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| 1 | AN ACT concerning public aid.
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| 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| 7 | (Section scheduled to be repealed on January 1, 2015) | ||||||||||||||||||||||||||||||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 | ||||||||||||||||||||||||||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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.
| ||||||
| |||||||
| |||||||
| 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).
| ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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: | ||||||
| |||||||
| |||||||
| 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. | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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). | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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. | ||||||
| |||||||
| |||||||
| 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" | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 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.
| ||||||