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Full Text of HB4678  99th General Assembly

HB4678enr 99TH GENERAL ASSEMBLY

  
  
  

 


 
HB4678 EnrolledLRB099 17926 RJF 42288 b

1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Administrative Procedure Act is
5amended by changing Section 5-45 as follows:
 
6    (5 ILCS 100/5-45)  (from Ch. 127, par. 1005-45)
7    Sec. 5-45. Emergency rulemaking.
8    (a) "Emergency" means the existence of any situation that
9any agency finds reasonably constitutes a threat to the public
10interest, safety, or welfare.
11    (b) If any agency finds that an emergency exists that
12requires adoption of a rule upon fewer days than is required by
13Section 5-40 and states in writing its reasons for that
14finding, the agency may adopt an emergency rule without prior
15notice or hearing upon filing a notice of emergency rulemaking
16with the Secretary of State under Section 5-70. The notice
17shall include the text of the emergency rule and shall be
18published in the Illinois Register. Consent orders or other
19court orders adopting settlements negotiated by an agency may
20be adopted under this Section. Subject to applicable
21constitutional or statutory provisions, an emergency rule
22becomes effective immediately upon filing under Section 5-65 or
23at a stated date less than 10 days thereafter. The agency's

 

 

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1finding and a statement of the specific reasons for the finding
2shall be filed with the rule. The agency shall take reasonable
3and appropriate measures to make emergency rules known to the
4persons who may be affected by them.
5    (c) An emergency rule may be effective for a period of not
6longer than 150 days, but the agency's authority to adopt an
7identical rule under Section 5-40 is not precluded. No
8emergency rule may be adopted more than once in any 24 month
9period, except that this limitation on the number of emergency
10rules that may be adopted in a 24 month period does not apply
11to (i) emergency rules that make additions to and deletions
12from the Drug Manual under Section 5-5.16 of the Illinois
13Public Aid Code or the generic drug formulary under Section
143.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
15emergency rules adopted by the Pollution Control Board before
16July 1, 1997 to implement portions of the Livestock Management
17Facilities Act, (iii) emergency rules adopted by the Illinois
18Department of Public Health under subsections (a) through (i)
19of Section 2 of the Department of Public Health Act when
20necessary to protect the public's health, (iv) emergency rules
21adopted pursuant to subsection (n) of this Section, (v)
22emergency rules adopted pursuant to subsection (o) of this
23Section, or (vi) emergency rules adopted pursuant to subsection
24(c-5) of this Section. Two or more emergency rules having
25substantially the same purpose and effect shall be deemed to be
26a single rule for purposes of this Section.

 

 

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1    (c-5) To facilitate the maintenance of the program of group
2health benefits provided to annuitants, survivors, and retired
3employees under the State Employees Group Insurance Act of
41971, rules to alter the contributions to be paid by the State,
5annuitants, survivors, retired employees, or any combination
6of those entities, for that program of group health benefits,
7shall be adopted as emergency rules. The adoption of those
8rules shall be considered an emergency and necessary for the
9public interest, safety, and welfare.
10    (d) In order to provide for the expeditious and timely
11implementation of the State's fiscal year 1999 budget,
12emergency rules to implement any provision of Public Act 90-587
13or 90-588 or any other budget initiative for fiscal year 1999
14may be adopted in accordance with this Section by the agency
15charged with administering that provision or initiative,
16except that the 24-month limitation on the adoption of
17emergency rules and the provisions of Sections 5-115 and 5-125
18do not apply to rules adopted under this subsection (d). The
19adoption of emergency rules authorized by this subsection (d)
20shall be deemed to be necessary for the public interest,
21safety, and welfare.
22    (e) In order to provide for the expeditious and timely
23implementation of the State's fiscal year 2000 budget,
24emergency rules to implement any provision of Public Act 91-24
25this amendatory Act of the 91st General Assembly or any other
26budget initiative for fiscal year 2000 may be adopted in

 

 

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1accordance with this Section by the agency charged with
2administering that provision or initiative, except that the
324-month limitation on the adoption of emergency rules and the
4provisions of Sections 5-115 and 5-125 do not apply to rules
5adopted under this subsection (e). The adoption of emergency
6rules authorized by this subsection (e) shall be deemed to be
7necessary for the public interest, safety, and welfare.
8    (f) In order to provide for the expeditious and timely
9implementation of the State's fiscal year 2001 budget,
10emergency rules to implement any provision of Public Act 91-712
11this amendatory Act of the 91st General Assembly or any other
12budget initiative for fiscal year 2001 may be adopted in
13accordance with this Section by the agency charged with
14administering that provision or initiative, except that the
1524-month limitation on the adoption of emergency rules and the
16provisions of Sections 5-115 and 5-125 do not apply to rules
17adopted under this subsection (f). The adoption of emergency
18rules authorized by this subsection (f) shall be deemed to be
19necessary for the public interest, safety, and welfare.
20    (g) In order to provide for the expeditious and timely
21implementation of the State's fiscal year 2002 budget,
22emergency rules to implement any provision of Public Act 92-10
23this amendatory Act of the 92nd General Assembly or any other
24budget initiative for fiscal year 2002 may be adopted in
25accordance with this Section by the agency charged with
26administering that provision or initiative, except that the

 

 

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124-month limitation on the adoption of emergency rules and the
2provisions of Sections 5-115 and 5-125 do not apply to rules
3adopted under this subsection (g). The adoption of emergency
4rules authorized by this subsection (g) shall be deemed to be
5necessary for the public interest, safety, and welfare.
6    (h) In order to provide for the expeditious and timely
7implementation of the State's fiscal year 2003 budget,
8emergency rules to implement any provision of Public Act 92-597
9this amendatory Act of the 92nd General Assembly or any other
10budget initiative for fiscal year 2003 may be adopted in
11accordance with this Section by the agency charged with
12administering that provision or initiative, except that the
1324-month limitation on the adoption of emergency rules and the
14provisions of Sections 5-115 and 5-125 do not apply to rules
15adopted under this subsection (h). The adoption of emergency
16rules authorized by this subsection (h) shall be deemed to be
17necessary for the public interest, safety, and welfare.
18    (i) In order to provide for the expeditious and timely
19implementation of the State's fiscal year 2004 budget,
20emergency rules to implement any provision of Public Act 93-20
21this amendatory Act of the 93rd General Assembly or any other
22budget initiative for fiscal year 2004 may be adopted in
23accordance with this Section by the agency charged with
24administering that provision or initiative, except that the
2524-month limitation on the adoption of emergency rules and the
26provisions of Sections 5-115 and 5-125 do not apply to rules

 

 

