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91_HB0454
LRB9101706SMdv
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 (h) (f) of this Section, that was at least the
10 mean Medicaid inpatient utilization rate for all
11 hospitals in Illinois receiving Medicaid payments from
12 the Illinois Department and which were located in a
13 planning area with one-third or fewer excess beds as
14 determined by the Illinois Health Facilities Planning
15 Board, and that, as of June 30, 1992, were located in a
16 federally designated 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 prior to September 30, 1998 shall be
34 considered a children's hospital to the degree that the
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1 hospital's Medicaid care is provided to children.
2 (6) An Illinois hospital located in Health Service
3 Area (HSA) 11 as defined in Section 1100.220 of Title 77
4 of the Illinois Administrative Code (77 Ill. Adm. Code
5 1100.220) with the highest number of licensed beds as
6 determined by the Department of Public Health based upon
7 the Department's published report entitled "Percent
8 Occupancy by Service for 1997 Short Stay, Non-Federal
9 Hospitals in Illinois", dated July 1998.
10 (c) Inpatient adjustment payments. The adjustment
11 payments required by paragraph (b) shall be calculated based
12 upon the hospital's Medicaid inpatient utilization rate as
13 follows:
14 (1) hospitals with a Medicaid inpatient utilization
15 rate below the mean shall receive a per day adjustment
16 payment equal to $25;
17 (2) hospitals with a Medicaid inpatient
18 utilization rate that is equal to or greater than the
19 mean Medicaid inpatient utilization rate but less than
20 one standard deviation above the mean Medicaid inpatient
21 utilization rate shall receive a per day adjustment
22 payment equal to the sum of $25 plus $1 for each one
23 percent that the hospital's Medicaid inpatient
24 utilization rate exceeds the mean Medicaid inpatient
25 utilization rate;
26 (3) hospitals with a Medicaid inpatient
27 utilization rate that is equal to or greater than one
28 standard deviation above the mean Medicaid inpatient
29 utilization rate but less than 1.5 standard deviations
30 above the mean Medicaid inpatient utilization rate shall
31 receive a per day adjustment payment equal to the sum of
32 $40 plus $7 for each one percent that the hospital's
33 Medicaid inpatient utilization rate exceeds one standard
34 deviation above the mean Medicaid inpatient utilization
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1 rate; and
2 (4) hospitals with a Medicaid inpatient
3 utilization rate that is equal to or greater than 1.5
4 standard deviations above the mean Medicaid inpatient
5 utilization rate shall receive a per day adjustment
6 payment equal to the sum of $90 plus $2 for each one
7 percent that the hospital's Medicaid inpatient
8 utilization rate exceeds 1.5 standard deviations above
9 the mean Medicaid inpatient utilization rate.
10 (d) Supplemental adjustment payments. In addition to
11 the adjustment payments described in paragraph (c), hospitals
12 as defined in clauses (1) through (5) of paragraph (b),
13 excluding county hospitals (as defined in subsection (c) of
14 Section 15-1 of this Code) and a hospital organized under the
15 University of Illinois Hospital Act, shall be paid
16 supplemental inpatient adjustment payments of $60 per day.
17 For purposes of Title XIX of the federal Social Security Act,
18 these supplemental adjustment payments shall not be
19 classified as adjustment payments to disproportionate share
20 hospitals.
21 (e) The inpatient adjustment payments described in
22 paragraphs (c) and (d) shall be increased on October 1, 1993
23 and annually thereafter by a percentage equal to the lesser
24 of (i) the increase in the DRI hospital cost index for the
25 most recent 12 month period for which data are available, or
26 (ii) the percentage increase in the statewide average
27 hospital payment rate over the previous year's statewide
28 average hospital payment rate. The sum of the inpatient
29 adjustment payments under paragraphs (c) and (d) to a
30 hospital, other than a county hospital (as defined in
31 subsection (c) of Section 15-1 of this Code) or a hospital
32 organized under the University of Illinois Hospital Act,
33 however, shall not exceed $275 per day; that limit shall be
34 increased on October 1, 1993 and annually thereafter by a
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1 percentage equal to the lesser of (i) the increase in the DRI
2 hospital cost index for the most recent 12-month period for
3 which data are available or (ii) the percentage increase in
4 the statewide average hospital payment rate over the previous
5 year's statewide average hospital payment rate.
6 (f) Children's hospital inpatient adjustment payments.
7 For children's hospitals, as defined in clause (5) of
8 paragraph (b), the adjustment payments required pursuant to
9 paragraphs (c) and (d) shall be multiplied by 2.0.
10 (g) County hospital inpatient adjustment payments. For
11 county hospitals, as defined in subsection (c) of Section
12 15-1 of this Code, there shall be an adjustment payment as
13 determined by rules issued by the Illinois Department.
14 (h) For the purposes of this Section the following
15 terms shall be defined as follows:
16 (1) "Medicaid inpatient utilization rate" means a
17 fraction, the numerator of which is the number of a
18 hospital's inpatient days provided in a given 12-month
19 period to patients who, for such days, were eligible for
20 Medicaid under Title XIX of the federal Social Security
21 Act, and the denominator of which is the total number of
22 the hospital's inpatient days in that same period.
23 (2) "Mean Medicaid inpatient utilization rate"
24 means the total number of Medicaid inpatient days
25 provided by all Illinois Medicaid-participating hospitals
26 divided by the total number of inpatient days provided by
27 those same hospitals.
28 (3) "Medicaid obstetrical inpatient utilization
29 rate" means the ratio of Medicaid obstetrical inpatient
30 days to total Medicaid inpatient days for all Illinois
31 hospitals receiving Medicaid payments from the Illinois
32 Department.
33 (i) Inpatient adjustment payment limit. In order to
34 meet the limits of Public Law 102-234 and Public Law 103-66,
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1 the Illinois Department shall by rule adjust disproportionate
2 share adjustment payments.
3 (j) University of Illinois Hospital inpatient adjustment
4 payments. For hospitals organized under the University of
5 Illinois Hospital Act, there shall be an adjustment payment
6 as determined by rules adopted by the Illinois Department.
7 (k) The Illinois Department may by rule establish
8 criteria for and develop methodologies for adjustment
9 payments to hospitals participating under this Article.
10 (Source: P.A. 89-21, eff. 7-1-95; 90-588, eff. 7-1-98.)