Rep. Gregory Harris

Filed: 2/6/2018

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1773

2    AMENDMENT NO. ______. Amend Senate Bill 1773, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5    "Section 1. The Illinois Administrative Procedure Act is
6amended by changing Section 5-45 and by adding Section 5-46.3
7as follows:
 
8    (5 ILCS 100/5-45)  (from Ch. 127, par. 1005-45)
9    Sec. 5-45. Emergency rulemaking.
10    (a) "Emergency" means the existence of any situation that
11any agency finds reasonably constitutes a threat to the public
12interest, safety, or welfare.
13    (b) If any agency finds that an emergency exists that
14requires adoption of a rule upon fewer days than is required by
15Section 5-40 and states in writing its reasons for that
16finding, the agency may adopt an emergency rule without prior

 

 

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1notice or hearing upon filing a notice of emergency rulemaking
2with the Secretary of State under Section 5-70. The notice
3shall include the text of the emergency rule and shall be
4published in the Illinois Register. Consent orders or other
5court orders adopting settlements negotiated by an agency may
6be adopted under this Section. Subject to applicable
7constitutional or statutory provisions, an emergency rule
8becomes effective immediately upon filing under Section 5-65 or
9at a stated date less than 10 days thereafter. The agency's
10finding and a statement of the specific reasons for the finding
11shall be filed with the rule. The agency shall take reasonable
12and appropriate measures to make emergency rules known to the
13persons who may be affected by them.
14    (c) An emergency rule may be effective for a period of not
15longer than 150 days, but the agency's authority to adopt an
16identical rule under Section 5-40 is not precluded. No
17emergency rule may be adopted more than once in any 24-month
18period, except that this limitation on the number of emergency
19rules that may be adopted in a 24-month period does not apply
20to (i) emergency rules that make additions to and deletions
21from the Drug Manual under Section 5-5.16 of the Illinois
22Public Aid Code or the generic drug formulary under Section
233.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
24emergency rules adopted by the Pollution Control Board before
25July 1, 1997 to implement portions of the Livestock Management
26Facilities Act, (iii) emergency rules adopted by the Illinois

 

 

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1Department of Public Health under subsections (a) through (i)
2of Section 2 of the Department of Public Health Act when
3necessary to protect the public's health, (iv) emergency rules
4adopted pursuant to subsection (n) of this Section, (v)
5emergency rules adopted pursuant to subsection (o) of this
6Section, or (vi) emergency rules adopted pursuant to subsection
7(c-5) of this Section. Two or more emergency rules having
8substantially the same purpose and effect shall be deemed to be
9a single rule for purposes of this Section.
10    (c-5) To facilitate the maintenance of the program of group
11health benefits provided to annuitants, survivors, and retired
12employees under the State Employees Group Insurance Act of
131971, rules to alter the contributions to be paid by the State,
14annuitants, survivors, retired employees, or any combination
15of those entities, for that program of group health benefits,
16shall be adopted as emergency rules. The adoption of those
17rules shall be considered an emergency and necessary for the
18public interest, safety, and welfare.
19    (d) In order to provide for the expeditious and timely
20implementation of the State's fiscal year 1999 budget,
21emergency rules to implement any provision of Public Act 90-587
22or 90-588 or any other budget initiative for fiscal year 1999
23may be adopted in accordance with this Section by the agency
24charged with administering that provision or initiative,
25except that the 24-month limitation on the adoption of
26emergency rules and the provisions of Sections 5-115 and 5-125

 

 

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1do not apply to rules adopted under this subsection (d). The
2adoption of emergency rules authorized by this subsection (d)
3shall be deemed to be necessary for the public interest,
4safety, and welfare.
5    (e) In order to provide for the expeditious and timely
6implementation of the State's fiscal year 2000 budget,
7emergency rules to implement any provision of Public Act 91-24
8or any other budget initiative for fiscal year 2000 may be
9adopted in accordance with this Section by the agency charged
10with administering that provision or initiative, except that
11the 24-month limitation on the adoption of emergency rules and
12the provisions of Sections 5-115 and 5-125 do not apply to
13rules adopted under this subsection (e). The adoption of
14emergency rules authorized by this subsection (e) shall be
15deemed to be necessary for the public interest, safety, and
16welfare.
17    (f) In order to provide for the expeditious and timely
18implementation of the State's fiscal year 2001 budget,
19emergency rules to implement any provision of Public Act 91-712
20or any other budget initiative for fiscal year 2001 may be
21adopted in accordance with this Section by the agency charged
22with administering that provision or initiative, except that
23the 24-month limitation on the adoption of emergency rules and
24the provisions of Sections 5-115 and 5-125 do not apply to
25rules adopted under this subsection (f). The adoption of
26emergency rules authorized by this subsection (f) shall be

 

 

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1deemed to be necessary for the public interest, safety, and
2welfare.
3    (g) In order to provide for the expeditious and timely
4implementation of the State's fiscal year 2002 budget,
5emergency rules to implement any provision of Public Act 92-10
6or any other budget initiative for fiscal year 2002 may be
7adopted in accordance with this Section by the agency charged
8with administering that provision or initiative, except that
9the 24-month limitation on the adoption of emergency rules and
10the provisions of Sections 5-115 and 5-125 do not apply to
11rules adopted under this subsection (g). The adoption of
12emergency rules authorized by this subsection (g) shall be
13deemed to be necessary for the public interest, safety, and
14welfare.
15    (h) In order to provide for the expeditious and timely
16implementation of the State's fiscal year 2003 budget,
17emergency rules to implement any provision of Public Act 92-597
18or any other budget initiative for fiscal year 2003 may be
19adopted in accordance with this Section by the agency charged
20with administering that provision or initiative, except that
21the 24-month limitation on the adoption of emergency rules and
22the provisions of Sections 5-115 and 5-125 do not apply to
23rules adopted under this subsection (h). The adoption of
24emergency rules authorized by this subsection (h) shall be
25deemed to be necessary for the public interest, safety, and
26welfare.

 

 

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1    (i) In order to provide for the expeditious and timely
2implementation of the State's fiscal year 2004 budget,
3emergency rules to implement any provision of Public Act 93-20
4or any other budget initiative for fiscal year 2004 may be
5adopted in accordance with this Section by the agency charged
6with administering that provision or initiative, except that
7the 24-month limitation on the adoption of emergency rules and
8the provisions of Sections 5-115 and 5-125 do not apply to
9rules adopted under this subsection (i). The adoption of
10emergency rules authorized by this subsection (i) shall be
11deemed to be necessary for the public interest, safety, and
12welfare.
13    (j) In order to provide for the expeditious and timely
14implementation of the provisions of the State's fiscal year
152005 budget as provided under the Fiscal Year 2005 Budget
16Implementation (Human Services) Act, emergency rules to
17implement any provision of the Fiscal Year 2005 Budget
18Implementation (Human Services) Act may be adopted in
19accordance with this Section by the agency charged with
20administering that provision, except that the 24-month
21limitation on the adoption of emergency rules and the
22provisions of Sections 5-115 and 5-125 do not apply to rules
23adopted under this subsection (j). The Department of Public Aid
24may also adopt rules under this subsection (j) necessary to
25administer the Illinois Public Aid Code and the Children's
26Health Insurance Program Act. The adoption of emergency rules

 

 

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1authorized by this subsection (j) shall be deemed to be
2necessary for the public interest, safety, and welfare.
3    (k) In order to provide for the expeditious and timely
4implementation of the provisions of the State's fiscal year
52006 budget, emergency rules to implement any provision of
6Public Act 94-48 or any other budget initiative for fiscal year
72006 may be adopted in accordance with this Section by the
8agency charged with administering that provision or
9initiative, except that the 24-month limitation on the adoption
10of emergency rules and the provisions of Sections 5-115 and
115-125 do not apply to rules adopted under this subsection (k).
12The Department of Healthcare and Family Services may also adopt
13rules under this subsection (k) necessary to administer the
14Illinois Public Aid Code, the Senior Citizens and Persons with
15Disabilities Property Tax Relief Act, the Senior Citizens and
16Disabled Persons Prescription Drug Discount Program Act (now
17the Illinois Prescription Drug Discount Program Act), and the
18Children's Health Insurance Program Act. The adoption of
19emergency rules authorized by this subsection (k) shall be
20deemed to be necessary for the public interest, safety, and
21welfare.
22    (l) In order to provide for the expeditious and timely
23implementation of the provisions of the State's fiscal year
242007 budget, the Department of Healthcare and Family Services
25may adopt emergency rules during fiscal year 2007, including
26rules effective July 1, 2007, in accordance with this

 

 

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1subsection to the extent necessary to administer the
2Department's responsibilities with respect to amendments to
3the State plans and Illinois waivers approved by the federal
4Centers for Medicare and Medicaid Services necessitated by the
5requirements of Title XIX and Title XXI of the federal Social
6Security Act. The adoption of emergency rules authorized by
7this subsection (l) shall be deemed to be necessary for the
8public interest, safety, and welfare.
9    (m) In order to provide for the expeditious and timely
10implementation of the provisions of the State's fiscal year
112008 budget, the Department of Healthcare and Family Services
12may adopt emergency rules during fiscal year 2008, including
13rules effective July 1, 2008, in accordance with this
14subsection to the extent necessary to administer the
15Department's responsibilities with respect to amendments to
16the State plans and Illinois waivers approved by the federal
17Centers for Medicare and Medicaid Services necessitated by the
18requirements of Title XIX and Title XXI of the federal Social
19Security Act. The adoption of emergency rules authorized by
20this subsection (m) shall be deemed to be necessary for the
21public interest, safety, and welfare.
22    (n) In order to provide for the expeditious and timely
23implementation of the provisions of the State's fiscal year
242010 budget, emergency rules to implement any provision of
25Public Act 96-45 or any other budget initiative authorized by
26the 96th General Assembly for fiscal year 2010 may be adopted

 

 

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1in accordance with this Section by the agency charged with
2administering that provision or initiative. The adoption of
3emergency rules authorized by this subsection (n) shall be
4deemed to be necessary for the public interest, safety, and
5welfare. The rulemaking authority granted in this subsection
6(n) shall apply only to rules promulgated during Fiscal Year
72010.
8    (o) In order to provide for the expeditious and timely
9implementation of the provisions of the State's fiscal year
102011 budget, emergency rules to implement any provision of
11Public Act 96-958 or any other budget initiative authorized by
12the 96th General Assembly for fiscal year 2011 may be adopted
13in accordance with this Section by the agency charged with
14administering that provision or initiative. The adoption of
15emergency rules authorized by this subsection (o) is deemed to
16be necessary for the public interest, safety, and welfare. The
17rulemaking authority granted in this subsection (o) applies
18only to rules promulgated on or after July 1, 2010 (the
19effective date of Public Act 96-958) through June 30, 2011.
20    (p) In order to provide for the expeditious and timely
21implementation of the provisions of Public Act 97-689,
22emergency rules to implement any provision of Public Act 97-689
23may be adopted in accordance with this subsection (p) by the
24agency charged with administering that provision or
25initiative. The 150-day limitation of the effective period of
26emergency rules does not apply to rules adopted under this

 

 

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1subsection (p), and the effective period may continue through
2June 30, 2013. The 24-month limitation on the adoption of
3emergency rules does not apply to rules adopted under this
4subsection (p). The adoption of emergency rules authorized by
5this subsection (p) is deemed to be necessary for the public
6interest, safety, and welfare.
7    (q) In order to provide for the expeditious and timely
8implementation of the provisions of Articles 7, 8, 9, 11, and
912 of Public Act 98-104, emergency rules to implement any
10provision of Articles 7, 8, 9, 11, and 12 of Public Act 98-104
11may be adopted in accordance with this subsection (q) by the
12agency charged with administering that provision or
13initiative. The 24-month limitation on the adoption of
14emergency rules does not apply to rules adopted under this
15subsection (q). The adoption of emergency rules authorized by
16this subsection (q) is deemed to be necessary for the public
17interest, safety, and welfare.
18    (r) In order to provide for the expeditious and timely
19implementation of the provisions of Public Act 98-651,
20emergency rules to implement Public Act 98-651 may be adopted
21in accordance with this subsection (r) by the Department of
22Healthcare and Family Services. The 24-month limitation on the
23adoption of emergency rules does not apply to rules adopted
24under this subsection (r). The adoption of emergency rules
25authorized by this subsection (r) is deemed to be necessary for
26the public interest, safety, and welfare.

 

 

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1    (s) In order to provide for the expeditious and timely
2implementation of the provisions of Sections 5-5b.1 and 5A-2 of
3the Illinois Public Aid Code, emergency rules to implement any
4provision of Section 5-5b.1 or Section 5A-2 of the Illinois
5Public Aid Code may be adopted in accordance with this
6subsection (s) by the Department of Healthcare and Family
7Services. The rulemaking authority granted in this subsection
8(s) shall apply only to those rules adopted prior to July 1,
92015. Notwithstanding any other provision of this Section, any
10emergency rule adopted under this subsection (s) shall only
11apply to payments made for State fiscal year 2015. The adoption
12of emergency rules authorized by this subsection (s) is deemed
13to be necessary for the public interest, safety, and welfare.
14    (t) In order to provide for the expeditious and timely
15implementation of the provisions of Article II of Public Act
1699-6, emergency rules to implement the changes made by Article
17II of Public Act 99-6 to the Emergency Telephone System Act may
18be adopted in accordance with this subsection (t) by the
19Department of State Police. The rulemaking authority granted in
20this subsection (t) shall apply only to those rules adopted
21prior to July 1, 2016. The 24-month limitation on the adoption
22of emergency rules does not apply to rules adopted under this
23subsection (t). The adoption of emergency rules authorized by
24this subsection (t) is deemed to be necessary for the public
25interest, safety, and welfare.
26    (u) In order to provide for the expeditious and timely

 

 

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1implementation of the provisions of the Burn Victims Relief
2Act, emergency rules to implement any provision of the Act may
3be adopted in accordance with this subsection (u) by the
4Department of Insurance. The rulemaking authority granted in
5this subsection (u) shall apply only to those rules adopted
6prior to December 31, 2015. The adoption of emergency rules
7authorized by this subsection (u) is deemed to be necessary for
8the public interest, safety, and welfare.
9    (v) In order to provide for the expeditious and timely
10implementation of the provisions of Public Act 99-516,
11emergency rules to implement Public Act 99-516 may be adopted
12in accordance with this subsection (v) by the Department of
13Healthcare and Family Services. The 24-month limitation on the
14adoption of emergency rules does not apply to rules adopted
15under this subsection (v). The adoption of emergency rules
16authorized by this subsection (v) is deemed to be necessary for
17the public interest, safety, and welfare.
18    (w) In order to provide for the expeditious and timely
19implementation of the provisions of Public Act 99-796,
20emergency rules to implement the changes made by Public Act
2199-796 may be adopted in accordance with this subsection (w) by
22the Adjutant General. The adoption of emergency rules
23authorized by this subsection (w) is deemed to be necessary for
24the public interest, safety, and welfare.
25    (x) In order to provide for the expeditious and timely
26implementation of the provisions of Public Act 99-906,

 

 

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1emergency rules to implement subsection (i) of Section 16-115D,
2subsection (g) of Section 16-128A, and subsection (a) of
3Section 16-128B of the Public Utilities Act may be adopted in
4accordance with this subsection (x) by the Illinois Commerce
5Commission. The rulemaking authority granted in this
6subsection (x) shall apply only to those rules adopted within
7180 days after June 1, 2017 (the effective date of Public Act
899-906). The adoption of emergency rules authorized by this
9subsection (x) is deemed to be necessary for the public
10interest, safety, and welfare.
11    (y) In order to provide for the expeditious and timely
12implementation of the provisions of this amendatory Act of the
13100th General Assembly, emergency rules to implement the
14changes made by this amendatory Act of the 100th General
15Assembly to Section 4.02 of the Illinois Act on Aging, Sections
165.5.4 and 5-5.4i of the Illinois Public Aid Code, Section 55-30
17of the Alcoholism and Other Drug Abuse and Dependency Act, and
18Sections 74 and 75 of the Mental Health and Developmental
19Disabilities Administrative Act may be adopted in accordance
20with this subsection (y) by the respective Department. The
21adoption of emergency rules authorized by this subsection (y)
22is deemed to be necessary for the public interest, safety, and
23welfare.
24    (z) In order to provide for the expeditious and timely
25implementation of the provisions of this amendatory Act of the
26100th General Assembly, emergency rules to implement the

 

 

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1changes made by this amendatory Act of the 100th General
2Assembly to Section 4.7 of the Lobbyist Registration Act may be
3adopted in accordance with this subsection (z) by the Secretary
4of State. The adoption of emergency rules authorized by this
5subsection (z) is deemed to be necessary for the public
6interest, safety, and welfare.
7    (aa) In order to provide for the expeditious and timely
8initial implementation of the changes made to Articles 5, 5A,
912, and 14 of the Illinois Public Aid Code under the provisions
10of this amendatory Act of the 100th General Assembly, the
11Department of Healthcare and Family Services may adopt
12emergency rules in accordance with this subsection (aa). The
1324-month limitation on the adoption of emergency rules does not
14apply to rules to initially implement the changes made to
15Articles 5, 5A, 12, and 14 of the Illinois Public Aid Code
16adopted under this subsection (aa). The adoption of emergency
17rules authorized by this subsection (aa) is deemed to be
18necessary for the public interest, safety, and welfare.
19(Source: P.A. 99-2, eff. 3-26-15; 99-6, eff. 1-1-16; 99-143,
20eff. 7-27-15; 99-455, eff. 1-1-16; 99-516, eff. 6-30-16;
2199-642, eff. 7-28-16; 99-796, eff. 1-1-17; 99-906, eff. 6-1-17;
22100-23, eff. 7-6-17; 100-554, eff. 11-16-17.)
 
23    (5 ILCS 100/5-46.3 new)
24    Sec. 5-46.3. Approval of rules to implement the hospital
25transformation program. Notwithstanding any other provision of

 

 

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1this Act, the Department of Healthcare and Family Services may
2not file, the Secretary of State may not accept, and the Joint
3Committee on Administrative Rules may not consider any rules
4adopted in accordance to subsection (d-5) of Section 14-12 of
5the Illinois Public Aid Code unless the rules have been
6approved by 7 of the 10 members of the Hospital Transformation
7Review Committee created under subsection (d-5) of Section
814-12 of the Illinois Public Aid Code. Approval of the rules
9shall be demonstrated by submission of a written document
10signed by each of the 7 approving members. The Department of
11Healthcare and Family Services shall submit the written
12document with signatures, along with a certified copy of each
13rule, to the Secretary of State.
 
