Bill Amendment: IL HB0174 | 2017-2018 | 100th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: PUBLIC AID-TECH

Status: 2019-01-08 - Session Sine Die [HB0174 Detail]

Download: Illinois-2017-HB0174-House_Amendment_001.html

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Rep. Robert Rita

Filed: 10/17/2017

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AMENDMENT TO HOUSE BILL 174
AMENDMENT NO. ______. Amend House Bill 174 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Public Aid Code is amended by
changing Sections 5A-2, 5A-12.2, 5A-12.4, 5A-12.5, and 14-12 as
follows:
(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
(Section scheduled to be repealed on July 1, 2018)
Sec. 5A-2. Assessment.
(a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
years 2009 through 2018, an annual assessment on inpatient
services is imposed on each hospital provider in an amount
equal to $218.38 multiplied by the difference of the hospital's
occupied bed days less the hospital's Medicare bed days,
provided, however, that the amount of $218.38 shall be
increased by a uniform percentage to generate an amount equal

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to 75% of the State share of the payments authorized under
Section 5A-12.5, with such increase only taking effect upon the
date that a State share for such payments is required under
federal law. For the period of April through June 2015, the
amount of $218.38 used to calculate the assessment under this
paragraph shall, by emergency rule under subsection (s) of
Section 5-45 of the Illinois Administrative Procedure Act, be
increased by a uniform percentage to generate $20,250,000 in
the aggregate for that period from all hospitals subject to the
annual assessment under this paragraph.
(2) In addition to any other assessments imposed under this
Article, effective July 1, 2016 and semi-annually thereafter
through June 2018, in addition to any federally required State
share as authorized under paragraph (1), the amount of $218.38
shall be increased by a uniform percentage to generate an
amount equal to 75% of the ACA Assessment Adjustment, as
defined in subsection (b-6) of this Section.
For State fiscal years 2009 through 2014 and after, a
hospital's occupied bed days and Medicare bed days shall be
determined using the most recent data available from each
hospital's 2005 Medicare cost report as contained in the
Healthcare Cost Report Information System file, for the quarter
ending on December 31, 2006, without regard to any subsequent
adjustments or changes to such data. If a hospital's 2005
Medicare cost report is not contained in the Healthcare Cost
Report Information System, then the Illinois Department may

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obtain the hospital provider's occupied bed days and Medicare
bed days from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Illinois Department or its duly authorized agents and
employees.
(b) (Blank).
(b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
portion of State fiscal year 2012, beginning June 10, 2012
through June 30, 2012, and for State fiscal years 2013 through
2018, an annual assessment on outpatient services is imposed on
each hospital provider in an amount equal to .008766 multiplied
by the hospital's outpatient gross revenue, provided, however,
that the amount of .008766 shall be increased by a uniform
percentage to generate an amount equal to 25% of the State
share of the payments authorized under Section 5A-12.5, with
such increase only taking effect upon the date that a State
share for such payments is required under federal law. For the
period beginning June 10, 2012 through June 30, 2012, the
annual assessment on outpatient services shall be prorated by
multiplying the assessment amount by a fraction, the numerator
of which is 21 days and the denominator of which is 365 days.
For the period of April through June 2015, the amount of
.008766 used to calculate the assessment under this paragraph
shall, by emergency rule under subsection (s) of Section 5-45
of the Illinois Administrative Procedure Act, be increased by a

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uniform percentage to generate $6,750,000 in the aggregate for
that period from all hospitals subject to the annual assessment
under this paragraph.
(2) In addition to any other assessments imposed under this
Article, effective July 1, 2016 and semi-annually thereafter
through June 2018, in addition to any federally required State
share as authorized under paragraph (1), the amount of .008766
shall be increased by a uniform percentage to generate an
amount equal to 25% of the ACA Assessment Adjustment, as
defined in subsection (b-6) of this Section.
For the portion of State fiscal year 2012, beginning June
10, 2012 through June 30, 2012, and State fiscal years 2013
through 2018, 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. If a hospital's 2009
Medicare cost report is not contained in the Healthcare Cost
Report Information System, then the Department may obtain the
hospital provider's outpatient gross revenue from any source
available, including, but not limited to, records maintained by
the hospital provider, which may be inspected at all times
during business hours of the day by the Department or its duly
authorized agents and employees.
(b-6)(1) As used in this Section, "ACA Assessment

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Adjustment" means:
(A) For the period of July 1, 2016 through December 31,
2016, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of April 2016 multiplied by 6.
(B) For the period of January 1, 2017 through June 30,
2017, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of October 2016 multiplied by 6, except that the
amount calculated under this subparagraph (B) shall be
adjusted, either positively or negatively, to account for
the difference between the actual payments issued under
Section 5A-12.5 for the period beginning July 1, 2016
through December 31, 2016 and the estimated payments due
and payable in the month of April 2016 multiplied by 6 as
described in subparagraph (A).
(C) For the period of July 1, 2017 through December 31,
2017, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under

