SB1773 EnrolledLRB100 09919 KTG 20090 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Legislative intent. The General Assembly
5declares that is the legislative intent of the 100th General
6Assembly that, in order to best preserve and improve access to
7hospital services for Illinois Medicaid beneficiaries, the
8assessment imposed and payments required under this Act are to
9be presented to the federal Centers for Medicare and Medicaid
10Services as a 6-year program.
11    In accordance with guidelines promulgated by the federal
12Centers for Medicare and Medicaid Services, the assessment plan
13presented shall phase in claims-based payments through
14increasing amounts over 6 years. The Department of Healthcare
15and Family Services, in consultation with the Hospital
16Transformation Review Committee, the hospital community, and
17the managed care organizations contracting with the State to
18provide medicaid services, shall evaluate the State fiscal year
19claims-based payments to monitor whether the proposed rates and
20methodologies resulted in expected reimbursement estimates,
21taking into consideration any changes in utilization patterns.
 
22    Section 2. The Illinois Administrative Procedure Act is
23amended by changing Section 5-45 and by adding Section 5-46.3

 

 

SB1773 Enrolled- 2 -LRB100 09919 KTG 20090 b

1as follows:
 
2    (5 ILCS 100/5-45)  (from Ch. 127, par. 1005-45)
3    Sec. 5-45. Emergency rulemaking.
4    (a) "Emergency" means the existence of any situation that
5any agency finds reasonably constitutes a threat to the public
6interest, safety, or welfare.
7    (b) If any agency finds that an emergency exists that
8requires adoption of a rule upon fewer days than is required by
9Section 5-40 and states in writing its reasons for that
10finding, the agency may adopt an emergency rule without prior
11notice or hearing upon filing a notice of emergency rulemaking
12with the Secretary of State under Section 5-70. The notice
13shall include the text of the emergency rule and shall be
14published in the Illinois Register. Consent orders or other
15court orders adopting settlements negotiated by an agency may
16be adopted under this Section. Subject to applicable
17constitutional or statutory provisions, an emergency rule
18becomes effective immediately upon filing under Section 5-65 or
19at a stated date less than 10 days thereafter. The agency's
20finding and a statement of the specific reasons for the finding
21shall be filed with the rule. The agency shall take reasonable
22and appropriate measures to make emergency rules known to the
23persons who may be affected by them.
24    (c) An emergency rule may be effective for a period of not
25longer than 150 days, but the agency's authority to adopt an

 

 

SB1773 Enrolled- 3 -LRB100 09919 KTG 20090 b

1identical rule under Section 5-40 is not precluded. No
2emergency rule may be adopted more than once in any 24-month
3period, except that this limitation on the number of emergency
4rules that may be adopted in a 24-month period does not apply
5to (i) emergency rules that make additions to and deletions
6from the Drug Manual under Section 5-5.16 of the Illinois
7Public Aid Code or the generic drug formulary under Section
83.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
9emergency rules adopted by the Pollution Control Board before
10July 1, 1997 to implement portions of the Livestock Management
11Facilities Act, (iii) emergency rules adopted by the Illinois
12Department of Public Health under subsections (a) through (i)
13of Section 2 of the Department of Public Health Act when
14necessary to protect the public's health, (iv) emergency rules
15adopted pursuant to subsection (n) of this Section, (v)
16emergency rules adopted pursuant to subsection (o) of this
17Section, or (vi) emergency rules adopted pursuant to subsection
18(c-5) of this Section. Two or more emergency rules having
19substantially the same purpose and effect shall be deemed to be
20a single rule for purposes of this Section.
21    (c-5) To facilitate the maintenance of the program of group
22health benefits provided to annuitants, survivors, and retired
23employees under the State Employees Group Insurance Act of
241971, rules to alter the contributions to be paid by the State,
25annuitants, survivors, retired employees, or any combination
26of those entities, for that program of group health benefits,

 

 

SB1773 Enrolled- 4 -LRB100 09919 KTG 20090 b

1shall be adopted as emergency rules. The adoption of those
2rules shall be considered an emergency and necessary for the
3public interest, safety, and welfare.
4    (d) In order to provide for the expeditious and timely
5implementation of the State's fiscal year 1999 budget,
6emergency rules to implement any provision of Public Act 90-587
7or 90-588 or any other budget initiative for fiscal year 1999
8may be adopted in accordance with this Section by the agency
9charged with administering that provision or initiative,
10except that the 24-month limitation on the adoption of
11emergency rules and the provisions of Sections 5-115 and 5-125
12do not apply to rules adopted under this subsection (d). The
13adoption of emergency rules authorized by this subsection (d)
14shall be deemed to be necessary for the public interest,
15safety, and welfare.
16    (e) In order to provide for the expeditious and timely
17implementation of the State's fiscal year 2000 budget,
18emergency rules to implement any provision of Public Act 91-24
19or any other budget initiative for fiscal year 2000 may be
20adopted in accordance with this Section by the agency charged
21with administering that provision or initiative, except that
22the 24-month limitation on the adoption of emergency rules and
23the provisions of Sections 5-115 and 5-125 do not apply to
24rules adopted under this subsection (e). The adoption of
25emergency rules authorized by this subsection (e) shall be
26deemed to be necessary for the public interest, safety, and

 

 

SB1773 Enrolled- 5 -LRB100 09919 KTG 20090 b

1welfare.
2    (f) In order to provide for the expeditious and timely
3implementation of the State's fiscal year 2001 budget,
4emergency rules to implement any provision of Public Act 91-712
5or any other budget initiative for fiscal year 2001 may be
6adopted in accordance with this Section by the agency charged
7with administering that provision or initiative, except that
8the 24-month limitation on the adoption of emergency rules and
9the provisions of Sections 5-115 and 5-125 do not apply to
10rules adopted under this subsection (f). The adoption of
11emergency rules authorized by this subsection (f) shall be
12deemed to be necessary for the public interest, safety, and
13welfare.
14    (g) In order to provide for the expeditious and timely
15implementation of the State's fiscal year 2002 budget,
16emergency rules to implement any provision of Public Act 92-10
17or any other budget initiative for fiscal year 2002 may be
18adopted in accordance with this Section by the agency charged
19with administering that provision or initiative, except that
20the 24-month limitation on the adoption of emergency rules and
21the provisions of Sections 5-115 and 5-125 do not apply to
22rules adopted under this subsection (g). The adoption of
23emergency rules authorized by this subsection (g) shall be
24deemed to be necessary for the public interest, safety, and
25welfare.
26    (h) In order to provide for the expeditious and timely

 

 

SB1773 Enrolled- 6 -LRB100 09919 KTG 20090 b

1implementation of the State's fiscal year 2003 budget,
2emergency rules to implement any provision of Public Act 92-597
3or any other budget initiative for fiscal year 2003 may be
4adopted in accordance with this Section by the agency charged
5with administering that provision or initiative, except that
6the 24-month limitation on the adoption of emergency rules and
7the provisions of Sections 5-115 and 5-125 do not apply to
8rules adopted under this subsection (h). The adoption of
9emergency rules authorized by this subsection (h) shall be
10deemed to be necessary for the public interest, safety, and
11welfare.
12    (i) In order to provide for the expeditious and timely
13implementation of the State's fiscal year 2004 budget,
14emergency rules to implement any provision of Public Act 93-20
15or any other budget initiative for fiscal year 2004 may be
16adopted in accordance with this Section by the agency charged
17with administering that provision or initiative, except that
18the 24-month limitation on the adoption of emergency rules and
19the provisions of Sections 5-115 and 5-125 do not apply to
20rules adopted under this subsection (i). The adoption of
21emergency rules authorized by this subsection (i) shall be
22deemed to be necessary for the public interest, safety, and
23welfare.
24    (j) In order to provide for the expeditious and timely
25implementation of the provisions of the State's fiscal year
262005 budget as provided under the Fiscal Year 2005 Budget

 

 

SB1773 Enrolled- 7 -LRB100 09919 KTG 20090 b

1Implementation (Human Services) Act, emergency rules to
2implement any provision of the Fiscal Year 2005 Budget
3Implementation (Human Services) Act may be adopted in
4accordance with this Section by the agency charged with
5administering that provision, except that the 24-month
6limitation on the adoption of emergency rules and the
7provisions of Sections 5-115 and 5-125 do not apply to rules
8adopted under this subsection (j). The Department of Public Aid
9may also adopt rules under this subsection (j) necessary to
10administer the Illinois Public Aid Code and the Children's
11Health Insurance Program Act. The adoption of emergency rules
12authorized by this subsection (j) shall be deemed to be
13necessary for the public interest, safety, and welfare.
14    (k) In order to provide for the expeditious and timely
15implementation of the provisions of the State's fiscal year
162006 budget, emergency rules to implement any provision of
17Public Act 94-48 or any other budget initiative for fiscal year
182006 may be adopted in accordance with this Section by the
19agency charged with administering that provision or
20initiative, except that the 24-month limitation on the adoption
21of emergency rules and the provisions of Sections 5-115 and
225-125 do not apply to rules adopted under this subsection (k).
23The Department of Healthcare and Family Services may also adopt
24rules under this subsection (k) necessary to administer the
25Illinois Public Aid Code, the Senior Citizens and Persons with
26Disabilities Property Tax Relief Act, the Senior Citizens and

 

 

SB1773 Enrolled- 8 -LRB100 09919 KTG 20090 b

1Disabled Persons Prescription Drug Discount Program Act (now
2the Illinois Prescription Drug Discount Program Act), and the
3Children's Health Insurance Program Act. The adoption of
4emergency rules authorized by this subsection (k) shall be
5deemed to be necessary for the public interest, safety, and
6welfare.
7    (l) In order to provide for the expeditious and timely
8implementation of the provisions of the State's fiscal year
92007 budget, the Department of Healthcare and Family Services
10may adopt emergency rules during fiscal year 2007, including
11rules effective July 1, 2007, in accordance with this
12subsection to the extent necessary to administer the
13Department's responsibilities with respect to amendments to
14the State plans and Illinois waivers approved by the federal
15Centers for Medicare and Medicaid Services necessitated by the
16requirements of Title XIX and Title XXI of the federal Social
17Security Act. The adoption of emergency rules authorized by
18this subsection (l) shall be deemed to be necessary for the
19public interest, safety, and welfare.
20    (m) In order to provide for the expeditious and timely
21implementation of the provisions of the State's fiscal year
222008 budget, the Department of Healthcare and Family Services
23may adopt emergency rules during fiscal year 2008, including
24rules effective July 1, 2008, in accordance with this
25subsection to the extent necessary to administer the
26Department's responsibilities with respect to amendments to

 

 

SB1773 Enrolled- 9 -LRB100 09919 KTG 20090 b

1the State plans and Illinois waivers approved by the federal
2Centers for Medicare and Medicaid Services necessitated by the
3requirements of Title XIX and Title XXI of the federal Social
4Security Act. The adoption of emergency rules authorized by
5this subsection (m) shall be deemed to be necessary for the
6public interest, safety, and welfare.
7    (n) In order to provide for the expeditious and timely
8implementation of the provisions of the State's fiscal year
92010 budget, emergency rules to implement any provision of
10Public Act 96-45 or any other budget initiative authorized by
11the 96th General Assembly for fiscal year 2010 may be adopted
12in accordance with this Section by the agency charged with
13administering that provision or initiative. The adoption of
14emergency rules authorized by this subsection (n) shall be
15deemed to be necessary for the public interest, safety, and
16welfare. The rulemaking authority granted in this subsection
17(n) shall apply only to rules promulgated during Fiscal Year
182010.
19    (o) In order to provide for the expeditious and timely
20implementation of the provisions of the State's fiscal year
212011 budget, emergency rules to implement any provision of
22Public Act 96-958 or any other budget initiative authorized by
23the 96th General Assembly for fiscal year 2011 may be adopted
24in accordance with this Section by the agency charged with
25administering that provision or initiative. The adoption of
26emergency rules authorized by this subsection (o) is deemed to

 

 

SB1773 Enrolled- 10 -LRB100 09919 KTG 20090 b

1be necessary for the public interest, safety, and welfare. The
2rulemaking authority granted in this subsection (o) applies
3only to rules promulgated on or after July 1, 2010 (the
4effective date of Public Act 96-958) through June 30, 2011.
5    (p) In order to provide for the expeditious and timely
6implementation of the provisions of Public Act 97-689,
7emergency rules to implement any provision of Public Act 97-689
8may be adopted in accordance with this subsection (p) by the
9agency charged with administering that provision or
10initiative. The 150-day limitation of the effective period of
11emergency rules does not apply to rules adopted under this
12subsection (p), and the effective period may continue through
13June 30, 2013. The 24-month limitation on the adoption of
14emergency rules does not apply to rules adopted under this
15subsection (p). The adoption of emergency rules authorized by
16this subsection (p) is deemed to be necessary for the public
17interest, safety, and welfare.
18    (q) In order to provide for the expeditious and timely
19implementation of the provisions of Articles 7, 8, 9, 11, and
2012 of Public Act 98-104, emergency rules to implement any
21provision of Articles 7, 8, 9, 11, and 12 of Public Act 98-104
22may be adopted in accordance with this subsection (q) by the
23agency charged with administering that provision or
24initiative. The 24-month limitation on the adoption of
25emergency rules does not apply to rules adopted under this
26subsection (q). The adoption of emergency rules authorized by

 

 

SB1773 Enrolled- 11 -LRB100 09919 KTG 20090 b

1this subsection (q) is deemed to be necessary for the public
2interest, safety, and welfare.
3    (r) In order to provide for the expeditious and timely
4implementation of the provisions of Public Act 98-651,
5emergency rules to implement Public Act 98-651 may be adopted
6in accordance with this subsection (r) by the Department of
7Healthcare and Family Services. The 24-month limitation on the
8adoption of emergency rules does not apply to rules adopted
9under this subsection (r). The adoption of emergency rules
10authorized by this subsection (r) is deemed to be necessary for
11the public interest, safety, and welfare.
12    (s) In order to provide for the expeditious and timely
13implementation of the provisions of Sections 5-5b.1 and 5A-2 of
14the Illinois Public Aid Code, emergency rules to implement any
15provision of Section 5-5b.1 or Section 5A-2 of the Illinois
16Public Aid Code may be adopted in accordance with this
17subsection (s) by the Department of Healthcare and Family
18Services. The rulemaking authority granted in this subsection
19(s) shall apply only to those rules adopted prior to July 1,
202015. Notwithstanding any other provision of this Section, any
21emergency rule adopted under this subsection (s) shall only
22apply to payments made for State fiscal year 2015. The adoption
23of emergency rules authorized by this subsection (s) is deemed
24to be necessary for the public interest, safety, and welfare.
25    (t) In order to provide for the expeditious and timely
26implementation of the provisions of Article II of Public Act

 

 

SB1773 Enrolled- 12 -LRB100 09919 KTG 20090 b

199-6, emergency rules to implement the changes made by Article
2II of Public Act 99-6 to the Emergency Telephone System Act may
3be adopted in accordance with this subsection (t) by the
4Department of State Police. The rulemaking authority granted in
5this subsection (t) shall apply only to those rules adopted
6prior to July 1, 2016. The 24-month limitation on the adoption
7of emergency rules does not apply to rules adopted under this
8subsection (t). The adoption of emergency rules authorized by
9this subsection (t) is deemed to be necessary for the public
10interest, safety, and welfare.
11    (u) In order to provide for the expeditious and timely
12implementation of the provisions of the Burn Victims Relief
13Act, emergency rules to implement any provision of the Act may
14be adopted in accordance with this subsection (u) by the
15Department of Insurance. The rulemaking authority granted in
16this subsection (u) shall apply only to those rules adopted
17prior to December 31, 2015. The adoption of emergency rules
18authorized by this subsection (u) is deemed to be necessary for
19the public interest, safety, and welfare.
20    (v) In order to provide for the expeditious and timely
21implementation of the provisions of Public Act 99-516,
22emergency rules to implement Public Act 99-516 may be adopted
23in accordance with this subsection (v) by the Department of
24Healthcare and Family Services. The 24-month limitation on the
25adoption of emergency rules does not apply to rules adopted
26under this subsection (v). The adoption of emergency rules

 

 

SB1773 Enrolled- 13 -LRB100 09919 KTG 20090 b

1authorized by this subsection (v) is deemed to be necessary for
2the public interest, safety, and welfare.
3    (w) In order to provide for the expeditious and timely
4implementation of the provisions of Public Act 99-796,
5emergency rules to implement the changes made by Public Act
699-796 may be adopted in accordance with this subsection (w) by
7the Adjutant General. The adoption of emergency rules
8authorized by this subsection (w) is deemed to be necessary for
9the public interest, safety, and welfare.
10    (x) In order to provide for the expeditious and timely
11implementation of the provisions of Public Act 99-906,
12emergency rules to implement subsection (i) of Section 16-115D,
13subsection (g) of Section 16-128A, and subsection (a) of
14Section 16-128B of the Public Utilities Act may be adopted in
15accordance with this subsection (x) by the Illinois Commerce
16Commission. The rulemaking authority granted in this
17subsection (x) shall apply only to those rules adopted within
18180 days after June 1, 2017 (the effective date of Public Act
1999-906). The adoption of emergency rules authorized by this
20subsection (x) is deemed to be necessary for the public
21interest, safety, and welfare.
22    (y) In order to provide for the expeditious and timely
23implementation of the provisions of this amendatory Act of the
24100th General Assembly, emergency rules to implement the
25changes made by this amendatory Act of the 100th General
26Assembly to Section 4.02 of the Illinois Act on Aging, Sections

 

 

SB1773 Enrolled- 14 -LRB100 09919 KTG 20090 b

15.5.4 and 5-5.4i of the Illinois Public Aid Code, Section 55-30
2of the Alcoholism and Other Drug Abuse and Dependency Act, and
3Sections 74 and 75 of the Mental Health and Developmental
4Disabilities Administrative Act may be adopted in accordance
5with this subsection (y) by the respective Department. The
6adoption of emergency rules authorized by this subsection (y)
7is deemed to be necessary for the public interest, safety, and
8welfare.
9    (z) In order to provide for the expeditious and timely
10implementation of the provisions of this amendatory Act of the
11100th General Assembly, emergency rules to implement the
12changes made by this amendatory Act of the 100th General
13Assembly to Section 4.7 of the Lobbyist Registration Act may be
14adopted in accordance with this subsection (z) by the Secretary
15of State. The adoption of emergency rules authorized by this
16subsection (z) is deemed to be necessary for the public
17interest, safety, and welfare.
18    (aa) In order to provide for the expeditious and timely
19initial implementation of the changes made to Articles 5, 5A,
2012, and 14 of the Illinois Public Aid Code under the provisions
21of this amendatory Act of the 100th General Assembly, the
22Department of Healthcare and Family Services may adopt
23emergency rules in accordance with this subsection (aa). The
2424-month limitation on the adoption of emergency rules does not
25apply to rules to initially implement the changes made to
26Articles 5, 5A, 12, and 14 of the Illinois Public Aid Code

 

 

SB1773 Enrolled- 15 -LRB100 09919 KTG 20090 b

1adopted under this subsection (aa). The adoption of emergency
2rules authorized by this subsection (aa) is deemed to be
3necessary for the public interest, safety, and welfare.
4(Source: P.A. 99-2, eff. 3-26-15; 99-6, eff. 1-1-16; 99-143,
5eff. 7-27-15; 99-455, eff. 1-1-16; 99-516, eff. 6-30-16;
699-642, eff. 7-28-16; 99-796, eff. 1-1-17; 99-906, eff. 6-1-17;
7100-23, eff. 7-6-17; 100-554, eff. 11-16-17.)
 
8    (5 ILCS 100/5-46.3 new)
9    Sec. 5-46.3. Approval of rules to implement the hospital
10transformation program. Notwithstanding any other provision of
11this Act, the Department of Healthcare and Family Services may
12not file, the Secretary of State may not accept, and the Joint
13Committee on Administrative Rules may not consider any rules
14adopted in accordance to subsection (d-5) of Section 14-12 of
15the Illinois Public Aid Code unless the rules have been
16approved by 9 of the 14 members of the Hospital Transformation
17Review Committee created under subsection (d-5) of Section
1814-12 of the Illinois Public Aid Code. Approval of the rules
19shall be demonstrated by submission of a written document
20signed by each of the 9 approving members. The Department of
21Healthcare and Family Services shall submit the written
22document with signatures, along with a certified copy of each
23rule, to the Secretary of State.
 
24    Section 3. The Illinois Health Facilities Planning Act is

 

 

SB1773 Enrolled- 16 -LRB100 09919 KTG 20090 b

1amended by changing Section 3 as follows:
 
2    (20 ILCS 3960/3)  (from Ch. 111 1/2, par. 1153)
3    (Text of Section before amendment by P.A. 100-518)
4    (Section scheduled to be repealed on December 31, 2019)
5    Sec. 3. Definitions. As used in this Act:
6    "Health care facilities" means and includes the following
7facilities, organizations, and related persons:
8        (1) An ambulatory surgical treatment center required
9    to be licensed pursuant to the Ambulatory Surgical
10    Treatment Center Act.
11        (2) An institution, place, building, or agency
12    required to be licensed pursuant to the Hospital Licensing
13    Act.
14        (3) Skilled and intermediate long term care facilities
15    licensed under the Nursing Home Care Act.
16            (A) If a demonstration project under the Nursing
17        Home Care Act applies for a certificate of need to
18        convert to a nursing facility, it shall meet the
19        licensure and certificate of need requirements in
20        effect as of the date of application.
21            (B) Except as provided in item (A) of this
22        subsection, this Act does not apply to facilities
23        granted waivers under Section 3-102.2 of the Nursing
24        Home Care Act.
25        (3.5) Skilled and intermediate care facilities

 

 

SB1773 Enrolled- 17 -LRB100 09919 KTG 20090 b

1    licensed under the ID/DD Community Care Act or the MC/DD
2    Act. No permit or exemption is required for a facility
3    licensed under the ID/DD Community Care Act or the MC/DD
4    Act prior to the reduction of the number of beds at a
5    facility. If there is a total reduction of beds at a
6    facility licensed under the ID/DD Community Care Act or the
7    MC/DD Act, this is a discontinuation or closure of the
8    facility. If a facility licensed under the ID/DD Community
9    Care Act or the MC/DD Act reduces the number of beds or
10    discontinues the facility, that facility must notify the
11    Board as provided in Section 14.1 of this Act.
12        (3.7) Facilities licensed under the Specialized Mental
13    Health Rehabilitation Act of 2013.
14        (4) Hospitals, nursing homes, ambulatory surgical
15    treatment centers, or kidney disease treatment centers
16    maintained by the State or any department or agency
17    thereof.
18        (5) Kidney disease treatment centers, including a
19    free-standing hemodialysis unit required to be licensed
20    under the End Stage Renal Disease Facility Act.
21            (A) This Act does not apply to a dialysis facility
22        that provides only dialysis training, support, and
23        related services to individuals with end stage renal
24        disease who have elected to receive home dialysis.
25            (B) This Act does not apply to a dialysis unit
26        located in a licensed nursing home that offers or

 

 

SB1773 Enrolled- 18 -LRB100 09919 KTG 20090 b

1        provides dialysis-related services to residents with
2        end stage renal disease who have elected to receive
3        home dialysis within the nursing home.
4            (C) The Board, however, may require dialysis
5        facilities and licensed nursing homes under items (A)
6        and (B) of this subsection to report statistical
7        information on a quarterly basis to the Board to be
8        used by the Board to conduct analyses on the need for
9        proposed kidney disease treatment centers.
10        (6) An institution, place, building, or room used for
11    the performance of outpatient surgical procedures that is
12    leased, owned, or operated by or on behalf of an
13    out-of-state facility.
14        (7) An institution, place, building, or room used for
15    provision of a health care category of service, including,
16    but not limited to, cardiac catheterization and open heart
17    surgery.
18        (8) An institution, place, building, or room housing
19    major medical equipment used in the direct clinical
20    diagnosis or treatment of patients, and whose project cost
21    is in excess of the capital expenditure minimum.
22    "Health care facilities" does not include the following
23entities or facility transactions:
24        (1) Federally-owned facilities.
25        (2) Facilities used solely for healing by prayer or
26    spiritual means.

