Rep. Barbara Flynn Currie

Filed: 5/29/2008

 

 


 

 


 
09500SB2857ham001 LRB095 19231 DRJ 51509 a

1
AMENDMENT TO SENATE BILL 2857

2     AMENDMENT NO. ______. Amend Senate Bill 2857 by replacing
3 everything after the enacting clause with the following:
 
4     "Section 5. The Illinois Administrative Procedure Act is
5 amended by changing Section 5-50 as follows:
 
6     (5 ILCS 100/5-50)  (from Ch. 127, par. 1005-50)
7     Sec. 5-50. Peremptory rulemaking. "Peremptory rulemaking"
8 means any rulemaking that is required as a result of federal
9 law, federal rules and regulations, an order of a court, or a
10 collective bargaining agreement pursuant to subsection (d) of
11 Section 1-5, under conditions that preclude compliance with the
12 general rulemaking requirements imposed by Section 5-40 and
13 that preclude the exercise of discretion by the agency as to
14 the content of the rule it is required to adopt. Peremptory
15 rulemaking shall not be used to implement consent orders or
16 other court orders adopting settlements negotiated by the

 

 

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1 agency. If any agency finds that peremptory rulemaking is
2 necessary and states in writing its reasons for that finding,
3 the agency may adopt peremptory rulemaking upon filing a notice
4 of rulemaking with the Secretary of State under Section 5-70.
5 The notice shall be published in the Illinois Register. A rule
6 adopted under the peremptory rulemaking provisions of this
7 Section becomes effective immediately upon filing with the
8 Secretary of State and in the agency's principal office, or at
9 a date required or authorized by the relevant federal law,
10 federal rules and regulations, or court order, as stated in the
11 notice of rulemaking. Notice of rulemaking under this Section
12 shall be published in the Illinois Register, shall specifically
13 refer to the appropriate State or federal court order or
14 federal law, rules, and regulations, and shall be in a form as
15 the Secretary of State may reasonably prescribe by rule. The
16 agency shall file the notice of peremptory rulemaking within 30
17 days after a change in rules is required.
18     The Department of Healthcare and Family Services may adopt
19 peremptory rulemaking under the terms and conditions of this
20 Section to implement final payments included in a State
21 Medicaid Plan Amendment approved by the Centers for Medicare
22 and Medicaid Services of the United States Department of Health
23 and Human Services and authorized under Section 5A-12.2 of the
24 Illinois Public Aid Code, and to adjust hospital provider
25 assessments as Medicaid Provider-Specific Taxes permitted by
26 Title XIX of the federal Social Security Act and authorized

 

 

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1 under Section 5A-2 of the Illinois Public Aid Code.
2 (Source: P.A. 87-823; 88-667, eff. 9-16-94.)
 
3     (30 ILCS 105/5.620 rep.)
4     (30 ILCS 105/6z-56 rep.)
5     Section 10. The State Finance Act is amended by repealing
6 Sections 5.620 and 6z-56.
 
7     Section 15. The Illinois Public Aid Code is amended by
8 changing Sections 5A-1, 5A-2, 5A-3, 5A-4, 5A-5, 5A-8, 5A-10,
9 5A-14, 15-2, 15-3, 15-5, and 15-8 and by adding Sections
10 5A-12.2, 15-10, and 15-11 as follows:
 
11     (305 ILCS 5/5A-1)  (from Ch. 23, par. 5A-1)
12     Sec. 5A-1. Definitions. As used in this Article, unless
13 the context requires otherwise:
14     "Adjusted gross hospital revenue" shall be determined
15 separately for inpatient and outpatient services for each
16 hospital conducted, operated or maintained by a hospital
17 provider, and means the hospital provider's total gross
18 revenues less: (i) gross revenue attributable to non-hospital
19 based services including home dialysis services, durable
20 medical equipment, ambulance services, outpatient clinics and
21 any other non-hospital based services as determined by the
22 Illinois Department by rule; and (ii) gross revenues
23 attributable to the routine services provided to persons

 

 

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1 receiving skilled or intermediate long-term care services
2 within the meaning of Title XVIII or XIX of the Social Security
3 Act; and (iii) Medicare gross revenue (excluding the Medicare
4 gross revenue attributable to clauses (i) and (ii) of this
5 paragraph and the Medicare gross revenue attributable to the
6 routine services provided to patients in a psychiatric
7 hospital, a rehabilitation hospital, a distinct part
8 psychiatric unit, a distinct part rehabilitation unit, or swing
9 beds). Adjusted gross hospital revenue shall be determined
10 using the most recent data available from each hospital's 2003
11 Medicare cost report as contained in the Healthcare Cost Report
12 Information System file, for the quarter ending on December 31,
13 2004, without regard to any subsequent adjustments or changes
14 to such data. If a hospital's 2003 Medicare cost report is not
15 contained in the Healthcare Cost Report Information System, the
16 hospital provider shall furnish such cost report or the data
17 necessary to determine its adjusted gross hospital revenue as
18 required by rule by the Illinois Department.
19     "Fund" means the Hospital Provider Fund.
20     "Hospital" means an institution, place, building, or
21 agency located in this State that is subject to licensure by
22 the Illinois Department of Public Health under the Hospital
23 Licensing Act, whether public or private and whether organized
24 for profit or not-for-profit.
25     "Hospital provider" means a person licensed by the
26 Department of Public Health to conduct, operate, or maintain a

 

 

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1 hospital, regardless of whether the person is a Medicaid
2 provider. For purposes of this paragraph, "person" means any
3 political subdivision of the State, municipal corporation,
4 individual, firm, partnership, corporation, company, limited
5 liability company, association, joint stock association, or
6 trust, or a receiver, executor, trustee, guardian, or other
7 representative appointed by order of any court.
8     "Medicare bed days" means, for each hospital, the sum of
9 the number of days that each bed was occupied by a patient who
10 was covered by Title XVIII of the Social Security Act,
11 excluding days attributable to the routine services provided to
12 persons receiving skilled or intermediate long term care
13 services. Medicare bed days shall be computed separately for
14 each hospital operated or maintained by a hospital provider.
15     "Occupied bed days" means the sum of the number of days
16 that each bed was occupied by a patient for all beds, excluding
17 days attributable to the routine services provided to persons
18 receiving skilled or intermediate long term care services
19 during calendar year 2001. Occupied bed days shall be computed
20 separately for each hospital operated or maintained by a
21 hospital provider.
22     "Proration factor" means a fraction, the numerator of which
23 is 53 and the denominator of which is 365.
24 (Source: P.A. 93-659, eff. 2-3-04; 93-1066, eff. 1-15-05;
25 94-242, eff. 7-18-05.)
 

 

 

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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, 2008)
3     Sec. 5A-2. Assessment; no local authorization to tax.
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 2004 and the hospital's occupied bed days
9 multiplied by $84.19 for State fiscal year 2005.
10     For State fiscal years 2004 and 2005, the The Department of
11 Healthcare and Family Services shall use the number of occupied
12 bed days as reported by each hospital on the Annual Survey of
13 Hospitals conducted by the Department of Public Health to
14 calculate the hospital's annual assessment. If the sum of a
15 hospital's occupied bed days is not reported on the Annual
16 Survey of Hospitals or if there are data errors in the reported
17 sum of a hospital's occupied bed days as determined by the
18 Department of Healthcare and Family Services (formerly
19 Department of Public Aid), then the Department of Healthcare
20 and Family Services may obtain the sum of occupied bed days
21 from any source available, including, but not limited to,
22 records maintained by the hospital provider, which may be
23 inspected at all times during business hours of the day by the
24 Department of Healthcare and Family Services or its duly
25 authorized agents and employees.
26     Subject to Sections 5A-3 and 5A-10, for the privilege of

 

 

