101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB2553

 

Introduced 1/29/2020, by Sen. Heather A. Steans

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5A-2  from Ch. 23, par. 5A-2

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning an assessment on inpatient services that is imposed on hospital providers.


LRB101 18760 KTG 68215 b

 

 

A BILL FOR

 

SB2553LRB101 18760 KTG 68215 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 5A-2 as follows:
 
6    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
7    (Section scheduled to be repealed on July 1, 2020)
8    Sec. 5A-2. Assessment.
9    (a)(1) Subject to Sections 5A-3 and and 5A-10, for State
10fiscal years 2009 through 2018, or as long as continued under
11Section 5A-16, an annual assessment on inpatient services is
12imposed on each hospital provider in an amount equal to $218.38
13multiplied by the difference of the hospital's occupied bed
14days less the hospital's Medicare bed days, provided, however,
15that the amount of $218.38 shall be increased by a uniform
16percentage to generate an amount equal to 75% of the State
17share of the payments authorized under Section 5A-12.5, with
18such increase only taking effect upon the date that a State
19share for such payments is required under federal law. For the
20period of April through June 2015, the amount of $218.38 used
21to calculate the assessment under this paragraph shall, by
22emergency rule under subsection (s) of Section 5-45 of the
23Illinois Administrative Procedure Act, be increased by a

 

 

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1uniform percentage to generate $20,250,000 in the aggregate for
2that period from all hospitals subject to the annual assessment
3under this paragraph.
4    (2) In addition to any other assessments imposed under this
5Article, effective July 1, 2016 and semi-annually thereafter
6through June 2018, or as provided in Section 5A-16, in addition
7to any federally required State share as authorized under
8paragraph (1), the amount of $218.38 shall be increased by a
9uniform percentage to generate an amount equal to 75% of the
10ACA Assessment Adjustment, as defined in subsection (b-6) of
11this Section.
12    For State fiscal years 2009 through 2018, or as provided in
13Section 5A-16, a hospital's occupied bed days and Medicare bed
14days shall be determined using the most recent data available
15from each hospital's 2005 Medicare cost report as contained in
16the Healthcare Cost Report Information System file, for the
17quarter ending on December 31, 2006, without regard to any
18subsequent adjustments or changes to such data. If a hospital's
192005 Medicare cost report is not contained in the Healthcare
20Cost Report Information System, then the Illinois Department
21may obtain the hospital provider's occupied bed days and
22Medicare bed days from any source available, including, but not
23limited to, records maintained by the hospital provider, which
24may be inspected at all times during business hours of the day
25by the Illinois Department or its duly authorized agents and
26employees.

 

 

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1    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
2fiscal years 2019 and 2020, an annual assessment on inpatient
3services is imposed on each hospital provider in an amount
4equal to $197.19 multiplied by the difference of the hospital's
5occupied bed days less the hospital's Medicare bed days;
6however, for State fiscal year 2021, the amount of $197.19
7shall be increased by a uniform percentage to generate an
8additional $6,250,000 in the aggregate for that period from all
9hospitals subject to the annual assessment under this
10paragraph. For State fiscal years 2019 and 2020, a hospital's
11occupied bed days and Medicare bed days shall be determined
12using the most recent data available from each hospital's 2015
13Medicare cost report as contained in the Healthcare Cost Report
14Information System file, for the quarter ending on March 31,
152017, without regard to any subsequent adjustments or changes
16to such data. If a hospital's 2015 Medicare cost report is not
17contained in the Healthcare Cost Report Information System,
18then the Illinois Department may obtain the hospital provider's
19occupied bed days and Medicare bed days from any source
20available, including, but not limited to, records maintained by
21the hospital provider, which may be inspected at all times
22during business hours of the day by the Illinois Department or
23its duly authorized agents and employees. Notwithstanding any
24other provision in this Article, for a hospital provider that
25did not have a 2015 Medicare cost report, but paid an
26assessment in State fiscal year 2018 on the basis of

 

 

