Full Text of SB0026 98th General Assembly
SB0026eng 98TH GENERAL ASSEMBLY |
| | SB0026 Engrossed | | LRB098 05310 KTG 35344 b |
|
| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. Findings. The General Assembly finds it is in | 5 | | the best interests of the State to take advantage of the | 6 | | Patient Protection and Affordable Care Act to enable Illinois | 7 | | to receive enhanced federal revenue to cover the costs of | 8 | | health care for low-income adults who are otherwise not | 9 | | eligible for Medicaid. The General Assembly further finds that | 10 | | the administration and financing of the Medicaid program must | 11 | | be sound to ensure Illinois may take full advantage of national | 12 | | health care reform to keep people healthier; reimburse | 13 | | hospitals and clinics for uncompensated and charity care for | 14 | | the uninsured; and replace spending by county and local | 15 | | governments for healthcare costs now borne by local health | 16 | | departments, social service agencies, homeless shelters, | 17 | | mental health clinics, drug treatment centers, township | 18 | | organizations, and others for the care of the uninsured. | 19 | | Accordingly, the General Assembly finds that, while filling the | 20 | | current gap in Medicaid coverage, it is essential that the | 21 | | State preserve and extend recent efforts to reform Illinois' | 22 | | Medicaid program. Changes designed to increase efficiencies | 23 | | and enhance program integrity must continue to prevent client | 24 | | and provider fraud and abuse; to impose controls on use of |
| | | SB0026 Engrossed | - 2 - | LRB098 05310 KTG 35344 b |
|
| 1 | | Medicaid services to prevent over-use or waste; to rationalize | 2 | | the Medicaid health care delivery system by adopting care | 3 | | coordination models wherever feasible to achieve effective and | 4 | | efficient care delivery across all covered services; and to | 5 | | operate the program within budget limits. | 6 | | Section 5. The Illinois Public Aid Code is amended by | 7 | | changing Sections 5-1.1, 5-1.4, 5-2, 5A-2, 5A-4, 5A-5, 5A-8, | 8 | | and 5A-12.4 as follows:
| 9 | | (305 ILCS 5/5-1.1) (from Ch. 23, par. 5-1.1)
| 10 | | Sec. 5-1.1. Definitions. The terms defined in this Section
| 11 | | shall have the meanings ascribed to them, except when the
| 12 | | context otherwise requires.
| 13 | | (a) "Nursing facility" means a facility, licensed by the | 14 | | Department of Public Health under the Nursing Home Care Act, | 15 | | that provides nursing facility services within the meaning of | 16 | | Title XIX of
the federal Social Security Act.
| 17 | | (b) "Intermediate care facility for the developmentally | 18 | | disabled" or "ICF/DD" means a facility, licensed by the | 19 | | Department of Public Health under the ID/DD Community Care Act, | 20 | | that is an intermediate care facility for the mentally retarded | 21 | | within the meaning of Title XIX
of the federal Social Security | 22 | | Act.
| 23 | | (c) "Standard services" means those services required for
| 24 | | the care of all patients in the facility and shall, as a
|
| | | SB0026 Engrossed | - 3 - | LRB098 05310 KTG 35344 b |
|
| 1 | | minimum, include the following: (1) administration; (2)
| 2 | | dietary (standard); (3) housekeeping; (4) laundry and linen;
| 3 | | (5) maintenance of property and equipment, including | 4 | | utilities;
(6) medical records; (7) training of employees; (8) | 5 | | utilization
review; (9) activities services; (10) social | 6 | | services; (11)
disability services; and all other similar | 7 | | services required
by either the laws of the State of Illinois | 8 | | or one of its
political subdivisions or municipalities or by | 9 | | Title XIX of
the Social Security Act.
| 10 | | (d) "Patient services" means those which vary with the
| 11 | | number of personnel; professional and para-professional
skills | 12 | | of the personnel; specialized equipment, and reflect
the | 13 | | intensity of the medical and psycho-social needs of the
| 14 | | patients. Patient services shall as a minimum include:
(1) | 15 | | physical services; (2) nursing services, including
restorative | 16 | | nursing; (3) medical direction and patient care
planning; (4) | 17 | | health related supportive and habilitative
services and all | 18 | | similar services required by either the
laws of the State of | 19 | | Illinois or one of its political
subdivisions or municipalities | 20 | | or by Title XIX of the
Social Security Act.
| 21 | | (e) "Ancillary services" means those services which
| 22 | | require a specific physician's order and defined as under
the | 23 | | medical assistance program as not being routine in
nature for | 24 | | skilled nursing facilities and ICF/DDs.
Such services | 25 | | generally must be authorized prior to delivery
and payment as | 26 | | provided for under the rules of the Department
of Healthcare |
| | | SB0026 Engrossed | - 4 - | LRB098 05310 KTG 35344 b |
|
| 1 | | and Family Services.
| 2 | | (f) "Capital" means the investment in a facility's assets
| 3 | | for both debt and non-debt funds. Non-debt capital is the
| 4 | | difference between an adjusted replacement value of the assets
| 5 | | and the actual amount of debt capital.
| 6 | | (g) "Profit" means the amount which shall accrue to a
| 7 | | facility as a result of its revenues exceeding its expenses
as | 8 | | determined in accordance with generally accepted accounting
| 9 | | principles.
| 10 | | (h) "Non-institutional services" means those services | 11 | | provided under
paragraph (f) of Section 3 of the Disabled | 12 | | Persons Rehabilitation Act and those services provided under | 13 | | Section 4.02 of the Illinois Act on the Aging.
| 14 | | (i) (Blank).
| 15 | | (j) "Institutionalized person" means an individual who is | 16 | | an inpatient
in an ICF/DD or nursing facility, or who is an | 17 | | inpatient in
a medical
institution receiving a level of care | 18 | | equivalent to that of an ICF/DD or nursing facility, or who is | 19 | | receiving services under
Section 1915(c) of the Social Security | 20 | | Act.
| 21 | | (k) "Institutionalized spouse" means an institutionalized | 22 | | person who is
expected to receive services at the same level of | 23 | | care for at least 30 days
and is married to a spouse who is not | 24 | | an institutionalized person.
| 25 | | (l) "Community spouse" is the spouse of an | 26 | | institutionalized spouse.
|
| | | SB0026 Engrossed | - 5 - | LRB098 05310 KTG 35344 b |
|
| 1 | | (m) "Health Benefits Service Package" means, subject to | 2 | | federal approval, benefits covered by the medical assistance | 3 | | program as determined by the Department by rule for individuals | 4 | | eligible for medical assistance under paragraph 18 of Section | 5 | | 5-2 of this Code. | 6 | | (Source: P.A. 96-1530, eff. 2-16-11; 97-227, eff. 1-1-12; | 7 | | 97-820, eff. 7-17-12.)
| 8 | | (305 ILCS 5/5-1.4) | 9 | | Sec. 5-1.4. Moratorium on eligibility expansions. | 10 | | Beginning on January 25, 2011 (the effective date of Public Act | 11 | | 96-1501), there shall be a 4-year moratorium on the expansion | 12 | | of eligibility through increasing financial eligibility | 13 | | standards, or through increasing income disregards, or through | 14 | | the creation of new programs which would add new categories of | 15 | | eligible individuals under the medical assistance program in | 16 | | addition to those categories covered on January 1, 2011 or | 17 | | above the level of any subsequent reduction in eligibility. | 18 | | This moratorium shall not apply to expansions required as a | 19 | | federal condition of State participation in the medical | 20 | | assistance program or to expansions approved by the federal | 21 | | government that are financed entirely by units of local | 22 | | government and federal matching funds. If the State of Illinois | 23 | | finds that the State has borne a cost related to such an | 24 | | expansion, the unit of local government shall reimburse the | 25 | | State. All federal funds associated with an expansion funded by |
| | | SB0026 Engrossed | - 6 - | LRB098 05310 KTG 35344 b |
|
| 1 | | a unit of local government shall be returned to the local | 2 | | government entity funding the expansion, pursuant to an | 3 | | intergovernmental agreement between the Department of | 4 | | Healthcare and Family Services and the local government entity. | 5 | | Within 10 calendar days of the effective date of this | 6 | | amendatory Act of the 97th General Assembly, the Department of | 7 | | Healthcare and Family Services shall formally advise the | 8 | | Centers for Medicare and Medicaid Services of the passage of | 9 | | this amendatory Act of the 97th General Assembly. The State is | 10 | | prohibited from submitting additional waiver requests that | 11 | | expand or allow for an increase in the classes of persons | 12 | | eligible for medical assistance under this Article to the | 13 | | federal government for its consideration beginning on the 20th | 14 | | calendar day following the effective date of this amendatory | 15 | | Act of the 97th General Assembly until January 25, 2015. This | 16 | | moratorium shall not apply to those persons eligible for | 17 | | medical assistance pursuant to 42 U.S.C. | 18 | | 1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of | 19 | | Section 5-2 of this Code.
