State of Illinois
90th General Assembly
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90_HB3400

      305 ILCS 5/5-5.02         from Ch. 23, par. 5-5.02
          Amends the Illinois Public Aid Code.  Provides  that  the
      Department  of  Public Aid shall publish its rules concerning
      county hospital inpatient adjustments.
                                                     LRB9009742LDbd
                                               LRB9009742LDbd
 1        AN ACT to amend the Illinois Public Aid Code by  changing
 2    Section 5-5.02.
 3        Be  it  enacted  by  the People of the State of Illinois,
 4    represented in the General Assembly:
 5        Section 5.  The Illinois Public Aid Code  is  amended  by
 6    changing Section 5-5.02 as follows:
 7        (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
 8        Sec. 5-5.02. Hospital reimbursements.
 9        (a)  Reimbursement  to  Hospitals;  July  1, 1992 through
10    September 30, 1992.  Notwithstanding any other provisions  of
11    this  Code  or  the  Illinois  Department's Rules promulgated
12    under   the   Illinois    Administrative    Procedure    Act,
13    reimbursement  to  hospitals for services provided during the
14    period July 1, 1992 through September 30, 1992, shall  be  as
15    follows:
16             (1)  For inpatient hospital services rendered, or if
17        applicable,  for inpatient hospital discharges occurring,
18        on or after July 1, 1992 and on or before  September  30,
19        1992,  the  Illinois Department shall reimburse hospitals
20        for   inpatient   services   under   the    reimbursement
21        methodologies  in  effect  for  each hospital, and at the
22        inpatient payment rate calculated for each  hospital,  as
23        of  June  30,  1992.   For  purposes  of  this paragraph,
24        "reimbursement  methodologies"  means  all  reimbursement
25        methodologies that pertain to the provision of  inpatient
26        hospital  services,  including,  but  not limited to, any
27        adjustments for disproportionate share, targeted  access,
28        critical  care  access and uncompensated care, as defined
29        by the Illinois Department on June 30, 1992.
30             (2)  For the purpose of  calculating  the  inpatient
31        payment  rate  for  each  hospital  eligible  to  receive
                            -2-                LRB9009742LDbd
 1        quarterly  adjustment  payments  for  targeted access and
 2        critical care, as defined by the Illinois  Department  on
 3        June 30, 1992, the adjustment payment for the period July
 4        1,  1992  through September 30, 1992, shall be 25% of the
 5        annual adjustment payments calculated for  each  eligible
 6        hospital,  as  of June 30, 1992.  The Illinois Department
 7        shall determine  by  rule  the  adjustment  payments  for
 8        targeted  access  and  critical care beginning October 1,
 9        1992.
10             (3)  For the purpose of  calculating  the  inpatient
11        payment  rate  for  each  hospital  eligible  to  receive
12        quarterly  adjustment payments for uncompensated care, as
13        defined by the Illinois Department on June 30, 1992,  the
14        adjustment  payment for the period August 1, 1992 through
15        September 30, 1992,  shall  be  one-sixth  of  the  total
16        uncompensated  care  adjustment  payments  calculated for
17        each eligible hospital for the  uncompensated  care  rate
18        year,  as  defined  by the Illinois Department, ending on
19        July 31, 1992.  The Illinois Department  shall  determine
20        by  rule  the  adjustment payments for uncompensated care
21        beginning October 1, 1992.
