Full Text of SB2212 93rd General Assembly
SB2212ham001 93RD GENERAL ASSEMBLY
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Rep. Michael J. Madigan
Filed: 1/10/2005
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| AMENDMENT TO SENATE BILL 2212
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| AMENDMENT NO. ______. Amend Senate Bill 2212 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 5. The Illinois Public Aid Code is amended by | 5 |
| changing Sections 5A-1, 5A-2, 5A-4, and 5A-12 as follows: | 6 |
| (305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1)
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| Sec. 5A-1. Definitions. As used in this Article, unless | 8 |
| the context requires
otherwise:
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| "Fund" means the Hospital Provider Fund.
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| "Hospital" means an institution, place, building, or | 11 |
| agency located in this
State that is subject to licensure by | 12 |
| the Illinois Department of Public Health
under the Hospital | 13 |
| Licensing Act, whether public or private and whether
organized | 14 |
| for profit or not-for-profit.
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| "Hospital provider" means a person licensed by the | 16 |
| Department of Public
Health to conduct, operate, or maintain a | 17 |
| hospital, regardless of whether the
person is a Medicaid | 18 |
| provider. For purposes of this paragraph, "person" means
any | 19 |
| political subdivision of the State, municipal corporation, | 20 |
| individual,
firm, partnership, corporation, company, limited | 21 |
| liability company,
association, joint stock association, or | 22 |
| trust, or a receiver, executor,
trustee, guardian, or other | 23 |
| representative appointed by order of any court.
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| "Occupied bed days" means the sum of the number of days
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| that each bed was occupied by a patient for all beds during
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| calendar year 2001. Occupied bed days shall be computed | 3 |
| separately for each
hospital operated or maintained by a | 4 |
| hospital provider. | 5 |
| "Proration factor" means a fraction, the numerator of which | 6 |
| is 53 and the denominator of which is 365.
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| (Source: P.A. 93-659, eff. 2-3-04.)
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| (305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) | 9 |
| (Section scheduled to be repealed on July 1, 2005) | 10 |
| Sec. 5A-2. Assessment; no local authorization to tax.
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| (a) Subject to Sections 5A-3 and 5A-10, an annual | 12 |
| assessment on inpatient
services is imposed on
each
hospital
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| provider in an amount equal to the hospital's occupied bed days | 14 |
| multiplied by $84.19 multiplied by the proration factor for | 15 |
| State fiscal year
years 2004 and the hospital's occupied bed | 16 |
| days multiplied by $84.19 for State fiscal year 2005 . , if the | 17 |
| payment methodologies required under 5A-12 and the waiver | 18 |
| granted under 42 CFR 433.68 are approved with an effective date | 19 |
| prior to July 1, 2004; or the assessment will be imposed for | 20 |
| fiscal year 2005 only, if the payment methodologies required | 21 |
| under Section 5A-12 and the waiver granted under 42 CFR 433.68 | 22 |
| are approved with an effective date on or after July 1, 2004.
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| The
Department of Public Aid shall use the number of | 24 |
| occupied bed days as reported
by
each hospital on the Annual | 25 |
| Survey of Hospitals conducted by the
Department of Public | 26 |
| Health to calculate the hospital's annual assessment. If
the | 27 |
| sum
of a hospital's occupied bed days is not reported on the | 28 |
| Annual Survey of
Hospitals or if there are data errors in the | 29 |
| reported sum of a hospital's occupied bed days as determined by | 30 |
| the Department of Public Aid, then the Department of Public Aid | 31 |
| may obtain the sum of occupied bed
days
from any source | 32 |
| available, including, but not limited to, records maintained by
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| the hospital provider, which may be inspected at all times |
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| during business
hours
of the day by the Department of Public | 2 |
| Aid or its duly authorized agents and
employees.
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| (b) Nothing in this amendatory Act of the 93rd General | 4 |
| Assembly
shall be construed to authorize
any home rule unit or | 5 |
| other unit of local government to license for revenue or
to | 6 |
| impose a tax or assessment upon hospital providers or the | 7 |
| occupation of
hospital provider, or a tax or assessment | 8 |
| measured by the income or earnings of
a hospital provider.
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| (c) As provided in Section 5A-14, this Section is repealed | 10 |
| on July 1,
2005.
