Full Text of SB2165 95th General Assembly
SB2165 95TH GENERAL ASSEMBLY
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95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008 SB2165
Introduced 2/14/2008, by Sen. Deanna Demuzio SYNOPSIS AS INTRODUCED: |
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305 ILCS 5/14-8 |
from Ch. 23, par. 14-8 |
305 ILCS 5/15-5 |
from Ch. 23, par. 15-5 |
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Amends the Illinois Public Aid Code. Provides that for inpatient or outpatient hospital services provided by any hospital receiving reimbursement by the Department of Healthcare and Family Services, the Department may establish by rule a means of adjusting the rate of reimbursement so as to eliminate any costs of medical education, to the extent that such costs are no longer available for federal reimbursement. In connection with adjustment payments to hospitals, eliminates adjustments for teaching costs. Eliminates teaching costs as a supplement to hospital inpatient reimbursements from the County Provider Trust Fund. Effective immediately.
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A BILL FOR
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SB2165 |
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LRB095 15635 DRJ 41639 b |
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Public Aid Code is amended by | 5 |
| changing Sections 14-8 and 15-5 as follows:
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| (305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
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| Sec. 14-8. Disbursements to Hospitals.
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| (a) For inpatient hospital services rendered on and after | 9 |
| September 1,
1991, the Illinois Department shall reimburse
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| hospitals for inpatient services at an inpatient payment rate | 11 |
| calculated for
each hospital based upon the Medicare | 12 |
| Prospective Payment System as set forth
in Sections 1886(b), | 13 |
| (d), (g), and (h) of the federal Social Security Act, and
the | 14 |
| regulations, policies, and procedures promulgated thereunder, | 15 |
| except as
modified by this Section. Payment rates for inpatient | 16 |
| hospital services
rendered on or after September 1, 1991 and on | 17 |
| or before September 30, 1992
shall be calculated using the | 18 |
| Medicare Prospective Payment rates in effect on
September 1, | 19 |
| 1991. Payment rates for inpatient hospital services rendered on
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| or after October 1, 1992 and on or before March 31, 1994 shall | 21 |
| be calculated
using the Medicare Prospective Payment rates in | 22 |
| effect on September 1, 1992.
Payment rates for inpatient | 23 |
| hospital services rendered on or after April 1,
1994 shall be |
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LRB095 15635 DRJ 41639 b |
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| calculated using the Medicare Prospective Payment rates
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| (including the Medicare grouping methodology and weighting | 3 |
| factors as adjusted
pursuant to paragraph (1) of this | 4 |
| subsection) in effect 90 days prior to the
date of admission. | 5 |
| For services rendered on or after July 1, 1995, the
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| reimbursement methodology implemented under this subsection | 7 |
| shall not include
those costs referred to in Sections | 8 |
| 1886(d)(5)(B) and 1886(h) of the Social
Security Act. The | 9 |
| additional payment amounts required under Section
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| 1886(d)(5)(F) of the Social Security Act, for hospitals serving | 11 |
| a
disproportionate share of low-income or indigent patients, | 12 |
| are not required
under this Section. For hospital inpatient | 13 |
| services rendered on or after July
1, 1995, the Illinois | 14 |
| Department shall
reimburse hospitals using the relative | 15 |
| weighting factors and the base payment
rates calculated for | 16 |
| each hospital that were in effect on June 30, 1995, less
the | 17 |
| portion of such rates attributed by the Illinois Department to | 18 |
| the cost of
medical education.
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| (1) The weighting factors established under Section | 20 |
| 1886(d)(4) of the
Social Security Act shall not be used in | 21 |
| the reimbursement system
established under this Section. | 22 |
| Rather, the Illinois Department shall
establish by rule | 23 |
| Medicaid weighting factors to be used in the reimbursement
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| system established under this Section.
