act is | 5 | | amended by changing Section 5-45 as follows: | 6 | | (5 ILCS 100/5-45) (from Ch. 127, par. 1005-45) | 7 | | Sec. 5-45. Emergency rulemaking. | 8 | | (a) "Emergency" means the existence of any situation that | 9 | | any agency
finds reasonably constitutes a threat to the public | 10 | | interest, safety, or
welfare. | 11 | | (b) If any agency finds that an
emergency exists that | 12 | | requires adoption of a rule upon fewer days than
is required by | 13 | | Section 5-40 and states in writing its reasons for that
| 14 | | finding, the agency may adopt an emergency rule without prior | 15 | | notice or
hearing upon filing a notice of emergency rulemaking | 16 | | with the Secretary of
State under Section 5-70. The notice | 17 | | shall include the text of the
emergency rule and shall be | 18 | | published in the Illinois Register. Consent
orders or other | 19 | | court orders adopting settlements negotiated by an agency
may | 20 | | be adopted under this Section. Subject to applicable | 21 | | constitutional or
statutory provisions, an emergency rule | 22 | | becomes effective immediately upon
filing under Section 5-65 or | 23 | | at a stated date less than 10 days
thereafter. The agency's |
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| 1 | | finding and a statement of the specific reasons
for the finding | 2 | | shall be filed with the rule. The agency shall take
reasonable | 3 | | and appropriate measures to make emergency rules known to the
| 4 | | persons who may be affected by them. | 5 | | (c) An emergency rule may be effective for a period of not | 6 | | longer than
150 days, but the agency's authority to adopt an | 7 | | identical rule under Section
5-40 is not precluded. No | 8 | | emergency rule may be adopted more
than once in any 24 month | 9 | | period, except that this limitation on the number
of emergency | 10 | | rules that may be adopted in a 24 month period does not apply
| 11 | | to (i) emergency rules that make additions to and deletions | 12 | | from the Drug
Manual under Section 5-5.16 of the Illinois | 13 | | Public Aid Code or the
generic drug formulary under Section | 14 | | 3.14 of the Illinois Food, Drug
and Cosmetic Act, (ii) | 15 | | emergency rules adopted by the Pollution Control
Board before | 16 | | July 1, 1997 to implement portions of the Livestock Management
| 17 | | Facilities Act, (iii) emergency rules adopted by the Illinois | 18 | | Department of Public Health under subsections (a) through (i) | 19 | | of Section 2 of the Department of Public Health Act when | 20 | | necessary to protect the public's health, (iv) emergency rules | 21 | | adopted pursuant to subsection (n) of this Section, (v) | 22 | | emergency rules adopted pursuant to subsection (o) of this | 23 | | Section, or (vi) emergency rules adopted pursuant to subsection | 24 | | (c-5) of this Section. Two or more emergency rules having | 25 | | substantially the same
purpose and effect shall be deemed to be | 26 | | a single rule for purposes of this
Section. |
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| 1 | | (c-5) To facilitate the maintenance of the program of group | 2 | | health benefits provided to annuitants, survivors, and retired | 3 | | employees under the State Employees Group Insurance Act of | 4 | | 1971, rules to alter the contributions to be paid by the State, | 5 | | annuitants, survivors, retired employees, or any combination | 6 | | of those entities, for that program of group health benefits, | 7 | | shall be adopted as emergency rules. The adoption of those | 8 | | rules shall be considered an emergency and necessary for the | 9 | | public interest, safety, and welfare. | 10 | | (d) In order to provide for the expeditious and timely | 11 | | implementation
of the State's fiscal year 1999 budget, | 12 | | emergency rules to implement any
provision of Public Act 90-587 | 13 | | or 90-588
or any other budget initiative for fiscal year 1999 | 14 | | may be adopted in
accordance with this Section by the agency | 15 | | charged with administering that
provision or initiative, | 16 | | except that the 24-month limitation on the adoption
of | 17 | | emergency rules and the provisions of Sections 5-115 and 5-125 | 18 | | do not apply
to rules adopted under this subsection (d). The | 19 | | adoption of emergency rules
authorized by this subsection (d) | 20 | | shall be deemed to be necessary for the
public interest, | 21 | | safety, and welfare. | 22 | | (e) In order to provide for the expeditious and timely | 23 | | implementation
of the State's fiscal year 2000 budget, | 24 | | emergency rules to implement any
provision of Public Act 91-24 | 25 | | this amendatory Act of the 91st General Assembly
or any other | 26 | | budget initiative for fiscal year 2000 may be adopted in
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| 1 | | accordance with this Section by the agency charged with | 2 | | administering that
provision or initiative, except that the | 3 | | 24-month limitation on the adoption
of emergency rules and the | 4 | | provisions of Sections 5-115 and 5-125 do not apply
to rules | 5 | | adopted under this subsection (e). The adoption of emergency | 6 | | rules
authorized by this subsection (e) shall be deemed to be | 7 | | necessary for the
public interest, safety, and welfare. | 8 | | (f) In order to provide for the expeditious and timely | 9 | | implementation
of the State's fiscal year 2001 budget, | 10 | | emergency rules to implement any
provision of Public Act 91-712 | 11 | | this amendatory Act of the 91st General Assembly
or any other | 12 | | budget initiative for fiscal year 2001 may be adopted in
| 13 | | accordance with this Section by the agency charged with | 14 | | administering that
provision or initiative, except that the | 15 | | 24-month limitation on the adoption
of emergency rules and the | 16 | | provisions of Sections 5-115 and 5-125 do not apply
to rules | 17 | | adopted under this subsection (f). The adoption of emergency | 18 | | rules
authorized by this subsection (f) shall be deemed to be | 19 | | necessary for the
public interest, safety, and welfare. | 20 | | (g) In order to provide for the expeditious and timely | 21 | | implementation
of the State's fiscal year 2002 budget, | 22 | | emergency rules to implement any
provision of Public Act 92-10 | 23 | | this amendatory Act of the 92nd General Assembly
or any other | 24 | | budget initiative for fiscal year 2002 may be adopted in
| 25 | | accordance with this Section by the agency charged with | 26 | | administering that
provision or initiative, except that the |
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| 1 | | 24-month limitation on the adoption
of emergency rules and the | 2 | | provisions of Sections 5-115 and 5-125 do not apply
to rules | 3 | | adopted under this subsection (g). The adoption of emergency | 4 | | rules
authorized by this subsection (g) shall be deemed to be | 5 | | necessary for the
public interest, safety, and welfare. | 6 | | (h) In order to provide for the expeditious and timely | 7 | | implementation
of the State's fiscal year 2003 budget, | 8 | | emergency rules to implement any
provision of Public Act 92-597 | 9 | | this amendatory Act of the 92nd General Assembly
or any other | 10 | | budget initiative for fiscal year 2003 may be adopted in
| 11 | | accordance with this Section by the agency charged with | 12 | | administering that
provision or initiative, except that the | 13 | | 24-month limitation on the adoption
of emergency rules and the | 14 | | provisions of Sections 5-115 and 5-125 do not apply
to rules | 15 | | adopted under this subsection (h). The adoption of emergency | 16 | | rules
authorized by this subsection (h) shall be deemed to be | 17 | | necessary for the
public interest, safety, and welfare. | 18 | | (i) In order to provide for the expeditious and timely | 19 | | implementation
of the State's fiscal year 2004 budget, | 20 | | emergency rules to implement any
provision of Public Act 93-20 | 21 | | this amendatory Act of the 93rd General Assembly
or any other | 22 | | budget initiative for fiscal year 2004 may be adopted in
| 23 | | accordance with this Section by the agency charged with | 24 | | administering that
provision or initiative, except that the | 25 | | 24-month limitation on the adoption
of emergency rules and the | 26 | | provisions of Sections 5-115 and 5-125 do not apply
to rules |
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| 1 | | adopted under this subsection (i). The adoption of emergency | 2 | | rules
authorized by this subsection (i) shall be deemed to be | 3 | | necessary for the
public interest, safety, and welfare. | 4 | | (j) In order to provide for the expeditious and timely | 5 | | implementation of the provisions of the State's fiscal year | 6 | | 2005 budget as provided under the Fiscal Year 2005 Budget | 7 | | Implementation (Human Services) Act, emergency rules to | 8 | | implement any provision of the Fiscal Year 2005 Budget | 9 | | Implementation (Human Services) Act may be adopted in | 10 | | accordance with this Section by the agency charged with | 11 | | administering that provision, except that the 24-month | 12 | | limitation on the adoption of emergency rules and the | 13 | | provisions of Sections 5-115 and 5-125 do not apply to rules | 14 | | adopted under this subsection (j). The Department of Public Aid | 15 | | may also adopt rules under this subsection (j) necessary to | 16 | | administer the Illinois Public Aid Code and the Children's | 17 | | Health Insurance Program Act. The adoption of emergency rules | 18 | | authorized by this subsection (j) shall be deemed to be | 19 | | necessary for the public interest, safety, and welfare.
