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Illinois Compiled Statutes
Information maintained by the Legislative Reference Bureau Updating the database of the Illinois Compiled Statutes (ILCS) is an ongoing process. Recent laws may not yet be included in the ILCS database, but they are found on this site as Public Acts soon after they become law. For information concerning the relationship between statutes and Public Acts, refer to the Guide. Because the statute database is maintained primarily for legislative drafting purposes, statutory changes are sometimes included in the statute database before they take effect. If the source note at the end of a Section of the statutes includes a Public Act that has not yet taken effect, the version of the law that is currently in effect may have already been removed from the database and you should refer to that Public Act to see the changes made to the current law.
PUBLIC AID (305 ILCS 5/) Illinois Public Aid Code. 305 ILCS 5/5-43 (305 ILCS 5/5-43) Sec. 5-43. Supports Waiver Program for Young Adults with Developmental Disabilities. (a) The Department of Human Services' Division of Developmental Disabilities, in partnership with the Department of Healthcare and Family Services and stakeholders, shall study the development and implementation of a supports waiver program for young adults with developmental disabilities. The Division shall explore the following components of a supports waiver program to determine what is most appropriate: (1) The age of individuals to be provided services in | | (2) The number of individuals to be provided services
| | (3) The services to be provided in a waiver program.
(4) The funding to be provided to individuals within
| | (5) The transition process to the Waiver for Adults
| | with Developmental Disabilities.
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| (6) The type of home and community-based services
| | (b) The Department of Human Services and the Department of Healthcare and Family Services are authorized to adopt and implement any rules necessary to study the supports waiver program.
(c) Subject to appropriation, no later than January 1, 2024, the Department of Healthcare and Family Services shall apply to the federal Centers for Medicare and Medicaid Services for a supports waiver for young adults with developmental disabilities utilizing the information learned from the study under subsection (a).
(Source: P.A. 102-43, eff. 7-6-21.)
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305 ILCS 5/5-44
(305 ILCS 5/5-44)
Sec. 5-44. Screening, Brief Intervention, and Referral to Treatment. As used in this Section, "SBIRT" means a comprehensive, integrated, public health approach to the delivery of early intervention and treatment
services for persons who are at risk of developing substance use disorders or have substance use disorders including, but not limited to, an addiction to alcohol, opioids,
tobacco, or cannabis.
SBIRT services include all of the following: (1) Screening to quickly assess the severity of | | substance use and to identify the appropriate level of treatment.
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| (2) Brief intervention focused on increasing insight
| | and awareness regarding substance use and motivation toward behavioral change.
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| (3) Referral to treatment provided to those
| | identified as needing more extensive treatment with access to specialty care.
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| SBIRT services may include, but are not limited to, the following settings and programs: primary care centers, hospital emergency rooms, hospital in-patient units,
trauma centers, community behavioral health programs, and other community settings that provide opportunities for early intervention with at-risk substance users before more severe
consequences occur.
The Department of Healthcare and Family Services shall develop and seek federal approval of a SBIRT benefit for which
qualified providers shall be reimbursed under the medical assistance program.
In conjunction with the Department of Human Services' Division of Substance Use Prevention and Recovery, the Department of Healthcare and
Family Services may develop a methodology and reimbursement rate for SBIRT services provided by qualified providers in approved
settings.
For opioid specific SBIRT services provided in a hospital emergency department, the Department of Healthcare and
Family Services shall develop a bundled reimbursement
methodology and rate for a package of opioid treatment services, which include initiation of medication for the treatment of opioid use disorder in
the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services when necessary. This
package of opioid related services shall be billed on a separate claim and shall be reimbursed outside of the Enhanced Ambulatory Patient
Grouping system.
(Source: P.A. 102-598, eff. 1-1-22; 102-813, eff. 5-13-22.)
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305 ILCS 5/5-45 (305 ILCS 5/5-45) Sec. 5-45. Reimbursement rates; substance use disorder
treatment providers and facilities. Beginning on July 1, 2022,
the Department of Human Services' Division of Substance Use
Prevention and Recovery in conjunction with the Department of
Healthcare and Family Services, shall provide for an increase
in reimbursement rates by way of an increase to existing rates of
47% for all community-based substance use disorder treatment
services, including, but not limited to, all of the following: (1) Admission and Discharge Assessment. (2) Level 1 (Individual). (3) Level 1 (Group). (4) Level 2 (Individual). (5) Level 2 (Group). (6) Psychiatric/Diagnostic. (7) Medication Monitoring (Individual). (8) Methadone as an Adjunct to Treatment. No existing or future reimbursement rates or add-ons shall be
reduced or changed to address the rate increase proposed under this Section.
The Department of Healthcare and Family Services shall immediately,
no later than 3 months following April 19, 2022 (the effective date of Public Act 102-699),
submit any necessary application to the federal Centers for Medicare
and Medicaid Services for a waiver or State Plan amendment to implement the requirements of this Section.
Beginning in State fiscal year 2023, and every State fiscal year thereafter,
reimbursement rates for those community-based substance use disorder
treatment services shall be adjusted upward by an amount equal
to the Consumer Price Index-U from the previous year, not to
exceed 2% in any State fiscal year. If there is a decrease in
the Consumer Price Index-U, rates shall remain unchanged for
that State fiscal year. The Department of Human Services shall adopt rules,
including emergency rules under Section 5-45.1 of the Illinois
Administrative Procedure Act, to implement the provisions of
this Section. As used in this Section, "consumer price index-u"
means the index published by the Bureau of Labor Statistics of
the United States Department of Labor that measures the average
change in prices of goods and services purchased by all urban
consumers, United States city average, all items, 1982-84 =
100.
(Source: P.A. 102-699, eff. 4-19-22; 103-154, eff. 6-30-23.) |
305 ILCS 5/5-46 (305 ILCS 5/5-46) Sec. 5-46. General acute care hospitals. A general acute care hospital is authorized to file a notice with the Department of Public Health and the Health Facilities and Services Review Board to establish an acute mental illness category of service in accordance with the Illinois Health Facilities Planning Act and add authorized acute mental illness beds if the following conditions are met: (1) the general acute care hospital qualifies as a | | safety-net hospital, as defined in Section 5-5e.1, as determined by the Department of Healthcare and Family Services at the time of filing the notice or for the year immediately prior to the date of filing the notice;
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| (2) the notice seeks to establish no more than 24
| | authorized acute mental illness beds; and
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| (3) the notice seeks to reduce the number of
| | authorized beds in another category of service to offset the number of authorized acute mental illness beds.
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(Source: P.A. 102-886, eff. 5-17-22; 103-154, eff. 6-30-23.)
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305 ILCS 5/5-47 (305 ILCS 5/5-47) Sec. 5-47. Medicaid reimbursement rates; substance use disorder treatment providers and facilities. (a) Beginning on January 1, 2024, subject to federal approval, the Department of Healthcare and Family Services, in conjunction with the Department of Human Services' Division of Substance Use Prevention and Recovery, shall provide a 30% increase in reimbursement rates for all Medicaid-covered ASAM Level 3 residential/inpatient substance use disorder treatment services. No existing or future reimbursement rates or add-ons shall be reduced or changed to address this proposed rate increase. No later than 3 months after June 16, 2023 (the effective date of Public Act 103-102), the Department of Healthcare and Family Services shall submit any necessary application to the federal Centers for Medicare and Medicaid Services to implement the requirements of this Section. (a-5) Beginning in State fiscal year 2025, and every State fiscal year thereafter, reimbursement rates for licensed or certified substance use disorder treatment providers of ASAM Level 3 residential/inpatient services for persons with substance use disorders shall be adjusted upward by an amount equal to the Consumer Price Index-U from the previous year, not to exceed 2% in any State fiscal year. If there is a decrease in the Consumer Price Index-U, rates shall remain unchanged for that State fiscal year. The Department shall adopt rules, including emergency rules, in accordance with the Illinois Administrative Procedure Act, to implement the provisions of this Section. As used in this Section, "Consumer Price Index-U" means the index published by the Bureau of Labor Statistics of the United States Department of Labor that measures the average change in prices of goods and services purchased by all urban consumers, United States city average, all items, 1982-84 = 100. (b) Parity in community-based behavioral health rates; implementation plan for cost reporting. For the purpose of understanding behavioral health services cost structures and their impact on the Medical Assistance Program, the Department of Healthcare and Family Services shall engage stakeholders to develop a plan for the regular collection of cost reporting for all entity-based substance use disorder providers. Data shall be used to inform on the effectiveness and efficiency of Illinois Medicaid rates. The Department and stakeholders shall develop a plan by April 1, 2024. The Department shall engage stakeholders on implementation of the plan. The plan, at minimum, shall consider all of the following: (1) Alignment with certified community behavioral | | health clinic requirements, standards, policies, and procedures.
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| (2) Inclusion of prospective costs to measure what is
| | needed to increase services and capacity.
