093_SB1771

 
                                     LRB093 10123 MBS 10375 b

 1        AN ACT in relation to public aid.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 5.  The Illinois Public Aid Code  is  amended  by
 5    changing Section 5-5.02 as follows:

 6        (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
 7        Sec. 5-5.02. Hospital reimbursements.
 8        (a)  Reimbursement  to  hospitals Hospitals; July 1, 1992
 9    through  September  30,  1992.    Notwithstanding  any  other
10    provisions of this Code or the  Illinois  Department's  Rules
11    promulgated  under the Illinois Administrative Procedure Act,
12    reimbursement to hospitals for services provided  during  the
13    period  July  1, 1992 through September 30, 1992, shall be as
14    follows:
15             (1)  For inpatient hospital services rendered, or if
16        applicable, for inpatient hospital discharges  occurring,
17        on  or  after July 1, 1992 and on or before September 30,
18        1992, the Illinois Department shall  reimburse  hospitals
19        for    inpatient   services   under   the   reimbursement
20        methodologies in effect for each  hospital,  and  at  the
21        inpatient  payment  rate calculated for each hospital, as
22        of June  30,  1992.   For  purposes  of  this  paragraph,
23        "reimbursement  methodologies"  means  all  reimbursement
24        methodologies  that pertain to the provision of inpatient
25        hospital services, including, but  not  limited  to,  any
26        adjustments  for disproportionate share, targeted access,
27        critical care access and uncompensated care,  as  defined
28        by the Illinois Department on June 30, 1992.
29             (2)  For  the  purpose  of calculating the inpatient
30        payment  rate  for  each  hospital  eligible  to  receive
31        quarterly adjustment payments  for  targeted  access  and
 
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 1        critical  care,  as defined by the Illinois Department on
 2        June 30, 1992, the adjustment payment for the period July
 3        1, 1992 through September 30, 1992, shall be 25%  of  the
 4        annual  adjustment  payments calculated for each eligible
 5        hospital, as of June 30, 1992.  The  Illinois  Department
 6        shall  determine  by  rule  the  adjustment  payments for
 7        targeted access and critical care  beginning  October  1,
 8        1992.
 9             (3)  For  the  purpose  of calculating the inpatient
10        payment  rate  for  each  hospital  eligible  to  receive
11        quarterly adjustment payments for uncompensated care,  as
12        defined  by the Illinois Department on June 30, 1992, the
13        adjustment payment for the period August 1, 1992  through
14        September  30,  1992,  shall  be  one-sixth  of the total
15        uncompensated care  adjustment  payments  calculated  for
16        each  eligible  hospital  for the uncompensated care rate
17        year, as defined by the Illinois  Department,  ending  on
18        July  31,  1992.  The Illinois Department shall determine
19        by rule the adjustment payments  for  uncompensated  care
20        beginning October 1, 1992.
21        (b)  Inpatient payments.  For inpatient services provided
22    on  or  after  October 1, 1993, in addition to rates paid for
23    hospital inpatient services pursuant to the  Illinois  Health
24    Finance  Reform  Act,  as  now  or  hereafter amended, or the
25    Illinois Department's prospective reimbursement  methodology,
26    or  any other methodology used by the Illinois Department for
27    inpatient  services,  the  Illinois  Department  shall   make
28    adjustment  payments, in an amount calculated pursuant to the
29    methodology described in paragraph (c) of  this  Section,  to
30    hospitals that the Illinois Department determines satisfy any
31    one of the following requirements:
32             (1)  Hospitals that are described in Section 1923 of
33        the  federal  Social  Security  Act,  as now or hereafter
34        amended; or
 
