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Full Text of HB4678  99th General Assembly

HB4678sam001 99TH GENERAL ASSEMBLY

Sen. Heather A. Steans

Filed: 5/24/2016

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 4678

2    AMENDMENT NO. ______. Amend House Bill 4678 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1shall include the text of the emergency rule and shall be
2published in the Illinois Register. Consent orders or other
3court orders adopting settlements negotiated by an agency may
4be adopted under this Section. Subject to applicable
5constitutional or statutory provisions, an emergency rule
6becomes effective immediately upon filing under Section 5-65 or
7at a stated date less than 10 days thereafter. The agency's
8finding and a statement of the specific reasons for the finding
9shall be filed with the rule. The agency shall take reasonable
10and appropriate measures to make emergency rules known to the
11persons who may be affected by them.
12    (c) An emergency rule may be effective for a period of not
13longer than 150 days, but the agency's authority to adopt an
14identical rule under Section 5-40 is not precluded. No
15emergency rule may be adopted more than once in any 24 month
16period, except that this limitation on the number of emergency
17rules that may be adopted in a 24 month period does not apply
18to (i) emergency rules that make additions to and deletions
19from the Drug Manual under Section 5-5.16 of the Illinois
20Public Aid Code or the generic drug formulary under Section
213.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
22emergency rules adopted by the Pollution Control Board before
23July 1, 1997 to implement portions of the Livestock Management
24Facilities Act, (iii) emergency rules adopted by the Illinois
25Department of Public Health under subsections (a) through (i)
26of Section 2 of the Department of Public Health Act when

 

 

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1necessary to protect the public's health, (iv) emergency rules
2adopted pursuant to subsection (n) of this Section, (v)
3emergency rules adopted pursuant to subsection (o) of this
4Section, or (vi) emergency rules adopted pursuant to subsection
5(c-5) of this Section. Two or more emergency rules having
6substantially the same purpose and effect shall be deemed to be
7a single rule for purposes of this Section.
8    (c-5) To facilitate the maintenance of the program of group
9health benefits provided to annuitants, survivors, and retired
10employees under the State Employees Group Insurance Act of
111971, rules to alter the contributions to be paid by the State,
12annuitants, survivors, retired employees, or any combination
13of those entities, for that program of group health benefits,
14shall be adopted as emergency rules. The adoption of those
15rules shall be considered an emergency and necessary for the
16public interest, safety, and welfare.
17    (d) In order to provide for the expeditious and timely
18implementation of the State's fiscal year 1999 budget,
19emergency rules to implement any provision of Public Act 90-587
20or 90-588 or any other budget initiative for fiscal year 1999
21may be adopted in accordance with this Section by the agency
22charged with administering that provision or initiative,
23except that the 24-month limitation on the adoption of
24emergency rules and the provisions of Sections 5-115 and 5-125
25do not apply to rules adopted under this subsection (d). The
26adoption of emergency rules authorized by this subsection (d)

 

 

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1shall be deemed to be necessary for the public interest,
2safety, and welfare.
3    (e) In order to provide for the expeditious and timely
4implementation of the State's fiscal year 2000 budget,
5emergency rules to implement any provision of Public Act 91-24
6this amendatory Act of the 91st General Assembly or any other
7budget initiative for fiscal year 2000 may be adopted in
8accordance with this Section by the agency charged with
9administering that provision or initiative, except that the
1024-month limitation on the adoption of emergency rules and the
11provisions of Sections 5-115 and 5-125 do not apply to rules
12adopted under this subsection (e). The adoption of emergency
13rules authorized by this subsection (e) shall be deemed to be
14necessary for the public interest, safety, and welfare.
15    (f) In order to provide for the expeditious and timely
16implementation of the State's fiscal year 2001 budget,
17emergency rules to implement any provision of Public Act 91-712
18this amendatory Act of the 91st General Assembly or any other
19budget initiative for fiscal year 2001 may be adopted in
20accordance with this Section by the agency charged with
21administering that provision or initiative, except that the
2224-month limitation on the adoption of emergency rules and the
23provisions of Sections 5-115 and 5-125 do not apply to rules
24adopted under this subsection (f). The adoption of emergency
25rules authorized by this subsection (f) shall be deemed to be
26necessary for the public interest, safety, and welfare.

 

 

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1    (g) In order to provide for the expeditious and timely
2implementation of the State's fiscal year 2002 budget,
3emergency rules to implement any provision of Public Act 92-10
4this amendatory Act of the 92nd General Assembly or any other
5budget initiative for fiscal year 2002 may be adopted in
6accordance with this Section by the agency charged with
7administering that provision or initiative, except that the
824-month limitation on the adoption of emergency rules and the
9provisions of Sections 5-115 and 5-125 do not apply to rules
10adopted under this subsection (g). The adoption of emergency
11rules authorized by this subsection (g) shall be deemed to be
12necessary for the public interest, safety, and welfare.
13    (h) In order to provide for the expeditious and timely
14implementation of the State's fiscal year 2003 budget,
15emergency rules to implement any provision of Public Act 92-597
16this amendatory Act of the 92nd General Assembly or any other
17budget initiative for fiscal year 2003 may be adopted in
18accordance with this Section by the agency charged with
19administering that provision or initiative, except that the
2024-month limitation on the adoption of emergency rules and the
21provisions of Sections 5-115 and 5-125 do not apply to rules
22adopted under this subsection (h). The adoption of emergency
23rules authorized by this subsection (h) shall be deemed to be
24necessary for the public interest, safety, and welfare.
25    (i) In order to provide for the expeditious and timely
26implementation of the State's fiscal year 2004 budget,

 

 

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1emergency rules to implement any provision of Public Act 93-20
2this amendatory Act of the 93rd General Assembly or any other
3budget initiative for fiscal year 2004 may be adopted in
4accordance with this Section by the agency charged with
5administering that provision or initiative, except that the
624-month limitation on the adoption of emergency rules and the
7provisions of Sections 5-115 and 5-125 do not apply to rules
8adopted under this subsection (i). The adoption of emergency
9rules authorized by this subsection (i) shall be deemed to be
10necessary for the public interest, safety, and welfare.
11    (j) In order to provide for the expeditious and timely
12implementation of the provisions of the State's fiscal year
132005 budget as provided under the Fiscal Year 2005 Budget
14Implementation (Human Services) Act, emergency rules to
15implement any provision of the Fiscal Year 2005 Budget
16Implementation (Human Services) Act may be adopted in
17accordance with this Section by the agency charged with
18administering that provision, except that the 24-month
19limitation on the adoption of emergency rules and the
20provisions of Sections 5-115 and 5-125 do not apply to rules
21adopted under this subsection (j). The Department of Public Aid
22may also adopt rules under this subsection (j) necessary to
23administer the Illinois Public Aid Code and the Children's
24Health Insurance Program Act. The adoption of emergency rules
25authorized by this subsection (j) shall be deemed to be
26necessary for the public interest, safety, and welfare.