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| (3) Consideration of differences in collection and
| | policies based on the size of providers.
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| (4) Consideration of additional administrative time
| | (5) Goals, purposes, and usage of data collected from
| | (6) Inclusion of qualitative data in addition to
| | (7) Technical assistance for providers for completing
| | cost reports including initial training by the Department for providers.
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| (8) Implementation of a timeline which allows an
| | initial grace period for providers to adjust internal procedures and data collection.
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| Details from collected cost reports shall be made publicly available on the Department's website and costs shall be used to ensure the effectiveness and efficiency of Illinois Medicaid rates.
(c) Reporting; access to substance use disorder treatment services and recovery supports. By no later than April 1, 2024, the Department of Healthcare and Family Services, with input from the Department of Human Services' Division of Substance Use Prevention and Recovery, shall submit a report to the General Assembly regarding access to treatment services and recovery supports for persons diagnosed with a substance use disorder. The report shall include, but is not limited to, the following information:
(1) The number of providers enrolled in the Illinois
| | Medical Assistance Program certified to provide substance use disorder treatment services, aggregated by ASAM level of care, and recovery supports.
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| (2) The number of Medicaid customers in Illinois with
| | a diagnosed substance use disorder receiving substance use disorder treatment, aggregated by provider type and ASAM level of care.
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| (3) A comparison of Illinois' substance use disorder
| | licensure and certification requirements with those of comparable state Medicaid programs.
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| (4) Recommendations for and an analysis of the impact
| | of aligning reimbursement rates for outpatient substance use disorder treatment services with reimbursement rates for community-based mental health treatment services.
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| (5) Recommendations for expanding substance use
| | disorder treatment to other qualified provider entities and licensed professionals of the healing arts. The recommendations shall include an analysis of the opportunities to maximize the flexibilities permitted by the federal Centers for Medicare and Medicaid Services for expanding access to the number and types of qualified substance use disorder providers.
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| (Source: P.A. 103-102, eff. 6-16-23; 103-588, eff. 6-5-24; 103-605, eff. 7-1-24.)
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305 ILCS 5/5-48 (305 ILCS 5/5-48) Sec. 5-48. Increasing behavioral health service capacity in federally qualified health centers. The Department of Healthcare and Family Services shall develop policies and procedures with the goal of increasing the capacity of behavioral health services provided by federally qualified health centers as defined in Section 1905(l)(2)(B) of the federal Social Security Act. Subject to federal approval, the Department shall develop, no later than January 1, 2024, billing policies that provide reimbursement to federally qualified health centers for services rendered by graduate-level, sub-clinical behavioral health professionals who deliver care under the supervision of a fully licensed behavioral health clinician who is licensed as a clinical social worker, clinical professional counselor, marriage and family therapist, or clinical psychologist. To be eligible for reimbursement as provided for in this Section, a graduate-level, sub-clinical professional must meet the educational requirements set forth by the Department of Financial and Professional Regulation for licensed clinical social workers, licensed clinical professional counselors, licensed marriage and family therapists, or licensed clinical psychologists. An individual seeking to fulfill post-degree experience requirements in order to qualify for licensing as a clinical social worker, clinical professional counselor, marriage and family therapist, or clinical psychologist shall also be eligible for reimbursement under this Section so long as the individual is in compliance with all applicable laws and regulations regarding supervision, including, but not limited to, the requirement that the supervised experience be under the order, control, and full professional responsibility of the individual's supervisor or that the individual is designated by a title that clearly indicates training status. The Department shall work with a trade association representing a majority of federally qualified health centers operating in Illinois to develop the policies and procedures required under this Section. (Source: P.A. 103-102, eff. 1-1-24 .) |
305 ILCS 5/5-49 (305 ILCS 5/5-49) Sec. 5-49. Long-acting reversible contraception. Subject to federal approval, the Department shall adopt policies and rates for long-acting reversible contraception by January 1, 2024 to ensure that reimbursement is not reduced by 4.4% below list price. The Department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for the purposes of implementing such policies and rates.
(Source: P.A. 103-102, eff. 7-1-23.) |
305 ILCS 5/5-50 (305 ILCS 5/5-50) Sec. 5-50. Coverage for mental health and substance use disorder telehealth services. (a) As used in this Section: "Behavioral health care professional" has the meaning given to "health care professional" in Section 5 of the Telehealth Act, but only with respect to professionals licensed or certified by the Division of Mental Health or Division of Substance Use Prevention and Recovery of the Department of Human Services engaged in the delivery of mental health or substance use disorder treatment or services. "Behavioral health facility" means a community mental health center, a behavioral health clinic, a substance use disorder treatment program, or a facility or provider licensed or certified by the Division of Mental Health or Division of Substance Use Prevention and Recovery of the Department of Human Services. "Behavioral telehealth services" has the meaning given to the term "telehealth services" in Section 5 of the Telehealth Act, but limited solely to mental health and substance use disorder treatment or services to a patient, regardless of patient location. "Distant site" has the meaning given to that term in Section 5 of the Telehealth Act. "Originating site" has the meaning given to that term in Section 5 of the Telehealth Act. (b) The Department and any managed care plans under contract with the Department for the medical assistance program shall provide for coverage of mental health and substance use disorder treatment or services delivered as behavioral telehealth services as specified in this Section. The Department and any managed care plans under contract with the Department for the medical assistance program may also provide reimbursement to a behavioral health facility that serves as the originating site at the time a behavioral telehealth service is rendered. (c) To ensure behavioral telehealth services are equitably provided, coverage required under this Section shall comply with all of the following: (1) The Department and any managed care plans under | | contract with the Department for the medical assistance program shall not:
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| (A) require that in-person contact occur between
| | a behavioral health care professional and a patient before the provision of a behavioral telehealth service;
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| (B) require patients, behavioral health care
| | professionals, or behavioral health facilities to prove or document a hardship or access barrier to an in-person consultation for coverage and reimbursement of behavioral telehealth services;
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| (C) require the use of behavioral telehealth
| | services when the behavioral health care professional has determined that it is not appropriate;
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| (D) require the use of behavioral telehealth
| | services when a patient chooses an in-person consultation;
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| (E) require a behavioral health care professional
| | to be physically present in the same room as the patient at the originating site, unless deemed medically necessary by the behavioral health care professional providing the behavioral telehealth service;
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| (F) create geographic or facility restrictions or
| | requirements for behavioral telehealth services;
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| (G) require behavioral health care professionals
| | or behavioral health facilities to offer or provide behavioral telehealth services;
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| (H) require patients to use behavioral telehealth
| | services or require patients to use a separate panel of behavioral health care professionals or behavioral health facilities to receive behavioral telehealth services; or
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| (I) impose upon behavioral telehealth services
| | utilization review requirements that are unnecessary, duplicative, or unwarranted or impose any treatment limitations, prior authorization, documentation, or recordkeeping requirements that are more stringent than the requirements applicable to the same behavioral health care service when rendered in-person, except that procedure code modifiers may be required to document behavioral telehealth.
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| (2) Any cost sharing applicable to services provided
| | through behavioral telehealth shall not exceed the cost sharing required by the medical assistance program for the same services provided through in-person consultation.
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| (3) The Department and any managed care plans under
| | contract with the Department for the medical assistance program shall notify behavioral health care professionals and behavioral health facilities of any instructions necessary to facilitate billing for behavioral telehealth services.
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| (d) For purposes of reimbursement, the Department and any managed care plans under contract with the Department for the medical assistance program shall reimburse a behavioral health care professional or behavioral health facility for behavioral telehealth services on the same basis, in the same manner, and at the same reimbursement rate that would apply to the services if the services had been delivered via an in-person encounter by a behavioral health care professional or behavioral health facility. This subsection applies only to those services provided by behavioral telehealth that may otherwise be billed as an in-person service.
(e) Behavioral health care professionals and behavioral health facilities shall determine the appropriateness of specific sites, technology platforms, and technology vendors for a behavioral telehealth service, as long as delivered services adhere to all federal and State privacy, security, and confidentiality laws, rules, or regulations, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996, 42 CFR Part 2, and the Mental Health and Developmental Disabilities Confidentiality Act.
(f) Nothing in this Section shall be deemed as precluding the Department and any managed care plans under contract with the Department for the medical assistance program from providing benefits for other telehealth services.
(g) There shall be no restrictions on originating site requirements for behavioral telehealth coverage or reimbursement to the distant site under this Section other than requiring the behavioral telehealth services to be medically necessary and clinically appropriate.
(h) Nothing in this Section shall be deemed as precluding the Department and any managed care plans under contract with the Department for the medical assistance program from establishing limits on the use of telehealth for a particular behavioral health service when the limits are consistent with generally accepted standards of mental, emotional, nervous, or substance use disorder or condition care.
(i) The Department may adopt rules to implement the provisions of this Section.
(Source: P.A. 103-243, eff. 1-1-24; 103-605, eff. 7-1-24.)