14    Section 2. The Illinois Health Facilities Planning Act is
15amended by changing Section 3 as follows:
 
16    (20 ILCS 3960/3)  (from Ch. 111 1/2, par. 1153)
17    (Text of Section before amendment by P.A. 100-518)
18    (Section scheduled to be repealed on December 31, 2019)
19    Sec. 3. Definitions. As used in this Act:
20    "Health care facilities" means and includes the following
21facilities, organizations, and related persons:
22        (1) An ambulatory surgical treatment center required
23    to be licensed pursuant to the Ambulatory Surgical
24    Treatment Center Act.

 

 

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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.

 

 

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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

 

 

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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        (9) Any project the Department of Healthcare and Family
12    Service certifies was approved by the Hospital
13    Transformation Review Committee as a project subject to the
14    hospital's transformation under subsection (d-5) of
15    Section 14-12 of the Illinois Public Aid Code, provided the
16    hospital shall submit the certification to the Board.
17    "Health care facilities" does not include the following
18entities or facility transactions:
19        (1) Federally-owned facilities.
20        (2) Facilities used solely for healing by prayer or
21    spiritual means.
22        (3) An existing facility located on any campus facility
23    as defined in Section 5-5.8b of the Illinois Public Aid
24    Code, provided that the campus facility encompasses 30 or
25    more contiguous acres and that the new or renovated
26    facility is intended for use by a licensed residential

 

 

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

 

 

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1        (8) Any change of ownership of a health care facility
2    that is licensed under the Nursing Home Care Act, the
3    Specialized Mental Health Rehabilitation Act of 2013, the
4    ID/DD Community Care Act, or the MC/DD Act, with the
5    exception of facilities operated by a county or Illinois
6    Veterans Homes. Changes of ownership of facilities
7    licensed under the Nursing Home Care Act must meet the
8    requirements set forth in Sections 3-101 through 3-119 of
9    the Nursing Home Care Act.
10    With the exception of those health care facilities
11specifically included in this Section, nothing in this Act
12shall be intended to include facilities operated as a part of
13the practice of a physician or other licensed health care
14professional, whether practicing in his individual capacity or
15within the legal structure of any partnership, medical or
16professional corporation, or unincorporated medical or
17professional group. Further, this Act shall not apply to
18physicians or other licensed health care professional's
19practices where such practices are carried out in a portion of
20a health care facility under contract with such health care
21facility by a physician or by other licensed health care
22professionals, whether practicing in his individual capacity
23or within the legal structure of any partnership, medical or
24professional corporation, or unincorporated medical or
25professional groups, unless the entity constructs, modifies,
26or establishes a health care facility as specifically defined

 

 

10000SB1773ham004- 21 -LRB100 09919 KTG 35698 a

1in this Section. This Act shall apply to construction or
2modification and to establishment by such health care facility
3of such contracted portion which is subject to facility
4licensing requirements, irrespective of the party responsible
5for such action or attendant financial obligation.
6    "Person" means any one or more natural persons, legal
7entities, governmental bodies other than federal, or any
8combination thereof.
9    "Consumer" means any person other than a person (a) whose
10major occupation currently involves or whose official capacity
11within the last 12 months has involved the providing,
12administering or financing of any type of health care facility,
13(b) who is engaged in health research or the teaching of
14health, (c) who has a material financial interest in any
15activity which involves the providing, administering or
16financing of any type of health care facility, or (d) who is or
17ever has been a member of the immediate family of the person
18defined by (a), (b), or (c).
19    "State Board" or "Board" means the Health Facilities and
20Services Review Board.
21    "Construction or modification" means the establishment,
22erection, building, alteration, reconstruction, modernization,
23improvement, extension, discontinuation, change of ownership,
24of or by a health care facility, or the purchase or acquisition
25by or through a health care facility of equipment or service
26for diagnostic or therapeutic purposes or for facility

 

 

10000SB1773ham004- 22 -LRB100 09919 KTG 35698 a

1administration or operation, or any capital expenditure made by
2or on behalf of a health care facility which exceeds the
3capital expenditure minimum; however, any capital expenditure
4made by or on behalf of a health care facility for (i) the
5construction or modification of a facility licensed under the
6Assisted Living and Shared Housing Act or (ii) a conversion
7project undertaken in accordance with Section 30 of the Older
8Adult Services Act shall be excluded from any obligations under
9this Act.
10    "Establish" means the construction of a health care
11facility or the replacement of an existing facility on another
12site or the initiation of a category of service.
13    "Major medical equipment" means medical equipment which is
14used for the provision of medical and other health services and
15which costs in excess of the capital expenditure minimum,
16except that such term does not include medical equipment
17acquired by or on behalf of a clinical laboratory to provide
18clinical laboratory services if the clinical laboratory is
19independent of a physician's office and a hospital and it has
20been determined under Title XVIII of the Social Security Act to
21meet the requirements of paragraphs (10) and (11) of Section
221861(s) of such Act. In determining whether medical equipment
23has a value in excess of the capital expenditure minimum, the
24value of studies, surveys, designs, plans, working drawings,
25specifications, and other activities essential to the
26acquisition of such equipment shall be included.

 

 

10000SB1773ham004- 23 -LRB100 09919 KTG 35698 a

1    "Capital Expenditure" means an expenditure: (A) made by or
2on behalf of a health care facility (as such a facility is
3defined in this Act); and (B) which under generally accepted
4accounting principles is not properly chargeable as an expense
5of operation and maintenance, or is made to obtain by lease or
6comparable arrangement any facility or part thereof or any
7equipment for a facility or part; and which exceeds the capital
8expenditure minimum.
9    For the purpose of this paragraph, the cost of any studies,
10surveys, designs, plans, working drawings, specifications, and
11other activities essential to the acquisition, improvement,
12expansion, or replacement of any plant or equipment with
13respect to which an expenditure is made shall be included in
14determining if such expenditure exceeds the capital
15expenditures minimum. Unless otherwise interdependent, or
16submitted as one project by the applicant, components of
17construction or modification undertaken by means of a single
18construction contract or financed through the issuance of a
19single debt instrument shall not be grouped together as one
20project. Donations of equipment or facilities to a health care
21facility which if acquired directly by such facility would be
22subject to review under this Act shall be considered capital
23expenditures, and a transfer of equipment or facilities for
24less than fair market value shall be considered a capital
25expenditure for purposes of this Act if a transfer of the
26equipment or facilities at fair market value would be subject

 

 

10000SB1773ham004- 24 -LRB100 09919 KTG 35698 a

1to review.
2    "Capital expenditure minimum" means $11,500,000 for
3projects by hospital applicants, $6,500,000 for applicants for
4projects related to skilled and intermediate care long-term
5care facilities licensed under the Nursing Home Care Act, and
6$3,000,000 for projects by all other applicants, which shall be
7annually adjusted to reflect the increase in construction costs
8due to inflation, for major medical equipment and for all other
9capital expenditures.
10    "Non-clinical service area" means an area (i) for the
11benefit of the patients, visitors, staff, or employees of a
12health care facility and (ii) not directly related to the
13diagnosis, treatment, or rehabilitation of persons receiving
14services from the health care facility. "Non-clinical service
15areas" include, but are not limited to, chapels; gift shops;
16news stands; computer systems; tunnels, walkways, and
17elevators; telephone systems; projects to comply with life
18safety codes; educational facilities; student housing;
19patient, employee, staff, and visitor dining areas;
20administration and volunteer offices; modernization of
21structural components (such as roof replacement and masonry
22work); boiler repair or replacement; vehicle maintenance and
23storage facilities; parking facilities; mechanical systems for
24heating, ventilation, and air conditioning; loading docks; and
25repair or replacement of carpeting, tile, wall coverings,
26window coverings or treatments, or furniture. Solely for the

 

 

10000SB1773ham004- 25 -LRB100 09919 KTG 35698 a

1purpose of this definition, "non-clinical service area" does
2not include health and fitness centers.
3    "Areawide" means a major area of the State delineated on a
4geographic, demographic, and functional basis for health
5planning and for health service and having within it one or
6more local areas for health planning and health service. The
7term "region", as contrasted with the term "subregion", and the
8word "area" may be used synonymously with the term "areawide".
9    "Local" means a subarea of a delineated major area that on
10a geographic, demographic, and functional basis may be
11considered to be part of such major area. The term "subregion"
12may be used synonymously with the term "local".
13    "Physician" means a person licensed to practice in
14accordance with the Medical Practice Act of 1987, as amended.
15    "Licensed health care professional" means a person
16licensed to practice a health profession under pertinent
17licensing statutes of the State of Illinois.
18    "Director" means the Director of the Illinois Department of
19Public Health.
20    "Agency" or "Department" means the Illinois Department of
21Public Health.
22    "Alternative health care model" means a facility or program
23authorized under the Alternative Health Care Delivery Act.
24    "Out-of-state facility" means a person that is both (i)
25licensed as a hospital or as an ambulatory surgery center under
26the laws of another state or that qualifies as a hospital or an

 

 

10000SB1773ham004- 26 -LRB100 09919 KTG 35698 a

1ambulatory surgery center under regulations adopted pursuant
2to the Social Security Act and (ii) not licensed under the
3Ambulatory Surgical Treatment Center Act, the Hospital
4Licensing Act, or the Nursing Home Care Act. Affiliates of
5out-of-state facilities shall be considered out-of-state
6facilities. Affiliates of Illinois licensed health care
7facilities 100% owned by an Illinois licensed health care
8facility, its parent, or Illinois physicians licensed to
9practice medicine in all its branches shall not be considered
10out-of-state facilities. Nothing in this definition shall be
11construed to include an office or any part of an office of a
12physician licensed to practice medicine in all its branches in
13Illinois that is not required to be licensed under the
14Ambulatory Surgical Treatment Center Act.
15    "Change of ownership of a health care facility" means a
16change in the person who has ownership or control of a health
17care facility's physical plant and capital assets. A change in
18ownership is indicated by the following transactions: sale,
19transfer, acquisition, lease, change of sponsorship, or other
20means of transferring control.
21    "Related person" means any person that: (i) is at least 50%
22owned, directly or indirectly, by either the health care
23facility or a person owning, directly or indirectly, at least
2450% of the health care facility; or (ii) owns, directly or
25indirectly, at least 50% of the health care facility.
26    "Charity care" means care provided by a health care

 

 

10000SB1773ham004- 27 -LRB100 09919 KTG 35698 a

1facility for which the provider does not expect to receive
2payment from the patient or a third-party payer.
3    "Freestanding emergency center" means a facility subject
4to licensure under Section 32.5 of the Emergency Medical
5Services (EMS) Systems Act.
6    "Category of service" means a grouping by generic class of
7various types or levels of support functions, equipment, care,
8or treatment provided to patients or residents, including, but
9not limited to, classes such as medical-surgical, pediatrics,
10or cardiac catheterization. A category of service may include
11subcategories or levels of care that identify a particular
12degree or type of care within the category of service. Nothing
13in this definition shall be construed to include the practice
14of a physician or other licensed health care professional while
15functioning in an office providing for the care, diagnosis, or
16treatment of patients. A category of service that is subject to
17the Board's jurisdiction must be designated in rules adopted by
18the Board.
19    "State Board Staff Report" means the document that sets
20forth the review and findings of the State Board staff, as
21prescribed by the State Board, regarding applications subject
22to Board jurisdiction.
23(Source: P.A. 98-414, eff. 1-1-14; 98-629, eff. 1-1-15; 98-651,
24eff. 6-16-14; 98-1086, eff. 8-26-14; 99-78, eff. 7-20-15;
2599-180, eff. 7-29-15; 99-527, eff. 1-1-17.)
 

 

 

10000SB1773ham004- 28 -LRB100 09919 KTG 35698 a

1    (Text of Section after amendment by P.A. 100-518)
2    (Section scheduled to be repealed on December 31, 2019)
3    Sec. 3. Definitions. As used in this Act:
4    "Health care facilities" means and includes the following
5facilities, organizations, and related persons:
6        (1) An ambulatory surgical treatment center required
7    to be licensed pursuant to the Ambulatory Surgical
8    Treatment Center Act.
9        (2) An institution, place, building, or agency
10    required to be licensed pursuant to the Hospital Licensing
11    Act.
12        (3) Skilled and intermediate long term care facilities
13    licensed under the Nursing Home Care Act.
14            (A) If a demonstration project under the Nursing
15        Home Care Act applies for a certificate of need to
16        convert to a nursing facility, it shall meet the
17        licensure and certificate of need requirements in
18        effect as of the date of application.
19            (B) Except as provided in item (A) of this
20        subsection, this Act does not apply to facilities
21        granted waivers under Section 3-102.2 of the Nursing
22        Home Care Act.
23        (3.5) Skilled and intermediate care facilities
24    licensed under the ID/DD Community Care Act or the MC/DD
25    Act. No permit or exemption is required for a facility
26    licensed under the ID/DD Community Care Act or the MC/DD

 

 

10000SB1773ham004- 29 -LRB100 09919 KTG 35698 a

1    Act prior to the reduction of the number of beds at a
2    facility. If there is a total reduction of beds at a
3    facility licensed under the ID/DD Community Care Act or the
4    MC/DD Act, this is a discontinuation or closure of the
5    facility. If a facility licensed under the ID/DD Community
6    Care Act or the MC/DD Act reduces the number of beds or
7    discontinues the facility, that facility must notify the
8    Board as provided in Section 14.1 of this Act.
9        (3.7) Facilities licensed under the Specialized Mental
10    Health Rehabilitation Act of 2013.
11        (4) Hospitals, nursing homes, ambulatory surgical
12    treatment centers, or kidney disease treatment centers
13    maintained by the State or any department or agency
14    thereof.
15        (5) Kidney disease treatment centers, including a
16    free-standing hemodialysis unit required to be licensed
17    under the End Stage Renal Disease Facility Act.
18            (A) This Act does not apply to a dialysis facility
19        that provides only dialysis training, support, and
20        related services to individuals with end stage renal
21        disease who have elected to receive home dialysis.
22            (B) This Act does not apply to a dialysis unit
23        located in a licensed nursing home that offers or
24        provides dialysis-related services to residents with
25        end stage renal disease who have elected to receive
26        home dialysis within the nursing home.

 

 

10000SB1773ham004- 30 -LRB100 09919 KTG 35698 a

1            (C) The Board, however, may require dialysis
2        facilities and licensed nursing homes under items (A)
3        and (B) of this subsection to report statistical
4        information on a quarterly basis to the Board to be
5        used by the Board to conduct analyses on the need for
6        proposed kidney disease treatment centers.
7        (6) An institution, place, building, or room used for
8    the performance of outpatient surgical procedures that is
9    leased, owned, or operated by or on behalf of an
10    out-of-state facility.
11        (7) An institution, place, building, or room used for
12    provision of a health care category of service, including,
13    but not limited to, cardiac catheterization and open heart
14    surgery.
15        (8) An institution, place, building, or room housing
16    major medical equipment used in the direct clinical
17    diagnosis or treatment of patients, and whose project cost
18    is in excess of the capital expenditure minimum.
19        (9) Any project the Department of Healthcare and Family
20    Service certifies was approved by the Hospital
21    Transformation Review Committee as a project subject to the
22    hospital's transformation under subsection (d-5) of
23    Section 14-12 of the Illinois Public Aid Code, provided the
24    hospital shall submit the certification to the Board.
25    "Health care facilities" does not include the following
26entities or facility transactions:

 

 

10000SB1773ham004- 31 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 32 -LRB100 09919 KTG 35698 a

1    facilities operated by a county or Illinois Veterans Homes,
2    that elect to convert, in whole or in part, to an assisted
3    living or shared housing establishment licensed under the
4    Assisted Living and Shared Housing Act and with the
5    exception of a facility licensed under the Specialized
6    Mental Health Rehabilitation Act of 2013 in connection with
7    a proposal to close a facility and re-establish the
8    facility in another location.
9        (8) Any change of ownership of a health care facility
10    that is licensed under the Nursing Home Care Act, the
11    Specialized Mental Health Rehabilitation Act of 2013, the
12    ID/DD Community Care Act, or the MC/DD Act, with the
13    exception of facilities operated by a county or Illinois
14    Veterans Homes. Changes of ownership of facilities
15    licensed under the Nursing Home Care Act must meet the
16    requirements set forth in Sections 3-101 through 3-119 of
17    the Nursing Home Care Act.
18    With the exception of those health care facilities
19specifically included in this Section, nothing in this Act
20shall be intended to include facilities operated as a part of
21the practice of a physician or other licensed health care
22professional, whether practicing in his individual capacity or
23within the legal structure of any partnership, medical or
24professional corporation, or unincorporated medical or
25professional group. Further, this Act shall not apply to
26physicians or other licensed health care professional's

 

 

10000SB1773ham004- 33 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 34 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 35 -LRB100 09919 KTG 35698 a

1independent of a physician's office and a hospital and it has
2been determined under Title XVIII of the Social Security Act to
3meet the requirements of paragraphs (10) and (11) of Section
41861(s) of such Act. In determining whether medical equipment
5has a value in excess of the capital expenditure minimum, the
6value of studies, surveys, designs, plans, working drawings,
7specifications, and other activities essential to the
8acquisition of such equipment shall be included.
9    "Capital Expenditure" means an expenditure: (A) made by or
10on behalf of a health care facility (as such a facility is
11defined in this Act); and (B) which under generally accepted
12accounting principles is not properly chargeable as an expense
13of operation and maintenance, or is made to obtain by lease or
14comparable arrangement any facility or part thereof or any
15equipment for a facility or part; and which exceeds the capital
16expenditure minimum.
17    For the purpose of this paragraph, the cost of any studies,
18surveys, designs, plans, working drawings, specifications, and
19other activities essential to the acquisition, improvement,
20expansion, or replacement of any plant or equipment with
21respect to which an expenditure is made shall be included in
22determining if such expenditure exceeds the capital
23expenditures minimum. Unless otherwise interdependent, or
24submitted as one project by the applicant, components of
25construction or modification undertaken by means of a single
26construction contract or financed through the issuance of a

 

 

10000SB1773ham004- 36 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 37 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 38 -LRB100 09919 KTG 35698 a

1accordance with the Medical Practice Act of 1987, as amended.
2    "Licensed health care professional" means a person
3licensed to practice a health profession under pertinent
4licensing statutes of the State of Illinois.
5    "Director" means the Director of the Illinois Department of
6Public Health.
7    "Agency" or "Department" means the Illinois Department of
8Public Health.
9    "Alternative health care model" means a facility or program
10authorized under the Alternative Health Care Delivery Act.
11    "Out-of-state facility" means a person that is both (i)
12licensed as a hospital or as an ambulatory surgery center under
13the laws of another state or that qualifies as a hospital or an
14ambulatory surgery center under regulations adopted pursuant
15to the Social Security Act and (ii) not licensed under the
16Ambulatory Surgical Treatment Center Act, the Hospital
17Licensing Act, or the Nursing Home Care Act. Affiliates of
18out-of-state facilities shall be considered out-of-state
19facilities. Affiliates of Illinois licensed health care
20facilities 100% owned by an Illinois licensed health care
21facility, its parent, or Illinois physicians licensed to
22practice medicine in all its branches shall not be considered
23out-of-state facilities. Nothing in this definition shall be
24construed to include an office or any part of an office of a
25physician licensed to practice medicine in all its branches in
26Illinois that is not required to be licensed under the

 

 

10000SB1773ham004- 39 -LRB100 09919 KTG 35698 a

1Ambulatory Surgical Treatment Center Act.
2    "Change of ownership of a health care facility" means a
3change in the person who has ownership or control of a health
4care facility's physical plant and capital assets. A change in
5ownership is indicated by the following transactions: sale,
6transfer, acquisition, lease, change of sponsorship, or other
7means of transferring control.
8    "Related person" means any person that: (i) is at least 50%
9owned, directly or indirectly, by either the health care
10facility or a person owning, directly or indirectly, at least
1150% of the health care facility; or (ii) owns, directly or
12indirectly, at least 50% of the health care facility.
13    "Charity care" means care provided by a health care
14facility for which the provider does not expect to receive
15payment from the patient or a third-party payer.
16    "Freestanding emergency center" means a facility subject
17to licensure under Section 32.5 of the Emergency Medical
18Services (EMS) Systems Act.
19    "Category of service" means a grouping by generic class of
20various types or levels of support functions, equipment, care,
21or treatment provided to patients or residents, including, but
22not limited to, classes such as medical-surgical, pediatrics,
23or cardiac catheterization. A category of service may include
24subcategories or levels of care that identify a particular
25degree or type of care within the category of service. Nothing
26in this definition shall be construed to include the practice

 

 

10000SB1773ham004- 40 -LRB100 09919 KTG 35698 a

1of a physician or other licensed health care professional while
2functioning in an office providing for the care, diagnosis, or
3treatment of patients. A category of service that is subject to
4the Board's jurisdiction must be designated in rules adopted by
5the Board.
6    "State Board Staff Report" means the document that sets
7forth the review and findings of the State Board staff, as
8prescribed by the State Board, regarding applications subject
9to Board jurisdiction.
10(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
1199-527, eff. 1-1-17; 100-518, eff. 6-1-18.)
 