| 20 | | (Source: P.A. 96-1501, eff. 1-25-11; 97-687, eff. 6-14-12.)
| 21 | | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
| 22 | | Sec. 5-2. Classes of Persons Eligible. Medical assistance | 23 | | under this
Article shall be available to any of the following | 24 | | classes of persons in
respect to whom a plan for coverage has | 25 | | been submitted to the Governor
by the Illinois Department and |
| | | SB0026 Engrossed | - 7 - | LRB098 05310 KTG 35344 b |
|
| 1 | | approved by him:
| 2 | | 1. Recipients of basic maintenance grants under | 3 | | Articles III and IV.
| 4 | | 2. Persons otherwise eligible for basic maintenance | 5 | | under Articles
III and IV, excluding any eligibility | 6 | | requirements that are inconsistent with any federal law or | 7 | | federal regulation, as interpreted by the U.S. Department | 8 | | of Health and Human Services, but who fail to qualify | 9 | | thereunder on the basis of need or who qualify but are not | 10 | | receiving basic maintenance under Article IV, and
who have | 11 | | insufficient income and resources to meet the costs of
| 12 | | necessary medical care, including but not limited to the | 13 | | following:
| 14 | | (a) All persons otherwise eligible for basic | 15 | | maintenance under Article
III but who fail to qualify | 16 | | under that Article on the basis of need and who
meet | 17 | | either of the following requirements:
| 18 | | (i) their income, as determined by the | 19 | | Illinois Department in
accordance with any federal | 20 | | requirements, is equal to or less than 70% in
| 21 | | fiscal year 2001, equal to or less than 85% in | 22 | | fiscal year 2002 and until
a date to be determined | 23 | | by the Department by rule, and equal to or less
| 24 | | than 100% beginning on the date determined by the | 25 | | Department by rule, of the nonfarm income official | 26 | | poverty
line, as defined by the federal Office of |
| | | SB0026 Engrossed | - 8 - | LRB098 05310 KTG 35344 b |
|
| 1 | | Management and Budget and revised
annually in | 2 | | accordance with Section 673(2) of the Omnibus | 3 | | Budget Reconciliation
Act of 1981, applicable to | 4 | | families of the same size; or
| 5 | | (ii) their income, after the deduction of | 6 | | costs incurred for medical
care and for other types | 7 | | of remedial care, is equal to or less than 70% in
| 8 | | fiscal year 2001, equal to or less than 85% in | 9 | | fiscal year 2002 and until
a date to be determined | 10 | | by the Department by rule, and equal to or less
| 11 | | than 100% beginning on the date determined by the | 12 | | Department by rule, of the nonfarm income official | 13 | | poverty
line, as defined in item (i) of this | 14 | | subparagraph (a).
| 15 | | (b) All persons who, excluding any eligibility | 16 | | requirements that are inconsistent with any federal | 17 | | law or federal regulation, as interpreted by the U.S. | 18 | | Department of Health and Human Services, would be | 19 | | determined eligible for such basic
maintenance under | 20 | | Article IV by disregarding the maximum earned income
| 21 | | permitted by federal law.
| 22 | | 3. Persons who would otherwise qualify for Aid to the | 23 | | Medically
Indigent under Article VII.
| 24 | | 4. Persons not eligible under any of the preceding | 25 | | paragraphs who fall
sick, are injured, or die, not having | 26 | | sufficient money, property or other
resources to meet the |
| | | SB0026 Engrossed | - 9 - | LRB098 05310 KTG 35344 b |
|
| 1 | | costs of necessary medical care or funeral and burial
| 2 | | expenses.
| 3 | | 5.(a) Women during pregnancy, after the fact
of | 4 | | pregnancy has been determined by medical diagnosis, and | 5 | | during the
60-day period beginning on the last day of the | 6 | | pregnancy, together with
their infants and children born | 7 | | after September 30, 1983,
whose income and
resources are | 8 | | insufficient to meet the costs of necessary medical care to
| 9 | | the maximum extent possible under Title XIX of the
Federal | 10 | | Social Security Act.
| 11 | | (b) The Illinois Department and the Governor shall | 12 | | provide a plan for
coverage of the persons eligible under | 13 | | paragraph 5(a) by April 1, 1990. Such
plan shall provide | 14 | | ambulatory prenatal care to pregnant women during a
| 15 | | presumptive eligibility period and establish an income | 16 | | eligibility standard
that is equal to 133%
of the nonfarm | 17 | | income official poverty line, as defined by
the federal | 18 | | Office of Management and Budget and revised annually in
| 19 | | accordance with Section 673(2) of the Omnibus Budget | 20 | | Reconciliation Act of
1981, applicable to families of the | 21 | | same size, provided that costs incurred
for medical care | 22 | | are not taken into account in determining such income
| 23 | | eligibility.
| 24 | | (c) The Illinois Department may conduct a | 25 | | demonstration in at least one
county that will provide | 26 | | medical assistance to pregnant women, together
with their |
| | | SB0026 Engrossed | - 10 - | LRB098 05310 KTG 35344 b |
|
| 1 | | infants and children up to one year of age,
where the | 2 | | income
eligibility standard is set up to 185% of the | 3 | | nonfarm income official
poverty line, as defined by the | 4 | | federal Office of Management and Budget.
The Illinois | 5 | | Department shall seek and obtain necessary authorization
| 6 | | provided under federal law to implement such a | 7 | | demonstration. Such
demonstration may establish resource | 8 | | standards that are not more
restrictive than those | 9 | | established under Article IV of this Code.
| 10 | | 6. Persons under the age of 18 who fail to qualify as | 11 | | dependent under
Article IV and who have insufficient income | 12 | | and resources to meet the costs
of necessary medical care | 13 | | to the maximum extent permitted under Title XIX
of the | 14 | | Federal Social Security Act.
| 15 | | 7. (Blank).
| 16 | | 8. Persons who become ineligible for basic maintenance | 17 | | assistance
under Article IV of this Code in programs | 18 | | administered by the Illinois
Department due to employment | 19 | | earnings and persons in
assistance units comprised of | 20 | | adults and children who become ineligible for
basic | 21 | | maintenance assistance under Article VI of this Code due to
| 22 | | employment earnings. The plan for coverage for this class | 23 | | of persons shall:
| 24 | | (a) extend the medical assistance coverage for up | 25 | | to 12 months following
termination of basic | 26 | | maintenance assistance; and
|
| | | SB0026 Engrossed | - 11 - | LRB098 05310 KTG 35344 b |
|
| 1 | | (b) offer persons who have initially received 6 | 2 | | months of the
coverage provided in paragraph (a) above, | 3 | | the option of receiving an
additional 6 months of | 4 | | coverage, subject to the following:
| 5 | | (i) such coverage shall be pursuant to | 6 | | provisions of the federal
Social Security Act;
| 7 | | (ii) such coverage shall include all services | 8 | | covered while the person
was eligible for basic | 9 | | maintenance assistance;
| 10 | | (iii) no premium shall be charged for such | 11 | | coverage; and
| 12 | | (iv) such coverage shall be suspended in the | 13 | | event of a person's
failure without good cause to | 14 | | file in a timely fashion reports required for
this | 15 | | coverage under the Social Security Act and | 16 | | coverage shall be reinstated
upon the filing of | 17 | | such reports if the person remains otherwise | 18 | | eligible.
| 19 | | 9. Persons with acquired immunodeficiency syndrome | 20 | | (AIDS) or with
AIDS-related conditions with respect to whom | 21 | | there has been a determination
that but for home or | 22 | | community-based services such individuals would
require | 23 | | the level of care provided in an inpatient hospital, | 24 | | skilled
nursing facility or intermediate care facility the | 25 | | cost of which is
reimbursed under this Article. Assistance | 26 | | shall be provided to such
persons to the maximum extent |
| | | SB0026 Engrossed | - 12 - | LRB098 05310 KTG 35344 b |
|
| 1 | | permitted under Title
XIX of the Federal Social Security | 2 | | Act.
| 3 | | 10. Participants in the long-term care insurance | 4 | | partnership program
established under the Illinois | 5 | | Long-Term Care Partnership Program Act who meet the
| 6 | | qualifications for protection of resources described in | 7 | | Section 15 of that
Act.
| 8 | | 11. Persons with disabilities who are employed and | 9 | | eligible for Medicaid,
pursuant to Section | 10 | | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | 11 | | subject to federal approval, persons with a medically | 12 | | improved disability who are employed and eligible for | 13 | | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | 14 | | the Social Security Act, as
provided by the Illinois | 15 | | Department by rule. In establishing eligibility standards | 16 | | under this paragraph 11, the Department shall, subject to | 17 | | federal approval: | 18 | | (a) set the income eligibility standard at not | 19 | | lower than 350% of the federal poverty level; | 20 | | (b) exempt retirement accounts that the person | 21 | | cannot access without penalty before the age
of 59 1/2, | 22 | | and medical savings accounts established pursuant to | 23 | | 26 U.S.C. 220; | 24 | | (c) allow non-exempt assets up to $25,000 as to | 25 | | those assets accumulated during periods of eligibility | 26 | | under this paragraph 11; and
|
| | | SB0026 Engrossed | - 13 - | LRB098 05310 KTG 35344 b |
|
| 1 | | (d) continue to apply subparagraphs (b) and (c) in | 2 | | determining the eligibility of the person under this | 3 | | Article even if the person loses eligibility under this | 4 | | paragraph 11.