 

 

SB1773 Enrolled- 19 -LRB100 09919 KTG 20090 b

1        (3) An existing facility located on any campus facility
2    as defined in Section 5-5.8b of the Illinois Public Aid
3    Code, provided that the campus facility encompasses 30 or
4    more contiguous acres and that the new or renovated
5    facility is intended for use by a licensed residential
6    facility.
7        (4) Facilities licensed under the Supportive
8    Residences Licensing Act or the Assisted Living and Shared
9    Housing Act.
10        (5) Facilities designated as supportive living
11    facilities that are in good standing with the program
12    established under Section 5-5.01a of the Illinois Public
13    Aid Code.
14        (6) Facilities established and operating under the
15    Alternative Health Care Delivery Act as a children's
16    community-based health care center alternative health care
17    model demonstration program or as an Alzheimer's Disease
18    Management Center alternative health care model
19    demonstration program.
20        (7) The closure of an entity or a portion of an entity
21    licensed under the Nursing Home Care Act, the Specialized
22    Mental Health Rehabilitation Act of 2013, the ID/DD
23    Community Care Act, or the MC/DD Act, with the exception of
24    facilities operated by a county or Illinois Veterans Homes,
25    that elect to convert, in whole or in part, to an assisted
26    living or shared housing establishment licensed under the

 

 

SB1773 Enrolled- 20 -LRB100 09919 KTG 20090 b

1    Assisted Living and Shared Housing Act and with the
2    exception of a facility licensed under the Specialized
3    Mental Health Rehabilitation Act of 2013 in connection with
4    a proposal to close a facility and re-establish the
5    facility in another location.
6        (8) Any change of ownership of a health care facility
7    that is licensed under the Nursing Home Care Act, the
8    Specialized Mental Health Rehabilitation Act of 2013, the
9    ID/DD Community Care Act, or the MC/DD Act, with the
10    exception of facilities operated by a county or Illinois
11    Veterans Homes. Changes of ownership of facilities
12    licensed under the Nursing Home Care Act must meet the
13    requirements set forth in Sections 3-101 through 3-119 of
14    the Nursing Home Care Act.
15        (9) Any project the Department of Healthcare and Family
16    Services certifies was approved by the Hospital
17    Transformation Review Committee as a project subject to the
18    hospital's transformation under subsection (d-5) of
19    Section 14-12 of the Illinois Public Aid Code, provided the
20    hospital shall submit the certification to the Board.
21    Nothing in this paragraph excludes a health care facility
22    from the requirements of this Act after the approved
23    transformation project is complete. All other requirements
24    under this Act continue to apply. Hospitals that are not
25    subject to this Act under this paragraph shall notify the
26    Health Facilities and Services Review Board within 30 days

 

 

SB1773 Enrolled- 21 -LRB100 09919 KTG 20090 b

1    of the dates that bed changes or service changes occur.
2    With the exception of those health care facilities
3specifically included in this Section, nothing in this Act
4shall be intended to include facilities operated as a part of
5the practice of a physician or other licensed health care
6professional, whether practicing in his individual capacity or
7within the legal structure of any partnership, medical or
8professional corporation, or unincorporated medical or
9professional group. Further, this Act shall not apply to
10physicians or other licensed health care professional's
11practices where such practices are carried out in a portion of
12a health care facility under contract with such health care
13facility by a physician or by other licensed health care
14professionals, whether practicing in his individual capacity
15or within the legal structure of any partnership, medical or
16professional corporation, or unincorporated medical or
17professional groups, unless the entity constructs, modifies,
18or establishes a health care facility as specifically defined
19in this Section. This Act shall apply to construction or
20modification and to establishment by such health care facility
21of such contracted portion which is subject to facility
22licensing requirements, irrespective of the party responsible
23for such action or attendant financial obligation.
24    "Person" means any one or more natural persons, legal
25entities, governmental bodies other than federal, or any
26combination thereof.

 

 

SB1773 Enrolled- 22 -LRB100 09919 KTG 20090 b

1    "Consumer" means any person other than a person (a) whose
2major occupation currently involves or whose official capacity
3within the last 12 months has involved the providing,
4administering or financing of any type of health care facility,
5(b) who is engaged in health research or the teaching of
6health, (c) who has a material financial interest in any
7activity which involves the providing, administering or
8financing of any type of health care facility, or (d) who is or
9ever has been a member of the immediate family of the person
10defined by (a), (b), or (c).
11    "State Board" or "Board" means the Health Facilities and
12Services Review Board.
13    "Construction or modification" means the establishment,
14erection, building, alteration, reconstruction, modernization,
15improvement, extension, discontinuation, change of ownership,
16of or by a health care facility, or the purchase or acquisition
17by or through a health care facility of equipment or service
18for diagnostic or therapeutic purposes or for facility
19administration or operation, or any capital expenditure made by
20or on behalf of a health care facility which exceeds the
21capital expenditure minimum; however, any capital expenditure
22made by or on behalf of a health care facility for (i) the
23construction or modification of a facility licensed under the
24Assisted Living and Shared Housing Act or (ii) a conversion
25project undertaken in accordance with Section 30 of the Older
26Adult Services Act shall be excluded from any obligations under

 

 

SB1773 Enrolled- 23 -LRB100 09919 KTG 20090 b

1this Act.
2    "Establish" means the construction of a health care
3facility or the replacement of an existing facility on another
4site or the initiation of a category of service.
5    "Major medical equipment" means medical equipment which is
6used for the provision of medical and other health services and
7which costs in excess of the capital expenditure minimum,
8except that such term does not include medical equipment
9acquired by or on behalf of a clinical laboratory to provide
10clinical laboratory services if the clinical laboratory is
11independent of a physician's office and a hospital and it has
12been determined under Title XVIII of the Social Security Act to
13meet the requirements of paragraphs (10) and (11) of Section
141861(s) of such Act. In determining whether medical equipment
15has a value in excess of the capital expenditure minimum, the
16value of studies, surveys, designs, plans, working drawings,
17specifications, and other activities essential to the
18acquisition of such equipment shall be included.
19    "Capital Expenditure" means an expenditure: (A) made by or
20on behalf of a health care facility (as such a facility is
21defined in this Act); and (B) which under generally accepted
22accounting principles is not properly chargeable as an expense
23of operation and maintenance, or is made to obtain by lease or
24comparable arrangement any facility or part thereof or any
25equipment for a facility or part; and which exceeds the capital
26expenditure minimum.

 

 

SB1773 Enrolled- 24 -LRB100 09919 KTG 20090 b

1    For the purpose of this paragraph, the cost of any studies,
2surveys, designs, plans, working drawings, specifications, and
3other activities essential to the acquisition, improvement,
4expansion, or replacement of any plant or equipment with
5respect to which an expenditure is made shall be included in
6determining if such expenditure exceeds the capital
7expenditures minimum. Unless otherwise interdependent, or
8submitted as one project by the applicant, components of
9construction or modification undertaken by means of a single
10construction contract or financed through the issuance of a
11single debt instrument shall not be grouped together as one
12project. Donations of equipment or facilities to a health care
13facility which if acquired directly by such facility would be
14subject to review under this Act shall be considered capital
15expenditures, and a transfer of equipment or facilities for
16less than fair market value shall be considered a capital
17expenditure for purposes of this Act if a transfer of the
18equipment or facilities at fair market value would be subject
19to review.
20    "Capital expenditure minimum" means $11,500,000 for
21projects by hospital applicants, $6,500,000 for applicants for
22projects related to skilled and intermediate care long-term
23care facilities licensed under the Nursing Home Care Act, and
24$3,000,000 for projects by all other applicants, which shall be
25annually adjusted to reflect the increase in construction costs
26due to inflation, for major medical equipment and for all other

 

 

SB1773 Enrolled- 25 -LRB100 09919 KTG 20090 b

1capital expenditures.
2    "Non-clinical service area" means an area (i) for the
3benefit of the patients, visitors, staff, or employees of a
4health care facility and (ii) not directly related to the
5diagnosis, treatment, or rehabilitation of persons receiving
6services from the health care facility. "Non-clinical service
7areas" include, but are not limited to, chapels; gift shops;
8news stands; computer systems; tunnels, walkways, and
9elevators; telephone systems; projects to comply with life
10safety codes; educational facilities; student housing;
11patient, employee, staff, and visitor dining areas;
12administration and volunteer offices; modernization of
13structural components (such as roof replacement and masonry
14work); boiler repair or replacement; vehicle maintenance and
15storage facilities; parking facilities; mechanical systems for
16heating, ventilation, and air conditioning; loading docks; and
17repair or replacement of carpeting, tile, wall coverings,
18window coverings or treatments, or furniture. Solely for the
19purpose of this definition, "non-clinical service area" does
20not include health and fitness centers.
21    "Areawide" means a major area of the State delineated on a
22geographic, demographic, and functional basis for health
23planning and for health service and having within it one or
24more local areas for health planning and health service. The
25term "region", as contrasted with the term "subregion", and the
26word "area" may be used synonymously with the term "areawide".

 

 

SB1773 Enrolled- 26 -LRB100 09919 KTG 20090 b

1    "Local" means a subarea of a delineated major area that on
2a geographic, demographic, and functional basis may be
3considered to be part of such major area. The term "subregion"
4may be used synonymously with the term "local".
5    "Physician" means a person licensed to practice in
6accordance with the Medical Practice Act of 1987, as amended.
7    "Licensed health care professional" means a person
8licensed to practice a health profession under pertinent
9licensing statutes of the State of Illinois.
10    "Director" means the Director of the Illinois Department of
11Public Health.
12    "Agency" or "Department" means the Illinois Department of
13Public Health.
14    "Alternative health care model" means a facility or program
15authorized under the Alternative Health Care Delivery Act.
16    "Out-of-state facility" means a person that is both (i)
17licensed as a hospital or as an ambulatory surgery center under
18the laws of another state or that qualifies as a hospital or an
19ambulatory surgery center under regulations adopted pursuant
20to the Social Security Act and (ii) not licensed under the
21Ambulatory Surgical Treatment Center Act, the Hospital
22Licensing Act, or the Nursing Home Care Act. Affiliates of
23out-of-state facilities shall be considered out-of-state
24facilities. Affiliates of Illinois licensed health care
25facilities 100% owned by an Illinois licensed health care
26facility, its parent, or Illinois physicians licensed to

 

 

SB1773 Enrolled- 27 -LRB100 09919 KTG 20090 b

1practice medicine in all its branches shall not be considered
2out-of-state facilities. Nothing in this definition shall be
3construed to include an office or any part of an office of a
4physician licensed to practice medicine in all its branches in
5Illinois that is not required to be licensed under the
6Ambulatory Surgical Treatment Center Act.
7    "Change of ownership of a health care facility" means a
8change in the person who has ownership or control of a health
9care facility's physical plant and capital assets. A change in
10ownership is indicated by the following transactions: sale,
11transfer, acquisition, lease, change of sponsorship, or other
12means of transferring control.
13    "Related person" means any person that: (i) is at least 50%
14owned, directly or indirectly, by either the health care
15facility or a person owning, directly or indirectly, at least
1650% of the health care facility; or (ii) owns, directly or
17indirectly, at least 50% of the health care facility.
18    "Charity care" means care provided by a health care
19facility for which the provider does not expect to receive
20payment from the patient or a third-party payer.
21    "Freestanding emergency center" means a facility subject
22to licensure under Section 32.5 of the Emergency Medical
23Services (EMS) Systems Act.
24    "Category of service" means a grouping by generic class of
25various types or levels of support functions, equipment, care,
26or treatment provided to patients or residents, including, but

 

 

SB1773 Enrolled- 28 -LRB100 09919 KTG 20090 b

1not limited to, classes such as medical-surgical, pediatrics,
2or cardiac catheterization. A category of service may include
3subcategories or levels of care that identify a particular
4degree or type of care within the category of service. Nothing
5in this definition shall be construed to include the practice
6of a physician or other licensed health care professional while
7functioning in an office providing for the care, diagnosis, or
8treatment of patients. A category of service that is subject to
9the Board's jurisdiction must be designated in rules adopted by
10the Board.
11    "State Board Staff Report" means the document that sets
12forth the review and findings of the State Board staff, as
13prescribed by the State Board, regarding applications subject
14to Board jurisdiction.
15(Source: P.A. 98-414, eff. 1-1-14; 98-629, eff. 1-1-15; 98-651,
16eff. 6-16-14; 98-1086, eff. 8-26-14; 99-78, eff. 7-20-15;
1799-180, eff. 7-29-15; 99-527, eff. 1-1-17.)
 
18    (Text of Section after amendment by P.A. 100-518)
19    (Section scheduled to be repealed on December 31, 2019)
20    Sec. 3. Definitions. As used in this Act:
21    "Health care facilities" means and includes the following
22facilities, organizations, and related persons:
23        (1) An ambulatory surgical treatment center required
24    to be licensed pursuant to the Ambulatory Surgical
25    Treatment Center Act.

 

 

SB1773 Enrolled- 29 -LRB100 09919 KTG 20090 b

1        (2) An institution, place, building, or agency
2    required to be licensed pursuant to the Hospital Licensing
3    Act.
4        (3) Skilled and intermediate long term care facilities
5    licensed under the Nursing Home Care Act.
6            (A) If a demonstration project under the Nursing
7        Home Care Act applies for a certificate of need to
8        convert to a nursing facility, it shall meet the
9        licensure and certificate of need requirements in
10        effect as of the date of application.
11            (B) Except as provided in item (A) of this
12        subsection, this Act does not apply to facilities
13        granted waivers under Section 3-102.2 of the Nursing
14        Home Care Act.
15        (3.5) Skilled and intermediate care facilities
16    licensed under the ID/DD Community Care Act or the MC/DD
17    Act. No permit or exemption is required for a facility
18    licensed under the ID/DD Community Care Act or the MC/DD
19    Act prior to the reduction of the number of beds at a
20    facility. If there is a total reduction of beds at a
21    facility licensed under the ID/DD Community Care Act or the
22    MC/DD Act, this is a discontinuation or closure of the
23    facility. If a facility licensed under the ID/DD Community
24    Care Act or the MC/DD Act reduces the number of beds or
25    discontinues the facility, that facility must notify the
26    Board as provided in Section 14.1 of this Act.

 

 

SB1773 Enrolled- 30 -LRB100 09919 KTG 20090 b

1        (3.7) Facilities licensed under the Specialized Mental
2    Health Rehabilitation Act of 2013.
3        (4) Hospitals, nursing homes, ambulatory surgical
4    treatment centers, or kidney disease treatment centers
5    maintained by the State or any department or agency
6    thereof.
7        (5) Kidney disease treatment centers, including a
8    free-standing hemodialysis unit required to be licensed
9    under the End Stage Renal Disease Facility Act.
10            (A) This Act does not apply to a dialysis facility
11        that provides only dialysis training, support, and
12        related services to individuals with end stage renal
13        disease who have elected to receive home dialysis.
14            (B) This Act does not apply to a dialysis unit
15        located in a licensed nursing home that offers or
16        provides dialysis-related services to residents with
17        end stage renal disease who have elected to receive
18        home dialysis within the nursing home.
19            (C) The Board, however, may require dialysis
20        facilities and licensed nursing homes under items (A)
21        and (B) of this subsection to report statistical
22        information on a quarterly basis to the Board to be
23        used by the Board to conduct analyses on the need for
24        proposed kidney disease treatment centers.
25        (6) An institution, place, building, or room used for
26    the performance of outpatient surgical procedures that is

 

 

SB1773 Enrolled- 31 -LRB100 09919 KTG 20090 b

1    leased, owned, or operated by or on behalf of an
2    out-of-state facility.
3        (7) An institution, place, building, or room used for
4    provision of a health care category of service, including,
5    but not limited to, cardiac catheterization and open heart
6    surgery.
7        (8) An institution, place, building, or room housing
8    major medical equipment used in the direct clinical
9    diagnosis or treatment of patients, and whose project cost
10    is in excess of the capital expenditure minimum.
11    "Health care facilities" does not include the following
12entities or facility transactions:
13        (1) Federally-owned facilities.
14        (2) Facilities used solely for healing by prayer or
15    spiritual means.
16        (3) An existing facility located on any campus facility
17    as defined in Section 5-5.8b of the Illinois Public Aid
18    Code, provided that the campus facility encompasses 30 or
19    more contiguous acres and that the new or renovated
20    facility is intended for use by a licensed residential
21    facility.
22        (4) Facilities licensed under the Supportive
23    Residences Licensing Act or the Assisted Living and Shared
24    Housing Act.
25        (5) Facilities designated as supportive living
26    facilities that are in good standing with the program

 

 

SB1773 Enrolled- 32 -LRB100 09919 KTG 20090 b

1    established under Section 5-5.01a of the Illinois Public
2    Aid Code.
3        (6) Facilities established and operating under the
4    Alternative Health Care Delivery Act as a children's
5    community-based health care center alternative health care
6    model demonstration program or as an Alzheimer's Disease
7    Management Center alternative health care model
8    demonstration program.
9        (7) The closure of an entity or a portion of an entity
10    licensed under the Nursing Home Care Act, the Specialized
11    Mental Health Rehabilitation Act of 2013, the ID/DD
12    Community Care Act, or the MC/DD Act, with the exception of
13    facilities operated by a county or Illinois Veterans Homes,
14    that elect to convert, in whole or in part, to an assisted
15    living or shared housing establishment licensed under the
16    Assisted Living and Shared Housing Act and with the
17    exception of a facility licensed under the Specialized
18    Mental Health Rehabilitation Act of 2013 in connection with
19    a proposal to close a facility and re-establish the
20    facility in another location.
21        (8) Any change of ownership of a health care facility
22    that is licensed under the Nursing Home Care Act, the
23    Specialized Mental Health Rehabilitation Act of 2013, the
24    ID/DD Community Care Act, or the MC/DD Act, with the
25    exception of facilities operated by a county or Illinois
26    Veterans Homes. Changes of ownership of facilities

 

 

SB1773 Enrolled- 33 -LRB100 09919 KTG 20090 b

1    licensed under the Nursing Home Care Act must meet the
2    requirements set forth in Sections 3-101 through 3-119 of
3    the Nursing Home Care Act.
4        (9) Any project the Department of Healthcare and Family
5    Services certifies was approved by the Hospital
6    Transformation Review Committee as a project subject to the
7    hospital's transformation under subsection (d-5) of
8    Section 14-12 of the Illinois Public Aid Code, provided the
9    hospital shall submit the certification to the Board.
10    Nothing in this paragraph excludes a health care facility
11    from the requirements of this Act after the approved
12    transformation project is complete. All other requirements
13    under this Act continue to apply. Hospitals that are not
14    subject to this Act under this paragraph shall notify the
15    Health Facilities and Services Review Board within 30 days
16    of the dates that bed changes or service changes occur.
17    With the exception of those health care facilities
18specifically included in this Section, nothing in this Act
19shall be intended to include facilities operated as a part of
20the practice of a physician or other licensed health care
21professional, whether practicing in his individual capacity or
22within the legal structure of any partnership, medical or
23professional corporation, or unincorporated medical or
24professional group. Further, this Act shall not apply to
25physicians or other licensed health care professional's
26practices where such practices are carried out in a portion of

 

 

SB1773 Enrolled- 34 -LRB100 09919 KTG 20090 b

1a health care facility under contract with such health care
2facility by a physician or by other licensed health care
3professionals, whether practicing in his individual capacity
4or within the legal structure of any partnership, medical or
5professional corporation, or unincorporated medical or
6professional groups, unless the entity constructs, modifies,
7or establishes a health care facility as specifically defined
8in this Section. This Act shall apply to construction or
9modification and to establishment by such health care facility
10of such contracted portion which is subject to facility
11licensing requirements, irrespective of the party responsible
12for such action or attendant financial obligation.
13    "Person" means any one or more natural persons, legal
14entities, governmental bodies other than federal, or any
15combination thereof.
16    "Consumer" means any person other than a person (a) whose
17major occupation currently involves or whose official capacity
18within the last 12 months has involved the providing,
19administering or financing of any type of health care facility,
20(b) who is engaged in health research or the teaching of
21health, (c) who has a material financial interest in any
22activity which involves the providing, administering or
23financing of any type of health care facility, or (d) who is or
24ever has been a member of the immediate family of the person
25defined by (a), (b), or (c).
26    "State Board" or "Board" means the Health Facilities and

 

 

SB1773 Enrolled- 35 -LRB100 09919 KTG 20090 b

1Services Review Board.
2    "Construction or modification" means the establishment,
3erection, building, alteration, reconstruction, modernization,
4improvement, extension, discontinuation, change of ownership,
5of or by a health care facility, or the purchase or acquisition
6by or through a health care facility of equipment or service
7for diagnostic or therapeutic purposes or for facility
8administration or operation, or any capital expenditure made by
9or on behalf of a health care facility which exceeds the
10capital expenditure minimum; however, any capital expenditure
11made by or on behalf of a health care facility for (i) the
12construction or modification of a facility licensed under the
13Assisted Living and Shared Housing Act or (ii) a conversion
14project undertaken in accordance with Section 30 of the Older
15Adult Services Act shall be excluded from any obligations under
16this Act.
17    "Establish" means the construction of a health care
18facility or the replacement of an existing facility on another
19site or the initiation of a category of service.
20    "Major medical equipment" means medical equipment which is
21used for the provision of medical and other health services and
22which costs in excess of the capital expenditure minimum,
23except that such term does not include medical equipment
24acquired by or on behalf of a clinical laboratory to provide
25clinical laboratory services if the clinical laboratory is
26independent of a physician's office and a hospital and it has