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1adopted under this subsection (i). The adoption of emergency
2rules authorized by this subsection (i) shall be deemed to be
3necessary for the public interest, safety, and welfare.
4    (j) In order to provide for the expeditious and timely
5implementation of the provisions of the State's fiscal year
62005 budget as provided under the Fiscal Year 2005 Budget
7Implementation (Human Services) Act, emergency rules to
8implement any provision of the Fiscal Year 2005 Budget
9Implementation (Human Services) Act may be adopted in
10accordance with this Section by the agency charged with
11administering that provision, except that the 24-month
12limitation on the adoption of emergency rules and the
13provisions of Sections 5-115 and 5-125 do not apply to rules
14adopted under this subsection (j). The Department of Public Aid
15may also adopt rules under this subsection (j) necessary to
16administer the Illinois Public Aid Code and the Children's
17Health Insurance Program Act. The adoption of emergency rules
18authorized by this subsection (j) shall be deemed to be
19necessary for the public interest, safety, and welfare.
20    (k) In order to provide for the expeditious and timely
21implementation of the provisions of the State's fiscal year
222006 budget, emergency rules to implement any provision of
23Public Act 94-48 this amendatory Act of the 94th General
24Assembly or any other budget initiative for fiscal year 2006
25may be adopted in accordance with this Section by the agency
26charged with administering that provision or initiative,

 

 

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1except that the 24-month limitation on the adoption of
2emergency rules and the provisions of Sections 5-115 and 5-125
3do not apply to rules adopted under this subsection (k). The
4Department of Healthcare and Family Services may also adopt
5rules under this subsection (k) necessary to administer the
6Illinois Public Aid Code, the Senior Citizens and Persons with
7Disabilities Property Tax Relief Act, the Senior Citizens and
8Disabled Persons Prescription Drug Discount Program Act (now
9the Illinois Prescription Drug Discount Program Act), and the
10Children's Health Insurance Program Act. The adoption of
11emergency rules authorized by this subsection (k) shall be
12deemed to be necessary for the public interest, safety, and
13welfare.
14    (l) In order to provide for the expeditious and timely
15implementation of the provisions of the State's fiscal year
162007 budget, the Department of Healthcare and Family Services
17may adopt emergency rules during fiscal year 2007, including
18rules effective July 1, 2007, in accordance with this
19subsection to the extent necessary to administer the
20Department's responsibilities with respect to amendments to
21the State plans and Illinois waivers approved by the federal
22Centers for Medicare and Medicaid Services necessitated by the
23requirements of Title XIX and Title XXI of the federal Social
24Security Act. The adoption of emergency rules authorized by
25this subsection (l) shall be deemed to be necessary for the
26public interest, safety, and welfare.

 

 

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1    (m) In order to provide for the expeditious and timely
2implementation of the provisions of the State's fiscal year
32008 budget, the Department of Healthcare and Family Services
4may adopt emergency rules during fiscal year 2008, including
5rules effective July 1, 2008, in accordance with this
6subsection to the extent necessary to administer the
7Department's responsibilities with respect to amendments to
8the State plans and Illinois waivers approved by the federal
9Centers for Medicare and Medicaid Services necessitated by the
10requirements of Title XIX and Title XXI of the federal Social
11Security Act. The adoption of emergency rules authorized by
12this subsection (m) shall be deemed to be necessary for the
13public interest, safety, and welfare.
14    (n) In order to provide for the expeditious and timely
15implementation of the provisions of the State's fiscal year
162010 budget, emergency rules to implement any provision of
17Public Act 96-45 this amendatory Act of the 96th General
18Assembly or any other budget initiative authorized by the 96th
19General Assembly for fiscal year 2010 may be adopted in
20accordance 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 this amendatory Act of the 96th General
5Assembly or any other budget initiative authorized by the 96th
6General Assembly for fiscal year 2011 may be adopted in
7accordance with this Section by the agency charged with
8administering that provision or initiative. The adoption of
9emergency rules authorized by this subsection (o) is deemed to
10be necessary for the public interest, safety, and welfare. The
11rulemaking authority granted in this subsection (o) applies
12only to rules promulgated on or after the effective date of
13Public Act 96-958 this amendatory Act of the 96th General
14Assembly through June 30, 2011.
15    (p) In order to provide for the expeditious and timely
16implementation of the provisions of Public Act 97-689,
17emergency rules to implement any provision of Public Act 97-689
18may be adopted in accordance with this subsection (p) by the
19agency charged with administering that provision or
20initiative. The 150-day limitation of the effective period of
21emergency rules does not apply to rules adopted under this
22subsection (p), and the effective period may continue through
23June 30, 2013. The 24-month limitation on the adoption of
24emergency rules does not apply to rules adopted under this
25subsection (p). The adoption of emergency rules authorized by
26this subsection (p) is deemed to be necessary for the public

 

 

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

 

 

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1the Illinois Public Aid Code, emergency rules to implement any
2provision of Section 5-5b.1 or Section 5A-2 of the Illinois
3Public Aid Code may be adopted in accordance with this
4subsection (s) by the Department of Healthcare and Family
5Services. The rulemaking authority granted in this subsection
6(s) shall apply only to those rules adopted prior to July 1,
72015. Notwithstanding any other provision of this Section, any
8emergency rule adopted under this subsection (s) shall only
9apply to payments made for State fiscal year 2015. The adoption
10of emergency rules authorized by this subsection (s) is deemed
11to be necessary for the public interest, safety, and welfare.
12    (t) In order to provide for the expeditious and timely
13implementation of the provisions of Article II of Public Act
1499-6 this amendatory Act of the 99th General Assembly,
15emergency rules to implement the changes made by Article II of
16Public Act 99-6 this amendatory Act of the 99th General
17Assembly to the Emergency Telephone System Act may be adopted
18in accordance with this subsection (t) by the Department of
19State Police. The rulemaking authority granted in this
20subsection (t) shall apply only to those rules adopted prior to
21July 1, 2016. The 24-month limitation on the adoption of
22emergency rules does not apply to rules adopted under this
23subsection (t). The adoption of emergency rules authorized by
24this subsection (t) is deemed to be necessary for the public
25interest, safety, and welfare.
26    (u) (t) In order to provide for the expeditious and timely

 

 

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1implementation of the provisions of the Burn Victims Relief
2Act, emergency rules to implement any provision of the Act may
3be adopted in accordance with this subsection (u) (t) by the
4Department of Insurance. The rulemaking authority granted in
5this subsection (u) (t) shall apply only to those rules adopted
6prior to December 31, 2015. The adoption of emergency rules
7authorized by this subsection (u) (t) is deemed to be necessary
8for the public interest, safety, and welfare.
9    (v) In order to provide for the expeditious and timely
10implementation of the provisions of this amendatory Act of the
1199th General Assembly, emergency rules to implement this
12amendatory Act of the 99th General Assembly may be adopted in
13accordance with this subsection (v) by the Department of
14Healthcare and Family Services. The 24-month limitation on the
15adoption of emergency rules does not apply to rules adopted
16under this subsection (v). The adoption of emergency rules
17authorized by this subsection (v) is deemed to be necessary for
18the public interest, safety, and welfare.
19(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
2098-651, eff. 6-16-14; 99-2, eff. 3-26-15; 99-6, eff. 1-1-16;
2199-143, eff. 7-27-15; 99-455, eff. 1-1-16; revised 10-15-15.)
 