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subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of April 2017 multiplied by 6, except that the amount
calculated under this subparagraph (C) shall be adjusted,
either positively or negatively, to account for the
difference between the actual payments issued under
Section 5A-12.5 for the period beginning January 1, 2017
through June 30, 2017 and the estimated payments due and
payable in the month of October 2016 multiplied by 6 as
described in subparagraph (B).
(D) For the period of January 1, 2018 through June 30,
2018, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of October 2017 multiplied by 6, except that:
(i) the amount calculated under this subparagraph
(D) shall be adjusted, either positively or
negatively, to account for the difference between the
actual payments issued under Section 5A-12.5 for the
period of July 1, 2017 through December 31, 2017 and
the estimated payments due and payable in the month of
April 2017 multiplied by 6 as described in subparagraph
(C); and
(ii) the amount calculated under this subparagraph

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(D) shall be adjusted to include the product of .19125
multiplied by the sum of the fee-for-service payments,
if any, estimated to be paid to hospitals under
subsection (b) of Section 5A-12.5.
(2) The Department shall complete and apply a final
reconciliation of the ACA Assessment Adjustment prior to June
30, 2018 to account for:
(A) any differences between the actual payments issued
or scheduled to be issued prior to June 30, 2018 as
authorized in Section 5A-12.5 for the period of January 1,
2018 through June 30, 2018 and the estimated payments due
and payable in the month of October 2017 multiplied by 6 as
described in subparagraph (D); and
(B) any difference between the estimated
fee-for-service payments under subsection (b) of Section
5A-12.5 and the amount of such payments that are actually
scheduled to be paid.
The Department shall notify hospitals of any additional
amounts owed or reduction credits to be applied to the June
2018 ACA Assessment Adjustment. This is to be considered the
final reconciliation for the ACA Assessment Adjustment.
(3) Notwithstanding any other provision of this Section, if
for any reason the scheduled payments under subsection (b) of
Section 5A-12.5 are not issued in full by the final day of the
period authorized under subsection (b) of Section 5A-12.5,
funds collected from each hospital pursuant to subparagraph (D)

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of paragraph (1) and pursuant to paragraph (2), attributable to
the scheduled payments authorized under subsection (b) of
Section 5A-12.5 that are not issued in full by the final day of
the period attributable to each payment authorized under
subsection (b) of Section 5A-12.5, shall be refunded.
(4) The increases authorized under paragraph (2) of
subsection (a) and paragraph (2) of subsection (b-5) shall be
limited to the federally required State share of the total
payments authorized under Section 5A-12.5 if the sum of such
payments yields an annualized amount equal to or less than
$450,000,000, or if the adjustments authorized under
subsection (t) of Section 5A-12.2 are found not to be
actuarially sound; however, this limitation shall not apply to
the fee-for-service payments described in subsection (b) of
Section 5A-12.5.
(c) (Blank).
(d) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules to reduce
the rate of any annual assessment imposed under this Section,
as authorized by Section 5-46.2 of the Illinois Administrative
Procedure Act.
(e) Notwithstanding any other provision of this Section,
any plan providing for an assessment on a hospital provider as
a permissible tax under Title XIX of the federal Social
Security Act and Medicaid-eligible payments to hospital
providers from the revenues derived from that assessment shall

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be reviewed by the Illinois Department of Healthcare and Family
Services, as the Single State Medicaid Agency required by
federal law, to determine whether those assessments and
hospital provider payments meet federal Medicaid standards. If
the Department determines that the elements of the plan may
meet federal Medicaid standards and a related State Medicaid
Plan Amendment is prepared in a manner and form suitable for
submission, that State Plan Amendment shall be submitted in a
timely manner for review by the Centers for Medicare and
Medicaid Services of the United States Department of Health and
Human Services and subject to approval by the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services. No such plan shall become
effective without approval by the Illinois General Assembly by
the enactment into law of related legislation. Notwithstanding
any other provision of this Section, the Department is
authorized to adopt rules to reduce the rate of any annual
assessment imposed under this Section. Any such rules may be
adopted by the Department under Section 5-50 of the Illinois
Administrative Procedure Act.
(f) Subject to federal approval and notwithstanding any
other provision of this Code, for any redesign of any
assessments authorized under this Section, the volume data used
to redesign the distribution of payments shall include managed
care organization denial payments or settlements between
hospitals and managed care organizations.

