Public Act 102-0886
 
HB1950 EnrolledLRB102 12590 KTG 17928 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
ARTICLE 5.

 
    Section 5-5. The Illinois Public Aid Code is amended by
changing Sections 5-5e.1, 5A-2, 5A-5, 5A-8, 5A-10, 5A-12.7,
and 5A-14 as follows:
 
    (305 ILCS 5/5-5e.1)
    Sec. 5-5e.1. Safety-Net Hospitals.
    (a) A Safety-Net Hospital is an Illinois hospital that:
        (1) is licensed by the Department of Public Health as
    a general acute care or pediatric hospital; and
        (2) is a disproportionate share hospital, as described
    in Section 1923 of the federal Social Security Act, as
    determined by the Department; and
        (3) meets one of the following:
            (A) has a MIUR of at least 40% and a charity
        percent of at least 4%; or
            (B) has a MIUR of at least 50%.
    (b) Definitions. As used in this Section:
        (1) "Charity percent" means the ratio of (i) the
    hospital's charity charges for services provided to
    individuals without health insurance or another source of
    third party coverage to (ii) the Illinois total hospital
    charges, each as reported on the hospital's OBRA form.
        (2) "MIUR" means Medicaid Inpatient Utilization Rate
    and is defined as a fraction, the numerator of which is the
    number of a hospital's inpatient days provided in the
    hospital's fiscal year ending 3 years prior to the rate
    year, to patients who, for such days, were eligible for
    Medicaid under Title XIX of the federal Social Security
    Act, 42 USC 1396a et seq., excluding those persons
    eligible for medical assistance pursuant to 42 U.S.C.
    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
    Section 5-2 of this Article, and the denominator of which
    is the total number of the hospital's inpatient days in
    that same period, excluding those persons eligible for
    medical assistance pursuant to 42 U.S.C.
    1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
    Section 5-2 of this Article.
        (3) "OBRA form" means form HFS-3834, OBRA '93 data
    collection form, for the rate year.
        (4) "Rate year" means the 12-month period beginning on
    October 1.
    (c) Beginning July 1, 2012 and ending on December 31, 2026
2022, a hospital that would have qualified for the rate year
beginning October 1, 2011 or October 1, 2012 shall be a
Safety-Net Hospital.
    (c-5) Beginning July 1, 2020 and ending on December 31,
2026, a hospital that would have qualified for the rate year
beginning October 1, 2020 and was designated a federal rural
referral center under 42 CFR 412.96 as of October 1, 2020 shall
be a Safety-Net Hospital.
    (d) No later than August 15 preceding the rate year, each
hospital shall submit the OBRA form to the Department. Prior
to October 1, the Department shall notify each hospital
whether it has qualified as a Safety-Net Hospital.
    (e) The Department may promulgate rules in order to
implement this Section.
    (f) Nothing in this Section shall be construed as limiting
the ability of the Department to include the Safety-Net
Hospitals in the hospital rate reform mandated by Section
14-11 of this Code and implemented under Section 14-12 of this
Code and by administrative rulemaking.
(Source: P.A. 100-581, eff. 3-12-18; 101-650, eff. 7-7-20;
101-669, eff. 4-2-21.)
 
