Rep. Gregory Harris

Filed: 2/26/2018

 

 


 

 


 
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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. Legislative intent. The General Assembly
6declares that is the legislative intent of the 100th General
7Assembly that, in order to best preserve and improve access to
8hospital services for Illinois Medicaid beneficiaries, the
9assessment imposed and payments required under this Act are to
10be presented to the federal Centers for Medicare and Medicaid
11Services as a 6-year program.
12    In accordance with guidelines promulgated by the federal
13Centers for Medicare and Medicaid Services, the assessment plan
14presented shall phase in claims-based payments through
15increasing amounts over 6 years. The Department of Healthcare
16and Family Services, in consultation with the Hospital
17Transformation Review Committee, the hospital community, and

 

 

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1the managed care organizations contracting with the State to
2provide medicaid services, shall evaluate the State fiscal year
3claims-based payments to monitor whether the proposed rates and
4methodologies resulted in expected reimbursement estimates,
5taking into consideration any changes in utilization patterns.
 
6    Section 2. The Illinois Administrative Procedure Act is
7amended by changing Section 5-45 and by adding Section 5-46.3
8as follows:
 
9    (5 ILCS 100/5-45)  (from Ch. 127, par. 1005-45)
10    Sec. 5-45. Emergency rulemaking.
11    (a) "Emergency" means the existence of any situation that
12any agency finds reasonably constitutes a threat to the public
13interest, safety, or welfare.
14    (b) If any agency finds that an emergency exists that
15requires adoption of a rule upon fewer days than is required by
16Section 5-40 and states in writing its reasons for that
17finding, the agency may adopt an emergency rule without prior
18notice or hearing upon filing a notice of emergency rulemaking
19with the Secretary of State under Section 5-70. The notice
20shall include the text of the emergency rule and shall be
21published in the Illinois Register. Consent orders or other
22court orders adopting settlements negotiated by an agency may
23be adopted under this Section. Subject to applicable
24constitutional or statutory provisions, an emergency rule

 

 

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1becomes effective immediately upon filing under Section 5-65 or
2at a stated date less than 10 days thereafter. The agency's
3finding and a statement of the specific reasons for the finding
4shall be filed with the rule. The agency shall take reasonable
5and appropriate measures to make emergency rules known to the
6persons who may be affected by them.
7    (c) An emergency rule may be effective for a period of not
8longer than 150 days, but the agency's authority to adopt an
9identical rule under Section 5-40 is not precluded. No
10emergency rule may be adopted more than once in any 24-month
11period, except that this limitation on the number of emergency
12rules that may be adopted in a 24-month period does not apply
13to (i) emergency rules that make additions to and deletions
14from the Drug Manual under Section 5-5.16 of the Illinois
15Public Aid Code or the generic drug formulary under Section
163.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
17emergency rules adopted by the Pollution Control Board before
18July 1, 1997 to implement portions of the Livestock Management
19Facilities Act, (iii) emergency rules adopted by the Illinois
20Department of Public Health under subsections (a) through (i)
21of Section 2 of the Department of Public Health Act when
22necessary to protect the public's health, (iv) emergency rules
23adopted pursuant to subsection (n) of this Section, (v)
24emergency rules adopted pursuant to subsection (o) of this
25Section, or (vi) emergency rules adopted pursuant to subsection
26(c-5) of this Section. Two or more emergency rules having

 

 

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1substantially the same purpose and effect shall be deemed to be
2a single rule for purposes of this Section.
3    (c-5) To facilitate the maintenance of the program of group
4health benefits provided to annuitants, survivors, and retired
5employees under the State Employees Group Insurance Act of
61971, rules to alter the contributions to be paid by the State,
7annuitants, survivors, retired employees, or any combination
8of those entities, for that program of group health benefits,
9shall be adopted as emergency rules. The adoption of those
10rules shall be considered an emergency and necessary for the
11public interest, safety, and welfare.
12    (d) In order to provide for the expeditious and timely
13implementation of the State's fiscal year 1999 budget,
14emergency rules to implement any provision of Public Act 90-587
15or 90-588 or any other budget initiative for fiscal year 1999
16may be adopted in accordance with this Section by the agency
17charged with administering that provision or initiative,
18except that the 24-month limitation on the adoption of
19emergency rules and the provisions of Sections 5-115 and 5-125
20do not apply to rules adopted under this subsection (d). The
21adoption of emergency rules authorized by this subsection (d)
22shall be deemed to be necessary for the public interest,
23safety, and welfare.
24    (e) In order to provide for the expeditious and timely
25implementation of the State's fiscal year 2000 budget,
26emergency rules to implement any provision of Public Act 91-24

 

 

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1or any other budget initiative for fiscal year 2000 may be
2adopted in accordance with this Section by the agency charged
3with administering that provision or initiative, except that
4the 24-month limitation on the adoption of emergency rules and
5the provisions of Sections 5-115 and 5-125 do not apply to
6rules adopted under this subsection (e). The adoption of
7emergency rules authorized by this subsection (e) shall be
8deemed to be necessary for the public interest, safety, and
9welfare.
10    (f) In order to provide for the expeditious and timely
11implementation of the State's fiscal year 2001 budget,
12emergency rules to implement any provision of Public Act 91-712
13or any other budget initiative for fiscal year 2001 may be
14adopted in accordance with this Section by the agency charged
15with administering that provision or initiative, except that
16the 24-month limitation on the adoption of emergency rules and
17the provisions of Sections 5-115 and 5-125 do not apply to
18rules adopted under this subsection (f). The adoption of
19emergency rules authorized by this subsection (f) shall be
20deemed to be necessary for the public interest, safety, and
21welfare.
22    (g) In order to provide for the expeditious and timely
23implementation of the State's fiscal year 2002 budget,
24emergency rules to implement any provision of Public Act 92-10
25or any other budget initiative for fiscal year 2002 may be
26adopted in accordance with this Section by the agency charged

 

 

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1with administering that provision or initiative, except that
2the 24-month limitation on the adoption of emergency rules and
3the provisions of Sections 5-115 and 5-125 do not apply to
4rules adopted under this subsection (g). The adoption of
5emergency rules authorized by this subsection (g) shall be
6deemed to be necessary for the public interest, safety, and
7welfare.
8    (h) In order to provide for the expeditious and timely
9implementation of the State's fiscal year 2003 budget,
10emergency rules to implement any provision of Public Act 92-597
11or any other budget initiative for fiscal year 2003 may be
12adopted in accordance with this Section by the agency charged
13with administering that provision or initiative, except that
14the 24-month limitation on the adoption of emergency rules and
15the provisions of Sections 5-115 and 5-125 do not apply to
16rules adopted under this subsection (h). The adoption of
17emergency rules authorized by this subsection (h) shall be
18deemed to be necessary for the public interest, safety, and
19welfare.
20    (i) In order to provide for the expeditious and timely
21implementation of the State's fiscal year 2004 budget,
22emergency rules to implement any provision of Public Act 93-20
23or any other budget initiative for fiscal year 2004 may be
24adopted in accordance with this Section by the agency charged
25with administering that provision or initiative, except that
26the 24-month limitation on the adoption of emergency rules and

 

 

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1the provisions of Sections 5-115 and 5-125 do not apply to
2rules adopted under this subsection (i). The adoption of
3emergency rules authorized by this subsection (i) shall be
4deemed to be necessary for the public interest, safety, and
5welfare.
6    (j) In order to provide for the expeditious and timely
7implementation of the provisions of the State's fiscal year
82005 budget as provided under the Fiscal Year 2005 Budget
9Implementation (Human Services) Act, emergency rules to
10implement any provision of the Fiscal Year 2005 Budget
11Implementation (Human Services) Act may be adopted in
12accordance with this Section by the agency charged with
13administering that provision, except that the 24-month
14limitation on the adoption of emergency rules and the
15provisions of Sections 5-115 and 5-125 do not apply to rules
16adopted under this subsection (j). The Department of Public Aid
17may also adopt rules under this subsection (j) necessary to
18administer the Illinois Public Aid Code and the Children's
19Health Insurance Program Act. The adoption of emergency rules
20authorized by this subsection (j) shall be deemed to be
21necessary for the public interest, safety, and welfare.
22    (k) In order to provide for the expeditious and timely
23implementation of the provisions of the State's fiscal year
242006 budget, emergency rules to implement any provision of
25Public Act 94-48 or any other budget initiative for fiscal year
262006 may be adopted in accordance with this Section by the

 

 

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1agency charged with administering that provision or
2initiative, except that the 24-month limitation on the adoption
3of emergency rules and the provisions of Sections 5-115 and
45-125 do not apply to rules adopted under this subsection (k).
5The Department of Healthcare and Family Services may also adopt
6rules under this subsection (k) necessary to administer the
7Illinois Public Aid Code, the Senior Citizens and Persons with
8Disabilities Property Tax Relief Act, the Senior Citizens and
9Disabled Persons Prescription Drug Discount Program Act (now
10the Illinois Prescription Drug Discount Program Act), and the
11Children's Health Insurance Program Act. The adoption of
12emergency rules authorized by this subsection (k) shall be
13deemed to be necessary for the public interest, safety, and
14welfare.
15    (l) In order to provide for the expeditious and timely
16implementation of the provisions of the State's fiscal year
172007 budget, the Department of Healthcare and Family Services
18may adopt emergency rules during fiscal year 2007, including
19rules effective July 1, 2007, in accordance with this
20subsection to the extent necessary to administer the
21Department's responsibilities with respect to amendments to
22the State plans and Illinois waivers approved by the federal
23Centers for Medicare and Medicaid Services necessitated by the
24requirements of Title XIX and Title XXI of the federal Social
25Security Act. The adoption of emergency rules authorized by
26this subsection (l) shall be deemed to be necessary for the

 

 

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1public interest, safety, and welfare.
2    (m) In order to provide for the expeditious and timely
3implementation of the provisions of the State's fiscal year
42008 budget, the Department of Healthcare and Family Services
5may adopt emergency rules during fiscal year 2008, including
6rules effective July 1, 2008, in accordance with this
7subsection to the extent necessary to administer the
8Department's responsibilities with respect to amendments to
9the State plans and Illinois waivers approved by the federal
10Centers for Medicare and Medicaid Services necessitated by the
11requirements of Title XIX and Title XXI of the federal Social
12Security Act. The adoption of emergency rules authorized by
13this subsection (m) shall be deemed to be necessary for the
14public interest, safety, and welfare.
15    (n) In order to provide for the expeditious and timely
16implementation of the provisions of the State's fiscal year
172010 budget, emergency rules to implement any provision of
18Public Act 96-45 or any other budget initiative authorized by
19the 96th General Assembly for fiscal year 2010 may be adopted
20in accordance with this Section by the agency charged with
21administering that provision or initiative. The adoption of
22emergency rules authorized by this subsection (n) shall be
23deemed to be necessary for the public interest, safety, and
24welfare. The rulemaking authority granted in this subsection
25(n) shall apply only to rules promulgated during Fiscal Year
262010.

 

 

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1    (o) In order to provide for the expeditious and timely
2implementation of the provisions of the State's fiscal year
32011 budget, emergency rules to implement any provision of
4Public Act 96-958 or any other budget initiative authorized by
5the 96th General Assembly for fiscal year 2011 may be adopted
6in accordance with this Section by the agency charged with
7administering that provision or initiative. The adoption of
8emergency rules authorized by this subsection (o) is deemed to
9be necessary for the public interest, safety, and welfare. The
10rulemaking authority granted in this subsection (o) applies
11only to rules promulgated on or after July 1, 2010 (the
12effective date of Public Act 96-958) through June 30, 2011.
13    (p) In order to provide for the expeditious and timely
14implementation of the provisions of Public Act 97-689,
15emergency rules to implement any provision of Public Act 97-689
16may be adopted in accordance with this subsection (p) by the
17agency charged with administering that provision or
18initiative. The 150-day limitation of the effective period of
19emergency rules does not apply to rules adopted under this
20subsection (p), and the effective period may continue through
21June 30, 2013. The 24-month limitation on the adoption of
22emergency rules does not apply to rules adopted under this
23subsection (p). The adoption of emergency rules authorized by
24this subsection (p) is deemed to be necessary for the public
25interest, safety, and welfare.
26    (q) In order to provide for the expeditious and timely

 

 

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

 

 

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1(s) shall apply only to those rules adopted prior to July 1,
22015. Notwithstanding any other provision of this Section, any
3emergency rule adopted under this subsection (s) shall only
4apply to payments made for State fiscal year 2015. The adoption
5of emergency rules authorized by this subsection (s) is deemed
6to be necessary for the public interest, safety, and welfare.
7    (t) In order to provide for the expeditious and timely
8implementation of the provisions of Article II of Public Act
999-6, emergency rules to implement the changes made by Article
10II of Public Act 99-6 to the Emergency Telephone System Act may
11be adopted in accordance with this subsection (t) by the
12Department of State Police. The rulemaking authority granted in
13this subsection (t) shall apply only to those rules adopted
14prior to July 1, 2016. The 24-month limitation on the adoption
15of emergency rules does not apply to rules adopted under this
16subsection (t). The adoption of emergency rules authorized by
17this subsection (t) is deemed to be necessary for the public
18interest, safety, and welfare.
19    (u) In order to provide for the expeditious and timely
20implementation of the provisions of the Burn Victims Relief
21Act, emergency rules to implement any provision of the Act may
22be adopted in accordance with this subsection (u) by the
23Department of Insurance. The rulemaking authority granted in
24this subsection (u) shall apply only to those rules adopted
25prior to December 31, 2015. The adoption of emergency rules
26authorized by this subsection (u) is deemed to be necessary for

 

 

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1the public interest, safety, and welfare.
2    (v) In order to provide for the expeditious and timely
3implementation of the provisions of Public Act 99-516,
4emergency rules to implement Public Act 99-516 may be adopted
5in accordance with this subsection (v) by the Department of
6Healthcare and Family Services. The 24-month limitation on the
7adoption of emergency rules does not apply to rules adopted
8under this subsection (v). The adoption of emergency rules
9authorized by this subsection (v) is deemed to be necessary for
10the public interest, safety, and welfare.
11    (w) In order to provide for the expeditious and timely
12implementation of the provisions of Public Act 99-796,
13emergency rules to implement the changes made by Public Act
1499-796 may be adopted in accordance with this subsection (w) by
15the Adjutant General. The adoption of emergency rules
16authorized by this subsection (w) is deemed to be necessary for
17the public interest, safety, and welfare.
18    (x) In order to provide for the expeditious and timely
19implementation of the provisions of Public Act 99-906,
20emergency rules to implement subsection (i) of Section 16-115D,
21subsection (g) of Section 16-128A, and subsection (a) of
22Section 16-128B of the Public Utilities Act may be adopted in
23accordance with this subsection (x) by the Illinois Commerce
24Commission. The rulemaking authority granted in this
25subsection (x) shall apply only to those rules adopted within
26180 days after June 1, 2017 (the effective date of Public Act

 

 

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199-906). The adoption of emergency rules authorized by this
2subsection (x) is deemed to be necessary for the public
3interest, safety, and welfare.
4    (y) In order to provide for the expeditious and timely
5implementation of the provisions of this amendatory Act of the
6100th General Assembly, emergency rules to implement the
7changes made by this amendatory Act of the 100th General
8Assembly to Section 4.02 of the Illinois Act on Aging, Sections
95.5.4 and 5-5.4i of the Illinois Public Aid Code, Section 55-30
10of the Alcoholism and Other Drug Abuse and Dependency Act, and
11Sections 74 and 75 of the Mental Health and Developmental
12Disabilities Administrative Act may be adopted in accordance
13with this subsection (y) by the respective Department. The
14adoption of emergency rules authorized by this subsection (y)
15is deemed to be necessary for the public interest, safety, and
16welfare.
17    (z) In order to provide for the expeditious and timely
18implementation of the provisions of this amendatory Act of the
19100th General Assembly, emergency rules to implement the
20changes made by this amendatory Act of the 100th General
21Assembly to Section 4.7 of the Lobbyist Registration Act may be
22adopted in accordance with this subsection (z) by the Secretary
23of State. The adoption of emergency rules authorized by this
24subsection (z) is deemed to be necessary for the public
25interest, safety, and welfare.
26    (aa) In order to provide for the expeditious and timely

 

 

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1initial implementation of the changes made to Articles 5, 5A,
212, and 14 of the Illinois Public Aid Code under the provisions
3of this amendatory Act of the 100th General Assembly, the
4Department of Healthcare and Family Services may adopt
5emergency rules in accordance with this subsection (aa). The
624-month limitation on the adoption of emergency rules does not
7apply to rules to initially implement the changes made to
8Articles 5, 5A, 12, and 14 of the Illinois Public Aid Code
9adopted under this subsection (aa). The adoption of emergency
10rules authorized by this subsection (aa) is deemed to be
11necessary for the public interest, safety, and welfare.
12(Source: P.A. 99-2, eff. 3-26-15; 99-6, eff. 1-1-16; 99-143,
13eff. 7-27-15; 99-455, eff. 1-1-16; 99-516, eff. 6-30-16;
1499-642, eff. 7-28-16; 99-796, eff. 1-1-17; 99-906, eff. 6-1-17;
15100-23, eff. 7-6-17; 100-554, eff. 11-16-17.)
 
