98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB1254

 

Introduced , by Rep. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5A-2  from Ch. 23, par. 5A-2
305 ILCS 5/5A-4  from Ch. 23, par. 5A-4
305 ILCS 5/5A-5  from Ch. 23, par. 5A-5
305 ILCS 5/5A-12.4

    Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Provides that an annual assessment on outpatient services shall be imposed on each hospital provider in a specified amount for June 10, 2012 through December 31, 2014 (rather than for State fiscal years 2013 through 2014, and July 1, 2014 through December 31, 2014). Provides that amounts shall be prorated if not in effect for a full year. Provides that for June 10, 2012 through December 31, 2014 (rather than for State fiscal years 2013 through 2014, and July 1, 2014 through December 31, 2014), a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2009 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on June 30, 2011, without regard to any subsequent adjustments or changes to such data. Provides that for State fiscal years 2009 through 2014 (rather than for State fiscal years 2009 through 2015) in the case of a hospital provider that did not conduct, operate, or maintain a hospital in 2005, the assessment for that State fiscal year shall be computed on the basis of hypothetical occupied bed days for the full calendar year as determined by the Department of Healthcare and Family Services. Makes other changes. Effective immediately.


LRB098 07601 KTG 37672 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB1254LRB098 07601 KTG 37672 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-2, 5A-4, 5A-5, and 5A-12.4 as follows:
 
6    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
7    (Section scheduled to be repealed on January 1, 2015)
8    Sec. 5A-2. Assessment.
9    (a) Subject to Sections 5A-3 and 5A-10, for State fiscal
10years 2009 through 2014, and from July 1, 2014 through December
1131, 2014, an annual assessment on inpatient services is imposed
12on each hospital provider in an amount equal to $218.38
13multiplied by the difference of the hospital's occupied bed
14days less the hospital's Medicare bed days.
15    For State fiscal years 2009 through 2014, and after a
16hospital's occupied bed days and Medicare bed days shall be
17determined using the most recent data available from each
18hospital's 2005 Medicare cost report as contained in the
19Healthcare Cost Report Information System file, for the quarter
20ending on December 31, 2006, without regard to any subsequent
21adjustments or changes to such data. If a hospital's 2005
22Medicare cost report is not contained in the Healthcare Cost
23Report Information System, then the Illinois Department may

 

 

HB1254- 2 -LRB098 07601 KTG 37672 b

1obtain the hospital provider's occupied bed days and Medicare
2bed days from any source available, including, but not limited
3to, records maintained by the hospital provider, which may be
4inspected at all times during business hours of the day by the
5Illinois Department or its duly authorized agents and
6employees.
7    (b) (Blank).
8    (b-5) Subject to Sections 5A-3 and 5A-10, for June 10, 2012
9State fiscal years 2013 through 2014, and July 1, 2014 through
10December 31, 2014, an annual assessment on outpatient services
11is imposed on each hospital provider in an amount equal to
12.008766 multiplied by the hospital's outpatient gross revenue.
13Amounts shall be prorated if not in effect for a full year.
14    For June 10, 2012 State fiscal years 2013 through 2014, and
15July 1, 2014 through December 31, 2014, a hospital's outpatient
16gross revenue shall be determined using the most recent data
17available from each hospital's 2009 Medicare cost report as
18contained in the Healthcare Cost Report Information System
19file, for the quarter ending on June 30, 2011, without regard
20to any subsequent adjustments or changes to such data. If a
21hospital's 2009 Medicare cost report is not contained in the
22Healthcare Cost Report Information System, then the Department
23may obtain the hospital provider's outpatient gross revenue
24from any source available, including, but not limited to,
25records maintained by the hospital provider, which may be
26inspected at all times during business hours of the day by the

 

 

