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90_SB1706enr New Act Creates the FY99 Budget Implementation (Health Related) Act. Provides that the purpose of the Act is to make the changes in State programs that are necessary to implement the Governor's FY1999 budget recommendations. Effective July 1, 1998. LRB9011519MWpc SB1706 Enrolled LRB9011519MWpc 1 AN ACT in relation to State government. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 1. Short title. This Act may be cited as the 5 FY99 Budget Implementation (Health Related) Act. 6 Section 5. Purpose. It is the purpose and subject of 7 this Act to make the changes in State programs that are 8 necessary to implement the Governor's FY1999 budget 9 recommendations. 10 Section 10. The Illinois Administrative Procedure Act is 11 amended by changing Section 5-45 as follows: 12 (5 ILCS 100/5-45) (from Ch. 127, par. 1005-45) 13 Sec. 5-45. Emergency rulemaking. 14 (a) "Emergency" means the existence of any situation 15 that any agency finds reasonably constitutes a threat to the 16 public interest, safety, or welfare. 17 (b) If any agency finds that an emergency exists that 18 requires adoption of a rule upon fewer days than is required 19 by Section 5-40 and states in writing its reasons for that 20 finding, the agency may adopt an emergency rule without prior 21 notice or hearing upon filing a notice of emergency 22 rulemaking with the Secretary of State under Section 5-70. 23 The notice shall include the text of the emergency rule and 24 shall be published in the Illinois Register. Consent orders 25 or other court orders adopting settlements negotiated by an 26 agency may be adopted under this Section. Subject to 27 applicable constitutional or statutory provisions, an 28 emergency rule becomes effective immediately upon filing 29 under Section 5-65 or at a stated date less than 10 days SB1706 Enrolled -2- LRB9011519MWpc 1 thereafter. The agency's finding and a statement of the 2 specific reasons for the finding shall be filed with the 3 rule. The agency shall take reasonable and appropriate 4 measures to make emergency rules known to the persons who may 5 be affected by them. 6 (c) An emergency rule may be effective for a period of 7 not longer than 150 days, but the agency's authority to adopt 8 an identical rule under Section 5-40 is not precluded. No 9 emergency rule may be adopted more than once in any 24 month 10 period, except that this limitation on the number of 11 emergency rules that may be adopted in a 24 month period does 12 not apply to (i) emergency rules that make additions to and 13 deletions from the Drug Manual under Section 5-5.16 of the 14 Illinois Public Aid Code or the generic drug formulary under 15 Section 3.14 of the Illinois Food, Drug and Cosmetic Act or 16 (ii) emergency rules adopted by the Pollution Control Board 17 before July 1, 1997 to implement portions of the Livestock 18 Management Facilities Act. Two or more emergency rules 19 having substantially the same purpose and effect shall be 20 deemed to be a single rule for purposes of this Section. 21 (d) In order to provide for the expeditious and timely 22 implementation of the State's fiscal year 1999
1998budget, 23 emergency rules to implement any provision of this amendatory 24 Act of 1998 1997or any other budget initiative for fiscal 25 year 1999 1998may be adopted in accordance with this Section 26 by the agency charged with administering that provision or 27 initiative, except that the 24-month limitation on the 28 adoption of emergency rules and the provisions of Sections 29 5-115 and 5-125 do not apply to rules adopted under this 30 subsection (d). The adoption of emergency rules authorized 31 by this subsection (d) shall be deemed to be necessary for 32 the public interest, safety, and welfare. 33 (Source: P.A. 89-714, eff. 2-21-97; 90-9, eff. 7-1-97.) SB1706 Enrolled -3- LRB9011519MWpc 1 Section 15. The Illinois Public Aid Code is amended by 2 changing Sections 5-5.02, 5-5.4, 12-4.34, and 14-8 and adding 3 Section 12-4.35 as follows: 4 (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02) 5 Sec. 5-5.02. Hospital reimbursements. 