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90_HB3832
225 ILCS 46/15
305 ILCS 5/5-5.02 from Ch. 23, par. 5-5.02
Amends the Health Care Worker Background Check Act and
the Public Aid Code. In the Health Care Worker Background
Check Act, includes a supportive living program in the
definition of "health care employer". In Section of the
Public Aid Code concerning hospital reimbursements, requires
that a facility devoted exclusively to caring for children
licensed as a hospital by a municipality prior to January 1,
1998 (now, no time limit) be considered a children's
hospital. Effective immediately.
LRB9008935DJcdC
LRB9008935DJcdC
1 AN ACT concerning health care, amending named Acts.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Health Care Worker Background Check Act
5 is amended by changing Section 15 as follows:
6 (225 ILCS 46/15)
7 Sec. 15. Definitions. For the purposes of this Act, the
8 following definitions apply:
9 "Applicant" means an individual seeking employment with a
10 health care employer who has received a bona fide conditional
11 offer of employment.
12 "Conditional offer of employment" means a bona fide offer
13 of employment by a health care employer to an applicant,
14 which is contingent upon the receipt of a report from the
15 Department of State Police indicating that the applicant does
16 not have a record of conviction of any of the criminal
17 offenses enumerated in Section 25.
18 "Direct care" means the provision of nursing care or
19 assistance with meals, dressing, movement, bathing, or other
20 personal needs or maintenance, or general supervision and
21 oversight of the physical and mental well-being of an
22 individual who is incapable of managing his or her person
23 whether or not a guardian has been appointed for that
24 individual.
25 "Health care employer" means:
26 (1) the owner or licensee of any of the following:
27 (i) a community living facility, as defined in the
28 Community Living Facilities Act;
29 (ii) a life care facility, as defined in the Life
30 Care Facilities Act;
31 (iii) a long-term care facility, as defined in the
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1 Nursing Home Care Act;
2 (iv) a home health agency, as defined in the Home
3 Health Agency Licensing Act;
4 (v) a full hospice, as defined in the Hospice
5 Program Licensing Act;
6 (vi) a hospital, as defined in the Hospital
7 Licensing Act;
8 (vii) a community residential alternative, as
9 defined in the Community Residential Alternatives
10 Licensing Act;
11 (viii) a nurse agency, as defined in the Nurse
12 Agency Licensing Act;
13 (ix) a respite care provider, as defined in the
14 Respite Program Act;
15 (x) a supportive living program, as defined in the
16 Illinois Public Aid Code;
17 (2) a day training program certified by the Department
18 of Human Services; or
19 (3) a community integrated living arrangement operated
20 by a community mental health and developmental service
21 agency, as defined in the Community-Integrated Living
22 Arrangements Licensing and Certification Act.
23 "Initiate" means the obtaining of the authorization for a
24 record check from a student, applicant, or employee. The
25 educational entity or health care employer or its designee
26 shall transmit all necessary information and fees to the
27 Illinois State Police within 10 working days after receipt of
28 the authorization.
29 (Source: P.A. 89-197, eff. 7-21-95; 89-507, eff. 7-1-97;
30 89-674, eff. 8-14-96; 90-14, eff. 7-1-97.)
31 Section 10. The Illinois Public Aid Code is amended by
32 changing Section 5-5.02 as follows:
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1 (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
2 Sec. 5-5.02. Hospital reimbursements.
3 (a) Reimbursement to Hospitals; July 1, 1992 through
4 September 30, 1992. Notwithstanding any other provisions of
5 this Code or the Illinois Department's Rules promulgated
6 under the Illinois Administrative Procedure Act,
7 reimbursement to hospitals for services provided during the
8 period July 1, 1992 through September 30, 1992, shall be as
9 follows:
10 (1) For inpatient hospital services rendered, or if
11 applicable, for inpatient hospital discharges occurring,
12 on or after July 1, 1992 and on or before September 30,
13 1992, the Illinois Department shall reimburse hospitals
14 for inpatient services under the reimbursement
15 methodologies in effect for each hospital, and at the
16 inpatient payment rate calculated for each hospital, as
17 of June 30, 1992. For purposes of this paragraph,
18 "reimbursement methodologies" means all reimbursement
19 methodologies that pertain to the provision of inpatient
20 hospital services, including, but not limited to, any
21 adjustments for disproportionate share, targeted access,
22 critical care access and uncompensated care, as defined
23 by the Illinois Department on June 30, 1992.