| 20 | | (k) In order to provide for the expeditious and timely | 21 | | implementation of the provisions of the State's fiscal year | 22 | | 2006 budget, emergency rules to implement any provision of | 23 | | Public Act 94-48 this amendatory Act of the 94th General | 24 | | Assembly or any other budget initiative for fiscal year 2006 | 25 | | may be adopted in accordance with this Section by the agency | 26 | | charged with administering that provision or initiative, |
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| 1 | | except that the 24-month limitation on the adoption of | 2 | | emergency rules and the provisions of Sections 5-115 and 5-125 | 3 | | do not apply to rules adopted under this subsection (k). The | 4 | | Department of Healthcare and Family Services may also adopt | 5 | | rules under this subsection (k) necessary to administer the | 6 | | Illinois Public Aid Code, the Senior Citizens and Persons with | 7 | | Disabilities Property Tax Relief Act, the Senior Citizens and | 8 | | Disabled Persons Prescription Drug Discount Program Act (now | 9 | | the Illinois Prescription Drug Discount Program Act), and the | 10 | | Children's Health Insurance Program Act. The adoption of | 11 | | emergency rules authorized by this subsection (k) shall be | 12 | | deemed to be necessary for the public interest, safety, and | 13 | | welfare.
| 14 | | (l) In order to provide for the expeditious and timely | 15 | | implementation of the provisions of the
State's fiscal year | 16 | | 2007 budget, the Department of Healthcare and Family Services | 17 | | may adopt emergency rules during fiscal year 2007, including | 18 | | rules effective July 1, 2007, in
accordance with this | 19 | | subsection to the extent necessary to administer the | 20 | | Department's responsibilities with respect to amendments to | 21 | | the State plans and Illinois waivers approved by the federal | 22 | | Centers for Medicare and Medicaid Services necessitated by the | 23 | | requirements of Title XIX and Title XXI of the federal Social | 24 | | Security Act. The adoption of emergency rules
authorized by | 25 | | this subsection (l) shall be deemed to be necessary for the | 26 | | public interest,
safety, and welfare.
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| 1 | | (m) In order to provide for the expeditious and timely | 2 | | implementation of the provisions of the
State's fiscal year | 3 | | 2008 budget, the Department of Healthcare and Family Services | 4 | | may adopt emergency rules during fiscal year 2008, including | 5 | | rules effective July 1, 2008, in
accordance with this | 6 | | subsection to the extent necessary to administer the | 7 | | Department's responsibilities with respect to amendments to | 8 | | the State plans and Illinois waivers approved by the federal | 9 | | Centers for Medicare and Medicaid Services necessitated by the | 10 | | requirements of Title XIX and Title XXI of the federal Social | 11 | | Security Act. The adoption of emergency rules
authorized by | 12 | | this subsection (m) shall be deemed to be necessary for the | 13 | | public interest,
safety, and welfare.
| 14 | | (n) In order to provide for the expeditious and timely | 15 | | implementation of the provisions of the State's fiscal year | 16 | | 2010 budget, emergency rules to implement any provision of | 17 | | Public Act 96-45 this amendatory Act of the 96th General | 18 | | Assembly or any other budget initiative authorized by the 96th | 19 | | General Assembly for fiscal year 2010 may be adopted in | 20 | | accordance with this Section by the agency charged with | 21 | | administering that provision or initiative. The adoption of | 22 | | emergency rules authorized by this subsection (n) shall be | 23 | | deemed to be necessary for the public interest, safety, and | 24 | | welfare. The rulemaking authority granted in this subsection | 25 | | (n) shall apply only to rules promulgated during Fiscal Year | 26 | | 2010. |
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| 1 | | (o) In order to provide for the expeditious and timely | 2 | | implementation of the provisions of the State's fiscal year | 3 | | 2011 budget, emergency rules to implement any provision of | 4 | | Public Act 96-958 this amendatory Act of the 96th General | 5 | | Assembly or any other budget initiative authorized by the 96th | 6 | | General Assembly for fiscal year 2011 may be adopted in | 7 | | accordance with this Section by the agency charged with | 8 | | administering that provision or initiative. The adoption of | 9 | | emergency rules authorized by this subsection (o) is deemed to | 10 | | be necessary for the public interest, safety, and welfare. The | 11 | | rulemaking authority granted in this subsection (o) applies | 12 | | only to rules promulgated on or after the effective date of | 13 | | Public Act 96-958 this amendatory Act of the 96th General | 14 | | Assembly through June 30, 2011. | 15 | | (p) In order to provide for the expeditious and timely | 16 | | implementation of the provisions of Public Act 97-689, | 17 | | emergency rules to implement any provision of Public Act 97-689 | 18 | | may be adopted in accordance with this subsection (p) by the | 19 | | agency charged with administering that provision or | 20 | | initiative. The 150-day limitation of the effective period of | 21 | | emergency rules does not apply to rules adopted under this | 22 | | subsection (p), and the effective period may continue through | 23 | | June 30, 2013. The 24-month limitation on the adoption of | 24 | | emergency rules does not apply to rules adopted under this | 25 | | subsection (p). The adoption of emergency rules authorized by | 26 | | this subsection (p) is deemed to be necessary for the public |
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| 1 | | interest, safety, and welfare. | 2 | | (q) In order to provide for the expeditious and timely | 3 | | implementation of the provisions of Articles 7, 8, 9, 11, and | 4 | | 12 of Public Act 98-104 this amendatory Act of the 98th General | 5 | | Assembly , emergency rules to implement any provision of | 6 | | Articles 7, 8, 9, 11, and 12 of Public Act 98-104 this | 7 | | amendatory Act of the 98th General Assembly may be adopted in | 8 | | accordance with this subsection (q) by the agency charged with | 9 | | administering that provision or initiative. The 24-month | 10 | | limitation on the adoption of emergency rules does not apply to | 11 | | rules adopted under this subsection (q). The adoption of | 12 | | emergency rules authorized by this subsection (q) is deemed to | 13 | | be necessary for the public interest, safety, and welfare. | 14 | | (r) In order to provide for the expeditious and timely | 15 | | implementation of the provisions of Public Act 98-651 this | 16 | | amendatory Act of the 98th General Assembly , emergency rules to | 17 | | implement Public Act 98-651 this amendatory Act of the 98th | 18 | | General Assembly may be adopted in accordance with this | 19 | | subsection (r) by the Department of Healthcare and Family | 20 | | Services. The 24-month limitation on the adoption of emergency | 21 | | rules does not apply to rules adopted under this subsection | 22 | | (r). The adoption of emergency rules authorized by this | 23 | | subsection (r) is deemed to be necessary for the public | 24 | | interest, safety, and welfare. | 25 | | (s) In order to provide for the expeditious and timely | 26 | | implementation of the provisions of Sections 5-5b.1 and 5A-2 of |
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| 1 | | the Illinois Public Aid Code, emergency rules to implement any | 2 | | provision of Section 5-5b.1 or Section 5A-2 of the Illinois | 3 | | Public Aid Code may be adopted in accordance with this | 4 | | subsection (s) by the Department of Healthcare and Family | 5 | | Services. The rulemaking authority granted in this subsection | 6 | | (s) shall apply only to those rules adopted prior to July 1, | 7 | | 2015. Notwithstanding any other provision of this Section, any | 8 | | emergency rule adopted under this subsection (s) shall only | 9 | | apply to payments made for State fiscal year 2015. The adoption | 10 | | of emergency rules authorized by this subsection (s) is deemed | 11 | | to be necessary for the public interest, safety, and welfare. | 12 | | (t) In order to provide for the expeditious and timely | 13 | | implementation of the provisions of Article II of Public Act | 14 | | 99-6 this amendatory Act of the 99th General Assembly , | 15 | | emergency rules to implement the changes made by Article II of | 16 | | Public Act 99-6 this amendatory Act of the 99th General | 17 | | Assembly to the Emergency Telephone System Act may be adopted | 18 | | in accordance with this subsection (t) by the Department of | 19 | | State Police. The rulemaking authority granted in this | 20 | | subsection (t) shall apply only to those rules adopted prior to | 21 | | July 1, 2016. The 24-month limitation on the adoption of | 22 | | emergency rules does not apply to rules adopted under this | 23 | | subsection (t). The adoption of emergency rules authorized by | 24 | | this subsection (t) is deemed to be necessary for the public | 25 | | interest, safety, and welfare. | 26 | | (u) (t) In order to provide for the expeditious and timely |