    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
    (Section scheduled to be repealed on December 31, 2022)
    Sec. 5A-2. Assessment.
    (a)(1) Subject to Sections 5A-3 and 5A-10, for State
fiscal years 2009 through 2018, or as long as continued under
Section 5A-16, an annual assessment on inpatient services is
imposed on each hospital provider in an amount equal to
$218.38 multiplied by the difference of the hospital's
occupied bed days less the hospital's Medicare bed days,
provided, however, that the amount of $218.38 shall be
increased by a uniform percentage to generate an amount equal
to 75% of the State share of the payments authorized under
Section 5A-12.5, with such increase only taking effect upon
the date that a State share for such payments is required under
federal law. For the period of April through June 2015, the
amount of $218.38 used to calculate the assessment under this
paragraph shall, by emergency rule under subsection (s) of
Section 5-45 of the Illinois Administrative Procedure Act, be
increased by a uniform percentage to generate $20,250,000 in
the aggregate for that period from all hospitals subject to
the annual assessment under this paragraph.
    (2) In addition to any other assessments imposed under
this Article, effective July 1, 2016 and semi-annually
thereafter through June 2018, or as provided in Section 5A-16,
in addition to any federally required State share as
authorized under paragraph (1), the amount of $218.38 shall be
increased by a uniform percentage to generate an amount equal
to 75% of the ACA Assessment Adjustment, as defined in
subsection (b-6) of this Section.
    For State fiscal years 2009 through 2018, or as provided
in Section 5A-16, a hospital's occupied bed days and Medicare
bed days shall be determined using the most recent data
available from each hospital's 2005 Medicare cost report as
contained in the Healthcare Cost Report Information System
file, for the quarter ending on December 31, 2006, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2005 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Illinois Department may obtain the hospital provider's
occupied bed days and Medicare bed days from any source
available, including, but not limited to, records maintained
by the hospital provider, which may be inspected at all times
during business hours of the day by the Illinois Department or
its duly authorized agents and employees.
    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on inpatient
services is imposed on each hospital provider in an amount
equal to $197.19 multiplied by the difference of the
hospital's occupied bed days less the hospital's Medicare bed
days. For State fiscal years 2019 and 2020, a hospital's
occupied bed days and Medicare bed days shall be determined
using the most recent data available from each hospital's 2015
Medicare cost report as contained in the Healthcare Cost
Report Information System file, for the quarter ending on
March 31, 2017, without regard to any subsequent adjustments
or changes to such data. If a hospital's 2015 Medicare cost
report is not contained in the Healthcare Cost Report
Information System, then the Illinois Department may obtain
the hospital provider's occupied bed days and Medicare bed
days from any source available, including, but not limited to,
records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Illinois Department or its duly authorized agents and
employees. Notwithstanding any other provision in this
Article, for a hospital provider that did not have a 2015
Medicare cost report, but paid an assessment in State fiscal
year 2018 on the basis of hypothetical data, that assessment
amount shall be used for State fiscal years 2019 and 2020.
    (4) Subject to Sections 5A-3 and 5A-10 and to subsection
(b-8), for the period of July 1, 2020 through December 31, 2020
and calendar years 2021 through 2026 and 2022, an annual
assessment on inpatient services is imposed on each hospital
provider in an amount equal to $221.50 multiplied by the
difference of the hospital's occupied bed days less the
hospital's Medicare bed days, provided however: for the period
of July 1, 2020 through December 31, 2020, (i) the assessment
shall be equal to 50% of the annual amount; and (ii) the amount
of $221.50 shall be retroactively adjusted by a uniform
percentage to generate an amount equal to 50% of the
Assessment Adjustment, as defined in subsection (b-7). For the
period of July 1, 2020 through December 31, 2020 and calendar
years 2021 through 2026 and 2022, a hospital's occupied bed
days and Medicare bed days shall be determined using the most
recent data available from each hospital's 2015 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Illinois Department may obtain the hospital provider's
occupied bed days and Medicare bed days from any source
available, including, but not limited to, records maintained
by the hospital provider, which may be inspected at all times
during business hours of the day by the Illinois Department or
its duly authorized agents and employees. Should the change in
the assessment methodology for fiscal years 2021 through
December 31, 2022 not be approved on or before June 30, 2020,
the assessment and payments under this Article in effect for
fiscal year 2020 shall remain in place until the new
assessment is approved. If the assessment methodology for July
1, 2020 through December 31, 2022, is approved on or after July
1, 2020, it shall be retroactive to July 1, 2020, subject to
federal approval and provided that the payments authorized
under Section 5A-12.7 have the same effective date as the new
assessment methodology. In giving retroactive effect to the
assessment approved after June 30, 2020, credit toward the new
assessment shall be given for any payments of the previous
assessment for periods after June 30, 2020. Notwithstanding
any other provision of this Article, for a hospital provider
that did not have a 2015 Medicare cost report, but paid an
assessment in State Fiscal Year 2020 on the basis of
hypothetical data, the data that was the basis for the 2020
assessment shall be used to calculate the assessment under
this paragraph until December 31, 2023. Beginning July 1, 2022
and through December 31, 2024, a safety-net hospital that had
a change of ownership in calendar year 2021, and whose
inpatient utilization had decreased by 90% from the prior year
and prior to the change of ownership, may be eligible to pay a
tax based on hypothetical data based on a determination of
financial distress by the Department.
    (b) (Blank).
    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
portion of State fiscal year 2012, beginning June 10, 2012
through June 30, 2012, and for State fiscal years 2013 through
2018, or as provided in Section 5A-16, an annual assessment on
outpatient services is imposed on each hospital provider in an
amount equal to .008766 multiplied by the hospital's
outpatient gross revenue, provided, however, that the amount
of .008766 shall be increased by a uniform percentage to
generate an amount equal to 25% of the State share of the
payments authorized under Section 5A-12.5, with such increase
only taking effect upon the date that a State share for such
payments is required under federal law. For the period
beginning June 10, 2012 through June 30, 2012, the annual
assessment on outpatient services shall be prorated by
multiplying the assessment amount by a fraction, the numerator
of which is 21 days and the denominator of which is 365 days.
For the period of April through June 2015, the amount of
.008766 used to calculate the assessment under this paragraph
shall, by emergency rule under subsection (s) of Section 5-45
of the Illinois Administrative Procedure Act, be increased by
a uniform percentage to generate $6,750,000 in the aggregate
for that period from all hospitals subject to the annual
assessment under this paragraph.
    (2) In addition to any other assessments imposed under
this Article, effective July 1, 2016 and semi-annually
thereafter through June 2018, in addition to any federally
required State share as authorized under paragraph (1), the
amount of .008766 shall be increased by a uniform percentage
to generate an amount equal to 25% of the ACA Assessment
Adjustment, as defined in subsection (b-6) of this Section.
    For the portion of State fiscal year 2012, beginning June
10, 2012 through June 30, 2012, and State fiscal years 2013
through 2018, or as provided in Section 5A-16, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2009 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on June 30, 2011, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2009 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on outpatient
services is imposed on each hospital provider in an amount
equal to .01358 multiplied by the hospital's outpatient gross
revenue. For State fiscal years 2019 and 2020, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2015 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
Notwithstanding any other provision in this Article, for a
hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State fiscal year 2018 on the
basis of hypothetical data, that assessment amount shall be
used for State fiscal years 2019 and 2020.
    (4) Subject to Sections 5A-3 and 5A-10 and to subsection
(b-8), for the period of July 1, 2020 through December 31, 2020
and calendar years 2021 through 2026 and 2022, an annual
assessment on outpatient services is imposed on each hospital
provider in an amount equal to .01525 multiplied by the
hospital's outpatient gross revenue, provided however: (i) for
the period of July 1, 2020 through December 31, 2020, the
assessment shall be equal to 50% of the annual amount; and (ii)
the amount of .01525 shall be retroactively adjusted by a
uniform percentage to generate an amount equal to 50% of the
Assessment Adjustment, as defined in subsection (b-7). For the
period of July 1, 2020 through December 31, 2020 and calendar
years 2021 through 2026 and 2022, a hospital's outpatient
gross revenue shall be determined using the most recent data
available from each hospital's 2015 Medicare cost report as
contained in the Healthcare Cost Report Information System
file, for the quarter ending on March 31, 2017, without regard
to any subsequent adjustments or changes to such data. If a
hospital's 2015 Medicare cost report is not contained in the
Healthcare Cost Report Information System, then the Illinois
Department may obtain the hospital provider's outpatient
revenue data from any source available, including, but not
limited to, records maintained by the hospital provider, which
may be inspected at all times during business hours of the day
by the Illinois Department or its duly authorized agents and
employees. Should the change in the assessment methodology
above for fiscal years 2021 through calendar year 2022 not be
approved prior to July 1, 2020, the assessment and payments
under this Article in effect for fiscal year 2020 shall remain
in place until the new assessment is approved. If the change in
the assessment methodology above for July 1, 2020 through
December 31, 2022, is approved after June 30, 2020, it shall
have a retroactive effective date of July 1, 2020, subject to
federal approval and provided that the payments authorized
under Section 12A-7 have the same effective date as the new
assessment methodology. In giving retroactive effect to the
assessment approved after June 30, 2020, credit toward the new
assessment shall be given for any payments of the previous
assessment for periods after June 30, 2020. Notwithstanding
any other provision of this Article, for a hospital provider
that did not have a 2015 Medicare cost report, but paid an
assessment in State Fiscal Year 2020 on the basis of
hypothetical data, the data that was the basis for the 2020
assessment shall be used to calculate the assessment under
this paragraph until December 31, 2023. Beginning July 1, 2022
and through December 31, 2024, a safety-net hospital that had
a change of ownership in calendar year 2021, and whose
inpatient utilization had decreased by 90% from the prior year
and prior to the change of ownership, may be eligible to pay a
tax based on hypothetical data based on a determination of
financial distress by the Department.
    (b-6)(1) As used in this Section, "ACA Assessment
Adjustment" means:
        (A) For the period of July 1, 2016 through December
    31, 2016, the product of .19125 multiplied by the sum of
    the fee-for-service payments to hospitals as authorized
    under Section 5A-12.5 and the adjustments authorized under
    subsection (t) of Section 5A-12.2 to managed care
    organizations for hospital services due and payable in the
    month of April 2016 multiplied by 6.
        (B) For the period of January 1, 2017 through June 30,
    2017, the product of .19125 multiplied by the sum of the
    fee-for-service payments to hospitals as authorized under
    Section 5A-12.5 and the adjustments authorized under
    subsection (t) of Section 5A-12.2 to managed care
    organizations for hospital services due and payable in the
    month of October 2016 multiplied by 6, except that the
    amount calculated under this subparagraph (B) shall be
    adjusted, either positively or negatively, to account for
    the difference between the actual payments issued under
    Section 5A-12.5 for the period beginning July 1, 2016
    through December 31, 2016 and the estimated payments due
    and payable in the month of April 2016 multiplied by 6 as
    described in subparagraph (A).
        (C) For the period of July 1, 2017 through December
    31, 2017, the product of .19125 multiplied by the sum of
    the fee-for-service payments to hospitals as authorized
    under Section 5A-12.5 and the adjustments authorized under
    subsection (t) of Section 5A-12.2 to managed care
    organizations for hospital services due and payable in the
    month of April 2017 multiplied by 6, except that the
    amount calculated under this subparagraph (C) shall be
    adjusted, either positively or negatively, to account for
    the difference between the actual payments issued under
    Section 5A-12.5 for the period beginning January 1, 2017
    through June 30, 2017 and the estimated payments due and
    payable in the month of October 2016 multiplied by 6 as
    described in subparagraph (B).
        (D) For the period of January 1, 2018 through June 30,
    2018, the product of .19125 multiplied by the sum of the
    fee-for-service payments to hospitals as authorized under
    Section 5A-12.5 and the adjustments authorized under
    subsection (t) of Section 5A-12.2 to managed care
    organizations for hospital services due and payable in the
    month of October 2017 multiplied by 6, except that:
            (i) the amount calculated under this subparagraph
        (D) shall be adjusted, either positively or
        negatively, to account for the difference between the
        actual payments issued under Section 5A-12.5 for the
        period of July 1, 2017 through December 31, 2017 and
        the estimated payments due and payable in the month of
        April 2017 multiplied by 6 as described in
        subparagraph (C); and
            (ii) the amount calculated under this subparagraph
        (D) shall be adjusted to include the product of .19125
        multiplied by the sum of the fee-for-service payments,
        if any, estimated to be paid to hospitals under
        subsection (b) of Section 5A-12.5.
    (2) The Department shall complete and apply a final
reconciliation of the ACA Assessment Adjustment prior to June
30, 2018 to account for:
        (A) any differences between the actual payments issued
    or scheduled to be issued prior to June 30, 2018 as
    authorized in Section 5A-12.5 for the period of January 1,
    2018 through June 30, 2018 and the estimated payments due
    and payable in the month of October 2017 multiplied by 6 as
    described in subparagraph (D); and
        (B) any difference between the estimated
    fee-for-service payments under subsection (b) of Section
    5A-12.5 and the amount of such payments that are actually
    scheduled to be paid.
    The Department shall notify hospitals of any additional
amounts owed or reduction credits to be applied to the June
2018 ACA Assessment Adjustment. This is to be considered the
final reconciliation for the ACA Assessment Adjustment.
    (3) Notwithstanding any other provision of this Section,
if for any reason the scheduled payments under subsection (b)
of Section 5A-12.5 are not issued in full by the final day of
the period authorized under subsection (b) of Section 5A-12.5,
funds collected from each hospital pursuant to subparagraph
(D) of paragraph (1) and pursuant to paragraph (2),
attributable to the scheduled payments authorized under
subsection (b) of Section 5A-12.5 that are not issued in full
by the final day of the period attributable to each payment
authorized under subsection (b) of Section 5A-12.5, shall be
refunded.
    (4) The increases authorized under paragraph (2) of
subsection (a) and paragraph (2) of subsection (b-5) shall be
limited to the federally required State share of the total
payments authorized under Section 5A-12.5 if the sum of such
payments yields an annualized amount equal to or less than
$450,000,000, or if the adjustments authorized under
subsection (t) of Section 5A-12.2 are found not to be
actuarially sound; however, this limitation shall not apply to
the fee-for-service payments described in subsection (b) of
Section 5A-12.5.
    (b-7)(1) As used in this Section, "Assessment Adjustment"
means:
        (A) For the period of July 1, 2020 through December
    31, 2020, the product of .3853 multiplied by the total of
    the actual payments made under subsections (c) through (k)
    of Section 5A-12.7 attributable to the period, less the
    total of the assessment imposed under subsections (a) and
    (b-5) of this Section for the period.
        (B) For each calendar quarter beginning on and after
    January 1, 2021 through December 31, 2022, the product of
    .3853 multiplied by the total of the actual payments made
    under subsections (c) through (k) of Section 5A-12.7
    attributable to the period, less the total of the
    assessment imposed under subsections (a) and (b-5) of this
    Section for the period.
        (C) Beginning on January 1, 2023, and each subsequent
    July 1 and January 1, the product of .3853 multiplied by
    the total of the actual payments made under subsections
    (c) through (j) of Section 5A-12.7 attributable to the
    6-month period immediately preceding the period to which
    the adjustment applies, less the total of the assessment
    imposed under subsections (a) and (b-5) of this Section
    for the 6-month period immediately preceding the period to
    which the adjustment applies.
    (2) The Department shall calculate and notify each
hospital of the total Assessment Adjustment and any additional
assessment owed by the hospital or refund owed to the hospital
on either a semi-annual or annual basis. Such notice shall be
issued at least 30 days prior to any period in which the
assessment will be adjusted. Any additional assessment owed by
the hospital or refund owed to the hospital shall be uniformly
applied to the assessment owed by the hospital in monthly
installments for the subsequent semi-annual period or calendar
year. If no assessment is owed in the subsequent year, any
amount owed by the hospital or refund due to the hospital,
shall be paid in a lump sum.
    (3) The Department shall publish all details of the
Assessment Adjustment calculation performed each year on its
website within 30 days of completing the calculation, and also
submit the details of the Assessment Adjustment calculation as
part of the Department's annual report to the General
Assembly.
    (b-8) Notwithstanding any other provision of this Article,
the Department shall reduce the assessments imposed on each
hospital under subsections (a) and (b-5) by the uniform
percentage necessary to reduce the total assessment imposed on
all hospitals by an aggregate amount of $240,000,000, with
such reduction being applied by June 30, 2022. The assessment
reduction required for each hospital under this subsection
shall be forever waived, forgiven, and released by the
Department.
    (c) (Blank).
    (d) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules to reduce
the rate of any annual assessment imposed under this Section,
as authorized by Section 5-46.2 of the Illinois Administrative
Procedure Act.
    (e) Notwithstanding any other provision of this Section,
any plan providing for an assessment on a hospital provider as
a permissible tax under Title XIX of the federal Social
Security Act and Medicaid-eligible payments to hospital
providers from the revenues derived from that assessment shall
be reviewed by the Illinois Department of Healthcare and
Family Services, as the Single State Medicaid Agency required
by federal law, to determine whether those assessments and
hospital provider payments meet federal Medicaid standards. If
the Department determines that the elements of the plan may
meet federal Medicaid standards and a related State Medicaid
Plan Amendment is prepared in a manner and form suitable for
submission, that State Plan Amendment shall be submitted in a
timely manner for review by the Centers for Medicare and
Medicaid Services of the United States Department of Health
and Human Services and subject to approval by the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services. No such plan shall become
effective without approval by the Illinois General Assembly by
the enactment into law of related legislation. Notwithstanding
any other provision of this Section, the Department is
authorized to adopt rules to reduce the rate of any annual
assessment imposed under this Section. Any such rules may be
adopted by the Department under Section 5-50 of the Illinois
Administrative Procedure Act.
(Source: P.A. 100-581, eff. 3-12-18; 101-10, eff. 6-5-19;
101-650, eff. 7-7-20; reenacted by P.A. 101-655, eff.
3-12-21.)
 
