Full Text of SB2165 95th General Assembly
SB2165eng 95TH GENERAL ASSEMBLY
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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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| 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, such that the | 17 |
| adjusted rate is no lower than the rate in effect on June | 18 |
| 30, 1995.
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| (3) (Blank)
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| (4) Notwithstanding any other provision of this | 21 |
| Section, hospitals
that on August 31, 1991, have a contract | 22 |
| with the Illinois Department under
Section 3-4 of the | 23 |
| Illinois Health Finance Reform Act may elect to continue
to | 24 |
| be reimbursed at rates stated in such contracts for general | 25 |
| and specialty
care.
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| (5) In addition to any payments made under this |
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| subsection (a), the
Illinois Department shall make the | 2 |
| adjustment payments required by Section
5-5.02 of this | 3 |
| Code; provided, that in the case of any hospital reimbursed
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| under a per case methodology, the Illinois Department shall | 5 |
| add an amount
equal to the product of the hospital's | 6 |
| average length of stay, less one
day, multiplied by 20, for | 7 |
| inpatient hospital services rendered on or
after September | 8 |
| 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 | 11 |
| of this Code,
hospitals licensed under the University of | 12 |
| Illinois Hospital Act, and
facilities operated by the Illinois | 13 |
| Department of Mental Health and
Developmental Disabilities (or | 14 |
| its successor, the Department of Human
Services), for | 15 |
| outpatient services rendered on or after July 1, 1995
and | 16 |
| before July 1, 1998 the Illinois Department shall reimburse
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| children's hospitals, as defined in the Illinois | 18 |
| Administrative Code
Section 149.50(c)(3), at the rates in | 19 |
| effect on June 30, 1995, less that
portion of such rates | 20 |
| attributed by the Illinois Department to the outpatient
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| indigent volume adjustment and shall reimburse all other | 22 |
| hospitals at the rates
in effect on June 30, 1995, less the | 23 |
| portions of such rates attributed by the
Illinois Department to | 24 |
| the cost of medical education and attributed by the
Illinois | 25 |
| Department to the outpatient indigent volume adjustment. For
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| outpatient services provided on or after July 1, 1998, |
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| reimbursement rates
shall be established by rule. For | 2 |
| outpatient hospital services provided by any hospital | 3 |
| receiving reimbursement by the Department, the Department may | 4 |
| establish by rule a means of adjusting the rate of | 5 |
| reimbursement so as to eliminate any costs of medical | 6 |
| education, to the extent that such costs are no longer | 7 |
| available for federal reimbursement, such that the adjusted | 8 |
| rate is no lower than the rate in effect on July 1, 1998.
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| (c) In addition to any other payments under this Code, the | 10 |
| Illinois
Department shall develop a hospital disproportionate | 11 |
| share reimbursement
methodology that, effective July 1, 1991, | 12 |
| through September 30, 1992,
shall reimburse hospitals | 13 |
| sufficiently to expend the fee monies described
in subsection | 14 |
| (b) of Section 14-3 of this Code and the federal matching
funds | 15 |
| received by the Illinois Department as a result of expenditures | 16 |
| made
by the Illinois Department as required by this subsection | 17 |
| (c) and Section
14-2 that are attributable to fee monies | 18 |
| deposited in the Fund, less
amounts applied to adjustment | 19 |
| 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 | 22 |
| Code,
the Illinois Department shall develop a | 23 |
| reimbursement methodology that shall
reimburse Critical | 24 |
| Care Access Hospitals for the specialized services that
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| qualify them as Critical Care Access Hospitals. No | 26 |
| adjustment payments shall be
made under this subsection on |
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| or after July 1, 1995.
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| (2) "Critical Care Access Hospitals" includes, but is | 3 |
| not limited to,
hospitals that meet at least one of the | 4 |
| following criteria:
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| (A) Hospitals located outside of a metropolitan | 6 |
| statistical area that
are designated as Level II | 7 |
| Perinatal Centers and that provide a
disproportionate | 8 |
| share of perinatal services to recipients; or
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| (B) Hospitals that are designated as Level I Trauma | 10 |
| Centers (adult
or pediatric) and certain Level II | 11 |
| Trauma Centers as determined by the
Illinois | 12 |
| Department; or
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| (C) Hospitals located outside of a metropolitan | 14 |
| statistical area and
that provide a disproportionate | 15 |
| share of obstetrical services to recipients.
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| (e) Inpatient high volume adjustment. For hospital | 17 |
| inpatient services,
effective with rate periods beginning on or | 18 |
| after October 1, 1993, in
addition to rates paid for inpatient | 19 |
| services by the Illinois Department, the
Illinois Department | 20 |
| shall make adjustment payments for inpatient services
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| furnished by Medicaid high volume hospitals. The Illinois | 22 |
| Department shall
establish by rule criteria for qualifying as a | 23 |
| Medicaid high volume hospital
and shall establish by rule a | 24 |
| reimbursement methodology for calculating these
adjustment | 25 |
| payments to Medicaid high volume hospitals. No adjustment | 26 |
| payment
shall be made under this subsection for services |
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| rendered on or after July 1,
1995.