22    Section 10. The State Finance Act is amended by changing
23Section 6z-81 as follows:
 
24    (30 ILCS 105/6z-81)

 

 

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1    Sec. 6z-81. Healthcare Provider Relief Fund.
2    (a) There is created in the State treasury a special fund
3to be known as the Healthcare Provider Relief Fund.
4    (b) The Fund is created for the purpose of receiving and
5disbursing moneys in accordance with this Section.
6Disbursements from the Fund shall be made only as follows:
7        (1) Subject to appropriation, for payment by the
8    Department of Healthcare and Family Services or by the
9    Department of Human Services of medical bills and related
10    expenses, including administrative expenses, for which the
11    State is responsible under Titles XIX and XXI of the Social
12    Security Act, the Illinois Public Aid Code, the Children's
13    Health Insurance Program Act, the Covering ALL KIDS Health
14    Insurance Act, and the Long Term Acute Care Hospital
15    Quality Improvement Transfer Program Act.
16        (2) For repayment of funds borrowed from other State
17    funds or from outside sources, including interest thereon.
18        (3) For State fiscal years 2017 and 2018, for making
19    payments to the human poison control center pursuant to
20    Section 12-4.105 of the Illinois Public Aid Code.
21    (c) The Fund shall consist of the following:
22        (1) Moneys received by the State from short-term
23    borrowing pursuant to the Short Term Borrowing Act on or
24    after the effective date of this amendatory Act of the 96th
25    General Assembly.
26        (2) All federal matching funds received by the Illinois

 

 

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1    Department of Healthcare and Family Services as a result of
2    expenditures made by the Department that are attributable
3    to moneys deposited in the Fund.
4        (3) All federal matching funds received by the Illinois
5    Department of Healthcare and Family Services as a result of
6    federal approval of Title XIX State plan amendment
7    transmittal number 07-09.
8        (4) All other moneys received for the Fund from any
9    other source, including interest earned thereon.
10        (5) All federal matching funds received by the Illinois
11    Department of Healthcare and Family Services as a result of
12    expenditures made by the Department for Medical Assistance
13    from the General Revenue Fund, the Tobacco Settlement
14    Recovery Fund, the Long-Term Care Provider Fund, and the
15    Drug Rebate Fund related to individuals eligible for
16    medical assistance pursuant to the Patient Protection and
17    Affordable Care Act (P.L. 111-148) and Section 5-2 of the
18    Illinois Public Aid Code.
19    (d) In addition to any other transfers that may be provided
20for by law, on the effective date of this amendatory Act of the
2197th General Assembly, or as soon thereafter as practical, the
22State Comptroller shall direct and the State Treasurer shall
23transfer the sum of $365,000,000 from the General Revenue Fund
24into the Healthcare Provider Relief Fund.
25    (e) In addition to any other transfers that may be provided
26for by law, on July 1, 2011, or as soon thereafter as

 

 

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1practical, the State Comptroller shall direct and the State
2Treasurer shall transfer the sum of $160,000,000 from the
3General Revenue Fund to the Healthcare Provider Relief Fund.
4    (f) Notwithstanding any other State law to the contrary,
5and in addition to any other transfers that may be provided for
6by law, the State Comptroller shall order transferred and the
7State Treasurer shall transfer $500,000,000 to the Healthcare
8Provider Relief Fund from the General Revenue Fund in equal
9monthly installments of $100,000,000, with the first transfer
10to be made on July 1, 2012, or as soon thereafter as practical,
11and with each of the remaining transfers to be made on August
121, 2012, September 1, 2012, October 1, 2012, and November 1,
132012, or as soon thereafter as practical. This transfer may
14assist the Department of Healthcare and Family Services in
15improving Medical Assistance bill processing timeframes or in
16meeting the possible requirements of Senate Bill 3397, or other
17similar legislation, of the 97th General Assembly should it
18become law.
19    (g) Notwithstanding any other State law to the contrary,
20and in addition to any other transfers that may be provided for
21by law, on July 1, 2013, or as soon thereafter as may be
22practical, the State Comptroller shall direct and the State
23Treasurer shall transfer the sum of $601,000,000 from the
24General Revenue Fund to the Healthcare Provider Relief Fund.
25(Source: P.A. 97-44, eff. 6-28-11; 97-641, eff. 12-19-11;
2697-689, eff. 6-14-12; 97-732, eff. 6-30-12; 98-24, eff.

 

 

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16-19-13; 98-463, eff. 8-16-13.)
 
2    Section 15. The Illinois Public Aid Code is amended by
3changing Sections 5A-2, 5A-8, 5A-12.2, and 5A-12.5 and by
4adding Section 12-4.105 as follows:
 
5    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
6    (Section scheduled to be repealed on July 1, 2018)
7    Sec. 5A-2. Assessment.
8    (a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
9years 2009 through 2018, an annual assessment on inpatient
10services is imposed on each hospital provider in an amount
11equal to $218.38 multiplied by the difference of the hospital's
12occupied bed days less the hospital's Medicare bed days,
13provided, however, that the amount of $218.38 shall be
14increased by a uniform percentage to generate an amount equal
15to 75% of the State share of the payments authorized under
16Section 5A-12.5 Section 12-5, with such increase only taking
17effect upon the date that a State share for such payments is
18required under federal law. For the period of April through
19June 2015, the amount of $218.38 used to calculate the
20assessment under this paragraph shall, by emergency rule under
21subsection (s) of Section 5-45 of the Illinois Administrative
22Procedure Act, be increased by a uniform percentage to generate
23$20,250,000 in the aggregate for that period from all hospitals
24subject to the annual assessment under this paragraph.