16    (5 ILCS 100/5-46.3 new)
17    Sec. 5-46.3. Approval of rules to implement the hospital
18transformation program. Notwithstanding any other provision of
19this Act, the Department of Healthcare and Family Services may
20not file, the Secretary of State may not accept, and the Joint
21Committee on Administrative Rules may not consider any rules
22adopted in accordance to subsection (d-5) of Section 14-12 of
23the Illinois Public Aid Code unless the rules have been
24approved by 9 of the 14 members of the Hospital Transformation
25Review Committee created under subsection (d-5) of Section

 

 

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114-12 of the Illinois Public Aid Code. Approval of the rules
2shall be demonstrated by submission of a written document
3signed by each of the 9 approving members. The Department of
4Healthcare and Family Services shall submit the written
5document with signatures, along with a certified copy of each
6rule, to the Secretary of State.
 
7    Section 3. The Illinois Health Facilities Planning Act is
8amended by changing Section 3 as follows:
 
9    (20 ILCS 3960/3)  (from Ch. 111 1/2, par. 1153)
10    (Text of Section before amendment by P.A. 100-518)
11    (Section scheduled to be repealed on December 31, 2019)
12    Sec. 3. Definitions. As used in this Act:
13    "Health care facilities" means and includes the following
14facilities, organizations, and related persons:
15        (1) An ambulatory surgical treatment center required
16    to be licensed pursuant to the Ambulatory Surgical
17    Treatment Center Act.
18        (2) An institution, place, building, or agency
19    required to be licensed pursuant to the Hospital Licensing
20    Act.
21        (3) Skilled and intermediate long term care facilities
22    licensed under the Nursing Home Care Act.
23            (A) If a demonstration project under the Nursing
24        Home Care Act applies for a certificate of need to

 

 

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1        convert to a nursing facility, it shall meet the
2        licensure and certificate of need requirements in
3        effect as of the date of application.
4            (B) Except as provided in item (A) of this
5        subsection, this Act does not apply to facilities
6        granted waivers under Section 3-102.2 of the Nursing
7        Home Care Act.
8        (3.5) Skilled and intermediate care facilities
9    licensed under the ID/DD Community Care Act or the MC/DD
10    Act. No permit or exemption is required for a facility
11    licensed under the ID/DD Community Care Act or the MC/DD
12    Act prior to the reduction of the number of beds at a
13    facility. If there is a total reduction of beds at a
14    facility licensed under the ID/DD Community Care Act or the
15    MC/DD Act, this is a discontinuation or closure of the
16    facility. If a facility licensed under the ID/DD Community
17    Care Act or the MC/DD Act reduces the number of beds or
18    discontinues the facility, that facility must notify the
19    Board as provided in Section 14.1 of this Act.
20        (3.7) Facilities licensed under the Specialized Mental
21    Health Rehabilitation Act of 2013.
22        (4) Hospitals, nursing homes, ambulatory surgical
23    treatment centers, or kidney disease treatment centers
24    maintained by the State or any department or agency
25    thereof.
26        (5) Kidney disease treatment centers, including a

 

 

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1    free-standing hemodialysis unit required to be licensed
2    under the End Stage Renal Disease Facility Act.
3            (A) This Act does not apply to a dialysis facility
4        that provides only dialysis training, support, and
5        related services to individuals with end stage renal
6        disease who have elected to receive home dialysis.
7            (B) This Act does not apply to a dialysis unit
8        located in a licensed nursing home that offers or
9        provides dialysis-related services to residents with
10        end stage renal disease who have elected to receive
11        home dialysis within the nursing home.
12            (C) The Board, however, may require dialysis
13        facilities and licensed nursing homes under items (A)
14        and (B) of this subsection to report statistical
15        information on a quarterly basis to the Board to be
16        used by the Board to conduct analyses on the need for
17        proposed kidney disease treatment centers.
18        (6) An institution, place, building, or room used for
19    the performance of outpatient surgical procedures that is
20    leased, owned, or operated by or on behalf of an
21    out-of-state facility.
22        (7) An institution, place, building, or room used for
23    provision of a health care category of service, including,
24    but not limited to, cardiac catheterization and open heart
25    surgery.
26        (8) An institution, place, building, or room housing

 

 

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1    major medical equipment used in the direct clinical
2    diagnosis or treatment of patients, and whose project cost
3    is in excess of the capital expenditure minimum.
4    "Health care facilities" does not include the following
5entities or facility transactions:
6        (1) Federally-owned facilities.
7        (2) Facilities used solely for healing by prayer or
8    spiritual means.
9        (3) An existing facility located on any campus facility
10    as defined in Section 5-5.8b of the Illinois Public Aid
11    Code, provided that the campus facility encompasses 30 or
12    more contiguous acres and that the new or renovated
13    facility is intended for use by a licensed residential
14    facility.
15        (4) Facilities licensed under the Supportive
16    Residences Licensing Act or the Assisted Living and Shared
17    Housing Act.
18        (5) Facilities designated as supportive living
19    facilities that are in good standing with the program
20    established under Section 5-5.01a of the Illinois Public
21    Aid Code.
22        (6) Facilities established and operating under the
23    Alternative Health Care Delivery Act as a children's
24    community-based health care center alternative health care
25    model demonstration program or as an Alzheimer's Disease
26    Management Center alternative health care model

 

 

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1    demonstration program.
2        (7) The closure of an entity or a portion of an entity
3    licensed under the Nursing Home Care Act, the Specialized
4    Mental Health Rehabilitation Act of 2013, the ID/DD
5    Community Care Act, or the MC/DD Act, with the exception of
6    facilities operated by a county or Illinois Veterans Homes,
7    that elect to convert, in whole or in part, to an assisted
8    living or shared housing establishment licensed under the
9    Assisted Living and Shared Housing Act and with the
10    exception of a facility licensed under the Specialized
11    Mental Health Rehabilitation Act of 2013 in connection with
12    a proposal to close a facility and re-establish the
13    facility in another location.
14        (8) Any change of ownership of a health care facility
15    that is licensed under the Nursing Home Care Act, the
16    Specialized Mental Health Rehabilitation Act of 2013, the
17    ID/DD Community Care Act, or the MC/DD Act, with the
18    exception of facilities operated by a county or Illinois
19    Veterans Homes. Changes of ownership of facilities
20    licensed under the Nursing Home Care Act must meet the
21    requirements set forth in Sections 3-101 through 3-119 of
22    the Nursing Home Care Act.
23        (9) Any project the Department of Healthcare and Family
24    Services certifies was approved by the Hospital
25    Transformation Review Committee as a project subject to the
26    hospital's transformation under subsection (d-5) of

 

 

10000SB1773ham008- 21 -LRB100 09919 KTG 36497 a

1    Section 14-12 of the Illinois Public Aid Code, provided the
2    hospital shall submit the certification to the Board.
3    Nothing in this paragraph excludes a health care facility
4    from the requirements of this Act after the approved
5    transformation project is complete. All other requirements
6    under this Act continue to apply. Hospitals that are not
7    subject to this Act under this paragraph shall notify the
8    Health Facilities and Services Review Board within 30 days
9    of the dates that bed changes or service changes occur.
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

 

 

10000SB1773ham008- 22 -LRB100 09919 KTG 36497 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

 

 

10000SB1773ham008- 23 -LRB100 09919 KTG 36497 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.

 

 

10000SB1773ham008- 24 -LRB100 09919 KTG 36497 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

 

 

10000SB1773ham008- 25 -LRB100 09919 KTG 36497 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

 

 

10000SB1773ham008- 26 -LRB100 09919 KTG 36497 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

 

 

10000SB1773ham008- 27 -LRB100 09919 KTG 36497 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

 

 

10000SB1773ham008- 28 -LRB100 09919 KTG 36497 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.)
 

 

 

10000SB1773ham008- 29 -LRB100 09919 KTG 36497 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

 

 

10000SB1773ham008- 30 -LRB100 09919 KTG 36497 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.

 

 

10000SB1773ham008- 31 -LRB100 09919 KTG 36497 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    "Health care facilities" does not include the following
20entities or facility transactions:
21        (1) Federally-owned facilities.
22        (2) Facilities used solely for healing by prayer or
23    spiritual means.
24        (3) An existing facility located on any campus facility
25    as defined in Section 5-5.8b of the Illinois Public Aid
26    Code, provided that the campus facility encompasses 30 or

 

 

10000SB1773ham008- 32 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 33 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 34 -LRB100 09919 KTG 36497 a

1shall be intended to include facilities operated as a part of
2the practice of a physician or other licensed health care
3professional, whether practicing in his individual capacity or
4within the legal structure of any partnership, medical or
5professional corporation, or unincorporated medical or
6professional group. Further, this Act shall not apply to
7physicians or other licensed health care professional's
8practices where such practices are carried out in a portion of
9a health care facility under contract with such health care
10facility by a physician or by other licensed health care
11professionals, whether practicing in his individual capacity
12or within the legal structure of any partnership, medical or
13professional corporation, or unincorporated medical or
14professional groups, unless the entity constructs, modifies,
15or establishes a health care facility as specifically defined
16in this Section. This Act shall apply to construction or
17modification and to establishment by such health care facility
18of such contracted portion which is subject to facility
19licensing requirements, irrespective of the party responsible
20for such action or attendant financial obligation.
21    "Person" means any one or more natural persons, legal
22entities, governmental bodies other than federal, or any
23combination thereof.
24    "Consumer" means any person other than a person (a) whose
25major occupation currently involves or whose official capacity
26within the last 12 months has involved the providing,

 

 

10000SB1773ham008- 35 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 36 -LRB100 09919 KTG 36497 a

1site or the initiation of a category of service.
2    "Major medical equipment" means medical equipment which is
3used for the provision of medical and other health services and
4which costs in excess of the capital expenditure minimum,
5except that such term does not include medical equipment
6acquired by or on behalf of a clinical laboratory to provide
7clinical laboratory services if the clinical laboratory is
8independent of a physician's office and a hospital and it has
9been determined under Title XVIII of the Social Security Act to
10meet the requirements of paragraphs (10) and (11) of Section
111861(s) of such Act. In determining whether medical equipment
12has a value in excess of the capital expenditure minimum, the
13value of studies, surveys, designs, plans, working drawings,
14specifications, and other activities essential to the
15acquisition of such equipment shall be included.
16    "Capital Expenditure" means an expenditure: (A) made by or
17on behalf of a health care facility (as such a facility is
18defined in this Act); and (B) which under generally accepted
19accounting principles is not properly chargeable as an expense
20of operation and maintenance, or is made to obtain by lease or
21comparable arrangement any facility or part thereof or any
22equipment for a facility or part; and which exceeds the capital
23expenditure minimum.
24    For the purpose of this paragraph, the cost of any studies,
25surveys, designs, plans, working drawings, specifications, and
26other activities essential to the acquisition, improvement,

 

 

10000SB1773ham008- 37 -LRB100 09919 KTG 36497 a

1expansion, or replacement of any plant or equipment with
2respect to which an expenditure is made shall be included in
3determining if such expenditure exceeds the capital
4expenditures minimum. Unless otherwise interdependent, or
5submitted as one project by the applicant, components of
6construction or modification undertaken by means of a single
7construction contract or financed through the issuance of a
8single debt instrument shall not be grouped together as one
9project. Donations of equipment or facilities to a health care
10facility which if acquired directly by such facility would be
11subject to review under this Act shall be considered capital
12expenditures, and a transfer of equipment or facilities for
13less than fair market value shall be considered a capital
14expenditure for purposes of this Act if a transfer of the
15equipment or facilities at fair market value would be subject
16to review.
17    "Capital expenditure minimum" means $11,500,000 for
18projects by hospital applicants, $6,500,000 for applicants for
19projects related to skilled and intermediate care long-term
20care facilities licensed under the Nursing Home Care Act, and
21$3,000,000 for projects by all other applicants, which shall be
22annually adjusted to reflect the increase in construction costs
23due to inflation, for major medical equipment and for all other
24capital expenditures.
25    "Financial Commitment" means the commitment of at least 33%
26of total funds assigned to cover total project cost, which

 

 

10000SB1773ham008- 38 -LRB100 09919 KTG 36497 a

1occurs by the actual expenditure of 33% or more of the total
2project cost or the commitment to expend 33% or more of the
3total project cost by signed contracts or other legal means.
4    "Non-clinical service area" means an area (i) for the
5benefit of the patients, visitors, staff, or employees of a
6health care facility and (ii) not directly related to the
7diagnosis, treatment, or rehabilitation of persons receiving
8services from the health care facility. "Non-clinical service
9areas" include, but are not limited to, chapels; gift shops;
10news stands; computer systems; tunnels, walkways, and
11elevators; telephone systems; projects to comply with life
12safety codes; educational facilities; student housing;
13patient, employee, staff, and visitor dining areas;
14administration and volunteer offices; modernization of
15structural components (such as roof replacement and masonry
16work); boiler repair or replacement; vehicle maintenance and
17storage facilities; parking facilities; mechanical systems for
18heating, ventilation, and air conditioning; loading docks; and
19repair or replacement of carpeting, tile, wall coverings,
20window coverings or treatments, or furniture. Solely for the
21purpose of this definition, "non-clinical service area" does
22not include health and fitness centers.
23    "Areawide" means a major area of the State delineated on a
24geographic, demographic, and functional basis for health
25planning and for health service and having within it one or
26more local areas for health planning and health service. The

 

 

10000SB1773ham008- 39 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 40 -LRB100 09919 KTG 36497 a

1facilities 100% owned by an Illinois licensed health care
2facility, its parent, or Illinois physicians licensed to
3practice medicine in all its branches shall not be considered
4out-of-state facilities. Nothing in this definition shall be
5construed to include an office or any part of an office of a
6physician licensed to practice medicine in all its branches in
7Illinois that is not required to be licensed under the
8Ambulatory Surgical Treatment Center Act.
9    "Change of ownership of a health care facility" means a
10change in the person who has ownership or control of a health
11care facility's physical plant and capital assets. A change in
12ownership is indicated by the following transactions: sale,
13transfer, acquisition, lease, change of sponsorship, or other
14means of transferring control.
15    "Related person" means any person that: (i) is at least 50%
16owned, directly or indirectly, by either the health care
17facility or a person owning, directly or indirectly, at least
1850% of the health care facility; or (ii) owns, directly or
19indirectly, at least 50% of the health care facility.
20    "Charity care" means care provided by a health care
21facility for which the provider does not expect to receive
22payment from the patient or a third-party payer.
23    "Freestanding emergency center" means a facility subject
24to licensure under Section 32.5 of the Emergency Medical
25Services (EMS) Systems Act.
26    "Category of service" means a grouping by generic class of

 

 

10000SB1773ham008- 41 -LRB100 09919 KTG 36497 a

1various types or levels of support functions, equipment, care,
2or treatment provided to patients or residents, including, but
3not limited to, classes such as medical-surgical, pediatrics,
4or cardiac catheterization. A category of service may include
5subcategories or levels of care that identify a particular
6degree or type of care within the category of service. Nothing
7in this definition shall be construed to include the practice
8of a physician or other licensed health care professional while
9functioning in an office providing for the care, diagnosis, or
10treatment of patients. A category of service that is subject to
11the Board's jurisdiction must be designated in rules adopted by
12the Board.
13    "State Board Staff Report" means the document that sets
14forth the review and findings of the State Board staff, as
15prescribed by the State Board, regarding applications subject
16to Board jurisdiction.
17(Source: P.A. 99-78, eff. 7-20-15; 99-180, eff. 7-29-15;
1899-527, eff. 1-1-17; 100-518, eff. 6-1-18.)
 
