97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5746

 

Introduced 2/16/2012, by Rep. Camille Y Lilly

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amend the Hospital Provider Funding Article of the Illinois Public Aid Code. Imposes specific assessments on outpatient services for State fiscal years 2012 through 2014. Provides that no installment payment of an assessment shall be due and payable until after: (i) the Department of Healthcare and Family Services notifies the hospital provider, in writing, that certain payment methodologies to hospitals required under the Article have been approved by the Centers for Medicare and Medicaid Services and a specified federal waiver has been granted by the Centers for Medicare and Medicaid Services; and (ii) the Comptroller has issued the payments required under the Article. Requires certain money transfers from the Hospital Provider Fund for State fiscal years 2012, 2013, and 2014. Provides that the new assessments shall not take effect or shall cease to be imposed if certain criteria are met. Contains provisions concerning hospital access improvement payments on or after January 1, 2012; magnet and perinatal hospital adjustments; trauma level II adjustments; dual eligible adjustments; medicaid volume adjustments; outpatient service adjustments; care coordination adjustments; specialty hospital adjustments; and physician supplemental adjustments. Defines terms. Makes other changes. Effective immediately.


LRB097 18814 KTG 65663 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5746LRB097 18814 KTG 65663 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5A-1, 5A-2, 5A-4, 5A-5, 5A-8, 5A-10, 5A-13,
6and 5A-14 and by adding Section 5A-12.4 as follows:
 
7    (305 ILCS 5/5A-1)  (from Ch. 23, par. 5A-1)
8    Sec. 5A-1. Definitions. As used in this Article, unless
9the context requires otherwise:
10    "Adjusted gross hospital revenue" shall be determined
11separately for inpatient and outpatient services for each
12hospital conducted, operated or maintained by a hospital
13provider, and means the hospital provider's total gross
14revenues less: (i) gross revenue attributable to non-hospital
15based services including home dialysis services, durable
16medical equipment, ambulance services, outpatient clinics and
17any other non-hospital based services as determined by the
18Illinois Department by rule; and (ii) gross revenues
19attributable to the routine services provided to persons
20receiving skilled or intermediate long-term care services
21within the meaning of Title XVIII or XIX of the Social Security
22Act; and (iii) Medicare gross revenue (excluding the Medicare
23gross revenue attributable to clauses (i) and (ii) of this

 

 

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1paragraph and the Medicare gross revenue attributable to the
2routine services provided to patients in a psychiatric
3hospital, a rehabilitation hospital, a distinct part
4psychiatric unit, a distinct part rehabilitation unit, or swing
5beds). Adjusted gross hospital revenue shall be determined
6using the most recent data available from each hospital's 2003
7Medicare cost report as contained in the Healthcare Cost Report
8Information System file, for the quarter ending on December 31,
92004, without regard to any subsequent adjustments or changes
10to such data. If a hospital's 2003 Medicare cost report is not
11contained in the Healthcare Cost Report Information System, the
12hospital provider shall furnish such cost report or the data
13necessary to determine its adjusted gross hospital revenue as
14required by rule by the Illinois Department.
15    "Fund" means the Hospital Provider Fund.
16    "Hospital" means an institution, place, building, or
17agency located in this State that is subject to licensure by
18the Illinois Department of Public Health under the Hospital
19Licensing Act, whether public or private and whether organized
20for profit or not-for-profit.
21    "Hospital provider" means a person licensed by the
22Department of Public Health to conduct, operate, or maintain a
23hospital, regardless of whether the person is a Medicaid
24provider. For purposes of this paragraph, "person" means any
25political subdivision of the State, municipal corporation,
26individual, firm, partnership, corporation, company, limited

 

 

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1liability company, association, joint stock association, or
2trust, or a receiver, executor, trustee, guardian, or other
3representative appointed by order of any court.
4    "Medicare bed days" means, for each hospital, the sum of
5the number of days that each bed was occupied by a patient who
6was covered by Title XVIII of the Social Security Act,
7excluding days attributable to the routine services provided to
8persons receiving skilled or intermediate long term care
9services. Medicare bed days shall be computed separately for
10each hospital operated or maintained by a hospital provider.
11    "Occupied bed days" means the sum of the number of days
12that each bed was occupied by a patient for all beds, excluding
13days attributable to the routine services provided to persons
14receiving skilled or intermediate long term care services.
15Occupied bed days shall be computed separately for each
16hospital operated or maintained by a hospital provider.
17    "Outpatient gross revenue" means, for each hospital, its
18total gross charges attributed to outpatient services as
19reported on the Medicare cost report at Worksheet C, Part I,
20Column 7, line 101, less the sum of lines 45, 60, 63, 64, 65,
2166, 67, and 68 (and any subsets of those lines).
22    "Proration factor" means a fraction, the numerator of which
23is 53 and the denominator of which is 365.
24(Source: P.A. 94-242, eff. 7-18-05; 95-859, eff. 8-19-08.)
 
25    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)

 

 

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1    (Section scheduled to be repealed on July 1, 2014)
2    Sec. 5A-2. Assessment.
3    (a) Subject to Sections 5A-3 and 5A-10, an annual
4assessment on inpatient services is imposed on each hospital
5provider in an amount equal to the hospital's occupied bed days
6multiplied by $84.19 multiplied by the proration factor for
7State fiscal year 2004 and the hospital's occupied bed days
8multiplied by $84.19 for State fiscal year 2005.
9    For State fiscal years 2004 and 2005, the Department of
10Healthcare and Family Services shall use the number of occupied
11bed days as reported by each hospital on the Annual Survey of
12Hospitals conducted by the Department of Public Health to
13calculate the hospital's annual assessment. If the sum of a
14hospital's occupied bed days is not reported on the Annual
15Survey of Hospitals or if there are data errors in the reported
16sum of a hospital's occupied bed days as determined by the
17Department of Healthcare and Family Services (formerly
18Department of Public Aid), then the Department of Healthcare
19and Family Services may obtain the sum of occupied bed days
20from any source available, including, but not limited to,
21records maintained by the hospital provider, which may be
22inspected at all times during business hours of the day by the
23Department of Healthcare and Family Services or its duly
24authorized agents and employees.
25    Subject to Sections 5A-3 and 5A-10, for the privilege of
26engaging in the occupation of hospital provider, beginning