HB1254- 3 -LRB098 07601 KTG 37672 b

1Department or its duly authorized agents and employees.
2    (c) (Blank).
3    (d) Notwithstanding any of the other provisions of this
4Section, the Department is authorized to adopt rules to reduce
5the rate of any annual assessment imposed under this Section,
6as authorized by Section 5-46.2 of the Illinois Administrative
7Procedure Act.
8    (e) Notwithstanding any other provision of this Section,
9any plan providing for an assessment on a hospital provider as
10a permissible tax under Title XIX of the federal Social
11Security Act and Medicaid-eligible payments to hospital
12providers from the revenues derived from that assessment shall
13be reviewed by the Illinois Department of Healthcare and Family
14Services, as the Single State Medicaid Agency required by
15federal law, to determine whether those assessments and
16hospital provider payments meet federal Medicaid standards. If
17the Department determines that the elements of the plan may
18meet federal Medicaid standards and a related State Medicaid
19Plan Amendment is prepared in a manner and form suitable for
20submission, that State Plan Amendment shall be submitted in a
21timely manner for review by the Centers for Medicare and
22Medicaid Services of the United States Department of Health and
23Human Services and subject to approval by the Centers for
24Medicare and Medicaid Services of the United States Department
25of Health and Human Services. No such plan shall become
26effective without approval by the Illinois General Assembly by

 

 

HB1254- 4 -LRB098 07601 KTG 37672 b

1the enactment into law of related legislation. Notwithstanding
2any other provision of this Section, the Department is
3authorized to adopt rules to reduce the rate of any annual
4assessment imposed under this Section. Any such rules may be
5adopted by the Department under Section 5-50 of the Illinois
6Administrative Procedure Act.
7(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
897-689, eff. 6-14-12.)
 
9    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
10    Sec. 5A-4. Payment of assessment; penalty.
11    (a) The assessment imposed by Section 5A-2 for State fiscal
12year 2009 and each subsequent State fiscal year shall be due
13and payable in monthly installments, each equaling one-twelfth
14of the assessment for the year, on the fourteenth State
15business day of each month. No installment payment of an
16assessment imposed by Section 5A-2 shall be due and payable,
17however, until after the Comptroller has issued the payments
18required under this Article.
19    Except as provided in subsection (a-5) of this Section, the
20assessment imposed by subsection (b-5) of Section 5A-2 for
21State fiscal year 2012 2013 and each subsequent State fiscal
22year shall be due and payable in monthly installments, each
23equaling one-twelfth of the assessment for the year, on the
2414th State business day of each month. No installment payment
25of an assessment imposed by subsection (b-5) of Section 5A-2

 

 

HB1254- 5 -LRB098 07601 KTG 37672 b

1shall be due and payable, however, until after: (i) the
2Department notifies the hospital provider, in writing, that the
3payment methodologies to hospitals required under Section
45A-12.4, have been approved by the Centers for Medicare and
5Medicaid Services of the U.S. Department of Health and Human
6Services, and the waiver under 42 CFR 433.68 for the assessment
7imposed by subsection (b-5) of Section 5A-2, if necessary, has
8been granted by the Centers for Medicare and Medicaid Services
9of the U.S. Department of Health and Human Services; and (ii)
10the Comptroller has issued the payments required under Section
115A-12.4. Upon notification to the Department of approval of the
12payment methodologies required under Section 5A-12.4 and the
13waiver granted under 42 CFR 433.68, if necessary, all
14installments otherwise due under subsection (b-5) of Section
155A-2 prior to the date of notification shall be due and payable
16to the Department upon written direction from the Department
17and issuance by the Comptroller of the payments required under
18Section 5A-12.4.
19    (a-5) The Illinois Department may accelerate the schedule
20upon which assessment installments are due and payable by
21hospitals with a payment ratio greater than or equal to one.
22Such acceleration of due dates for payment of the assessment
23may be made only in conjunction with a corresponding
24acceleration in access payments identified in Section 5A-12.2
25or Section 5A-12.4 to the same hospitals. For the purposes of
26this subsection (a-5), a hospital's payment ratio is defined as