 

 

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1    (k) In order to provide for the expeditious and timely
2implementation of the provisions of the State's fiscal year
32006 budget, emergency rules to implement any provision of
4Public Act 94-48 this amendatory Act of the 94th General
5Assembly or any other budget initiative for fiscal year 2006
6may be adopted in accordance with this Section by the agency
7charged with administering that provision or initiative,
8except that the 24-month limitation on the adoption of
9emergency rules and the provisions of Sections 5-115 and 5-125
10do not apply to rules adopted under this subsection (k). The
11Department of Healthcare and Family Services may also adopt
12rules under this subsection (k) necessary to administer the
13Illinois Public Aid Code, the Senior Citizens and Persons with
14Disabilities Property Tax Relief Act, the Senior Citizens and
15Disabled Persons Prescription Drug Discount Program Act (now
16the Illinois Prescription Drug Discount Program Act), and the
17Children's Health Insurance Program Act. The adoption of
18emergency rules authorized by this subsection (k) shall be
19deemed to be necessary for the public interest, safety, and
20welfare.
21    (l) In order to provide for the expeditious and timely
22implementation of the provisions of the State's fiscal year
232007 budget, the Department of Healthcare and Family Services
24may adopt emergency rules during fiscal year 2007, including
25rules effective July 1, 2007, in accordance with this
26subsection to the extent necessary to administer the

 

 

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1Department's responsibilities with respect to amendments to
2the State plans and Illinois waivers approved by the federal
3Centers for Medicare and Medicaid Services necessitated by the
4requirements of Title XIX and Title XXI of the federal Social
5Security Act. The adoption of emergency rules authorized by
6this subsection (l) shall be deemed to be necessary for the
7public interest, safety, and welfare.
8    (m) In order to provide for the expeditious and timely
9implementation of the provisions of the State's fiscal year
102008 budget, the Department of Healthcare and Family Services
11may adopt emergency rules during fiscal year 2008, including
12rules effective July 1, 2008, in accordance with this
13subsection to the extent necessary to administer the
14Department's responsibilities with respect to amendments to
15the State plans and Illinois waivers approved by the federal
16Centers for Medicare and Medicaid Services necessitated by the
17requirements of Title XIX and Title XXI of the federal Social
18Security Act. The adoption of emergency rules authorized by
19this subsection (m) shall be deemed to be necessary for the
20public interest, safety, and welfare.
21    (n) In order to provide for the expeditious and timely
22implementation of the provisions of the State's fiscal year
232010 budget, emergency rules to implement any provision of
24Public Act 96-45 this amendatory Act of the 96th General
25Assembly or any other budget initiative authorized by the 96th
26General Assembly for fiscal year 2010 may be adopted in

 

 

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1accordance with this Section by the agency charged with
2administering that provision or initiative. The adoption of
3emergency rules authorized by this subsection (n) shall be
4deemed to be necessary for the public interest, safety, and
5welfare. The rulemaking authority granted in this subsection
6(n) shall apply only to rules promulgated during Fiscal Year
72010.
8    (o) In order to provide for the expeditious and timely
9implementation of the provisions of the State's fiscal year
102011 budget, emergency rules to implement any provision of
11Public Act 96-958 this amendatory Act of the 96th General
12Assembly or any other budget initiative authorized by the 96th
13General Assembly for fiscal year 2011 may be adopted in
14accordance with this Section by the agency charged with
15administering that provision or initiative. The adoption of
16emergency rules authorized by this subsection (o) is deemed to
17be necessary for the public interest, safety, and welfare. The
18rulemaking authority granted in this subsection (o) applies
19only to rules promulgated on or after the effective date of
20Public Act 96-958 this amendatory Act of the 96th General
21Assembly through June 30, 2011.
22    (p) In order to provide for the expeditious and timely
23implementation of the provisions of Public Act 97-689,
24emergency rules to implement any provision of Public Act 97-689
25may be adopted in accordance with this subsection (p) by the
26agency charged with administering that provision or

 

 

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1initiative. The 150-day limitation of the effective period of
2emergency rules does not apply to rules adopted under this
3subsection (p), and the effective period may continue through
4June 30, 2013. The 24-month limitation on the adoption of
5emergency rules does not apply to rules adopted under this
6subsection (p). The adoption of emergency rules authorized by
7this subsection (p) is deemed to be necessary for the public
8interest, safety, and welfare.
9    (q) In order to provide for the expeditious and timely
10implementation of the provisions of Articles 7, 8, 9, 11, and
1112 of Public Act 98-104 this amendatory Act of the 98th General
12Assembly, emergency rules to implement any provision of
13Articles 7, 8, 9, 11, and 12 of Public Act 98-104 this
14amendatory Act of the 98th General Assembly may be adopted in
15accordance with this subsection (q) by the agency charged with
16administering that provision or initiative. The 24-month
17limitation on the adoption of emergency rules does not apply to
18rules adopted under this subsection (q). The adoption of
19emergency rules authorized by this subsection (q) is deemed to
20be necessary for the public interest, safety, and welfare.
21    (r) In order to provide for the expeditious and timely
22implementation of the provisions of Public Act 98-651 this
23amendatory Act of the 98th General Assembly, emergency rules to
24implement Public Act 98-651 this amendatory Act of the 98th
25General Assembly may be adopted in accordance with this
26subsection (r) by the Department of Healthcare and Family

 

 

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1Services. The 24-month limitation on the adoption of emergency
2rules does not apply to rules adopted under this subsection
3(r). The adoption of emergency rules authorized by this
4subsection (r) is deemed to be necessary for the public
5interest, safety, and welfare.
6    (s) In order to provide for the expeditious and timely
7implementation of the provisions of Sections 5-5b.1 and 5A-2 of
8the Illinois Public Aid Code, emergency rules to implement any
9provision of Section 5-5b.1 or Section 5A-2 of the Illinois
10Public Aid Code may be adopted in accordance with this
11subsection (s) by the Department of Healthcare and Family
12Services. The rulemaking authority granted in this subsection
13(s) shall apply only to those rules adopted prior to July 1,
142015. Notwithstanding any other provision of this Section, any
15emergency rule adopted under this subsection (s) shall only
16apply to payments made for State fiscal year 2015. The adoption
17of emergency rules authorized by this subsection (s) is deemed
18to be necessary for the public interest, safety, and welfare.
19    (t) In order to provide for the expeditious and timely
20implementation of the provisions of Article II of Public Act
2199-6 this amendatory Act of the 99th General Assembly,
22emergency rules to implement the changes made by Article II of
23Public Act 99-6 this amendatory Act of the 99th General
24Assembly to the Emergency Telephone System Act may be adopted
25in accordance with this subsection (t) by the Department of
26State Police. The rulemaking authority granted in this

 

 

