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1 | AN ACT in relation to budget implementation.
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2 | Be it enacted by the People of the State of Illinois, | ||||||
3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Sections 5A-1, 5A-2, 5A-4, and 5A-12 as follows: | ||||||
6 | (305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1)
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7 | Sec. 5A-1. Definitions. As used in this Article, unless | ||||||
8 | the context requires
otherwise:
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9 | "Fund" means the Hospital Provider Fund.
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10 | "Hospital" means an institution, place, building, or | ||||||
11 | agency located in this
State that is subject to licensure by | ||||||
12 | the Illinois Department of Public Health
under the Hospital | ||||||
13 | Licensing Act, whether public or private and whether
organized | ||||||
14 | for profit or not-for-profit.
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15 | "Hospital provider" means a person licensed by the | ||||||
16 | Department of Public
Health to conduct, operate, or maintain a | ||||||
17 | hospital, regardless of whether the
person is a Medicaid | ||||||
18 | provider. For purposes of this paragraph, "person" means
any | ||||||
19 | political subdivision of the State, municipal corporation, | ||||||
20 | individual,
firm, partnership, corporation, company, limited | ||||||
21 | liability company,
association, joint stock association, or | ||||||
22 | trust, or a receiver, executor,
trustee, guardian, or other | ||||||
23 | representative appointed by order of any court.
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24 | "Occupied bed days" means the sum of the number of days
| ||||||
25 | that each bed was occupied by a patient for all beds during
| ||||||
26 | calendar year 2001. Occupied bed days shall be computed | ||||||
27 | separately for each
hospital operated or maintained by a | ||||||
28 | hospital provider. | ||||||
29 | "Proration factor" means a fraction, the numerator of which | ||||||
30 | is 53 and the denominator of which is 365.
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31 | (Source: P.A. 93-659, eff. 2-3-04.)
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1 | (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | ||||||
2 | (Section scheduled to be repealed on July 1, 2005) | ||||||
3 | Sec. 5A-2. Assessment; no local authorization to tax.
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4 | (a) Subject to Sections 5A-3 and 5A-10, an annual | ||||||
5 | assessment on inpatient
services is imposed on
each
hospital
| ||||||
6 | provider in an amount equal to the hospital's occupied bed days | ||||||
7 | multiplied by $84.19 multiplied by the proration factor for | ||||||
8 | State fiscal year
years 2004 and the hospital's occupied bed | ||||||
9 | days multiplied by $84.19 for State fiscal year 2005 . , if the | ||||||
10 | payment methodologies required under 5A-12 and the waiver | ||||||
11 | granted under 42 CFR 433.68 are approved with an effective date | ||||||
12 | prior to July 1, 2004; or the assessment will be imposed for | ||||||
13 | fiscal year 2005 only, if the payment methodologies required | ||||||
14 | under Section 5A-12 and the waiver granted under 42 CFR 433.68 | ||||||
15 | are approved with an effective date on or after July 1, 2004.
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16 | The
Department of Public Aid shall use the number of | ||||||
17 | occupied bed days as reported
by
each hospital on the Annual | ||||||
18 | Survey of Hospitals conducted by the
Department of Public | ||||||
19 | Health to calculate the hospital's annual assessment. If
the | ||||||
20 | sum
of a hospital's occupied bed days is not reported on the | ||||||
21 | Annual Survey of
Hospitals or if there are data errors in the | ||||||
22 | reported sum of a hospital's occupied bed days as determined by | ||||||
23 | the Department of Public Aid, then the Department of Public Aid | ||||||
24 | may obtain the sum of occupied bed
days
from any source | ||||||
25 | available, including, but not limited to, records maintained by
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26 | the hospital provider, which may be inspected at all times | ||||||
27 | during business
hours
of the day by the Department of Public | ||||||
28 | Aid or its duly authorized agents and
employees.
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29 | (b) Nothing in this amendatory Act of the 93rd General | ||||||
30 | Assembly
shall be construed to authorize
any home rule unit or | ||||||
31 | other unit of local government to license for revenue or
to | ||||||
32 | impose a tax or assessment upon hospital providers or the | ||||||
33 | occupation of
hospital provider, or a tax or assessment | ||||||
34 | measured by the income or earnings of
a hospital provider.
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35 | (c) As provided in Section 5A-14, this Section is repealed | ||||||
36 | on July 1,
2005.
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1 | (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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2 | (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) | ||||||
3 | Sec. 5A-4. Payment of assessment; penalty.
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4 | (a) The annual assessment imposed by Section 5A-2 for State | ||||||
5 | fiscal year
2004
shall be due
and payable on June 18 of
the
| ||||||
6 | year.
