100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB2994

 

Introduced , by Rep. Camille Y. Lilly

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5e.1
305 ILCS 5/5A-2  from Ch. 23, par. 5A-2
305 ILCS 5/5A-5  from Ch. 23, par. 5A-5
305 ILCS 5/5A-8  from Ch. 23, par. 5A-8
305 ILCS 5/5A-10  from Ch. 23, par. 5A-10
305 ILCS 5/5A-12.5
305 ILCS 5/5A-14
305 ILCS 5/12-4.105
305 ILCS 5/14-12

    Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Extends the period of time certain hospital assessments are imposed through State fiscal year 2020. Effective July 1, 2017.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB2994LRB100 08641 KTG 18775 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-5e.1, 5A-2, 5A-5, 5A-8, 5A-10, 5A-12.5,
65A-14, 12-4.105, and 14-12 as follows:
 
7    (305 ILCS 5/5-5e.1)
8    Sec. 5-5e.1. Safety-Net Hospitals.
9    (a) A Safety-Net Hospital is an Illinois hospital that:
10        (1) is licensed by the Department of Public Health as a
11    general acute care or pediatric hospital; and
12        (2) is a disproportionate share hospital, as described
13    in Section 1923 of the federal Social Security Act, as
14    determined by the Department; and
15        (3) meets one of the following:
16            (A) has a MIUR of at least 40% and a charity
17        percent of at least 4%; or
18            (B) has a MIUR of at least 50%.
19    (b) Definitions. As used in this Section:
20        (1) "Charity percent" means the ratio of (i) the
21    hospital's charity charges for services provided to
22    individuals without health insurance or another source of
23    third party coverage to (ii) the Illinois total hospital

 

 

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1    charges, each as reported on the hospital's OBRA form.
2        (2) "MIUR" means Medicaid Inpatient Utilization Rate
3    and is defined as a fraction, the numerator of which is the
4    number of a hospital's inpatient days provided in the
5    hospital's fiscal year ending 3 years prior to the rate
6    year, to patients who, for such days, were eligible for
7    Medicaid under Title XIX of the federal Social Security
8    Act, 42 USC 1396a et seq., excluding those persons eligible
9    for medical assistance pursuant to 42 U.S.C.
10    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
11    Section 5-2 of this Article, and the denominator of which
12    is the total number of the hospital's inpatient days in
13    that same period, excluding those persons eligible for
14    medical assistance pursuant to 42 U.S.C.
15    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
16    Section 5-2 of this Article.
17        (3) "OBRA form" means form HFS-3834, OBRA '93 data
18    collection form, for the rate year.
19        (4) "Rate year" means the 12-month period beginning on
20    October 1.
21    (c) Beginning July 1, 2012 and ending on June 30, 2020
222018, a hospital that would have qualified for the rate year
23beginning October 1, 2011, shall be a Safety-Net Hospital.
24    (d) No later than August 15 preceding the rate year, each
25hospital shall submit the OBRA form to the Department. Prior to
26October 1, the Department shall notify each hospital whether it

 

 

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1has qualified as a Safety-Net Hospital.
2    (e) The Department may promulgate rules in order to
3implement this Section.
4    (f) Nothing in this Section shall be construed as limiting
5the ability of the Department to include the Safety-Net
6Hospitals in the hospital rate reform mandated by Section 14-11
7of this Code and implemented under Section 14-12 of this Code
8and by administrative rulemaking.
9(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13;
1098-651, eff. 6-16-14.)
 
11    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
12    (Section scheduled to be repealed on July 1, 2018)
13    Sec. 5A-2. Assessment.
14    (a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
15years 2009 through 2020 2018, an annual assessment on inpatient
16services is imposed on each hospital provider in an amount
17equal to $218.38 multiplied by the difference of the hospital's
18occupied bed days less the hospital's Medicare bed days,
19provided, however, that the amount of $218.38 shall be
20increased by a uniform percentage to generate an amount equal
21to 75% of the State share of the payments authorized under
22Section 5A-12.5, with such increase only taking effect upon the
23date that a State share for such payments is required under
24federal law. For the period of April through June 2015, the
25amount of $218.38 used to calculate the assessment under this

 

 