 

 

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1August 1, 2005, an annual assessment is imposed on each
2hospital provider for State fiscal years 2006, 2007, and 2008,
3in an amount equal to 2.5835% of the hospital provider's
4adjusted gross hospital revenue for inpatient services and
52.5835% of the hospital provider's adjusted gross hospital
6revenue for outpatient services. If the hospital provider's
7adjusted gross hospital revenue is not available, then the
8Illinois Department may obtain the hospital provider's
9adjusted gross hospital revenue from any source available,
10including, but not limited to, records maintained by the
11hospital provider, which may be inspected at all times during
12business hours of the day by the Illinois Department or its
13duly authorized agents and employees.
14    Subject to Sections 5A-3 and 5A-10, for State fiscal years
152009 through 2014, an annual assessment on inpatient services
16is imposed on each hospital provider in an amount equal to
17$218.38 multiplied by the difference of the hospital's occupied
18bed days less the hospital's Medicare bed days.
19    For State fiscal years 2009 through 2014, a hospital's
20occupied bed days and Medicare bed days shall be determined
21using the most recent data available from each hospital's 2005
22Medicare cost report as contained in the Healthcare Cost Report
23Information System file, for the quarter ending on December 31,
242006, without regard to any subsequent adjustments or changes
25to such data. If a hospital's 2005 Medicare cost report is not
26contained in the Healthcare Cost Report Information System,

 

 

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1then the Illinois Department may obtain the hospital provider's
2occupied bed days and Medicare bed days from any source
3available, including, but not limited to, records maintained by
4the hospital provider, which may be inspected at all times
5during business hours of the day by the Illinois Department or
6its duly authorized agents and employees.
7    (b) (Blank).
8    (b-5) Subject to Sections 5A-3 and 5A-10, for State fiscal
9years 2012 through 2014, an annual assessment on outpatient
10services is imposed on each hospital provider in an amount
11equal to .007236 multiplied by the hospital's outpatient gross
12revenue. For State fiscal year 2012, the amount of the
13assessment shall be prorated based on the portion of the fiscal
14year for which it and the payments authorized under Section
155A-12.4 are in effect.
16    For State fiscal years 2012 through 2014, a hospital's
17outpatient gross revenue shall be determined using the most
18recent data available from each hospital's 2009 Medicare cost
19report as contained in the Healthcare Cost Report Information
20System file, for the quarter ending on June 30, 2011, without
21regard to any subsequent adjustments or changes to such data.
22If a hospital's 2009 Medicare cost report is not contained in
23the Healthcare Cost Report Information System, then the
24Department may obtain the hospital provider's outpatient gross
25revenue from any source available, including, but not limited
26to, records maintained by the hospital provider, which may be

 

 

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1inspected at all times during business hours of the day by the
2Department or its duly authorized agents and employees.
3    (c) (Blank).
4    (d) Notwithstanding any of the other provisions of this
5Section, the Department is authorized, during this 94th General
6Assembly, to adopt rules to reduce the rate of any annual
7assessment imposed under this Section, as authorized by Section
85-46.2 of the Illinois Administrative Procedure Act.
9    (e) Notwithstanding any other provision of this Section,
10any plan providing for an assessment on a hospital provider as
11a permissible tax under Title XIX of the federal Social
12Security Act and Medicaid-eligible payments to hospital
13providers from the revenues derived from that assessment shall
14be reviewed by the Illinois Department of Healthcare and Family
15Services, as the Single State Medicaid Agency required by
16federal law, to determine whether those assessments and
17hospital provider payments meet federal Medicaid standards. If
18the Department determines that the elements of the plan may
19meet federal Medicaid standards and a related State Medicaid
20Plan Amendment is prepared in a manner and form suitable for
21submission, that State Plan Amendment shall be submitted in a
22timely manner for review by the Centers for Medicare and
23Medicaid Services of the United States Department of Health and
24Human Services and subject to approval by the Centers for
25Medicare and Medicaid Services of the United States Department
26of Health and Human Services. No such plan shall become

 

 

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1effective without approval by the Illinois General Assembly by
2the enactment into law of related legislation. Notwithstanding
3any other provision of this Section, the Department is
4authorized to adopt rules to reduce the rate of any annual
5assessment imposed under this Section. Any such rules may be
6adopted by the Department under Section 5-50 of the Illinois
7Administrative Procedure Act.
8(Source: P.A. 95-859, eff. 8-19-08; 96-1530, eff. 2-16-11.)
 
9    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
10    Sec. 5A-4. Payment of assessment; penalty.
11    (a) The annual assessment imposed by Section 5A-2 for State
12fiscal year 2004 shall be due and payable on June 18 of the
13year. The assessment imposed by Section 5A-2 for State fiscal
14year 2005 shall be due and payable in quarterly installments,
15each equalling one-fourth of the assessment for the year, on
16July 19, October 19, January 18, and April 19 of the year. The
17assessment imposed by Section 5A-2 for State fiscal years 2006
18through 2008 shall be due and payable in quarterly
19installments, each equaling one-fourth of the assessment for
20the year, on the fourteenth State business day of September,
21December, March, and May. Except as provided in subsection
22(a-5) of this Section, the assessment imposed by Section 5A-2
23for State fiscal year 2009 and each subsequent State fiscal
24year shall be due and payable in monthly installments, each
25equaling one-twelfth of the assessment for the year, on the

 

 

