Full Text of HB1254 98th General Assembly
HB1254 98TH GENERAL ASSEMBLY |
| | 98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014 HB1254 Introduced , by Rep. Sara Feigenholtz SYNOPSIS AS INTRODUCED: |
| 305 ILCS 5/5A-2 | from Ch. 23, par. 5A-2 | 305 ILCS 5/5A-4 | from Ch. 23, par. 5A-4 | 305 ILCS 5/5A-5 | from Ch. 23, par. 5A-5 | 305 ILCS 5/5A-12.4 | |
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Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Provides that an annual assessment on outpatient services shall be imposed on each hospital provider in a specified amount for June 10, 2012 through December 31, 2014 (rather than for State fiscal years 2013 through 2014, and July 1, 2014 through December 31, 2014). Provides that amounts shall be prorated if not in effect for a full year. Provides that for June 10, 2012 through December 31, 2014 (rather than for State fiscal years 2013 through 2014, and July 1, 2014 through December 31, 2014), a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2009 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on June 30, 2011, without regard to any subsequent adjustments or changes to such data. Provides that for State fiscal years 2009 through 2014 (rather than for State fiscal years 2009 through 2015) in the case of a hospital provider that did not conduct, operate, or maintain a hospital in 2005, the assessment for that State fiscal year shall be computed on the basis of hypothetical occupied bed days for the full calendar year as determined by the Department of Healthcare and Family Services. Makes other changes. Effective immediately.
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| 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 5. The Illinois Public Aid Code is amended by | 5 | | changing Sections 5A-2, 5A-4, 5A-5, and 5A-12.4 as follows: | 6 | | (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | 7 | | (Section scheduled to be repealed on January 1, 2015) | 8 | | Sec. 5A-2. Assessment.
| 9 | | (a)
Subject to Sections 5A-3 and 5A-10, for State fiscal | 10 | | years 2009 through 2014, and from July 1, 2014 through December | 11 | | 31, 2014, an annual assessment on inpatient services is imposed | 12 | | on each hospital provider in an amount equal to $218.38 | 13 | | multiplied by the difference of the hospital's occupied bed | 14 | | days less the hospital's Medicare bed days. | 15 | | For State fiscal years 2009 through 2014, and after a | 16 | | hospital's occupied bed days and Medicare bed days shall be | 17 | | determined using the most recent data available from each | 18 | | hospital's 2005 Medicare cost report as contained in the | 19 | | Healthcare Cost Report Information System file, for the quarter | 20 | | ending on December 31, 2006, without regard to any subsequent | 21 | | adjustments or changes to such data. If a hospital's 2005 | 22 | | Medicare cost report is not contained in the Healthcare Cost | 23 | | Report Information System, then the Illinois Department may |
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| 1 | | obtain the hospital provider's occupied bed days and Medicare | 2 | | bed days from any source available, including, but not limited | 3 | | to, records maintained by the hospital provider, which may be | 4 | | inspected at all times during business hours of the day by the | 5 | | Illinois Department or its duly authorized agents and | 6 | | employees. | 7 | | (b) (Blank).
| 8 | | (b-5) Subject to Sections 5A-3 and 5A-10, for June 10, 2012 | 9 | | State fiscal years 2013 through 2014, and July 1, 2014 through | 10 | | December 31, 2014, an annual assessment on outpatient services | 11 | | is imposed on each hospital provider in an amount equal to | 12 | | .008766 multiplied by the hospital's outpatient gross revenue. | 13 | | Amounts shall be prorated if not in effect for a full year. | 14 | | For June 10, 2012 State fiscal years 2013 through 2014, and | 15 | | July 1, 2014 through December 31, 2014, a hospital's outpatient | 16 | | gross revenue shall be determined using the most recent data | 17 | | available from each hospital's 2009 Medicare cost report as | 18 | | contained in the Healthcare Cost Report Information System | 19 | | file, for the quarter ending on June 30, 2011, without regard | 20 | | to any subsequent adjustments or changes to such data. If a | 21 | | hospital's 2009 Medicare cost report is not contained in the | 22 | | Healthcare Cost Report Information System, then the Department | 23 | | may obtain the hospital provider's outpatient gross revenue | 24 | | from any source available, including, but not limited to, | 25 | | records maintained by the hospital provider, which may be | 26 | | inspected at all times during business hours of the day by the |
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| 1 | | Department or its duly authorized agents and employees. | 2 | | (c) (Blank).