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1hypothetical data, that assessment amount shall be used for
2State fiscal years 2019 and 2020; however, for State fiscal
3year 2021, the assessment amount shall be increased by the
4proportion that it represents of the total annual assessment
5that is generated from all hospitals in order to generate
6$6,250,000 in the aggregate for that period from all hospitals
7subject to the annual assessment under this paragraph.
8    Subject to Sections 5A-3 and 5A-10, for State fiscal years
92021 through 2024, an annual assessment on inpatient services
10is imposed on each hospital provider in an amount equal to
11$197.19 multiplied by the difference of the hospital's occupied
12bed days less the hospital's Medicare bed days, provided
13however, that the amount of $197.19 used to calculate the
14assessment under this paragraph shall, by rule, be adjusted by
15a uniform percentage to generate the same total annual
16assessment that was generated in State fiscal year 2020 from
17all hospitals subject to the annual assessment under this
18paragraph plus $6,250,000. For State fiscal years 2021 and
192022, a hospital's occupied bed days and Medicare bed days
20shall be determined using the most recent data available from
21each hospital's 2017 Medicare cost report as contained in the
22Healthcare Cost Report Information System file, for the quarter
23ending on March 31, 2019, without regard to any subsequent
24adjustments or changes to such data. For State fiscal years
252023 and 2024, a hospital's occupied bed days and Medicare bed
26days shall be determined using the most recent data available

 

 

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1from each hospital's 2019 Medicare cost report as contained in
2the Healthcare Cost Report Information System file, for the
3quarter ending on March 31, 2021, without regard to any
4subsequent adjustments or changes to such data.
5    (b) (Blank).
6    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
7portion of State fiscal year 2012, beginning June 10, 2012
8through June 30, 2012, and for State fiscal years 2013 through
92018, or as provided in Section 5A-16, an annual assessment on
10outpatient services is imposed on each hospital provider in an
11amount equal to .008766 multiplied by the hospital's outpatient
12gross revenue, provided, however, that the amount of .008766
13shall be increased by a uniform percentage to generate an
14amount equal to 25% of the State share of the payments
15authorized under Section 5A-12.5, with such increase only
16taking effect upon the date that a State share for such
17payments is required under federal law. For the period
18beginning June 10, 2012 through June 30, 2012, the annual
19assessment on outpatient services shall be prorated by
20multiplying the assessment amount by a fraction, the numerator
21of which is 21 days and the denominator of which is 365 days.
22For the period of April through June 2015, the amount of
23.008766 used to calculate the assessment under this paragraph
24shall, by emergency rule under subsection (s) of Section 5-45
25of the Illinois Administrative Procedure Act, be increased by a
26uniform percentage to generate $6,750,000 in the aggregate for

 

 

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1that period from all hospitals subject to the annual assessment
2under this paragraph.
3    (2) In addition to any other assessments imposed under this
4Article, effective July 1, 2016 and semi-annually thereafter
5through June 2018, in addition to any federally required State
6share as authorized under paragraph (1), the amount of .008766
7shall be increased by a uniform percentage to generate an
8amount equal to 25% of the ACA Assessment Adjustment, as
9defined in subsection (b-6) of this Section.
10    For the portion of State fiscal year 2012, beginning June
1110, 2012 through June 30, 2012, and State fiscal years 2013
12through 2018, or as provided in Section 5A-16, a hospital's
13outpatient gross revenue shall be determined using the most
14recent data available from each hospital's 2009 Medicare cost
15report as contained in the Healthcare Cost Report Information
16System file, for the quarter ending on June 30, 2011, without
17regard to any subsequent adjustments or changes to such data.
18If a hospital's 2009 Medicare cost report is not contained in
19the Healthcare Cost Report Information System, then the
20Department may obtain the hospital provider's outpatient gross
21revenue from any source available, including, but not limited
22to, records maintained by the hospital provider, which may be
23inspected at all times during business hours of the day by the
24Department or its duly authorized agents and employees.
25    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
26fiscal years 2019 and 2020, an annual assessment on outpatient

 

 