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305 ILCS 5/5-51 (305 ILCS 5/5-51) Sec. 5-51. Proton beam therapy; managed care. Notwithstanding any other provision of this Article, a managed care organization under contract with the Department to provide services to recipients of medical assistance shall provide coverage for proton beam therapy. As used in this Section: "Proton beam therapy" means a type of radiation therapy treatment that utilizes protons as the radiation delivery method for the treatment of tumors and cancerous cells. "Radiation therapy treatment" means the delivery of biological effective doses with proton therapy, intensity modulated radiation therapy, brachytherapy, stereotactic body radiation therapy, three-dimensional conformal radiation therapy, or other forms of therapy using radiation. (Source: P.A. 103-325, eff. 1-1-24; 103-605, eff. 7-1-24.) |
305 ILCS 5/5-53 (305 ILCS 5/5-53) Sec. 5-53. Coverage for self-measure blood pressure monitoring services. Subject to federal approval and notwithstanding any other provision of this Code, for services on and after January 1, 2025, the following self-measure blood pressure monitoring services shall be covered and reimbursed under the medical assistance program for persons who are otherwise eligible for medical assistance under this Article: (1) patient education and training services on the | | set-up and use of a self-measure blood pressure measurement device validated for clinical accuracy and device calibration; and
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| (2) separate self-measurement readings and the
| | collection of data reports by the patient or caregiver to the health care provider in order to communicate blood pressure readings and create or modify treatment plans.
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(Source: P.A. 103-593, eff. 6-7-24.)
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305 ILCS 5/5-55 (305 ILCS 5/5-55) Sec. 5-55. Reimbursement for music therapy services. Subject to federal approval, for dates of service beginning on and after July 1, 2025, the Department shall reimburse music therapy services provided by licensed professional music therapists. To be eligible for reimbursement under this Section, music therapy services must be provided by a licensed professional music therapist authorized to practice under the Music Therapy Licensing and Practice Act.
(Source: P.A. 103-593, eff. 6-7-24.) |
305 ILCS 5/5-60 (305 ILCS 5/5-60) Sec. 5-60. Optometric services; reimbursement rates. Notwithstanding any other law or rule to the contrary and subject to federal approval, for dates of service beginning on and after January 1, 2025, the reimbursement rates for optometric and optical services for determining refractive state, fitting of spectacles, and fitting of bifocal spectacles shall be increased by 35% above the rates in effect on January 1, 2024.
(Source: P.A. 103-593, eff. 6-7-24.) |
305 ILCS 5/Art. V-A
(305 ILCS 5/Art. V-A heading)
ARTICLE V-A.
HOSPITAL PROVIDER FUNDING
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305 ILCS 5/5A-1 (305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1)
Sec. 5A-1. Definitions. As used in this Article, unless the context requires
otherwise:
"Fund" means the Hospital Provider Fund.
"Hospital" means an institution, place, building, or agency located in this
State that is subject to licensure by the Illinois Department of Public Health
under the Hospital Licensing Act, whether public or private and whether
organized for profit or not-for-profit.
"Hospital provider" means a person licensed by the Department of Public
Health to conduct, operate, or maintain a hospital, regardless of whether the
person is a Medicaid provider. For purposes of this paragraph, "person" means
any political subdivision of the State, municipal corporation, individual,
firm, partnership, corporation, company, limited liability company,
association, joint stock association, or trust, or a receiver, executor,
trustee, guardian, or other representative appointed by order of any court.
"Medicare bed days" means, for each hospital, the sum of the number of days that each bed was occupied by a patient who was covered by Title XVIII of the Social Security Act, excluding days attributable to the routine services provided to persons receiving skilled or intermediate long term care services. Medicare bed days shall be computed separately for each hospital operated or maintained by a hospital provider. "Occupied bed days" means the sum of the number of days
that each bed was occupied by a patient for all beds, excluding days attributable to the routine services provided to persons receiving skilled or intermediate long term care services. Occupied bed days shall be computed separately for each
hospital operated or maintained by a hospital provider. "Outpatient gross revenue" means, for each hospital, its total gross charges attributed to outpatient services as reported on the Medicare cost report at Worksheet C, Part I, Column 7, line 101, less the sum of lines 45, 60, 63, 64, 65, 66, 67, and 68 (and any subsets of those lines).
(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
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305 ILCS 5/5A-2 (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) (Section scheduled to be repealed on December 31, 2026) Sec. 5A-2. Assessment.
(a)(1)
Subject to Sections 5A-3 and 5A-10, for State fiscal years 2009 through 2018, or as long as continued under Section 5A-16, an annual assessment on inpatient services is imposed on each hospital provider in an amount equal to $218.38 multiplied by the difference of the hospital's occupied bed days less the hospital's Medicare bed days, provided, however, that the amount of $218.38 shall be increased by a uniform percentage to generate an amount equal to 75% of the State share of the payments authorized under Section 5A-12.5, with such increase only taking effect upon the date that a State share for such payments is required under federal law. For the period of April through June 2015, the amount of $218.38 used to calculate the assessment under this paragraph shall, by emergency rule under subsection (s) of Section 5-45 of the Illinois Administrative Procedure Act, be increased by a uniform percentage to generate $20,250,000 in the aggregate for that period from all hospitals subject to the annual assessment under this paragraph. (2) In addition to any other assessments imposed under this Article, effective July 1, 2016 and semi-annually thereafter through June 2018, or as provided in Section 5A-16, in addition to any federally required State share as authorized under paragraph (1), the amount of $218.38 shall be increased by a uniform percentage to generate an amount equal to 75% of the ACA Assessment Adjustment, as defined in subsection (b-6) of this Section. For State fiscal years 2009 through 2018, or as provided in Section 5A-16, a hospital's occupied bed days and Medicare bed days shall be determined using the most recent data available from each hospital's 2005 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on December 31, 2006, without regard to any subsequent adjustments or changes to such data. If a hospital's 2005 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Illinois Department may obtain the hospital provider's occupied bed days and Medicare bed days from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois Department or its duly authorized agents and employees. (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State fiscal years 2019 and 2020, an annual assessment on inpatient services is imposed on each hospital provider in an amount equal to $197.19 multiplied by the difference of the hospital's occupied bed days less the hospital's Medicare bed days. For State fiscal years 2019 and 2020, a hospital's occupied bed days and Medicare bed days shall be determined using the most recent data available from each hospital's 2015 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on March 31, 2017, without regard to any subsequent adjustments or changes to such data. If a hospital's 2015 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Illinois Department may obtain the hospital provider's occupied bed days and Medicare bed days from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois Department or its duly authorized agents and employees. Notwithstanding any other provision in this Article, for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State fiscal year 2018 on the basis of hypothetical data, that assessment amount shall be used for State fiscal years 2019 and 2020. (4) Subject to Sections 5A-3 and 5A-10 and to subsection (b-8), for the period of July 1, 2020 through December 31, 2020 and calendar years 2021 through 2026, an annual assessment on inpatient services is imposed on each hospital provider in an amount equal to $221.50 multiplied by the difference of the hospital's occupied bed days less the hospital's Medicare bed days, provided however: for the period of July 1, 2020 through December 31, 2020, (i) the assessment shall be equal to 50% of the annual amount; and (ii) the amount of $221.50 shall be retroactively adjusted by a uniform percentage to generate an amount equal to 50% of the Assessment Adjustment, as defined in subsection (b-7). For the period of July 1, 2020 through December 31, 2020 and calendar years 2021 through 2026, a hospital's occupied bed days and Medicare bed days shall be determined using the most recent data available from each hospital's 2015 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on March 31, 2017, without regard to any subsequent adjustments or changes to such data. If a hospital's 2015 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Illinois Department may obtain the hospital provider's occupied bed days and Medicare bed days from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois Department or its duly authorized agents and employees. Should the change in the assessment methodology for fiscal years 2021 through December 31, 2022 not be approved on or before June 30, 2020, the assessment and payments under this Article in effect for fiscal year 2020 shall remain in place until the new assessment is approved. If the assessment methodology for July 1, 2020 through December 31, 2022, is approved on or after July 1, 2020, it shall be retroactive to July 1, 2020, subject to federal approval and provided that the payments authorized under Section 5A-12.7 have the same effective date as the new assessment methodology. In giving retroactive effect to the assessment approved after June 30, 2020, credit toward the new assessment shall be given for any payments of the previous assessment for periods after June 30, 2020. Notwithstanding any other provision of this Article, for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State Fiscal Year 2020 on the basis of hypothetical data, the data that was the basis for the 2020 assessment shall be used to calculate the assessment under this paragraph until December 31, 2023. Beginning July 1, 2022 and through December 31, 2024, a safety-net hospital that had a change of ownership in calendar year 2021, and whose inpatient utilization had decreased by 90% from the prior year and prior to the change of ownership, may be eligible to pay a tax based on hypothetical data based on a determination of financial distress by the Department. Subject to federal approval, the Department may, by January 1, 2024, develop a hypothetical tax for a specialty cancer hospital which had a structural change of ownership during calendar year 2022 from a for-profit entity to a non-profit entity, and which has experienced a decline of 60% or greater in inpatient days of care as compared to the prior owners 2015 Medicare cost report. This change of ownership may make the hospital eligible for a hypothetical tax under the new hospital provision of the assessment defined in this Section. This new hypothetical tax may be applicable from January 1, 2024 through December 31, 2026. (b) (Blank).