| 3 | | (d) Notwithstanding any of the other provisions of this | 4 | | Section, the Department is authorized to adopt rules to reduce | 5 | | the rate of any annual assessment imposed under this Section, | 6 | | as authorized by Section 5-46.2 of the Illinois Administrative | 7 | | Procedure Act.
| 8 | | (e) Notwithstanding any other provision of this Section, | 9 | | any plan providing for an assessment on a hospital provider as | 10 | | a permissible tax under Title XIX of the federal Social | 11 | | Security Act and Medicaid-eligible payments to hospital | 12 | | providers from the revenues derived from that assessment shall | 13 | | be reviewed by the Illinois Department of Healthcare and Family | 14 | | Services, as the Single State Medicaid Agency required by | 15 | | federal law, to determine whether those assessments and | 16 | | hospital provider payments meet federal Medicaid standards. If | 17 | | the Department determines that the elements of the plan may | 18 | | meet federal Medicaid standards and a related State Medicaid | 19 | | Plan Amendment is prepared in a manner and form suitable for | 20 | | submission, that State Plan Amendment shall be submitted in a | 21 | | timely manner for review by the Centers for Medicare and | 22 | | Medicaid Services of the United States Department of Health and | 23 | | Human Services and subject to approval by the Centers for | 24 | | Medicare and Medicaid Services of the United States Department | 25 | | of Health and Human Services. No such plan shall become | 26 | | effective without approval by the Illinois General Assembly by |
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| 1 | | the enactment into law of related legislation. Notwithstanding | 2 | | any other provision of this Section, the Department is | 3 | | authorized to adopt rules to reduce the rate of any annual | 4 | | assessment imposed under this Section. Any such rules may be | 5 | | adopted by the Department under Section 5-50 of the Illinois | 6 | | Administrative Procedure Act. | 7 | | (Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; | 8 | | 97-689, eff. 6-14-12.)
| 9 | | (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) | 10 | | Sec. 5A-4. Payment of assessment; penalty.
| 11 | | (a) The assessment imposed by Section 5A-2 for State fiscal | 12 | | year 2009 and each subsequent State fiscal year shall be due | 13 | | and payable in monthly installments, each equaling one-twelfth | 14 | | of the assessment for the year, on the fourteenth State | 15 | | business day of each month.
No installment payment of an | 16 | | assessment imposed by Section 5A-2 shall be due
and
payable, | 17 | | however, until after the Comptroller has issued the payments | 18 | | required under this Article.
| 19 | | Except as provided in subsection (a-5) of this Section, the | 20 | | assessment imposed by subsection (b-5) of Section 5A-2 for | 21 | | State fiscal year 2012 2013 and each subsequent State fiscal | 22 | | year shall be due and payable in monthly installments, each | 23 | | equaling one-twelfth of the assessment for the year, on the | 24 | | 14th State business day of each month. No installment payment | 25 | | of an assessment imposed by subsection (b-5) of Section 5A-2 |
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| 1 | | shall be due and payable, however, until after: (i) the | 2 | | Department notifies the hospital provider, in writing, that the | 3 | | payment methodologies to hospitals required under Section | 4 | | 5A-12.4, have been approved by the Centers for Medicare and | 5 | | Medicaid Services of the U.S. Department of Health and Human | 6 | | Services, and the waiver under 42 CFR 433.68 for the assessment | 7 | | imposed by subsection (b-5) of Section 5A-2, if necessary, has | 8 | | been granted by the Centers for Medicare and Medicaid Services | 9 | | of the U.S. Department of Health and Human Services; and (ii) | 10 | | the Comptroller has issued the payments required under Section | 11 | | 5A-12.4. Upon notification to the Department of approval of the | 12 | | payment methodologies required under Section 5A-12.4 and the | 13 | | waiver granted under 42 CFR 433.68, if necessary, all | 14 | | installments otherwise due under subsection (b-5) of Section | 15 | | 5A-2 prior to the date of notification shall be due and payable | 16 | | to the Department upon written direction from the Department | 17 | | and issuance by the Comptroller of the payments required under | 18 | | Section 5A-12.4. | 19 | | (a-5) The Illinois Department may accelerate the schedule | 20 | | upon which assessment installments are due and payable by | 21 | | hospitals with a payment ratio greater than or equal to one. | 22 | | Such acceleration of due dates for payment of the assessment | 23 | | may be made only in conjunction with a corresponding | 24 | | acceleration in access payments identified in Section 5A-12.2 | 25 | | or Section 5A-12.4 to the same hospitals. For the purposes of | 26 | | this subsection (a-5), a hospital's payment ratio is defined as |
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| 1 | | the quotient obtained by dividing the total payments for the | 2 | | State fiscal year, as authorized under Section 5A-12.2 or | 3 | | Section 5A-12.4, by the total assessment for the State fiscal | 4 | | year imposed under Section 5A-2 or subsection (b-5) of Section | 5 | | 5A-2. | 6 | | (b) The Illinois Department is authorized to establish
| 7 | | delayed payment schedules for hospital providers that are | 8 | | unable
to make installment payments when due under this Section | 9 | | due to
financial difficulties, as determined by the Illinois | 10 | | Department.