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1paragraph shall, by emergency rule under subsection (s) of
2Section 5-45 of the Illinois Administrative Procedure Act, be
3increased by a uniform percentage to generate $20,250,000 in
4the aggregate for that period from all hospitals subject to the
5annual assessment under this paragraph.
6    (2) In addition to any other assessments imposed under this
7Article, effective July 1, 2016 and semi-annually thereafter
8through June 2020 2018, in addition to any federally required
9State share as authorized under paragraph (1), the amount of
10$218.38 shall be increased by a uniform percentage to generate
11an amount equal to 75% of the ACA Assessment Adjustment, as
12defined in subsection (b-6) of this Section.
13    For State fiscal years 2009 through 2020 2014 and after, a
14hospital's occupied bed days and Medicare bed days shall be
15determined using the most recent data available from each
16hospital's 2005 Medicare cost report as contained in the
17Healthcare Cost Report Information System file, for the quarter
18ending on December 31, 2006, without regard to any subsequent
19adjustments or changes to such data. If a hospital's 2005
20Medicare cost report is not contained in the Healthcare Cost
21Report Information System, then the Illinois Department may
22obtain the hospital provider's occupied bed days and Medicare
23bed days from any source available, including, but not limited
24to, records maintained by the hospital provider, which may be
25inspected at all times during business hours of the day by the
26Illinois Department or its duly authorized agents and

 

 

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1employees.
2    (b) (Blank).
3    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
4portion of State fiscal year 2012, beginning June 10, 2012
5through June 30, 2012, and for State fiscal years 2013 through
62020 2018, an annual assessment on outpatient services is
7imposed on each hospital provider in an amount equal to .008766
8multiplied by the hospital's outpatient gross revenue,
9provided, however, that the amount of .008766 shall be
10increased by a uniform percentage to generate an amount equal
11to 25% of the State share of the payments authorized under
12Section 5A-12.5, with such increase only taking effect upon the
13date that a State share for such payments is required under
14federal law. For the period beginning June 10, 2012 through
15June 30, 2012, the annual assessment on outpatient services
16shall be prorated by multiplying the assessment amount by a
17fraction, the numerator of which is 21 days and the denominator
18of which is 365 days. For the period of April through June
192015, the amount of .008766 used to calculate the assessment
20under this paragraph shall, by emergency rule under subsection
21(s) of Section 5-45 of the Illinois Administrative Procedure
22Act, be increased by a uniform percentage to generate
23$6,750,000 in the aggregate for that period from all hospitals
24subject to the annual assessment under this paragraph.
25    (2) In addition to any other assessments imposed under this
26Article, effective July 1, 2016 and semi-annually thereafter

 

 

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1through June 2020 2018, in addition to any federally required
2State share as authorized under paragraph (1), the amount of
3.008766 shall be increased by a uniform percentage to generate
4an amount equal to 25% of the ACA Assessment Adjustment, as
5defined in subsection (b-6) of this Section.
6    For the portion of State fiscal year 2012, beginning June
710, 2012 through June 30, 2012, and State fiscal years 2013
8through 2020 2018, a hospital's outpatient gross revenue shall
9be determined using the most recent data available from each
10hospital's 2009 Medicare cost report as contained in the
11Healthcare Cost Report Information System file, for the quarter
12ending on June 30, 2011, without regard to any subsequent
13adjustments or changes to such data. If a hospital's 2009
14Medicare cost report is not contained in the Healthcare Cost
15Report Information System, then the Department may obtain the
16hospital provider's outpatient gross revenue from any source
17available, including, but not limited to, records maintained by
18the hospital provider, which may be inspected at all times
19during business hours of the day by the Department or its duly
20authorized agents and employees.
21    (b-6)(1) As used in this Section, "ACA Assessment
22Adjustment" means:
23        (A) For the period of July 1, 2016 through December 31,
24    2016, the product of .19125 multiplied by the sum of the
25    fee-for-service payments to hospitals as authorized under
26    Section 5A-12.5 and the adjustments authorized under

 

 

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

 

 

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1    difference between the actual payments issued under
2    Section 5A-12.5 for the period beginning January 1, 2017
3    through June 30, 2017 and the estimated payments due and
4    payable in the month of October 2016 multiplied by 6 as
5    described in subparagraph (B).
6        (D) For the period of January 1, 2018 through June 30,
7    2018, 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 2017 multiplied by 6, except that:
13            (i) the amount calculated under this subparagraph
14        (D) shall be adjusted, either positively or
15        negatively, to account for the difference between the
16        actual payments issued under Section 5A-12.5 for the
17        period of July 1, 2017 through December 31, 2017 and
18        the estimated payments due and payable in the month of
19        April 2017 multiplied by 6 as described in subparagraph
20        (C); and
21            (ii) the amount calculated under this subparagraph
22        (D) shall be adjusted to include the product of .19125
23        multiplied by the sum of the fee-for-service payments,
24        if any, estimated to be paid to hospitals under
25        subsection (b) of Section 5A-12.5.
26    (1.5) Subject to federal approval, payments made under

 

 

