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| Public Act 093-1066 |
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AN ACT in relation to budget implementation.
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Be it enacted by the People of the State of Illinois, | ||||
represented in the General Assembly:
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Section 5. The Illinois Public Aid Code is amended by | ||||
changing Sections 5A-1, 5A-2, 5A-4, and 5A-12 as follows: | ||||
(305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1)
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Sec. 5A-1. Definitions. As used in this Article, unless | ||||
the context requires
otherwise:
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"Fund" means the Hospital Provider Fund.
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"Hospital" means an institution, place, building, or | ||||
agency located in this
State that is subject to licensure by | ||||
the Illinois Department of Public Health
under the Hospital | ||||
Licensing Act, whether public or private and whether
organized | ||||
for profit or not-for-profit.
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"Hospital provider" means a person licensed by the | ||||
Department of Public
Health to conduct, operate, or maintain a | ||||
hospital, regardless of whether the
person is a Medicaid | ||||
provider. For purposes of this paragraph, "person" means
any | ||||
political subdivision of the State, municipal corporation, | ||||
individual,
firm, partnership, corporation, company, limited | ||||
liability company,
association, joint stock association, or | ||||
trust, or a receiver, executor,
trustee, guardian, or other | ||||
representative appointed by order of any court.
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"Occupied bed days" means the sum of the number of days
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that each bed was occupied by a patient for all beds during
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calendar year 2001. Occupied bed days shall be computed | ||||
separately for each
hospital operated or maintained by a | ||||
hospital provider. | ||||
"Proration factor" means a fraction, the numerator of which | ||||
is 53 and the denominator of which is 365.
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(Source: P.A. 93-659, eff. 2-3-04.)
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(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | ||
(Section scheduled to be repealed on July 1, 2005) | ||
Sec. 5A-2. Assessment; no local authorization to tax.
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(a) Subject to Sections 5A-3 and 5A-10, an annual | ||
assessment on inpatient
services is imposed on
each
hospital
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provider in an amount equal to the hospital's occupied bed days | ||
multiplied by $84.19 multiplied by the proration factor for | ||
State fiscal year
years 2004 and the hospital's occupied bed | ||
days multiplied by $84.19 for State fiscal year 2005. , if the | ||
payment methodologies required under 5A-12 and the waiver | ||
granted under 42 CFR 433.68 are approved with an effective date | ||
prior to July 1, 2004; or the assessment will be imposed for | ||
fiscal year 2005 only, if the payment methodologies required | ||
under Section 5A-12 and the waiver granted under 42 CFR 433.68 | ||
are approved with an effective date on or after July 1, 2004.
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The
Department of Public Aid shall use the number of | ||
occupied bed days as reported
by
each hospital on the Annual | ||
Survey of Hospitals conducted by the
Department of Public | ||
Health to calculate the hospital's annual assessment. If
the | ||
sum
of a hospital's occupied bed days is not reported on the | ||
Annual Survey of
Hospitals or if there are data errors in the | ||
reported sum of a hospital's occupied bed days as determined by | ||
the Department of Public Aid, then the Department of Public Aid | ||
may obtain the sum of occupied bed
days
from any source | ||
available, including, but not limited to, records maintained by
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the hospital provider, which may be inspected at all times | ||
during business
hours
of the day by the Department of Public | ||
Aid or its duly authorized agents and
employees.
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(b) Nothing in this amendatory Act of the 93rd General | ||
Assembly
shall be construed to authorize
any home rule unit or | ||
other unit of local government to license for revenue or
to | ||
impose a tax or assessment upon hospital providers or the | ||
occupation of
hospital provider, or a tax or assessment | ||
measured by the income or earnings of
a hospital provider.
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(c) As provided in Section 5A-14, this Section is repealed | ||
on July 1,
2005.
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(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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(305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) | ||
Sec. 5A-4. Payment of assessment; penalty.
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(a) The annual assessment imposed by Section 5A-2 for State | ||
fiscal year
2004
shall be due
and payable on June 18 of
the
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year.
The assessment imposed by Section 5A-2 for State fiscal | ||
year 2005
shall be
due and payable in quarterly installments, | ||
each equalling one-fourth of the
assessment for the year, on | ||
July 19, October 19, January 18, and April 19 of
the year.
No | ||
installment payment of an assessment imposed by Section 5A-2 | ||
shall be due
and
payable, however, until after: (i) the | ||
hospital provider
receives written
notice from the Department | ||
of Public Aid that the payment methodologies to
hospitals
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required under
Section 5A-12 have been approved by the Centers | ||
for Medicare and Medicaid
Services of
the U.S. Department of | ||
Health and Human Services and the waiver under 42 CFR
433.68 | ||
for the assessment imposed by Section 5A-2 has been granted by | ||
the
Centers for Medicare and Medicaid Services of the U.S. | ||
Department of Health and
Human Services; and (ii) the hospital
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has
received the payments required under Section 5A-12.
