Sen. Heather A. Steans

Filed: 2/5/2013

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 26

2    AMENDMENT NO. ______. Amend Senate Bill 26 as follows:
 
3on page 2, line 7, by replacing "and 5-2" with "5-2, 5A-2,
45A-4, 5A-5, 5A-8, and 5A-12.4"; and
 
5on page 21, immediately below line 18, by inserting the
6following:
 
7    "(305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
8    (Section scheduled to be repealed on January 1, 2015)
9    Sec. 5A-2. Assessment.
10    (a) Subject to Sections 5A-3 and 5A-10, for State fiscal
11years 2009 through 2014, and from July 1, 2014 through December
1231, 2014, an annual assessment on inpatient services is imposed
13on each hospital provider in an amount equal to $218.38
14multiplied by the difference of the hospital's occupied bed
15days less the hospital's Medicare bed days.

 

 

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1    For State fiscal years 2009 through 2014, and after a
2hospital's occupied bed days and Medicare bed days shall be
3determined using the most recent data available from each
4hospital's 2005 Medicare cost report as contained in the
5Healthcare Cost Report Information System file, for the quarter
6ending on December 31, 2006, without regard to any subsequent
7adjustments or changes to such data. If a hospital's 2005
8Medicare cost report is not contained in the Healthcare Cost
9Report Information System, then the Illinois Department may
10obtain the hospital provider's occupied bed days and Medicare
11bed days from any source available, including, but not limited
12to, records maintained by the hospital provider, which may be
13inspected at all times during business hours of the day by the
14Illinois Department or its duly authorized agents and
15employees.
16    (b) (Blank).
17    (b-5) Subject to Sections 5A-3 and 5A-10, for the portion
18of State fiscal year 2012, beginning June 10, 2012 through June
1930, 2012, and for State fiscal years 2013 through 2014, and
20July 1, 2014 through December 31, 2014, an annual assessment on
21outpatient services is imposed on each hospital provider in an
22amount equal to .008766 multiplied by the hospital's outpatient
23gross revenue. For the period beginning June 10, 2012 through
24June 30, 2012, the annual assessment on outpatient services
25shall be prorated by multiplying the assessment amount by a
26fraction, the numerator of which is 21 days and the denominator

 

 

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1of which is 365 days.
2    For the portion of State fiscal year 2012, beginning June
310, 2012 through June 30, 2012, and State fiscal years 2013
4through 2014, and July 1, 2014 through December 31, 2014, a
5hospital's outpatient gross revenue shall be determined using
6the most recent data available from each hospital's 2009
7Medicare cost report as contained in the Healthcare Cost Report
8Information System file, for the quarter ending on June 30,
92011, without regard to any subsequent adjustments or changes
10to such data. If a hospital's 2009 Medicare cost report is not
11contained in the Healthcare Cost Report Information System,
12then the Department may obtain the hospital provider's
13outpatient gross revenue from any source available, including,
14but not limited to, records maintained by the hospital
15provider, which may be inspected at all times during business
16hours of the day by the Department or its duly authorized
17agents and employees.
18    (c) (Blank).
19    (d) Notwithstanding any of the other provisions of this
20Section, the Department is authorized to adopt rules to reduce
21the rate of any annual assessment imposed under this Section,
22as authorized by Section 5-46.2 of the Illinois Administrative
23Procedure Act.
24    (e) Notwithstanding any other provision of this Section,
25any plan providing for an assessment on a hospital provider as
26a permissible tax under Title XIX of the federal Social

 

 