24 (2) For the purpose of calculating the inpatient
25 payment rate for each hospital eligible to receive
26 quarterly adjustment payments for targeted access and
27 critical care, as defined by the Illinois Department on
28 June 30, 1992, the adjustment payment for the period July
29 1, 1992 through September 30, 1992, shall be 25% of the
30 annual adjustment payments calculated for each eligible
31 hospital, as of June 30, 1992. The Illinois Department
32 shall determine by rule the adjustment payments for
33 targeted access and critical care beginning October 1,
34 1992.
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1 (3) For the purpose of calculating the inpatient
2 payment rate for each hospital eligible to receive
3 quarterly adjustment payments for uncompensated care, as
4 defined by the Illinois Department on June 30, 1992, the
5 adjustment payment for the period August 1, 1992 through
6 September 30, 1992, shall be one-sixth of the total
7 uncompensated care adjustment payments calculated for
8 each eligible hospital for the uncompensated care rate
9 year, as defined by the Illinois Department, ending on
10 July 31, 1992. The Illinois Department shall determine
11 by rule the adjustment payments for uncompensated care
12 beginning October 1, 1992.
13 (b) Inpatient payments. For inpatient services provided
14 on or after October 1, 1993, in addition to rates paid for
15 hospital inpatient services pursuant to the Illinois Health
16 Finance Reform Act, as now or hereafter amended, or the
17 Illinois Department's prospective reimbursement methodology,
18 or any other methodology used by the Illinois Department for
19 inpatient services, the Illinois Department shall make
20 adjustment payments, in an amount calculated pursuant to the
21 methodology described in paragraph (c) of this Section, to
22 hospitals that the Illinois Department determines satisfy any
23 one of the following requirements:
24 (1) Hospitals that are described in Section 1923 of
25 the federal Social Security Act, as now or hereafter
26 amended; or
27 (2) Illinois hospitals that have a Medicaid
28 inpatient utilization rate which is at least one-half a
29 standard deviation above the mean Medicaid inpatient
30 utilization rate for all hospitals in Illinois receiving
31 Medicaid payments from the Illinois Department; or
32 (3) Illinois hospitals that on July 1, 1991 had a
33 Medicaid inpatient utilization rate, as defined in
34 paragraph (f) of this Section, that was at least the mean
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1 Medicaid inpatient utilization rate for all hospitals in
2 Illinois receiving Medicaid payments from the Illinois
3 Department and which were located in a planning area with
4 one-third or fewer excess beds as determined by the
5 Illinois Health Facilities Planning Board, and that, as
6 of June 30, 1992, were located in a federally designated
7 Health Manpower Shortage Area; or
8 (4) Illinois hospitals that:
9 (A) have a Medicaid inpatient utilization rate
10 that is at least equal to the mean Medicaid
11 inpatient utilization rate for all hospitals in
12 Illinois receiving Medicaid payments from the
13 Department; and
14 (B) also have a Medicaid obstetrical inpatient
15 utilization rate that is at least one standard
16 deviation above the mean Medicaid obstetrical
17 inpatient utilization rate for all hospitals in
18 Illinois receiving Medicaid payments from the
19 Department for obstetrical services; or
20 (5) Any children's hospital, which means a hospital
21 devoted exclusively to caring for children. A hospital
22 which includes a facility devoted exclusively to caring
23 for children that was is separately licensed as a
24 hospital by a municipality prior to January 1, 1998 shall
25 be considered a children's hospital to the degree that
26 the hospital's Medicaid care is provided to children.
27 (c) Inpatient adjustment payments. The adjustment
28 payments required by paragraph (b) shall be calculated based
29 upon the hospital's Medicaid inpatient utilization rate as
30 follows:
31 (1) hospitals with a Medicaid inpatient utilization
32 rate below the mean shall receive a per day adjustment
33 payment equal to $25;
34 (2) hospitals with a Medicaid inpatient
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1 utilization rate that is equal to or greater than the
2 mean Medicaid inpatient utilization rate but less than
3 one standard deviation above the mean Medicaid inpatient
4 utilization rate shall receive a per day adjustment
5 payment equal to the sum of $25 plus $1 for each one
6 percent that the hospital's Medicaid inpatient
7 utilization rate exceeds the mean Medicaid inpatient
8 utilization rate;
9 (3) hospitals with a Medicaid inpatient
10 utilization rate that is equal to or greater than one
11 standard deviation above the mean Medicaid inpatient
12 utilization rate but less than 1.5 standard deviations
13 above the mean Medicaid inpatient utilization rate shall
14 receive a per day adjustment payment equal to the sum of
15 $40 plus $7 for each one percent that the hospital's
16 Medicaid inpatient utilization rate exceeds one standard
17 deviation above the mean Medicaid inpatient utilization
18 rate; and
19 (4) hospitals with a Medicaid inpatient
20 utilization rate that is equal to or greater than 1.5
21 standard deviations above the mean Medicaid inpatient
22 utilization rate shall receive a per day adjustment
23 payment equal to the sum of $90 plus $2 for each one
24 percent that the hospital's Medicaid inpatient
25 utilization rate exceeds 1.5 standard deviations above
26 the mean Medicaid inpatient utilization rate.