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(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14; 99-2,
eff. 3-26-15; 99-516, eff. 6-30-16.)
(305 ILCS 5/5A-12.2)
(Section scheduled to be repealed on July 1, 2018)
Sec. 5A-12.2. Hospital access payments on or after July 1,
2008.
(a) To preserve and improve access to hospital services,
for hospital services rendered on or after July 1, 2008, the
Illinois Department shall, except for hospitals described in
subsection (b) of Section 5A-3, make payments to hospitals as
set forth in this Section. These payments shall be paid in 12
equal installments on or before the seventh State business day
of each month, except that no payment shall be due within 100
days after the later of the date of notification of federal
approval of the payment methodologies required under this
Section or any waiver required under 42 CFR 433.68, at which
time the sum of amounts required under this Section prior to
the date of notification is due and payable. Payments under
this Section are not due and payable, however, until (i) the
methodologies described in this Section are approved by the
federal government in an appropriate State Plan amendment and
(ii) the assessment imposed under this Article is determined to
be a permissible tax under Title XIX of the Social Security
Act.
(a-5) The Illinois Department may, when practicable,

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accelerate the schedule upon which payments authorized under
this Section are made.
(b) Across-the-board inpatient adjustment.
(1) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois general
acute care hospital an amount equal to 40% of the total
base inpatient payments paid to the hospital for services
provided in State fiscal year 2005.
(2) In addition to rates paid for inpatient hospital
services, the Department shall pay to each freestanding
Illinois specialty care hospital as defined in 89 Ill. Adm.
Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
the total base inpatient payments paid to the hospital for
services provided in State fiscal year 2005.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay to each freestanding
Illinois rehabilitation or psychiatric hospital an amount
equal to $1,000 per Medicaid inpatient day multiplied by
the increase in the hospital's Medicaid inpatient
utilization ratio (determined using the positive
percentage change from the rate year 2005 Medicaid
inpatient utilization ratio to the rate year 2007 Medicaid
inpatient utilization ratio, as calculated by the
Department for the disproportionate share determination).
(4) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois

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children's hospital an amount equal to 20% of the total
base inpatient payments paid to the hospital for services
provided in State fiscal year 2005 and an additional amount
equal to 20% of the base inpatient payments paid to the
hospital for psychiatric services provided in State fiscal
year 2005.
(5) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois
hospital eligible for a pediatric inpatient adjustment
payment under 89 Ill. Adm. Code 148.298, as in effect for
State fiscal year 2007, a supplemental pediatric inpatient
adjustment payment equal to:
(i) For freestanding children's hospitals as
defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5
multiplied by the hospital's pediatric inpatient
adjustment payment required under 89 Ill. Adm. Code
148.298, as in effect for State fiscal year 2008.
(ii) For hospitals other than freestanding
children's hospitals as defined in 89 Ill. Adm. Code
149.50(c)(3)(B), 1.0 multiplied by the hospital's
pediatric inpatient adjustment payment required under
89 Ill. Adm. Code 148.298, as in effect for State
fiscal year 2008.
(c) Outpatient adjustment.
(1) In addition to the rates paid for outpatient
hospital services, the Department shall pay each Illinois

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hospital an amount equal to 2.2 multiplied by the
hospital's ambulatory procedure listing payments for
categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
148.140(b), for State fiscal year 2005.
(2) In addition to the rates paid for outpatient
hospital services, the Department shall pay each Illinois
freestanding psychiatric hospital an amount equal to 3.25
multiplied by the hospital's ambulatory procedure listing
payments for category 5b, as defined in 89 Ill. Adm. Code
148.140(b)(1)(E), for State fiscal year 2005.
(d) Medicaid high volume adjustment. In addition to rates
paid for inpatient hospital services, the Department shall pay
to each Illinois general acute care hospital that provided more
than 20,500 Medicaid inpatient days of care in State fiscal
year 2005 amounts as follows:
(1) For hospitals with a case mix index equal to or
greater than the 85th percentile of hospital case mix
indices, $350 for each Medicaid inpatient day of care
provided during that period; and
(2) For hospitals with a case mix index less than the
85th percentile of hospital case mix indices, $100 for each
Medicaid inpatient day of care provided during that period.
(e) Capital adjustment. In addition to rates paid for
inpatient hospital services, the Department shall pay an
additional payment to each Illinois general acute care hospital
that has a Medicaid inpatient utilization rate of at least 10%

