State of Illinois
91st General Assembly
Legislation

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[ House Amendment 001 ][ House Amendment 002 ]

91_HB0454

 
                                               LRB9101706SMdv

 1        AN  ACT to amend the Illinois Public Aid Code by changing
 2    Section 5-5.02.

 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 Section 5-5.02 as follows:

 7        (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
 8        Sec. 5-5.02. Hospital reimbursements.
 9        (a)  Reimbursement to Hospitals;  July  1,  1992  through
10    September  30, 1992.  Notwithstanding any other provisions of
11    this Code or  the  Illinois  Department's  Rules  promulgated
12    under    the    Illinois    Administrative   Procedure   Act,
13    reimbursement to hospitals for services provided  during  the
14    period  July  1, 1992 through September 30, 1992, shall be as
15    follows:
16             (1)  For inpatient hospital services rendered, or if
17        applicable, for inpatient hospital discharges  occurring,
18        on  or  after July 1, 1992 and on or before September 30,
19        1992, the Illinois Department shall  reimburse  hospitals
20        for    inpatient   services   under   the   reimbursement
21        methodologies in effect for each  hospital,  and  at  the
22        inpatient  payment  rate calculated for each hospital, as
23        of June  30,  1992.   For  purposes  of  this  paragraph,
24        "reimbursement  methodologies"  means  all  reimbursement
25        methodologies  that pertain to the provision of inpatient
26        hospital services, including, but  not  limited  to,  any
27        adjustments  for disproportionate share, targeted access,
28        critical care access and uncompensated care,  as  defined
29        by the Illinois Department on June 30, 1992.
30             (2)  For  the  purpose  of calculating the inpatient
31        payment  rate  for  each  hospital  eligible  to  receive
 
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 1        quarterly adjustment payments  for  targeted  access  and
 2        critical  care,  as defined by the Illinois Department on
 3        June 30, 1992, the adjustment payment for the period July
 4        1, 1992 through September 30, 1992, shall be 25%  of  the
 5        annual  adjustment  payments calculated for each eligible
 6        hospital, as of June 30, 1992.  The  Illinois  Department
 7        shall  determine  by  rule  the  adjustment  payments for
 8        targeted access and critical care  beginning  October  1,
 9        1992.
10             (3)  For  the  purpose  of calculating the inpatient
11        payment  rate  for  each  hospital  eligible  to  receive
12        quarterly adjustment payments for uncompensated care,  as
13        defined  by the Illinois Department on June 30, 1992, the
14        adjustment payment for the period August 1, 1992  through
15        September  30,  1992,  shall  be  one-sixth  of the total
16        uncompensated care  adjustment  payments  calculated  for
17        each  eligible  hospital  for the uncompensated care rate
18        year, as defined by the Illinois  Department,  ending  on
19        July  31,  1992.  The Illinois Department shall determine
20        by rule the adjustment payments  for  uncompensated  care
21        beginning October 1, 1992.
22        (b)  Inpatient payments.  For inpatient services provided
23    on  or  after  October 1, 1993, in addition to rates paid for
24    hospital inpatient services pursuant to the  Illinois  Health
25    Finance  Reform  Act,  as  now  or  hereafter amended, or the
26    Illinois Department's prospective reimbursement  methodology,
27    or  any other methodology used by the Illinois Department for
28    inpatient  services,  the  Illinois  Department  shall   make
29    adjustment  payments, in an amount calculated pursuant to the
30    methodology described in paragraph (c) of  this  Section,  to
31    hospitals that the Illinois Department determines satisfy any
32    one of the following requirements:
33             (1)  Hospitals that are described in Section 1923 of
34        the  federal  Social  Security  Act,  as now or hereafter
 