6 (a) Reimbursement to Hospitals; July 1, 1992 through 7 September 30, 1992. Notwithstanding any other provisions of 8 this Code or the Illinois Department's Rules promulgated 9 under the Illinois Administrative Procedure Act, 10 reimbursement to hospitals for services provided during the 11 period July 1, 1992 through September 30, 1992, shall be as 12 follows: 13 (1) For inpatient hospital services rendered, or if 14 applicable, for inpatient hospital discharges occurring, 15 on or after July 1, 1992 and on or before September 30, 16 1992, the Illinois Department shall reimburse hospitals 17 for inpatient services under the reimbursement 18 methodologies in effect for each hospital, and at the 19 inpatient payment rate calculated for each hospital, as 20 of June 30, 1992. For purposes of this paragraph, 21 "reimbursement methodologies" means all reimbursement 22 methodologies that pertain to the provision of inpatient 23 hospital services, including, but not limited to, any 24 adjustments for disproportionate share, targeted access, 25 critical care access and uncompensated care, as defined 26 by the Illinois Department on June 30, 1992. 27 (2) For the purpose of calculating the inpatient 28 payment rate for each hospital eligible to receive 29 quarterly adjustment payments for targeted access and 30 critical care, as defined by the Illinois Department on 31 June 30, 1992, the adjustment payment for the period July 32 1, 1992 through September 30, 1992, shall be 25% of the 33 annual adjustment payments calculated for each eligible SB1706 Enrolled -4- LRB9011519MWpc 1 hospital, as of June 30, 1992. The Illinois Department 2 shall determine by rule the adjustment payments for 3 targeted access and critical care beginning October 1, 4 1992. 5 (3) For the purpose of calculating the inpatient 6 payment rate for each hospital eligible to receive 7 quarterly adjustment payments for uncompensated care, as 8 defined by the Illinois Department on June 30, 1992, the 9 adjustment payment for the period August 1, 1992 through 10 September 30, 1992, shall be one-sixth of the total 11 uncompensated care adjustment payments calculated for 12 each eligible hospital for the uncompensated care rate 13 year, as defined by the Illinois Department, ending on 14 July 31, 1992. The Illinois Department shall determine 15 by rule the adjustment payments for uncompensated care 16 beginning October 1, 1992. 17 (b) Inpatient payments. For inpatient services provided 18 on or after October 1, 1993, in addition to rates paid for 19 hospital inpatient services pursuant to the Illinois Health 20 Finance Reform Act, as now or hereafter amended, or the 21 Illinois Department's prospective reimbursement methodology, 22 or any other methodology used by the Illinois Department for 23 inpatient services, the Illinois Department shall make 24 adjustment payments, in an amount calculated pursuant to the 25 methodology described in paragraph (c) of this Section, to 26 hospitals that the Illinois Department determines satisfy any 27 one of the following requirements: 28 (1) Hospitals that are described in Section 1923 of 29 the federal Social Security Act, as now or hereafter 30 amended; or 31 (2) Illinois hospitals that have a Medicaid 32 inpatient utilization rate which is at least one-half a 33 standard deviation above the mean Medicaid inpatient 34 utilization rate for all hospitals in Illinois receiving SB1706 Enrolled -5- LRB9011519MWpc 1 Medicaid payments from the Illinois Department; or 2 (3) Illinois hospitals that on July 1, 1991 had a 3 Medicaid inpatient utilization rate, as defined in 4 paragraph (f) of this Section, that was at least the mean 5 Medicaid inpatient utilization rate for all hospitals in 6 Illinois receiving Medicaid payments from the Illinois 7 Department and which were located in a planning area with 8 one-third or fewer excess beds as determined by the 9 Illinois Health Facilities Planning Board, and that, as 10 of June 30, 1992, were located in a federally designated 11 Health Manpower Shortage Area; or 12 (4) Illinois hospitals that: 13 (A) have a Medicaid inpatient utilization rate 14 that is at least equal to the mean Medicaid 15 inpatient utilization rate for all hospitals in 16 Illinois receiving Medicaid payments from the 17 Department; and 18 (B) also have a Medicaid obstetrical inpatient 19 utilization rate that is at least one standard 20 deviation above the mean Medicaid obstetrical 21 inpatient utilization rate for all hospitals in 22 Illinois receiving Medicaid payments from the 23 Department for obstetrical services; or 24 (5) Any children's hospital, which means a hospital 25 devoted exclusively to caring for children. A hospital 26 which includes a facility devoted exclusively to caring 27 for children that is separately licensed as a hospital by 28 a municipality prior to September 30, 1998 shall be 29 considered a children's hospital to the degree that the 30 hospital's Medicaid care is provided to children. 