093_SB0740enr SB740 Enrolled LRB093 03235 JLS 03252 b 1 AN ACT concerning public assistance. 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 Section 5-5.02 as follows: 6 (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02) 7 Sec. 5-5.02. Hospital reimbursements. 8 (a) Reimbursement to Hospitals; July 1, 1992 through 9 September 30, 1992. Notwithstanding any other provisions of 10 this Code or the Illinois Department's Rules promulgated 11 under the Illinois Administrative Procedure Act, 12 reimbursement to hospitals for services provided during the 13 period July 1, 1992 through September 30, 1992, shall be as 14 follows: 15 (1) For inpatient hospital services rendered, or if 16 applicable, for inpatient hospital discharges occurring, 17 on or after July 1, 1992 and on or before September 30, 18 1992, the Illinois Department shall reimburse hospitals 19 for inpatient services under the reimbursement 20 methodologies in effect for each hospital, and at the 21 inpatient payment rate calculated for each hospital, as 22 of June 30, 1992. For purposes of this paragraph, 23 "reimbursement methodologies" means all reimbursement 24 methodologies that pertain to the provision of inpatient 25 hospital services, including, but not limited to, any 26 adjustments for disproportionate share, targeted access, 27 critical care access and uncompensated care, as defined 28 by the Illinois Department on June 30, 1992. 29 (2) For the purpose of calculating the inpatient 30 payment rate for each hospital eligible to receive SB740 Enrolled -2- LRB093 03235 JLS 03252 b 1 quarterly adjustment payments for targeted access and 2 critical care, as defined by the Illinois Department on 3 June 30, 1992, the adjustment payment for the period July 4 1, 1992 through September 30, 1992, shall be 25% of the 5 annual adjustment payments calculated for each eligible 6 hospital, as of June 30, 1992. The Illinois Department 7 shall determine by rule the adjustment payments for 8 targeted access and critical care beginning October 1, 9 1992. 10 (3) For the purpose of calculating the inpatient 11 payment rate for each hospital eligible to receive 12 quarterly adjustment payments for uncompensated care, as 13 defined by the Illinois Department on June 30, 1992, the 14 adjustment payment for the period August 1, 1992 through 15 September 30, 1992, shall be one-sixth of the total 16 uncompensated care adjustment payments calculated for 17 each eligible hospital for the uncompensated care rate 18 year, as defined by the Illinois Department, ending on 19 July 31, 1992. The Illinois Department shall determine 20 by rule the adjustment payments for uncompensated care 21 beginning October 1, 1992. 22 (b) Inpatient payments. For inpatient services provided 23 on or after October 1, 1993, in addition to rates paid for 24 hospital inpatient services pursuant to the Illinois Health 25 Finance Reform Act, as now or hereafter amended, or the 26 Illinois Department's prospective reimbursement methodology, 27 or any other methodology used by the Illinois Department for 28 inpatient services, the Illinois Department shall make 29 adjustment payments, in an amount calculated pursuant to the 30 methodology described in paragraph (c) of this Section, to 31 hospitals that the Illinois Department determines satisfy any 32 one of the following requirements: 33 (1) Hospitals that are described in Section 1923 of 34 the federal Social Security Act, as now or hereafter SB740 Enrolled -3- LRB093 03235 JLS 03252 b 1 amended; or 2 (2) Illinois hospitals that have a Medicaid 3 inpatient utilization rate which is at least one-half a 4 standard deviation above the mean Medicaid inpatient 5 utilization rate for all hospitals in Illinois receiving 6 Medicaid payments from the Illinois Department; or 7 (3) Illinois hospitals that on July 1, 1991 had a 8 Medicaid inpatient utilization rate, as defined in 9 paragraph (h) of this Section, that was at least the mean 10 Medicaid inpatient utilization rate for all hospitals in 11 Illinois receiving Medicaid payments from the Illinois 12 Department and which were located in a planning area with 13 one-third or fewer excess beds as determined by the 14 Illinois Health Facilities Planning Board, and that, as 15 of June 30, 1992, were located in a federally designated 16 Health Manpower Shortage Area; or 17 (4) Illinois hospitals that: 18 (A) have a Medicaid inpatient utilization rate 19 that is at least equal to the mean Medicaid 20 inpatient utilization rate for all hospitals in 21 Illinois receiving Medicaid payments from the 22 Department; and 23 (B) also have a Medicaid obstetrical inpatient 24 utilization rate that is at least one standard 25 deviation above the mean Medicaid obstetrical 26 inpatient utilization rate for all hospitals in 27 Illinois receiving Medicaid payments from the 28 Department for obstetrical services; or 29 (5) Any children's hospital, which means a hospital 30 devoted exclusively to caring for children. A hospital 31 which includes a facility devoted exclusively to caring 32 for childrenthat is separately licensed as a hospital by33a municipality prior to September 30, 1998shall be 34 considered a children's hospital to the degree that the SB740 Enrolled -4- LRB093 03235 JLS 03252 b 1 hospital's Medicaid care is provided to children if 2 either (i) the facility devoted exclusively to caring for 3 children is separately licensed as a hospital by a 4 municipality prior to September 30, 1998 or (ii) the 5 hospital has been designated by the State as a Level III 6 perinatal care facility, has a Medicaid Inpatient 7 Utilization rate greater than 55% for the rate year 2003 8 disproportionate share determination, and has more than 9 10,000 qualified children days as defined by the 10 Department in rulemaking. 