                            -3-      LRB093 10123 MBS 10375 b
 1             (2)  Illinois  hospitals  that   have   a   Medicaid
 2        inpatient  utilization  rate which is at least one-half a
 3        standard deviation  above  the  mean  Medicaid  inpatient
 4        utilization  rate for all hospitals in Illinois receiving
 5        Medicaid payments from the Illinois Department; or
 6             (3)  Illinois hospitals that on July 1, 1991  had  a
 7        Medicaid   inpatient  utilization  rate,  as  defined  in
 8        paragraph (h) of this Section, that was at least the mean
 9        Medicaid inpatient utilization rate for all hospitals  in
10        Illinois  receiving  Medicaid  payments from the Illinois
11        Department and which were located in a planning area with
12        one-third or fewer  excess  beds  as  determined  by  the
13        Illinois  Health  Facilities Planning Board, and that, as
14        of June 30, 1992, were located in a federally  designated
15        Health Manpower Shortage Area; or
16             (4)  Illinois hospitals that:
17                  (A)  have a Medicaid inpatient utilization rate
18             that   is  at  least  equal  to  the  mean  Medicaid
19             inpatient utilization  rate  for  all  hospitals  in
20             Illinois   receiving   Medicaid  payments  from  the
21             Department; and
22                  (B)  also have a Medicaid obstetrical inpatient
23             utilization rate  that  is  at  least  one  standard
24             deviation   above   the  mean  Medicaid  obstetrical
25             inpatient utilization  rate  for  all  hospitals  in
26             Illinois   receiving   Medicaid  payments  from  the
27             Department for obstetrical services; or
28             (5)  Any children's hospital, which means a hospital
29        devoted exclusively to caring for children.   A  hospital
30        which  includes  a facility devoted exclusively to caring
31        for children that is separately licensed as a hospital by
32        a municipality prior  to  September  30,  1998  shall  be
33        considered  a  children's hospital to the degree that the
34        hospital's Medicaid care is provided to children.
 
                            -4-      LRB093 10123 MBS 10375 b
 1        (c)  Inpatient  adjustment  payments.    The   adjustment
 2    payments  required by paragraph (b) shall be calculated based
 3    upon the hospital's Medicaid inpatient  utilization  rate  as
 4    follows:
 5             (1)  hospitals with a Medicaid inpatient utilization
 6        rate  below  the  mean shall receive a per day adjustment
 7        payment equal to $25;
 8             (2)   hospitals   with    a    Medicaid    inpatient
 9        utilization  rate  that  is  equal to or greater than the
10        mean Medicaid inpatient utilization rate  but  less  than
11        one  standard deviation above the mean Medicaid inpatient
12        utilization rate  shall  receive  a  per  day  adjustment
13        payment  equal  to  the  sum  of $25 plus $1 for each one
14        percent   that   the   hospital's   Medicaid    inpatient
15        utilization  rate  exceeds  the  mean  Medicaid inpatient
16        utilization rate;
17             (3)   hospitals   with    a    Medicaid    inpatient
18        utilization  rate  that  is  equal to or greater than one
19        standard deviation  above  the  mean  Medicaid  inpatient
20        utilization  rate  but  less than 1.5 standard deviations
21        above the mean Medicaid inpatient utilization rate  shall
22        receive  a per day adjustment payment equal to the sum of
23        $40 plus $7 for each  one  percent  that  the  hospital's
24        Medicaid  inpatient utilization rate exceeds one standard
25        deviation above the mean Medicaid  inpatient  utilization
26        rate; and
27             (4)   hospitals    with    a    Medicaid   inpatient
28        utilization rate that is equal to  or  greater  than  1.5
29        standard  deviations  above  the  mean Medicaid inpatient
30        utilization rate  shall  receive  a  per  day  adjustment
31        payment  equal  to  the  sum  of $90 plus $2 for each one
32        percent   that   the   hospital's   Medicaid    inpatient
33        utilization  rate  exceeds  1.5 standard deviations above
34        the mean Medicaid inpatient utilization rate.
 