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| 1 | | implementation of the provisions of the Burn Victims Relief | 2 | | Act, emergency rules to implement any provision of the Act may | 3 | | be adopted in accordance with this subsection (u) (t) by the | 4 | | Department of Insurance. The rulemaking authority granted in | 5 | | this subsection (u) (t) shall apply only to those rules adopted | 6 | | prior to December 31, 2015. The adoption of emergency rules | 7 | | authorized by this subsection (u) (t) is deemed to be necessary | 8 | | for the public interest, safety, and welfare. | 9 | | (v) In order to provide for the expeditious and timely | 10 | | implementation of the provisions of this amendatory Act of the | 11 | | 99th General Assembly, emergency rules to implement this | 12 | | amendatory Act of the 99th General Assembly may be adopted in | 13 | | accordance with this subsection (v) by the Department of | 14 | | Healthcare and Family Services. The 24-month limitation on the | 15 | | adoption of emergency rules does not apply to rules adopted | 16 | | under this subsection (v). The adoption of emergency rules | 17 | | authorized by this subsection (v) is deemed to be necessary for | 18 | | the public interest, safety, and welfare. | 19 | | (Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13; | 20 | | 98-651, eff. 6-16-14; 99-2, eff. 3-26-15; 99-6, eff. 1-1-16; | 21 | | 99-143, eff. 7-27-15; 99-455, eff. 1-1-16; revised 10-15-15.) | 22 | | Section 10. The State Finance Act is amended by changing | 23 | | Section 6z-81 as follows: | 24 | | (30 ILCS 105/6z-81) |
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| 1 | | Sec. 6z-81. Healthcare Provider Relief Fund. | 2 | | (a) There is created in the State treasury a special fund | 3 | | to be known as the Healthcare Provider Relief Fund. | 4 | | (b) The Fund is created for the purpose of receiving and | 5 | | disbursing moneys in accordance with this Section. | 6 | | Disbursements from the Fund shall be made only as follows: | 7 | | (1) Subject to appropriation, for payment by the | 8 | | Department of Healthcare and
Family Services or by the | 9 | | Department of Human Services of medical bills and related | 10 | | expenses, including administrative expenses, for which the | 11 | | State is responsible under Titles XIX and XXI of the Social | 12 | | Security Act, the Illinois Public Aid Code, the Children's | 13 | | Health Insurance Program Act, the Covering ALL KIDS Health | 14 | | Insurance Act, and the Long Term Acute Care Hospital | 15 | | Quality Improvement Transfer Program Act. | 16 | | (2) For repayment of funds borrowed from other State
| 17 | | funds or from outside sources, including interest thereon. | 18 | | (3) For State fiscal years 2017 and 2018, for making | 19 | | payments to the human poison control center pursuant to | 20 | | Section 12-4.105 of the Illinois Public Aid Code. | 21 | | (c) The Fund shall consist of the following: | 22 | | (1) Moneys received by the State from short-term
| 23 | | borrowing pursuant to the Short Term Borrowing Act on or | 24 | | after the effective date of this amendatory Act of the 96th | 25 | | General Assembly. | 26 | | (2) All federal matching funds received by the
Illinois |
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| 1 | | Department of Healthcare and Family Services as a result of | 2 | | expenditures made by the Department that are attributable | 3 | | to moneys deposited in the Fund. | 4 | | (3) All federal matching funds received by the
Illinois | 5 | | Department of Healthcare and Family Services as a result of | 6 | | federal approval of Title XIX State plan amendment | 7 | | transmittal number 07-09. | 8 | | (4) All other moneys received for the Fund from any
| 9 | | other source, including interest earned thereon. | 10 | | (5) All federal matching funds received by the
Illinois | 11 | | Department of Healthcare and Family Services as a result of | 12 | | expenditures made by the Department for Medical Assistance | 13 | | from the General Revenue Fund, the Tobacco Settlement | 14 | | Recovery Fund, the Long-Term Care Provider Fund, and the | 15 | | Drug Rebate Fund related to individuals eligible for | 16 | | medical assistance pursuant to the Patient Protection and | 17 | | Affordable Care Act (P.L. 111-148) and Section 5-2 of the | 18 | | Illinois Public Aid Code. | 19 | | (d) In addition to any other transfers that may be provided | 20 | | for by law, on the effective date of this amendatory Act of the | 21 | | 97th General Assembly, or as soon thereafter as practical, the | 22 | | State Comptroller shall direct and the State Treasurer shall | 23 | | transfer the sum of $365,000,000 from the General Revenue Fund | 24 | | into the Healthcare Provider Relief Fund.
| 25 | | (e) In addition to any other transfers that may be provided | 26 | | for by law, on July 1, 2011, or as soon thereafter as |
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| 1 | | practical, the State Comptroller shall direct and the State | 2 | | Treasurer shall transfer the sum of $160,000,000 from the | 3 | | General Revenue Fund to the Healthcare Provider Relief Fund. | 4 | | (f) Notwithstanding any other State law to the contrary, | 5 | | and in addition to any other transfers that may be provided for | 6 | | by law, the State Comptroller shall order transferred and the | 7 | | State Treasurer shall transfer $500,000,000 to the Healthcare | 8 | | Provider Relief Fund from the General Revenue Fund in equal | 9 | | monthly installments of $100,000,000, with the first transfer | 10 | | to be made on July 1, 2012, or as soon thereafter as practical, | 11 | | and with each of the remaining transfers to be made on August | 12 | | 1, 2012, September 1, 2012, October 1, 2012, and November 1, | 13 | | 2012, or as soon thereafter as practical. This transfer may | 14 | | assist the Department of Healthcare and Family Services in | 15 | | improving Medical Assistance bill processing timeframes or in | 16 | | meeting the possible requirements of Senate Bill 3397, or other | 17 | | similar legislation, of the 97th General Assembly should it | 18 | | become law. | 19 | | (g) Notwithstanding any other State law to the contrary, | 20 | | and in addition to any other transfers that may be provided for | 21 | | by law, on July 1, 2013, or as soon thereafter as may be | 22 | | practical, the State Comptroller shall direct and the State | 23 | | Treasurer shall transfer the sum of $601,000,000 from the | 24 | | General Revenue Fund to the Healthcare Provider Relief Fund. | 25 | | (Source: P.A. 97-44, eff. 6-28-11; 97-641, eff. 12-19-11; | 26 | | 97-689, eff. 6-14-12; 97-732, eff. 6-30-12; 98-24, eff. |
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| 1 | | 6-19-13; 98-463, eff. 8-16-13.) | 2 | | Section 15. The Illinois Public Aid Code is amended by | 3 | | changing Sections 5A-2, 5A-8, 5A-12.2, and 5A-12.5 and by | 4 | | adding Section 12-4.105 as follows: | 5 | | (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | 6 | | (Section scheduled to be repealed on July 1, 2018) | 7 | | Sec. 5A-2. Assessment.
| 8 | | (a) (1)
Subject to Sections 5A-3 and 5A-10, for State fiscal | 9 | | years 2009 through 2018, an annual assessment on inpatient | 10 | | services is imposed on each hospital provider in an amount | 11 | | equal to $218.38 multiplied by the difference of the hospital's | 12 | | occupied bed days less the hospital's Medicare bed days, | 13 | | provided, however, that the amount of $218.38 shall be | 14 | | increased by a uniform percentage to generate an amount equal | 15 | | to 75% of the State share of the payments authorized under | 16 | | Section 5A-12.5 Section 12-5 , with such increase only taking | 17 | | effect upon the date that a State share for such payments is | 18 | | required under federal law. For the period of April through | 19 | | June 2015, the amount of $218.38 used to calculate the | 20 | | assessment under this paragraph shall, by emergency rule under | 21 | | subsection (s) of Section 5-45 of the Illinois Administrative | 22 | | Procedure Act, be increased by a uniform percentage to generate | 23 | | $20,250,000 in the aggregate for that period from all hospitals | 24 | | subject to the 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 $218.38 | 5 | | shall be increased by a uniform percentage to generate an | 6 | | amount equal to 75% of the ACA Assessment Adjustment, as | 7 | | defined in subsection (b-6) of this Section. | 8 | | For State fiscal years 2009 through 2014 and after, a | 9 | | hospital's occupied bed days and Medicare bed days shall be | 10 | | determined using the most recent data available from each | 11 | | hospital's 2005 Medicare cost report as contained in the | 12 | | Healthcare Cost Report Information System file, for the quarter | 13 | | ending on December 31, 2006, without regard to any subsequent | 14 | | adjustments or changes to such data. If a hospital's 2005 | 15 | | Medicare cost report is not contained in the Healthcare Cost | 16 | | Report Information System, then the Illinois Department may | 17 | | obtain the hospital provider's occupied bed days and Medicare | 18 | | bed days from any source available, including, but not limited | 19 | | to, records maintained by the hospital provider, which may be | 20 | | inspected at all times during business hours of the day by the | 21 | | Illinois Department or its duly authorized agents and | 22 | | employees. | 23 | | (b) (Blank).