| 11 | | (c) If a hospital provider fails to pay the full amount of
| 12 | | an installment when due (including any extensions granted under
| 13 | | subsection (b)), there shall, unless waived by the Illinois
| 14 | | Department for reasonable cause, be added to the assessment
| 15 | | imposed by Section 5A-2 a penalty
assessment equal to the | 16 | | lesser of (i) 5% of the amount of the
installment not paid on | 17 | | or before the due date plus 5% of the
portion thereof remaining | 18 | | unpaid on the last day of each 30-day period
thereafter or (ii) | 19 | | 100% of the installment amount not paid on or
before the due | 20 | | date. For purposes of this subsection, payments
will be | 21 | | credited first to unpaid installment amounts (rather than
to | 22 | | penalty or interest), beginning with the most delinquent
| 23 | | installments.
| 24 | | (d) Any assessment amount that is due and payable to the | 25 | | Illinois Department more frequently than once per calendar | 26 | | quarter shall be remitted to the Illinois Department by the |
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| 1 | | hospital provider by means of electronic funds transfer. The | 2 | | Illinois Department may provide for remittance by other means | 3 | | if (i) the amount due is less than $10,000 or (ii) electronic | 4 | | funds transfer is unavailable for this purpose. | 5 | | (Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12; | 6 | | 97-689, eff. 6-14-12.) | 7 | | (305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5) | 8 | | Sec. 5A-5. Notice; penalty; maintenance of records.
| 9 | | (a)
The Illinois Department shall send a
notice of | 10 | | assessment to every hospital provider subject
to assessment | 11 | | under this Article. The notice of assessment shall notify the | 12 | | hospital of its assessment and shall be sent after receipt by | 13 | | the Department of notification from the Centers for Medicare | 14 | | and Medicaid Services of the U.S. Department of Health and | 15 | | Human Services that the payment methodologies required under | 16 | | this Article and, if necessary, the waiver granted under 42 CFR | 17 | | 433.68 have been approved. The notice
shall be on a form
| 18 | | prepared by the Illinois Department and shall state the | 19 | | following:
| 20 | | (1) The name of the hospital provider.
| 21 | | (2) The address of the hospital provider's principal | 22 | | place
of business from which the provider engages in the | 23 | | occupation of hospital
provider in this State, and the name | 24 | | and address of each hospital
operated, conducted, or | 25 | | maintained by the provider in this State.
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| 1 | | (3) The occupied bed days, occupied bed days less | 2 | | Medicare days, adjusted gross hospital revenue, or | 3 | | outpatient gross revenue of the
hospital
provider | 4 | | (whichever is applicable), the amount of
assessment | 5 | | imposed under Section 5A-2 for the State fiscal year
for | 6 | | which the notice is sent, and the amount of
each
| 7 | | installment to be paid during the State fiscal year.
| 8 | | (4) (Blank).
| 9 | | (5) Other reasonable information as determined by the | 10 | | Illinois
Department.
| 11 | | (b) If a hospital provider conducts, operates, or
maintains | 12 | | more than one hospital licensed by the Illinois
Department of | 13 | | Public Health, the provider shall pay the
assessment for each | 14 | | hospital separately.
| 15 | | (c) Notwithstanding any other provision in this Article, in
| 16 | | the case of a person who ceases to conduct, operate, or | 17 | | maintain a
hospital in respect of which the person is subject | 18 | | to assessment
under this Article as a hospital provider, the | 19 | | assessment for the State
fiscal year in which the cessation | 20 | | occurs shall be adjusted by
multiplying the assessment computed | 21 | | under Section 5A-2 by a
fraction, the numerator of which is the | 22 | | number of days in the
year during which the provider conducts, | 23 | | operates, or maintains
the hospital and the denominator of | 24 | | which is 365. Immediately
upon ceasing to conduct, operate, or | 25 | | maintain a hospital, the person
shall pay the assessment
for | 26 | | the year as so adjusted (to the extent not previously paid).