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1 engaging in the occupation of hospital provider, beginning
2 August 1, 2005, an annual assessment is imposed on each
3 hospital provider for State fiscal years 2006, 2007, and 2008,
4 in an amount equal to 2.5835% of the hospital provider's
5 adjusted gross hospital revenue for inpatient services and
6 2.5835% of the hospital provider's adjusted gross hospital
7 revenue for outpatient services. If the hospital provider's
8 adjusted gross hospital revenue is not available, then the
9 Illinois Department may obtain the hospital provider's
10 adjusted gross hospital revenue from any source available,
11 including, but not limited to, records maintained by the
12 hospital provider, which may be inspected at all times during
13 business hours of the day by the Illinois Department or its
14 duly authorized agents and employees.
15     Subject to Sections 5A-3 and 5A-10, for State fiscal years
16 2009 through 2013, an annual assessment on inpatient services
17 is imposed on each hospital provider in an amount equal to
18 $218.38 multiplied by the difference of the hospital's occupied
19 bed days less the hospital's Medicare bed days.
20     For State fiscal years 2009 through 2013, a hospital's
21 occupied bed days and Medicare bed days shall be determined
22 using the most recent data available from each hospital's 2005
23 Medicare cost report as contained in the Healthcare Cost Report
24 Information System file, for the quarter ending on December 31,
25 2006, without regard to any subsequent adjustments or changes
26 to such data. If a hospital's 2005 Medicare cost report is not

 

 

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1 contained in the Healthcare Cost Report Information System,
2 then the Illinois Department may obtain the hospital provider's
3 occupied bed days and Medicare bed days from any source
4 available, including, but not limited to, records maintained by
5 the hospital provider, which may be inspected at all times
6 during business hours of the day by the Illinois Department or
7 its duly authorized agents and employees.
8     (b) (Blank). Nothing in this Article shall be construed to
9 authorize any home rule unit or other unit of local government
10 to license for revenue or to impose a tax or assessment upon
11 hospital providers or the occupation of hospital provider, or a
12 tax or assessment measured by the income or earnings of a
13 hospital provider.
14     (c) (Blank). As provided in Section 5A-14, this Section is
15 repealed on July 1, 2008.
16     (d) Notwithstanding any of the other provisions of this
17 Section, the Department is authorized, during this 94th General
18 Assembly, to adopt rules to reduce the rate of any annual
19 assessment imposed under this Section, as authorized by Section
20 5-46.2 of the Illinois Administrative Procedure Act.
21     (e) Notwithstanding any other provision of this Section,
22 any plan providing for an assessment on a hospital provider as
23 a permissible tax under Title XIX of the federal Social
24 Security Act and Medicaid-eligible payments to hospital
25 providers from the revenues derived from that assessment shall
26 be reviewed by the Illinois Department of Healthcare and Family

 

 

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1 Services, as the Single State Medicaid Agency required by
2 federal law, to determine whether those assessments and
3 hospital provider payments meet federal Medicaid standards. If
4 the Department determines that the elements of the plan may
5 meet federal Medicaid standards and a related State Medicaid
6 Plan Amendment is prepared in a manner and form suitable for
7 submission, that State Plan Amendment shall be submitted in a
8 timely manner for review by the Centers for Medicare and
9 Medicaid Services of the United States Department of Health and
10 Human Services and subject to approval by the Centers for
11 Medicare and Medicaid Services of the United States Department
12 of Health and Human Services. No such plan shall become
13 effective without approval by the Illinois General Assembly by
14 the enactment into law of related legislation. Notwithstanding
15 any other provision of this Section, the Department is
16 authorized to adopt rules to reduce the rate of any annual
17 assessment imposed under this Section. Any such rules may be
18 adopted by the Department under Section 5-50 of the Illinois
19 Administrative Procedure Act.
20 (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04;
21 93-1066, eff. 1-15-05; 94-242, eff. 7-18-05; 94-838, eff.
22 6-6-06.)
 
23     (305 ILCS 5/5A-3)  (from Ch. 23, par. 5A-3)
24     Sec. 5A-3. Exemptions.
25     (a) (Blank).

 

 

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1     (b) A hospital provider that is a State agency, a State
2 university, or a county with a population of 3,000,000 or more
3 is exempt from the assessment imposed by Section 5A-2.
4     (b-2) A hospital provider that is a county with a
5 population of less than 3,000,000 or a township, municipality,
6 hospital district, or any other local governmental unit is
7 exempt from the assessment imposed by Section 5A-2.
8     (b-5) (Blank).
9     (b-10) For State fiscal years 2004 through 2013 and 2005, a
10 hospital provider, described in Section 1903(w)(3)(F) of the
11 Social Security Act, whose hospital does not charge for its
12 services is exempt from the assessment imposed by Section 5A-2,
13 unless the exemption is adjudged to be unconstitutional or
14 otherwise invalid, in which case the hospital provider shall
15 pay the assessment imposed by Section 5A-2.
16     (b-15) For State fiscal years 2004 and 2005, a hospital
17 provider whose hospital is licensed by the Department of Public
18 Health as a psychiatric hospital is exempt from the assessment
19 imposed by Section 5A-2, unless the exemption is adjudged to be
20 unconstitutional or otherwise invalid, in which case the
21 hospital provider shall pay the assessment imposed by Section
22 5A-2.
23     (b-20) For State fiscal years 2004 and 2005, a hospital
24 provider whose hospital is licensed by the Department of Public
25 Health as a rehabilitation hospital is exempt from the
26 assessment imposed by Section 5A-2, unless the exemption is

 

 

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1 adjudged to be unconstitutional or otherwise invalid, in which
2 case the hospital provider shall pay the assessment imposed by
3 Section 5A-2.
4     (b-25) For State fiscal years 2004 and 2005, a hospital
5 provider whose hospital (i) is not a psychiatric hospital,
6 rehabilitation hospital, or children's hospital and (ii) has an
7 average length of inpatient stay greater than 25 days is exempt
8 from the assessment imposed by Section 5A-2, unless the
9 exemption is adjudged to be unconstitutional or otherwise
10 invalid, in which case the hospital provider shall pay the
11 assessment imposed by Section 5A-2.
12     (c) (Blank).
13 (Source: P.A. 93-659, eff. 2-3-04; 94-242, eff. 7-18-05.)
 
14     (305 ILCS 5/5A-4)  (from Ch. 23, par. 5A-4)
15     Sec. 5A-4. Payment of assessment; penalty.
16     (a) The annual assessment imposed by Section 5A-2 for State
17 fiscal year 2004 shall be due and payable on June 18 of the
18 year. The assessment imposed by Section 5A-2 for State fiscal
19 year 2005 shall be due and payable in quarterly installments,
20 each equalling one-fourth of the assessment for the year, on
21 July 19, October 19, January 18, and April 19 of the year. The
22 assessment imposed by Section 5A-2 for State fiscal years year
23 2006 through 2008 and each subsequent State fiscal year shall
24 be due and payable in quarterly installments, each equaling
25 one-fourth of the assessment for the year, on the fourteenth

 

 

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1 State business day of September, December, March, and May. The
2 assessment imposed by Section 5A-2 for State fiscal year 2009
3 and each subsequent State fiscal year shall be due and payable
4 in monthly installments, each equaling one-twelfth of the
5 assessment for the year, on the fourteenth State business day
6 of each month. No installment payment of an assessment imposed
7 by Section 5A-2 shall be due and payable, however, until after:
8 (i) the Department notifies the hospital provider, in writing,
9 receives written notice from the Department of Healthcare and
10 Family Services (formerly Department of Public Aid) that the
11 payment methodologies to hospitals required under Section
12 5A-12, or Section 5A-12.1, or Section 5A-12.2, whichever is
13 applicable for that fiscal year, have been approved by the
14 Centers for Medicare and Medicaid Services of the U.S.
15 Department of Health and Human Services and the waiver under 42
16 CFR 433.68 for the assessment imposed by Section 5A-2, if
17 necessary, has been granted by the Centers for Medicare and
18 Medicaid Services of the U.S. Department of Health and Human
19 Services; and (ii) the Comptroller has issued the hospital has
20 received the payments required under Section 5A-12, or Section
21 5A-12.1, or Section 5A-12.2, whichever is applicable for that
22 fiscal year. Upon notification to the Department of approval of
23 the payment methodologies required under Section 5A-12, or
24 Section 5A-12.1, or Section 5A-12.2, whichever is applicable
25 for that fiscal year, and the waiver granted under 42 CFR
26 433.68, all quarterly installments otherwise due under Section

 

 