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| (f) The Illinois Department shall modify its current rules | 3 |
| governing
adjustment payments for targeted access, critical | 4 |
| care access, and
uncompensated care to classify those | 5 |
| adjustment payments as not being payments
to disproportionate | 6 |
| share hospitals under Title XIX of the federal Social
Security | 7 |
| Act. Rules adopted under this subsection shall not be effective | 8 |
| with
respect to services rendered on or after July 1, 1995. The | 9 |
| Illinois Department
has no obligation to adopt or implement any | 10 |
| rules or make any payments under
this subsection for services | 11 |
| rendered on or after July 1, 1995.
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| (f-5) The State recognizes that adjustment payments to | 13 |
| hospitals providing
certain services or incurring certain | 14 |
| costs may be necessary to assure that
recipients of medical | 15 |
| assistance have adequate access to necessary medical
services. | 16 |
| These adjustments include payments for teaching costs and
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| uncompensated care, trauma center payments, rehabilitation | 18 |
| hospital payments,
perinatal center payments, obstetrical care | 19 |
| payments, targeted access payments,
Medicaid high volume | 20 |
| payments, and outpatient indigent volume payments. On or
before | 21 |
| April 1, 1995, the Illinois Department shall issue | 22 |
| recommendations
regarding (i) reimbursement mechanisms or | 23 |
| adjustment payments to reflect these
costs and services, | 24 |
| including methods by which the payments may be calculated
and | 25 |
| the method by which the payments may be financed, and (ii) | 26 |
| reimbursement
mechanisms or adjustment payments to reflect |
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| costs and services of federally
qualified health centers with | 2 |
| respect to recipients of medical assistance.
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| (g) If one or more hospitals file suit in any court | 4 |
| challenging any part of
this Article XIV, payments to hospitals | 5 |
| under this Article XIV shall be made
only to the extent that | 6 |
| sufficient monies are available in the Fund and only to
the | 7 |
| extent that any monies in the Fund are not prohibited from | 8 |
| disbursement
under any order of the court.
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| (h) Payments under the disbursement methodology described | 10 |
| in this Section
are subject to approval by the federal | 11 |
| government in an appropriate State plan
amendment.
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| (i) The Illinois Department may by rule establish criteria | 13 |
| for and develop
methodologies for adjustment payments to | 14 |
| hospitals participating under this
Article.
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| (j) Hospital Residing Long Term Care Services. In addition | 16 |
| to any other
payments made under this Code, the Illinois | 17 |
| Department may by rule establish
criteria and develop | 18 |
| methodologies for payments to hospitals for Hospital
Residing | 19 |
| 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 | 24 |
| provided in
Section 15-2 of this Code and as follows:
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| (1) To pay the county hospitals' inpatient |
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| reimbursement rate based on
actual costs, trended forward | 2 |
| annually by an inflation index and
supplemented by | 3 |
| teaching, capital , and other direct and indirect costs,
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| according to a State plan approved by the federal | 5 |
| government.
Effective October 1, 1992, the inpatient | 6 |
| reimbursement rate (including
any disproportionate or | 7 |
| supplemental disproportionate share payments) for
hospital | 8 |
| services provided by county operated facilities within the | 9 |
| County
shall be no less than the reimbursement rates in | 10 |
| effect on June 1, 1992,
except that this minimum shall be | 11 |
| adjusted as of July 1, 1992 and each July 1
thereafter | 12 |
| through July 1, 2002 by the annual percentage change in the | 13 |
| per
diem cost of
inpatient hospital services as reported in | 14 |
| the most recent annual Medicaid
cost report.
Effective July | 15 |
| 1, 2003, the rate for hospital inpatient services provided | 16 |
| by
county hospitals
shall be the rate in effect on
January | 17 |
| 1, 2003, except that this minimum may be adjusted by the | 18 |
| Illinois
Department to ensure
compliance with aggregate | 19 |
| and hospital-specific federal payment limitations.
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| (2) To pay county hospitals and county operated | 21 |
| outpatient
facilities for outpatient services based on a | 22 |
| federally approved
methodology to cover the maximum | 23 |
| allowable costs per patient visit.
Effective October 1, | 24 |
| 1992, the outpatient reimbursement rate for
outpatient | 25 |
| services provided by county hospitals and county operated
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| outpatient facilities shall be no less than the |
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| reimbursement rates in
effect on June 1, 1992, except that | 2 |
| this minimum shall be adjusted as of
July 1, 1992 and each | 3 |
| July 1 thereafter through July 1, 2002 by the annual
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| percentage change in
the per diem cost of inpatient | 5 |
| hospital services as reported in the most
recent annual | 6 |
| Medicaid cost report.
Effective July 1, 2003, the Illinois | 7 |
| Department shall by rule establish
rates for outpatient | 8 |
| services provided by
county hospitals and other | 9 |
| county-operated facilities within
the County that are in | 10 |
| compliance with aggregate and hospital-specific
federal | 11 |
| payment limitations.