19    Section 10. The Emergency Medical Services (EMS) Systems
20Act is amended by changing Section 32.5 as follows:
 
21    (210 ILCS 50/32.5)
22    Sec. 32.5. Freestanding Emergency Center.
23    (a) The Department shall issue an annual Freestanding
24Emergency Center (FEC) license to any facility that has

 

 

10000SB1773ham008- 42 -LRB100 09919 KTG 36497 a

1received a permit from the Health Facilities and Services
2Review Board to establish a Freestanding Emergency Center by
3January 1, 2015, and:
4        (1) is located: (A) in a municipality with a population
5    of 50,000 or fewer inhabitants; (B) within 50 miles of the
6    hospital that owns or controls the FEC; and (C) within 50
7    miles of the Resource Hospital affiliated with the FEC as
8    part of the EMS System;
9        (2) is wholly owned or controlled by an Associate or
10    Resource Hospital, but is not a part of the hospital's
11    physical plant;
12        (3) meets the standards for licensed FECs, adopted by
13    rule of the Department, including, but not limited to:
14            (A) facility design, specification, operation, and
15        maintenance standards;
16            (B) equipment standards; and
17            (C) the number and qualifications of emergency
18        medical personnel and other staff, which must include
19        at least one board certified emergency physician
20        present at the FEC 24 hours per day.
21        (4) limits its participation in the EMS System strictly
22    to receiving a limited number of patients by ambulance: (A)
23    according to the FEC's 24-hour capabilities; (B) according
24    to protocols developed by the Resource Hospital within the
25    FEC's designated EMS System; and (C) as pre-approved by
26    both the EMS Medical Director and the Department;

 

 

10000SB1773ham008- 43 -LRB100 09919 KTG 36497 a

1        (5) provides comprehensive emergency treatment
2    services, as defined in the rules adopted by the Department
3    pursuant to the Hospital Licensing Act, 24 hours per day,
4    on an outpatient basis;
5        (6) provides an ambulance and maintains on site
6    ambulance services staffed with paramedics 24 hours per
7    day;
8        (7) (blank);
9        (8) complies with all State and federal patient rights
10    provisions, including, but not limited to, the Emergency
11    Medical Treatment Act and the federal Emergency Medical
12    Treatment and Active Labor Act;
13        (9) maintains a communications system that is fully
14    integrated with its Resource Hospital within the FEC's
15    designated EMS System;
16        (10) reports to the Department any patient transfers
17    from the FEC to a hospital within 48 hours of the transfer
18    plus any other data determined to be relevant by the
19    Department;
20        (11) submits to the Department, on a quarterly basis,
21    the FEC's morbidity and mortality rates for patients
22    treated at the FEC and other data determined to be relevant
23    by the Department;
24        (12) does not describe itself or hold itself out to the
25    general public as a full service hospital or hospital
26    emergency department in its advertising or marketing

 

 

10000SB1773ham008- 44 -LRB100 09919 KTG 36497 a

1    activities;
2        (13) complies with any other rules adopted by the
3    Department under this Act that relate to FECs;
4        (14) passes the Department's site inspection for
5    compliance with the FEC requirements of this Act;
6        (15) submits a copy of the permit issued by the Health
7    Facilities and Services Review Board indicating that the
8    facility has complied with the Illinois Health Facilities
9    Planning Act with respect to the health services to be
10    provided at the facility;
11        (16) submits an application for designation as an FEC
12    in a manner and form prescribed by the Department by rule;
13    and
14        (17) pays the annual license fee as determined by the
15    Department by rule.
16    (a-5) Notwithstanding any other provision of this Section,
17the Department may issue an annual FEC license to a facility
18that is located in a county that does not have a licensed
19general acute care hospital if the facility's application for a
20permit from the Illinois Health Facilities Planning Board has
21been deemed complete by the Department of Public Health by
22January 1, 2014 and if the facility complies with the
23requirements set forth in paragraphs (1) through (17) of
24subsection (a).
25    (a-10) Notwithstanding any other provision of this
26Section, the Department may issue an annual FEC license to a

 

 

10000SB1773ham008- 45 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 46 -LRB100 09919 KTG 36497 a

1    forth in paragraphs (1) through (17), provided however that
2    the FEC may be located in a municipality with a population
3    greater than 50,000 inhabitants and shall not be subject to
4    the requirements of the Illinois Health Facilities
5    Planning Act that are applicable to the conversion to an
6    FEC if the Department of Healthcare and Family Service has
7    certified the conversion to an FEC was approved by the
8    Hospital Transformation Review Committee as a project
9    subject to the hospital's transformation under subsection
10    (d-5) of Section 14-12 of the Illinois Public Aid Code; and
11        (4) the facility is located at the same physical
12    location where the facility served as a hospital.
13    (b) The Department shall:
14        (1) annually inspect facilities of initial FEC
15    applicants and licensed FECs, and issue annual licenses to
16    or annually relicense FECs that satisfy the Department's
17    licensure requirements as set forth in subsection (a);
18        (2) suspend, revoke, refuse to issue, or refuse to
19    renew the license of any FEC, after notice and an
20    opportunity for a hearing, when the Department finds that
21    the FEC has failed to comply with the standards and
22    requirements of the Act or rules adopted by the Department
23    under the Act;
24        (3) issue an Emergency Suspension Order for any FEC
25    when the Director or his or her designee has determined
26    that the continued operation of the FEC poses an immediate

 

 

10000SB1773ham008- 47 -LRB100 09919 KTG 36497 a

1    and serious danger to the public health, safety, and
2    welfare. An opportunity for a hearing shall be promptly
3    initiated after an Emergency Suspension Order has been
4    issued; and
5        (4) adopt rules as needed to implement this Section.
6(Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16.)
 
7    Section 15. The Illinois Public Aid Code is amended by
8changing Sections 5-5.02, 5-5e.1, 5A-2, 5A-4, 5A-5, 5A-8,
95A-10, 5A-12.5, 5A-13, 5A-14, 5A-15, 12-4.105, and 14-12, and
10by adding Sections 5A-12.6, and 5A-16 as follows:
 
11    (305 ILCS 5/5-5.02)  (from Ch. 23, par. 5-5.02)
12    Sec. 5-5.02. Hospital reimbursements.
13    (a) Reimbursement to Hospitals; July 1, 1992 through
14September 30, 1992. Notwithstanding any other provisions of
15this Code or the Illinois Department's Rules promulgated under
16the Illinois Administrative Procedure Act, reimbursement to
17hospitals for services provided during the period July 1, 1992
18through September 30, 1992, shall be as follows:
19        (1) For inpatient hospital services rendered, or if
20    applicable, for inpatient hospital discharges occurring,
21    on or after July 1, 1992 and on or before September 30,
22    1992, the Illinois Department shall reimburse hospitals
23    for inpatient services under the reimbursement
24    methodologies in effect for each hospital, and at the

 

 

10000SB1773ham008- 48 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 49 -LRB100 09919 KTG 36497 a

1    eligible hospital for the uncompensated care rate year, as
2    defined by the Illinois Department, ending on July 31,
3    1992. The Illinois Department shall determine by rule the
4    adjustment payments for uncompensated care beginning
5    October 1, 1992.
6    (b) Inpatient payments. For inpatient services provided on
7or after October 1, 1993, in addition to rates paid for
8hospital inpatient services pursuant to the Illinois Health
9Finance Reform Act, as now or hereafter amended, or the
10Illinois Department's prospective reimbursement methodology,
11or any other methodology used by the Illinois Department for
12inpatient services, the Illinois Department shall make
13adjustment payments, in an amount calculated pursuant to the
14methodology described in paragraph (c) of this Section, to
15hospitals that the Illinois Department determines satisfy any
16one of the following requirements:
17        (1) Hospitals that are described in Section 1923 of the
18    federal Social Security Act, as now or hereafter amended,
19    except that for rate year 2015 and after a hospital
20    described in Section 1923(b)(1)(B) of the federal Social
21    Security Act and qualified for the payments described in
22    subsection (c) of this Section for rate year 2014 provided
23    the hospital continues to meet the description in Section
24    1923(b)(1)(B) in the current determination year; or
25        (2) Illinois hospitals that have a Medicaid inpatient
26    utilization rate which is at least one-half a standard

 

 

10000SB1773ham008- 50 -LRB100 09919 KTG 36497 a

1    deviation above the mean Medicaid inpatient utilization
2    rate for all hospitals in Illinois receiving Medicaid
3    payments from the Illinois Department; or
4        (3) Illinois hospitals that on July 1, 1991 had a
5    Medicaid inpatient utilization rate, as defined in
6    paragraph (h) of this Section, that was at least the mean
7    Medicaid inpatient utilization rate for all hospitals in
8    Illinois receiving Medicaid payments from the Illinois
9    Department and which were located in a planning area with
10    one-third or fewer excess beds as determined by the Health
11    Facilities and Services Review Board, and that, as of June
12    30, 1992, were located in a federally designated Health
13    Manpower Shortage Area; or
14        (4) Illinois hospitals that:
15            (A) have a Medicaid inpatient utilization rate
16        that is at least equal to the mean Medicaid inpatient
17        utilization rate for all hospitals in Illinois
18        receiving Medicaid payments from the Department; and
19            (B) also have a Medicaid obstetrical inpatient
20        utilization rate that is at least one standard
21        deviation above the mean Medicaid obstetrical
22        inpatient utilization rate for all hospitals in
23        Illinois receiving Medicaid payments from the
24        Department for obstetrical services; or
25        (5) Any children's hospital, which means a hospital
26    devoted exclusively to caring for children. A hospital

 

 

10000SB1773ham008- 51 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 52 -LRB100 09919 KTG 36497 a

1        (3) hospitals with a Medicaid inpatient utilization
2    rate that is equal to or greater than one standard
3    deviation above the mean Medicaid inpatient utilization
4    rate but less than 1.5 standard deviations above the mean
5    Medicaid inpatient utilization rate shall receive a per day
6    adjustment payment equal to the sum of $40 plus $7 for each
7    one percent that the hospital's Medicaid inpatient
8    utilization rate exceeds one standard deviation above the
9    mean Medicaid inpatient utilization rate; and
10        (4) hospitals with a Medicaid inpatient utilization
11    rate that is equal to or greater than 1.5 standard
12    deviations above the mean Medicaid inpatient utilization
13    rate shall receive a per day adjustment payment equal to
14    the sum of $90 plus $2 for each one percent that the
15    hospital's Medicaid inpatient utilization rate exceeds 1.5
16    standard deviations above the mean Medicaid inpatient
17    utilization rate.
18    (d) Supplemental adjustment payments. In addition to the
19adjustment payments described in paragraph (c), hospitals as
20defined in clauses (1) through (5) of paragraph (b), excluding
21county hospitals (as defined in subsection (c) of Section 15-1
22of this Code) and a hospital organized under the University of
23Illinois Hospital Act, shall be paid supplemental inpatient
24adjustment payments of $60 per day. For purposes of Title XIX
25of the federal Social Security Act, these supplemental
26adjustment payments shall not be classified as adjustment

 

 

10000SB1773ham008- 53 -LRB100 09919 KTG 36497 a

1payments to disproportionate share hospitals.
2    (e) The inpatient adjustment payments described in
3paragraphs (c) and (d) shall be increased on October 1, 1993
4and annually thereafter by a percentage equal to the lesser of
5(i) the increase in the DRI hospital cost index for the most
6recent 12 month period for which data are available, or (ii)
7the percentage increase in the statewide average hospital
8payment rate over the previous year's statewide average
9hospital payment rate. The sum of the inpatient adjustment
10payments under paragraphs (c) and (d) to a hospital, other than
11a county hospital (as defined in subsection (c) of Section 15-1
12of this Code) or a hospital organized under the University of
13Illinois Hospital Act, however, shall not exceed $275 per day;
14that limit shall be increased on October 1, 1993 and annually
15thereafter by a percentage equal to the lesser of (i) the
16increase in the DRI hospital cost index for the most recent
1712-month period for which data are available or (ii) the
18percentage increase in the statewide average hospital payment
19rate over the previous year's statewide average hospital
20payment rate.
21    (f) Children's hospital inpatient adjustment payments. For
22children's hospitals, as defined in clause (5) of paragraph
23(b), the adjustment payments required pursuant to paragraphs
24(c) and (d) shall be multiplied by 2.0.
25    (g) County hospital inpatient adjustment payments. For
26county hospitals, as defined in subsection (c) of Section 15-1

 

 

10000SB1773ham008- 54 -LRB100 09919 KTG 36497 a

1of this Code, there shall be an adjustment payment as
2determined by rules issued by the Illinois Department.
3    (h) For the purposes of this Section the following terms
4shall be defined as follows:
5        (1) "Medicaid inpatient utilization rate" means a
6    fraction, the numerator of which is the number of a
7    hospital's inpatient days provided in a given 12-month
8    period to patients who, for such days, were eligible for
9    Medicaid under Title XIX of the federal Social Security
10    Act, and the denominator of which is the total number of
11    the hospital's inpatient days in that same period.
12        (2) "Mean Medicaid inpatient utilization rate" means
13    the total number of Medicaid inpatient days provided by all
14    Illinois Medicaid-participating hospitals divided by the
15    total number of inpatient days provided by those same
16    hospitals.
17        (3) "Medicaid obstetrical inpatient utilization rate"
18    means the ratio of Medicaid obstetrical inpatient days to
19    total Medicaid inpatient days for all Illinois hospitals
20    receiving Medicaid payments from the Illinois Department.
21    (i) Inpatient adjustment payment limit. In order to meet
22the limits of Public Law 102-234 and Public Law 103-66, the
23Illinois Department shall by rule adjust disproportionate
24share adjustment payments.
25    (j) University of Illinois Hospital inpatient adjustment
26payments. For hospitals organized under the University of

 

 

10000SB1773ham008- 55 -LRB100 09919 KTG 36497 a

1Illinois Hospital Act, there shall be an adjustment payment as
2determined by rules adopted by the Illinois Department.
3    (k) The Illinois Department may by rule establish criteria
4for and develop methodologies for adjustment payments to
5hospitals participating under this Article.
6    (l) On and after July 1, 2012, the Department shall reduce
7any rate of reimbursement for services or other payments or
8alter any methodologies authorized by this Code to reduce any
9rate of reimbursement for services or other payments in
10accordance with Section 5-5e.
11    (m) The Department shall establish a cost-based
12reimbursement methodology for determining payments to
13hospitals for approved graduate medical education (GME)
14programs for dates of service on and after July 1, 2018.
15        (1) As used in this subsection, "hospitals" means the
16    University of Illinois Hospital as defined in the
17    University of Illinois Hospital Act and a county hospital
18    in a county of over 3,000,000 inhabitants.
19        (2) An amendment to the Illinois Title XIX State Plan
20    defining GME shall maximize reimbursement, shall not be
21    limited to the education programs or special patient care
22    payments allowed under Medicare, and shall include:
23            (A) inpatient days;
24            (B) outpatient days;
25            (C) direct costs;
26            (D) indirect costs;

 

 

10000SB1773ham008- 56 -LRB100 09919 KTG 36497 a

1            (E) managed care days;
2            (F) all stages of medical training and education
3        including students, interns, residents, and fellows
4        with no caps on the number of persons who may qualify;
5        and
6            (G) patient care payments related to the
7        complexities of treating Medicaid enrollees including
8        clinical and social determinants of health.
9        (3) The Department shall make all GME payments directly
10    to hospitals including such costs in support of clients
11    enrolled in Medicaid managed care entities.
12        (4) The Department shall promptly take all actions
13    necessary for reimbursement to be effective for dates of
14    service on and after July 1, 2018 including publishing all
15    appropriate public notices, amendments to the Illinois
16    Title XIX State Plan, and adoption of administrative rules
17    if necessary.
18        (5) As used in this subsection, "managed care days"
19    means costs associated with services rendered to enrollees
20    of Medicaid managed care entities. "Medicaid managed care
21    entities" means any entity which contracts with the
22    Department to provide services paid for on a capitated
23    basis. "Medicaid managed care entities" includes a managed
24    care organization and a managed care community network.
25        (6) All payments under this Section are contingent upon
26    federal approval of changes to the Illinois Title XIX State

 

 

10000SB1773ham008- 57 -LRB100 09919 KTG 36497 a

1    Plan, if that approval is required.
2        (7) The Department may adopt rules necessary to
3    implement this amendatory Act of the 100th General Assembly
4    through the use of emergency rulemaking in accordance with
5    subsection (aa) of Section 5-45 of the Illinois
6    Administrative Procedure Act. For purposes of that Act, the
7    General Assembly finds that the adoption of rules to
8    implement this amendatory Act of the 100th General Assembly
9    is deemed an emergency and necessary for the public
10    interest, safety, and welfare.
11(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)
 
12    (305 ILCS 5/5-5e.1)
13    Sec. 5-5e.1. Safety-Net Hospitals.
14    (a) A Safety-Net Hospital is an Illinois hospital that:
15        (1) is licensed by the Department of Public Health as a
16    general acute care or pediatric hospital; and
17        (2) is a disproportionate share hospital, as described
18    in Section 1923 of the federal Social Security Act, as
19    determined by the Department; and
20        (3) meets one of the following:
21            (A) has a MIUR of at least 40% and a charity
22        percent of at least 4%; or
23            (B) has a MIUR of at least 50%.
24    (b) Definitions. As used in this Section:
25        (1) "Charity percent" means the ratio of (i) the

 

 

10000SB1773ham008- 58 -LRB100 09919 KTG 36497 a

1    hospital's charity charges for services provided to
2    individuals without health insurance or another source of
3    third party coverage to (ii) the Illinois total hospital
4    charges, each as reported on the hospital's OBRA form.
5        (2) "MIUR" means Medicaid Inpatient Utilization Rate
6    and is defined as a fraction, the numerator of which is the
7    number of a hospital's inpatient days provided in the
8    hospital's fiscal year ending 3 years prior to the rate
9    year, to patients who, for such days, were eligible for
10    Medicaid under Title XIX of the federal Social Security
11    Act, 42 USC 1396a et seq., excluding those persons eligible
12    for medical assistance pursuant to 42 U.S.C.
13    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
14    Section 5-2 of this Article, and the denominator of which
15    is the total number of the hospital's inpatient days in
16    that same period, excluding those persons eligible for
17    medical assistance pursuant to 42 U.S.C.
18    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
19    Section 5-2 of this Article.
20        (3) "OBRA form" means form HFS-3834, OBRA '93 data
21    collection form, for the rate year.
22        (4) "Rate year" means the 12-month period beginning on
23    October 1.
24    (c) Beginning July 1, 2012 and ending on June 30, 2020
252018, a hospital that would have qualified for the rate year
26beginning October 1, 2011, shall be a Safety-Net Hospital.

 

 

10000SB1773ham008- 59 -LRB100 09919 KTG 36497 a

1    (d) No later than August 15 preceding the rate year, each
2hospital shall submit the OBRA form to the Department. Prior to
3October 1, the Department shall notify each hospital whether it
4has qualified as a Safety-Net Hospital.
5    (e) The Department may promulgate rules in order to
6implement this Section.
7    (f) Nothing in this Section shall be construed as limiting
8the ability of the Department to include the Safety-Net
9Hospitals in the hospital rate reform mandated by Section 14-11
10of this Code and implemented under Section 14-12 of this Code
11and by administrative rulemaking.
12(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13;
1398-651, eff. 6-16-14.)
 