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1subparagraphs (A), (B), (C), and (D) shall continue through
2December 31, 2019.
3    (2) The Department shall complete and apply a final
4reconciliation of the ACA Assessment Adjustment prior to June
530, 2018 to account for:
6        (A) any differences between the actual payments issued
7    or scheduled to be issued prior to June 30, 2018 as
8    authorized in Section 5A-12.5 for the period of January 1,
9    2018 through June 30, 2020 2018 and the estimated payments
10    due and payable in the month of October 2017 multiplied by
11    6 as described in subparagraph (D); and
12        (B) any difference between the estimated
13    fee-for-service payments under subsection (b) of Section
14    5A-12.5 and the amount of such payments that are actually
15    scheduled to be paid.
16    The Department shall notify hospitals of any additional
17amounts owed or reduction credits to be applied to the June
182018 ACA Assessment Adjustment. This is to be considered the
19final reconciliation for the ACA Assessment Adjustment.
20    (3) Notwithstanding any other provision of this Section, if
21for any reason the scheduled payments under subsection (b) of
22Section 5A-12.5 are not issued in full by the final day of the
23period authorized under subsection (b) of Section 5A-12.5,
24funds collected from each hospital pursuant to subparagraph (D)
25of paragraph (1) and pursuant to paragraph (2), attributable to
26the scheduled payments authorized under subsection (b) of

 

 

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

 

 

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1federal law, to determine whether those assessments and
2hospital provider payments meet federal Medicaid standards. If
3the Department determines that the elements of the plan may
4meet federal Medicaid standards and a related State Medicaid
5Plan Amendment is prepared in a manner and form suitable for
6submission, that State Plan Amendment shall be submitted in a
7timely manner for review by the Centers for Medicare and
8Medicaid Services of the United States Department of Health and
9Human Services and subject to approval by the Centers for
10Medicare and Medicaid Services of the United States Department
11of Health and Human Services. No such plan shall become
12effective without approval by the Illinois General Assembly by
13the enactment into law of related legislation. Notwithstanding
14any other provision of this Section, the Department is
15authorized to adopt rules to reduce the rate of any annual
16assessment imposed under this Section. Any such rules may be
17adopted by the Department under Section 5-50 of the Illinois
18Administrative Procedure Act.
19(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2,
20eff. 3-26-15; 99-516, eff. 6-30-16.)
 
21    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
22    Sec. 5A-5. Notice; penalty; maintenance of records.
23    (a) The Illinois Department shall send a notice of
24assessment to every hospital provider subject to assessment
25under this Article. The notice of assessment shall notify the

 

 

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1hospital of its assessment and shall be sent after receipt by
2the Department of notification from the Centers for Medicare
3and Medicaid Services of the U.S. Department of Health and
4Human Services that the payment methodologies required under
5this Article and, if necessary, the waiver granted under 42 CFR
6433.68 have been approved. The notice shall be on a form
7prepared by the Illinois Department and shall state the
8following:
9        (1) The name of the hospital provider.
10        (2) The address of the hospital provider's principal
11    place of business from which the provider engages in the
12    occupation of hospital provider in this State, and the name
13    and address of each hospital operated, conducted, or
14    maintained by the provider in this State.
15        (3) The occupied bed days, occupied bed days less
16    Medicare days, adjusted gross hospital revenue, or
17    outpatient gross revenue of the hospital provider
18    (whichever is applicable), the amount of assessment
19    imposed under Section 5A-2 for the State fiscal year for
20    which the notice is sent, and the amount of each
21    installment to be paid during the State fiscal year.
22        (4) (Blank).
23        (5) Other reasonable information as determined by the
24    Illinois Department.
25    (b) If a hospital provider conducts, operates, or maintains
26more than one hospital licensed by the Illinois Department of

 

 

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1Public Health, the provider shall pay the assessment for each
2hospital separately.
3    (c) Notwithstanding any other provision in this Article, in
4the case of a person who ceases to conduct, operate, or
5maintain a hospital in respect of which the person is subject
6to assessment under this Article as a hospital provider, the
7assessment for the State fiscal year in which the cessation
8occurs shall be adjusted by multiplying the assessment computed
9under Section 5A-2 by a fraction, the numerator of which is the
10number of days in the year during which the provider conducts,
11operates, or maintains the hospital and the denominator of
12which is 365. Immediately upon ceasing to conduct, operate, or
13maintain a hospital, the person shall pay the assessment for
14the year as so adjusted (to the extent not previously paid).
15    (d) Notwithstanding any other provision in this Article, a
16provider who commences conducting, operating, or maintaining a
17hospital, upon notice by the Illinois Department, shall pay the
18assessment computed under Section 5A-2 and subsection (e) in
19installments on the due dates stated in the notice and on the
20regular installment due dates for the State fiscal year
21occurring after the due dates of the initial notice.
22    (e) Notwithstanding any other provision in this Article,
23for State fiscal years 2009 through 2020 2018, in the case of a
24hospital provider that did not conduct, operate, or maintain a
25hospital in 2005, the assessment for that State fiscal year
26shall be computed on the basis of hypothetical occupied bed