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1subsection (t) shall apply only to those rules adopted prior to
2July 1, 2016. The 24-month limitation on the adoption of
3emergency rules does not apply to rules adopted under this
4subsection (t). The adoption of emergency rules authorized by
5this subsection (t) is deemed to be necessary for the public
6interest, safety, and welfare.
7    (u) (t) In order to provide for the expeditious and timely
8implementation of the provisions of the Burn Victims Relief
9Act, emergency rules to implement any provision of the Act may
10be adopted in accordance with this subsection (u) (t) by the
11Department of Insurance. The rulemaking authority granted in
12this subsection (u) (t) shall apply only to those rules adopted
13prior to December 31, 2015. The adoption of emergency rules
14authorized by this subsection (u) (t) is deemed to be necessary
15for the public interest, safety, and welfare.
16    (v) In order to provide for the expeditious and timely
17implementation of the provisions of this amendatory Act of the
1899th General Assembly, emergency rules to implement this
19amendatory Act of the 99th General Assembly may be adopted in
20accordance with this subsection (v) by the Department of
21Healthcare and Family Services. The 24-month limitation on the
22adoption of emergency rules does not apply to rules adopted
23under this subsection (v). The adoption of emergency rules
24authorized by this subsection (v) is deemed to be necessary for
25the public interest, safety, and welfare.
26(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;

 

 

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198-651, eff. 6-16-14; 99-2, eff. 3-26-15; 99-6, eff. 1-1-16;
299-143, eff. 7-27-15; 99-455, eff. 1-1-16; revised 10-15-15.)
 
3    Section 10. The State Finance Act is amended by changing
4Section 6z-81 as follows:
 
5    (30 ILCS 105/6z-81)
6    Sec. 6z-81. Healthcare Provider Relief Fund.
7    (a) There is created in the State treasury a special fund
8to be known as the Healthcare Provider Relief Fund.
9    (b) The Fund is created for the purpose of receiving and
10disbursing moneys in accordance with this Section.
11Disbursements from the Fund shall be made only as follows:
12        (1) Subject to appropriation, for payment by the
13    Department of Healthcare and Family Services or by the
14    Department of Human Services of medical bills and related
15    expenses, including administrative expenses, for which the
16    State is responsible under Titles XIX and XXI of the Social
17    Security Act, the Illinois Public Aid Code, the Children's
18    Health Insurance Program Act, the Covering ALL KIDS Health
19    Insurance Act, and the Long Term Acute Care Hospital
20    Quality Improvement Transfer Program Act.
21        (2) For repayment of funds borrowed from other State
22    funds or from outside sources, including interest thereon.
23        (3) For State fiscal years 2017 and 2018, for making
24    payments to the human poison control center pursuant to

 

 

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1    Section 12-4.105 of the Illinois Public Aid Code.
2    (c) The Fund shall consist of the following:
3        (1) Moneys received by the State from short-term
4    borrowing pursuant to the Short Term Borrowing Act on or
5    after the effective date of this amendatory Act of the 96th
6    General Assembly.
7        (2) All federal matching funds received by the Illinois
8    Department of Healthcare and Family Services as a result of
9    expenditures made by the Department that are attributable
10    to moneys deposited in the Fund.
11        (3) All federal matching funds received by the Illinois
12    Department of Healthcare and Family Services as a result of
13    federal approval of Title XIX State plan amendment
14    transmittal number 07-09.
15        (4) All other moneys received for the Fund from any
16    other source, including interest earned thereon.
17        (5) All federal matching funds received by the Illinois
18    Department of Healthcare and Family Services as a result of
19    expenditures made by the Department for Medical Assistance
20    from the General Revenue Fund, the Tobacco Settlement
21    Recovery Fund, the Long-Term Care Provider Fund, and the
22    Drug Rebate Fund related to individuals eligible for
23    medical assistance pursuant to the Patient Protection and
24    Affordable Care Act (P.L. 111-148) and Section 5-2 of the
25    Illinois Public Aid Code.
26    (d) In addition to any other transfers that may be provided

 

 

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1for by law, on the effective date of this amendatory Act of the
297th General Assembly, or as soon thereafter as practical, the
3State Comptroller shall direct and the State Treasurer shall
4transfer the sum of $365,000,000 from the General Revenue Fund
5into the Healthcare Provider Relief Fund.
6    (e) In addition to any other transfers that may be provided
7for by law, on July 1, 2011, or as soon thereafter as
8practical, the State Comptroller shall direct and the State
9Treasurer shall transfer the sum of $160,000,000 from the
10General Revenue Fund to the Healthcare Provider Relief Fund.
11    (f) Notwithstanding any other State law to the contrary,
12and in addition to any other transfers that may be provided for
13by law, the State Comptroller shall order transferred and the
14State Treasurer shall transfer $500,000,000 to the Healthcare
15Provider Relief Fund from the General Revenue Fund in equal
16monthly installments of $100,000,000, with the first transfer
17to be made on July 1, 2012, or as soon thereafter as practical,
18and with each of the remaining transfers to be made on August
191, 2012, September 1, 2012, October 1, 2012, and November 1,
202012, or as soon thereafter as practical. This transfer may
21assist the Department of Healthcare and Family Services in
22improving Medical Assistance bill processing timeframes or in
23meeting the possible requirements of Senate Bill 3397, or other
24similar legislation, of the 97th General Assembly should it
25become law.
26    (g) Notwithstanding any other State law to the contrary,

 

 

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1and in addition to any other transfers that may be provided for
2by law, on July 1, 2013, or as soon thereafter as may be
3practical, the State Comptroller shall direct and the State
4Treasurer shall transfer the sum of $601,000,000 from the
5General Revenue Fund to the Healthcare Provider Relief Fund.
6(Source: P.A. 97-44, eff. 6-28-11; 97-641, eff. 12-19-11;
797-689, eff. 6-14-12; 97-732, eff. 6-30-12; 98-24, eff.
86-19-13; 98-463, eff. 8-16-13.)
 