 

 

HB1254- 6 -LRB098 07601 KTG 37672 b

1the quotient obtained by dividing the total payments for the
2State fiscal year, as authorized under Section 5A-12.2 or
3Section 5A-12.4, by the total assessment for the State fiscal
4year imposed under Section 5A-2 or subsection (b-5) of Section
55A-2.
6    (b) The Illinois Department is authorized to establish
7delayed payment schedules for hospital providers that are
8unable to make installment payments when due under this Section
9due to financial difficulties, as determined by the Illinois
10Department.
11    (c) If a hospital provider fails to pay the full amount of
12an installment when due (including any extensions granted under
13subsection (b)), there shall, unless waived by the Illinois
14Department for reasonable cause, be added to the assessment
15imposed by Section 5A-2 a penalty assessment equal to the
16lesser of (i) 5% of the amount of the installment not paid on
17or before the due date plus 5% of the portion thereof remaining
18unpaid on the last day of each 30-day period thereafter or (ii)
19100% of the installment amount not paid on or before the due
20date. For purposes of this subsection, payments will be
21credited first to unpaid installment amounts (rather than to
22penalty or interest), beginning with the most delinquent
23installments.
24    (d) Any assessment amount that is due and payable to the
25Illinois Department more frequently than once per calendar
26quarter shall be remitted to the Illinois Department by the

 

 

HB1254- 7 -LRB098 07601 KTG 37672 b

1hospital provider by means of electronic funds transfer. The
2Illinois Department may provide for remittance by other means
3if (i) the amount due is less than $10,000 or (ii) electronic
4funds transfer is unavailable for this purpose.
5(Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12;
697-689, eff. 6-14-12.)
 
7    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
8    Sec. 5A-5. Notice; penalty; maintenance of records.
9    (a) The Illinois Department shall send a notice of
10assessment to every hospital provider subject to assessment
11under this Article. The notice of assessment shall notify the
12hospital of its assessment and shall be sent after receipt by
13the Department of notification from the Centers for Medicare
14and Medicaid Services of the U.S. Department of Health and
15Human Services that the payment methodologies required under
16this Article and, if necessary, the waiver granted under 42 CFR
17433.68 have been approved. The notice shall be on a form
18prepared by the Illinois Department and shall state the
19following:
20        (1) The name of the hospital provider.
21        (2) The address of the hospital provider's principal
22    place of business from which the provider engages in the
23    occupation of hospital provider in this State, and the name
24    and address of each hospital operated, conducted, or
25    maintained by the provider in this State.

 

 

HB1254- 8 -LRB098 07601 KTG 37672 b

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

 

 

HB1254- 9 -LRB098 07601 KTG 37672 b

1    (d) Notwithstanding any other provision in this Article, a
2provider who commences conducting, operating, or maintaining a
3hospital, upon notice by the Illinois Department, shall pay the
4assessment computed under Section 5A-2 and subsection (e) in
5installments on the due dates stated in the notice and on the
6regular installment due dates for the State fiscal year
7occurring after the due dates of the initial notice.
8    (e) Notwithstanding any other provision in this Article,
9for State fiscal years 2009 through 2014 2015, in the case of a
10hospital provider that did not conduct, operate, or maintain a
11hospital in 2005, the assessment for that State fiscal year
12shall be computed on the basis of hypothetical occupied bed
13days for the full calendar year as determined by the Illinois
14Department. Notwithstanding any other provision in this
15Article, for June 10, 2012 State fiscal years 2013 through
162014, and for July 1, 2014 through December 31, 2014, in the
17case of a hospital provider that did not conduct, operate, or
18maintain a hospital in 2009, the assessment under subsection
19(b-5) of Section 5A-2 for that State fiscal year shall be
20computed on the basis of hypothetical gross outpatient revenue
21for the full calendar year as determined by the Illinois
22Department.
23    (f) Every hospital provider subject to assessment under
24this Article shall keep sufficient records to permit the
25determination of adjusted gross hospital revenue for the
26hospital's fiscal year. All such records shall be kept in the

