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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
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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
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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
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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
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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
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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
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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.)