Full Text of HB4969 93rd General Assembly
HB4969 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 HB4969
Introduced 02/05/04, by Rosemary Mulligan SYNOPSIS AS INTRODUCED: |
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305 ILCS 5/5-5.02 |
from Ch. 23, par. 5-5.02 |
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Amends the Illinois Public Aid Code. Makes a technical change in a Section
concerning Medicaid rates for hospitals.
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A BILL FOR
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HB4969 |
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LRB093 18794 DRJ 44528 b |
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| AN ACT in relation to public aid.
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| Be it enacted by the People of the State of Illinois, | 3 |
| represented in the General Assembly:
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| Section 5. The Illinois Public Aid Code is amended by | 5 |
| changing
Section 5-5.02 as follows:
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| (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
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| Sec. 5-5.02. Hospital reimbursements.
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| (a) Reimbursement to hospitals
Hospitals ; July 1, 1992 | 9 |
| through
September 30, 1992.
Notwithstanding any other | 10 |
| provisions of this Code or the Illinois
Department's Rules | 11 |
| promulgated under the Illinois Administrative Procedure
Act, | 12 |
| reimbursement to hospitals for services provided during the | 13 |
| period
July 1, 1992 through September 30, 1992, shall be as | 14 |
| follows:
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| (1) For inpatient hospital services rendered, or if | 16 |
| applicable, for
inpatient hospital discharges occurring, | 17 |
| on or after July 1, 1992 and on
or before September 30, | 18 |
| 1992, the Illinois Department shall reimburse
hospitals | 19 |
| for inpatient services under the reimbursement | 20 |
| methodologies in
effect for each hospital, and at the | 21 |
| inpatient payment rate calculated for
each hospital, as of | 22 |
| June 30, 1992. For purposes of this paragraph,
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| "reimbursement methodologies" means all reimbursement | 24 |
| methodologies that
pertain to the provision of inpatient | 25 |
| hospital services, including, but not
limited to, any | 26 |
| adjustments for disproportionate share, targeted access,
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| critical care access and uncompensated care, as defined by | 28 |
| the Illinois
Department on June 30, 1992.
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| (2) For the purpose of calculating the inpatient | 30 |
| payment rate for each
hospital eligible to receive | 31 |
| quarterly adjustment payments for targeted
access and | 32 |
| critical care, as defined by the Illinois Department on |
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LRB093 18794 DRJ 44528 b |
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| June 30,
1992, the adjustment payment for the period July | 2 |
| 1, 1992 through September
30, 1992, shall be 25% of the | 3 |
| annual adjustment payments calculated for
each eligible | 4 |
| hospital, as of June 30, 1992. The Illinois Department | 5 |
| shall
determine by rule the adjustment payments for | 6 |
| targeted access and critical
care beginning October 1, | 7 |
| 1992.
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| (3) For the purpose of calculating the inpatient | 9 |
| payment rate for each
hospital eligible to receive | 10 |
| quarterly adjustment payments for
uncompensated care, as | 11 |
| defined by the Illinois Department on June 30, 1992,
the | 12 |
| adjustment payment for the period August 1, 1992 through | 13 |
| September 30,
1992, shall be one-sixth of the total | 14 |
| uncompensated care adjustment payments
calculated for each | 15 |
| eligible hospital for the uncompensated care rate year,
as | 16 |
| defined by the Illinois Department, ending on July 31, | 17 |
| 1992. The
Illinois Department shall determine by rule the | 18 |
| adjustment payments for
uncompensated care beginning | 19 |
| October 1, 1992.