| 5 | | 12. Subject to federal approval, persons who are | 6 | | eligible for medical
assistance coverage under applicable | 7 | | provisions of the federal Social Security
Act and the | 8 | | federal Breast and Cervical Cancer Prevention and | 9 | | Treatment Act of
2000. Those eligible persons are defined | 10 | | to include, but not be limited to,
the following persons:
| 11 | | (1) persons who have been screened for breast or | 12 | | cervical cancer under
the U.S. Centers for Disease | 13 | | Control and Prevention Breast and Cervical Cancer
| 14 | | Program established under Title XV of the federal | 15 | | Public Health Services Act in
accordance with the | 16 | | requirements of Section 1504 of that Act as | 17 | | administered by
the Illinois Department of Public | 18 | | Health; and
| 19 | | (2) persons whose screenings under the above | 20 | | program were funded in whole
or in part by funds | 21 | | appropriated to the Illinois Department of Public | 22 | | Health
for breast or cervical cancer screening.
| 23 | | "Medical assistance" under this paragraph 12 shall be | 24 | | identical to the benefits
provided under the State's | 25 | | approved plan under Title XIX of the Social Security
Act. | 26 | | The Department must request federal approval of the |
| | | SB0026 Engrossed | - 14 - | LRB098 05310 KTG 35344 b |
|
| 1 | | coverage under this
paragraph 12 within 30 days after the | 2 | | effective date of this amendatory Act of
the 92nd General | 3 | | Assembly.
| 4 | | In addition to the persons who are eligible for medical | 5 | | assistance pursuant to subparagraphs (1) and (2) of this | 6 | | paragraph 12, and to be paid from funds appropriated to the | 7 | | Department for its medical programs, any uninsured person | 8 | | as defined by the Department in rules residing in Illinois | 9 | | who is younger than 65 years of age, who has been screened | 10 | | for breast and cervical cancer in accordance with standards | 11 | | and procedures adopted by the Department of Public Health | 12 | | for screening, and who is referred to the Department by the | 13 | | Department of Public Health as being in need of treatment | 14 | | for breast or cervical cancer is eligible for medical | 15 | | assistance benefits that are consistent with the benefits | 16 | | provided to those persons described in subparagraphs (1) | 17 | | and (2). Medical assistance coverage for the persons who | 18 | | are eligible under the preceding sentence is not dependent | 19 | | on federal approval, but federal moneys may be used to pay | 20 | | for services provided under that coverage upon federal | 21 | | approval. | 22 | | 13. Subject to appropriation and to federal approval, | 23 | | persons living with HIV/AIDS who are not otherwise eligible | 24 | | under this Article and who qualify for services covered | 25 | | under Section 5-5.04 as provided by the Illinois Department | 26 | | by rule.
|
| | | SB0026 Engrossed | - 15 - | LRB098 05310 KTG 35344 b |
|
| 1 | | 14. Subject to the availability of funds for this | 2 | | purpose, the Department may provide coverage under this | 3 | | Article to persons who reside in Illinois who are not | 4 | | eligible under any of the preceding paragraphs and who meet | 5 | | the income guidelines of paragraph 2(a) of this Section and | 6 | | (i) have an application for asylum pending before the | 7 | | federal Department of Homeland Security or on appeal before | 8 | | a court of competent jurisdiction and are represented | 9 | | either by counsel or by an advocate accredited by the | 10 | | federal Department of Homeland Security and employed by a | 11 | | not-for-profit organization in regard to that application | 12 | | or appeal, or (ii) are receiving services through a | 13 | | federally funded torture treatment center. Medical | 14 | | coverage under this paragraph 14 may be provided for up to | 15 | | 24 continuous months from the initial eligibility date so | 16 | | long as an individual continues to satisfy the criteria of | 17 | | this paragraph 14. If an individual has an appeal pending | 18 | | regarding an application for asylum before the Department | 19 | | of Homeland Security, eligibility under this paragraph 14 | 20 | | may be extended until a final decision is rendered on the | 21 | | appeal. The Department may adopt rules governing the | 22 | | implementation of this paragraph 14.
| 23 | | 15. Family Care Eligibility. | 24 | | (a) On and after July 1, 2012, a caretaker relative | 25 | | who is 19 years of age or older when countable income | 26 | | is at or below 133% of the Federal Poverty Level |
| | | SB0026 Engrossed | - 16 - | LRB098 05310 KTG 35344 b |
|
| 1 | | Guidelines, as published annually in the Federal | 2 | | Register, for the appropriate family size. A person may | 3 | | not spend down to become eligible under this paragraph | 4 | | 15. | 5 | | (b) Eligibility shall be reviewed annually. | 6 | | (c) (Blank). | 7 | | (d) (Blank). | 8 | | (e) (Blank). | 9 | | (f) (Blank). | 10 | | (g) (Blank). | 11 | | (h) (Blank). | 12 | | (i) Following termination of an individual's | 13 | | coverage under this paragraph 15, the individual must | 14 | | be determined eligible before the person can be | 15 | | re-enrolled. | 16 | | 16. Subject to appropriation, uninsured persons who | 17 | | are not otherwise eligible under this Section who have been | 18 | | certified and referred by the Department of Public Health | 19 | | as having been screened and found to need diagnostic | 20 | | evaluation or treatment, or both diagnostic evaluation and | 21 | | treatment, for prostate or testicular cancer. For the | 22 | | purposes of this paragraph 16, uninsured persons are those | 23 | | who do not have creditable coverage, as defined under the | 24 | | Health Insurance Portability and Accountability Act, or | 25 | | have otherwise exhausted any insurance benefits they may | 26 | | have had, for prostate or testicular cancer diagnostic |
| | | SB0026 Engrossed | - 17 - | LRB098 05310 KTG 35344 b |
|
| 1 | | evaluation or treatment, or both diagnostic evaluation and | 2 | | treatment.
To be eligible, a person must furnish a Social | 3 | | Security number.
A person's assets are exempt from | 4 | | consideration in determining eligibility under this | 5 | | paragraph 16.
Such persons shall be eligible for medical | 6 | | assistance under this paragraph 16 for so long as they need | 7 | | treatment for the cancer. A person shall be considered to | 8 | | need treatment if, in the opinion of the person's treating | 9 | | physician, the person requires therapy directed toward | 10 | | cure or palliation of prostate or testicular cancer, | 11 | | including recurrent metastatic cancer that is a known or | 12 | | presumed complication of prostate or testicular cancer and | 13 | | complications resulting from the treatment modalities | 14 | | themselves. Persons who require only routine monitoring | 15 | | services are not considered to need treatment.
"Medical | 16 | | assistance" under this paragraph 16 shall be identical to | 17 | | the benefits provided under the State's approved plan under | 18 | | Title XIX of the Social Security Act.