Upon | ||
notification to the Department of approval of the payment | ||
methodologies required under Section 5A-12 and the waiver | ||
granted under 42 CFR 433.68, all quarterly installments | ||
otherwise due under Section 5A-2 prior to the date of | ||
notification shall be due and payable to the Department upon | ||
written direction from the Department
within 30 days of the | ||
date of notification.
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(b) The Illinois Department is authorized to establish
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delayed payment schedules for hospital providers that are | ||
unable
to make installment payments when due under this Section | ||
due to
financial difficulties, as determined by the Illinois | ||
Department.
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(c) If a hospital provider fails to pay the full amount of
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an installment when due (including any extensions granted under
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subsection (b)), there shall, unless waived by the Illinois
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Department for reasonable cause, be added to the assessment
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imposed by Section 5A-2 a penalty
assessment equal to the | ||
lesser of (i) 5% of the amount of the
installment not paid on | ||
or before the due date plus 5% of the
portion thereof remaining | ||
unpaid on the last day of each 30-day period
thereafter or (ii) | ||
100% of the installment amount not paid on or
before the due | ||
date. For purposes of this subsection, payments
will be | ||
credited first to unpaid installment amounts (rather than
to | ||
penalty or interest), beginning with the most delinquent
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installments.
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(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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(305 ILCS 5/5A-12)
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(Section scheduled to be repealed on July 1, 2005) | ||
Sec. 5A-12. Hospital access improvement payments.
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(a) To improve access to hospital services, for hospital | ||
services rendered
on or
after June 1, 2004, the Department of | ||
Public Aid shall make
payments
to hospitals as set forth in | ||
this Section, except for hospitals described in
subsection (b) | ||
of
Section 5A-3.
These payments shall be paid on a quarterly | ||
basis. For State fiscal year 2004, if the effective date of the | ||
approval of the payment methodology required under this Section | ||
and the waiver granted under 42 CFR 433.68 by the Centers for | ||
Medicare and Medicaid Services of the U.S. Department of Health | ||
and Human Services is prior to July 1, 2004,
the
Department | ||
shall pay the total amounts required for fiscal year 2004 under | ||
this Section within 75
25 days of the latest notification. No | ||
payment shall be made for State fiscal year 2004 if the | ||
effective date of the approval is on or after July 1, 2004.
In | ||
State fiscal year 2005,
the total
amounts required under this | ||
Section shall be paid in 4 equal installments on or
before
July | ||
15, October 15, January 14, and April 15
of the year, except | ||
that if the date of notification of the approval of the payment | ||
methodologies required under this Section and the waiver | ||
granted under 42 CFR 433.68 is on or after July 1, 2004, the | ||
sum of amounts required under this Section prior to the date of | ||
notification shall be paid within 75
25 days of the date of the | ||
last notification. Payments under
this
Section are not due and | ||
payable, however, until (i) the methodologies described
in
this
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Section are approved by the federal government in an | ||
appropriate State Plan
amendment,
(ii) the assessment imposed | ||
under this Article is determined to be a
permissible tax under | ||
Title XIX of the Social Security Act, and (iii) the
assessment | ||
is in effect.
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(b) High volume payment. In addition to rates paid for | ||
inpatient hospital
services, the Department of Public Aid shall | ||
pay, to each Illinois hospital
that provided
more than 20,000 | ||
Medicaid inpatient days of care during State fiscal year 2001
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(except
for hospitals
that qualify for adjustment payments | ||
under Section 5-5.02 for the 12-month
period beginning on | ||
October 1, 2002), $190 for each
Medicaid inpatient day
of care | ||
provided during that fiscal year. A hospital that provided less | ||
than
30,000 Medicaid inpatient days of
care during that period, | ||
however, is not entitled to receive more than
$3,500,000 per | ||
year
in such payments.
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(c) Medicaid inpatient utilization rate adjustment. In | ||
addition to rates
paid for
inpatient hospital services, the | ||
Department of Public Aid shall pay each
Illinois hospital
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(except for hospitals described in Section 5A-3), for each | ||
Medicaid inpatient
day of
care provided
during State fiscal | ||
year 2001, an amount equal to the product of $57.25
multiplied | ||
by the
quotient of 1 divided by the greater of 1.6% or the | ||
hospital's Medicaid
inpatient
utilization rate (as used to | ||
determine eligibility for adjustment payments
under Section | ||
5-5.02 for the 12-month period beginning on October 1, 2002). | ||
The
total payments under this
subsection to a
hospital may
not | ||
exceed $10,500,000 annually.
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(d) Psychiatric base rate adjustment.
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(1) In addition to rates paid for
inpatient
psychiatric | ||
services, the Department of Public Aid shall pay each | ||
Illinois
general acute care hospital with a distinct | ||
part-psychiatric unit, for
each Medicaid inpatient | ||
psychiatric day of care provided in State fiscal year
2001, | ||
an
amount equal
to $400 less the hospital's per-diem rate | ||
for Medicaid inpatient psychiatric
services as in effect on | ||
October 1, 2003. In no
event, however, shall that amount be | ||
less than zero.
