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90_HB2464
305 ILCS 5/5-5.4 from Ch. 23, par. 5-5.4
305 ILCS 5/12-4.11 from Ch. 23, par. 12-4.11
305 ILCS 5/14-8 from Ch. 23, par. 14-8
Amends the Illinois Public Aid Code. Provides that the
payment for a funeral shall be increased from $650 to $670 on
January 1, 1998 and to $690 on July 1, 1998, and that the
payment for a cemetery burial shall increase from $325 to
$335 on January 1, 1998 and to $345 on July 1, 1998.
Provides that the Department of Public Aid shall periodically
increase the payment rate for skilled nursing and
intermediate care services as well as for hospital services
on the basis of appropriations approved from time to time by
the General Assembly for those purposes. Effective
immediately.
LRB9008312SMdvA
LRB9008312SMdvA
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Sections 5-5.4, 12-4.11, and 14-8.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Sections 5-5.4, 12-4.11, and 14-8 as follows:
7 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
8 Sec. 5-5.4. Standards of Payment - Department of Public
9 Aid. The Department of Public Aid shall develop standards of
10 payment of skilled nursing and intermediate care services in
11 facilities providing such services under this Article which:
12 (1) Provides for the determination of a facility's
13 payment for skilled nursing and intermediate care services on
14 a prospective basis. The amount of the payment rate for all
15 nursing facilities certified under the medical assistance
16 program shall be prospectively established annually on the
17 basis of historical, financial, and statistical data
18 reflecting actual costs from prior years, which shall be
19 applied to the current rate year and updated for inflation,
20 except that the capital cost element for newly constructed
21 facilities shall be based upon projected budgets. The
22 annually established payment rate shall take effect on July 1
23 in 1984 and subsequent years. Rate increases shall be
24 provided annually thereafter on July 1 in 1984 and on each
25 subsequent July 1 in the following years, except that no rate
26 increase and no update for inflation shall be provided on or
27 after July 1, 1994, except as otherwise provided in this
28 Section. Rates established effective each July 1 shall
29 govern payment for services rendered throughout that fiscal
30 year, except that rates established on July 1, 1996 shall be
31 increased by 6.8% for services provided on or after January
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1 1, 1997. Thereafter the Illinois Department shall
2 periodically increase the payment rate on the basis of
3 appropriations approved from time to time by the General
4 Assembly for that purpose. Such rates will be based upon the
5 rates calculated for the year beginning July 1, 1990, and for
6 subsequent years thereafter shall be based on the facility
7 cost reports for the facility fiscal year ending at any point
8 in time during the previous calendar year, updated to the
9 midpoint of the rate year. The cost report shall be on file
10 with the Department no later than April 1 of the current rate
11 year. Should the cost report not be on file by April 1, the
12 Department shall base the rate on the latest cost report
13 filed by each skilled care facility and intermediate care
14 facility, updated to the midpoint of the current rate year.
15 In determining rates for services rendered on and after July
16 1, 1985, fixed time shall not be computed at less than zero.
17 The Department shall not make any alterations of regulations
18 which would reduce any component of the Medicaid rate to a
19 level below what that component would have been utilizing in
20 the rate effective on July 1, 1984.
21 (2) Shall take into account the actual costs incurred by
22 facilities in providing services for recipients of skilled
23 nursing and intermediate care services under the medical
24 assistance program.
25 (3) Shall take into account the medical and
26 psycho-social characteristics and needs of the patients.
27 (4) Shall take into account the actual costs incurred by
28 facilities in meeting, licensing and certification standards
29 imposed and prescribed by the State of Illinois, any of its
30 political subdivisions or municipalities and by the United
31 States Department of Health, Education and Welfare pursuant
32 to Title XIX of the Social Security Act.
33 The Department of Public Aid shall develop precise
34 standards for payments to reimburse nursing facilities for
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1 any utilization of appropriate rehabilitative personnel for
2 the provision of rehabilitative services which is authorized
3 by federal regulations, including reimbursement for services
4 provided by qualified therapists or qualified assistants, and
5 which is in accordance with accepted professional practices.
6 Reimbursement also may be made for utilization of other
7 supportive personnel under appropriate supervision.
8 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96; 90-9,
9 eff. 7-1-97.)
10 (305 ILCS 5/12-4.11) (from Ch. 23, par. 12-4.11)
11 (Text of Section before amendment by P.A. 90-372)
12 Sec. 12-4.11. Grant amounts. The Department, with due
13 regard for and subject to budgetary limitations, shall
14 establish grant amounts for each of the programs, by
15 regulation. The grant amounts may vary by program, size of
16 assistance unit and geographic area.