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| (2) The Illinois Department shall define by rule those | 26 |
| hospitals or
distinct parts of hospitals that shall be |
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| exempt from the reimbursement
system established under | 2 |
| this Section. In defining such hospitals, the
Illinois | 3 |
| Department shall take into consideration those hospitals | 4 |
| exempt
from the Medicare Prospective Payment System as of | 5 |
| September 1, 1991. For
hospitals defined as exempt under | 6 |
| this subsection, the Illinois Department
shall by rule | 7 |
| establish a reimbursement system for payment of inpatient
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| hospital services rendered on and after September 1, 1991. | 9 |
| For all
hospitals that are children's hospitals as defined | 10 |
| in Section 5-5.02 of
this Code, the reimbursement | 11 |
| methodology shall, through June 30, 1992, net
of all | 12 |
| applicable fees, at least equal each children's hospital | 13 |
| 1990 ICARE
payment rates, indexed to the current year by | 14 |
| application of the DRI hospital
cost index from 1989 to the | 15 |
| year in which payments are made. Excepting county
providers | 16 |
| as defined in Article XV of this Code, hospitals licensed | 17 |
| under the
University of Illinois Hospital Act, and | 18 |
| facilities operated by the
Department of Mental Health and | 19 |
| Developmental Disabilities (or its successor,
the | 20 |
| Department of Human Services) for hospital inpatient | 21 |
| services rendered on
or after July 1, 1995, the Illinois | 22 |
| Department shall reimburse children's
hospitals, as | 23 |
| defined in 89 Illinois Administrative Code Section | 24 |
| 149.50(c)(3),
at the rates in effect on June 30, 1995, and | 25 |
| shall reimburse all other
hospitals at the rates in effect | 26 |
| on June 30, 1995, less the portion of such
rates attributed |
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| by the Illinois Department to the cost of medical | 2 |
| education.
For inpatient hospital services provided on or | 3 |
| after August 1, 1998, the
Illinois Department may establish | 4 |
| by rule a means of adjusting the rates of
children's | 5 |
| hospitals, as defined in 89 Illinois Administrative Code | 6 |
| Section
149.50(c)(3), that did not meet that definition on | 7 |
| June 30, 1995, in order
for the inpatient hospital rates of | 8 |
| such hospitals to take into account the
average inpatient | 9 |
| hospital rates of those children's hospitals that did meet
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| the definition of children's hospitals on June 30, 1995. | 11 |
| For inpatient hospital services provided by any hospital | 12 |
| receiving reimbursement by the Department, the Department | 13 |
| may establish by rule a means of adjusting the rate of | 14 |
| reimbursement so as to eliminate any costs of medical | 15 |
| education, to the extent that such costs are no longer | 16 |
| available for federal reimbursement.
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| (3) (Blank)
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| (4) Notwithstanding any other provision of this | 19 |
| Section, hospitals
that on August 31, 1991, have a contract | 20 |
| with the Illinois Department under
Section 3-4 of the | 21 |
| Illinois Health Finance Reform Act may elect to continue
to | 22 |
| be reimbursed at rates stated in such contracts for general | 23 |
| and specialty
care.
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| (5) In addition to any payments made under this | 25 |
| subsection (a), the
Illinois Department shall make the | 26 |
| adjustment payments required by Section
5-5.02 of this |
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| Code; provided, that in the case of any hospital reimbursed
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| under a per case methodology, the Illinois Department shall | 3 |
| add an amount
equal to the product of the hospital's | 4 |
| average length of stay, less one
day, multiplied by 20, for | 5 |
| inpatient hospital services rendered on or
after September | 6 |
| 1, 1991 and on or before September 30, 1992.
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| (b) (Blank)
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| (b-5) Excepting county providers as defined in Article XV | 9 |
| of this Code,
hospitals licensed under the University of | 10 |
| Illinois Hospital Act, and
facilities operated by the Illinois | 11 |
| Department of Mental Health and
Developmental Disabilities (or | 12 |
| its successor, the Department of Human
Services), for | 13 |
| outpatient services rendered on or after July 1, 1995
and | 14 |
| before July 1, 1998 the Illinois Department shall reimburse
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| children's hospitals, as defined in the Illinois | 16 |
| Administrative Code
Section 149.50(c)(3), at the rates in | 17 |
| effect on June 30, 1995, less that
portion of such rates | 18 |
| attributed by the Illinois Department to the outpatient
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| indigent volume adjustment and shall reimburse all other | 20 |
| hospitals at the rates
in effect on June 30, 1995, less the | 21 |
| portions of such rates attributed by the
Illinois Department to | 22 |
| the cost of medical education and attributed by the
Illinois | 23 |
| Department to the outpatient indigent volume adjustment. For
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| outpatient services provided on or after July 1, 1998, | 25 |
| reimbursement rates
shall be established by rule. For | 26 |
| outpatient hospital services provided by any hospital |
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| receiving reimbursement by the Department, the Department may | 2 |
| establish by rule a means of adjusting the rate of | 3 |
| reimbursement so as to eliminate any costs of medical | 4 |
| education, to the extent that such costs are no longer | 5 |
| available for federal reimbursement.