31 (c) Inpatient adjustment payments. The adjustment 32 payments required by paragraph (b) shall be calculated based 33 upon the hospital's Medicaid inpatient utilization rate as 34 follows: SB1706 Enrolled -6- LRB9011519MWpc 1 (1) hospitals with a Medicaid inpatient utilization 2 rate below the mean shall receive a per day adjustment 3 payment equal to $25; 4 (2) hospitals with a Medicaid inpatient 5 utilization rate that is equal to or greater than the 6 mean Medicaid inpatient utilization rate but less than 7 one standard deviation above the mean Medicaid inpatient 8 utilization rate shall receive a per day adjustment 9 payment equal to the sum of $25 plus $1 for each one 10 percent that the hospital's Medicaid inpatient 11 utilization rate exceeds the mean Medicaid inpatient 12 utilization rate; 13 (3) hospitals with a Medicaid inpatient 14 utilization rate that is equal to or greater than one 15 standard deviation above the mean Medicaid inpatient 16 utilization rate but less than 1.5 standard deviations 17 above the mean Medicaid inpatient utilization rate shall 18 receive a per day adjustment payment equal to the sum of 19 $40 plus $7 for each one percent that the hospital's 20 Medicaid inpatient utilization rate exceeds one standard 21 deviation above the mean Medicaid inpatient utilization 22 rate; and 23 (4) hospitals with a Medicaid inpatient 24 utilization rate that is equal to or greater than 1.5 25 standard deviations above the mean Medicaid inpatient 26 utilization rate shall receive a per day adjustment 27 payment equal to the sum of $90 plus $2 for each one 28 percent that the hospital's Medicaid inpatient 29 utilization rate exceeds 1.5 standard deviations above 30 the mean Medicaid inpatient utilization rate. 31 (d) Supplemental adjustment payments. In addition to 32 the adjustment payments described in paragraph (c), hospitals 33 as defined in clauses (1) through (5) of paragraph (b), 34 excluding county hospitals (as defined in subsection (c) of SB1706 Enrolled -7- LRB9011519MWpc 1 Section 15-1 of this Code) and a hospital organized under the 2 University of Illinois Hospital Act, shall be paid 3 supplemental inpatient adjustment payments of $60 per day. 4 For purposes of Title XIX of the federal Social Security Act, 5 these supplemental adjustment payments shall not be 6 classified as adjustment payments to disproportionate share 7 hospitals. 8 (e) The inpatient adjustment payments described in 9 paragraphs (c) and (d) shall be increased on October 1, 1993 10 and annually thereafter by a percentage equal to the lesser 11 of (i) the increase in the DRI hospital cost index for the 12 most recent 12 month period for which data are available, or 13 (ii) the percentage increase in the statewide average 14 hospital payment rate over the previous year's statewide 15 average hospital payment rate. The sum of the inpatient 16 adjustment payments under paragraphs (c) and (d) to a 17 hospital, other than a county hospital (as defined in 18 subsection (c) of Section 15-1 of this Code) or a hospital 19 organized under the University of Illinois Hospital Act, 20 however, shall not exceed $275 per day; that limit shall be 21 increased on October 1, 1993 and annually thereafter by a 22 percentage equal to the lesser of (i) the increase in the DRI 23 hospital cost index for the most recent 12-month period for 24 which data are available or (ii) the percentage increase in 25 the statewide average hospital payment rate over the previous 26 year's statewide average hospital payment rate. 27 (f) Children's hospital inpatient adjustment payments. 28 For children's hospitals, as defined in clause (5) of 29 paragraph (b), the adjustment payments required pursuant to 30 paragraphs (c) and (d) shall be multiplied by 2.0. 31 (g) County hospital inpatient adjustment payments. For 32 county hospitals, as defined in subsection (c) of Section 33 15-1 of this Code, there shall be an adjustment payment as 34 determined by rules issued by the Illinois Department. SB1706 Enrolled -8- LRB9011519MWpc 1 (h) For the purposes of this Section the following 2 terms shall be defined as follows: 3 (1) "Medicaid inpatient utilization rate" means a 4 fraction, the numerator of which is the number of a 5 hospital's inpatient days provided in a given 12-month 6 period to patients who, for such days, were eligible for 7 Medicaid under Title XIX of the federal Social Security 8 Act, and the denominator of which is the total number of 9 the hospital's inpatient days in that same period. 