Notwithstanding any | 19 | | other provision of law, the Department (i) does not have a | 20 | | claim against the estate of a deceased recipient of | 21 | | services under this paragraph 16 and (ii) does not have a | 22 | | lien against any homestead property or other legal or | 23 | | equitable real property interest owned by a recipient of | 24 | | services under this paragraph 16. | 25 | | 17. Persons who, pursuant to a waiver approved by the | 26 | | Secretary of the U.S. Department of Health and Human |
| | | SB0026 Engrossed | - 18 - | LRB098 05310 KTG 35344 b |
|
| 1 | | Services, are eligible for medical assistance under Title | 2 | | XIX or XXI of the federal Social Security Act. | 3 | | Notwithstanding any other provision of this Code and | 4 | | consistent with the terms of the approved waiver, the | 5 | | Illinois Department, may by rule: | 6 | | (a) Limit the geographic areas in which the waiver | 7 | | program operates. | 8 | | (b) Determine the scope, quantity, duration, and | 9 | | quality, and the rate and method of reimbursement, of | 10 | | the medical services to be provided, which may differ | 11 | | from those for other classes of persons eligible for | 12 | | assistance under this Article. | 13 | | (c) Restrict the persons' freedom in choice of | 14 | | providers. | 15 | | 18. Beginning January 1, 2014, persons aged 19 or | 16 | | older, but younger than 65, who are not otherwise eligible | 17 | | for medical assistance under this Section 5-2, who qualify | 18 | | for medical assistance pursuant to 42 U.S.C. | 19 | | 1396a(a)(10)(A)(i)(VIII) and as set forth in 42 CFR | 20 | | 435.119, and who have income at or below 133% of the | 21 | | federal poverty level plus 5% for the applicable family | 22 | | size as determined pursuant to 42 U.S.C. 1396a(e)(14) and | 23 | | as set forth in 42 CFR 435.603. Persons eligible for | 24 | | medical assistance under this paragraph 18 shall receive | 25 | | coverage for the Health Benefits Service Package as that | 26 | | term is defined in subsection (m) of Section 5-1.1 of this |
| | | SB0026 Engrossed | - 19 - | LRB098 05310 KTG 35344 b |
|
| 1 | | Code. If Illinois' federal medical assistance percentage | 2 | | (FMAP) is reduced below 90% for persons eligible for | 3 | | medical
assistance under this paragraph 18, eligibility | 4 | | under this paragraph 18 shall cease no later than the end | 5 | | of the third month following the month in which the | 6 | | reduction in FMAP takes effect. | 7 | | In implementing the provisions of Public Act 96-20, the | 8 | | Department is authorized to adopt only those rules necessary, | 9 | | including emergency rules. Nothing in Public Act 96-20 permits | 10 | | the Department to adopt rules or issue a decision that expands | 11 | | eligibility for the FamilyCare Program to a person whose income | 12 | | exceeds 185% of the Federal Poverty Level as determined from | 13 | | time to time by the U.S. Department of Health and Human | 14 | | Services, unless the Department is provided with express | 15 | | statutory authority. | 16 | | The Illinois Department and the Governor shall provide a | 17 | | plan for
coverage of the persons eligible under paragraph 7 as | 18 | | soon as possible after
July 1, 1984.
| 19 | | The eligibility of any such person for medical assistance | 20 | | under this
Article is not affected by the payment of any grant | 21 | | under the Senior
Citizens and Disabled Persons Property Tax | 22 | | Relief Act or any distributions or items of income described | 23 | | under
subparagraph (X) of
paragraph (2) of subsection (a) of | 24 | | Section 203 of the Illinois Income Tax
Act. The Department | 25 | | shall by rule establish the amounts of
assets to be disregarded | 26 | | in determining eligibility for medical assistance,
which shall |
| | | SB0026 Engrossed | - 20 - | LRB098 05310 KTG 35344 b |
|
| 1 | | at a minimum equal the amounts to be disregarded under the
| 2 | | Federal Supplemental Security Income Program. The amount of | 3 | | assets of a
single person to be disregarded
shall not be less | 4 | | than $2,000, and the amount of assets of a married couple
to be | 5 | | disregarded shall not be less than $3,000.
| 6 | | To the extent permitted under federal law, any person found | 7 | | guilty of a
second violation of Article VIIIA
shall be | 8 | | ineligible for medical assistance under this Article, as | 9 | | provided
in Section 8A-8.
| 10 | | The eligibility of any person for medical assistance under | 11 | | this Article
shall not be affected by the receipt by the person | 12 | | of donations or benefits
from fundraisers held for the person | 13 | | in cases of serious illness,
as long as neither the person nor | 14 | | members of the person's family
have actual control over the | 15 | | donations or benefits or the disbursement
of the donations or | 16 | | benefits.
| 17 | | Notwithstanding any other provision of this Code, if the | 18 | | United States Supreme Court holds Title II, Subtitle A, Section | 19 | | 2001(a) of Public Law 111-148 to be unconstitutional, or if a | 20 | | holding of Public Law 111-148 makes Medicaid eligibility | 21 | | allowed under Section 2001(a) inoperable, the State or a unit | 22 | | of local government shall be prohibited from enrolling | 23 | | individuals in the Medical Assistance Program as the result of | 24 | | federal approval of a State Medicaid waiver on or after the | 25 | | effective date of this amendatory Act of the 97th General | 26 | | Assembly, and any individuals enrolled in the Medical |
| | | SB0026 Engrossed | - 21 - | LRB098 05310 KTG 35344 b |
|
| 1 | | Assistance Program pursuant to eligibility permitted as a | 2 | | result of such a State Medicaid waiver shall become immediately | 3 | | ineligible. | 4 | | Notwithstanding any other provision of this Code, if an Act | 5 | | of Congress that becomes a Public Law eliminates Section | 6 | | 2001(a) of Public Law 111-148, the State or a unit of local | 7 | | government shall be prohibited from enrolling individuals in | 8 | | the Medical Assistance Program as the result of federal | 9 | | approval of a State Medicaid waiver on or after the effective | 10 | | date of this amendatory Act of the 97th General Assembly, and | 11 | | any individuals enrolled in the Medical Assistance Program | 12 | | pursuant to eligibility permitted as a result of such a State | 13 | | Medicaid waiver shall become immediately ineligible. | 14 | | (Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; | 15 | | 96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. | 16 | | 7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, | 17 | | eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; | 18 | | 97-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff. | 19 | | 7-13-12; revised 7-23-12.)
| 20 | | (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | 21 | | (Section scheduled to be repealed on January 1, 2015) | 22 | | Sec. 5A-2. Assessment.
| 23 | | (a)
Subject to Sections 5A-3 and 5A-10, for State fiscal | 24 | | years 2009 through 2014, and from July 1, 2014 through December | 25 | | 31, 2014, an annual assessment on inpatient services is imposed |
| | | SB0026 Engrossed | - 22 - | LRB098 05310 KTG 35344 b |
|
| 1 | | on each hospital provider in an amount equal to $218.38 | 2 | | multiplied by the difference of the hospital's occupied bed | 3 | | days less the hospital's Medicare bed days. | 4 | | For State fiscal years 2009 through 2014, and after a | 5 | | hospital's occupied bed days and Medicare bed days shall be | 6 | | determined using the most recent data available from each | 7 | | hospital's 2005 Medicare cost report as contained in the | 8 | | Healthcare Cost Report Information System file, for the quarter | 9 | | ending on December 31, 2006, without regard to any subsequent | 10 | | adjustments or changes to such data. If a hospital's 2005 | 11 | | Medicare cost report is not contained in the Healthcare Cost | 12 | | Report Information System, then the Illinois Department may | 13 | | obtain the hospital provider's occupied bed days and Medicare | 14 | | bed days from any source available, including, but not limited | 15 | | to, records maintained by the hospital provider, which may be | 16 | | inspected at all times during business hours of the day by the | 17 | | Illinois Department or its duly authorized agents and | 18 | | employees. | 19 | | (b) (Blank).
| 20 | | (b-5) Subject to Sections 5A-3 and 5A-10, for the portion | 21 | | of State fiscal year 2012, beginning June 10, 2012 through June | 22 | | 30, 2012, and for State fiscal years 2013 through 2014, and | 23 | | July 1, 2014 through December 31, 2014, an annual assessment on | 24 | | outpatient services is imposed on each hospital provider in an | 25 | | amount equal to .008766 multiplied by the hospital's outpatient | 26 | | gross revenue. For the period beginning June 10, 2012 through |
| | | SB0026 Engrossed | - 23 - | LRB098 05310 KTG 35344 b |
|
| 1 | | June 30, 2012, the annual assessment on outpatient services | 2 | | shall be prorated by multiplying the assessment amount by a | 3 | | fraction, the numerator of which is 21 days and the denominator | 4 | | of which is 365 days. | 5 | | For the portion of State fiscal year 2012, beginning June | 6 | | 10, 2012 through June 30, 2012, and State fiscal years 2013 | 7 | | through 2014, and July 1, 2014 through December 31, 2014, a | 8 | | hospital's outpatient gross revenue shall be determined using | 9 | | the most recent data available from each hospital's 2009 | 10 | | Medicare cost report as contained in the Healthcare Cost Report | 11 | | Information System file, for the quarter ending on June 30, | 12 | | 2011, without regard to any subsequent adjustments or changes | 13 | | to such data. If a hospital's 2009 Medicare cost report is not | 14 | | contained in the Healthcare Cost Report Information System, | 15 | | then the Department may obtain the hospital provider's | 16 | | outpatient gross revenue from any source available, including, | 17 | | but not limited to, records maintained by the hospital | 18 | | provider, which may be inspected at all times during business | 19 | | hours of the day by the Department or its duly authorized | 20 | | agents and employees. | 21 | | (c) (Blank).
| 22 | | (d) Notwithstanding any of the other provisions of this | 23 | | Section, the Department is authorized to adopt rules to reduce | 24 | | the rate of any annual assessment imposed under this Section, | 25 | | as authorized by Section 5-46.2 of the Illinois Administrative | 26 | | Procedure Act.