17 Aid payments shall not be reduced except: (1) for changes
18 in the cost of items included in the grant amounts, or (2)
19 for changes in the expenses of the recipient, or (3) for
20 changes in the income or resources available to the
21 recipient, or (4) for changes in grants resulting from
22 adoption of a consolidated grant amount, or (5) beginning
23 July 1, 1992, to reduce grant amounts for recipients of cash
24 assistance under Sections 3-1a and 6-11 of this Code during
25 fiscal year 1993.
26 In fixing standards to govern payments or reimbursements
27 for funeral and burial expenses, the Department shall take
28 into account the services essential to a dignified, low-cost
29 funeral and burial, but no payment shall be authorized from
30 public aid funds for the funeral in excess of $670 on and
31 after January 1, 1998 and $690 on and after July 1, 1998
32 $650, exclusive of reasonable amounts as may be necessary for
33 burial space and cemetery charges, and any applicable taxes
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1 or other required governmental fees or charges. The
2 Department shall authorize no payment in excess of $335 on
3 and after January 1, 1998 and $345 on and after July 1, 1998
4 $325 for a cemetery burial.
5 Nothing contained in this Section or in any other Section
6 of this Code shall be construed to prohibit the Illinois
7 Department (1) from consolidating existing standards on the
8 basis of any standards which are or were in effect on, or
9 subsequent to July 1, 1969, or (2) from employing any
10 consolidated standards in determining need for public aid and
11 the amount of money payment or grant for individual
12 recipients or recipient families.
13 Notwithstanding any other provision of this Code to the
14 contrary, the Illinois Department is authorized to reduce
15 payment levels under Article VI as necessary to implement
16 contingency reserves under the Emergency Budget Act of Fiscal
17 Year 1992, to the extent permitted by federal law. Any such
18 reduction shall expire on July 1, 1992.
19 (Source: P.A. 89-507, eff. 7-1-97; 90-17, eff. 7-1-97,
20 90-326, eff. 8-8-97; revised 10-23-97.)
21 (Text of Section after amendment by P.A. 90-372)
22 Sec. 12-4.11. Grant amounts. The Department, with due
23 regard for and subject to budgetary limitations, shall
24 establish grant amounts for each of the programs, by
25 regulation. The grant amounts may vary by program, size of
26 assistance unit and geographic area.
27 Aid payments shall not be reduced except: (1) for changes
28 in the cost of items included in the grant amounts, or (2)
29 for changes in the expenses of the recipient, or (3) for
30 changes in the income or resources available to the
31 recipient, or (4) for changes in grants resulting from
32 adoption of a consolidated grant amount, or (5).
33 In fixing standards to govern payments or reimbursements
34 for funeral and burial expenses, the Department shall take
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1 into account the services essential to a dignified, low-cost
2 funeral and burial, but no payment shall be authorized from
3 public aid funds for the funeral in excess of $670 on and
4 after January 1, 1998 and $690 on and after July 1, 1998
5 $650, exclusive of reasonable amounts as may be necessary for
6 burial space and cemetery charges, and any applicable taxes
7 or other required governmental fees or charges. The
8 Department shall authorize no payment in excess of $335 on
9 and after January 1, 1998 and $345 on and after July 1, 1998,
10 $325 for a cemetery burial.
11 Nothing contained in this Section or in any other Section
12 of this Code shall be construed to prohibit the Illinois
13 Department (1) from consolidating existing standards on the
14 basis of any standards which are or were in effect on, or
15 subsequent to July 1, 1969, or (2) from employing any
16 consolidated standards in determining need for public aid and
17 the amount of money payment or grant for individual
18 recipients or recipient families.
19 (Source: P.A. 89-507, eff. 7-1-97; 90-17, eff. 7-1-97,
20 90-326, eff. 8-8-97; 90-372, eff. 7-1-98; revised 10-23-97.)
21 (305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
22 Sec. 14-8. Disbursements to Hospitals.
23 (a) For inpatient hospital services rendered on and
24 after September 1, 1991, the Illinois Department shall
25 reimburse hospitals for inpatient services at an inpatient
26 payment rate calculated for each hospital based upon the
27 Medicare Prospective Payment System as set forth in Sections
28 1886(b), (d), (g), and (h) of the federal Social Security
29 Act, and the regulations, policies, and procedures
30 promulgated thereunder, except as modified by this Section.