22        (b)  Inpatient payments.  For inpatient services provided
23    on or after October 1, 1993, in addition to  rates  paid  for
24    hospital  inpatient  services pursuant to the Illinois Health
25    Finance Reform Act, as  now  or  hereafter  amended,  or  the
26    Illinois  Department's prospective reimbursement methodology,
27    or any other methodology used by the Illinois Department  for
28    inpatient   services,  the  Illinois  Department  shall  make
29    adjustment payments, in an amount calculated pursuant to  the
30    methodology  described  in  paragraph (c) of this Section, to
31    hospitals that the Illinois Department determines satisfy any
32    one of the following requirements:
33             (1)  Hospitals that are described in Section 1923 of
34        the federal Social Security  Act,  as  now  or  hereafter
                            -3-                LRB9009742LDbd
 1        amended; or
 2             (2)  Illinois   hospitals   that   have  a  Medicaid
 3        inpatient utilization rate which is at least  one-half  a
 4        standard  deviation  above  the  mean  Medicaid inpatient
 5        utilization rate for all hospitals in Illinois  receiving
 6        Medicaid payments from the Illinois Department; or
 7             (3)  Illinois  hospitals  that on July 1, 1991 had a
 8        Medicaid  inpatient  utilization  rate,  as  defined   in
 9        paragraph (f) of this Section, that was at least the mean
10        Medicaid  inpatient utilization rate for all hospitals in
11        Illinois receiving Medicaid  payments from  the  Illinois
12        Department and which were located in a planning area with
13        one-third  or  fewer  excess  beds  as  determined by the
14        Illinois Health Facilities Planning Board, and  that,  as
15        of  June 30, 1992, were located in a federally designated
16        Health Manpower Shortage Area; or
17             (4)  Illinois hospitals that:
18                  (A)  have a Medicaid inpatient utilization rate
19             that  is  at  least  equal  to  the  mean   Medicaid
20             inpatient  utilization  rate  for  all  hospitals in
21             Illinois  receiving  Medicaid  payments   from   the
22             Department; and
23                  (B)  also have a Medicaid obstetrical inpatient
24             utilization  rate  that  is  at  least  one standard
25             deviation  above  the  mean   Medicaid   obstetrical
26             inpatient  utilization  rate  for  all  hospitals in
27             Illinois  receiving  Medicaid  payments   from   the
28             Department for obstetrical services; or
29             (5)  Any children's hospital, which means a hospital
30        devoted  exclusively  to caring for children.  A hospital
31        which includes a facility devoted exclusively  to  caring
32        for children that is separately licensed as a hospital by
33        a  municipality shall be considered a children's hospital
34        to the  degree  that  the  hospital's  Medicaid  care  is
                            -4-                LRB9009742LDbd
 1        provided to children.
 2        (c)  Inpatient   adjustment   payments.   The  adjustment
 3    payments required by paragraph (b) shall be calculated  based
 4    upon  the  hospital's  Medicaid inpatient utilization rate as
 5    follows:
 6             (1)  hospitals with a Medicaid inpatient utilization
 7        rate below the mean shall receive a  per  day  adjustment
 8        payment equal to $25;
 9             (2)   hospitals    with    a    Medicaid   inpatient
10        utilization rate that is equal to  or  greater  than  the
11        mean  Medicaid  inpatient  utilization rate but less than
12        one standard deviation above the mean Medicaid  inpatient
13        utilization  rate  shall  receive  a  per  day adjustment
14        payment equal to the sum of $25  plus  $1  for  each  one
15        percent    that   the   hospital's   Medicaid   inpatient
16        utilization rate  exceeds  the  mean  Medicaid  inpatient
17        utilization rate;
18             (3)   hospitals    with    a    Medicaid   inpatient
19        utilization rate that is equal to  or  greater  than  one
20        standard  deviation  above  the  mean  Medicaid inpatient
21        utilization rate but less than  1.5  standard  deviations
22        above  the mean Medicaid inpatient utilization rate shall
23        receive a per day adjustment payment equal to the sum  of
24        $40  plus  $7  for  each  one percent that the hospital's
25        Medicaid inpatient utilization rate exceeds one  standard
26        deviation  above  the mean Medicaid inpatient utilization
27        rate; and
28             (4)   hospitals   with    a    Medicaid    inpatient
29        utilization  rate  that  is  equal to or greater than 1.5
30        standard deviations above  the  mean  Medicaid  inpatient
31        utilization  rate  shall  receive  a  per  day adjustment
32        payment equal to the sum of $90  plus  $2  for  each  one
33        percent    that   the   hospital's   Medicaid   inpatient
34        utilization rate exceeds 1.5  standard  deviations  above
                            -5-                LRB9009742LDbd
 1        the mean Medicaid inpatient utilization rate.