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1fourteenth State business day of each month. No installment
2payment of an assessment imposed by Section 5A-2 shall be due
3and payable, however, until after: (i) the Department notifies
4the hospital provider, in writing, that the payment
5methodologies to hospitals required under Section 5A-12,
6Section 5A-12.1, or Section 5A-12.2, whichever is applicable
7for that fiscal year, have been approved by the Centers for
8Medicare and Medicaid Services of the U.S. Department of Health
9and Human Services and the waiver under 42 CFR 433.68 for the
10assessment imposed by Section 5A-2, if necessary, has been
11granted by the Centers for Medicare and Medicaid Services of
12the U.S. Department of Health and Human Services; and (ii) the
13Comptroller has issued the payments required under Section
145A-12, Section 5A-12.1, or Section 5A-12.2, whichever is
15applicable for that fiscal year. Upon notification to the
16Department of approval of the payment methodologies required
17under Section 5A-12, Section 5A-12.1, or Section 5A-12.2,
18whichever is applicable for that fiscal year, and the waiver
19granted under 42 CFR 433.68, all installments otherwise due
20under Section 5A-2 prior to the date of notification shall be
21due and payable to the Department upon written direction from
22the Department and issuance by the Comptroller of the payments
23required under Section 5A-12.1 or Section 5A-12.2, whichever is
24applicable for that fiscal year.
25    Except as provided in subsection (a-5) of this Section, the
26assessment imposed by subsection (b-5) of Section 5A-2 for

 

 

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1State fiscal year 2012 and each subsequent State fiscal year
2shall be due and payable in monthly installments, each equaling
3one-twelfth of the assessment for the year, on the 14th State
4business day of each month. No installment payment of an
5assessment imposed by subsection (b-5) of Section 5A-2 shall be
6due and payable, however, until after: (i) the Department
7notifies the hospital provider, in writing, that the payment
8methodologies to hospitals required under Section 5A-12.4,
9have been approved by the Centers for Medicare and Medicaid
10Services of the U.S. Department of Health and Human Services,
11and the waiver under 42 CFR 433.68 for the assessment imposed
12by subsection (b-5) of Section 5A-2, if necessary, has been
13granted by the Centers for Medicare and Medicaid Services of
14the U.S. Department of Health and Human Services; and (ii) the
15Comptroller has issued the payments required under Section
165A-12.4. Upon notification to the Department of approval of the
17payment methodologies required under Section 5A-12.4 and the
18waiver granted under 42 CFR 433.68, if necessary, all
19installments otherwise due under subsection (b-5) of Section
205A-2 prior to the date of notification shall be due and payable
21to the Department upon written direction from the Department
22and issuance by the Comptroller of the payments required under
23Section 5A-12.4.
24    (a-5) The Illinois Department may, for the purpose of
25maximizing federal revenue, accelerate the schedule upon which
26assessment installments are due and payable by hospitals with a

 

 

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1payment ratio greater than or equal to one. Such acceleration
2of due dates for payment of the assessment may be made only in
3conjunction with a corresponding acceleration in access
4payments identified in Section 5A-12.2 or Section 5A-12.4 to
5the same hospitals. For the purposes of this subsection (a-5),
6a hospital's payment ratio is defined as the quotient obtained
7by dividing the total payments for the State fiscal year, as
8authorized under Section 5A-12.2 or Section 5A-12.4, by the
9total assessment for the State fiscal year imposed under
10Section 5A-2 or subsection (b-5) of Section 5A-2.
11    (b) The Illinois Department is authorized to establish
12delayed payment schedules for hospital providers that are
13unable to make installment payments when due under this Section
14due to financial difficulties, as determined by the Illinois
15Department.
16    (c) If a hospital provider fails to pay the full amount of
17an installment when due (including any extensions granted under
18subsection (b)), there shall, unless waived by the Illinois
19Department for reasonable cause, be added to the assessment
20imposed by Section 5A-2 a penalty assessment equal to the
21lesser of (i) 5% of the amount of the installment not paid on
22or before the due date plus 5% of the portion thereof remaining
23unpaid on the last day of each 30-day period thereafter or (ii)
24100% of the installment amount not paid on or before the due
25date. For purposes of this subsection, payments will be
26credited first to unpaid installment amounts (rather than to

 

 

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1penalty or interest), beginning with the most delinquent
2installments.
3    (d) Any assessment amount that is due and payable to the
4Illinois Department more frequently than once per calendar
5quarter shall be remitted to the Illinois Department by the
6hospital provider by means of electronic funds transfer. The
7Illinois Department may provide for remittance by other means
8if (i) the amount due is less than $10,000 or (ii) electronic
9funds transfer is unavailable for this purpose.
10(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08;
1196-821, eff. 11-20-09.)
 
12    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
13    Sec. 5A-5. Notice; penalty; maintenance of records.
14    (a) The Department of Healthcare and Family Services shall
15send a notice of assessment to every hospital provider subject
16to assessment under this Article. The notice of assessment
17shall notify the hospital of its assessment and shall be sent
18after receipt by the Department of notification from the
19Centers for Medicare and Medicaid Services of the U.S.
20Department of Health and Human Services that the payment
21methodologies required under Section 5A-12, Section 5A-12.1,
22or Section 5A-12.2, or Section 5A-12.4, whichever is applicable
23for that fiscal year, and, if necessary, the waiver granted
24under 42 CFR 433.68 have been approved. The notice shall be on
25a form prepared by the Illinois Department and shall state the

 

 

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1following:
2        (1) The name of the hospital provider.
3        (2) The address of the hospital provider's principal
4    place of business from which the provider engages in the
5    occupation of hospital provider in this State, and the name
6    and address of each hospital operated, conducted, or
7    maintained by the provider in this State.
8        (3) The occupied bed days, occupied bed days less
9    Medicare days, or adjusted gross hospital revenue, or
10    outpatient gross revenue of the hospital provider
11    (whichever is applicable), the amount of assessment
12    imposed under Section 5A-2 for the State fiscal year for
13    which the notice is sent, and the amount of each
14    installment to be paid during the State fiscal year.
15        (4) (Blank).
16        (5) Other reasonable information as determined by the
17    Illinois Department.
18    (b) If a hospital provider conducts, operates, or maintains
19more than one hospital licensed by the Illinois Department of
20Public Health, the provider shall pay the assessment for each
21hospital separately.
22    (c) Notwithstanding any other provision in this Article, in
23the case of a person who ceases to conduct, operate, or
24maintain a hospital in respect of which the person is subject
25to assessment under this Article as a hospital provider, the
26assessment for the State fiscal year in which the cessation