 

 

SB1773 Enrolled- 36 -LRB100 09919 KTG 20090 b

1been determined under Title XVIII of the Social Security Act to
2meet the requirements of paragraphs (10) and (11) of Section
31861(s) of such Act. In determining whether medical equipment
4has a value in excess of the capital expenditure minimum, the
5value of studies, surveys, designs, plans, working drawings,
6specifications, and other activities essential to the
7acquisition of such equipment shall be included.
8    "Capital Expenditure" means an expenditure: (A) made by or
9on behalf of a health care facility (as such a facility is
10defined in this Act); and (B) which under generally accepted
11accounting principles is not properly chargeable as an expense
12of operation and maintenance, or is made to obtain by lease or
13comparable arrangement any facility or part thereof or any
14equipment for a facility or part; and which exceeds the capital
15expenditure minimum.
16    For the purpose of this paragraph, the cost of any studies,
17surveys, designs, plans, working drawings, specifications, and
18other activities essential to the acquisition, improvement,
19expansion, or replacement of any plant or equipment with
20respect to which an expenditure is made shall be included in
21determining if such expenditure exceeds the capital
22expenditures minimum. Unless otherwise interdependent, or
23submitted as one project by the applicant, components of
24construction or modification undertaken by means of a single
25construction contract or financed through the issuance of a
26single debt instrument shall not be grouped together as one

 

 

SB1773 Enrolled- 37 -LRB100 09919 KTG 20090 b

1project. Donations of equipment or facilities to a health care
2facility which if acquired directly by such facility would be
3subject to review under this Act shall be considered capital
4expenditures, and a transfer of equipment or facilities for
5less than fair market value shall be considered a capital
6expenditure for purposes of this Act if a transfer of the
7equipment or facilities at fair market value would be subject
8to review.
9    "Capital expenditure minimum" means $11,500,000 for
10projects by hospital applicants, $6,500,000 for applicants for
11projects related to skilled and intermediate care long-term
12care facilities licensed under the Nursing Home Care Act, and
13$3,000,000 for projects by all other applicants, which shall be
14annually adjusted to reflect the increase in construction costs
15due to inflation, for major medical equipment and for all other
16capital expenditures.
17    "Financial Commitment" means the commitment of at least 33%
18of total funds assigned to cover total project cost, which
19occurs by the actual expenditure of 33% or more of the total
20project cost or the commitment to expend 33% or more of the
21total project cost by signed contracts or other legal means.
22    "Non-clinical service area" means an area (i) for the
23benefit of the patients, visitors, staff, or employees of a
24health care facility and (ii) not directly related to the
25diagnosis, treatment, or rehabilitation of persons receiving
26services from the health care facility. "Non-clinical service

 

 

SB1773 Enrolled- 38 -LRB100 09919 KTG 20090 b

1areas" include, but are not limited to, chapels; gift shops;
2news stands; computer systems; tunnels, walkways, and
3elevators; telephone systems; projects to comply with life
4safety codes; educational facilities; student housing;
5patient, employee, staff, and visitor dining areas;
6administration and volunteer offices; modernization of
7structural components (such as roof replacement and masonry
8work); boiler repair or replacement; vehicle maintenance and
9storage facilities; parking facilities; mechanical systems for
10heating, ventilation, and air conditioning; loading docks; and
11repair or replacement of carpeting, tile, wall coverings,
12window coverings or treatments, or furniture. Solely for the
13purpose of this definition, "non-clinical service area" does
14not include health and fitness centers.
15    "Areawide" means a major area of the State delineated on a
16geographic, demographic, and functional basis for health
17planning and for health service and having within it one or
18more local areas for health planning and health service. The
19term "region", as contrasted with the term "subregion", and the
20word "area" may be used synonymously with the term "areawide".
21    "Local" means a subarea of a delineated major area that on
22a geographic, demographic, and functional basis may be
23considered to be part of such major area. The term "subregion"
24may be used synonymously with the term "local".
25    "Physician" means a person licensed to practice in
26accordance with the Medical Practice Act of 1987, as amended.

 

 

SB1773 Enrolled- 39 -LRB100 09919 KTG 20090 b

1    "Licensed health care professional" means a person
2licensed to practice a health profession under pertinent
3licensing statutes of the State of Illinois.
4    "Director" means the Director of the Illinois Department of
5Public Health.
6    "Agency" or "Department" means the Illinois Department of
7Public Health.
8    "Alternative health care model" means a facility or program
9authorized under the Alternative Health Care Delivery Act.
10    "Out-of-state facility" means a person that is both (i)
11licensed as a hospital or as an ambulatory surgery center under
12the laws of another state or that qualifies as a hospital or an
13ambulatory surgery center under regulations adopted pursuant
14to the Social Security Act and (ii) not licensed under the
15Ambulatory Surgical Treatment Center Act, the Hospital
16Licensing Act, or the Nursing Home Care Act. Affiliates of
17out-of-state facilities shall be considered out-of-state
18facilities. Affiliates of Illinois licensed health care
19facilities 100% owned by an Illinois licensed health care
20facility, its parent, or Illinois physicians licensed to
21practice medicine in all its branches shall not be considered
22out-of-state facilities. Nothing in this definition shall be
23construed to include an office or any part of an office of a
24physician licensed to practice medicine in all its branches in
25Illinois that is not required to be licensed under the
26Ambulatory Surgical Treatment Center Act.

 

 

SB1773 Enrolled- 40 -LRB100 09919 KTG 20090 b

1    "Change of ownership of a health care facility" means a
2change in the person who has ownership or control of a health
3care facility's physical plant and capital assets. A change in
4ownership is indicated by the following transactions: sale,
5transfer, acquisition, lease, change of sponsorship, or other
6means of transferring control.
7    "Related person" means any person that: (i) is at least 50%
8owned, directly or indirectly, by either the health care
9facility or a person owning, directly or indirectly, at least
1050% of the health care facility; or (ii) owns, directly or
11indirectly, at least 50% of the health care facility.
12    "Charity care" means care provided by a health care
13facility for which the provider does not expect to receive
14payment from the patient or a third-party payer.
15    "Freestanding emergency center" means a facility subject
16to licensure under Section 32.5 of the Emergency Medical
17Services (EMS) Systems Act.
18    "Category of service" means a grouping by generic class of
19various types or levels of support functions, equipment, care,
20or treatment provided to patients or residents, including, but
21not limited to, classes such as medical-surgical, pediatrics,
22or cardiac catheterization. A category of service may include
23subcategories or levels of care that identify a particular
24degree or type of care within the category of service. Nothing
25in this definition shall be construed to include the practice
26of a physician or other licensed health care professional while

 

 

SB1773 Enrolled- 41 -LRB100 09919 KTG 20090 b

1functioning in an office providing for the care, diagnosis, or
2treatment of patients. A category of service that is subject to
3the Board's jurisdiction must be designated in rules adopted by
4the Board.
5    "State Board Staff Report" means the document that sets
6forth the review and findings of the State Board staff, as
7prescribed by the State Board, regarding applications subject
8to Board jurisdiction.
9(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
1099-527, eff. 1-1-17; 100-518, eff. 6-1-18.)
 
11    Section 10. The Emergency Medical Services (EMS) Systems
12Act is amended by changing Section 32.5 as follows:
 
13    (210 ILCS 50/32.5)
14    Sec. 32.5. Freestanding Emergency Center.
15    (a) The Department shall issue an annual Freestanding
16Emergency Center (FEC) license to any facility that has
17received a permit from the Health Facilities and Services
18Review Board to establish a Freestanding Emergency Center by
19January 1, 2015, and:
20        (1) is located: (A) in a municipality with a population
21    of 50,000 or fewer inhabitants; (B) within 50 miles of the
22    hospital that owns or controls the FEC; and (C) within 50
23    miles of the Resource Hospital affiliated with the FEC as
24    part of the EMS System;

 

 

SB1773 Enrolled- 42 -LRB100 09919 KTG 20090 b

1        (2) is wholly owned or controlled by an Associate or
2    Resource Hospital, but is not a part of the hospital's
3    physical plant;
4        (3) meets the standards for licensed FECs, adopted by
5    rule of the Department, including, but not limited to:
6            (A) facility design, specification, operation, and
7        maintenance standards;
8            (B) equipment standards; and
9            (C) the number and qualifications of emergency
10        medical personnel and other staff, which must include
11        at least one board certified emergency physician
12        present at the FEC 24 hours per day.
13        (4) limits its participation in the EMS System strictly
14    to receiving a limited number of patients by ambulance: (A)
15    according to the FEC's 24-hour capabilities; (B) according
16    to protocols developed by the Resource Hospital within the
17    FEC's designated EMS System; and (C) as pre-approved by
18    both the EMS Medical Director and the Department;
19        (5) provides comprehensive emergency treatment
20    services, as defined in the rules adopted by the Department
21    pursuant to the Hospital Licensing Act, 24 hours per day,
22    on an outpatient basis;
23        (6) provides an ambulance and maintains on site
24    ambulance services staffed with paramedics 24 hours per
25    day;
26        (7) (blank);

 

 

SB1773 Enrolled- 43 -LRB100 09919 KTG 20090 b

1        (8) complies with all State and federal patient rights
2    provisions, including, but not limited to, the Emergency
3    Medical Treatment Act and the federal Emergency Medical
4    Treatment and Active Labor Act;
5        (9) maintains a communications system that is fully
6    integrated with its Resource Hospital within the FEC's
7    designated EMS System;
8        (10) reports to the Department any patient transfers
9    from the FEC to a hospital within 48 hours of the transfer
10    plus any other data determined to be relevant by the
11    Department;
12        (11) submits to the Department, on a quarterly basis,
13    the FEC's morbidity and mortality rates for patients
14    treated at the FEC and other data determined to be relevant
15    by the Department;
16        (12) does not describe itself or hold itself out to the
17    general public as a full service hospital or hospital
18    emergency department in its advertising or marketing
19    activities;
20        (13) complies with any other rules adopted by the
21    Department under this Act that relate to FECs;
22        (14) passes the Department's site inspection for
23    compliance with the FEC requirements of this Act;
24        (15) submits a copy of the permit issued by the Health
25    Facilities and Services Review Board indicating that the
26    facility has complied with the Illinois Health Facilities

 

 

SB1773 Enrolled- 44 -LRB100 09919 KTG 20090 b

1    Planning Act with respect to the health services to be
2    provided at the facility;
3        (16) submits an application for designation as an FEC
4    in a manner and form prescribed by the Department by rule;
5    and
6        (17) pays the annual license fee as determined by the
7    Department by rule.
8    (a-5) Notwithstanding any other provision of this Section,
9the Department may issue an annual FEC license to a facility
10that is located in a county that does not have a licensed
11general acute care hospital if the facility's application for a
12permit from the Illinois Health Facilities Planning Board has
13been deemed complete by the Department of Public Health by
14January 1, 2014 and if the facility complies with the
15requirements set forth in paragraphs (1) through (17) of
16subsection (a).
17    (a-10) Notwithstanding any other provision of this
18Section, the Department may issue an annual FEC license to a
19facility if the facility has, by January 1, 2014, filed a
20letter of intent to establish an FEC and if the facility
21complies with the requirements set forth in paragraphs (1)
22through (17) of subsection (a).
23    (a-15) Notwithstanding any other provision of this
24Section, the Department shall issue an annual FEC license to a
25facility if the facility: (i) discontinues operation as a
26hospital within 180 days after the effective date of this

 

 

SB1773 Enrolled- 45 -LRB100 09919 KTG 20090 b

1amendatory Act of the 99th General Assembly with a Health
2Facilities and Services Review Board project number of
3E-017-15; (ii) has an application for a permit to establish an
4FEC from the Health Facilities and Services Review Board that
5is deemed complete by January 1, 2017; and (iii) complies with
6the requirements set forth in paragraphs (1) through (17) of
7subsection (a) of this Section.
8    (a20) Notwithstanding any other provision of this
9Section, the Department shall issue an annual FEC license to a
10facility if:
11        (1) the facility is a hospital that has discontinued
12    inpatient hospital services;
13        (2) the Department of Healthcare and Family Services
14    has certified the conversion to an FEC was approved by the
15    Hospital Transformation Review Committee as a project
16    subject to the hospital's transformation under subsection
17    (d-5) of Section 14-12 of the Illinois Public Aid Code;
18        (3) the facility complies with the requirements set
19    forth in paragraphs (1) through (17), provided however that
20    the FEC may be located in a municipality with a population
21    greater than 50,000 inhabitants and shall not be subject to
22    the requirements of the Illinois Health Facilities
23    Planning Act that are applicable to the conversion to an
24    FEC if the Department of Healthcare and Family Service has
25    certified the conversion to an FEC was approved by the
26    Hospital Transformation Review Committee as a project

 

 

SB1773 Enrolled- 46 -LRB100 09919 KTG 20090 b

1    subject to the hospital's transformation under subsection
2    (d-5) of Section 14-12 of the Illinois Public Aid Code; and
3        (4) the facility is located at the same physical
4    location where the facility served as a hospital.
5    (b) The Department shall:
6        (1) annually inspect facilities of initial FEC
7    applicants and licensed FECs, and issue annual licenses to
8    or annually relicense FECs that satisfy the Department's
9    licensure requirements as set forth in subsection (a);
10        (2) suspend, revoke, refuse to issue, or refuse to
11    renew the license of any FEC, after notice and an
12    opportunity for a hearing, when the Department finds that
13    the FEC has failed to comply with the standards and
14    requirements of the Act or rules adopted by the Department
15    under the Act;
16        (3) issue an Emergency Suspension Order for any FEC
17    when the Director or his or her designee has determined
18    that the continued operation of the FEC poses an immediate
19    and serious danger to the public health, safety, and
20    welfare. An opportunity for a hearing shall be promptly
21    initiated after an Emergency Suspension Order has been
22    issued; and
23        (4) adopt rules as needed to implement this Section.
24(Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16.)
 
25    Section 15. The Illinois Public Aid Code is amended by

 

 

SB1773 Enrolled- 47 -LRB100 09919 KTG 20090 b

1changing Sections 5-5.02, 5-5e.1, 5A-2, 5A-4, 5A-5, 5A-8,
25A-10, 5A-12.5, 5A-13, 5A-14, 5A-15, 12-4.105, and 14-12, and
3by adding Sections 5A-12.6, and 5A-16 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
7September 30, 1992. Notwithstanding any other provisions of
8this Code or the Illinois Department's Rules promulgated under
9the Illinois Administrative Procedure Act, reimbursement to
10hospitals for services provided during the period July 1, 1992
11through September 30, 1992, shall be as follows:
12        (1) For inpatient hospital services rendered, or if
13    applicable, for inpatient hospital discharges occurring,
14    on or after July 1, 1992 and on or before September 30,
15    1992, the Illinois Department shall reimburse hospitals
16    for inpatient services under the reimbursement
17    methodologies in effect for each hospital, and at the
18    inpatient payment rate calculated for each hospital, as of
19    June 30, 1992. For purposes of this paragraph,
20    "reimbursement methodologies" means all reimbursement
21    methodologies that pertain to the provision of inpatient
22    hospital services, including, but not limited to, any
23    adjustments for disproportionate share, targeted access,
24    critical care access and uncompensated care, as defined by
25    the Illinois Department on June 30, 1992.

 

 

SB1773 Enrolled- 48 -LRB100 09919 KTG 20090 b

1        (2) For the purpose of calculating the inpatient
2    payment rate for each hospital eligible to receive
3    quarterly adjustment payments for targeted access and
4    critical care, as defined by the Illinois Department on
5    June 30, 1992, the adjustment payment for the period July
6    1, 1992 through September 30, 1992, shall be 25% of the
7    annual adjustment payments calculated for each eligible
8    hospital, as of June 30, 1992. The Illinois Department
9    shall determine by rule the adjustment payments for
10    targeted access and critical care beginning October 1,
11    1992.
12        (3) For the purpose of calculating the inpatient
13    payment rate for each hospital eligible to receive
14    quarterly adjustment payments for uncompensated care, as
15    defined by the Illinois Department on June 30, 1992, the
16    adjustment payment for the period August 1, 1992 through
17    September 30, 1992, shall be one-sixth of the total
18    uncompensated care adjustment payments calculated for each
19    eligible hospital for the uncompensated care rate year, as
20    defined by the Illinois Department, ending on July 31,
21    1992. The Illinois Department shall determine by rule the
22    adjustment payments for uncompensated care beginning
23    October 1, 1992.
24    (b) Inpatient payments. For inpatient services provided on
25or after October 1, 1993, in addition to rates paid for
26hospital inpatient services pursuant to the Illinois Health

 

 

SB1773 Enrolled- 49 -LRB100 09919 KTG 20090 b

1Finance Reform Act, as now or hereafter amended, or the
2Illinois Department's prospective reimbursement methodology,
3or any other methodology used by the Illinois Department for
4inpatient services, the Illinois Department shall make
5adjustment payments, in an amount calculated pursuant to the
6methodology described in paragraph (c) of this Section, to
7hospitals that the Illinois Department determines satisfy any
8one of the following requirements:
9        (1) Hospitals that are described in Section 1923 of the
10    federal Social Security Act, as now or hereafter amended,
11    except that for rate year 2015 and after a hospital
12    described in Section 1923(b)(1)(B) of the federal Social
13    Security Act and qualified for the payments described in
14    subsection (c) of this Section for rate year 2014 provided
15    the hospital continues to meet the description in Section
16    1923(b)(1)(B) in the current determination year; or
17        (2) Illinois hospitals that have a Medicaid inpatient
18    utilization rate which is at least one-half a standard
19    deviation above the mean Medicaid inpatient utilization
20    rate for all hospitals in Illinois receiving Medicaid
21    payments from the Illinois Department; or
22        (3) Illinois hospitals that on July 1, 1991 had a
23    Medicaid inpatient utilization rate, as defined in
24    paragraph (h) of this Section, that was at least the mean
25    Medicaid inpatient utilization rate for all hospitals in
26    Illinois receiving Medicaid payments from the Illinois

 

 

SB1773 Enrolled- 50 -LRB100 09919 KTG 20090 b

1    Department and which were located in a planning area with
2    one-third or fewer excess beds as determined by the Health
3    Facilities and Services Review Board, and that, as of June
4    30, 1992, were located in a federally designated Health
5    Manpower Shortage Area; or
6        (4) Illinois hospitals that:
7            (A) have a Medicaid inpatient utilization rate
8        that is at least equal to the mean Medicaid inpatient
9        utilization rate for all hospitals in Illinois
10        receiving Medicaid payments from the Department; and
11            (B) also have a Medicaid obstetrical inpatient
12        utilization rate that is at least one standard
13        deviation above the mean Medicaid obstetrical
14        inpatient utilization rate for all hospitals in
15        Illinois receiving Medicaid payments from the
16        Department for obstetrical services; or
17        (5) Any children's hospital, which means a hospital
18    devoted exclusively to caring for children. A hospital
19    which includes a facility devoted exclusively to caring for
20    children shall be considered a children's hospital to the
21    degree that the hospital's Medicaid care is provided to
22    children if either (i) the facility devoted exclusively to
23    caring for children is separately licensed as a hospital by
24    a municipality prior to February 28, 2013 or (ii) the
25    hospital has been designated by the State as a Level III
26    perinatal care facility, has a Medicaid Inpatient

 

 

SB1773 Enrolled- 51 -LRB100 09919 KTG 20090 b

1    Utilization rate greater than 55% for the rate year 2003
2    disproportionate share determination, and has more than
3    10,000 qualified children days as defined by the Department
4    in rulemaking.
5    (c) Inpatient adjustment payments. The adjustment payments
6required by paragraph (b) shall be calculated based upon the
7hospital's Medicaid inpatient utilization rate as follows:
8        (1) hospitals with a Medicaid inpatient utilization
9    rate below the mean shall receive a per day adjustment
10    payment equal to $25;
11        (2) hospitals with a Medicaid inpatient utilization
12    rate that is equal to or greater than the mean Medicaid
13    inpatient utilization rate but less than one standard
14    deviation above the mean Medicaid inpatient utilization
15    rate shall receive a per day adjustment payment equal to
16    the sum of $25 plus $1 for each one percent that the
17    hospital's Medicaid inpatient utilization rate exceeds the
18    mean Medicaid inpatient utilization rate;
19        (3) hospitals with a Medicaid inpatient utilization
20    rate that is equal to or greater than one standard
21    deviation above the mean Medicaid inpatient utilization
22    rate but less than 1.5 standard deviations above the mean
23    Medicaid inpatient utilization rate shall receive a per day
24    adjustment payment equal to the sum of $40 plus $7 for each
25    one percent that the hospital's Medicaid inpatient
26    utilization rate exceeds one standard deviation above the

 

 

SB1773 Enrolled- 52 -LRB100 09919 KTG 20090 b

1    mean Medicaid inpatient utilization rate; and
2        (4) hospitals with a Medicaid inpatient utilization
3    rate that is equal to or greater than 1.5 standard
4    deviations above the mean Medicaid inpatient utilization
5    rate shall receive a per day adjustment payment equal to
6    the sum of $90 plus $2 for each one percent that the
7    hospital's Medicaid inpatient utilization rate exceeds 1.5
8    standard deviations above the mean Medicaid inpatient
9    utilization rate.
10    (d) Supplemental adjustment payments. In addition to the
11adjustment payments described in paragraph (c), hospitals as
12defined in clauses (1) through (5) of paragraph (b), excluding
13county hospitals (as defined in subsection (c) of Section 15-1
14of this Code) and a hospital organized under the University of
15Illinois Hospital Act, shall be paid supplemental inpatient
16adjustment payments of $60 per day. For purposes of Title XIX
17of the federal Social Security Act, these supplemental
18adjustment payments shall not be classified as adjustment
19payments to disproportionate share hospitals.
20    (e) The inpatient adjustment payments described in
21paragraphs (c) and (d) shall be increased on October 1, 1993
22and annually thereafter by a percentage equal to the lesser of
23(i) the increase in the DRI hospital cost index for the most
24recent 12 month period for which data are available, or (ii)
25the percentage increase in the statewide average hospital
26payment rate over the previous year's statewide average

 

 

