Public Act 093-1066
 
SB2212 Enrolled LRB093 15828 RCE 41445 b

    AN ACT in relation to budget implementation.
 
    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
changing Sections 5A-1, 5A-2, 5A-4, and 5A-12 as follows:
 
    (305 ILCS 5/5A-1)  (from Ch. 23, par. 5A-1)
    Sec. 5A-1. Definitions. As used in this Article, unless
the context requires otherwise:
    "Fund" means the Hospital Provider Fund.
    "Hospital" means an institution, place, building, or
agency located in this State that is subject to licensure by
the Illinois Department of Public Health under the Hospital
Licensing Act, whether public or private and whether organized
for profit or not-for-profit.
    "Hospital provider" means a person licensed by the
Department of Public Health to conduct, operate, or maintain a
hospital, regardless of whether the person is a Medicaid
provider. For purposes of this paragraph, "person" means any
political subdivision of the State, municipal corporation,
individual, firm, partnership, corporation, company, limited
liability company, association, joint stock association, or
trust, or a receiver, executor, trustee, guardian, or other
representative appointed by order of any court.
    "Occupied bed days" means the sum of the number of days
that each bed was occupied by a patient for all beds during
calendar year 2001. Occupied bed days shall be computed
separately for each hospital operated or maintained by a
hospital provider.
    "Proration factor" means a fraction, the numerator of which
is 53 and the denominator of which is 365.
(Source: P.A. 93-659, eff. 2-3-04.)
 
    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
    (Section scheduled to be repealed on July 1, 2005)
    Sec. 5A-2. Assessment; no local authorization to tax.
    (a) Subject to Sections 5A-3 and 5A-10, an annual
assessment on inpatient services is imposed on each hospital
provider in an amount equal to the hospital's occupied bed days
multiplied by $84.19 multiplied by the proration factor for
State fiscal year years 2004 and the hospital's occupied bed
days multiplied by $84.19 for State fiscal year 2005. , if the
payment methodologies required under 5A-12 and the waiver
granted under 42 CFR 433.68 are approved with an effective date
prior to July 1, 2004; or the assessment will be imposed for
fiscal year 2005 only, if the payment methodologies required
under Section 5A-12 and the waiver granted under 42 CFR 433.68
are approved with an effective date on or after July 1, 2004.
    The Department of Public Aid shall use the number of
occupied bed days as reported by each hospital on the Annual
Survey of Hospitals conducted by the Department of Public
Health to calculate the hospital's annual assessment. If the
sum of a hospital's occupied bed days is not reported on the
Annual Survey of Hospitals or if there are data errors in the
reported sum of a hospital's occupied bed days as determined by
the Department of Public Aid, then the Department of Public Aid
may obtain the sum of occupied 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 Department of Public
Aid or its duly authorized agents and employees.
    (b) Nothing in this amendatory Act of the 93rd General
Assembly shall be construed to authorize any home rule unit or
other unit of local government to license for revenue or to
impose a tax or assessment upon hospital providers or the
occupation of hospital provider, or a tax or assessment
measured by the income or earnings of a hospital provider.
    (c) As provided in Section 5A-14, this Section is repealed
on July 1, 2005.
(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
 
    (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
    Sec. 5A-4. Payment of assessment; penalty.
    (a) The annual assessment imposed by Section 5A-2 for State
fiscal year 2004 shall be due and payable on June 18 of the
year. The assessment imposed by Section 5A-2 for State fiscal
year 2005 shall be due and payable in quarterly installments,
each equalling one-fourth of the assessment for the year, on
July 19, October 19, January 18, and April 19 of the year. No
installment payment of an assessment imposed by Section 5A-2
shall be due and payable, however, until after: (i) the
hospital provider receives written notice from the Department
of Public Aid that the payment methodologies to hospitals
required under Section 5A-12 have been approved by the Centers
for Medicare and Medicaid Services of the U.S. Department of
Health and Human Services and the waiver under 42 CFR 433.68
for the assessment imposed by Section 5A-2 has been granted by
the Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services; and (ii) the hospital
has received the payments required under Section 5A-12. Upon
notification to the Department of approval of the payment
methodologies required under Section 5A-12 and the waiver
granted under 42 CFR 433.68, all quarterly installments
otherwise due under Section 5A-2 prior to the date of
notification shall be due and payable to the Department upon
written direction from the Department within 30 days of the
date of notification.
    (b) The Illinois Department is authorized to establish
delayed payment schedules for hospital providers that are
unable to make installment payments when due under this Section
due to financial difficulties, as determined by the Illinois
Department.
    (c) If a hospital provider fails to pay the full amount of
an installment when due (including any extensions granted under
subsection (b)), there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5A-2 a penalty assessment equal to the
lesser of (i) 5% of the amount of the installment not paid on
or before the due date plus 5% of the portion thereof remaining
unpaid on the last day of each 30-day period thereafter or (ii)
100% of the installment amount not paid on or before the due
date. For purposes of this subsection, payments will be
credited first to unpaid installment amounts (rather than to
penalty or interest), beginning with the most delinquent
installments.
(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
 