14    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
15    (Section scheduled to be repealed on July 1, 2018)
16    Sec. 5A-2. Assessment.
17    (a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
18years 2009 through 2018, or as long as continued under Section
195A-16, an annual assessment on inpatient services is imposed on
20each hospital provider in an amount equal to $218.38 multiplied
21by the difference of the hospital's occupied bed days less the
22hospital's Medicare bed days, provided, however, that the
23amount of $218.38 shall be increased by a uniform percentage to
24generate an amount equal to 75% of the State share of the
25payments authorized under Section 5A-12.5, with such increase

 

 

10000SB1773ham008- 60 -LRB100 09919 KTG 36497 a

1only taking effect upon the date that a State share for such
2payments is required under federal law. For the period of April
3through June 2015, the amount of $218.38 used to calculate the
4assessment under this paragraph shall, by emergency rule under
5subsection (s) of Section 5-45 of the Illinois Administrative
6Procedure Act, be increased by a uniform percentage to generate
7$20,250,000 in the aggregate for that period from all hospitals
8subject to the annual assessment under this paragraph.
9    (2) In addition to any other assessments imposed under this
10Article, effective July 1, 2016 and semi-annually thereafter
11through June 2018, or as provided in Section 5A-16, in addition
12to any federally required State share as authorized under
13paragraph (1), the amount of $218.38 shall be increased by a
14uniform percentage to generate an amount equal to 75% of the
15ACA Assessment Adjustment, as defined in subsection (b-6) of
16this Section.
17    For State fiscal years 2009 through 2018 2014 and after, or
18as provided in Section 5A-16, a hospital's occupied bed days
19and Medicare bed days shall be determined using the most recent
20data available from each hospital's 2005 Medicare cost report
21as contained in the Healthcare Cost Report Information System
22file, for the quarter ending on December 31, 2006, without
23regard to any subsequent adjustments or changes to such data.
24If a hospital's 2005 Medicare cost report is not contained in
25the Healthcare Cost Report Information System, then the
26Illinois Department may obtain the hospital provider's

 

 

10000SB1773ham008- 61 -LRB100 09919 KTG 36497 a

1occupied bed days and Medicare bed days from any source
2available, including, but not limited to, records maintained by
3the hospital provider, which may be inspected at all times
4during business hours of the day by the Illinois Department or
5its duly authorized agents and employees.
6    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
7fiscal years 2019 and 2020, an annual assessment on inpatient
8services is imposed on each hospital provider in an amount
9equal to $197.19 multiplied by the difference of the hospital's
10occupied bed days less the hospital's Medicare bed days;
11however, for State fiscal year 2020, the amount of $197.19
12shall be increased by a uniform percentage to generate an
13additional $6,250,000 in the aggregate for that period from all
14hospitals subject to the annual assessment under this
15paragraph. For State fiscal years 2019 and 2020, a hospital's
16occupied bed days and Medicare bed days shall be determined
17using the most recent data available from each hospital's 2015
18Medicare cost report as contained in the Healthcare Cost Report
19Information System file, for the quarter ending on March 31,
202017, without regard to any subsequent adjustments or changes
21to such data. If a hospital's 2015 Medicare cost report is not
22contained in the Healthcare Cost Report Information System,
23then the Illinois Department may obtain the hospital provider's
24occupied bed days and Medicare bed days from any source
25available, including, but not limited to, records maintained by
26the hospital provider, which may be inspected at all times

 

 

10000SB1773ham008- 62 -LRB100 09919 KTG 36497 a

1during business hours of the day by the Illinois Department or
2its duly authorized agents and employees. Notwithstanding any
3other provision in this Article, for a hospital provider that
4did not have a 2015 Medicare cost report, but paid an
5assessment in State fiscal year 2018 on the basis of
6hypothetical data, that assessment amount shall be used for
7State fiscal years 2019 and 2020; however, for State fiscal
8year 2020, the assessment amount shall be increased by the
9proportion that it represents of the total annual assessment
10that is generated from all hospitals in order to generate
11$6,250,000 in the aggregate for that period from all hospitals
12subject to the annual assessment under this paragraph.
13    Subject to Sections 5A-3 and 5A-10, for State fiscal years
142021 through 2024, an annual assessment on inpatient services
15is imposed on each hospital provider in an amount equal to
16$197.19 multiplied by the difference of the hospital's occupied
17bed days less the hospital's Medicare bed days, provided
18however, that the amount of $197.19 used to calculate the
19assessment under this paragraph shall, by rule, be adjusted by
20a uniform percentage to generate the same total annual
21assessment that was generated in State fiscal year 2020 from
22all hospitals subject to the annual assessment under this
23paragraph plus $6,250,000. For State fiscal years 2021 and
242022, a hospital's occupied bed days and Medicare bed days
25shall be determined using the most recent data available from
26each hospital's 2017 Medicare cost report as contained in the

 

 

10000SB1773ham008- 63 -LRB100 09919 KTG 36497 a

1Healthcare Cost Report Information System file, for the quarter
2ending on March 31, 2019, without regard to any subsequent
3adjustments or changes to such data. For State fiscal years
42023 and 2024, a hospital's occupied bed days and Medicare bed
5days shall be determined using the most recent data available
6from each hospital's 2019 Medicare cost report as contained in
7the Healthcare Cost Report Information System file, for the
8quarter ending on March 31, 2021, without regard to any
9subsequent adjustments or changes to such data.
10    (b) (Blank).
11    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
12portion of State fiscal year 2012, beginning June 10, 2012
13through June 30, 2012, and for State fiscal years 2013 through
142018, or as provided in Section 5A-16, an annual assessment on
15outpatient services is imposed on each hospital provider in an
16amount equal to .008766 multiplied by the hospital's outpatient
17gross revenue, provided, however, that the amount of .008766
18shall be increased by a uniform percentage to generate an
19amount equal to 25% of the State share of the payments
20authorized under Section 5A-12.5, with such increase only
21taking effect upon the date that a State share for such
22payments is required under federal law. For the period
23beginning June 10, 2012 through June 30, 2012, the annual
24assessment on outpatient services shall be prorated by
25multiplying the assessment amount by a fraction, the numerator
26of which is 21 days and the denominator of which is 365 days.

 

 

10000SB1773ham008- 64 -LRB100 09919 KTG 36497 a

1For the period of April through June 2015, the amount of
2.008766 used to calculate the assessment under this paragraph
3shall, by emergency rule under subsection (s) of Section 5-45
4of the Illinois Administrative Procedure Act, be increased by a
5uniform percentage to generate $6,750,000 in the aggregate for
6that period from all hospitals subject to the annual assessment
7under this paragraph.
8    (2) In addition to any other assessments imposed under this
9Article, effective July 1, 2016 and semi-annually thereafter
10through June 2018, in addition to any federally required State
11share as authorized under paragraph (1), the amount of .008766
12shall be increased by a uniform percentage to generate an
13amount equal to 25% of the ACA Assessment Adjustment, as
14defined in subsection (b-6) of this Section.
15    For the portion of State fiscal year 2012, beginning June
1610, 2012 through June 30, 2012, and State fiscal years 2013
17through 2018, or as provided in Section 5A-16, a hospital's
18outpatient gross revenue shall be determined using the most
19recent data available from each hospital's 2009 Medicare cost
20report as contained in the Healthcare Cost Report Information
21System file, for the quarter ending on June 30, 2011, without
22regard to any subsequent adjustments or changes to such data.
23If a hospital's 2009 Medicare cost report is not contained in
24the Healthcare Cost Report Information System, then the
25Department may obtain the hospital provider's outpatient gross
26revenue from any source available, including, but not limited

 

 

10000SB1773ham008- 65 -LRB100 09919 KTG 36497 a

1to, records maintained by the hospital provider, which may be
2inspected at all times during business hours of the day by the
3Department or its duly authorized agents and employees.
4    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
5fiscal years 2019 and 2020, an annual assessment on outpatient
6services is imposed on each hospital provider in an amount
7equal to .01358 multiplied by the hospital's outpatient gross
8revenue; however, for State fiscal year 2020, the amount of
9.01358 shall be increased by a uniform percentage to generate
10an additional $6,250,000 in the aggregate for that period from
11all hospitals subject to the annual assessment under this
12paragraph. For State fiscal years 2019 and 2020, a hospital's
13outpatient gross revenue shall be determined using the most
14recent data available from each hospital's 2015 Medicare cost
15report as contained in the Healthcare Cost Report Information
16System file, for the quarter ending on March 31, 2017, without
17regard to any subsequent adjustments or changes to such data.
18If a hospital's 2015 Medicare cost report is not contained in
19the Healthcare Cost Report Information System, then the
20Department may obtain the hospital provider's outpatient gross
21revenue from any source available, including, but not limited
22to, records maintained by the hospital provider, which may be
23inspected at all times during business hours of the day by the
24Department or its duly authorized agents and employees.
25Notwithstanding any other provision in this Article, for a
26hospital provider that did not have a 2015 Medicare cost

 

 

10000SB1773ham008- 66 -LRB100 09919 KTG 36497 a

1report, but paid an assessment in State fiscal year 2018 on the
2basis of hypothetical data, that assessment amount shall be
3used for State fiscal years 2019 and 2020; however, for State
4fiscal year 2020, the assessment amount shall be increased by
5the proportion that it represents of the total annual
6assessment that is generated from all hospitals in order to
7generate $6,250,000 in the aggregate for that period from all
8hospitals subject to the annual assessment under this
9paragraph.
10    Subject to Sections 5A-3 and 5A-10, for State fiscal years
112021 through 2024, an annual assessment on outpatient services
12is imposed on each hospital provider in an amount equal to
13.01358 multiplied by the hospital's outpatient gross revenue,
14provided however, that the amount of .01358 used to calculate
15the assessment under this paragraph shall, by rule, be adjusted
16by a uniform percentage to generate the same total annual
17assessment that was generated in State fiscal year 2020 from
18all hospitals subject to the annual assessment under this
19paragraph plus $6,250,000. For State fiscal years 2021 and
202022, a hospital's outpatient gross revenue shall be determined
21using the most recent data available from each hospital's 2017
22Medicare cost report as contained in the Healthcare Cost Report
23Information System file, for the quarter ending on March 31,
242019, without regard to any subsequent adjustments or changes
25to such data. For State fiscal years 2023 and 2024, a
26hospital's outpatient gross revenue shall be determined using

 

 

10000SB1773ham008- 67 -LRB100 09919 KTG 36497 a

1the most recent data available from each hospital's 2019
2Medicare cost report as contained in the Healthcare Cost Report
3Information System file, for the quarter ending on March 31,
42021, without regard to any subsequent adjustments or changes
5to such data.
6    (b-6)(1) As used in this Section, "ACA Assessment
7Adjustment" means:
8        (A) For the period of July 1, 2016 through December 31,
9    2016, the product of .19125 multiplied by the sum of the
10    fee-for-service payments to hospitals as authorized under
11    Section 5A-12.5 and the adjustments authorized under
12    subsection (t) of Section 5A-12.2 to managed care
13    organizations for hospital services due and payable in the
14    month of April 2016 multiplied by 6.
15        (B) For the period of January 1, 2017 through June 30,
16    2017, the product of .19125 multiplied by the sum of the
17    fee-for-service payments to hospitals as authorized under
18    Section 5A-12.5 and the adjustments authorized under
19    subsection (t) of Section 5A-12.2 to managed care
20    organizations for hospital services due and payable in the
21    month of October 2016 multiplied by 6, except that the
22    amount calculated under this subparagraph (B) shall be
23    adjusted, either positively or negatively, to account for
24    the difference between the actual payments issued under
25    Section 5A-12.5 for the period beginning July 1, 2016
26    through December 31, 2016 and the estimated payments due

 

 

10000SB1773ham008- 68 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 69 -LRB100 09919 KTG 36497 a

1        actual payments issued under Section 5A-12.5 for the
2        period of July 1, 2017 through December 31, 2017 and
3        the estimated payments due and payable in the month of
4        April 2017 multiplied by 6 as described in subparagraph
5        (C); and
6            (ii) the amount calculated under this subparagraph
7        (D) shall be adjusted to include the product of .19125
8        multiplied by the sum of the fee-for-service payments,
9        if any, estimated to be paid to hospitals under
10        subsection (b) of Section 5A-12.5.
11    (2) The Department shall complete and apply a final
12reconciliation of the ACA Assessment Adjustment prior to June
1330, 2018 to account for:
14        (A) any differences between the actual payments issued
15    or scheduled to be issued prior to June 30, 2018 as
16    authorized in Section 5A-12.5 for the period of January 1,
17    2018 through June 30, 2018 and the estimated payments due
18    and payable in the month of October 2017 multiplied by 6 as
19    described in subparagraph (D); and
20        (B) any difference between the estimated
21    fee-for-service payments under subsection (b) of Section
22    5A-12.5 and the amount of such payments that are actually
23    scheduled to be paid.
24    The Department shall notify hospitals of any additional
25amounts owed or reduction credits to be applied to the June
262018 ACA Assessment Adjustment. This is to be considered the

 

 

10000SB1773ham008- 70 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 71 -LRB100 09919 KTG 36497 a

1Procedure Act.
2    (e) Notwithstanding any other provision of this Section,
3any plan providing for an assessment on a hospital provider as
4a permissible tax under Title XIX of the federal Social
5Security Act and Medicaid-eligible payments to hospital
6providers from the revenues derived from that assessment shall
7be reviewed by the Illinois Department of Healthcare and Family
8Services, as the Single State Medicaid Agency required by
9federal law, to determine whether those assessments and
10hospital provider payments meet federal Medicaid standards. If
11the Department determines that the elements of the plan may
12meet federal Medicaid standards and a related State Medicaid
13Plan Amendment is prepared in a manner and form suitable for
14submission, that State Plan Amendment shall be submitted in a
15timely manner for review by the Centers for Medicare and
16Medicaid Services of the United States Department of Health and
17Human Services and subject to approval by the Centers for
18Medicare and Medicaid Services of the United States Department
19of Health and Human Services. No such plan shall become
20effective without approval by the Illinois General Assembly by
21the enactment into law of related legislation. Notwithstanding
22any other provision of this Section, the Department is
23authorized to adopt rules to reduce the rate of any annual
24assessment imposed under this Section. Any such rules may be
25adopted by the Department under Section 5-50 of the Illinois
26Administrative Procedure Act.

 

 

10000SB1773ham008- 72 -LRB100 09919 KTG 36497 a

1(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2,
2eff. 3-26-15; 99-516, eff. 6-30-16.)
 
3    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
4    Sec. 5A-4. Payment of assessment; penalty.
5    (a) The assessment imposed by Section 5A-2 for State fiscal
6year 2009 through State fiscal year 2018 or as provided in
7Section 5A-16, and each subsequent State fiscal year shall be
8due and payable in monthly installments, each equaling
9one-twelfth of the assessment for the year, on the fourteenth
10State business day of each month. No installment payment of an
11assessment imposed by Section 5A-2 shall be due and payable,
12however, until after the Comptroller has issued the payments
13required under this Article.
14    Except as provided in subsection (a-5) of this Section, the
15assessment imposed by subsection (b-5) of Section 5A-2 for the
16portion of State fiscal year 2012 beginning June 10, 2012
17through June 30, 2012, and for State fiscal year 2013 through
18State fiscal year 2018 or as provided in Section 5A-16, and
19each subsequent State fiscal year shall be due and payable in
20monthly installments, each equaling one-twelfth of the
21assessment for the year, on the 14th State business day of each
22month. No installment payment of an assessment imposed by
23subsection (b-5) of Section 5A-2 shall be due and payable,
24however, until after: (i) the Department notifies the hospital
25provider, in writing, that the payment methodologies to

 

 

10000SB1773ham008- 73 -LRB100 09919 KTG 36497 a

1hospitals required under Section 5A-12.4, have been approved by
2the Centers for Medicare and Medicaid Services of the U.S.
3Department of Health and Human Services, and the waiver under
442 CFR 433.68 for the assessment imposed by subsection (b-5) of
5Section 5A-2, if necessary, has been granted by the Centers for
6Medicare and Medicaid Services of the U.S. Department of Health
7and Human Services; and (ii) the Comptroller has issued the
8payments required under Section 5A-12.4. Upon notification to
9the Department of approval of the payment methodologies
10required under Section 5A-12.4 and the waiver granted under 42
11CFR 433.68, if necessary, all installments otherwise due under
12subsection (b-5) of Section 5A-2 prior to the date of
13notification shall be due and payable to the Department upon
14written direction from the Department and issuance by the
15Comptroller of the payments required under Section 5A-12.4.
16    Except as provided in subsection (a-5) of this Section, the
17assessment imposed under Section 5A-2 for State fiscal year
182019 and each subsequent State fiscal year shall be due and
19payable in monthly installments, each equaling one-twelfth of
20the assessment for the year, on the 14th State business day of
21each month. No installment payment of an assessment imposed by
22Section 5A-2 shall be due and payable, however, until after:
23(i) the Department notifies the hospital provider, in writing,
24that the payment methodologies to hospitals required under
25Section 5A-12.6 have been approved by the Centers for Medicare
26and Medicaid Services of the U.S. Department of Health and

 

 

10000SB1773ham008- 74 -LRB100 09919 KTG 36497 a

1Human Services, and the waiver under 42 CFR 433.68 for the
2assessment imposed by Section 5A-2, if necessary, has been
3granted by the Centers for Medicare and Medicaid Services of
4the U.S. Department of Health and Human Services; and (ii) the
5Comptroller has issued the payments required under Section
65A-12.6. Upon notification to the Department of approval of the
7payment methodologies required under Section 5A-12.6 and the
8waiver granted under 42 CFR 433.68, if necessary, all
9installments otherwise due under Section 5A-2 prior to the date
10of notification shall be due and payable to the Department upon
11written direction from the Department and issuance by the
12Comptroller of the payments required under Section 5A-12.6.
13    (a-5) The Illinois Department may accelerate the schedule
14upon which assessment installments are due and payable by
15hospitals with a payment ratio greater than or equal to one.
16Such acceleration of due dates for payment of the assessment
17may be made only in conjunction with a corresponding
18acceleration in access payments identified in Section 5A-12.2,
19or Section 5A-12.4, or Section 5A-12.6 to the same hospitals.
20For the purposes of this subsection (a-5), a hospital's payment
21ratio is defined as the quotient obtained by dividing the total
22payments for the State fiscal year, as authorized under Section
235A-12.2, or Section 5A-12.4, or Section 5A-12.6, by the total
24assessment for the State fiscal year imposed under Section 5A-2
25or subsection (b-5) of Section 5A-2.
26    (b) The Illinois Department is authorized to establish

 

 

10000SB1773ham008- 75 -LRB100 09919 KTG 36497 a

1delayed payment schedules for hospital providers that are
2unable to make installment payments when due under this Section
3due to financial difficulties, as determined by the Illinois
4Department.
5    (c) If a hospital provider fails to pay the full amount of
6an installment when due (including any extensions granted under
7subsection (b)), there shall, unless waived by the Illinois
8Department for reasonable cause, be added to the assessment
9imposed by Section 5A-2 a penalty assessment equal to the
10lesser of (i) 5% of the amount of the installment not paid on
11or before the due date plus 5% of the portion thereof remaining
12unpaid on the last day of each 30-day period thereafter or (ii)
13100% of the installment amount not paid on or before the due
14date. For purposes of this subsection, payments will be
15credited first to unpaid installment amounts (rather than to
16penalty or interest), beginning with the most delinquent
17installments.
18    (d) Any assessment amount that is due and payable to the
19Illinois Department more frequently than once per calendar
20quarter shall be remitted to the Illinois Department by the
21hospital provider by means of electronic funds transfer. The
22Illinois Department may provide for remittance by other means
23if (i) the amount due is less than $10,000 or (ii) electronic
24funds transfer is unavailable for this purpose.
25(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
2698-104, eff. 7-22-13.)
 