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1services is imposed on each hospital provider in an amount
2equal to .01358 multiplied by the hospital's outpatient gross
3revenue; however, for State fiscal year 2021, the amount of
4.01358 shall be increased by a uniform percentage to generate
5an additional $6,250,000 in the aggregate for that period from
6all hospitals subject to the annual assessment under this
7paragraph. For State fiscal years 2019 and 2020, a hospital's
8outpatient gross revenue shall be determined using the most
9recent data available from each hospital's 2015 Medicare cost
10report as contained in the Healthcare Cost Report Information
11System file, for the quarter ending on March 31, 2017, without
12regard to any subsequent adjustments or changes to such data.
13If a hospital's 2015 Medicare cost report is not contained in
14the Healthcare Cost Report Information System, then the
15Department may obtain the hospital provider's outpatient gross
16revenue from any source available, including, but not limited
17to, records maintained by the hospital provider, which may be
18inspected at all times during business hours of the day by the
19Department or its duly authorized agents and employees.
20Notwithstanding any other provision in this Article, for a
21hospital provider that did not have a 2015 Medicare cost
22report, but paid an assessment in State fiscal year 2018 on the
23basis of hypothetical data, that assessment amount shall be
24used for State fiscal years 2019 and 2020; however, for State
25fiscal year 2021, the assessment amount shall be increased by
26the proportion that it represents of the total annual

 

 

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1assessment that is generated from all hospitals in order to
2generate $6,250,000 in the aggregate for that period from all
3hospitals subject to the annual assessment under this
4paragraph.
5    Subject to Sections 5A-3 and 5A-10, for State fiscal years
62021 through 2024, an annual assessment on outpatient services
7is imposed on each hospital provider in an amount equal to
8.01358 multiplied by the hospital's outpatient gross revenue,
9provided however, that the amount of .01358 used to calculate
10the assessment under this paragraph shall, by rule, be adjusted
11by a uniform percentage to generate the same total annual
12assessment that was generated in State fiscal year 2020 from
13all hospitals subject to the annual assessment under this
14paragraph plus $6,250,000. For State fiscal years 2021 and
152022, a hospital's outpatient gross revenue shall be determined
16using the most recent data available from each hospital's 2017
17Medicare cost report as contained in the Healthcare Cost Report
18Information System file, for the quarter ending on March 31,
192019, without regard to any subsequent adjustments or changes
20to such data. For State fiscal years 2023 and 2024, a
21hospital's outpatient gross revenue shall be determined using
22the most recent data available from each hospital's 2019
23Medicare cost report as contained in the Healthcare Cost Report
24Information System file, for the quarter ending on March 31,
252021, without regard to any subsequent adjustments or changes
26to such data.

 

 

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1    (b-6)(1) As used in this Section, "ACA Assessment
2Adjustment" means:
3        (A) For the period of July 1, 2016 through December 31,
4    2016, the product of .19125 multiplied by the sum of the
5    fee-for-service payments to hospitals as authorized under
6    Section 5A-12.5 and the adjustments authorized under
7    subsection (t) of Section 5A-12.2 to managed care
8    organizations for hospital services due and payable in the
9    month of April 2016 multiplied by 6.
10        (B) For the period of January 1, 2017 through June 30,
11    2017, the product of .19125 multiplied by the sum of the
12    fee-for-service payments to hospitals as authorized under
13    Section 5A-12.5 and the adjustments authorized under
14    subsection (t) of Section 5A-12.2 to managed care
15    organizations for hospital services due and payable in the
16    month of October 2016 multiplied by 6, except that the
17    amount calculated under this subparagraph (B) shall be
18    adjusted, either positively or negatively, to account for
19    the difference between the actual payments issued under
20    Section 5A-12.5 for the period beginning July 1, 2016
21    through December 31, 2016 and the estimated payments due
22    and payable in the month of April 2016 multiplied by 6 as
23    described in subparagraph (A).
24        (C) For the period of July 1, 2017 through December 31,
25    2017, the product of .19125 multiplied by the sum of the
26    fee-for-service payments to hospitals as authorized under

 

 

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1    Section 5A-12.5 and the adjustments authorized under
2    subsection (t) of Section 5A-12.2 to managed care
3    organizations for hospital services due and payable in the
4    month of April 2017 multiplied by 6, except that the amount
5    calculated under this subparagraph (C) shall be adjusted,
6    either positively or negatively, to account for the
7    difference between the actual payments issued under
8    Section 5A-12.5 for the period beginning January 1, 2017
9    through June 30, 2017 and the estimated payments due and
10    payable in the month of October 2016 multiplied by 6 as
11    described in subparagraph (B).
12        (D) For the period of January 1, 2018 through June 30,
13    2018, the product of .19125 multiplied by the sum of the
14    fee-for-service payments to hospitals as authorized under
15    Section 5A-12.5 and the adjustments authorized under
16    subsection (t) of Section 5A-12.2 to managed care
17    organizations for hospital services due and payable in the
18    month of October 2017 multiplied by 6, except that:
19            (i) the amount calculated under this subparagraph
20        (D) shall be adjusted, either positively or
21        negatively, to account for the difference between the
22        actual payments issued under Section 5A-12.5 for the
23        period of July 1, 2017 through December 31, 2017 and
24        the estimated payments due and payable in the month of
25        April 2017 multiplied by 6 as described in subparagraph
26        (C); and