12    Section 5. The Illinois Procurement Code is amended by
13changing Section 1-10 as follows:
 
14    (30 ILCS 500/1-10)
15    Sec. 1-10. Application.
16    (a) This Code applies only to procurements for which
17bidders, offerors, potential contractors, or contractors were
18first solicited on or after July 1, 1998. This Code shall not
19be construed to affect or impair any contract, or any provision
20of a contract, entered into based on a solicitation prior to
21the implementation date of this Code as described in Article
2299, including but not limited to any covenant entered into with
23respect to any revenue bonds or similar instruments. All
24procurements for which contracts are solicited between the

 

 

10000SB1773ham004- 41 -LRB100 09919 KTG 35698 a

1effective date of Articles 50 and 99 and July 1, 1998 shall be
2substantially in accordance with this Code and its intent.
3    (b) This Code shall apply regardless of the source of the
4funds with which the contracts are paid, including federal
5assistance moneys. This Except as specifically provided in this
6Code, this Code shall not apply to:
7        (1) Contracts between the State and its political
8    subdivisions or other governments, or between State
9    governmental bodies, except as specifically provided in
10    this Code.
11        (2) Grants, except for the filing requirements of
12    Section 20-80.
13        (3) Purchase of care, except as provided in Section
14    5-30.6 of the Illinois Public Aid Code and this Section.
15        (4) Hiring of an individual as employee and not as an
16    independent contractor, whether pursuant to an employment
17    code or policy or by contract directly with that
18    individual.
19        (5) Collective bargaining contracts.
20        (6) Purchase of real estate, except that notice of this
21    type of contract with a value of more than $25,000 must be
22    published in the Procurement Bulletin within 10 calendar
23    days after the deed is recorded in the county of
24    jurisdiction. The notice shall identify the real estate
25    purchased, the names of all parties to the contract, the
26    value of the contract, and the effective date of the

 

 

10000SB1773ham004- 42 -LRB100 09919 KTG 35698 a

1    contract.
2        (7) Contracts necessary to prepare for anticipated
3    litigation, enforcement actions, or investigations,
4    provided that the chief legal counsel to the Governor shall
5    give his or her prior approval when the procuring agency is
6    one subject to the jurisdiction of the Governor, and
7    provided that the chief legal counsel of any other
8    procuring entity subject to this Code shall give his or her
9    prior approval when the procuring entity is not one subject
10    to the jurisdiction of the Governor.
11        (8) (Blank).
12        (9) Procurement expenditures by the Illinois
13    Conservation Foundation when only private funds are used.
14        (10) (Blank).
15        (11) Public-private agreements entered into according
16    to the procurement requirements of Section 20 of the
17    Public-Private Partnerships for Transportation Act and
18    design-build agreements entered into according to the
19    procurement requirements of Section 25 of the
20    Public-Private Partnerships for Transportation Act.
21        (12) Contracts for legal, financial, and other
22    professional and artistic services entered into on or
23    before December 31, 2018 by the Illinois Finance Authority
24    in which the State of Illinois is not obligated. Such
25    contracts shall be awarded through a competitive process
26    authorized by the Board of the Illinois Finance Authority

 

 

10000SB1773ham004- 43 -LRB100 09919 KTG 35698 a

1    and are subject to Sections 5-30, 20-160, 50-13, 50-20,
2    50-35, and 50-37 of this Code, as well as the final
3    approval by the Board of the Illinois Finance Authority of
4    the terms of the contract.
5        (13) Contracts for services, commodities, and
6    equipment to support the delivery of timely forensic
7    science services in consultation with and subject to the
8    approval of the Chief Procurement Officer as provided in
9    subsection (d) of Section 5-4-3a of the Unified Code of
10    Corrections, except for the requirements of Sections
11    20-60, 20-65, 20-70, and 20-160 and Article 50 of this
12    Code; however, the Chief Procurement Officer may, in
13    writing with justification, waive any certification
14    required under Article 50 of this Code. For any contracts
15    for services which are currently provided by members of a
16    collective bargaining agreement, the applicable terms of
17    the collective bargaining agreement concerning
18    subcontracting shall be followed.
19        On and after January 1, 2019, this paragraph (13),
20    except for this sentence, is inoperative.
21        (14) Contracts for participation expenditures required
22    by a domestic or international trade show or exhibition of
23    an exhibitor, member, or sponsor.
24        (15) Contracts with a railroad or utility that requires
25    the State to reimburse the railroad or utilities for the
26    relocation of utilities for construction or other public

 

 

10000SB1773ham004- 44 -LRB100 09919 KTG 35698 a

1    purpose. Contracts included within this paragraph (15)
2    shall include, but not be limited to, those associated
3    with: relocations, crossings, installations, and
4    maintenance. For the purposes of this paragraph (15),
5    "railroad" means any form of non-highway ground
6    transportation that runs on rails or electromagnetic
7    guideways and "utility" means: (1) public utilities as
8    defined in Section 3-105 of the Public Utilities Act, (2)
9    telecommunications carriers as defined in Section 13-202
10    of the Public Utilities Act, (3) electric cooperatives as
11    defined in Section 3.4 of the Electric Supplier Act, (4)
12    telephone or telecommunications cooperatives as defined in
13    Section 13-212 of the Public Utilities Act, (5) rural water
14    or waste water systems with 10,000 connections or less, (6)
15    a holder as defined in Section 21-201 of the Public
16    Utilities Act, and (7) municipalities owning or operating
17    utility systems consisting of public utilities as that term
18    is defined in Section 11-117-2 of the Illinois Municipal
19    Code.
20    Notwithstanding any other provision of law, for contracts
21entered into on or after October 1, 2017 under an exemption
22provided in any paragraph of this subsection (b), except
23paragraph (1), (2), or (5), each State agency shall post to the
24appropriate procurement bulletin the name of the contractor, a
25description of the supply or service provided, the total amount
26of the contract, the term of the contract, and the exception to

 

 

10000SB1773ham004- 45 -LRB100 09919 KTG 35698 a

1the Code utilized. The chief procurement officer shall submit a
2report to the Governor and General Assembly no later than
3November 1 of each year that shall include, at a minimum, an
4annual summary of the monthly information reported to the chief
5procurement officer.
6    (c) This Code does not apply to the electric power
7procurement process provided for under Section 1-75 of the
8Illinois Power Agency Act and Section 16-111.5 of the Public
9Utilities Act.
10    (d) Except for Section 20-160 and Article 50 of this Code,
11and as expressly required by Section 9.1 of the Illinois
12Lottery Law, the provisions of this Code do not apply to the
13procurement process provided for under Section 9.1 of the
14Illinois Lottery Law.
15    (e) This Code does not apply to the process used by the
16Capital Development Board to retain a person or entity to
17assist the Capital Development Board with its duties related to
18the determination of costs of a clean coal SNG brownfield
19facility, as defined by Section 1-10 of the Illinois Power
20Agency Act, as required in subsection (h-3) of Section 9-220 of
21the Public Utilities Act, including calculating the range of
22capital costs, the range of operating and maintenance costs, or
23the sequestration costs or monitoring the construction of clean
24coal SNG brownfield facility for the full duration of
25construction.
26    (f) (Blank).

 

 

10000SB1773ham004- 46 -LRB100 09919 KTG 35698 a

1    (g) (Blank).
2    (h) This Code does not apply to the process to procure or
3contracts entered into in accordance with Sections 11-5.2 and
411-5.3 of the Illinois Public Aid Code.
5    (i) Each chief procurement officer may access records
6necessary to review whether a contract, purchase, or other
7expenditure is or is not subject to the provisions of this
8Code, unless such records would be subject to attorney-client
9privilege.
10    (j) This Code does not apply to the process used by the
11Capital Development Board to retain an artist or work or works
12of art as required in Section 14 of the Capital Development
13Board Act.
14    (k) This Code does not apply to the process to procure
15contracts, or contracts entered into, by the State Board of
16Elections or the State Electoral Board for hearing officers
17appointed pursuant to the Election Code.
18    (l) This Code does not apply to the processes used by the
19Illinois Student Assistance Commission to procure supplies and
20services paid for from the private funds of the Illinois
21Prepaid Tuition Fund. As used in this subsection (l), "private
22funds" means funds derived from deposits paid into the Illinois
23Prepaid Tuition Trust Fund and the earnings thereon.
24(Source: P.A. 99-801, eff. 1-1-17; 100-43, eff. 8-9-17.)
 
25    Section 10. The Emergency Medical Services (EMS) Systems

 

 

10000SB1773ham004- 47 -LRB100 09919 KTG 35698 a

1Act is amended by changing Section 32.5 as follows:
 
2    (210 ILCS 50/32.5)
3    Sec. 32.5. Freestanding Emergency Center.
4    (a) The Department shall issue an annual Freestanding
5Emergency Center (FEC) license to any facility that has
6received a permit from the Health Facilities and Services
7Review Board to establish a Freestanding Emergency Center by
8January 1, 2015, and:
9        (1) is located: (A) in a municipality with a population
10    of 50,000 or fewer inhabitants; (B) within 50 miles of the
11    hospital that owns or controls the FEC; and (C) within 50
12    miles of the Resource Hospital affiliated with the FEC as
13    part of the EMS System;
14        (2) is wholly owned or controlled by an Associate or
15    Resource Hospital, but is not a part of the hospital's
16    physical plant;
17        (3) meets the standards for licensed FECs, adopted by
18    rule of the Department, including, but not limited to:
19            (A) facility design, specification, operation, and
20        maintenance standards;
21            (B) equipment standards; and
22            (C) the number and qualifications of emergency
23        medical personnel and other staff, which must include
24        at least one board certified emergency physician
25        present at the FEC 24 hours per day.

 

 

10000SB1773ham004- 48 -LRB100 09919 KTG 35698 a

1        (4) limits its participation in the EMS System strictly
2    to receiving a limited number of patients by ambulance: (A)
3    according to the FEC's 24-hour capabilities; (B) according
4    to protocols developed by the Resource Hospital within the
5    FEC's designated EMS System; and (C) as pre-approved by
6    both the EMS Medical Director and the Department;
7        (5) provides comprehensive emergency treatment
8    services, as defined in the rules adopted by the Department
9    pursuant to the Hospital Licensing Act, 24 hours per day,
10    on an outpatient basis;
11        (6) provides an ambulance and maintains on site
12    ambulance services staffed with paramedics 24 hours per
13    day;
14        (7) (blank);
15        (8) complies with all State and federal patient rights
16    provisions, including, but not limited to, the Emergency
17    Medical Treatment Act and the federal Emergency Medical
18    Treatment and Active Labor Act;
19        (9) maintains a communications system that is fully
20    integrated with its Resource Hospital within the FEC's
21    designated EMS System;
22        (10) reports to the Department any patient transfers
23    from the FEC to a hospital within 48 hours of the transfer
24    plus any other data determined to be relevant by the
25    Department;
26        (11) submits to the Department, on a quarterly basis,

 

 

10000SB1773ham004- 49 -LRB100 09919 KTG 35698 a

1    the FEC's morbidity and mortality rates for patients
2    treated at the FEC and other data determined to be relevant
3    by the Department;
4        (12) does not describe itself or hold itself out to the
5    general public as a full service hospital or hospital
6    emergency department in its advertising or marketing
7    activities;
8        (13) complies with any other rules adopted by the
9    Department under this Act that relate to FECs;
10        (14) passes the Department's site inspection for
11    compliance with the FEC requirements of this Act;
12        (15) submits a copy of the permit issued by the Health
13    Facilities and Services Review Board indicating that the
14    facility has complied with the Illinois Health Facilities
15    Planning Act with respect to the health services to be
16    provided at the facility;
17        (16) submits an application for designation as an FEC
18    in a manner and form prescribed by the Department by rule;
19    and
20        (17) pays the annual license fee as determined by the
21    Department by rule.
22    (a-5) Notwithstanding any other provision of this Section,
23the Department may issue an annual FEC license to a facility
24that is located in a county that does not have a licensed
25general acute care hospital if the facility's application for a
26permit from the Illinois Health Facilities Planning Board has

 

 

10000SB1773ham004- 50 -LRB100 09919 KTG 35698 a

1been deemed complete by the Department of Public Health by
2January 1, 2014 and if the facility complies with the
3requirements set forth in paragraphs (1) through (17) of
4subsection (a).
5    (a-10) Notwithstanding any other provision of this
6Section, the Department may issue an annual FEC license to a
7facility if the facility has, by January 1, 2014, filed a
8letter of intent to establish an FEC and if the facility
9complies with the requirements set forth in paragraphs (1)
10through (17) of subsection (a).
11    (a-15) Notwithstanding any other provision of this
12Section, the Department shall issue an annual FEC license to a
13facility if the facility: (i) discontinues operation as a
14hospital within 180 days after the effective date of this
15amendatory Act of the 99th General Assembly with a Health
16Facilities and Services Review Board project number of
17E-017-15; (ii) has an application for a permit to establish an
18FEC from the Health Facilities and Services Review Board that
19is deemed complete by January 1, 2017; and (iii) complies with
20the requirements set forth in paragraphs (1) through (17) of
21subsection (a) of this Section.
22    (a20) Notwithstanding any other provision of this
23Section, the Department shall issue an annual FEC license to a
24facility if:
25        (1) the facility is a hospital that has discontinued
26    inpatient hospital services;

 

 

10000SB1773ham004- 51 -LRB100 09919 KTG 35698 a

1        (2) the Department of Healthcare and Family Services
2    has certified the conversion to an FEC was approved by the
3    Hospital Transformation Review Committee as a project
4    subject to the hospital's transformation under subsection
5    (d-5) of Section 14-12 of the Illinois Public Aid Code;
6        (3) the facility complies with the requirements set
7    forth in paragraphs (1) through (17), provided however that
8    the FEC may be located in a municipality with a population
9    greater than 50,000 inhabitants and shall be exempt from
10    the requirements of the Health Facilities Planning Act if
11    the Department of Healthcare and Family Service has
12    certified the conversion to an FEC was approved by the
13    Hospital Transformation Review Committee as a project
14    subject to the hospital's transformation under subsection
15    (d-5) of Section 14-12 of the Illinois Public Aid Code; and
16        (4) the facility is located at the same physical
17    location where the facility served as a hospital.
18    (b) The Department shall:
19        (1) annually inspect facilities of initial FEC
20    applicants and licensed FECs, and issue annual licenses to
21    or annually relicense FECs that satisfy the Department's
22    licensure requirements as set forth in subsection (a);
23        (2) suspend, revoke, refuse to issue, or refuse to
24    renew the license of any FEC, after notice and an
25    opportunity for a hearing, when the Department finds that
26    the FEC has failed to comply with the standards and

 

 

10000SB1773ham004- 52 -LRB100 09919 KTG 35698 a

1    requirements of the Act or rules adopted by the Department
2    under the Act;
3        (3) issue an Emergency Suspension Order for any FEC
4    when the Director or his or her designee has determined
5    that the continued operation of the FEC poses an immediate
6    and serious danger to the public health, safety, and
7    welfare. An opportunity for a hearing shall be promptly
8    initiated after an Emergency Suspension Order has been
9    issued; and
10        (4) adopt rules as needed to implement this Section.
11(Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16.)
 