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| (b) Inpatient payments. For inpatient services provided on | 21 |
| or after October
1, 1993, in addition to rates paid for | 22 |
| hospital inpatient services pursuant to
the Illinois Health | 23 |
| Finance Reform Act, as now or hereafter amended, or the
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| Illinois Department's prospective reimbursement methodology, | 25 |
| or any other
methodology used by the Illinois Department for | 26 |
| inpatient services, the
Illinois Department shall make | 27 |
| adjustment payments, in an amount calculated
pursuant to the | 28 |
| methodology described in paragraph (c) of this Section, to
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| hospitals that the Illinois Department determines satisfy any | 30 |
| one of the
following requirements:
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| (1) Hospitals that are described in Section 1923 of the | 32 |
| federal Social
Security Act, as now or hereafter amended; | 33 |
| or
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| (2) Illinois hospitals that have a Medicaid inpatient | 35 |
| utilization
rate which is at least one-half a standard | 36 |
| deviation above the mean Medicaid
inpatient utilization |
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LRB093 18794 DRJ 44528 b |
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| rate for all hospitals in Illinois receiving Medicaid
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| payments from the Illinois Department; or
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| (3) Illinois hospitals that on July 1, 1991 had a | 4 |
| Medicaid inpatient
utilization rate, as defined in | 5 |
| paragraph (h) of this Section,
that was at least the mean | 6 |
| Medicaid inpatient utilization rate for all
hospitals in | 7 |
| Illinois receiving Medicaid payments from the Illinois
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| Department and which were located in a planning area with | 9 |
| one-third or
fewer excess beds as determined by the | 10 |
| Illinois Health Facilities
Planning Board, and that, as of | 11 |
| June 30, 1992, were located in a federally
designated | 12 |
| Health Manpower Shortage Area; or
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| (4) Illinois hospitals that:
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| (A) have a Medicaid inpatient utilization rate | 15 |
| that is at least
equal to the mean Medicaid inpatient | 16 |
| utilization rate for all hospitals in
Illinois | 17 |
| receiving Medicaid payments from the Department; and
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| (B) also have a Medicaid obstetrical inpatient | 19 |
| utilization
rate that is at least one standard | 20 |
| deviation above the mean Medicaid
obstetrical | 21 |
| inpatient utilization rate for all hospitals in | 22 |
| Illinois
receiving Medicaid payments from the | 23 |
| Department for obstetrical services; or
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| (5) Any children's hospital, which means a hospital | 25 |
| devoted exclusively
to caring for children. A hospital | 26 |
| which includes a facility devoted
exclusively to caring for | 27 |
| children shall be considered a
children's hospital to the | 28 |
| degree that the hospital's Medicaid care is
provided to | 29 |
| children
if either (i) the facility devoted exclusively to | 30 |
| caring for children is
separately licensed as a hospital by | 31 |
| a municipality prior to
September
30, 1998 or
(ii) the | 32 |
| hospital has been
designated
by the State
as a Level III | 33 |
| perinatal care facility, has a Medicaid Inpatient
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| Utilization rate
greater than 55% for the rate year 2003 | 35 |
| disproportionate share determination,
and has more than | 36 |
| 10,000 qualified children days as defined by
the
Department |
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LRB093 18794 DRJ 44528 b |
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| in rulemaking.
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| (c) Inpatient adjustment payments. The adjustment payments | 3 |
| required by
paragraph (b) shall be calculated based upon the | 4 |
| hospital's Medicaid
inpatient utilization rate as follows:
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| (1) hospitals with a Medicaid inpatient utilization | 6 |
| rate below the mean
shall receive a per day adjustment | 7 |
| payment equal to $25;
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| (2) hospitals with a Medicaid inpatient utilization | 9 |
| rate
that is equal to or greater than the mean Medicaid | 10 |
| inpatient utilization rate
but less than one standard | 11 |
| deviation above the mean Medicaid inpatient
utilization | 12 |
| rate shall receive a per day adjustment payment
equal to | 13 |
| the sum of $25 plus $1 for each one percent that the | 14 |
| hospital's
Medicaid inpatient utilization rate exceeds the | 15 |
| mean Medicaid inpatient
utilization rate;
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| (3) hospitals with a Medicaid inpatient utilization | 17 |
| rate that is equal
to or greater than one standard | 18 |
| deviation above the mean Medicaid inpatient
utilization | 19 |
| rate but less than 1.5 standard deviations above the mean | 20 |
| Medicaid
inpatient utilization rate shall receive a per day | 21 |
| adjustment payment equal to
the sum of $40 plus $7 for each | 22 |
| one percent that the hospital's Medicaid
inpatient | 23 |
| utilization rate exceeds one standard deviation above the | 24 |
| mean
Medicaid inpatient utilization rate; and
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| (4) hospitals with a Medicaid inpatient utilization | 26 |
| rate that is equal
to or greater than 1.5 standard | 27 |
| deviations above the mean Medicaid inpatient
utilization | 28 |
| rate shall receive a per day adjustment payment equal to | 29 |
| the sum of
$90 plus $2 for each one percent that the | 30 |
| hospital's Medicaid inpatient
utilization rate exceeds 1.5 | 31 |
| standard deviations above the mean Medicaid
inpatient | 32 |
| utilization rate.