(b-5)(1) Subject to Sections 5A-3 and 5A-10, for the portion of State fiscal year 2012, beginning June 10, 2012 through June 30, 2012, and for State fiscal years 2013 through 2018, or as provided in Section 5A-16, an annual assessment on outpatient services is imposed on each hospital provider in an amount equal to .008766 multiplied by the hospital's outpatient gross revenue, provided, however, that the amount of .008766 shall be increased by a uniform percentage to generate an amount equal to 25% of the State share of the payments authorized under Section 5A-12.5, with such increase only taking effect upon the date that a State share for such payments is required under federal law. For the period beginning June 10, 2012 through June 30, 2012, the annual assessment on outpatient services shall be prorated by multiplying the assessment amount by a fraction, the numerator of which is 21 days and the denominator of which is 365 days. For the period of April through June 2015, the amount of .008766 used to calculate the assessment under this paragraph shall, by emergency rule under subsection (s) of Section 5-45 of the Illinois Administrative Procedure Act, be increased by a uniform percentage to generate $6,750,000 in the aggregate for that period from all hospitals subject to the annual assessment under this paragraph. (2) In addition to any other assessments imposed under this Article, effective July 1, 2016 and semi-annually thereafter through June 2018, in addition to any federally required State share as authorized under paragraph (1), the amount of .008766 shall be increased by a uniform percentage to generate an amount equal to 25% of the ACA Assessment Adjustment, as defined in subsection (b-6) of this Section. For the portion of State fiscal year 2012, beginning June 10, 2012 through June 30, 2012, and State fiscal years 2013 through 2018, or as provided in Section 5A-16, a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2009 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on June 30, 2011, without regard to any subsequent adjustments or changes to such data. If a hospital's 2009 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Department may obtain the hospital provider's outpatient gross revenue from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Department or its duly authorized agents and employees. (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State fiscal years 2019 and 2020, an annual assessment on outpatient services is imposed on each hospital provider in an amount equal to .01358 multiplied by the hospital's outpatient gross revenue. For State fiscal years 2019 and 2020, a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2015 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on March 31, 2017, without regard to any subsequent adjustments or changes to such data. If a hospital's 2015 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Department may obtain the hospital provider's outpatient gross revenue from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Department or its duly authorized agents and employees. Notwithstanding any other provision in this Article, for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State fiscal year 2018 on the basis of hypothetical data, that assessment amount shall be used for State fiscal years 2019 and 2020. (4) Subject to Sections 5A-3 and 5A-10 and to subsection (b-8), for the period of July 1, 2020 through December 31, 2020 and calendar years 2021 through 2026, an annual assessment on outpatient services is imposed on each hospital provider in an amount equal to .01525 multiplied by the hospital's outpatient gross revenue, provided however: (i) for the period of July 1, 2020 through December 31, 2020, the assessment shall be equal to 50% of the annual amount; and (ii) the amount of .01525 shall be retroactively adjusted by a uniform percentage to generate an amount equal to 50% of the Assessment Adjustment, as defined in subsection (b-7). For the period of July 1, 2020 through December 31, 2020 and calendar years 2021 through 2026, a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2015 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on March 31, 2017, without regard to any subsequent adjustments or changes to such data. If a hospital's 2015 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Illinois Department may obtain the hospital provider's outpatient revenue data from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois Department or its duly authorized agents and employees. Should the change in the assessment methodology above for fiscal years 2021 through calendar year 2022 not be approved prior to July 1, 2020, the assessment and payments under this Article in effect for fiscal year 2020 shall remain in place until the new assessment is approved. If the change in the assessment methodology above for July 1, 2020 through December 31, 2022, is approved after June 30, 2020, it shall have a retroactive effective date of July 1, 2020, subject to federal approval and provided that the payments authorized under Section 12A-7 have the same effective date as the new assessment methodology. In giving retroactive effect to the assessment approved after June 30, 2020, credit toward the new assessment shall be given for any payments of the previous assessment for periods after June 30, 2020. Notwithstanding any other provision of this Article, for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State Fiscal Year 2020 on the basis of hypothetical data, the data that was the basis for the 2020 assessment shall be used to calculate the assessment under this paragraph until December 31, 2023. Beginning July 1, 2022 and through December 31, 2024, a safety-net hospital that had a change of ownership in calendar year 2021, and whose inpatient utilization had decreased by 90% from the prior year and prior to the change of ownership, may be eligible to pay a tax based on hypothetical data based on a determination of financial distress by the Department. (b-6)(1) As used in this Section, "ACA Assessment Adjustment" means: (A) For the period of July 1, 2016 through December | | 31, 2016, the product of .19125 multiplied by the sum of the fee-for-service payments to hospitals as authorized under Section 5A-12.5 and the adjustments authorized under subsection (t) of Section 5A-12.2 to managed care organizations for hospital services due and payable in the month of April 2016 multiplied by 6.
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| (B) For the period of January 1, 2017 through June
| | 30, 2017, the product of .19125 multiplied by the sum of the fee-for-service payments to hospitals as authorized under Section 5A-12.5 and the adjustments authorized under subsection (t) of Section 5A-12.2 to managed care organizations for hospital services due and payable in the month of October 2016 multiplied by 6, except that the amount calculated under this subparagraph (B) shall be adjusted, either positively or negatively, to account for the difference between the actual payments issued under Section 5A-12.5 for the period beginning July 1, 2016 through December 31, 2016 and the estimated payments due and payable in the month of April 2016 multiplied by 6 as described in subparagraph (A).
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| (C) For the period of July 1, 2017 through December
| | 31, 2017, the product of .19125 multiplied by the sum of the fee-for-service payments to hospitals as authorized under Section 5A-12.5 and the adjustments authorized under subsection (t) of Section 5A-12.2 to managed care organizations for hospital services due and payable in the month of April 2017 multiplied by 6, except that the amount calculated under this subparagraph (C) shall be adjusted, either positively or negatively, to account for the difference between the actual payments issued under Section 5A-12.5 for the period beginning January 1, 2017 through June 30, 2017 and the estimated payments due and payable in the month of October 2016 multiplied by 6 as described in subparagraph (B).
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| (D) For the period of January 1, 2018 through June
| | 30, 2018, the product of .19125 multiplied by the sum of the fee-for-service payments to hospitals as authorized under Section 5A-12.5 and the adjustments authorized under subsection (t) of Section 5A-12.2 to managed care organizations for hospital services due and payable in the month of October 2017 multiplied by 6, except that:
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| (i) the amount calculated under this subparagraph
| | (D) shall be adjusted, either positively or negatively, to account for the difference between the actual payments issued under Section 5A-12.5 for the period of July 1, 2017 through December 31, 2017 and the estimated payments due and payable in the month of April 2017 multiplied by 6 as described in subparagraph (C); and
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| (ii) the amount calculated under this
| | subparagraph (D) shall be adjusted to include the product of .19125 multiplied by the sum of the fee-for-service payments, if any, estimated to be paid to hospitals under subsection (b) of Section 5A-12.5.
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| (2) The Department shall complete and apply a final reconciliation of the ACA Assessment Adjustment prior to June 30, 2018 to account for:
(A) any differences between the actual payments
| | issued or scheduled to be issued prior to June 30, 2018 as authorized in Section 5A-12.5 for the period of January 1, 2018 through June 30, 2018 and the estimated payments due and payable in the month of October 2017 multiplied by 6 as described in subparagraph (D); and
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| (B) any difference between the estimated
| | fee-for-service payments under subsection (b) of Section 5A-12.5 and the amount of such payments that are actually scheduled to be paid.
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| The Department shall notify hospitals of any additional amounts owed or reduction credits to be applied to the June 2018 ACA Assessment Adjustment. This is to be considered the final reconciliation for the ACA Assessment Adjustment.
(3) Notwithstanding any other provision of this Section, if for any reason the scheduled payments under subsection (b) of Section 5A-12.5 are not issued in full by the final day of the period authorized under subsection (b) of Section 5A-12.5, funds collected from each hospital pursuant to subparagraph (D) of paragraph (1) and pursuant to paragraph (2), attributable to the scheduled payments authorized under subsection (b) of Section 5A-12.5 that are not issued in full by the final day of the period attributable to each payment authorized under subsection (b) of Section 5A-12.5, shall be refunded.