31 Payment rates for inpatient hospital services rendered on or
32 after September 1, 1991 and on or before September 30, 1992
33 shall be calculated using the Medicare Prospective Payment
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1 rates in effect on September 1, 1991. Payment rates for
2 inpatient hospital services rendered on or after October 1,
3 1992 and on or before March 31, 1994 shall be calculated
4 using the Medicare Prospective Payment rates in effect on
5 September 1, 1992. Payment rates for inpatient hospital
6 services rendered on or after April 1, 1994 shall be
7 calculated using the Medicare Prospective Payment rates
8 (including the Medicare grouping methodology and weighting
9 factors as adjusted pursuant to paragraph (1) of this
10 subsection) in effect 90 days prior to the date of
11 admission. For services rendered on or after July 1, 1995,
12 the reimbursement methodology implemented under this
13 subsection shall not include those costs referred to in
14 Sections 1886(d)(5)(B) and 1886(h) of the Social Security
15 Act. The additional payment amounts required under Section
16 1886(d)(5)(F) of the Social Security Act, for hospitals
17 serving a disproportionate share of low-income or indigent
18 patients, are not required under this Section. For hospital
19 inpatient services rendered on or after July 1, 1995 and
20 before the effective date of this amendatory Act of 1998, the
21 Illinois Department shall reimburse hospitals using the
22 relative weighting factors and the base payment rates
23 calculated for each hospital that were in effect on June 30,
24 1995, less the portion of such rates attributed by the
25 Illinois Department to the cost of medical education.
26 (1) The weighting factors established under Section
27 1886(d)(4) of the Social Security Act shall not be used
28 in the reimbursement system established under this
29 Section. Rather, the Illinois Department shall establish
30 by rule Medicaid weighting factors to be used in the
31 reimbursement system established under this Section.
32 (2) The Illinois Department shall define by rule
33 those hospitals or distinct parts of hospitals that shall
34 be exempt from the reimbursement system established under
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1 this Section. In defining such hospitals, the Illinois
2 Department shall take into consideration those hospitals
3 exempt from the Medicare Prospective Payment System as of
4 September 1, 1991. For hospitals defined as exempt under
5 this subsection, the Illinois Department shall by rule
6 establish a reimbursement system for payment of inpatient
7 hospital services rendered on and after September 1,
8 1991. For all hospitals that are children's hospitals as
9 defined in Section 5-5.02 of this Code, the reimbursement
10 methodology shall, through June 30, 1992, net of all
11 applicable fees, at least equal each children's hospital
12 1990 ICARE payment rates, indexed to the current year by
13 application of the DRI hospital cost index from 1989 to
14 the year in which payments are made. Excepting county
15 providers as defined in Article XV of this Code,
16 hospitals licensed under the University of Illinois
17 Hospital Act, and facilities operated by the Department
18 of Mental Health and Developmental Disabilities (or its
19 successor, the Department of Human Services) for hospital
20 inpatient services rendered on or after July 1, 1995 and
21 before the effective date of this amendatory Act of 1998,
22 the Illinois Department shall reimburse children's
23 hospitals, as defined in 89 Illinois Administrative Code
24 Section 149.50(c)(3), at the rates in effect on June 30,
25 1995, and shall reimburse all other hospitals at the
26 rates in effect on June 30, 1995, less the portion of
27 such rates attributed by the Illinois Department to the
28 cost of medical education.
29 (3) (Blank)
30 (4) Notwithstanding any other provision of this
31 Section, hospitals that on August 31, 1991, have a
32 contract with the Illinois Department under Section 3-4
33 of the Illinois Health Finance Reform Act may elect to
34 continue to be reimbursed at rates stated in such
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1 contracts for general and specialty care.
2 (5) In addition to any payments made under this
3 subsection (a), the Illinois Department shall make the
4 adjustment payments required by Section 5-5.02 of this
5 Code; provided, that in the case of any hospital
6 reimbursed under a per case methodology, the Illinois
7 Department shall add an amount equal to the product of
8 the hospital's average length of stay, less one day,
9 multiplied by 20, for inpatient hospital services
10 rendered on or after September 1, 1991 and on or before
11 September 30, 1992.
12 (b) (Blank)
13 (b-5) Excepting county providers as defined in Article
14 XV of this Code, hospitals licensed under the University of
15 Illinois Hospital Act, and facilities operated by the
16 Illinois Department of Mental Health and Developmental
17 Disabilities (or its successor, the Department of Human
18 Services) for outpatient services rendered on or after July
19 1, 1995 and before the effective date of this amendatory Act
20 of 1998, the Illinois Department shall reimburse children's
21 hospitals, as defined in the Illinois Administrative Code
22 Section 149.50(c)(3), at the rates in effect on June 30,
23 1995, less that portion of such rates attributed by the
24 Illinois Department to the outpatient indigent volume
25 adjustment and shall reimburse all other hospitals at the
26 rates in effect on June 30, 1995, less the portions of such
27 rates attributed by the Illinois Department to the cost of
28 medical education and attributed by the Illinois Department
29 to the outpatient indigent volume adjustment.