 

 

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1            (ii) the amount calculated under this subparagraph
2        (D) shall be adjusted to include the product of .19125
3        multiplied by the sum of the fee-for-service payments,
4        if any, estimated to be paid to hospitals under
5        subsection (b) of Section 5A-12.5.
6    (2) The Department shall complete and apply a final
7reconciliation of the ACA Assessment Adjustment prior to June
830, 2018 to account for:
9        (A) any differences between the actual payments issued
10    or scheduled to be issued prior to June 30, 2018 as
11    authorized in Section 5A-12.5 for the period of January 1,
12    2018 through June 30, 2018 and the estimated payments due
13    and payable in the month of October 2017 multiplied by 6 as
14    described in subparagraph (D); and
15        (B) any difference between the estimated
16    fee-for-service payments under subsection (b) of Section
17    5A-12.5 and the amount of such payments that are actually
18    scheduled to be paid.
19    The Department shall notify hospitals of any additional
20amounts owed or reduction credits to be applied to the June
212018 ACA Assessment Adjustment. This is to be considered the
22final reconciliation for the ACA Assessment Adjustment.
23    (3) Notwithstanding any other provision of this Section, if
24for any reason the scheduled payments under subsection (b) of
25Section 5A-12.5 are not issued in full by the final day of the
26period authorized under subsection (b) of Section 5A-12.5,

 

 

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1funds collected from each hospital pursuant to subparagraph (D)
2of paragraph (1) and pursuant to paragraph (2), attributable to
3the scheduled payments authorized under subsection (b) of
4Section 5A-12.5 that are not issued in full by the final day of
5the period attributable to each payment authorized under
6subsection (b) of Section 5A-12.5, shall be refunded.
7    (4) The increases authorized under paragraph (2) of
8subsection (a) and paragraph (2) of subsection (b-5) shall be
9limited to the federally required State share of the total
10payments authorized under Section 5A-12.5 if the sum of such
11payments yields an annualized amount equal to or less than
12$450,000,000, or if the adjustments authorized under
13subsection (t) of Section 5A-12.2 are found not to be
14actuarially sound; however, this limitation shall not apply to
15the fee-for-service payments described in subsection (b) of
16Section 5A-12.5.
17    (c) (Blank).
18    (d) Notwithstanding any of the other provisions of this
19Section, the Department is authorized to adopt rules to reduce
20the rate of any annual assessment imposed under this Section,
21as authorized by Section 5-46.2 of the Illinois Administrative
22Procedure Act.
23    (e) Notwithstanding any other provision of this Section,
24any plan providing for an assessment on a hospital provider as
25a permissible tax under Title XIX of the federal Social
26Security Act and Medicaid-eligible payments to hospital

 

 

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1providers from the revenues derived from that assessment shall
2be reviewed by the Illinois Department of Healthcare and Family
3Services, as the Single State Medicaid Agency required by
4federal law, to determine whether those assessments and
5hospital provider payments meet federal Medicaid standards. If
6the Department determines that the elements of the plan may
7meet federal Medicaid standards and a related State Medicaid
8Plan Amendment is prepared in a manner and form suitable for
9submission, that State Plan Amendment shall be submitted in a
10timely manner for review by the Centers for Medicare and
11Medicaid Services of the United States Department of Health and
12Human Services and subject to approval by the Centers for
13Medicare and Medicaid Services of the United States Department
14of Health and Human Services. No such plan shall become
15effective without approval by the Illinois General Assembly by
16the enactment into law of related legislation. Notwithstanding
17any other provision of this Section, the Department is
18authorized to adopt rules to reduce the rate of any annual
19assessment imposed under this Section. Any such rules may be
20adopted by the Department under Section 5-50 of the Illinois
21Administrative Procedure Act.
22(Source: P.A. 100-581, eff. 3-12-18; 101-10, eff. 6-5-19.)