(4) The increases authorized under paragraph (2) of subsection (a) and paragraph (2) of subsection (b-5) shall be limited to the federally required State share of the total payments authorized under Section 5A-12.5 if the sum of such payments yields an annualized amount equal to or less than $450,000,000, or if the adjustments authorized under subsection (t) of Section 5A-12.2 are found not to be actuarially sound; however, this limitation shall not apply to the fee-for-service payments described in subsection (b) of Section 5A-12.5.
(b-7)(1) As used in this Section, "Assessment Adjustment" means:
(A) For the period of July 1, 2020 through
| | December 31, 2020, the product of .3853 multiplied by the total of the actual payments made under subsections (c) through (k) of Section 5A-12.7 attributable to the period, less the total of the assessment imposed under subsections (a) and (b-5) of this Section for the period.
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| (B) For each calendar quarter beginning January 1,
| | 2021 through December 31, 2022, the product of .3853 multiplied by the total of the actual payments made under subsections (c) through (k) of Section 5A-12.7 attributable to the period, less the total of the assessment imposed under subsections (a) and (b-5) of this Section for the period.
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| (C) Beginning on January 1, 2023, and each subsequent
| | July 1 and January 1, the product of .3853 multiplied by the total of the actual payments made under subsections (c) through (j) of Section 5A-12.7 attributable to the 6-month period immediately preceding the period to which the adjustment applies, less the total of the assessment imposed under subsections (a) and (b-5) of this Section for the 6-month period immediately preceding the period to which the adjustment applies.
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| (2) The Department shall calculate and notify each hospital of the total Assessment Adjustment and any additional assessment owed by the hospital or refund owed to the hospital on either a semi-annual or annual basis. Such notice shall be issued at least 30 days prior to any period in which the assessment will be adjusted. Any additional assessment owed by the hospital or refund owed to the hospital shall be uniformly applied to the assessment owed by the hospital in monthly installments for the subsequent semi-annual period or calendar year. If no assessment is owed in the subsequent year, any amount owed by the hospital or refund due to the hospital, shall be paid in a lump sum.
(3) The Department shall publish all details of the Assessment Adjustment calculation performed each year on its website within 30 days of completing the calculation, and also submit the details of the Assessment Adjustment calculation as part of the Department's annual report to the General Assembly.
(b-8) Notwithstanding any other provision of this Article, the Department shall reduce the assessments imposed on each hospital under subsections (a) and (b-5) by the uniform percentage necessary to reduce the total assessment imposed on all hospitals by an aggregate amount of $240,000,000, with such reduction being applied by June 30, 2022. The assessment reduction required for each hospital under this subsection shall be forever waived, forgiven, and released by the Department.
(c) (Blank).
(d) Notwithstanding any of the other provisions of this Section, the Department is authorized to adopt rules to reduce the rate of any annual assessment imposed under this Section, as authorized by Section 5-46.2 of the Illinois Administrative Procedure Act.
(e) Notwithstanding any other provision of this Section, any plan providing for an assessment on a hospital provider as a permissible tax under Title XIX of the federal Social Security Act and Medicaid-eligible payments to hospital providers from the revenues derived from that assessment shall be reviewed by the Illinois Department of Healthcare and Family Services, as the Single State Medicaid Agency required by federal law, to determine whether those assessments and hospital provider payments meet federal Medicaid standards. If the Department determines that the elements of the plan may meet federal Medicaid standards and a related State Medicaid Plan Amendment is prepared in a manner and form suitable for submission, that State Plan Amendment shall be submitted in a timely manner for review by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services and subject to approval by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. No such plan shall become effective without approval by the Illinois General Assembly by the enactment into law of related legislation. Notwithstanding any other provision of this Section, the Department is authorized to adopt rules to reduce the rate of any annual assessment imposed under this Section. Any such rules may be adopted by the Department under Section 5-50 of the Illinois Administrative Procedure Act.
(Source: P.A. 102-886, eff. 5-17-22; 103-102, eff. 1-1-24 .)
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305 ILCS 5/5A-2.1 (305 ILCS 5/5A-2.1) Sec. 5A-2.1. Continuation of Section 5A-2 of this Code; validation. (a) The General Assembly finds and declares that: (1) Public Act 101-650, which took effect on July 7, | | 2020, contained provisions that would have changed the repeal date for Section 5A-2 of this Act from July 1, 2020 to December 31, 2022.
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| (2) The Statute on Statutes sets forth general rules
| | on the repeal of statutes and the construction of multiple amendments, but Section 1 of that Act also states that these rules will not be observed when the result would be "inconsistent with the manifest intent of the General Assembly or repugnant to the context of the statute".
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| (3) This amendatory Act of the 101st General Assembly
| | manifests the intention of the General Assembly to extend the repeal date for Section 5A-2 of this Code and have Section 5A-2 of this Code, as amended by Public Act 101-650, continue in effect until December 31, 2022.
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| (b) Any construction of this Code that results in the repeal of Section 5A-2 of this Code on July 1, 2020 would be inconsistent with the manifest intent of the General Assembly and repugnant to the context of this Code.
(c) It is hereby declared to have been the intent of the General Assembly that Section 5A-2 of this Code shall not be subject to repeal on July 1, 2020.
(d) Section 5A-2 of this Code shall be deemed to have been in continuous effect since July 8, 1992 (the effective date of Public Act 87-861), and it shall continue to be in effect, as amended by Public Act 101-650, until it is otherwise lawfully amended or repealed. All previously enacted amendments to the Section taking effect on or after July 8, 1992, are hereby validated.
(e) In order to ensure the continuing effectiveness of Section 5A-2 of this Code, that Section is set forth in
full and reenacted by this amendatory Act of the 101st General
Assembly. In this amendatory Act of the 101st General Assembly, the base text of the reenacted Section is set forth as amended by Public Act 101-650.
(f) All actions of the Illinois Department or any other person or entity taken in reliance on or pursuant to Section 5A-2 of this Code are hereby validated.
(Source: P.A. 101-655, eff. 3-12-21.)
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305 ILCS 5/5A-3 (305 ILCS 5/5A-3) (from Ch. 23, par. 5A-3)
Sec. 5A-3. Exemptions.
(a) (Blank).
(b) A hospital provider that is a State agency, a State university, or
a county
with a population of 3,000,000 or more is exempt from the assessment imposed
by Section 5A-2.
(b-2) A hospital provider
that is a county with a population of less than 3,000,000 or a
township,
municipality,
hospital district, or any other local governmental unit is exempt from the
assessment
imposed by Section 5A-2.
(b-5) (Blank).
(b-10) (Blank).
(b-15) (Blank).
(b-20) (Blank).
(b-25) (Blank).
(c) (Blank).
(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
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305 ILCS 5/5A-4 (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) Sec. 5A-4. Payment of assessment; penalty.
(a) The assessment imposed by Section 5A-2 for State fiscal year 2009 through State fiscal year 2018 or as provided in Section 5A-16, shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the fourteenth State business day of each month.
No installment payment of an assessment imposed by Section 5A-2 shall be due
and
payable, however, until after the Comptroller has issued the payments required under this Article.
Except as provided in subsection (a-5) of this Section, the assessment imposed by subsection (b-5) of Section 5A-2 for the portion of State fiscal year 2012 beginning June 10, 2012 through June 30, 2012, and for State fiscal year 2013 through State fiscal year 2018 or as provided in Section 5A-16, shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the 17th State business day of each month. No installment payment of an assessment imposed by subsection (b-5) of Section 5A-2 shall be due and payable, however, until after: (i) the Department notifies the hospital provider, in writing, that the payment methodologies to hospitals required under Section 5A-12.4, have been approved by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services, and the waiver under 42 CFR 433.68 for the assessment imposed by subsection (b-5) of Section 5A-2, if necessary, has been granted by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services; and (ii) the Comptroller has issued the payments required under Section 5A-12.4. Upon notification to the Department of approval of the payment methodologies required under Section 5A-12.4 and the waiver granted under 42 CFR 433.68, if necessary, all installments otherwise due under subsection (b-5) of Section 5A-2 prior to the date of notification shall be due and payable to the Department upon written direction from the Department and issuance by the Comptroller of the payments required under Section 5A-12.4. Except as provided in subsection (a-5) of this Section, the assessment imposed under Section 5A-2 for State fiscal year 2019 and each subsequent State fiscal year shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the 17th State business day of each month. The Department has discretion to establish a later date due to delays in payments being made to hospitals as required under Section 5A-12.7. No installment payment of an assessment imposed by Section 5A-2 shall be due and payable, however, until after: (i) the Department notifies the hospital provider, in writing, that the payment methodologies to hospitals required under Section 5A-12.6 or 5A-12.7 have been approved by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services, and the waiver under 42 CFR 433.68 for the assessment imposed by Section 5A-2, if necessary, has been granted by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services; and (ii) the Comptroller and managed care organizations have issued the payments required under Section 5A-12.6 or 5A-12.7. Upon notification to the Department of approval of the payment methodologies required under Section 5A-12.6 or 5A-12.7 and the waiver granted under 42 CFR 433.68, if necessary, all installments otherwise due under Section 5A-2 prior to the date of notification shall be due and payable to the Department upon written direction from the Department and issuance by the Comptroller and managed care organizations of the payments required under Section 5A-12.6 or 5A-12.7. (a-5) The Illinois Department may accelerate the schedule upon which assessment installments are due and payable by hospitals with a payment ratio greater than or equal to one. Such acceleration of due dates for payment of the assessment may be made only in conjunction with a corresponding acceleration in access payments identified in Section 5A-12.2, Section 5A-12.4, Section 5A-12.6, or Section 5A-12.7 to the same hospitals. For the purposes of this subsection (a-5), a hospital's payment ratio is defined as the quotient obtained by dividing the total payments for the State fiscal year, as authorized under Section 5A-12.2, Section 5A-12.4, Section 5A-12.6, or Section 5A-12.7, by the total assessment for the State fiscal year imposed under Section 5A-2 or subsection (b-5) of Section 5A-2. (b) The Illinois Department is authorized to establish
delayed payment schedules for hospital providers that are unable
to make installment payments when due under this Section due to
financial difficulties, as determined by the Illinois Department.