 

 

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1occurs shall be adjusted by multiplying the assessment computed
2under Section 5A-2 by a fraction, the numerator of which is the
3number of days in the year during which the provider conducts,
4operates, or maintains the hospital and the denominator of
5which is 365. Immediately upon ceasing to conduct, operate, or
6maintain a hospital, the person shall pay the assessment for
7the year as so adjusted (to the extent not previously paid).
8    (d) Notwithstanding any other provision in this Article, a
9provider who commences conducting, operating, or maintaining a
10hospital, upon notice by the Illinois Department, shall pay the
11assessment computed under Section 5A-2 and subsection (e) in
12installments on the due dates stated in the notice and on the
13regular installment due dates for the State fiscal year
14occurring after the due dates of the initial notice.
15    (e) Notwithstanding any other provision in this Article,
16for State fiscal years 2004 and 2005, in the case of a hospital
17provider that did not conduct, operate, or maintain a hospital
18throughout calendar year 2001, the assessment for that State
19fiscal year shall be computed on the basis of hypothetical
20occupied bed days for the full calendar year as determined by
21the Illinois Department. Notwithstanding any other provision
22in this Article, for State fiscal years 2006 through 2008, in
23the case of a hospital provider that did not conduct, operate,
24or maintain a hospital in 2003, the assessment for that State
25fiscal year shall be computed on the basis of hypothetical
26adjusted gross hospital revenue for the hospital's first full

 

 

HB5746- 15 -LRB097 18814 KTG 65663 b

1fiscal year as determined by the Illinois Department (which may
2be based on annualization of the provider's actual revenues for
3a portion of the year, or revenues of a comparable hospital for
4the year, including revenues realized by a prior provider of
5the same hospital during the year). Notwithstanding any other
6provision in this Article, for State fiscal years 2009 through
72014, in the case of a hospital provider that did not conduct,
8operate, or maintain a hospital in 2005, the assessment for
9that State fiscal year shall be computed on the basis of
10hypothetical occupied bed days for the full calendar year as
11determined by the Illinois Department. Notwithstanding any
12other provision in this Article, for State fiscal years 2012
13through 2014, in the case of a hospital provider that did not
14conduct, operate, or maintain a hospital in 2009, the
15assessment under subsection (b-5) of Section 5A-2 for that
16State fiscal year shall be computed on the basis of
17hypothetical gross outpatient revenue for the full calendar
18year as determined by the Illinois Department.
19    (f) Every hospital provider subject to assessment under
20this Article shall keep sufficient records to permit the
21determination of adjusted gross hospital revenue for the
22hospital's fiscal year. All such records shall be kept in the
23English language and shall, at all times during regular
24business hours of the day, be subject to inspection by the
25Illinois Department or its duly authorized agents and
26employees.

 

 

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1    (g) The Illinois Department may, by rule, provide a
2hospital provider a reasonable opportunity to request a
3clarification or correction of any clerical or computational
4errors contained in the calculation of its assessment, but such
5corrections shall not extend to updating the cost report
6information used to calculate the assessment.
7    (h) (Blank).
8(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08;
996-1530, eff. 2-16-11.)
 
10    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
11    Sec. 5A-8. Hospital Provider Fund.
12    (a) There is created in the State Treasury the Hospital
13Provider Fund. Interest earned by the Fund shall be credited to
14the Fund. The Fund shall not be used to replace any moneys
15appropriated to the Medicaid program by the General Assembly.
16    (b) The Fund is created for the purpose of receiving moneys
17in accordance with Section 5A-6 and disbursing moneys only for
18the following purposes, notwithstanding any other provision of
19law:
20        (1) For making payments to hospitals as required under
21    Articles V, V-A, VI, and XIV of this Code, under the
22    Children's Health Insurance Program Act, under the
23    Covering ALL KIDS Health Insurance Act, and under the
24    Senior Citizens and Disabled Persons Property Tax Relief
25    and Pharmaceutical Assistance Act.

 

 

HB5746- 17 -LRB097 18814 KTG 65663 b

1        (2) For the reimbursement of moneys collected by the
2    Illinois Department from hospitals or hospital providers
3    through error or mistake in performing the activities
4    authorized under this Article and Article V of this Code.
5        (3) For payment of administrative expenses incurred by
6    the Illinois Department or its agent in performing the
7    activities authorized by this Article.
8        (4) For payments of any amounts which are reimbursable
9    to the federal government for payments from this Fund which
10    are required to be paid by State warrant.
11        (5) For making transfers, as those transfers are
12    authorized in the proceedings authorizing debt under the
13    Short Term Borrowing Act, but transfers made under this
14    paragraph (5) shall not exceed the principal amount of debt
15    issued in anticipation of the receipt by the State of
16    moneys to be deposited into the Fund.
17        (6) For making transfers to any other fund in the State
18    treasury, but transfers made under this paragraph (6) shall
19    not exceed the amount transferred previously from that
20    other fund into the Hospital Provider Fund.
21        (6.5) For making transfers to the Healthcare Provider
22    Relief Fund, except that transfers made under this
23    paragraph (6.5) shall not exceed $60,000,000 in the
24    aggregate.
25        (7) For State fiscal years 2004 and 2005 for making
26    transfers to the Health and Human Services Medicaid Trust

 

 

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1    Fund, including 20% of the moneys received from hospital
2    providers under Section 5A-4 and transferred into the
3    Hospital Provider Fund under Section 5A-6. For State fiscal
4    year 2006 for making transfers to the Health and Human
5    Services Medicaid Trust Fund of up to $130,000,000 per year
6    of the moneys received from hospital providers under
7    Section 5A-4 and transferred into the Hospital Provider
8    Fund under Section 5A-6. Transfers under this paragraph
9    shall be made within 7 days after the payments have been
10    received pursuant to the schedule of payments provided in
11    subsection (a) of Section 5A-4.
12        (7.5) For State fiscal year 2007 for making transfers
13    of the moneys received from hospital providers under
14    Section 5A-4 and transferred into the Hospital Provider
15    Fund under Section 5A-6 to the designated funds not
16    exceeding the following amounts in that State fiscal year:
17        Health and Human Services
18            Medicaid Trust Fund................. $20,000,000
19        Long-Term Care Provider Fund............ $30,000,000
20        General Revenue Fund................... $80,000,000.
21        Transfers under this paragraph shall be made within 7
22    days after the payments have been received pursuant to the
23    schedule of payments provided in subsection (a) of Section
24    5A-4.
25        (7.8) For State fiscal year 2008, for making transfers
26    of the moneys received from hospital providers under