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(as calculated by the Department for the rate year 2007
disproportionate share determination) amounts as follows:
(1) For each Illinois general acute care hospital that
has a Medicaid inpatient utilization rate of at least 10%
and less than 36.94% and whose capital cost is less than
the 60th percentile of the capital costs of all Illinois
hospitals, the amount of such payment shall equal the
hospital's Medicaid inpatient days multiplied by the
difference between the capital costs at the 60th percentile
of the capital costs of all Illinois hospitals and the
hospital's capital costs.
(2) For each Illinois general acute care hospital that
has a Medicaid inpatient utilization rate of at least
36.94% and whose capital cost is less than the 75th
percentile of the capital costs of all Illinois hospitals,
the amount of such payment shall equal the hospital's
Medicaid inpatient days multiplied by the difference
between the capital costs at the 75th percentile of the
capital costs of all Illinois hospitals and the hospital's
capital costs.
(f) Obstetrical care adjustment.
(1) In addition to rates paid for inpatient hospital
services, the Department shall pay $1,500 for each Medicaid
obstetrical day of care provided in State fiscal year 2005
by each Illinois rural hospital that had a Medicaid
obstetrical percentage (Medicaid obstetrical days divided

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by Medicaid inpatient days) greater than 15% for State
fiscal year 2005.
(2) In addition to rates paid for inpatient hospital
services, the Department shall pay $1,350 for each Medicaid
obstetrical day of care provided in State fiscal year 2005
by each Illinois general acute care hospital that was
designated a level III perinatal center as of December 31,
2006, and that had a case mix index equal to or greater
than the 45th percentile of the case mix indices for all
level III perinatal centers.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay $900 for each Medicaid
obstetrical day of care provided in State fiscal year 2005
by each Illinois general acute care hospital that was
designated a level II or II+ perinatal center as of
December 31, 2006, and that had a case mix index equal to
or greater than the 35th percentile of the case mix indices
for all level II and II+ perinatal centers.
(g) Trauma adjustment.
(1) In addition to rates paid for inpatient hospital
services, the Department shall pay each Illinois general
acute care hospital designated as a trauma center as of
July 1, 2007, a payment equal to 3.75 multiplied by the
hospital's State fiscal year 2005 Medicaid capital
payments.
(2) In addition to rates paid for inpatient hospital

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services, the Department shall pay $400 for each Medicaid
acute inpatient day of care provided in State fiscal year
2005 by each Illinois general acute care hospital that was
designated a level II trauma center, as defined in 89 Ill.
Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
2007.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay $235 for each Illinois
Medicaid acute inpatient day of care provided in State
fiscal year 2005 by each level I pediatric trauma center
located outside of Illinois that had more than 8,000
Illinois Medicaid inpatient days in State fiscal year 2005.
(h) Supplemental tertiary care adjustment. In addition to
rates paid for inpatient services, the Department shall pay to
each Illinois hospital eligible for tertiary care adjustment
payments under 89 Ill. Adm. Code 148.296, as in effect for
State fiscal year 2007, a supplemental tertiary care adjustment
payment equal to the tertiary care adjustment payment required
under 89 Ill. Adm. Code 148.296, as in effect for State fiscal
year 2007.
(i) Crossover adjustment. In addition to rates paid for
inpatient services, the Department shall pay each Illinois
general acute care hospital that had a ratio of crossover days
to total inpatient days for medical assistance programs
administered by the Department (utilizing information from
2005 paid claims) greater than 50%, and a case mix index

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greater than the 65th percentile of case mix indices for all
Illinois hospitals, a rate of $1,125 for each Medicaid
inpatient day including crossover days.
(j) Magnet hospital adjustment. In addition to rates paid
for inpatient hospital services, the Department shall pay to
each Illinois general acute care hospital and each Illinois
freestanding children's hospital that, as of February 1, 2008,
was recognized as a Magnet hospital by the American Nurses
Credentialing Center and that had a case mix index greater than
the 75th percentile of case mix indices for all Illinois
hospitals amounts as follows:
(1) For hospitals located in a county whose eligibility
growth factor is greater than the mean, $450 multiplied by
the eligibility growth factor for the county in which the
hospital is located for each Medicaid inpatient day of care
provided by the hospital during State fiscal year 2005.
(2) For hospitals located in a county whose eligibility
growth factor is less than or equal to the mean, $225
multiplied by the eligibility growth factor for the county
in which the hospital is located for each Medicaid
inpatient day of care provided by the hospital during State
fiscal year 2005.
For purposes of this subsection, "eligibility growth
factor" means the percentage by which the number of Medicaid
recipients in the county increased from State fiscal year 1998
to State fiscal year 2005.