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1Security Act and Medicaid-eligible payments to hospital
2providers from the revenues derived from that assessment shall
3be reviewed by the Illinois Department of Healthcare and Family
4Services, as the Single State Medicaid Agency required by
5federal law, to determine whether those assessments and
6hospital provider payments meet federal Medicaid standards. If
7the Department determines that the elements of the plan may
8meet federal Medicaid standards and a related State Medicaid
9Plan Amendment is prepared in a manner and form suitable for
10submission, that State Plan Amendment shall be submitted in a
11timely manner for review by the Centers for Medicare and
12Medicaid Services of the United States Department of Health and
13Human Services and subject to approval by the Centers for
14Medicare and Medicaid Services of the United States Department
15of Health and Human Services. No such plan shall become
16effective without approval by the Illinois General Assembly by
17the enactment into law of related legislation. Notwithstanding
18any other provision of this Section, the Department is
19authorized to adopt rules to reduce the rate of any annual
20assessment imposed under this Section. Any such rules may be
21adopted by the Department under Section 5-50 of the Illinois
22Administrative Procedure Act.
23(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
2497-689, eff. 6-14-12.)
 
25    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)

 

 

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1    Sec. 5A-4. Payment of assessment; penalty.
2    (a) The assessment imposed by Section 5A-2 for State fiscal
3year 2009 and each subsequent State fiscal year shall be due
4and payable in monthly installments, each equaling one-twelfth
5of the assessment for the year, on the fourteenth State
6business day of each month. No installment payment of an
7assessment imposed by Section 5A-2 shall be due and payable,
8however, until after the Comptroller has issued the payments
9required under this Article.
10    Except as provided in subsection (a-5) of this Section, the
11assessment imposed by subsection (b-5) of Section 5A-2 for the
12portion of State fiscal year 2012 beginning June 10, 2012
13through June 30, 2012, and for State fiscal year 2013 and each
14subsequent State fiscal year shall be due and payable in
15monthly installments, each equaling one-twelfth of the
16assessment for the year, on the 14th State business day of each
17month. No installment payment of an assessment imposed by
18subsection (b-5) of Section 5A-2 shall be due and payable,
19however, until after: (i) the Department notifies the hospital
20provider, in writing, that the payment methodologies to
21hospitals required under Section 5A-12.4, have been approved by
22the Centers for Medicare and Medicaid Services of the U.S.
23Department of Health and Human Services, and the waiver under
2442 CFR 433.68 for the assessment imposed by subsection (b-5) of
25Section 5A-2, if necessary, has been granted by the Centers for
26Medicare and Medicaid Services of the U.S. Department of Health

 

 

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1and Human Services; and (ii) the Comptroller has issued the
2payments required under Section 5A-12.4. Upon notification to
3the Department of approval of the payment methodologies
4required under Section 5A-12.4 and the waiver granted under 42
5CFR 433.68, if necessary, all installments otherwise due under
6subsection (b-5) of Section 5A-2 prior to the date of
7notification shall be due and payable to the Department upon
8written direction from the Department and issuance by the
9Comptroller of the payments required under Section 5A-12.4.
10    (a-5) The Illinois Department may accelerate the schedule
11upon which assessment installments are due and payable by
12hospitals with a payment ratio greater than or equal to one.
13Such acceleration of due dates for payment of the assessment
14may be made only in conjunction with a corresponding
15acceleration in access payments identified in Section 5A-12.2
16or Section 5A-12.4 to the same hospitals. For the purposes of
17this subsection (a-5), a hospital's payment ratio is defined as
18the quotient obtained by dividing the total payments for the
19State fiscal year, as authorized under Section 5A-12.2 or
20Section 5A-12.4, by the total assessment for the State fiscal
21year imposed under Section 5A-2 or subsection (b-5) of Section
225A-2.
23    (b) The Illinois Department is authorized to establish
24delayed payment schedules for hospital providers that are
25unable to make installment payments when due under this Section
26due to financial difficulties, as determined by the Illinois

 

 