 

 

10000SB1773ham008- 76 -LRB100 09919 KTG 36497 a

1    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
2    Sec. 5A-5. Notice; penalty; maintenance of records.
3    (a) The Illinois Department shall send a notice of
4assessment to every hospital provider subject to assessment
5under this Article. The notice of assessment shall notify the
6hospital of its assessment and shall be sent after receipt by
7the Department of notification from the Centers for Medicare
8and Medicaid Services of the U.S. Department of Health and
9Human Services that the payment methodologies required under
10this Article and, if necessary, the waiver granted under 42 CFR
11433.68 have been approved. The notice shall be on a form
12prepared by the Illinois Department and shall state the
13following:
14        (1) The name of the hospital provider.
15        (2) The address of the hospital provider's principal
16    place of business from which the provider engages in the
17    occupation of hospital provider in this State, and the name
18    and address of each hospital operated, conducted, or
19    maintained by the provider in this State.
20        (3) The occupied bed days, occupied bed days less
21    Medicare days, adjusted gross hospital revenue, or
22    outpatient gross revenue of the hospital provider
23    (whichever is applicable), the amount of assessment
24    imposed under Section 5A-2 for the State fiscal year for
25    which the notice is sent, and the amount of each

 

 

10000SB1773ham008- 77 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 78 -LRB100 09919 KTG 36497 a

1occurring after the due dates of the initial notice.
2    (e) Notwithstanding any other provision in this Article,
3for State fiscal years 2009 through 2018, in the case of a
4hospital provider that did not conduct, operate, or maintain a
5hospital in 2005, the assessment for that State fiscal year
6shall be computed on the basis of hypothetical occupied bed
7days for the full calendar year as determined by the Illinois
8Department. Notwithstanding any other provision in this
9Article, for the portion of State fiscal year 2012 beginning
10June 10, 2012 through June 30, 2012, and for State fiscal years
112013 through 2018, in the case of a hospital provider that did
12not conduct, operate, or maintain a hospital in 2009, the
13assessment under subsection (b-5) of Section 5A-2 for that
14State fiscal year shall be computed on the basis of
15hypothetical gross outpatient revenue for the full calendar
16year as determined by the Illinois Department.
17    Notwithstanding any other provision in this Article, for
18State fiscal years 2019 through 2024, in the case of a hospital
19provider that did not conduct, operate, or maintain a hospital
20in the year that is the basis of the calculation of the
21assessment under this Article, the assessment under paragraph
22(3) of subsection (a) of Section 5A-2 for the State fiscal year
23shall be computed on the basis of hypothetical occupied bed
24days for the full calendar year as determined by the Illinois
25Department, except that for a hospital provider that did not
26have a 2015 Medicare cost report, but paid an assessment in

 

 

10000SB1773ham008- 79 -LRB100 09919 KTG 36497 a

1State fiscal year 2018 on the basis of hypothetical data, that
2assessment amount shall be used for State fiscal years 2019 and
32020; however, for State fiscal year 2020, the assessment
4amount shall be increased by the proportion that it represents
5of the total annual assessment that is generated from all
6hospitals in order to generate $6,250,000 in the aggregate for
7that period from all hospitals subject to the annual assessment
8under this paragraph.
9    Notwithstanding any other provision in this Article, for
10State fiscal years 2019 through 2024, in the case of a hospital
11provider that did not conduct, operate, or maintain a hospital
12in the year that is the basis of the calculation of the
13assessment under this Article, the assessment under subsection
14(b-5) of Section 5A-2 for that State fiscal year shall be
15computed on the basis of hypothetical gross outpatient revenue
16for the full calendar year as determined by the Illinois
17Department, except that for a hospital provider that did not
18have a 2015 Medicare cost report, but paid an assessment in
19State fiscal year 2018 on the basis of hypothetical data, that
20assessment amount shall be used for State fiscal years 2019 and
212020; however, for State fiscal year 2020, the assessment
22amount shall be increased by the proportion that it represents
23of the total annual assessment that is generated from all
24hospitals in order to generate $6,250,000 in the aggregate for
25that period from all hospitals subject to the annual assessment
26under this paragraph.

 

 

10000SB1773ham008- 80 -LRB100 09919 KTG 36497 a

1    (f) Every hospital provider subject to assessment under
2this Article shall keep sufficient records to permit the
3determination of adjusted gross hospital revenue for the
4hospital's fiscal year. All such records shall be kept in the
5English language and shall, at all times during regular
6business hours of the day, be subject to inspection by the
7Illinois Department or its duly authorized agents and
8employees.
9    (g) The Illinois Department may, by rule, provide a
10hospital provider a reasonable opportunity to request a
11clarification or correction of any clerical or computational
12errors contained in the calculation of its assessment, but such
13corrections shall not extend to updating the cost report
14information used to calculate the assessment.
15    (h) (Blank).
16(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
1798-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
187-20-15.)
 
19    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
20    Sec. 5A-8. Hospital Provider Fund.
21    (a) There is created in the State Treasury the Hospital
22Provider Fund. Interest earned by the Fund shall be credited to
23the Fund. The Fund shall not be used to replace any moneys
24appropriated to the Medicaid program by the General Assembly.
25    (b) The Fund is created for the purpose of receiving moneys

 

 

10000SB1773ham008- 81 -LRB100 09919 KTG 36497 a

1in accordance with Section 5A-6 and disbursing moneys only for
2the following purposes, notwithstanding any other provision of
3law:
4        (1) For making payments to hospitals as required under
5    this Code, under the Children's Health Insurance Program
6    Act, under the Covering ALL KIDS Health Insurance Act, and
7    under the Long Term Acute Care Hospital Quality Improvement
8    Transfer Program Act.
9        (2) For the reimbursement of moneys collected by the
10    Illinois Department from hospitals or hospital providers
11    through error or mistake in performing the activities
12    authorized under this Code.
13        (3) For payment of administrative expenses incurred by
14    the Illinois Department or its agent in performing
15    activities under this Code, under the Children's Health
16    Insurance Program Act, under the Covering ALL KIDS Health
17    Insurance Act, and under the Long Term Acute Care Hospital
18    Quality Improvement Transfer Program Act.
19        (4) For payments of any amounts which are reimbursable
20    to the federal government for payments from this Fund which
21    are required to be paid by State warrant.
22        (5) For making transfers, as those transfers are
23    authorized in the proceedings authorizing debt under the
24    Short Term Borrowing Act, but transfers made under this
25    paragraph (5) shall not exceed the principal amount of debt
26    issued in anticipation of the receipt by the State of

 

 

10000SB1773ham008- 82 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 83 -LRB100 09919 KTG 36497 a

1        (7.10) For State fiscal year 2014, for making transfers
2    of the moneys resulting from the assessment under
3    subsection (b-5) of Section 5A-2 and received from hospital
4    providers under Section 5A-4 and transferred into the
5    Hospital Provider Fund under Section 5A-6 to the designated
6    funds not exceeding the following amounts in that State
7    fiscal year:
8            Healthcare Provider Relief Fund......$100,000,000
9        Transfers under this paragraph shall be made within 7
10    days after the payments have been received pursuant to the
11    schedule of payments provided in subsection (a) of Section
12    5A-4.
13        The additional amount of transfers in this paragraph
14    (7.10), authorized by Public Act 98-651, shall be made
15    within 10 State business days after June 16, 2014 (the
16    effective date of Public Act 98-651). That authority shall
17    remain in effect even if Public Act 98-651 does not become
18    law until State fiscal year 2015.
19        (7.10a) For State fiscal years 2015 through 2018, for
20    making transfers of the moneys resulting from the
21    assessment under subsection (b-5) of Section 5A-2 and
22    received from hospital providers under Section 5A-4 and
23    transferred into the Hospital Provider Fund under Section
24    5A-6 to the designated funds not exceeding the following
25    amounts related to each State fiscal year:
26            Healthcare Provider Relief Fund......$50,000,000

 

 

10000SB1773ham008- 84 -LRB100 09919 KTG 36497 a

1        Transfers under this paragraph shall be made within 7
2    days after the payments have been received pursuant to the
3    schedule of payments provided in subsection (a) of Section
4    5A-4.
5        (7.11) (Blank).
6        (7.12) For State fiscal year 2013, for increasing by
7    21/365ths the transfer of the moneys resulting from the
8    assessment under subsection (b-5) of Section 5A-2 and
9    received from hospital providers under Section 5A-4 for the
10    portion of State fiscal year 2012 beginning June 10, 2012
11    through June 30, 2012 and transferred into the Hospital
12    Provider Fund under Section 5A-6 to the designated funds
13    not exceeding the following amounts in that State fiscal
14    year:
15            Healthcare Provider Relief Fund.......$2,870,000
16        Since the federal Centers for Medicare and Medicaid
17    Services approval of the assessment authorized under
18    subsection (b-5) of Section 5A-2, received from hospital
19    providers under Section 5A-4 and the payment methodologies
20    to hospitals required under Section 5A-12.4 was not
21    received by the Department until State fiscal year 2014 and
22    since the Department made retroactive payments during
23    State fiscal year 2014 related to the referenced period of
24    June 2012, the transfer authority granted in this paragraph
25    (7.12) is extended through the date that is 10 State
26    business days after June 16, 2014 (the effective date of

 

 

10000SB1773ham008- 85 -LRB100 09919 KTG 36497 a

1    Public Act 98-651).
2        (7.13) In addition to any other transfers authorized
3    under this Section, for State fiscal years 2017 and 2018,
4    for making transfers to the Healthcare Provider Relief Fund
5    of moneys collected from the ACA Assessment Adjustment
6    authorized under subsections (a) and (b-5) of Section 5A-2
7    and paid by hospital providers under Section 5A-4 into the
8    Hospital Provider Fund under Section 5A-6 for each State
9    fiscal year. Timing of transfers to the Healthcare Provider
10    Relief Fund under this paragraph shall be at the discretion
11    of the Department, but no less frequently than quarterly.
12        (7.14) For making transfers not exceeding the
13    following amounts, related to State fiscal years 2019
14    through 2024, to the following designated funds:
15            Health and Human Services Medicaid Trust
16                Fund..............................$20,000,000
17            Long-Term Care Provider Fund..........$30,000,000
18            Health Care Provider Relief Fund....$325,000,000.
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        (8) For making refunds to hospital providers pursuant
24    to Section 5A-10.
25        (9) For making payment to capitated managed care
26    organizations as described in subsections (s) and (t) of

 

 

10000SB1773ham008- 86 -LRB100 09919 KTG 36497 a

1    Section 5A-12.2 and subsection (r) of Section 5A-12.6 of
2    this Code.
3    Disbursements from the Fund, other than transfers
4authorized under paragraphs (5) and (6) of this subsection,
5shall be by warrants drawn by the State Comptroller upon
6receipt of vouchers duly executed and certified by the Illinois
7Department.
8    (c) The Fund shall consist of the following:
9        (1) All moneys collected or received by the Illinois
10    Department from the hospital provider assessment imposed
11    by this Article.
12        (2) All federal matching funds received by the Illinois
13    Department as a result of expenditures made by the Illinois
14    Department that are attributable to moneys deposited in the
15    Fund.
16        (3) Any interest or penalty levied in conjunction with
17    the administration of this Article.
18        (3.5) As applicable, proceeds from surety bond
19    payments payable to the Department as referenced in
20    subsection (s) of Section 5A-12.2 of this Code.
21        (4) Moneys transferred from another fund in the State
22    treasury.
23        (5) All other moneys received for the Fund from any
24    other source, including interest earned thereon.
25    (d) (Blank).
26(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;

 

 

10000SB1773ham008- 87 -LRB100 09919 KTG 36497 a

198-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
27-20-15; 99-516, eff. 6-30-16; 99-933, eff. 1-27-17; revised
32-15-17.)
 
4    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
5    Sec. 5A-10. Applicability.
6    (a) The assessment imposed by subsection (a) of Section
75A-2 shall cease to be imposed and the Department's obligation
8to make payments shall immediately cease, and any moneys
9remaining in the Fund shall be refunded to hospital providers
10in proportion to the amounts paid by them, if:
11        (1) The payments to hospitals required under this
12    Article are not eligible for federal matching funds under
13    Title XIX or XXI of the Social Security Act;
14        (2) For State fiscal years 2009 through 2018, and as
15    provided in Section 5A-16, the Department of Healthcare and
16    Family Services adopts any administrative rule change to
17    reduce payment rates or alters any payment methodology that
18    reduces any payment rates made to operating hospitals under
19    the approved Title XIX or Title XXI State plan in effect
20    January 1, 2008 except for:
21            (A) any changes for hospitals described in
22        subsection (b) of Section 5A-3;
23            (B) any rates for payments made under this Article
24        V-A;
25            (C) any changes proposed in State plan amendment

 

 

10000SB1773ham008- 88 -LRB100 09919 KTG 36497 a

1        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
2        08-07;
3            (D) in relation to any admissions on or after
4        January 1, 2011, a modification in the methodology for
5        calculating outlier payments to hospitals for
6        exceptionally costly stays, for hospitals reimbursed
7        under the diagnosis-related grouping methodology in
8        effect on July 1, 2011; provided that the Department
9        shall be limited to one such modification during the
10        36-month period after the effective date of this
11        amendatory Act of the 96th General Assembly;
12            (E) any changes affecting hospitals authorized by
13        Public Act 97-689;
14            (F) any changes authorized by Section 14-12 of this
15        Code, or for any changes authorized under Section 5A-15
16        of this Code; or
17            (G) any changes authorized under Section 5-5b.1.
18    (b) The assessment imposed by Section 5A-2 shall not take
19effect or shall cease to be imposed, and the Department's
20obligation to make payments shall immediately cease, if the
21assessment is determined to be an impermissible tax under Title
22XIX of the Social Security Act. Moneys in the Hospital Provider
23Fund derived from assessments imposed prior thereto shall be
24disbursed in accordance with Section 5A-8 to the extent federal
25financial participation is not reduced due to the
26impermissibility of the assessments, and any remaining moneys

 

 

10000SB1773ham008- 89 -LRB100 09919 KTG 36497 a

1shall be refunded to hospital providers in proportion to the
2amounts paid by them.
3    (c) The assessments imposed by subsection (b-5) of Section
45A-2 shall not take effect or shall cease to be imposed, the
5Department's obligation to make payments shall immediately
6cease, and any moneys remaining in the Fund shall be refunded
7to hospital providers in proportion to the amounts paid by
8them, if the payments to hospitals required under Section
95A-12.4 or Section 5A-12.6 are not eligible for federal
10matching funds under Title XIX of the Social Security Act.
11    (d) The assessments imposed by Section 5A-2 shall not take
12effect or shall cease to be imposed, the Department's
13obligation to make payments shall immediately cease, and any
14moneys remaining in the Fund shall be refunded to hospital
15providers in proportion to the amounts paid by them, if:
16        (1) for State fiscal years 2013 through 2018, and as
17    provided in Section 5A-16, the Department reduces any
18    payment rates to hospitals as in effect on May 1, 2012, or
19    alters any payment methodology as in effect on May 1, 2012,
20    that has the effect of reducing payment rates to hospitals,
21    except for any changes affecting hospitals authorized in
22    Public Act 97-689 and any changes authorized by Section
23    14-12 of this Code, and except for any changes authorized
24    under Section 5A-15, and except for any changes authorized
25    under Section 5-5b.1;
26        (2) for State fiscal years 2013 through 2018, and as

 

 

10000SB1773ham008- 90 -LRB100 09919 KTG 36497 a

1    provided in Section 5A-16, the Department reduces any
2    supplemental payments made to hospitals below the amounts
3    paid for services provided in State fiscal year 2011 as
4    implemented by administrative rules adopted and in effect
5    on or prior to June 30, 2011, except for any changes
6    affecting hospitals authorized in Public Act 97-689 and any
7    changes authorized by Section 14-12 of this Code, and
8    except for any changes authorized under Section 5A-15, and
9    except for any changes authorized under Section 5-5b.1; or
10        (3) for State fiscal years 2015 through 2018, and as
11    provided in Section 5A-16, the Department reduces the
12    overall effective rate of reimbursement to hospitals below
13    the level authorized under Section 14-12 of this Code,
14    except for any changes under Section 14-12 or Section 5A-15
15    of this Code, and except for any changes authorized under
16    Section 5-5b.1.
17    (e) Beginning in State fiscal year 2019, the assessments
18imposed under Section 5A-2 shall not take effect or shall cease
19to be imposed, the Department's obligation to make payments
20shall immediately cease, and any moneys remaining in the Fund
21shall be refunded to hospital providers in proportion to the
22amounts paid by them, if:
23        (1) the payments to hospitals required under Section
24    5A12.6 are not eligible for federal matching funds under
25    Title XIX of the Social Security Act; or
26        (2) the Department reduces the overall effective rate

 

 

10000SB1773ham008- 91 -LRB100 09919 KTG 36497 a

1    of reimbursement to hospitals below the level authorized
2    under Section 14-12 of this Code, as in effect on December
3    31, 2017, except for any changes authorized under Sections
4    14-12 or Section 5A-15 of this Code, and except for any
5    changes authorized under changes to Sections 5A-12.2,
6    5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by this
7    amendatory Act of the 100th General Assembly.
8(Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-2,
9eff. 3-26-15.)
 