(c) If a hospital provider fails to pay the full amount of
an installment when due (including any extensions granted under
subsection (b)), there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5A-2 a penalty
assessment equal to the lesser of (i) 5% of the amount of the
installment not paid on or before the due date plus 5% of the
portion thereof remaining unpaid on the last day of each 30-day period
thereafter or (ii) 100% of the installment amount not paid on or
before the due date. For purposes of this subsection, payments
will be credited first to unpaid installment amounts (rather than
to penalty or interest), beginning with the most delinquent
installments.
(d) Any assessment amount that is due and payable to the Illinois Department more frequently than once per calendar quarter shall be remitted to the Illinois Department by the hospital provider by means of electronic funds transfer. The Illinois Department may provide for remittance by other means if (i) the amount due is less than $10,000 or (ii) electronic funds transfer is unavailable for this purpose. (Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19; 101-209, eff. 8-5-19; 101-650, eff. 7-7-20.) |
305 ILCS 5/5A-5 (305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5) Sec. 5A-5. Notice; penalty; maintenance of records.
(a)
The Illinois Department shall send a
notice of assessment to every hospital provider subject
to assessment under this Article. The notice of assessment shall notify the hospital of its assessment and shall be sent after receipt by the Department of notification from the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services that the payment methodologies required under this Article and, if necessary, the waiver granted under 42 CFR 433.68 have been approved. The notice
shall be on a form
prepared by the Illinois Department and shall state the following:
(1) The name of the hospital provider.
(2) The address of the hospital provider's principal | | place of business from which the provider engages in the occupation of hospital provider in this State, and the name and address of each hospital operated, conducted, or maintained by the provider in this State.
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(3) The occupied bed days, occupied bed days less
| | Medicare days, adjusted gross hospital revenue, or outpatient gross revenue of the hospital provider (whichever is applicable), the amount of assessment imposed under Section 5A-2 for the State fiscal year for which the notice is sent, and the amount of each installment to be paid during the State fiscal year.
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(4) (Blank).
(5) Other reasonable information as determined by the
| |
(b) If a hospital provider conducts, operates, or
maintains more than one hospital licensed by the Illinois
Department of Public Health, the provider shall pay the
assessment for each hospital separately.
(c) Notwithstanding any other provision in this Article, in
the case of a person who ceases to conduct, operate, or maintain a
hospital in respect of which the person is subject to assessment
under this Article as a hospital provider, the assessment for the State
fiscal year in which the cessation occurs shall be adjusted by
multiplying the assessment computed under Section 5A-2 by a
fraction, the numerator of which is the number of days in the
year during which the provider conducts, operates, or maintains
the hospital and the denominator of which is 365. Immediately
upon ceasing to conduct, operate, or maintain a hospital, the person
shall pay the assessment
for the year as so adjusted (to the extent not previously paid).
(d) Notwithstanding any other provision in this Article, a
provider who commences conducting, operating, or maintaining a
hospital, upon notice by the Illinois Department,
shall pay the assessment computed under Section 5A-2 and
subsection (e) in installments on the due dates stated in the
notice and on the regular installment due dates for the State
fiscal year occurring after the due dates of the initial
notice.
(e)
Notwithstanding any other provision in this Article, for State fiscal years 2009 through 2018, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in 2005, the assessment for that State fiscal year shall be computed on the basis of hypothetical occupied bed days for the full calendar year as determined by the Illinois Department. Notwithstanding any other provision in this Article, for the portion of State fiscal year 2012 beginning June 10, 2012 through June 30, 2012, and for State fiscal years 2013 through 2018, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in 2009, the assessment under subsection (b-5) of Section 5A-2 for that State fiscal year shall be computed on the basis of hypothetical gross outpatient revenue for the full calendar year as determined by the Illinois Department.
Notwithstanding any other provision in this Article, beginning July 1, 2018 through December 31, 2026, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in the year that is the basis of the calculation of the assessment under this Article, the assessment under paragraph (3) of subsection (a) of Section 5A-2 for the State fiscal year shall be computed on the basis of hypothetical occupied bed days for the full calendar year as determined by the Illinois Department, except that for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State fiscal year 2018 on the basis of hypothetical data, that assessment amount shall be used for State fiscal years 2019 and 2020; however, for State fiscal year 2020, the assessment amount shall be increased by the proportion that it represents of the total annual assessment that is generated from all hospitals in order to generate $6,250,000 in the aggregate for that period from all hospitals subject to the annual assessment under this paragraph.
Notwithstanding any other provision in this Article, beginning July 1, 2018 through December 31, 2026, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in the year that is the basis of the calculation of the assessment under this Article, the assessment under subsection (b-5) of Section 5A-2 for that State fiscal year shall be computed on the basis of hypothetical gross outpatient revenue for the full calendar year as determined by the Illinois Department, except that for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State fiscal year 2018 on the basis of hypothetical data, that assessment amount shall be used for State fiscal years 2019 and 2020; however, for State fiscal year 2020, the assessment amount shall be increased by the proportion that it represents of the total annual assessment that is generated from all hospitals in order to generate $6,250,000 in the aggregate for that period from all hospitals subject to the annual assessment under this paragraph.
(f) Every hospital provider subject to assessment under this Article shall keep sufficient records to permit the determination of adjusted gross hospital revenue for the hospital's fiscal year. All such records shall be kept in the English language and shall, at all times during regular business hours of the day, be subject to inspection by the Illinois Department or its duly authorized agents and employees.
(g) The Illinois Department may, by rule, provide a hospital provider a reasonable opportunity to request a clarification or correction of any clerical or computational errors contained in the calculation of its assessment, but such corrections shall not extend to updating the cost report information used to calculate the assessment.
(h) (Blank).
(Source: P.A. 102-886, eff. 5-17-22.)
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305 ILCS 5/5A-6
(305 ILCS 5/5A-6) (from Ch. 23, par. 5A-6)
Sec. 5A-6. Disposition of proceeds. The Illinois Department
shall deposit all moneys received from hospital providers under this
Article into the Hospital Provider Fund. Upon certification by
the Illinois Department to the State Comptroller of its intent to
withhold payments from a provider pursuant to Section 5A-7(b), the State
Comptroller shall draw a warrant on the treasury or other fund
held by the State Treasurer, as appropriate. The warrant shall
state the amount for which the provider is entitled to a
warrant, the amount of the deduction, and the reason therefor and
shall direct the State Treasurer to pay the balance to the provider,
all in accordance with Section 10.05 of the State Comptroller Act.
The warrant also shall direct the State Treasurer to transfer the amount of the
deduction so ordered from the treasury or other fund into the
Hospital Provider Fund.
(Source: P.A. 97-689, eff. 6-14-12.)
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305 ILCS 5/5A-7 (305 ILCS 5/5A-7) (from Ch. 23, par. 5A-7)
Sec. 5A-7. Administration; enforcement provisions.
(a) The Illinois Department shall establish and maintain a listing of all hospital providers appearing in the licensing records of the Illinois Department of Public Health, which shall show each provider's name and principal place of business and the name and address of each hospital operated, conducted, or maintained by the provider in this State. The Illinois Department shall administer and enforce this Article and collect the assessments and penalty assessments imposed under this Article using procedures employed in its administration of this Code generally. The Illinois Department, its Director, and every hospital provider subject to assessment under this Article shall have the following powers, duties, and rights: (1) The Illinois Department may initiate either | | administrative or judicial proceedings, or both, to enforce provisions of this Article. Administrative enforcement proceedings initiated hereunder shall be governed by the Illinois Department's administrative rules. Judicial enforcement proceedings initiated hereunder shall be governed by the rules of procedure applicable in the courts of this State.
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| (2) No proceedings for collection, refund, credit, or
| | other adjustment of an assessment amount shall be issued more than 3 years after the due date of the assessment, except in the case of an extended period agreed to in writing by the Illinois Department and the hospital provider before the expiration of this limitation period.
