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92_HB0257
LRB9202806DJgc
1 AN ACT in relation to public aid.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5 changing Section 5-5.02 as follows:
6 (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
7 Sec. 5-5.02. Hospital reimbursements.
8 (a) Reimbursement to Hospitals; July 1, 1992 through
9 September 30, 1992. Notwithstanding any other provisions of
10 this Code or the Illinois Department's Rules promulgated
11 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:
15 (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
22 of June 30, 1992. For purposes of this paragraph,
23 "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,
27 critical care access and uncompensated care, as defined
28 by the Illinois Department on June 30, 1992.
29 (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
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1 critical care, as defined by the Illinois Department on
2 June 30, 1992, the adjustment payment for the period July
3 1, 1992 through September 30, 1992, shall be 25% of the
4 annual adjustment payments calculated for each eligible
5 hospital, as of June 30, 1992. The Illinois Department
6 shall determine by rule the adjustment payments for
7 targeted access and critical care beginning October 1,
8 1992.
9 (3) For the purpose of calculating the inpatient
10 payment rate for each hospital eligible to receive
11 quarterly adjustment payments for uncompensated care, as
12 defined by the Illinois Department on June 30, 1992, the
13 adjustment payment for the period August 1, 1992 through
14 September 30, 1992, shall be one-sixth of the total
15 uncompensated care adjustment payments calculated for
16 each eligible hospital for the uncompensated care rate
17 year, as defined by the Illinois Department, ending on
18 July 31, 1992. The Illinois Department shall determine
19 by rule the adjustment payments for uncompensated care
20 beginning October 1, 1992.
21 (b) Inpatient payments. For inpatient services provided
22 on or after October 1, 1993, in addition to rates paid for
23 hospital inpatient services pursuant to the Illinois Health
24 Finance Reform Act, as now or hereafter amended, or the
25 Illinois Department's prospective reimbursement methodology,
26 or any other methodology used by the Illinois Department for
27 inpatient services, the Illinois Department shall make
28 adjustment payments, in an amount calculated pursuant to the
29 methodology described in paragraph (c) of this Section, to
30 hospitals that the Illinois Department determines satisfy any
31 one of the following requirements:
32 (1) Hospitals that are described in Section 1923 of
33 the federal Social Security Act, as now or hereafter
34 amended; or
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1 (2) Illinois hospitals that have a Medicaid
2 inpatient utilization rate which is at least one-half a
3 standard deviation above the mean Medicaid inpatient
4 utilization rate for all hospitals in Illinois receiving
5 Medicaid payments from the Illinois Department; or
6 (3) Illinois hospitals that on July 1, 1991 had a
7 Medicaid inpatient utilization rate, as defined in
8 paragraph (h) of this Section, that was at least the mean
9 Medicaid inpatient utilization rate for all hospitals in
10 Illinois receiving Medicaid payments from the Illinois
11 Department and which were located in a planning area with
12 one-third or fewer excess beds as determined by the
13 Illinois Health Facilities Planning Board, and that, as
14 of June 30, 1992, were located in a federally designated
15 Health Manpower Shortage Area; or
16 (4) Illinois hospitals that:
17 (A) have a Medicaid inpatient utilization rate
18 that is at least equal to the mean Medicaid
19 inpatient utilization rate for all hospitals in
20 Illinois receiving Medicaid payments from the
21 Department; and
22 (B) also have a Medicaid obstetrical inpatient
23 utilization rate that is at least one standard
24 deviation above the mean Medicaid obstetrical
25 inpatient utilization rate for all hospitals in
26 Illinois receiving Medicaid payments from the
27 Department for obstetrical services; or
28 (5) Any children's hospital, which means a hospital
29 devoted exclusively to caring for children. A hospital
30 which includes a facility devoted exclusively to caring
31 for children that is separately licensed as a hospital by
32 a municipality prior to September 30, 1998 shall be
33 considered a children's hospital to the degree that the
34 hospital's Medicaid care is provided to children; or.
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1 (6) Any Illinois hospital located in a county with a
2 population determined by the 1990 decennial census to be
3 over 250,000 and under 300,000 that borders another state
4 which is within 25 miles of at least 2 hospitals which
5 receive disproportionate share payments under Title XIX
6 of the Social Security Act and Article V of this Code.