 2        (d)  Supplemental  adjustment  payments.   In addition to
 3    the adjustment payments described in paragraph (c), hospitals
 4    as defined in clauses  (1)  through  (5)  of  paragraph  (b),
 5    excluding  county  hospitals (as defined in subsection (c) of
 6    Section 15-1 of this Code) and a hospital organized under the
 7    University  of  Illinois  Hospital   Act,   shall   be   paid
 8    supplemental  inpatient  adjustment  payments of $60 per day.
 9    For purposes of Title XIX of the federal Social Security Act,
10    these  supplemental  adjustment   payments   shall   not   be
11    classified  as  adjustment payments to disproportionate share
12    hospitals.
13        (e)  The  inpatient  adjustment  payments  described   in
14    paragraphs  (c) and (d) shall be increased on October 1, 1993
15    and annually thereafter by a percentage equal to  the  lesser
16    of  (i)  the  increase in the DRI hospital cost index for the
17    most recent 12 month period for which data are available,  or
18    (ii)   the  percentage  increase  in  the  statewide  average
19    hospital payment rate  over  the  previous  year's  statewide
20    average  hospital  payment  rate.   The  sum of the inpatient
21    adjustment  payments  under  paragraphs  (c)  and  (d)  to  a
22    hospital,  other  than  a  county  hospital  (as  defined  in
23    subsection (c) of Section 15-1 of this Code)  or  a  hospital
24    organized  under  the  University  of  Illinois Hospital Act,
25    however, shall not exceed $275 per day; that limit  shall  be
26    increased  on  October  1,  1993 and annually thereafter by a
27    percentage equal to the lesser of (i) the increase in the DRI
28    hospital cost index for the most recent 12-month  period  for
29    which  data  are available or (ii) the percentage increase in
30    the statewide average hospital payment rate over the previous
31    year's statewide average hospital payment rate.
32        (f)   Children's hospital inpatient adjustment  payments.
33    For  children's  hospitals,  as  defined  in  clause  (5)  of
34    paragraph  (b),  the adjustment payments required pursuant to
                            -6-                LRB9009742LDbd
 1    paragraphs (c) and (d) shall be multiplied by 2.0.
 2        (g)   County hospital inpatient adjustment payments.  For
 3    county hospitals, as defined in  subsection  (c)  of  Section
 4    15-1  of  this  Code, there shall be an adjustment payment as
 5    determined by rules issued  and  published  by  the  Illinois
 6    Department.
 7        (h)   For  the  purposes  of  this  Section the following
 8    terms shall be defined as follows:
 9             (1)  "Medicaid inpatient utilization rate"  means  a
10        fraction,  the  numerator  of  which  is  the number of a
11        hospital's inpatient days provided in  a  given  12-month
12        period  to patients who, for such days, were eligible for
13        Medicaid under Title XIX of the federal  Social  Security
14        Act,  and the denominator of which is the total number of
15        the hospital's inpatient days in that same period.
16             (2)  "Mean  Medicaid  inpatient  utilization   rate"
17        means   the  total  number  of  Medicaid  inpatient  days
18        provided by all Illinois Medicaid-participating hospitals
19        divided by the total number of inpatient days provided by
20        those same hospitals.
21             (3)  "Medicaid  obstetrical  inpatient   utilization
22        rate"  means  the ratio of Medicaid obstetrical inpatient
23        days to total Medicaid inpatient days  for  all  Illinois
24        hospitals  receiving  Medicaid payments from the Illinois
25        Department.
26        (i)   Inpatient adjustment payment limit.   In  order  to
27    meet  the limits of Public Law 102-234 and Public Law 103-66,
28    the Illinois Department shall by rule adjust disproportionate
29    share adjustment payments.
30        (j)  University of Illinois Hospital inpatient adjustment
31    payments.  For hospitals organized under  the  University  of
32    Illinois  Hospital  Act, there shall be an adjustment payment
33    as determined by rules adopted by the Illinois Department.
34        (k)  The  Illinois  Department  may  by  rule   establish
                            -7-                LRB9009742LDbd
 1    criteria   for   and  develop  methodologies  for  adjustment
 2    payments to hospitals participating under this Article.
 3    (Source: P.A. 88-88; 89-21, eff. 7-1-95.)

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