12    Section 15. The Illinois Public Aid Code is amended by
13changing Sections 5-5.02, 5-5e.1, 5-30.1, 5A-2, 5A-4, 5A-5,
145A-8, 5A-10, 5A-12.5, 5A-13, 5A-14, 5A-15, 12-4.105, and 14-12,
15and by adding Sections 5-30.6, 5-30.7, 5A-12.6, and 5A-16 as
16follows:
 
17    (305 ILCS 5/5-5.02)  (from Ch. 23, par. 5-5.02)
18    Sec. 5-5.02. Hospital reimbursements.
19    (a) Reimbursement to Hospitals; July 1, 1992 through
20September 30, 1992. Notwithstanding any other provisions of
21this Code or the Illinois Department's Rules promulgated under
22the Illinois Administrative Procedure Act, reimbursement to
23hospitals for services provided during the period July 1, 1992
24through September 30, 1992, shall be as follows:

 

 

10000SB1773ham004- 53 -LRB100 09919 KTG 35698 a

1        (1) For inpatient hospital services rendered, or if
2    applicable, for inpatient hospital discharges occurring,
3    on or after July 1, 1992 and on or before September 30,
4    1992, the Illinois Department shall reimburse hospitals
5    for inpatient services under the reimbursement
6    methodologies in effect for each hospital, and at the
7    inpatient payment rate calculated for each hospital, as of
8    June 30, 1992. For purposes of this paragraph,
9    "reimbursement methodologies" means all reimbursement
10    methodologies that pertain to the provision of inpatient
11    hospital services, including, but not limited to, any
12    adjustments for disproportionate share, targeted access,
13    critical care access and uncompensated care, as defined by
14    the Illinois Department on June 30, 1992.
15        (2) For the purpose of calculating the inpatient
16    payment rate for each hospital eligible to receive
17    quarterly adjustment payments for targeted access and
18    critical care, as defined by the Illinois Department on
19    June 30, 1992, the adjustment payment for the period July
20    1, 1992 through September 30, 1992, shall be 25% of the
21    annual adjustment payments calculated for each eligible
22    hospital, as of June 30, 1992. The Illinois Department
23    shall determine by rule the adjustment payments for
24    targeted access and critical care beginning October 1,
25    1992.
26        (3) For the purpose of calculating the inpatient

 

 

10000SB1773ham004- 54 -LRB100 09919 KTG 35698 a

1    payment rate for each hospital eligible to receive
2    quarterly adjustment payments for uncompensated care, as
3    defined by the Illinois Department on June 30, 1992, the
4    adjustment payment for the period August 1, 1992 through
5    September 30, 1992, shall be one-sixth of the total
6    uncompensated care adjustment payments calculated for each
7    eligible hospital for the uncompensated care rate year, as
8    defined by the Illinois Department, ending on July 31,
9    1992. The Illinois Department shall determine by rule the
10    adjustment payments for uncompensated care beginning
11    October 1, 1992.
12    (b) Inpatient payments. For inpatient services provided on
13or after October 1, 1993, in addition to rates paid for
14hospital inpatient services pursuant to the Illinois Health
15Finance Reform Act, as now or hereafter amended, or the
16Illinois Department's prospective reimbursement methodology,
17or any other methodology used by the Illinois Department for
18inpatient services, the Illinois Department shall make
19adjustment payments, in an amount calculated pursuant to the
20methodology described in paragraph (c) of this Section, to
21hospitals that the Illinois Department determines satisfy any
22one of the following requirements:
23        (1) Hospitals that are described in Section 1923 of the
24    federal Social Security Act, as now or hereafter amended,
25    except that for rate year 2015 and after a hospital
26    described in Section 1923(b)(1)(B) of the federal Social

 

 

10000SB1773ham004- 55 -LRB100 09919 KTG 35698 a

1    Security Act and qualified for the payments described in
2    subsection (c) of this Section for rate year 2014 provided
3    the hospital continues to meet the description in Section
4    1923(b)(1)(B) in the current determination year; or
5        (2) Illinois hospitals that have a Medicaid inpatient
6    utilization rate which is at least one-half a standard
7    deviation above the mean Medicaid inpatient utilization
8    rate for all hospitals in Illinois receiving Medicaid
9    payments from the Illinois Department; or
10        (3) Illinois hospitals that on July 1, 1991 had a
11    Medicaid inpatient utilization rate, as defined in
12    paragraph (h) of this Section, that was at least the mean
13    Medicaid inpatient utilization rate for all hospitals in
14    Illinois receiving Medicaid payments from the Illinois
15    Department and which were located in a planning area with
16    one-third or fewer excess beds as determined by the Health
17    Facilities and Services Review Board, and that, as of June
18    30, 1992, were located in a federally designated Health
19    Manpower Shortage Area; or
20        (4) Illinois hospitals that:
21            (A) have a Medicaid inpatient utilization rate
22        that is at least equal to the mean Medicaid inpatient
23        utilization rate for all hospitals in Illinois
24        receiving Medicaid payments from the Department; and
25            (B) also have a Medicaid obstetrical inpatient
26        utilization rate that is at least one standard

 

 

10000SB1773ham004- 56 -LRB100 09919 KTG 35698 a

1        deviation above the mean Medicaid obstetrical
2        inpatient utilization rate for all hospitals in
3        Illinois receiving Medicaid payments from the
4        Department for obstetrical services; or
5        (5) Any children's hospital, which means a hospital
6    devoted exclusively to caring for children. A hospital
7    which includes a facility devoted exclusively to caring for
8    children shall be considered a children's hospital to the
9    degree that the hospital's Medicaid care is provided to
10    children if either (i) the facility devoted exclusively to
11    caring for children is separately licensed as a hospital by
12    a municipality prior to February 28, 2013 or (ii) the
13    hospital has been designated by the State as a Level III
14    perinatal care facility, has a Medicaid Inpatient
15    Utilization rate greater than 55% for the rate year 2003
16    disproportionate share determination, and has more than
17    10,000 qualified children days as defined by the Department
18    in rulemaking.
19    (c) Inpatient adjustment payments. The adjustment payments
20required by paragraph (b) shall be calculated based upon the
21hospital's Medicaid inpatient utilization rate as follows:
22        (1) hospitals with a Medicaid inpatient utilization
23    rate below the mean shall receive a per day adjustment
24    payment equal to $25;
25        (2) hospitals with a Medicaid inpatient utilization
26    rate that is equal to or greater than the mean Medicaid

 

 

10000SB1773ham004- 57 -LRB100 09919 KTG 35698 a

1    inpatient utilization rate but less than one standard
2    deviation above the mean Medicaid inpatient utilization
3    rate shall receive a per day adjustment payment equal to
4    the sum of $25 plus $1 for each one percent that the
5    hospital's Medicaid inpatient utilization rate exceeds the
6    mean Medicaid inpatient utilization rate;
7        (3) hospitals with a Medicaid inpatient utilization
8    rate that is equal to or greater than one standard
9    deviation above the mean Medicaid inpatient utilization
10    rate but less than 1.5 standard deviations above the mean
11    Medicaid inpatient utilization rate shall receive a per day
12    adjustment payment equal to the sum of $40 plus $7 for each
13    one percent that the hospital's Medicaid inpatient
14    utilization rate exceeds one standard deviation above the
15    mean Medicaid inpatient utilization rate; and
16        (4) hospitals with a Medicaid inpatient utilization
17    rate that is equal to or greater than 1.5 standard
18    deviations above the mean Medicaid inpatient utilization
19    rate shall receive a per day adjustment payment equal to
20    the sum of $90 plus $2 for each one percent that the
21    hospital's Medicaid inpatient utilization rate exceeds 1.5
22    standard deviations above the mean Medicaid inpatient
23    utilization rate.
24    (d) Supplemental adjustment payments. In addition to the
25adjustment payments described in paragraph (c), hospitals as
26defined in clauses (1) through (5) of paragraph (b), excluding

 

 

10000SB1773ham004- 58 -LRB100 09919 KTG 35698 a

1county hospitals (as defined in subsection (c) of Section 15-1
2of this Code) and a hospital organized under the University of
3Illinois Hospital Act, shall be paid supplemental inpatient
4adjustment payments of $60 per day. For purposes of Title XIX
5of the federal Social Security Act, these supplemental
6adjustment payments shall not be classified as adjustment
7payments to disproportionate share hospitals.
8    (e) The inpatient adjustment payments described in
9paragraphs (c) and (d) shall be increased on October 1, 1993
10and annually thereafter by a percentage equal to the lesser of
11(i) the increase in the DRI hospital cost index for the most
12recent 12 month period for which data are available, or (ii)
13the percentage increase in the statewide average hospital
14payment rate over the previous year's statewide average
15hospital payment rate. The sum of the inpatient adjustment
16payments under paragraphs (c) and (d) to a hospital, other than
17a county hospital (as defined in subsection (c) of Section 15-1
18of this Code) or a hospital organized under the University of
19Illinois Hospital Act, however, shall not exceed $275 per day;
20that limit shall be increased on October 1, 1993 and annually
21thereafter by a percentage equal to the lesser of (i) the
22increase in the DRI hospital cost index for the most recent
2312-month period for which data are available or (ii) the
24percentage increase in the statewide average hospital payment
25rate over the previous year's statewide average hospital
26payment rate.

 

 

10000SB1773ham004- 59 -LRB100 09919 KTG 35698 a

1    (f) Children's hospital inpatient adjustment payments. For
2children's hospitals, as defined in clause (5) of paragraph
3(b), the adjustment payments required pursuant to paragraphs
4(c) and (d) shall be multiplied by 2.0.
5    (g) County hospital inpatient adjustment payments. For
6county hospitals, as defined in subsection (c) of Section 15-1
7of this Code, there shall be an adjustment payment as
8determined by rules issued by the Illinois Department.
9    (h) For the purposes of this Section the following terms
10shall be defined as follows:
11        (1) "Medicaid inpatient utilization rate" means a
12    fraction, the numerator of which is the number of a
13    hospital's inpatient days provided in a given 12-month
14    period to patients who, for such days, were eligible for
15    Medicaid under Title XIX of the federal Social Security
16    Act, and the denominator of which is the total number of
17    the hospital's inpatient days in that same period.
18        (2) "Mean Medicaid inpatient utilization rate" means
19    the total number of Medicaid inpatient days provided by all
20    Illinois Medicaid-participating hospitals divided by the
21    total number of inpatient days provided by those same
22    hospitals.
23        (3) "Medicaid obstetrical inpatient utilization rate"
24    means the ratio of Medicaid obstetrical inpatient days to
25    total Medicaid inpatient days for all Illinois hospitals
26    receiving Medicaid payments from the Illinois Department.

 

 

10000SB1773ham004- 60 -LRB100 09919 KTG 35698 a

1    (i) Inpatient adjustment payment limit. In order to meet
2the limits of Public Law 102-234 and Public Law 103-66, the
3Illinois Department shall by rule adjust disproportionate
4share adjustment payments.
5    (j) University of Illinois Hospital inpatient adjustment
6payments. For hospitals organized under the University of
7Illinois Hospital Act, there shall be an adjustment payment as
8determined by rules adopted by the Illinois Department.
9    (k) The Illinois Department may by rule establish criteria
10for and develop methodologies for adjustment payments to
11hospitals participating under this Article.
12    (l) On and after July 1, 2012, the Department shall reduce
13any rate of reimbursement for services or other payments or
14alter any methodologies authorized by this Code to reduce any
15rate of reimbursement for services or other payments in
16accordance with Section 5-5e.
17    (m) The Department shall establish a cost-based
18reimbursement methodology for determining payments to
19hospitals for approved graduate medical education (GME)
20programs for dates of service on and after July 1, 2018.
21        (1) As used in this subsection, "hospitals" means the
22    University of Illinois Hospital as defined in the
23    University of Illinois Hospital Act and a county hospital
24    in a county of over 3,000,000 inhabitants.
25        (2) An amendment to the Illinois Title XIX State Plan
26    defining GME shall maximize reimbursement, shall not be

 

 

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1    limited to the education programs or special patient care
2    payments allowed under Medicare, and shall include:
3            (A) inpatient days;
4            (B) outpatient days;
5            (C) direct costs;
6            (D) indirect costs;
7            (E) managed care days;
8            (F) all stages of medical training and education
9        including students, interns, residents, and fellows
10        with no caps on the number of persons who may qualify;
11        and
12            (G) patient care payments related to the
13        complexities of treating Medicaid enrollees including
14        clinical and social determinants of health.
15        (3) The Department shall make all GME payments directly
16    to hospitals including such costs in support of clients
17    enrolled in Medicaid managed care entities.
18        (4) The Department shall promptly take all actions
19    necessary for reimbursement to be effective for dates of
20    service on and after July 1, 2018 including publishing all
21    appropriate public notices, amendments to the Illinois
22    Title XIX State Plan, and adoption of administrative rules
23    if necessary.
24        (5) As used in this subsection, "managed care days"
25    means costs associated with services rendered to enrollees
26    of Medicaid managed care entities. "Medicaid managed care

 

 

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1    entities" means any entity which contracts with the
2    Department to provide services paid for on a capitated
3    basis. "Medicaid managed care entities" includes a managed
4    care organization and a managed care community network.
5        (6) All payments under this Section are contingent upon
6    federal approval of changes to the Illinois Title XIX State
7    Plan, if that approval is required.
8        (7) The Department may adopt rules necessary to
9    implement this amendatory Act of the 100th General Assembly
10    through the use of emergency rulemaking in accordance with
11    subsection (aa) of Section 5-45 of the Illinois
12    Administrative Procedure Act. For purposes of that Act, the
13    General Assembly finds that the adoption of rules to
14    implement this amendatory Act of the 100th General Assembly
15    is deemed an emergency and necessary for the public
16    interest, safety, and welfare.
17(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
 
18    (305 ILCS 5/5-5e.1)
19    Sec. 5-5e.1. Safety-Net Hospitals.
20    (a) A Safety-Net Hospital is an Illinois hospital that:
21        (1) is licensed by the Department of Public Health as a
22    general acute care or pediatric hospital; and
23        (2) is a disproportionate share hospital, as described
24    in Section 1923 of the federal Social Security Act, as
25    determined by the Department; and

 

 

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1        (3) meets one of the following:
2            (A) has a MIUR of at least 40% and a charity
3        percent of at least 4%; or
4            (B) has a MIUR of at least 50%.
5    (b) Definitions. As used in this Section:
6        (1) "Charity percent" means the ratio of (i) the
7    hospital's charity charges for services provided to
8    individuals without health insurance or another source of
9    third party coverage to (ii) the Illinois total hospital
10    charges, each as reported on the hospital's OBRA form.
11        (2) "MIUR" means Medicaid Inpatient Utilization Rate
12    and is defined as a fraction, the numerator of which is the
13    number of a hospital's inpatient days provided in the
14    hospital's fiscal year ending 3 years prior to the rate
15    year, to patients who, for such days, were eligible for
16    Medicaid under Title XIX of the federal Social Security
17    Act, 42 USC 1396a et seq., excluding those persons eligible
18    for medical assistance pursuant to 42 U.S.C.
19    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
20    Section 5-2 of this Article, and the denominator of which
21    is the total number of the hospital's inpatient days in
22    that same period, excluding those persons eligible for
23    medical assistance pursuant to 42 U.S.C.
24    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
25    Section 5-2 of this Article.
26        (3) "OBRA form" means form HFS-3834, OBRA '93 data

 

 

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1    collection form, for the rate year.
2        (4) "Rate year" means the 12-month period beginning on
3    October 1.
4    (c) Beginning July 1, 2012 and ending on June 30, 2020
52018, a hospital that would have qualified for the rate year
6beginning October 1, 2011, shall be a Safety-Net Hospital.
7    (d) No later than August 15 preceding the rate year, each
8hospital shall submit the OBRA form to the Department. Prior to
9October 1, the Department shall notify each hospital whether it
10has qualified as a Safety-Net Hospital.
11    (e) The Department may promulgate rules in order to
12implement this Section.
13    (f) Nothing in this Section shall be construed as limiting
14the ability of the Department to include the Safety-Net
15Hospitals in the hospital rate reform mandated by Section 14-11
16of this Code and implemented under Section 14-12 of this Code
17and by administrative rulemaking.
18(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13;
1998-651, eff. 6-16-14.)
 
20    (305 ILCS 5/5-30.1)
21    Sec. 5-30.1. Managed care protections.
22    (a) As used in this Section:
23    "Managed care organization" or "MCO" means any entity which
24contracts with the Department to provide services where payment
25for medical services is made on a capitated basis.

 

 

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1    "Emergency services" include:
2        (1) emergency services, as defined by Section 10 of the
3    Managed Care Reform and Patient Rights Act;
4        (2) emergency medical screening examinations, as
5    defined by Section 10 of the Managed Care Reform and
6    Patient Rights Act;
7        (3) post-stabilization medical services, as defined by
8    Section 10 of the Managed Care Reform and Patient Rights
9    Act; and
10        (4) emergency medical conditions, as defined by
11    Section 10 of the Managed Care Reform and Patient Rights
12    Act.
13    (b) As provided by Section 5-16.12, managed care
14organizations are subject to the provisions of the Managed Care
15Reform and Patient Rights Act.
16    (c) An MCO shall pay any provider of emergency services
17that does not have in effect a contract with the contracted
18Medicaid MCO. The default rate of reimbursement shall be the
19rate paid under Illinois Medicaid fee-for-service program
20methodology, including all policy adjusters, including but not
21limited to Medicaid High Volume Adjustments, Medicaid
22Percentage Adjustments, Outpatient High Volume Adjustments,
23and all outlier add-on adjustments to the extent such
24adjustments are incorporated in the development of the
25applicable MCO capitated rates.
26    (d) An MCO shall pay for all post-stabilization services as

 

 

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1a covered service in any of the following situations:
2        (1) the MCO authorized such services;
3        (2) such services were administered to maintain the
4    enrollee's stabilized condition within one hour after a
5    request to the MCO for authorization of further
6    post-stabilization services;
7        (3) the MCO did not respond to a request to authorize
8    such services within one hour;
9        (4) the MCO could not be contacted; or
10        (5) the MCO and the treating provider, if the treating
11    provider is a non-affiliated provider, could not reach an
12    agreement concerning the enrollee's care and an affiliated
13    provider was unavailable for a consultation, in which case
14    the MCO must pay for such services rendered by the treating
15    non-affiliated provider until an affiliated provider was
16    reached and either concurred with the treating
17    non-affiliated provider's plan of care or assumed
18    responsibility for the enrollee's care. Such payment shall
19    be made at the default rate of reimbursement paid under
20    Illinois Medicaid fee-for-service program methodology,
21    including all policy adjusters, including but not limited
22    to Medicaid High Volume Adjustments, Medicaid Percentage
23    Adjustments, Outpatient High Volume Adjustments and all
24    outlier add-on adjustments to the extent that such
25    adjustments are incorporated in the development of the
26    applicable MCO capitated rates.