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1Department.
2    (c) If a hospital provider fails to pay the full amount of
3an installment when due (including any extensions granted under
4subsection (b)), there shall, unless waived by the Illinois
5Department for reasonable cause, be added to the assessment
6imposed by Section 5A-2 a penalty assessment equal to the
7lesser of (i) 5% of the amount of the installment not paid on
8or before the due date plus 5% of the portion thereof remaining
9unpaid on the last day of each 30-day period thereafter or (ii)
10100% of the installment amount not paid on or before the due
11date. For purposes of this subsection, payments will be
12credited first to unpaid installment amounts (rather than to
13penalty or interest), beginning with the most delinquent
14installments.
15    (d) Any assessment amount that is due and payable to the
16Illinois Department more frequently than once per calendar
17quarter shall be remitted to the Illinois Department by the
18hospital provider by means of electronic funds transfer. The
19Illinois Department may provide for remittance by other means
20if (i) the amount due is less than $10,000 or (ii) electronic
21funds transfer is unavailable for this purpose.
22(Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12;
2397-689, eff. 6-14-12.)
 
24    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
25    Sec. 5A-5. Notice; penalty; maintenance of records.

 

 

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1    (a) The Illinois Department shall send a notice of
2assessment to every hospital provider subject to assessment
3under this Article. The notice of assessment shall notify the
4hospital of its assessment and shall be sent after receipt by
5the Department of notification from the Centers for Medicare
6and Medicaid Services of the U.S. Department of Health and
7Human Services that the payment methodologies required under
8this Article and, if necessary, the waiver granted under 42 CFR
9433.68 have been approved. The notice shall be on a form
10prepared by the Illinois Department and shall state the
11following:
12        (1) The name of the hospital provider.
13        (2) The address of the hospital provider's principal
14    place of business from which the provider engages in the
15    occupation of hospital provider in this State, and the name
16    and address of each hospital operated, conducted, or
17    maintained by the provider in this State.
18        (3) The occupied bed days, occupied bed days less
19    Medicare days, adjusted gross hospital revenue, or
20    outpatient gross revenue of the hospital provider
21    (whichever is applicable), the amount of assessment
22    imposed under Section 5A-2 for the State fiscal year for
23    which the notice is sent, and the amount of each
24    installment to be paid during the State fiscal year.
25        (4) (Blank).
26        (5) Other reasonable information as determined by the

 

 

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1    Illinois Department.
2    (b) If a hospital provider conducts, operates, or maintains
3more than one hospital licensed by the Illinois Department of
4Public Health, the provider shall pay the assessment for each
5hospital separately.
6    (c) Notwithstanding any other provision in this Article, in
7the case of a person who ceases to conduct, operate, or
8maintain a hospital in respect of which the person is subject
9to assessment under this Article as a hospital provider, the
10assessment for the State fiscal year in which the cessation
11occurs shall be adjusted by multiplying the assessment computed
12under Section 5A-2 by a fraction, the numerator of which is the
13number of days in the year during which the provider conducts,
14operates, or maintains the hospital and the denominator of
15which is 365. Immediately upon ceasing to conduct, operate, or
16maintain a hospital, the person shall pay the assessment for
17the year as so adjusted (to the extent not previously paid).
18    (d) Notwithstanding any other provision in this Article, a
19provider who commences conducting, operating, or maintaining a
20hospital, upon notice by the Illinois Department, shall pay the
21assessment computed under Section 5A-2 and subsection (e) in
22installments on the due dates stated in the notice and on the
23regular installment due dates for the State fiscal year
24occurring after the due dates of the initial notice.
25    (e) Notwithstanding any other provision in this Article,
26for State fiscal years 2009 through 2014 2015, in the case of a

 

 