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1 5A-2 prior to the date of notification shall be due and payable
2 to the Department upon written direction from the Department
3 and issuance by the Comptroller receipt of the payments
4 required under Section 5A-12.1 or Section 5A-12.2, whichever is
5 applicable for that fiscal year.
6     (b) The Illinois Department is authorized to establish
7 delayed payment schedules for hospital providers that are
8 unable to make installment payments when due under this Section
9 due to financial difficulties, as determined by the Illinois
10 Department.
11     (c) If a hospital provider fails to pay the full amount of
12 an installment when due (including any extensions granted under
13 subsection (b)), there shall, unless waived by the Illinois
14 Department for reasonable cause, be added to the assessment
15 imposed by Section 5A-2 a penalty assessment equal to the
16 lesser of (i) 5% of the amount of the installment not paid on
17 or before the due date plus 5% of the portion thereof remaining
18 unpaid on the last day of each 30-day period thereafter or (ii)
19 100% of the installment amount not paid on or before the due
20 date. For purposes of this subsection, payments will be
21 credited first to unpaid installment amounts (rather than to
22 penalty or interest), beginning with the most delinquent
23 installments.
24     (d) Any assessment amount that is due and payable to the
25 Illinois Department more frequently than once per calendar
26 quarter shall be remitted to the Illinois Department by the

 

 

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1 hospital provider by means of electronic funds transfer. The
2 Illinois Department may provide for remittance by other means
3 if (i) the amount due is less than $10,000 or (ii) electronic
4 funds transfer is unavailable for this purpose.
5 (Source: P.A. 94-242, eff. 7-18-05; 95-331, eff. 8-21-07.)
 
6     (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
7     Sec. 5A-5. Notice; penalty; maintenance of records.
8     (a) The Department of Healthcare and Family Services shall
9 send a notice of assessment to every hospital provider subject
10 to assessment under this Article. The notice of assessment
11 shall notify the hospital of its assessment and shall be sent
12 after receipt by the Department of notification from the
13 Centers for Medicare and Medicaid Services of the U.S.
14 Department of Health and Human Services that the payment
15 methodologies required under Section 5A-12, or Section
16 5A-12.1, or Section 5A-12.2, whichever is applicable for that
17 fiscal year, and, if necessary, the waiver granted under 42 CFR
18 433.68 have been approved. The notice shall be on a form
19 prepared by the Illinois Department and shall state the
20 following:
21         (1) The name of the hospital provider.
22         (2) The address of the hospital provider's principal
23     place of business from which the provider engages in the
24     occupation of hospital provider in this State, and the name
25     and address of each hospital operated, conducted, or

 

 

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1     maintained by the provider in this State.
2         (3) The occupied bed days, occupied bed days less
3     Medicare days, or adjusted gross hospital revenue of the
4     hospital provider (whichever is applicable), the amount of
5     assessment imposed under Section 5A-2 for the State fiscal
6     year for which the notice is sent, and the amount of each
7     quarterly installment to be paid during the State fiscal
8     year.
9         (4) (Blank).
10         (5) Other reasonable information as determined by the
11     Illinois Department.
12     (b) If a hospital provider conducts, operates, or maintains
13 more than one hospital licensed by the Illinois Department of
14 Public Health, the provider shall pay the assessment for each
15 hospital separately.
16     (c) Notwithstanding any other provision in this Article, in
17 the case of a person who ceases to conduct, operate, or
18 maintain a hospital in respect of which the person is subject
19 to assessment under this Article as a hospital provider, the
20 assessment for the State fiscal year in which the cessation
21 occurs shall be adjusted by multiplying the assessment computed
22 under Section 5A-2 by a fraction, the numerator of which is the
23 number of days in the year during which the provider conducts,
24 operates, or maintains the hospital and the denominator of
25 which is 365. Immediately upon ceasing to conduct, operate, or
26 maintain a hospital, the person shall pay the assessment for

 

 

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1 the year as so adjusted (to the extent not previously paid).
2     (d) Notwithstanding any other provision in this Article, a
3 provider who commences conducting, operating, or maintaining a
4 hospital, upon notice by the Illinois Department, shall pay the
5 assessment computed under Section 5A-2 and subsection (e) in
6 installments on the due dates stated in the notice and on the
7 regular installment due dates for the State fiscal year
8 occurring after the due dates of the initial notice.
9     (e) Notwithstanding any other provision in this Article,
10 for State fiscal years 2004 and 2005, in the case of a hospital
11 provider that did not conduct, operate, or maintain a hospital
12 throughout calendar year 2001, the assessment for that State
13 fiscal year shall be computed on the basis of hypothetical
14 occupied bed days for the full calendar year as determined by
15 the Illinois Department. Notwithstanding any other provision
16 in this Article, for State fiscal years 2006 through 2008 after
17 2005, in the case of a hospital provider that did not conduct,
18 operate, or maintain a hospital in 2003, the assessment for
19 that State fiscal year shall be computed on the basis of
20 hypothetical adjusted gross hospital revenue for the
21 hospital's first full fiscal year as determined by the Illinois
22 Department (which may be based on annualization of the
23 provider's actual revenues for a portion of the year, or
24 revenues of a comparable hospital for the year, including
25 revenues realized by a prior provider of the same hospital
26 during the year). Notwithstanding any other provision in this

 

 

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1 Article, for State fiscal years 2009 through 2013, in the case
2 of a hospital provider that did not conduct, operate, or
3 maintain a hospital in 2005, the assessment for that State
4 fiscal year shall be computed on the basis of hypothetical
5 occupied bed days for the full calendar year as determined by
6 the Illinois Department.
7     (f) Every hospital provider subject to assessment under
8 this Article shall keep sufficient records to permit the
9 determination of adjusted gross hospital revenue for the
10 hospital's fiscal year. All such records shall be kept in the
11 English language and shall, at all times during regular
12 business hours of the day, be subject to inspection by the
13 Illinois Department or its duly authorized agents and
14 employees.
15     (g) The Illinois Department may, by rule, provide a
16 hospital provider a reasonable opportunity to request a
17 clarification or correction of any clerical or computational
18 errors contained in the calculation of its assessment, but such
19 corrections shall not extend to updating the cost report
20 information used to calculate the assessment.
21     (h) (Blank).
22 (Source: P.A. 94-242, eff. 7-18-05; 95-331, eff. 8-21-07.)
 
23     (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
24     Sec. 5A-8. Hospital Provider Fund.
25     (a) There is created in the State Treasury the Hospital

 

 

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1 Provider Fund. Interest earned by the Fund shall be credited to
2 the Fund. The Fund shall not be used to replace any moneys
3 appropriated to the Medicaid program by the General Assembly.
4     (b) The Fund is created for the purpose of receiving moneys
5 in accordance with Section 5A-6 and disbursing moneys only for
6 the following purposes, notwithstanding any other provision of
7 law:
8         (1) For making payments to hospitals as required under
9     Articles V, VI, and XIV of this Code, and under the
10     Children's Health Insurance Program Act, and under the
11     Covering ALL KIDS Health Insurance Act.
12         (2) For the reimbursement of moneys collected by the
13     Illinois Department from hospitals or hospital providers
14     through error or mistake in performing the activities
15     authorized under this Article and Article V of this Code.
16         (3) For payment of administrative expenses incurred by
17     the Illinois Department or its agent in performing the
18     activities authorized by this Article.
19         (4) For payments of any amounts which are reimbursable
20     to the federal government for payments from this Fund which
21     are required to be paid by State warrant.
22         (5) For making transfers, as those transfers are
23     authorized in the proceedings authorizing debt under the
24     Short Term Borrowing Act, but transfers made under this
25     paragraph (5) shall not exceed the principal amount of debt
26     issued in anticipation of the receipt by the State of

 

 

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1     moneys to be deposited into the Fund.
2         (6) For making transfers to any other fund in the State
3     treasury, but transfers made under this paragraph (6) shall
4     not exceed the amount transferred previously from that
5     other fund into the Hospital Provider Fund.
6         (7) For State fiscal years 2004 and 2005 for making
7     transfers to the Health and Human Services Medicaid Trust
8     Fund, including 20% of the moneys received from hospital
9     providers under Section 5A-4 and transferred into the
10     Hospital Provider Fund under Section 5A-6. For State fiscal
11     year 2006 for making transfers to the Health and Human
12     Services Medicaid Trust Fund of up to $130,000,000 per year
13     of the moneys received from hospital providers under
14     Section 5A-4 and transferred into the Hospital Provider
15     Fund under Section 5A-6. Transfers under this paragraph
16     shall be made within 7 days after the payments have been
17     received pursuant to the schedule of payments provided in
18     subsection (a) of Section 5A-4.
19         (7.5) For State fiscal year 2007 for making transfers
20     of the moneys received from hospital providers under
21     Section 5A-4 and transferred into the Hospital Provider
22     Fund under Section 5A-6 to the designated funds not
23     exceeding the following amounts in that State fiscal year:
24         Health and Human Services
25             Medicaid Trust Fund................. $20,000,000
26         Long-Term Care Provider Fund............ $30,000,000