7 (c) Inpatient adjustment payments. The adjustment
8 payments required by paragraph (b) shall be calculated based
9 upon the hospital's Medicaid inpatient utilization rate as
10 follows:
11 (1) hospitals with a Medicaid inpatient utilization
12 rate below the mean shall receive a per day adjustment
13 payment equal to $25;
14 (2) hospitals with a Medicaid inpatient
15 utilization rate that is equal to or greater than the
16 mean Medicaid inpatient utilization rate but less than
17 one standard deviation above the mean Medicaid inpatient
18 utilization rate shall receive a per day adjustment
19 payment equal to the sum of $25 plus $1 for each one
20 percent that the hospital's Medicaid inpatient
21 utilization rate exceeds the mean Medicaid inpatient
22 utilization rate;
23 (3) hospitals with a Medicaid inpatient
24 utilization rate that is equal to or greater than one
25 standard deviation above the mean Medicaid inpatient
26 utilization rate but less than 1.5 standard deviations
27 above the mean Medicaid inpatient utilization rate shall
28 receive a per day adjustment payment equal to the sum of
29 $40 plus $7 for each one percent that the hospital's
30 Medicaid inpatient utilization rate exceeds one standard
31 deviation above the mean Medicaid inpatient utilization
32 rate; and
33 (4) hospitals with a Medicaid inpatient
34 utilization rate that is equal to or greater than 1.5
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1 standard deviations above the mean Medicaid inpatient
2 utilization rate shall receive a per day adjustment
3 payment equal to the sum of $90 plus $2 for each one
4 percent that the hospital's Medicaid inpatient
5 utilization rate exceeds 1.5 standard deviations above
6 the mean Medicaid inpatient utilization rate.
7 (d) Supplemental adjustment payments. In addition to
8 the adjustment payments described in paragraph (c), hospitals
9 as defined in clauses (1) through (5) of paragraph (b),
10 excluding county hospitals (as defined in subsection (c) of
11 Section 15-1 of this Code) and a hospital organized under the
12 University of Illinois Hospital Act, shall be paid
13 supplemental inpatient adjustment payments of $60 per day.
14 For purposes of Title XIX of the federal Social Security Act,
15 these supplemental adjustment payments shall not be
16 classified as adjustment payments to disproportionate share
17 hospitals.
18 (e) The inpatient adjustment payments described in
19 paragraphs (c) and (d) shall be increased on October 1, 1993
20 and annually thereafter by a percentage equal to the lesser
21 of (i) the increase in the DRI hospital cost index for the
22 most recent 12 month period for which data are available, or
23 (ii) the percentage increase in the statewide average
24 hospital payment rate over the previous year's statewide
25 average hospital payment rate. The sum of the inpatient
26 adjustment payments under paragraphs (c) and (d) to a
27 hospital, other than a county hospital (as defined in
28 subsection (c) of Section 15-1 of this Code) or a hospital
29 organized under the University of Illinois Hospital Act,
30 however, shall not exceed $275 per day; that limit shall be
31 increased on October 1, 1993 and annually thereafter by a
32 percentage equal to the lesser of (i) the increase in the DRI
33 hospital cost index for the most recent 12-month period for
34 which data are available or (ii) the percentage increase in
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1 the statewide average hospital payment rate over the previous
2 year's statewide average hospital payment rate.
3 (f) Children's hospital inpatient adjustment payments.
4 For children's hospitals, as defined in clause (5) of
5 paragraph (b), the adjustment payments required pursuant to
6 paragraphs (c) and (d) shall be multiplied by 2.0.
7 (g) County hospital inpatient adjustment payments. For
8 county hospitals, as defined in subsection (c) of Section
9 15-1 of this Code, there shall be an adjustment payment as
10 determined by rules issued by the Illinois Department.
11 (h) For the purposes of this Section the following
12 terms shall be defined as follows:
13 (1) "Medicaid inpatient utilization rate" means a
14 fraction, the numerator of which is the number of a
15 hospital's inpatient days provided in a given 12-month
16 period to patients who, for such days, were eligible for
17 Medicaid under Title XIX of the federal Social Security
18 Act, and the denominator of which is the total number of
19 the hospital's inpatient days in that same period.
20 (2) "Mean Medicaid inpatient utilization rate"
21 means the total number of Medicaid inpatient days
22 provided by all Illinois Medicaid-participating hospitals
23 divided by the total number of inpatient days provided by
24 those same hospitals.
25 (3) "Medicaid obstetrical inpatient utilization
26 rate" means the ratio of Medicaid obstetrical inpatient
27 days to total Medicaid inpatient days for all Illinois
28 hospitals receiving Medicaid payments from the Illinois
29 Department.
30 (i) Inpatient adjustment payment limit. In order to
31 meet the limits of Public Law 102-234 and Public Law 103-66,
32 the Illinois Department shall by rule adjust disproportionate
33 share adjustment payments.
34 (j) University of Illinois Hospital inpatient adjustment
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1 payments. For hospitals organized under the University of
2 Illinois Hospital Act, there shall be an adjustment payment
3 as determined by rules adopted by the Illinois Department.
4 (k) The Illinois Department may by rule establish
5 criteria for and develop methodologies for adjustment
6 payments to hospitals participating under this Article.
7 (Source: P.A. 90-588, eff. 7-1-98; 91-533, eff. 8-13-99.)