27 (d) Supplemental adjustment payments. In addition to
28 the adjustment payments described in paragraph (c), hospitals
29 as defined in clauses (1) through (5) of paragraph (b),
30 excluding county hospitals (as defined in subsection (c) of
31 Section 15-1 of this Code) and a hospital organized under the
32 University of Illinois Hospital Act, shall be paid
33 supplemental inpatient adjustment payments of $60 per day.
34 For purposes of Title XIX of the federal Social Security Act,
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1 these supplemental adjustment payments shall not be
2 classified as adjustment payments to disproportionate share
3 hospitals.
4 (e) The inpatient adjustment payments described in
5 paragraphs (c) and (d) shall be increased on October 1, 1993
6 and annually thereafter by a percentage equal to the lesser
7 of (i) the increase in the DRI hospital cost index for the
8 most recent 12 month period for which data are available, or
9 (ii) the percentage increase in the statewide average
10 hospital payment rate over the previous year's statewide
11 average hospital payment rate. The sum of the inpatient
12 adjustment payments under paragraphs (c) and (d) to a
13 hospital, other than a county hospital (as defined in
14 subsection (c) of Section 15-1 of this Code) or a hospital
15 organized under the University of Illinois Hospital Act,
16 however, shall not exceed $275 per day; that limit shall be
17 increased on October 1, 1993 and annually thereafter by a
18 percentage equal to the lesser of (i) the increase in the DRI
19 hospital cost index for the most recent 12-month period for
20 which data are available or (ii) the percentage increase in
21 the statewide average hospital payment rate over the previous
22 year's statewide average hospital payment rate.
23 (f) Children's hospital inpatient adjustment payments.
24 For children's hospitals, as defined in clause (5) of
25 paragraph (b), the adjustment payments required pursuant to
26 paragraphs (c) and (d) shall be multiplied by 2.0.
27 (g) County hospital inpatient adjustment payments. For
28 county hospitals, as defined in subsection (c) of Section
29 15-1 of this Code, there shall be an adjustment payment as
30 determined by rules issued by the Illinois Department.
31 (h) For the purposes of this Section the following
32 terms shall be defined as follows:
33 (1) "Medicaid inpatient utilization rate" means a
34 fraction, the numerator of which is the number of a
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1 hospital's inpatient days provided in a given 12-month
2 period to patients who, for such days, were eligible for
3 Medicaid under Title XIX of the federal Social Security
4 Act, and the denominator of which is the total number of
5 the hospital's inpatient days in that same period.
6 (2) "Mean Medicaid inpatient utilization rate"
7 means the total number of Medicaid inpatient days
8 provided by all Illinois Medicaid-participating hospitals
9 divided by the total number of inpatient days provided by
10 those same hospitals.
11 (3) "Medicaid obstetrical inpatient utilization
12 rate" means the ratio of Medicaid obstetrical inpatient
13 days to total Medicaid inpatient days for all Illinois
14 hospitals receiving Medicaid payments from the Illinois
15 Department.
16 (i) Inpatient adjustment payment limit. In order to
17 meet the limits of Public Law 102-234 and Public Law 103-66,
18 the Illinois Department shall by rule adjust disproportionate
19 share adjustment payments.
20 (j) University of Illinois Hospital inpatient adjustment
21 payments. For hospitals organized under the University of
22 Illinois Hospital Act, there shall be an adjustment payment
23 as determined by rules adopted by the Illinois Department.
24 (k) The Illinois Department may by rule establish
25 criteria for and develop methodologies for adjustment
26 payments to hospitals participating under this Article.
27 (Source: P.A. 88-88; 89-21, eff. 7-1-95.)
28 Section 99. Effective date. This Act takes effect upon
29 becoming law.