 

 

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1         General Revenue Fund................... $80,000,000.
2         Transfers under this paragraph shall be made within 7
3     days after the payments have been received pursuant to the
4     schedule of payments provided in subsection (a) of Section
5     5A-4.
6         (7.8) For State fiscal year 2008, for making transfers
7     of the moneys received from hospital providers under
8     Section 5A-4 and transferred into the Hospital Provider
9     Fund under Section 5A-6 to the designated funds not
10     exceeding the following amounts in that State fiscal year:
11         Health and Human Services
12             Medicaid Trust Fund..................$40,000,000
13         Long-Term Care Provider Fund..............$60,000,000
14         General Revenue Fund...................$160,000,000.
15         Transfers under this paragraph shall be made within 7
16     days after the payments have been received pursuant to the
17     schedule of payments provided in subsection (a) of Section
18     5A-4.
19         (7.9) For State fiscal years 2009 through 2013, for
20     making transfers of the moneys received from hospital
21     providers under Section 5A-4 and transferred into the
22     Hospital Provider Fund under Section 5A-6 to the designated
23     funds not exceeding the following amounts in that State
24     fiscal year:
25         Health and Human Services
26             Medicaid Trust Fund...................$20,000,000

 

 

09500SB2857ham001 - 21 - LRB095 19231 DRJ 51509 a

1         Long Term Care Provider Fund..............$30,000,000
2         General Revenue Fund.....................$80,000,000.
3         Transfers under this paragraph shall be made within 7
4     business days after the payments have been received
5     pursuant to the schedule of payments provided in subsection
6     (a) of Section 5A-4.
7         (8) For making refunds to hospital providers pursuant
8     to Section 5A-10.
9     Disbursements from the Fund, other than transfers
10 authorized under paragraphs (5) and (6) of this subsection,
11 shall be by warrants drawn by the State Comptroller upon
12 receipt of vouchers duly executed and certified by the Illinois
13 Department.
14     (c) The Fund shall consist of the following:
15         (1) All moneys collected or received by the Illinois
16     Department from the hospital provider assessment imposed
17     by this Article.
18         (2) All federal matching funds received by the Illinois
19     Department as a result of expenditures made by the Illinois
20     Department that are attributable to moneys deposited in the
21     Fund.
22         (3) Any interest or penalty levied in conjunction with
23     the administration of this Article.
24         (4) Moneys transferred from another fund in the State
25     treasury.
26         (5) All other moneys received for the Fund from any

 

 

09500SB2857ham001 - 22 - LRB095 19231 DRJ 51509 a

1     other source, including interest earned thereon.
2     (d) (Blank).
3 (Source: P.A. 94-242, eff. 7-18-05; 94-839, eff. 6-6-06;
4 95-707, eff. 1-11-08.)
 
5     (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
6     Sec. 5A-10. Applicability.
7     (a) The assessment imposed by Section 5A-2 shall not take
8 effect or shall cease to be imposed, and any moneys remaining
9 in the Fund shall be refunded to hospital providers in
10 proportion to the amounts paid by them, if:
11         (1) The the sum of the appropriations for State fiscal
12     years 2004 and 2005 from the General Revenue Fund for
13     hospital payments under the medical assistance program is
14     less than $4,500,000,000 or the appropriation for each of
15     State fiscal years 2006, 2007 and 2008 from the General
16     Revenue Fund for hospital payments under the medical
17     assistance program is less than $2,500,000,000 increased
18     annually to reflect any increase in the number of
19     recipients, or the annual appropriation for State fiscal
20     years 2009 through 2013, from the General Revenue Fund for
21     hospital payments under the medical assistance program, is
22     less than the amount appropriated for State fiscal year
23     2009, adjusted annually to reflect any change in the number
24     of recipients; or
25         (2) For State fiscal years prior to State fiscal year

 

 

09500SB2857ham001 - 23 - LRB095 19231 DRJ 51509 a

1     2009, the Department of Healthcare and Family Services
2     (formerly Department of Public Aid) makes changes in its
3     rules that reduce the hospital inpatient or outpatient
4     payment rates, including adjustment payment rates, in
5     effect on October 1, 2004, except for hospitals described
6     in subsection (b) of Section 5A-3 and except for changes in
7     the methodology for calculating outlier payments to
8     hospitals for exceptionally costly stays, so long as those
9     changes do not reduce aggregate expenditures below the
10     amount expended in State fiscal year 2005 for such
11     services; or
12         (2.1) For State fiscal years 2009 through 2013, the
13     Department of Healthcare and Family Services adopts any
14     administrative rule change to reduce payment rates or
15     alters any payment methodology that reduces any payment
16     rates made to operating hospitals under the approved Title
17     XIX or Title XXI State plan in effect January 1, 2008
18     except for:
19             (A) any changes for hospitals described in
20         subsection (b) of Section 5A-3; or
21             (B) any rates for payments made under this Article
22         V-A; or
23         (3) The the payments to hospitals required under
24     Section 5A-12 or Section 5A-12.2 are changed or are not
25     eligible for federal matching funds under Title XIX or XXI
26     of the Social Security Act.

 

 

09500SB2857ham001 - 24 - LRB095 19231 DRJ 51509 a

1     (b) The assessment imposed by Section 5A-2 shall not take
2 effect or shall cease to be imposed if the assessment is
3 determined to be an impermissible tax under Title XIX of the
4 Social Security Act. Moneys in the Hospital Provider Fund
5 derived from assessments imposed prior thereto shall be
6 disbursed in accordance with Section 5A-8 to the extent federal
7 financial participation matching is not reduced due to the
8 impermissibility of the assessments, and any remaining moneys
9 shall be refunded to hospital providers in proportion to the
10 amounts paid by them.
11 (Source: P.A. 94-242, eff. 7-18-05; 95-331, eff. 8-21-07.)
 
12     (305 ILCS 5/5A-12.2 new)
13     Sec. 5A-12.2. Hospital access payments on or after July 1,
14 2008.
15     (a) To preserve and improve access to hospital services,
16 for hospital services rendered on or after July 1, 2008, the
17 Illinois Department shall, except for hospitals described in
18 subsection (b) of Section 5A-3, make payments to hospitals as
19 set forth in this Section. These payments shall be paid in 12
20 equal installments on or before the seventh State business day
21 of each month, except that no payment shall be due within 100
22 days after the later of the date of notification of federal
23 approval of the payment methodologies required under this
24 Section or any waiver required under 42 CFR 433.68, at which
25 time the sum of amounts required under this Section prior to

 

 

09500SB2857ham001 - 25 - LRB095 19231 DRJ 51509 a

1 the date of notification is due and payable. Payments under
2 this Section are not due and payable, however, until (i) the
3 methodologies described in this Section are approved by the
4 federal government in an appropriate State Plan amendment and
5 (ii) the assessment imposed under this Article is determined to
6 be a permissible tax under Title XIX of the Social Security
7 Act.
8     (b) Across-the-board inpatient adjustment.
9         (1) In addition to rates paid for inpatient hospital
10     services, the Department shall pay to each Illinois general
11     acute care hospital an amount equal to 40% of the total
12     base inpatient payments paid to the hospital for services
13     provided in State fiscal year 2005.
14         (2) In addition to rates paid for inpatient hospital
15     services, the Department shall pay to each freestanding
16     Illinois specialty care hospital as defined in 89 Ill. Adm.
17     Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
18     the total base inpatient payments paid to the hospital for
19     services provided in State fiscal year 2005.
20         (3) In addition to rates paid for inpatient hospital
21     services, the Department shall pay to each freestanding
22     Illinois rehabilitation or psychiatric hospital an amount
23     equal to $1,000 per Medicaid inpatient day multiplied by
24     the increase in the hospital's Medicaid inpatient
25     utilization ratio (determined using the positive
26     percentage change from the rate year 2005 Medicaid