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| (d) Supplemental adjustment payments. In addition to the | 34 |
| adjustment
payments described in paragraph (c), hospitals as | 35 |
| defined in clauses
(1) through (5) of paragraph (b), excluding | 36 |
| county hospitals (as defined in
subsection (c) of Section 15-1 |
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LRB093 18794 DRJ 44528 b |
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| of this Code) and a hospital organized under the
University of | 2 |
| Illinois Hospital Act, shall be paid supplemental inpatient
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| adjustment payments of $60 per day. For purposes of Title XIX | 4 |
| of the federal
Social Security Act, these supplemental | 5 |
| adjustment payments shall not be
classified as adjustment | 6 |
| payments to disproportionate share hospitals.
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| (e) The inpatient adjustment payments described in | 8 |
| paragraphs (c) and (d)
shall be increased on October 1, 1993 | 9 |
| and annually thereafter by a percentage
equal to the lesser of | 10 |
| (i) the increase in the DRI hospital cost index for the
most | 11 |
| recent 12 month period for which data are available, or (ii) | 12 |
| the
percentage increase in the statewide average hospital | 13 |
| payment rate over the
previous year's statewide average | 14 |
| hospital payment rate. The sum of the
inpatient adjustment | 15 |
| payments under paragraphs (c) and (d) to a hospital, other
than | 16 |
| a county hospital (as defined in subsection (c) of Section 15-1 | 17 |
| of this
Code) or a hospital organized under the University of | 18 |
| Illinois Hospital Act,
however, shall not exceed $275 per day; | 19 |
| that limit shall be increased on
October 1, 1993 and annually | 20 |
| thereafter by a percentage equal to the lesser of
(i) the | 21 |
| increase in the DRI hospital cost index for the most recent | 22 |
| 12-month
period for which data are available or (ii) the | 23 |
| percentage increase in the
statewide average hospital payment | 24 |
| rate over the previous year's statewide
average hospital | 25 |
| payment rate.
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| (f) Children's hospital inpatient adjustment payments. For | 27 |
| children's
hospitals, as defined in clause (5) of paragraph | 28 |
| (b), the adjustment payments
required pursuant to paragraphs | 29 |
| (c) and (d) shall be multiplied by 2.0.
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| (g) County hospital inpatient adjustment payments. For | 31 |
| county hospitals,
as defined in subsection (c) of Section 15-1 | 32 |
| of this Code, there shall be an
adjustment payment as | 33 |
| determined by rules issued by the Illinois Department.
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| (h) For the purposes of this Section the following terms | 35 |
| shall be defined
as follows:
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| (1) "Medicaid inpatient utilization rate" means a |
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LRB093 18794 DRJ 44528 b |
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| fraction, the numerator
of which is the number of a | 2 |
| hospital's inpatient days provided in a given
12-month | 3 |
| period to patients who, for such days, were eligible for | 4 |
| Medicaid
under Title XIX of the federal Social Security | 5 |
| Act, and the denominator of
which is the total number of | 6 |
| the hospital's inpatient days in that same period.
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| (2) "Mean Medicaid inpatient utilization rate" means | 8 |
| the total number
of Medicaid inpatient days provided by all | 9 |
| Illinois Medicaid-participating
hospitals divided by the | 10 |
| total number of inpatient days provided by those same
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| hospitals.
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| (3) "Medicaid obstetrical inpatient utilization rate" | 13 |
| means the
ratio of Medicaid obstetrical inpatient days to | 14 |
| total Medicaid inpatient
days for all Illinois hospitals | 15 |
| receiving Medicaid payments from the
Illinois Department.
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| (i) Inpatient adjustment payment limit. In order to meet | 17 |
| the limits
of Public Law 102-234 and Public Law 103-66, the
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| Illinois Department shall by rule adjust
disproportionate | 19 |
| share adjustment payments.
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| (j) University of Illinois Hospital inpatient adjustment | 21 |
| payments. For
hospitals organized under the University of | 22 |
| Illinois Hospital Act, there shall
be an adjustment payment as | 23 |
| determined by rules adopted by the Illinois
Department.
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| (k) The Illinois Department may by rule establish criteria | 25 |
| for and develop
methodologies for adjustment payments to | 26 |
| hospitals participating under this
Article.
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| (Source: P.A. 93-40, eff. 6-27-03 .)
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