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| 1 | | (d) Notwithstanding any other provision in this Article, a
| 2 | | provider who commences conducting, operating, or maintaining a
| 3 | | hospital, upon notice by the Illinois Department,
shall pay the | 4 | | assessment computed under Section 5A-2 and
subsection (e) in | 5 | | installments on the due dates stated in the
notice and on the | 6 | | regular installment due dates for the State
fiscal year | 7 | | occurring after the due dates of the initial
notice.
| 8 | | (e)
Notwithstanding any other provision in this Article, | 9 | | for State fiscal years 2009 through 2014 2015 , in the case of a | 10 | | hospital provider that did not conduct, operate, or maintain a | 11 | | hospital in 2005, the assessment for that State fiscal year | 12 | | shall be computed on the basis of hypothetical occupied bed | 13 | | days for the full calendar year as determined by the Illinois | 14 | | Department. Notwithstanding any other provision in this | 15 | | Article, for June 10, 2012 State fiscal years 2013 through | 16 | | 2014, and for July 1, 2014 through December 31, 2014, in the | 17 | | case of a hospital provider that did not conduct, operate, or | 18 | | maintain a hospital in 2009, the assessment under subsection | 19 | | (b-5) of Section 5A-2 for that State fiscal year shall be | 20 | | computed on the basis of hypothetical gross outpatient revenue | 21 | | for the full calendar year as determined by the Illinois | 22 | | Department.
| 23 | | (f) Every hospital provider subject to assessment under | 24 | | this Article shall keep sufficient records to permit the | 25 | | determination of adjusted gross hospital revenue for the | 26 | | hospital's fiscal year. All such records shall be kept in the |
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| 1 | | English language and shall, at all times during regular | 2 | | business hours of the day, be subject to inspection by the | 3 | | Illinois Department or its duly authorized agents and | 4 | | employees.
| 5 | | (g) The Illinois Department may, by rule, provide a | 6 | | hospital provider a reasonable opportunity to request a | 7 | | clarification or correction of any clerical or computational | 8 | | errors contained in the calculation of its assessment, but such | 9 | | corrections shall not extend to updating the cost report | 10 | | information used to calculate the assessment.
| 11 | | (h) (Blank).
| 12 | | (Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; | 13 | | 97-689, eff. 6-14-12; revised 10-17-12.)
| 14 | | (305 ILCS 5/5A-12.4) | 15 | | (Section scheduled to be repealed on January 1, 2015) | 16 | | Sec. 5A-12.4. Hospital access improvement payments on or | 17 | | after June 10, 2012 July 1, 2012 . | 18 | | (a) Hospital access improvement payments. To preserve and | 19 | | improve access to hospital services, for hospital and physician | 20 | | services rendered on or after June 10, 2012 July 1, 2012 , the | 21 | | Illinois Department shall, except for hospitals described in | 22 | | subsection (b) of Section 5A-3, make payments to hospitals as | 23 | | set forth in this Section. These payments shall be paid in 12 | 24 | | equal installments on or before the 7th State business day of | 25 | | each month, except that no payment shall be due within 100 days |
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| 1 | | after the later of the date of notification of federal approval | 2 | | of the payment methodologies required under this Section or any | 3 | | waiver required under 42 CFR 433.68, at which time the sum of | 4 | | amounts required under this Section prior to the date of | 5 | | notification is due and payable. Payments under this Section | 6 | | are not due and payable, however, until (i) the methodologies | 7 | | described in this Section are approved by the federal | 8 | | government in an appropriate State Plan amendment and (ii) the | 9 | | assessment imposed under subsection (b-5) of Section 5A-2 of | 10 | | this Article is determined to be a permissible tax under Title | 11 | | XIX of the Social Security Act. The Illinois Department shall | 12 | | take all actions necessary to implement the payments under this | 13 | | Section effective June 10, 2012 July 1, 2012 , including but not | 14 | | limited to providing public notice pursuant to federal | 15 | | requirements, the filing of a State Plan amendment, and the | 16 | | adoption of administrative rules. | 17 | | (a-5) Accelerated schedule. The Illinois Department may, | 18 | | when practicable, accelerate the schedule upon which payments | 19 | | authorized under this Section are made. | 20 | | (b) Magnet and perinatal hospital adjustment. In addition | 21 | | to rates paid for inpatient hospital services, the Department | 22 | | shall pay to each Illinois general acute care hospital that, as | 23 | | of August 25, 2011, was recognized as a Magnet hospital by the | 24 | | American Nurses Credentialing Center and that, as of September | 25 | | 14, 2011, was designated as a level III perinatal center | 26 | | amounts as follows: |