    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
    Sec. 5A-5. Notice; penalty; maintenance of records.
    (a) The Illinois Department shall send a notice of
assessment to every hospital provider subject to assessment
under this Article. The notice of assessment shall notify the
hospital of its assessment and shall be sent after receipt by
the Department of notification from the Centers for Medicare
and Medicaid Services of the U.S. Department of Health and
Human Services that the payment methodologies required under
this Article and, if necessary, the waiver granted under 42
CFR 433.68 have been approved. The notice shall be on a form
prepared by the Illinois Department and shall state the
following:
        (1) The name of the hospital provider.
        (2) The address of the hospital provider's principal
    place of business from which the provider engages in the
    occupation of hospital provider in this State, and the
    name and address of each hospital operated, conducted, or
    maintained by the provider in this State.
        (3) The occupied bed days, occupied bed days less
    Medicare days, adjusted gross hospital revenue, or
    outpatient gross revenue of the hospital provider
    (whichever is applicable), the amount of assessment
    imposed under Section 5A-2 for the State fiscal year for
    which the notice is sent, and the amount of each
    installment to be paid during the State fiscal year.
        (4) (Blank).
        (5) Other reasonable information as determined by the
    Illinois Department.
    (b) If a hospital provider conducts, operates, or
maintains more than one hospital licensed by the Illinois
Department of Public Health, the provider shall pay the
assessment for each hospital separately.
    (c) Notwithstanding any other provision in this Article,
in the case of a person who ceases to conduct, operate, or
maintain a hospital in respect of which the person is subject
to assessment under this Article as a hospital provider, the
assessment for the State fiscal year in which the cessation
occurs shall be adjusted by multiplying the assessment
computed under Section 5A-2 by a fraction, the numerator of
which is the number of days in the year during which the
provider conducts, operates, or maintains the hospital and the
denominator of which is 365. Immediately upon ceasing to
conduct, operate, or maintain a hospital, the person shall pay
the assessment for the year as so adjusted (to the extent not
previously paid).
    (d) Notwithstanding any other provision in this Article, a
provider who commences conducting, operating, or maintaining a
hospital, upon notice by the Illinois Department, shall pay
the assessment computed under Section 5A-2 and subsection (e)
in installments on the due dates stated in the notice and on
the regular installment due dates for the State fiscal year
occurring after the due dates of the initial notice.
    (e) Notwithstanding any other provision in this Article,
for State fiscal years 2009 through 2018, in the case of a
hospital provider that did not conduct, operate, or maintain a
hospital in 2005, the assessment for that State fiscal year
shall be computed on the basis of hypothetical occupied bed
days for the full calendar year as determined by the Illinois
Department. Notwithstanding any other provision in this
Article, for the portion of State fiscal year 2012 beginning
June 10, 2012 through June 30, 2012, and for State fiscal years
2013 through 2018, in the case of a hospital provider that did
not conduct, operate, or maintain a hospital in 2009, the
assessment under subsection (b-5) of Section 5A-2 for that
State fiscal year shall be computed on the basis of
hypothetical gross outpatient revenue for the full calendar
year as determined by the Illinois Department.
    Notwithstanding any other provision in this Article,
beginning July 1, 2018 through December 31, 2026 for State
fiscal years 2019 through 2024, in the case of a hospital
provider that did not conduct, operate, or maintain a hospital
in the year that is the basis of the calculation of the
assessment under this Article, the assessment under paragraph
(3) of subsection (a) of Section 5A-2 for the State fiscal year
shall be computed on the basis of hypothetical occupied bed
days for the full calendar year as determined by the Illinois
Department, except that for a hospital provider that did not
have a 2015 Medicare cost report, but paid an assessment in
State fiscal year 2018 on the basis of hypothetical data, that
assessment amount shall be used for State fiscal years 2019
and 2020; however, for State fiscal year 2020, the assessment
amount shall be increased by the proportion that it represents
of the total annual assessment that is generated from all
hospitals in order to generate $6,250,000 in the aggregate for
that period from all hospitals subject to the annual
assessment under this paragraph.
    Notwithstanding any other provision in this Article,
beginning July 1, 2018 through December 31, 2026 for State
fiscal years 2019 through 2024, in the case of a hospital
provider that did not conduct, operate, or maintain a hospital
in the year that is the basis of the calculation of the
assessment under this Article, the assessment under subsection
(b-5) of Section 5A-2 for that State fiscal year shall be
computed on the basis of hypothetical gross outpatient revenue
for the full calendar year as determined by the Illinois
Department, except that for a hospital provider that did not
have a 2015 Medicare cost report, but paid an assessment in
State fiscal year 2018 on the basis of hypothetical data, that
assessment amount shall be used for State fiscal years 2019
and 2020; however, for State fiscal year 2020, the assessment
amount shall be increased by the proportion that it represents
of the total annual assessment that is generated from all
hospitals in order to generate $6,250,000 in the aggregate for
that period from all hospitals subject to the annual
assessment under this paragraph.
    (f) Every hospital provider subject to assessment under
this Article shall keep sufficient records to permit the
determination of adjusted gross hospital revenue for the
hospital's fiscal year. All such records shall be kept in the
English language and shall, at all times during regular
business hours of the day, be subject to inspection by the
Illinois Department or its duly authorized agents and
employees.
    (g) The Illinois Department may, by rule, provide a
hospital provider a reasonable opportunity to request a
clarification or correction of any clerical or computational
errors contained in the calculation of its assessment, but
such corrections shall not extend to updating the cost report
information used to calculate the assessment.
    (h) (Blank).
(Source: P.A. 99-78, eff. 7-20-15; 100-581, eff. 3-12-18.)
 
    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
    Sec. 5A-8. Hospital Provider Fund.
    (a) There is created in the State Treasury the Hospital
Provider Fund. Interest earned by the Fund shall be credited
to the Fund. The Fund shall not be used to replace any moneys
appropriated to the Medicaid program by the General Assembly.
    (b) The Fund is created for the purpose of receiving
moneys in accordance with Section 5A-6 and disbursing moneys
only for the following purposes, notwithstanding any other
provision of law:
        (1) For making payments to hospitals as required under
    this Code, under the Children's Health Insurance Program
    Act, under the Covering ALL KIDS Health Insurance Act, and
    under the Long Term Acute Care Hospital Quality
    Improvement Transfer Program Act.
        (2) For the reimbursement of moneys collected by the
    Illinois Department from hospitals or hospital providers
    through error or mistake in performing the activities
    authorized under this Code.
        (3) For payment of administrative expenses incurred by
    the Illinois Department or its agent in performing
    activities under this Code, under the Children's Health
    Insurance Program Act, under the Covering ALL KIDS Health
    Insurance Act, and under the Long Term Acute Care Hospital
    Quality Improvement Transfer Program Act.
        (4) For payments of any amounts which are reimbursable
    to the federal government for payments from this Fund
    which are required to be paid by State warrant.
        (5) For making transfers, as those transfers are
    authorized in the proceedings authorizing debt under the
    Short Term Borrowing Act, but transfers made under this
    paragraph (5) shall not exceed the principal amount of
    debt issued in anticipation of the receipt by the State of
    moneys to be deposited into the Fund.
        (6) For making transfers to any other fund in the
    State treasury, but transfers made under this paragraph
    (6) shall not exceed the amount transferred previously
    from that other fund into the Hospital Provider Fund plus
    any interest that would have been earned by that fund on
    the monies that had been transferred.
        (6.5) For making transfers to the Healthcare Provider
    Relief Fund, except that transfers made under this
    paragraph (6.5) shall not exceed $60,000,000 in the
    aggregate.
        (7) For making transfers not exceeding the following
    amounts, related to State fiscal years 2013 through 2018,
    to the following designated funds:
            Health and Human Services Medicaid Trust
                Fund..............................$20,000,000
            Long-Term Care Provider Fund..........$30,000,000
            General Revenue Fund.................$80,000,000.
    Transfers under this paragraph shall be made within 7 days
    after the payments have been received pursuant to the
    schedule of payments provided in subsection (a) of Section
    5A-4.
        (7.1) (Blank).
        (7.5) (Blank).
        (7.8) (Blank).
        (7.9) (Blank).
        (7.10) For State fiscal year 2014, for making
    transfers of the moneys resulting from the assessment
    under subsection (b-5) of Section 5A-2 and received from
    hospital providers under Section 5A-4 and transferred into
    the Hospital Provider Fund under Section 5A-6 to the
    designated funds not exceeding the following amounts in
    that State fiscal year:
            Healthcare Provider Relief Fund......$100,000,000
        Transfers under this paragraph shall be made within 7
    days after the payments have been received pursuant to the
    schedule of payments provided in subsection (a) of Section
    5A-4.
        The additional amount of transfers in this paragraph
    (7.10), authorized by Public Act 98-651, shall be made
    within 10 State business days after June 16, 2014 (the
    effective date of Public Act 98-651). That authority shall
    remain in effect even if Public Act 98-651 does not become
    law until State fiscal year 2015.
        (7.10a) For State fiscal years 2015 through 2018, for
    making transfers of the moneys resulting from the
    assessment under subsection (b-5) of Section 5A-2 and
    received from hospital providers under Section 5A-4 and
    transferred into the Hospital Provider Fund under Section
    5A-6 to the designated funds not exceeding the following
    amounts related to each State fiscal year:
            Healthcare Provider Relief Fund......$50,000,000
        Transfers under this paragraph shall be made within 7
    days after the payments have been received pursuant to the
    schedule of payments provided in subsection (a) of Section
    5A-4.
        (7.11) (Blank).
        (7.12) For State fiscal year 2013, for increasing by
    21/365ths the transfer of the moneys resulting from the
    assessment under subsection (b-5) of Section 5A-2 and
    received from hospital providers under Section 5A-4 for
    the portion of State fiscal year 2012 beginning June 10,
    2012 through June 30, 2012 and transferred into the
    Hospital Provider Fund under Section 5A-6 to the
    designated funds not exceeding the following amounts in
    that State fiscal year:
            Healthcare Provider Relief Fund.......$2,870,000
        Since the federal Centers for Medicare and Medicaid
    Services approval of the assessment authorized under
    subsection (b-5) of Section 5A-2, received from hospital
    providers under Section 5A-4 and the payment methodologies
    to hospitals required under Section 5A-12.4 was not
    received by the Department until State fiscal year 2014
    and since the Department made retroactive payments during
    State fiscal year 2014 related to the referenced period of
    June 2012, the transfer authority granted in this
    paragraph (7.12) is extended through the date that is 10
    State business days after June 16, 2014 (the effective
    date of Public Act 98-651).
        (7.13) In addition to any other transfers authorized
    under this Section, for State fiscal years 2017 and 2018,
    for making transfers to the Healthcare Provider Relief
    Fund of moneys collected from the ACA Assessment
    Adjustment authorized under subsections (a) and (b-5) of
    Section 5A-2 and paid by hospital providers under Section
    5A-4 into the Hospital Provider Fund under Section 5A-6
    for each State fiscal year. Timing of transfers to the
    Healthcare Provider Relief Fund under this paragraph shall
    be at the discretion of the Department, but no less
    frequently than quarterly.
        (7.14) For making transfers not exceeding the
    following amounts, related to State fiscal years 2019 and
    2020, to the following designated funds:
            Health and Human Services Medicaid Trust
                Fund..............................$20,000,000
            Long-Term Care Provider Fund..........$30,000,000
            Healthcare Provider Relief Fund.....$325,000,000.
        Transfers under this paragraph shall be made within 7
    days after the payments have been received pursuant to the
    schedule of payments provided in subsection (a) of Section
    5A-4.
        (7.15) For making transfers not exceeding the
    following amounts, related to State fiscal years 2023
    through 2026 2021 and 2022, to the following designated
    funds:
            Health and Human Services Medicaid Trust
                Fund.............................$20,000,000
            Long-Term Care Provider Fund.........$30,000,000
            Healthcare Provider Relief Fund.....$365,000,000
        (7.16) For making transfers not exceeding the
    following amounts, related to July 1, 2026 2022 to
    December 31, 2026 2022, to the following designated funds:
            Health and Human Services Medicaid Trust
                Fund.............................$10,000,000
            Long-Term Care Provider Fund.........$15,000,000
            Healthcare Provider Relief Fund.....$182,500,000
        (8) For making refunds to hospital providers pursuant
    to Section 5A-10.
        (9) For making payment to capitated managed care
    organizations as described in subsections (s) and (t) of
    Section 5A-12.2, subsection (r) of Section 5A-12.6, and
    Section 5A-12.7 of this Code.
    Disbursements from the Fund, other than transfers
authorized under paragraphs (5) and (6) of this subsection,
shall be by warrants drawn by the State Comptroller upon
receipt of vouchers duly executed and certified by the
Illinois Department.
    (c) The Fund shall consist of the following:
        (1) All moneys collected or received by the Illinois
    Department from the hospital provider assessment imposed
    by this Article.
        (2) All federal matching funds received by the
    Illinois Department as a result of expenditures made by
    the Illinois Department that are attributable to moneys
    deposited in the Fund.
        (3) Any interest or penalty levied in conjunction with
    the administration of this Article.
        (3.5) As applicable, proceeds from surety bond
    payments payable to the Department as referenced in
    subsection (s) of Section 5A-12.2 of this Code.
        (4) Moneys transferred from another fund in the State
    treasury.
        (5) All other moneys received for the Fund from any
    other source, including interest earned thereon.
    (d) (Blank).
(Source: P.A. 100-581, eff. 3-12-18; 100-863, eff. 8-14-19;
101-650, eff. 7-7-20.)
 