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| (c) In addition to any other payments under this Code, the | 7 |
| Illinois
Department shall develop a hospital disproportionate | 8 |
| share reimbursement
methodology that, effective July 1, 1991, | 9 |
| through September 30, 1992,
shall reimburse hospitals | 10 |
| sufficiently to expend the fee monies described
in subsection | 11 |
| (b) of Section 14-3 of this Code and the federal matching
funds | 12 |
| received by the Illinois Department as a result of expenditures | 13 |
| made
by the Illinois Department as required by this subsection | 14 |
| (c) and Section
14-2 that are attributable to fee monies | 15 |
| deposited in the Fund, less
amounts applied to adjustment | 16 |
| payments under Section 5-5.02.
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| (d) Critical Care Access Payments.
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| (1) In addition to any other payments made under this | 19 |
| Code,
the Illinois Department shall develop a | 20 |
| reimbursement methodology that shall
reimburse Critical | 21 |
| Care Access Hospitals for the specialized services that
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| qualify them as Critical Care Access Hospitals. No | 23 |
| adjustment payments shall be
made under this subsection on | 24 |
| or after July 1, 1995.
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| (2) "Critical Care Access Hospitals" includes, but is | 26 |
| not limited to,
hospitals that meet at least one of the |
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| following criteria:
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| (A) Hospitals located outside of a metropolitan | 3 |
| statistical area that
are designated as Level II | 4 |
| Perinatal Centers and that provide a
disproportionate | 5 |
| share of perinatal services to recipients; or
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| (B) Hospitals that are designated as Level I Trauma | 7 |
| Centers (adult
or pediatric) and certain Level II | 8 |
| Trauma Centers as determined by the
Illinois | 9 |
| Department; or
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| (C) Hospitals located outside of a metropolitan | 11 |
| statistical area and
that provide a disproportionate | 12 |
| share of obstetrical services to recipients.
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| (e) Inpatient high volume adjustment. For hospital | 14 |
| inpatient services,
effective with rate periods beginning on or | 15 |
| after October 1, 1993, in
addition to rates paid for inpatient | 16 |
| services by the Illinois Department, the
Illinois Department | 17 |
| shall make adjustment payments for inpatient services
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| furnished by Medicaid high volume hospitals. The Illinois | 19 |
| Department shall
establish by rule criteria for qualifying as a | 20 |
| Medicaid high volume hospital
and shall establish by rule a | 21 |
| reimbursement methodology for calculating these
adjustment | 22 |
| payments to Medicaid high volume hospitals. No adjustment | 23 |
| payment
shall be made under this subsection for services | 24 |
| rendered on or after July 1,
1995.
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| (f) The Illinois Department shall modify its current rules | 26 |
| governing
adjustment payments for targeted access, critical |
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| care access, and
uncompensated care to classify those | 2 |
| adjustment payments as not being payments
to disproportionate | 3 |
| share hospitals under Title XIX of the federal Social
Security | 4 |
| Act. Rules adopted under this subsection shall not be effective | 5 |
| with
respect to services rendered on or after July 1, 1995. The | 6 |
| Illinois Department
has no obligation to adopt or implement any | 7 |
| rules or make any payments under
this subsection for services | 8 |
| rendered on or after July 1, 1995.
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| (f-5) The State recognizes that adjustment payments to | 10 |
| hospitals providing
certain services or incurring certain | 11 |
| costs may be necessary to assure that
recipients of medical | 12 |
| assistance have adequate access to necessary medical
services. | 13 |
| These adjustments include payments for teaching costs and
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| uncompensated care, trauma center payments, rehabilitation | 15 |
| hospital payments,
perinatal center payments, obstetrical care | 16 |
| payments, targeted access payments,
Medicaid high volume | 17 |
| payments, and outpatient indigent volume payments. On or
before | 18 |
| April 1, 1995, the Illinois Department shall issue | 19 |
| recommendations
regarding (i) reimbursement mechanisms or | 20 |
| adjustment payments to reflect these
costs and services, | 21 |
| including methods by which the payments may be calculated
and | 22 |
| the method by which the payments may be financed, and (ii) | 23 |
| reimbursement
mechanisms or adjustment payments to reflect | 24 |
| costs and services of federally
qualified health centers with | 25 |
| respect to recipients of medical assistance.