 

 

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1days for the full calendar year as determined by the Illinois
2Department. Notwithstanding any other provision in this
3Article, for the portion of State fiscal year 2012 beginning
4June 10, 2012 through June 30, 2012, and for State fiscal years
52013 through 2020 2018, in the case of a hospital provider that
6did not conduct, operate, or maintain a hospital in 2009, the
7assessment under subsection (b-5) of Section 5A-2 for that
8State fiscal year shall be computed on the basis of
9hypothetical gross outpatient revenue for the full calendar
10year as determined by the Illinois Department.
11    (f) Every hospital provider subject to assessment under
12this Article shall keep sufficient records to permit the
13determination of adjusted gross hospital revenue for the
14hospital's fiscal year. All such records shall be kept in the
15English language and shall, at all times during regular
16business hours of the day, be subject to inspection by the
17Illinois Department or its duly authorized agents and
18employees.
19    (g) The Illinois Department may, by rule, provide a
20hospital provider a reasonable opportunity to request a
21clarification or correction of any clerical or computational
22errors contained in the calculation of its assessment, but such
23corrections shall not extend to updating the cost report
24information used to calculate the assessment.
25    (h) (Blank).
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; 98-756, eff. 7-16-14; 99-78, eff.
27-20-15.)
 
3    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
4    Sec. 5A-8. Hospital Provider Fund.
5    (a) There is created in the State Treasury the Hospital
6Provider Fund. Interest earned by the Fund shall be credited to
7the Fund. The Fund shall not be used to replace any moneys
8appropriated to the Medicaid program by the General Assembly.
9    (b) The Fund is created for the purpose of receiving moneys
10in accordance with Section 5A-6 and disbursing moneys only for
11the following purposes, notwithstanding any other provision of
12law:
13        (1) For making payments to hospitals as required under
14    this Code, under the Children's Health Insurance Program
15    Act, under the Covering ALL KIDS Health Insurance Act, and
16    under the Long Term Acute Care Hospital Quality Improvement
17    Transfer Program Act.
18        (2) For the reimbursement of moneys collected by the
19    Illinois Department from hospitals or hospital providers
20    through error or mistake in performing the activities
21    authorized under this Code.
22        (3) For payment of administrative expenses incurred by
23    the Illinois Department or its agent in performing
24    activities under this Code, under the Children's Health
25    Insurance Program Act, under the Covering ALL KIDS Health

 

 

HB2994- 16 -LRB100 08641 KTG 18775 b

1    Insurance Act, and under the Long Term Acute Care Hospital
2    Quality Improvement Transfer Program Act.
3        (4) For payments of any amounts which are reimbursable
4    to the federal government for payments from this Fund which
5    are required to be paid by State warrant.
6        (5) For making transfers, as those transfers are
7    authorized in the proceedings authorizing debt under the
8    Short Term Borrowing Act, but transfers made under this
9    paragraph (5) shall not exceed the principal amount of debt
10    issued in anticipation of the receipt by the State of
11    moneys to be deposited into the Fund.
12        (6) For making transfers to any other fund in the State
13    treasury, but transfers made under this paragraph (6) shall
14    not exceed the amount transferred previously from that
15    other fund into the Hospital Provider Fund plus any
16    interest that would have been earned by that fund on the
17    monies that had been transferred.
18        (6.5) For making transfers to the Healthcare Provider
19    Relief Fund, except that transfers made under this
20    paragraph (6.5) shall not exceed $60,000,000 in the
21    aggregate.
22        (7) For making transfers not exceeding the following
23    amounts, related to State fiscal years 2013 through 2020
24    2018, to the following designated funds:
25            Health and Human Services Medicaid Trust
26                Fund..............................$20,000,000

 

 

HB2994- 17 -LRB100 08641 KTG 18775 b

1            Long-Term Care Provider Fund..........$30,000,000
2            General Revenue Fund.................$80,000,000.
3    Transfers under this paragraph shall be made within 7 days
4    after the payments have been received pursuant to the
5    schedule of payments provided in subsection (a) of Section
6    5A-4.
7        (7.1) (Blank).
8        (7.5) (Blank).
9        (7.8) (Blank).
10        (7.9) (Blank).
11        (7.10) For State fiscal year 2014, for making transfers
12    of the moneys resulting from the assessment under
13    subsection (b-5) of Section 5A-2 and received from hospital
14    providers under Section 5A-4 and transferred into the
15    Hospital Provider Fund under Section 5A-6 to the designated
16    funds not exceeding the following amounts in that State
17    fiscal year:
18            Health Care Provider Relief Fund.....$100,000,000
19        Transfers under this paragraph shall be made within 7
20    days after the payments have been received pursuant to the
21    schedule of payments provided in subsection (a) of Section
22    5A-4.
23        The additional amount of transfers in this paragraph
24    (7.10), authorized by Public Act 98-651, shall be made
25    within 10 State business days after June 16, 2014 (the
26    effective date of Public Act 98-651). That authority shall