 

 

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1    (2) In addition to any other assessments imposed under this
2Article, effective July 1, 2016 and semi-annually thereafter
3through June 2018, in addition to any federally required State
4share as authorized under paragraph (1), the amount of $218.38
5shall be increased by a uniform percentage to generate an
6amount equal to 75% of the ACA Assessment Adjustment, as
7defined in subsection (b-6) of this Section.
8    For State fiscal years 2009 through 2014 and after, a
9hospital's occupied bed days and Medicare bed days shall be
10determined using the most recent data available from each
11hospital's 2005 Medicare cost report as contained in the
12Healthcare Cost Report Information System file, for the quarter
13ending on December 31, 2006, without regard to any subsequent
14adjustments or changes to such data. If a hospital's 2005
15Medicare cost report is not contained in the Healthcare Cost
16Report Information System, then the Illinois Department may
17obtain the hospital provider's occupied bed days and Medicare
18bed days from any source available, including, but not limited
19to, records maintained by the hospital provider, which may be
20inspected at all times during business hours of the day by the
21Illinois Department or its duly authorized agents and
22employees.
23    (b) (Blank).
24    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
25portion of State fiscal year 2012, beginning June 10, 2012
26through June 30, 2012, and for State fiscal years 2013 through

 

 

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12018, an annual assessment on outpatient services is imposed on
2each hospital provider in an amount equal to .008766 multiplied
3by the hospital's outpatient gross revenue, provided, however,
4that the amount of .008766 shall be increased by a uniform
5percentage to generate an amount equal to 25% of the State
6share of the payments authorized under Section 5A-12.5 Section
712-5, with such increase only taking effect upon the date that
8a State share for such payments is required under federal law.
9For the period beginning June 10, 2012 through June 30, 2012,
10the annual assessment on outpatient services shall be prorated
11by multiplying the assessment amount by a fraction, the
12numerator of which is 21 days and the denominator of which is
13365 days. For the period of April through June 2015, the amount
14of .008766 used to calculate the assessment under this
15paragraph shall, by emergency rule under subsection (s) of
16Section 5-45 of the Illinois Administrative Procedure Act, be
17increased by a uniform percentage to generate $6,750,000 in the
18aggregate for that period from all hospitals subject to the
19annual assessment under this paragraph.
20    (2) In addition to any other assessments imposed under this
21Article, effective July 1, 2016 and semi-annually thereafter
22through June 2018, in addition to any federally required State
23share as authorized under paragraph (1), the amount of .008766
24shall be increased by a uniform percentage to generate an
25amount equal to 25% of the ACA Assessment Adjustment, as
26defined in subsection (b-6) of this Section.

 

 

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1    For the portion of State fiscal year 2012, beginning June
210, 2012 through June 30, 2012, and State fiscal years 2013
3through 2018, a hospital's outpatient gross revenue shall be
4determined using the most recent data available from each
5hospital's 2009 Medicare cost report as contained in the
6Healthcare Cost Report Information System file, for the quarter
7ending on June 30, 2011, without regard to any subsequent
8adjustments or changes to such data. If a hospital's 2009
9Medicare cost report is not contained in the Healthcare Cost
10Report Information System, then the Department may obtain the
11hospital provider's outpatient gross revenue from any source
12available, including, but not limited to, records maintained by
13the hospital provider, which may be inspected at all times
14during business hours of the day by the Department or its duly
15authorized agents and employees.
16    (b-6)(1) As used in this Section, "ACA Assessment
17Adjustment" means:
18        (A) For the period of July 1, 2016 through December 31,
19    2016, the product of .19125 multiplied by the sum of the
20    fee-for-service payments to hospitals as authorized under
21    Section 5A-12.5 and the adjustments authorized under
22    subsection (t) of Section 5A-12.2 to managed care
23    organizations for hospital services due and payable in the
24    month of April 2016 multiplied by 6.
25        (B) For the period of January 1, 2017 through June 30,
26    2017, the product of .19125 multiplied by the sum of the

 

 

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

 

 

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1        (D) For the period of January 1, 2018 through June 30,
2    2018, the product of .19125 multiplied by the sum of the
3    fee-for-service payments to hospitals as authorized under
4    Section 5A-12.5 and the adjustments authorized under
5    subsection (t) of Section 5A-12.2 to managed care
6    organizations for hospital services due and payable in the
7    month of October 2017 multiplied by 6, except that:
8            (i) the amount calculated under this subparagraph
9        (D) shall be adjusted, either positively or
10        negatively, to account for the difference between the
11        actual payments issued under Section 5A-12.5 for the
12        period of July 1, 2017 through December 31, 2017 and
13        the estimated payments due and payable in the month of
14        April 2017 multiplied by 6 as described in subparagraph
15        (C); and
16            (ii) the amount calculated under this subparagraph
17        (D) shall be adjusted to include the product of .19125
18        multiplied by the sum of the fee-for-service payments,
19        if any, estimated to be paid to hospitals under
20        subsection (b) of Section 5A-12.5.
21    (2) The Department shall complete and apply a final
22reconciliation of the ACA Assessment Adjustment prior to June
2330, 2018 to account for:
24        (A) any differences between the actual payments issued
25    or scheduled to be issued prior to June 30, 2018 as
26    authorized in Section 5A-12.5 for the period of January 1,

 

 

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1    2018 through June 30, 2018 and the estimated payments due
2    and payable in the month of October 2017 multiplied by 6 as
3    described in subparagraph (D); and
4        (B) any difference between the estimated
5    fee-for-service payments under subsection (b) of Section
6    5A-12.5 and the amount of such payments that are actually
7    scheduled to be paid.
8    The Department shall notify hospitals of any additional
9amounts owed or reduction credits to be applied to the June
102018 ACA Assessment Adjustment. This is to be considered the
11final reconciliation for the ACA Assessment Adjustment.
12    (3) Notwithstanding any other provision of this Section, if
13for any reason the scheduled payments under subsection (b) of
14Section 5A-12.5 are not issued in full by the final day of the
15period authorized under subsection (b) of Section 5A-12.5,
16funds collected from each hospital pursuant to subparagraph (D)
17of paragraph (1) and pursuant to paragraph (2), attributable to
18the scheduled payments authorized under subsection (b) of
19Section 5A-12.5 that are not issued in full by the final day of
20the period attributable to each payment authorized under
21subsection (b) of Section 5A-12.5, shall be refunded.
22    (4) The increases authorized under paragraph (2) of
23subsection (a) and paragraph (2) of subsection (b-5) shall be
24limited to the federally required State share of the total
25payments authorized under Section 5A-12.5 if the sum of such
26payments yields an annualized amount equal to or less than

 

 

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1$450,000,000, or if the adjustments authorized under
2subsection (t) of Section 5A-12.2 are found not to be
3actuarially sound; however, this limitation shall not apply to
4the fee-for-service payments described in subsection (b) of
5Section 5A-12.5.
6    (c) (Blank).
7    (d) Notwithstanding any of the other provisions of this
8Section, the Department is authorized to adopt rules to reduce
9the rate of any annual assessment imposed under this Section,
10as authorized by Section 5-46.2 of the Illinois Administrative
11Procedure Act.
12    (e) Notwithstanding any other provision of this Section,
13any plan providing for an assessment on a hospital provider as
14a permissible tax under Title XIX of the federal Social
15Security Act and Medicaid-eligible payments to hospital
16providers from the revenues derived from that assessment shall
17be reviewed by the Illinois Department of Healthcare and Family
18Services, as the Single State Medicaid Agency required by
19federal law, to determine whether those assessments and
20hospital provider payments meet federal Medicaid standards. If
21the Department determines that the elements of the plan may
22meet federal Medicaid standards and a related State Medicaid
23Plan Amendment is prepared in a manner and form suitable for
24submission, that State Plan Amendment shall be submitted in a
25timely manner for review by the Centers for Medicare and
26Medicaid Services of the United States Department of Health and

 

 

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1Human Services and subject to approval by the Centers for
2Medicare and Medicaid Services of the United States Department
3of Health and Human Services. No such plan shall become
4effective without approval by the Illinois General Assembly by
5the enactment into law of related legislation. Notwithstanding
6any other provision of this Section, the Department is
7authorized to adopt rules to reduce the rate of any annual
8assessment imposed under this Section. Any such rules may be
9adopted by the Department under Section 5-50 of the Illinois
10Administrative Procedure Act.
11(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2,
12eff. 3-26-15.)
 