| 24 | | (b-5) (1) Subject to Sections 5A-3 and 5A-10, for the | 25 | | portion of State fiscal year 2012, beginning June 10, 2012 | 26 | | through June 30, 2012, and for State fiscal years 2013 through |
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| 1 | | 2018, an annual assessment on outpatient services is imposed on | 2 | | each hospital provider in an amount equal to .008766 multiplied | 3 | | by the hospital's outpatient gross revenue, provided, however, | 4 | | that the amount of .008766 shall be increased by a uniform | 5 | | percentage to generate an amount equal to 25% of the State | 6 | | share of the payments authorized under Section 5A-12.5 Section | 7 | | 12-5 , with such increase only taking effect upon the date that | 8 | | a State share for such payments is required under federal law. | 9 | | For the period beginning June 10, 2012 through June 30, 2012, | 10 | | the annual assessment on outpatient services shall be prorated | 11 | | by multiplying the assessment amount by a fraction, the | 12 | | numerator of which is 21 days and the denominator of which is | 13 | | 365 days. For the period of April through June 2015, the amount | 14 | | of .008766 used to calculate the assessment under this | 15 | | paragraph shall, by emergency rule under subsection (s) of | 16 | | Section 5-45 of the Illinois Administrative Procedure Act, be | 17 | | increased by a uniform percentage to generate $6,750,000 in the | 18 | | aggregate for that period from all hospitals subject to the | 19 | | annual assessment under this paragraph. | 20 | | (2) In addition to any other assessments imposed under this | 21 | | Article, effective July 1, 2016 and semi-annually thereafter | 22 | | through June 2018, in addition to any federally required State | 23 | | share as authorized under paragraph (1), the amount of .008766 | 24 | | shall be increased by a uniform percentage to generate an | 25 | | amount equal to 25% of the ACA Assessment Adjustment, as | 26 | | defined in subsection (b-6) of this Section. |
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| 1 | | For the portion of State fiscal year 2012, beginning June | 2 | | 10, 2012 through June 30, 2012, and State fiscal years 2013 | 3 | | through 2018, a hospital's outpatient gross revenue shall be | 4 | | determined using the most recent data available from each | 5 | | hospital's 2009 Medicare cost report as contained in the | 6 | | Healthcare Cost Report Information System file, for the quarter | 7 | | ending on June 30, 2011, without regard to any subsequent | 8 | | adjustments or changes to such data. If a hospital's 2009 | 9 | | Medicare cost report is not contained in the Healthcare Cost | 10 | | Report Information System, then the Department may obtain the | 11 | | hospital provider's outpatient gross revenue from any source | 12 | | available, including, but not limited to, records maintained by | 13 | | the hospital provider, which may be inspected at all times | 14 | | during business hours of the day by the Department or its duly | 15 | | authorized agents and employees. | 16 | | (b-6)(1) As used in this Section, "ACA Assessment | 17 | | Adjustment" means: | 18 | | (A) For the period of July 1, 2016 through December 31, | 19 | | 2016, the product of .19125 multiplied by the sum of the | 20 | | fee-for-service payments to hospitals as authorized under | 21 | | Section 5A-12.5 and the adjustments authorized under | 22 | | subsection (t) of Section 5A-12.2 to managed care | 23 | | organizations for hospital services due and payable in the | 24 | | month of April 2016 multiplied by 6. | 25 | | (B) For the period of January 1, 2017 through June 30, | 26 | | 2017, 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 October 2016 multiplied by 6, except that the | 6 | | amount calculated under this subparagraph (B) shall be | 7 | | adjusted, either positively or negatively, to account for | 8 | | the difference between the actual payments issued under | 9 | | Section 5A-12.5 for the period beginning July 1, 2016 | 10 | | through December 31, 2016 and the estimated payments due | 11 | | and payable in the month of April 2016 multiplied by 6 as | 12 | | described in subparagraph (A). | 13 | | (C) For the period of July 1, 2017 through December 31, | 14 | | 2017, the product of .19125 multiplied by the sum of the | 15 | | fee-for-service payments to hospitals as authorized under | 16 | | Section 5A-12.5 and the adjustments authorized under | 17 | | subsection (t) of Section 5A-12.2 to managed care | 18 | | organizations for hospital services due and payable in the | 19 | | month of April 2017 multiplied by 6, except that the amount | 20 | | calculated under this subparagraph (C) shall be adjusted, | 21 | | either positively or negatively, to account for the | 22 | | difference between the actual payments issued under | 23 | | Section 5A-12.5 for the period beginning January 1, 2017 | 24 | | through June 30, 2017 and the estimated payments due and | 25 | | payable in the month of October 2016 multiplied by 6 as | 26 | | described in subparagraph (B). |
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| 1 | | (D) For the period of January 1, 2018 through June 30, | 2 | | 2018, the product of .19125 multiplied by the sum of the | 3 | | fee-for-service payments to hospitals as authorized under | 4 | | Section 5A-12.5 and the adjustments authorized under | 5 | | subsection (t) of Section 5A-12.2 to managed care | 6 | | organizations for hospital services due and payable in the | 7 | | month of October 2017 multiplied by 6, except that: | 8 | | (i) the amount calculated under this subparagraph | 9 | | (D) shall be adjusted, either positively or | 10 | | negatively, to account for the difference between the | 11 | | actual payments issued under Section 5A-12.5 for the | 12 | | period of July 1, 2017 through December 31, 2017 and | 13 | | the estimated payments due and payable in the month of | 14 | | April 2017 multiplied by 6 as described in subparagraph | 15 | | (C); and | 16 | | (ii) the amount calculated under this subparagraph | 17 | | (D) shall be adjusted to include the product of .19125 | 18 | | multiplied by the sum of the fee-for-service payments, | 19 | | if any, estimated to be paid to hospitals under | 20 | | subsection (b) of Section 5A-12.5. | 21 | | (2) The Department shall complete and apply a final | 22 | | reconciliation of the ACA Assessment Adjustment prior to June | 23 | | 30, 2018 to account for: | 24 | | (A) any differences between the actual payments issued | 25 | | or scheduled to be issued prior to June 30, 2018 as | 26 | | authorized in Section 5A-12.5 for the period of January 1, |
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| 1 | | 2018 through June 30, 2018 and the estimated payments due | 2 | | and payable in the month of October 2017 multiplied by 6 as | 3 | | described in subparagraph (D); and | 4 | | (B) any difference between the estimated | 5 | | fee-for-service payments under subsection (b) of Section | 6 | | 5A-12.5 and the amount of such payments that are actually | 7 | | scheduled to be paid. | 8 | | The Department shall notify hospitals of any additional | 9 | | amounts owed or reduction credits to be applied to the June | 10 | | 2018 ACA Assessment Adjustment. This is to be considered the | 11 | | final reconciliation for the ACA Assessment Adjustment. | 12 | | (3) Notwithstanding any other provision of this Section, if | 13 | | for any reason the scheduled payments under subsection (b) of | 14 | | Section 5A-12.5 are not issued in full by the final day of the | 15 | | period authorized under subsection (b) of Section 5A-12.5, | 16 | | funds collected from each hospital pursuant to subparagraph (D) | 17 | | of paragraph (1) and pursuant to paragraph (2), attributable to | 18 | | the scheduled payments authorized under subsection (b) of | 19 | | Section 5A-12.5 that are not issued in full by the final day of | 20 | | the period attributable to each payment authorized under | 21 | | subsection (b) of Section 5A-12.5, shall be refunded. | 22 | | (4) The increases authorized under paragraph (2) of | 23 | | subsection (a) and paragraph (2) of subsection (b-5) shall be | 24 | | limited to the federally required State share of the total | 25 | | payments authorized under Section 5A-12.5 if the sum of such | 26 | | payments yields an annualized amount equal to or less than |
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| 1 | | $450,000,000, or if the adjustments authorized under | 2 | | subsection (t) of Section 5A-12.2 are found not to be | 3 | | actuarially sound; however, this limitation shall not apply to | 4 | | the fee-for-service payments described in subsection (b) of | 5 | | Section 5A-12.5. | 6 | | (c) (Blank).
| 7 | | (d) Notwithstanding any of the other provisions of this | 8 | | Section, the Department is authorized to adopt rules to reduce | 9 | | the rate of any annual assessment imposed under this Section, | 10 | | as authorized by Section 5-46.2 of the Illinois Administrative | 11 | | Procedure Act.