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| (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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| (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) | 13 |
| Sec. 5A-4. Payment of assessment; penalty.
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| (a) The annual assessment imposed by Section 5A-2 for State | 15 |
| fiscal year
2004
shall be due
and payable on June 18 of
the
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| year.
The assessment imposed by Section 5A-2 for State fiscal | 17 |
| year 2005
shall be
due and payable in quarterly installments, | 18 |
| each equalling one-fourth of the
assessment for the year, on | 19 |
| July 19, October 19, January 18, and April 19 of
the year.
No | 20 |
| installment payment of an assessment imposed by Section 5A-2 | 21 |
| shall be due
and
payable, however, until after: (i) the | 22 |
| hospital provider
receives written
notice from the Department | 23 |
| of Public Aid that the payment methodologies to
hospitals
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| required under
Section 5A-12 have been approved by the Centers | 25 |
| for Medicare and Medicaid
Services of
the U.S. Department of | 26 |
| Health and Human Services and the waiver under 42 CFR
433.68 | 27 |
| for the assessment imposed by Section 5A-2 has been granted by | 28 |
| the
Centers for Medicare and Medicaid Services of the U.S. | 29 |
| Department of Health and
Human Services; and (ii) the hospital
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| has
received the payments required under Section 5A-12.
Upon | 31 |
| notification to the Department of approval of the payment | 32 |
| methodologies required under Section 5A-12 and the waiver | 33 |
| granted under 42 CFR 433.68, all quarterly installments |
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| otherwise due under Section 5A-2 prior to the date of | 2 |
| notification shall be due and payable to the Department upon | 3 |
| written direction from the Department
within 30 days of the | 4 |
| date of notification .
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| (b) The Illinois Department is authorized to establish
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| delayed payment schedules for hospital providers that are | 7 |
| unable
to make installment payments when due under this Section | 8 |
| due to
financial difficulties, as determined by the Illinois | 9 |
| Department.
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| (c) If a hospital provider fails to pay the full amount of
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| an installment when due (including any extensions granted under
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| subsection (b)), there shall, unless waived by the Illinois
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| Department for reasonable cause, be added to the assessment
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| imposed by Section 5A-2 a penalty
assessment equal to the | 15 |
| lesser of (i) 5% of the amount of the
installment not paid on | 16 |
| or before the due date plus 5% of the
portion thereof remaining | 17 |
| unpaid on the last day of each 30-day period
thereafter or (ii) | 18 |
| 100% of the installment amount not paid on or
before the due | 19 |
| date. For purposes of this subsection, payments
will be | 20 |
| credited first to unpaid installment amounts (rather than
to | 21 |
| penalty or interest), beginning with the most delinquent
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| installments.
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| (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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| (305 ILCS 5/5A-12)
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| (Section scheduled to be repealed on July 1, 2005) | 26 |
| Sec. 5A-12. Hospital access improvement payments.
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| (a) To improve access to hospital services, for hospital | 28 |
| services rendered
on or
after June 1, 2004, the Department of | 29 |
| Public Aid shall make
payments
to hospitals as set forth in | 30 |
| this Section, except for hospitals described in
subsection (b) | 31 |
| of
Section 5A-3.
These payments shall be paid on a quarterly | 32 |
| basis. For State fiscal year 2004, if the effective date of the | 33 |
| approval of the payment methodology required under this Section |
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| and the waiver granted under 42 CFR 433.68 by the Centers for | 2 |
| Medicare and Medicaid Services of the U.S. Department of Health | 3 |
| and Human Services is prior to July 1, 2004,
the
Department | 4 |
| shall pay the total amounts required for fiscal year 2004 under | 5 |
| this Section within 75
25 days of the latest notification. No | 6 |
| payment shall be made for State fiscal year 2004 if the | 7 |
| effective date of the approval is on or after July 1, 2004.