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1hospital provider that did not conduct, operate, or maintain a
2hospital in 2005, the assessment for that State fiscal year
3shall be computed on the basis of hypothetical occupied bed
4days for the full calendar year as determined by the Illinois
5Department. Notwithstanding any other provision in this
6Article, for the portion of State fiscal year 2012 beginning
7June 10, 2012 through June 30, 2012, and for State fiscal years
82013 through 2014, and for July 1, 2014 through December 31,
92014, in the case of a hospital provider that did not conduct,
10operate, or maintain a hospital in 2009, the assessment under
11subsection (b-5) of Section 5A-2 for that State fiscal year
12shall be computed on the basis of hypothetical gross outpatient
13revenue for the full calendar year as determined by the
14Illinois Department.
15    (f) Every hospital provider subject to assessment under
16this Article shall keep sufficient records to permit the
17determination of adjusted gross hospital revenue for the
18hospital's fiscal year. All such records shall be kept in the
19English language and shall, at all times during regular
20business hours of the day, be subject to inspection by the
21Illinois Department or its duly authorized agents and
22employees.
23    (g) The Illinois Department may, by rule, provide a
24hospital provider a reasonable opportunity to request a
25clarification or correction of any clerical or computational
26errors contained in the calculation of its assessment, but such

 

 

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1corrections shall not extend to updating the cost report
2information used to calculate the assessment.
3    (h) (Blank).
4(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
597-689, eff. 6-14-12; revised 10-17-12.)
 
6    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
7    Sec. 5A-8. Hospital Provider Fund.
8    (a) There is created in the State Treasury the Hospital
9Provider Fund. Interest earned by the Fund shall be credited to
10the Fund. The Fund shall not be used to replace any moneys
11appropriated to the Medicaid program by the General Assembly.
12    (b) The Fund is created for the purpose of receiving moneys
13in accordance with Section 5A-6 and disbursing moneys only for
14the following purposes, notwithstanding any other provision of
15law:
16        (1) For making payments to hospitals as required under
17    this Code, under the Children's Health Insurance Program
18    Act, under the Covering ALL KIDS Health Insurance Act, and
19    under the Long Term Acute Care Hospital Quality Improvement
20    Transfer Program Act.
21        (2) For the reimbursement of moneys collected by the
22    Illinois Department from hospitals or hospital providers
23    through error or mistake in performing the activities
24    authorized under this Code.
25        (3) For payment of administrative expenses incurred by

 

 

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1    the Illinois Department or its agent in performing
2    activities under this Code, under the Children's Health
3    Insurance Program Act, under the Covering ALL KIDS Health
4    Insurance Act, and under the Long Term Acute Care Hospital
5    Quality Improvement Transfer Program Act.
6        (4) For payments of any amounts which are reimbursable
7    to the federal government for payments from this Fund which
8    are required to be paid by State warrant.
9        (5) For making transfers, as those transfers are
10    authorized in the proceedings authorizing debt under the
11    Short Term Borrowing Act, but transfers made under this
12    paragraph (5) shall not exceed the principal amount of debt
13    issued in anticipation of the receipt by the State of
14    moneys to be deposited into the Fund.
15        (6) For making transfers to any other fund in the State
16    treasury, but transfers made under this paragraph (6) shall
17    not exceed the amount transferred previously from that
18    other fund into the Hospital Provider Fund plus any
19    interest that would have been earned by that fund on the
20    monies that had been transferred.
21        (6.5) For making transfers to the Healthcare Provider
22    Relief Fund, except that transfers made under this
23    paragraph (6.5) shall not exceed $60,000,000 in the
24    aggregate.
25        (7) For making transfers not exceeding the following
26    amounts, in State fiscal years 2013 and 2014 in each State

 

 

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1    fiscal year during which an assessment is imposed pursuant
2    to Section 5A-2, to the following designated funds:
3            Health and Human Services Medicaid Trust
4                Fund..............................$20,000,000
5            Long-Term Care Provider Fund..........$30,000,000
6            General Revenue Fund.................$80,000,000.
7    Transfers under this paragraph shall be made within 7 days
8    after the payments have been received pursuant to the
9    schedule of payments provided in subsection (a) of Section
10    5A-4.
11        (7.1) For making transfers not exceeding the following
12    amounts, in State fiscal year 2015, to the following
13    designated funds:
14            Health and Human Services Medicaid Trust
15                 Fund..............................$10,000,000
16            Long-Term Care Provider Fund..........$15,000,000
17            General Revenue Fund.................$40,000,000.
18    Transfers under this paragraph shall be made within 7 days
19    after the payments have been received pursuant to the
20    schedule of payments provided in subsection (a) of Section
21    5A-4.
22        (7.5) (Blank).
23        (7.8) (Blank).
24        (7.9) (Blank).
25        (7.10) For State fiscal years 2013 and 2014, for making
26    transfers of the moneys resulting from the assessment under