 

 

HB2994- 18 -LRB100 08641 KTG 18775 b

1    remain in effect even if Public Act 98-651 does not become
2    law until State fiscal year 2015.
3        (7.10a) For State fiscal years 2015 through 2020 2018,
4    for making transfers of the moneys resulting from the
5    assessment under subsection (b-5) of Section 5A-2 and
6    received from hospital providers under Section 5A-4 and
7    transferred into the Hospital Provider Fund under Section
8    5A-6 to the designated funds not exceeding the following
9    amounts related to each State fiscal year:
10            Health Care Provider Relief Fund ....$50,000,000
11        Transfers under this paragraph shall be made within 7
12    days after the payments have been received pursuant to the
13    schedule of payments provided in subsection (a) of Section
14    5A-4.
15        (7.11) (Blank).
16        (7.12) For State fiscal year 2013, for increasing by
17    21/365ths the transfer of the moneys resulting from the
18    assessment under subsection (b-5) of Section 5A-2 and
19    received from hospital providers under Section 5A-4 for the
20    portion of State fiscal year 2012 beginning June 10, 2012
21    through June 30, 2012 and transferred into the Hospital
22    Provider Fund under Section 5A-6 to the designated funds
23    not exceeding the following amounts in that State fiscal
24    year:
25            Health Care Provider Relief Fund......$2,870,000
26        Since the federal Centers for Medicare and Medicaid

 

 

HB2994- 19 -LRB100 08641 KTG 18775 b

1    Services approval of the assessment authorized under
2    subsection (b-5) of Section 5A-2, received from hospital
3    providers under Section 5A-4 and the payment methodologies
4    to hospitals required under Section 5A-12.4 was not
5    received by the Department until State fiscal year 2014 and
6    since the Department made retroactive payments during
7    State fiscal year 2014 related to the referenced period of
8    June 2012, the transfer authority granted in this paragraph
9    (7.12) is extended through the date that is 10 State
10    business days after June 16, 2014 (the effective date of
11    Public Act 98-651).
12        (7.13) In addition to any other transfers authorized
13    under this Section, for State fiscal years 2017 and 2020
14    2018, for making transfers to the Healthcare Provider
15    Relief Fund of moneys collected from the ACA Assessment
16    Adjustment authorized under subsections (a) and (b-5) of
17    Section 5A-2 and paid by hospital providers under Section
18    5A-4 into the Hospital Provider Fund under Section 5A-6 for
19    each State fiscal year. Timing of transfers to the
20    Healthcare Provider Relief Fund under this paragraph shall
21    be at the discretion of the Department, but no less
22    frequently than quarterly.
23        (8) For making refunds to hospital providers pursuant
24    to Section 5A-10.
25        (9) For making payment to capitated managed care
26    organizations as described in subsections (s) and (t) of

 

 

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1    Section 5A-12.2 of this Code.
2    Disbursements from the Fund, other than transfers
3authorized under paragraphs (5) and (6) of this subsection,
4shall be by warrants drawn by the State Comptroller upon
5receipt of vouchers duly executed and certified by the Illinois
6Department.
7    (c) The Fund shall consist of the following:
8        (1) All moneys collected or received by the Illinois
9    Department from the hospital provider assessment imposed
10    by this Article.
11        (2) All federal matching funds received by the Illinois
12    Department as a result of expenditures made by the Illinois
13    Department that are attributable to moneys deposited in the
14    Fund.
15        (3) Any interest or penalty levied in conjunction with
16    the administration of this Article.
17        (3.5) As applicable, proceeds from surety bond
18    payments payable to the Department as referenced in
19    subsection (s) of Section 5A-12.2 of this Code.
20        (4) Moneys transferred from another fund in the State
21    treasury.
22        (5) All other moneys received for the Fund from any
23    other source, including interest earned thereon.
24    (d) (Blank).
25(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
2698-651, eff. 6-16-14; 98-756, eff. 7-16-14; 99-78, eff.

 

 

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17-20-15; 99-516, eff. 6-30-16.)
 