 

 

09500SB2857ham001 - 26 - LRB095 19231 DRJ 51509 a

1     inpatient utilization ratio to the rate year 2007 Medicaid
2     inpatient utilization ratio, as calculated by the
3     Department for the disproportionate share determination).
4         (4) In addition to rates paid for inpatient hospital
5     services, the Department shall pay to each Illinois
6     children's hospital an amount equal to 20% of the total
7     base inpatient payments paid to the hospital for services
8     provided in State fiscal year 2005 and an additional amount
9     equal to 20% of the base inpatient payments paid to the
10     hospital for psychiatric services provided in State fiscal
11     year 2005.
12         (5) In addition to rates paid for inpatient hospital
13     services, the Department shall pay to each Illinois
14     hospital eligible for a pediatric inpatient adjustment
15     payment under 89 Ill. Adm. Code 148.298, as in effect for
16     State fiscal year 2007, a supplemental pediatric inpatient
17     adjustment payment equal to:
18             (i) For freestanding children's hospitals as
19         defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5
20         multiplied by the hospital's pediatric inpatient
21         adjustment payment required under 89 Ill. Adm. Code
22         148.298, as in effect for State fiscal year 2008.
23             (ii) For hospitals other than freestanding
24         children's hospitals as defined in 89 Ill. Adm. Code
25         149.50(c)(3)(B), 1.0 multiplied by the hospital's
26         pediatric inpatient adjustment payment required under

 

 

09500SB2857ham001 - 27 - LRB095 19231 DRJ 51509 a

1         89 Ill. Adm. Code 148.298, as in effect for State
2         fiscal year 2008.
3     (c) Outpatient adjustment.
4         (1) In addition to the rates paid for outpatient
5     hospital services, the Department shall pay each Illinois
6     hospital an amount equal to 2.2 multiplied by the
7     hospital's ambulatory procedure listing payments for
8     categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
9     148.140(b), for State fiscal year 2005.
10         (2) In addition to the rates paid for outpatient
11     hospital services, the Department shall pay each Illinois
12     freestanding psychiatric hospital an amount equal to 3.25
13     multiplied by the hospital's ambulatory procedure listing
14     payments for category 5b, as defined in 89 Ill. Adm. Code
15     148.140(b)(1)(E), for State fiscal year 2005.
16     (d) Medicaid high volume adjustment. In addition to rates
17 paid for inpatient hospital services, the Department shall pay
18 to each Illinois general acute care hospital that provided more
19 than 20,500 Medicaid inpatient days of care in State fiscal
20 year 2005 amounts as follows:
21         (1) For hospitals with a case mix index equal to or
22     greater than the 85th percentile of hospital case mix
23     indices, $350 for each Medicaid inpatient day of care
24     provided during that period; and
25         (2) For hospitals with a case mix index less than the
26     85th percentile of hospital case mix indices, $100 for each

 

 

09500SB2857ham001 - 28 - LRB095 19231 DRJ 51509 a

1     Medicaid inpatient day of care provided during that period.
2     (e) Capital adjustment. In addition to rates paid for
3 inpatient hospital services, the Department shall pay an
4 additional payment to each Illinois general acute care hospital
5 that has a Medicaid inpatient utilization rate of at least 10%
6 (as calculated by the Department for the rate year 2007
7 disproportionate share determination) amounts as follows:
8         (1) For each Illinois general acute care hospital that
9     has a Medicaid inpatient utilization rate of at least 10%
10     and less than 36.94% and whose capital cost is less than
11     the 60th percentile of the capital costs of all Illinois
12     hospitals, the amount of such payment shall equal the
13     hospital's Medicaid inpatient days multiplied by the
14     difference between the capital costs at the 60th percentile
15     of the capital costs of all Illinois hospitals and the
16     hospital's capital costs.
17         (2) For each Illinois general acute care hospital that
18     has a Medicaid inpatient utilization rate of at least
19     36.94% and whose capital cost is less than the 75th
20     percentile of the capital costs of all Illinois hospitals,
21     the amount of such payment shall equal the hospital's
22     Medicaid inpatient days multiplied by the difference
23     between the capital costs at the 75th percentile of the
24     capital costs of all Illinois hospitals and the hospital's
25     capital costs.
26     (f) Obstetrical care adjustment.

 

 

09500SB2857ham001 - 29 - LRB095 19231 DRJ 51509 a

1         (1) In addition to rates paid for inpatient hospital
2     services, the Department shall pay $1,500 for each Medicaid
3     obstetrical day of care provided in State fiscal year 2005
4     by each Illinois rural hospital that had a Medicaid
5     obstetrical percentage (Medicaid obstetrical days divided
6     by Medicaid inpatient days) greater than 15% for State
7     fiscal year 2005.
8         (2) In addition to rates paid for inpatient hospital
9     services, the Department shall pay $1,350 for each Medicaid
10     obstetrical day of care provided in State fiscal year 2005
11     by each Illinois general acute care hospital that was
12     designated a level III perinatal center as of December 31,
13     2006, and that had a case mix index equal to or greater
14     than the 45th percentile of the case mix indices for all
15     level III perinatal centers.
16         (3) In addition to rates paid for inpatient hospital
17     services, the Department shall pay $900 for each Medicaid
18     obstetrical day of care provided in State fiscal year 2005
19     by each Illinois general acute care hospital that was
20     designated a level II or II+ perinatal center as of
21     December 31, 2006, and that had a case mix index equal to
22     or greater than the 35th percentile of the case mix indices
23     for all level II and II+ perinatal centers.
24     (g) Trauma adjustment.
25         (1) In addition to rates paid for inpatient hospital
26     services, the Department shall pay each Illinois general

 

 

09500SB2857ham001 - 30 - LRB095 19231 DRJ 51509 a

1     acute care hospital designated as a trauma center as of
2     July 1, 2007, a payment equal to 3.75 multiplied by the
3     hospital's State fiscal year 2005 Medicaid capital
4     payments.
5         (2) In addition to rates paid for inpatient hospital
6     services, the Department shall pay $400 for each Medicaid
7     acute inpatient day of care provided in State fiscal year
8     2005 by each Illinois general acute care hospital that was
9     designated a level II trauma center, as defined in 89 Ill.
10     Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
11     2007.
12         (3) In addition to rates paid for inpatient hospital
13     services, the Department shall pay $235 for each Illinois
14     Medicaid acute inpatient day of care provided in State
15     fiscal year 2005 by each level I pediatric trauma center
16     located outside of Illinois that had more than 8,000
17     Illinois Medicaid inpatient days in State fiscal year 2005.
18     (h) Supplemental tertiary care adjustment. In addition to
19 rates paid for inpatient services, the Department shall pay to
20 each Illinois hospital eligible for tertiary care adjustment
21 payments under 89 Ill. Adm. Code 148.296, as in effect for
22 State fiscal year 2007, a supplemental tertiary care adjustment
23 payment equal to the tertiary care adjustment payment required
24 under 89 Ill. Adm. Code 148.296, as in effect for State fiscal
25 year 2007.
26     (i) Crossover adjustment. In addition to rates paid for

 

 

09500SB2857ham001 - 31 - LRB095 19231 DRJ 51509 a

1 inpatient services, the Department shall pay each Illinois
2 general acute care hospital that had a ratio of crossover days
3 to total inpatient days for medical assistance programs
4 administered by the Department (utilizing information from
5 2005 paid claims) greater than 50%, and a case mix index
6 greater than the 65th percentile of case mix indices for all
7 Illinois hospitals, a rate of $1,125 for each Medicaid
8 inpatient day including crossover days.
9     (j) Magnet hospital adjustment. In addition to rates paid
10 for inpatient hospital services, the Department shall pay to
11 each Illinois general acute care hospital and each Illinois
12 freestanding children's hospital that, as of February 1, 2008,
13 was recognized as a Magnet hospital by the American Nurses
14 Credentialing Center and that had a case mix index greater than
15 the 75th percentile of case mix indices for all Illinois
16 hospitals amounts as follows:
17         (1) For hospitals located in a county whose eligibility
18     growth factor is greater than the mean, $450 multiplied by
19     the eligibility growth factor for the county in which the
20     hospital is located for each Medicaid inpatient day of care
21     provided by the hospital during State fiscal year 2005.
22         (2) For hospitals located in a county whose eligibility
23     growth factor is less than or equal to the mean, $225
24     multiplied by the eligibility growth factor for the county
25     in which the hospital is located for each Medicaid
26     inpatient day of care provided by the hospital during State