13    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
14    Sec. 5A-8. Hospital Provider Fund.
15    (a) There is created in the State Treasury the Hospital
16Provider Fund. Interest earned by the Fund shall be credited to
17the Fund. The Fund shall not be used to replace any moneys
18appropriated to the Medicaid program by the General Assembly.
19    (b) The Fund is created for the purpose of receiving moneys
20in accordance with Section 5A-6 and disbursing moneys only for
21the following purposes, notwithstanding any other provision of
22law:
23        (1) For making payments to hospitals as required under
24    this Code, under the Children's Health Insurance Program
25    Act, under the Covering ALL KIDS Health Insurance Act, and

 

 

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

 

 

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

 

 

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1    fiscal year:
2            Health Care Provider Relief Fund.....$100,000,000
3        Transfers under this paragraph shall be made within 7
4    days after the payments have been received pursuant to the
5    schedule of payments provided in subsection (a) of Section
6    5A-4.
7        The additional amount of transfers in this paragraph
8    (7.10), authorized by Public Act 98-651, shall be made
9    within 10 State business days after June 16, 2014 (the
10    effective date of Public Act 98-651). That authority shall
11    remain in effect even if Public Act 98-651 does not become
12    law until State fiscal year 2015.
13        (7.10a) For State fiscal years 2015 through 2018, for
14    making transfers of the moneys resulting from the
15    assessment under subsection (b-5) of Section 5A-2 and
16    received from hospital providers under Section 5A-4 and
17    transferred into the Hospital Provider Fund under Section
18    5A-6 to the designated funds not exceeding the following
19    amounts related to each State fiscal year:
20            Health Care Provider Relief Fund ....$50,000,000
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        (7.11) (Blank).
26        (7.12) For State fiscal year 2013, for increasing by

 

 

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1    21/365ths the transfer of the moneys resulting from the
2    assessment under subsection (b-5) of Section 5A-2 and
3    received from hospital providers under Section 5A-4 for the
4    portion of State fiscal year 2012 beginning June 10, 2012
5    through June 30, 2012 and transferred into the Hospital
6    Provider Fund under Section 5A-6 to the designated funds
7    not exceeding the following amounts in that State fiscal
8    year:
9            Health Care Provider Relief Fund......$2,870,000
10        Since the federal Centers for Medicare and Medicaid
11    Services approval of the assessment authorized under
12    subsection (b-5) of Section 5A-2, received from hospital
13    providers under Section 5A-4 and the payment methodologies
14    to hospitals required under Section 5A-12.4 was not
15    received by the Department until State fiscal year 2014 and
16    since the Department made retroactive payments during
17    State fiscal year 2014 related to the referenced period of
18    June 2012, the transfer authority granted in this paragraph
19    (7.12) is extended through the date that is 10 State
20    business days after June 16, 2014 (the effective date of
21    Public Act 98-651).
22        (7.13) In addition to any other transfers authorized
23    under this Section, for State fiscal years 2017 and 2018,
24    for making transfers to the Healthcare Provider Relief Fund
25    of moneys collected from the ACA Assessment Adjustment
26    authorized under subsections (a) and (b-5) of Section 5A-2

 

 

HB4678 Enrolled- 29 -LRB099 17926 RJF 42288 b

1    and paid by hospital providers under Section 5A-4 into the
2    Hospital Provider Fund under Section 5A-6 for each State
3    fiscal year. Timing of transfers to the Healthcare Provider
4    Relief Fund under this paragraph shall be at the discretion
5    of the Department, but no less frequently than quarterly.
6        (8) For making refunds to hospital providers pursuant
7    to Section 5A-10.
8        (9) For making payment to capitated managed care
9    organizations as described in subsections (s) and (t) of
10    Section 5A-12.2 of this Code.
11    Disbursements from the Fund, other than transfers
12authorized under paragraphs (5) and (6) of this subsection,
13shall be by warrants drawn by the State Comptroller upon
14receipt of vouchers duly executed and certified by the Illinois
15Department.
16    (c) The Fund shall consist of the following:
17        (1) All moneys collected or received by the Illinois
18    Department from the hospital provider assessment imposed
19    by this Article.
20        (2) All federal matching funds received by the Illinois
21    Department as a result of expenditures made by the Illinois
22    Department that are attributable to moneys deposited in the
23    Fund.
24        (3) Any interest or penalty levied in conjunction with
25    the administration of this Article.
26        (3.5) As applicable, proceeds from surety bond

 

 

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1    payments payable to the Department as referenced in
2    subsection (s) of Section 5A-12.2 of this Code.
3        (4) Moneys transferred from another fund in the State
4    treasury.
5        (5) All other moneys received for the Fund from any
6    other source, including interest earned thereon.
7    (d) (Blank).
8(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
998-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
107-20-15.)
 
11    (305 ILCS 5/5A-12.2)
12    (Section scheduled to be repealed on July 1, 2018)
13    Sec. 5A-12.2. Hospital access payments on or after July 1,
142008.
15    (a) To preserve and improve access to hospital services,
16for hospital services rendered on or after July 1, 2008, the
17Illinois Department shall, except for hospitals described in
18subsection (b) of Section 5A-3, make payments to hospitals as
19set forth in this Section. These payments shall be paid in 12
20equal installments on or before the seventh State business day
21of each month, except that no payment shall be due within 100
22days after the later of the date of notification of federal
23approval of the payment methodologies required under this
24Section or any waiver required under 42 CFR 433.68, at which
25time the sum of amounts required under this Section prior to

 

 

HB4678 Enrolled- 31 -LRB099 17926 RJF 42288 b

1the date of notification is due and payable. Payments under
2this Section are not due and payable, however, until (i) the
3methodologies described in this Section are approved by the
4federal government in an appropriate State Plan amendment and
5(ii) the assessment imposed under this Article is determined to
6be a permissible tax under Title XIX of the Social Security
7Act.
8    (a-5) The Illinois Department may, when practicable,
9accelerate the schedule upon which payments authorized under
10this Section are made.
11    (b) Across-the-board inpatient adjustment.
12        (1) In addition to rates paid for inpatient hospital
13    services, the Department shall pay to each Illinois general
14    acute care hospital an amount equal to 40% of the total
15    base inpatient payments paid to the hospital for services
16    provided in State fiscal year 2005.
17        (2) In addition to rates paid for inpatient hospital
18    services, the Department shall pay to each freestanding
19    Illinois specialty care hospital as defined in 89 Ill. Adm.
20    Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
21    the total base inpatient payments paid to the hospital for
22    services provided in State fiscal year 2005.
23        (3) In addition to rates paid for inpatient hospital
24    services, the Department shall pay to each freestanding
25    Illinois rehabilitation or psychiatric hospital an amount
26    equal to $1,000 per Medicaid inpatient day multiplied by