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| (3) Any unpaid assessment under this Article shall
| | become a lien upon the assets of the hospital upon which it was assessed. If any hospital provider, outside the usual course of its business, sells or transfers the major part of any one or more of (A) the real property and improvements, (B) the machinery and equipment, or (C) the furniture or fixtures, of any hospital that is subject to the provisions of this Article, the seller or transferor shall pay the Illinois Department the amount of any assessment, assessment penalty, and interest (if any) due from it under this Article up to the date of the sale or transfer. If the seller or transferor fails to pay any assessment, assessment penalty, and interest (if any) due, the purchaser or transferee of such asset shall be liable for the amount of the assessment, penalties, and interest (if any) up to the amount of the reasonable value of the property acquired by the purchaser or transferee. The purchaser or transferee shall continue to be liable until the purchaser or transferee pays the full amount of the assessment, penalties, and interest (if any) up to the amount of the reasonable value of the property acquired by the purchaser or transferee or until the purchaser or transferee receives from the Illinois Department a certificate showing that such assessment, penalty, and interest have been paid or a certificate from the Illinois Department showing that no assessment, penalty, or interest is due from the seller or transferor under this Article.
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| (4) Payments under this Article are not subject to
| | the Illinois Prompt Payment Act. Credits or refunds shall not bear interest.
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| (b) In addition to any other remedy provided for and without sending a notice of assessment liability, the Illinois Department may collect an unpaid assessment by withholding, as payment of the assessment, reimbursements or other amounts otherwise payable by the Illinois Department to the hospital provider.
(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04; 94-242, eff. 7-18-05.)
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305 ILCS 5/5A-8 (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
Sec. 5A-8. Hospital Provider Fund.
(a) There is created in the State Treasury the Hospital Provider Fund.
Interest earned by the Fund shall be credited to the Fund. The
Fund shall not be used to replace any moneys appropriated to the
Medicaid program by the General Assembly.
(b) The Fund is created for the purpose of receiving moneys
in accordance with Section 5A-6 and disbursing moneys only for the following
purposes, notwithstanding any other provision of law:
(1) For making payments to hospitals as required | | under this Code, under the Children's Health Insurance Program Act, under the Covering ALL KIDS Health Insurance Act, and under the Long Term Acute Care Hospital Quality Improvement Transfer Program Act.
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(2) For the reimbursement of moneys collected by the
| | Illinois Department from hospitals or hospital providers through error or mistake in performing the activities authorized under this Code.
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(3) For payment of administrative expenses incurred
| | by the Illinois Department or its agent in performing activities under this Code, under the Children's Health Insurance Program Act, under the Covering ALL KIDS Health Insurance Act, and under the Long Term Acute Care Hospital Quality Improvement Transfer Program Act.
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(4) For payments of any amounts which are
| | reimbursable to the federal government for payments from this Fund which are required to be paid by State warrant.
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(5) For making transfers, as those transfers are
| | authorized in the proceedings authorizing debt under the Short Term Borrowing Act, but transfers made under this paragraph (5) shall not exceed the principal amount of debt issued in anticipation of the receipt by the State of moneys to be deposited into the Fund.
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(6) For making transfers to any other fund in the
| | State treasury, but transfers made under this paragraph (6) shall not exceed the amount transferred previously from that other fund into the Hospital Provider Fund plus any interest that would have been earned by that fund on the monies that had been transferred.
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(6.5) For making transfers to the Healthcare Provider
| | Relief Fund, except that transfers made under this paragraph (6.5) shall not exceed $60,000,000 in the aggregate.
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| (7) For making transfers not exceeding the following
| | amounts, related to State fiscal years 2013 through 2018, to the following designated funds:
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| Health and Human Services Medicaid Trust
Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$20,000,000
Long-Term Care Provider Fund . . . . . . . . . . .
$30,000,000
General Revenue Fund . . . . . . . . . . . . . . . . . .
$80,000,000.
Transfers under this paragraph shall be made within 7
| | days after the payments have been received pursuant to the schedule of payments provided in subsection (a) of Section 5A-4.
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| (7.1) (Blank).
(7.5) (Blank).
(7.8) (Blank).
(7.9) (Blank).
(7.10) For State fiscal year 2014, for making
| | transfers of the moneys resulting from the assessment under subsection (b-5) of Section 5A-2 and received from hospital providers under Section 5A-4 and transferred into the Hospital Provider Fund under Section 5A-6 to the designated funds not exceeding the following amounts in that State fiscal year:
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| Healthcare Provider Relief Fund . . . . . . .
$100,000,000
Transfers under this paragraph shall be made within 7
| | days after the payments have been received pursuant to the schedule of payments provided in subsection (a) of Section 5A-4.
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| The additional amount of transfers in this paragraph
| | (7.10), authorized by Public Act 98-651, shall be made within 10 State business days after June 16, 2014 (the effective date of Public Act 98-651). That authority shall remain in effect even if Public Act 98-651 does not become law until State fiscal year 2015.
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| (7.10a) For State fiscal years 2015 through 2018, for
| | making transfers of the moneys resulting from the assessment under subsection (b-5) of Section 5A-2 and received from hospital providers under Section 5A-4 and transferred into the Hospital Provider Fund under Section 5A-6 to the designated funds not exceeding the following amounts related to each State fiscal year:
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| Healthcare Provider Relief Fund . . . . . . .
$50,000,000
Transfers under this paragraph shall be made within 7
| | days after the payments have been received pursuant to the schedule of payments provided in subsection (a) of Section 5A-4.
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| (7.11) (Blank).
(7.12) For State fiscal year 2013, for increasing by
| | 21/365ths the transfer of the moneys resulting from the assessment under subsection (b-5) of Section 5A-2 and received from hospital providers under Section 5A-4 for the portion of State fiscal year 2012 beginning June 10, 2012 through June 30, 2012 and transferred into the Hospital Provider Fund under Section 5A-6 to the designated funds not exceeding the following amounts in that State fiscal year:
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| Healthcare Provider Relief Fund . . . . . . . .
$2,870,000
Since the federal Centers for Medicare and Medicaid
| | Services approval of the assessment authorized under subsection (b-5) of Section 5A-2, received from hospital providers under Section 5A-4 and the payment methodologies to hospitals required under Section 5A-12.4 was not received by the Department until State fiscal year 2014 and since the Department made retroactive payments during State fiscal year 2014 related to the referenced period of June 2012, the transfer authority granted in this paragraph (7.12) is extended through the date that is 10 State business days after June 16, 2014 (the effective date of Public Act 98-651).
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| (7.13) In addition to any other transfers authorized
| | under this Section, for State fiscal years 2017 and 2018, for making transfers to the Healthcare Provider Relief Fund of moneys collected from the ACA Assessment Adjustment authorized under subsections (a) and (b-5) of Section 5A-2 and paid by hospital providers under Section 5A-4 into the Hospital Provider Fund under Section 5A-6 for each State fiscal year. Timing of transfers to the Healthcare Provider Relief Fund under this paragraph shall be at the discretion of the Department, but no less frequently than quarterly.
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| (7.14) For making transfers not exceeding the
| | following amounts, related to State fiscal years 2019 and 2020, to the following designated funds:
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| Health and Human Services Medicaid Trust
Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$20,000,000
Long-Term Care Provider Fund . . . . . . . . . . .
$30,000,000
Healthcare Provider Relief Fund . . . . . .
$325,000,000.
Transfers under this paragraph shall be made within 7
| | days after the payments have been received pursuant to the schedule of payments provided in subsection (a) of Section 5A-4.
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| (7.15) For making transfers not exceeding the
| | following amounts, related to State fiscal years 2023 through 2026, to the following designated funds:
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| Health and Human Services Medicaid Trust
Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$20,000,000
Long-Term Care Provider Fund . . . . . . . . . .
$30,000,000
Healthcare Provider Relief Fund . . . . . .
$365,000,000
(7.16) For making transfers not exceeding the
| | following amounts, related to July 1, 2026 to December 31, 2026, to the following designated funds:
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| Health and Human Services Medicaid Trust
Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$10,000,000
Long-Term Care Provider Fund . . . . . . . . . .
$15,000,000
Healthcare Provider Relief Fund . . . . . .
$182,500,000
(8) For making refunds to hospital providers pursuant
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(9) For making payment to capitated managed care
| | organizations as described in subsections (s) and (t) of Section 5A-12.2, subsection (r) of Section 5A-12.6, and Section 5A-12.7 of this Code.
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| Disbursements from the Fund, other than transfers authorized under
paragraphs (5) and (6) of this subsection, shall be by
warrants drawn by the State Comptroller upon receipt of vouchers
duly executed and certified by the Illinois Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois
| | Department from the hospital provider assessment imposed by this Article.
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(2) All federal matching funds received by the
| | Illinois Department as a result of expenditures made by the Illinois Department that are attributable to moneys deposited in the Fund.