 

 

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1    (e) The following requirements apply to MCOs in determining
2payment for all emergency services:
3        (1) MCOs shall not impose any requirements for prior
4    approval of emergency services.
5        (2) The MCO shall cover emergency services provided to
6    enrollees who are temporarily away from their residence and
7    outside the contracting area to the extent that the
8    enrollees would be entitled to the emergency services if
9    they still were within the contracting area.
10        (3) The MCO shall have no obligation to cover medical
11    services provided on an emergency basis that are not
12    covered services under the contract.
13        (4) The MCO shall not condition coverage for emergency
14    services on the treating provider notifying the MCO of the
15    enrollee's screening and treatment within 10 days after
16    presentation for emergency services.
17        (5) The determination of the attending emergency
18    physician, or the provider actually treating the enrollee,
19    of whether an enrollee is sufficiently stabilized for
20    discharge or transfer to another facility, shall be binding
21    on the MCO. The MCO shall cover emergency services for all
22    enrollees whether the emergency services are provided by an
23    affiliated or non-affiliated provider.
24        (6) The MCO's financial responsibility for
25    post-stabilization care services it has not pre-approved
26    ends when:

 

 

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1            (A) a plan physician with privileges at the
2        treating hospital assumes responsibility for the
3        enrollee's care;
4            (B) a plan physician assumes responsibility for
5        the enrollee's care through transfer;
6            (C) a contracting entity representative and the
7        treating physician reach an agreement concerning the
8        enrollee's care; or
9            (D) the enrollee is discharged.
10    (f) Network adequacy and transparency.
11        (1) The Department shall:
12            (A) ensure that an adequate provider network is in
13        place, taking into consideration health professional
14        shortage areas and medically underserved areas;
15            (B) publicly release an explanation of its process
16        for analyzing network adequacy;
17            (C) periodically ensure that an MCO continues to
18        have an adequate network in place; and
19            (D) require MCOs, including Medicaid Managed Care
20        Entities as defined in Section 5-30.2, to meet provider
21        directory requirements under Section 5-30.3.
22        (2) Each MCO shall confirm its receipt of information
23    submitted specific to physician additions or physician
24    deletions from the MCO's provider network within 3 days
25    after receiving all required information from contracted
26    physicians, and electronic physician directories must be

 

 

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1    updated consistent with current rules as published by the
2    Centers for Medicare and Medicaid Services or its successor
3    agency.
4    (g) Timely payment of claims.
5        (1) The MCO shall pay a claim within 30 days of
6    receiving a claim that contains all the essential
7    information needed to adjudicate the claim.
8        (2) The MCO shall notify the billing party of its
9    inability to adjudicate a claim within 30 days of receiving
10    that claim.
11        (3) The MCO shall pay a penalty that is at least equal
12    to the penalty imposed under the Illinois Insurance Code
13    for any claims not timely paid.
14        (4) The Department may establish a process for MCOs to
15    expedite payments to providers based on criteria
16    established by the Department.
17    (g-5) Recognizing that the rapid transformation of the
18Illinois Medicaid program may have unintended operational
19challenges for both payers and providers:
20        (1) in no instance shall a medically necessary covered
21    service rendered in good faith, based upon eligibility
22    information documented by the provider, be denied coverage
23    or diminished in payment amount if the eligibility or
24    coverage information available at the time the service was
25    rendered is later found to be inaccurate; and
26        (2) the Department shall, by December 31, 2016, adopt

 

 

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1    rules establishing policies that shall be included in the
2    Medicaid managed care policy and procedures manual
3    addressing payment resolutions in situations in which a
4    provider renders services based upon information obtained
5    after verifying a patient's eligibility and coverage plan
6    through either the Department's current enrollment system
7    or a system operated by the coverage plan identified by the
8    patient presenting for services:
9            (A) such medically necessary covered services
10        shall be considered rendered in good faith;
11            (B) such policies and procedures shall be
12        developed in consultation with industry
13        representatives of the Medicaid managed care health
14        plans and representatives of provider associations
15        representing the majority of providers within the
16        identified provider industry; and
17            (C) such rules shall be published for a review and
18        comment period of no less than 30 days on the
19        Department's website with final rules remaining
20        available on the Department's website.
21        (3) The rules on payment resolutions shall include, but
22    not be limited to:
23            (A) the extension of the timely filing period;
24            (B) retroactive prior authorizations; and
25            (C) guaranteed minimum payment rate of no less than
26        the current, as of the date of service, fee-for-service

 

 

10000SB1773ham004- 71 -LRB100 09919 KTG 35698 a

1        rate, plus all applicable add-ons, when the resulting
2        service relationship is out of network.
3        (4) The rules shall be applicable for both MCO coverage
4    and fee-for-service coverage.
5    (g-6) MCO Performance Metrics Report.
6        (1) The Department shall publish, on at least a
7    quarterly basis, each MCO's operational performance,
8    including, but not limited to, the following categories of
9    metrics:
10            (A) claims payment, including timeliness and
11        accuracy;
12            (B) prior authorizations;
13            (C) grievance and appeals;
14            (D) utilization statistics;
15            (E) provider disputes;
16            (F) provider credentialing; and
17            (G) member and provider customer service.
18        (2) The Department shall ensure that the metrics report
19    is accessible to providers online by January 1, 2017.
20        (3) The metrics shall be developed in consultation with
21    industry representatives of the Medicaid managed care
22    health plans and representatives of associations
23    representing the majority of providers within the
24    identified industry.
25        (4) Metrics shall be defined and incorporated into the
26    applicable Managed Care Policy Manual issued by the

 

 

10000SB1773ham004- 72 -LRB100 09919 KTG 35698 a

1    Department.
2    (g-7) MCO claims processing performance analysis.
3        (1) In order to enable the Department, the General
4    Assembly, and the public to monitor and evaluate the
5    efficiency and effectiveness of each MCO, the Department
6    shall engage an independent third party to perform an
7    annual claims processing performance analysis of each MCO.
8    The report of the first claims processing performance
9    analysis shall be published by September 1, 2019, and every
10    other year thereafter. The Department shall publish the
11    report on its website.
12        (2) The MCO claims processing performance analysis
13    shall evaluate each MCO's performance related to its
14    processing of claims for payments and shall evaluate
15    metrics that include, but are not limited to:
16            (A) claim rejections rates for clean and unclean
17        claims and the top 10 reasons for rejections;
18            (B) claim denial rates, for clean and unclean
19        claims and the top 10 reasons for denials;
20            (C) timeliness of claims adjudication, which
21        identifies the percentage of claims adjudicated within
22        30, 60, 90, 120, 150, and over 150 days, and the dollar
23        amounts associated with those claims;
24            (D) a statistically valid sample of claims
25        rejected, denied in whole or in part, or adjudicated
26        greater than 30 days after original submission shall be

 

 

10000SB1773ham004- 73 -LRB100 09919 KTG 35698 a

1        examined to determine the root cause for the rejection,
2        denial, or untimely adjudication;
3            (E) the percentage of claims that were subject to
4        payment of interest penalties;
5            (F) accuracy of claims payments, including
6        applicable add-ons that are the responsibility of the
7        MCO;
8            (G) number of claims disputes submitted to an
9        appeals process and the number resulting in a payment
10        or resolution in favor of the provider;
11            (H) percentage of claims disputes resolved through
12        an appeals process;
13            (I) timeframe for completion of the appeals
14        process;
15            (J) total dollar value paid to providers for claims
16        resolved through an appeals process;
17            (K) total number and dollar amount of overpayment
18        requests; and
19            (L) percentage of overpayment requests as a
20        percentage of overall claims volume.
21        (3) The analysis under this Section shall, at a
22    minimum, analyze and report on each MCO's claims processing
23    of provider claims, and shall analyze and report on the
24    performance by each type of provider separately.
25    (h) The Department shall not expand mandatory MCO
26enrollment into new counties beyond those counties already

 

 

10000SB1773ham004- 74 -LRB100 09919 KTG 35698 a

1designated by the Department as of June 1, 2014 for the
2individuals whose eligibility for medical assistance is not the
3seniors or people with disabilities population until the
4Department provides an opportunity for accountable care
5entities and MCOs to participate in such newly designated
6counties.
7    (i) The requirements of this Section apply to contracts
8with accountable care entities and MCOs entered into, amended,
9or renewed after June 16, 2014 (the effective date of Public
10Act 98-651).
11(Source: P.A. 99-725, eff. 8-5-16; 99-751, eff. 8-5-16;
12100-201, eff. 8-18-17.)
 
13    (305 ILCS 5/5-30.6 new)
14    Sec. 5-30.6. Managed care organization contracts
15procurement requirement. Beginning on the effective date of
16this amendatory Act of the 100th General Assembly, any new
17contract between the Department and a managed care organization
18as defined in Section 5-30.1 shall be procured in accordance
19with the Illinois Procurement Code.
20    (a) Application.
21        (1) This Section does not apply to the State of
22    Illinois Medicaid Managed Care Organization Request for
23    Proposals (2018-24-001) or any agreement, regardless of
24    what it may be called, related to or arising from this
25    procurement, including, but not limited to, contracts,

 

 

10000SB1773ham004- 75 -LRB100 09919 KTG 35698 a

1    renewals, renegotiated contracts, amendments, and change
2    orders.
3        (2) This Section does not apply to Medicare-Medicaid
4    Alignment Initiative contracts executed under Article V-F
5    of this Code.
6    (b) In the event any provision of this Section or of the
7Illinois Procurement Code is inconsistent with applicable
8federal law or would have the effect of foreclosing the use,
9potential use, or receipt of federal financial participation
10the applicable federal law or funding condition shall prevail,
11but only to the extent of such inconsistency.
 
12    (305 ILCS 5/5-30.7 new)
13    Sec. 5-30.7. Encounter data guidelines; provider fee
14schedule.
15    (a) No later than 60 days after the effective date of this
16amendatory Act of the 100th General Assembly, the Department
17shall publish on its website comprehensive written guidance on
18the submission of encounter data by managed care organizations.
19This information shall be updated and published as needed, but
20at least quarterly. The Department shall inform providers and
21managed care organizations of any updates via provider notices
22delivered at least 90 days prior to the effective date of any
23change.
24    (b) The Department shall publish on its website provider
25fee schedules on both a portable document format (PDF) and

 

 

10000SB1773ham004- 76 -LRB100 09919 KTG 35698 a

1EXCEL format. The portable document format shall serve as the
2ultimate source if there is a discrepancy.
 
3    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
4    (Section scheduled to be repealed on July 1, 2018)
5    Sec. 5A-2. Assessment.
6    (a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
7years 2009 through 2018, or as long as continued under Section
85A-16, an annual assessment on inpatient services is imposed on
9each hospital provider in an amount equal to $218.38 multiplied
10by the difference of the hospital's occupied bed days less the
11hospital's Medicare bed days, provided, however, that the
12amount of $218.38 shall be increased by a uniform percentage to
13generate an amount equal to 75% of the State share of the
14payments authorized under Section 5A-12.5, with such increase
15only taking effect upon the date that a State share for such
16payments is required under federal law. For the period of April
17through June 2015, the amount of $218.38 used to calculate the
18assessment under this paragraph shall, by emergency rule under
19subsection (s) of Section 5-45 of the Illinois Administrative
20Procedure Act, be increased by a uniform percentage to generate
21$20,250,000 in the aggregate for that period from all hospitals
22subject to the annual assessment under this paragraph.
23    (2) In addition to any other assessments imposed under this
24Article, effective July 1, 2016 and semi-annually thereafter
25through June 2018, or as provided in Section 5A-16, in addition

 

 

10000SB1773ham004- 77 -LRB100 09919 KTG 35698 a

1to any federally required State share as authorized under
2paragraph (1), the amount of $218.38 shall be increased by a
3uniform percentage to generate an amount equal to 75% of the
4ACA Assessment Adjustment, as defined in subsection (b-6) of
5this Section.
6    For State fiscal years 2009 through 2018 2014 and after, or
7as provided in Section 5A-16, a hospital's occupied bed days
8and Medicare bed days shall be determined using the most recent
9data available from each hospital's 2005 Medicare cost report
10as contained in the Healthcare Cost Report Information System
11file, for the quarter ending on December 31, 2006, without
12regard to any subsequent adjustments or changes to such data.
13If a hospital's 2005 Medicare cost report is not contained in
14the Healthcare Cost Report Information System, then the
15Illinois 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.
21    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
22fiscal years 2019 and 2020, an annual assessment on inpatient
23services is imposed on each hospital provider in an amount
24equal to $XX multiplied by the difference of the hospital's
25occupied bed days less the hospital's Medicare bed days. For
26State fiscal years 2019 and 2020, a hospital's occupied bed

 

 

10000SB1773ham004- 78 -LRB100 09919 KTG 35698 a

1days and Medicare bed days shall be determined using the most
2recent data available from each hospital's 2015 Medicare cost
3report as contained in the Healthcare Cost Report Information
4System file, for the quarter ending on March 31, 2017, without
5regard to any subsequent adjustments or changes to such data.
6If a hospital's 2015 Medicare cost report is not contained in
7the Healthcare Cost Report Information System, then the
8Illinois Department may obtain the hospital provider's
9occupied bed days and Medicare bed days from any source
10available, including, but not limited to, records maintained by
11the hospital provider, which may be inspected at all times
12during business hours of the day by the Illinois Department or
13its duly authorized agents and employees. Notwithstanding any
14other provision in this Article, for a hospital provider that
15did not have a 2015 Medicare cost report, but paid an
16assessment in State fiscal year 2018 on the basis of
17hypothetical data, that assessment amount shall be used for
18State fiscal years 2019 and 2020.
19    Subject to Sections 5A-3 and 5A-10, for State fiscal years
202021 through 2024, an annual assessment on inpatient services
21is imposed on each hospital provider in an amount equal to $XX
22multiplied by the difference of the hospital's occupied bed
23days less the hospital's Medicare bed days, provided however,
24that the amount of $XX used to calculate the assessment under
25this paragraph shall, by rule, be adjusted by a uniform
26percentage to generate the same total annual assessment that

 

 

10000SB1773ham004- 79 -LRB100 09919 KTG 35698 a

1was generated in State fiscal year 2020 from all hospitals
2subject to the annual assessment under this paragraph. For
3State fiscal years 2021 and 2022, a hospital's occupied bed
4days and Medicare bed days shall be determined using the most
5recent data available from each hospital's 2017 Medicare cost
6report as contained in the Healthcare Cost Report Information
7System file, for the quarter ending on March 31, 2019, without
8regard to any subsequent adjustments or changes to such data.
9For State fiscal years 2023 and 2024, a hospital's occupied bed
10days and Medicare bed days shall be determined using the most
11recent data available from each hospital's 2019 Medicare cost
12report as contained in the Healthcare Cost Report Information
13System file, for the quarter ending on March 31, 2021, without
14regard to any subsequent adjustments or changes to such data.
15    (b) (Blank).
16    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
17portion of State fiscal year 2012, beginning June 10, 2012
18through June 30, 2012, and for State fiscal years 2013 through
192018, or as provided in Section 5A-16, an annual assessment on
20outpatient services is imposed on each hospital provider in an
21amount equal to .008766 multiplied by the hospital's outpatient
22gross revenue, provided, however, that the amount of .008766
23shall be increased by a uniform percentage to generate an
24amount equal to 25% of the State share of the payments
25authorized under Section 5A-12.5, with such increase only
26taking effect upon the date that a State share for such

 

 

10000SB1773ham004- 80 -LRB100 09919 KTG 35698 a

1payments is required under federal law. For the period
2beginning June 10, 2012 through June 30, 2012, the annual
3assessment on outpatient services shall be prorated by
4multiplying the assessment amount by a fraction, the numerator
5of which is 21 days and the denominator of which is 365 days.
6For the period of April through June 2015, the amount of
7.008766 used to calculate the assessment under this paragraph
8shall, by emergency rule under subsection (s) of Section 5-45
9of the Illinois Administrative Procedure Act, be increased by a
10uniform percentage to generate $6,750,000 in the aggregate for
11that period from all hospitals subject to the annual assessment
12under this paragraph.
13    (2) In addition to any other assessments imposed under this
14Article, effective July 1, 2016 and semi-annually thereafter
15through June 2018, in addition to any federally required State
16share as authorized under paragraph (1), the amount of .008766
17shall be increased by a uniform percentage to generate an
18amount equal to 25% of the ACA Assessment Adjustment, as
19defined in subsection (b-6) of this Section.
20    For the portion of State fiscal year 2012, beginning June
2110, 2012 through June 30, 2012, and State fiscal years 2013
22through 2018, or as provided in Section 5A-16, a hospital's
23outpatient gross revenue shall be determined using the most
24recent data available from each hospital's 2009 Medicare cost
25report as contained in the Healthcare Cost Report Information
26System file, for the quarter ending on June 30, 2011, without

 

 

10000SB1773ham004- 81 -LRB100 09919 KTG 35698 a

1regard to any subsequent adjustments or changes to such data.
2If a hospital's 2009 Medicare cost report is not contained in
3the Healthcare Cost Report Information System, then the
4Department may obtain the hospital provider's outpatient gross
5revenue from any source available, including, but not limited
6to, records maintained by the hospital provider, which may be
7inspected at all times during business hours of the day by the
8Department or its duly authorized agents and employees.
9    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
10fiscal years 2019 and 2020, an annual assessment on outpatient
11services is imposed on each hospital provider in an amount
12equal to 0.XXXX multiplied by the hospital's outpatient gross
13revenue. For State fiscal years 2019 and 2020, a hospital's
14outpatient gross revenue shall be determined using the most
15recent data available from each hospital's 2015 Medicare cost
16report as contained in the Healthcare Cost Report Information
17System file, for the quarter ending on March 31, 2017, without
18regard to any subsequent adjustments or changes to such data.
19If a hospital's 2015 Medicare cost report is not contained in
20the Healthcare Cost Report Information System, then the
21Department may obtain the hospital provider's outpatient gross
22revenue from any source available, including, but not limited
23to, records maintained by the hospital provider, which may be
24inspected at all times during business hours of the day by the
25Department or its duly authorized agents and employees.
26Notwithstanding any other provision in this Article, for a

 

 

10000SB1773ham004- 82 -LRB100 09919 KTG 35698 a

1hospital provider that did not have a 2015 Medicare cost
2report, but paid an assessment in State fiscal year 2018 on the
3basis of hypothetical data, that assessment amount shall be
4used for State fiscal years 2019 and 2020.
5    Subject to Sections 5A-3 and 5A-10, for State fiscal years
62021 through 2024, an annual assessment on outpatient services
7is imposed on each hospital provider in an amount equal to $XX
8multiplied by the hospital's outpatient gross revenue,
9provided however, that the amount of $XX used to calculate the
10assessment under this paragraph shall, by rule, be adjusted by
11a uniform percentage to generate the same total annual
12assessment that was generated in State fiscal year 2020 from
13all hospitals subject to the annual assessment under this
14paragraph. For State fiscal years 2021 and 2022, a hospital's
15outpatient gross revenue shall be determined using the most
16recent data available from each hospital's 2017 Medicare cost
17report as contained in the Healthcare Cost Report Information
18System file, for the quarter ending on March 31, 2019, without
19regard to any subsequent adjustments or changes to such data.
20For State fiscal years 2023 and 2024, a hospital's outpatient
21gross revenue shall be determined using the most recent data
22available from each hospital's 2019 Medicare cost report as
23contained in the Healthcare Cost Report Information System
24file, for the quarter ending on March 31, 2021, without regard
25to any subsequent adjustments or changes to such data.
26    (b-6)(1) As used in this Section, "ACA Assessment

 

 

10000SB1773ham004- 83 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 84 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 85 -LRB100 09919 KTG 35698 a

1        (D) shall be adjusted to include the product of .19125
2        multiplied by the sum of the fee-for-service payments,
3        if any, estimated to be paid to hospitals under
4        subsection (b) of Section 5A-12.5.
5    (2) The Department shall complete and apply a final
6reconciliation of the ACA Assessment Adjustment prior to June
730, 2018 to account for:
8        (A) any differences between the actual payments issued
9    or scheduled to be issued prior to June 30, 2018 as
10    authorized in Section 5A-12.5 for the period of January 1,
11    2018 through June 30, 2018 and the estimated payments due
12    and payable in the month of October 2017 multiplied by 6 as
13    described in subparagraph (D); and
14        (B) any difference between the estimated
15    fee-for-service payments under subsection (b) of Section
16    5A-12.5 and the amount of such payments that are actually
17    scheduled to be paid.
18    The Department shall notify hospitals of any additional
19amounts owed or reduction credits to be applied to the June
202018 ACA Assessment Adjustment. This is to be considered the
21final reconciliation for the ACA Assessment Adjustment.
22    (3) Notwithstanding any other provision of this Section, if
23for any reason the scheduled payments under subsection (b) of
24Section 5A-12.5 are not issued in full by the final day of the
25period authorized under subsection (b) of Section 5A-12.5,
26funds collected from each hospital pursuant to subparagraph (D)