                            -5-      LRB093 10123 MBS 10375 b
 1        (d)  Supplemental adjustment payments.   In  addition  to
 2    the adjustment payments described in paragraph (c), hospitals
 3    as  defined  in  clauses  (1)  through  (5) of paragraph (b),
 4    excluding county hospitals (as defined in subsection  (c)  of
 5    Section 15-1 of this Code) and a hospital organized under the
 6    University   of   Illinois   Hospital   Act,  shall  be  paid
 7    supplemental inpatient adjustment payments of  $60  per  day.
 8    For purposes of Title XIX of the federal Social Security Act,
 9    these   supplemental   adjustment   payments   shall  not  be
10    classified as adjustment payments to  disproportionate  share
11    hospitals.
12        (e)  The   inpatient  adjustment  payments  described  in
13    paragraphs (c) and (d) shall be increased on October 1,  1993
14    and  annually  thereafter by a percentage equal to the lesser
15    of (i) the increase in the DRI hospital cost  index  for  the
16    most  recent 12 month period for which data are available, or
17    (ii)  the  percentage  increase  in  the  statewide   average
18    hospital  payment  rate  over  the  previous year's statewide
19    average hospital payment rate.   The  sum  of  the  inpatient
20    adjustment  payments  under  paragraphs  (c)  and  (d)  to  a
21    hospital,  other  than  a  county  hospital  (as  defined  in
22    subsection  (c)  of  Section 15-1 of this Code) or a hospital
23    organized under the  University  of  Illinois  Hospital  Act,
24    however,  shall  not exceed $275 per day; that limit shall be
25    increased on October 1, 1993 and  annually  thereafter  by  a
26    percentage equal to the lesser of (i) the increase in the DRI
27    hospital  cost  index for the most recent 12-month period for
28    which data are available or (ii) the percentage  increase  in
29    the statewide average hospital payment rate over the previous
30    year's statewide average hospital payment rate.
31        (f)   Children's  hospital inpatient adjustment payments.
32    For  children's  hospitals,  as  defined  in  clause  (5)  of
33    paragraph (b), the adjustment payments required  pursuant  to
34    paragraphs (c) and (d) shall be multiplied by 2.0.
 
                            -6-      LRB093 10123 MBS 10375 b
 1        (g)   County hospital inpatient adjustment payments.  For
 2    county  hospitals,  as  defined  in subsection (c) of Section
 3    15-1 of this Code, there shall be an  adjustment  payment  as
 4    determined by rules issued by the Illinois Department.
 5        (h)   For  the  purposes  of  this  Section the following
 6    terms shall be defined as follows:
 7             (1)  "Medicaid inpatient utilization rate"  means  a
 8        fraction,  the  numerator  of  which  is  the number of a
 9        hospital's inpatient days provided in  a  given  12-month
10        period  to patients who, for such days, were eligible for
11        Medicaid under Title XIX of the federal  Social  Security
12        Act,  and the denominator of which is the total number of
13        the hospital's inpatient days in that same period.
14             (2)  "Mean  Medicaid  inpatient  utilization   rate"
15        means   the  total  number  of  Medicaid  inpatient  days
16        provided by all Illinois Medicaid-participating hospitals
17        divided by the total number of inpatient days provided by
18        those same hospitals.
19             (3)  "Medicaid  obstetrical  inpatient   utilization
20        rate"  means  the ratio of Medicaid obstetrical inpatient
21        days to total Medicaid inpatient days  for  all  Illinois
22        hospitals  receiving  Medicaid payments from the Illinois
23        Department.
24        (i)   Inpatient adjustment payment limit.   In  order  to
25    meet  the limits of Public Law 102-234 and Public Law 103-66,
26    the Illinois Department shall by rule adjust disproportionate
27    share adjustment payments.
28        (j)  University of Illinois Hospital inpatient adjustment
29    payments.  For hospitals organized under  the  University  of
30    Illinois  Hospital  Act, there shall be an adjustment payment
31    as determined by rules adopted by the Illinois Department.
32        (k)  The  Illinois  Department  may  by  rule   establish
33    criteria   for   and  develop  methodologies  for  adjustment
34    payments to hospitals participating under this Article.
 
                            -7-      LRB093 10123 MBS 10375 b
 1    (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)