2    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
3    Sec. 5A-10. Applicability.
4    (a) The assessment imposed by subsection (a) of Section
55A-2 shall cease to be imposed and the Department's obligation
6to make payments shall immediately cease, and any moneys
7remaining in the Fund shall be refunded to hospital providers
8in proportion to the amounts paid by them, if:
9        (1) The payments to hospitals required under this
10    Article are not eligible for federal matching funds under
11    Title XIX or XXI of the Social Security Act;
12        (2) For State fiscal years 2009 through 2020 2018, the
13    Department of Healthcare and Family Services adopts any
14    administrative rule change to reduce payment rates or
15    alters any payment methodology that reduces any payment
16    rates made to operating hospitals under the approved Title
17    XIX or Title XXI State plan in effect January 1, 2008
18    except for:
19            (A) any changes for hospitals described in
20        subsection (b) of Section 5A-3;
21            (B) any rates for payments made under this Article
22        V-A;
23            (C) any changes proposed in State plan amendment
24        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
25        08-07;

 

 

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1            (D) in relation to any admissions on or after
2        January 1, 2011, a modification in the methodology for
3        calculating outlier payments to hospitals for
4        exceptionally costly stays, for hospitals reimbursed
5        under the diagnosis-related grouping methodology in
6        effect on July 1, 2011; provided that the Department
7        shall be limited to one such modification during the
8        36-month period after the effective date of this
9        amendatory Act of the 96th General Assembly;
10            (E) any changes affecting hospitals authorized by
11        Public Act 97-689;
12            (F) any changes authorized by Section 14-12 of this
13        Code, or for any changes authorized under Section 5A-15
14        of this Code; or
15            (G) any changes authorized under Section 5-5b.1.
16    (b) The assessment imposed by Section 5A-2 shall not take
17effect or shall cease to be imposed, and the Department's
18obligation to make payments shall immediately cease, if the
19assessment is determined to be an impermissible tax under Title
20XIX of the Social Security Act. Moneys in the Hospital Provider
21Fund derived from assessments imposed prior thereto shall be
22disbursed in accordance with Section 5A-8 to the extent federal
23financial participation is not reduced due to the
24impermissibility of the assessments, and any remaining moneys
25shall be refunded to hospital providers in proportion to the
26amounts paid by them.

 

 

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1    (c) The assessments imposed by subsection (b-5) of Section
25A-2 shall not take effect or shall cease to be imposed, the
3Department's obligation to make payments shall immediately
4cease, and any moneys remaining in the Fund shall be refunded
5to hospital providers in proportion to the amounts paid by
6them, if the payments to hospitals required under Section
75A-12.4 are not eligible for federal matching funds under Title
8XIX of the Social Security Act.
9    (d) The assessments imposed by Section 5A-2 shall not take
10effect or shall cease to be imposed, the Department's
11obligation to make payments shall immediately cease, and any
12moneys remaining in the Fund shall be refunded to hospital
13providers in proportion to the amounts paid by them, if:
14        (1) for State fiscal years 2013 through 2020 2018, the
15    Department reduces any payment rates to hospitals as in
16    effect on May 1, 2012, or alters any payment methodology as
17    in effect on May 1, 2012, that has the effect of reducing
18    payment rates to hospitals, except for any changes
19    affecting hospitals authorized in Public Act 97-689 and any
20    changes authorized by Section 14-12 of this Code, and
21    except for any changes authorized under Section 5A-15, and
22    except for any changes authorized under Section 5-5b.1;
23        (2) for State fiscal years 2013 through 2020 2018, the
24    Department reduces any supplemental payments made to
25    hospitals below the amounts paid for services provided in
26    State fiscal year 2011 as implemented by administrative

 

 

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1    rules adopted and in effect on or prior to June 30, 2011,
2    except for any changes affecting hospitals authorized in
3    Public Act 97-689 and any changes authorized by Section
4    14-12 of this Code, and except for any changes authorized
5    under Section 5A-15, and except for any changes authorized
6    under Section 5-5b.1; or
7        (3) for State fiscal years 2015 through 2020 2018, the
8    Department reduces the overall effective rate of
9    reimbursement to hospitals below the level authorized
10    under Section 14-12 of this Code, except for any changes
11    under Section 14-12 or Section 5A-15 of this Code, and
12    except for any changes authorized under Section 5-5b.1.
13(Source: P.A. 98-463, eff. 8-16-13; 98-651, eff. 6-16-14; 99-2,
14eff. 3-26-15.)
 
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, 2020 2018, even if such increases are paid out
7during an extended payment period beyond such date. Payment of
8such increases 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; 99-516, eff. 6-30-16.)
 