 

 

HB1254- 10 -LRB098 07601 KTG 37672 b

1English language and shall, at all times during regular
2business hours of the day, be subject to inspection by the
3Illinois Department or its duly authorized agents and
4employees.
5    (g) The Illinois Department may, by rule, provide a
6hospital provider a reasonable opportunity to request a
7clarification or correction of any clerical or computational
8errors contained in the calculation of its assessment, but such
9corrections shall not extend to updating the cost report
10information used to calculate the assessment.
11    (h) (Blank).
12(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
1397-689, eff. 6-14-12; revised 10-17-12.)
 
14    (305 ILCS 5/5A-12.4)
15    (Section scheduled to be repealed on January 1, 2015)
16    Sec. 5A-12.4. Hospital access improvement payments on or
17after June 10, 2012 July 1, 2012.
18    (a) Hospital access improvement payments. To preserve and
19improve access to hospital services, for hospital and physician
20services rendered on or after June 10, 2012 July 1, 2012, the
21Illinois Department shall, except for hospitals described in
22subsection (b) of Section 5A-3, make payments to hospitals as
23set forth in this Section. These payments shall be paid in 12
24equal installments on or before the 7th State business day of
25each month, except that no payment shall be due within 100 days

 

 

HB1254- 11 -LRB098 07601 KTG 37672 b

1after the later of the date of notification of federal approval
2of the payment methodologies required under this Section or any
3waiver required under 42 CFR 433.68, at which time the sum of
4amounts required under this Section prior to the date of
5notification is due and payable. Payments under this Section
6are not due and payable, however, until (i) the methodologies
7described in this Section are approved by the federal
8government in an appropriate State Plan amendment and (ii) the
9assessment imposed under subsection (b-5) of Section 5A-2 of
10this Article is determined to be a permissible tax under Title
11XIX of the Social Security Act. The Illinois Department shall
12take all actions necessary to implement the payments under this
13Section effective June 10, 2012 July 1, 2012, including but not
14limited to providing public notice pursuant to federal
15requirements, the filing of a State Plan amendment, and the
16adoption of administrative rules.
17    (a-5) Accelerated schedule. The Illinois Department may,
18when practicable, accelerate the schedule upon which payments
19authorized under this Section are made.
20    (b) Magnet and perinatal hospital adjustment. In addition
21to rates paid for inpatient hospital services, the Department
22shall pay to each Illinois general acute care hospital that, as
23of August 25, 2011, was recognized as a Magnet hospital by the
24American Nurses Credentialing Center and that, as of September
2514, 2011, was designated as a level III perinatal center
26amounts as follows:

 

 

HB1254- 12 -LRB098 07601 KTG 37672 b

1        (1) For hospitals with a case mix index equal to or
2    greater than the 80th percentile of case mix indices for
3    all Illinois hospitals, $470 for each Medicaid general
4    acute care inpatient day of care provided by the hospital
5    during State fiscal year 2009.
6        (2) For all other hospitals, $170 for each Medicaid
7    general acute care inpatient day of care provided by the
8    hospital during State fiscal year 2009.
9    (c) Trauma level II adjustment. In addition to rates paid
10for inpatient hospital services, the Department shall pay to
11each Illinois general acute care hospital that, as of July 1,
122011, was designated as a level II trauma center amounts as
13follows:
14        (1) For hospitals with a case mix index equal to or
15    greater than the 50th percentile of case mix indices for
16    all Illinois hospitals, $470 for each Medicaid general
17    acute care inpatient day of care provided by the hospital
18    during State fiscal year 2009.
19        (2) For all other hospitals, $170 for each Medicaid
20    general acute care inpatient day of care provided by the
21    hospital during State fiscal year 2009.
22        (3) For the purposes of this adjustment, hospitals
23    located in the same city that alternate their trauma center
24    designation as defined in 89 Ill. Adm. Code 148.295(a)(2)
25    shall have the adjustment provided under this Section
26    divided between the 2 hospitals.