 

 

HB5746- 19 -LRB097 18814 KTG 65663 b

1    Section 5A-4 and transferred into the Hospital Provider
2    Fund under Section 5A-6 to the designated funds not
3    exceeding the following amounts in that State fiscal year:
4        Health and Human Services
5            Medicaid Trust Fund..................$40,000,000
6        Long-Term Care Provider Fund..............$60,000,000
7        General Revenue Fund...................$160,000,000.
8        Transfers under this paragraph shall be made within 7
9    days after the payments have been received pursuant to the
10    schedule of payments provided in subsection (a) of Section
11    5A-4.
12        (7.9) For State fiscal years 2009 through 2014, for
13    making transfers of the moneys received from hospital
14    providers under Section 5A-4 and transferred into the
15    Hospital Provider Fund under Section 5A-6 to the designated
16    funds not exceeding the following amounts in that State
17    fiscal year:
18        Health and Human Services
19            Medicaid Trust Fund...................$20,000,000
20        Long Term Care Provider Fund..............$30,000,000
21        General Revenue Fund.....................$80,000,000.
22        Except as provided under this paragraph, transfers
23    under this paragraph shall be made within 7 business days
24    after the payments have been received pursuant to the
25    schedule of payments provided in subsection (a) of Section
26    5A-4. For State fiscal year 2009, transfers to the General

 

 

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1    Revenue Fund under this paragraph shall be made on or
2    before June 30, 2009, as sufficient funds become available
3    in the Hospital Provider Fund to both make the transfers
4    and continue hospital payments.
5        (7.10) For State fiscal year 2012, for making transfers
6    of the moneys resulting from the assessment under
7    subsection (b-5) of Section 5A-2 and received from hospital
8    providers under Section 5A-4 and transferred into the
9    Hospital Provider Fund under Section 5A-6 to the designated
10    funds not exceeding the following amounts in that State
11    fiscal year:
12            Health Care Provider Relief Fund......$10,000,000
13        Transfers under this paragraph shall be made within 7
14    days after the payments have been received pursuant to the
15    schedule of payments provided in subsection (a) of Section
16    5A-4.
17        (7.11) For State fiscal years 2013 and 2014, for making
18    transfers of the moneys resulting from the assessment under
19    subsection (b-5) of Section 5A-2 and received from hospital
20    providers under Section 5A-4 and transferred into the
21    Hospital Provider Fund under Section 5A-6 to the designated
22    funds not exceeding the following amounts in that State
23    fiscal year:
24            Health Care Provider Relief Fund......$20,000,000
25        Transfers under this paragraph shall be made within 7
26    days after the payments have been received pursuant to the

 

 

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1    schedule of payments provided in subsection (a) of Section
2    5A-4.
3        (8) For making refunds to hospital providers pursuant
4    to Section 5A-10.
5    Disbursements from the Fund, other than transfers
6authorized under paragraphs (5) and (6) of this subsection,
7shall be by warrants drawn by the State Comptroller upon
8receipt of vouchers duly executed and certified by the Illinois
9Department.
10    (c) The Fund shall consist of the following:
11        (1) All moneys collected or received by the Illinois
12    Department from the hospital provider assessment imposed
13    by this Article.
14        (2) All federal matching funds received by the Illinois
15    Department as a result of expenditures made by the Illinois
16    Department that are attributable to moneys deposited in the
17    Fund.
18        (3) Any interest or penalty levied in conjunction with
19    the administration of this Article.
20        (4) Moneys transferred from another fund in the State
21    treasury.
22        (5) All other moneys received for the Fund from any
23    other source, including interest earned thereon.
24    (d) (Blank).
25(Source: P.A. 95-707, eff. 1-11-08; 95-859, eff. 8-19-08; 96-3,
26eff. 2-27-09; 96-45, eff. 7-15-09; 96-821, eff. 11-20-09;

 

 

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196-1530, eff. 2-16-11.)
 
2    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
3    Sec. 5A-10. Applicability.
4    (a) The assessment imposed by subsection (a) of Section
55A-2 shall not take effect or shall cease to be imposed, and
6any moneys remaining in the Fund shall be refunded to hospital
7providers in proportion to the amounts paid by them, if:
8        (1) The sum of the appropriations for State fiscal
9    years 2004 and 2005 from the General Revenue Fund for
10    hospital payments under the medical assistance program is
11    less than $4,500,000,000 or the appropriation for each of
12    State fiscal years 2006, 2007 and 2008 from the General
13    Revenue Fund for hospital payments under the medical
14    assistance program is less than $2,500,000,000 increased
15    annually to reflect any increase in the number of
16    recipients, or the annual appropriation for State fiscal
17    years 2009, 2010, 2011, 2013, and 2014, from the General
18    Revenue Fund combined with the Hospital Provider Fund as
19    authorized in Section 5A-8 for hospital payments under the
20    medical assistance program, is less than the amount
21    appropriated for State fiscal year 2009, adjusted annually
22    to reflect any change in the number of recipients,
23    excluding State fiscal year 2009 supplemental
24    appropriations made necessary by the enactment of the
25    American Recovery and Reinvestment Act of 2009; or

 

 