9    Section 15. The Illinois Public Aid Code is amended by
10changing Sections 5A-2, 5A-8, 5A-12.2, and 5A-12.5 and by
11adding Section 12-4.105 as follows:
 
12    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
13    (Section scheduled to be repealed on July 1, 2018)
14    Sec. 5A-2. Assessment.
15    (a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
16years 2009 through 2018, an annual assessment on inpatient
17services is imposed on each hospital provider in an amount
18equal to $218.38 multiplied by the difference of the hospital's
19occupied bed days less the hospital's Medicare bed days,
20provided, however, that the amount of $218.38 shall be
21increased by a uniform percentage to generate an amount equal
22to 75% of the State share of the payments authorized under
23Section 5A-12.5 Section 12-5, with such increase only taking
24effect upon the date that a State share for such payments is

 

 

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1required under federal law. For the period of April through
2June 2015, the amount of $218.38 used to calculate the
3assessment under this paragraph shall, by emergency rule under
4subsection (s) of Section 5-45 of the Illinois Administrative
5Procedure Act, be increased by a uniform percentage to generate
6$20,250,000 in the aggregate for that period from all hospitals
7subject to the annual assessment under this paragraph.
8    (2) In addition to any other assessments imposed under this
9Article, effective July 1, 2016 and semi-annually thereafter
10through June 2018, in addition to any federally required State
11share as authorized under paragraph (1), the amount of $218.38
12shall be increased by a uniform percentage to generate an
13amount equal to 75% of the ACA Assessment Adjustment, as
14defined in subsection (b-6) of this Section.
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
24obtain the hospital provider's occupied bed days and Medicare
25bed days from any source available, including, but not limited
26to, records maintained by the hospital provider, which may be

 

 

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1inspected at all times during business hours of the day by the
2Illinois Department or its duly authorized agents and
3employees.
4    (b) (Blank).
5    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
6portion of State fiscal year 2012, beginning June 10, 2012
7through June 30, 2012, and for State fiscal years 2013 through
82018, an annual assessment on outpatient services is imposed on
9each hospital provider in an amount equal to .008766 multiplied
10by the hospital's outpatient gross revenue, provided, however,
11that the amount of .008766 shall be increased by a uniform
12percentage to generate an amount equal to 25% of the State
13share of the payments authorized under Section 5A-12.5 Section
1412-5, with such increase only taking effect upon the date that
15a State share for such payments is required under federal law.
16For the period beginning June 10, 2012 through June 30, 2012,
17the annual assessment on outpatient services shall be prorated
18by multiplying the assessment amount by a fraction, the
19numerator of which is 21 days and the denominator of which is
20365 days. For the period of April through June 2015, the amount
21of .008766 used to calculate the assessment under this
22paragraph shall, by emergency rule under subsection (s) of
23Section 5-45 of the Illinois Administrative Procedure Act, be
24increased by a uniform percentage to generate $6,750,000 in the
25aggregate for that period from all hospitals subject to the
26annual 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 .008766
5shall be increased by a uniform percentage to generate an
6amount equal to 25% of the ACA Assessment Adjustment, as
7defined in subsection (b-6) of this Section.
8    For the portion of State fiscal year 2012, beginning June
910, 2012 through June 30, 2012, and State fiscal years 2013
10through 2018, a hospital's outpatient gross revenue shall be
11determined using the most recent data available from each
12hospital's 2009 Medicare cost report as contained in the
13Healthcare Cost Report Information System file, for the quarter
14ending on June 30, 2011, without regard to any subsequent
15adjustments or changes to such data. If a hospital's 2009
16Medicare cost report is not contained in the Healthcare Cost
17Report Information System, then the Department may obtain the
18hospital provider's outpatient gross revenue from any source
19available, including, but not limited to, records maintained by
20the hospital provider, which may be inspected at all times
21during business hours of the day by the Department or its duly
22authorized agents and employees.
23    (b-6)(1) As used in this Section, "ACA Assessment
24Adjustment" means:
25        (A) For the period of July 1, 2016 through December 31,
26    2016, 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 April 2016 multiplied by 6.
6        (B) For the period of January 1, 2017 through June 30,
7    2017, the product of .19125 multiplied by the sum of the
8    fee-for-service payments to hospitals as authorized under
9    Section 5A-12.5 and the adjustments authorized under
10    subsection (t) of Section 5A-12.2 to managed care
11    organizations for hospital services due and payable in the
12    month of October 2016 multiplied by 6, except that the
13    amount calculated under this subparagraph (B) shall be
14    adjusted, either positively or negatively, to account for
15    the difference between the actual payments issued under
16    Section 5A-12.5 for the period beginning July 1, 2016
17    through December 31, 2016 and the estimated payments due
18    and payable in the month of April 2016 multiplied by 6 as
19    described in subparagraph (A).
20        (C) For the period of July 1, 2017 through December 31,
21    2017, the product of .19125 multiplied by the sum of the
22    fee-for-service payments to hospitals as authorized under
23    Section 5A-12.5 and the adjustments authorized under
24    subsection (t) of Section 5A-12.2 to managed care
25    organizations for hospital services due and payable in the
26    month of April 2017 multiplied by 6, except that the amount

 

 

09900HB4678sam001- 21 -LRB099 17926 KTG 49068 a

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

 

 

09900HB4678sam001- 22 -LRB099 17926 KTG 49068 a

1        subsection (b) of Section 5A-12.5.
2    (2) The Department shall complete and apply a final
3reconciliation of the ACA Assessment Adjustment prior to June
430, 2018 to account for:
5        (A) any differences between the actual payments issued
6    or scheduled to be issued prior to June 30, 2018 as
7    authorized in Section 5A-12.5 for the period of January 1,
8    2018 through June 30, 2018 and the estimated payments due
9    and payable in the month of October 2017 multiplied by 6 as
10    described in subparagraph (D); and
11        (B) any difference between the estimated
12    fee-for-service payments under subsection (b) of Section
13    5A-12.5 and the amount of such payments that are actually
14    scheduled to be paid.
15    The Department shall notify hospitals of any additional
16amounts owed or reduction credits to be applied to the June
172018 ACA Assessment Adjustment. This is to be considered the
18final reconciliation for the ACA Assessment Adjustment.
19    (3) Notwithstanding any other provision of this Section, if
20for any reason the scheduled payments under subsection (b) of
21Section 5A-12.5 are not issued in full by the final day of the
22period authorized under subsection (b) of Section 5A-12.5,
23funds collected from each hospital pursuant to subparagraph (D)
24of paragraph (1) and pursuant to paragraph (2), attributable to
25the scheduled payments authorized under subsection (b) of
26Section 5A-12.5 that are not issued in full by the final day of

 

 

09900HB4678sam001- 23 -LRB099 17926 KTG 49068 a

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

 

 

09900HB4678sam001- 24 -LRB099 17926 KTG 49068 a

1hospital provider payments meet federal Medicaid standards. If
2the Department determines that the elements of the plan may
3meet federal Medicaid standards and a related State Medicaid
4Plan Amendment is prepared in a manner and form suitable for
5submission, that State Plan Amendment shall be submitted in a
6timely manner for review by the Centers for Medicare and
7Medicaid Services of the United States Department of Health and
8Human Services and subject to approval by the Centers for
9Medicare and Medicaid Services of the United States Department
10of Health and Human Services. No such plan shall become
11effective without approval by the Illinois General Assembly by
12the enactment into law of related legislation. Notwithstanding
13any other provision of this Section, the Department is
14authorized to adopt rules to reduce the rate of any annual
15assessment imposed under this Section. Any such rules may be
16adopted by the Department under Section 5-50 of the Illinois
17Administrative Procedure Act.
18(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2,
19eff. 3-26-15.)
 