SB1773 Enrolled- 53 -LRB100 09919 KTG 20090 b

1hospital payment rate. The sum of the inpatient adjustment
2payments under paragraphs (c) and (d) to a hospital, other than
3a county hospital (as defined in subsection (c) of Section 15-1
4of this Code) or a hospital organized under the University of
5Illinois Hospital Act, however, shall not exceed $275 per day;
6that limit shall be increased on October 1, 1993 and annually
7thereafter by a percentage equal to the lesser of (i) the
8increase in the DRI hospital cost index for the most recent
912-month period for which data are available or (ii) the
10percentage increase in the statewide average hospital payment
11rate over the previous year's statewide average hospital
12payment rate.
13    (f) Children's hospital inpatient adjustment payments. For
14children's hospitals, as defined in clause (5) of paragraph
15(b), the adjustment payments required pursuant to paragraphs
16(c) and (d) shall be multiplied by 2.0.
17    (g) County hospital inpatient adjustment payments. For
18county hospitals, as defined in subsection (c) of Section 15-1
19of this Code, there shall be an adjustment payment as
20determined by rules issued by the Illinois Department.
21    (h) For the purposes of this Section the following terms
22shall be defined as follows:
23        (1) "Medicaid inpatient utilization rate" means a
24    fraction, the numerator of which is the number of a
25    hospital's inpatient days provided in a given 12-month
26    period to patients who, for such days, were eligible for

 

 

SB1773 Enrolled- 54 -LRB100 09919 KTG 20090 b

1    Medicaid under Title XIX of the federal Social Security
2    Act, and the denominator of which is the total number of
3    the hospital's inpatient days in that same period.
4        (2) "Mean Medicaid inpatient utilization rate" means
5    the total number of Medicaid inpatient days provided by all
6    Illinois Medicaid-participating hospitals divided by the
7    total number of inpatient days provided by those same
8    hospitals.
9        (3) "Medicaid obstetrical inpatient utilization rate"
10    means the ratio of Medicaid obstetrical inpatient days to
11    total Medicaid inpatient days for all Illinois hospitals
12    receiving Medicaid payments from the Illinois Department.
13    (i) Inpatient adjustment payment limit. In order to meet
14the limits of Public Law 102-234 and Public Law 103-66, the
15Illinois Department shall by rule adjust disproportionate
16share adjustment payments.
17    (j) University of Illinois Hospital inpatient adjustment
18payments. For hospitals organized under the University of
19Illinois Hospital Act, there shall be an adjustment payment as
20determined by rules adopted by the Illinois Department.
21    (k) The Illinois Department may by rule establish criteria
22for and develop methodologies for adjustment payments to
23hospitals participating under this Article.
24    (l) On and after July 1, 2012, the Department shall reduce
25any rate of reimbursement for services or other payments or
26alter any methodologies authorized by this Code to reduce any

 

 

SB1773 Enrolled- 55 -LRB100 09919 KTG 20090 b

1rate of reimbursement for services or other payments in
2accordance with Section 5-5e.
3    (m) The Department shall establish a cost-based
4reimbursement methodology for determining payments to
5hospitals for approved graduate medical education (GME)
6programs for dates of service on and after July 1, 2018.
7        (1) As used in this subsection, "hospitals" means the
8    University of Illinois Hospital as defined in the
9    University of Illinois Hospital Act and a county hospital
10    in a county of over 3,000,000 inhabitants.
11        (2) An amendment to the Illinois Title XIX State Plan
12    defining GME shall maximize reimbursement, shall not be
13    limited to the education programs or special patient care
14    payments allowed under Medicare, and shall include:
15            (A) inpatient days;
16            (B) outpatient days;
17            (C) direct costs;
18            (D) indirect costs;
19            (E) managed care days;
20            (F) all stages of medical training and education
21        including students, interns, residents, and fellows
22        with no caps on the number of persons who may qualify;
23        and
24            (G) patient care payments related to the
25        complexities of treating Medicaid enrollees including
26        clinical and social determinants of health.

 

 

SB1773 Enrolled- 56 -LRB100 09919 KTG 20090 b

1        (3) The Department shall make all GME payments directly
2    to hospitals including such costs in support of clients
3    enrolled in Medicaid managed care entities.
4        (4) The Department shall promptly take all actions
5    necessary for reimbursement to be effective for dates of
6    service on and after July 1, 2018 including publishing all
7    appropriate public notices, amendments to the Illinois
8    Title XIX State Plan, and adoption of administrative rules
9    if necessary.
10        (5) As used in this subsection, "managed care days"
11    means costs associated with services rendered to enrollees
12    of Medicaid managed care entities. "Medicaid managed care
13    entities" means any entity which contracts with the
14    Department to provide services paid for on a capitated
15    basis. "Medicaid managed care entities" includes a managed
16    care organization and a managed care community network.
17        (6) All payments under this Section are contingent upon
18    federal approval of changes to the Illinois Title XIX State
19    Plan, if that approval is required.
20        (7) The Department may adopt rules necessary to
21    implement this amendatory Act of the 100th General Assembly
22    through the use of emergency rulemaking in accordance with
23    subsection (aa) of Section 5-45 of the Illinois
24    Administrative Procedure Act. For purposes of that Act, the
25    General Assembly finds that the adoption of rules to
26    implement this amendatory Act of the 100th General Assembly

 

 

SB1773 Enrolled- 57 -LRB100 09919 KTG 20090 b

1    is deemed an emergency and necessary for the public
2    interest, safety, and welfare.
3(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
 
4    (305 ILCS 5/5-5e.1)
5    Sec. 5-5e.1. Safety-Net Hospitals.
6    (a) A Safety-Net Hospital is an Illinois hospital that:
7        (1) is licensed by the Department of Public Health as a
8    general acute care or pediatric hospital; and
9        (2) is a disproportionate share hospital, as described
10    in Section 1923 of the federal Social Security Act, as
11    determined by the Department; and
12        (3) meets one of the following:
13            (A) has a MIUR of at least 40% and a charity
14        percent of at least 4%; or
15            (B) has a MIUR of at least 50%.
16    (b) Definitions. As used in this Section:
17        (1) "Charity percent" means the ratio of (i) the
18    hospital's charity charges for services provided to
19    individuals without health insurance or another source of
20    third party coverage to (ii) the Illinois total hospital
21    charges, each as reported on the hospital's OBRA form.
22        (2) "MIUR" means Medicaid Inpatient Utilization Rate
23    and is defined as a fraction, the numerator of which is the
24    number of a hospital's inpatient days provided in the
25    hospital's fiscal year ending 3 years prior to the rate

 

 

SB1773 Enrolled- 58 -LRB100 09919 KTG 20090 b

1    year, to patients who, for such days, were eligible for
2    Medicaid under Title XIX of the federal Social Security
3    Act, 42 USC 1396a et seq., excluding those persons eligible
4    for medical assistance pursuant to 42 U.S.C.
5    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
6    Section 5-2 of this Article, and the denominator of which
7    is the total number of the hospital's inpatient days in
8    that same period, excluding those persons eligible for
9    medical assistance pursuant to 42 U.S.C.
10    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
11    Section 5-2 of this Article.
12        (3) "OBRA form" means form HFS-3834, OBRA '93 data
13    collection form, for the rate year.
14        (4) "Rate year" means the 12-month period beginning on
15    October 1.
16    (c) Beginning July 1, 2012 and ending on June 30, 2020
172018, a hospital that would have qualified for the rate year
18beginning October 1, 2011, shall be a Safety-Net Hospital.
19    (d) No later than August 15 preceding the rate year, each
20hospital shall submit the OBRA form to the Department. Prior to
21October 1, the Department shall notify each hospital whether it
22has qualified as a Safety-Net Hospital.
23    (e) The Department may promulgate rules in order to
24implement this Section.
25    (f) Nothing in this Section shall be construed as limiting
26the ability of the Department to include the Safety-Net

 

 

SB1773 Enrolled- 59 -LRB100 09919 KTG 20090 b

1Hospitals in the hospital rate reform mandated by Section 14-11
2of this Code and implemented under Section 14-12 of this Code
3and by administrative rulemaking.
4(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13;
598-651, eff. 6-16-14.)
 
6    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
7    (Section scheduled to be repealed on July 1, 2018)
8    Sec. 5A-2. Assessment.
9    (a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
10years 2009 through 2018, or as long as continued under Section
115A-16, an annual assessment on inpatient services is imposed on
12each hospital provider in an amount equal to $218.38 multiplied
13by the difference of the hospital's occupied bed days less the
14hospital's Medicare bed days, provided, however, that the
15amount of $218.38 shall be increased by a uniform percentage to
16generate an amount equal to 75% of the State share of the
17payments authorized under Section 5A-12.5, with such increase
18only taking effect upon the date that a State share for such
19payments is required under federal law. For the period of April
20through June 2015, the amount of $218.38 used to calculate the
21assessment under this paragraph shall, by emergency rule under
22subsection (s) of Section 5-45 of the Illinois Administrative
23Procedure Act, be increased by a uniform percentage to generate
24$20,250,000 in the aggregate for that period from all hospitals
25subject to the annual assessment under this paragraph.

 

 

SB1773 Enrolled- 60 -LRB100 09919 KTG 20090 b

1    (2) In addition to any other assessments imposed under this
2Article, effective July 1, 2016 and semi-annually thereafter
3through June 2018, or as provided in Section 5A-16, in addition
4to any federally required State share as authorized under
5paragraph (1), the amount of $218.38 shall be increased by a
6uniform percentage to generate an amount equal to 75% of the
7ACA Assessment Adjustment, as defined in subsection (b-6) of
8this Section.
9    For State fiscal years 2009 through 2018 2014 and after, or
10as provided in Section 5A-16, a hospital's occupied bed days
11and Medicare bed days shall be determined using the most recent
12data available from each hospital's 2005 Medicare cost report
13as contained in the Healthcare Cost Report Information System
14file, for the quarter ending on December 31, 2006, without
15regard to any subsequent adjustments or changes to such data.
16If a hospital's 2005 Medicare cost report is not contained in
17the Healthcare Cost Report Information System, then the
18Illinois Department may obtain the hospital provider's
19occupied bed days and Medicare bed days from any source
20available, including, but not limited to, records maintained by
21the hospital provider, which may be inspected at all times
22during business hours of the day by the Illinois Department or
23its duly authorized agents and employees.
24    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
25fiscal years 2019 and 2020, an annual assessment on inpatient
26services is imposed on each hospital provider in an amount

 

 

SB1773 Enrolled- 61 -LRB100 09919 KTG 20090 b

1equal to $197.19 multiplied by the difference of the hospital's
2occupied bed days less the hospital's Medicare bed days;
3however, for State fiscal year 2020, the amount of $197.19
4shall be increased by a uniform percentage to generate an
5additional $6,250,000 in the aggregate for that period from all
6hospitals subject to the annual assessment under this
7paragraph. For State fiscal years 2019 and 2020, a hospital's
8occupied bed days and Medicare bed days shall be determined
9using the most recent data available from each hospital's 2015
10Medicare cost report as contained in the Healthcare Cost Report
11Information System file, for the quarter ending on March 31,
122017, without regard to any subsequent adjustments or changes
13to such data. If a hospital's 2015 Medicare cost report is not
14contained in the Healthcare Cost Report Information System,
15then the Illinois Department may obtain the hospital provider's
16occupied bed days and Medicare bed days from any source
17available, including, but not limited to, records maintained by
18the hospital provider, which may be inspected at all times
19during business hours of the day by the Illinois Department or
20its duly authorized agents and employees. Notwithstanding any
21other provision in this Article, for a hospital provider that
22did not have a 2015 Medicare cost report, but paid an
23assessment in State fiscal year 2018 on the basis of
24hypothetical data, that assessment amount shall be used for
25State fiscal years 2019 and 2020; however, for State fiscal
26year 2020, the assessment amount shall be increased by the

 

 

SB1773 Enrolled- 62 -LRB100 09919 KTG 20090 b

1proportion that it represents of the total annual assessment
2that is generated from all hospitals in order to generate
3$6,250,000 in the aggregate for that period from all hospitals
4subject to the annual assessment under this paragraph.
5    Subject to Sections 5A-3 and 5A-10, for State fiscal years
62021 through 2024, an annual assessment on inpatient services
7is imposed on each hospital provider in an amount equal to
8$197.19 multiplied by the difference of the hospital's occupied
9bed days less the hospital's Medicare bed days, provided
10however, that the amount of $197.19 used to calculate the
11assessment under this paragraph shall, by rule, be adjusted by
12a uniform percentage to generate the same total annual
13assessment that was generated in State fiscal year 2020 from
14all hospitals subject to the annual assessment under this
15paragraph plus $6,250,000. For State fiscal years 2021 and
162022, a hospital's occupied bed days and Medicare bed days
17shall be determined using the most recent data available from
18each hospital's 2017 Medicare cost report as contained in the
19Healthcare Cost Report Information System file, for the quarter
20ending on March 31, 2019, without regard to any subsequent
21adjustments or changes to such data. For State fiscal years
222023 and 2024, a hospital's occupied bed days and Medicare bed
23days shall be determined using the most recent data available
24from each hospital's 2019 Medicare cost report as contained in
25the Healthcare Cost Report Information System file, for the
26quarter ending on March 31, 2021, without regard to any

 

 

SB1773 Enrolled- 63 -LRB100 09919 KTG 20090 b

1subsequent adjustments or changes to such data.
2    (b) (Blank).
3    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
4portion of State fiscal year 2012, beginning June 10, 2012
5through June 30, 2012, and for State fiscal years 2013 through
62018, or as provided in Section 5A-16, an annual assessment on
7outpatient services is imposed on each hospital provider in an
8amount equal to .008766 multiplied by the hospital's outpatient
9gross revenue, provided, however, that the amount of .008766
10shall be increased by a uniform percentage to generate an
11amount equal to 25% of the State share of the payments
12authorized under Section 5A-12.5, with such increase only
13taking effect upon the date that a State share for such
14payments is required under federal law. For the period
15beginning June 10, 2012 through June 30, 2012, the annual
16assessment on outpatient services shall be prorated by
17multiplying the assessment amount by a fraction, the numerator
18of which is 21 days and the denominator of which is 365 days.
19For the period of April through June 2015, the amount of
20.008766 used to calculate the assessment under this paragraph
21shall, by emergency rule under subsection (s) of Section 5-45
22of the Illinois Administrative Procedure Act, be increased by a
23uniform percentage to generate $6,750,000 in the aggregate for
24that period from all hospitals subject to the annual assessment
25under this paragraph.
26    (2) In addition to any other assessments imposed under this

 

 

SB1773 Enrolled- 64 -LRB100 09919 KTG 20090 b

1Article, effective July 1, 2016 and semi-annually thereafter
2through June 2018, in addition to any federally required State
3share as authorized under paragraph (1), the amount of .008766
4shall be increased by a uniform percentage to generate an
5amount equal to 25% of the ACA Assessment Adjustment, as
6defined in subsection (b-6) of this Section.
7    For the portion of State fiscal year 2012, beginning June
810, 2012 through June 30, 2012, and State fiscal years 2013
9through 2018, or as provided in Section 5A-16, a hospital's
10outpatient gross revenue shall be determined using the most
11recent data available from each hospital's 2009 Medicare cost
12report as contained in the Healthcare Cost Report Information
13System file, for the quarter ending on June 30, 2011, without
14regard to any subsequent adjustments or changes to such data.
15If a hospital's 2009 Medicare cost report is not contained in
16the Healthcare Cost Report Information System, then the
17Department may obtain the hospital provider's outpatient gross
18revenue from any source available, including, but not limited
19to, records maintained by the hospital provider, which may be
20inspected at all times during business hours of the day by the
21Department or its duly authorized agents and employees.
22    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
23fiscal years 2019 and 2020, an annual assessment on outpatient
24services is imposed on each hospital provider in an amount
25equal to .01358 multiplied by the hospital's outpatient gross
26revenue; however, for State fiscal year 2020, the amount of

 

 

SB1773 Enrolled- 65 -LRB100 09919 KTG 20090 b

1.01358 shall be increased by a uniform percentage to generate
2an additional $6,250,000 in the aggregate for that period from
3all hospitals subject to the annual assessment under this
4paragraph. For State fiscal years 2019 and 2020, a hospital's
5outpatient gross revenue shall be determined using the most
6recent data available from each hospital's 2015 Medicare cost
7report as contained in the Healthcare Cost Report Information
8System file, for the quarter ending on March 31, 2017, without
9regard to any subsequent adjustments or changes to such data.
10If a hospital's 2015 Medicare cost report is not contained in
11the Healthcare Cost Report Information System, then the
12Department may obtain the hospital provider's outpatient gross
13revenue from any source available, including, but not limited
14to, records maintained by the hospital provider, which may be
15inspected at all times during business hours of the day by the
16Department or its duly authorized agents and employees.
17Notwithstanding any other provision in this Article, for a
18hospital provider that did not have a 2015 Medicare cost
19report, but paid an assessment in State fiscal year 2018 on the
20basis of hypothetical data, that assessment amount shall be
21used for State fiscal years 2019 and 2020; however, for State
22fiscal year 2020, the assessment amount shall be increased by
23the proportion that it represents of the total annual
24assessment that is generated from all hospitals in order to
25generate $6,250,000 in the aggregate for that period from all
26hospitals subject to the annual assessment under this

 

 

SB1773 Enrolled- 66 -LRB100 09919 KTG 20090 b

1paragraph.
2    Subject to Sections 5A-3 and 5A-10, for State fiscal years
32021 through 2024, an annual assessment on outpatient services
4is imposed on each hospital provider in an amount equal to
5.01358 multiplied by the hospital's outpatient gross revenue,
6provided however, that the amount of .01358 used to calculate
7the assessment under this paragraph shall, by rule, be adjusted
8by a uniform percentage to generate the same total annual
9assessment that was generated in State fiscal year 2020 from
10all hospitals subject to the annual assessment under this
11paragraph plus $6,250,000. For State fiscal years 2021 and
122022, a hospital's outpatient gross revenue shall be determined
13using the most recent data available from each hospital's 2017
14Medicare cost report as contained in the Healthcare Cost Report
15Information System file, for the quarter ending on March 31,
162019, without regard to any subsequent adjustments or changes
17to such data. For State fiscal years 2023 and 2024, a
18hospital's outpatient gross revenue shall be determined using
19the most recent data available from each hospital's 2019
20Medicare cost report as contained in the Healthcare Cost Report
21Information System file, for the quarter ending on March 31,
222021, without regard to any subsequent adjustments or changes
23to such data.
24    (b-6)(1) As used in this Section, "ACA Assessment
25Adjustment" means:
26        (A) For the period of July 1, 2016 through December 31,

 

 

SB1773 Enrolled- 67 -LRB100 09919 KTG 20090 b

1    2016, the product of .19125 multiplied by the sum of the
2    fee-for-service payments to hospitals as authorized under
3    Section 5A-12.5 and the adjustments authorized under
4    subsection (t) of Section 5A-12.2 to managed care
5    organizations for hospital services due and payable in the
6    month of April 2016 multiplied by 6.
7        (B) For the period of January 1, 2017 through June 30,
8    2017, the product of .19125 multiplied by the sum of the
9    fee-for-service payments to hospitals as authorized under
10    Section 5A-12.5 and the adjustments authorized under
11    subsection (t) of Section 5A-12.2 to managed care
12    organizations for hospital services due and payable in the
13    month of October 2016 multiplied by 6, except that the
14    amount calculated under this subparagraph (B) shall be
15    adjusted, either positively or negatively, to account for
16    the difference between the actual payments issued under
17    Section 5A-12.5 for the period beginning July 1, 2016
18    through December 31, 2016 and the estimated payments due
19    and payable in the month of April 2016 multiplied by 6 as
20    described in subparagraph (A).
21        (C) For the period of July 1, 2017 through December 31,
22    2017, the product of .19125 multiplied by the sum of the
23    fee-for-service payments to hospitals as authorized under
24    Section 5A-12.5 and the adjustments authorized under
25    subsection (t) of Section 5A-12.2 to managed care
26    organizations for hospital services due and payable in the

 

 

SB1773 Enrolled- 68 -LRB100 09919 KTG 20090 b

1    month of April 2017 multiplied by 6, except that the amount
2    calculated under this subparagraph (C) shall be adjusted,
3    either positively or negatively, to account for the
4    difference between the actual payments issued under
5    Section 5A-12.5 for the period beginning January 1, 2017
6    through June 30, 2017 and the estimated payments due and
7    payable in the month of October 2016 multiplied by 6 as
8    described in subparagraph (B).
9        (D) For the period of January 1, 2018 through June 30,
10    2018, the product of .19125 multiplied by the sum of the
11    fee-for-service payments to hospitals as authorized under
12    Section 5A-12.5 and the adjustments authorized under
13    subsection (t) of Section 5A-12.2 to managed care
14    organizations for hospital services due and payable in the
15    month of October 2017 multiplied by 6, except that:
16            (i) the amount calculated under this subparagraph
17        (D) shall be adjusted, either positively or
18        negatively, to account for the difference between the
19        actual payments issued under Section 5A-12.5 for the
20        period of July 1, 2017 through December 31, 2017 and
21        the estimated payments due and payable in the month of
22        April 2017 multiplied by 6 as described in subparagraph
23        (C); and
24            (ii) the amount calculated under this subparagraph
25        (D) shall be adjusted to include the product of .19125
26        multiplied by the sum of the fee-for-service payments,

 

 

SB1773 Enrolled- 69 -LRB100 09919 KTG 20090 b

1        if any, estimated to be paid to hospitals under
2        subsection (b) of Section 5A-12.5.
3    (2) The Department shall complete and apply a final
4reconciliation of the ACA Assessment Adjustment prior to June
530, 2018 to account for:
6        (A) any differences between the actual payments issued
7    or scheduled to be issued prior to June 30, 2018 as
8    authorized in Section 5A-12.5 for the period of January 1,
9    2018 through June 30, 2018 and the estimated payments due
10    and payable in the month of October 2017 multiplied by 6 as
11    described in subparagraph (D); and
12        (B) any difference between the estimated
13    fee-for-service payments under subsection (b) of Section
14    5A-12.5 and the amount of such payments that are actually
15    scheduled to be paid.
16    The Department shall notify hospitals of any additional
17amounts owed or reduction credits to be applied to the June
182018 ACA Assessment Adjustment. This is to be considered the
19final reconciliation for the ACA Assessment Adjustment.
20    (3) Notwithstanding any other provision of this Section, if
21for any reason the scheduled payments under subsection (b) of
22Section 5A-12.5 are not issued in full by the final day of the
23period authorized under subsection (b) of Section 5A-12.5,
24funds collected from each hospital pursuant to subparagraph (D)
25of paragraph (1) and pursuant to paragraph (2), attributable to
26the scheduled payments authorized under subsection (b) of

 

 

SB1773 Enrolled- 70 -LRB100 09919 KTG 20090 b

1Section 5A-12.5 that are not issued in full by the final day of
2the period attributable to each payment authorized under
3subsection (b) of Section 5A-12.5, shall be refunded.
4    (4) The increases authorized under paragraph (2) of
5subsection (a) and paragraph (2) of subsection (b-5) shall be
6limited to the federally required State share of the total
7payments authorized under Section 5A-12.5 if the sum of such
8payments yields an annualized amount equal to or less than
9$450,000,000, or if the adjustments authorized under
10subsection (t) of Section 5A-12.2 are found not to be
11actuarially sound; however, this limitation shall not apply to
12the fee-for-service payments described in subsection (b) of
13Section 5A-12.5.
14    (c) (Blank).
15    (d) Notwithstanding any of the other provisions of this
16Section, the Department is authorized to adopt rules to reduce
17the rate of any annual assessment imposed under this Section,
18as authorized by Section 5-46.2 of the Illinois Administrative
19Procedure Act.
20    (e) Notwithstanding any other provision of this Section,
21any plan providing for an assessment on a hospital provider as
22a permissible tax under Title XIX of the federal Social
23Security Act and Medicaid-eligible payments to hospital
24providers from the revenues derived from that assessment shall
25be reviewed by the Illinois Department of Healthcare and Family
26Services, as the Single State Medicaid Agency required by

 

 

SB1773 Enrolled- 71 -LRB100 09919 KTG 20090 b

1federal law, to determine whether those assessments and
2hospital provider payments meet federal Medicaid standards. If
3the Department determines that the elements of the plan may
4meet federal Medicaid standards and a related State Medicaid
5Plan Amendment is prepared in a manner and form suitable for
6submission, that State Plan Amendment shall be submitted in a
7timely manner for review by the Centers for Medicare and
8Medicaid Services of the United States Department of Health and
9Human Services and subject to approval by the Centers for
10Medicare and Medicaid Services of the United States Department
11of Health and Human Services. No such plan shall become
12effective without approval by the Illinois General Assembly by
13the enactment into law of related legislation. Notwithstanding
14any other provision of this Section, the Department is
15authorized to adopt rules to reduce the rate of any annual
16assessment imposed under this Section. Any such rules may be
17adopted by the Department under Section 5-50 of the Illinois
18Administrative Procedure Act.
19(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2,
20eff. 3-26-15; 99-516, eff. 6-30-16.)
 