|
| | | SB0026 Engrossed | - 24 - | LRB098 05310 KTG 35344 b |
|
| 1 | | (e) Notwithstanding any other provision of this Section, | 2 | | any plan providing for an assessment on a hospital provider as | 3 | | a permissible tax under Title XIX of the federal Social | 4 | | Security Act and Medicaid-eligible payments to hospital | 5 | | providers from the revenues derived from that assessment shall | 6 | | be reviewed by the Illinois Department of Healthcare and Family | 7 | | Services, as the Single State Medicaid Agency required by | 8 | | federal law, to determine whether those assessments and | 9 | | hospital provider payments meet federal Medicaid standards. If | 10 | | the Department determines that the elements of the plan may | 11 | | meet federal Medicaid standards and a related State Medicaid | 12 | | Plan Amendment is prepared in a manner and form suitable for | 13 | | submission, that State Plan Amendment shall be submitted in a | 14 | | timely manner for review by the Centers for Medicare and | 15 | | Medicaid Services of the United States Department of Health and | 16 | | Human Services and subject to approval by the Centers for | 17 | | Medicare and Medicaid Services of the United States Department | 18 | | of Health and Human Services. No such plan shall become | 19 | | effective without approval by the Illinois General Assembly by | 20 | | the enactment into law of related legislation. Notwithstanding | 21 | | any other provision of this Section, the Department is | 22 | | authorized to adopt rules to reduce the rate of any annual | 23 | | assessment imposed under this Section. Any such rules may be | 24 | | adopted by the Department under Section 5-50 of the Illinois | 25 | | Administrative Procedure Act. | 26 | | (Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; |
| | | SB0026 Engrossed | - 25 - | LRB098 05310 KTG 35344 b |
|
| 1 | | 97-689, eff. 6-14-12.)
| 2 | | (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) | 3 | | Sec. 5A-4. Payment of assessment; penalty.
| 4 | | (a) The assessment imposed by Section 5A-2 for State fiscal | 5 | | year 2009 and each subsequent State fiscal year shall be due | 6 | | and payable in monthly installments, each equaling one-twelfth | 7 | | of the assessment for the year, on the fourteenth State | 8 | | business day of each month.
No installment payment of an | 9 | | assessment imposed by Section 5A-2 shall be due
and
payable, | 10 | | however, until after the Comptroller has issued the payments | 11 | | required under this Article.
| 12 | | Except as provided in subsection (a-5) of this Section, the | 13 | | assessment imposed by subsection (b-5) of Section 5A-2 for the | 14 | | portion of State fiscal year 2012 beginning June 10, 2012 | 15 | | through June 30, 2012, and for State fiscal year 2013 and each | 16 | | subsequent State fiscal year shall be due and payable in | 17 | | monthly installments, each equaling one-twelfth of the | 18 | | assessment for the year, on the 14th State business day of each | 19 | | month. No installment payment of an assessment imposed by | 20 | | subsection (b-5) of Section 5A-2 shall be due and payable, | 21 | | however, until after: (i) the Department notifies the hospital | 22 | | provider, in writing, that the payment methodologies to | 23 | | hospitals required under Section 5A-12.4, have been approved by | 24 | | the Centers for Medicare and Medicaid Services of the U.S. | 25 | | Department of Health and Human Services, and the waiver under |
| | | SB0026 Engrossed | - 26 - | LRB098 05310 KTG 35344 b |
|
| 1 | | 42 CFR 433.68 for the assessment imposed by subsection (b-5) of | 2 | | Section 5A-2, if necessary, has been granted by the Centers for | 3 | | Medicare and Medicaid Services of the U.S. Department of Health | 4 | | and Human Services; and (ii) the Comptroller has issued the | 5 | | payments required under Section 5A-12.4. Upon notification to | 6 | | the Department of approval of the payment methodologies | 7 | | required under Section 5A-12.4 and the waiver granted under 42 | 8 | | CFR 433.68, if necessary, all installments otherwise due under | 9 | | subsection (b-5) of Section 5A-2 prior to the date of | 10 | | notification shall be due and payable to the Department upon | 11 | | written direction from the Department and issuance by the | 12 | | Comptroller of the payments required under Section 5A-12.4. | 13 | | (a-5) The Illinois Department may accelerate the schedule | 14 | | upon which assessment installments are due and payable by | 15 | | hospitals with a payment ratio greater than or equal to one. | 16 | | Such acceleration of due dates for payment of the assessment | 17 | | may be made only in conjunction with a corresponding | 18 | | acceleration in access payments identified in Section 5A-12.2 | 19 | | or Section 5A-12.4 to the same hospitals. For the purposes of | 20 | | this subsection (a-5), a hospital's payment ratio is defined as | 21 | | the quotient obtained by dividing the total payments for the | 22 | | State fiscal year, as authorized under Section 5A-12.2 or | 23 | | Section 5A-12.4, by the total assessment for the State fiscal | 24 | | year imposed under Section 5A-2 or subsection (b-5) of Section | 25 | | 5A-2. | 26 | | (b) The Illinois Department is authorized to establish
|
| | | SB0026 Engrossed | - 27 - | LRB098 05310 KTG 35344 b |
|
| 1 | | delayed payment schedules for hospital providers that are | 2 | | unable
to make installment payments when due under this Section | 3 | | due to
financial difficulties, as determined by the Illinois | 4 | | Department.
| 5 | | (c) If a hospital provider fails to pay the full amount of
| 6 | | an installment when due (including any extensions granted under
| 7 | | subsection (b)), there shall, unless waived by the Illinois
| 8 | | Department for reasonable cause, be added to the assessment
| 9 | | imposed by Section 5A-2 a penalty
assessment equal to the | 10 | | lesser of (i) 5% of the amount of the
installment not paid on | 11 | | or before the due date plus 5% of the
portion thereof remaining | 12 | | unpaid on the last day of each 30-day period
thereafter or (ii) | 13 | | 100% of the installment amount not paid on or
before the due | 14 | | date. For purposes of this subsection, payments
will be | 15 | | credited first to unpaid installment amounts (rather than
to | 16 | | penalty or interest), beginning with the most delinquent
| 17 | | installments.
| 18 | | (d) Any assessment amount that is due and payable to the | 19 | | Illinois Department more frequently than once per calendar | 20 | | quarter shall be remitted to the Illinois Department by the | 21 | | hospital provider by means of electronic funds transfer. The | 22 | | Illinois Department may provide for remittance by other means | 23 | | if (i) the amount due is less than $10,000 or (ii) electronic | 24 | | funds transfer is unavailable for this purpose. | 25 | | (Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12; | 26 | | 97-689, eff. 6-14-12.) |
| | | SB0026 Engrossed | - 28 - | LRB098 05310 KTG 35344 b |
|
| 1 | | (305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5) | 2 | | Sec. 5A-5. Notice; penalty; maintenance of records.
| 3 | | (a)
The Illinois Department shall send a
notice of | 4 | | assessment to every hospital provider subject
to assessment | 5 | | under this Article. The notice of assessment shall notify the | 6 | | hospital of its assessment and shall be sent after receipt by | 7 | | the Department of notification from the Centers for Medicare | 8 | | and Medicaid Services of the U.S. Department of Health and | 9 | | Human Services that the payment methodologies required under | 10 | | this Article and, if necessary, the waiver granted under 42 CFR | 11 | | 433.68 have been approved. The notice
shall be on a form
| 12 | | prepared by the Illinois Department and shall state the | 13 | | following:
| 14 | | (1) The name of the hospital provider.
| 15 | | (2) The address of the hospital provider's principal | 16 | | place
of business from which the provider engages in the | 17 | | occupation of hospital
provider in this State, and the name | 18 | | and address of each hospital
operated, conducted, or | 19 | | maintained by the provider in this State.
| 20 | | (3) The occupied bed days, occupied bed days less | 21 | | Medicare days, adjusted gross hospital revenue, or | 22 | | outpatient gross revenue of the
hospital
provider | 23 | | (whichever is applicable), the amount of
assessment | 24 | | imposed under Section 5A-2 for the State fiscal year
for | 25 | | which the notice is sent, and the amount of
each
|
| | | SB0026 Engrossed | - 29 - | LRB098 05310 KTG 35344 b |
|
| 1 | | installment to be paid during the State fiscal year.
| 2 | | (4) (Blank).
| 3 | | (5) Other reasonable information as determined by the | 4 | | Illinois
Department.
| 5 | | (b) If a hospital provider conducts, operates, or
maintains | 6 | | more than one hospital licensed by the Illinois
Department of | 7 | | Public Health, the provider shall pay the
assessment for each | 8 | | hospital separately.
| 9 | | (c) Notwithstanding any other provision in this Article, in
| 10 | | the case of a person who ceases to conduct, operate, or | 11 | | maintain a
hospital in respect of which the person is subject | 12 | | to assessment
under this Article as a hospital provider, the | 13 | | assessment for the State
fiscal year in which the cessation | 14 | | occurs shall be adjusted by
multiplying the assessment computed | 15 | | under Section 5A-2 by a
fraction, the numerator of which is the | 16 | | number of days in the
year during which the provider conducts, | 17 | | operates, or maintains
the hospital and the denominator of | 18 | | which is 365. Immediately
upon ceasing to conduct, operate, or | 19 | | maintain a hospital, the person
shall pay the assessment
for | 20 | | the year as so adjusted (to the extent not previously paid).