 

 

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1    subsection (b-5) of Section 5A-2 and received from hospital
2    providers under Section 5A-4 and transferred into the
3    Hospital Provider Fund under Section 5A-6 to the designated
4    funds not exceeding the following amounts in that State
5    fiscal year:
6            Health Care Provider Relief Fund......$50,000,000
7        Transfers under this paragraph shall be made within 7
8    days after the payments have been received pursuant to the
9    schedule of payments provided in subsection (a) of Section
10    5A-4.
11        (7.11) For State fiscal year 2015, 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.....$25,000,000
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        (7.12) For State fiscal year 2013, for increasing by
24    21/365ths the transfer of the moneys resulting from the
25    assessment under subsection (b-5) of Section 5A-2 and
26    received from hospital providers under Section 5A-4 for the

 

 

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1    portion of State fiscal year 2012 beginning June 10, 2012
2    through June 30, 2012 and transferred into the Hospital
3    Provider Fund under Section 5A-6 to the designated funds
4    not exceeding the following amounts in that State fiscal
5    year:
6            Health Care Provider Relief Fund.......$2,870,000
7        (8) For making refunds to hospital providers pursuant
8    to Section 5A-10.
9    Disbursements from the Fund, other than transfers
10authorized under paragraphs (5) and (6) of this subsection,
11shall be by warrants drawn by the State Comptroller upon
12receipt of vouchers duly executed and certified by the Illinois
13Department.
14    (c) The Fund shall consist of the following:
15        (1) All moneys collected or received by the Illinois
16    Department from the hospital provider assessment imposed
17    by this Article.
18        (2) All federal matching funds received by the Illinois
19    Department as a result of expenditures made by the Illinois
20    Department that are attributable to moneys deposited in the
21    Fund.
22        (3) Any interest or penalty levied in conjunction with
23    the administration of this Article.
24        (4) Moneys transferred from another fund in the State
25    treasury.
26        (5) All other moneys received for the Fund from any

 

 

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1    other source, including interest earned thereon.
2    (d) (Blank).
3(Source: P.A. 96-3, eff. 2-27-09; 96-45, eff. 7-15-09; 96-821,
4eff. 11-20-09; 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
597-689, eff. 6-14-12; revised 10-17-12.)
 
6    (305 ILCS 5/5A-12.4)
7    (Section scheduled to be repealed on January 1, 2015)
8    Sec. 5A-12.4. Hospital access improvement payments on or
9after June 10, 2012 July 1, 2012.
10    (a) Hospital access improvement payments. To preserve and
11improve access to hospital services, for hospital and physician
12services rendered on or after June 10, 2012 July 1, 2012, the
13Illinois Department shall, except for hospitals described in
14subsection (b) of Section 5A-3, make payments to hospitals as
15set forth in this Section. These payments shall be paid in 12
16equal installments on or before the 7th State business day of
17each month, except that no payment shall be due within 100 days
18after the later of the date of notification of federal approval
19of the payment methodologies required under this Section or any
20waiver required under 42 CFR 433.68, at which time the sum of
21amounts required under this Section prior to the date of
22notification is due and payable. Payments under this Section
23are not due and payable, however, until (i) the methodologies
24described in this Section are approved by the federal
25government in an appropriate State Plan amendment and (ii) the

 

 