| 12 | | (e) Notwithstanding any other provision of this Section, | 13 | | any plan providing for an assessment on a hospital provider as | 14 | | a permissible tax under Title XIX of the federal Social | 15 | | Security Act and Medicaid-eligible payments to hospital | 16 | | providers from the revenues derived from that assessment shall | 17 | | be reviewed by the Illinois Department of Healthcare and Family | 18 | | Services, as the Single State Medicaid Agency required by | 19 | | federal law, to determine whether those assessments and | 20 | | hospital provider payments meet federal Medicaid standards. If | 21 | | the Department determines that the elements of the plan may | 22 | | meet federal Medicaid standards and a related State Medicaid | 23 | | Plan Amendment is prepared in a manner and form suitable for | 24 | | submission, that State Plan Amendment shall be submitted in a | 25 | | timely manner for review by the Centers for Medicare and | 26 | | Medicaid Services of the United States Department of Health and |
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| 1 | | Human Services and subject to approval by the Centers for | 2 | | Medicare and Medicaid Services of the United States Department | 3 | | of Health and Human Services. No such plan shall become | 4 | | effective without approval by the Illinois General Assembly by | 5 | | the enactment into law of related legislation. Notwithstanding | 6 | | any other provision of this Section, the Department is | 7 | | authorized to adopt rules to reduce the rate of any annual | 8 | | assessment imposed under this Section. Any such rules may be | 9 | | adopted by the Department under Section 5-50 of the Illinois | 10 | | Administrative Procedure Act. | 11 | | (Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2, | 12 | | eff. 3-26-15.)
| 13 | | (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
| 14 | | Sec. 5A-8. Hospital Provider Fund.
| 15 | | (a) There is created in the State Treasury the Hospital | 16 | | Provider Fund.
Interest earned by the Fund shall be credited to | 17 | | the Fund. The
Fund shall not be used to replace any moneys | 18 | | appropriated to the
Medicaid program by the General Assembly.
| 19 | | (b) The Fund is created for the purpose of receiving moneys
| 20 | | in accordance with Section 5A-6 and disbursing moneys only for | 21 | | the following
purposes, notwithstanding any other provision of | 22 | | law:
| 23 | | (1) For making payments to hospitals as required under | 24 | | this Code, under the Children's Health Insurance Program | 25 | | Act, under the Covering ALL KIDS Health Insurance Act, and |
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| 1 | | under the Long Term Acute Care Hospital Quality Improvement | 2 | | Transfer Program Act.
| 3 | | (2) For the reimbursement of moneys collected by the
| 4 | | Illinois Department from hospitals or hospital providers | 5 | | through error or
mistake in performing the
activities | 6 | | authorized under this Code.
| 7 | | (3) For payment of administrative expenses incurred by | 8 | | the
Illinois Department or its agent in performing | 9 | | activities
under this Code, under the Children's Health | 10 | | Insurance Program Act, under the Covering ALL KIDS Health | 11 | | Insurance Act, and under the Long Term Acute Care Hospital | 12 | | Quality Improvement Transfer Program Act.
| 13 | | (4) For payments of any amounts which are reimbursable | 14 | | to
the federal government for payments from this Fund which | 15 | | are
required to be paid by State warrant.
| 16 | | (5) For making transfers, as those transfers are | 17 | | authorized
in the proceedings authorizing debt under the | 18 | | Short Term Borrowing Act,
but transfers made under this | 19 | | paragraph (5) shall not exceed the
principal amount of debt | 20 | | issued in anticipation of the receipt by
the State of | 21 | | moneys to be deposited into the Fund.
| 22 | | (6) For making transfers to any other fund in the State | 23 | | treasury, but
transfers made under this paragraph (6) shall | 24 | | not exceed the amount transferred
previously from that | 25 | | other fund into the Hospital Provider Fund plus any | 26 | | interest that would have been earned by that fund on the |
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| 1 | | monies that had been transferred.
| 2 | | (6.5) For making transfers to the Healthcare Provider | 3 | | Relief Fund, except that transfers made under this | 4 | | paragraph (6.5) shall not exceed $60,000,000 in the | 5 | | aggregate. | 6 | | (7) For making transfers not exceeding the following | 7 | | amounts, related to State fiscal years 2013 through 2018, | 8 | | to the following designated funds: | 9 | | Health and Human Services Medicaid Trust | 10 | | Fund ..............................$20,000,000 | 11 | | Long-Term Care Provider Fund ..........$30,000,000 | 12 | | General Revenue Fund .................$80,000,000. | 13 | | Transfers under this paragraph shall be made within 7 days | 14 | | after the payments have been received pursuant to the | 15 | | schedule of payments provided in subsection (a) of Section | 16 | | 5A-4. | 17 | | (7.1) (Blank).
| 18 | | (7.5) (Blank). | 19 | | (7.8) (Blank). | 20 | | (7.9) (Blank). | 21 | | (7.10) For State fiscal year 2014, for making transfers | 22 | | of the moneys resulting from the assessment under | 23 | | subsection (b-5) of Section 5A-2 and received from hospital | 24 | | providers under Section 5A-4 and transferred into the | 25 | | Hospital Provider Fund under Section 5A-6 to the designated | 26 | | funds not exceeding the following amounts in that State |
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| 1 | | fiscal year: | 2 | | Health Care Provider Relief Fund .....$100,000,000 | 3 | | Transfers under this paragraph shall be made within 7 | 4 | | days after the payments have been received pursuant to the | 5 | | schedule of payments provided in subsection (a) of Section | 6 | | 5A-4. | 7 | | The additional amount of transfers in this paragraph | 8 | | (7.10), authorized by Public Act 98-651, shall be made | 9 | | within 10 State business days after June 16, 2014 (the | 10 | | effective date of Public Act 98-651). That authority shall | 11 | | remain in effect even if Public Act 98-651 does not become | 12 | | law until State fiscal year 2015. | 13 | | (7.10a) For State fiscal years 2015 through 2018, for | 14 | | making transfers of the moneys resulting from the | 15 | | assessment under subsection (b-5) of Section 5A-2 and | 16 | | received from hospital providers under Section 5A-4 and | 17 | | transferred into the Hospital Provider Fund under Section | 18 | | 5A-6 to the designated funds not exceeding the following | 19 | | amounts related to each State fiscal year: | 20 | | Health Care Provider Relief Fund ....$50,000,000 | 21 | | Transfers under this paragraph shall be made within 7 | 22 | | days after the payments have been received pursuant to the | 23 | | schedule of payments provided in subsection (a) of Section | 24 | | 5A-4. | 25 | | (7.11) (Blank). | 26 | | (7.12) For State fiscal year 2013, for increasing by |
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| 1 | | 21/365ths the transfer of the moneys resulting from the | 2 | | assessment under subsection (b-5) of Section 5A-2 and | 3 | | received from hospital providers under Section 5A-4 for the | 4 | | portion of State fiscal year 2012 beginning June 10, 2012 | 5 | | through June 30, 2012 and transferred into the Hospital | 6 | | Provider Fund under Section 5A-6 to the designated funds | 7 | | not exceeding the following amounts in that State fiscal | 8 | | year: | 9 | | Health Care Provider Relief Fund ......$2,870,000 | 10 | | Since the federal Centers for Medicare and Medicaid | 11 | | Services approval of the assessment authorized under | 12 | | subsection (b-5) of Section 5A-2, received from hospital | 13 | | providers under Section 5A-4 and the payment methodologies | 14 | | to hospitals required under Section 5A-12.4 was not | 15 | | received by the Department until State fiscal year 2014 and | 16 | | since the Department made retroactive payments during | 17 | | State fiscal year 2014 related to the referenced period of | 18 | | June 2012, the transfer authority granted in this paragraph | 19 | | (7.12) is extended through the date that is 10 State | 20 | | business days after June 16, 2014 (the effective date of | 21 | | Public Act 98-651). | 22 | | (7.13) In addition to any other transfers authorized | 23 | | under this Section, for State fiscal years 2017 and 2018, | 24 | | for making transfers to the Healthcare Provider Relief Fund | 25 | | of moneys collected from the ACA Assessment Adjustment | 26 | | authorized under subsections (a) and (b-5) of Section 5A-2 |
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| 1 | | and paid by hospital providers under Section 5A-4 into the | 2 | | Hospital Provider Fund under Section 5A-6 for each State | 3 | | fiscal year. Timing of transfers to the Healthcare Provider | 4 | | Relief Fund under this paragraph shall be at the discretion | 5 | | of the Department, but no less frequently than quarterly. | 6 | | (8) For making refunds to hospital providers pursuant | 7 | | to Section 5A-10.
| 8 | | (9) For making payment to capitated managed care | 9 | | organizations as described in subsections (s) and (t) of | 10 | | Section 5A-12.2 of this Code. | 11 | | Disbursements from the Fund, other than transfers | 12 | | authorized under
paragraphs (5) and (6) of this subsection, | 13 | | shall be by
warrants drawn by the State Comptroller upon | 14 | | receipt of vouchers
duly executed and certified by the Illinois | 15 | | Department.