 

 

09500SB2857ham001 - 32 - LRB095 19231 DRJ 51509 a

1     fiscal year 2005.
2     For purposes of this subsection, "eligibility growth
3 factor" means the percentage by which the number of Medicaid
4 recipients in the county increased from State fiscal year 1998
5 to State fiscal year 2005.
6     (k) For purposes of this Section, a hospital that is
7 enrolled to provide Medicaid services during State fiscal year
8 2005 shall have its utilization and associated reimbursements
9 annualized prior to the payment calculations being performed
10 under this Section.
11     (l) For purposes of this Section, the terms "Medicaid
12 days", "ambulatory procedure listing services", and
13 "ambulatory procedure listing payments" do not include any
14 days, charges, or services for which Medicare or a managed care
15 organization reimbursed on a capitated basis was liable for
16 payment, except where explicitly stated otherwise in this
17 Section.
18     (m) For purposes of this Section, in determining the
19 percentile ranking of an Illinois hospital's case mix index or
20 capital costs, hospitals described in subsection (b) of Section
21 5A-3 shall be excluded from the ranking.
22     (n) Definitions. Unless the context requires otherwise or
23 unless provided otherwise in this Section, the terms used in
24 this Section for qualifying criteria and payment calculations
25 shall have the same meanings as those terms have been given in
26 the Illinois Department's administrative rules as in effect on

 

 

09500SB2857ham001 - 33 - LRB095 19231 DRJ 51509 a

1 March 1, 2008. Other terms shall be defined by the Illinois
2 Department by rule.
3     As used in this Section, unless the context requires
4 otherwise:
5     "Base inpatient payments" means, for a given hospital, the
6 sum of base payments for inpatient services made on a per diem
7 or per admission (DRG) basis, excluding those portions of per
8 admission payments that are classified as capital payments.
9 Disproportionate share hospital adjustment payments, Medicaid
10 Percentage Adjustments, Medicaid High Volume Adjustments, and
11 outlier payments, as defined by rule by the Department as of
12 January 1, 2008, are not base payments.
13     "Capital costs" means, for a given hospital, the total
14 capital costs determined using the most recent 2005 Medicare
15 cost report as contained in the Healthcare Cost Report
16 Information System file, for the quarter ending on December 31,
17 2006, divided by the total inpatient days from the same cost
18 report to calculate a capital cost per day. The resulting
19 capital cost per day is inflated to the midpoint of State
20 fiscal year 2009 utilizing the national hospital market price
21 proxies (DRI) hospital cost index. If a hospital's 2005
22 Medicare cost report is not contained in the Healthcare Cost
23 Report Information System, the Department may obtain the data
24 necessary to compute the hospital's capital costs from any
25 source available, including, but not limited to, records
26 maintained by the hospital provider, which may be inspected at

 

 

09500SB2857ham001 - 34 - LRB095 19231 DRJ 51509 a

1 all times during business hours of the day by the Illinois
2 Department or its duly authorized agents and employees.
3     "Case mix index" means, for a given hospital, the sum of
4 the DRG relative weighting factors in effect on January 1,
5 2005, for all general acute care admissions for State fiscal
6 year 2005, excluding Medicare crossover admissions and
7 transplant admissions reimbursed under 89 Ill. Adm. Code
8 148.82, divided by the total number of general acute care
9 admissions for State fiscal year 2005, excluding Medicare
10 crossover admissions and transplant admissions reimbursed
11 under 89 Ill. Adm. Code 148.82.
12     "Medicaid inpatient day" means, for a given hospital, the
13 sum of days of inpatient hospital days provided to recipients
14 of medical assistance under Title XIX of the federal Social
15 Security Act, excluding days for individuals eligible for
16 Medicare under Title XVIII of that Act (Medicaid/Medicare
17 crossover days), as tabulated from the Department's paid claims
18 data for admissions occurring during State fiscal year 2005
19 that was adjudicated by the Department through March 23, 2007.
20     "Medicaid obstetrical day" means, for a given hospital, the
21 sum of days of inpatient hospital days grouped by the
22 Department to DRGs of 370 through 375 provided to recipients of
23 medical assistance under Title XIX of the federal Social
24 Security Act, excluding days for individuals eligible for
25 Medicare under Title XVIII of that Act (Medicaid/Medicare
26 crossover days), as tabulated from the Department's paid claims

 

 

09500SB2857ham001 - 35 - LRB095 19231 DRJ 51509 a

1 data for admissions occurring during State fiscal year 2005
2 that was adjudicated by the Department through March 23, 2007.
3     "Outpatient ambulatory procedure listing payments" means,
4 for a given hospital, the sum of payments for ambulatory
5 procedure listing services, as described in 89 Ill. Adm. Code
6 148.140(b), provided to recipients of medical assistance under
7 Title XIX of the federal Social Security Act, excluding
8 payments for individuals eligible for Medicare under Title
9 XVIII of the Act (Medicaid/Medicare crossover days), as
10 tabulated from the Department's paid claims data for services
11 occurring in State fiscal year 2005 that were adjudicated by
12 the Department through March 23, 2007.
13     (o) The Department may adjust payments made under this
14 Section 12.2 to comply with federal law or regulations
15 regarding hospital-specific payment limitations on
16 government-owned or government-operated hospitals.
17     (p) Notwithstanding any of the other provisions of this
18 Section, the Department is authorized to adopt rules that
19 change the hospital access improvement payments specified in
20 this Section, but only to the extent necessary to conform to
21 any federally approved amendment to the Title XIX State plan.
22 Any such rules shall be adopted by the Department as authorized
23 by Section 5-50 of the Illinois Administrative Procedure Act.
24 Notwithstanding any other provision of law, any changes
25 implemented as a result of this subsection (p) shall be given
26 retroactive effect so that they shall be deemed to have taken

 

 

09500SB2857ham001 - 36 - LRB095 19231 DRJ 51509 a

1 effect as of the effective date of this Section.
2     (q) For State fiscal years 2012 and 2013, the Department
3 may make recommendations to the General Assembly regarding the
4 use of more recent data for purposes of calculating the
5 assessment authorized under Section 5A-2 and the payments
6 authorized under this Section 5A-12.2.
 
7     (305 ILCS 5/5A-14)
8     Sec. 5A-14. Repeal of assessments and disbursements.
9     (a) Section 5A-2 is repealed on July 1, 2013 2008.
10     (b) Section 5A-12 is repealed on July 1, 2005.
11     (c) Section 5A-12.1 is repealed on July 1, 2008.
12     (d) Section 5A-12.2 is repealed on July 1, 2013.
13 (Source: P.A. 93-659, eff. 2-3-04; 94-242, eff. 7-18-05.)
 
14     (305 ILCS 5/15-2)  (from Ch. 23, par. 15-2)
15     Sec. 15-2. County Provider Trust Fund.
16     (a) There is created in the State Treasury the County
17 Provider Trust Fund. Interest earned by the Fund shall be
18 credited to the Fund. The Fund shall not be used to replace any
19 funds appropriated to the Medicaid program by the General
20 Assembly.
21     (b) The Fund is created solely for the purposes of
22 receiving, investing, and distributing monies in accordance
23 with this Article XV. The Fund shall consist of:
24         (1) All monies collected or received by the Illinois

 

 

09500SB2857ham001 - 37 - LRB095 19231 DRJ 51509 a

1     Department under Section 15-3 of this Code;
2         (2) All federal financial participation monies
3     received by the Illinois Department pursuant to Title XIX
4     of the Social Security Act, 42 U.S.C. 1396b 1396(b),
5     attributable to eligible expenditures made by the Illinois
6     Department pursuant to Section 15-5 of this Code;
7         (3) All federal moneys received by the Illinois
8     Department pursuant to Title XXI of the Social Security Act
9     attributable to eligible expenditures made by the Illinois
10     Department pursuant to Section 15-5 of this Code; and
11         (4) All other monies received by the Fund from any
12     source, including interest thereon.
13     (c) Disbursements from the Fund shall be by warrants drawn
14 by the State Comptroller upon receipt of vouchers duly executed
15 and certified by the Illinois Department and shall be made
16 only:
17         (1) For hospital inpatient care, hospital outpatient
18     care, care provided by other outpatient facilities
19     operated by a county, and disproportionate share hospital
20     adjustment payments made under Title XIX of the Social
21     Security Act and Article V of this Code as required by
22     Section 15-5 of this Code;
23         (1.5) For services provided by county providers
24     pursuant to Section 5-11 of this Code;
25         (2) For the reimbursement of administrative expenses
26     incurred by county providers on behalf of the Illinois