21    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
22    Sec. 5A-4. Payment of assessment; penalty.
23    (a) The assessment imposed by Section 5A-2 for State fiscal
24year 2009 through State fiscal year 2018 or as provided in
25Section 5A-16, and each subsequent State fiscal year shall be

 

 

SB1773 Enrolled- 72 -LRB100 09919 KTG 20090 b

1due and payable in monthly installments, each equaling
2one-twelfth of the assessment for the year, on the fourteenth
3State business day of each month. No installment payment of an
4assessment imposed by Section 5A-2 shall be due and payable,
5however, until after the Comptroller has issued the payments
6required under this Article.
7    Except as provided in subsection (a-5) of this Section, the
8assessment imposed by subsection (b-5) of Section 5A-2 for the
9portion of State fiscal year 2012 beginning June 10, 2012
10through June 30, 2012, and for State fiscal year 2013 through
11State fiscal year 2018 or as provided in Section 5A-16, and
12each subsequent State fiscal year shall be due and payable in
13monthly installments, each equaling one-twelfth of the
14assessment for the year, on the 14th State business day of each
15month. No installment payment of an assessment imposed by
16subsection (b-5) of Section 5A-2 shall be due and payable,
17however, until after: (i) the Department notifies the hospital
18provider, in writing, that the payment methodologies to
19hospitals required under Section 5A-12.4, have been approved by
20the Centers for Medicare and Medicaid Services of the U.S.
21Department of Health and Human Services, and the waiver under
2242 CFR 433.68 for the assessment imposed by subsection (b-5) of
23Section 5A-2, if necessary, has been granted by the Centers for
24Medicare and Medicaid Services of the U.S. Department of Health
25and Human Services; and (ii) the Comptroller has issued the
26payments required under Section 5A-12.4. Upon notification to

 

 

SB1773 Enrolled- 73 -LRB100 09919 KTG 20090 b

1the Department of approval of the payment methodologies
2required under Section 5A-12.4 and the waiver granted under 42
3CFR 433.68, if necessary, all installments otherwise due under
4subsection (b-5) of Section 5A-2 prior to the date of
5notification shall be due and payable to the Department upon
6written direction from the Department and issuance by the
7Comptroller of the payments required under Section 5A-12.4.
8    Except as provided in subsection (a-5) of this Section, the
9assessment imposed under Section 5A-2 for State fiscal year
102019 and each subsequent State fiscal year shall be due and
11payable in monthly installments, each equaling one-twelfth of
12the assessment for the year, on the 14th State business day of
13each month. No installment payment of an assessment imposed by
14Section 5A-2 shall be due and payable, however, until after:
15(i) the Department notifies the hospital provider, in writing,
16that the payment methodologies to hospitals required under
17Section 5A-12.6 have been approved by the Centers for Medicare
18and Medicaid Services of the U.S. Department of Health and
19Human Services, and the waiver under 42 CFR 433.68 for the
20assessment imposed by Section 5A-2, if necessary, has been
21granted by the Centers for Medicare and Medicaid Services of
22the U.S. Department of Health and Human Services; and (ii) the
23Comptroller has issued the payments required under Section
245A-12.6. Upon notification to the Department of approval of the
25payment methodologies required under Section 5A-12.6 and the
26waiver granted under 42 CFR 433.68, if necessary, all

 

 

SB1773 Enrolled- 74 -LRB100 09919 KTG 20090 b

1installments otherwise due under Section 5A-2 prior to the date
2of notification shall be due and payable to the Department upon
3written direction from the Department and issuance by the
4Comptroller of the payments required under Section 5A-12.6.
5    (a-5) The Illinois Department may accelerate the schedule
6upon which assessment installments are due and payable by
7hospitals with a payment ratio greater than or equal to one.
8Such acceleration of due dates for payment of the assessment
9may be made only in conjunction with a corresponding
10acceleration in access payments identified in Section 5A-12.2,
11or Section 5A-12.4, or Section 5A-12.6 to the same hospitals.
12For the purposes of this subsection (a-5), a hospital's payment
13ratio is defined as the quotient obtained by dividing the total
14payments for the State fiscal year, as authorized under Section
155A-12.2, or Section 5A-12.4, or Section 5A-12.6, by the total
16assessment for the State fiscal year imposed under Section 5A-2
17or subsection (b-5) of Section 5A-2.
18    (b) The Illinois Department is authorized to establish
19delayed payment schedules for hospital providers that are
20unable to make installment payments when due under this Section
21due to financial difficulties, as determined by the Illinois
22Department.
23    (c) If a hospital provider fails to pay the full amount of
24an installment when due (including any extensions granted under
25subsection (b)), there shall, unless waived by the Illinois
26Department for reasonable cause, be added to the assessment

 

 

SB1773 Enrolled- 75 -LRB100 09919 KTG 20090 b

1imposed by Section 5A-2 a penalty assessment equal to the
2lesser of (i) 5% of the amount of the installment not paid on
3or before the due date plus 5% of the portion thereof remaining
4unpaid on the last day of each 30-day period thereafter or (ii)
5100% of the installment amount not paid on or before the due
6date. For purposes of this subsection, payments will be
7credited first to unpaid installment amounts (rather than to
8penalty or interest), beginning with the most delinquent
9installments.
10    (d) Any assessment amount that is due and payable to the
11Illinois Department more frequently than once per calendar
12quarter shall be remitted to the Illinois Department by the
13hospital provider by means of electronic funds transfer. The
14Illinois Department may provide for remittance by other means
15if (i) the amount due is less than $10,000 or (ii) electronic
16funds transfer is unavailable for this purpose.
17(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
1898-104, eff. 7-22-13.)
 
19    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
20    Sec. 5A-5. Notice; penalty; maintenance of records.
21    (a) The Illinois Department shall send a notice of
22assessment to every hospital provider subject to assessment
23under this Article. The notice of assessment shall notify the
24hospital of its assessment and shall be sent after receipt by
25the Department of notification from the Centers for Medicare

 

 

SB1773 Enrolled- 76 -LRB100 09919 KTG 20090 b

1and Medicaid Services of the U.S. Department of Health and
2Human Services that the payment methodologies required under
3this Article and, if necessary, the waiver granted under 42 CFR
4433.68 have been approved. The notice shall be on a form
5prepared by the Illinois Department and shall state the
6following:
7        (1) The name of the hospital provider.
8        (2) The address of the hospital provider's principal
9    place of business from which the provider engages in the
10    occupation of hospital provider in this State, and the name
11    and address of each hospital operated, conducted, or
12    maintained by the provider in this State.
13        (3) The occupied bed days, occupied bed days less
14    Medicare days, adjusted gross hospital revenue, or
15    outpatient gross revenue of the hospital provider
16    (whichever is applicable), the amount of assessment
17    imposed under Section 5A-2 for the State fiscal year for
18    which the notice is sent, and the amount of each
19    installment to be paid during the State fiscal year.
20        (4) (Blank).
21        (5) Other reasonable information as determined by the
22    Illinois Department.
23    (b) If a hospital provider conducts, operates, or maintains
24more than one hospital licensed by the Illinois Department of
25Public Health, the provider shall pay the assessment for each
26hospital separately.

 

 

SB1773 Enrolled- 77 -LRB100 09919 KTG 20090 b

1    (c) Notwithstanding any other provision in this Article, in
2the case of a person who ceases to conduct, operate, or
3maintain a hospital in respect of which the person is subject
4to assessment under this Article as a hospital provider, the
5assessment for the State fiscal year in which the cessation
6occurs shall be adjusted by multiplying the assessment computed
7under Section 5A-2 by a fraction, the numerator of which is the
8number of days in the year during which the provider conducts,
9operates, or maintains the hospital and the denominator of
10which is 365. Immediately upon ceasing to conduct, operate, or
11maintain a hospital, the person shall pay the assessment for
12the year as so adjusted (to the extent not previously paid).
13    (d) Notwithstanding any other provision in this Article, a
14provider who commences conducting, operating, or maintaining a
15hospital, upon notice by the Illinois Department, shall pay the
16assessment computed under Section 5A-2 and subsection (e) in
17installments on the due dates stated in the notice and on the
18regular installment due dates for the State fiscal year
19occurring after the due dates of the initial notice.
20    (e) Notwithstanding any other provision in this Article,
21for State fiscal years 2009 through 2018, in the case of a
22hospital provider that did not conduct, operate, or maintain a
23hospital in 2005, the assessment for that State fiscal year
24shall be computed on the basis of hypothetical occupied bed
25days for the full calendar year as determined by the Illinois
26Department. Notwithstanding any other provision in this

 

 

SB1773 Enrolled- 78 -LRB100 09919 KTG 20090 b

1Article, for the portion of State fiscal year 2012 beginning
2June 10, 2012 through June 30, 2012, and for State fiscal years
32013 through 2018, in the case of a hospital provider that did
4not conduct, operate, or maintain a hospital in 2009, the
5assessment under subsection (b-5) of Section 5A-2 for that
6State fiscal year shall be computed on the basis of
7hypothetical gross outpatient revenue for the full calendar
8year as determined by the Illinois Department.
9    Notwithstanding any other provision in this Article, for
10State fiscal years 2019 through 2024, in the case of a hospital
11provider that did not conduct, operate, or maintain a hospital
12in the year that is the basis of the calculation of the
13assessment under this Article, the assessment under paragraph
14(3) of subsection (a) of Section 5A-2 for the State fiscal year
15shall be computed on the basis of hypothetical occupied bed
16days for the full calendar year as determined by the Illinois
17Department, except that for a hospital provider that did not
18have a 2015 Medicare cost report, but paid an assessment in
19State fiscal year 2018 on the basis of hypothetical data, that
20assessment amount shall be used for State fiscal years 2019 and
212020; however, for State fiscal year 2020, the assessment
22amount shall be increased by the proportion that it represents
23of the total annual assessment that is generated from all
24hospitals in order to generate $6,250,000 in the aggregate for
25that period from all hospitals subject to the annual assessment
26under this paragraph.

 

 

SB1773 Enrolled- 79 -LRB100 09919 KTG 20090 b

1    Notwithstanding any other provision in this Article, for
2State fiscal years 2019 through 2024, in the case of a hospital
3provider that did not conduct, operate, or maintain a hospital
4in the year that is the basis of the calculation of the
5assessment under this Article, the assessment under subsection
6(b-5) of Section 5A-2 for that State fiscal year shall be
7computed on the basis of hypothetical gross outpatient revenue
8for the full calendar year as determined by the Illinois
9Department, except that for a hospital provider that did not
10have a 2015 Medicare cost report, but paid an assessment in
11State fiscal year 2018 on the basis of hypothetical data, that
12assessment amount shall be used for State fiscal years 2019 and
132020; however, for State fiscal year 2020, the assessment
14amount shall be increased by the proportion that it represents
15of the total annual assessment that is generated from all
16hospitals in order to generate $6,250,000 in the aggregate for
17that period from all hospitals subject to the annual assessment
18under this paragraph.
19    (f) Every hospital provider subject to assessment under
20this Article shall keep sufficient records to permit the
21determination of adjusted gross hospital revenue for the
22hospital's fiscal year. All such records shall be kept in the
23English language and shall, at all times during regular
24business hours of the day, be subject to inspection by the
25Illinois Department or its duly authorized agents and
26employees.

 

 

SB1773 Enrolled- 80 -LRB100 09919 KTG 20090 b

1    (g) The Illinois Department may, by rule, provide a
2hospital provider a reasonable opportunity to request a
3clarification or correction of any clerical or computational
4errors contained in the calculation of its assessment, but such
5corrections shall not extend to updating the cost report
6information used to calculate the assessment.
7    (h) (Blank).
8(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
998-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
107-20-15.)
 
11    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
12    Sec. 5A-8. Hospital Provider Fund.
13    (a) There is created in the State Treasury the Hospital
14Provider Fund. Interest earned by the Fund shall be credited to
15the Fund. The Fund shall not be used to replace any moneys
16appropriated to the Medicaid program by the General Assembly.
17    (b) The Fund is created for the purpose of receiving moneys
18in accordance with Section 5A-6 and disbursing moneys only for
19the following purposes, notwithstanding any other provision of
20law:
21        (1) For making payments to hospitals as required under
22    this Code, under the Children's Health Insurance Program
23    Act, under the Covering ALL KIDS Health Insurance Act, and
24    under the Long Term Acute Care Hospital Quality Improvement
25    Transfer Program Act.

 

 

SB1773 Enrolled- 81 -LRB100 09919 KTG 20090 b

1        (2) For the reimbursement of moneys collected by the
2    Illinois Department from hospitals or hospital providers
3    through error or mistake in performing the activities
4    authorized under this Code.
5        (3) For payment of administrative expenses incurred by
6    the Illinois Department or its agent in performing
7    activities under this Code, under the Children's Health
8    Insurance Program Act, under the Covering ALL KIDS Health
9    Insurance Act, and under the Long Term Acute Care Hospital
10    Quality Improvement Transfer Program Act.
11        (4) For payments of any amounts which are reimbursable
12    to the federal government for payments from this Fund which
13    are required to be paid by State warrant.
14        (5) For making transfers, as those transfers are
15    authorized in the proceedings authorizing debt under the
16    Short Term Borrowing Act, but transfers made under this
17    paragraph (5) shall not exceed the principal amount of debt
18    issued in anticipation of the receipt by the State of
19    moneys to be deposited into the Fund.
20        (6) For making transfers to any other fund in the State
21    treasury, but transfers made under this paragraph (6) shall
22    not exceed the amount transferred previously from that
23    other fund into the Hospital Provider Fund plus any
24    interest that would have been earned by that fund on the
25    monies that had been transferred.
26        (6.5) For making transfers to the Healthcare Provider

 

 

SB1773 Enrolled- 82 -LRB100 09919 KTG 20090 b

1    Relief Fund, except that transfers made under this
2    paragraph (6.5) shall not exceed $60,000,000 in the
3    aggregate.
4        (7) For making transfers not exceeding the following
5    amounts, related to State fiscal years 2013 through 2018,
6    to the following designated funds:
7            Health and Human Services Medicaid Trust
8                Fund..............................$20,000,000
9            Long-Term Care Provider Fund..........$30,000,000
10            General Revenue Fund.................$80,000,000.
11    Transfers under this paragraph shall be made within 7 days
12    after the payments have been received pursuant to the
13    schedule of payments provided in subsection (a) of Section
14    5A-4.
15        (7.1) (Blank).
16        (7.5) (Blank).
17        (7.8) (Blank).
18        (7.9) (Blank).
19        (7.10) For State fiscal year 2014, for making transfers
20    of the moneys resulting from the assessment under
21    subsection (b-5) of Section 5A-2 and received from hospital
22    providers under Section 5A-4 and transferred into the
23    Hospital Provider Fund under Section 5A-6 to the designated
24    funds not exceeding the following amounts in that State
25    fiscal year:
26            Healthcare Provider Relief Fund......$100,000,000

 

 

SB1773 Enrolled- 83 -LRB100 09919 KTG 20090 b

1        Transfers under this paragraph shall be made within 7
2    days after the payments have been received pursuant to the
3    schedule of payments provided in subsection (a) of Section
4    5A-4.
5        The additional amount of transfers in this paragraph
6    (7.10), authorized by Public Act 98-651, shall be made
7    within 10 State business days after June 16, 2014 (the
8    effective date of Public Act 98-651). That authority shall
9    remain in effect even if Public Act 98-651 does not become
10    law until State fiscal year 2015.
11        (7.10a) For State fiscal years 2015 through 2018, for
12    making transfers of the moneys resulting from the
13    assessment under subsection (b-5) of Section 5A-2 and
14    received from hospital providers under Section 5A-4 and
15    transferred into the Hospital Provider Fund under Section
16    5A-6 to the designated funds not exceeding the following
17    amounts related to each State fiscal year:
18            Healthcare Provider Relief Fund......$50,000,000
19        Transfers under this paragraph shall be made within 7
20    days after the payments have been received pursuant to the
21    schedule of payments provided in subsection (a) of Section
22    5A-4.
23        (7.11) (Blank).
24        (7.12) For State fiscal year 2013, for increasing by
25    21/365ths the transfer of the moneys resulting from the
26    assessment under subsection (b-5) of Section 5A-2 and

 

 

SB1773 Enrolled- 84 -LRB100 09919 KTG 20090 b

1    received from hospital providers under Section 5A-4 for the
2    portion of State fiscal year 2012 beginning June 10, 2012
3    through June 30, 2012 and transferred into the Hospital
4    Provider Fund under Section 5A-6 to the designated funds
5    not exceeding the following amounts in that State fiscal
6    year:
7            Healthcare Provider Relief Fund.......$2,870,000
8        Since the federal Centers for Medicare and Medicaid
9    Services approval of the assessment authorized under
10    subsection (b-5) of Section 5A-2, received from hospital
11    providers under Section 5A-4 and the payment methodologies
12    to hospitals required under Section 5A-12.4 was not
13    received by the Department until State fiscal year 2014 and
14    since the Department made retroactive payments during
15    State fiscal year 2014 related to the referenced period of
16    June 2012, the transfer authority granted in this paragraph
17    (7.12) is extended through the date that is 10 State
18    business days after June 16, 2014 (the effective date of
19    Public Act 98-651).
20        (7.13) In addition to any other transfers authorized
21    under this Section, for State fiscal years 2017 and 2018,
22    for making transfers to the Healthcare Provider Relief Fund
23    of moneys collected from the ACA Assessment Adjustment
24    authorized under subsections (a) and (b-5) of Section 5A-2
25    and paid by hospital providers under Section 5A-4 into the
26    Hospital Provider Fund under Section 5A-6 for each State

 

 

SB1773 Enrolled- 85 -LRB100 09919 KTG 20090 b

1    fiscal year. Timing of transfers to the Healthcare Provider
2    Relief Fund under this paragraph shall be at the discretion
3    of the Department, but no less frequently than quarterly.
4        (7.14) For making transfers not exceeding the
5    following amounts, related to State fiscal years 2019
6    through 2024, to the following designated funds:
7            Health and Human Services Medicaid Trust
8                Fund..............................$20,000,000
9            Long-Term Care Provider Fund..........$30,000,000
10            Health Care Provider Relief Fund....$325,000,000.
11        Transfers under this paragraph shall be made within 7
12    days after the payments have been received pursuant to the
13    schedule of payments provided in subsection (a) of Section
14    5A-4.
15        (8) For making refunds to hospital providers pursuant
16    to Section 5A-10.
17        (9) For making payment to capitated managed care
18    organizations as described in subsections (s) and (t) of
19    Section 5A-12.2 and subsection (r) of Section 5A-12.6 of
20    this Code.
21    Disbursements from the Fund, other than transfers
22authorized under paragraphs (5) and (6) of this subsection,
23shall be by warrants drawn by the State Comptroller upon
24receipt of vouchers duly executed and certified by the Illinois
25Department.
26    (c) The Fund shall consist of the following:

 

 

SB1773 Enrolled- 86 -LRB100 09919 KTG 20090 b

1        (1) All moneys collected or received by the Illinois
2    Department from the hospital provider assessment imposed
3    by this Article.
4        (2) All federal matching funds received by the Illinois
5    Department as a result of expenditures made by the Illinois
6    Department that are attributable to moneys deposited in the
7    Fund.
8        (3) Any interest or penalty levied in conjunction with
9    the administration of this Article.
10        (3.5) As applicable, proceeds from surety bond
11    payments payable to the Department as referenced in
12    subsection (s) of Section 5A-12.2 of this Code.
13        (4) Moneys transferred from another fund in the State
14    treasury.
15        (5) All other moneys received for the Fund from any
16    other source, including interest earned thereon.
17    (d) (Blank).
18(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
1998-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
207-20-15; 99-516, eff. 6-30-16; 99-933, eff. 1-27-17; revised
212-15-17.)
 