    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
    Sec. 5A-10. Applicability.
    (a) The assessment imposed by subsection (a) of Section
5A-2 shall cease to be imposed and the Department's obligation
to make payments shall immediately cease, and any moneys
remaining in the Fund shall be refunded to hospital providers
in proportion to the amounts paid by them, if:
        (1) The payments to hospitals required under this
    Article are not eligible for federal matching funds under
    Title XIX or XXI of the Social Security Act;
        (2) For State fiscal years 2009 through 2018, and as
    provided in Section 5A-16, the Department of Healthcare
    and Family Services adopts any administrative rule change
    to reduce payment rates or alters any payment methodology
    that reduces any payment rates made to operating hospitals
    under the approved Title XIX or Title XXI State plan in
    effect January 1, 2008 except for:
            (A) any changes for hospitals described in
        subsection (b) of Section 5A-3;
            (B) any rates for payments made under this Article
        V-A;
            (C) any changes proposed in State plan amendment
        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
        08-07;
            (D) in relation to any admissions on or after
        January 1, 2011, a modification in the methodology for
        calculating outlier payments to hospitals for
        exceptionally costly stays, for hospitals reimbursed
        under the diagnosis-related grouping methodology in
        effect on July 1, 2011; provided that the Department
        shall be limited to one such modification during the
        36-month period after the effective date of this
        amendatory Act of the 96th General Assembly;
            (E) any changes affecting hospitals authorized by
        Public Act 97-689;
            (F) any changes authorized by Section 14-12 of
        this Code, or for any changes authorized under Section
        5A-15 of this Code; or
            (G) any changes authorized under Section 5-5b.1.
    (b) The assessment imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, and the Department's
obligation to make payments shall immediately cease, if the
assessment is determined to be an impermissible tax under
Title XIX of the Social Security Act. Moneys in the Hospital
Provider Fund derived from assessments imposed prior thereto
shall be disbursed in accordance with Section 5A-8 to the
extent federal financial participation is not reduced due to
the impermissibility of the assessments, and any remaining
moneys shall be refunded to hospital providers in proportion
to the amounts paid by them.
    (c) The assessments imposed by subsection (b-5) of Section
5A-2 shall not take effect or shall cease to be imposed, the
Department's obligation to make payments shall immediately
cease, and any moneys remaining in the Fund shall be refunded
to hospital providers in proportion to the amounts paid by
them, if the payments to hospitals required under Section
5A-12.4 or Section 5A-12.6 are not eligible for federal
matching funds under Title XIX of the Social Security Act.
    (d) The assessments imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, the Department's
obligation to make payments shall immediately cease, and any
moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
        (1) for State fiscal years 2013 through 2018, and as
    provided in Section 5A-16, the Department reduces any
    payment rates to hospitals as in effect on May 1, 2012, or
    alters any payment methodology as in effect on May 1,
    2012, that has the effect of reducing payment rates to
    hospitals, except for any changes affecting hospitals
    authorized in Public Act 97-689 and any changes authorized
    by Section 14-12 of this Code, and except for any changes
    authorized under Section 5A-15, and except for any changes
    authorized under Section 5-5b.1;
        (2) for State fiscal years 2013 through 2018, and as
    provided in Section 5A-16, the Department reduces any
    supplemental payments made to hospitals below the amounts
    paid for services provided in State fiscal year 2011 as
    implemented by administrative rules adopted and in effect
    on or prior to June 30, 2011, except for any changes
    affecting hospitals authorized in Public Act 97-689 and
    any changes authorized by Section 14-12 of this Code, and
    except for any changes authorized under Section 5A-15, and
    except for any changes authorized under Section 5-5b.1; or
        (3) for State fiscal years 2015 through 2018, and as
    provided in Section 5A-16, the Department reduces the
    overall effective rate of reimbursement to hospitals below
    the level authorized under Section 14-12 of this Code,
    except for any changes under Section 14-12 or Section
    5A-15 of this Code, and except for any changes authorized
    under Section 5-5b.1.
    (e) In State fiscal year 2019 through State fiscal year
2020, the assessments imposed under Section 5A-2 shall not
take effect or shall cease to be imposed, the Department's
obligation to make payments shall immediately cease, and any
moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
        (1) the payments to hospitals required under Section
    5A12.6 are not eligible for federal matching funds under
    Title XIX of the Social Security Act; or
        (2) the Department reduces the overall effective rate
    of reimbursement to hospitals below the level authorized
    under Section 14-12 of this Code, as in effect on December
    31, 2017, except for any changes authorized under Sections
    14-12 or Section 5A-15 of this Code, and except for any
    changes authorized under changes to Sections 5A-12.2,
    5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by Public Act
    100-581.
    (f) Beginning in State Fiscal Year 2021, the assessments
imposed under Section 5A-2 shall not take effect or shall
cease to be imposed, the Department's obligation to make
payments shall immediately cease, and any moneys remaining in
the Fund shall be refunded to hospital providers in proportion
to the amounts paid by them, if:
        (1) the payments to hospitals required under Section
    5A-12.7 are not eligible for federal matching funds under
    Title XIX of the Social Security Act; or
        (2) the Department reduces the overall effective rate
    of reimbursement to hospitals below the level authorized
    under Section 14-12, as in effect on December 31, 2021
    2019, except for any changes authorized under Sections
    14-12 or 5A-15, and except for any changes authorized
    under changes to Sections 5A-12.7 and 14-12 made by this
    amendatory Act of the 101st General Assembly, and except
    for any changes to Section 5A-12.7 made by this amendatory
    Act of the 102nd General Assembly.
(Source: P.A. 100-581, eff. 3-12-18; 101-650, eff. 7-7-20.)
 