10    (305 ILCS 5/5A-12.5)
11    Sec. 5A-12.5. Affordable Care Act adults; hospital access
12payments.
13    (a) The Department shall, subject to federal approval,
14mirror the Medical Assistance hospital reimbursement
15methodology for Affordable Care Act adults who are enrolled
16under a fee-for-service or capitated managed care program,
17including hospital access payments as defined in Section
185A-12.2 of this Article and hospital access improvement
19payments as defined in Section 5A-12.4 of this Article, in
20compliance with the equivalent rate provisions of the
21Affordable Care Act.
22    (b) If the fee-for-service payments authorized under this
23Section are deemed to be increases to payments for a prior
24period, the Department shall seek federal approval to issue
25such increases for the payments made through the period ending

 

 

10000SB1773ham008- 92 -LRB100 09919 KTG 36497 a

1on June 30, 2018, or as provided in Section 5A-16, even if such
2increases are paid out during an extended payment period beyond
3such date. Payment of such increases beyond such date is
4subject to federal approval. If the Department receives federal
5approval of such increases, the Department shall pay such
6increases on the same schedule as it had used for such payments
7prior to June 30, 2018.
8    (c) As used in this Section, "Affordable Care Act" is the
9collective term for the Patient Protection and Affordable Care
10Act (Pub. L. 111-148) and the Health Care and Education
11Reconciliation Act of 2010 (Pub. L. 111-152).
12(Source: P.A. 98-651, eff. 6-16-14; 99-516, eff. 6-30-16.)
 
13    (305 ILCS 5/5A-12.6 new)
14    Sec. 5A-12.6. Continuation of hospital access payments on
15or after July 1, 2018.
16    (a) To preserve and improve access to hospital services,
17for hospital services rendered on or after July 1, 2018 the
18Department shall, except for hospitals described in subsection
19(b) of Section 5A-3, make payments to hospitals as set forth in
20this Section. Payments under this Section are not due and
21payable, however, until (i) the methodologies described in this
22Section are approved by the federal government in an
23appropriate State Plan amendment and (ii) the assessment
24imposed under this Article is determined to be a permissible
25tax under Title XIX of the Social Security Act. In determining

 

 

10000SB1773ham008- 93 -LRB100 09919 KTG 36497 a

1the hospital access payments authorized under subsections (f)
2through (n) of this Section, unless otherwise specified, only
3Illinois hospitals shall be eligible for a payment and total
4Medicaid utilization statistics shall be used to determine the
5payment amount. In determining the hospital access payments
6authorized under subsection (d) and subsections (f) through (l)
7of this Section, if a hospital ceases to receive payments from
8the pool, the payments for all hospitals continuing to receive
9payments from such pool shall be uniformly adjusted to fully
10expend the aggregate amount of the pool, with such adjustment
11being effective on the first day of the second month following
12the date the hospital ceases to receive payments from such
13pool.
14    (b) Phase in of funds to claims-based payments and updates.
15To ensure access to hospital services, the Department may only
16use funds financed by the assessment authorized under Section
175A-2 to increase claims-based payment rates, including
18applicable policy add-on payments or adjusters, in accordance
19with this subsection. To increase the claims-based payment
20rates up to the amounts specified in this subsection, the
21hospital access payments authorized in subsection (d) and
22subsections (g) through (l) of this Section shall be uniformly
23reduced.
24        (1) For State fiscal years 2019 and 2020, up to
25    $635,000,000 of the total spending financed from the
26    assessment authorized under Section 5A-2 that is intended

 

 

10000SB1773ham008- 94 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 95 -LRB100 09919 KTG 36497 a

1    Section 14-12 for payment in State Fiscal Year 2018 may be
2    used to increase claims-based hospital payment rates as
3    specified under Section 14-12.
4        (5) Beginning in State fiscal year 2021, and at least
5    every 24 months thereafter, the Department shall, by rule,
6    update the hospital access payments authorized under this
7    Section to take into account the amount of funds being used
8    to increase claims-based hospital payment rates under
9    Section 14-12 and to apply the most recently available data
10    and information, including data from the most recent base
11    year and qualifying criteria which shall correlate to the
12    updated base year data, to determine a hospital's
13    eligibility for each payment and the amount of the payment
14    authorized under this Section. Any updates of the hospital
15    access payment methodologies shall not result in any
16    diminishment of the aggregate amount of hospital access
17    payment expenditures, except for reductions attributable
18    to the use of such funds to increase claims-based hospital
19    payment rates as authorized by this Section. Nothing in
20    this Section shall be construed as precluding variations in
21    the amount of any individual hospital's access payments.
22    The Department shall publish the proposed rules to update
23    the hospital access payments at least 90 days before their
24    proposed effective date. The proposed rules shall not be
25    adopted using emergency rulemaking authority. The
26    Department shall notify each hospital, in writing, of the

 

 

10000SB1773ham008- 96 -LRB100 09919 KTG 36497 a

1    impact of these updates on the hospital at least 30
2    calendar days prior to their effective date.
3    (c) The hospital access payments authorized under
4subsections (d) through (n) of this Section shall be paid in 12
5equal installments on or before the seventh State business day
6of each month, except that no payment shall be due within 100
7days after the later of the date of notification of federal
8approval of the payment methodologies required under this
9Section or any waiver required under 42 CFR 433.68, at which
10time the sum of amounts required under this Section prior to
11the date of notification is due and payable. Payments under
12this Section are not due and payable, however, until (i) the
13methodologies described in this Section are approved by the
14federal government in an appropriate State Plan amendment and
15(ii) the assessment imposed under this Article is determined to
16be a permissible tax under Title XIX of the Social Security
17Act. The Department may, when practicable, accelerate the
18schedule upon which payments authorized under this Section are
19made.
20    (d) Rate increase-based adjustment.
21        (1) From the funds financed by the assessment
22    authorized under Section 5A-2, individual funding pools by
23    category of service shall be established, for Inpatient
24    General Acute Care services in the amount of $268,051,572,
25    Inpatient Rehab Care services in the amount of $24,500,610,
26    Inpatient Psychiatric Care service in the amount of

 

 

10000SB1773ham008- 97 -LRB100 09919 KTG 36497 a

1    $94,617,812, and Outpatient Care Services in the amount of
2    $328,828,641.
3        (2) Each Illinois hospital and other hospitals
4    authorized under this subsection, except for long-term
5    acute care hospitals and public hospitals, shall be
6    assigned a pool allocation percentage for each category of
7    service that is equal to the ratio of the hospital's
8    estimated FY2019 claims-based payments including all
9    applicable FY2019 policy adjusters, multiplied by the
10    applicable service credit factor for the hospital, divided
11    by the total of the FY2019 claims-based payments including
12    all FY2019 policy adjusters for each category of service
13    adjusted by each hospital's applicable service credit
14    factor for all qualified hospitals. For each category of
15    service, a hospital shall receive a supplemental payment
16    equal to its pool allocation percentage multiplied by the
17    total pool amount.
18        (3) Effective July 1, 2018, for purposes of determining
19    for State fiscal years 2019 and 2020 the hospitals eligible
20    for the payments authorized under this subsection, the
21    Department shall include children's hospitals located in
22    St. Louis that are designated a Level III perinatal center
23    by the Department of Public Health and also designated a
24    Level I pediatric trauma center by the Department of Public
25    Health as of December 1, 2017.
26        (4) As used in this subsection, "service credit factor"

 

 

10000SB1773ham008- 98 -LRB100 09919 KTG 36497 a

1    is determined based on a hospital's Rate Year 2017 Medicaid
2    inpatient utilization rate ("MIUR") rounded to the nearest
3    whole percentage, as follows:
4            (A) Tier 1: A hospital with a MIUR equal to or
5        greater than 60% 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 60% 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,

 

 

10000SB1773ham008- 99 -LRB100 09919 KTG 36497 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 $10,000,000 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

 

 

10000SB1773ham008- 100 -LRB100 09919 KTG 36497 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 $40,000,000 multiplied by a
9    fraction, the numerator of which is the hospital's Fiscal
10    Year 2015 outpatient services and the denominator of which
11    is the Fiscal Year 2015 outpatient services for all
12    hospitals eligible under this paragraph for this payment.
13        (2) Each critical access hospital that is not publicly
14    owned shall be paid an outpatient high volume access
15    payment equal to $55,000,000 multiplied by a fraction, the
16    numerator of which is the hospital's Fiscal Year 2015
17    outpatient services and the denominator of which is the
18    Fiscal Year 2015 outpatient services for all hospitals
19    eligible under this paragraph for this payment.
20        (3) Each tier 1 hospital that is not publicly owned
21    shall be paid an outpatient high volume access payment
22    equal to $25,000,000 multiplied by a fraction, the
23    numerator of which is the hospital's Fiscal Year 2015
24    outpatient services and the denominator of which is the
25    Fiscal Year 2015 outpatient services for all hospitals
26    eligible under this paragraph for this payment. A tier 1

 

 

10000SB1773ham008- 101 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 102 -LRB100 09919 KTG 36497 a

1    region but less than the mean plus 2 standard deviations.
2        (5) Each tier 3 hospital that is not publicly owned
3    shall be paid an outpatient high volume access payment
4    equal to $58,000,000 multiplied by a fraction, the
5    numerator of which is the hospital's Fiscal Year 2015
6    outpatient services and the denominator of which is the
7    Fiscal Year 2015 outpatient services for all hospitals
8    eligible under this paragraph for this payment. A tier 3
9    outpatient high volume hospital means a non-publicly owned
10    hospital, excluding a safety-net hospital as defined in
11    Section 5-5e.1 of this Code for Rate Year 2017, with total
12    outpatient services equal to or greater than the regional
13    mean plus 2 standard deviations for all hospitals in the
14    region.
15    (h) Medicaid dependent or high volume hospital access
16payment.
17        (1) To qualify for a Medicaid dependent hospital access
18    payment, a hospital shall meet one of the following
19    criteria:
20            (A) Be a non-publicly owned general acute care
21        hospital that is a safety-net hospital, as defined in
22        Section 5-5e.1 of this Code, for Rate Year 2017.
23            (B) Be a pediatric hospital that is a safety net
24        hospital, as defined in Section 5-5e.1 of this Code,
25        for Rate Year 2017 and have a Medicaid inpatient
26        utilization rate equal to or greater than 50%.

 

 

10000SB1773ham008- 103 -LRB100 09919 KTG 36497 a

1            (C) Be a general acute care hospital with a
2        Medicaid inpatient utilization rate equal to or
3        greater than 50% in Rate Year 2017.
4        (2) The Medicaid dependent hospital access payment
5    shall be determined as follows:
6            (A) Each tier 1 hospital shall be paid a Medicaid
7        dependent hospital access payment equal to $23,000,000
8        multiplied by a fraction, the numerator of which is the
9        hospital's Fiscal Year 2015 total days and the
10        denominator of which is the Fiscal Year 2015 total days
11        for all hospitals eligible under this subparagraph for
12        this payment. A tier 1 Medicaid dependent hospital
13        means a qualifying hospital with a Rate Year 2017
14        Medicaid inpatient utilization rate equal to or
15        greater than the statewide mean but less than the
16        statewide mean plus 0.5 standard deviation.
17            (B) Each tier 2 hospital shall be paid a Medicaid
18        dependent hospital access payment equal to $15,000,000
19        multiplied by a fraction, the numerator of which is the
20        hospital's Fiscal Year 2015 total days and the
21        denominator of which is the Fiscal Year 2015 total days
22        for all hospitals eligible under this subparagraph for
23        this payment. A tier 2 Medicaid dependent hospital
24        means a qualifying hospital with a Rate Year 2017
25        Medicaid inpatient utilization rate equal to or
26        greater than the statewide mean plus 0.5 standard

 

 

10000SB1773ham008- 104 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 105 -LRB100 09919 KTG 36497 a

1            (E) Each tier 5 hospital shall be paid a Medicaid
2        dependent hospital access payment equal to $75,000,000
3        multiplied by a fraction, the numerator of which is the
4        hospital's Fiscal Year 2015 total days and the
5        denominator of which is the Fiscal Year 2015 total days
6        for all hospitals eligible under this subparagraph for
7        this payment. A tier 5 Medicaid dependent hospital
8        means a qualifying hospital with a Rate Year 2017
9        Medicaid inpatient utilization rate equal to or
10        greater than the statewide mean plus 2 standard
11        deviations.
12        (3) Each Medicaid high volume hospital shall be paid a
13    Medicaid high volume access payment equal to $300,000,000
14    multiplied by a fraction, the numerator of which is the
15    hospital's Fiscal Year 2015 total admissions and the
16    denominator of which is the Fiscal Year 2015 total
17    admissions for all hospitals eligible under this paragraph
18    for this payment. A Medicaid high volume hospital means the
19    Illinois general acute care hospitals with the highest
20    number of Fiscal Year 2015 total admissions that when
21    ranked in descending order from the highest Fiscal Year
22    2015 total admissions to the lowest Fiscal Year 2015 total
23    admissions, in the aggregate, sum to at least 50% of the
24    total admissions for all such hospitals in Fiscal Year
25    2015; however, any hospital which has qualified as a
26    Medicaid dependent hospital shall not also be considered a

 

 

10000SB1773ham008- 106 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 107 -LRB100 09919 KTG 36497 a

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

 

 

10000SB1773ham008- 108 -LRB100 09919 KTG 36497 a

1    inpatient utilization rate equal to or greater than 20% and
2    a calendar year 2015 occupancy ratio equal to or greater
3    than 50%, shall be paid an access payment equal to
4    $200,000,000 multiplied by a fraction, the numerator of
5    which is the hospital's Fiscal Year 2015 total admissions
6    and the denominator of which is the Fiscal Year 2015 total
7    admissions for all hospitals eligible under this paragraph
8    for this payment.
9    (l) Long-term acute care access payment. Each Illinois
10non-publicly owned long-term acute care hospital that has a
11Rate Year 2017 Medicaid inpatient utilization rate equal to or
12greater than 25% and a calendar year 2015 occupancy ratio equal
13to or greater than 60% shall be paid an access payment equal to
14$19,000,000 multiplied by a fraction, the numerator of which is
15the hospital's Fiscal Year 2015 general acute care admissions
16and the denominator of which is the Fiscal Year 2015 general
17acute care admissions for all hospitals eligible under this
18subsection for this payment.
19    (m) Small public hospital access payment.
20        (1) As used in this subsection, "small public hospital"
21    means any Illinois publicly owned hospital which is not a
22    "large public hospital" as described in 89 Ill. Adm. Code
23    148.25(a).
24        (2) Each small public hospital shall be paid an
25    inpatient access payment equal to $2,825,000 multiplied by
26    a fraction, the numerator of which is the hospital's Fiscal

 

 

10000SB1773ham008- 109 -LRB100 09919 KTG 36497 a

1    Year 2015 total days and the denominator of which is the
2    Fiscal Year 2015 total days for all hospitals under this
3    paragraph for this payment.
4        (3) Each small public hospital shall be paid an
5    outpatient access payment equal to $24,000,000 multiplied
6    by a fraction, the numerator of which is the hospital's
7    Fiscal Year 2015 outpatient services and the denominator of
8    which is the Fiscal Year 2015 outpatient services for all
9    hospitals eligible under this paragraph for this payment.
10    (n) Psychiatric care access payment. In addition to rates
11paid for inpatient psychiatric services, the Illinois
12Department shall, by rule, establish an access payment for
13inpatient hospital psychiatric services that shall, in the
14aggregate, spend approximately $61,141,188 annually. In
15consultation with the hospital community, the Department may,
16by rule, incorporate the funds used for this access payment to
17increase the payment rates for inpatient psychiatric services,
18except that such changes shall not take effect before July 1,
192019. Upon incorporation into the claims payment rates, this
20access payment shall be repealed. Beginning July 1, 2018, for
21purposes of determining for State fiscal years 2019 and 2020
22the hospitals eligible for the payments authorized under this
23subsection, the Department shall include out-of-state
24hospitals that are designated a Level I pediatric trauma center
25or a Level I trauma center by the Department of Public Health
26as of December 1, 2017.