| 21 | | (d) Notwithstanding any other provision in this Article, a
| 22 | | provider who commences conducting, operating, or maintaining a
| 23 | | hospital, upon notice by the Illinois Department,
shall pay the | 24 | | assessment computed under Section 5A-2 and
subsection (e) in | 25 | | installments on the due dates stated in the
notice and on the | 26 | | regular installment due dates for the State
fiscal year |
| | | SB0026 Engrossed | - 30 - | LRB098 05310 KTG 35344 b |
|
| 1 | | occurring after the due dates of the initial
notice.
| 2 | | (e)
Notwithstanding any other provision in this Article, | 3 | | for State fiscal years 2009 through 2015, in the case of a | 4 | | hospital provider that did not conduct, operate, or maintain a | 5 | | hospital in 2005, the assessment for that State fiscal year | 6 | | shall be computed on the basis of hypothetical occupied bed | 7 | | days for the full calendar year as determined by the Illinois | 8 | | Department. Notwithstanding any other provision in this | 9 | | Article, for the portion of State fiscal year 2012 beginning | 10 | | June 10, 2012 through June 30, 2012, and for State fiscal years | 11 | | 2013 through 2014, and for July 1, 2014 through December 31, | 12 | | 2014, in the case of a hospital provider that did not conduct, | 13 | | operate, or maintain a hospital in 2009, the assessment under | 14 | | subsection (b-5) of Section 5A-2 for that State fiscal year | 15 | | shall be computed on the basis of hypothetical gross outpatient | 16 | | revenue for the full calendar year as determined by the | 17 | | Illinois Department.
| 18 | | (f) Every hospital provider subject to assessment under | 19 | | this Article shall keep sufficient records to permit the | 20 | | determination of adjusted gross hospital revenue for the | 21 | | hospital's fiscal year. All such records shall be kept in the | 22 | | English language and shall, at all times during regular | 23 | | business hours of the day, be subject to inspection by the | 24 | | Illinois Department or its duly authorized agents and | 25 | | employees.
| 26 | | (g) The Illinois Department may, by rule, provide a |
| | | SB0026 Engrossed | - 31 - | LRB098 05310 KTG 35344 b |
|
| 1 | | hospital provider a reasonable opportunity to request a | 2 | | clarification or correction of any clerical or computational | 3 | | errors contained in the calculation of its assessment, but such | 4 | | corrections shall not extend to updating the cost report | 5 | | information used to calculate the assessment.
| 6 | | (h) (Blank).
| 7 | | (Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; | 8 | | 97-689, eff. 6-14-12; revised 10-17-12.)
| 9 | | (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
| 10 | | Sec. 5A-8. Hospital Provider Fund.
| 11 | | (a) There is created in the State Treasury the Hospital | 12 | | Provider Fund.
Interest earned by the Fund shall be credited to | 13 | | the Fund. The
Fund shall not be used to replace any moneys | 14 | | appropriated to the
Medicaid program by the General Assembly.
| 15 | | (b) The Fund is created for the purpose of receiving moneys
| 16 | | in accordance with Section 5A-6 and disbursing moneys only for | 17 | | the following
purposes, notwithstanding any other provision of | 18 | | law:
| 19 | | (1) For making payments to hospitals as required under | 20 | | this Code, under the Children's Health Insurance Program | 21 | | Act, under the Covering ALL KIDS Health Insurance Act, and | 22 | | under the Long Term Acute Care Hospital Quality Improvement | 23 | | Transfer Program Act.
| 24 | | (2) For the reimbursement of moneys collected by the
| 25 | | Illinois Department from hospitals or hospital providers |
| | | SB0026 Engrossed | - 32 - | LRB098 05310 KTG 35344 b |
|
| 1 | | through error or
mistake in performing the
activities | 2 | | authorized under this Code.
| 3 | | (3) For payment of administrative expenses incurred by | 4 | | the
Illinois Department or its agent in performing | 5 | | activities
under this Code, under the Children's Health | 6 | | Insurance Program Act, under the Covering ALL KIDS Health | 7 | | Insurance Act, and under the Long Term Acute Care Hospital | 8 | | Quality Improvement Transfer Program Act.
| 9 | | (4) For payments of any amounts which are reimbursable | 10 | | to
the federal government for payments from this Fund which | 11 | | are
required to be paid by State warrant.
| 12 | | (5) For making transfers, as those transfers are | 13 | | authorized
in the proceedings authorizing debt under the | 14 | | Short Term Borrowing Act,
but transfers made under this | 15 | | paragraph (5) shall not exceed the
principal amount of debt | 16 | | issued in anticipation of the receipt by
the State of | 17 | | moneys to be deposited into the Fund.
| 18 | | (6) For making transfers to any other fund in the State | 19 | | treasury, but
transfers made under this paragraph (6) shall | 20 | | not exceed the amount transferred
previously from that | 21 | | other fund into the Hospital Provider Fund plus any | 22 | | interest that would have been earned by that fund on the | 23 | | monies that had been transferred.
| 24 | | (6.5) For making transfers to the Healthcare Provider | 25 | | Relief Fund, except that transfers made under this | 26 | | paragraph (6.5) shall not exceed $60,000,000 in the |
| | | SB0026 Engrossed | - 33 - | LRB098 05310 KTG 35344 b |
|
| 1 | | aggregate. | 2 | | (7) For making transfers not exceeding the following | 3 | | amounts, in State fiscal years 2013 and 2014 in each State | 4 | | fiscal year during which an assessment is imposed pursuant | 5 | | to Section 5A-2, to the following designated funds: | 6 | | Health and Human Services Medicaid Trust | 7 | | Fund ..............................$20,000,000 | 8 | | Long-Term Care Provider Fund ..........$30,000,000 | 9 | | General Revenue Fund .................$80,000,000. | 10 | | Transfers under this paragraph shall be made within 7 days | 11 | | after the payments have been received pursuant to the | 12 | | schedule of payments provided in subsection (a) of Section | 13 | | 5A-4. | 14 | | (7.1) For making transfers not exceeding the following | 15 | | amounts, in State fiscal year 2015, to the following | 16 | | designated funds: | 17 | | Health and Human Services Medicaid Trust | 18 | | Fund ..............................$10,000,000 | 19 | | Long-Term Care Provider Fund ..........$15,000,000 | 20 | | General Revenue Fund .................$40,000,000. | 21 | | Transfers under this paragraph shall be made within 7 days | 22 | | after the payments have been received pursuant to the | 23 | | schedule of payments provided in subsection (a) of Section | 24 | | 5A-4.
| 25 | | (7.5) (Blank). | 26 | | (7.8) (Blank). |
| | | SB0026 Engrossed | - 34 - | LRB098 05310 KTG 35344 b |
|
| 1 | | (7.9) (Blank). | 2 | | (7.10) For State fiscal years 2013 and 2014, for making | 3 | | transfers of the moneys resulting from the assessment under | 4 | | subsection (b-5) of Section 5A-2 and received from hospital | 5 | | providers under Section 5A-4 and transferred into the | 6 | | Hospital Provider Fund under Section 5A-6 to the designated | 7 | | funds not exceeding the following amounts in that State | 8 | | fiscal year: | 9 | | Health Care Provider Relief Fund ......$50,000,000 | 10 | | Transfers under this paragraph shall be made within 7 | 11 | | days after the payments have been received pursuant to the | 12 | | schedule of payments provided in subsection (a) of Section | 13 | | 5A-4. | 14 | | (7.11) For State fiscal year 2015, for making transfers | 15 | | of the moneys resulting from the assessment under | 16 | | subsection (b-5) of Section 5A-2 and received from hospital | 17 | | providers under Section 5A-4 and transferred into the | 18 | | Hospital Provider Fund under Section 5A-6 to the designated | 19 | | funds not exceeding the following amounts in that State | 20 | | fiscal year: | 21 | | Health Care Provider Relief Fund .....$25,000,000 | 22 | | Transfers under this paragraph shall be made within 7 | 23 | | days after the payments have been received pursuant to the | 24 | | schedule of payments provided in subsection (a) of Section | 25 | | 5A-4. | 26 | | (7.12) For State fiscal year 2013, for increasing by |
| | | SB0026 Engrossed | - 35 - | LRB098 05310 KTG 35344 b |
|
| 1 | | 21/365ths the transfer of the moneys resulting from the | 2 | | assessment under subsection (b-5) of Section 5A-2 and | 3 | | received from hospital providers under Section 5A-4 for the | 4 | | portion of State fiscal year 2012 beginning June 10, 2012 | 5 | | through June 30, 2012 and transferred into the Hospital | 6 | | Provider Fund under Section 5A-6 to the designated funds | 7 | | not exceeding the following amounts in that State fiscal | 8 | | year: | 9 | | Health Care Provider Relief Fund .......$2,870,000 | 10 | | (8) For making refunds to hospital providers pursuant | 11 | | to Section 5A-10.
