Public Act 93-0040

SB740 Enrolled                       LRB093 03235 JLS 03252 b

    AN ACT concerning public assistance.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  5.  The  Illinois  Public Aid Code is amended by
changing Section 5-5.02 as follows:


    (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
    Sec. 5-5.02. Hospital reimbursements.
    (a)  Reimbursement to Hospitals;  July  1,  1992  through
September  30, 1992.  Notwithstanding any other provisions of
this Code or  the  Illinois  Department's  Rules  promulgated
under    the    Illinois    Administrative   Procedure   Act,
reimbursement to hospitals for services provided  during  the
period  July  1, 1992 through September 30, 1992, shall be as
follows:
         (1)  For inpatient hospital services rendered, or if
    applicable, for inpatient hospital discharges  occurring,
    on  or  after July 1, 1992 and on or before September 30,
    1992, the Illinois Department shall  reimburse  hospitals
    for    inpatient   services   under   the   reimbursement
    methodologies in effect for each  hospital,  and  at  the
    inpatient  payment  rate calculated for each hospital, as
    of June  30,  1992.   For  purposes  of  this  paragraph,
    "reimbursement  methodologies"  means  all  reimbursement
    methodologies  that pertain to the provision of inpatient
    hospital services, including, but  not  limited  to,  any
    adjustments  for disproportionate share, targeted access,
    critical care access and uncompensated care,  as  defined
    by the Illinois Department on June 30, 1992.
         (2)  For  the  purpose  of calculating the inpatient
    payment  rate  for  each  hospital  eligible  to  receive
    quarterly adjustment payments  for  targeted  access  and
    critical  care,  as defined by the Illinois Department on
    June 30, 1992, the adjustment payment for the period July
    1, 1992 through September 30, 1992, shall be 25%  of  the
    annual  adjustment  payments calculated for each eligible
    hospital, as of June 30, 1992.  The  Illinois  Department
    shall  determine  by  rule  the  adjustment  payments for
    targeted access and critical care  beginning  October  1,
    1992.
         (3)  For  the  purpose  of calculating the inpatient
    payment  rate  for  each  hospital  eligible  to  receive
    quarterly adjustment payments for uncompensated care,  as
    defined  by the Illinois Department on June 30, 1992, the
    adjustment payment for the period August 1, 1992  through
    September  30,  1992,  shall  be  one-sixth  of the total
    uncompensated care  adjustment  payments  calculated  for
    each  eligible  hospital  for the uncompensated care rate
    year, as defined by the Illinois  Department,  ending  on
    July  31,  1992.  The Illinois Department shall determine
    by rule the adjustment payments  for  uncompensated  care
    beginning October 1, 1992.
    (b)  Inpatient payments.  For inpatient services provided
on  or  after  October 1, 1993, in addition to rates paid for
hospital inpatient services pursuant to the  Illinois  Health
Finance  Reform  Act,  as  now  or  hereafter amended, or the
Illinois Department's prospective reimbursement  methodology,
or  any other methodology used by the Illinois Department for
inpatient  services,  the  Illinois  Department  shall   make
adjustment  payments, in an amount calculated pursuant to the
methodology described in paragraph (c) of  this  Section,  to
hospitals that the Illinois Department determines satisfy any
one of the following requirements:
         (1)  Hospitals that are described in Section 1923 of
    the  federal  Social  Security  Act,  as now or hereafter
    amended; or
         (2)  Illinois  hospitals  that   have   a   Medicaid
    inpatient  utilization  rate which is at least one-half a
    standard deviation  above  the  mean  Medicaid  inpatient
    utilization  rate for all hospitals in Illinois receiving
    Medicaid payments from the Illinois Department; or
         (3)  Illinois hospitals that on July 1, 1991  had  a
    Medicaid   inpatient  utilization  rate,  as  defined  in
    paragraph (h) of this Section, that was at least the mean
    Medicaid inpatient utilization rate for all hospitals  in
    Illinois  receiving  Medicaid  payments from the Illinois
    Department and which were located in a planning area with
    one-third or fewer  excess  beds  as  determined  by  the
    Illinois  Health  Facilities Planning Board, and that, as
    of June 30, 1992, were located in a federally  designated
    Health Manpower Shortage Area; or
         (4)  Illinois hospitals that:
              (A)  have a Medicaid inpatient utilization rate
         that   is  at  least  equal  to  the  mean  Medicaid
         inpatient utilization  rate  for  all  hospitals  in
         Illinois   receiving   Medicaid  payments  from  the
         Department; and
              (B)  also have a Medicaid obstetrical inpatient
         utilization rate  that  is  at  least  one  standard
         deviation   above   the  mean  Medicaid  obstetrical
         inpatient utilization  rate  for  all  hospitals  in
         Illinois   receiving   Medicaid  payments  from  the
         Department for obstetrical services; or
         (5)  Any children's hospital, which means a hospital
    devoted exclusively to caring for children.   A  hospital
    which  includes  a facility devoted exclusively to caring
    for children that is separately licensed as a hospital by
    a municipality prior  to  September  30,  1998  shall  be
    considered  a  children's hospital to the degree that the
    hospital's Medicaid  care  is  provided  to  children  if
    either (i) the facility devoted exclusively to caring for
    children  is  separately  licensed  as  a  hospital  by a
    municipality prior to September  30,  1998  or  (ii)  the
    hospital  has been designated by the State as a Level III
    perinatal  care  facility,  has  a   Medicaid   Inpatient
    Utilization  rate greater than 55% for the rate year 2003