22    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
23    Sec. 5A-10. Applicability.
24    (a) The assessment imposed by subsection (a) of Section
255A-2 shall cease to be imposed and the Department's obligation

 

 

SB1773 Enrolled- 87 -LRB100 09919 KTG 20090 b

1to make payments shall immediately cease, and any moneys
2remaining in the Fund shall be refunded to hospital providers
3in proportion to the amounts paid by them, if:
4        (1) The payments to hospitals required under this
5    Article are not eligible for federal matching funds under
6    Title XIX or XXI of the Social Security Act;
7        (2) For State fiscal years 2009 through 2018, and as
8    provided in Section 5A-16, the Department of Healthcare and
9    Family Services adopts any administrative rule change to
10    reduce payment rates or alters any payment methodology that
11    reduces any payment rates made to operating hospitals under
12    the approved Title XIX or Title XXI State plan in effect
13    January 1, 2008 except for:
14            (A) any changes for hospitals described in
15        subsection (b) of Section 5A-3;
16            (B) any rates for payments made under this Article
17        V-A;
18            (C) any changes proposed in State plan amendment
19        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
20        08-07;
21            (D) in relation to any admissions on or after
22        January 1, 2011, a modification in the methodology for
23        calculating outlier payments to hospitals for
24        exceptionally costly stays, for hospitals reimbursed
25        under the diagnosis-related grouping methodology in
26        effect on July 1, 2011; provided that the Department

 

 

SB1773 Enrolled- 88 -LRB100 09919 KTG 20090 b

1        shall be limited to one such modification during the
2        36-month period after the effective date of this
3        amendatory Act of the 96th General Assembly;
4            (E) any changes affecting hospitals authorized by
5        Public Act 97-689;
6            (F) any changes authorized by Section 14-12 of this
7        Code, or for any changes authorized under Section 5A-15
8        of this Code; or
9            (G) any changes authorized under Section 5-5b.1.
10    (b) The assessment imposed by Section 5A-2 shall not take
11effect or shall cease to be imposed, and the Department's
12obligation to make payments shall immediately cease, if the
13assessment is determined to be an impermissible tax under Title
14XIX of the Social Security Act. Moneys in the Hospital Provider
15Fund derived from assessments imposed prior thereto shall be
16disbursed in accordance with Section 5A-8 to the extent federal
17financial participation is not reduced due to the
18impermissibility of the assessments, and any remaining moneys
19shall be refunded to hospital providers in proportion to the
20amounts paid by them.
21    (c) The assessments imposed by subsection (b-5) of Section
225A-2 shall not take effect or shall cease to be imposed, the
23Department's obligation to make payments shall immediately
24cease, and any moneys remaining in the Fund shall be refunded
25to hospital providers in proportion to the amounts paid by
26them, if the payments to hospitals required under Section

 

 

SB1773 Enrolled- 89 -LRB100 09919 KTG 20090 b

15A-12.4 or Section 5A-12.6 are not eligible for federal
2matching funds under Title XIX of the Social Security Act.
3    (d) The assessments imposed by Section 5A-2 shall not take
4effect or shall cease to be imposed, the Department's
5obligation to make payments shall immediately cease, and any
6moneys remaining in the Fund shall be refunded to hospital
7providers in proportion to the amounts paid by them, if:
8        (1) for State fiscal years 2013 through 2018, and as
9    provided in Section 5A-16, the Department reduces any
10    payment rates to hospitals as in effect on May 1, 2012, or
11    alters any payment methodology as in effect on May 1, 2012,
12    that has the effect of reducing payment rates to hospitals,
13    except for any changes affecting hospitals authorized in
14    Public Act 97-689 and any changes authorized by Section
15    14-12 of this Code, and except for any changes authorized
16    under Section 5A-15, and except for any changes authorized
17    under Section 5-5b.1;
18        (2) for State fiscal years 2013 through 2018, and as
19    provided in Section 5A-16, the Department reduces any
20    supplemental payments made to hospitals below the amounts
21    paid for services provided in State fiscal year 2011 as
22    implemented by administrative rules adopted and in effect
23    on or prior to June 30, 2011, except for any changes
24    affecting hospitals authorized in Public Act 97-689 and any
25    changes authorized by Section 14-12 of this Code, and
26    except for any changes authorized under Section 5A-15, and

 

 

SB1773 Enrolled- 90 -LRB100 09919 KTG 20090 b

1    except for any changes authorized under Section 5-5b.1; or
2        (3) for State fiscal years 2015 through 2018, and as
3    provided in Section 5A-16, the Department reduces the
4    overall effective rate of reimbursement to hospitals below
5    the level authorized under Section 14-12 of this Code,
6    except for any changes under Section 14-12 or Section 5A-15
7    of this Code, and except for any changes authorized under
8    Section 5-5b.1.
9    (e) Beginning in State fiscal year 2019, the assessments
10imposed under Section 5A-2 shall not take effect or shall cease
11to be imposed, the Department's obligation to make payments
12shall immediately cease, and any moneys remaining in the Fund
13shall be refunded to hospital providers in proportion to the
14amounts paid by them, if:
15        (1) the payments to hospitals required under Section
16    5A12.6 are not eligible for federal matching funds under
17    Title XIX of the Social Security Act; or
18        (2) the Department reduces the overall effective rate
19    of reimbursement to hospitals below the level authorized
20    under Section 14-12 of this Code, as in effect on December
21    31, 2017, except for any changes authorized under Sections
22    14-12 or Section 5A-15 of this Code, and except for any
23    changes authorized under changes to Sections 5A-12.2,
24    5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by this
25    amendatory Act of the 100th General Assembly.
26(Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-2,

 

 

SB1773 Enrolled- 91 -LRB100 09919 KTG 20090 b

1eff. 3-26-15.)
 
2    (305 ILCS 5/5A-12.5)
3    Sec. 5A-12.5. Affordable Care Act adults; hospital access
4payments.
5    (a) The Department shall, subject to federal approval,
6mirror the Medical Assistance hospital reimbursement
7methodology for Affordable Care Act adults who are enrolled
8under a fee-for-service or capitated managed care program,
9including hospital access payments as defined in Section
105A-12.2 of this Article and hospital access improvement
11payments as defined in Section 5A-12.4 of this Article, in
12compliance with the equivalent rate provisions of the
13Affordable Care Act.
14    (b) If the fee-for-service payments authorized under this
15Section are deemed to be increases to payments for a prior
16period, the Department shall seek federal approval to issue
17such increases for the payments made through the period ending
18on June 30, 2018, or as provided in Section 5A-16, even if such
19increases are paid out during an extended payment period beyond
20such date. Payment of such increases beyond such date is
21subject to federal approval. If the Department receives federal
22approval of such increases, the Department shall pay such
23increases on the same schedule as it had used for such payments
24prior to June 30, 2018.
25    (c) As used in this Section, "Affordable Care Act" is the

 

 

SB1773 Enrolled- 92 -LRB100 09919 KTG 20090 b

1collective term for the Patient Protection and Affordable Care
2Act (Pub. L. 111-148) and the Health Care and Education
3Reconciliation Act of 2010 (Pub. L. 111-152).
4(Source: P.A. 98-651, eff. 6-16-14; 99-516, eff. 6-30-16.)
 
5    (305 ILCS 5/5A-12.6 new)
6    Sec. 5A-12.6. Continuation of hospital access payments on
7or after July 1, 2018.
8    (a) To preserve and improve access to hospital services,
9for hospital services rendered on or after July 1, 2018 the
10Department shall, except for hospitals described in subsection
11(b) of Section 5A-3, make payments to hospitals as set forth in
12this Section. Payments under this Section are not due and
13payable, however, until (i) the methodologies described in this
14Section are approved by the federal government in an
15appropriate State Plan amendment and (ii) the assessment
16imposed under this Article is determined to be a permissible
17tax under Title XIX of the Social Security Act. In determining
18the hospital access payments authorized under subsections (f)
19through (n) of this Section, unless otherwise specified, only
20Illinois hospitals shall be eligible for a payment and total
21Medicaid utilization statistics shall be used to determine the
22payment amount. In determining the hospital access payments
23authorized under subsection (d) and subsections (f) through (l)
24of this Section, if a hospital ceases to receive payments from
25the pool, the payments for all hospitals continuing to receive

 

 

SB1773 Enrolled- 93 -LRB100 09919 KTG 20090 b

1payments from such pool shall be uniformly adjusted to fully
2expend the aggregate amount of the pool, with such adjustment
3being effective on the first day of the second month following
4the date the hospital ceases to receive payments from such
5pool.
6    (b) Phase in of funds to claims-based payments and updates.
7To ensure access to hospital services, the Department may only
8use funds financed by the assessment authorized under Section
95A-2 to increase claims-based payment rates, including
10applicable policy add-on payments or adjusters, in accordance
11with this subsection. To increase the claims-based payment
12rates up to the amounts specified in this subsection, the
13hospital access payments authorized in subsection (d) and
14subsections (g) through (l) of this Section shall be uniformly
15reduced.
16        (1) For State fiscal years 2019 and 2020, up to
17    $635,000,000 of the total spending financed from the
18    assessment authorized under Section 5A-2 that is intended
19    to pay for hospital services and the hospital supplemental
20    access payments authorized under subsections (d) and (f) of
21    Section 14-12 for payment in State fiscal year 2018 may be
22    used to increase claims-based hospital payment rates as
23    specified under Section 14-12.
24        (2) For State fiscal years 2021 and 2022, up to
25    $1,164,000,000 of the total spending financed from the
26    assessment authorized under Section 5A-2 that is intended

 

 

SB1773 Enrolled- 94 -LRB100 09919 KTG 20090 b

1    to pay for hospital services and the hospital supplemental
2    access payments authorized under subsections (d) and (f) of
3    Section 14-12 for payment in State Fiscal Year 2018 may be
4    used to increase claims-based hospital payment rates as
5    specified under Section 14-12.
6        (3) For State fiscal years 2023, up to $1,397,000,000
7    of the total spending financed from the assessment
8    authorized under Section 5A-2 that is intended to pay for
9    hospital services and the hospital supplemental access
10    payments authorized under subsections (d) and (f) of
11    Section 14-12 for payment in State Fiscal Year 2018 may be
12    used to increase claims-based hospital payment rates as
13    specified under Section 14-12.
14        (4) For State fiscal years 2024, up to $1,663,000,000
15    of the total spending financed from the assessment
16    authorized under Section 5A-2 that is intended to pay for
17    hospital services and the hospital supplemental access
18    payments authorized under subsections (d) and (f) of
19    Section 14-12 for payment in State Fiscal Year 2018 may be
20    used to increase claims-based hospital payment rates as
21    specified under Section 14-12.
22        (5) Beginning in State fiscal year 2021, and at least
23    every 24 months thereafter, the Department shall, by rule,
24    update the hospital access payments authorized under this
25    Section to take into account the amount of funds being used
26    to increase claims-based hospital payment rates under

 

 

SB1773 Enrolled- 95 -LRB100 09919 KTG 20090 b

1    Section 14-12 and to apply the most recently available data
2    and information, including data from the most recent base
3    year and qualifying criteria which shall correlate to the
4    updated base year data, to determine a hospital's
5    eligibility for each payment and the amount of the payment
6    authorized under this Section. Any updates of the hospital
7    access payment methodologies shall not result in any
8    diminishment of the aggregate amount of hospital access
9    payment expenditures, except for reductions attributable
10    to the use of such funds to increase claims-based hospital
11    payment rates as authorized by this Section. Nothing in
12    this Section shall be construed as precluding variations in
13    the amount of any individual hospital's access payments.
14    The Department shall publish the proposed rules to update
15    the hospital access payments at least 90 days before their
16    proposed effective date. The proposed rules shall not be
17    adopted using emergency rulemaking authority. The
18    Department shall notify each hospital, in writing, of the
19    impact of these updates on the hospital at least 30
20    calendar days prior to their effective date.
21    (c) The hospital access payments authorized under
22subsections (d) through (n) of this Section shall be paid in 12
23equal installments on or before the seventh State business day
24of each month, except that no payment shall be due within 100
25days after the later of the date of notification of federal
26approval of the payment methodologies required under this

 

 

SB1773 Enrolled- 96 -LRB100 09919 KTG 20090 b

1Section or any waiver required under 42 CFR 433.68, at which
2time the sum of amounts required under this Section prior to
3the date of notification is due and payable. Payments under
4this Section are not due and payable, however, until (i) the
5methodologies described in this Section are approved by the
6federal government in an appropriate State Plan amendment and
7(ii) the assessment imposed under this Article is determined to
8be a permissible tax under Title XIX of the Social Security
9Act. The Department may, when practicable, accelerate the
10schedule upon which payments authorized under this Section are
11made.
12    (d) Rate increase-based adjustment.
13        (1) From the funds financed by the assessment
14    authorized under Section 5A-2, individual funding pools by
15    category of service shall be established, for Inpatient
16    General Acute Care services in the amount of $268,051,572,
17    Inpatient Rehab Care services in the amount of $24,500,610,
18    Inpatient Psychiatric Care service in the amount of
19    $94,617,812, and Outpatient Care Services in the amount of
20    $328,828,641.
21        (2) Each Illinois hospital and other hospitals
22    authorized under this subsection, except for long-term
23    acute care hospitals and public hospitals, shall be
24    assigned a pool allocation percentage for each category of
25    service that is equal to the ratio of the hospital's
26    estimated FY2019 claims-based payments including all

 

 

SB1773 Enrolled- 97 -LRB100 09919 KTG 20090 b

1    applicable FY2019 policy adjusters, multiplied by the
2    applicable service credit factor for the hospital, divided
3    by the total of the FY2019 claims-based payments including
4    all FY2019 policy adjusters for each category of service
5    adjusted by each hospital's applicable service credit
6    factor for all qualified hospitals. For each category of
7    service, a hospital shall receive a supplemental payment
8    equal to its pool allocation percentage multiplied by the
9    total pool amount.
10        (3) Effective July 1, 2018, for purposes of determining
11    for State fiscal years 2019 and 2020 the hospitals eligible
12    for the payments authorized under this subsection, the
13    Department shall include children's hospitals located in
14    St. Louis that are designated a Level III perinatal center
15    by the Department of Public Health and also designated a
16    Level I pediatric trauma center by the Department of Public
17    Health as of December 1, 2017.
18        (4) As used in this subsection, "service credit factor"
19    is determined based on a hospital's Rate Year 2017 Medicaid
20    inpatient utilization rate ("MIUR") rounded to the nearest
21    whole percentage, as follows:
22            (A) Tier 1: A hospital with a MIUR equal to or
23        greater than 60% shall have a service credit factor of
24        200%.
25            (B) Tier 2: A hospital with a MIUR equal to or
26        greater than 33% but less than 60% shall have a service

 

 

SB1773 Enrolled- 98 -LRB100 09919 KTG 20090 b

1        credit factor of 100%.
2            (C) Tier 3: A hospital with a MIUR equal to or
3        greater than 20% but less than 33% shall have a service
4        credit factor of 50%.
5            (D) Tier 4: A hospital with a MIUR less than 20%
6        shall have a service credit factor of 10%.
7    (e) Graduate medical education.
8        (1) The calculation of graduate medical education
9    payments shall be based on the hospital's Medicare cost
10    report ending in Calendar Year 2015, as reported in
11    Medicare cost reports released on October 19, 2016 with
12    data through September 30, 2016. An Illinois hospital
13    reporting intern and resident cost on its Medicare cost
14    report shall be eligible for graduate medical education
15    payments.
16        (2) Each hospital's annualized Medicaid Intern
17    Resident Cost is calculated using annualized intern and
18    resident total costs obtained from Worksheet B Part I,
19    Column 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
20    96-98, and 105-112 multiplied by the percentage that the
21    hospital's Medicaid days (Worksheet S3 Part I, Column 7,
22    Lines 14 and 16-18) comprise of the hospital's total days
23    (Worksheet S3 Part I, Column 8, Lines 14 and 16-18).
24        (3) An annualized Medicaid indirect medical education
25    (IME) payment is calculated for each hospital using its IME
26    payments (Worksheet E Part A, Line 29, Col 1) multiplied by

 

 

SB1773 Enrolled- 99 -LRB100 09919 KTG 20090 b

1    the percentage that its Medicaid days (Worksheet S3 Part I,
2    Column 7, Lines 14 and 16-18) comprise of its Medicare days
3    (Worksheet S3 Part I, Column 6, Lines 14 and 16-18).
4        (4) For each hospital, its annualized Medicaid Intern
5    Resident Cost and its annualized Medicaid IME payment are
6    summed and multiplied by 33% to determine the hospital's
7    final graduate medical education payment.
8    (f) Alzheimer's treatment access payment. Each Illinois
9academic medical center or teaching hospital, as defined in
10Section 5-5e.2 of this Code, that is identified as the primary
11hospital affiliate of one of the Regional Alzheimer's Disease
12Assistance Centers, as designated by the Alzheimer's Disease
13Assistance Act and identified in the Department of Public
14Health's Alzheimer's Disease State Plan dated December 2016,
15shall be paid an Alzheimer's treatment access payment equal to
16the product of $10,000,000 multiplied by a fraction, the
17numerator of which is the qualifying hospital's Fiscal Year
182015 total admissions and the denominator of which is the
19Fiscal Year 2015 total admissions for all hospitals eligible
20for the payment.
21    (g) Safety-net hospital, private critical access hospital,
22and outpatient high volume access payment.
23        (1) Each safety-net hospital, as defined in Section
24    5-5e.1 of this Code, for Rate Year 2017 that is not
25    publicly owned shall be paid an outpatient high volume
26    access payment equal to $40,000,000 multiplied by a

 

 

SB1773 Enrolled- 100 -LRB100 09919 KTG 20090 b

1    fraction, the numerator of which is the hospital's Fiscal
2    Year 2015 outpatient services and the denominator of which
3    is the Fiscal Year 2015 outpatient services for all
4    hospitals eligible under this paragraph for this payment.
5        (2) Each critical access hospital that is not publicly
6    owned shall be paid an outpatient high volume access
7    payment equal to $55,000,000 multiplied by a fraction, the
8    numerator of which is the hospital's Fiscal Year 2015
9    outpatient services and the denominator of which is the
10    Fiscal Year 2015 outpatient services for all hospitals
11    eligible under this paragraph for this payment.
12        (3) Each tier 1 hospital that is not publicly owned
13    shall be paid an outpatient high volume access payment
14    equal to $25,000,000 multiplied by a fraction, the
15    numerator of which is the hospital's Fiscal Year 2015
16    outpatient services and the denominator of which is the
17    Fiscal Year 2015 outpatient services for all hospitals
18    eligible under this paragraph for this payment. A tier 1
19    outpatient high volume hospital means one of the following:
20    (i) a non-publicly owned hospital, excluding a safety net
21    hospital as defined in Section 5-5e.1 of this Code for Rate
22    Year 2017, with total outpatient services, equal to or
23    greater than the regional mean plus one standard deviation
24    for all hospitals in the region but less than the mean plus
25    1.5 standard deviation; (ii) an Illinois non-publicly
26    owned hospital with total outpatient service units equal to

 

 

SB1773 Enrolled- 101 -LRB100 09919 KTG 20090 b

1    or greater than the statewide mean plus one standard
2    deviation; or (iii) a non-publicly owned safety net
3    hospital as defined in Section 5-5e.1 of this Code for Rate
4    Year 2017, with total outpatient services, equal to or
5    greater than the regional mean plus one standard deviation
6    for all hospitals in the region.
7        (4) Each tier 2 hospital that is not publicly owned
8    shall be paid an outpatient high volume access payment
9    equal to $25,000,000 multiplied by a fraction, the
10    numerator of which is the hospital's Fiscal Year 2015
11    outpatient services and the denominator of which is the
12    Fiscal Year 2015 outpatient services for all hospitals
13    eligible under this paragraph for this payment. A tier 2
14    outpatient high volume hospital means a non-publicly owned
15    hospital, excluding a safety-net hospital as defined in
16    Section 5-5e.1 of this Code for Rate Year 2017, with total
17    outpatient services equal to or greater than the regional
18    mean plus 1.5 standard deviations for all hospitals in the
19    region but less than the mean plus 2 standard deviations.
20        (5) Each tier 3 hospital that is not publicly owned
21    shall be paid an outpatient high volume access payment
22    equal to $58,000,000 multiplied by a fraction, the
23    numerator of which is the hospital's Fiscal Year 2015
24    outpatient services and the denominator of which is the
25    Fiscal Year 2015 outpatient services for all hospitals
26    eligible under this paragraph for this payment. A tier 3

 

 

SB1773 Enrolled- 102 -LRB100 09919 KTG 20090 b

1    outpatient high volume hospital means a non-publicly owned
2    hospital, excluding a safety-net hospital as defined in
3    Section 5-5e.1 of this Code for Rate Year 2017, with total
4    outpatient services equal to or greater than the regional
5    mean plus 2 standard deviations for all hospitals in the
6    region.
7    (h) Medicaid dependent or high volume hospital access
8payment.
9        (1) To qualify for a Medicaid dependent hospital access
10    payment, a hospital shall meet one of the following
11    criteria:
12            (A) Be a non-publicly owned general acute care
13        hospital that is a safety-net hospital, as defined in
14        Section 5-5e.1 of this Code, for Rate Year 2017.
15            (B) Be a pediatric hospital that is a safety net
16        hospital, as defined in Section 5-5e.1 of this Code,
17        for Rate Year 2017 and have a Medicaid inpatient
18        utilization rate equal to or greater than 50%.
19            (C) Be a general acute care hospital with a
20        Medicaid inpatient utilization rate equal to or
21        greater than 50% in Rate Year 2017.
22        (2) The Medicaid dependent hospital access payment
23    shall be determined as follows:
24            (A) Each tier 1 hospital shall be paid a Medicaid
25        dependent hospital access payment equal to $23,000,000
26        multiplied by a fraction, the numerator of which is the

 

 

SB1773 Enrolled- 103 -LRB100 09919 KTG 20090 b

1        hospital's Fiscal Year 2015 total days and the
2        denominator of which is the Fiscal Year 2015 total days
3        for all hospitals eligible under this subparagraph for
4        this payment. A tier 1 Medicaid dependent hospital
5        means a qualifying hospital with a Rate Year 2017
6        Medicaid inpatient utilization rate equal to or
7        greater than the statewide mean but less than the
8        statewide mean plus 0.5 standard deviation.
9            (B) Each tier 2 hospital shall be paid a Medicaid
10        dependent hospital access payment equal to $15,000,000
11        multiplied by a fraction, the numerator of which is the
12        hospital's Fiscal Year 2015 total days and the
13        denominator of which is the Fiscal Year 2015 total days
14        for all hospitals eligible under this subparagraph for
15        this payment. A tier 2 Medicaid dependent hospital
16        means a qualifying hospital with a Rate Year 2017
17        Medicaid inpatient utilization rate equal to or
18        greater than the statewide mean plus 0.5 standard
19        deviations but less than the statewide mean plus one
20        standard deviation.
21            (C) Each tier 3 hospital shall be paid a Medicaid
22        dependent hospital access payment equal to $15,000,000
23        multiplied by a fraction, the numerator of which is the
24        hospital's Fiscal Year 2015 total days and the
25        denominator of which is the Fiscal Year 2015 total days
26        for all hospitals eligible under this subparagraph for