 

 

HB4678 Enrolled- 32 -LRB099 17926 RJF 42288 b

1    the increase in the hospital's Medicaid inpatient
2    utilization ratio (determined using the positive
3    percentage change from the rate year 2005 Medicaid
4    inpatient utilization ratio to the rate year 2007 Medicaid
5    inpatient utilization ratio, as calculated by the
6    Department for the disproportionate share determination).
7        (4) In addition to rates paid for inpatient hospital
8    services, the Department shall pay to each Illinois
9    children's hospital an amount equal to 20% of the total
10    base inpatient payments paid to the hospital for services
11    provided in State fiscal year 2005 and an additional amount
12    equal to 20% of the base inpatient payments paid to the
13    hospital for psychiatric services provided in State fiscal
14    year 2005.
15        (5) In addition to rates paid for inpatient hospital
16    services, the Department shall pay to each Illinois
17    hospital eligible for a pediatric inpatient adjustment
18    payment under 89 Ill. Adm. Code 148.298, as in effect for
19    State fiscal year 2007, a supplemental pediatric inpatient
20    adjustment payment equal to:
21            (i) For freestanding children's hospitals as
22        defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5
23        multiplied by the hospital's pediatric inpatient
24        adjustment payment required under 89 Ill. Adm. Code
25        148.298, as in effect for State fiscal year 2008.
26            (ii) For hospitals other than freestanding

 

 

HB4678 Enrolled- 33 -LRB099 17926 RJF 42288 b

1        children's hospitals as defined in 89 Ill. Adm. Code
2        149.50(c)(3)(B), 1.0 multiplied by the hospital's
3        pediatric inpatient adjustment payment required under
4        89 Ill. Adm. Code 148.298, as in effect for State
5        fiscal year 2008.
6    (c) Outpatient adjustment.
7        (1) In addition to the rates paid for outpatient
8    hospital services, the Department shall pay each Illinois
9    hospital an amount equal to 2.2 multiplied by the
10    hospital's ambulatory procedure listing payments for
11    categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
12    148.140(b), for State fiscal year 2005.
13        (2) In addition to the rates paid for outpatient
14    hospital services, the Department shall pay each Illinois
15    freestanding psychiatric hospital an amount equal to 3.25
16    multiplied by the hospital's ambulatory procedure listing
17    payments for category 5b, as defined in 89 Ill. Adm. Code
18    148.140(b)(1)(E), for State fiscal year 2005.
19    (d) Medicaid high volume adjustment. In addition to rates
20paid for inpatient hospital services, the Department shall pay
21to each Illinois general acute care hospital that provided more
22than 20,500 Medicaid inpatient days of care in State fiscal
23year 2005 amounts as follows:
24        (1) For hospitals with a case mix index equal to or
25    greater than the 85th percentile of hospital case mix
26    indices, $350 for each Medicaid inpatient day of care

 

 

HB4678 Enrolled- 34 -LRB099 17926 RJF 42288 b

1    provided during that period; and
2        (2) For hospitals with a case mix index less than the
3    85th percentile of hospital case mix indices, $100 for each
4    Medicaid inpatient day of care provided during that period.
5    (e) Capital adjustment. In addition to rates paid for
6inpatient hospital services, the Department shall pay an
7additional payment to each Illinois general acute care hospital
8that has a Medicaid inpatient utilization rate of at least 10%
9(as calculated by the Department for the rate year 2007
10disproportionate share determination) amounts as follows:
11        (1) For each Illinois general acute care hospital that
12    has a Medicaid inpatient utilization rate of at least 10%
13    and less than 36.94% and whose capital cost is less than
14    the 60th percentile of the capital costs of all Illinois
15    hospitals, the amount of such payment shall equal the
16    hospital's Medicaid inpatient days multiplied by the
17    difference between the capital costs at the 60th percentile
18    of the capital costs of all Illinois hospitals and the
19    hospital's capital costs.
20        (2) For each Illinois general acute care hospital that
21    has a Medicaid inpatient utilization rate of at least
22    36.94% and whose capital cost is less than the 75th
23    percentile of the capital costs of all Illinois hospitals,
24    the amount of such payment shall equal the hospital's
25    Medicaid inpatient days multiplied by the difference
26    between the capital costs at the 75th percentile of the

 

 

HB4678 Enrolled- 35 -LRB099 17926 RJF 42288 b

1    capital costs of all Illinois hospitals and the hospital's
2    capital costs.
3    (f) Obstetrical care adjustment.
4        (1) In addition to rates paid for inpatient hospital
5    services, the Department shall pay $1,500 for each Medicaid
6    obstetrical day of care provided in State fiscal year 2005
7    by each Illinois rural hospital that had a Medicaid
8    obstetrical percentage (Medicaid obstetrical days divided
9    by Medicaid inpatient days) greater than 15% for State
10    fiscal year 2005.
11        (2) In addition to rates paid for inpatient hospital
12    services, the Department shall pay $1,350 for each Medicaid
13    obstetrical day of care provided in State fiscal year 2005
14    by each Illinois general acute care hospital that was
15    designated a level III perinatal center as of December 31,
16    2006, and that had a case mix index equal to or greater
17    than the 45th percentile of the case mix indices for all
18    level III perinatal centers.
19        (3) In addition to rates paid for inpatient hospital
20    services, the Department shall pay $900 for each Medicaid
21    obstetrical day of care provided in State fiscal year 2005
22    by each Illinois general acute care hospital that was
23    designated a level II or II+ perinatal center as of
24    December 31, 2006, and that had a case mix index equal to
25    or greater than the 35th percentile of the case mix indices
26    for all level II and II+ perinatal centers.