    disproportionate share determination, and has  more  than
    10,000   qualified   children  days  as  defined  by  the
    Department in rulemaking.
    (c)  Inpatient  adjustment  payments.    The   adjustment
payments  required by paragraph (b) shall be calculated based
upon the hospital's Medicaid inpatient  utilization  rate  as
follows:
         (1)  hospitals with a Medicaid inpatient utilization
    rate  below  the  mean shall receive a per day adjustment
    payment equal to $25;
         (2)   hospitals   with    a    Medicaid    inpatient
    utilization  rate  that  is  equal to or greater than the
    mean Medicaid inpatient utilization rate  but  less  than
    one  standard deviation above the mean Medicaid inpatient
    utilization rate  shall  receive  a  per  day  adjustment
    payment  equal  to  the  sum  of $25 plus $1 for each one
    percent   that   the   hospital's   Medicaid    inpatient
    utilization  rate  exceeds  the  mean  Medicaid inpatient
    utilization rate;
         (3)   hospitals   with    a    Medicaid    inpatient
    utilization  rate  that  is  equal to or greater than one
    standard deviation  above  the  mean  Medicaid  inpatient
    utilization  rate  but  less than 1.5 standard deviations
    above the mean Medicaid inpatient utilization rate  shall
    receive  a per day adjustment payment equal to the sum of
    $40 plus $7 for each  one  percent  that  the  hospital's
    Medicaid  inpatient utilization rate exceeds one standard
    deviation above the mean Medicaid  inpatient  utilization
    rate; and
         (4)   hospitals    with    a    Medicaid   inpatient
    utilization rate that is equal to  or  greater  than  1.5
    standard  deviations  above  the  mean Medicaid inpatient
    utilization rate  shall  receive  a  per  day  adjustment
    payment  equal  to  the  sum  of $90 plus $2 for each one
    percent   that   the   hospital's   Medicaid    inpatient
    utilization  rate  exceeds  1.5 standard deviations above
    the mean Medicaid inpatient utilization rate.
    (d)  Supplemental adjustment payments.   In  addition  to
the adjustment payments described in paragraph (c), hospitals
as  defined  in  clauses  (1)  through  (5) of paragraph (b),
excluding county hospitals (as defined in subsection  (c)  of
Section 15-1 of this Code) and a hospital organized under the
University   of   Illinois   Hospital   Act,  shall  be  paid
supplemental inpatient adjustment payments of  $60  per  day.
For purposes of Title XIX of the federal Social Security Act,
these   supplemental   adjustment   payments   shall  not  be
classified as adjustment payments to  disproportionate  share
hospitals.
    (e)  The   inpatient  adjustment  payments  described  in
paragraphs (c) and (d) shall be increased on October 1,  1993
and  annually  thereafter by a percentage equal to the lesser
of (i) the increase in the DRI hospital cost  index  for  the
most  recent 12 month period for which data are available, or
(ii)  the  percentage  increase  in  the  statewide   average
hospital  payment  rate  over  the  previous year's statewide
average hospital payment rate.   The  sum  of  the  inpatient
adjustment  payments  under  paragraphs  (c)  and  (d)  to  a
hospital,  other  than  a  county  hospital  (as  defined  in
subsection  (c)  of  Section 15-1 of this Code) or a hospital
organized under the  University  of  Illinois  Hospital  Act,
however,  shall  not exceed $275 per day; that limit shall be
increased on October 1, 1993 and  annually  thereafter  by  a
percentage equal to the lesser of (i) the increase in the DRI
hospital  cost  index for the most recent 12-month period for
which data are available or (ii) the percentage  increase  in
the statewide average hospital payment rate over the previous
year's statewide average hospital payment rate.
    (f)   Children's  hospital inpatient adjustment payments.
For  children's  hospitals,  as  defined  in  clause  (5)  of
paragraph (b), the adjustment payments required  pursuant  to
paragraphs (c) and (d) shall be multiplied by 2.0.
    (g)   County hospital inpatient adjustment payments.  For
county  hospitals,  as  defined  in subsection (c) of Section
15-1 of this Code, there shall be an  adjustment  payment  as
determined by rules issued by the Illinois Department.
    (h)   For  the  purposes  of  this  Section the following
terms shall be defined as follows:
         (1)  "Medicaid inpatient utilization rate"  means  a
    fraction,  the  numerator  of  which  is  the number of a
    hospital's inpatient days provided in  a  given  12-month
    period  to patients who, for such days, were eligible for
    Medicaid under Title XIX of the federal  Social  Security
    Act,  and the denominator of which is the total number of
    the hospital's inpatient days in that same period.
         (2)  "Mean  Medicaid  inpatient  utilization   rate"
    means   the  total  number  of  Medicaid  inpatient  days
    provided by all Illinois Medicaid-participating hospitals
    divided by the total number of inpatient days provided by
    those same hospitals.
         (3)  "Medicaid  obstetrical  inpatient   utilization
    rate"  means  the ratio of Medicaid obstetrical inpatient
    days to total Medicaid inpatient days  for  all  Illinois
    hospitals  receiving  Medicaid payments from the Illinois
    Department.
    (i)   Inpatient adjustment payment limit.   In  order  to
meet  the limits of Public Law 102-234 and Public Law 103-66,
the Illinois Department shall by rule adjust disproportionate
share adjustment payments.
    (j)  University of Illinois Hospital inpatient adjustment
payments.  For hospitals organized under  the  University  of
Illinois  Hospital  Act, there shall be an adjustment payment
as determined by rules adopted by the Illinois Department.
    (k)  The  Illinois  Department  may  by  rule   establish
criteria   for   and  develop  methodologies  for  adjustment
payments to hospitals participating under this Article.
(Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)

    Section 99.  Effective date.  This Act takes effect  upon
becoming law.