Bill Text: IL SB1391 | 2025-2026 | 104th General Assembly | Introduced

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Bill Title: Amends the Illinois Public Aid Code. In a provision in the Medical Assistance Article concerning safety-net hospitals, provides that, subject to federal approval, reimbursement rates for inpatient hospital services in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10% for safety-net hospitals; and reimbursement rates for outpatient hospital services in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10% for safety-net hospitals. Requires the Department of Healthcare and Family Services to take all actions necessary to ensure the rate increases for safety-net hospitals are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary. In the Hospital Services Trust Fund Article, provides that, subject to federal approval, reimbursement rates for inpatient hospital services in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10%; and reimbursement rates for outpatient hospital services in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10%. Requires the Department of Healthcare and Family Services to take all actions necessary to ensure the rate increases are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary. Effective immediately.

Sponsorship: Partisan Bill (Democrat 1)

Status: (Introduced - Dead) 2025-06-02 - Senate Committee Amendment No. 1 Rule 3-9(a) / Re-referred to Assignments [SB1391 Detail]

Download: Illinois-2025-SB1391-Introduced.html

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104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1391 Introduced 1/29/2025, by Sen. Kimberly A. Lightford SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5e.1
305 ILCS 5/14-12.6 new
Amends the Illinois Public Aid Code. In a provision in the Medical Assistance Article concerning safety-net hospitals, provides that, subject to federal approval, reimbursement rates for inpatient hospital services in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10% for safety-net hospitals; and reimbursement rates for outpatient hospital services in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10% for safety-net hospitals. Requires the Department of Healthcare and Family Services to take all actions necessary to ensure the rate increases for safety-net hospitals are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary. In the Hospital Services Trust Fund Article, provides that, subject to federal approval, reimbursement rates for inpatient hospital services in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10%; and reimbursement rates for outpatient hospital services in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10%. Requires the Department of Healthcare and Family Services to take all actions necessary to ensure the rate increases are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary. Effective immediately.
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A BILL FOR
SB1391 LRB104 09551 KTG 19614 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
adding Sections 5-5e.1 and 14-12.6 as follows:
(305 ILCS 5/5-5e.1)
Sec. 5-5e.1. Safety-Net Hospitals.
(a) A Safety-Net Hospital is an Illinois hospital that:
(1) is licensed by the Department of Public Health as
a general acute care or pediatric hospital; and
(2) is a disproportionate share hospital, as described
in Section 1923 of the federal Social Security Act, as
determined by the Department; and
(3) meets one of the following:
(A) has a MIUR of at least 40% and a charity
percent of at least 4%; or
(B) has a MIUR of at least 50%.
(b) Definitions. As used in this Section:
(1) "Charity percent" means the ratio of (i) the
hospital's charity charges for services provided to
individuals without health insurance or another source of
third party coverage to (ii) the Illinois total hospital
charges, each as reported on the hospital's OBRA form.

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(2) "MIUR" means Medicaid Inpatient Utilization Rate
and is defined as a fraction, the numerator of which is the
number of a hospital's inpatient days provided in the
hospital's fiscal year ending 3 years prior to the rate
year, to patients who, for such days, were eligible for
Medicaid under Title XIX of the federal Social Security
Act, 42 USC 1396a et seq., excluding those persons
eligible for medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
Section 5-2 of this Article, and the denominator of which
is the total number of the hospital's inpatient days in
that same period, excluding those persons eligible for
medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
Section 5-2 of this Article.
(3) "OBRA form" means form HFS-3834, OBRA '93 data
collection form, for the rate year.
(4) "Rate year" means the 12-month period beginning on
October 1.
(c) Beginning July 1, 2012 and ending on December 31,
2026, a hospital that would have qualified for the rate year
beginning October 1, 2011 or October 1, 2012 shall be a
Safety-Net Hospital.
(c-5) Beginning July 1, 2020 and ending on December 31,
2026, a hospital that would have qualified for the rate year
beginning October 1, 2020 and was designated a federal rural

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referral center under 42 CFR 412.96 as of October 1, 2020 shall
be a Safety-Net Hospital.
(d) No later than August 15 preceding the rate year, each
hospital shall submit the OBRA form to the Department. Prior
to October 1, the Department shall notify each hospital
whether it has qualified as a Safety-Net Hospital.
(e) The Department may promulgate rules in order to
implement this Section.
(f) Nothing in this Section shall be construed as limiting
the ability of the Department to include the Safety-Net
Hospitals in the hospital rate reform mandated by Section
14-11 of this Code and implemented under Section 14-12 of this
Code and by administrative rulemaking.
(g) Notwithstanding any other provision of this Code,
effective for dates of service on and after January 1, 2026,
subject to federal approval, reimbursement rates for
safety-net hospitals shall be revised as follows:
(1) For inpatient hospital services, reimbursement
rates in effect January 1, 2025 under the All Patient
Refined-Diagnosis Related Groups system shall be increased
by 10% for safety-net hospitals.
(2) For outpatient hospital services, reimbursement
rates in effect January 1, 2025 under the Enhanced
Ambulatory Procedure Grouping system shall be increased by
10% for safety-net hospitals.
The Department shall take all actions necessary to ensure

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the rate increases for safety-net hospitals authorized by this
amendatory Act of the 104th General Assembly are in effect for
dates of service on and after January 1, 2026, including
publishing all appropriate public notices, applying for
federal approval of amendments to the Illinois Title XIX State
Plan, and adopting administrative rules if necessary.
(Source: P.A. 101-650, eff. 7-7-20; 101-669, eff. 4-2-21;
102-886, eff. 5-17-22.)
(305 ILCS 5/14-12.6 new)
Sec. 14-12.6. Hospital services; rate increases.
(a) Notwithstanding any other provision of this Code,
effective for dates of service on and after January 1, 2026,
subject to federal approval, hospital reimbursement rates
shall be revised as follows:
(1) For inpatient hospital services, reimbursement
rates in effect January 1, 2025 under the All Patient
Refined-Diagnosis Related Groups system shall be increased
by 10%.
(2) For outpatient hospital services, reimbursement
rates in effect January 1, 2025 under the Enhanced
Ambulatory Procedure Grouping system shall be increased by
10%.
(b) The Department shall take all actions necessary to
ensure the rate increases authorized in this amendatory Act of
the 104th General Assembly are in effect for dates of service

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on and after January 1, 2026, including publishing all
appropriate public notices, applying for federal approval of
amendments to the Illinois Title XIX State Plan, and adopting
administrative rules if necessary.
Section 99. Effective date. This Act takes effect upon
becoming law.