The assessment imposed by Section 5A-2 for State fiscal | ||||||
7 | year 2005
shall be
due and payable in quarterly installments, | ||||||
8 | each equalling one-fourth of the
assessment for the year, on | ||||||
9 | July 19, October 19, January 18, and April 19 of
the year.
No | ||||||
10 | installment payment of an assessment imposed by Section 5A-2 | ||||||
11 | shall be due
and
payable, however, until after: (i) the | ||||||
12 | hospital provider
receives written
notice from the Department | ||||||
13 | of Public Aid that the payment methodologies to
hospitals
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14 | required under
Section 5A-12 have been approved by the Centers | ||||||
15 | for Medicare and Medicaid
Services of
the U.S. Department of | ||||||
16 | Health and Human Services and the waiver under 42 CFR
433.68 | ||||||
17 | for the assessment imposed by Section 5A-2 has been granted by | ||||||
18 | the
Centers for Medicare and Medicaid Services of the U.S. | ||||||
19 | Department of Health and
Human Services; and (ii) the hospital
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20 | has
received the payments required under Section 5A-12.
Upon | ||||||
21 | notification to the Department of approval of the payment | ||||||
22 | methodologies required under Section 5A-12 and the waiver | ||||||
23 | granted under 42 CFR 433.68, all quarterly installments | ||||||
24 | otherwise due under Section 5A-2 prior to the date of | ||||||
25 | notification shall be due and payable to the Department upon | ||||||
26 | written direction from the Department
within 30 days of the | ||||||
27 | date of notification .
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28 | (b) The Illinois Department is authorized to establish
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29 | delayed payment schedules for hospital providers that are | ||||||
30 | unable
to make installment payments when due under this Section | ||||||
31 | due to
financial difficulties, as determined by the Illinois | ||||||
32 | Department.
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33 | (c) If a hospital provider fails to pay the full amount of
| ||||||
34 | an installment when due (including any extensions granted under
| ||||||
35 | subsection (b)), there shall, unless waived by the Illinois
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1 | Department for reasonable cause, be added to the assessment
| ||||||
2 | imposed by Section 5A-2 a penalty
assessment equal to the | ||||||
3 | lesser of (i) 5% of the amount of the
installment not paid on | ||||||
4 | or before the due date plus 5% of the
portion thereof remaining | ||||||
5 | unpaid on the last day of each 30-day period
thereafter or (ii) | ||||||
6 | 100% of the installment amount not paid on or
before the due | ||||||
7 | date. For purposes of this subsection, payments
will be | ||||||
8 | credited first to unpaid installment amounts (rather than
to | ||||||
9 | penalty or interest), beginning with the most delinquent
| ||||||
10 | installments.
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11 | (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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12 | (305 ILCS 5/5A-12)
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13 | (Section scheduled to be repealed on July 1, 2005) | ||||||
14 | Sec. 5A-12. Hospital access improvement payments.
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15 | (a) To improve access to hospital services, for hospital | ||||||
16 | services rendered
on or
after June 1, 2004, the Department of | ||||||
17 | Public Aid shall make
payments
to hospitals as set forth in | ||||||
18 | this Section, except for hospitals described in
subsection (b) | ||||||
19 | of
Section 5A-3.
These payments shall be paid on a quarterly | ||||||
20 | basis. For State fiscal year 2004, if the effective date of the | ||||||
21 | approval of the payment methodology required under this Section | ||||||
22 | and the waiver granted under 42 CFR 433.68 by the Centers for | ||||||
23 | Medicare and Medicaid Services of the U.S. Department of Health | ||||||
24 | and Human Services is prior to July 1, 2004,
the
Department | ||||||
25 | shall pay the total amounts required for fiscal year 2004 under | ||||||
26 | this Section within 75
25 days of the latest notification. No | ||||||
27 | payment shall be made for State fiscal year 2004 if the | ||||||
28 | effective date of the approval is on or after July 1, 2004.
In | ||||||
29 | State fiscal year 2005,
the total
amounts required under this | ||||||
30 | Section shall be paid in 4 equal installments on or
before
July | ||||||
31 | 15, October 15, January 14, and April 15
of the year, except | ||||||
32 | that if the date of notification of the approval of the payment | ||||||
33 | methodologies required under this Section and the waiver | ||||||
34 | granted under 42 CFR 433.68 is on or after July 1, 2004, the | ||||||
35 | sum of amounts required under this Section prior to the date of |
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1 | notification shall be paid within 75
25 days of the date of the | ||||||
2 | last notification. Payments under
this
Section are not due and | ||||||
3 | payable, however, until (i) the methodologies described
in
this
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4 | Section are approved by the federal government in an | ||||||
5 | appropriate State Plan
amendment,
(ii) the assessment imposed | ||||||
6 | under this Article is determined to be a
permissible tax under | ||||||
7 | Title XIX of the Social Security Act, and (iii) the
assessment | ||||||
8 | is in effect.