| 16 | | (c) The Fund shall consist of the following:
| 17 | | (1) All moneys collected or received by the Illinois
| 18 | | Department from the hospital provider assessment imposed | 19 | | by this
Article.
| 20 | | (2) All federal matching funds received by the Illinois
| 21 | | Department as a result of expenditures made by the Illinois
| 22 | | Department that are attributable to moneys deposited in the | 23 | | Fund.
| 24 | | (3) Any interest or penalty levied in conjunction with | 25 | | the
administration of this Article.
| 26 | | (3.5) As applicable, proceeds from surety bond |
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| 1 | | payments payable to the Department as referenced in | 2 | | subsection (s) of Section 5A-12.2 of this Code. | 3 | | (4) Moneys transferred from another fund in the State | 4 | | treasury.
| 5 | | (5) All other moneys received for the Fund from any | 6 | | other
source, including interest earned thereon.
| 7 | | (d) (Blank).
| 8 | | (Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13; | 9 | | 98-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff. | 10 | | 7-20-15.)
| 11 | | (305 ILCS 5/5A-12.2) | 12 | | (Section scheduled to be repealed on July 1, 2018) | 13 | | Sec. 5A-12.2. Hospital access payments on or after July 1, | 14 | | 2008. | 15 | | (a) To preserve and improve access to hospital services, | 16 | | for hospital services rendered on or after July 1, 2008, the | 17 | | Illinois Department shall, except for hospitals described in | 18 | | subsection (b) of Section 5A-3, make payments to hospitals as | 19 | | set forth in this Section. These payments shall be paid in 12 | 20 | | equal installments on or before the seventh State business day | 21 | | of each month, except that no payment shall be due within 100 | 22 | | days after the later of the date of notification of federal | 23 | | approval of the payment methodologies required under this | 24 | | Section or any waiver required under 42 CFR 433.68, at which | 25 | | time the sum of amounts required under this Section prior to |
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| 1 | | the date of notification is due and payable. Payments under | 2 | | this Section are not due and payable, however, until (i) the | 3 | | methodologies described in this Section are approved by the | 4 | | federal government in an appropriate State Plan amendment and | 5 | | (ii) the assessment imposed under this Article is determined to | 6 | | be a permissible tax under Title XIX of the Social Security | 7 | | Act. | 8 | | (a-5) The Illinois Department may, when practicable, | 9 | | accelerate the schedule upon which payments authorized under | 10 | | this Section are made. | 11 | | (b) Across-the-board inpatient adjustment. | 12 | | (1) In addition to rates paid for inpatient hospital | 13 | | services, the Department shall pay to each Illinois general | 14 | | acute care hospital an amount equal to 40% of the total | 15 | | base inpatient payments paid to the hospital for services | 16 | | provided in State fiscal year 2005. | 17 | | (2) In addition to rates paid for inpatient hospital | 18 | | services, the Department shall pay to each freestanding | 19 | | Illinois specialty care hospital as defined in 89 Ill. Adm. | 20 | | Code 149.50(c)(1), (2), or (4) an amount equal to 60% of | 21 | | the total base inpatient payments paid to the hospital for | 22 | | services provided in State fiscal year 2005. | 23 | | (3) In addition to rates paid for inpatient hospital | 24 | | services, the Department shall pay to each freestanding | 25 | | Illinois rehabilitation or psychiatric hospital an amount | 26 | | equal to $1,000 per Medicaid inpatient day multiplied by |
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| 1 | | the increase in the hospital's Medicaid inpatient | 2 | | utilization ratio (determined using the positive | 3 | | percentage change from the rate year 2005 Medicaid | 4 | | inpatient utilization ratio to the rate year 2007 Medicaid | 5 | | inpatient utilization ratio, as calculated by the | 6 | | Department for the disproportionate share determination). | 7 | | (4) In addition to rates paid for inpatient hospital | 8 | | services, the Department shall pay to each Illinois | 9 | | children's hospital an amount equal to 20% of the total | 10 | | base inpatient payments paid to the hospital for services | 11 | | provided in State fiscal year 2005 and an additional amount | 12 | | equal to 20% of the base inpatient payments paid to the | 13 | | hospital for psychiatric services provided in State fiscal | 14 | | year 2005. | 15 | | (5) In addition to rates paid for inpatient hospital | 16 | | services, the Department shall pay to each Illinois | 17 | | hospital eligible for a pediatric inpatient adjustment | 18 | | payment under 89 Ill. Adm. Code 148.298, as in effect for | 19 | | State fiscal year 2007, a supplemental pediatric inpatient | 20 | | adjustment payment equal to: | 21 | | (i) For freestanding children's hospitals as | 22 | | defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5 | 23 | | multiplied by the hospital's pediatric inpatient | 24 | | adjustment payment required under 89 Ill. Adm. Code | 25 | | 148.298, as in effect for State fiscal year 2008. | 26 | | (ii) For hospitals other than freestanding |
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| 1 | | children's hospitals as defined in 89 Ill. Adm. Code | 2 | | 149.50(c)(3)(B), 1.0 multiplied by the hospital's | 3 | | pediatric inpatient adjustment payment required under | 4 | | 89 Ill. Adm. Code 148.298, as in effect for State | 5 | | fiscal year 2008. | 6 | | (c) Outpatient adjustment. | 7 | | (1) In addition to the rates paid for outpatient | 8 | | hospital services, the Department shall pay each Illinois | 9 | | hospital an amount equal to 2.2 multiplied by the | 10 | | hospital's ambulatory procedure listing payments for | 11 | | categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code | 12 | | 148.140(b), for State fiscal year 2005. | 13 | | (2) In addition to the rates paid for outpatient | 14 | | hospital services, the Department shall pay each Illinois | 15 | | freestanding psychiatric hospital an amount equal to 3.25 | 16 | | multiplied by the hospital's ambulatory procedure listing | 17 | | payments for category 5b, as defined in 89 Ill. Adm. Code | 18 | | 148.140(b)(1)(E), for State fiscal year 2005. | 19 | | (d) Medicaid high volume adjustment. In addition to rates | 20 | | paid for inpatient hospital services, the Department shall pay | 21 | | to each Illinois general acute care hospital that provided more | 22 | | than 20,500 Medicaid inpatient days of care in State fiscal | 23 | | year 2005 amounts as follows: | 24 | | (1) For hospitals with a case mix index equal to or | 25 | | greater than the 85th percentile of hospital case mix | 26 | | indices, $350 for each Medicaid inpatient day of care |
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| 1 | | provided during that period; and | 2 | | (2) For hospitals with a case mix index less than the | 3 | | 85th percentile of hospital case mix indices, $100 for each | 4 | | Medicaid inpatient day of care provided during that period. | 5 | | (e) Capital adjustment. In addition to rates paid for | 6 | | inpatient hospital services, the Department shall pay an | 7 | | additional payment to each Illinois general acute care hospital | 8 | | that has a Medicaid inpatient utilization rate of at least 10% | 9 | | (as calculated by the Department for the rate year 2007 | 10 | | disproportionate share determination) amounts as follows: | 11 | | (1) For each Illinois general acute care hospital that | 12 | | has a Medicaid inpatient utilization rate of at least 10% | 13 | | and less than 36.94% and whose capital cost is less than | 14 | | the 60th percentile of the capital costs of all Illinois | 15 | | hospitals, the amount of such payment shall equal the | 16 | | hospital's Medicaid inpatient days multiplied by the | 17 | | difference between the capital costs at the 60th percentile | 18 | | of the capital costs of all Illinois hospitals and the | 19 | | hospital's capital costs. | 20 | | (2) For each Illinois general acute care hospital that | 21 | | has a Medicaid inpatient utilization rate of at least | 22 | | 36.94% and whose capital cost is less than the 75th | 23 | | percentile of the capital costs of all Illinois hospitals, | 24 | | the amount of such payment shall equal the hospital's | 25 | | Medicaid inpatient days multiplied by the difference | 26 | | between the capital costs at the 75th percentile of the |
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| 1 | | capital costs of all Illinois hospitals and the hospital's | 2 | | capital costs. | 3 | | (f) Obstetrical care adjustment. | 4 | | (1) In addition to rates paid for inpatient hospital | 5 | | services, the Department shall pay $1,500 for each Medicaid | 6 | | obstetrical day of care provided in State fiscal year 2005 | 7 | | by each Illinois rural hospital that had a Medicaid | 8 | | obstetrical percentage (Medicaid obstetrical days divided | 9 | | by Medicaid inpatient days) greater than 15% for State | 10 | | fiscal year 2005. | 11 | | (2) In addition to rates paid for inpatient hospital | 12 | | services, the Department shall pay $1,350 for each Medicaid | 13 | | obstetrical day of care provided in State fiscal year 2005 | 14 | | by each Illinois general acute care hospital that was | 15 | | designated a level III perinatal center as of December 31, | 16 | | 2006, and that had a case mix index equal to or greater | 17 | | than the 45th percentile of the case mix indices for all | 18 | | level III perinatal centers. | 19 | | (3) In addition to rates paid for inpatient hospital | 20 | | services, the Department shall pay $900 for each Medicaid | 21 | | obstetrical day of care provided in State fiscal year 2005 | 22 | | by each Illinois general acute care hospital that was | 23 | | designated a level II or II+ perinatal center as of | 24 | | December 31, 2006, and that had a case mix index equal to | 25 | | or greater than the 35th percentile of the case mix indices | 26 | | for all level II and II+ perinatal centers. |