 

 

09500SB2857ham001 - 38 - LRB095 19231 DRJ 51509 a

1     Department as permitted by Section 15-4 of this Code;
2         (3) For the reimbursement of monies received by the
3     Fund through error or mistake;
4         (4) For the payment of administrative expenses
5     necessarily incurred by the Illinois Department or its
6     agent in performing the activities required by this Article
7     XV;
8         (5) For the payment of any amounts that are
9     reimbursable to the federal government, attributable
10     solely to the Fund, and required to be paid by State
11     warrant; and
12         (6) For hospital inpatient care, hospital outpatient
13     care, care provided by other outpatient facilities
14     operated by a county, and disproportionate share hospital
15     adjustment payments made under Title XXI of the Social
16     Security Act, pursuant to Section 15-5 of this Code.
17 (Source: P.A. 91-24, eff. 7-1-99; 92-370, eff. 8-15-01.)
 
18     (305 ILCS 5/15-3)  (from Ch. 23, par. 15-3)
19     Sec. 15-3. Intergovernmental Transfers.
20     (a) Each qualifying county shall make an annual
21 intergovernmental transfer to the Illinois Department in an
22 amount equal to 71.7% of the difference between the total
23 payments made by the Illinois Department to such county
24 provider for hospital services under Titles XIX and XXI of the
25 Social Security Act or pursuant to subsection (a) of Section

 

 

09500SB2857ham001 - 39 - LRB095 19231 DRJ 51509 a

1 15-5 5-11 of this Code and the total federal financial
2 participation monies received by the fund in each fiscal year
3 ending June 30 (or fraction thereof during the fiscal year
4 ending June 30, 1993) and $108,800,000 (or fraction thereof),
5 except that the annual intergovernmental transfer shall not
6 exceed the total payments made by the Illinois Department to
7 such county provider for hospital services under this Code,
8 less the sum of (i) 50% of payments reimbursable under the
9 Social Security Act at a rate of 50% and (ii) 65% of payments
10 reimbursable under the Social Security Act at a rate of 65%, in
11 each fiscal year ending June 30 (or fraction thereof).
12     (b) The payment schedule for the intergovernmental
13 transfer made hereunder shall be established by
14 intergovernmental agreement between the Illinois Department
15 and the applicable county, which agreement shall at a minimum
16 provide:
17         (1) For periodic payments no less frequently than
18     monthly to the county provider for inpatient and outpatient
19     approved or adjudicated claims and for disproportionate
20     share adjustment payments as may be specified in the
21     Illinois Title XIX State plan. under Section 5-5.02 of this
22     Code (in the initial year, for services after July 1, 1991,
23     or such other date as an approved State Medical Assistance
24     Plan shall provide).
25         (2) (Blank.) For periodic payments no less frequently
26     than monthly to the county provider for supplemental

 

 

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1     disproportionate share payments hereunder based on a
2     federally approved State Medical Assistance Plan.
3         (3) For calculation of the intergovernmental transfer
4     payment to be made by the county equal to 71.7% of the
5     difference between the amount of the periodic payments to
6     county providers payment and any amount of federal
7     financial participation due the Illinois Department under
8     Titles XIX and XXI of the Social Security Act as a result
9     of such payments to county providers. the base amount;
10     provided, however, that if the periodic payment for any
11     period is less than the base amount for such period, the
12     base amount for the succeeding period (and any successive
13     period if necessary) shall be increased by the amount of
14     such shortfall.
15         (4) For an intergovernmental transfer methodology
16     which obligates the Illinois Department to notify the
17     county and county provider in writing of each impending
18     periodic payment and the intergovernmental transfer
19     payment attributable thereto and which obligates the
20     Comptroller to release the periodic payment to the county
21     provider within one working day of receipt of the
22     intergovernmental transfer payment from the county.
23 (Source: P.A. 91-24, eff. 7-1-99; 92-370, eff. 8-15-01.)
 
24     (305 ILCS 5/15-5)  (from Ch. 23, par. 15-5)
25     Sec. 15-5. Disbursements from the Fund.

 

 

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1     (a) The monies in the Fund shall be disbursed only as
2 provided in Section 15-2 of this Code and as follows:
3         (1) To the extent that such costs are reimbursable
4     under federal law, to pay the county hospitals' inpatient
5     reimbursement rates rate based on actual costs incurred,
6     trended forward annually by an inflation index. and
7     supplemented by teaching, capital, and other direct and
8     indirect costs, according to a State plan approved by the
9     federal government. Effective October 1, 1992, the
10     inpatient reimbursement rate (including any
11     disproportionate or supplemental disproportionate share
12     payments) for hospital services provided by county
13     operated facilities within the County shall be no less than
14     the reimbursement rates in effect on June 1, 1992, except
15     that this minimum shall be adjusted as of July 1, 1992 and
16     each July 1 thereafter through July 1, 2002 by the annual
17     percentage change in the per diem cost of inpatient
18     hospital services as reported in the most recent annual
19     Medicaid cost report. Effective July 1, 2003, the rate for
20     hospital inpatient services provided by county hospitals
21     shall be the rate in effect on January 1, 2003, except that
22     this minimum may be adjusted by the Illinois Department to
23     ensure compliance with aggregate and hospital-specific
24     federal payment limitations.
25         (2) To the extent that such costs are reimbursable
26     under federal law, to pay county hospitals and county

 

 

09500SB2857ham001 - 42 - LRB095 19231 DRJ 51509 a

1     operated outpatient facilities for outpatient services
2     based on a federally approved methodology to cover the
3     maximum allowable costs. per patient visit. Effective
4     October 1, 1992, the outpatient reimbursement rate for
5     outpatient services provided by county hospitals and
6     county operated outpatient facilities shall be no less than
7     the reimbursement rates in effect on June 1, 1992, except
8     that this minimum shall be adjusted as of July 1, 1992 and
9     each July 1 thereafter through July 1, 2002 by the annual
10     percentage change in the per diem cost of inpatient
11     hospital services as reported in the most recent annual
12     Medicaid cost report. Effective July 1, 2003, the Illinois
13     Department shall by rule establish rates for outpatient
14     services provided by county hospitals and other
15     county-operated facilities within the County that are in
16     compliance with aggregate and hospital-specific federal
17     payment limitations.
18         (3) To pay the county hospitals hospitals'
19     disproportionate share hospital adjustment payments as may
20     be specified in the Illinois Title XIX State plan. as
21     established by the Illinois Department under Section
22     5-5.02 of this Code. Effective October 1, 1992, the
23     disproportionate share payments for hospital services
24     provided by county operated facilities within the County
25     shall be no less than the reimbursement rates in effect on
26     June 1, 1992, except that this minimum shall be adjusted as

 

 

09500SB2857ham001 - 43 - LRB095 19231 DRJ 51509 a

1     of July 1, 1992 and each July 1 thereafter through July 1,
2     2002 by the annual percentage change in the per diem cost
3     of inpatient hospital services as reported in the most
4     recent annual Medicaid cost report. Effective July 1, 2003,
5     the Illinois Department may by rule establish rates for
6     disproportionate share payments to county hospitals that
7     are in compliance with aggregate and hospital-specific
8     federal payment limitations.
9         (3.5) To pay county providers for services provided
10     pursuant to Section 5-11 of this Code.
11         (4) To reimburse the county providers for expenses
12     contractually assumed pursuant to Section 15-4 of this
13     Code.
14         (5) To pay the Illinois Department its necessary
15     administrative expenses relative to the Fund and other
16     amounts agreed to, if any, by the county providers in the
17     agreement provided for in subsection (c).
18         (6) To pay the county providers any other amount due
19     according to a federally approved State plan, including but
20     not limited to payments made under the provisions of
21     Section 701(d)(3)(B) of the federal Medicare, Medicaid,
22     and SCHIP Benefits Improvement and Protection Act of 2000.
23     Intergovernmental transfers supporting payments under this
24     paragraph (6) shall not be subject to the computation
25     described in subsection (a) of Section 15-3 of this Code,
26     but shall be computed as the difference between the total