20    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
21    Sec. 5A-8. Hospital Provider Fund.
22    (a) There is created in the State Treasury the Hospital
23Provider Fund. Interest earned by the Fund shall be credited to
24the Fund. The Fund shall not be used to replace any moneys
25appropriated to the Medicaid program by the General Assembly.

 

 

09900HB4678sam001- 25 -LRB099 17926 KTG 49068 a

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

 

 

09900HB4678sam001- 26 -LRB099 17926 KTG 49068 a

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

 

 

09900HB4678sam001- 27 -LRB099 17926 KTG 49068 a

1        (7.9) (Blank).
2        (7.10) For State fiscal year 2014, for making transfers
3    of the moneys resulting from the assessment under
4    subsection (b-5) of Section 5A-2 and received from hospital
5    providers under Section 5A-4 and transferred into the
6    Hospital Provider Fund under Section 5A-6 to the designated
7    funds not exceeding the following amounts in that State
8    fiscal year:
9            Health Care Provider Relief Fund.....$100,000,000
10        Transfers under this paragraph shall be made within 7
11    days after the payments have been received pursuant to the
12    schedule of payments provided in subsection (a) of Section
13    5A-4.
14        The additional amount of transfers in this paragraph
15    (7.10), authorized by Public Act 98-651, shall be made
16    within 10 State business days after June 16, 2014 (the
17    effective date of Public Act 98-651). That authority shall
18    remain in effect even if Public Act 98-651 does not become
19    law until State fiscal year 2015.
20        (7.10a) For State fiscal years 2015 through 2018, for
21    making transfers of the moneys resulting from the
22    assessment under subsection (b-5) of Section 5A-2 and
23    received from hospital providers under Section 5A-4 and
24    transferred into the Hospital Provider Fund under Section
25    5A-6 to the designated funds not exceeding the following
26    amounts related to each State fiscal year:

 

 

09900HB4678sam001- 28 -LRB099 17926 KTG 49068 a

1            Health Care Provider Relief Fund ....$50,000,000
2        Transfers under this paragraph shall be made within 7
3    days after the payments have been received pursuant to the
4    schedule of payments provided in subsection (a) of Section
5    5A-4.
6        (7.11) (Blank).
7        (7.12) For State fiscal year 2013, for increasing by
8    21/365ths the transfer of the moneys resulting from the
9    assessment under subsection (b-5) of Section 5A-2 and
10    received from hospital providers under Section 5A-4 for the
11    portion of State fiscal year 2012 beginning June 10, 2012
12    through June 30, 2012 and transferred into the Hospital
13    Provider Fund under Section 5A-6 to the designated funds
14    not exceeding the following amounts in that State fiscal
15    year:
16            Health Care Provider Relief Fund......$2,870,000
17        Since the federal Centers for Medicare and Medicaid
18    Services approval of the assessment authorized under
19    subsection (b-5) of Section 5A-2, received from hospital
20    providers under Section 5A-4 and the payment methodologies
21    to hospitals required under Section 5A-12.4 was not
22    received by the Department until State fiscal year 2014 and
23    since the Department made retroactive payments during
24    State fiscal year 2014 related to the referenced period of
25    June 2012, the transfer authority granted in this paragraph
26    (7.12) is extended through the date that is 10 State

 

 

09900HB4678sam001- 29 -LRB099 17926 KTG 49068 a

1    business days after June 16, 2014 (the effective date of
2    Public Act 98-651).
3        (7.13) In addition to any other transfers authorized
4    under this Section, for State fiscal years 2017 and 2018,
5    for making transfers to the Healthcare Provider Relief Fund
6    of moneys collected from the ACA Assessment Adjustment
7    authorized under subsections (a) and (b-5) of Section 5A-2
8    and paid by hospital providers under Section 5A-4 into the
9    Hospital Provider Fund under Section 5A-6 for each State
10    fiscal year. Timing of transfers to the Healthcare Provider
11    Relief Fund under this paragraph shall be at the discretion
12    of the Department, but no less frequently than quarterly.
13        (8) For making refunds to hospital providers pursuant
14    to Section 5A-10.
15        (9) For making payment to capitated managed care
16    organizations as described in subsections (s) and (t) of
17    Section 5A-12.2 of this Code.
18    Disbursements from the Fund, other than transfers
19authorized under paragraphs (5) and (6) of this subsection,
20shall be by warrants drawn by the State Comptroller upon
21receipt of vouchers duly executed and certified by the Illinois
22Department.
23    (c) The Fund shall consist of the following:
24        (1) All moneys collected or received by the Illinois
25    Department from the hospital provider assessment imposed
26    by this Article.

 

 

09900HB4678sam001- 30 -LRB099 17926 KTG 49068 a

1        (2) All federal matching funds received by the Illinois
2    Department as a result of expenditures made by the Illinois
3    Department that are attributable to moneys deposited in the
4    Fund.
5        (3) Any interest or penalty levied in conjunction with
6    the administration of this Article.
7        (3.5) As applicable, proceeds from surety bond
8    payments payable to the Department as referenced in
9    subsection (s) of Section 5A-12.2 of this Code.
10        (4) Moneys transferred from another fund in the State
11    treasury.
12        (5) All other moneys received for the Fund from any
13    other source, including interest earned thereon.
14    (d) (Blank).
15(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
1698-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.
177-20-15.)
 
18    (305 ILCS 5/5A-12.2)
19    (Section scheduled to be repealed on July 1, 2018)
20    Sec. 5A-12.2. Hospital access payments on or after July 1,
212008.
22    (a) To preserve and improve access to hospital services,
23for hospital services rendered on or after July 1, 2008, the
24Illinois Department shall, except for hospitals described in
25subsection (b) of Section 5A-3, make payments to hospitals as

 

 

09900HB4678sam001- 31 -LRB099 17926 KTG 49068 a

1set forth in this Section. These payments shall be paid in 12
2equal installments on or before the seventh State business day
3of each month, except that no payment shall be due within 100
4days after the later of the date of notification of federal
5approval of the payment methodologies required under this
6Section or any waiver required under 42 CFR 433.68, at which
7time the sum of amounts required under this Section prior to
8the date of notification is due and payable. Payments under
9this Section are not due and payable, however, until (i) the
10methodologies described in this Section are approved by the
11federal government in an appropriate State Plan amendment and
12(ii) the assessment imposed under this Article is determined to
13be a permissible tax under Title XIX of the Social Security
14Act.
15    (a-5) The Illinois Department may, when practicable,
16accelerate the schedule upon which payments authorized under
17this Section are made.
18    (b) Across-the-board inpatient adjustment.
19        (1) In addition to rates paid for inpatient hospital
20    services, the Department shall pay to each Illinois general
21    acute care hospital an amount equal to 40% of the total
22    base inpatient payments paid to the hospital for services
23    provided in State fiscal year 2005.
24        (2) In addition to rates paid for inpatient hospital
25    services, the Department shall pay to each freestanding
26    Illinois specialty care hospital as defined in 89 Ill. Adm.