                            -3-                LRB9101706SMdv
 1        amended; or
 2             (2)  Illinois  hospitals  that   have   a   Medicaid
 3        inpatient  utilization  rate which is at least one-half a
 4        standard deviation  above  the  mean  Medicaid  inpatient
 5        utilization  rate for all hospitals in Illinois receiving
 6        Medicaid payments from the Illinois Department; or
 7             (3)  Illinois hospitals that on July 1, 1991  had  a
 8        Medicaid   inpatient  utilization  rate,  as  defined  in
 9        paragraph (h) (f) of this Section, that was at least  the
10        mean   Medicaid   inpatient   utilization  rate  for  all
11        hospitals in Illinois receiving Medicaid   payments  from
12        the  Illinois  Department  and  which  were  located in a
13        planning area with one-third  or  fewer  excess  beds  as
14        determined  by  the  Illinois  Health Facilities Planning
15        Board, and that, as of June 30, 1992, were located  in  a
16        federally designated Health Manpower Shortage Area; or
17             (4)  Illinois hospitals that:
18                  (A)  have a Medicaid inpatient utilization rate
19             that   is  at  least  equal  to  the  mean  Medicaid
20             inpatient utilization  rate  for  all  hospitals  in
21             Illinois   receiving   Medicaid  payments  from  the
22             Department; and
23                  (B)  also have a Medicaid obstetrical inpatient
24             utilization rate  that  is  at  least  one  standard
25             deviation   above   the  mean  Medicaid  obstetrical
26             inpatient utilization  rate  for  all  hospitals  in
27             Illinois   receiving   Medicaid  payments  from  the
28             Department for obstetrical services; or
29             (5)  Any children's hospital, which means a hospital
30        devoted exclusively to caring for children.   A  hospital
31        which  includes  a facility devoted exclusively to caring
32        for children that is separately licensed as a hospital by
33        a municipality prior  to  September  30,  1998  shall  be
34        considered  a  children's hospital to the degree that the
 
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 1        hospital's Medicaid care is provided to children.
 2             (6) An Illinois hospital located in  Health  Service
 3        Area  (HSA) 11 as defined in Section 1100.220 of Title 77
 4        of the Illinois Administrative Code (77  Ill.  Adm.  Code
 5        1100.220)  with  the  highest  number of licensed beds as
 6        determined by the Department of Public Health based  upon
 7        the   Department's  published  report  entitled  "Percent
 8        Occupancy by Service for  1997  Short  Stay,  Non-Federal
 9        Hospitals in Illinois", dated July 1998.
10        (c)  Inpatient   adjustment   payments.   The  adjustment
11    payments required by paragraph (b) shall be calculated  based
12    upon  the  hospital's  Medicaid inpatient utilization rate as
13    follows:
14             (1)  hospitals with a Medicaid inpatient utilization
15        rate below the mean shall receive a  per  day  adjustment
16        payment equal to $25;
17             (2)   hospitals    with    a    Medicaid   inpatient
18        utilization rate that is equal to  or  greater  than  the
19        mean  Medicaid  inpatient  utilization rate but less than
20        one standard deviation above the mean Medicaid  inpatient
21        utilization  rate  shall  receive  a  per  day adjustment
22        payment equal to the sum of $25  plus  $1  for  each  one
23        percent    that   the   hospital's   Medicaid   inpatient
24        utilization rate  exceeds  the  mean  Medicaid  inpatient
25        utilization rate;
26             (3)   hospitals    with    a    Medicaid   inpatient
27        utilization rate that is equal to  or  greater  than  one
28        standard  deviation  above  the  mean  Medicaid inpatient
29        utilization rate but less than  1.5  standard  deviations
30        above  the mean Medicaid inpatient utilization rate shall
31        receive a per day adjustment payment equal to the sum  of
32        $40  plus  $7  for  each  one percent that the hospital's
33        Medicaid inpatient utilization rate exceeds one  standard
34        deviation  above  the mean Medicaid inpatient utilization
 