In | 8 |
| State fiscal year 2005,
the total
amounts required under this | 9 |
| Section shall be paid in 4 equal installments on or
before
July | 10 |
| 15, October 15, January 14, and April 15
of the year, except | 11 |
| that if the date of notification of the approval of the payment | 12 |
| methodologies required under this Section and the waiver | 13 |
| granted under 42 CFR 433.68 is on or after July 1, 2004, the | 14 |
| sum of amounts required under this Section prior to the date of | 15 |
| notification shall be paid within 75
25 days of the date of the | 16 |
| last notification. Payments under
this
Section are not due and | 17 |
| payable, however, until (i) the methodologies described
in
this
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| Section are approved by the federal government in an | 19 |
| appropriate State Plan
amendment,
(ii) the assessment imposed | 20 |
| under this Article is determined to be a
permissible tax under | 21 |
| Title XIX of the Social Security Act, and (iii) the
assessment | 22 |
| is in effect.
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| (b) High volume payment. In addition to rates paid for | 24 |
| inpatient hospital
services, the Department of Public Aid shall | 25 |
| pay, to each Illinois hospital
that provided
more than 20,000 | 26 |
| Medicaid inpatient days of care during State fiscal year 2001
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| (except
for hospitals
that qualify for adjustment payments | 28 |
| under Section 5-5.02 for the 12-month
period beginning on | 29 |
| October 1, 2002), $190 for each
Medicaid inpatient day
of care | 30 |
| provided during that fiscal year. A hospital that provided less | 31 |
| than
30,000 Medicaid inpatient days of
care during that period, | 32 |
| however, is not entitled to receive more than
$3,500,000 per | 33 |
| year
in such payments.
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| (c) Medicaid inpatient utilization rate adjustment. In |
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| addition to rates
paid for
inpatient hospital services, the | 2 |
| Department of Public Aid shall pay each
Illinois hospital
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| (except for hospitals described in Section 5A-3), for each | 4 |
| Medicaid inpatient
day of
care provided
during State fiscal | 5 |
| year 2001, an amount equal to the product of $57.25
multiplied | 6 |
| by the
quotient of 1 divided by the greater of 1.6% or the | 7 |
| hospital's Medicaid
inpatient
utilization rate (as used to | 8 |
| determine eligibility for adjustment payments
under Section | 9 |
| 5-5.02 for the 12-month period beginning on October 1, 2002). | 10 |
| The
total payments under this
subsection to a
hospital may
not | 11 |
| exceed $10,500,000 annually.
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| (d) Psychiatric base rate adjustment.
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| (1) In addition to rates paid for
inpatient
psychiatric | 14 |
| services, the Department of Public Aid shall pay each | 15 |
| Illinois
general acute care hospital with a distinct | 16 |
| part-psychiatric unit, for
each Medicaid inpatient | 17 |
| psychiatric day of care provided in State fiscal year
2001, | 18 |
| an
amount equal
to $400 less the hospital's per-diem rate | 19 |
| for Medicaid inpatient psychiatric
services as in effect on | 20 |
| October 1, 2003. In no
event, however, shall that amount be | 21 |
| less than zero.
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| (2) For distinct
part-psychiatric units of Illinois
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| general acute care hospitals, except for all hospitals | 24 |
| excluded in Section
5A-3,
whose inpatient per-diem rate as | 25 |
| in effect on
October 1, 2003 is greater than
$400, the
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| Department shall pay, in addition to any other amounts | 27 |
| authorized under this
Code, $25
for each Medicaid inpatient | 28 |
| psychiatric day of care provided in State fiscal
year 2001.
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| (e) Supplemental tertiary care adjustment. In addition to | 30 |
| rates paid for
inpatient
services, the Department of Public Aid | 31 |
| shall pay to each Illinois hospital
eligible for
tertiary care | 32 |
| adjustment payments under 89 Ill. Adm. Code 148.296, as in | 33 |
| effect
for State fiscal year
2003, a supplemental tertiary care | 34 |
| adjustment payment equal to
the tertiary
care adjustment |
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| payment required under 89 Ill. Adm. Code 148.296, as in effect
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| for State fiscal year
2003.
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| (f) Medicaid outpatient utilization rate adjustment. In | 4 |
| addition to rates
paid for
outpatient hospital services, the | 5 |
| Department of Public Aid shall pay each
Illinois hospital
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| (except for hospitals described in Section 5A-3), an amount | 7 |
| equal to the
product of 2.45%
multiplied by the hospital's | 8 |
| Medicaid outpatient charges multiplied by the
quotient of 1
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| divided by the greater of 1.6% or the hospital's Medicaid | 10 |
| outpatient
utilization rate. The
total payments under this | 11 |
| subsection to a hospital may not exceed $6,750,000
annually.