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1        (2) For State fiscal years prior to State fiscal year
2    2009, the Department of Healthcare and Family Services
3    (formerly Department of Public Aid) makes changes in its
4    rules that reduce the hospital inpatient or outpatient
5    payment rates, including adjustment payment rates, in
6    effect on October 1, 2004, except for hospitals described
7    in subsection (b) of Section 5A-3 and except for changes in
8    the methodology for calculating outlier payments to
9    hospitals for exceptionally costly stays, so long as those
10    changes do not reduce aggregate expenditures below the
11    amount expended in State fiscal year 2005 for such
12    services; or
13        (2.1) For State fiscal years 2009 through 2014, the
14    Department of Healthcare and Family Services adopts any
15    administrative rule change to reduce payment rates or
16    alters any payment methodology that reduces any payment
17    rates made to operating hospitals under the approved Title
18    XIX or Title XXI State plan in effect January 1, 2008
19    except for:
20            (A) any changes for hospitals described in
21        subsection (b) of Section 5A-3; or
22            (B) any rates for payments made under this Article
23        V-A; or
24            (C) any changes proposed in State plan amendment
25        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
26        08-07; or

 

 

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1            (D) in relation to any admissions on or after
2        January 1, 2011, a modification in the methodology for
3        calculating outlier payments to hospitals for
4        exceptionally costly stays, for hospitals reimbursed
5        under the diagnosis-related grouping methodology;
6        provided that the Department shall be limited to one
7        such modification during the 36-month period after the
8        effective date of this amendatory Act of the 96th
9        General Assembly; or
10        (3) The payments to hospitals required under Section
11    5A-12 or Section 5A-12.2 are changed or are not eligible
12    for federal matching funds under Title XIX or XXI of the
13    Social Security Act.
14    (b) The assessment imposed by Section 5A-2 shall not take
15effect or shall cease to be imposed if the assessment is
16determined to be an impermissible tax under Title XIX of the
17Social Security Act. Moneys in the Hospital Provider Fund
18derived from assessments imposed prior thereto shall be
19disbursed in accordance with Section 5A-8 to the extent federal
20financial participation is not reduced due to the
21impermissibility of the assessments, and any remaining moneys
22shall be refunded to hospital providers in proportion to the
23amounts paid by them.
24    (c) The assessments imposed by subsection (b-5) of Section
255A-2 shall not take effect or shall cease to be imposed, and
26any moneys remaining in the Fund shall be refunded to hospital

 

 

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1providers in proportion to the amounts paid by them, if the
2payments to hospitals required under Section 5A-12.4 are
3changed, unless the change is pursuant to subsection (p) of
4Section 5A-12.4 or are not eligible for federal matching funds
5under Title XIX of the Social Security Act.
6    (d) The assessments imposed by Section 5A-2 shall not take
7effect or shall cease to be imposed, and any moneys remaining
8in the Fund shall be refunded to hospital providers in
9proportion to the amounts paid by them, if:
10        (1) for State fiscal years 2012 through 2014, the
11    Department reduces any payment rates to hospitals as in
12    effect on November 1, 2011, or alters any payment
13    methodology as in effect on November 1, 2011, that has the
14    effect of reducing payment rates to hospitals; or
15        (2) for State fiscal years 2012 through 2014, the
16    Department reduces any supplemental payments made to
17    hospitals below the amounts paid for services provided in
18    State fiscal year 2011 as implemented by administrative
19    rules adopted and in effect on or prior to June 30, 2011.
20    (e) If the payments under Section 5A-12.4 are reduced
21pursuant to subsection (p) of Section 5A-12.4, then the
22assessment rate imposed under subsection (b-5) of Section 5A-2
23shall be reduced such that the aggregate assessment is reduced
24by 50% of the amount of any reduction in payments pursuant to
25subsection (p) of Section 5A-12.4.
26(Source: P.A. 96-8, eff. 4-28-09; 96-1530, eff. 2-16-11; 97-72,

 

 

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1eff. 7-1-11; 97-74, eff. 6-30-11.)
 
2    (305 ILCS 5/5A-12.4 new)
3    Sec. 5A-12.4. Hospital access improvement payments on or
4after January 1, 2012.
5    (a) Hospital access improvement payments. To preserve and
6improve access to hospital services, for hospital and physician
7services rendered on or after January 1, 2012, the Illinois
8Department shall, except for hospitals described in subsection
9(b) of Section 5A-3, make payments to hospitals as set forth in
10this Section. These payments shall be paid in 12 equal
11installments on or before the 7th State business day of each
12month, except that no payment shall be due within 100 days
13after the later of the date of notification of federal approval
14of the payment methodologies required under this Section or any
15waiver required under 42 CFR 433.68, at which time the sum of
16amounts required under this Section prior to the date of
17notification is due and payable. Payments under this Section
18are not due and payable, however, until (i) the methodologies
19described in this Section are approved by the federal
20government in an appropriate State Plan amendment and (ii) the
21assessment imposed under subsection (b-5) of Section 5A-2 of
22this Article is determined to be a permissible tax under Title
23XIX of the Social Security Act. For State fiscal year 2013, the
24amount of the payments shall be prorated based on the portion
25of the fiscal year for which they and the assessment authorized

 

 

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1under subsection (b-5) of Section 5A-2 are in effect.
2    (a-5) Accelerated schedule. The Illinois Department may,
3when practicable, accelerate the schedule upon which payments
4authorized under this Section are made.
5    (b) Magnet and perinatal hospital adjustment. In addition
6to rates paid for inpatient hospital services, the Department
7shall pay to each Illinois general acute care hospital that, as
8of August 25, 2011, was recognized as a Magnet hospital by the
9American Nurses Credentialing Center and that, as of September
1014, 2011, was designated as a level III perinatal center
11amounts as follows:
12        (1) For hospitals with a case mix index equal to or
13    greater than the 80th percentile of case mix indices for
14    all Illinois hospitals, $380 for each Medicaid general
15    acute care inpatient day of care provided by the hospital
16    during State fiscal year 2009.
17        (2) For all other hospitals, $200 for each Medicaid
18    general acute care inpatient day of care provided by the
19    hospital during State fiscal year 2009.
20    (c) Trauma level II adjustment. In addition to rates paid
21for inpatient hospital services, the Department shall pay to
22each Illinois general acute care hospital that, as of July 1,
232011, was designated as a level II trauma center amounts as
24follows:
25        (1) For hospitals with a case mix index equal to or
26    greater than the 50th percentile of case mix indices for

 

 