10 (2) "Mean Medicaid inpatient utilization rate" 11 means the total number of Medicaid inpatient days 12 provided by all Illinois Medicaid-participating hospitals 13 divided by the total number of inpatient days provided by 14 those same hospitals. 15 (3) "Medicaid obstetrical inpatient utilization 16 rate" means the ratio of Medicaid obstetrical inpatient 17 days to total Medicaid inpatient days for all Illinois 18 hospitals receiving Medicaid payments from the Illinois 19 Department. 20 (i) Inpatient adjustment payment limit. In order to 21 meet the limits of Public Law 102-234 and Public Law 103-66, 22 the Illinois Department shall by rule adjust disproportionate 23 share adjustment payments. 24 (j) University of Illinois Hospital inpatient adjustment 25 payments. For hospitals organized under the University of 26 Illinois Hospital Act, there shall be an adjustment payment 27 as determined by rules adopted by the Illinois Department. 28 (k) The Illinois Department may by rule establish 29 criteria for and develop methodologies for adjustment 30 payments to hospitals participating under this Article. 31 (Source: P.A. 88-88; 89-21, eff. 7-1-95.) 32 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) 33 Sec. 5-5.4. Standards of Payment - Department of Public SB1706 Enrolled -9- LRB9011519MWpc 1 Aid. The Department of Public Aid shall develop standards of 2 payment of skilled nursing and intermediate care services in 3 facilities providing such services under this Article which: 4 (1) Provides for the determination of a facility's 5 payment for skilled nursing and intermediate care services on 6 a prospective basis. The amount of the payment rate for all 7 nursing facilities certified under the medical assistance 8 program shall be prospectively established annually on the 9 basis of historical, financial, and statistical data 10 reflecting actual costs from prior years, which shall be 11 applied to the current rate year and updated for inflation, 12 except that the capital cost element for newly constructed 13 facilities shall be based upon projected budgets. The 14 annually established payment rate shall take effect on July 1 15 in 1984 and subsequent years. Rate increases shall be 16 provided annually thereafter on July 1 in 1984 and on each 17 subsequent July 1 in the following years, except that no rate 18 increase and no update for inflation shall be provided on or 19 after July 1, 1994 and before July 1, 1999, unless 20 specifically provided for in this Section. For facilities 21 licensed by the Department of Public Health under the Nursing 22 Home Care Act as Intermediate Care for the Developmentally 23 Disabled facilities or Long Term Care for Under Age 22 24 facilities, the rates taking effect on July 1, 1998 shall 25 include an increase of 3%. For facilities licensed by the 26 Department of Public Health under the Nursing Home Care Act 27 as Skilled Nursing facilities or Intermediate Care 28 facilities, the rates taking effect on July 1, 1998 shall 29 include an increase of 3% plus $1.10 per resident-day, as 30 defined by the Department. Rates established effective each 31 July 1 shall govern payment for services rendered throughout 32 that fiscal year, except that rates established on July 1, 33 1996 shall be increased by 6.8% for services provided on or 34 after January 1, 1997. Such rates will be based upon the SB1706 Enrolled -10- LRB9011519MWpc 1 rates calculated for the year beginning July 1, 1990, and for 2 subsequent years thereafter shall be based on the facility 3 cost reports for the facility fiscal year ending at any point 4 in time during the previous calendar year, updated to the 5 midpoint of the rate year. The cost report shall be on file 6 with the Department no later than April 1 of the current rate 7 year. Should the cost report not be on file by April 1, the 8 Department shall base the rate on the latest cost report 9 filed by each skilled care facility and intermediate care 10 facility, updated to the midpoint of the current rate year. 11 In determining rates for services rendered on and after July 12 1, 1985, fixed time shall not be computed at less than zero. 13 The Department shall not make any alterations of regulations 14 which would reduce any component of the Medicaid rate to a 15 level below what that component would have been utilizing in 16 the rate effective on July 1, 1984. 