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| (3) To pay the county hospitals' disproportionate | 13 |
| share payments as
established by the Illinois Department | 14 |
| under Section 5-5.02 of this Code.
Effective October 1, | 15 |
| 1992, the disproportionate share payments for
hospital | 16 |
| services provided by county operated facilities within the | 17 |
| County
shall be no less than the reimbursement rates in | 18 |
| effect on June 1, 1992,
except that this minimum shall be | 19 |
| adjusted as of July 1, 1992 and each July 1
thereafter | 20 |
| through July 1, 2002 by the annual percentage change in the | 21 |
| per
diem cost of
inpatient hospital services as reported in | 22 |
| the most recent annual Medicaid
cost report.
Effective July | 23 |
| 1, 2003, the Illinois Department may by rule establish | 24 |
| rates
for disproportionate share
payments to county | 25 |
| 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 | 2 |
| 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 | 5 |
| Code.
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| (5) To pay the Illinois Department its necessary | 7 |
| administrative
expenses relative to the Fund and other | 8 |
| amounts agreed to, if any, by the
county providers in the | 9 |
| agreement provided for in subsection
(c).
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| (6) To pay the county providers any other amount due | 11 |
| according to a federally approved State plan, including
but | 12 |
| not limited to payments made under the provisions of | 13 |
| Section
701(d)(3)(B) of the federal Medicare, Medicaid, | 14 |
| and SCHIP Benefits Improvement
and Protection Act of
2000. | 15 |
| Intergovernmental transfers supporting payments under this | 16 |
| paragraph
(6) shall not be subject to the
computation | 17 |
| described in subsection (a) of Section 15-3 of this Code, | 18 |
| but
shall be computed as the difference between
the total | 19 |
| of such payments made by the Illinois Department to county
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| providers less any amount of federal
financial | 21 |
| participation due the Illinois Department under Titles XIX | 22 |
| and XXI
of the Social Security Act as a
result of such | 23 |
| payments to county providers.
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| (b) The Illinois Department shall promptly seek all | 25 |
| appropriate
amendments to the Illinois State Plan to effect the | 26 |
| foregoing payment
methodology.
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| (c) The Illinois Department shall implement the changes | 2 |
| made by
Article 3 of this amendatory Act of 1992 beginning | 3 |
| October 1, 1992. All terms
and conditions of the disbursement | 4 |
| of monies from the Fund not set forth
expressly in this Article | 5 |
| shall be set forth in the agreement executed
under the | 6 |
| Intergovernmental Cooperation Act so long as those terms and
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| conditions are not inconsistent with this Article or applicable | 8 |
| federal
law. The Illinois Department shall report in writing to | 9 |
| the Hospital
Service Procurement Advisory Board and the Health | 10 |
| Care Cost Containment
Council by October 15, 1992, the terms | 11 |
| and conditions of all
such initial agreements and, where no | 12 |
| such initial agreement has yet been
executed with a qualifying | 13 |
| county, the Illinois Department's reasons that
each such | 14 |
| initial agreement has not been executed. Copies and reports of
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| amended agreements following the initial agreements shall | 16 |
| likewise be filed
by the Illinois Department with the Hospital | 17 |
| Service Procurement Advisory
Board and the Health Care Cost | 18 |
| Containment Council within 30 days following
their execution. | 19 |
| The foregoing filing obligations of the Illinois
Department are | 20 |
| informational only, to allow the Board and Council,
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| respectively, to better perform their public roles, except that | 22 |
| the Board
or Council may, at its discretion, advise the | 23 |
| Illinois Department in the
case of the failure of the Illinois | 24 |
| Department to reach agreement with any
qualifying county by the | 25 |
| required date.
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| (d) The payments provided for herein are intended to cover |
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| services
rendered on and after July 1, 1991, and any agreement | 2 |
| executed between a
qualifying county and the Illinois | 3 |
| Department pursuant to this Section may
relate back to that | 4 |
| date, provided the Illinois Department obtains federal
| 5 |
| approval. Any changes in payment rates resulting from the | 6 |
| provisions of
Article 3 of this amendatory Act of 1992 are | 7 |
| intended to apply to services
rendered on or after October 1, | 8 |
| 1992, and any agreement executed between a
qualifying county | 9 |
| and the Illinois Department pursuant to this Section may
be | 10 |
| effective as of that date.
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| (e) If one or more hospitals file suit in any court | 12 |
| challenging any part
of this Article XV, payments to hospitals | 13 |
| from the Fund under this Article
XV shall be made only to the | 14 |
| extent that sufficient monies are available in
the Fund and | 15 |
| only to the extent that any monies in the Fund are not
| 16 |
| prohibited from disbursement and may be disbursed under any | 17 |
| order of the court.
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| (f) All payments under this Section are contingent upon | 19 |
| federal
approval of changes to the State plan, if that approval | 20 |
| 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 | 23 |
| becoming law.
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