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(3) Any interest or penalty levied in conjunction
| | with the administration of this Article.
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(3.5) As applicable, proceeds from surety bond
| | payments payable to the Department as referenced in subsection (s) of Section 5A-12.2 of this Code.
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| (4) Moneys transferred from another fund in the State
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(5) All other moneys received for the Fund from any
| | other source, including interest earned thereon.
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(d) (Blank).
(Source: P.A. 101-650, eff. 7-7-20; 102-886, eff. 5-17-22.)
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305 ILCS 5/5A-9
(305 ILCS 5/5A-9) (from Ch. 23, par. 5A-9)
Sec. 5A-9. Emergency services audits. The Illinois Department may
audit hospital claims for payment for emergency services provided to a
recipient who does not require admission as an inpatient. The Illinois
Department shall adopt rules that describe how the emergency services audit
process will be conducted. These rules shall include, but need not be
limited to, the following provisions:
(1) The determination that an emergency medical | | condition exists shall be based upon the symptoms and condition of the recipient at the time the recipient is initially examined by the hospital emergency department and not upon the final determination of the recipient's actual medical condition.
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(2) The Illinois Department or its authorized
| | representative shall meet with the chief executive officer of the hospital, or a person designated by the chief executive officer, upon arrival at the hospital to conduct the audit and before leaving the hospital at the conclusion of the audit. The purpose of the pre-audit meeting shall be to inform the hospital concerning the scope of the audit. The purpose of the post-audit meeting shall be to provide the hospital with the preliminary findings of the audit.
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(3) An emergency services audit shall be limited to a
| | review of records related to services rendered within 6 years of the date of the audit. The hospital's business and professional records for at least 12 previous calendar months shall be maintained and available for inspection by authorized Illinois Department personnel on the premises of the hospital. Illinois Department personnel shall make requests in writing to inspect records more than 12 months old at least 2 business days in advance of the date they must be produced.
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(4) Where the purpose of the audit is to determine
| | the appropriateness of the emergency services provided, any final determination that would result in a denial of or reduction in payment to the hospital shall be made by a physician licensed to practice medicine in all of its branches who is board certified in emergency medicine or by the appropriate health care professionals under the supervision of the physician.
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(5) The preliminary audit findings shall be provided
| | to the hospital within 120 days of the date on which the audit conducted on the hospital premises was completed.
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(6) The Illinois Department or its designated review
| | agent shall use statistically valid sampling techniques when conducting audits.
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(Source: P.A. 97-48, eff. 6-28-11.)
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305 ILCS 5/5A-10 (305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
Sec. 5A-10. Applicability.
(a) The assessment imposed by subsection (a) of Section 5A-2 shall cease to be imposed and the Department's obligation to make payments shall immediately cease, and
any moneys
remaining in the Fund shall be refunded to hospital providers
in proportion to the amounts paid by them, if:
(1) The payments to hospitals required under this | | Article are not eligible for federal matching funds under Title XIX or XXI of the Social Security Act;
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(2) For State fiscal years 2009 through 2018, and as
| | provided in Section 5A-16, the Department of Healthcare and Family Services adopts any administrative rule change to reduce payment rates or alters any payment methodology that reduces any payment rates made to operating hospitals under the approved Title XIX or Title XXI State plan in effect January 1, 2008 except for:
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| (A) any changes for hospitals described in
| | subsection (b) of Section 5A-3;
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| (B) any rates for payments made under this
| | (C) any changes proposed in State plan amendment
| | transmittal numbers 08-01, 08-02, 08-04, 08-06, and 08-07;
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| (D) in relation to any admissions on or after
| | January 1, 2011, a modification in the methodology for calculating outlier payments to hospitals for exceptionally costly stays, for hospitals reimbursed under the diagnosis-related grouping methodology in effect on July 1, 2011; provided that the Department shall be limited to one such modification during the 36-month period after the effective date of this amendatory Act of the 96th General Assembly;
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| (E) any changes affecting hospitals authorized by
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(F) any changes authorized by Section 14-12 of
| | this Code, or for any changes authorized under Section 5A-15 of this Code; or
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| (G) any changes authorized under Section 5-5b.1.
(b) The assessment imposed by Section 5A-2 shall not take effect or
shall
cease to be imposed, and the Department's obligation to make payments shall immediately cease, if the assessment is determined to be an impermissible
tax under Title XIX
of the Social Security Act. Moneys in the Hospital Provider Fund derived
from assessments imposed prior thereto shall be
disbursed in accordance with Section 5A-8 to the extent federal financial participation is
not reduced due to the impermissibility of the assessments, and any
remaining
moneys shall be
refunded to hospital providers in proportion to the amounts paid by them.
(c) The assessments imposed by subsection (b-5) of Section 5A-2 shall not take effect or shall cease to be imposed, the Department's obligation to make payments shall immediately cease, and any moneys remaining in the Fund shall be refunded to hospital providers in proportion to the amounts paid by them, if the payments to hospitals required under Section 5A-12.4 or Section 5A-12.6 are not eligible for federal matching funds under Title XIX of the Social Security Act.
(d) The assessments imposed by Section 5A-2 shall not take effect or shall cease to be imposed, the Department's obligation to make payments shall immediately cease, and any moneys remaining in the Fund shall be refunded to hospital providers in proportion to the amounts paid by them, if:
(1) for State fiscal years 2013 through 2018, and as
| | provided in Section 5A-16, the Department reduces any payment rates to hospitals as in effect on May 1, 2012, or alters any payment methodology as in effect on May 1, 2012, that has the effect of reducing payment rates to hospitals, except for any changes affecting hospitals authorized in Public Act 97-689 and any changes authorized by Section 14-12 of this Code, and except for any changes authorized under Section 5A-15, and except for any changes authorized under Section 5-5b.1;
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| (2) for State fiscal years 2013 through 2018, and as
| | provided in Section 5A-16, the Department reduces any supplemental payments made to hospitals below the amounts paid for services provided in State fiscal year 2011 as implemented by administrative rules adopted and in effect on or prior to June 30, 2011, except for any changes affecting hospitals authorized in Public Act 97-689 and any changes authorized by Section 14-12 of this Code, and except for any changes authorized under Section 5A-15, and except for any changes authorized under Section 5-5b.1; or
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| (3) for State fiscal years 2015 through 2018, and as
| | provided in Section 5A-16, the Department reduces the overall effective rate of reimbursement to hospitals below the level authorized under Section 14-12 of this Code, except for any changes under Section 14-12 or Section 5A-15 of this Code, and except for any changes authorized under Section 5-5b.1.
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| (e) In State fiscal year 2019 through State fiscal year 2020, the assessments imposed under Section 5A-2 shall not take effect or shall cease to be imposed, the Department's obligation to make payments shall immediately cease, and any moneys remaining in the Fund shall be refunded to hospital providers in proportion to the amounts paid by them, if:
(1) the payments to hospitals required under Section
| | 5A-12.6 are not eligible for federal matching funds under Title XIX of the Social Security Act; or
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| (2) the Department reduces the overall effective
| | rate of reimbursement to hospitals below the level authorized under Section 14-12 of this Code, as in effect on December 31, 2017, except for any changes authorized under Sections 14-12 or Section 5A-15 of this Code, and except for any changes authorized under changes to Sections 5A-12.2, 5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by Public Act 100-581.
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| (f) Beginning in State Fiscal Year 2021, the assessments imposed under Section 5A-2 shall not take effect or shall cease to be imposed, the Department's obligation to make payments shall immediately cease, and any moneys remaining in the Fund shall be refunded to hospital providers in proportion to the amounts paid by them, if:
(1) the payments to hospitals required under Section
| | 5A-12.7 are not eligible for federal matching funds under Title XIX of the Social Security Act; or
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| (2) the Department reduces the overall effective rate
| | of reimbursement to hospitals below the level authorized under Section 14-12, as in effect on December 31, 2021, except for any changes authorized under Sections 14-12 or 5A-15, and except for any changes authorized under changes to Sections 5A-12.7 and 14-12 made by this amendatory Act of the 101st General Assembly, and except for any changes to Section 5A-12.7 made by this amendatory Act of the 102nd General Assembly.
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| (Source: P.A. 101-650, eff. 7-7-20; 102-886, eff. 5-17-22.)
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305 ILCS 5/5A-11
(305 ILCS 5/5A-11) (from Ch. 23, par. 5A-11)
Sec. 5A-11.
Severability.
If any clause, sentence, Section,
exemption, provision, or part of this Article or the application
thereof to any person or circumstance shall be adjudged to be
unconstitutional or otherwise invalid, the remainder of this
Article or its application to persons or circumstances other than
those to which it is held invalid shall not be affected thereby.
This Article V-A is intended to be separate from and independent
of Articles V-B and V-C, and the application and validity of
this Article V-A shall not be affected by the invalidity of one or
more of Articles V-B and V-C.
(Source: P.A. 87-861.)
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