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| 1 | | (1) For hospitals with a case mix index equal to or | 2 | | greater than the 80th percentile of case mix indices for | 3 | | all Illinois hospitals, $470 for each Medicaid general | 4 | | acute care inpatient day of care provided by the hospital | 5 | | during State fiscal year 2009. | 6 | | (2) For all other hospitals, $170 for each Medicaid | 7 | | general acute care inpatient day of care provided by the | 8 | | hospital during State fiscal year 2009. | 9 | | (c) Trauma level II adjustment. In addition to rates paid | 10 | | for inpatient hospital services, the Department shall pay to | 11 | | each Illinois general acute care hospital that, as of July 1, | 12 | | 2011, was designated as a level II trauma center amounts as | 13 | | follows: | 14 | | (1) For hospitals with a case mix index equal to or | 15 | | greater than the 50th percentile of case mix indices for | 16 | | all Illinois hospitals, $470 for each Medicaid general | 17 | | acute care inpatient day of care provided by the hospital | 18 | | during State fiscal year 2009. | 19 | | (2) For all other hospitals, $170 for each Medicaid | 20 | | general acute care inpatient day of care provided by the | 21 | | hospital during State fiscal year 2009. | 22 | | (3) For the purposes of this adjustment, hospitals | 23 | | located in the same city that alternate their trauma center | 24 | | designation as defined in 89 Ill. Adm. Code 148.295(a)(2) | 25 | | shall have the adjustment provided under this Section | 26 | | divided between the 2 hospitals. |
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| 1 | | (d) Dual-eligible adjustment. In addition to rates paid for | 2 | | inpatient services, the Department shall pay each Illinois | 3 | | general acute care hospital that had a ratio of crossover days | 4 | | to total inpatient days for programs under Title XIX of the | 5 | | Social Security Act administered by the Department (utilizing | 6 | | information from 2009 paid claims) greater than 50%, and a case | 7 | | mix index equal to or greater than the 75th percentile of case | 8 | | mix indices for all Illinois hospitals, a rate of $400 for each | 9 | | Medicaid inpatient day during State fiscal year 2009 including | 10 | | crossover days. | 11 | | (e) Medicaid volume adjustment. In addition to rates paid | 12 | | for inpatient hospital services, the Department shall pay to | 13 | | each Illinois general acute care hospital that provided more | 14 | | than 10,000 Medicaid inpatient days of care in State fiscal | 15 | | year 2009, has a Medicaid inpatient utilization rate of at | 16 | | least 29.05% as calculated by the Department for the Rate Year | 17 | | 2011 Disproportionate Share determination, and is not eligible | 18 | | for Medicaid Percentage Adjustment payments in rate year 2011 | 19 | | an amount equal to $135 for each Medicaid inpatient day of care | 20 | | provided during State fiscal year 2009. | 21 | | (f) Outpatient service adjustment. In addition to the rates | 22 | | paid for outpatient hospital services, the Department shall pay | 23 | | each Illinois hospital an amount at least equal to $100 | 24 | | multiplied by the hospital's outpatient ambulatory procedure | 25 | | listing services (excluding categories 3B and 3C) and by the | 26 | | hospital's end stage renal disease treatment services provided |
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| 1 | | for State fiscal year 2009. | 2 | | (g) Ambulatory service adjustment. | 3 | | (1) In addition to the rates paid for outpatient | 4 | | hospital services provided in the emergency department, | 5 | | the Department shall pay each Illinois hospital an amount | 6 | | equal to $105 multiplied by the hospital's outpatient | 7 | | ambulatory procedure listing services for categories 3A, | 8 | | 3B, and 3C for State fiscal year 2009. | 9 | | (2) In addition to the rates paid for outpatient | 10 | | hospital services, the Department shall pay each Illinois | 11 | | freestanding psychiatric hospital an amount equal to $200 | 12 | | multiplied by the hospital's ambulatory procedure listing | 13 | | services for category 5A for State fiscal year 2009. | 14 | | (h) Specialty hospital adjustment. In addition to the rates | 15 | | paid for outpatient hospital services, the Department shall pay | 16 | | each Illinois long term