 

 

10000SB1773ham004- 86 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 87 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 88 -LRB100 09919 KTG 35698 a

1year 2009 and each subsequent State fiscal year or as provided
2in Section 5A-16, shall be due and payable in monthly
3installments, each equaling one-twelfth of the assessment for
4the year, on the fourteenth State business day of each month.
5No installment payment of an assessment imposed by Section 5A-2
6shall be due and payable, however, until after the Comptroller
7has issued the payments required under this Article.
8    Except as provided in subsection (a-5) of this Section, the
9assessment imposed by subsection (b-5) of Section 5A-2 for the
10portion of State fiscal year 2012 beginning June 10, 2012
11through June 30, 2012, and for State fiscal year 2013 through
12State fiscal year 2018 or as provided in Section 5A-16, and
13each subsequent State fiscal year shall be due and payable in
14monthly installments, each equaling one-twelfth of the
15assessment for the year, on the 14th State business day of each
16month. No installment payment of an assessment imposed by
17subsection (b-5) of Section 5A-2 shall be due and payable,
18however, until after: (i) the Department notifies the hospital
19provider, in writing, that the payment methodologies to
20hospitals required under Section 5A-12.4, have been approved by
21the Centers for Medicare and Medicaid Services of the U.S.
22Department of Health and Human Services, and the waiver under
2342 CFR 433.68 for the assessment imposed by subsection (b-5) of
24Section 5A-2, if necessary, has been granted by the Centers for
25Medicare and Medicaid Services of the U.S. Department of Health
26and Human Services; and (ii) the Comptroller has issued the

 

 

10000SB1773ham004- 89 -LRB100 09919 KTG 35698 a

1payments required under Section 5A-12.4. Upon notification to
2the Department of approval of the payment methodologies
3required under Section 5A-12.4 and the waiver granted under 42
4CFR 433.68, if necessary, all installments otherwise due under
5subsection (b-5) of Section 5A-2 prior to the date of
6notification shall be due and payable to the Department upon
7written direction from the Department and issuance by the
8Comptroller of the payments required under Section 5A-12.4.
9    Except as provided in subsection (a-5) of this Section, the
10assessment imposed under Section 5A-2 for State fiscal year
112019 and each subsequent State fiscal year shall be due and
12payable in monthly installments, each equaling one-twelfth of
13the assessment for the year, on the 14th State business day of
14each month. No installment payment of an assessment imposed by
15subsection Section 5A-2 shall be due and payable, however,
16until after: (i) the Department notifies the hospital provider,
17in writing, that the payment methodologies to hospitals
18required under Section 5A-12.6 have been approved by the
19Centers for Medicare and Medicaid Services of the U.S.
20Department of Health and Human Services, and the waiver under
2142 CFR 433.68 for the assessment imposed by Section 5A-2, if
22necessary, has been granted by the Centers for Medicare and
23Medicaid Services of the U.S. Department of Health and Human
24Services; and (ii) the Comptroller has issued the payments
25required under Section 5A-12.6. Upon notification to the
26Department of approval of the payment methodologies required

 

 

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1under Section 5A-12.6 and the waiver granted under 42 CFR
2433.68, if necessary, all installments otherwise due under
3Section 5A-2 prior to the date of notification shall be due and
4payable to the Department upon written direction from the
5Department and issuance by the Comptroller of the payments
6required under Section 5A-12.6.
7    (a-5) The Illinois Department may accelerate the schedule
8upon which assessment installments are due and payable by
9hospitals with a payment ratio greater than or equal to one.
10Such acceleration of due dates for payment of the assessment
11may be made only in conjunction with a corresponding
12acceleration in access payments identified in Section 5A-12.2,
13or Section 5A-12.4, or Section 5A-12.6 to the same hospitals.
14For the purposes of this subsection (a-5), a hospital's payment
15ratio is defined as the quotient obtained by dividing the total
16payments for the State fiscal year, as authorized under Section
175A-12.2, or Section 5A-12.4, or Section 5A-12.6, by the total
18assessment for the State fiscal year imposed under Section 5A-2
19or subsection (b-5) of Section 5A-2.
20    (b) The Illinois Department is authorized to establish
21delayed payment schedules for hospital providers that are
22unable to make installment payments when due under this Section
23due to financial difficulties, as determined by the Illinois
24Department.
25    (c) If a hospital provider fails to pay the full amount of
26an installment when due (including any extensions granted under

 

 

10000SB1773ham004- 91 -LRB100 09919 KTG 35698 a

1subsection (b)), there shall, unless waived by the Illinois
2Department for reasonable cause, be added to the assessment
3imposed by Section 5A-2 a penalty assessment equal to the
4lesser of (i) 5% of the amount of the installment not paid on
5or before the due date plus 5% of the portion thereof remaining
6unpaid on the last day of each 30-day period thereafter or (ii)
7100% of the installment amount not paid on or before the due
8date. For purposes of this subsection, payments will be
9credited first to unpaid installment amounts (rather than to
10penalty or interest), beginning with the most delinquent
11installments.
12    (d) Any assessment amount that is due and payable to the
13Illinois Department more frequently than once per calendar
14quarter shall be remitted to the Illinois Department by the
15hospital provider by means of electronic funds transfer. The
16Illinois Department may provide for remittance by other means
17if (i) the amount due is less than $10,000 or (ii) electronic
18funds transfer is unavailable for this purpose.
19(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
2098-104, eff. 7-22-13.)
 
21    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
22    Sec. 5A-5. Notice; penalty; maintenance of records.
23    (a) The Illinois Department shall send a notice of
24assessment to every hospital provider subject to assessment
25under this Article. The notice of assessment shall notify the

 

 

10000SB1773ham004- 92 -LRB100 09919 KTG 35698 a

1hospital of its assessment and shall be sent after receipt by
2the Department of notification from the Centers for Medicare
3and Medicaid Services of the U.S. Department of Health and
4Human Services that the payment methodologies required under
5this Article and, if necessary, the waiver granted under 42 CFR
6433.68 have been approved. The notice shall be on a form
7prepared by the Illinois Department and shall state the
8following:
9        (1) The name of the hospital provider.
10        (2) The address of the hospital provider's principal
11    place of business from which the provider engages in the
12    occupation of hospital provider in this State, and the name
13    and address of each hospital operated, conducted, or
14    maintained by the provider in this State.
15        (3) The occupied bed days, occupied bed days less
16    Medicare days, adjusted gross hospital revenue, or
17    outpatient gross revenue of the hospital provider
18    (whichever is applicable), the amount of assessment
19    imposed under Section 5A-2 for the State fiscal year for
20    which the notice is sent, and the amount of each
21    installment to be paid during the State fiscal year.
22        (4) (Blank).
23        (5) Other reasonable information as determined by the
24    Illinois Department.
25    (b) If a hospital provider conducts, operates, or maintains
26more than one hospital licensed by the Illinois Department of

 

 

10000SB1773ham004- 93 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 94 -LRB100 09919 KTG 35698 a

1days for the full calendar year as determined by the Illinois
2Department. Notwithstanding any other provision in this
3Article, for the portion of State fiscal year 2012 beginning
4June 10, 2012 through June 30, 2012, and for State fiscal years
52013 through 2018, in the case of a hospital provider that did
6not conduct, operate, or maintain a hospital in 2009, the
7assessment under subsection (b-5) of Section 5A-2 for that
8State fiscal year shall be computed on the basis of
9hypothetical gross outpatient revenue for the full calendar
10year as determined by the Illinois Department.
11    Notwithstanding any other provision in this Article, for
12State fiscal years 2019 through 2024, in the case of a hospital
13provider that did not conduct, operate, or maintain a hospital
14in the year that is the basis of the calculation of the
15assessment under this Article, the assessment under paragraph
16(3) of subsection (a) of Section 5A-2 for the State fiscal year
17shall be computed on the basis of hypothetical occupied bed
18days for the full calendar year as determined by the Illinois
19Department, except that for a hospital provider that did not
20have a 2015 Medicare cost report, but paid an assessment in
21State fiscal year 2018 on the basis of hypothetical data, that
22assessment amount shall be used for State fiscal years 2019 and
232020.
24    Notwithstanding any other provision in this Article, for
25State fiscal years 2019 through 2024, in the case of a hospital
26provider that did not conduct, operate, or maintain a hospital

 

 

10000SB1773ham004- 95 -LRB100 09919 KTG 35698 a

1in the year that is the basis of the calculation of the
2assessment under this Article, the assessment under subsection
3(b-5) of Section 5A-2 for that State fiscal year shall be
4computed on the basis of hypothetical gross outpatient revenue
5for the full calendar year as determined by the Illinois
6Department, except that for a hospital provider that did not
7have a 2015 Medicare cost report, but paid an assessment in
8State fiscal year 2018 on the basis of hypothetical data, that
9assessment amount shall be used for State fiscal years 2019 and
102020.
11    (f) Every hospital provider subject to assessment under
12this Article shall keep sufficient records to permit the
13determination of adjusted gross hospital revenue for the
14hospital's fiscal year. All such records shall be kept in the
15English language and shall, at all times during regular
16business hours of the day, be subject to inspection by the
17Illinois Department or its duly authorized agents and
18employees.
19    (g) The Illinois Department may, by rule, provide a
20hospital provider a reasonable opportunity to request a
21clarification or correction of any clerical or computational
22errors contained in the calculation of its assessment, but such
23corrections shall not extend to updating the cost report
24information used to calculate the assessment.
25    (h) (Blank).
26(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;

 

 

10000SB1773ham004- 96 -LRB100 09919 KTG 35698 a

198-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
27-20-15.)
 
3    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
4    Sec. 5A-8. Hospital Provider Fund.
5    (a) There is created in the State Treasury the Hospital
6Provider Fund. Interest earned by the Fund shall be credited to
7the Fund. The Fund shall not be used to replace any moneys
8appropriated to the Medicaid program by the General Assembly.
9    (b) The Fund is created for the purpose of receiving moneys
10in accordance with Section 5A-6 and disbursing moneys only for
11the following purposes, notwithstanding any other provision of
12law:
13        (1) For making payments to hospitals as required under
14    this Code, under the Children's Health Insurance Program
15    Act, under the Covering ALL KIDS Health Insurance Act, and
16    under the Long Term Acute Care Hospital Quality Improvement
17    Transfer Program Act.
18        (2) For the reimbursement of moneys collected by the
19    Illinois Department from hospitals or hospital providers
20    through error or mistake in performing the activities
21    authorized under this Code.
22        (3) For payment of administrative expenses incurred by
23    the Illinois Department or its agent in performing
24    activities under this Code, under the Children's Health
25    Insurance Program Act, under the Covering ALL KIDS Health

 

 

10000SB1773ham004- 97 -LRB100 09919 KTG 35698 a

1    Insurance Act, and under the Long Term Acute Care Hospital
2    Quality Improvement Transfer Program Act.
3        (4) For payments of any amounts which are reimbursable
4    to the federal government for payments from this Fund which
5    are required to be paid by State warrant.
6        (5) For making transfers, as those transfers are
7    authorized in the proceedings authorizing debt under the
8    Short Term Borrowing Act, but transfers made under this
9    paragraph (5) shall not exceed the principal amount of debt
10    issued in anticipation of the receipt by the State of
11    moneys to be deposited into the Fund.
12        (6) For making transfers to any other fund in the State
13    treasury, but transfers made under this paragraph (6) shall
14    not exceed the amount transferred previously from that
15    other fund into the Hospital Provider Fund plus any
16    interest that would have been earned by that fund on the
17    monies that had been transferred.
18        (6.5) For making transfers to the Healthcare Provider
19    Relief Fund, except that transfers made under this
20    paragraph (6.5) shall not exceed $60,000,000 in the
21    aggregate.
22        (7) For making transfers not exceeding the following
23    amounts, related to State fiscal years 2013 through 2018,
24    to the following designated funds:
25            Health and Human Services Medicaid Trust
26                Fund..............................$20,000,000

 

 

10000SB1773ham004- 98 -LRB100 09919 KTG 35698 a

1            Long-Term Care Provider Fund..........$30,000,000
2            General Revenue Fund.................$80,000,000.
3    Transfers under this paragraph shall be made within 7 days
4    after the payments have been received pursuant to the
5    schedule of payments provided in subsection (a) of Section
6    5A-4.
7        (7.1) (Blank).
8        (7.5) (Blank).
9        (7.8) (Blank).
10        (7.9) (Blank).
11        (7.10) For State fiscal year 2014, for making transfers
12    of the moneys resulting from the assessment under
13    subsection (b-5) of Section 5A-2 and received from hospital
14    providers under Section 5A-4 and transferred into the
15    Hospital Provider Fund under Section 5A-6 to the designated
16    funds not exceeding the following amounts in that State
17    fiscal year:
18            Healthcare Provider Relief Fund......$100,000,000
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        The additional amount of transfers in this paragraph
24    (7.10), authorized by Public Act 98-651, shall be made
25    within 10 State business days after June 16, 2014 (the
26    effective date of Public Act 98-651). That authority shall

 

 

10000SB1773ham004- 99 -LRB100 09919 KTG 35698 a

1    remain in effect even if Public Act 98-651 does not become
2    law until State fiscal year 2015.
3        (7.10a) For State fiscal years 2015 through 2018, for
4    making transfers of the moneys resulting from the
5    assessment under subsection (b-5) of Section 5A-2 and
6    received from hospital providers under Section 5A-4 and
7    transferred into the Hospital Provider Fund under Section
8    5A-6 to the designated funds not exceeding the following
9    amounts related to each State fiscal year:
10            Healthcare Provider Relief Fund......$50,000,000
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        (7.11) (Blank).
16        (7.12) For State fiscal year 2013, for increasing by
17    21/365ths the transfer of the moneys resulting from the
18    assessment under subsection (b-5) of Section 5A-2 and
19    received from hospital providers under Section 5A-4 for the
20    portion of State fiscal year 2012 beginning June 10, 2012
21    through June 30, 2012 and transferred into the Hospital
22    Provider Fund under Section 5A-6 to the designated funds
23    not exceeding the following amounts in that State fiscal
24    year:
25            Healthcare Provider Relief Fund.......$2,870,000
26        Since the federal Centers for Medicare and Medicaid

 

 

10000SB1773ham004- 100 -LRB100 09919 KTG 35698 a

1    Services approval of the assessment authorized under
2    subsection (b-5) of Section 5A-2, received from hospital
3    providers under Section 5A-4 and the payment methodologies
4    to hospitals required under Section 5A-12.4 was not
5    received by the Department until State fiscal year 2014 and
6    since the Department made retroactive payments during
7    State fiscal year 2014 related to the referenced period of
8    June 2012, the transfer authority granted in this paragraph
9    (7.12) is extended through the date that is 10 State
10    business days after June 16, 2014 (the effective date of
11    Public Act 98-651).
12        (7.13) In addition to any other transfers authorized
13    under this Section, for State fiscal years 2017 and 2018,
14    for making transfers to the Healthcare Provider Relief Fund
15    of moneys collected from the ACA Assessment Adjustment
16    authorized under subsections (a) and (b-5) of Section 5A-2
17    and paid by hospital providers under Section 5A-4 into the
18    Hospital Provider Fund under Section 5A-6 for each State
19    fiscal year. Timing of transfers to the Healthcare Provider
20    Relief Fund under this paragraph shall be at the discretion
21    of the Department, but no less frequently than quarterly.
22        (7.14) For making transfers not exceeding the
23    following amounts, related to State fiscal years 2019
24    through 2021, to the following designated funds:
25            Health and Human Services Medicaid Trust
26                Fund..............................$20,000,000

 

 

10000SB1773ham004- 101 -LRB100 09919 KTG 35698 a

1            Long-Term Care Provider Fund..........$30,000,000
2            Health Care Provider Relief Fund....$325,000,000.
3        Transfers under this paragraph shall be made within 7
4    days after the payments have been received pursuant to the
5    schedule of payments provided in subsection (a) of Section
6    5A-4.
7        (8) For making refunds to hospital providers pursuant
8    to Section 5A-10.
9        (9) For making payment to capitated managed care
10    organizations as described in subsections (s) and (t) of
11    Section 5A-12.2 and subsection (s) of Section 5A-12.6 of
12    this Code.
13    Disbursements from the Fund, other than transfers
14authorized under paragraphs (5) and (6) of this subsection,
15shall be by warrants drawn by the State Comptroller upon
16receipt of vouchers duly executed and certified by the Illinois
17Department.
18    (c) The Fund shall consist of the following:
19        (1) All moneys collected or received by the Illinois
20    Department from the hospital provider assessment imposed
21    by this Article.
22        (2) All federal matching funds received by the Illinois
23    Department as a result of expenditures made by the Illinois
24    Department that are attributable to moneys deposited in the
25    Fund.
26        (3) Any interest or penalty levied in conjunction with

 

 

10000SB1773ham004- 102 -LRB100 09919 KTG 35698 a

1    the administration of this Article.
2        (3.5) As applicable, proceeds from surety bond
3    payments payable to the Department as referenced in
4    subsection (s) of Section 5A-12.2 of this Code.
5        (4) Moneys transferred from another fund in the State
6    treasury.
7        (5) All other moneys received for the Fund from any
8    other source, including interest earned thereon.
9    (d) (Blank).
10(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
1198-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
127-20-15; 99-516, eff. 6-30-16; 99-933, eff. 1-27-17; revised
132-15-17.)
 