    (305 ILCS 5/5A-12.7)
    (Section scheduled to be repealed on December 31, 2022)
    Sec. 5A-12.7. Continuation of hospital access payments on
and after July 1, 2020.
    (a) To preserve and improve access to hospital services,
for hospital services rendered on and after July 1, 2020, the
Department shall, except for hospitals described in subsection
(b) of Section 5A-3, make payments to hospitals or require
capitated managed care organizations to make payments as set
forth in this Section. Payments under this Section are not due
and payable, however, until: (i) the methodologies described
in this Section are approved by the federal government in an
appropriate State Plan amendment or directed payment preprint;
and (ii) the assessment imposed under this Article is
determined to be a permissible tax under Title XIX of the
Social Security Act. In determining the hospital access
payments authorized under subsection (g) of this Section, if a
hospital ceases to qualify for payments from the pool, the
payments for all hospitals continuing to qualify for payments
from such pool shall be uniformly adjusted to fully expend the
aggregate net amount of the pool, with such adjustment being
effective on the first day of the second month following the
date the hospital ceases to receive payments from such pool.
    (b) Amounts moved into claims-based rates and distributed
in accordance with Section 14-12 shall remain in those
claims-based rates.
    (c) Graduate medical education.
        (1) The calculation of graduate medical education
    payments shall be based on the hospital's Medicare cost
    report ending in Calendar Year 2018, as reported in the
    Healthcare Cost Report Information System file, release
    date September 30, 2019. An Illinois hospital reporting
    intern and resident cost on its Medicare cost report shall
    be eligible for graduate medical education payments.
        (2) Each hospital's annualized Medicaid Intern
    Resident Cost is calculated using annualized intern and
    resident total costs obtained from Worksheet B Part I,
    Columns 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
    96-98, and 105-112 multiplied by the percentage that the
    hospital's Medicaid days (Worksheet S3 Part I, Column 7,
    Lines 2, 3, 4, 14, 16-18, and 32) comprise of the
    hospital's total days (Worksheet S3 Part I, Column 8,
    Lines 14, 16-18, and 32).
        (3) An annualized Medicaid indirect medical education
    (IME) payment is calculated for each hospital using its
    IME payments (Worksheet E Part A, Line 29, Column 1)
    multiplied by the percentage that its Medicaid days
    (Worksheet S3 Part I, Column 7, Lines 2, 3, 4, 14, 16-18,
    and 32) comprise of its Medicare days (Worksheet S3 Part
    I, Column 6, Lines 2, 3, 4, 14, and 16-18).
        (4) For each hospital, its annualized Medicaid Intern
    Resident Cost and its annualized Medicaid IME payment are
    summed, and, except as capped at 120% of the average cost
    per intern and resident for all qualifying hospitals as
    calculated under this paragraph, is multiplied by the
    applicable reimbursement factor as described in this
    paragraph, 22.6% to determine the hospital's final
    graduate medical education payment. Each hospital's
    average cost per intern and resident shall be calculated
    by summing its total annualized Medicaid Intern Resident
    Cost plus its annualized Medicaid IME payment and dividing
    that amount by the hospital's total Full Time Equivalent
    Residents and Interns. If the hospital's average per
    intern and resident cost is greater than 120% of the same
    calculation for all qualifying hospitals, the hospital's
    per intern and resident cost shall be capped at 120% of the
    average cost for all qualifying hospitals.
            (A) For the period of July 1, 2020 through
        December 31, 2022, the applicable reimbursement factor
        shall be 22.6%.
            (B) For the period of January 1, 2023 through
        December 31, 2026, the applicable reimbursement factor
        shall be 35% for all qualified safety-net hospitals,
        as defined in Section 5-5e.1 of this Code, and all
        hospitals with 100 or more Full Time Equivalent
        Residents and Interns, as reported on the hospital's
        Medicare cost report ending in Calendar Year 2018, and
        for all other qualified hospitals the applicable
        reimbursement factor shall be 30%.
    (d) Fee-for-service supplemental payments. For the period
of July 1, 2020 through December 31, 2022, each Each Illinois
hospital shall receive an annual payment equal to the amounts
below, to be paid in 12 equal installments on or before the
seventh State business day of each month, except that no
payment shall be due within 30 days after the later of the date
of notification of federal approval of the payment
methodologies required under this Section or any waiver
required under 42 CFR 433.68, at which time the sum of amounts
required under this Section prior to the date of notification
is due and payable.
        (1) For critical access hospitals, $385 per covered
    inpatient day contained in paid fee-for-service claims and
    $530 per paid fee-for-service outpatient claim for dates
    of service in Calendar Year 2019 in the Department's
    Enterprise Data Warehouse as of May 11, 2020.
        (2) For safety-net hospitals, $960 per covered
    inpatient day contained in paid fee-for-service claims and
    $625 per paid fee-for-service outpatient claim for dates
    of service in Calendar Year 2019 in the Department's
    Enterprise Data Warehouse as of May 11, 2020.
        (3) For long term acute care hospitals, $295 per
    covered inpatient day contained in paid fee-for-service
    claims for dates of service in Calendar Year 2019 in the
    Department's Enterprise Data Warehouse as of May 11, 2020.
        (4) For freestanding psychiatric hospitals, $125 per
    covered inpatient day contained in paid fee-for-service
    claims and $130 per paid fee-for-service outpatient claim
    for dates of service in Calendar Year 2019 in the
    Department's Enterprise Data Warehouse as of May 11, 2020.
        (5) For freestanding rehabilitation hospitals, $355
    per covered inpatient day contained in paid
    fee-for-service claims for dates of service in Calendar
    Year 2019 in the Department's Enterprise Data Warehouse as
    of May 11, 2020.
        (6) For all general acute care hospitals and high
    Medicaid hospitals as defined in subsection (f), $350 per
    covered inpatient day for dates of service in Calendar
    Year 2019 contained in paid fee-for-service claims and
    $620 per paid fee-for-service outpatient claim in the
    Department's Enterprise Data Warehouse as of May 11, 2020.
        (7) Alzheimer's treatment access payment. Each
    Illinois academic medical center or teaching hospital, as
    defined in Section 5-5e.2 of this Code, that is identified
    as the primary hospital affiliate of one of the Regional
    Alzheimer's Disease Assistance Centers, as designated by
    the Alzheimer's Disease Assistance Act and identified in
    the Department of Public Health's Alzheimer's Disease
    State Plan dated December 2016, shall be paid an
    Alzheimer's treatment access payment equal to the product
    of the qualifying hospital's State Fiscal Year 2018 total
    inpatient fee-for-service days multiplied by the
    applicable Alzheimer's treatment rate of $226.30 for
    hospitals located in Cook County and $116.21 for hospitals
    located outside Cook County.
    (d-2) Fee-for-service supplemental payments. Beginning
January 1, 2023, each Illinois hospital shall receive an
annual payment equal to the amounts listed below, to be paid in
12 equal installments on or before the seventh State business
day of each month, except that no payment shall be due within
30 days after the later of the date of notification of federal
approval of the payment methodologies required under this
Section or any waiver required under 42 CFR 433.68, at which
time the sum of amounts required under this Section prior to
the date of notification is due and payable. The Department
may adjust the rates in paragraphs (1) through (7) to comply
with the federal upper payment limits, with such adjustments
being determined so that the total estimated spending by
hospital class, under such adjusted rates, remains
substantially similar to the total estimated spending under
the original rates set forth in this subsection.
        (1) For critical access hospitals, as defined in
    subsection (f), $750 per covered inpatient day contained
    in paid fee-for-service claims and $750 per paid
    fee-for-service outpatient claim for dates of service in
    Calendar Year 2019 in the Department's Enterprise Data
    Warehouse as of August 6, 2021.
        (2) For safety-net hospitals, as described in
    subsection (f), $1,350 per inpatient day contained in paid
    fee-for-service claims and $1,350 per paid fee-for-service
    outpatient claim for dates of service in Calendar Year
    2019 in the Department's Enterprise Data Warehouse as of
    August 6, 2021.
        (3) For long term acute care hospitals, $550 per
    covered inpatient day contained in paid fee-for-service
    claims for dates of service in Calendar Year 2019 in the
    Department's Enterprise Data Warehouse as of August 6,
    2021.
        (4) For freestanding psychiatric hospitals, $200 per
    covered inpatient day contained in paid fee-for-service
    claims and $200 per paid fee-for-service outpatient claim
    for dates of service in Calendar Year 2019 in the
    Department's Enterprise Data Warehouse as of August 6,
    2021.
        (5) For freestanding rehabilitation hospitals, $550
    per covered inpatient day contained in paid
    fee-for-service claims and $125 per paid fee-for-service
    outpatient claim for dates of service in Calendar Year
    2019 in the Department's Enterprise Data Warehouse as of
    August 6, 2021.
        (6) For all general acute care hospitals and high
    Medicaid hospitals as defined in subsection (f), $500 per
    covered inpatient day for dates of service in Calendar
    Year 2019 contained in paid fee-for-service claims and
    $500 per paid fee-for-service outpatient claim in the
    Department's Enterprise Data Warehouse as of August 6,
    2021.
        (7) For public hospitals, as defined in subsection
    (f), $275 per covered inpatient day contained in paid
    fee-for-service claims and $275 per paid fee-for-service
    outpatient claim for dates of service in Calendar Year
    2019 in the Department's Enterprise Data Warehouse as of
    August 6, 2021.
        (8) Alzheimer's treatment access payment. Each
    Illinois academic medical center or teaching hospital, as
    defined in Section 5-5e.2 of this Code, that is identified
    as the primary hospital affiliate of one of the Regional
    Alzheimer's Disease Assistance Centers, as designated by
    the Alzheimer's Disease Assistance Act and identified in
    the Department of Public Health's Alzheimer's Disease
    State Plan dated December 2016, shall be paid an
    Alzheimer's treatment access payment equal to the product
    of the qualifying hospital's Calendar Year 2019 total
    inpatient fee-for-service days, in the Department's
    Enterprise Data Warehouse as of August 6, 2021, multiplied
    by the applicable Alzheimer's treatment rate of $244.37
    for hospitals located in Cook County and $312.03 for
    hospitals located outside Cook County.
    (e) The Department shall require managed care
organizations (MCOs) to make directed payments and
pass-through payments according to this Section. Each calendar
year, the Department shall require MCOs to pay the maximum
amount out of these funds as allowed as pass-through payments
under federal regulations. The Department shall require MCOs
to make such pass-through payments as specified in this
Section. The Department shall require the MCOs to pay the
remaining amounts as directed Payments as specified in this
Section. The Department shall issue payments to the
Comptroller by the seventh business day of each month for all
MCOs that are sufficient for MCOs to make the directed
payments and pass-through payments according to this Section.
The Department shall require the MCOs to make pass-through
payments and directed payments using electronic funds
transfers (EFT), if the hospital provides the information
necessary to process such EFTs, in accordance with directions
provided monthly by the Department, within 7 business days of
the date the funds are paid to the MCOs, as indicated by the
"Paid Date" on the website of the Office of the Comptroller if
the funds are paid by EFT and the MCOs have received directed
payment instructions. If funds are not paid through the
Comptroller by EFT, payment must be made within 7 business
days of the date actually received by the MCO. The MCO will be
considered to have paid the pass-through payments when the
payment remittance number is generated or the date the MCO
sends the check to the hospital, if EFT information is not
supplied. If an MCO is late in paying a pass-through payment or
directed payment as required under this Section (including any
extensions granted by the Department), it shall pay a penalty,
unless waived by the Department for reasonable cause, to the
Department equal to 5% of the amount of the pass-through
payment or directed payment not paid on or before the due date
plus 5% of the portion thereof remaining unpaid on the last day
of each 30-day period thereafter. Payments to MCOs that would
be paid consistent with actuarial certification and enrollment
in the absence of the increased capitation payments under this
Section shall not be reduced as a consequence of payments made
under this subsection. The Department shall publish and
maintain on its website for a period of no less than 8 calendar
quarters, the quarterly calculation of directed payments and
pass-through payments owed to each hospital from each MCO. All
calculations and reports shall be posted no later than the
first day of the quarter for which the payments are to be