 

 

HB4678 Enrolled- 36 -LRB099 17926 RJF 42288 b

1    (g) Trauma adjustment.
2        (1) In addition to rates paid for inpatient hospital
3    services, the Department shall pay each Illinois general
4    acute care hospital designated as a trauma center as of
5    July 1, 2007, a payment equal to 3.75 multiplied by the
6    hospital's State fiscal year 2005 Medicaid capital
7    payments.
8        (2) In addition to rates paid for inpatient hospital
9    services, the Department shall pay $400 for each Medicaid
10    acute inpatient day of care provided in State fiscal year
11    2005 by each Illinois general acute care hospital that was
12    designated a level II trauma center, as defined in 89 Ill.
13    Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
14    2007.
15        (3) In addition to rates paid for inpatient hospital
16    services, the Department shall pay $235 for each Illinois
17    Medicaid acute inpatient day of care provided in State
18    fiscal year 2005 by each level I pediatric trauma center
19    located outside of Illinois that had more than 8,000
20    Illinois Medicaid inpatient days in State fiscal year 2005.
21    (h) Supplemental tertiary care adjustment. In addition to
22rates paid for inpatient services, the Department shall pay to
23each Illinois hospital eligible for tertiary care adjustment
24payments under 89 Ill. Adm. Code 148.296, as in effect for
25State fiscal year 2007, a supplemental tertiary care adjustment
26payment equal to the tertiary care adjustment payment required

 

 

HB4678 Enrolled- 37 -LRB099 17926 RJF 42288 b

1under 89 Ill. Adm. Code 148.296, as in effect for State fiscal
2year 2007.
3    (i) Crossover adjustment. In addition to rates paid for
4inpatient services, the Department shall pay each Illinois
5general acute care hospital that had a ratio of crossover days
6to total inpatient days for medical assistance programs
7administered by the Department (utilizing information from
82005 paid claims) greater than 50%, and a case mix index
9greater than the 65th percentile of case mix indices for all
10Illinois hospitals, a rate of $1,125 for each Medicaid
11inpatient day including crossover days.
12    (j) Magnet hospital adjustment. In addition to rates paid
13for inpatient hospital services, the Department shall pay to
14each Illinois general acute care hospital and each Illinois
15freestanding children's hospital that, as of February 1, 2008,
16was recognized as a Magnet hospital by the American Nurses
17Credentialing Center and that had a case mix index greater than
18the 75th percentile of case mix indices for all Illinois
19hospitals amounts as follows:
20        (1) For hospitals located in a county whose eligibility
21    growth factor is greater than the mean, $450 multiplied by
22    the eligibility growth factor for the county in which the
23    hospital is located for each Medicaid inpatient day of care
24    provided by the hospital during State fiscal year 2005.
25        (2) For hospitals located in a county whose eligibility
26    growth factor is less than or equal to the mean, $225

 

 

HB4678 Enrolled- 38 -LRB099 17926 RJF 42288 b

1    multiplied by the eligibility growth factor for the county
2    in which the hospital is located for each Medicaid
3    inpatient day of care provided by the hospital during State
4    fiscal year 2005.
5    For purposes of this subsection, "eligibility growth
6factor" means the percentage by which the number of Medicaid
7recipients in the county increased from State fiscal year 1998
8to State fiscal year 2005.
9    (k) For purposes of this Section, a hospital that is
10enrolled to provide Medicaid services during State fiscal year
112005 shall have its utilization and associated reimbursements
12annualized prior to the payment calculations being performed
13under this Section.
14    (l) For purposes of this Section, the terms "Medicaid
15days", "ambulatory procedure listing services", and
16"ambulatory procedure listing payments" do not include any
17days, charges, or services for which Medicare or a managed care
18organization reimbursed on a capitated basis was liable for
19payment, except where explicitly stated otherwise in this
20Section.
21    (m) For purposes of this Section, in determining the
22percentile ranking of an Illinois hospital's case mix index or
23capital costs, hospitals described in subsection (b) of Section
245A-3 shall be excluded from the ranking.
25    (n) Definitions. Unless the context requires otherwise or
26unless provided otherwise in this Section, the terms used in

 

 

HB4678 Enrolled- 39 -LRB099 17926 RJF 42288 b

1this Section for qualifying criteria and payment calculations
2shall have the same meanings as those terms have been given in
3the Illinois Department's administrative rules as in effect on
4March 1, 2008. Other terms shall be defined by the Illinois
5Department by rule.
6    As used in this Section, unless the context requires
7otherwise:
8    "Base inpatient payments" means, for a given hospital, the
9sum of base payments for inpatient services made on a per diem
10or per admission (DRG) basis, excluding those portions of per
11admission payments that are classified as capital payments.
12Disproportionate share hospital adjustment payments, Medicaid
13Percentage Adjustments, Medicaid High Volume Adjustments, and
14outlier payments, as defined by rule by the Department as of
15January 1, 2008, are not base payments.
16    "Capital costs" means, for a given hospital, the total
17capital costs determined using the most recent 2005 Medicare
18cost report as contained in the Healthcare Cost Report
19Information System file, for the quarter ending on December 31,
202006, divided by the total inpatient days from the same cost
21report to calculate a capital cost per day. The resulting
22capital cost per day is inflated to the midpoint of State
23fiscal year 2009 utilizing the national hospital market price
24proxies (DRI) hospital cost index. If a hospital's 2005
25Medicare cost report is not contained in the Healthcare Cost
26Report Information System, the Department may obtain the data

 

 

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1necessary to compute the hospital's capital costs from any
2source available, including, but not limited to, records
3maintained by the hospital provider, which may be inspected at
4all times during business hours of the day by the Illinois
5Department or its duly authorized agents and employees.
6    "Case mix index" means, for a given hospital, the sum of
7the DRG relative weighting factors in effect on January 1,
82005, for all general acute care admissions for State fiscal
9year 2005, excluding Medicare crossover admissions and
10transplant admissions reimbursed under 89 Ill. Adm. Code
11148.82, divided by the total number of general acute care
12admissions for State fiscal year 2005, excluding Medicare
13crossover admissions and transplant admissions reimbursed
14under 89 Ill. Adm. Code 148.82.
15    "Medicaid inpatient day" means, for a given hospital, the
16sum of days of inpatient hospital days provided to recipients
17of medical assistance under Title XIX of the federal Social
18Security Act, excluding days for individuals eligible for
19Medicare under Title XVIII of that Act (Medicaid/Medicare
20crossover days), as tabulated from the Department's paid claims
21data for admissions occurring during State fiscal year 2005
22that was adjudicated by the Department through March 23, 2007.
23    "Medicaid obstetrical day" means, for a given hospital, the
24sum of days of inpatient hospital days grouped by the
25Department to DRGs of 370 through 375 provided to recipients of
26medical assistance under Title XIX of the federal Social

 

 

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1Security Act, excluding days for individuals eligible for
2Medicare under Title XVIII of that Act (Medicaid/Medicare
3crossover days), as tabulated from the Department's paid claims
4data for admissions occurring during State fiscal year 2005
5that was adjudicated by the Department through March 23, 2007.
6    "Outpatient ambulatory procedure listing payments" means,
7for a given hospital, the sum of payments for ambulatory
8procedure listing services, as described in 89 Ill. Adm. Code
9148.140(b), provided to recipients of medical assistance under
10Title XIX of the federal Social Security Act, excluding
11payments for individuals eligible for Medicare under Title
12XVIII of the Act (Medicaid/Medicare crossover days), as
13tabulated from the Department's paid claims data for services
14occurring in State fiscal year 2005 that were adjudicated by
15the Department through March 23, 2007.
16    (o) The Department may adjust payments made under this
17Section 5A-12.2 to comply with federal law or regulations
18regarding hospital-specific payment limitations on
19government-owned or government-operated hospitals.
20    (p) Notwithstanding any of the other provisions of this
21Section, the Department is authorized to adopt rules that
22change the hospital access improvement payments specified in
23this Section, but only to the extent necessary to conform to
24any federally approved amendment to the Title XIX State plan.
25Any such rules shall be adopted by the Department as authorized
26by Section 5-50 of the Illinois Administrative Procedure Act.