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1assessment imposed under subsection (b-5) of Section 5A-2 of
2this Article is determined to be a permissible tax under Title
3XIX of the Social Security Act. The Illinois Department shall
4take all actions necessary to implement the payments under this
5Section effective June 10, 2012 July 1, 2012, including but not
6limited to providing public notice pursuant to federal
7requirements, the filing of a State Plan amendment, and the
8adoption of administrative rules. For State fiscal year 2013,
9payments under this Section shall be increased by 21/365ths of
10the moneys resulting from the assessment under subsection (b-5)
11of Section 5A-2 and received from hospital providers under
12Section 5A-4 for the portion of State fiscal year 2012
13beginning June 10, 2012 through June 30, 2012.
14    (a-5) Accelerated schedule. The Illinois Department may,
15when practicable, accelerate the schedule upon which payments
16authorized under this Section are made.
17    (b) Magnet and perinatal hospital adjustment. In addition
18to rates paid for inpatient hospital services, the Department
19shall pay to each Illinois general acute care hospital that, as
20of August 25, 2011, was recognized as a Magnet hospital by the
21American Nurses Credentialing Center and that, as of September
2214, 2011, was designated as a level III perinatal center
23amounts as follows:
24        (1) For hospitals with a case mix index equal to or
25    greater than the 80th percentile of case mix indices for
26    all Illinois hospitals, $470 for each Medicaid general

 

 

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1    acute care inpatient day of care provided by the hospital
2    during State fiscal year 2009.
3        (2) For all other hospitals, $170 for each Medicaid
4    general acute care inpatient day of care provided by the
5    hospital during State fiscal year 2009.
6    (c) Trauma level II adjustment. In addition to rates paid
7for inpatient hospital services, the Department shall pay to
8each Illinois general acute care hospital that, as of July 1,
92011, was designated as a level II trauma center amounts as
10follows:
11        (1) For hospitals with a case mix index equal to or
12    greater than the 50th percentile of case mix indices for
13    all Illinois hospitals, $470 for each Medicaid general
14    acute care inpatient day of care provided by the hospital
15    during State fiscal year 2009.
16        (2) For all other hospitals, $170 for each Medicaid
17    general acute care inpatient day of care provided by the
18    hospital during State fiscal year 2009.
19        (3) For the purposes of this adjustment, hospitals
20    located in the same city that alternate their trauma center
21    designation as defined in 89 Ill. Adm. Code 148.295(a)(2)
22    shall have the adjustment provided under this Section
23    divided between the 2 hospitals.
24    (d) Dual-eligible adjustment. In addition to rates paid for
25inpatient services, the Department shall pay each Illinois
26general acute care hospital that had a ratio of crossover days

 

 

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1to total inpatient days for programs under Title XIX of the
2Social Security Act administered by the Department (utilizing
3information from 2009 paid claims) greater than 50%, and a case
4mix index equal to or greater than the 75th percentile of case
5mix indices for all Illinois hospitals, a rate of $400 for each
6Medicaid inpatient day during State fiscal year 2009 including
7crossover days.
8    (e) Medicaid volume adjustment. In addition to rates paid
9for inpatient hospital services, the Department shall pay to
10each Illinois general acute care hospital that provided more
11than 10,000 Medicaid inpatient days of care in State fiscal
12year 2009, has a Medicaid inpatient utilization rate of at
13least 29.05% as calculated by the Department for the Rate Year
142011 Disproportionate Share determination, and is not eligible
15for Medicaid Percentage Adjustment payments in rate year 2011
16an amount equal to $135 for each Medicaid inpatient day of care
17provided during State fiscal year 2009.
18    (f) Outpatient service adjustment. In addition to the rates
19paid for outpatient hospital services, the Department shall pay
20each Illinois hospital an amount at least equal to $100
21multiplied by the hospital's outpatient ambulatory procedure
22listing services (excluding categories 3B and 3C) and by the
23hospital's end stage renal disease treatment services provided
24for State fiscal year 2009.
25    (g) Ambulatory service adjustment.
26        (1) In addition to the rates paid for outpatient

 

 