14    (305 ILCS 5/5A-14)
15    Sec. 5A-14. Repeal of assessments and disbursements.
16    (a) Section 5A-2 is repealed on July 1, 2020 2018.
17    (b) Section 5A-12 is repealed on July 1, 2005.
18    (c) Section 5A-12.1 is repealed on July 1, 2008.
19    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
20July 1, 2020 2018.
21    (e) Section 5A-12.3 is repealed on July 1, 2011.
22(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12;
2398-651, eff. 6-16-14.)
 
24    (305 ILCS 5/12-4.105)

 

 

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1    Sec. 12-4.105. Human poison control center; payment
2program. Subject to funding availability resulting from
3transfers made from the Hospital Provider Fund to the
4Healthcare Provider Relief Fund as authorized under this Code,
5for State fiscal year 2017 and State fiscal year 2020 2018, the
6Department of Healthcare and Family Services shall pay to the
7human poison control center designated under the Poison Control
8System Act an amount of not less than $3,000,000 for each of
9those State fiscal years that the human poison control center
10is in operation.
11(Source: P.A. 99-516, eff. 6-30-16.)
 
12    (305 ILCS 5/14-12)
13    Sec. 14-12. Hospital rate reform payment system. The
14hospital payment system pursuant to Section 14-11 of this
15Article shall be as follows:
16    (a) Inpatient hospital services. Effective for discharges
17on and after July 1, 2014, reimbursement for inpatient general
18acute care services shall utilize the All Patient Refined
19Diagnosis Related Grouping (APR-DRG) software, version 30,
20distributed by 3MTM Health Information System.
21        (1) The Department shall establish Medicaid weighting
22    factors to be used in the reimbursement system established
23    under this subsection. Initial weighting factors shall be
24    the weighting factors as published by 3M Health Information
25    System, associated with Version 30.0 adjusted for the

 

 

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1    Illinois experience.
2        (2) The Department shall establish a
3    statewide-standardized amount to be used in the inpatient
4    reimbursement system. The Department shall publish these
5    amounts on its website no later than 10 calendar days prior
6    to their effective date.
7        (3) In addition to the statewide-standardized amount,
8    the Department shall develop adjusters to adjust the rate
9    of reimbursement for critical Medicaid providers or
10    services for trauma, transplantation services, perinatal
11    care, and Graduate Medical Education (GME).
12        (4) The Department shall develop add-on payments to
13    account for exceptionally costly inpatient stays,
14    consistent with Medicare outlier principles. Outlier fixed
15    loss thresholds may be updated to control for excessive
16    growth in outlier payments no more frequently than on an
17    annual basis, but at least triennially. Upon updating the
18    fixed loss thresholds, the Department shall be required to
19    update base rates within 12 months.
20        (5) The Department shall define those hospitals or
21    distinct parts of hospitals that shall be exempt from the
22    APR-DRG reimbursement system established under this
23    Section. The Department shall publish these hospitals'
24    inpatient rates on its website no later than 10 calendar
25    days prior to their effective date.
26        (6) Beginning July 1, 2014 and ending on June 30, 2018,

 

 

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1    in addition to the statewide-standardized amount, the
2    Department shall develop an adjustor to adjust the rate of
3    reimbursement for safety-net hospitals defined in Section
4    5-5e.1 of this Code excluding pediatric hospitals.
5        (7) Beginning July 1, 2014 and ending on June 30, 2018,
6    in addition to the statewide-standardized amount, the
7    Department shall develop an adjustor to adjust the rate of
8    reimbursement for Illinois freestanding inpatient
9    psychiatric hospitals that are not designated as
10    children's hospitals by the Department but are primarily
11    treating patients under the age of 21.
12    (b) Outpatient hospital services. Effective for dates of
13service on and after July 1, 2014, reimbursement for outpatient
14services shall utilize the Enhanced Ambulatory Procedure
15Grouping (E-APG) software, version 3.7 distributed by 3MTM
16Health Information System.
17        (1) The Department shall establish Medicaid weighting
18    factors to be used in the reimbursement system established
19    under this subsection. The initial weighting factors shall
20    be the weighting factors as published by 3M Health
21    Information System, associated with Version 3.7.
22        (2) The Department shall establish service specific
23    statewide-standardized amounts to be used in the
24    reimbursement system.
25            (A) The initial statewide standardized amounts,
26        with the labor portion adjusted by the Calendar Year

 

 