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| (g) If one or more hospitals file suit in any court |
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| challenging any part of
this Article XIV, payments to hospitals | 2 |
| under this Article XIV shall be made
only to the extent that | 3 |
| sufficient monies are available in the Fund and only to
the | 4 |
| extent that any monies in the Fund are not prohibited from | 5 |
| disbursement
under any order of the court.
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| (h) Payments under the disbursement methodology described | 7 |
| in this Section
are subject to approval by the federal | 8 |
| government in an appropriate State plan
amendment.
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| (i) The Illinois Department may by rule establish criteria | 10 |
| for and develop
methodologies for adjustment payments to | 11 |
| hospitals participating under this
Article.
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| (j) Hospital Residing Long Term Care Services. In addition | 13 |
| to any other
payments made under this Code, the Illinois | 14 |
| Department may by rule establish
criteria and develop | 15 |
| methodologies for payments to hospitals for Hospital
Residing | 16 |
| Long Term Care Services.
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| (Source: P.A. 93-20, eff. 6-20-03.)
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| (305 ILCS 5/15-5) (from Ch. 23, par. 15-5)
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| Sec. 15-5. Disbursements from the Fund.
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| (a) The monies in the Fund shall be disbursed only as | 21 |
| provided in
Section 15-2 of this Code and as follows:
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| (1) To pay the county hospitals' inpatient | 23 |
| reimbursement rate based on
actual costs, trended forward | 24 |
| annually by an inflation index and
supplemented by | 25 |
| teaching, capital , and other direct and indirect costs,
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| according to a State plan approved by the federal | 2 |
| government.
Effective October 1, 1992, the inpatient | 3 |
| reimbursement rate (including
any disproportionate or | 4 |
| supplemental disproportionate share payments) for
hospital | 5 |
| services provided by county operated facilities within the | 6 |
| County
shall be no less than the reimbursement rates in | 7 |
| effect on June 1, 1992,
except that this minimum shall be | 8 |
| adjusted as of July 1, 1992 and each July 1
thereafter | 9 |
| through July 1, 2002 by the annual percentage change in the | 10 |
| per
diem cost of
inpatient hospital services as reported in | 11 |
| the most recent annual Medicaid
cost report.
Effective July | 12 |
| 1, 2003, the rate for hospital inpatient services provided | 13 |
| by
county hospitals
shall be the rate in effect on
January | 14 |
| 1, 2003, except that this minimum may be adjusted by the | 15 |
| Illinois
Department to ensure
compliance with aggregate | 16 |
| and hospital-specific federal payment limitations.
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| (2) To pay county hospitals and county operated | 18 |
| outpatient
facilities for outpatient services based on a | 19 |
| federally approved
methodology to cover the maximum | 20 |
| allowable costs per patient visit.
Effective October 1, | 21 |
| 1992, the outpatient reimbursement rate for
outpatient | 22 |
| services provided by county hospitals and county operated
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| outpatient facilities shall be no less than the | 24 |
| reimbursement rates in
effect on June 1, 1992, except that | 25 |
| this minimum shall be adjusted as of
July 1, 1992 and each | 26 |
| July 1 thereafter through July 1, 2002 by the annual
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| percentage change in
the per diem cost of inpatient | 2 |
| hospital services as reported in the most
recent annual | 3 |
| Medicaid cost report.
Effective July 1, 2003, the Illinois | 4 |
| Department shall by rule establish
rates for outpatient | 5 |
| services provided by
county hospitals and other | 6 |
| county-operated facilities within
the County that are in | 7 |
| compliance with aggregate and hospital-specific
federal | 8 |
| payment limitations.
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| (3) To pay the county hospitals' disproportionate | 10 |
| share payments as
established by the Illinois Department | 11 |
| under Section 5-5.02 of this Code.
Effective October 1, | 12 |
| 1992, the disproportionate share payments for
hospital | 13 |
| services provided by county operated facilities within the | 14 |
| County
shall be no less than the reimbursement rates in | 15 |
| effect on June 1, 1992,
except that this minimum shall be | 16 |
| adjusted as of July 1, 1992 and each July 1
thereafter | 17 |
| through July 1, 2002 by the annual percentage change in the | 18 |
| per
diem cost of
inpatient hospital services as reported in | 19 |
| the most recent annual Medicaid
cost report.
Effective July | 20 |
| 1, 2003, the Illinois Department may by rule establish | 21 |
| rates
for disproportionate share
payments to county | 22 |
| hospitals that are in compliance with aggregate and
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| hospital-specific federal
payment limitations.