11 (c) Inpatient adjustment payments. The adjustment 12 payments required by paragraph (b) shall be calculated based 13 upon the hospital's Medicaid inpatient utilization rate as 14 follows: 15 (1) hospitals with a Medicaid inpatient utilization 16 rate below the mean shall receive a per day adjustment 17 payment equal to $25; 18 (2) hospitals with a Medicaid inpatient 19 utilization rate that is equal to or greater than the 20 mean Medicaid inpatient utilization rate but less than 21 one standard deviation above the mean Medicaid inpatient 22 utilization rate shall receive a per day adjustment 23 payment equal to the sum of $25 plus $1 for each one 24 percent that the hospital's Medicaid inpatient 25 utilization rate exceeds the mean Medicaid inpatient 26 utilization rate; 27 (3) hospitals with a Medicaid inpatient 28 utilization rate that is equal to or greater than one 29 standard deviation above the mean Medicaid inpatient 30 utilization rate but less than 1.5 standard deviations 31 above the mean Medicaid inpatient utilization rate shall 32 receive a per day adjustment payment equal to the sum of 33 $40 plus $7 for each one percent that the hospital's 34 Medicaid inpatient utilization rate exceeds one standard SB740 Enrolled -5- LRB093 03235 JLS 03252 b 1 deviation above the mean Medicaid inpatient utilization 2 rate; and 3 (4) hospitals with a Medicaid inpatient 4 utilization rate that is equal to or greater than 1.5 5 standard deviations above the mean Medicaid inpatient 6 utilization rate shall receive a per day adjustment 7 payment equal to the sum of $90 plus $2 for each one 8 percent that the hospital's Medicaid inpatient 9 utilization rate exceeds 1.5 standard deviations above 10 the mean Medicaid inpatient utilization rate. 11 (d) Supplemental adjustment payments. In addition to 12 the adjustment payments described in paragraph (c), hospitals 13 as defined in clauses (1) through (5) of paragraph (b), 14 excluding county hospitals (as defined in subsection (c) of 15 Section 15-1 of this Code) and a hospital organized under the 16 University of Illinois Hospital Act, shall be paid 17 supplemental inpatient adjustment payments of $60 per day. 18 For purposes of Title XIX of the federal Social Security Act, 19 these supplemental adjustment payments shall not be 20 classified as adjustment payments to disproportionate share 21 hospitals. 22 (e) The inpatient adjustment payments described in 23 paragraphs (c) and (d) shall be increased on October 1, 1993 24 and annually thereafter by a percentage equal to the lesser 25 of (i) the increase in the DRI hospital cost index for the 26 most recent 12 month period for which data are available, or 27 (ii) the percentage increase in the statewide average 28 hospital payment rate over the previous year's statewide 29 average hospital payment rate. The sum of the inpatient 30 adjustment payments under paragraphs (c) and (d) to a 31 hospital, other than a county hospital (as defined in 32 subsection (c) of Section 15-1 of this Code) or a hospital 33 organized under the University of Illinois Hospital Act, 34 however, shall not exceed $275 per day; that limit shall be SB740 Enrolled -6- LRB093 03235 JLS 03252 b 1 increased on October 1, 1993 and annually thereafter by a 2 percentage equal to the lesser of (i) the increase in the DRI 3 hospital cost index for the most recent 12-month period for 4 which data are available or (ii) the percentage increase in 5 the statewide average hospital payment rate over the previous 6 year's statewide average hospital payment rate. 7 (f) Children's hospital inpatient adjustment payments. 8 For children's hospitals, as defined in clause (5) of 9 paragraph (b), the adjustment payments required pursuant to 10 paragraphs (c) and (d) shall be multiplied by 2.0. 11 (g) County hospital inpatient adjustment payments. For 12 county hospitals, as defined in subsection (c) of Section 13 15-1 of this Code, there shall be an adjustment payment as 14 determined by rules issued by the Illinois Department. 15 (h) For the purposes of this Section the following 16 terms shall be defined as follows: 17 (1) "Medicaid inpatient utilization rate" means a 18 fraction, the numerator of which is the number of a 19 hospital's inpatient days provided in a given 12-month 20 period to patients who, for such days, were eligible for 21 Medicaid under Title XIX of the federal Social Security 22 Act, and the denominator of which is the total number of 23 the hospital's inpatient days in that same period. 24 (2) "Mean Medicaid inpatient utilization rate" 25 means the total number of Medicaid inpatient days 26 provided by all Illinois Medicaid-participating hospitals 27 divided by the total number of inpatient days provided by 28 those same hospitals. 29 (3) "Medicaid obstetrical inpatient utilization 30 rate" means the ratio of Medicaid obstetrical inpatient 31 days to total Medicaid inpatient days for all Illinois 32 hospitals receiving Medicaid payments from the Illinois 33 Department. 34 (i) Inpatient adjustment payment limit. In order to SB740 Enrolled -7- LRB093 03235 JLS 03252 b 1 meet the limits of Public Law 102-234 and Public Law 103-66, 2 the Illinois Department shall by rule adjust disproportionate 3 share adjustment payments. 4 (j) University of Illinois Hospital inpatient adjustment 5 payments. For hospitals organized under the University of 6 Illinois Hospital Act, there shall be an adjustment payment 7 as determined by rules adopted by the Illinois Department. 8 (k) The Illinois Department may by rule establish 9 criteria for and develop methodologies for adjustment 10 payments to hospitals participating under this Article. 11 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.) 12 Section 99. Effective date. This Act takes effect upon 13 becoming law.