| 12 | | Disbursements from the Fund, other than transfers | 13 | | authorized under
paragraphs (5) and (6) of this subsection, | 14 | | shall be by
warrants drawn by the State Comptroller upon | 15 | | receipt of vouchers
duly executed and certified by the Illinois | 16 | | Department.
| 17 | | (c) The Fund shall consist of the following:
| 18 | | (1) All moneys collected or received by the Illinois
| 19 | | Department from the hospital provider assessment imposed | 20 | | by this
Article.
| 21 | | (2) All federal matching funds received by the Illinois
| 22 | | Department as a result of expenditures made by the Illinois
| 23 | | Department that are attributable to moneys deposited in the | 24 | | Fund.
| 25 | | (3) Any interest or penalty levied in conjunction with | 26 | | the
administration of this Article.
|
| | | SB0026 Engrossed | - 36 - | LRB098 05310 KTG 35344 b |
|
| 1 | | (4) Moneys transferred from another fund in the State | 2 | | treasury.
| 3 | | (5) All other moneys received for the Fund from any | 4 | | other
source, including interest earned thereon.
| 5 | | (d) (Blank).
| 6 | | (Source: P.A. 96-3, eff. 2-27-09; 96-45, eff. 7-15-09; 96-821, | 7 | | eff. 11-20-09; 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; | 8 | | 97-689, eff. 6-14-12; revised 10-17-12.)
| 9 | | (305 ILCS 5/5A-12.4) | 10 | | (Section scheduled to be repealed on January 1, 2015) | 11 | | Sec. 5A-12.4. Hospital access improvement payments on or | 12 | | after June 10, 2012 July 1, 2012 . | 13 | | (a) Hospital access improvement payments. To preserve and | 14 | | improve access to hospital services, for hospital and physician | 15 | | services rendered on or after June 10, 2012 July 1, 2012 , the | 16 | | Illinois Department shall, except for hospitals described in | 17 | | subsection (b) of Section 5A-3, make payments to hospitals as | 18 | | set forth in this Section. These payments shall be paid in 12 | 19 | | equal installments on or before the 7th State business day of | 20 | | each month, except that no payment shall be due within 100 days | 21 | | after the later of the date of notification of federal approval | 22 | | of the payment methodologies required under this Section or any | 23 | | waiver required under 42 CFR 433.68, at which time the sum of | 24 | | amounts required under this Section prior to the date of | 25 | | notification is due and payable. Payments under this Section |
| | | SB0026 Engrossed | - 37 - | LRB098 05310 KTG 35344 b |
|
| 1 | | are not due and payable, however, until (i) the methodologies | 2 | | described in this Section are approved by the federal | 3 | | government in an appropriate State Plan amendment and (ii) the | 4 | | assessment imposed under subsection (b-5) of Section 5A-2 of | 5 | | this Article is determined to be a permissible tax under Title | 6 | | XIX of the Social Security Act. The Illinois Department shall | 7 | | take all actions necessary to implement the payments under this | 8 | | Section effective June 10, 2012 July 1, 2012 , including but not | 9 | | limited to providing public notice pursuant to federal | 10 | | requirements, the filing of a State Plan amendment, and the | 11 | | adoption of administrative rules. For State fiscal year 2013, | 12 | | payments under this Section shall be increased by 21/365ths. | 13 | | The funding source for these additional payments shall be from | 14 | | the increased assessment under subsection (b-5) of Section 5A-2 | 15 | | that was received from hospital providers under Section 5A-4 | 16 | | for the portion of State fiscal year 2012 beginning June 10, | 17 | | 2012 through June 30, 2012. | 18 | | (a-5) Accelerated schedule. The Illinois Department may, | 19 | | when practicable, accelerate the schedule upon which payments | 20 | | authorized under this Section are made. | 21 | | (b) Magnet and perinatal hospital adjustment. In addition | 22 | | to rates paid for inpatient hospital services, the Department | 23 | | shall pay to each Illinois general acute care hospital that, as | 24 | | of August 25, 2011, was recognized as a Magnet hospital by the | 25 | | American Nurses Credentialing Center and that, as of September | 26 | | 14, 2011, was designated as a level III perinatal center |
| | | SB0026 Engrossed | - 38 - | LRB098 05310 KTG 35344 b |
|
| 1 | | amounts as follows: | 2 | | (1) For hospitals with a case mix index equal to or | 3 | | greater than the 80th percentile of case mix indices for | 4 | | all Illinois hospitals, $470 for each Medicaid general | 5 | | acute care inpatient day of care provided by the hospital | 6 | | during State fiscal year 2009. | 7 | | (2) For all other hospitals, $170 for each Medicaid | 8 | | general acute care inpatient day of care provided by the | 9 | | hospital during State fiscal year 2009. | 10 | | (c) Trauma level II adjustment. In addition to rates paid | 11 | | for inpatient hospital services, the Department shall pay to | 12 | | each Illinois general acute care hospital that, as of July 1, | 13 | | 2011, was designated as a level II trauma center amounts as | 14 | | follows: | 15 | | (1) For hospitals with a case mix index equal to or | 16 | | greater than the 50th percentile of case mix indices for | 17 | | all Illinois hospitals, $470 for each Medicaid general | 18 | | acute care inpatient day of care provided by the hospital | 19 | | during State fiscal year 2009. | 20 | | (2) For all other hospitals, $170 for each Medicaid | 21 | | general acute care inpatient day of care provided by the | 22 | | hospital during State fiscal year 2009. | 23 | | (3) For the purposes of this adjustment, hospitals | 24 | | located in the same city that alternate their trauma center | 25 | | designation as defined in 89 Ill. Adm. Code 148.295(a)(2) | 26 | | shall have the adjustment provided under this Section |
| | | SB0026 Engrossed | - 39 - | LRB098 05310 KTG 35344 b |
|
| 1 | | divided between the 2 hospitals. | 2 | | (d) Dual-eligible adjustment. In addition to rates paid for | 3 | | inpatient services, the Department shall pay each Illinois | 4 | | general acute care hospital that had a ratio of crossover days | 5 | | to total inpatient days for programs under Title XIX of the | 6 | | Social Security Act administered by the Department (utilizing | 7 | | information from 2009 paid claims) greater than 50%, and a case | 8 | | mix index equal to or greater than the 75th percentile of case | 9 | | mix indices for all Illinois hospitals, a rate of $400 for each | 10 | | Medicaid inpatient day during State fiscal year 2009 including | 11 | | crossover days. | 12 | | (e) Medicaid volume adjustment. In addition to rates paid | 13 | | for inpatient hospital services, the Department shall pay to | 14 | | each Illinois general acute care hospital that provided more | 15 | | than 10,000 Medicaid inpatient days of care in State fiscal | 16 | | year 2009, has a Medicaid inpatient utilization rate of at | 17 | | least 29.05% as calculated by the Department for the Rate Year | 18 | | 2011 Disproportionate Share determination, and is not eligible | 19 | | for Medicaid Percentage Adjustment payments in rate year 2011 | 20 | | an amount equal to $135 for each Medicaid inpatient day of care | 21 | | provided during State fiscal year 2009. | 22 | | (f) Outpatient service adjustment. In addition to the rates | 23 | | paid for outpatient hospital services, the Department shall pay | 24 | | each Illinois hospital an amount at least equal to $100 | 25 | | multiplied by the hospital's outpatient ambulatory procedure | 26 | | listing services (excluding categories 3B and 3C) and by the |
| | | SB0026 Engrossed | - 40 - | LRB098 05310 KTG 35344 b |
|
| 1 | | hospital's end stage renal disease treatment services provided | 2 | | for State fiscal year 2009. | 3 | | (g) Ambulatory service adjustment. | 4 | | (1) In addition to the rates paid for outpatient | 5 | | hospital services provided in the emergency department, | 6 | | the Department shall pay each Illinois hospital an amount | 7 | | equal to $105 multiplied by the hospital's outpatient | 8 | | ambulatory procedure listing services for categories 3A, | 9 | | 3B, and 3C for State fiscal year 2009. | 10 | | (2) In addition to the rates paid for outpatient | 11 | | hospital services, the Department shall pay each Illinois | 12 | | freestanding psychiatric hospital an amount equal to $200 | 13 | | multiplied by the hospital's ambulatory procedure listing | 14 | | services for category 5A for State fiscal year 2009. | 15 | | (h) Specialty hospital adjustment. In addition to the rates | 16 | | paid for outpatient hospital services, the Department shall pay | 17 | | each Illinois long term acute care hospital and each Illinois | 18 | | hospital devoted exclusively to the treatment of cancer, an | 19 | | amount equal to $700 multiplied by the hospital's outpatient | 20 | | ambulatory procedure listing services and by the hospital's end | 21 | | stage renal disease treatment services (including services | 22 | | provided to individuals eligible for both Medicaid and | 23 | | Medicare) provided for State fiscal year 2009. | 24 | | (h-1) ER Safety Net Payments. In addition to rates paid for | 25 | | outpatient services, the Department shall pay to each Illinois | 26 | | general acute care hospital with an emergency room ratio equal |