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| For purposes of this subsection:
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| "Medicaid outpatient charges" means the charges for | 14 |
| outpatient services
provided to Medicaid patients for State | 15 |
| fiscal year 2001 as submitted by the
hospital on the UB-92 | 16 |
| billing form or under the ambulatory procedure listing
and
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| adjudicated by the Department of Public Aid on or before | 18 |
| September 12, 2003.
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| "Medicaid outpatient utilization rate" means a fraction, | 20 |
| the numerator of
which is the hospital's Medicaid outpatient | 21 |
| charges and the denominator of
which
is the total number of the | 22 |
| hospital's charges for outpatient services for the
hospital's | 23 |
| fiscal year ending in 2001.
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| (g) State outpatient service adjustment. In addition to | 25 |
| rates paid for
outpatient
hospital services, the Department of | 26 |
| Public Aid shall pay each Illinois
hospital an amount
equal to | 27 |
| the product of 75.5% multiplied by the hospital's Medicaid | 28 |
| outpatient
services
submitted to
the Department on the UB-92 | 29 |
| billing form for State fiscal year 2001 multiplied
by the
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| hospital's outpatient access fraction.
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| For purposes of this subsection,
"outpatient access
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| fraction" means a fraction, the numerator of which is the | 33 |
| hospital's Medicaid
payments
for outpatient services for | 34 |
| ambulatory procedure listing services submitted to
the |
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| Department on the UB-92 billing form
for State
fiscal year | 2 |
| 2001, and the denominator of which is the hospital's Medicaid
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| outpatient
services submitted to the Department on the UB-92 | 4 |
| billing form for State fiscal
year
2001.
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| The total payments under this subsection to a hospital may | 6 |
| not exceed
$3,000,000
annually.
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| (h) Rural hospital outpatient adjustment. In addition to | 8 |
| rates paid for
outpatient
hospital services, the Department of | 9 |
| Public Aid shall pay each Illinois rural
hospital an
amount | 10 |
| equal to the product of $14,500,000 multiplied by the rural | 11 |
| hospital
outpatient
adjustment fraction.
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| For purposes of this subsection, "rural hospital
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| outpatient
adjustment fraction" means a fraction, the | 14 |
| numerator of which is the hospital's
Medicaid
visits for | 15 |
| outpatient services for
ambulatory procedure listing services
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| submitted to the Department on the UB-92 billing
form for
State | 17 |
| fiscal year 2001, and the denominator of which is the total | 18 |
| Medicaid
visits for
outpatient services for ambulatory | 19 |
| procedure listing services for all Illinois
rural hospitals | 20 |
| submitted to the
Department on the UB-92 billing form for State | 21 |
| fiscal year 2001.
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| For purposes
of this subsection, "rural
hospital" has the | 23 |
| same meaning as in 89 Ill. Adm. Code 148.25, as in effect on
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| September
30, 2003.
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| (i) Merged/closed hospital adjustment. If any hospital | 26 |
| files a
combined Medicaid cost report with another hospital | 27 |
| after January 1, 2001, and
if
that hospital subsequently | 28 |
| closes, then except for the payments
described in
subsection | 29 |
| (e), all payments described in the various subsections of this
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| Section shall, before the application of the annual limitation | 31 |
| amount specified
in each such subsection, be multiplied by a | 32 |
| fraction, the numerator of which is
the number
of occupied bed | 33 |
| days attributable to the open hospital and the denominator of
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| which is the sum of the number of occupied bed days of each |
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| open hospital and
each
closed hospital. For purposes of this | 2 |
| subsection, "occupied bed
days" has the same meaning as the | 3 |
| term is defined in subsection (a) of
Section 5A-2.
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| (j) For purposes of this Section, the terms "Medicaid | 5 |
| days", "Medicaid
charges", and "Medicaid services" do not | 6 |
| include any days, charges, or services
for which Medicare was | 7 |
| liable for payment.
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| (j-5) For State fiscal year 2004, all payments described in | 9 |
| this Section shall be multiplied by the proration factor.
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| (k) As provided in Section 5A-14, this Section is repealed | 11 |
| on July 1,
2005.
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| (Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04.)
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| Section 99. Effective date. This Act takes effect upon | 14 |
| becoming law.".
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