 

 

SB1773 Enrolled- 104 -LRB100 09919 KTG 20090 b

1        this payment. A tier 3 Medicaid dependent hospital
2        means a qualifying hospital with a Rate Year 2017
3        Medicaid inpatient utilization rate equal to or
4        greater than the statewide mean plus one standard
5        deviation but less than the statewide mean plus 1.5
6        standard deviations.
7            (D) Each tier 4 hospital shall be paid a Medicaid
8        dependent hospital access payment equal to $53,000,000
9        multiplied by a fraction, the numerator of which is the
10        hospital's Fiscal Year 2015 total days and the
11        denominator of which is the Fiscal Year 2015 total days
12        for all hospitals eligible under this subparagraph for
13        this payment. A tier 4 Medicaid dependent hospital
14        means a qualifying hospital with a Rate Year 2017
15        Medicaid inpatient utilization rate equal to or
16        greater than the statewide mean plus 1.5 standard
17        deviations but less than the statewide mean plus 2
18        standard deviations.
19            (E) Each tier 5 hospital shall be paid a Medicaid
20        dependent hospital access payment equal to $75,000,000
21        multiplied by a fraction, the numerator of which is the
22        hospital's Fiscal Year 2015 total days and the
23        denominator of which is the Fiscal Year 2015 total days
24        for all hospitals eligible under this subparagraph for
25        this payment. A tier 5 Medicaid dependent hospital
26        means a qualifying hospital with a Rate Year 2017

 

 

SB1773 Enrolled- 105 -LRB100 09919 KTG 20090 b

1        Medicaid inpatient utilization rate equal to or
2        greater than the statewide mean plus 2 standard
3        deviations.
4        (3) Each Medicaid high volume hospital shall be paid a
5    Medicaid high volume access payment equal to $300,000,000
6    multiplied by a fraction, the numerator of which is the
7    hospital's Fiscal Year 2015 total admissions and the
8    denominator of which is the Fiscal Year 2015 total
9    admissions for all hospitals eligible under this paragraph
10    for this payment. A Medicaid high volume hospital means the
11    Illinois general acute care hospitals with the highest
12    number of Fiscal Year 2015 total admissions that when
13    ranked in descending order from the highest Fiscal Year
14    2015 total admissions to the lowest Fiscal Year 2015 total
15    admissions, in the aggregate, sum to at least 50% of the
16    total admissions for all such hospitals in Fiscal Year
17    2015; however, any hospital which has qualified as a
18    Medicaid dependent hospital shall not also be considered a
19    Medicaid high volume hospital.
20    (i) Perinatal care access payment.
21        (1) Each Illinois non-publicly owned hospital
22    designated a Level II or II+ perinatal center by the
23    Department of Public Health as of December 1, 2017 shall be
24    paid an access payment equal to $200,000,000 multiplied by
25    a fraction, the numerator of which is the hospital's Fiscal
26    Year 2015 total admissions and the denominator of which is

 

 

SB1773 Enrolled- 106 -LRB100 09919 KTG 20090 b

1    the Fiscal Year 2015 total admissions for all hospitals
2    eligible under this paragraph for this payment.
3        (2) Each Illinois non-publicly owned hospital
4    designated a Level III perinatal center by the Department
5    of Public Health as of December 1, 2017 shall be paid an
6    access payment equal to $100,000,000 multiplied by a
7    fraction, the numerator of which is the hospital's Fiscal
8    Year 2015 total admissions and the denominator of which is
9    the Fiscal Year 2015 total admissions for all hospitals
10    eligible under this paragraph for this payment.
11    (j) Trauma care access payment.
12        (1) Each Illinois non-publicly owned hospital
13    designated a Level I trauma center by the Department of
14    Public Health as of December 1, 2017 shall be paid an
15    access payment equal to $160,000,000 multiplied by a
16    fraction, the numerator of which is the hospital's Fiscal
17    Year 2015 total admissions and the denominator of which is
18    the Fiscal Year 2015 total admissions for all hospitals
19    eligible under this paragraph for this payment.
20        (2) Each Illinois non-publicly owned hospital
21    designated a Level II trauma center by the Department of
22    Public Health as of December 1, 2017 shall be paid an
23    access payment equal to $200,000,000 multiplied by a
24    fraction, the numerator of which is the hospital's Fiscal
25    Year 2015 total admissions and the denominator of which is
26    the Fiscal Year 2015 total admissions for all hospitals

 

 

SB1773 Enrolled- 107 -LRB100 09919 KTG 20090 b

1    eligible under this paragraph for this payment.
2    (k) Perinatal and trauma center access payment.
3        (1) Each Illinois non-publicly owned hospital
4    designated a Level III perinatal center and a Level I or II
5    trauma center by the Department of Public Health as of
6    December 1, 2017, and that has a Rate Year 2017 Medicaid
7    inpatient utilization rate equal to or greater than 20% and
8    a calendar year 2015 occupancy ratio equal to or greater
9    than 50%, shall be paid an access payment equal to
10    $160,000,000 multiplied by a fraction, the numerator of
11    which is the hospital's Fiscal Year 2015 total admissions
12    and the denominator of which is the Fiscal Year 2015 total
13    admissions for all hospitals eligible under this paragraph
14    for this payment.
15        (2) Each Illinois non-publicly owned hospital
16    designated a Level II or II+ perinatal center and a Level I
17    or II trauma center by the Department of Public Health as
18    of December 1, 2017, and that has a Rate Year 2017 Medicaid
19    inpatient utilization rate equal to or greater than 20% and
20    a calendar year 2015 occupancy ratio equal to or greater
21    than 50%, shall be paid an access payment equal to
22    $200,000,000 multiplied by a fraction, the numerator of
23    which is the hospital's Fiscal Year 2015 total admissions
24    and the denominator of which is the Fiscal Year 2015 total
25    admissions for all hospitals eligible under this paragraph
26    for this payment.

 

 

SB1773 Enrolled- 108 -LRB100 09919 KTG 20090 b

1    (l) Long-term acute care access payment. Each Illinois
2non-publicly owned long-term acute care hospital that has a
3Rate Year 2017 Medicaid inpatient utilization rate equal to or
4greater than 25% and a calendar year 2015 occupancy ratio equal
5to or greater than 60% shall be paid an access payment equal to
6$19,000,000 multiplied by a fraction, the numerator of which is
7the hospital's Fiscal Year 2015 general acute care admissions
8and the denominator of which is the Fiscal Year 2015 general
9acute care admissions for all hospitals eligible under this
10subsection for this payment.
11    (m) Small public hospital access payment.
12        (1) As used in this subsection, "small public hospital"
13    means any Illinois publicly owned hospital which is not a
14    "large public hospital" as described in 89 Ill. Adm. Code
15    148.25(a).
16        (2) Each small public hospital shall be paid an
17    inpatient access payment equal to $2,825,000 multiplied by
18    a fraction, the numerator of which is the hospital's Fiscal
19    Year 2015 total days and the denominator of which is the
20    Fiscal Year 2015 total days for all hospitals under this
21    paragraph for this payment.
22        (3) Each small public hospital shall be paid an
23    outpatient access payment equal to $24,000,000 multiplied
24    by a fraction, the numerator of which is the hospital's
25    Fiscal Year 2015 outpatient services and the denominator of
26    which is the Fiscal Year 2015 outpatient services for all

 

 

SB1773 Enrolled- 109 -LRB100 09919 KTG 20090 b

1    hospitals eligible under this paragraph for this payment.
2    (n) Psychiatric care access payment. In addition to rates
3paid for inpatient psychiatric services, the Illinois
4Department shall, by rule, establish an access payment for
5inpatient hospital psychiatric services that shall, in the
6aggregate, spend approximately $61,141,188 annually. In
7consultation with the hospital community, the Department may,
8by rule, incorporate the funds used for this access payment to
9increase the payment rates for inpatient psychiatric services,
10except that such changes shall not take effect before July 1,
112019. Upon incorporation into the claims payment rates, this
12access payment shall be repealed. Beginning July 1, 2018, for
13purposes of determining for State fiscal years 2019 and 2020
14the hospitals eligible for the payments authorized under this
15subsection, the Department shall include out-of-state
16hospitals that are designated a Level I pediatric trauma center
17or a Level I trauma center by the Department of Public Health
18as of December 1, 2017.
19    (o) For purposes of this Section, a hospital that is
20enrolled to provide Medicaid services during State fiscal year
212015 shall have its utilization and associated reimbursements
22annualized prior to the payment calculations being performed
23under this Section.
24    (p) Definitions. As used in this Section, unless the
25context requires otherwise:
26    "General acute care admissions" means, for a given

 

 

SB1773 Enrolled- 110 -LRB100 09919 KTG 20090 b

1hospital, the sum of inpatient hospital admissions provided to
2recipients of medical assistance under Title XIX of the Social
3Security Act for general acute care, excluding admissions for
4individuals eligible for Medicare under Title XVIII of the
5Social Security Act (Medicaid/Medicare crossover admissions),
6as tabulated from the Department's paid claims data for general
7acute care admissions occurring during State fiscal year 2015
8that was adjudicated by the Department through October 28,
92016.
10    "Occupancy ratio" is determined utilizing the IDPH
11Hospital Profile CY15 Facility Utilization Data Source 2015
12Annual Hospital Questionnaire. Utilizes all beds and days
13including observation days but excludes Long Term Care and
14Swing bed and their associated beds and days.
15    "Outpatient services" means, for a given hospital, the sum
16of the number of outpatient encounters identified as unique
17services provided to recipients of medical assistance under
18Title XIX of the Social Security Act for general acute care,
19psychiatric care, and rehabilitation care, excluding
20outpatient services for individuals eligible for Medicare
21under Title XVIII of the Social Security Act (Medicaid/Medicare
22crossover services), as tabulated from the Department's paid
23claims data for outpatient services occurring during State
24fiscal year 2015 that was adjudicated by the Department through
25October 28, 2016.
26    "Total days" means, for a given hospital, the sum of

 

 

SB1773 Enrolled- 111 -LRB100 09919 KTG 20090 b

1inpatient hospital days provided to recipients of medical
2assistance under Title XIX of the Social Security Act for
3general acute care, psychiatric care, and rehabilitation care,
4excluding days for individuals eligible for Medicare under
5Title XVIII of the Social Security Act (Medicaid/Medicare
6crossover days), as tabulated from the Department's paid claims
7data for total days occurring during State fiscal year 2015
8that was adjudicated by the Department through October 28,
92016.
10    "Total admissions" means, for a given hospital, the sum of
11inpatient hospital admissions provided to recipients of
12medical assistance under Title XIX of the Social Security Act
13for general acute care, psychiatric care, and rehabilitation
14care, excluding admissions for individuals eligible for
15Medicare under Title XVIII of that Act (Medicaid/Medicare
16crossover admissions), as tabulated from the Department's paid
17claims data for admissions occurring during State fiscal year
182015 that was adjudicated by the Department through October 28,
192016.
20    (q) Notwithstanding any of the other provisions of this
21Section, the Department is authorized to adopt rules that
22change the hospital access payments specified in this Section,
23but only to the extent necessary to conform to any federally
24approved amendment to the Title XIX State Plan. Any such rules
25shall be adopted by the Department as authorized by Section
265-50 of the Illinois Administrative Procedure Act.

 

 

SB1773 Enrolled- 112 -LRB100 09919 KTG 20090 b

1Notwithstanding any other provision of law, any changes
2implemented as a result of this subsection (q) shall be given
3retroactive effect so that they shall be deemed to have taken
4effect as of the effective date of this amendatory Act of the
5100th General Assembly.
6    (r) On or after July 1, 2018, and no less than annually
7thereafter, the Department shall increase capitation payments
8to capitated managed care organizations (MCOs) to equal the
9aggregate reduction of payments made in this Section to
10preserve access to hospital services for recipients under the
11Medical Assistance Program. The aggregate amount of all
12increased capitation payments to all MCOs for a fiscal year
13shall at least be the amount needed to avoid reduction in
14payments authorized under Section 5A-15. Payments to MCOs under
15this Section shall be consistent with actuarial certification
16and shall be published by the Department each year. Managed
17care organizations and hospitals (including through their
18representative organizations), shall develop and implement
19methodologies and rates for payments that will preserve and
20improve access to hospital services for recipients in
21furtherance of the State's public policy to ensure equal access
22to covered services to recipients under the Medical Assistance
23Program. The Department shall make available, on a monthly
24basis, a report of the capitation payments that are made to
25each MCO, including the number of enrollees for which such
26payment is made, the per enrollee amount of the payment, and

 

 

SB1773 Enrolled- 113 -LRB100 09919 KTG 20090 b

1any adjustments that have been made. Payments to MCOs that
2would be paid consistent with actuarial certification and
3enrollment in the absence of the increased capitation payments
4under this Section shall not be reduced as a consequence of
5payments made under this subsection.
6    As used in this subsection, "MCO" means an entity which
7contracts with the Department to provide services where payment
8for medical services is made on a capitated basis.
 
9    (305 ILCS 5/5A-13)
10    Sec. 5A-13. Emergency rulemaking.
11    (a) The Department of Healthcare and Family Services
12(formerly Department of Public Aid) may adopt rules necessary
13to implement this amendatory Act of the 94th General Assembly
14through the use of emergency rulemaking in accordance with
15Section 5-45 of the Illinois Administrative Procedure Act. For
16purposes of that Act, the General Assembly finds that the
17adoption of rules to implement this amendatory Act of the 94th
18General Assembly is deemed an emergency and necessary for the
19public interest, safety, and welfare.
20    (b) The Department of Healthcare and Family Services may
21adopt rules necessary to implement this amendatory Act of the
2297th General Assembly through the use of emergency rulemaking
23in accordance with Section 5-45 of the Illinois Administrative
24Procedure Act. For purposes of that Act, the General Assembly
25finds that the adoption of rules to implement this amendatory

 

 

SB1773 Enrolled- 114 -LRB100 09919 KTG 20090 b

1Act of the 97th General Assembly is deemed an emergency and
2necessary for the public interest, safety, and welfare.
3    (c) The Department of Healthcare and Family Services may
4adopt rules necessary to initially implement the changes to
5Articles 5, 5A, 12, and 14 of this Code under this amendatory
6Act of the 100th General Assembly through the use of emergency
7rulemaking in accordance with subsection (aa) of Section 5-45
8of the Illinois Administrative Procedure Act. For purposes of
9that Act, the General Assembly finds that the adoption of rules
10to implement the changes to Articles 5, 5A, 12, and 14 of this
11Code under this amendatory Act of the 100th General Assembly is
12deemed an emergency and necessary for the public interest,
13safety, and welfare. The 24-month limitation on the adoption of
14emergency rules does not apply to rules adopted to initially
15implement the changes to Articles 5, 5A, 12, and 14 of this
16Code under this amendatory Act of the 100th General Assembly.
17For purposes of this subsection, "initially" means any
18emergency rules necessary to immediately implement the changes
19authorized to Articles 5, 5A, 12, and 14 of this Code under
20this amendatory Act of the 100th General Assembly; however,
21emergency rulemaking authority shall not be used to make
22changes that could otherwise be made following the process
23established in the Illinois Administrative Procedure Act.
24(Source: P.A. 97-688, eff. 6-14-12.)
 
25    (305 ILCS 5/5A-14)

 

 

SB1773 Enrolled- 115 -LRB100 09919 KTG 20090 b

1    Sec. 5A-14. Repeal of assessments and disbursements.
2    (a) Section 5A-2 is repealed on July 1, 2020 2018.
3    (b) Section 5A-12 is repealed on July 1, 2005.
4    (c) Section 5A-12.1 is repealed on July 1, 2008.
5    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
6July 1, 2018, subject to Section 5A-16.
7    (e) Section 5A-12.3 is repealed on July 1, 2011.
8    (f) Section 5A-12.6 is repealed on July 1, 2020.
9(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
1098-651, eff. 6-16-14.)
 
11    (305 ILCS 5/5A-15)
12    Sec. 5A-15. Protection of federal revenue.
13    (a) If the federal Centers for Medicare and Medicaid
14Services finds that any federal upper payment limit applicable
15to the payments under this Article is exceeded then:
16        (1) (i) if such finding is made before payments have
17    been issued, the payments under this Article and the
18    increases in claims-based hospital payment rates specified
19    under Section 14-12 of this Code, as authorized under this
20    amendatory Act of the 100th General Assembly, that exceed
21    the applicable federal upper payment limit shall be reduced
22    uniformly to the extent necessary to comply with the
23    applicable federal upper payment limit; or (ii) if such
24    finding is made after payments have been issued, the
25    payments under this Article that exceed the applicable

 

 

SB1773 Enrolled- 116 -LRB100 09919 KTG 20090 b

1    federal upper payment limit shall be reduced uniformly to
2    the extent necessary to comply with the applicable federal
3    upper payment limit; and
4        (2) any assessment rate imposed under this Article
5    shall be reduced such that the aggregate assessment is
6    reduced by the same percentage reduction applied in
7    paragraph (1); and
8        (3) any transfers from the Hospital Provider Fund under
9    Section 5A-8 shall be reduced by the same percentage
10    reduction applied in paragraph (1).
11    (b) Any payment reductions made under the authority granted
12in this Section are exempt from the requirements and actions
13under Section 5A-10.
14(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
 
15    (305 ILCS 5/5A-16 new)
16    Sec. 5A-16. State fiscal year 2019 implementation
17protection. To preserve access to hospital services, it is the
18intent of the General Assembly that there not be a gap in
19payments to hospitals while the changes authorized under this
20amendatory Act of the 100th General Assembly are being reviewed
21by the federal Centers for Medicare and Medicaid Services and
22implemented by the Department. Therefore, pending the review
23and approval of the changes to the assessment and hospital
24reimbursement methodologies authorized under this amendatory
25Act of the 100th General Assembly by the federal Centers for

 

 

SB1773 Enrolled- 117 -LRB100 09919 KTG 20090 b

1Medicare and Medicaid Services and the final implementation of
2such program by the Department, the Department shall take all
3actions necessary to continue the reimbursement methodologies
4and payments to hospitals that are changed under this
5amendatory Act of the 100th General Assembly, as they are in
6effect on June 30, 2018, until the first day of the second
7month after the new and revised methodologies and payments
8authorized under this amendatory Act of the 100th General
9Assembly are effective and implemented by the Department. Such
10actions by the Department shall include, but not be limited to,
11requesting the extension of any federal approval of the
12currently approved payment methodologies contained in
13Illinois' Medicaid State Plan while the federal Centers for
14Medicare and Medicaid Services reviews the proposed changes
15authorized under this amendatory Act of the 100th General
16Assembly.
17    Notwithstanding any other provision of this Code, if the
18federal Centers for Medicare and Medicaid Services should
19approve the continuation of the reimbursement methodologies
20and payments to hospitals under Sections 5A-12.2, 5A-12.4,
215A-12.5, and Section 14-12, as they are in effect on June 30,
222018, until the new and revised methodologies and payments
23authorized under Sections 5A-12.6 and Section 14-12 of this
24amendatory Act of the 100th General Assembly are federally
25approved, then the reimbursement methodologies and payments to
26hospitals under Sections 5A-12.2, 5A-12.4, 5A-12.5, and 14-12,

 

 

SB1773 Enrolled- 118 -LRB100 09919 KTG 20090 b

1and the assessments imposed under Section 5A-2, as they are in
2effect on June 30, 2018, shall continue until the effective
3date of the new and revised methodologies and payments, which
4shall be the first day of the second month following the date
5of approval by the federal Centers for Medicare and Medicaid
6Services.
 
7    (305 ILCS 5/12-4.105)
8    Sec. 12-4.105. Human poison control center; payment
9program. Subject to funding availability resulting from
10transfers made from the Hospital Provider Fund to the
11Healthcare Provider Relief Fund as authorized under this Code,
12for State fiscal year 2017 and State fiscal year 2018, and for
13each State fiscal year thereafter in which the assessment under
14Section 5A-2 is imposed, the Department of Healthcare and
15Family Services shall pay to the human poison control center
16designated under the Poison Control System Act an amount of not
17less than $3,000,000 for each of those State fiscal years that
18the human poison control center is in operation.
19(Source: P.A. 99-516, eff. 6-30-16.)
 
