100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB1436

 

Introduced , by Rep. Michael J. Madigan

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.02  from Ch. 23, par. 5-5.02

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning Medicaid rates for hospitals.


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A BILL FOR

 

HB1436LRB100 03146 KTG 13151 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing 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
9September 30, 1992. Notwithstanding any other provisions of
10this Code or the the Illinois Department's Rules promulgated
11under the Illinois Administrative Procedure Act, reimbursement
12to hospitals for services provided during the period July 1,
131992 through September 30, 1992, shall be as follows:
14        (1) For inpatient hospital services rendered, or if
15    applicable, for inpatient hospital discharges occurring,
16    on or after July 1, 1992 and on or before September 30,
17    1992, the Illinois Department shall reimburse hospitals
18    for inpatient services under the reimbursement
19    methodologies in effect for each hospital, and at the
20    inpatient payment rate calculated for each hospital, as of
21    June 30, 1992. For purposes of this paragraph,
22    "reimbursement methodologies" means all reimbursement
23    methodologies that pertain to the provision of inpatient

 

 

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1    hospital services, including, but not limited to, any
2    adjustments for disproportionate share, targeted access,
3    critical care access and uncompensated care, as defined by
4    the Illinois Department on June 30, 1992.
5        (2) For the purpose of calculating the inpatient
6    payment rate for each hospital eligible to receive
7    quarterly adjustment payments for targeted access and
8    critical care, as defined by the Illinois Department on
9    June 30, 1992, the adjustment payment for the period July
10    1, 1992 through September 30, 1992, shall be 25% of the
11    annual adjustment payments calculated for each eligible
12    hospital, as of June 30, 1992. The Illinois Department
13    shall determine by rule the adjustment payments for
14    targeted access and critical care beginning October 1,
15    1992.
16        (3) For the purpose of calculating the inpatient
17    payment rate for each hospital eligible to receive
18    quarterly adjustment payments for uncompensated care, as
19    defined by the Illinois Department on June 30, 1992, the
20    adjustment payment for the period August 1, 1992 through
21    September 30, 1992, shall be one-sixth of the total
22    uncompensated care adjustment payments calculated for each
23    eligible hospital for the uncompensated care rate year, as
24    defined by the Illinois Department, ending on July 31,
25    1992. The Illinois Department shall determine by rule the
26    adjustment payments for uncompensated care beginning

 

 

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1    October 1, 1992.
2    (b) Inpatient payments. For inpatient services provided on
3or after October 1, 1993, in addition to rates paid for
4hospital inpatient services pursuant to the Illinois Health
5Finance Reform Act, as now or hereafter amended, or the
6Illinois Department's prospective reimbursement methodology,
7or any other methodology used by the Illinois Department for
8inpatient services, the Illinois Department shall make
9adjustment payments, in an amount calculated pursuant to the
10methodology described in paragraph (c) of this Section, to
11hospitals that the Illinois Department determines satisfy any
12one of the following requirements:
13        (1) Hospitals that are described in Section 1923 of the
14    federal Social Security Act, as now or hereafter amended,
15    except that for rate year 2015 and after a hospital
16    described in Section 1923(b)(1)(B) of the federal Social
17    Security Act and qualified for the payments described in
18    subsection (c) of this Section for rate year 2014 provided
19    the hospital continues to meet the description in Section
20    1923(b)(1)(B) in the current determination year; or
21        (2) Illinois hospitals that have a Medicaid inpatient
22    utilization rate which is at least one-half a standard
23    deviation above the mean Medicaid inpatient utilization
24    rate for all hospitals in Illinois receiving Medicaid
25    payments from the Illinois Department; or
26        (3) Illinois hospitals that on July 1, 1991 had a

 

 

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1    Medicaid inpatient utilization rate, as defined in
2    paragraph (h) of this Section, that was at least the mean
3    Medicaid inpatient utilization rate for all hospitals in
4    Illinois receiving Medicaid payments from the Illinois
5    Department and which were located in a planning area with
6    one-third or fewer excess beds as determined by the Health
7    Facilities and Services Review Board, and that, as of June
8    30, 1992, were located in a federally designated Health
9    Manpower Shortage Area; or
10        (4) Illinois hospitals that:
11            (A) have a Medicaid inpatient utilization rate
12        that is at least equal to the mean Medicaid inpatient
13        utilization rate for all hospitals in Illinois
14        receiving Medicaid payments from the Department; and
15            (B) also have a Medicaid obstetrical inpatient
16        utilization rate that is at least one standard
17        deviation above the mean Medicaid obstetrical
18        inpatient utilization rate for all hospitals in
19        Illinois receiving Medicaid payments from the
20        Department for obstetrical services; or
21        (5) Any children's hospital, which means a hospital
22    devoted exclusively to caring for children. A hospital
23    which includes a facility devoted exclusively to caring for
24    children shall be considered a children's hospital to the
25    degree that the hospital's Medicaid care is provided to
26    children if either (i) the facility devoted exclusively to

 

 