17 (2) Shall take into account the actual costs incurred by 18 facilities in providing services for recipients of skilled 19 nursing and intermediate care services under the medical 20 assistance program. 21 (3) Shall take into account the medical and 22 psycho-social characteristics and needs of the patients. 23 (4) Shall take into account the actual costs incurred by 24 facilities in meeting ,licensing and certification standards 25 imposed and prescribed by the State of Illinois, any of its 26 political subdivisions or municipalities and by the United 27 States Department of Health, Education and Welfare pursuant 28 to Title XIX of the Social Security Act. 29 The Department of Public Aid shall develop precise 30 standards for payments to reimburse nursing facilities for 31 any utilization of appropriate rehabilitative personnel for 32 the provision of rehabilitative services which is authorized 33 by federal regulations, including reimbursement for services 34 provided by qualified therapists or qualified assistants, and SB1706 Enrolled -11- LRB9011519MWpc 1 which is in accordance with accepted professional practices. 2 Reimbursement also may be made for utilization of other 3 supportive personnel under appropriate supervision. 4 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96; 90-9, 5 eff. 7-1-97.) 6 (305 ILCS 5/12-4.34) 7 (Section scheduled to be repealed on August 31, 1998) 8 Sec. 12-4.34. Naturalization and nutritionServices to 9 noncitizens. 10 (a) Subject to specific appropriation for this purpose 11 and notwithstanding Sections 1-11 and 3-1 of this Code, the 12 Department of Human Services is authorized to provide 13 naturalizationservices to legal immigrants, including but 14 not limited to naturalization and nutrition services and 15 financial assistance. The nature of these services, payment 16 levels, and eligibility conditions shall be determined by 17 rule. 18 (b) Subject to specific appropriation for this purpose,19 the Department of Human Services is authorized to provide20 nutrition services to noncitizens who are 65 years of age or21 older, under 18 years of age, or disabled, and who were in22 the United States prior to August 22, 1996 and are not23 eligible for the federal food stamp program due to their24 noncitizen status. The payment levels and other eligibility25 conditions for these services shall be determined by rule.26 The Illinois Department is authorized to lower the 27 payment levels established under this subsection or take such 28 other actions during the fiscal year as are necessary to 29 ensure that payments under this subsection do not exceed the 30 amounts appropriated for this purpose. These changes may be 31 accomplished by emergency rule under Section 5-45 of the 32 Illinois Administrative Procedure Act, except that the 33 limitation on the number of emergency rules that may be SB1706 Enrolled -12- LRB9011519MWpc 1 adopted in a 24-month period shall not apply. 2 (c) This Section is repealed on August 31, 1999 1998. 3 (Source: P.A. 90-564, eff. 12-22-97.) 4 (305 ILCS 5/12-4.35 new) 5 Sec. 12-4.35. Medical services for certain noncitizens. 6 (a) Subject to specific appropriation for this purpose, 7 and notwithstanding Section 1-11 of this Code or Section 8 20(a) of the Children's Health Insurance Program Act, the 9 Department of Public Aid may provide medical services to 10 noncitizens who have not yet attained 19 years of age and who 11 are not eligible for medical assistance under Article V of 12 this Code or under the Children's Health Insurance Program 13 created by the Children's Health Insurance Program Act due to 14 their not meeting the otherwise applicable provisions of 15 Section 1-11 of this Code or Section 20(a) of the Children's 16 Health Insurance Program Act. The medical services 17 available, standards for eligibility, and other conditions of 18 participation under this Section shall be established by rule 19 by the Department; however, any such rule shall be at least 20 as restrictive as the rules for medical assistance under 21 Article V of this Code or the Children's Health Insurance 22 Program created by the Children's Health Insurance Program 23 Act. 24 (b) The Department is authorized to take any action, 25 including without limitation cessation of enrollment, 26 reduction of available medical services, and changing 27 standards for eligibility, that is deemed necessary by the 28 Department during a State fiscal year to assure that payments 29 under this Section do not exceed the amounts appropriated for 30 this purpose. 