14    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
15    Sec. 5A-10. Applicability.
16    (a) The assessment imposed by subsection (a) of Section
175A-2 shall cease to be imposed and the Department's obligation
18to make payments shall immediately cease, and any moneys
19remaining in the Fund shall be refunded to hospital providers
20in proportion to the amounts paid by them, if:
21        (1) The payments to hospitals required under this
22    Article are not eligible for federal matching funds under
23    Title XIX or XXI of the Social Security Act;
24        (2) For State fiscal years 2009 through 2018, and as
25    provided in Section 5A-16, the Department of Healthcare and

 

 

10000SB1773ham004- 103 -LRB100 09919 KTG 35698 a

1    Family Services adopts any administrative rule change to
2    reduce payment rates or alters any payment methodology that
3    reduces any payment rates made to operating hospitals under
4    the approved Title XIX or Title XXI State plan in effect
5    January 1, 2008 except for:
6            (A) any changes for hospitals described in
7        subsection (b) of Section 5A-3;
8            (B) any rates for payments made under this Article
9        V-A;
10            (C) any changes proposed in State plan amendment
11        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
12        08-07;
13            (D) in relation to any admissions on or after
14        January 1, 2011, a modification in the methodology for
15        calculating outlier payments to hospitals for
16        exceptionally costly stays, for hospitals reimbursed
17        under the diagnosis-related grouping methodology in
18        effect on July 1, 2011; provided that the Department
19        shall be limited to one such modification during the
20        36-month period after the effective date of this
21        amendatory Act of the 96th General Assembly;
22            (E) any changes affecting hospitals authorized by
23        Public Act 97-689;
24            (F) any changes authorized by Section 14-12 of this
25        Code, or for any changes authorized under Section 5A-15
26        of this Code; or

 

 

10000SB1773ham004- 104 -LRB100 09919 KTG 35698 a

1            (G) any changes authorized under Section 5-5b.1.
2    (b) The assessment imposed by Section 5A-2 shall not take
3effect or shall cease to be imposed, and the Department's
4obligation to make payments shall immediately cease, if the
5assessment is determined to be an impermissible tax under Title
6XIX of the Social Security Act. Moneys in the Hospital Provider
7Fund derived from assessments imposed prior thereto shall be
8disbursed in accordance with Section 5A-8 to the extent federal
9financial participation is not reduced due to the
10impermissibility of the assessments, and any remaining moneys
11shall be refunded to hospital providers in proportion to the
12amounts paid by them.
13    (c) The assessments imposed by subsection (b-5) of Section
145A-2 shall not take effect or shall cease to be imposed, the
15Department's obligation to make payments shall immediately
16cease, and any moneys remaining in the Fund shall be refunded
17to hospital providers in proportion to the amounts paid by
18them, if the payments to hospitals required under Section
195A-12.4 or Section 5A-12.6 are not eligible for federal
20matching funds under Title XIX of the Social Security Act.
21    (d) The assessments imposed by Section 5A-2 shall not take
22effect or shall cease to be imposed, the Department's
23obligation to make payments shall immediately cease, and any
24moneys remaining in the Fund shall be refunded to hospital
25providers in proportion to the amounts paid by them, if:
26        (1) for State fiscal years 2013 through 2018, and as

 

 

10000SB1773ham004- 105 -LRB100 09919 KTG 35698 a

1    provided in Section 5A-16, the Department reduces any
2    payment rates to hospitals as in effect on May 1, 2012, or
3    alters any payment methodology as in effect on May 1, 2012,
4    that has the effect of reducing payment rates to hospitals,
5    except for any changes affecting hospitals authorized in
6    Public Act 97-689 and any changes authorized by Section
7    14-12 of this Code, and except for any changes authorized
8    under Section 5A-15, and except for any changes authorized
9    under Section 5-5b.1;
10        (2) for State fiscal years 2013 through 2018, and as
11    provided in Section 5A-16, the Department reduces any
12    supplemental payments made to hospitals below the amounts
13    paid for services provided in State fiscal year 2011 as
14    implemented by administrative rules adopted and in effect
15    on or prior to June 30, 2011, except for any changes
16    affecting hospitals authorized in Public Act 97-689 and any
17    changes authorized by Section 14-12 of this Code, and
18    except for any changes authorized under Section 5A-15, and
19    except for any changes authorized under Section 5-5b.1; or
20        (3) for State fiscal years 2015 through 2018, and as
21    provided in Section 5A-16, the Department reduces the
22    overall effective rate of reimbursement to hospitals below
23    the level authorized under Section 14-12 of this Code,
24    except for any changes under Section 14-12 or Section 5A-15
25    of this Code, and except for any changes authorized under
26    Section 5-5b.1.

 

 

10000SB1773ham004- 106 -LRB100 09919 KTG 35698 a

1    (e) Beginning in State fiscal year 2019, the assessments
2imposed under Section 5A-2 shall not take effect or shall cease
3to be imposed, the Department's obligation to make payments
4shall immediately cease, and any moneys remaining in the Fund
5shall be refunded to hospital providers in proportion to the
6amounts paid by them, if:
7        (1) the payments to hospitals required under Section
8    5A12.6 are not eligible for federal matching funds under
9    Title XIX of the Social Security Act; or
10        (2) the Department reduces the overall effective rate
11    of reimbursement to hospitals below the level authorized
12    under Section 14-12 of this Code, as in effect on December
13    31, 2017, except for any changes authorized under Sections
14    14-12 or Section 5A-15 of this Code, and except for any
15    changes authorized under changes to Sections 5A-12.2,
16    5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by this
17    amendatory Act of the 100th General Assembly.
18(Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-2,
19eff. 3-26-15.)
 
20    (305 ILCS 5/5A-12.5)
21    Sec. 5A-12.5. Affordable Care Act adults; hospital access
22payments.
23    (a) The Department shall, subject to federal approval,
24mirror the Medical Assistance hospital reimbursement
25methodology for Affordable Care Act adults who are enrolled

 

 

10000SB1773ham004- 107 -LRB100 09919 KTG 35698 a

1under a fee-for-service or capitated managed care program,
2including hospital access payments as defined in Section
35A-12.2 of this Article and hospital access improvement
4payments as defined in Section 5A-12.4 of this Article, in
5compliance with the equivalent rate provisions of the
6Affordable Care Act.
7    (b) If the fee-for-service payments authorized under this
8Section are deemed to be increases to payments for a prior
9period, the Department shall seek federal approval to issue
10such increases for the payments made through the period ending
11on June 30, 2018, or as provided in Section 5A-16, even if such
12increases are paid out during an extended payment period beyond
13such date. Payment of such increases beyond such date is
14subject to federal approval. If the Department receives federal
15approval of such increases, the Department shall pay such
16increases on the same schedule as it had used for such payments
17prior to June 30, 2018.
18    (c) As used in this Section, "Affordable Care Act" is the
19collective term for the Patient Protection and Affordable Care
20Act (Pub. L. 111-148) and the Health Care and Education
21Reconciliation Act of 2010 (Pub. L. 111-152).
22(Source: P.A. 98-651, eff. 6-16-14; 99-516, eff. 6-30-16.)
 
23    (305 ILCS 5/5A-12.6 new)
24    Sec. 5A-12.6. Continuation of hospital access payments on
25or after July 1, 2018.

 

 

10000SB1773ham004- 108 -LRB100 09919 KTG 35698 a

1    (a) To preserve and improve access to hospital services,
2for hospital services rendered on or after July 1, 2018 the
3Department shall, except for hospitals described in subsection
4(b) of Section 5A-3, make payments to hospitals as set forth in
5this Section. Payments under this Section are not due and
6payable, however, until (i) the methodologies described in this
7Section are approved by the federal government in an
8appropriate State Plan amendment and (ii) the assessment
9imposed under this Article is determined to be a permissible
10tax under Title XIX of the Social Security Act. In determining
11the hospital access payments authorized under subsections (f)
12through (o) of this Section, unless otherwise specified, only
13Illinois hospitals shall be eligible for a payment and total
14Medicaid utilization statistics shall be used to determine the
15payment amount.
16    (b) Phase in of funds to claims-based payments and updates.
17To ensure access to hospital services, the Department may only
18use funds financed by the assessment authorized under Section
195A-2 to increase claims-based payment rates, including
20applicable policy add-on payments or adjusters, in accordance
21with this subsection. To increase the claims-based payment
22rates up to the amounts specified in this subsection, the
23hospital access payments authorized in subsection (d) and
24subsections (g) through (l) of this Section shall be uniformly
25reduced.
26        (1) For State fiscal years 2019 and 2020, up to

 

 

10000SB1773ham004- 109 -LRB100 09919 KTG 35698 a

1    $630,000,000 of the total spending financed from the
2    assessment authorized under Section 5A-2 that is intended
3    to pay for hospital services and the hospital supplemental
4    access payments authorized under subsections (d) and (f) of
5    Section 14-12 for payment in State fiscal year 2018 may be
6    used to increase claims-based hospital payment rates as
7    specified under Section 14-12.
8        (2) For State fiscal years 2021 and 2022, up to
9    $1,164,000,000 of the total spending financed from the
10    assessment authorized under Section 5A-2 that is intended
11    to pay for hospital services and the hospital supplemental
12    access payments authorized under subsections (d) and (f) of
13    Section 14-12 for payment in State Fiscal Year 2018 may be
14    used to increase claims-based hospital payment rates as
15    specified under Section 14-12.
16        (3) For State fiscal years 2023, up to $1,397,000,000
17    of the total spending financed from the assessment
18    authorized under Section 5A-2 that is intended to pay for
19    hospital services and the hospital supplemental access
20    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        (4) For State fiscal years 2024, up to $1,663,000,000
25    of the total spending financed from the assessment
26    authorized under Section 5A-2 that is intended to pay for

 

 

10000SB1773ham004- 110 -LRB100 09919 KTG 35698 a

1    hospital services and the hospital supplemental access
2    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        (5) Beginning in State fiscal year 2021, and at least
7    every 24 months thereafter, the Department shall, by rule,
8    update the hospital access payments authorized under this
9    Section to take into account the amount of funds being used
10    to increase claims-based hospital payment rates under
11    Section 14-12 and to apply the most recently available data
12    and information, including data from the most recent base
13    year and qualifying criteria which shall correlate to the
14    updated base year data, to determine a hospital's
15    eligibility for each payment and the amount of the payment
16    authorized under this Section. Any updates of the hospital
17    access payment methodologies shall not result in any
18    diminishment of the aggregate amount of hospital access
19    payment expenditures, except for reductions attributable
20    to the use of such funds to increase claims-based hospital
21    payment rates as authorized by this Section. Nothing in
22    this Section shall be construed as precluding variations in
23    the amount of any individual hospital's access payments.
24    The Department shall publish the proposed rules to update
25    the hospital access payments at least 90 days before their
26    proposed effective date. The proposed rules shall not be

 

 

10000SB1773ham004- 111 -LRB100 09919 KTG 35698 a

1    adopted using emergency rulemaking authority. The
2    Department shall notify each hospital, in writing, of the
3    impact of these updates on the hospital at least 30
4    calendar days prior to their effective date.
5    (c) The hospital access payments authorized under
6subsections (d) through (n) of this Section shall be paid in 12
7equal installments on or before the seventh State business day
8of each month, except that no payment shall be due within 100
9days after the later of the date of notification of federal
10approval of the payment methodologies required under this
11Section or any waiver required under 42 CFR 433.68, at which
12time the sum of amounts required under this Section prior to
13the date of notification is due and payable. Payments under
14this Section are not due and payable, however, until (i) the
15methodologies described in this Section are approved by the
16federal government in an appropriate State Plan amendment and
17(ii) the assessment imposed under this Article is determined to
18be a permissible tax under Title XIX of the Social Security
19Act. The Department may, when practicable, accelerate the
20schedule upon which payments authorized under this Section are
21made.
22    (d) Rate increase-based adjustment.
23        (1) From the funds financed by the assessment
24    authorized under Section 5A-2, individual funding pools by
25    category of service shall be established, for Inpatient
26    General Acute Care services in the amount of $XX, Inpatient

 

 

10000SB1773ham004- 112 -LRB100 09919 KTG 35698 a

1    Rehab Care services in the amount of $XX, Inpatient
2    Psychiatric Care service in the amount of $XX, and
3    Outpatient Care Services in the amount of $XX.
4        (2) Each Illinois hospital and other hospitals
5    authorized under this subsection, except for long-term
6    acute care hospitals and public hospitals, shall be
7    assigned a pool allocation percentage for each category of
8    service that is equal to the ratio of the hospital's
9    estimated FY2019 claims-based payments including all
10    applicable FY2019 policy adjusters, multiplied by the
11    applicable service credit factor for the hospital, divided
12    by the total of the FY2019 claims-based payments including
13    all FY2019 policy adjusters for each category of service
14    adjusted by each hospital's applicable service credit
15    factor for all qualified hospitals. For each category of
16    service, a hospital shall receive a supplemental payment
17    equal to its pool allocation percentage multiplied by the
18    total pool amount.
19        (3) Effective July 1, 2018, for purposes of determining
20    for State fiscal years 2019 and 2020 the hospitals eligible
21    for the payments authorized under this subsection, the
22    Department shall include children's hospitals located in
23    St. Louis that are designated a Level III perinatal center
24    by the Department of Public Health and also designated a
25    Level I pediatric trauma center by the Department of Public
26    Health as of December 1, 2017.

 

 

10000SB1773ham004- 113 -LRB100 09919 KTG 35698 a

1        (4) As used in this subsection, "service credit factor"
2    is determined based on a hospital's Rate Year 2017 Medicaid
3    inpatient utilization rate ("MIUR"), as follows:
4            (A) Tier 1: A hospital with a MIUR equal to or
5        greater than 75% shall have a service credit factor of
6        200%.
7            (B) Tier 2: A hospital with a MIUR equal to or
8        greater than 33% but less than 75% shall have a service
9        credit factor of 100%.
10            (C) Tier 3: A hospital with a MIUR equal to or
11        greater than 20% but less than 33% shall have a service
12        credit factor of 50%.
13            (D) Tier 4: A hospital with a MIUR less than 20%
14        shall have a service credit factor of 10%.
15    (e) Graduate medical education.
16        (1) The calculation of graduate medical education
17    payments shall be based on the hospital's Medicare cost
18    report ending in Calendar Year 2015, as reported in
19    Medicare cost reports released on October 19, 2016 with
20    data through September 30, 2016. An Illinois hospital
21    reporting intern and resident cost on its Medicare cost
22    report shall be eligible for graduate medical education
23    payments.
24        (2) Each hospital's annualized Medicaid Intern
25    Resident Cost is calculated using annualized intern and
26    resident total costs obtained from Worksheet B Part I,

 

 

10000SB1773ham004- 114 -LRB100 09919 KTG 35698 a

1    Column 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
2    96-98, and 105-112 multiplied by the percentage that the
3    hospital's Medicaid days (Worksheet S3 Part I, Column 7,
4    Lines 14 and 16-18) comprise of the hospital's total days
5    (Worksheet S3 Part I, Column 8, Lines 14 and 16-18).
6        (3) An annualized Medicaid indirect medical education
7    (IME) payment is calculated for each hospital using its IME
8    payments (Worksheet E Part A, Line 29, Col 1) multiplied by
9    the percentage that its Medicaid days (Worksheet S3 Part I,
10    Column 7, Lines 14 and 16-18) comprise of its Medicare days
11    (Worksheet S3 Part I, Column 6, Lines 14 and 16-18).
12        (4) For each hospital, its annualized Medicaid Intern
13    Resident Cost and its annualized Medicaid IME payment are
14    summed and multiplied by 33% to determine the hospital's
15    final graduate medical education payment.
16    (f) Alzheimer's treatment access payment. Each Illinois
17academic medical center or teaching hospital, as defined in
18Section 5-5e.2 of this Code, that is identified as the primary
19hospital affiliate of one of the Regional Alzheimer's Disease
20Assistance Centers, as designated by the Alzheimer's Disease
21Assistance Act and identified in the Department of Public
22Health's Alzheimer's Disease State Plan dated December 2016,
23shall be paid an Alzheimer's treatment access payment equal to
24the product of $XX million multiplied by a fraction, the
25numerator of which is the qualifying hospital's Fiscal Year
262015 total admissions and the denominator of which is the

 

 

10000SB1773ham004- 115 -LRB100 09919 KTG 35698 a

1Fiscal Year 2015 total admissions for all hospitals eligible
2for the payment.
3    (g) Safety-net hospital, private critical access hospital,
4and outpatient high volume access payment.
5        (1) Each safety-net hospital, as defined in Section
6    5-5e.1 of this Code, for Rate Year 2017 that is not
7    publicly owned shall be paid an outpatient high volume
8    access payment equal to $XX million multiplied by a
9    fraction, the numerator of which is the hospital's Fiscal
10    Year 2015 outpatient EIS services and the denominator of
11    which is the Fiscal Year 2015 outpatient EIS services for
12    all hospitals eligible under this paragraph for this
13    payment.
14        (2) Each critical access hospital that is not publicly
15    owned shall be paid an outpatient high volume access
16    payment equal to $XX million multiplied by a fraction, the
17    numerator of which is the hospital's Fiscal Year 2015
18    outpatient EIS services and the denominator of which is the
19    Fiscal Year 2015 outpatient EIS services for all hospitals
20    eligible under this paragraph for this payment.
21        (3) Each tier 1 hospital that is not publicly owned
22    shall be paid an outpatient high volume access payment
23    equal to $XX million multiplied by a fraction, the
24    numerator of which is the hospital's Fiscal Year 2015
25    outpatient EIS services and the denominator of which is the
26    Fiscal Year 2015 outpatient EIS services for all hospitals

 

 

10000SB1773ham004- 116 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 117 -LRB100 09919 KTG 35698 a

1    outpatient EIS services and the denominator of which is the
2    Fiscal Year 2015 outpatient EIS services for all hospitals
3    eligible under this paragraph for this payment. A tier 3
4    outpatient high volume hospital means a non-publicly owned
5    hospital, excluding a safety-net hospital as defined in
6    Section 5-5e.1 of this Code, with total outpatient EIS
7    services equal to or greater than the regional mean plus 2
8    standard deviations for all hospitals in the region.
9    (h) Medicaid dependent or high volume hospital access
10payment.
11        (1) To qualify for a Medicaid dependent hospital access
12    payment, a hospital shall meet one of the following
13    criteria:
14            (A) Be a non-publicly owned general acute care
15        hospital that is a safety-net hospital, as defined in
16        Section 5-5e.1 of this Code, for Rate Year 2017.
17            (B) Be a pediatric hospital that is a safety net
18        hospital, as defined in Section 5-5e.1 of this Code,
19        for Rate Year 2017 and have a Medicaid inpatient
20        utilization rate equal to or greater than 50%.
21            (C) Be a general acute care hospital with a
22        Medicaid inpatient utilization rate equal to or
23        greater than 50% in Rate Year 2017.
24        (2) The Medicaid dependent hospital access payment
25    shall be determined as follows:
26            (A) Each tier 1 hospital shall be paid a Medicaid

 

 

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

 

 

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1        denominator of which is the Fiscal Year 2015 total days
2        for all hospitals eligible under this subparagraph for
3        this payment. A tier 3 Medicaid dependent hospital
4        means a qualifying hospital with a Rate Year 2017
5        Medicaid inpatient utilization rate equal to or
6        greater than the statewide mean plus one standard
7        deviation but less than the statewide mean plus 1.5
8        standard deviations.
9            (D) Each tier 4 hospital shall be paid a Medicaid
10        dependent hospital access payment equal to $XX million
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 4 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 1.5 standard
19        deviations but less than the statewide mean plus 2
20        standard deviations.
21            (E) Each tier 5 hospital shall be paid a Medicaid
22        dependent hospital access payment equal to $XX million
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