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1    caring for children is separately licensed as a hospital by
2    a municipality prior to February 28, 2013 or (ii) the
3    hospital has been designated by the State as a Level III
4    perinatal care facility, has a Medicaid Inpatient
5    Utilization rate greater than 55% for the rate year 2003
6    disproportionate share determination, and has more than
7    10,000 qualified children days as defined by the Department
8    in rulemaking.
9    (c) Inpatient adjustment payments. The adjustment payments
10required by paragraph (b) shall be calculated based upon the
11hospital's Medicaid inpatient utilization rate as follows:
12        (1) hospitals with a Medicaid inpatient utilization
13    rate below the mean shall receive a per day adjustment
14    payment equal to $25;
15        (2) hospitals with a Medicaid inpatient utilization
16    rate that is equal to or greater than the mean Medicaid
17    inpatient utilization rate but less than one standard
18    deviation above the mean Medicaid inpatient utilization
19    rate shall receive a per day adjustment payment equal to
20    the sum of $25 plus $1 for each one percent that the
21    hospital's Medicaid inpatient utilization rate exceeds the
22    mean Medicaid inpatient utilization rate;
23        (3) hospitals with a Medicaid inpatient utilization
24    rate that is equal to or greater than one standard
25    deviation above the mean Medicaid inpatient utilization
26    rate but less than 1.5 standard deviations above the mean

 

 

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1    Medicaid inpatient utilization rate shall receive a per day
2    adjustment payment equal to the sum of $40 plus $7 for each
3    one percent that the hospital's Medicaid inpatient
4    utilization rate exceeds one standard deviation above the
5    mean Medicaid inpatient utilization rate; and
6        (4) hospitals with a Medicaid inpatient utilization
7    rate that is equal to or greater than 1.5 standard
8    deviations above the mean Medicaid inpatient utilization
9    rate shall receive a per day adjustment payment equal to
10    the sum of $90 plus $2 for each one percent that the
11    hospital's Medicaid inpatient utilization rate exceeds 1.5
12    standard deviations above the mean Medicaid inpatient
13    utilization rate.
14    (d) Supplemental adjustment payments. In addition to the
15adjustment payments described in paragraph (c), hospitals as
16defined in clauses (1) through (5) of paragraph (b), excluding
17county hospitals (as defined in subsection (c) of Section 15-1
18of this Code) and a hospital organized under the University of
19Illinois Hospital Act, shall be paid supplemental inpatient
20adjustment payments of $60 per day. For purposes of Title XIX
21of the federal Social Security Act, these supplemental
22adjustment payments shall not be classified as adjustment
23payments to disproportionate share hospitals.
24    (e) The inpatient adjustment payments described in
25paragraphs (c) and (d) shall be increased on October 1, 1993
26and annually thereafter by a percentage equal to the lesser of

 

 

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1(i) the increase in the DRI hospital cost index for the most
2recent 12 month period for which data are available, or (ii)
3the percentage increase in the statewide average hospital
4payment rate over the previous year's statewide average
5hospital payment rate. The sum of the inpatient adjustment
6payments under paragraphs (c) and (d) to a hospital, other than
7a county hospital (as defined in subsection (c) of Section 15-1
8of this Code) or a hospital organized under the University of
9Illinois Hospital Act, however, shall not exceed $275 per day;
10that limit shall be increased on October 1, 1993 and annually
11thereafter by a percentage equal to the lesser of (i) the
12increase in the DRI hospital cost index for the most recent
1312-month period for which data are available or (ii) the
14percentage increase in the statewide average hospital payment
15rate over the previous year's statewide average hospital
16payment rate.
17    (f) Children's hospital inpatient adjustment payments. For
18children's hospitals, as defined in clause (5) of paragraph
19(b), the adjustment payments required pursuant to paragraphs
20(c) and (d) shall be multiplied by 2.0.
21    (g) County hospital inpatient adjustment payments. For
22county hospitals, as defined in subsection (c) of Section 15-1
23of this Code, there shall be an adjustment payment as
24determined by rules issued by the Illinois Department.
25    (h) For the purposes of this Section the following terms
26shall be defined as follows:

 

 

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1        (1) "Medicaid inpatient utilization rate" means a
2    fraction, the numerator of which is the number of a
3    hospital's inpatient days provided in a given 12-month
4    period to patients who, for such days, were eligible for
5    Medicaid under Title XIX of the federal Social Security
6    Act, and the denominator of which is the total number of
7    the hospital's inpatient days in that same period.
8        (2) "Mean Medicaid inpatient utilization rate" means
9    the total number of Medicaid inpatient days provided by all
10    Illinois Medicaid-participating hospitals divided by the
11    total number of inpatient days provided by those same
12    hospitals.
13        (3) "Medicaid obstetrical inpatient utilization rate"
14    means the ratio of Medicaid obstetrical inpatient days to
15    total Medicaid inpatient days for all Illinois hospitals
16    receiving Medicaid payments from the Illinois Department.
17    (i) Inpatient adjustment payment limit. In order to meet
18the limits of Public Law 102-234 and Public Law 103-66, the
19Illinois Department shall by rule adjust disproportionate
20share adjustment payments.
21    (j) University of Illinois Hospital inpatient adjustment
22payments. For hospitals organized under the University of
23Illinois Hospital Act, there shall be an adjustment payment as
24determined by rules adopted by the Illinois Department.
25    (k) The Illinois Department may by rule establish criteria
26for and develop methodologies for adjustment payments to

 

 

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1hospitals participating under this Article.
2    (l) On and after July 1, 2012, the Department shall reduce
3any rate of reimbursement for services or other payments or
4alter any methodologies authorized by this Code to reduce any
5rate of reimbursement for services or other payments in
6accordance with Section 5-5e.
7(Source: P.A. 97-689, eff. 6-14-12; 98-104, eff. 7-22-13.)