 

 

09900HB4678sam001- 32 -LRB099 17926 KTG 49068 a

1    Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
2    the total base inpatient payments paid to the hospital for
3    services provided in State fiscal year 2005.
4        (3) In addition to rates paid for inpatient hospital
5    services, the Department shall pay to each freestanding
6    Illinois rehabilitation or psychiatric hospital an amount
7    equal to $1,000 per Medicaid inpatient day multiplied by
8    the increase in the hospital's Medicaid inpatient
9    utilization ratio (determined using the positive
10    percentage change from the rate year 2005 Medicaid
11    inpatient utilization ratio to the rate year 2007 Medicaid
12    inpatient utilization ratio, as calculated by the
13    Department for the disproportionate share determination).
14        (4) In addition to rates paid for inpatient hospital
15    services, the Department shall pay to each Illinois
16    children's hospital an amount equal to 20% of the total
17    base inpatient payments paid to the hospital for services
18    provided in State fiscal year 2005 and an additional amount
19    equal to 20% of the base inpatient payments paid to the
20    hospital for psychiatric services provided in State fiscal
21    year 2005.
22        (5) In addition to rates paid for inpatient hospital
23    services, the Department shall pay to each Illinois
24    hospital eligible for a pediatric inpatient adjustment
25    payment under 89 Ill. Adm. Code 148.298, as in effect for
26    State fiscal year 2007, a supplemental pediatric inpatient

 

 

09900HB4678sam001- 33 -LRB099 17926 KTG 49068 a

1    adjustment payment equal to:
2            (i) For freestanding children's hospitals as
3        defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5
4        multiplied by the hospital's pediatric inpatient
5        adjustment payment required under 89 Ill. Adm. Code
6        148.298, as in effect for State fiscal year 2008.
7            (ii) For hospitals other than freestanding
8        children's hospitals as defined in 89 Ill. Adm. Code
9        149.50(c)(3)(B), 1.0 multiplied by the hospital's
10        pediatric inpatient adjustment payment required under
11        89 Ill. Adm. Code 148.298, as in effect for State
12        fiscal year 2008.
13    (c) Outpatient adjustment.
14        (1) In addition to the rates paid for outpatient
15    hospital services, the Department shall pay each Illinois
16    hospital an amount equal to 2.2 multiplied by the
17    hospital's ambulatory procedure listing payments for
18    categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
19    148.140(b), for State fiscal year 2005.
20        (2) In addition to the rates paid for outpatient
21    hospital services, the Department shall pay each Illinois
22    freestanding psychiatric hospital an amount equal to 3.25
23    multiplied by the hospital's ambulatory procedure listing
24    payments for category 5b, as defined in 89 Ill. Adm. Code
25    148.140(b)(1)(E), for State fiscal year 2005.
26    (d) Medicaid high volume adjustment. In addition to rates

 

 

09900HB4678sam001- 34 -LRB099 17926 KTG 49068 a

1paid for inpatient hospital services, the Department shall pay
2to each Illinois general acute care hospital that provided more
3than 20,500 Medicaid inpatient days of care in State fiscal
4year 2005 amounts as follows:
5        (1) For hospitals with a case mix index equal to or
6    greater than the 85th percentile of hospital case mix
7    indices, $350 for each Medicaid inpatient day of care
8    provided during that period; and
9        (2) For hospitals with a case mix index less than the
10    85th percentile of hospital case mix indices, $100 for each
11    Medicaid inpatient day of care provided during that period.
12    (e) Capital adjustment. In addition to rates paid for
13inpatient hospital services, the Department shall pay an
14additional payment to each Illinois general acute care hospital
15that has a Medicaid inpatient utilization rate of at least 10%
16(as calculated by the Department for the rate year 2007
17disproportionate share determination) amounts as follows:
18        (1) For each Illinois general acute care hospital that
19    has a Medicaid inpatient utilization rate of at least 10%
20    and less than 36.94% and whose capital cost is less than
21    the 60th percentile of the capital costs of all Illinois
22    hospitals, the amount of such payment shall equal the
23    hospital's Medicaid inpatient days multiplied by the
24    difference between the capital costs at the 60th percentile
25    of the capital costs of all Illinois hospitals and the
26    hospital's capital costs.

 

 

09900HB4678sam001- 35 -LRB099 17926 KTG 49068 a

1        (2) For each Illinois general acute care hospital that
2    has a Medicaid inpatient utilization rate of at least
3    36.94% and whose capital cost is less than the 75th
4    percentile of the capital costs of all Illinois hospitals,
5    the amount of such payment shall equal the hospital's
6    Medicaid inpatient days multiplied by the difference
7    between the capital costs at the 75th percentile of the
8    capital costs of all Illinois hospitals and the hospital's
9    capital costs.
10    (f) Obstetrical care adjustment.
11        (1) In addition to rates paid for inpatient hospital
12    services, the Department shall pay $1,500 for each Medicaid
13    obstetrical day of care provided in State fiscal year 2005
14    by each Illinois rural hospital that had a Medicaid
15    obstetrical percentage (Medicaid obstetrical days divided
16    by Medicaid inpatient days) greater than 15% for State
17    fiscal year 2005.
18        (2) In addition to rates paid for inpatient hospital
19    services, the Department shall pay $1,350 for each Medicaid
20    obstetrical day of care provided in State fiscal year 2005
21    by each Illinois general acute care hospital that was
22    designated a level III perinatal center as of December 31,
23    2006, and that had a case mix index equal to or greater
24    than the 45th percentile of the case mix indices for all
25    level III perinatal centers.
26        (3) In addition to rates paid for inpatient hospital

 

 

09900HB4678sam001- 36 -LRB099 17926 KTG 49068 a

1    services, the Department shall pay $900 for each Medicaid
2    obstetrical day of care provided in State fiscal year 2005
3    by each Illinois general acute care hospital that was
4    designated a level II or II+ perinatal center as of
5    December 31, 2006, and that had a case mix index equal to
6    or greater than the 35th percentile of the case mix indices
7    for all level II and II+ perinatal centers.
8    (g) Trauma adjustment.
9        (1) In addition to rates paid for inpatient hospital
10    services, the Department shall pay each Illinois general
11    acute care hospital designated as a trauma center as of
12    July 1, 2007, a payment equal to 3.75 multiplied by the
13    hospital's State fiscal year 2005 Medicaid capital
14    payments.
15        (2) In addition to rates paid for inpatient hospital
16    services, the Department shall pay $400 for each Medicaid
17    acute inpatient day of care provided in State fiscal year
18    2005 by each Illinois general acute care hospital that was
19    designated a level II trauma center, as defined in 89 Ill.
20    Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
21    2007.
22        (3) In addition to rates paid for inpatient hospital
23    services, the Department shall pay $235 for each Illinois
24    Medicaid acute inpatient day of care provided in State
25    fiscal year 2005 by each level I pediatric trauma center
26    located outside of Illinois that had more than 8,000