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(k) For purposes of this Section, a hospital that is
enrolled to provide Medicaid services during State fiscal year
2005 shall have its utilization and associated reimbursements
annualized prior to the payment calculations being performed
under this Section.
(l) For purposes of this Section, the terms "Medicaid
days", "ambulatory procedure listing services", and
"ambulatory procedure listing payments" do not include any
days, charges, or services for which Medicare or a managed care
organization reimbursed on a capitated basis was liable for
payment, except where explicitly stated otherwise in this
Section.
(m) For purposes of this Section, in determining the
percentile ranking of an Illinois hospital's case mix index or
capital costs, hospitals described in subsection (b) of Section
5A-3 shall be excluded from the ranking.
(n) Definitions. Unless the context requires otherwise or
unless provided otherwise in this Section, the terms used in
this Section for qualifying criteria and payment calculations
shall have the same meanings as those terms have been given in
the Illinois Department's administrative rules as in effect on
March 1, 2008. Other terms shall be defined by the Illinois
Department by rule.
As used in this Section, unless the context requires
otherwise:
"Base inpatient payments" means, for a given hospital, the

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sum of base payments for inpatient services made on a per diem
or per admission (DRG) basis, excluding those portions of per
admission payments that are classified as capital payments.
Disproportionate share hospital adjustment payments, Medicaid
Percentage Adjustments, Medicaid High Volume Adjustments, and
outlier payments, as defined by rule by the Department as of
January 1, 2008, are not base payments.
"Capital costs" means, for a given hospital, the total
capital costs determined using the most recent 2005 Medicare
cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on December 31,
2006, divided by the total inpatient days from the same cost
report to calculate a capital cost per day. The resulting
capital cost per day is inflated to the midpoint of State
fiscal year 2009 utilizing the national hospital market price
proxies (DRI) hospital cost index. If a hospital's 2005
Medicare cost report is not contained in the Healthcare Cost
Report Information System, the Department may obtain the data
necessary to compute the hospital's capital costs from any
source available, including, but not limited to, records
maintained by the hospital provider, which may be inspected at
all times during business hours of the day by the Illinois
Department or its duly authorized agents and employees.
"Case mix index" means, for a given hospital, the sum of
the DRG relative weighting factors in effect on January 1,
2005, for all general acute care admissions for State fiscal

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year 2005, excluding Medicare crossover admissions and
transplant admissions reimbursed under 89 Ill. Adm. Code
148.82, divided by the total number of general acute care
admissions for State fiscal year 2005, excluding Medicare
crossover admissions and transplant admissions reimbursed
under 89 Ill. Adm. Code 148.82.
"Medicaid inpatient day" means, for a given hospital, the
sum of days of inpatient hospital days provided to recipients
of medical assistance under Title XIX of the federal Social
Security Act, excluding days for individuals eligible for
Medicare under Title XVIII of that Act (Medicaid/Medicare
crossover days), as tabulated from the Department's paid claims
data for admissions occurring during State fiscal year 2005
that was adjudicated by the Department through March 23, 2007.
"Medicaid obstetrical day" means, for a given hospital, the
sum of days of inpatient hospital days grouped by the
Department to DRGs of 370 through 375 provided to recipients of
medical assistance under Title XIX of the federal Social
Security Act, excluding days for individuals eligible for
Medicare under Title XVIII of that Act (Medicaid/Medicare
crossover days), as tabulated from the Department's paid claims
data for admissions occurring during State fiscal year 2005
that was adjudicated by the Department through March 23, 2007.
"Outpatient ambulatory procedure listing payments" means,
for a given hospital, the sum of payments for ambulatory
procedure listing services, as described in 89 Ill. Adm. Code

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148.140(b), provided to recipients of medical assistance under
Title XIX of the federal Social Security Act, excluding
payments for individuals eligible for Medicare under Title
XVIII of the Act (Medicaid/Medicare crossover days), as
tabulated from the Department's paid claims data for services
occurring in State fiscal year 2005 that were adjudicated by
the Department through March 23, 2007.
(o) The Department may adjust payments made under this
Section 5A-12.2 to comply with federal law or regulations
regarding hospital-specific payment limitations on
government-owned or government-operated hospitals.
(p) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules that
change the hospital access improvement payments specified in
this Section, but only to the extent necessary to conform to
any federally approved amendment to the Title XIX State plan.
Any such rules shall be adopted by the Department as authorized
by Section 5-50 of the Illinois Administrative Procedure Act.
Notwithstanding any other provision of law, any changes
implemented as a result of this subsection (p) shall be given
retroactive effect so that they shall be deemed to have taken
effect as of the effective date of this Section.
(q) (Blank).
(r) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any