 

 

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1     of such payments made by the Illinois Department to county
2     providers less any amount of federal financial
3     participation due the Illinois Department under Titles XIX
4     and XXI of the Social Security Act as a result of such
5     payments to county providers.
6     (b) The Illinois Department shall promptly seek all
7 appropriate amendments to the Illinois Title XIX State Plan to
8 maximize reimbursement, including disproportionate share
9 hospital adjustment payments, to the county providers effect
10 the foregoing payment methodology.
11     (c) (Blank). The Illinois Department shall implement the
12 changes made by Article 3 of this amendatory Act of 1992
13 beginning October 1, 1992. All terms and conditions of the
14 disbursement of monies from the Fund not set forth expressly in
15 this Article shall be set forth in the agreement executed under
16 the Intergovernmental Cooperation Act so long as those terms
17 and conditions are not inconsistent with this Article or
18 applicable federal law. The Illinois Department shall report in
19 writing to the Hospital Service Procurement Advisory Board and
20 the Health Care Cost Containment Council by October 15, 1992,
21 the terms and conditions of all such initial agreements and,
22 where no such initial agreement has yet been executed with a
23 qualifying county, the Illinois Department's reasons that each
24 such initial agreement has not been executed. Copies and
25 reports of amended agreements following the initial agreements
26 shall likewise be filed by the Illinois Department with the

 

 

09500SB2857ham001 - 45 - LRB095 19231 DRJ 51509 a

1 Hospital Service Procurement Advisory Board and the Health Care
2 Cost Containment Council within 30 days following their
3 execution. The foregoing filing obligations of the Illinois
4 Department are informational only, to allow the Board and
5 Council, respectively, to better perform their public roles,
6 except that the Board or Council may, at its discretion, advise
7 the Illinois Department in the case of the failure of the
8 Illinois Department to reach agreement with any qualifying
9 county by the required date.
10     (d) The payments provided for herein are intended to cover
11 services rendered on and after July 1, 1991, and any agreement
12 executed between a qualifying county and the Illinois
13 Department pursuant to this Section may relate back to that
14 date, provided the Illinois Department obtains federal
15 approval. Any changes in payment rates resulting from the
16 provisions of Article 3 of this amendatory Act of 1992 are
17 intended to apply to services rendered on or after October 1,
18 1992, and any agreement executed between a qualifying county
19 and the Illinois Department pursuant to this Section may be
20 effective as of that date.
21     (e) If one or more hospitals file suit in any court
22 challenging any part of this Article XV, payments to hospitals
23 from the Fund under this Article XV shall be made only to the
24 extent that sufficient monies are available in the Fund and
25 only to the extent that any monies in the Fund are not
26 prohibited from disbursement and may be disbursed under any

 

 

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1 order of the court.
2     (f) All payments under this Section are contingent upon
3 federal approval of changes to the Title XIX State plan, if
4 that approval is required.
5 (Source: P.A. 92-370, eff. 8-15-01; 93-20, eff. 6-20-03.)
 
6     (305 ILCS 5/15-8)  (from Ch. 23, par. 15-8)
7     Sec. 15-8. Federal disallowances. In the event of any
8 federal deferral or disallowance of any federal matching funds
9 obtained through this Article which have been disbursed by the
10 Illinois Department under this Article based upon challenges to
11 reimbursement methodologies, methodology or disproportionate
12 share methodology, the full faith and credit of the county is
13 pledged for repayment by the county of those amounts deferred
14 or disallowed to the Illinois Department.
15 (Source: P.A. 87-13.)
 
16     (305 ILCS 5/15-10 new)
17     Sec. 15-10. Disproportionate share hospital adjustment
18 payments.
19     (a) The provisions of this Section become operative if:
20         (1) The federal government approves State Plan
21     Amendment transmittal number 08-06 or a State Plan
22     Amendment that permits disproportionate share hospital
23     adjustment payments to be made to county hospitals.
24         (2) Proposed federal regulations, or other regulations

 

 

09500SB2857ham001 - 47 - LRB095 19231 DRJ 51509 a

1     or limitations driven by the federal government,
2     negatively impact the net revenues realized by county
3     providers from the Fund during a State fiscal year by more
4     than 15%, as measured by the aggregate average net monthly
5     payment received by the county providers from the Fund from
6     July 2007 through May 2008.
7         (3) The county providers have in good faith submitted
8     timely, complete, and accurate cost reports and
9     supplemental documents as required by the Illinois
10     Department.
11         (4) the county providers maintain and bill for service
12     volumes to individuals eligible for medical assistance
13     under this Code that are no lower than 85% of the volumes
14     provided by and billed to the Illinois Department by the
15     county providers associated with payments received by the
16     county providers from July 2007 through May 2008. Given the
17     substantial financial burdens of the county associated
18     with uncompensated care, the Illinois Department shall
19     make good faith efforts to work with the county to maintain
20     Medicaid volumes to the extent that the county has the
21     adequate capacity to meet the obligations of patient
22     volumes.
23     The Illinois Department and the county shall include in an
24 intergovernmental agreement the process by which these
25 conditions are assessed. The parties may, if necessary,
26 contract with a large, nationally recognized public accounting

 

 

09500SB2857ham001 - 48 - LRB095 19231 DRJ 51509 a

1 firm to carry out this function.
2     (b) If the conditions of subsection (a) are met, and
3 subject to appropriation or other available funding for such
4 purpose, the Illinois Department shall make a payment or
5 otherwise make funds available to the county hospitals, during
6 the lapse period, that provides for total payments to be at
7 least at a level that is equivalent to the total
8 fee-for-service payments received by the county providers that
9 are enrolled with the Illinois Department to provide services
10 during the fiscal year of the payment from the Fund from July
11 2007 through May 2008 multiplied by twelve-elevenths.
12     (c) In addition, notwithstanding any provision in
13 subsection (a), the Illinois Department shall maximize
14 disproportionate share hospital adjustment payments to the
15 county hospitals that, at a minimum, are 42% of the State's
16 federal fiscal year 2007 disproportionate share allocation.
17     (d) For the purposes of this Section, "net revenues" means
18 the difference between the total fee-for-service payments made
19 by the Illinois Department to county providers less the
20 intergovernmental transfer made by the county in support of
21 those payments.
22     (e) If (i) the disproportionate share hospital adjustment
23 State Plan Amendment referenced in subdivision (a)(1) is not
24 approved, or (ii) any reconciliation of payments to costs
25 incurred would require repayment to the federal government of
26 at least $2,500,000, or (iii) there is no funding available for

 

 

09500SB2857ham001 - 49 - LRB095 19231 DRJ 51509 a

1 the Illinois Department's obligations under subsection (b),
2 the Illinois Department, the county, and the leadership of the
3 General Assembly shall designate individuals to convene,
4 within 30 days, to discuss how mutual funding goals for the
5 county providers are to be achieved.
 
6     (305 ILCS 5/15-11 new)
7     Sec. 15-11. Uses of State funds.
8     (a) At any point, if State revenues referenced in
9 subsection (b) or (c) of Section 15-10 or additional State
10 grants are disbursed to the Cook County Health and Hospitals
11 System, all funds may be used only for the following:
12         (1) medical services provided at hospitals or clinics
13     owned and operated by the Cook County Bureau of Health
14     Services; or
15         (2) information technology to enhance billing
16     capabilities for medical claiming and reimbursement.
17     (b) State funds may not be used for the following:
18         (1) non-clinical services, except services that may be
19     required by accreditation bodies or State or federal
20     regulatory or licensing authorities;
21         (2) non-clinical support staff, except as pursuant to
22     paragraph (1) of this subsection; or
23         (3) capital improvements, other than investments in
24     medical technology, except for capital improvements that
25     may be required by accreditation bodies or State or federal

 

 

09500SB2857ham001 - 50 - LRB095 19231 DRJ 51509 a

1     regulatory or licensing authorities.
 
2     Section 99. Effective date. This Act takes effect upon
3 becoming law.".