issued.
    (f)(1) For purposes of allocating the funds included in
capitation payments to MCOs, Illinois hospitals shall be
divided into the following classes as defined in
administrative rules:
        (A) Beginning July 1, 2020 through December 31, 2022,
    critical Critical access hospitals. Beginning January 1,
    2023, "critical access hospital" means a hospital
    designated by the Department of Public Health as a
    critical access hospital, excluding any hospital meeting
    the definition of a public hospital in subparagraph (F).
        (B) Safety-net hospitals, except that stand-alone
    children's hospitals that are not specialty children's
    hospitals will not be included. For the calendar year
    beginning January 1, 2023, and each calendar year
    thereafter, assignment to the safety-net class shall be
    based on the annual safety-net rate year beginning 15
    months before the beginning of the first Payout Quarter of
    the calendar year.
        (C) Long term acute care hospitals.
        (D) Freestanding psychiatric hospitals.
        (E) Freestanding rehabilitation hospitals.
        (F) Beginning January 1, 2023, "public hospital" means
    a hospital that is owned or operated by an Illinois
    Government body or municipality, excluding a hospital
    provider that is a State agency, a State university, or a
    county with a population of 3,000,000 or more.
        (G) (F) High Medicaid hospitals.
            (i) As used in this Section, "high Medicaid
        hospital" means a general acute care hospital that:
                (I) For the payout periods July 1, 2020
            through December 31, 2022, is not a safety-net
            hospital or critical access hospital and that has
            a Medicaid Inpatient Utilization Rate above 30% or
            a hospital that had over 35,000 inpatient Medicaid
            days during the applicable period. For the period
            July 1, 2020 through December 31, 2020, the
            applicable period for the Medicaid Inpatient
            Utilization Rate (MIUR) is the rate year 2020 MIUR
            and for the number of inpatient days it is State
            fiscal year 2018. Beginning in calendar year 2021,
            the Department shall use the most recently
            determined MIUR, as defined in subsection (h) of
            Section 5-5.02, and for the inpatient day
            threshold, the State fiscal year ending 18 months
            prior to the beginning of the calendar year. For
            purposes of calculating MIUR under this Section,
            children's hospitals and affiliated general acute
            care hospitals shall be considered a single
            hospital.
                (II) For the calendar year beginning January
            1, 2023, and each calendar year thereafter, is not
            a public hospital, safety-net hospital, or
            critical access hospital and that qualifies as a
            regional high volume hospital or is a hospital
            that has a Medicaid Inpatient Utilization Rate
            (MIUR) above 30%. As used in this item, "regional
            high volume hospital" means a hospital which ranks
            in the top 2 quartiles based on total hospital
            services volume, of all eligible general acute
            care hospitals, when ranked in descending order
            based on total hospital services volume, within
            the same Medicaid managed care region, as
            designated by the Department, as of January 1,
            2022. As used in this item, "total hospital
            services volume" means the total of all Medical
            Assistance hospital inpatient admissions plus all
            Medical Assistance hospital outpatient visits. For
            purposes of determining regional high volume
            hospital inpatient admissions and outpatient
            visits, the Department shall use dates of service
            provided during State Fiscal Year 2020 for the
            Payout Quarter beginning January 1, 2023. The
            Department shall use dates of service from the
            State fiscal year ending 18 month before the
            beginning of the first Payout Quarter of the
            subsequent annual determination period.
            (ii) For the calendar year beginning January 1,
        2023, the Department shall use the Rate Year 2022
        Medicaid inpatient utilization rate (MIUR), as defined
        in subsection (h) of Section 5-5.02. For each
        subsequent annual determination, the Department shall
        use the MIUR applicable to the rate year ending
        September 30 of the year preceding the beginning of
        the calendar year.
        (H) (G) General acute care hospitals. As used under
    this Section, "general acute care hospitals" means all
    other Illinois hospitals not identified in subparagraphs
    (A) through (G) (F).
    (2) Hospitals' qualification for each class shall be
assessed prior to the beginning of each calendar year and the
new class designation shall be effective January 1 of the next
year. The Department shall publish by rule the process for
establishing class determination.
    (g) Fixed pool directed payments. Beginning July 1, 2020,
the Department shall issue payments to MCOs which shall be
used to issue directed payments to qualified Illinois
safety-net hospitals and critical access hospitals on a
monthly basis in accordance with this subsection. Prior to the
beginning of each Payout Quarter beginning July 1, 2020, the
Department shall use encounter claims data from the
Determination Quarter, accepted by the Department's Medicaid
Management Information System for inpatient and outpatient
services rendered by safety-net hospitals and critical access
hospitals to determine a quarterly uniform per unit add-on for
each hospital class.
        (1) Inpatient per unit add-on. A quarterly uniform per
    diem add-on shall be derived by dividing the quarterly
    Inpatient Directed Payments Pool amount allocated to the
    applicable hospital class by the total inpatient days
    contained on all encounter claims received during the
    Determination Quarter, for all hospitals in the class.
            (A) Each hospital in the class shall have a
        quarterly inpatient directed payment calculated that
        is equal to the product of the number of inpatient days
        attributable to the hospital used in the calculation
        of the quarterly uniform class per diem add-on,
        multiplied by the calculated applicable quarterly
        uniform class per diem add-on of the hospital class.
            (B) Each hospital shall be paid 1/3 of its
        quarterly inpatient directed payment in each of the 3
        months of the Payout Quarter, in accordance with
        directions provided to each MCO by the Department.
        (2) Outpatient per unit add-on. A quarterly uniform
    per claim add-on shall be derived by dividing the
    quarterly Outpatient Directed Payments Pool amount
    allocated to the applicable hospital class by the total
    outpatient encounter claims received during the
    Determination Quarter, for all hospitals in the class.
            (A) Each hospital in the class shall have a
        quarterly outpatient directed payment calculated that
        is equal to the product of the number of outpatient
        encounter claims attributable to the hospital used in
        the calculation of the quarterly uniform class per
        claim add-on, multiplied by the calculated applicable
        quarterly uniform class per claim add-on of the
        hospital class.
            (B) Each hospital shall be paid 1/3 of its
        quarterly outpatient directed payment in each of the 3
        months of the Payout Quarter, in accordance with
        directions provided to each MCO by the Department.
        (3) Each MCO shall pay each hospital the Monthly
    Directed Payment as identified by the Department on its
    quarterly determination report.
        (4) Definitions. As used in this subsection:
            (A) "Payout Quarter" means each 3 month calendar
        quarter, beginning July 1, 2020.
            (B) "Determination Quarter" means each 3 month
        calendar quarter, which ends 3 months prior to the
        first day of each Payout Quarter.
        (5) For the period July 1, 2020 through December 2020,
    the following amounts shall be allocated to the following
    hospital class directed payment pools for the quarterly
    development of a uniform per unit add-on:
            (A) $2,894,500 for hospital inpatient services for
        critical access hospitals.
            (B) $4,294,374 for hospital outpatient services
        for critical access hospitals.
            (C) $29,109,330 for hospital inpatient services
        for safety-net hospitals.
            (D) $35,041,218 for hospital outpatient services
        for safety-net hospitals.
        (6) For the period January 1, 2023 through December
    31, 2023, the Department shall establish the amounts that
    shall be allocated to the hospital class directed payment
    fixed pools identified in this paragraph for the quarterly
    development of a uniform per unit add-on. The Department
    shall establish such amounts so that the total amount of
    payments to each hospital under this Section in calendar
    year 2023 is projected to be substantially similar to the
    total amount of such payments received by the hospital
    under this Section in calendar year 2021, adjusted for
    increased funding provided for fixed pool directed
    payments under subsection (g) in calendar year 2022,
    assuming that the volume and acuity of claims are held
    constant. The Department shall publish the directed
    payment fixed pool amounts to be established under this
    paragraph on its website by November 15, 2022.
            (A) Hospital inpatient services for critical
        access hospitals.
            (B) Hospital outpatient services for critical
        access hospitals.
            (C) Hospital inpatient services for public
        hospitals.
            (D) Hospital outpatient services for public
        hospitals.
            (E) Hospital inpatient services for safety-net
        hospitals.
            (F) Hospital outpatient services for safety-net
        hospitals.
        (7) Semi-annual rate maintenance review. The
    Department shall ensure that hospitals assigned to the
    fixed pools in paragraph (6) are paid no less than 95% of
    the annual initial rate for each 6-month period of each
    annual payout period. For each calendar year, the
    Department shall calculate the annual initial rate per day
    and per visit for each fixed pool hospital class listed in
    paragraph (6), by dividing the total of all applicable
    inpatient or outpatient directed payments issued in the
    preceding calendar year to the hospitals in each fixed
    pool class for the calendar year, plus any increase
    resulting from the annual adjustments described in
    subsection (i), by the actual applicable total service
    units for the preceding calendar year which were the basis
    of the total applicable inpatient or outpatient directed
    payments issued to the hospitals in each fixed pool class
    in the calendar year, except that for calendar year 2023,
    the service units from calendar year 2021 shall be used.
            (A) The Department shall calculate the effective
        rate, per day and per visit, for the payout periods of
        January to June and July to December of each year, for
        each fixed pool listed in paragraph (6), by dividing
        50% of the annual pool by the total applicable
        reported service units for the 2 applicable
        determination quarters.
            (B) If the effective rate calculated in
        subparagraph (A) is less than 95% of the annual
        initial rate assigned to the class for each pool under
        paragraph (6), the Department shall adjust the payment
        for each hospital to a level equal to no less than 95%
        of the annual initial rate, by issuing a retroactive
        adjustment payment for the 6-month period under review
        as identified in subparagraph (A).
    (h) Fixed rate directed payments. Effective July 1, 2020,
the Department shall issue payments to MCOs which shall be
used to issue directed payments to Illinois hospitals not
identified in paragraph (g) on a monthly basis. Prior to the
beginning of each Payout Quarter beginning July 1, 2020, the
Department shall use encounter claims data from the
Determination Quarter, accepted by the Department's Medicaid
Management Information System for inpatient and outpatient
services rendered by hospitals in each hospital class
identified in paragraph (f) and not identified in paragraph
(g). For the period July 1, 2020 through December 2020, the
Department shall direct MCOs to make payments as follows:
        (1) For general acute care hospitals an amount equal
    to $1,750 multiplied by the hospital's category of service
    20 case mix index for the determination quarter multiplied
    by the hospital's total number of inpatient admissions for
    category of service 20 for the determination quarter.
        (2) For general acute care hospitals an amount equal
    to $160 multiplied by the hospital's category of service
    21 case mix index for the determination quarter multiplied
    by the hospital's total number of inpatient admissions for
    category of service 21 for the determination quarter.
        (3) For general acute care hospitals an amount equal
    to $80 multiplied by the hospital's category of service 22
    case mix index for the determination quarter multiplied by
    the hospital's total number of inpatient admissions for
    category of service 22 for the determination quarter.
        (4) For general acute care hospitals an amount equal
    to $375 multiplied by the hospital's category of service
    24 case mix index for the determination quarter multiplied
    by the hospital's total number of category of service 24