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1    hospital services provided in the emergency department,
2    the Department shall pay each Illinois hospital an amount
3    equal to $105 multiplied by the hospital's outpatient
4    ambulatory procedure listing services for categories 3A,
5    3B, and 3C for State fiscal year 2009.
6        (2) In addition to the rates paid for outpatient
7    hospital services, the Department shall pay each Illinois
8    freestanding psychiatric hospital an amount equal to $200
9    multiplied by the hospital's ambulatory procedure listing
10    services for category 5A for State fiscal year 2009.
11    (h) Specialty hospital adjustment. In addition to the rates
12paid for outpatient hospital services, the Department shall pay
13each Illinois long term acute care hospital and each Illinois
14hospital devoted exclusively to the treatment of cancer, an
15amount equal to $700 multiplied by the hospital's outpatient
16ambulatory procedure listing services and by the hospital's end
17stage renal disease treatment services (including services
18provided to individuals eligible for both Medicaid and
19Medicare) provided for State fiscal year 2009.
20    (h-1) ER Safety Net Payments. In addition to rates paid for
21outpatient services, the Department shall pay to each Illinois
22general acute care hospital with an emergency room ratio equal
23to or greater than 55%, that is not eligible for Medicaid
24percentage adjustments payments in rate year 2011, with a case
25mix index equal to or greater than the 20th percentile, and
26that is not designated as a trauma center by the Illinois

 

 

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1Department of Public Health on July 1, 2011, as follows:
2        (1) Each hospital with an emergency room ratio equal to
3    or greater than 74% shall receive a rate of $225 for each
4    outpatient ambulatory procedure listing and end-stage
5    renal disease treatment service provided for State fiscal
6    year 2009.
7        (2) For all other hospitals, $65 shall be paid for each
8    outpatient ambulatory procedure listing and end-stage
9    renal disease treatment service provided for State fiscal
10    year 2009.
11    (i) Physician supplemental adjustment. In addition to the
12rates paid for physician services, the Department shall make an
13adjustment payment for services provided by physicians as
14follows:
15        (1) Physician services eligible for the adjustment
16    payment are those provided by physicians employed by or who
17    have a contract to provide services to patients of the
18    following hospitals: (i) Illinois general acute care
19    hospitals that provided at least 17,000 Medicaid inpatient
20    days of care in State fiscal year 2009 and are eligible for
21    Medicaid Percentage Adjustment Payments in rate year 2011;
22    and (ii) Illinois freestanding children's hospitals, as
23    defined in 89 Ill. Adm. Code 149.50(c)(3)(A).
24        (2) The amount of the adjustment for each eligible
25    hospital under this subsection (i) shall be determined by
26    rule by the Department to spend a total pool of at least

 

 

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1    $6,960,000 annually. This pool shall be allocated among the
2    eligible hospitals based on the difference between the
3    upper payment limit for what could have been paid under
4    Medicaid for physician services provided during State
5    fiscal year 2009 by physicians employed by or who had a
6    contract with the hospital and the amount that was paid
7    under Medicaid for such services, provided however, that in
8    no event shall physicians at any individual hospital
9    collectively receive an annual, aggregate adjustment in
10    excess of $435,000, except that any amount that is not
11    distributed to a hospital because of the upper payment
12    limit shall be reallocated among the remaining eligible
13    hospitals that are below the upper payment limitation, on a
14    proportionate basis.
15    (i-5) For any children's hospital which did not charge for
16its services during the base period, the Department shall use
17data supplied by the hospital to determine payments using
18similar methodologies for freestanding children's hospitals
19under this Section or Section 5A-12.2 12.2.
20    (j) For purposes of this Section, a hospital that is
21enrolled to provide Medicaid services during State fiscal year
222009 shall have its utilization and associated reimbursements
23annualized prior to the payment calculations being performed
24under this Section.
25    (k) For purposes of this Section, the terms "Medicaid
26days", "ambulatory procedure listing services", and

 

 