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9 | (b) High volume payment. In addition to rates paid for | ||||||
10 | inpatient hospital
services, the Department of Public Aid shall | ||||||
11 | pay, to each Illinois hospital
that provided
more than 20,000 | ||||||
12 | Medicaid inpatient days of care during State fiscal year 2001
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13 | (except
for hospitals
that qualify for adjustment payments | ||||||
14 | under Section 5-5.02 for the 12-month
period beginning on | ||||||
15 | October 1, 2002), $190 for each
Medicaid inpatient day
of care | ||||||
16 | provided during that fiscal year. A hospital that provided less | ||||||
17 | than
30,000 Medicaid inpatient days of
care during that period, | ||||||
18 | however, is not entitled to receive more than
$3,500,000 per | ||||||
19 | year
in such payments.
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20 | (c) Medicaid inpatient utilization rate adjustment. In | ||||||
21 | addition to rates
paid for
inpatient hospital services, the | ||||||
22 | Department of Public Aid shall pay each
Illinois hospital
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23 | (except for hospitals described in Section 5A-3), for each | ||||||
24 | Medicaid inpatient
day of
care provided
during State fiscal | ||||||
25 | year 2001, an amount equal to the product of $57.25
multiplied | ||||||
26 | by the
quotient of 1 divided by the greater of 1.6% or the | ||||||
27 | hospital's Medicaid
inpatient
utilization rate (as used to | ||||||
28 | determine eligibility for adjustment payments
under Section | ||||||
29 | 5-5.02 for the 12-month period beginning on October 1, 2002). | ||||||
30 | The
total payments under this
subsection to a
hospital may
not | ||||||
31 | exceed $10,500,000 annually.
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32 | (d) Psychiatric base rate adjustment.
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33 | (1) In addition to rates paid for
inpatient
psychiatric | ||||||
34 | services, the Department of Public Aid shall pay each | ||||||
35 | Illinois
general acute care hospital with a distinct | ||||||
36 | part-psychiatric unit, for
each Medicaid inpatient |
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1 | psychiatric day of care provided in State fiscal year
2001, | ||||||
2 | an
amount equal
to $400 less the hospital's per-diem rate | ||||||
3 | for Medicaid inpatient psychiatric
services as in effect on | ||||||
4 | October 1, 2003. In no
event, however, shall that amount be | ||||||
5 | less than zero.
| ||||||
6 | (2) For distinct
part-psychiatric units of Illinois
| ||||||
7 | general acute care hospitals, except for all hospitals | ||||||
8 | excluded in Section
5A-3,
whose inpatient per-diem rate as | ||||||
9 | in effect on
October 1, 2003 is greater than
$400, the
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10 | Department shall pay, in addition to any other amounts | ||||||
11 | authorized under this
Code, $25
for each Medicaid inpatient | ||||||
12 | psychiatric day of care provided in State fiscal
year 2001.
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13 | (e) Supplemental tertiary care adjustment. In addition to | ||||||
14 | rates paid for
inpatient
services, the Department of Public Aid | ||||||
15 | shall pay to each Illinois hospital
eligible for
tertiary care | ||||||
16 | adjustment payments under 89 Ill. Adm. Code 148.296, as in | ||||||
17 | effect
for State fiscal year
2003, a supplemental tertiary care | ||||||
18 | adjustment payment equal to
the tertiary
care adjustment | ||||||
19 | payment required under 89 Ill. Adm. Code 148.296, as in effect
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20 | for State fiscal year
2003.
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21 | (f) Medicaid outpatient utilization rate adjustment. In | ||||||
22 | addition to rates
paid for
outpatient hospital services, the | ||||||
23 | Department of Public Aid shall pay each
Illinois hospital
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24 | (except for hospitals described in Section 5A-3), an amount | ||||||
25 | equal to the
product of 2.45%
multiplied by the hospital's | ||||||
26 | Medicaid outpatient charges multiplied by the
quotient of 1
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27 | divided by the greater of 1.6% or the hospital's Medicaid | ||||||
28 | outpatient
utilization rate. The
total payments under this | ||||||
29 | subsection to a hospital may not exceed $6,750,000
annually.