    (305 ILCS 5/5A-12)
    (Section scheduled to be repealed on July 1, 2005)
    Sec. 5A-12. Hospital access improvement payments.
    (a) To improve access to hospital services, for hospital
services rendered on or after June 1, 2004, the Department of
Public Aid shall make payments to hospitals as set forth in
this Section, except for hospitals described in subsection (b)
of Section 5A-3. These payments shall be paid on a quarterly
basis. For State fiscal year 2004, if the effective date of the
approval of the payment methodology required under this Section
and the waiver granted under 42 CFR 433.68 by the Centers for
Medicare and Medicaid Services of the U.S. Department of Health
and Human Services is prior to July 1, 2004, the Department
shall pay the total amounts required for fiscal year 2004 under
this Section within 75 25 days of the latest notification. No
payment shall be made for State fiscal year 2004 if the
effective date of the approval is on or after July 1, 2004. In
State fiscal year 2005, the total amounts required under this
Section shall be paid in 4 equal installments on or before July
15, October 15, January 14, and April 15 of the year, except
that if the date of notification of the approval of the payment
methodologies required under this Section and the waiver
granted under 42 CFR 433.68 is on or after July 1, 2004, the
sum of amounts required under this Section prior to the date of
notification shall be paid within 75 25 days of the date of the
last notification. 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, (ii) the assessment imposed
under this Article is determined to be a permissible tax under
Title XIX of the Social Security Act, and (iii) the assessment
is in effect.
    (b) High volume payment. In addition to rates paid for
inpatient hospital services, the Department of Public Aid shall
pay, to each Illinois hospital that provided more than 20,000
Medicaid inpatient days of care during State fiscal year 2001
(except for hospitals that qualify for adjustment payments
under Section 5-5.02 for the 12-month period beginning on
October 1, 2002), $190 for each Medicaid inpatient day of care
provided during that fiscal year. A hospital that provided less
than 30,000 Medicaid inpatient days of care during that period,
however, is not entitled to receive more than $3,500,000 per
year in such payments.
    (c) Medicaid inpatient utilization rate adjustment. In
addition to rates paid for inpatient hospital services, the
Department of Public Aid shall pay each Illinois hospital
(except for hospitals described in Section 5A-3), for each
Medicaid inpatient day of care provided during State fiscal
year 2001, an amount equal to the product of $57.25 multiplied
by the quotient of 1 divided by the greater of 1.6% or the
hospital's Medicaid inpatient utilization rate (as used to
determine eligibility for adjustment payments under Section
5-5.02 for the 12-month period beginning on October 1, 2002).
The total payments under this subsection to a hospital may not
exceed $10,500,000 annually.
    (d) Psychiatric base rate adjustment.
        (1) In addition to rates paid for inpatient psychiatric
    services, the Department of Public Aid shall pay each
    Illinois general acute care hospital with a distinct
    part-psychiatric unit, for each Medicaid inpatient
    psychiatric day of care provided in State fiscal year 2001,
    an amount equal to $400 less the hospital's per-diem rate
    for Medicaid inpatient psychiatric services as in effect on
    October 1, 2003. In no event, however, shall that amount be
    less than zero.
        (2) For distinct part-psychiatric units of Illinois
    general acute care hospitals, except for all hospitals
    excluded in Section 5A-3, whose inpatient per-diem rate as
    in effect on October 1, 2003 is greater than $400, the
    Department shall pay, in addition to any other amounts
    authorized under this Code, $25 for each Medicaid inpatient
    psychiatric day of care provided in State fiscal year 2001.
    (e) Supplemental tertiary care adjustment. In addition to
rates paid for inpatient services, the Department of Public Aid
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 2003, 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 2003.