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| 1 | | (g) Trauma adjustment. | 2 | | (1) In addition to rates paid for inpatient hospital | 3 | | services, the Department shall pay each Illinois general | 4 | | acute care hospital designated as a trauma center as of | 5 | | July 1, 2007, a payment equal to 3.75 multiplied by the | 6 | | hospital's State fiscal year 2005 Medicaid capital | 7 | | payments. | 8 | | (2) In addition to rates paid for inpatient hospital | 9 | | services, the Department shall pay $400 for each Medicaid | 10 | | acute inpatient day of care provided in State fiscal year | 11 | | 2005 by each Illinois general acute care hospital that was | 12 | | designated a level II trauma center, as defined in 89 Ill. | 13 | | Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1, | 14 | | 2007. | 15 | | (3) In addition to rates paid for inpatient hospital | 16 | | services, the Department shall pay $235 for each Illinois | 17 | | Medicaid acute inpatient day of care provided in State | 18 | | fiscal year 2005 by each level I pediatric trauma center | 19 | | located outside of Illinois that had more than 8,000 | 20 | | Illinois Medicaid inpatient days in State fiscal year 2005. | 21 | | (h) Supplemental tertiary care adjustment. In addition to | 22 | | rates paid for inpatient services, the Department shall pay to | 23 | | each Illinois hospital eligible for tertiary care adjustment | 24 | | payments under 89 Ill. Adm. Code 148.296, as in effect for | 25 | | State fiscal year 2007, a supplemental tertiary care adjustment | 26 | | payment equal to the tertiary care adjustment payment required |
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| 1 | | under 89 Ill. Adm. Code 148.296, as in effect for State fiscal | 2 | | year 2007. | 3 | | (i) Crossover adjustment. In addition to rates paid for | 4 | | inpatient services, the Department shall pay each Illinois | 5 | | general acute care hospital that had a ratio of crossover days | 6 | | to total inpatient days for medical assistance programs | 7 | | administered by the Department (utilizing information from | 8 | | 2005 paid claims) greater than 50%, and a case mix index | 9 | | greater than the 65th percentile of case mix indices for all | 10 | | Illinois hospitals, a rate of $1,125 for each Medicaid | 11 | | inpatient day including crossover days. | 12 | | (j) Magnet hospital adjustment. In addition to rates paid | 13 | | for inpatient hospital services, the Department shall pay to | 14 | | each Illinois general acute care hospital and each Illinois | 15 | | freestanding children's hospital that, as of February 1, 2008, | 16 | | was recognized as a Magnet hospital by the American Nurses | 17 | | Credentialing Center and that had a case mix index greater than | 18 | | the 75th percentile of case mix indices for all Illinois | 19 | | hospitals amounts as follows: | 20 | | (1) For hospitals located in a county whose eligibility | 21 | | growth factor is greater than the mean, $450 multiplied by | 22 | | the eligibility growth factor for the county in which the | 23 | | hospital is located for each Medicaid inpatient day of care | 24 | | provided by the hospital during State fiscal year 2005. | 25 | | (2) For hospitals located in a county whose eligibility | 26 | | growth factor is less than or equal to the mean, $225 |
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| 1 | | multiplied by the eligibility growth factor for the county | 2 | | in which the hospital is located for each Medicaid | 3 | | inpatient day of care provided by the hospital during State | 4 | | fiscal year 2005. | 5 | | For purposes of this subsection, "eligibility growth | 6 | | factor" means the percentage by which the number of Medicaid | 7 | | recipients in the county increased from State fiscal year 1998 | 8 | | to State fiscal year 2005. | 9 | | (k) For purposes of this Section, a hospital that is | 10 | | enrolled to provide Medicaid services during State fiscal year | 11 | | 2005 shall have its utilization and associated reimbursements | 12 | | annualized prior to the payment calculations being performed | 13 | | under this Section. | 14 | | (l) For purposes of this Section, the terms "Medicaid | 15 | | days", "ambulatory procedure listing services", and | 16 | | "ambulatory procedure listing payments" do not include any | 17 | | days, charges, or services for which Medicare or a managed care | 18 | | organization reimbursed on a capitated basis was liable for | 19 | | payment, except where explicitly stated otherwise in this | 20 | | Section. | 21 | | (m) For purposes of this Section, in determining the | 22 | | percentile ranking of an Illinois hospital's case mix index or | 23 | | capital costs, hospitals described in subsection (b) of Section | 24 | | 5A-3 shall be excluded from the ranking. | 25 | | (n) Definitions. Unless the context requires otherwise or | 26 | | unless provided otherwise in this Section, the terms used in |
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| 1 | | this Section for qualifying criteria and payment calculations | 2 | | shall have the same meanings as those terms have been given in | 3 | | the Illinois Department's administrative rules as in effect on | 4 | | March 1, 2008. Other terms shall be defined by the Illinois | 5 | | Department by rule. | 6 | | As used in this Section, unless the context requires | 7 | | otherwise: | 8 | | "Base inpatient payments" means, for a given hospital, the | 9 | | sum of base payments for inpatient services made on a per diem | 10 | | or per admission (DRG) basis, excluding those portions of per | 11 | | admission payments that are classified as capital payments. | 12 | | Disproportionate share hospital adjustment payments, Medicaid | 13 | | Percentage Adjustments, Medicaid High Volume Adjustments, and | 14 | | outlier payments, as defined by rule by the Department as of | 15 | | January 1, 2008, are not base payments. | 16 | | "Capital costs" means, for a given hospital, the total | 17 | | capital costs determined using the most recent 2005 Medicare | 18 | | cost report as contained in the Healthcare Cost Report | 19 | | Information System file, for the quarter ending on December 31, | 20 | | 2006, divided by the total inpatient days from the same cost | 21 | | report to calculate a capital cost per day. The resulting | 22 | | capital cost per day is inflated to the midpoint of State | 23 | | fiscal year 2009 utilizing the national hospital market price | 24 | | proxies (DRI) hospital cost index. If a hospital's 2005 | 25 | | Medicare cost report is not contained in the Healthcare Cost | 26 | | Report Information System, the Department may obtain the data |
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| 1 | | necessary to compute the hospital's capital costs from any | 2 | | source available, including, but not limited to, records | 3 | | maintained by the hospital provider, which may be inspected at | 4 | | all times during business hours of the day by the Illinois | 5 | | Department or its duly authorized agents and employees. | 6 | | "Case mix index" means, for a given hospital, the sum of | 7 | | the DRG relative weighting factors in effect on January 1, | 8 | | 2005, for all general acute care admissions for State fiscal | 9 | | year 2005, excluding Medicare crossover admissions and | 10 | | transplant admissions reimbursed under 89 Ill. Adm. Code | 11 | | 148.82, divided by the total number of general acute care | 12 | | admissions for State fiscal year 2005, excluding Medicare | 13 | | crossover admissions and transplant admissions reimbursed | 14 | | under 89 Ill. Adm. Code 148.82. | 15 | | "Medicaid inpatient day" means, for a given hospital, the | 16 | | sum of days of inpatient hospital days provided to recipients | 17 | | of medical assistance under Title XIX of the federal Social | 18 | | Security Act, excluding days for individuals eligible for | 19 | | Medicare under Title XVIII of that Act (Medicaid/Medicare | 20 | | crossover days), as tabulated from the Department's paid claims | 21 | | data for admissions occurring during State fiscal year 2005 | 22 | | that was adjudicated by the Department through March 23, 2007. | 23 | | "Medicaid obstetrical day" means, for a given hospital, the | 24 | | sum of days of inpatient hospital days grouped by the | 25 | | Department to DRGs of 370 through 375 provided to recipients of | 26 | | medical assistance under Title XIX of the federal Social |