                            -5-                LRB9101706SMdv
 1        rate; and
 2             (4)   hospitals   with    a    Medicaid    inpatient
 3        utilization  rate  that  is  equal to or greater than 1.5
 4        standard deviations above  the  mean  Medicaid  inpatient
 5        utilization  rate  shall  receive  a  per  day adjustment
 6        payment equal to the sum of $90  plus  $2  for  each  one
 7        percent    that   the   hospital's   Medicaid   inpatient
 8        utilization rate exceeds 1.5  standard  deviations  above
 9        the mean Medicaid inpatient utilization rate.
10        (d)  Supplemental  adjustment  payments.   In addition to
11    the adjustment payments described in paragraph (c), hospitals
12    as defined in clauses  (1)  through  (5)  of  paragraph  (b),
13    excluding  county  hospitals (as defined in subsection (c) of
14    Section 15-1 of this Code) and a hospital organized under the
15    University  of  Illinois  Hospital   Act,   shall   be   paid
16    supplemental  inpatient  adjustment  payments of $60 per day.
17    For purposes of Title XIX of the federal Social Security Act,
18    these  supplemental  adjustment   payments   shall   not   be
19    classified  as  adjustment payments to disproportionate share
20    hospitals.
21        (e)  The  inpatient  adjustment  payments  described   in
22    paragraphs  (c) and (d) shall be increased on October 1, 1993
23    and annually thereafter by a percentage equal to  the  lesser
24    of  (i)  the  increase in the DRI hospital cost index for the
25    most recent 12 month period for which data are available,  or
26    (ii)   the  percentage  increase  in  the  statewide  average
27    hospital payment rate  over  the  previous  year's  statewide
28    average  hospital  payment  rate.   The  sum of the inpatient
29    adjustment  payments  under  paragraphs  (c)  and  (d)  to  a
30    hospital,  other  than  a  county  hospital  (as  defined  in
31    subsection (c) of Section 15-1 of this Code)  or  a  hospital
32    organized  under  the  University  of  Illinois Hospital Act,
33    however, shall not exceed $275 per day; that limit  shall  be
34    increased  on  October  1,  1993 and annually thereafter by a
 
                            -6-                LRB9101706SMdv
 1    percentage equal to the lesser of (i) the increase in the DRI
 2    hospital cost index for the most recent 12-month  period  for
 3    which  data  are available or (ii) the percentage increase in
 4    the statewide average hospital payment rate over the previous
 5    year's statewide average hospital payment rate.
 6        (f)   Children's hospital inpatient adjustment  payments.
 7    For  children's  hospitals,  as  defined  in  clause  (5)  of
 8    paragraph  (b),  the adjustment payments required pursuant to
 9    paragraphs (c) and (d) shall be multiplied by 2.0.
10        (g)   County hospital inpatient adjustment payments.  For
11    county hospitals, as defined in  subsection  (c)  of  Section
12    15-1  of  this  Code, there shall be an adjustment payment as
13    determined by rules issued by the Illinois Department.
14        (h)   For the purposes  of  this  Section  the  following
15    terms shall be defined as follows:
16             (1)  "Medicaid  inpatient  utilization rate" means a
17        fraction, the numerator of  which  is  the  number  of  a
18        hospital's  inpatient  days  provided in a given 12-month
19        period to patients who, for such days, were eligible  for
20        Medicaid  under  Title XIX of the federal Social Security
21        Act, and the denominator of which is the total number  of
22        the hospital's inpatient days in that same period.
23             (2)  "Mean   Medicaid  inpatient  utilization  rate"
24        means  the  total  number  of  Medicaid  inpatient   days
25        provided by all Illinois Medicaid-participating hospitals
26        divided by the total number of inpatient days provided by
27        those same hospitals.
28             (3)  "Medicaid   obstetrical  inpatient  utilization
29        rate" means the ratio of Medicaid  obstetrical  inpatient
30        days  to  total  Medicaid inpatient days for all Illinois
31        hospitals receiving Medicaid payments from  the  Illinois
32        Department.
33        (i)   Inpatient  adjustment  payment  limit.  In order to
34    meet the limits of Public Law 102-234 and Public Law  103-66,
 
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 1    the Illinois Department shall by rule adjust disproportionate
 2    share adjustment payments.
 3        (j)  University of Illinois Hospital inpatient adjustment
 4    payments.   For  hospitals  organized under the University of
 5    Illinois Hospital Act, there shall be an  adjustment  payment
 6    as determined by rules adopted by the Illinois Department.
 7        (k)  The   Illinois  Department  may  by  rule  establish
 8    criteria  for  and  develop  methodologies   for   adjustment
 9    payments to hospitals participating under this Article.
10    (Source: P.A. 89-21, eff. 7-1-95; 90-588, eff. 7-1-98.)

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