    (f) Medicaid outpatient utilization rate adjustment. In
addition to rates paid for outpatient hospital services, the
Department of Public Aid shall pay each Illinois hospital
(except for hospitals described in Section 5A-3), an amount
equal to the product of 2.45% multiplied by the hospital's
Medicaid outpatient charges multiplied by the quotient of 1
divided by the greater of 1.6% or the hospital's Medicaid
outpatient utilization rate. The total payments under this
subsection to a hospital may not exceed $6,750,000 annually.
    For purposes of this subsection:
    "Medicaid outpatient charges" means the charges for
outpatient services provided to Medicaid patients for State
fiscal year 2001 as submitted by the hospital on the UB-92
billing form or under the ambulatory procedure listing and
adjudicated by the Department of Public Aid on or before
September 12, 2003.
    "Medicaid outpatient utilization rate" means a fraction,
the numerator of which is the hospital's Medicaid outpatient
charges and the denominator of which is the total number of the
hospital's charges for outpatient services for the hospital's
fiscal year ending in 2001.
    (g) State outpatient service adjustment. In addition to
rates paid for outpatient hospital services, the Department of
Public Aid shall pay each Illinois hospital an amount equal to
the product of 75.5% multiplied by the hospital's Medicaid
outpatient services submitted to the Department on the UB-92
billing form for State fiscal year 2001 multiplied by the
hospital's outpatient access fraction.
    For purposes of this subsection, "outpatient access
fraction" means a fraction, the numerator of which is the
hospital's Medicaid payments for outpatient services for
ambulatory procedure listing services submitted to the
Department on the UB-92 billing form for State fiscal year
2001, and the denominator of which is the hospital's Medicaid
outpatient services submitted to the Department on the UB-92
billing form for State fiscal year 2001.
    The total payments under this subsection to a hospital may
not exceed $3,000,000 annually.
    (h) Rural hospital outpatient adjustment. In addition to
rates paid for outpatient hospital services, the Department of
Public Aid shall pay each Illinois rural hospital an amount
equal to the product of $14,500,000 multiplied by the rural
hospital outpatient adjustment fraction.
    For purposes of this subsection, "rural hospital
outpatient adjustment fraction" means a fraction, the
numerator of which is the hospital's Medicaid visits for
outpatient services for ambulatory procedure listing services
submitted to the Department on the UB-92 billing form for State
fiscal year 2001, and the denominator of which is the total
Medicaid visits for outpatient services for ambulatory
procedure listing services for all Illinois rural hospitals
submitted to the Department on the UB-92 billing form for State
fiscal year 2001.
    For purposes of this subsection, "rural hospital" has the
same meaning as in 89 Ill. Adm. Code 148.25, as in effect on
September 30, 2003.
    (i) Merged/closed hospital adjustment. If any hospital
files a combined Medicaid cost report with another hospital
after January 1, 2001, and if that hospital subsequently
closes, then except for the payments described in subsection
(e), all payments described in the various subsections of this
Section shall, before the application of the annual limitation
amount specified in each such subsection, be multiplied by a
fraction, the numerator of which is the number of occupied bed
days attributable to the open hospital and the denominator of
which is the sum of the number of occupied bed days of each
open hospital and each closed hospital. For purposes of this
subsection, "occupied bed days" has the same meaning as the
term is defined in subsection (a) of Section 5A-2.
    (j) For purposes of this Section, the terms "Medicaid
days", "Medicaid charges", and "Medicaid services" do not
include any days, charges, or services for which Medicare was
liable for payment.
    (j-5) For State fiscal year 2004, all payments described in
this Section shall be multiplied by the proration factor.
    (k) As provided in Section 5A-14, this Section is repealed
on July 1, 2005.
(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.