 

 

HB1254- 13 -LRB098 07601 KTG 37672 b

1    (d) Dual-eligible adjustment. In addition to rates paid for
2inpatient services, the Department shall pay each Illinois
3general acute care hospital that had a ratio of crossover days
4to total inpatient days for programs under Title XIX of the
5Social Security Act administered by the Department (utilizing
6information from 2009 paid claims) greater than 50%, and a case
7mix index equal to or greater than the 75th percentile of case
8mix indices for all Illinois hospitals, a rate of $400 for each
9Medicaid inpatient day during State fiscal year 2009 including
10crossover days.
11    (e) Medicaid volume adjustment. In addition to rates paid
12for inpatient hospital services, the Department shall pay to
13each Illinois general acute care hospital that provided more
14than 10,000 Medicaid inpatient days of care in State fiscal
15year 2009, has a Medicaid inpatient utilization rate of at
16least 29.05% as calculated by the Department for the Rate Year
172011 Disproportionate Share determination, and is not eligible
18for Medicaid Percentage Adjustment payments in rate year 2011
19an amount equal to $135 for each Medicaid inpatient day of care
20provided during State fiscal year 2009.
21    (f) Outpatient service adjustment. In addition to the rates
22paid for outpatient hospital services, the Department shall pay
23each Illinois hospital an amount at least equal to $100
24multiplied by the hospital's outpatient ambulatory procedure
25listing services (excluding categories 3B and 3C) and by the
26hospital's end stage renal disease treatment services provided

 

 

HB1254- 14 -LRB098 07601 KTG 37672 b

1for State fiscal year 2009.
2    (g) Ambulatory service adjustment.
3        (1) In addition to the rates paid for outpatient
4    hospital services provided in the emergency department,
5    the Department shall pay each Illinois hospital an amount
6    equal to $105 multiplied by the hospital's outpatient
7    ambulatory procedure listing services for categories 3A,
8    3B, and 3C for State fiscal year 2009.
9        (2) In addition to the rates paid for outpatient
10    hospital services, the Department shall pay each Illinois
11    freestanding psychiatric hospital an amount equal to $200
12    multiplied by the hospital's ambulatory procedure listing
13    services for category 5A for State fiscal year 2009.
14    (h) Specialty hospital adjustment. In addition to the rates
15paid for outpatient hospital services, the Department shall pay
16each Illinois long term acute care hospital and each Illinois
17hospital devoted exclusively to the treatment of cancer, an
18amount equal to $700 multiplied by the hospital's outpatient
19ambulatory procedure listing services and by the hospital's end
20stage renal disease treatment services (including services
21provided to individuals eligible for both Medicaid and
22Medicare) provided for State fiscal year 2009.
23    (h-1) ER Safety Net Payments. In addition to rates paid for
24outpatient services, the Department shall pay to each Illinois
25general acute care hospital with an emergency room ratio equal
26to or greater than 55%, that is not eligible for Medicaid

 

 