 

 

09900HB4678sam001- 37 -LRB099 17926 KTG 49068 a

1    Illinois Medicaid inpatient days in State fiscal year 2005.
2    (h) Supplemental tertiary care adjustment. In addition to
3rates paid for inpatient services, the Department shall pay to
4each Illinois hospital eligible for tertiary care adjustment
5payments under 89 Ill. Adm. Code 148.296, as in effect for
6State fiscal year 2007, a supplemental tertiary care adjustment
7payment equal to the tertiary care adjustment payment required
8under 89 Ill. Adm. Code 148.296, as in effect for State fiscal
9year 2007.
10    (i) Crossover adjustment. In addition to rates paid for
11inpatient services, the Department shall pay each Illinois
12general acute care hospital that had a ratio of crossover days
13to total inpatient days for medical assistance programs
14administered by the Department (utilizing information from
152005 paid claims) greater than 50%, and a case mix index
16greater than the 65th percentile of case mix indices for all
17Illinois hospitals, a rate of $1,125 for each Medicaid
18inpatient day including crossover days.
19    (j) Magnet hospital adjustment. In addition to rates paid
20for inpatient hospital services, the Department shall pay to
21each Illinois general acute care hospital and each Illinois
22freestanding children's hospital that, as of February 1, 2008,
23was recognized as a Magnet hospital by the American Nurses
24Credentialing Center and that had a case mix index greater than
25the 75th percentile of case mix indices for all Illinois
26hospitals amounts as follows:

 

 

09900HB4678sam001- 38 -LRB099 17926 KTG 49068 a

1        (1) For hospitals located in a county whose eligibility
2    growth factor is greater than the mean, $450 multiplied by
3    the eligibility growth factor for the county in which the
4    hospital is located for each Medicaid inpatient day of care
5    provided by the hospital during State fiscal year 2005.
6        (2) For hospitals located in a county whose eligibility
7    growth factor is less than or equal to the mean, $225
8    multiplied by the eligibility growth factor for the county
9    in which the hospital is located for each Medicaid
10    inpatient day of care provided by the hospital during State
11    fiscal year 2005.
12    For purposes of this subsection, "eligibility growth
13factor" means the percentage by which the number of Medicaid
14recipients in the county increased from State fiscal year 1998
15to State fiscal year 2005.
16    (k) For purposes of this Section, a hospital that is
17enrolled to provide Medicaid services during State fiscal year
182005 shall have its utilization and associated reimbursements
19annualized prior to the payment calculations being performed
20under this Section.
21    (l) For purposes of this Section, the terms "Medicaid
22days", "ambulatory procedure listing services", and
23"ambulatory procedure listing payments" do not include any
24days, charges, or services for which Medicare or a managed care
25organization reimbursed on a capitated basis was liable for
26payment, except where explicitly stated otherwise in this

 

 

09900HB4678sam001- 39 -LRB099 17926 KTG 49068 a

1Section.
2    (m) For purposes of this Section, in determining the
3percentile ranking of an Illinois hospital's case mix index or
4capital costs, hospitals described in subsection (b) of Section
55A-3 shall be excluded from the ranking.
6    (n) Definitions. Unless the context requires otherwise or
7unless provided otherwise in this Section, the terms used in
8this Section for qualifying criteria and payment calculations
9shall have the same meanings as those terms have been given in
10the Illinois Department's administrative rules as in effect on
11March 1, 2008. Other terms shall be defined by the Illinois
12Department by rule.
13    As used in this Section, unless the context requires
14otherwise:
15    "Base inpatient payments" means, for a given hospital, the
16sum of base payments for inpatient services made on a per diem
17or per admission (DRG) basis, excluding those portions of per
18admission payments that are classified as capital payments.
19Disproportionate share hospital adjustment payments, Medicaid
20Percentage Adjustments, Medicaid High Volume Adjustments, and
21outlier payments, as defined by rule by the Department as of
22January 1, 2008, are not base payments.
23    "Capital costs" means, for a given hospital, the total
24capital costs determined using the most recent 2005 Medicare
25cost report as contained in the Healthcare Cost Report
26Information System file, for the quarter ending on December 31,

 

 

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12006, divided by the total inpatient days from the same cost
2report to calculate a capital cost per day. The resulting
3capital cost per day is inflated to the midpoint of State
4fiscal year 2009 utilizing the national hospital market price
5proxies (DRI) hospital cost index. If a hospital's 2005
6Medicare cost report is not contained in the Healthcare Cost
7Report Information System, the Department may obtain the data
8necessary to compute the hospital's capital costs from any
9source available, including, but not limited to, records
10maintained by the hospital provider, which may be inspected at
11all times during business hours of the day by the Illinois
12Department or its duly authorized agents and employees.
13    "Case mix index" means, for a given hospital, the sum of
14the DRG relative weighting factors in effect on January 1,
152005, for all general acute care admissions for State fiscal
16year 2005, excluding Medicare crossover admissions and
17transplant admissions reimbursed under 89 Ill. Adm. Code
18148.82, divided by the total number of general acute care
19admissions for State fiscal year 2005, excluding Medicare
20crossover admissions and transplant admissions reimbursed
21under 89 Ill. Adm. Code 148.82.
22    "Medicaid inpatient day" means, for a given hospital, the
23sum of days of inpatient hospital days provided to recipients
24of medical assistance under Title XIX of the federal Social
25Security Act, excluding days for individuals eligible for
26Medicare under Title XVIII of that Act (Medicaid/Medicare

 

 

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1crossover days), as tabulated from the Department's paid claims
2data for admissions occurring during State fiscal year 2005
3that was adjudicated by the Department through March 23, 2007.
4    "Medicaid obstetrical day" means, for a given hospital, the
5sum of days of inpatient hospital days grouped by the
6Department to DRGs of 370 through 375 provided to recipients of
7medical assistance under Title XIX of the federal Social
8Security Act, excluding days for individuals eligible for
9Medicare under Title XVIII of that Act (Medicaid/Medicare
10crossover days), as tabulated from the Department's paid claims
11data for admissions occurring during State fiscal year 2005
12that was adjudicated by the Department through March 23, 2007.
13    "Outpatient ambulatory procedure listing payments" means,
14for a given hospital, the sum of payments for ambulatory
15procedure listing services, as described in 89 Ill. Adm. Code
16148.140(b), provided to recipients of medical assistance under
17Title XIX of the federal Social Security Act, excluding
18payments for individuals eligible for Medicare under Title
19XVIII of the Act (Medicaid/Medicare crossover days), as
20tabulated from the Department's paid claims data for services
21occurring in State fiscal year 2005 that were adjudicated by
22the Department through March 23, 2007.
23    (o) The Department may adjust payments made under this
24Section 5A-12.2 to comply with federal law or regulations
25regarding hospital-specific payment limitations on
26government-owned or government-operated hospitals.