| | | SB0026 Engrossed | - 41 - | LRB098 05310 KTG 35344 b |
|
| 1 | | to or greater than 55%, that is not eligible for Medicaid | 2 | | percentage adjustments payments in rate year 2011, with a case | 3 | | mix index equal to or greater than the 20th percentile, and | 4 | | that is not designated as a trauma center by the Illinois | 5 | | Department of Public Health on July 1, 2011, as follows: | 6 | | (1) Each hospital with an emergency room ratio equal to | 7 | | or greater than 74% shall receive a rate of $225 for each | 8 | | outpatient ambulatory procedure listing and end-stage | 9 | | renal disease treatment service provided for State fiscal | 10 | | year 2009. | 11 | | (2) For all other hospitals, $65 shall be paid for each | 12 | | outpatient ambulatory procedure listing and end-stage | 13 | | renal disease treatment service provided for State fiscal | 14 | | year 2009. | 15 | | (i) Physician supplemental adjustment. In addition to the | 16 | | rates paid for physician services, the Department shall make an | 17 | | adjustment payment for services provided by physicians as | 18 | | follows: | 19 | | (1) Physician services eligible for the adjustment | 20 | | payment are those provided by physicians employed by or who | 21 | | have a contract to provide services to patients of the | 22 | | following hospitals: (i) Illinois general acute care | 23 | | hospitals that provided at least 17,000 Medicaid inpatient | 24 | | days of care in State fiscal year 2009 and are eligible for | 25 | | Medicaid Percentage Adjustment Payments in rate year 2011; | 26 | | and (ii) Illinois freestanding children's hospitals, as |
| | | SB0026 Engrossed | - 42 - | LRB098 05310 KTG 35344 b |
|
| 1 | | defined in 89 Ill. Adm. Code 149.50(c)(3)(A). | 2 | | (2) The amount of the adjustment for each eligible | 3 | | hospital under this subsection (i) shall be determined by | 4 | | rule by the Department to spend a total pool of at least | 5 | | $6,960,000 annually. This pool shall be allocated among the | 6 | | eligible hospitals based on the difference between the | 7 | | upper payment limit for what could have been paid under | 8 | | Medicaid for physician services provided during State | 9 | | fiscal year 2009 by physicians employed by or who had a | 10 | | contract with the hospital and the amount that was paid | 11 | | under Medicaid for such services, provided however, that in | 12 | | no event shall physicians at any individual hospital | 13 | | collectively receive an annual, aggregate adjustment in | 14 | | excess of $435,000, except that any amount that is not | 15 | | distributed to a hospital because of the upper payment | 16 | | limit shall be reallocated among the remaining eligible | 17 | | hospitals that are below the upper payment limitation, on a | 18 | | proportionate basis. | 19 | | (i-5) For any children's hospital which did not charge for | 20 | | its services during the base period, the Department shall use | 21 | | data supplied by the hospital to determine payments using | 22 | | similar methodologies for freestanding children's hospitals | 23 | | under this Section or Section 5A-12.2 12.2 . | 24 | | (j) For purposes of this Section, a hospital that is | 25 | | enrolled to provide Medicaid services during State fiscal year | 26 | | 2009 shall have its utilization and associated reimbursements |
| | | SB0026 Engrossed | - 43 - | LRB098 05310 KTG 35344 b |
|
| 1 | | annualized prior to the payment calculations being performed | 2 | | under this Section. | 3 | | (k) For purposes of this Section, the terms "Medicaid | 4 | | days", "ambulatory procedure listing services", and | 5 | | "ambulatory procedure listing payments" do not include any | 6 | | days, charges, or services for which Medicare or a managed care | 7 | | organization reimbursed on a capitated basis was liable for | 8 | | payment, except where explicitly stated otherwise in this | 9 | | Section. | 10 | | (l) Definitions. Unless the context requires otherwise or | 11 | | unless provided otherwise in this Section, the terms used in | 12 | | this Section for qualifying criteria and payment calculations | 13 | | shall have the same meanings as those terms have been given in | 14 | | the Illinois Department's administrative rules as in effect on | 15 | | October 1, 2011. Other terms shall be defined by the Illinois | 16 | | Department by rule. | 17 | | As used in this Section, unless the context requires | 18 | | otherwise: | 19 | | "Case mix index" means, for a given hospital, the sum of
| 20 | | the per admission (DRG) relative weighting factors in effect on | 21 | | January 1, 2005, for all general acute care admissions for | 22 | | State fiscal year 2009, excluding Medicare crossover | 23 | | admissions and transplant admissions reimbursed under 89 Ill. | 24 | | Adm. Code 148.82, divided by the total number of general acute | 25 | | care admissions for State fiscal year 2009, excluding Medicare | 26 | | crossover admissions and transplant admissions reimbursed |
| | | SB0026 Engrossed | - 44 - | LRB098 05310 KTG 35344 b |
|
| 1 | | under 89 Ill. Adm. Code 148.82. | 2 | | "Emergency room ratio" means, for a given hospital, a | 3 | | fraction, the denominator of which is the number of the | 4 | | hospital's outpatient ambulatory procedure listing and | 5 | | end-stage renal disease treatment services provided for State | 6 | | fiscal year 2009 and the numerator of which is the hospital's | 7 | | outpatient ambulatory procedure listing services for | 8 | | categories 3A, 3B, and 3C for State fiscal year 2009. | 9 | | "Medicaid inpatient day" means, for a given hospital, the
| 10 | | sum of days of inpatient hospital days provided to recipients | 11 | | of medical assistance under Title XIX of the federal Social | 12 | | Security Act, excluding days for individuals eligible for | 13 | | Medicare under Title XVIII of that Act (Medicaid/Medicare | 14 | | crossover days), as tabulated from the Department's paid claims | 15 | | data for admissions occurring during State fiscal year 2009 | 16 | | that was adjudicated by the Department through June 30, 2010. | 17 | | "Outpatient ambulatory procedure listing services" means, | 18 | | for a given hospital, ambulatory procedure listing services, as | 19 | | described in 89 Ill. Adm. Code 148.140(b), provided to | 20 | | recipients of medical assistance under Title XIX of the federal | 21 | | Social Security Act, excluding services for individuals | 22 | | eligible for Medicare under Title XVIII of the Act | 23 | | (Medicaid/Medicare crossover days), as tabulated from the | 24 | | Department's paid claims data for services occurring in State | 25 | | fiscal year 2009 that were adjudicated by the Department | 26 | | through September 2, 2010. |
| | | SB0026 Engrossed | - 45 - | LRB098 05310 KTG 35344 b |
|
| 1 | | "Outpatient end-stage renal disease treatment services" | 2 | | means, for a given hospital, the services, as described in 89 | 3 | | Ill. Adm. Code 148.140(c), provided to recipients of medical | 4 | | assistance under Title XIX of the federal Social Security Act, | 5 | | excluding payments for individuals eligible for Medicare under | 6 | | Title XVIII of the Act (Medicaid/Medicare crossover days), as | 7 | | tabulated from the Department's paid claims data for services | 8 | | occurring in State fiscal year 2009 that were adjudicated by | 9 | | the Department through September 2, 2010. | 10 | | (m) The Department may adjust payments made under this | 11 | | Section 5A-12.4 to comply with federal law or regulations | 12 | | regarding hospital-specific payment limitations on | 13 | | government-owned or government-operated hospitals. | 14 | | (n) Notwithstanding any of the other provisions of this | 15 | | Section, the Department is authorized to adopt rules that | 16 | | change the hospital access improvement payments specified in | 17 | | this Section, but only to the extent necessary to conform to | 18 | | any federally approved amendment to the Title XIX State plan. | 19 | | Any such rules shall be adopted by the Department as authorized | 20 | | by Section 5-50 of the Illinois Administrative Procedure Act. | 21 | | Notwithstanding any other provision of law, any changes | 22 | | implemented as a result of this subsection (n) shall be given | 23 | | retroactive effect so that they shall be deemed to have taken | 24 | | effect as of the effective date of this Section. | 25 | | (o) The Department of Healthcare and Family Services must | 26 | | submit a State Medicaid Plan Amendment to the Centers of |
| | | SB0026 Engrossed | - 46 - | LRB098 05310 KTG 35344 b |
|
| 1 | | Medicare and Medicaid Services to implement the payments under | 2 | | this Section . within 30 days of the effective date of this Act.
| 3 | | (Source: P.A. 97-688, eff. 6-14-12; revised 8-3-12.)
| 4 | | Section 99. Effective date. This Act takes effect upon | 5 | | becoming law.
|
|