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30 | For purposes of this subsection:
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31 | "Medicaid outpatient charges" means the charges for | ||||||
32 | outpatient services
provided to Medicaid patients for State | ||||||
33 | fiscal year 2001 as submitted by the
hospital on the UB-92 | ||||||
34 | billing form or under the ambulatory procedure listing
and
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35 | adjudicated by the Department of Public Aid on or before | ||||||
36 | September 12, 2003.
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1 | "Medicaid outpatient utilization rate" means a fraction, | ||||||
2 | the numerator of
which is the hospital's Medicaid outpatient | ||||||
3 | charges and the denominator of
which
is the total number of the | ||||||
4 | hospital's charges for outpatient services for the
hospital's | ||||||
5 | fiscal year ending in 2001.
| ||||||
6 | (g) State outpatient service adjustment. In addition to | ||||||
7 | rates paid for
outpatient
hospital services, the Department of | ||||||
8 | Public Aid shall pay each Illinois
hospital an amount
equal to | ||||||
9 | the product of 75.5% multiplied by the hospital's Medicaid | ||||||
10 | outpatient
services
submitted to
the Department on the UB-92 | ||||||
11 | billing form for State fiscal year 2001 multiplied
by the
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12 | hospital's outpatient access fraction.
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13 | For purposes of this subsection,
"outpatient access
| ||||||
14 | fraction" means a fraction, the numerator of which is the | ||||||
15 | hospital's Medicaid
payments
for outpatient services for | ||||||
16 | ambulatory procedure listing services submitted to
the | ||||||
17 | Department on the UB-92 billing form
for State
fiscal year | ||||||
18 | 2001, and the denominator of which is the hospital's Medicaid
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19 | outpatient
services submitted to the Department on the UB-92 | ||||||
20 | billing form for State fiscal
year
2001.
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21 | The total payments under this subsection to a hospital may | ||||||
22 | not exceed
$3,000,000
annually.
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23 | (h) Rural hospital outpatient adjustment. In addition to | ||||||
24 | rates paid for
outpatient
hospital services, the Department of | ||||||
25 | Public Aid shall pay each Illinois rural
hospital an
amount | ||||||
26 | equal to the product of $14,500,000 multiplied by the rural | ||||||
27 | hospital
outpatient
adjustment fraction.
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28 | For purposes of this subsection, "rural hospital
| ||||||
29 | outpatient
adjustment fraction" means a fraction, the | ||||||
30 | numerator of which is the hospital's
Medicaid
visits for | ||||||
31 | outpatient services for
ambulatory procedure listing services
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32 | submitted to the Department on the UB-92 billing
form for
State | ||||||
33 | fiscal year 2001, and the denominator of which is the total | ||||||
34 | Medicaid
visits for
outpatient services for ambulatory | ||||||
35 | procedure listing services for all Illinois
rural hospitals | ||||||
36 | submitted to the
Department on the UB-92 billing form for State |
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1 | fiscal year 2001.
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2 | For purposes
of this subsection, "rural
hospital" has the | ||||||
3 | same meaning as in 89 Ill. Adm. Code 148.25, as in effect on
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4 | September
30, 2003.
| ||||||
5 | (i) Merged/closed hospital adjustment. If any hospital | ||||||
6 | files a
combined Medicaid cost report with another hospital | ||||||
7 | after January 1, 2001, and
if
that hospital subsequently | ||||||
8 | closes, then except for the payments
described in
subsection | ||||||
9 | (e), all payments described in the various subsections of this
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10 | Section shall, before the application of the annual limitation | ||||||
11 | amount specified
in each such subsection, be multiplied by a | ||||||
12 | fraction, the numerator of which is
the number
of occupied bed | ||||||
13 | days attributable to the open hospital and the denominator of
| ||||||
14 | which is the sum of the number of occupied bed days of each | ||||||
15 | open hospital and
each
closed hospital. For purposes of this | ||||||
16 | subsection, "occupied bed
days" has the same meaning as the | ||||||
17 | term is defined in subsection (a) of
Section 5A-2.
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18 | (j) For purposes of this Section, the terms "Medicaid | ||||||
19 | days", "Medicaid
charges", and "Medicaid services" do not | ||||||
20 | include any days, charges, or services
for which Medicare was | ||||||
21 | liable for payment.
| ||||||
22 | (j-5) For State fiscal year 2004, all payments described in | ||||||
23 | this Section shall be multiplied by the proration factor.
| ||||||
24 | (k) As provided in Section 5A-14, this Section is repealed | ||||||
25 | on July 1,
2005.
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26 | (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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27 | Section 99. Effective date. This Act takes effect upon | ||||||
28 | becoming law.
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