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| 1 | | Security Act, excluding days for individuals eligible for | 2 | | Medicare under Title XVIII of that Act (Medicaid/Medicare | 3 | | crossover days), as tabulated from the Department's paid claims | 4 | | data for admissions occurring during State fiscal year 2005 | 5 | | that was adjudicated by the Department through March 23, 2007. | 6 | | "Outpatient ambulatory procedure listing payments" means, | 7 | | for a given hospital, the sum of payments for ambulatory | 8 | | procedure listing services, as described in 89 Ill. Adm. Code | 9 | | 148.140(b), provided to recipients of medical assistance under | 10 | | Title XIX of the federal Social Security Act, excluding | 11 | | payments for individuals eligible for Medicare under Title | 12 | | XVIII of the Act (Medicaid/Medicare crossover days), as | 13 | | tabulated from the Department's paid claims data for services | 14 | | occurring in State fiscal year 2005 that were adjudicated by | 15 | | the Department through March 23, 2007. | 16 | | (o) The Department may adjust payments made under this | 17 | | Section 5A-12.2 to comply with federal law or regulations | 18 | | regarding hospital-specific payment limitations on | 19 | | government-owned or government-operated hospitals. | 20 | | (p) Notwithstanding any of the other provisions of this | 21 | | Section, the Department is authorized to adopt rules that | 22 | | change the hospital access improvement payments specified in | 23 | | this Section, but only to the extent necessary to conform to | 24 | | any federally approved amendment to the Title XIX State plan. | 25 | | Any such rules shall be adopted by the Department as authorized | 26 | | by Section 5-50 of the Illinois Administrative Procedure Act. |
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| 1 | | Notwithstanding any other provision of law, any changes | 2 | | implemented as a result of this subsection (p) shall be given | 3 | | retroactive effect so that they shall be deemed to have taken | 4 | | effect as of the effective date of this Section. | 5 | | (q) (Blank). | 6 | | (r) On and after July 1, 2012, the Department shall reduce | 7 | | any rate of reimbursement for services or other payments or | 8 | | alter any methodologies authorized by this Code to reduce any | 9 | | rate of reimbursement for services or other payments in | 10 | | accordance with Section 5-5e. | 11 | | (s) On or after January 1, 2016 July 1, 2014, but no later | 12 | | than October 1, 2014 , and no less than annually thereafter, the | 13 | | Department shall may increase capitation payments to capitated | 14 | | managed care organizations (MCOs) to equal the aggregate | 15 | | reduction of payments made in this Section and in Section | 16 | | 5A-12.4 by a uniform percentage on a regional basis to preserve | 17 | | access to hospital services for recipients under the Illinois | 18 | | Medical Assistance Program. The aggregate amount of all | 19 | | increased capitation payments to all MCOs for a fiscal year | 20 | | shall be the amount needed to avoid reduction in payments | 21 | | authorized under Section 5A-15. Payments to MCOs under this | 22 | | Section shall be consistent with actuarial certification and | 23 | | shall be published by the Department each year. Each MCO shall | 24 | | only expend the increased capitation payments it receives under | 25 | | this Section to support the availability of hospital services | 26 | | and to ensure access to hospital services, with such |
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| 1 | | expenditures being made within 15 calendar days from when the | 2 | | MCO receives the increased capitation payment. The Department | 3 | | shall make available, on a monthly basis, a report of the | 4 | | capitation payments that are made to each MCO pursuant to this | 5 | | subsection, including the number of enrollees for which such | 6 | | payment is made, the per enrollee amount of the payment, and | 7 | | any adjustments that have been made. Payments made under this | 8 | | subsection shall be guaranteed by a surety bond obtained by the | 9 | | MCO in an amount established by the Department to approximate | 10 | | one month's liability of payments authorized under this | 11 | | subsection. The Department may advance the payments guaranteed | 12 | | by the surety bond. Payments to MCOs that would be paid | 13 | | consistent with actuarial certification and enrollment in the | 14 | | absence of the increased capitation payments under this Section | 15 | | shall not be reduced as a consequence of payments made under | 16 | | this subsection. | 17 | | As used in this subsection, "MCO" means an entity which | 18 | | contracts with the Department to provide services where payment | 19 | | for medical services is made on a capitated basis. | 20 | | (t) On or after July 1, 2014, the Department may increase | 21 | | capitation payments to capitated managed care organizations | 22 | | (MCOs) to equal the aggregate reduction of payments made in | 23 | | Section 5A-12.5 to preserve access to hospital services for | 24 | | recipients under the Illinois Medical Assistance Program. | 25 | | Effective January 1, 2016, the Department shall increase | 26 | | capitation payments to MCOs to include the payments authorized |
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| 1 | | under Section 5A-12.5 to preserve access to hospital services | 2 | | for recipients under the Illinois Medical Assistance Program by | 3 | | ensuring that the reimbursement provided for Affordable Care | 4 | | Act adults enrolled in a MCO is equivalent to the reimbursement | 5 | | provided for Affordable Care Act adults enrolled in a | 6 | | fee-for-service program. Payments to MCOs under this Section | 7 | | shall be consistent with actuarial certification and federal | 8 | | approval (which may be retrospectively determined) and shall be | 9 | | published by the Department each year. Each MCO shall only | 10 | | expend the increased capitation payments it receives under this | 11 | | Section to support the availability of hospital services and to | 12 | | ensure access to hospital services, with such expenditures | 13 | | being made within 15 calendar days from when the MCO receives | 14 | | the increased capitation payment. Payments made under this | 15 | | subsection may 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 to | 19 | | hospitals under this subsection, in the event the MCO fails to | 20 | | make such payments. The Department shall make available, on a | 21 | | monthly basis, a report of the capitation payments that are | 22 | | made to each MCO pursuant to this subsection, including the | 23 | | number of enrollees for which such payment is made, the per | 24 | | enrollee amount of the payment, and any adjustments that have | 25 | | been made. Payments to MCOs that would be paid consistent with | 26 | | actuarial certification and enrollment in the absence of the |
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| 1 | | increased capitation payments under this subsection shall not | 2 | | be reduced as a consequence of payments made under this | 3 | | subsection. | 4 | | As used in this subsection, "MCO" means an entity which | 5 | | contracts with the Department to provide services where payment | 6 | | for medical services is made on a capitated basis. | 7 | | (Source: P.A. 97-689, eff. 6-14-12; 98-651, eff. 6-16-14.) | 8 | | (305 ILCS 5/5A-12.5) | 9 | | Sec. 5A-12.5. Affordable Care Act adults; hospital access | 10 | | payments. | 11 | | (a) The Department shall, subject to federal approval, | 12 | | mirror the Medical Assistance hospital reimbursement | 13 | | methodology for Affordable Care Act adults who are enrolled | 14 | | under a fee-for-service or capitated managed care program , | 15 | | including hospital access payments as defined in Section | 16 | | 5A-12.2 of this Article and hospital access improvement | 17 | | payments as defined in Section 5A-12.4 of this Article, in | 18 | | compliance with the equivalent rate provisions of the | 19 | | Affordable Care Act. | 20 | | (b) If the fee-for-service payments authorized under this | 21 | | Section are deemed to be increases to payments for a prior | 22 | | period, the Department shall seek federal approval to issue | 23 | | such increases for the payments made through the period ending | 24 | | on June 30, 2018, even if such increases are paid out during an | 25 | | extended payment period beyond such date. Payment of such |
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| 1 | | increases beyond such date is subject to federal approval. | 2 | | (c) As used in this Section, "Affordable Care Act" is the | 3 | | collective term for the Patient Protection and Affordable Care | 4 | | Act (Pub. L. 111-148) and the Health Care and Education | 5 | | Reconciliation Act of 2010 (Pub. L. 111-152).
| 6 | | (Source: P.A. 98-651, eff. 6-16-14.) | 7 | | (305 ILCS 5/12-4.105 new) | 8 | | Sec. 12-4.105. Human poison control center; payment | 9 | | program. Subject to funding availability resulting from | 10 | | transfers made from the Hospital Provider Fund to the | 11 | | Healthcare Provider Relief Fund as authorized under this Code, | 12 | | for State fiscal year 2017 and State fiscal year 2018, the | 13 | | Department of Healthcare and Family Services shall pay to the | 14 | | human poison control center designated under the Poison Control | 15 | | System Act an amount of not less than $3,000,000 for each of | 16 | | those State fiscal years that the human poison control center | 17 | | is in operation. | 18 | | Section 20. The Lead Poisoning Prevention Act is amended by | 19 | | changing Section 15.1 as follows: | 20 | | (410 ILCS 45/15.1) | 21 | | Sec. 15.1. Funding. Beginning July 1, 2014 and ending June | 22 | | 30, 2015 2018 , a hospital satisfying the definition, as of July | 23 | | 1, 2014, of Section 5-5e.1 of the Illinois Public Aid Code and |
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| 1 | | located in DuPage County shall pay the sum of $2,000,000 | 2 | | annually in 4 equal quarterly installments to the human poison | 3 | | control center in existence as of July 1, 2014 and established | 4 | | under the authority of this Act.
| 5 | | (Source: P.A. 98-651, eff. 6-16-14.)
| 6 | | Section 99. Effective date. This Act takes effect upon | 7 | | becoming law.
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