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1    all Illinois hospitals, $380 for each Medicaid general
2    acute care inpatient day of care provided by the hospital
3    during State fiscal year 2009.
4        (2) For all other hospitals, $135 for each Medicaid
5    general acute care inpatient day of care provided by the
6    hospital during State fiscal year 2009.
7        (3) For the purposes of this adjustment, hospitals
8    located in the same city that alternate their trauma center
9    designation as defined in 89 Ill. Adm. Code 148.295(a)(2)
10    shall have the adjustment provided under this section
11    divided between the 2 hospitals.
12    (d) Dual eligible adjustment. In addition to rates paid for
13inpatient services, the Department shall pay each Illinois
14general acute care hospital that had a ratio of crossover days
15to total inpatient days for programs under Title XIX of the
16Social Security Act administered by the Department (utilizing
17information from 2009 paid claims) greater than 50%, and a case
18mix index equal to or greater than the 75th percentile of case
19mix indices for all Illinois hospitals, a rate of $380 for each
20Medicaid inpatient day during State fiscal year 2009 including
21crossover days.
22    (e) Medicaid volume adjustment. In addition to rates paid
23for inpatient hospital services, the Department shall pay to
24each Illinois general acute care hospital that provided more
25than 10,000 Medicaid inpatient days of care in State fiscal
26year 2009, has a Medicaid inpatient utilization rate of at

 

 

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1least 29.05% as calculated by the Department for the Rate Year
22011 Disproportionate Share determination, and is not eligible
3for Medicaid Percentage Adjustment payments in rate year 2012
4an amount equal to $75 for each Medicaid inpatient day of care
5provided during State fiscal year 2009.
6    (f) Outpatient service adjustment. In addition to the rates
7paid for outpatient hospital services, the Department shall pay
8each Illinois hospital an amount at least equal to $100
9multiplied by the hospital's outpatient ambulatory procedure
10listing services (excluding categories 3B and 3C) and by the
11hospital's end stage renal disease treatment services provided
12for State fiscal year 2009.
13    (g) Care coordination adjustment.
14        (1) In addition to the rates paid for outpatient
15    hospital services provided in the emergency department,
16    the Department shall pay each Illinois hospital an amount
17    equal to $100 multiplied by the hospital's outpatient
18    ambulatory procedure listing services for categories 3A,
19    3B, and 3C for State fiscal year 2009.
20        (2) In addition to the rates paid for outpatient
21    hospital services, the Department shall pay each Illinois
22    freestanding psychiatric hospital an amount equal to $100
23    multiplied by the hospital's ambulatory procedure listing
24    services for category 5A for State fiscal year 2009.
25        (3) In order to incentivize better coordination of care
26    for patients receiving emergency room services and

 

 

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1    services related to behavioral health and substance abuse,
2    the Department may seek to have the care coordination
3    activities that are developed in consultation with a
4    statewide association representing hospitals and that are
5    supported by these adjustment payments considered under
6    Section 2703 of the Affordable Care Act.
7    (h) Specialty hospital adjustment. In addition to the rates
8paid for outpatient hospital services, the Department shall pay
9each Illinois long term acute care hospital and each Illinois
10hospital devoted exclusively to the treatment of cancer, an
11amount equal to $715 multiplied by the hospital's outpatient
12ambulatory procedure listing services and by the hospital's end
13stage renal disease treatment services (including services
14provided to individuals eligible for both Medicaid and
15Medicare) provided for State fiscal year 2009.
16    (i) Physician supplemental adjustment. In addition to the
17rates paid for physician services, the Department shall make an
18adjustment payment for services provided by physicians as
19follows:
20        (1) Physician services eligible for the adjustment
21    payment are those provided by physicians employed by or who
22    have an exclusive contract to provide services to patients
23    of the following hospitals: (i) Illinois general acute care
24    hospitals that provided at least 17,000 Medicaid inpatient
25    days of care in State fiscal year 2009 and had a Medicaid
26    inpatient utilization rate of at least 19.23% as calculated

 

 

HB5746- 31 -LRB097 18814 KTG 65663 b

1    by the Department for the Rate Year 2011 Disproportionate
2    Share determination; and (ii) Illinois freestanding
3    children's hospitals, as defined in 89 Ill. Adm. Code
4    149.50(c)(3)(A).
5        (2) The amount of the adjustment for each eligible
6    hospital under this subsection (i) shall be determined by
7    rule by the Department to spend a total pool of at least
8    $22,000,000 annually. This pool shall be allocated among
9    the eligible hospitals based on the difference between the
10    upper payment limit for what could have been paid under
11    Medicaid for physician services provided during State
12    fiscal year 2009 by physicians employed by or who had an
13    exclusive contract with the hospital and the amount that
14    was paid under Medicaid for such services, provided
15    however, that in no event shall physicians at any
16    individual hospital collectively receive an annual,
17    aggregate adjustment in excess of $1,000,000. Any amount
18    that is not distributed to a hospital because of the upper
19    payment limit shall be reallocated among the remaining
20    eligible hospitals that are below the upper payment
21    limitation, on a proportionate basis.
22    (j) For purposes of this Section, a hospital that is
23enrolled to provide Medicaid services during State fiscal year
242009 shall have its utilization and associated reimbursements
25annualized prior to the payment calculations being performed
26under this Section.