 

 

10000SB1773ham008- 110 -LRB100 09919 KTG 36497 a

1    (o) For purposes of this Section, a hospital that is
2enrolled to provide Medicaid services during State fiscal year
32015 shall have its utilization and associated reimbursements
4annualized prior to the payment calculations being performed
5under this Section.
6    (p) Definitions. As used in this Section, unless the
7context requires otherwise:
8    "General acute care admissions" means, for a given
9hospital, the sum of inpatient hospital admissions provided to
10recipients of medical assistance under Title XIX of the Social
11Security Act for general acute care, excluding admissions for
12individuals eligible for Medicare under Title XVIII of the
13Social Security Act (Medicaid/Medicare crossover admissions),
14as tabulated from the Department's paid claims data for general
15acute care admissions occurring during State fiscal year 2015
16that was adjudicated by the Department through October 28,
172016.
18    "Occupancy ratio" is determined utilizing the IDPH
19Hospital Profile CY15 Facility Utilization Data Source 2015
20Annual Hospital Questionnaire. Utilizes all beds and days
21including observation days but excludes Long Term Care and
22Swing bed and their associated beds and days.
23    "Outpatient services" means, for a given hospital, the sum
24of the number of outpatient encounters identified as unique
25services provided to recipients of medical assistance under
26Title XIX of the Social Security Act for general acute care,

 

 

10000SB1773ham008- 111 -LRB100 09919 KTG 36497 a

1psychiatric care, and rehabilitation care, excluding
2outpatient services for individuals eligible for Medicare
3under Title XVIII of the Social Security Act (Medicaid/Medicare
4crossover services), as tabulated from the Department's paid
5claims data for outpatient services occurring during State
6fiscal year 2015 that was adjudicated by the Department through
7October 28, 2016.
8    "Total days" means, for a given hospital, the sum of
9inpatient hospital days provided to recipients of medical
10assistance under Title XIX of the Social Security Act for
11general acute care, psychiatric care, and rehabilitation care,
12excluding days for individuals eligible for Medicare under
13Title XVIII of the Social Security Act (Medicaid/Medicare
14crossover days), as tabulated from the Department's paid claims
15data for total days occurring during State fiscal year 2015
16that was adjudicated by the Department through October 28,
172016.
18    "Total admissions" means, for a given hospital, the sum of
19inpatient hospital admissions provided to recipients of
20medical assistance under Title XIX of the Social Security Act
21for general acute care, psychiatric care, and rehabilitation
22care, excluding admissions for individuals eligible for
23Medicare under Title XVIII of that Act (Medicaid/Medicare
24crossover admissions), as tabulated from the Department's paid
25claims data for admissions occurring during State fiscal year
262015 that was adjudicated by the Department through October 28,

 

 

10000SB1773ham008- 112 -LRB100 09919 KTG 36497 a

12016.
2    (q) Notwithstanding any of the other provisions of this
3Section, the Department is authorized to adopt rules that
4change the hospital access payments specified in this Section,
5but only to the extent necessary to conform to any federally
6approved amendment to the Title XIX State Plan. Any such rules
7shall be adopted by the Department as authorized by Section
85-50 of the Illinois Administrative Procedure Act.
9Notwithstanding any other provision of law, any changes
10implemented as a result of this subsection (q) shall be given
11retroactive effect so that they shall be deemed to have taken
12effect as of the effective date of this amendatory Act of the
13100th General Assembly.
14    (r) On or after July 1, 2018, and no less than annually
15thereafter, the Department shall increase capitation payments
16to capitated managed care organizations (MCOs) to equal the
17aggregate reduction of payments made in this Section to
18preserve access to hospital services for recipients under the
19Medical Assistance Program. The aggregate amount of all
20increased capitation payments to all MCOs for a fiscal year
21shall at least be the amount needed to avoid reduction in
22payments authorized under Section 5A-15. Payments to MCOs under
23this Section shall be consistent with actuarial certification
24and shall be published by the Department each year. Managed
25care organizations and hospitals (including through their
26representative organizations), shall develop and implement

 

 

10000SB1773ham008- 113 -LRB100 09919 KTG 36497 a

1methodologies and rates for payments that will preserve and
2improve access to hospital services for recipients in
3furtherance of the State's public policy to ensure equal access
4to covered services to recipients under the Medical Assistance
5Program. The Department shall make available, on a monthly
6basis, a report of the capitation payments that are made to
7each MCO, including the number of enrollees for which such
8payment is made, the per enrollee amount of the payment, and
9any adjustments that have been made. Payments to MCOs that
10would be paid consistent with actuarial certification and
11enrollment in the absence of the increased capitation payments
12under this Section shall not be reduced as a consequence of
13payments made under this subsection.
14    As used in this subsection, "MCO" means an entity which
15contracts with the Department to provide services where payment
16for medical services is made on a capitated basis.
 
17    (305 ILCS 5/5A-13)
18    Sec. 5A-13. Emergency rulemaking.
19    (a) The Department of Healthcare and Family Services
20(formerly Department of Public Aid) may adopt rules necessary
21to implement this amendatory Act of the 94th General Assembly
22through the use of emergency rulemaking in accordance with
23Section 5-45 of the Illinois Administrative Procedure Act. For
24purposes of that Act, the General Assembly finds that the
25adoption of rules to implement this amendatory Act of the 94th

 

 

10000SB1773ham008- 114 -LRB100 09919 KTG 36497 a

1General Assembly is deemed an emergency and necessary for the
2public interest, safety, and welfare.
3    (b) The Department of Healthcare and Family Services may
4adopt rules necessary to implement this amendatory Act of the
597th General Assembly through the use of emergency rulemaking
6in accordance with Section 5-45 of the Illinois Administrative
7Procedure Act. For purposes of that Act, the General Assembly
8finds that the adoption of rules to implement this amendatory
9Act of the 97th General Assembly is deemed an emergency and
10necessary for the public interest, safety, and welfare.
11    (c) The Department of Healthcare and Family Services may
12adopt rules necessary to initially implement the changes to
13Articles 5, 5A, 12, and 14 of this Code under this amendatory
14Act of the 100th General Assembly through the use of emergency
15rulemaking in accordance with subsection (aa) of Section 5-45
16of the Illinois Administrative Procedure Act. For purposes of
17that Act, the General Assembly finds that the adoption of rules
18to implement the changes to Articles 5, 5A, 12, and 14 of this
19Code under this amendatory Act of the 100th General Assembly is
20deemed an emergency and necessary for the public interest,
21safety, and welfare. The 24-month limitation on the adoption of
22emergency rules does not apply to rules adopted to initially
23implement the changes to Articles 5, 5A, 12, and 14 of this
24Code under this amendatory Act of the 100th General Assembly.
25For purposes of this subsection, "initially" means any
26emergency rules necessary to immediately implement the changes

 

 

10000SB1773ham008- 115 -LRB100 09919 KTG 36497 a

1authorized to Articles 5, 5A, 12, and 14 of this Code under
2this amendatory Act of the 100th General Assembly; however,
3emergency rulemaking authority shall not be used to make
4changes that could otherwise be made following the process
5established in the Illinois Administrative Procedure Act.
6(Source: P.A. 97-688, eff. 6-14-12.)
 
7    (305 ILCS 5/5A-14)
8    Sec. 5A-14. Repeal of assessments and disbursements.
9    (a) Section 5A-2 is repealed on July 1, 2020 2018.
10    (b) Section 5A-12 is repealed on July 1, 2005.
11    (c) Section 5A-12.1 is repealed on July 1, 2008.
12    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
13July 1, 2018, subject to Section 5A-16.
14    (e) Section 5A-12.3 is repealed on July 1, 2011.
15    (f) Section 5A-12.6 is repealed on July 1, 2020.
16(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
1798-651, eff. 6-16-14.)
 
18    (305 ILCS 5/5A-15)
19    Sec. 5A-15. Protection of federal revenue.
20    (a) If the federal Centers for Medicare and Medicaid
21Services finds that any federal upper payment limit applicable
22to the payments under this Article is exceeded then:
23        (1) (i) if such finding is made before payments have
24    been issued, the payments under this Article and the

 

 

10000SB1773ham008- 116 -LRB100 09919 KTG 36497 a

1    increases in claims-based hospital payment rates specified
2    under Section 14-12 of this Code, as authorized under this
3    amendatory Act of the 100th General Assembly, that exceed
4    the applicable federal upper payment limit shall be reduced
5    uniformly to the extent necessary to comply with the
6    applicable federal upper payment limit; or (ii) if such
7    finding is made after payments have been issued, the
8    payments under this Article that exceed the applicable
9    federal upper payment limit shall be reduced uniformly to
10    the extent necessary to comply with the applicable federal
11    upper payment limit; and
12        (2) any assessment rate imposed under this Article
13    shall be reduced such that the aggregate assessment is
14    reduced by the same percentage reduction applied in
15    paragraph (1); and
16        (3) any transfers from the Hospital Provider Fund under
17    Section 5A-8 shall be reduced by the same percentage
18    reduction applied in paragraph (1).
19    (b) Any payment reductions made under the authority granted
20in this Section are exempt from the requirements and actions
21under Section 5A-10.
22(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
 
23    (305 ILCS 5/5A-16 new)
24    Sec. 5A-16. State fiscal year 2019 implementation
25protection. To preserve access to hospital services, it is the

 

 

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1intent of the General Assembly that there not be a gap in
2payments to hospitals while the changes authorized under this
3amendatory Act of the 100th General Assembly are being reviewed
4by the federal Centers for Medicare and Medicaid Services and
5implemented by the Department. Therefore, pending the review
6and approval of the changes to the assessment and hospital
7reimbursement methodologies authorized under this amendatory
8Act of the 100th General Assembly by the federal Centers for
9Medicare and Medicaid Services and the final implementation of
10such program by the Department, the Department shall take all
11actions necessary to continue the reimbursement methodologies
12and payments to hospitals that are changed under this
13amendatory Act of the 100th General Assembly, as they are in
14effect on June 30, 2018, until the first day of the second
15month after the new and revised methodologies and payments
16authorized under this amendatory Act of the 100th General
17Assembly are effective and implemented by the Department. Such
18actions by the Department shall include, but not be limited to,
19requesting the extension of any federal approval of the
20currently approved payment methodologies contained in
21Illinois' Medicaid State Plan while the federal Centers for
22Medicare and Medicaid Services reviews the proposed changes
23authorized under this amendatory Act of the 100th General
24Assembly.
25    Notwithstanding any other provision of this Code, if the
26federal Centers for Medicare and Medicaid Services should

 

 

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1approve the continuation of the reimbursement methodologies
2and payments to hospitals under Sections 5A-12.2, 5A-12.4,
35A-12.5, and Section 14-12, as they are in effect on June 30,
42018, until the new and revised methodologies and payments
5authorized under Sections 5A-12.6 and Section 14-12 of this
6amendatory Act of the 100th General Assembly are federally
7approved, then the reimbursement methodologies and payments to
8hospitals under Sections 5A-12.2, 5A-12.4, 5A-12.5, and 14-12,
9and the assessments imposed under Section 5A-2, as they are in
10effect on June 30, 2018, shall continue until the effective
11date of the new and revised methodologies and payments, which
12shall be the first day of the second month following the date
13of approval by the federal Centers for Medicare and Medicaid
14Services.
 
15    (305 ILCS 5/12-4.105)
16    Sec. 12-4.105. Human poison control center; payment
17program. Subject to funding availability resulting from
18transfers made from the Hospital Provider Fund to the
19Healthcare Provider Relief Fund as authorized under this Code,
20for State fiscal year 2017 and State fiscal year 2018, and for
21each State fiscal year thereafter in which the assessment under
22Section 5A-2 is imposed, the Department of Healthcare and
23Family Services shall pay to the human poison control center
24designated under the Poison Control System Act an amount of not
25less than $3,000,000 for each of those State fiscal years that

 

 

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1the human poison control center is in operation.
2(Source: P.A. 99-516, eff. 6-30-16.)
 
3    (305 ILCS 5/14-12)
4    Sec. 14-12. Hospital rate reform payment system. The
5hospital payment system pursuant to Section 14-11 of this
6Article shall be as follows:
7    (a) Inpatient hospital services. Effective for discharges
8on and after July 1, 2014, reimbursement for inpatient general
9acute care services shall utilize the All Patient Refined
10Diagnosis Related Grouping (APR-DRG) software, version 30,
11distributed by 3MTM Health Information System.
12        (1) The Department shall establish Medicaid weighting
13    factors to be used in the reimbursement system established
14    under this subsection. Initial weighting factors shall be
15    the weighting factors as published by 3M Health Information
16    System, associated with Version 30.0 adjusted for the
17    Illinois experience.
18        (2) The Department shall establish a
19    statewide-standardized amount to be used in the inpatient
20    reimbursement system. The Department shall publish these
21    amounts on its website no later than 10 calendar days prior
22    to their effective date.
23        (3) In addition to the statewide-standardized amount,
24    the Department shall develop adjusters to adjust the rate
25    of reimbursement for critical Medicaid providers or

 

 

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1    services for trauma, transplantation services, perinatal
2    care, and Graduate Medical Education (GME).
3        (4) The Department shall develop add-on payments to
4    account for exceptionally costly inpatient stays,
5    consistent with Medicare outlier principles. Outlier fixed
6    loss thresholds may be updated to control for excessive
7    growth in outlier payments no more frequently than on an
8    annual basis, but at least triennially. Upon updating the
9    fixed loss thresholds, the Department shall be required to
10    update base rates within 12 months.
11        (5) The Department shall define those hospitals or
12    distinct parts of hospitals that shall be exempt from the
13    APR-DRG reimbursement system established under this
14    Section. The Department shall publish these hospitals'
15    inpatient rates on its website no later than 10 calendar
16    days prior to their effective date.
17        (6) Beginning July 1, 2014 and ending on June 30, 2024
18    2018, in addition to the statewide-standardized amount,
19    the Department shall develop an adjustor to adjust the rate
20    of reimbursement for safety-net hospitals defined in
21    Section 5-5e.1 of this Code excluding pediatric hospitals.
22        (7) Beginning July 1, 2014 and ending on June 30, 2020,
23    or upon implementation of inpatient psychiatric rate
24    increases as described in subsection (n) of Section 5A-12.6
25    2018, in addition to the statewide-standardized amount,
26    the Department shall develop an adjustor to adjust the rate

 

 

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1    of reimbursement for Illinois freestanding inpatient
2    psychiatric hospitals that are not designated as
3    children's hospitals by the Department but are primarily
4    treating patients under the age of 21.
5        (7.5) Beginning July 1, 2020, the reimbursement for
6    inpatient psychiatric services shall be so that base claims
7    projected reimbursement is increased by an amount equal to
8    the funds allocated in paragraph (2) of subsection (b) of
9    Section 5A-12.6, less the amount allocated under
10    paragraphs (8) and (9) of this subsection and paragraphs
11    (3) and (4) of subsection (b) multiplied by 13%. Beginning
12    July 1, 2022, the reimbursement for inpatient psychiatric
13    services shall be so that base claims projected
14    reimbursement is increased by an amount equal to the funds
15    allocated in paragraph (3) of subsection (b) of Section
16    5A-12.6, less the amount allocated under paragraphs (8) and
17    (9) of this subsection and paragraphs (3) and (4) of
18    subsection (b) multiplied by 13%. Beginning July 1, 2024,
19    the reimbursement for inpatient psychiatric services shall
20    be so that base claims projected reimbursement is increased
21    by an amount equal to the funds allocated in paragraph (4)
22    of subsection (b) of Section 5A-12.6, less the amount
23    allocated under paragraphs (8) and (9) of this subsection
24    and paragraphs (3) and (4) of subsection (b) multiplied by
25    13%.
26        (8) Beginning July 1, 2018, in addition to the

 

 

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

 

 

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

 

 