30 (c) In addition to any other payments under this Code,
31 the Illinois Department shall develop a hospital
32 disproportionate share reimbursement methodology that,
33 effective July 1, 1991, through September 30, 1992, shall
34 reimburse hospitals sufficiently to expend the fee monies
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1 described in subsection (b) of Section 14-3 of this Code and
2 the federal matching funds received by the Illinois
3 Department as a result of expenditures made by the Illinois
4 Department as required by this subsection (c) and Section
5 14-2 that are attributable to fee monies deposited in the
6 Fund, less amounts applied to adjustment payments under
7 Section 5-5.02.
8 (d) Critical Care Access Payments.
9 (1) In addition to any other payments made under
10 this Code, the Illinois Department shall develop a
11 reimbursement methodology that shall reimburse Critical
12 Care Access Hospitals for the specialized services that
13 qualify them as Critical Care Access Hospitals. No
14 adjustment payments shall be made under this subsection
15 on or after July 1, 1995.
16 (2) "Critical Care Access Hospitals" includes, but
17 is not limited to, hospitals that meet at least one of
18 the following criteria:
19 (A) Hospitals located outside of a
20 metropolitan statistical area that are designated as
21 Level II Perinatal Centers and that provide a
22 disproportionate share of perinatal services to
23 recipients; or
24 (B) Hospitals that are designated as Level I
25 Trauma Centers (adult or pediatric) and certain
26 Level II Trauma Centers as determined by the
27 Illinois Department; or
28 (C) Hospitals located outside of a
29 metropolitan statistical area and that provide a
30 disproportionate share of obstetrical services to
31 recipients.
32 (e) Inpatient high volume adjustment. For hospital
33 inpatient services, effective with rate periods beginning on
34 or after October 1, 1993, in addition to rates paid for
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1 inpatient services by the Illinois Department, the Illinois
2 Department shall make adjustment payments for inpatient
3 services furnished by Medicaid high volume hospitals. The
4 Illinois Department shall establish by rule criteria for
5 qualifying as a Medicaid high volume hospital and shall
6 establish by rule a reimbursement methodology for calculating
7 these adjustment payments to Medicaid high volume hospitals.
8 No adjustment payment shall be made under this subsection for
9 services rendered on or after July 1, 1995.
10 (f) The Illinois Department shall modify its current
11 rules governing adjustment payments for targeted access,
12 critical care access, and uncompensated care to classify
13 those adjustment payments as not being payments to
14 disproportionate share hospitals under Title XIX of the
15 federal Social Security Act. Rules adopted under this
16 subsection shall not be effective with respect to services
17 rendered on or after July 1, 1995. The Illinois Department
18 has no obligation to adopt or implement any rules or make any
19 payments under this subsection for services rendered on or
20 after July 1, 1995.
21 (f-5) The State recognizes that adjustment payments to
22 hospitals providing certain services or incurring certain
23 costs may be necessary to assure that recipients of medical
24 assistance have adequate access to necessary medical
25 services. These adjustments include payments for teaching
26 costs and uncompensated care, trauma center payments,
27 rehabilitation hospital payments, perinatal center payments,
28 obstetrical care payments, targeted access payments, Medicaid
29 high volume payments, and outpatient indigent volume
30 payments. On or before April 1, 1995, the Illinois
31 Department shall issue recommendations regarding (i)
32 reimbursement mechanisms or adjustment payments to reflect
33 these costs and services, including methods by which the
34 payments may be calculated and the method by which the
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1 payments may be financed, and (ii) reimbursement mechanisms
2 or adjustment payments to reflect costs and services of
3 federally qualified health centers with respect to recipients
4 of medical assistance.
5 (g) If one or more hospitals file suit in any court
6 challenging any part of this Article XIV, payments to
7 hospitals under this Article XIV shall be made only to the
8 extent that sufficient monies are available in the Fund and
9 only to the extent that any monies in the Fund are not
10 prohibited from disbursement under any order of the court.
11 (h) Payments under the disbursement methodology
12 described in this Section are subject to approval by the
13 federal government in an appropriate State plan amendment.
14 (i) The Illinois Department may by rule establish
15 criteria for and develop methodologies for adjustment
16 payments to hospitals participating under this Article.
17 (j) On and after the effective date of this amendatory
18 Act of 1998, the Illinois Department shall periodically
19 increase the payment rate for hospital services on the basis
20 of appropriations approved from time to time by the General
21 Assembly for that purpose.
22 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96;
23 89-507, eff. 7-1-97; 90-9, eff. 7-1-97; 90-14, eff. 7-1-97.)
24 Section 99. Effective date. This Act takes effect upon
25 becoming law.