    paid EAPG (EAPGs) for the determination quarter.
        (5) For general acute care hospitals an amount equal
    to $240 multiplied by the hospital's category of service
    27 and 28 case mix index for the determination quarter
    multiplied by the hospital's total number of category of
    service 27 and 28 paid EAPGs for the determination
    quarter.
        (6) For general acute care hospitals an amount equal
    to $290 multiplied by the hospital's category of service
    29 case mix index for the determination quarter multiplied
    by the hospital's total number of category of service 29
    paid EAPGs for the determination quarter.
        (7) For high Medicaid hospitals an amount equal to
    $1,800 multiplied by the hospital's category of service 20
    case mix index for the determination quarter multiplied by
    the hospital's total number of inpatient admissions for
    category of service 20 for the determination quarter.
        (8) For high Medicaid hospitals an amount equal to
    $160 multiplied by the hospital's category of service 21
    case mix index for the determination quarter multiplied by
    the hospital's total number of inpatient admissions for
    category of service 21 for the determination quarter.
        (9) For high Medicaid hospitals an amount equal to $80
    multiplied by the hospital's category of service 22 case
    mix index for the determination quarter multiplied by the
    hospital's total number of inpatient admissions for
    category of service 22 for the determination quarter.
        (10) For high Medicaid hospitals an amount equal to
    $400 multiplied by the hospital's category of service 24
    case mix index for the determination quarter multiplied by
    the hospital's total number of category of service 24 paid
    EAPG outpatient claims for the determination quarter.
        (11) For high Medicaid hospitals an amount equal to
    $240 multiplied by the hospital's category of service 27
    and 28 case mix index for the determination quarter
    multiplied by the hospital's total number of category of
    service 27 and 28 paid EAPGs for the determination
    quarter.
        (12) For high Medicaid hospitals an amount equal to
    $290 multiplied by the hospital's category of service 29
    case mix index for the determination quarter multiplied by
    the hospital's total number of category of service 29 paid
    EAPGs for the determination quarter.
        (13) For long term acute care hospitals the amount of
    $495 multiplied by the hospital's total number of
    inpatient days for the determination quarter.
        (14) For psychiatric hospitals the amount of $210
    multiplied by the hospital's total number of inpatient
    days for category of service 21 for the determination
    quarter.
        (15) For psychiatric hospitals the amount of $250
    multiplied by the hospital's total number of outpatient
    claims for category of service 27 and 28 for the
    determination quarter.
        (16) For rehabilitation hospitals the amount of $410
    multiplied by the hospital's total number of inpatient
    days for category of service 22 for the determination
    quarter.
        (17) For rehabilitation hospitals the amount of $100
    multiplied by the hospital's total number of outpatient
    claims for category of service 29 for the determination
    quarter.
        (18) Effective for the Payout Quarter beginning
    January 1, 2023, for the directed payments to hospitals
    required under this subsection, the Department shall
    establish the amounts that shall be used to calculate such
    directed payments using the methodologies specified in
    this paragraph. The Department shall use a single, uniform
    rate, adjusted for acuity as specified in paragraphs (1)
    through (12), for all categories of inpatient services
    provided by each class of hospitals and a single uniform
    rate, adjusted for acuity as specified in paragraphs (1)
    through (12), for all categories of outpatient services
    provided by each class of hospitals. The Department shall
    establish such amounts so that the total amount of
    payments to each hospital under this Section in calendar
    year 2023 is projected to be substantially similar to the
    total amount of such payments received by the hospital
    under this Section in calendar year 2021, adjusted for
    increased funding provided for fixed pool directed
    payments under subsection (g) in calendar year 2022,
    assuming that the volume and acuity of claims are held
    constant. The Department shall publish the directed
    payment amounts to be established under this subsection on
    its website by November 15, 2022.
        (19) (18) Each hospital shall be paid 1/3 of their
    quarterly inpatient and outpatient directed payment in
    each of the 3 months of the Payout Quarter, in accordance
    with directions provided to each MCO by the Department.
        20 (19) Each MCO shall pay each hospital the Monthly
    Directed Payment amount as identified by the Department on
    its quarterly determination report.
    Notwithstanding any other provision of this subsection, if
the Department determines that the actual total hospital
utilization data that is used to calculate the fixed rate
directed payments is substantially different than anticipated
when the rates in this subsection were initially determined
(for unforeseeable circumstances (such as the COVID-19
pandemic or some other public health emergency), the
Department may adjust the rates specified in this subsection
so that the total directed payments approximate the total
spending amount anticipated when the rates were initially
established.
    Definitions. As used in this subsection:
            (A) "Payout Quarter" means each calendar quarter,
        beginning July 1, 2020.
            (B) "Determination Quarter" means each calendar
        quarter which ends 3 months prior to the first day of
        each Payout Quarter.
            (C) "Case mix index" means a hospital specific
        calculation. For inpatient claims the case mix index
        is calculated each quarter by summing the relative
        weight of all inpatient Diagnosis-Related Group (DRG)
        claims for a category of service in the applicable
        Determination Quarter and dividing the sum by the
        number of sum total of all inpatient DRG admissions
        for the category of service for the associated claims.
        The case mix index for outpatient claims is calculated
        each quarter by summing the relative weight of all
        paid EAPGs in the applicable Determination Quarter and
        dividing the sum by the sum total of paid EAPGs for the
        associated claims.
    (i) Beginning January 1, 2021, the rates for directed
payments shall be recalculated in order to spend the
additional funds for directed payments that result from
reduction in the amount of pass-through payments allowed under
federal regulations. The additional funds for directed
payments shall be allocated proportionally to each class of
hospitals based on that class' proportion of services.
        (1) Beginning January 1, 2024, the fixed pool directed
    payment amounts and the associated annual initial rates
    referenced in paragraph (6) of subsection (f) for each
    hospital class shall be uniformly increased by a ratio of
    not less than, the ratio of the total pass-through
    reduction amount pursuant to paragraph (4) of subsection
    (j), for the hospitals comprising the hospital fixed pool
    directed payment class for the next calendar year, to the
    total inpatient and outpatient directed payments for the
    hospitals comprising the hospital fixed pool directed
    payment class paid during the preceding calendar year.
        (2) Beginning January 1, 2024, the fixed rates for the
    directed payments referenced in paragraph (18) of
    subsection (h) for each hospital class shall be uniformly
    increased by a ratio of not less than, the ratio of the
    total pass-through reduction amount pursuant to paragraph
    (4) of subsection (j), for the hospitals comprising the
    hospital directed payment class for the next calendar
    year, to the total inpatient and outpatient directed
    payments for the hospitals comprising the hospital fixed
    rate directed payment class paid during the preceding
    calendar year.
    (j) Pass-through payments.
        (1) For the period July 1, 2020 through December 31,
    2020, the Department shall assign quarterly pass-through
    payments to each class of hospitals equal to one-fourth of
    the following annual allocations:
            (A) $390,487,095 to safety-net hospitals.
            (B) $62,553,886 to critical access hospitals.
            (C) $345,021,438 to high Medicaid hospitals.
            (D) $551,429,071 to general acute care hospitals.
            (E) $27,283,870 to long term acute care hospitals.
            (F) $40,825,444 to freestanding psychiatric
        hospitals.
            (G) $9,652,108 to freestanding rehabilitation
        hospitals.
        (2) For the period of July 1, 2020 through December
    31, 2020, the The pass-through payments shall at a minimum
    ensure hospitals receive a total amount of monthly
    payments under this Section as received in calendar year
    2019 in accordance with this Article and paragraph (1) of
    subsection (d-5) of Section 14-12, exclusive of amounts
    received through payments referenced in subsection (b).
        (3) For the calendar year beginning January 1, 2023,
    the Department shall establish the annual pass-through
    allocation to each class of hospitals and the pass-through
    payments to each hospital so that the total amount of
    payments to each hospital under this Section in calendar
    year 2023 is projected to be substantially similar to the
    total amount of such payments received by the hospital
    under this Section in calendar year 2021, adjusted for
    increased funding provided for fixed pool directed
    payments under subsection (g) in calendar year 2022,
    assuming that the volume and acuity of claims are held
    constant. The Department shall publish the pass-through
    allocation to each class and the pass-through payments to
    each hospital to be established under this subsection on
    its website by November 15, 2022.
        (4) (3) For the calendar years year beginning January
    1, 2021, January 1, 2022, and January 1, 2024, and each
    calendar year thereafter, each hospital's pass-through
    payment amount shall be reduced proportionally to the
    reduction of all pass-through payments required by federal
    regulations.
    (k) At least 30 days prior to each calendar year, the
Department shall notify each hospital of changes to the
payment methodologies in this Section, including, but not
limited to, changes in the fixed rate directed payment rates,
the aggregate pass-through payment amount for all hospitals,
and the hospital's pass-through payment amount for the
upcoming calendar year.
    (l) Notwithstanding any other provisions of this Section,
the Department may adopt rules to change the methodology for
directed and pass-through payments as set forth in this
Section, but only to the extent necessary to obtain federal
approval of a necessary State Plan amendment or Directed
Payment Preprint or to otherwise conform to federal law or
federal regulation.
    (m) As used in this subsection, "managed care
organization" or "MCO" means an entity which contracts with
the Department to provide services where payment for medical
services is made on a capitated basis, excluding contracted
entities for dual eligible or Department of Children and
Family Services youth populations.
    (n) In order to address the escalating infant mortality
rates among minority communities in Illinois, the State shall,
subject to appropriation, create a pool of funding of at least
$50,000,000 annually to be disbursed among safety-net
hospitals that maintain perinatal designation from the
Department of Public Health. The funding shall be used to
preserve or enhance OB/GYN services or other specialty
services at the receiving hospital, with the distribution of
funding to be established by rule and with consideration to
perinatal hospitals with safe birthing levels and quality
metrics for healthy mothers and babies.
    (o) In order to address the growing challenges of
providing stable access to healthcare in rural Illinois,
including perinatal services, behavioral healthcare including
substance use disorder services (SUDs) and other specialty
services, and to expand access to telehealth services among
rural communities in Illinois, the Department of Healthcare
and Family Services, subject to appropriation, shall
administer a program to provide at least $10,000,000 in
financial support annually to critical access hospitals for
delivery of perinatal and OB/GYN services, behavioral
healthcare including SUDS, other specialty services and
telehealth services. The funding shall be used to preserve or
enhance perinatal and OB/GYN services, behavioral healthcare
including SUDS, other specialty services, as well as the
explanation of telehealth services by the receiving hospital,
with the distribution of funding to be established by rule.
    (p) For calendar year 2023, the final amounts, rates, and
payments under subsections (c), (d-2), (g), (h), and (j) shall
be established by the Department, so that the sum of the total
estimated annual payments under subsections (c), (d-2), (g),
(h), and (j) for each hospital class for calendar year 2023, is
no less than:
        (1) $858,260,000 to safety-net hospitals.
        (2) $86,200,000 to critical access hospitals.
        (3) $1,765,000,000 to high Medicaid hospitals.
        (4) $673,860,000 to general acute care hospitals.
        (5) $48,330,000 to long term acute care hospitals.
        (6) $89,110,000 to freestanding psychiatric hospitals.
        (7) $24,300,000 to freestanding rehabilitation
    hospitals.
        (8) $32,570,000 to public hospitals.
(Source: P.A. 101-650, eff. 7-7-20; 102-4, eff. 4-27-21;
102-16, eff. 6-17-21.)
 