 

 

HB5746- 32 -LRB097 18814 KTG 65663 b

1    (k) For purposes of this Section, the terms "Medicaid
2days", "ambulatory procedure listing services", and
3"ambulatory procedure listing payments" do not include any
4days, charges, or services for which Medicare or a managed care
5organization reimbursed on a capitated basis was liable for
6payment, except where explicitly stated otherwise in this
7Section.
8    (l) Definitions. Unless the context requires otherwise or
9unless provided otherwise in this Section, the terms used in
10this Section for qualifying criteria and payment calculations
11shall have the same meanings as those terms have been given in
12the Illinois Department's administrative rules as in effect on
13October 1, 2011. Other terms shall be defined by the Illinois
14Department by rule.
15    As used in this Section, unless the context requires
16otherwise:
17    "Case mix index" means, for a given hospital, the sum of
18the per admission (DRG) relative weighting factors in effect on
19January 1, 2005, for all general acute care admissions for
20State fiscal year 2009, excluding Medicare crossover
21admissions and transplant admissions reimbursed under 89 Ill.
22Adm. Code 148.82, divided by the total number of general acute
23care admissions for State fiscal year 2009, excluding Medicare
24crossover admissions and transplant admissions reimbursed
25under 89 Ill. Adm. Code 148.82.
26    "Medicaid inpatient day" means, for a given hospital, the

 

 

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1sum of days of inpatient hospital days provided to recipients
2of medical assistance under Title XIX of the federal Social
3Security Act, excluding days for individuals eligible for
4Medicare under Title XVIII of that Act (Medicaid/Medicare
5crossover days), as tabulated from the Department's paid claims
6data for admissions occurring during State fiscal year 2009
7that was adjudicated by the Department through June 30, 2010.
8    "Outpatient ambulatory procedure listing services" means,
9for a given hospital, ambulatory procedure listing services, as
10described in 89 Ill. Adm. Code 148.140(b), provided to
11recipients of medical assistance under Title XIX of the federal
12Social Security Act, excluding services for individuals
13eligible for Medicare under Title XVIII of the Act
14(Medicaid/Medicare crossover days), as tabulated from the
15Department's paid claims data for services occurring in State
16fiscal year 2009 that were adjudicated by the Department
17through September 2, 2010.
18    "Outpatient end-stage renal disease treatment services"
19means, for a given hospital, the services, as described in 89
20Ill. Adm. Code 148.140(c), provided to recipients of medical
21assistance under Title XIX of the federal Social Security Act,
22excluding payments for individuals eligible for Medicare under
23Title XVIII of the Act (Medicaid/Medicare crossover days), as
24tabulated from the Department's paid claims data for services
25occurring in State fiscal year 2009 that were adjudicated by
26the Department through September 2, 2010.

 

 

HB5746- 34 -LRB097 18814 KTG 65663 b

1    (m) The Department may adjust payments made under this
2Section 5A-12.4 to comply with federal law or regulations
3regarding hospital-specific payment limitations on
4government-owned or government-operated hospitals.
5    (n) Notwithstanding any of the other provisions of this
6Section, the Department is authorized to adopt rules that
7change the hospital access improvement payments specified in
8this Section, but only to the extent necessary to conform to
9any federally approved amendment to the Title XIX State plan.
10Any such rules shall be adopted by the Department as authorized
11by Section 5-50 of the Illinois Administrative Procedure Act.
12Notwithstanding any other provision of law, any changes
13implemented as a result of this subsection (n) shall be given
14retroactive effect so that they shall be deemed to have taken
15effect as of the effective date of this Section.
16    (o) The Department of Healthcare and Family Services must
17submit a State Medicaid Plan Amendment to the Centers of
18Medicare and Medicaid Services to implement the payments under
19this Section within 30 days of the effective date of this
20amendatory Act of the 97th General Assembly.
21    (p) If any of the federal upper payment limits applicable
22to the payments under this Section are exceeded due to an
23expansion of the number of recipients enrolled in
24fully-capitated, risk-based managed care arrangements prior to
25the dates set forth in subsections (a) and (d) of Section
265A-14, the payments under this Section that exceed the

 

 

HB5746- 35 -LRB097 18814 KTG 65663 b

1applicable federal upper payment limits may be reduced
2uniformly to the extent necessary to comply with the applicable
3federal upper payment limit.
 
4    (305 ILCS 5/5A-13)
5    Sec. 5A-13. Emergency rulemaking. The Department of
6Healthcare and Family Services (formerly Department of Public
7Aid) may adopt rules necessary to implement this amendatory Act
8of the 94th General Assembly through the use of emergency
9rulemaking in accordance with Section 5-45 of the Illinois
10Administrative Procedure Act. For purposes of that Act, the
11General Assembly finds that the adoption of rules to implement
12this amendatory Act of the 94th General Assembly is deemed an
13emergency and necessary for the public interest, safety, and
14welfare.
15    The Department of Healthcare and Family Services may adopt
16rules necessary to implement this amendatory Act of the 97th
17General Assembly through the use of emergency rulemaking in
18accordance with Section 5-45 of the Illinois Administrative
19Procedure Act. For purposes of that Act, the General Assembly
20finds that the adoption of rules to implement this amendatory
21Act of the 97th General Assembly is deemed an emergency and
22necessary for the public interest, safety, and welfare.
23(Source: P.A. 94-242, eff. 7-18-05; 95-331, eff. 8-21-07.)
 
24    (305 ILCS 5/5A-14)

 

 

HB5746- 36 -LRB097 18814 KTG 65663 b

1    Sec. 5A-14. Repeal of assessments and disbursements.
2    (a) Section 5A-2 is repealed on July 1, 2014.
3    (b) Section 5A-12 is repealed on July 1, 2005.
4    (c) Section 5A-12.1 is repealed on July 1, 2008.
5    (d) Section 5A-12.2 and Section 5A-12.4 are is repealed on
6July 1, 2014.
7    (e) Section 5A-12.3 is repealed on July 1, 2011.
8(Source: P.A. 95-859, eff. 8-19-08; 96-821, eff. 11-20-09;
996-1530, eff. 2-16-11.)
 
10    Section 99. Effective date. This Act takes effect upon
11becoming law.

 

 

HB5746- 37 -LRB097 18814 KTG 65663 b

1 INDEX
2 Statutes amended in order of appearance
3    305 ILCS 5/5A-1from Ch. 23, par. 5A-1
4    305 ILCS 5/5A-2from Ch. 23, par. 5A-2
5    305 ILCS 5/5A-4from Ch. 23, par. 5A-4
6    305 ILCS 5/5A-5from Ch. 23, par. 5A-5
7    305 ILCS 5/5A-8from Ch. 23, par. 5A-8
8    305 ILCS 5/5A-10from Ch. 23, par. 5A-10
9    305 ILCS 5/5A-12.4 new
10    305 ILCS 5/5A-13
11    305 ILCS 5/5A-14