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rate of reimbursement for services or other payments in
accordance with Section 5-5e.
(s) On or after January 1, 2016, and no less than annually
thereafter, the Department shall increase capitation payments
to capitated managed care organizations (MCOs) to equal the
aggregate reduction of payments made in this Section and in
Section 5A-12.4 by a uniform percentage on a regional basis to
preserve access to hospital services for recipients under the
Illinois Medical Assistance Program. The aggregate amount of
all increased capitation payments to all MCOs for a fiscal year
shall be the amount needed to avoid reduction in payments
authorized under Section 5A-15. Payments to MCOs under this
Section shall be consistent with actuarial certification and
shall be published by the Department each year. Each MCO shall
only expend the increased capitation payments it receives under
this Section to support the availability of hospital services
and to ensure access to hospital services, with such
expenditures being made within 15 calendar days from when the
MCO receives the increased capitation payment. The Department
shall make available, on a monthly basis, a report of the
capitation payments that are made to each MCO pursuant to this
subsection, including the number of enrollees for which such
payment is made, the per enrollee amount of the payment, and
any adjustments that have been made. Payments made under this
subsection shall be guaranteed by a surety bond obtained by the
MCO in an amount established by the Department to approximate

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one month's liability of payments authorized under this
subsection. The Department may advance the payments guaranteed
by the surety bond. Payments to MCOs that would be paid
consistent with actuarial certification and enrollment in the
absence of the increased capitation payments under this Section
shall not be reduced as a consequence of payments made under
this subsection.
As used in this subsection, "MCO" means an entity which
contracts with the Department to provide services where payment
for medical services is made on a capitated basis.
(t) On or after July 1, 2014, the Department may increase
capitation payments to capitated managed care organizations
(MCOs) to equal the aggregate reduction of payments made in
Section 5A-12.5 to preserve access to hospital services for
recipients under the Illinois Medical Assistance Program.
Effective January 1, 2016, the Department shall increase
capitation payments to MCOs to include the payments authorized
under Section 5A-12.5 to preserve access to hospital services
for recipients under the Illinois Medical Assistance Program by
ensuring that the reimbursement provided for Affordable Care
Act adults enrolled in a MCO is equivalent to the reimbursement
provided for Affordable Care Act adults enrolled in a
fee-for-service program. Payments to MCOs under this Section
shall be consistent with actuarial certification and federal
approval (which may be retrospectively determined) and shall be
published by the Department each year. Each MCO shall only

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expend the increased capitation payments it receives under this
Section to support the availability of hospital services and to
ensure access to hospital services, with such expenditures
being made within 15 calendar days from when the MCO receives
the increased capitation payment. Payments made under this
subsection may be guaranteed by a surety bond obtained by the
MCO in an amount established by the Department to approximate
one month's liability of payments authorized under this
subsection. The Department may advance the payments to
hospitals under this subsection, in the event the MCO fails to
make such payments. The Department shall make available, on a
monthly basis, a report of the capitation payments that are
made to each MCO pursuant to this subsection, including the
number of enrollees for which such payment is made, the per
enrollee amount of the payment, and any adjustments that have
been made. Payments to MCOs that would be paid consistent with
actuarial certification and enrollment in the absence of the
increased capitation payments under this subsection shall not
be reduced as a consequence of payments made under this
subsection.
As used in this subsection, "MCO" means an entity which
contracts with the Department to provide services where payment
for medical services is made on a capitated basis.
(u) Subject to federal approval and notwithstanding any
other provision of this Code, for any redesign of any payments
authorized under this Section, the volume data used to redesign

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the distribution of payments shall include managed care
organization denial payments or settlements between hospitals
and managed care organizations.
(Source: P.A. 98-651, eff. 6-16-14; 99-516, eff. 6-30-16.)
(305 ILCS 5/5A-12.4)
(Section scheduled to be repealed on July 1, 2018)
Sec. 5A-12.4. Hospital access improvement payments on or
after June 10, 2012.
(a) Hospital access improvement payments. To preserve and
improve access to hospital services, for hospital and physician
services rendered on or after June 10, 2012, the Illinois
Department shall, except for hospitals described in subsection
(b) of Section 5A-3, make payments to hospitals as set forth in
this Section. These payments shall be paid in 12 equal
installments on or before the 7th State business day of each
month, except that no payment shall be due within 100 days
after the later of the date of notification of federal approval
of the payment methodologies required under this Section or any
waiver required under 42 CFR 433.68, at which time the sum of
amounts required under this Section prior to the date of
notification is due and payable. Payments under this Section
are not due and payable, however, until (i) the methodologies
described in this Section are approved by the federal
government in an appropriate State Plan amendment and (ii) the
assessment imposed under subsection (b-5) of Section 5A-2 of

