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.