HB1254- 15 -LRB098 07601 KTG 37672 b

1percentage adjustments payments in rate year 2011, with a case
2mix index equal to or greater than the 20th percentile, and
3that is not designated as a trauma center by the Illinois
4Department of Public Health on July 1, 2011, as follows:
5        (1) Each hospital with an emergency room ratio equal to
6    or greater than 74% shall receive a rate of $225 for each
7    outpatient ambulatory procedure listing and end-stage
8    renal disease treatment service provided for State fiscal
9    year 2009.
10        (2) For all other hospitals, $65 shall be paid for each
11    outpatient ambulatory procedure listing and end-stage
12    renal disease treatment service provided for State fiscal
13    year 2009.
14    (i) Physician supplemental adjustment. In addition to the
15rates paid for physician services, the Department shall make an
16adjustment payment for services provided by physicians as
17follows:
18        (1) Physician services eligible for the adjustment
19    payment are those provided by physicians employed by or who
20    have a contract to provide services to patients of the
21    following hospitals: (i) Illinois general acute care
22    hospitals that provided at least 17,000 Medicaid inpatient
23    days of care in State fiscal year 2009 and are eligible for
24    Medicaid Percentage Adjustment Payments in rate year 2011;
25    and (ii) Illinois freestanding children's hospitals, as
26    defined in 89 Ill. Adm. Code 149.50(c)(3)(A).

 

 

HB1254- 16 -LRB098 07601 KTG 37672 b

1        (2) The amount of the adjustment for each eligible
2    hospital under this subsection (i) shall be determined by
3    rule by the Department to spend a total pool of at least
4    $6,960,000 annually. This pool shall be allocated among the
5    eligible hospitals based on the difference between the
6    upper payment limit for what could have been paid under
7    Medicaid for physician services provided during State
8    fiscal year 2009 by physicians employed by or who had a
9    contract with the hospital and the amount that was paid
10    under Medicaid for such services, provided however, that in
11    no event shall physicians at any individual hospital
12    collectively receive an annual, aggregate adjustment in
13    excess of $435,000, except that any amount that is not
14    distributed to a hospital because of the upper payment
15    limit shall be reallocated among the remaining eligible
16    hospitals that are below the upper payment limitation, on a
17    proportionate basis.
18    (i-5) For any children's hospital which did not charge for
19its services during the base period, the Department shall use
20data supplied by the hospital to determine payments using
21similar methodologies for freestanding children's hospitals
22under this Section or Section 5A-12.2 12.2.
23    (j) For purposes of this Section, a hospital that is
24enrolled to provide Medicaid services during State fiscal year
252009 shall have its utilization and associated reimbursements
26annualized prior to the payment calculations being performed

 

 

HB1254- 17 -LRB098 07601 KTG 37672 b

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

 

 

HB1254- 18 -LRB098 07601 KTG 37672 b

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

 

 

HB1254- 19 -LRB098 07601 KTG 37672 b

1means, for a given hospital, the services, as described in 89
2Ill. Adm. Code 148.140(c), provided to recipients of medical
3assistance under Title XIX of the federal Social Security Act,
4excluding payments for individuals eligible for Medicare under
5Title XVIII of the Act (Medicaid/Medicare crossover days), as
6tabulated from the Department's paid claims data for services
7occurring in State fiscal year 2009 that were adjudicated by
8the Department through September 2, 2010.
9    (m) The Department may adjust payments made under this
10Section 5A-12.4 to comply with federal law or regulations
11regarding hospital-specific payment limitations on
12government-owned or government-operated hospitals.
13    (n) Notwithstanding any of the other provisions of this
14Section, the Department is authorized to adopt rules that
15change the hospital access improvement payments specified in
16this Section, but only to the extent necessary to conform to
17any federally approved amendment to the Title XIX State plan.
18Any such rules shall be adopted by the Department as authorized
19by Section 5-50 of the Illinois Administrative Procedure Act.
20Notwithstanding any other provision of law, any changes
21implemented as a result of this subsection (n) shall be given
22retroactive effect so that they shall be deemed to have taken
23effect as of the effective date of this Section.
24    (o) The Department of Healthcare and Family Services must
25submit a State Medicaid Plan Amendment to the Centers of
26Medicare and Medicaid Services to implement the payments under

 

 

HB1254- 20 -LRB098 07601 KTG 37672 b

1this Section within 30 days of June 14, 2012 (the effective
2date of Public Act 97-688) this Act.
3(Source: P.A. 97-688, eff. 6-14-12; revised 8-3-12.)
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.