31 (c) In the event that the appropriation in any fiscal 32 year for the Children's Health Insurance Program created by 33 the Children's Health Insurance Program Act is determined by SB1706 Enrolled -13- LRB9011519MWpc 1 the Department to be insufficient to continue enrollment of 2 otherwise eligible children under that Program during that 3 fiscal year, the Department is authorized to use funds 4 appropriated for the purposes of this Section to fund that 5 Program and to take any other action necessary to continue 6 the operation of that Program. Furthermore, continued 7 enrollment of individuals into the program created under this 8 Section in any fiscal year is contingent upon continued 9 enrollment of individuals into the Children's Health 10 Insurance Program during that fiscal year. 11 (d) The General Assembly finds that the adoption of 12 rules to meet the purposes of subsections (a), (b), and (c) 13 is an emergency and necessary for the public interest, 14 safety, and welfare. The Department may adopt such rules 15 through the use of emergency rulemaking in accordance with 16 Section 5-45 of the Illinois Administrative Procedure Act, 17 except that the limitation on the number of emergency rules 18 that may be adopted in a 24-month period shall not apply. 19 (305 ILCS 5/14-8) (from Ch. 23, par. 14-8) 20 Sec. 14-8. Disbursements to Hospitals. 21 (a) For inpatient hospital services rendered on and 22 after September 1, 1991, the Illinois Department shall 23 reimburse hospitals for inpatient services at an inpatient 24 payment rate calculated for each hospital based upon the 25 Medicare Prospective Payment System as set forth in Sections 26 1886(b), (d), (g), and (h) of the federal Social Security 27 Act, and the regulations, policies, and procedures 28 promulgated thereunder, except as modified by this Section. 29 Payment rates for inpatient hospital services rendered on or 30 after September 1, 1991 and on or before September 30, 1992 31 shall be calculated using the Medicare Prospective Payment 32 rates in effect on September 1, 1991. Payment rates for 33 inpatient hospital services rendered on or after October 1, SB1706 Enrolled -14- LRB9011519MWpc 1 1992 and on or before March 31, 1994 shall be calculated 2 using the Medicare Prospective Payment rates in effect on 3 September 1, 1992. Payment rates for inpatient hospital 4 services rendered on or after April 1, 1994 shall be 5 calculated using the Medicare Prospective Payment rates 6 (including the Medicare grouping methodology and weighting 7 factors as adjusted pursuant to paragraph (1) of this 8 subsection) in effect 90 days prior to the date of 9 admission. For services rendered on or after July 1, 1995, 10 the reimbursement methodology implemented under this 11 subsection shall not include those costs referred to in 12 Sections 1886(d)(5)(B) and 1886(h) of the Social Security 13 Act. The additional payment amounts required under Section 14 1886(d)(5)(F) of the Social Security Act, for hospitals 15 serving a disproportionate share of low-income or indigent 16 patients, are not required under this Section. For hospital 17 inpatient services rendered on or after July 1, 1995, the 18 Illinois Department shall reimburse hospitals using the 19 relative weighting factors and the base payment rates 20 calculated for each hospital that were in effect on June 30, 21 1995, less the portion of such rates attributed by the 22 Illinois Department to the cost of medical education. 23 (1) The weighting factors established under Section 24 1886(d)(4) of the Social Security Act shall not be used 25 in the reimbursement system established under this 26 Section. Rather, the Illinois Department shall establish 27 by rule Medicaid weighting factors to be used in the 28 reimbursement system established under this Section. 