 

 

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1Notwithstanding any other provision of law, any changes
2implemented as a result of this subsection (p) shall be given
3retroactive effect so that they shall be deemed to have taken
4effect as of the effective date of this Section.
5    (q) (Blank).
6    (r) 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    (s) On or after January 1, 2016 July 1, 2014, but no later
12than October 1, 2014, and no less than annually thereafter, the
13Department shall may increase capitation payments to capitated
14managed care organizations (MCOs) to equal the aggregate
15reduction of payments made in this Section and in Section
165A-12.4 by a uniform percentage on a regional basis to preserve
17access to hospital services for recipients under the Illinois
18Medical Assistance Program. The aggregate amount of all
19increased capitation payments to all MCOs for a fiscal year
20shall be the amount needed to avoid reduction in payments
21authorized under Section 5A-15. Payments to MCOs under this
22Section shall be consistent with actuarial certification and
23shall be published by the Department each year. Each MCO shall
24only expend the increased capitation payments it receives under
25this Section to support the availability of hospital services
26and to ensure access to hospital services, with such

 

 

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1expenditures being made within 15 calendar days from when the
2MCO receives the increased capitation payment. The Department
3shall make available, on a monthly basis, a report of the
4capitation payments that are made to each MCO pursuant to this
5subsection, including the number of enrollees for which such
6payment is made, the per enrollee amount of the payment, and
7any adjustments that have been made. Payments made under this
8subsection shall be guaranteed by a surety bond obtained by the
9MCO in an amount established by the Department to approximate
10one month's liability of payments authorized under this
11subsection. The Department may advance the payments guaranteed
12by the surety bond. Payments to MCOs that would be paid
13consistent with actuarial certification and enrollment in the
14absence of the increased capitation payments under this Section
15shall not be reduced as a consequence of payments made under
16this subsection.
17    As used in this subsection, "MCO" means an entity which
18contracts with the Department to provide services where payment
19for medical services is made on a capitated basis.
20    (t) On or after July 1, 2014, the Department may increase
21capitation payments to capitated managed care organizations
22(MCOs) to equal the aggregate reduction of payments made in
23Section 5A-12.5 to preserve access to hospital services for
24recipients under the Illinois Medical Assistance Program.
25Effective January 1, 2016, the Department shall increase
26capitation payments to MCOs to include the payments authorized

 

 

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1under Section 5A-12.5 to preserve access to hospital services
2for recipients under the Illinois Medical Assistance Program by
3ensuring that the reimbursement provided for Affordable Care
4Act adults enrolled in a MCO is equivalent to the reimbursement
5provided for Affordable Care Act adults enrolled in a
6fee-for-service program. Payments to MCOs under this Section
7shall be consistent with actuarial certification and federal
8approval (which may be retrospectively determined) and shall be
9published by the Department each year. Each MCO shall only
10expend the increased capitation payments it receives under this
11Section to support the availability of hospital services and to
12ensure access to hospital services, with such expenditures
13being made within 15 calendar days from when the MCO receives
14the increased capitation payment. Payments made under this
15subsection may be guaranteed by a surety bond obtained by the
16MCO in an amount established by the Department to approximate
17one month's liability of payments authorized under this
18subsection. The Department may advance the payments to
19hospitals under this subsection, in the event the MCO fails to
20make such payments. The Department shall make available, on a
21monthly basis, a report of the capitation payments that are
22made to each MCO pursuant to this subsection, including the
23number of enrollees for which such payment is made, the per
24enrollee amount of the payment, and any adjustments that have
25been made. Payments to MCOs that would be paid consistent with
26actuarial certification and enrollment in the absence of the

 

 

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1increased capitation payments under this subsection shall not
2be reduced as a consequence of payments made under this
3subsection.
4    As used in this subsection, "MCO" means an entity which
5contracts with the Department to provide services where payment
6for medical services is made on a capitated basis.
7(Source: P.A. 97-689, eff. 6-14-12; 98-651, eff. 6-16-14.)
 
8    (305 ILCS 5/5A-12.5)
9    Sec. 5A-12.5. Affordable Care Act adults; hospital access
10payments.
11    (a) The Department shall, subject to federal approval,
12mirror the Medical Assistance hospital reimbursement
13methodology for Affordable Care Act adults who are enrolled
14under a fee-for-service or capitated managed care program,
15including hospital access payments as defined in Section
165A-12.2 of this Article and hospital access improvement
17payments as defined in Section 5A-12.4 of this Article, in
18compliance with the equivalent rate provisions of the
19Affordable Care Act.
20    (b) If the fee-for-service payments authorized under this
21Section are deemed to be increases to payments for a prior
22period, the Department shall seek federal approval to issue
23such increases for the payments made through the period ending
24on June 30, 2018, even if such increases are paid out during an
25extended payment period beyond such date. Payment of such

 

 

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1increases beyond such date is subject to federal approval.
2    (c) As used in this Section, "Affordable Care Act" is the
3collective term for the Patient Protection and Affordable Care
4Act (Pub. L. 111-148) and the Health Care and Education
5Reconciliation Act of 2010 (Pub. L. 111-152).
6(Source: P.A. 98-651, eff. 6-16-14.)
 
7    (305 ILCS 5/12-4.105 new)
8    Sec. 12-4.105. Human poison control center; payment
9program. Subject to funding availability resulting from
10transfers made from the Hospital Provider Fund to the
11Healthcare Provider Relief Fund as authorized under this Code,
12for State fiscal year 2017 and State fiscal year 2018, the
13Department of Healthcare and Family Services shall pay to the
14human poison control center designated under the Poison Control
15System Act an amount of not less than $3,000,000 for each of
16those State fiscal years that the human poison control center
17is in operation.
 
18    Section 20. The Lead Poisoning Prevention Act is amended by
19changing Section 15.1 as follows:
 
20    (410 ILCS 45/15.1)
21    Sec. 15.1. Funding. Beginning July 1, 2014 and ending June
2230, 2015 2018, a hospital satisfying the definition, as of July
231, 2014, of Section 5-5e.1 of the Illinois Public Aid Code and

 

 

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1located in DuPage County shall pay the sum of $2,000,000
2annually in 4 equal quarterly installments to the human poison
3control center in existence as of July 1, 2014 and established
4under the authority of this Act.
5(Source: P.A. 98-651, eff. 6-16-14.)
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.