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

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acute care inpatient day of care provided by the hospital
during State fiscal year 2009.
(2) For all other hospitals, $170 for each Medicaid
general acute care inpatient day of care provided by the
hospital during State fiscal year 2009.
(c) Trauma level II adjustment. In addition to rates paid
for inpatient hospital services, the Department shall pay to
each Illinois general acute care hospital that, as of July 1,
2011, was designated as a level II trauma center amounts as
follows:
(1) For hospitals with a case mix index equal to or
greater than the 50th percentile of case mix indices for
all Illinois hospitals, $470 for each Medicaid general
acute care inpatient day of care provided by the hospital
during State fiscal year 2009.
(2) For all other hospitals, $170 for each Medicaid
general acute care inpatient day of care provided by the
hospital during State fiscal year 2009.
(3) For the purposes of this adjustment, hospitals
located in the same city that alternate their trauma center
designation as defined in 89 Ill. Adm. Code 148.295(a)(2)
shall have the adjustment provided under this Section
divided between the 2 hospitals.
(d) Dual-eligible adjustment. In addition to rates paid for
inpatient services, the Department shall pay each Illinois
general acute care hospital that had a ratio of crossover days

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

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

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

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

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

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end-stage renal disease treatment services provided for State
fiscal year 2009 and the numerator of which is the hospital's
outpatient ambulatory procedure listing services for
categories 3A, 3B, and 3C for State fiscal year 2009.
"Medicaid inpatient day" means, for a given hospital, the
sum of days of inpatient hospital days provided to recipients
of medical assistance under Title XIX of the federal Social
Security Act, excluding days for individuals eligible for
Medicare under Title XVIII of that Act (Medicaid/Medicare
crossover days), as tabulated from the Department's paid claims
data for admissions occurring during State fiscal year 2009
that was adjudicated by the Department through June 30, 2010.
"Outpatient ambulatory procedure listing services" means,
for a given hospital, ambulatory procedure listing services, as
described in 89 Ill. Adm. Code 148.140(b), provided to
recipients of medical assistance under Title XIX of the federal
Social Security Act, excluding services for individuals
eligible for Medicare under Title XVIII of the Act
(Medicaid/Medicare crossover days), as tabulated from the
Department's paid claims data for services occurring in State
fiscal year 2009 that were adjudicated by the Department
through September 2, 2010.
"Outpatient end-stage renal disease treatment services"
means, for a given hospital, the services, as described in 89
Ill. Adm. Code 148.140(c), provided to recipients of medical
assistance under Title XIX of the federal Social Security Act,

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excluding payments for individuals eligible for Medicare under
Title XVIII of the Act (Medicaid/Medicare crossover days), as
tabulated from the Department's paid claims data for services
occurring in State fiscal year 2009 that were adjudicated by
the Department through September 2, 2010.
(m) The Department may adjust payments made under this
Section 5A-12.4 to comply with federal law or regulations
regarding hospital-specific payment limitations on
government-owned or government-operated hospitals.
(n) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules that
change the hospital access improvement payments specified in
this Section, but only to the extent necessary to conform to
any federally approved amendment to the Title XIX State plan.
Any such rules shall be adopted by the Department as authorized
by Section 5-50 of the Illinois Administrative Procedure Act.
Notwithstanding any other provision of law, any changes
implemented as a result of this subsection (n) shall be given
retroactive effect so that they shall be deemed to have taken
effect as of the effective date of this Section.
(o) The Department of Healthcare and Family Services must
submit a State Medicaid Plan Amendment to the Centers for
Medicare and Medicaid Services to implement the payments under
this Section.
(p) Subject to federal approval and notwithstanding any
other provision of this Code, for any redesign of any payments

10000HB0174ham001 - 35 - LRB100 03132 KTG 29385 a
authorized under this Section, the volume data used to redesign
the distribution of payments shall include managed care
organization denial payments or settlements between hospitals
and managed care organizations.
(Source: P.A. 97-688, eff. 6-14-12; 98-104, eff. 7-22-13;
98-463, eff. 8-16-13; 98-756, eff. 7-16-14.)
(305 ILCS 5/5A-12.5)
Sec. 5A-12.5. Affordable Care Act adults; hospital access
payments.
(a) The Department shall, subject to federal approval,
mirror the Medical Assistance hospital reimbursement
methodology for Affordable Care Act adults who are enrolled
under a fee-for-service or capitated managed care program,
including hospital access payments as defined in Section
5A-12.2 of this Article and hospital access improvement
payments as defined in Section 5A-12.4 of this Article, in
compliance with the equivalent rate provisions of the
Affordable Care Act.
(b) If the fee-for-service payments authorized under this
Section are deemed to be increases to payments for a prior
period, the Department shall seek federal approval to issue
such increases for the payments made through the period ending
on June 30, 2018, even if such increases are paid out during an
extended payment period beyond such date. Payment of such
increases beyond such date is subject to federal approval.