29 (2) The Illinois Department shall define by rule 30 those hospitals or distinct parts of hospitals that shall 31 be exempt from the reimbursement system established under 32 this Section. In defining such hospitals, the Illinois 33 Department shall take into consideration those hospitals 34 exempt from the Medicare Prospective Payment System as of SB1706 Enrolled -15- LRB9011519MWpc 1 September 1, 1991. For hospitals defined as exempt under 2 this subsection, the Illinois Department shall by rule 3 establish a reimbursement system for payment of inpatient 4 hospital services rendered on and after September 1, 5 1991. For all hospitals that are children's hospitals as 6 defined in Section 5-5.02 of this Code, the reimbursement 7 methodology shall, through June 30, 1992, net of all 8 applicable fees, at least equal each children's hospital 9 1990 ICARE payment rates, indexed to the current year by 10 application of the DRI hospital cost index from 1989 to 11 the year in which payments are made. Excepting county 12 providers as defined in Article XV of this Code, 13 hospitals licensed under the University of Illinois 14 Hospital Act, and facilities operated by the Department 15 of Mental Health and Developmental Disabilities (or its 16 successor, the Department of Human Services) for hospital 17 inpatient services rendered on or after July 1, 1995, the 18 Illinois Department shall reimburse children's hospitals, 19 as defined in 89 Illinois Administrative Code Section 20 149.50(c)(3), at the rates in effect on June 30, 1995, 21 and shall reimburse all other hospitals at the rates in 22 effect on June 30, 1995, less the portion of such rates 23 attributed by the Illinois Department to the cost of 24 medical education. For inpatient hospital services 25 provided on or after August 1, 1998, the Illinois 26 Department may establish by rule a means of adjusting the 27 rates of children's hospitals, as defined in 89 Illinois 28 Administrative Code Section 149.50(c)(3), that did not 29 meet that definition on June 30, 1995, in order for the 30 inpatient hospital rates of such hospitals to take into 31 account the average inpatient hospital rates of those 32 children's hospitals that did meet the definition of 33 children's hospitals on June 30, 1995. 34 (3) (Blank) SB1706 Enrolled -16- LRB9011519MWpc 1 (4) Notwithstanding any other provision of this 2 Section, hospitals that on August 31, 1991, have a 3 contract with the Illinois Department under Section 3-4 4 of the Illinois Health Finance Reform Act may elect to 5 continue to be reimbursed at rates stated in such 6 contracts for general and specialty care. 7 (5) In addition to any payments made under this 8 subsection (a), the Illinois Department shall make the 9 adjustment payments required by Section 5-5.02 of this 10 Code; provided, that in the case of any hospital 11 reimbursed under a per case methodology, the Illinois 12 Department shall add an amount equal to the product of 13 the hospital's average length of stay, less one day, 14 multiplied by 20, for inpatient hospital services 15 rendered on or after September 1, 1991 and on or before 16 September 30, 1992. 17 (b) (Blank) 18 (b-5) Excepting county providers as defined in Article 19 XV of this Code, hospitals licensed under the University of 20 Illinois Hospital Act, and facilities operated by the 21 Illinois Department of Mental Health and Developmental 22 Disabilities (or its successor, the Department of Human 23 Services), for outpatient services rendered on or after July 24 1, 1995 and before July 1, 1998 ,the Illinois Department 25 shall reimburse children's hospitals, as defined in the 26 Illinois Administrative Code Section 149.50(c)(3), at the 27 rates in effect on June 30, 1995, less that portion of such 28 rates attributed by the Illinois Department to the outpatient 29 indigent volume adjustment and shall reimburse all other 30 hospitals at the rates in effect on June 30, 1995, less the 31 portions of such rates attributed by the Illinois Department 32 to the cost of medical education and attributed by the 33 Illinois Department to the outpatient indigent volume 34 adjustment. For outpatient services provided on or after SB1706 Enrolled -17- LRB9011519MWpc 1 July 1, 1998, reimbursement rates shall be established by 2 rule. 3 (c) In addition to any other payments under this Code, 4 the Illinois Department shall develop a hospital 5 disproportionate share reimbursement methodology that, 6 effective July 1, 1991, through September 30, 1992, shall 7 reimburse hospitals sufficiently to expend the fee monies 8 described in subsection (b) of Section 14-3 of this Code and 9 the federal matching funds received by the Illinois 10 Department as a result of expenditures made by the Illinois 11 Department as required by this subsection (c) and Section 12 14-2 that are attributable to fee monies deposited in the 13 Fund, less amounts applied to adjustment payments under 14 Section 5-5.02. 