 

 

10000SB1773ham004- 120 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 121 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 122 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 123 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 124 -LRB100 09919 KTG 35698 a

1    fraction, the numerator of which is the hospital's Fiscal
2    Year 2015 outpatient EIS services and the denominator of
3    which is the Fiscal Year 2015 outpatient EIS services for
4    all hospitals eligible under this paragraph for this
5    payment.
6    (n) Psychiatric care access payment. In addition to rates
7paid for inpatient psychiatric services, the Illinois
8Department shall, by rule, establish an access payment for
9inpatient hospital psychiatric services that shall, in the
10aggregate, spend approximately $XX million annually. In
11consultation with the hospital community, the Department may,
12by rule, incorporate the funds used for this access payment to
13increase the payment rates for inpatient psychiatric services,
14except that such changes shall not take effect before July 1,
152019. Upon incorporation into the claims payment rates, this
16access payment shall be repealed.
17    (o) For purposes of this Section, a hospital that is
18enrolled to provide Medicaid services during State fiscal year
192015 shall have its utilization and associated reimbursements
20annualized prior to the payment calculations being performed
21under this Section.
22    (p) Definitions. As used in this Section, unless the
23context requires otherwise:
24    "General acute care admissions" means, for a given
25hospital, the sum of inpatient hospital admissions provided to
26recipients of medical assistance under Title XIX of the Social

 

 

10000SB1773ham004- 125 -LRB100 09919 KTG 35698 a

1Security Act for general acute care, excluding admissions for
2individuals eligible for Medicare under Title XVIII of the
3Social Security Act (Medicaid/Medicare crossover admissions),
4as tabulated from the Department's paid claims data for general
5acute care admissions occurring during State fiscal year 2015
6that was adjudicated by the Department through October 28,
72016.
8    "Occupancy ratio" is determined utilizing the IDPH
9Hospital Profile CY15 Facility Utilization Data Source 2015
10Annual Hospital Questionnaire. Utilizes all beds and days
11including observation days but excludes Long Term Care and
12Swing bed and their associated beds and days.
13    "Outpatient EIS services" means, for a given hospital, the
14sum of the number of outpatient encounters identified as unique
15services provided to recipients of medical assistance under
16Title XIX of the Social Security Act for general acute care,
17psychiatric care, and rehabilitation care, excluding
18outpatient EIS services for individuals eligible for Medicare
19under Title XVIII of the Social Security Act (Medicaid/Medicare
20crossover services), as tabulated from the Department's paid
21claims data for outpatient EIS services occurring during State
22fiscal year 2015 that was adjudicated by the Department through
23October 28, 2016.
24    "Total days" means, for a given hospital, the sum of
25inpatient hospital days provided to recipients of medical
26assistance under Title XIX of the Social Security Act for

 

 

10000SB1773ham004- 126 -LRB100 09919 KTG 35698 a

1general acute care, psychiatric care, and rehabilitation care,
2excluding days for individuals eligible for Medicare under
3Title XVIII of the Social Security Act (Medicaid/Medicare
4crossover days), as tabulated from the Department's paid claims
5data for total days occurring during State fiscal year 2015
6that was adjudicated by the Department through October 28,
72016.
8    "Total admissions" means, for a given hospital, the sum of
9inpatient hospital admissions provided to recipients of
10medical assistance under Title XIX of the Social Security Act
11for general acute care, psychiatric care, and rehabilitation
12care, excluding admissions for individuals eligible for
13Medicare under Title XVIII of that Act (Medicaid/Medicare
14crossover admissions), as tabulated from the Department's paid
15claims data for admissions occurring during State fiscal year
162015 that was adjudicated by the Department through October 28,
172016.
18    (q) Notwithstanding any of the other provisions of this
19Section, the Department is authorized to adopt rules that
20change the hospital access payments specified in this Section,
21but only to the extent necessary to conform to any federally
22approved amendment to the Title XIX State Plan. Any such rules
23shall be adopted by the Department as authorized by Section
245-50 of the Illinois Administrative Procedure Act.
25Notwithstanding any other provision of law, any changes
26implemented as a result of this subsection (q) shall be given

 

 

10000SB1773ham004- 127 -LRB100 09919 KTG 35698 a

1retroactive effect so that they shall be deemed to have taken
2effect as of the effective date of this amendatory Act of the
3100th General Assembly.
4    (r) On or after July 1, 2018, and no less than annually
5thereafter, the Department shall increase capitation payments
6to capitated managed care organizations (MCOs) to equal the
7aggregate reduction of payments made in this Section to
8preserve access to hospital services for recipients under the
9Medical Assistance Program. The aggregate amount of all
10increased capitation payments to all MCOs for a fiscal year
11shall at least be the amount needed to avoid reduction in
12payments authorized under Section 5A-15. Payments to MCOs under
13this Section shall be consistent with actuarial certification
14and shall be published by the Department each year. Managed
15care organizations and hospitals (including through their
16representative organizations), shall develop and implement
17methodologies and rates for payments that will preserve and
18improve access to hospital services for recipients in
19furtherance of the State's public policy to ensure equal access
20to covered services to recipients under the Medical Assistance
21Program. The Department shall make available, on a monthly
22basis, a report of the capitation payments that are made to
23each MCO, including the number of enrollees for which such
24payment is made, the per enrollee amount of the payment, and
25any adjustments that have been made. Payments made under this
26subsection shall be guaranteed by a surety bond obtained by the

 

 

10000SB1773ham004- 128 -LRB100 09919 KTG 35698 a

1MCO in an amount established by the Department to approximate
2one month's liability of payments authorized under this
3subsection. Payments to MCOs that would be paid consistent with
4actuarial certification and enrollment in the absence of the
5increased capitation payments under this Section shall not be
6reduced as a consequence of payments made under this
7subsection.
8    As used in this subsection, "MCO" means an entity which
9contracts with the Department to provide services where payment
10for medical services is made on a capitated basis.
 
11    (305 ILCS 5/5A-13)
12    Sec. 5A-13. Emergency rulemaking.
13    (a) The Department of Healthcare and Family Services
14(formerly Department of Public Aid) may adopt rules necessary
15to implement this amendatory Act of the 94th General Assembly
16through the use of emergency rulemaking in accordance with
17Section 5-45 of the Illinois Administrative Procedure Act. For
18purposes of that Act, the General Assembly finds that the
19adoption of rules to implement this amendatory Act of the 94th
20General Assembly is deemed an emergency and necessary for the
21public interest, safety, and welfare.
22    (b) The Department of Healthcare and Family Services may
23adopt rules necessary to implement this amendatory Act of the
2497th General Assembly through the use of emergency rulemaking
25in accordance with Section 5-45 of the Illinois Administrative

 

 

10000SB1773ham004- 129 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 130 -LRB100 09919 KTG 35698 a

1    (305 ILCS 5/5A-14)
2    Sec. 5A-14. Repeal of assessments and disbursements.
3    (a) Section 5A-2 is repealed on July 1, 2020 2018.
4    (b) Section 5A-12 is repealed on July 1, 2005.
5    (c) Section 5A-12.1 is repealed on July 1, 2008.
6    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
7July 1, 2018, subject to Section 5A-16.
8    (e) Section 5A-12.3 is repealed on July 1, 2011.
9    (f) Section 5A-12.6 is repealed on July 1, 2020.
10(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
1198-651, eff. 6-16-14.)
 
12    (305 ILCS 5/5A-15)
13    Sec. 5A-15. Protection of federal revenue.
14    (a) If the federal Centers for Medicare and Medicaid
15Services finds that any federal upper payment limit applicable
16to the payments under this Article is exceeded then:
17        (1) (i) if such finding is made before payments have
18    been issued, the payments under this Article and the
19    increases in claims-based hospital payment rates specified
20    under Section 14-12 of this Code, as authorized under this
21    amendatory Act of the 100th General Assembly, that exceed
22    the applicable federal upper payment limit shall be reduced
23    uniformly to the extent necessary to comply with the
24    applicable federal upper payment limit; or (ii) if such

 

 

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

 

 

10000SB1773ham004- 132 -LRB100 09919 KTG 35698 a

1reimbursement methodologies authorized under this amendatory
2Act of the 100th General Assembly by the federal Centers for
3Medicare and Medicaid Services and the final implementation of
4such program by the Department, the Department shall take all
5actions necessary to continue the reimbursement methodologies
6and payments to hospitals that are changed under this
7amendatory Act of the 100th General Assembly, as they are in
8effect on June 30, 2018, until the first day of the second
9month after the new and revised methodologies and payments
10authorized under this amendatory Act of the 100th General
11Assembly are effective and implemented by the Department. Such
12actions by the Department shall include, but not be limited to,
13requesting the extension of any federal approval of the
14currently approved payment methodologies contained in
15Illinois' Medicaid State Plan while the federal Centers for
16Medicare and Medicaid Services reviews the proposed changes
17authorized under this amendatory Act of the 100th General
18Assembly.
19    Notwithstanding any other provision of this Code, if the
20federal Centers for Medicare and Medicaid Services should
21approve the continuation of the reimbursement methodologies
22and payments to hospitals under Sections 5A-12.2, 5A-12.4,
235A-12.5, and Section 14-12, as they are in effect on June 30,
242018, until the new and revised methodologies and payments
25authorized under Sections 5A-12.6 and Section 14-12 of this
26amendatory Act of the 100th General Assembly are federally

 

 

10000SB1773ham004- 133 -LRB100 09919 KTG 35698 a

1approved, then the reimbursement methodologies and payments to
2hospitals under Sections 5A-12.2, 5A-12.4, 5A-12.5, and 14-12,
3and the assessments imposed under Section 5A-2, as they are in
4effect on June 30, 2018, shall continue until the effective
5date of the new and revised methodologies and payments, which
6shall be the first day of the second month following the date
7of approval by the federal Centers for Medicare and Medicaid
8Services.
 
9    (305 ILCS 5/12-4.105)
10    Sec. 12-4.105. Human poison control center; payment
11program. Subject to funding availability resulting from
12transfers made from the Hospital Provider Fund to the
13Healthcare Provider Relief Fund as authorized under this Code,
14for State fiscal year 2017 and State fiscal year 2018, and for
15each State fiscal year thereafter in which the assessment under
16Section 5A-2 is imposed, the Department of Healthcare and
17Family Services shall pay to the human poison control center
18designated under the Poison Control System Act an amount of not
19less than $3,000,000 for each of those State fiscal years that
20the human poison control center is in operation.
21(Source: P.A. 99-516, eff. 6-30-16.)
 
22    (305 ILCS 5/14-12)
23    Sec. 14-12. Hospital rate reform payment system. The
24hospital payment system pursuant to Section 14-11 of this

 

 

10000SB1773ham004- 134 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 135 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 136 -LRB100 09919 KTG 35698 a

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

 

 

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

 

 

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

 

 

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

 

 

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1        with the labor portion adjusted by the Calendar Year
2        2013 Medicare Outpatient Prospective Payment System
3        wage index with reclassifications, shall be published
4        by the Department on its website no later than 10
5        calendar days prior to their effective date.
6            (B) The Department shall establish adjustments to
7        the statewide-standardized amounts for each Critical
8        Access Hospital, as designated by the Department of
9        Public Health in accordance with 42 CFR 485, Subpart F.
10        The EAPG standardized amounts are determined
11        separately for each critical access hospital such that
12        simulated EAPG payments using outpatient base period
13        paid claim data plus payments under Section 5A-12.4 of
14        this Code net of the associated tax costs are equal to
15        the estimated costs of outpatient base period claims
16        data with a rate year cost inflation factor applied.
17        (3) In addition to the statewide-standardized amounts,
18    the Department shall develop adjusters to adjust the rate
19    of reimbursement for critical Medicaid hospital outpatient
20    providers or services, including outpatient high volume or
21    safety-net hospitals. Beginning July 1, 2018, the
22    outpatient high volume adjustor shall be increased to XX
23    and this adjustor shall apply to public hospitals, except
24    for large public hospitals, as defined under 89 Ill. Adm.
25    Code 148.25(a).
26        (4) Beginning July 1, 2018, in addition to the

 

 

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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

 

 

10000SB1773ham004- 142 -LRB100 09919 KTG 35698 a

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.

 

 

10000SB1773ham004- 143 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 144 -LRB100 09919 KTG 35698 a

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 $X 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

 

 

10000SB1773ham004- 145 -LRB100 09919 KTG 35698 a

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,

 

 

10000SB1773ham004- 146 -LRB100 09919 KTG 35698 a

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 exempt 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 for an exemption, the hospital must submit to
22        the Health Facilities and Services Review Board
23        certification from the Department, approved by the
24        Hospital Transformation Review Committee, that the
25        project is a part of the hospital's transformation.
26            (C) As provided in subsection (a-20) of Section

 

 

10000SB1773ham004- 147 -LRB100 09919 KTG 35698 a

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

 

 

10000SB1773ham004- 148 -LRB100 09919 KTG 35698 a

1    for approval only if the rule has first been approved by 7
2    of the 10 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 10 members. No later than 30
7    days after the effective date of this amendatory Act of the
8    100th General Assembly, the Governor and the 4 legislative
9    leaders shall each appoint 2 members. Any vacancy shall be
10    filled by the applicable appointing authority within 15
11    calendar days. The members of the Committee shall select a
12    Chair and a Vice-Chair from among its members, provided
13    that the Chair and Co-Chair cannot be appointed by the same
14    appointing authority and must be from different political
15    parties. The Chair shall have the authority to establish a
16    meeting schedule and convene meetings of the Committee, and
17    the Vice-Chair shall have the authority to convene meetings
18    in the absence of the Chair. The Committee may establish
19    its own rules with respect to meeting schedule, notice of
20    meetings, and the disclosure of documents; however, the
21    Committee shall not have the power to subpoena individuals
22    or documents and any rules must be approved by 7 of the 10
23    members. The Committee shall perform the functions
24    described in this Section and advise and consult with the
25    Director in the administration of this Section. In addition
26    to reviewing and approving the policies, procedures, and

 

 

10000SB1773ham004- 149 -LRB100 09919 KTG 35698 a

1    rules for the hospital transformation program, the
2    Committee shall consider and make recommendations related
3    to qualifying criteria and payment methodologies related
4    to safety-net hospitals and children's hospitals. Members
5    of the Committee appointed by the legislative leaders shall
6    be subject to the jurisdiction of the Legislative Ethics
7    Commission, not the Executive Ethics Commission, and all
8    requests under the Freedom of Information Act shall be
9    directed to the applicable Freedom of Information officer
10    for the General Assembly. The Department shall provide
11    operational support to the Committee as necessary.
12    (e) Beginning 36 months after initial implementation, the
13Department shall update the reimbursement components in
14subsections (a) and (b), including standardized amounts and
15weighting factors, and at least triennially and no more
16frequently than annually thereafter. The Department shall
17publish these updates on its website no later than 30 calendar
18days prior to their effective date.
19    (f) Continuation of supplemental payments. Any
20supplemental payments authorized under Illinois Administrative
21Code 148 effective January 1, 2014 and that continue during the
22period of July 1, 2014 through December 31, 2014 shall remain
23in effect as long as the assessment imposed by Section 5A-2
24that is in effect on December 31, 2017 remains is in effect.
25    (g) Notwithstanding subsections (a) through (f) of this
26Section and notwithstanding the changes authorized under

 

 

10000SB1773ham004- 150 -LRB100 09919 KTG 35698 a

1Section 5-5b.1, any updates to the system shall not result in
2any diminishment of the overall effective rates of
3reimbursement as of the implementation date of the new system
4(July 1, 2014). These updates shall not preclude variations in
5any individual component of the system or hospital rate
6variations. Nothing in this Section shall prohibit the
7Department from increasing the rates of reimbursement or
8developing payments to ensure access to hospital services.
9Nothing in this Section shall be construed to guarantee a
10minimum amount of spending in the aggregate or per hospital as
11spending may be impacted by factors including but not limited
12to the number of individuals in the medical assistance program
13and the severity of illness of the individuals.
14    (h) The Department shall have the authority to modify by
15rulemaking any changes to the rates or methodologies in this
16Section as required by the federal government to obtain federal
17financial participation for expenditures made under this
18Section.
19    (i) Except for subsections (g) and (h) of this Section, the
20Department shall, pursuant to subsection (c) of Section 5-40 of
21the Illinois Administrative Procedure Act, provide for
22presentation at the June 2014 hearing of the Joint Committee on
23Administrative Rules (JCAR) additional written notice to JCAR
24of the following rules in order to commence the second notice
25period for the following rules: rules published in the Illinois
26Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559

 

 

10000SB1773ham004- 151 -LRB100 09919 KTG 35698 a

1(Medical Payment), 4628 (Specialized Health Care Delivery
2Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
3Grouping (DRG) Prospective Payment System (PPS)), and 4977
4(Hospital Reimbursement Changes), and published in the
5Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
6(Specialized Health Care Delivery Systems) and 6505 (Hospital
7Services).
8    (j) Out-of-state hospitals. The Department shall develop
9reimbursement methodologies to recognize the importance of
10out-of-state hospitals located in states that border Illinois
11and provide access to specialty hospital services, but only if
12such services are not reasonably available to beneficiaries
13from an Illinois hospital, or such hospital provides a
14significant volume of care. Effective July 1, 2018, for
15purposes of determining for State fiscal years 2019 and 2020
16the hospitals eligible for the payments authorized under
17subsections (a) and (b) of this Section, the Department shall
18include children's hospitals located in St. Louis that are
19designated a Level III perinatal center by the Department of
20Public Health and also designated a Level I pediatric trauma
21center by the Department of Public Health as of December 1,
222017.
23    (k) Data sharing. The Department shall provide to the
24statewide association representing a majority of hospitals the
25data and information needed to perform data analyses related to
26potential hospital reimbursement methodologies, including, but

 

 

10000SB1773ham004- 152 -LRB100 09919 KTG 35698 a

1not limited to, those methodologies authorized under this
2Section and Article V-A of this Code. Such data shall include,
3but not be limited to, de-identified claims level data, any
4federal report annually required which identifies or evaluates
5the Medical Assistance Program's compliance with limits on
6spending, and any other data requested which can reasonably be
7considered necessary to develop, monitor, and evaluate the
8payment methodologies authorized in this Section. To the extent
9required by law, the release of such data may be subject to the
10execution of a data use agreement.
11    (l) The Department shall notify each hospital and managed
12care organization, in writing, of the impact of the updates
13under this Section at least 30 calendar days prior to their
14effective date.
15(Source: P.A. 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)
 
16    Section 95. No acceleration or delay. Where this Act makes
17changes in a statute that is represented in this Act by text
18that is not yet or no longer in effect (for example, a Section
19represented by multiple versions), the use of that text does
20not accelerate or delay the taking effect of (i) the changes
21made by this Act or (ii) provisions derived from any other
22Public Act.
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.".