20    (305 ILCS 5/14-12)
21    Sec. 14-12. Hospital rate reform payment system. The
22hospital payment system pursuant to Section 14-11 of this
23Article shall be as follows:
24    (a) Inpatient hospital services. Effective for discharges

 

 

SB1773 Enrolled- 119 -LRB100 09919 KTG 20090 b

1on and after July 1, 2014, reimbursement for inpatient general
2acute care services shall utilize the All Patient Refined
3Diagnosis Related Grouping (APR-DRG) software, version 30,
4distributed by 3MTM Health Information System.
5        (1) The Department shall establish Medicaid weighting
6    factors to be used in the reimbursement system established
7    under this subsection. Initial weighting factors shall be
8    the weighting factors as published by 3M Health Information
9    System, associated with Version 30.0 adjusted for the
10    Illinois experience.
11        (2) The Department shall establish a
12    statewide-standardized amount to be used in the inpatient
13    reimbursement system. The Department shall publish these
14    amounts on its website no later than 10 calendar days prior
15    to their effective date.
16        (3) In addition to the statewide-standardized amount,
17    the Department shall develop adjusters to adjust the rate
18    of reimbursement for critical Medicaid providers or
19    services for trauma, transplantation services, perinatal
20    care, and Graduate Medical Education (GME).
21        (4) The Department shall develop add-on payments to
22    account for exceptionally costly inpatient stays,
23    consistent with Medicare outlier principles. Outlier fixed
24    loss thresholds may be updated to control for excessive
25    growth in outlier payments no more frequently than on an
26    annual basis, but at least triennially. Upon updating the

 

 

SB1773 Enrolled- 120 -LRB100 09919 KTG 20090 b

1    fixed loss thresholds, the Department shall be required to
2    update base rates within 12 months.
3        (5) The Department shall define those hospitals or
4    distinct parts of hospitals that shall be exempt from the
5    APR-DRG reimbursement system established under this
6    Section. The Department shall publish these hospitals'
7    inpatient rates on its website no later than 10 calendar
8    days prior to their effective date.
9        (6) Beginning July 1, 2014 and ending on June 30, 2024
10    2018, in addition to the statewide-standardized amount,
11    the Department shall develop an adjustor to adjust the rate
12    of reimbursement for safety-net hospitals defined in
13    Section 5-5e.1 of this Code excluding pediatric hospitals.
14        (7) Beginning July 1, 2014 and ending on June 30, 2020,
15    or upon implementation of inpatient psychiatric rate
16    increases as described in subsection (n) of Section 5A-12.6
17    2018, in addition to the statewide-standardized amount,
18    the Department shall develop an adjustor to adjust the rate
19    of reimbursement for Illinois freestanding inpatient
20    psychiatric hospitals that are not designated as
21    children's hospitals by the Department but are primarily
22    treating patients under the age of 21.
23        (7.5) Beginning July 1, 2020, the reimbursement for
24    inpatient psychiatric services shall be so that base claims
25    projected reimbursement is increased by an amount equal to
26    the funds allocated in paragraph (2) of subsection (b) of

 

 

SB1773 Enrolled- 121 -LRB100 09919 KTG 20090 b

1    Section 5A-12.6, less the amount allocated under
2    paragraphs (8) and (9) of this subsection and paragraphs
3    (3) and (4) of subsection (b) multiplied by 13%. Beginning
4    July 1, 2022, the reimbursement for inpatient psychiatric
5    services shall be so that base claims projected
6    reimbursement is increased by an amount equal to the funds
7    allocated in paragraph (3) of subsection (b) of Section
8    5A-12.6, less the amount allocated under paragraphs (8) and
9    (9) of this subsection and paragraphs (3) and (4) of
10    subsection (b) multiplied by 13%. Beginning July 1, 2024,
11    the reimbursement for inpatient psychiatric services shall
12    be so that base claims projected reimbursement is increased
13    by an amount equal to the funds allocated in paragraph (4)
14    of subsection (b) of Section 5A-12.6, less the amount
15    allocated under paragraphs (8) and (9) of this subsection
16    and paragraphs (3) and (4) of subsection (b) multiplied by
17    13%.
18        (8) Beginning July 1, 2018, in addition to the
19    statewide-standardized amount, the Department shall adjust
20    the rate of reimbursement for hospitals designated by the
21    Department of Public Health as a Perinatal Level II or II+
22    center by applying the same adjustor that is applied to
23    Perinatal and Obstetrical care cases for Perinatal Level
24    III centers, as of December 31, 2017.
25        (9) Beginning July 1, 2018, in addition to the
26    statewide-standardized amount, the Department shall apply

 

 

SB1773 Enrolled- 122 -LRB100 09919 KTG 20090 b

1    the same adjustor that is applied to trauma cases as of
2    December 31, 2017 to inpatient claims to treat patients
3    with burns, including, but not limited to, APR-DRGs 841,
4    842, 843, and 844.
5        (10) Beginning July 1, 2018, the
6    statewide-standardized amount for inpatient general acute
7    care services shall be uniformly increased so that base
8    claims projected reimbursement is increased by an amount
9    equal to the funds allocated in paragraph (1) of subsection
10    (b) of Section 5A-12.6, less the amount allocated under
11    paragraphs (8) and (9) of this subsection and paragraphs
12    (3) and (4) of subsection (b) multiplied by 40%. Beginning
13    July 1, 2020, the statewide-standardized amount for
14    inpatient general acute care services shall be uniformly
15    increased so that base claims projected reimbursement is
16    increased by an amount equal to the funds allocated in
17    paragraph (2) of subsection (b) of Section 5A-12.6, less
18    the amount allocated under paragraphs (8) and (9) of this
19    subsection and paragraphs (3) and (4) of subsection (b)
20    multiplied by 40%. Beginning July 1, 2022, the
21    statewide-standardized amount for inpatient general acute
22    care services shall be uniformly increased so that base
23    claims projected reimbursement is increased by an amount
24    equal to the funds allocated in paragraph (3) of subsection
25    (b) of Section 5A-12.6, less the amount allocated under
26    paragraphs (8) and (9) of this subsection and paragraphs

 

 

SB1773 Enrolled- 123 -LRB100 09919 KTG 20090 b

1    (3) and (4) of subsection (b) multiplied by 40%. Beginning
2    July 1, 2023 the statewide-standardized amount for
3    inpatient general acute care services shall be uniformly
4    increased so that base claims projected reimbursement is
5    increased by an amount equal to the funds allocated in
6    paragraph (4) of subsection (b) of Section 5A-12.6, less
7    the amount allocated under paragraphs (8) and (9) of this
8    subsection and paragraphs (3) and (4) of subsection (b)
9    multiplied by 40%.
10        (11) Beginning July 1, 2018, the reimbursement for
11    inpatient rehabilitation services shall be increased by
12    the addition of a $96 per day add-on.
13        Beginning July 1, 2020, the reimbursement for
14    inpatient rehabilitation services shall be uniformly
15    increased so that the $96 per day add-on is increased by an
16    amount equal to the funds allocated in paragraph (2) of
17    subsection (b) of Section 5A-12.6, less the amount
18    allocated under paragraphs (8) and (9) of this subsection
19    and paragraphs (3) and (4) of subsection (b) multiplied by
20    0.9%.
21        Beginning July 1, 2022, the reimbursement for
22    inpatient rehabilitation services shall be uniformly
23    increased so that the $96 per day add-on as adjusted by the
24    July 1, 2020 increase, is increased by an amount equal to
25    the funds allocated in paragraph (3) of subsection (b) of
26    Section 5A-12.6, less the amount allocated under

 

 

SB1773 Enrolled- 124 -LRB100 09919 KTG 20090 b

1    paragraphs (8) and (9) of this subsection and paragraphs
2    (3) and (4) of subsection (b) multiplied by 0.9%.
3        Beginning July 1, 2023, the reimbursement for
4    inpatient rehabilitation services shall be uniformly
5    increased so that the $96 per day add-on as adjusted by the
6    July 1, 2022 increase, is increased by an amount equal to
7    the funds allocated in paragraph (4) of subsection (b) of
8    Section 5A-12.6, less the amount allocated under
9    paragraphs (8) and (9) of this subsection and paragraphs
10    (3) and (4) of subsection (b) multiplied by 0.9%.
11    (b) Outpatient hospital services. Effective for dates of
12service on and after July 1, 2014, reimbursement for outpatient
13services shall utilize the Enhanced Ambulatory Procedure
14Grouping (E-APG) software, version 3.7 distributed by 3MTM
15Health Information System.
16        (1) The Department shall establish Medicaid weighting
17    factors to be used in the reimbursement system established
18    under this subsection. The initial weighting factors shall
19    be the weighting factors as published by 3M Health
20    Information System, associated with Version 3.7.
21        (2) The Department shall establish service specific
22    statewide-standardized amounts to be used in the
23    reimbursement system.
24            (A) The initial statewide standardized amounts,
25        with the labor portion adjusted by the Calendar Year
26        2013 Medicare Outpatient Prospective Payment System

 

 

SB1773 Enrolled- 125 -LRB100 09919 KTG 20090 b

1        wage index with reclassifications, shall be published
2        by the Department on its website no later than 10
3        calendar days prior to their effective date.
4            (B) The Department shall establish adjustments to
5        the statewide-standardized amounts for each Critical
6        Access Hospital, as designated by the Department of
7        Public Health in accordance with 42 CFR 485, Subpart F.
8        The EAPG standardized amounts are determined
9        separately for each critical access hospital such that
10        simulated EAPG payments using outpatient base period
11        paid claim data plus payments under Section 5A-12.4 of
12        this Code net of the associated tax costs are equal to
13        the estimated costs of outpatient base period claims
14        data with a rate year cost inflation factor applied.
15        (3) In addition to the statewide-standardized amounts,
16    the Department shall develop adjusters to adjust the rate
17    of reimbursement for critical Medicaid hospital outpatient
18    providers or services, including outpatient high volume or
19    safety-net hospitals. Beginning July 1, 2018, the
20    outpatient high volume adjustor shall be increased to
21    increase annual expenditures associated with this adjustor
22    by $79,200,000, based on the State Fiscal Year 2015 base
23    year data and this adjustor shall apply to public
24    hospitals, except for large public hospitals, as defined
25    under 89 Ill. Adm. Code 148.25(a).
26        (4) Beginning July 1, 2018, in addition to the

 

 

SB1773 Enrolled- 126 -LRB100 09919 KTG 20090 b

1    statewide standardized amounts, the Department shall make
2    an add-on payment for outpatient expensive devices and
3    drugs. This add-on payment shall at least apply to claim
4    lines that: (i) are assigned with one of the following
5    EAPGs: 490, 1001 to 1020, and coded with one of the
6    following revenue codes: 0274 to 0276, 0278; or (ii) are
7    assigned with one of the following EAPGs: 430 to 441, 443,
8    444, 460 to 465, 495, 496, 1090. The add-on payment shall
9    be calculated as follows: the claim line's covered charges
10    multiplied by the hospital's total acute cost to charge
11    ratio, less the claim line's EAPG payment plus $1,000,
12    multiplied by 0.8.
13        (5) Beginning July 1, 2018, the statewide-standardized
14    amounts for outpatient services shall be increased so that
15    base claims projected reimbursement is increased by an
16    amount equal to the funds allocated in paragraph (1) of
17    subsection (b) of Section 5A-12.6, less the amount
18    allocated under paragraphs (8) and (9) of subsection (a)
19    and paragraphs (3) and (4) of this subsection multiplied by
20    46%. Beginning July 1, 2020, the statewide-standardized
21    amounts for outpatient services shall be increased so that
22    base claims projected reimbursement is increased by an
23    amount equal to the funds allocated in paragraph (2) of
24    subsection (b) of Section 5A-12.6, less the amount
25    allocated under paragraphs (8) and (9) of subsection (a)
26    and paragraphs (3) and (4) of this subsection multiplied by

 

 

SB1773 Enrolled- 127 -LRB100 09919 KTG 20090 b

1    46%. Beginning July 1, 2022, the statewide-standardized
2    amounts for outpatient services shall be increased so that
3    base claims projected reimbursement is increased by an
4    amount equal to the funds allocated in paragraph (3) of
5    subsection (b) of Section 5A-12.6, less the amount
6    allocated under paragraphs (8) and (9) of subsection (a)
7    and paragraphs (3) and (4) of this subsection multiplied by
8    46%. Beginning July 1, 2023, the statewide-standardized
9    amounts for outpatient services shall be increased so that
10    base claims projected reimbursement is increased by an
11    amount equal to the funds allocated in paragraph (4) of
12    subsection (b) of Section 5A-12.6, less the amount
13    allocated under paragraphs (8) and (9) of subsection (a)
14    and paragraphs (3) and (4) of this subsection multiplied by
15    46%.
16    (c) In consultation with the hospital community, the
17Department is authorized to replace 89 Ill. Admin. Code 152.150
18as published in 38 Ill. Reg. 4980 through 4986 within 12 months
19of the effective date of this amendatory Act of the 98th
20General Assembly. If the Department does not replace these
21rules within 12 months of the effective date of this amendatory
22Act of the 98th General Assembly, the rules in effect for
23152.150 as published in 38 Ill. Reg. 4980 through 4986 shall
24remain in effect until modified by rule by the Department.
25Nothing in this subsection shall be construed to mandate that
26the Department file a replacement rule.

 

 

SB1773 Enrolled- 128 -LRB100 09919 KTG 20090 b

1    (d) Transition period. There shall be a transition period
2to the reimbursement systems authorized under this Section that
3shall begin on the effective date of these systems and continue
4until June 30, 2018, unless extended by rule by the Department.
5To help provide an orderly and predictable transition to the
6new reimbursement systems and to preserve and enhance access to
7the hospital services during this transition, the Department
8shall allocate a transitional hospital access pool of at least
9$290,000,000 annually so that transitional hospital access
10payments are made to hospitals.
11        (1) After the transition period, the Department may
12    begin incorporating the transitional hospital access pool
13    into the base rate structure; however, the transitional
14    hospital access payments in effect on June 30, 2018 shall
15    continue to be paid, if continued under Section 5A-16.
16        (2) After the transition period, if the Department
17    reduces payments from the transitional hospital access
18    pool, it shall increase base rates, develop new adjustors,
19    adjust current adjustors, develop new hospital access
20    payments based on updated information, or any combination
21    thereof by an amount equal to the decreases proposed in the
22    transitional hospital access pool payments, ensuring that
23    the entire transitional hospital access pool amount shall
24    continue to be used for hospital payments.
25    (d-5) Hospital transformation program. The Department, in
26conjunction with the Hospital Transformation Review Committee

 

 

SB1773 Enrolled- 129 -LRB100 09919 KTG 20090 b

1created under subsection (d-5), shall develop a hospital
2transformation program to provide financial assistance to
3hospitals in transforming their services and care models to
4better align with the needs of the communities they serve. The
5payments authorized in this Section shall be subject to
6approval by the federal government.
7        (1) Phase 1. In State fiscal years 2019 through 2020,
8    the Department shall allocate funds from the transitional
9    access hospital pool to create a hospital transformation
10    pool of at least $262,906,870 annually and make hospital
11    transformation payments to hospitals. Subject to Section
12    5A-16, in State fiscal years 2019 and 2020, an Illinois
13    hospital that received either a transitional hospital
14    access payment under subsection (d) or a supplemental
15    payment under subsection (f) of this Section in State
16    fiscal year 2018, shall receive a hospital transformation
17    payment as follows:
18            (A) If the hospital's Rate Year 2017 Medicaid
19        inpatient utilization rate is equal to or greater than
20        45%, the hospital transformation payment shall be
21        equal to 100% of the sum of its transitional hospital
22        access payment authorized under subsection (d) and any
23        supplemental payment authorized under subsection (f).
24            (B) If the hospital's Rate Year 2017 Medicaid
25        inpatient utilization rate is equal to or greater than
26        25% but less than 45%, the hospital transformation

 

 

SB1773 Enrolled- 130 -LRB100 09919 KTG 20090 b

1        payment shall be equal to 75% of the sum of its
2        transitional hospital access payment authorized under
3        subsection (d) and any supplemental payment authorized
4        under subsection (f).
5            (C) If the hospital's Rate Year 2017 Medicaid
6        inpatient utilization rate is less than 25%, the
7        hospital transformation payment shall be equal to 50%
8        of the sum of its transitional hospital access payment
9        authorized under subsection (d) and any supplemental
10        payment authorized under subsection (f).
11        (2) Phase 2. During State fiscal years 2021 and 2022,
12    the Department shall allocate funds from the transitional
13    access hospital pool to create a hospital transformation
14    pool annually and make hospital transformation payments to
15    hospitals participating in the transformation program. Any
16    hospital may seek transformation funding in Phase 2. Any
17    hospital that seeks transformation funding in Phase 2 to
18    update or repurpose the hospital's physical structure to
19    transition to a new delivery model, must submit to the
20    Department in writing a transformation plan, based on the
21    Department's guidelines, that describes the desired
22    delivery model with projections of patient volumes by
23    service lines and projected revenues, expenses, and net
24    income that correspond to the new delivery model. In Phase
25    2, subject to the approval of rules, the Department may use
26    the hospital transformation pool to increase base rates,

 

 

SB1773 Enrolled- 131 -LRB100 09919 KTG 20090 b

1    develop new adjustors, adjust current adjustors, or
2    develop new access payments in order to support and
3    incentivize hospitals to pursue such transformation. In
4    developing such methodologies, the Department shall ensure
5    that the entire hospital transformation pool continues to
6    be expended to ensure access to hospital services or to
7    support organizations that had received hospital
8    transformation payments under this Section.
9            (A) Any hospital participating in the hospital
10        transformation program shall provide an opportunity
11        for public input by local community groups, hospital
12        workers, and healthcare professionals and assist in
13        facilitating discussions about any transformations or
14        changes to the hospital.
15            (B) As provided in paragraph (9) of Section 3 of
16        the Illinois Health Facilities Planning Act, any
17        hospital participating in the transformation program
18        may be excluded from the requirements of the Illinois
19        Health Facilities Planning Act for those projects
20        related to the hospital's transformation. To be
21        eligible, the hospital must submit to the Health
22        Facilities and Services Review Board certification
23        from the Department, approved by the Hospital
24        Transformation Review Committee, that the project is a
25        part of the hospital's transformation.
26            (C) As provided in subsection (a-20) of Section

 

 

SB1773 Enrolled- 132 -LRB100 09919 KTG 20090 b

1        32.5 of the Emergency Medical Services (EMS) Systems
2        Act, a hospital that received hospital transformation
3        payments under this Section may convert to a
4        freestanding emergency center. To be eligible for such
5        a conversion, the hospital must submit to the
6        Department of Public Health certification from the
7        Department, approved by the Hospital Transformation
8        Review Committee, that the project is a part of the
9        hospital's transformation.
10        (3) Within 6 months after the effective date of this
11    amendatory Act of the 100th General Assembly, the
12    Department, in conjunction with the Hospital
13    Transformation Review Committee, shall develop and adopt,
14    by rule, the goals, objectives, policies, standards,
15    payment models, or criteria to be applied in Phase 2 of the
16    program to allocate the hospital transformation funds. The
17    goals, objectives, and policies to be considered may
18    include, but are not limited to, achieving unmet needs of a
19    community that a hospital serves such as behavioral health
20    services, outpatient services, or drug rehabilitation
21    services; attaining certain quality or patient safety
22    benchmarks for health care services; or improving the
23    coordination, effectiveness, and efficiency of care
24    delivery. Notwithstanding any other provision of law, any
25    rule adopted in accordance with this subsection (d-5) may
26    be submitted to the Joint Committee on Administrative Rules

 

 

SB1773 Enrolled- 133 -LRB100 09919 KTG 20090 b

1    for approval only if the rule has first been approved by 9
2    of the 14 members of the Hospital Transformation Review
3    Committee.
4        (4) Hospital Transformation Review Committee. There is
5    created the Hospital Transformation Review Committee. The
6    Committee shall consist of 14 members. No later than 30
7    days after the effective date of this amendatory Act of the
8    100th General Assembly, the 4 legislative leaders shall
9    each appoint 3 members; the Governor shall appoint the
10    Director of Healthcare and Family Services, or his or her
11    designee, as a member; and the Director of Healthcare and
12    Family Services shall appoint one member. Any vacancy shall
13    be filled by the applicable appointing authority within 15
14    calendar days. The members of the Committee shall select a
15    Chair and a Vice-Chair from among its members, provided
16    that the Chair and Vice-Chair cannot be appointed by the
17    same appointing authority and must be from different
18    political parties. The Chair shall have the authority to
19    establish a meeting schedule and convene meetings of the
20    Committee, and the Vice-Chair shall have the authority to
21    convene meetings in the absence of the Chair. The Committee
22    may establish its own rules with respect to meeting
23    schedule, notice of meetings, and the disclosure of
24    documents; however, the Committee shall not have the power
25    to subpoena individuals or documents and any rules must be
26    approved by 9 of the 14 members. The Committee shall

 

 

SB1773 Enrolled- 134 -LRB100 09919 KTG 20090 b

1    perform the functions described in this Section and advise
2    and consult with the Director in the administration of this
3    Section. In addition to reviewing and approving the
4    policies, procedures, and rules for the hospital
5    transformation program, the Committee shall consider and
6    make recommendations related to qualifying criteria and
7    payment methodologies related to safety-net hospitals and
8    children's hospitals. Members of the Committee appointed
9    by the legislative leaders shall be subject to the
10    jurisdiction of the Legislative Ethics Commission, not the
11    Executive Ethics Commission, and all requests under the
12    Freedom of Information Act shall be directed to the
13    applicable Freedom of Information officer for the General
14    Assembly. The Department shall provide operational support
15    to the Committee as necessary.
16    (e) Beginning 36 months after initial implementation, the
17Department shall update the reimbursement components in
18subsections (a) and (b), including standardized amounts and
19weighting factors, and at least triennially and no more
20frequently than annually thereafter. The Department shall
21publish these updates on its website no later than 30 calendar
22days prior to their effective date.
23    (f) Continuation of supplemental payments. Any
24supplemental payments authorized under Illinois Administrative
25Code 148 effective January 1, 2014 and that continue during the
26period of July 1, 2014 through December 31, 2014 shall remain

 

 

SB1773 Enrolled- 135 -LRB100 09919 KTG 20090 b

1in effect as long as the assessment imposed by Section 5A-2
2that is in effect on December 31, 2017 remains is in effect.
3    (g) Notwithstanding subsections (a) through (f) of this
4Section and notwithstanding the changes authorized under
5Section 5-5b.1, any updates to the system shall not result in
6any diminishment of the overall effective rates of
7reimbursement as of the implementation date of the new system
8(July 1, 2014). These updates shall not preclude variations in
9any individual component of the system or hospital rate
10variations. Nothing in this Section shall prohibit the
11Department from increasing the rates of reimbursement or
12developing payments to ensure access to hospital services.
13Nothing in this Section shall be construed to guarantee a
14minimum amount of spending in the aggregate or per hospital as
15spending may be impacted by factors including but not limited
16to the number of individuals in the medical assistance program
17and the severity of illness of the individuals.
18    (h) The Department shall have the authority to modify by
19rulemaking any changes to the rates or methodologies in this
20Section as required by the federal government to obtain federal
21financial participation for expenditures made under this
22Section.
23    (i) Except for subsections (g) and (h) of this Section, the
24Department shall, pursuant to subsection (c) of Section 5-40 of
25the Illinois Administrative Procedure Act, provide for
26presentation at the June 2014 hearing of the Joint Committee on

 

 

SB1773 Enrolled- 136 -LRB100 09919 KTG 20090 b

1Administrative Rules (JCAR) additional written notice to JCAR
2of the following rules in order to commence the second notice
3period for the following rules: rules published in the Illinois
4Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
5(Medical Payment), 4628 (Specialized Health Care Delivery
6Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
7Grouping (DRG) Prospective Payment System (PPS)), and 4977
8(Hospital Reimbursement Changes), and published in the
9Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
10(Specialized Health Care Delivery Systems) and 6505 (Hospital
11Services).
12    (j) Out-of-state hospitals. Beginning July 1, 2018, for
13purposes of determining for State fiscal years 2019 and 2020
14the hospitals eligible for the payments authorized under
15subsections (a) and (b) of this Section, the Department shall
16include out-of-state hospitals that are designated a Level I
17pediatric trauma center or a Level I trauma center by the
18Department of Public Health as of December 1, 2017.
19    (k) The Department shall notify each hospital and managed
20care organization, in writing, of the impact of the updates
21under this Section at least 30 calendar days prior to their
22effective date.
23(Source: P.A. 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)
 
24    Section 95. No acceleration or delay. Where this Act makes
25changes in a statute that is represented in this Act by text

 

 

SB1773 Enrolled- 137 -LRB100 09919 KTG 20090 b

1that is not yet or no longer in effect (for example, a Section
2represented by multiple versions), the use of that text does
3not accelerate or delay the taking effect of (i) the changes
4made by this Act or (ii) provisions derived from any other
5Public Act.
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law, but this Act does not take effect at all unless
8Senate Bill 1573 of the 100th General Assembly, as amended,
9becomes law.