15 (d) Critical Care Access Payments. 16 (1) In addition to any other payments made under 17 this Code, the Illinois Department shall develop a 18 reimbursement methodology that shall reimburse Critical 19 Care Access Hospitals for the specialized services that 20 qualify them as Critical Care Access Hospitals. No 21 adjustment payments shall be made under this subsection 22 on or after July 1, 1995. 23 (2) "Critical Care Access Hospitals" includes, but 24 is not limited to, hospitals that meet at least one of 25 the following criteria: 26 (A) Hospitals located outside of a 27 metropolitan statistical area that are designated as 28 Level II Perinatal Centers and that provide a 29 disproportionate share of perinatal services to 30 recipients; or 31 (B) Hospitals that are designated as Level I 32 Trauma Centers (adult or pediatric) and certain 33 Level II Trauma Centers as determined by the 34 Illinois Department; or SB1706 Enrolled -18- LRB9011519MWpc 1 (C) Hospitals located outside of a 2 metropolitan statistical area and that provide a 3 disproportionate share of obstetrical services to 4 recipients. 5 (e) Inpatient high volume adjustment. For hospital 6 inpatient services, effective with rate periods beginning on 7 or after October 1, 1993, in addition to rates paid for 8 inpatient services by the Illinois Department, the Illinois 9 Department shall make adjustment payments for inpatient 10 services furnished by Medicaid high volume hospitals. The 11 Illinois Department shall establish by rule criteria for 12 qualifying as a Medicaid high volume hospital and shall 13 establish by rule a reimbursement methodology for calculating 14 these adjustment payments to Medicaid high volume hospitals. 15 No adjustment payment shall be made under this subsection for 16 services rendered on or after July 1, 1995. 17 (f) The Illinois Department shall modify its current 18 rules governing adjustment payments for targeted access, 19 critical care access, and uncompensated care to classify 20 those adjustment payments as not being payments to 21 disproportionate share hospitals under Title XIX of the 22 federal Social Security Act. Rules adopted under this 23 subsection shall not be effective with respect to services 24 rendered on or after July 1, 1995. The Illinois Department 25 has no obligation to adopt or implement any rules or make any 26 payments under this subsection for services rendered on or 27 after July 1, 1995. 28 (f-5) The State recognizes that adjustment payments to 29 hospitals providing certain services or incurring certain 30 costs may be necessary to assure that recipients of medical 31 assistance have adequate access to necessary medical 32 services. These adjustments include payments for teaching 33 costs and uncompensated care, trauma center payments, 34 rehabilitation hospital payments, perinatal center payments, SB1706 Enrolled -19- LRB9011519MWpc 1 obstetrical care payments, targeted access payments, Medicaid 2 high volume payments, and outpatient indigent volume 3 payments. On or before April 1, 1995, the Illinois 4 Department shall issue recommendations regarding (i) 5 reimbursement mechanisms or adjustment payments to reflect 6 these costs and services, including methods by which the 7 payments may be calculated and the method by which the 8 payments may be financed, and (ii) reimbursement mechanisms 9 or adjustment payments to reflect costs and services of 10 federally qualified health centers with respect to recipients 11 of medical assistance. 12 (g) If one or more hospitals file suit in any court 13 challenging any part of this Article XIV, payments to 14 hospitals under this Article XIV shall be made only to the 15 extent that sufficient monies are available in the Fund and 16 only to the extent that any monies in the Fund are not 17 prohibited from disbursement under any order of the court. 18 (h) Payments under the disbursement methodology 19 described in this Section are subject to approval by the 20 federal government in an appropriate State plan amendment. 21 (i) The Illinois Department may by rule establish 22 criteria for and develop methodologies for adjustment 23 payments to hospitals participating under this Article. 24 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96; 25 89-507, eff. 7-1-97; 90-9, eff. 7-1-97; 90-14, eff. 7-1-97.) 26 Section 99. Effective date. This Act takes effect on 27 July 1, 1998.
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