acute care hospital and each Illinois | 17 | | hospital devoted exclusively to the treatment of cancer, an | 18 | | amount equal to $700 multiplied by the hospital's outpatient | 19 | | ambulatory procedure listing services and by the hospital's end | 20 | | stage renal disease treatment services (including services | 21 | | provided to individuals eligible for both Medicaid and | 22 | | Medicare) provided for State fiscal year 2009. | 23 | | (h-1) ER Safety Net Payments. In addition to rates paid for | 24 | | outpatient services, the Department shall pay to each Illinois | 25 | | general acute care hospital with an emergency room ratio equal | 26 | | to or greater than 55%, that is not eligible for Medicaid |
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| 1 | | percentage adjustments payments in rate year 2011, with a case | 2 | | mix index equal to or greater than the 20th percentile, and | 3 | | that is not designated as a trauma center by the Illinois | 4 | | Department of Public Health on July 1, 2011, as follows: | 5 | | (1) Each hospital with an emergency room ratio equal to | 6 | | or greater than 74% shall receive a rate of $225 for each | 7 | | outpatient ambulatory procedure listing and end-stage | 8 | | renal disease treatment service provided for State fiscal | 9 | | year 2009. | 10 | | (2) For all other hospitals, $65 shall be paid for each | 11 | | outpatient ambulatory procedure listing and end-stage | 12 | | renal disease treatment service provided for State fiscal | 13 | | year 2009. | 14 | | (i) Physician supplemental adjustment. In addition to the | 15 | | rates paid for physician services, the Department shall make an | 16 | | adjustment payment for services provided by physicians as | 17 | | follows: | 18 | | (1) Physician services eligible for the adjustment | 19 | | payment are those provided by physicians employed by or who | 20 | | have a contract to provide services to patients of the | 21 | | following hospitals: (i) Illinois general acute care | 22 | | hospitals that provided at least 17,000 Medicaid inpatient | 23 | | days of care in State fiscal year 2009 and are eligible for | 24 | | Medicaid Percentage Adjustment Payments in rate year 2011; | 25 | | and (ii) Illinois freestanding children's hospitals, as | 26 | | defined in 89 Ill. Adm. Code 149.50(c)(3)(A). |
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| 1 | | (2) The amount of the adjustment for each eligible | 2 | | hospital under this subsection (i) shall be determined by | 3 | | rule by the Department to spend a total pool of at least | 4 | | $6,960,000 annually. This pool shall be allocated among the | 5 | | eligible hospitals based on the difference between the | 6 | | upper payment limit for what could have been paid under | 7 | | Medicaid for physician services provided during State | 8 | | fiscal year 2009 by physicians employed by or who had a | 9 | | contract with the hospital and the amount that was paid | 10 | | under Medicaid for such services, provided however, that in | 11 | | no event shall physicians at any individual hospital | 12 | | collectively receive an annual, aggregate adjustment in | 13 | | excess of $435,000, except that any amount that is not | 14 | | distributed to a hospital because of the upper payment | 15 | | limit shall be reallocated among the remaining eligible | 16 | | hospitals that are below the upper payment limitation, on a | 17 | | proportionate basis. | 18 | | (i-5) For any children's hospital which did not charge for | 19 | | its services during the base period, the Department shall use | 20 | | data supplied by the hospital to determine payments using | 21 | | similar methodologies for freestanding children's hospitals | 22 | | under this Section or Section 5A-12.2 12.2 . | 23 | | (j) For purposes of this Section, a hospital that is | 24 | | enrolled to provide Medicaid services during State fiscal year | 25 | | 2009 shall have its utilization and associated reimbursements | 26 | | annualized prior to the payment calculations being performed |
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| 1 | | under this Section. | 2 | | (k) For purposes of this Section, the terms "Medicaid | 3 | | days", "ambulatory procedure listing services", and | 4 | | "ambulatory procedure listing payments" do not include any | 5 | | days, charges, or services for which Medicare or a managed care | 6 | | organization reimbursed on a capitated basis was liable for | 7 | | payment, except where explicitly stated otherwise in this | 8 | | Section. | 9 | | (l) Definitions. Unless the context requires otherwise or | 10 | | unless provided otherwise in this Section, the terms used in | 11 | | this Section for qualifying criteria and payment calculations | 12 | | shall have the same meanings as those terms have been given in | 13 | | the Illinois Department's administrative rules as in effect on | 14 | | October 1, 2011. Other terms shall be defined by the Illinois | 15 | | Department by rule. | 16 | | As used in this Section, unless the context requires | 17 | | otherwise: | 18 | | "Case mix index" means, for a given hospital, the sum of