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1"ambulatory procedure listing payments" do not include any
2days, charges, or services for which Medicare or a managed care
3organization reimbursed on a capitated basis was liable for
4payment, except where explicitly stated otherwise in this
5Section.
6    (l) Definitions. Unless the context requires otherwise or
7unless provided otherwise in this Section, the terms used in
8this Section for qualifying criteria and payment calculations
9shall have the same meanings as those terms have been given in
10the Illinois Department's administrative rules as in effect on
11October 1, 2011. Other terms shall be defined by the Illinois
12Department by rule.
13    As used in this Section, unless the context requires
14otherwise:
15    "Case mix index" means, for a given hospital, the sum of
16the per admission (DRG) relative weighting factors in effect on
17January 1, 2005, for all general acute care admissions for
18State fiscal year 2009, excluding Medicare crossover
19admissions and transplant admissions reimbursed under 89 Ill.
20Adm. Code 148.82, divided by the total number of general acute
21care admissions for State fiscal year 2009, excluding Medicare
22crossover admissions and transplant admissions reimbursed
23under 89 Ill. Adm. Code 148.82.
24    "Emergency room ratio" means, for a given hospital, a
25fraction, the denominator of which is the number of the
26hospital's outpatient ambulatory procedure listing and

 

 

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1end-stage renal disease treatment services provided for State
2fiscal year 2009 and the numerator of which is the hospital's
3outpatient ambulatory procedure listing services for
4categories 3A, 3B, and 3C for State fiscal year 2009.
5    "Medicaid inpatient day" means, for a given hospital, the
6sum of days of inpatient hospital days provided to recipients
7of medical assistance under Title XIX of the federal Social
8Security Act, excluding days for individuals eligible for
9Medicare under Title XVIII of that Act (Medicaid/Medicare
10crossover days), as tabulated from the Department's paid claims
11data for admissions occurring during State fiscal year 2009
12that was adjudicated by the Department through June 30, 2010.
13    "Outpatient ambulatory procedure listing services" means,
14for a given hospital, ambulatory procedure listing services, as
15described in 89 Ill. Adm. Code 148.140(b), provided to
16recipients of medical assistance under Title XIX of the federal
17Social Security Act, excluding services for individuals
18eligible for Medicare under Title XVIII of the Act
19(Medicaid/Medicare crossover days), as tabulated from the
20Department's paid claims data for services occurring in State
21fiscal year 2009 that were adjudicated by the Department
22through September 2, 2010.
23    "Outpatient end-stage renal disease treatment services"
24means, for a given hospital, the services, as described in 89
25Ill. Adm. Code 148.140(c), provided to recipients of medical
26assistance under Title XIX of the federal Social Security Act,

 

 

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1excluding payments for individuals eligible for Medicare under
2Title XVIII of the Act (Medicaid/Medicare crossover days), as
3tabulated from the Department's paid claims data for services
4occurring in State fiscal year 2009 that were adjudicated by
5the Department through September 2, 2010.
6    (m) The Department may adjust payments made under this
7Section 5A-12.4 to comply with federal law or regulations
8regarding hospital-specific payment limitations on
9government-owned or government-operated hospitals.
10    (n) Notwithstanding any of the other provisions of this
11Section, the Department is authorized to adopt rules that
12change the hospital access improvement payments specified in
13this Section, but only to the extent necessary to conform to
14any federally approved amendment to the Title XIX State plan.
15Any such rules shall be adopted by the Department as authorized
16by Section 5-50 of the Illinois Administrative Procedure Act.
17Notwithstanding any other provision of law, any changes
18implemented as a result of this subsection (n) shall be given
19retroactive effect so that they shall be deemed to have taken
20effect as of the effective date of this Section.
21    (o) The Department of Healthcare and Family Services must
22submit a State Medicaid Plan Amendment to the Centers of
23Medicare and Medicaid Services to implement the payments under
24this Section within 30 days of June 14, 2012 (the effective
25date of Public Act 97-688) this Act.
26(Source: P.A. 97-688, eff. 6-14-12; revised 8-3-12.)".