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| (3.5) To pay county providers for services provided | 25 |
| pursuant to Section
5-11 of this Code.
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| (4) To reimburse the county providers for expenses
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| contractually
assumed pursuant to Section 15-4 of this | 2 |
| Code.
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| (5) To pay the Illinois Department its necessary | 4 |
| administrative
expenses relative to the Fund and other | 5 |
| amounts agreed to, if any, by the
county providers in the | 6 |
| agreement provided for in subsection
(c).
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| (6) To pay the county providers any other amount due | 8 |
| according to a federally approved State plan, including
but | 9 |
| not limited to payments made under the provisions of | 10 |
| Section
701(d)(3)(B) of the federal Medicare, Medicaid, | 11 |
| and SCHIP Benefits Improvement
and Protection Act of
2000. | 12 |
| Intergovernmental transfers supporting payments under this | 13 |
| paragraph
(6) shall not be subject to the
computation | 14 |
| described in subsection (a) of Section 15-3 of this Code, | 15 |
| but
shall be computed as the difference between
the total | 16 |
| of such payments made by the Illinois Department to county
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| providers less any amount of federal
financial | 18 |
| participation due the Illinois Department under Titles XIX | 19 |
| and XXI
of the Social Security Act as a
result of such | 20 |
| payments to county providers.
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| (b) The Illinois Department shall promptly seek all | 22 |
| appropriate
amendments to the Illinois State Plan to effect the | 23 |
| foregoing payment
methodology.
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| (c) The Illinois Department shall implement the changes | 25 |
| made by
Article 3 of this amendatory Act of 1992 beginning | 26 |
| October 1, 1992. All terms
and conditions of the disbursement |
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| of monies from the Fund not set forth
expressly in this Article | 2 |
| shall be set forth in the agreement executed
under the | 3 |
| Intergovernmental Cooperation Act so long as those terms and
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| conditions are not inconsistent with this Article or applicable | 5 |
| federal
law. The Illinois Department shall report in writing to | 6 |
| the Hospital
Service Procurement Advisory Board and the Health | 7 |
| Care Cost Containment
Council by October 15, 1992, the terms | 8 |
| and conditions of all
such initial agreements and, where no | 9 |
| such initial agreement has yet been
executed with a qualifying | 10 |
| county, the Illinois Department's reasons that
each such | 11 |
| initial agreement has not been executed. Copies and reports of
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| amended agreements following the initial agreements shall | 13 |
| likewise be filed
by the Illinois Department with the Hospital | 14 |
| Service Procurement Advisory
Board and the Health Care Cost | 15 |
| Containment Council within 30 days following
their execution. | 16 |
| The foregoing filing obligations of the Illinois
Department are | 17 |
| informational only, to allow the Board and Council,
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| respectively, to better perform their public roles, except that | 19 |
| the Board
or Council may, at its discretion, advise the | 20 |
| Illinois Department in the
case of the failure of the Illinois | 21 |
| Department to reach agreement with any
qualifying county by the | 22 |
| required date.
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| (d) The payments provided for herein are intended to cover | 24 |
| services
rendered on and after July 1, 1991, and any agreement | 25 |
| executed between a
qualifying county and the Illinois | 26 |
| Department pursuant to this Section may
relate back to that |
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| date, provided the Illinois Department obtains federal
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| approval. Any changes in payment rates resulting from the | 3 |
| provisions of
Article 3 of this amendatory Act of 1992 are | 4 |
| intended to apply to services
rendered on or after October 1, | 5 |
| 1992, and any agreement executed between a
qualifying county | 6 |
| and the Illinois Department pursuant to this Section may
be | 7 |
| effective as of that date.
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| (e) If one or more hospitals file suit in any court | 9 |
| challenging any part
of this Article XV, payments to hospitals | 10 |
| from the Fund under this Article
XV shall be made only to the | 11 |
| extent that sufficient monies are available in
the Fund and | 12 |
| only to the extent that any monies in the Fund are not
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| prohibited from disbursement and may be disbursed under any | 14 |
| order of the court.
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| (f) All payments under this Section are contingent upon | 16 |
| federal
approval of changes to the State plan, if that approval | 17 |
| is required.
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| (Source: P.A. 92-370, eff. 8-15-01; 93-20, eff. 6-20-03.)
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| Section 99. Effective date. This Act takes effect upon | 20 |
| becoming law.
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