| 19 | | the per admission (DRG) relative weighting factors in effect on | 20 | | January 1, 2005, for all general acute care admissions for | 21 | | State fiscal year 2009, excluding Medicare crossover | 22 | | admissions and transplant admissions reimbursed under 89 Ill. | 23 | | Adm. Code 148.82, divided by the total number of general acute | 24 | | care admissions for State fiscal year 2009, excluding Medicare | 25 | | crossover admissions and transplant admissions reimbursed | 26 | | under 89 Ill. Adm. Code 148.82. |
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| 1 | | "Emergency room ratio" means, for a given hospital, a | 2 | | fraction, the denominator of which is the number of the | 3 | | hospital's outpatient ambulatory procedure listing and | 4 | | end-stage renal disease treatment services provided for State | 5 | | fiscal year 2009 and the numerator of which is the hospital's | 6 | | outpatient ambulatory procedure listing services for | 7 | | categories 3A, 3B, and 3C for State fiscal year 2009. | 8 | | "Medicaid inpatient day" means, for a given hospital, the
| 9 | | sum of days of inpatient hospital days provided to recipients | 10 | | of medical assistance under Title XIX of the federal Social | 11 | | Security Act, excluding days for individuals eligible for | 12 | | Medicare under Title XVIII of that Act (Medicaid/Medicare | 13 | | crossover days), as tabulated from the Department's paid claims | 14 | | data for admissions occurring during State fiscal year 2009 | 15 | | that was adjudicated by the Department through June 30, 2010. | 16 | | "Outpatient ambulatory procedure listing services" means, | 17 | | for a given hospital, ambulatory procedure listing services, as | 18 | | described in 89 Ill. Adm. Code 148.140(b), provided to | 19 | | recipients of medical assistance under Title XIX of the federal | 20 | | Social Security Act, excluding services for individuals | 21 | | eligible for Medicare under Title XVIII of the Act | 22 | | (Medicaid/Medicare crossover days), as tabulated from the | 23 | | Department's paid claims data for services occurring in State | 24 | | fiscal year 2009 that were adjudicated by the Department | 25 | | through September 2, 2010. | 26 | | "Outpatient end-stage renal disease treatment services" |
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| 1 | | means, for a given hospital, the services, as described in 89 | 2 | | Ill. Adm. Code 148.140(c), provided to recipients of medical | 3 | | assistance under Title XIX of the federal Social Security Act, | 4 | | excluding payments for individuals eligible for Medicare under | 5 | | Title XVIII of the Act (Medicaid/Medicare crossover days), as | 6 | | tabulated from the Department's paid claims data for services | 7 | | occurring in State fiscal year 2009 that were adjudicated by | 8 | | the Department through September 2, 2010. | 9 | | (m) The Department may adjust payments made under this | 10 | | Section 5A-12.4 to comply with federal law or regulations | 11 | | regarding hospital-specific payment limitations on | 12 | | government-owned or government-operated hospitals. | 13 | | (n) Notwithstanding any of the other provisions of this | 14 | | Section, the Department is authorized to adopt rules that | 15 | | change the hospital access improvement payments specified in | 16 | | this Section, but only to the extent necessary to conform to | 17 | | any federally approved amendment to the Title XIX State plan. | 18 | | Any such rules shall be adopted by the Department as authorized | 19 | | by Section 5-50 of the Illinois Administrative Procedure Act. | 20 | | Notwithstanding any other provision of law, any changes | 21 | | implemented as a result of this subsection (n) shall be given | 22 | | retroactive effect so that they shall be deemed to have taken | 23 | | effect as of the effective date of this Section. | 24 | | (o) The Department of Healthcare and Family Services must | 25 | | submit a State Medicaid Plan Amendment to the Centers of | 26 | | Medicare and Medicaid Services to implement the payments under |
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| 1 | | this Section within 30 days of June 14, 2012 ( the effective | 2 | | date of Public Act 97-688) 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.
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