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1        2013 Medicare Outpatient Prospective Payment System
2        wage index with reclassifications, shall be published
3        by the Department on its website no later than 10
4        calendar days prior to their effective date.
5            (B) The Department shall establish adjustments to
6        the statewide-standardized amounts for each Critical
7        Access Hospital, as designated by the Department of
8        Public Health in accordance with 42 CFR 485, Subpart F.
9        The EAPG standardized amounts are determined
10        separately for each critical access hospital such that
11        simulated EAPG payments using outpatient base period
12        paid claim data plus payments under Section 5A-12.4 of
13        this Code net of the associated tax costs are equal to
14        the estimated costs of outpatient base period claims
15        data with a rate year cost inflation factor applied.
16        (3) In addition to the statewide-standardized amounts,
17    the Department shall develop adjusters to adjust the rate
18    of reimbursement for critical Medicaid hospital outpatient
19    providers or services, including outpatient high volume or
20    safety-net hospitals.
21    (c) In consultation with the hospital community, the
22Department is authorized to replace 89 Ill. Admin. Code 152.150
23as published in 38 Ill. Reg. 4980 through 4986 within 12 months
24of the effective date of this amendatory Act of the 98th
25General Assembly. If the Department does not replace these
26rules within 12 months of the effective date of this amendatory

 

 

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1Act of the 98th General Assembly, the rules in effect for
2152.150 as published in 38 Ill. Reg. 4980 through 4986 shall
3remain in effect until modified by rule by the Department.
4Nothing in this subsection shall be construed to mandate that
5the Department file a replacement rule.
6    (d) Transition period. There shall be a transition period
7to the reimbursement systems authorized under this Section that
8shall begin on the effective date of these systems and continue
9until June 30, 2020 2018, unless extended by rule by the
10Department. To help provide an orderly and predictable
11transition to the new reimbursement systems and to preserve and
12enhance access to the hospital services during this transition,
13the Department shall allocate a transitional hospital access
14pool of at least $290,000,000 annually so that transitional
15hospital access payments are made to hospitals.
16        (1) After the transition period, the Department may
17    begin incorporating the transitional hospital access pool
18    into the base rate structure.
19        (2) After the transition period, if the Department
20    reduces payments from the transitional hospital access
21    pool, it shall increase base rates, develop new adjustors,
22    adjust current adjustors, develop new hospital access
23    payments based on updated information, or any combination
24    thereof by an amount equal to the decreases proposed in the
25    transitional hospital access pool payments, ensuring that
26    the entire transitional hospital access pool amount shall

 

 

HB2994- 31 -LRB100 08641 KTG 18775 b

1    continue to be used for hospital payments.
2    (e) Beginning 36 months after initial implementation, the
3Department shall update the reimbursement components in
4subsections (a) and (b), including standardized amounts and
5weighting factors, and at least triennially and no more
6frequently than annually thereafter. The Department shall
7publish these updates on its website no later than 30 calendar
8days prior to their effective date.
9    (f) Continuation of supplemental payments. Any
10supplemental payments authorized under Illinois Administrative
11Code 148 effective January 1, 2014 and that continue during the
12period of July 1, 2014 through December 31, 2014 shall remain
13in effect as long as the assessment imposed by Section 5A-2 is
14in effect.
15    (g) Notwithstanding subsections (a) through (f) of this
16Section and notwithstanding the changes authorized under
17Section 5-5b.1, any updates to the system shall not result in
18any diminishment of the overall effective rates of
19reimbursement as of the implementation date of the new system
20(July 1, 2014). These updates shall not preclude variations in
21any individual component of the system or hospital rate
22variations. Nothing in this Section shall prohibit the
23Department from increasing the rates of reimbursement or
24developing payments to ensure access to hospital services.
25Nothing in this Section shall be construed to guarantee a
26minimum amount of spending in the aggregate or per hospital as

 

 

HB2994- 32 -LRB100 08641 KTG 18775 b

1spending may be impacted by factors including but not limited
2to the number of individuals in the medical assistance program
3and the severity of illness of the individuals.
4    (h) The Department shall have the authority to modify by
5rulemaking any changes to the rates or methodologies in this
6Section as required by the federal government to obtain federal
7financial participation for expenditures made under this
8Section.
9    (i) Except for subsections (g) and (h) of this Section, the
10Department shall, pursuant to subsection (c) of Section 5-40 of
11the Illinois Administrative Procedure Act, provide for
12presentation at the June 2014 hearing of the Joint Committee on
13Administrative Rules (JCAR) additional written notice to JCAR
14of the following rules in order to commence the second notice
15period for the following rules: rules published in the Illinois
16Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
17(Medical Payment), 4628 (Specialized Health Care Delivery
18Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
19Grouping (DRG) Prospective Payment System (PPS)), and 4977
20(Hospital Reimbursement Changes), and published in the
21Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
22(Specialized Health Care Delivery Systems) and 6505 (Hospital
23Services).
24(Source: P.A. 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)
 
25    Section 99. Effective date. This Act takes effect July 1,
262017.