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(b-5) Subject to federal approval and notwithstanding any
other provision of this Code, for any redesign of any payments
authorized under this Section, the volume data used to redesign
the distribution of payments shall include managed care
organization denial payments or settlements between hospitals
and managed care organizations.
(c) As used in this Section, "Affordable Care Act" is the
collective term for the Patient Protection and Affordable Care
Act (Pub. L. 111-148) and the Health Care and Education
Reconciliation Act of 2010 (Pub. L. 111-152).
(Source: P.A. 98-651, eff. 6-16-14; 99-516, eff. 6-30-16.)
(305 ILCS 5/14-12)
Sec. 14-12. Hospital rate reform payment system. The
hospital payment system pursuant to Section 14-11 of this
Article shall be as follows:
(a) Inpatient hospital services. Effective for discharges
on and after July 1, 2014, reimbursement for inpatient general
acute care services shall utilize the All Patient Refined
Diagnosis Related Grouping (APR-DRG) software, version 30,
distributed by 3MTM Health Information System.
(1) The Department shall establish Medicaid weighting
factors to be used in the reimbursement system established
under this subsection. Initial weighting factors shall be
the weighting factors as published by 3M Health Information
System, associated with Version 30.0 adjusted for the

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

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

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

10000HB0174ham001 - 40 - LRB100 03132 KTG 29385 a
Act of the 98th General Assembly, the rules in effect for
152.150 as published in 38 Ill. Reg. 4980 through 4986 shall
remain in effect until modified by rule by the Department.
Nothing in this subsection shall be construed to mandate that
the Department file a replacement rule.
(d) Transition period. There shall be a transition period
to the reimbursement systems authorized under this Section that
shall begin on the effective date of these systems and continue
until June 30, 2018, unless extended by rule by the Department.
To help provide an orderly and predictable transition to the
new reimbursement systems and to preserve and enhance access to
the hospital services during this transition, the Department
shall allocate a transitional hospital access pool of at least
$290,000,000 annually so that transitional hospital access
payments are made to hospitals.
(1) After the transition period, the Department may
begin incorporating the transitional hospital access pool
into the base rate structure.
(2) After the transition period, if the Department
reduces payments from the transitional hospital access
pool, it shall increase base rates, develop new adjustors,
adjust current adjustors, develop new hospital access
payments based on updated information, or any combination
thereof by an amount equal to the decreases proposed in the
transitional hospital access pool payments, ensuring that
the entire transitional hospital access pool amount shall

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continue to be used for hospital payments.
Subject to federal approval and notwithstanding any other
provision of this Code, for any redesign of transitional
hospital access payments authorized under this Section, the
volume data used to redesign the distribution of payments shall
include managed care organization denial payments or
settlements between hospitals and managed care organizations.
(e) Beginning 36 months after initial implementation, the
Department shall update the reimbursement components in
subsections (a) and (b), including standardized amounts and
weighting factors, and at least triennially and no more
frequently than annually thereafter. The Department shall
publish these updates on its website no later than 30 calendar
days prior to their effective date.
(f) Continuation of supplemental payments. Any
supplemental payments authorized under Illinois Administrative
Code 148 effective January 1, 2014 and that continue during the
period of July 1, 2014 through December 31, 2014 shall remain
in effect as long as the assessment imposed by Section 5A-2 is
in effect.
(g) Notwithstanding subsections (a) through (f) of this
Section and notwithstanding the changes authorized under
Section 5-5b.1, any updates to the system shall not result in
any diminishment of the overall effective rates of
reimbursement as of the implementation date of the new system
(July 1, 2014). These updates shall not preclude variations in

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any individual component of the system or hospital rate
variations. Nothing in this Section shall prohibit the
Department from increasing the rates of reimbursement or
developing payments to ensure access to hospital services.
Nothing in this Section shall be construed to guarantee a
minimum amount of spending in the aggregate or per hospital as
spending may be impacted by factors including but not limited
to the number of individuals in the medical assistance program
and the severity of illness of the individuals.
(h) The Department shall have the authority to modify by
rulemaking any changes to the rates or methodologies in this
Section as required by the federal government to obtain federal
financial participation for expenditures made under this
Section.
(i) Except for subsections (g) and (h) of this Section, the
Department shall, pursuant to subsection (c) of Section 5-40 of
the Illinois Administrative Procedure Act, provide for
presentation at the June 2014 hearing of the Joint Committee on
Administrative Rules (JCAR) additional written notice to JCAR
of the following rules in order to commence the second notice
period for the following rules: rules published in the Illinois
Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
(Medical Payment), 4628 (Specialized Health Care Delivery
Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
Grouping (DRG) Prospective Payment System (PPS)), and 4977
(Hospital Reimbursement Changes), and published in the

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Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
(Specialized Health Care Delivery Systems) and 6505 (Hospital
Services).
(Source: P.A. 98-651, eff. 6-16-14; 99-2, eff. 3-26-15.)
Section 99. Effective date. This Act takes effect upon
becoming law.".