 

 

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1    (p) Notwithstanding any of the other provisions of this
2Section, the Department is authorized to adopt rules that
3change the hospital access improvement payments specified in
4this Section, but only to the extent necessary to conform to
5any federally approved amendment to the Title XIX State plan.
6Any such rules shall be adopted by the Department as authorized
7by Section 5-50 of the Illinois Administrative Procedure Act.
8Notwithstanding any other provision of law, any changes
9implemented as a result of this subsection (p) shall be given
10retroactive effect so that they shall be deemed to have taken
11effect as of the effective date of this Section.
12    (q) (Blank).
13    (r) On and after July 1, 2012, the Department shall reduce
14any rate of reimbursement for services or other payments or
15alter any methodologies authorized by this Code to reduce any
16rate of reimbursement for services or other payments in
17accordance with Section 5-5e.
18    (s) On or after January 1, 2016 July 1, 2014, but no later
19than October 1, 2014, and no less than annually thereafter, the
20Department shall may increase capitation payments to capitated
21managed care organizations (MCOs) to equal the aggregate
22reduction of payments made in this Section and in Section
235A-12.4 by a uniform percentage on a regional basis to preserve
24access to hospital services for recipients under the Illinois
25Medical Assistance Program. The aggregate amount of all
26increased capitation payments to all MCOs for a fiscal year

 

 

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1shall be the amount needed to avoid reduction in payments
2authorized under Section 5A-15. Payments to MCOs under this
3Section shall be consistent with actuarial certification and
4shall be published by the Department each year. Each MCO shall
5only expend the increased capitation payments it receives under
6this Section to support the availability of hospital services
7and to ensure access to hospital services, with such
8expenditures being made within 15 calendar days from when the
9MCO receives the increased capitation payment. The Department
10shall make available, on a monthly basis, a report of the
11capitation payments that are made to each MCO pursuant to this
12subsection, including the number of enrollees for which such
13payment is made, the per enrollee amount of the payment, and
14any adjustments that have been made. Payments made under this
15subsection shall 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 guaranteed
19by the surety bond. Payments to MCOs that would be paid
20consistent with actuarial certification and enrollment in the
21absence of the increased capitation payments under this Section
22shall not be reduced as a consequence of payments made under
23this subsection.
24    As used in this subsection, "MCO" means an entity which
25contracts with the Department to provide services where payment
26for medical services is made on a capitated basis.

 

 

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1    (t) On or after July 1, 2014, the Department may increase
2capitation payments to capitated managed care organizations
3(MCOs) to equal the aggregate reduction of payments made in
4Section 5A-12.5 to preserve access to hospital services for
5recipients under the Illinois Medical Assistance Program.
6Effective January 1, 2016, the Department shall increase
7capitation payments to MCOs to include the payments authorized
8under Section 5A-12.5 to preserve access to hospital services
9for recipients under the Illinois Medical Assistance Program by
10ensuring that the reimbursement provided for Affordable Care
11Act adults enrolled in a MCO is equivalent to the reimbursement
12provided for Affordable Care Act adults enrolled in a
13fee-for-service program. Payments to MCOs under this Section
14shall be consistent with actuarial certification and federal
15approval (which may be retrospectively determined) and shall be
16published by the Department each year. Each MCO shall only
17expend the increased capitation payments it receives under this
18Section to support the availability of hospital services and to
19ensure access to hospital services, with such expenditures
20being made within 15 calendar days from when the MCO receives
21the increased capitation payment. Payments made under this
22subsection may be guaranteed by a surety bond obtained by the
23MCO in an amount established by the Department to approximate
24one month's liability of payments authorized under this
25subsection. The Department may advance the payments to
26hospitals under this subsection, in the event the MCO fails to

 

 

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1make such payments. The Department shall make available, on a
2monthly basis, a report of the capitation payments that are
3made to each MCO pursuant to this subsection, including the
4number of enrollees for which such payment is made, the per
5enrollee amount of the payment, and any adjustments that have
6been made. Payments to MCOs that would be paid consistent with
7actuarial certification and enrollment in the absence of the
8increased capitation payments under this subsection shall not
9be reduced as a consequence of payments made under this
10subsection.
11    As used in this subsection, "MCO" means an entity which
12contracts with the Department to provide services where payment
13for medical services is made on a capitated basis.
14(Source: P.A. 97-689, eff. 6-14-12; 98-651, eff. 6-16-14.)
 
15    (305 ILCS 5/5A-12.5)
16    Sec. 5A-12.5. Affordable Care Act adults; hospital access
17payments.
18    (a) The Department shall, subject to federal approval,
19mirror the Medical Assistance hospital reimbursement
20methodology for Affordable Care Act adults who are enrolled
21under a fee-for-service or capitated managed care program,
22including hospital access payments as defined in Section
235A-12.2 of this Article and hospital access improvement
24payments as defined in Section 5A-12.4 of this Article, in
25compliance with the equivalent rate provisions of the

 

 

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1Affordable Care Act.
2    (b) If the fee-for-service payments authorized under this
3Section are deemed to be increases to payments for a prior
4period, the Department shall seek federal approval to issue
5such increases for the payments made through the period ending
6on June 30, 2018, even if such increases are paid out during an
7extended payment period beyond such date. Payment of such
8increases beyond such date is subject to federal approval.
9    (c) As used in this Section, "Affordable Care Act" is the
10collective term for the Patient Protection and Affordable Care
11Act (Pub. L. 111-148) and the Health Care and Education
12Reconciliation Act of 2010 (Pub. L. 111-152).
13(Source: P.A. 98-651, eff. 6-16-14.)
 
14    (305 ILCS 5/12-4.105 new)
15    Sec. 12-4.105. Human poison control center; payment
16program. Subject to funding availability resulting from
17transfers made from the Hospital Provider Fund to the
18Healthcare Provider Relief Fund as authorized under this Code,
19for State fiscal year 2017 and State fiscal year 2018, the
20Department of Healthcare and Family Services shall pay to the
21human poison control center designated under the Poison Control
22System Act an amount of not less than $3,000,000 for each of
23those State fiscal years that the human poison control center
24is in operation.
 

 

 

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1    Section 20. The Lead Poisoning Prevention Act is amended by
2changing Section 15.1 as follows:
 
3    (410 ILCS 45/15.1)
4    Sec. 15.1. Funding. Beginning July 1, 2014 and ending June
530, 2015 2018, a hospital satisfying the definition, as of July
61, 2014, of Section 5-5e.1 of the Illinois Public Aid Code and
7located in DuPage County shall pay the sum of $2,000,000
8annually in 4 equal quarterly installments to the human poison
9control center in existence as of July 1, 2014 and established
10under the authority of this Act.
11(Source: P.A. 98-651, eff. 6-16-14.)
 
12    Section 99. Effective date. This Act takes effect upon
13becoming law.".