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(2) For distinct
part-psychiatric units of Illinois
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general acute care hospitals, except for all hospitals | ||
excluded in Section
5A-3,
whose inpatient per-diem rate as | ||
in effect on
October 1, 2003 is greater than
$400, the
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Department shall pay, in addition to any other amounts | ||
authorized under this
Code, $25
for each Medicaid inpatient | ||
psychiatric day of care provided in State fiscal
year 2001.
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(e) Supplemental tertiary care adjustment. In addition to | ||
rates paid for
inpatient
services, the Department of Public Aid | ||
shall pay to each Illinois hospital
eligible for
tertiary care | ||
adjustment payments under 89 Ill. Adm. Code 148.296, as in | ||
effect
for State fiscal year
2003, a supplemental tertiary care | ||
adjustment payment equal to
the tertiary
care adjustment | ||
payment required under 89 Ill. Adm. Code 148.296, as in effect
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for State fiscal year
2003.
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(f) Medicaid outpatient utilization rate adjustment. In | ||
addition to rates
paid for
outpatient hospital services, the | ||
Department of Public Aid shall pay each
Illinois hospital
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(except for hospitals described in Section 5A-3), an amount | ||
equal to the
product of 2.45%
multiplied by the hospital's | ||
Medicaid outpatient charges multiplied by the
quotient of 1
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divided by the greater of 1.6% or the hospital's Medicaid | ||
outpatient
utilization rate. The
total payments under this | ||
subsection to a hospital may not exceed $6,750,000
annually.
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For purposes of this subsection:
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"Medicaid outpatient charges" means the charges for | ||
outpatient services
provided to Medicaid patients for State | ||
fiscal year 2001 as submitted by the
hospital on the UB-92 | ||
billing form or under the ambulatory procedure listing
and
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adjudicated by the Department of Public Aid on or before | ||
September 12, 2003.
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"Medicaid outpatient utilization rate" means a fraction, | ||
the numerator of
which is the hospital's Medicaid outpatient | ||
charges and the denominator of
which
is the total number of the | ||
hospital's charges for outpatient services for the
hospital's | ||
fiscal year ending in 2001.
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(g) State outpatient service adjustment. In addition to | ||
rates paid for
outpatient
hospital services, the Department of | ||
Public Aid shall pay each Illinois
hospital an amount
equal to | ||
the product of 75.5% multiplied by the hospital's Medicaid | ||
outpatient
services
submitted to
the Department on the UB-92 | ||
billing form for State fiscal year 2001 multiplied
by the
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hospital's outpatient access fraction.
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For purposes of this subsection,
"outpatient access
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fraction" means a fraction, the numerator of which is the | ||
hospital's Medicaid
payments
for outpatient services for | ||
ambulatory procedure listing services submitted to
the | ||
Department on the UB-92 billing form
for State
fiscal year | ||
2001, and the denominator of which is the hospital's Medicaid
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outpatient
services submitted to the Department on the UB-92 | ||
billing form for State fiscal
year
2001.
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The total payments under this subsection to a hospital may | ||
not exceed
$3,000,000
annually.
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(h) Rural hospital outpatient adjustment. In addition to | ||
rates paid for
outpatient
hospital services, the Department of | ||
Public Aid shall pay each Illinois rural
hospital an
amount | ||
equal to the product of $14,500,000 multiplied by the rural | ||
hospital
outpatient
adjustment fraction.
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For purposes of this subsection, "rural hospital
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outpatient
adjustment fraction" means a fraction, the | ||
numerator of which is the hospital's
Medicaid
visits for | ||
outpatient services for
ambulatory procedure listing services
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submitted to the Department on the UB-92 billing
form for
State | ||
fiscal year 2001, and the denominator of which is the total | ||
Medicaid
visits for
outpatient services for ambulatory | ||
procedure listing services for all Illinois
rural hospitals | ||
submitted to the
Department on the UB-92 billing form for State | ||
fiscal year 2001.
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For purposes
of this subsection, "rural
hospital" has the | ||
same meaning as in 89 Ill. Adm. Code 148.25, as in effect on
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September
30, 2003.
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(i) Merged/closed hospital adjustment. If any hospital | ||
files a
combined Medicaid cost report with another hospital | ||
after January 1, 2001, and
if
that hospital subsequently | ||
closes, then except for the payments
described in
subsection | ||
(e), all payments described in the various subsections of this
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Section shall, before the application of the annual limitation | ||
amount specified
in each such subsection, be multiplied by a | ||
fraction, the numerator of which is
the number
of occupied bed | ||
days attributable to the open hospital and the denominator of
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which is the sum of the number of occupied bed days of each | ||
open hospital and
each
closed hospital. For purposes of this | ||
subsection, "occupied bed
days" has the same meaning as the | ||
term is defined in subsection (a) of
Section 5A-2.
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(j) For purposes of this Section, the terms "Medicaid | ||
days", "Medicaid
charges", and "Medicaid services" do not | ||
include any days, charges, or services
for which Medicare was | ||
liable for payment.
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(j-5) For State fiscal year 2004, all payments described in | ||
this Section shall be multiplied by the proration factor.
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(k) As provided in Section 5A-14, this Section is repealed | ||
on July 1,
2005.
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(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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