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1    and paragraphs (3) and (4) of subsection (b) multiplied by
2    0.9%.
3        Beginning July 1, 2022, the reimbursement for
4    inpatient rehabilitation services shall be uniformly
5    increased so that the $96 per day add-on as adjusted by the
6    July 1, 2020 increase, is increased by an amount equal to
7    the funds allocated in paragraph (3) of subsection (b) of
8    Section 5A-12.6, less the amount allocated under
9    paragraphs (8) and (9) of this subsection and paragraphs
10    (3) and (4) of subsection (b) multiplied by 0.9%.
11        Beginning July 1, 2023, the reimbursement for
12    inpatient rehabilitation services shall be uniformly
13    increased so that the $96 per day add-on as adjusted by the
14    July 1, 2022 increase, is increased by an amount equal to
15    the funds allocated in paragraph (4) of subsection (b) of
16    Section 5A-12.6, less the amount allocated under
17    paragraphs (8) and (9) of this subsection and paragraphs
18    (3) and (4) of subsection (b) multiplied by 0.9%.
19    (b) Outpatient hospital services. Effective for dates of
20service on and after July 1, 2014, reimbursement for outpatient
21services shall utilize the Enhanced Ambulatory Procedure
22Grouping (E-APG) software, version 3.7 distributed by 3MTM
23Health Information System.
24        (1) The Department shall establish Medicaid weighting
25    factors to be used in the reimbursement system established
26    under this subsection. The initial weighting factors shall

 

 

10000SB1773ham008- 125 -LRB100 09919 KTG 36497 a

1    be the weighting factors as published by 3M Health
2    Information System, associated with Version 3.7.
3        (2) The Department shall establish service specific
4    statewide-standardized amounts to be used in the
5    reimbursement system.
6            (A) The initial statewide standardized amounts,
7        with the labor portion adjusted by the Calendar Year
8        2013 Medicare Outpatient Prospective Payment System
9        wage index with reclassifications, shall be published
10        by the Department on its website no later than 10
11        calendar days prior to their effective date.
12            (B) The Department shall establish adjustments to
13        the statewide-standardized amounts for each Critical
14        Access Hospital, as designated by the Department of
15        Public Health in accordance with 42 CFR 485, Subpart F.
16        The EAPG standardized amounts are determined
17        separately for each critical access hospital such that
18        simulated EAPG payments using outpatient base period
19        paid claim data plus payments under Section 5A-12.4 of
20        this Code net of the associated tax costs are equal to
21        the estimated costs of outpatient base period claims
22        data with a rate year cost inflation factor applied.
23        (3) In addition to the statewide-standardized amounts,
24    the Department shall develop adjusters to adjust the rate
25    of reimbursement for critical Medicaid hospital outpatient
26    providers or services, including outpatient high volume or

 

 

10000SB1773ham008- 126 -LRB100 09919 KTG 36497 a

1    safety-net hospitals. Beginning July 1, 2018, the
2    outpatient high volume adjustor shall be increased to
3    increase annual expenditures associated with this adjustor
4    by $79,200,000, based on the State Fiscal Year 2015 base
5    year data and this adjustor shall apply to public
6    hospitals, except for large public hospitals, as defined
7    under 89 Ill. Adm. Code 148.25(a).
8        (4) Beginning July 1, 2018, in addition to the
9    statewide standardized amounts, the Department shall make
10    an add-on payment for outpatient expensive devices and
11    drugs. This add-on payment shall at least apply to claim
12    lines that: (i) are assigned with one of the following
13    EAPGs: 490, 1001 to 1020, and coded with one of the
14    following revenue codes: 0274 to 0276, 0278; or (ii) are
15    assigned with one of the following EAPGs: 430 to 441, 443,
16    444, 460 to 465, 495, 496, 1090. The add-on payment shall
17    be calculated as follows: the claim line's covered charges
18    multiplied by the hospital's total acute cost to charge
19    ratio, less the claim line's EAPG payment plus $1,000,
20    multiplied by 0.8.
21        (5) Beginning July 1, 2018, the statewide-standardized
22    amounts for outpatient services shall be increased so that
23    base claims projected reimbursement is increased by an
24    amount equal to the funds allocated in paragraph (1) of
25    subsection (b) of Section 5A-12.6, less the amount
26    allocated under paragraphs (8) and (9) of subsection (a)

 

 

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1    and paragraphs (3) and (4) of this subsection multiplied by
2    46%. Beginning July 1, 2020, the statewide-standardized
3    amounts for outpatient services shall be increased so that
4    base claims projected reimbursement is increased by an
5    amount equal to the funds allocated in paragraph (2) of
6    subsection (b) of Section 5A-12.6, less the amount
7    allocated under paragraphs (8) and (9) of subsection (a)
8    and paragraphs (3) and (4) of this subsection multiplied by
9    46%. Beginning July 1, 2022, the statewide-standardized
10    amounts for outpatient services shall be increased so that
11    base claims projected reimbursement is increased by an
12    amount equal to the funds allocated in paragraph (3) of
13    subsection (b) of Section 5A-12.6, less the amount
14    allocated under paragraphs (8) and (9) of subsection (a)
15    and paragraphs (3) and (4) of this subsection multiplied by
16    46%. Beginning July 1, 2023, the statewide-standardized
17    amounts for outpatient services shall be increased so that
18    base claims projected reimbursement is increased by an
19    amount equal to the funds allocated in paragraph (4) of
20    subsection (b) of Section 5A-12.6, less the amount
21    allocated under paragraphs (8) and (9) of subsection (a)
22    and paragraphs (3) and (4) of this subsection multiplied by
23    46%.
24    (c) In consultation with the hospital community, the
25Department is authorized to replace 89 Ill. Admin. Code 152.150
26as published in 38 Ill. Reg. 4980 through 4986 within 12 months

 

 

10000SB1773ham008- 128 -LRB100 09919 KTG 36497 a

1of the effective date of this amendatory Act of the 98th
2General Assembly. If the Department does not replace these
3rules within 12 months of the effective date of this amendatory
4Act of the 98th General Assembly, the rules in effect for
5152.150 as published in 38 Ill. Reg. 4980 through 4986 shall
6remain in effect until modified by rule by the Department.
7Nothing in this subsection shall be construed to mandate that
8the Department file a replacement rule.
9    (d) Transition period. There shall be a transition period
10to the reimbursement systems authorized under this Section that
11shall begin on the effective date of these systems and continue
12until June 30, 2018, unless extended by rule by the Department.
13To help provide an orderly and predictable transition to the
14new reimbursement systems and to preserve and enhance access to
15the hospital services during this transition, the Department
16shall allocate a transitional hospital access pool of at least
17$290,000,000 annually so that transitional hospital access
18payments are made to hospitals.
19        (1) After the transition period, the Department may
20    begin incorporating the transitional hospital access pool
21    into the base rate structure; however, the transitional
22    hospital access payments in effect on June 30, 2018 shall
23    continue to be paid, if continued under Section 5A-16.
24        (2) After the transition period, if the Department
25    reduces payments from the transitional hospital access
26    pool, it shall increase base rates, develop new adjustors,

 

 

10000SB1773ham008- 129 -LRB100 09919 KTG 36497 a

1    adjust current adjustors, develop new hospital access
2    payments based on updated information, or any combination
3    thereof by an amount equal to the decreases proposed in the
4    transitional hospital access pool payments, ensuring that
5    the entire transitional hospital access pool amount shall
6    continue to be used for hospital payments.
7    (d-5) Hospital transformation program. The Department, in
8conjunction with the Hospital Transformation Review Committee
9created under subsection (d-5), shall develop a hospital
10transformation program to provide financial assistance to
11hospitals in transforming their services and care models to
12better align with the needs of the communities they serve. The
13payments authorized in this Section shall be subject to
14approval by the federal government.
15        (1) Phase 1. In State fiscal years 2019 through 2020,
16    the Department shall allocate funds from the transitional
17    access hospital pool to create a hospital transformation
18    pool of at least $262,906,870 annually and make hospital
19    transformation payments to hospitals. Subject to Section
20    5A-16, in State fiscal years 2019 and 2020, an Illinois
21    hospital that received either a transitional hospital
22    access payment under subsection (d) or a supplemental
23    payment under subsection (f) of this Section in State
24    fiscal year 2018, shall receive a hospital transformation
25    payment as follows:
26            (A) If the hospital's Rate Year 2017 Medicaid

 

 

10000SB1773ham008- 130 -LRB100 09919 KTG 36497 a

1        inpatient utilization rate is equal to or greater than
2        45%, the hospital transformation payment shall be
3        equal to 100% of the sum of its transitional hospital
4        access payment authorized under subsection (d) and any
5        supplemental payment authorized under subsection (f).
6            (B) If the hospital's Rate Year 2017 Medicaid
7        inpatient utilization rate is equal to or greater than
8        25% but less than 45%, the hospital transformation
9        payment shall be equal to 75% of the sum of its
10        transitional hospital access payment authorized under
11        subsection (d) and any supplemental payment authorized
12        under subsection (f).
13            (C) If the hospital's Rate Year 2017 Medicaid
14        inpatient utilization rate is less than 25%, the
15        hospital transformation payment shall be equal to 50%
16        of the sum of its transitional hospital access payment
17        authorized under subsection (d) and any supplemental
18        payment authorized under subsection (f).
19        (2) Phase 2. During State fiscal years 2021 and 2022,
20    the Department shall allocate funds from the transitional
21    access hospital pool to create a hospital transformation
22    pool annually and make hospital transformation payments to
23    hospitals participating in the transformation program. Any
24    hospital may seek transformation funding in Phase 2. Any
25    hospital that seeks transformation funding in Phase 2 to
26    update or repurpose the hospital's physical structure to

 

 

10000SB1773ham008- 131 -LRB100 09919 KTG 36497 a

1    transition to a new delivery model, must submit to the
2    Department in writing a transformation plan, based on the
3    Department's guidelines, that describes the desired
4    delivery model with projections of patient volumes by
5    service lines and projected revenues, expenses, and net
6    income that correspond to the new delivery model. In Phase
7    2, subject to the approval of rules, the Department may use
8    the hospital transformation pool to increase base rates,
9    develop new adjustors, adjust current adjustors, or
10    develop new access payments in order to support and
11    incentivize hospitals to pursue such transformation. In
12    developing such methodologies, the Department shall ensure
13    that the entire hospital transformation pool continues to
14    be expended to ensure access to hospital services or to
15    support organizations that had received hospital
16    transformation payments under this Section.
17            (A) Any hospital participating in the hospital
18        transformation program shall provide an opportunity
19        for public input by local community groups, hospital
20        workers, and healthcare professionals and assist in
21        facilitating discussions about any transformations or
22        changes to the hospital.
23            (B) As provided in paragraph (9) of Section 3 of
24        the Illinois Health Facilities Planning Act, any
25        hospital participating in the transformation program
26        may be excluded from the requirements of the Illinois

 

 

10000SB1773ham008- 132 -LRB100 09919 KTG 36497 a

1        Health Facilities Planning Act for those projects
2        related to the hospital's transformation. To be
3        eligible, the hospital must submit to the Health
4        Facilities and Services Review Board certification
5        from the Department, approved by the Hospital
6        Transformation Review Committee, that the project is a
7        part of the hospital's transformation.
8            (C) As provided in subsection (a-20) of Section
9        32.5 of the Emergency Medical Services (EMS) Systems
10        Act, a hospital that received hospital transformation
11        payments under this Section may convert to a
12        freestanding emergency center. To be eligible for such
13        a conversion, the hospital must submit to the
14        Department of Public Health certification from the
15        Department, approved by the Hospital Transformation
16        Review Committee, that the project is a part of the
17        hospital's transformation.
18        (3) Within 6 months after the effective date of this
19    amendatory Act of the 100th General Assembly, the
20    Department, in conjunction with the Hospital
21    Transformation Review Committee, shall develop and adopt,
22    by rule, the goals, objectives, policies, standards,
23    payment models, or criteria to be applied in Phase 2 of the
24    program to allocate the hospital transformation funds. The
25    goals, objectives, and policies to be considered may
26    include, but are not limited to, achieving unmet needs of a

 

 

10000SB1773ham008- 133 -LRB100 09919 KTG 36497 a

1    community that a hospital serves such as behavioral health
2    services, outpatient services, or drug rehabilitation
3    services; attaining certain quality or patient safety
4    benchmarks for health care services; or improving the
5    coordination, effectiveness, and efficiency of care
6    delivery. Notwithstanding any other provision of law, any
7    rule adopted in accordance with this subsection (d-5) may
8    be submitted to the Joint Committee on Administrative Rules
9    for approval only if the rule has first been approved by 9
10    of the 14 members of the Hospital Transformation Review
11    Committee.
12        (4) Hospital Transformation Review Committee. There is
13    created the Hospital Transformation Review Committee. The
14    Committee shall consist of 14 members. No later than 30
15    days after the effective date of this amendatory Act of the
16    100th General Assembly, the 4 legislative leaders shall
17    each appoint 3 members; the Governor shall appoint the
18    Director of Healthcare and Family Services, or his or her
19    designee, as a member; and the Director of Healthcare and
20    Family Services shall appoint one member. Any vacancy shall
21    be filled by the applicable appointing authority within 15
22    calendar days. The members of the Committee shall select a
23    Chair and a Vice-Chair from among its members, provided
24    that the Chair and Co-Chair cannot be appointed by the same
25    appointing authority and must be from different political
26    parties. The Chair shall have the authority to establish a

 

 

10000SB1773ham008- 134 -LRB100 09919 KTG 36497 a

1    meeting schedule and convene meetings of the Committee, and
2    the Vice-Chair shall have the authority to convene meetings
3    in the absence of the Chair. The Committee may establish
4    its own rules with respect to meeting schedule, notice of
5    meetings, and the disclosure of documents; however, the
6    Committee shall not have the power to subpoena individuals
7    or documents and any rules must be approved by 9 of the 14
8    members. The Committee shall perform the functions
9    described in this Section and advise and consult with the
10    Director in the administration of this Section. In addition
11    to reviewing and approving the policies, procedures, and
12    rules for the hospital transformation program, the
13    Committee shall consider and make recommendations related
14    to qualifying criteria and payment methodologies related
15    to safety-net hospitals and children's hospitals. Members
16    of the Committee appointed by the legislative leaders shall
17    be subject to the jurisdiction of the Legislative Ethics
18    Commission, not the Executive Ethics Commission, and all
19    requests under the Freedom of Information Act shall be
20    directed to the applicable Freedom of Information officer
21    for the General Assembly. The Department shall provide
22    operational support to the Committee as necessary.
23    (e) Beginning 36 months after initial implementation, the
24Department shall update the reimbursement components in
25subsections (a) and (b), including standardized amounts and
26weighting factors, and at least triennially and no more

 

 

10000SB1773ham008- 135 -LRB100 09919 KTG 36497 a

1frequently than annually thereafter. The Department shall
2publish these updates on its website no later than 30 calendar
3days prior to their effective date.
4    (f) Continuation of supplemental payments. Any
5supplemental payments authorized under Illinois Administrative
6Code 148 effective January 1, 2014 and that continue during the
7period of July 1, 2014 through December 31, 2014 shall remain
8in effect as long as the assessment imposed by Section 5A-2
9that is in effect on December 31, 2017 remains is in effect.
10    (g) Notwithstanding subsections (a) through (f) of this
11Section and notwithstanding the changes authorized under
12Section 5-5b.1, any updates to the system shall not result in
13any diminishment of the overall effective rates of
14reimbursement as of the implementation date of the new system
15(July 1, 2014). These updates shall not preclude variations in
16any individual component of the system or hospital rate
17variations. Nothing in this Section shall prohibit the
18Department from increasing the rates of reimbursement or
19developing payments to ensure access to hospital services.
20Nothing in this Section shall be construed to guarantee a
21minimum amount of spending in the aggregate or per hospital as
22spending may be impacted by factors including but not limited
23to the number of individuals in the medical assistance program
24and the severity of illness of the individuals.
25    (h) The Department shall have the authority to modify by
26rulemaking any changes to the rates or methodologies in this

 

 

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1Section as required by the federal government to obtain federal
2financial participation for expenditures made under this
3Section.
4    (i) Except for subsections (g) and (h) of this Section, the
5Department shall, pursuant to subsection (c) of Section 5-40 of
6the Illinois Administrative Procedure Act, provide for
7presentation at the June 2014 hearing of the Joint Committee on
8Administrative Rules (JCAR) additional written notice to JCAR
9of the following rules in order to commence the second notice
10period for the following rules: rules published in the Illinois
11Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
12(Medical Payment), 4628 (Specialized Health Care Delivery
13Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
14Grouping (DRG) Prospective Payment System (PPS)), and 4977
15(Hospital Reimbursement Changes), and published in the
16Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
17(Specialized Health Care Delivery Systems) and 6505 (Hospital
18Services).
19    (j) Out-of-state hospitals. Beginning July 1, 2018, for
20purposes of determining for State fiscal years 2019 and 2020
21the hospitals eligible for the payments authorized under
22subsections (a) and (b) of this Section, the Department shall
23include out-of-state hospitals that are designated a Level I
24pediatric trauma center or a Level I trauma center by the
25Department of Public Health as of December 1, 2017.
26    (k) The Department shall notify each hospital and managed

 

 

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1care organization, in writing, of the impact of the updates
2under this Section at least 30 calendar days prior to their
3effective date.
4(Source: P.A. 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)
 
5    Section 95. No acceleration or delay. Where this Act makes
6changes in a statute that is represented in this Act by text
7that is not yet or no longer in effect (for example, a Section
8represented by multiple versions), the use of that text does
9not accelerate or delay the taking effect of (i) the changes
10made by this Act or (ii) provisions derived from any other
11Public Act.
 
12    Section 99. Effective date. This Act takes effect upon
13becoming law, but this Act does not take effect at all unless
14Senate Bill 1573 of the 100th General Assembly, as amended,
15becomes law.".