    (305 ILCS 5/5A-14)
    Sec. 5A-14. Repeal of assessments and disbursements.
    (a) Section 5A-2 is repealed on December 31, 2026 2022.
    (b) Section 5A-12 is repealed on July 1, 2005.
    (c) Section 5A-12.1 is repealed on July 1, 2008.
    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
July 1, 2018, subject to Section 5A-16.
    (e) Section 5A-12.3 is repealed on July 1, 2011.
    (f) Section 5A-12.6 is repealed on July 1, 2020.
    (g) Section 5A-12.7 is repealed on December 31, 2026 2022.
(Source: P.A. 100-581, eff. 3-12-18; 101-650, eff. 7-7-20.)
 
ARTICLE 10.

 
    Section 10-5. The Illinois Public Aid Code is amended by
adding Section 5-45 as follows:
 
    (305 ILCS 5/5-45 new)
    Sec. 5-45. General acute care hospitals. A general acute
care hospital is authorized to file a notice with the
Department of Public Health and the Health Facilities and
Services Review Board to establish an acute mental illness
category of service in accordance with the Illinois Health
Facilities Planning Act and add authorized acute mental
illness beds if the following conditions are met:
        (1) the general acute care hospital qualifies as a
    safety-net hospital, as defined in Section 5-5e.1, as
    determined by the Department of Healthcare and Family
    Services at the time of filing the notice or for the year
    immediately prior to the date of filing the notice;
        (2) the notice seeks to establish no more than 24
    authorized acute mental illness beds; and
        (3) the notice seeks to reduce the number of
    authorized beds in another category of service to offset
    the number of authorized acute mental illness beds.
 
ARTICLE 15.

 
    Section 15-5. The Illinois Public Aid Code is amended by
changing Section 12-4.105 as follows:
 
    (305 ILCS 5/12-4.105)
    Sec. 12-4.105. Human poison control center; payment
program. Subject to funding availability resulting from
transfers made from the Hospital Provider Fund to the
Healthcare Provider Relief Fund as authorized under this Code,
for State fiscal year 2017 and State fiscal year 2018, and for
each State fiscal year thereafter in which the assessment
under Section 5A-2 is imposed, the Department of Healthcare
and Family Services shall pay to the human poison control
center designated under the Poison Control System Act an
amount of not less than $3,000,000 for each of State fiscal
years 2017 through 2020, and for State fiscal years year 2021
through 2026 and 2022 an amount of not less than $3,750,000 and
for the period July 1, 2026 2022 through December 31, 2026 2022
an amount of not less than $1,875,000, if the human poison
control center is in operation.
(Source: P.A. 100-581, eff. 3-12-18; 101-650, eff. 7-7-20.)
 
ARTICLE 20.

 
    Section 20-5. The Department of Public Health Powers and
Duties Law is amended by adding Section 2310-710 as follows:
 
    (20 ILCS 2310/2310-710 new)
    Sec. 2310-710. Safety-Net Hospital Health Equity and
Access Leadership (HEAL) Grant Program.
    (a) Findings. The General Assembly finds that there are
communities in Illinois that experience significant health
care disparities, as recently emphasized by the COVID-19
pandemic, aggravated by social determinants of health and a
lack of sufficient access to high quality healthcare
resources, particularly community-based services, preventive
care, obstetric care, chronic disease management, and
specialty care. Safety-net hospitals, as defined under the
Illinois Public Aid Code, serve as the anchors of the health
care system for many of these communities. Safety-net
hospitals not only care for their patients, they also are
rooted in their communities by providing jobs and partnering
with local organizations to help address the social
determinants of health, such as food, housing, and
transportation needs.
    However, safety-net hospitals serve a significant number
of Medicare, Medicaid, and uninsured patients, and therefore,
are heavily dependent on underfunded government payers, and
are heavily burdened by uncompensated care. At the same time,
the overall cost of providing care has increased substantially
in recent years, driven by increasing costs for staffing,
prescription drugs, technology, and infrastructure.
    For all of these reasons, the General Assembly finds that
the long term sustainability of safety-net hospitals is
threatened. While the General Assembly is providing funding to
the Department to be paid to support the expenses of specific
safety-net hospitals in State Fiscal Year 2023, such annual,
ad hoc funding is not a reliable and stable source of funding
that will enable safety-net hospitals to develop strategies to
achieve long term sustainability. Such annual, ad hoc funding
also does not provide the State with transparency and
accountability to ensure that such funding is being used
effectively and efficiently to maximize the benefit to members
of the community.
    Therefore, it is the intent of the General Assembly that
the Department of Public Health and the Department of
Healthcare and Family Services jointly provide options and
recommendations to the General Assembly by February 1, 2023,
for the establishment of a permanent Safety-Net Hospital
Health Equity and Access Leadership (HEAL) Grant Program, in
accordance with this Section. It is the intention of the
General Assembly that during State fiscal years 2024 through
2029, the Safety-Net Hospital Health Equity and Access
Leadership (HEAL) Grant Program shall be supported by an
annual funding pool of up to $100,000,000, subject to
appropriation.
    (b) By February 1, 2023, the Department of Public Health
and the Department of Healthcare and Family Services shall
provide a joint report to the General Assembly on options and
recommendations for the establishment of a permanent
Safety-Net Hospital Health Equity and Access Leadership (HEAL)
Grant Program to be administered by the State. For this
report, "safety-net hospital" means a hospital identified by
the Department of Healthcare and Family Services under Section
5-5e.1 of the Illinois Public Aid Code. The Departments of
Public Health and Healthcare and Family Services may consult
with the statewide association representing a majority of
hospitals and safety-net hospitals on the report. The report
may include, but need not be limited to:
        (1) Criteria for a safety-net hospital to be eligible
    for the program, such as:
            (A) The hospital is a participating provider in at
        least one Medicaid managed care plan.
            (B) The hospital is located in a medically
        underserved area.
            (C) The hospital's Medicaid utilization rate (for
        both inpatient and outpatient services).
            (D) The hospital's Medicare utilization rate (for
        both inpatient and outpatient services).
            (E) The hospital's uncompensated care percentage.
            (F) The hospital's role in providing access to
        services, reducing health disparities, and improving
        health equity in its service area.
            (G) The hospital's performance on quality
        indicators.
        (2) Potential projects eligible for grant funds which
    may include projects to reduce health disparities, advance
    health equity, or improve access to or the quality of
    healthcare services.
        (3) Potential policies, standards, and procedures to
    ensure accountability for the use of grant funds.
        (4) Potential strategies to generate federal Medicaid
    matching funds for expenditures under the program.
        (5) Potential policies, processes, and procedures for
    the administration of the program.
 
ARTICLE 25.

 
    Section 25-5. The Illinois Public Aid Code is amended by
changing Section 5-5.02 as follows:
 
    (305 ILCS 5/5-5.02)  (from Ch. 23, par. 5-5.02)
    Sec. 5-5.02. Hospital reimbursements.
    (a) Reimbursement to hospitals; July 1, 1992 through
September 30, 1992. Notwithstanding any other provisions of
this Code or the Illinois Department's Rules promulgated under
the Illinois Administrative Procedure Act, reimbursement to
hospitals for services provided during the period July 1, 1992
through September 30, 1992, shall be as follows:
        (1) For inpatient hospital services rendered, or if
    applicable, for inpatient hospital discharges occurring,
    on or after July 1, 1992 and on or before September 30,
    1992, the Illinois Department shall reimburse hospitals
    for inpatient services under the reimbursement
    methodologies in effect for each hospital, and at the
    inpatient payment rate calculated for each hospital, as of
    June 30, 1992. For purposes of this paragraph,
    "reimbursement methodologies" means all reimbursement
    methodologies that pertain to the provision of inpatient
    hospital services, including, but not limited to, any
    adjustments for disproportionate share, targeted access,
    critical care access and uncompensated care, as defined by
    the Illinois Department on June 30, 1992.
        (2) For the purpose of calculating the inpatient
    payment rate for each hospital eligible to receive
    quarterly adjustment payments for targeted access and
    critical care, as defined by the Illinois Department on
    June 30, 1992, the adjustment payment for the period July
    1, 1992 through September 30, 1992, shall be 25% of the
    annual adjustment payments calculated for each eligible
    hospital, as of June 30, 1992. The Illinois Department
    shall determine by rule the adjustment payments for
    targeted access and critical care beginning October 1,
    1992.
        (3) For the purpose of calculating the inpatient
    payment rate for each hospital eligible to receive
    quarterly adjustment payments for uncompensated care, as
    defined by the Illinois Department on June 30, 1992, the
    adjustment payment for the period August 1, 1992 through
    September 30, 1992, shall be one-sixth of the total
    uncompensated care adjustment payments calculated for each
    eligible hospital for the uncompensated care rate year, as
    defined by the Illinois Department, ending on July 31,
    1992. The Illinois Department shall determine by rule the
    adjustment payments for uncompensated care beginning
    October 1, 1992.
    (b) Inpatient payments. For inpatient services provided on
or after October 1, 1993, in addition to rates paid for
hospital inpatient services pursuant to the Illinois Health
Finance Reform Act, as now or hereafter amended, or the
Illinois Department's prospective reimbursement methodology,
or any other methodology used by the Illinois Department for
inpatient services, the Illinois Department shall make
adjustment payments, in an amount calculated pursuant to the
methodology described in paragraph (c) of this Section, to
hospitals that the Illinois Department determines satisfy any
one of the following requirements:
        (1) Hospitals that are described in Section 1923 of
    the federal Social Security Act, as now or hereafter
    amended, except that for rate year 2015 and after a
    hospital described in Section 1923(b)(1)(B) of the federal
    Social Security Act and qualified for the payments
    described in subsection (c) of this Section for rate year
    2014 provided the hospital continues to meet the
    description in Section 1923(b)(1)(B) in the current
    determination year; or
        (2) Illinois hospitals that have a Medicaid inpatient
    utilization rate which is at least one-half a standard
    deviation above the mean Medicaid inpatient utilization
    rate for all hospitals in Illinois receiving Medicaid
    payments from the Illinois Department; or
        (3) Illinois hospitals that on July 1, 1991 had a
    Medicaid inpatient utilization rate, as defined in
    paragraph (h) of this Section, that was at least the mean
    Medicaid inpatient utilization rate for all hospitals in
    Illinois receiving Medicaid payments from the Illinois
    Department and which were located in a planning area with
    one-third or fewer excess beds as determined by the Health
    Facilities and Services Review Board, and that, as of June
    30, 1992, were located in a federally designated Health
    Manpower Shortage Area; or
        (4) Illinois hospitals that:
            (A) have a Medicaid inpatient utilization rate
        that is at least equal to the mean Medicaid inpatient
        utilization rate for all hospitals in Illinois
        receiving Medicaid payments from the Department; and
            (B) also have a Medicaid obstetrical inpatient
        utilization rate that is at least one standard
        deviation above the mean Medicaid obstetrical
        inpatient utilization rate for all hospitals in
        Illinois receiving Medicaid payments from the
        Department for obstetrical services; or
        (5) Any children's hospital, which means a hospital
    devoted exclusively to caring for children. A hospital
    which includes a facility devoted exclusively to caring
    for children shall be considered a children's hospital to
    the degree that the hospital's Medicaid care is provided
    to children if either (i) the facility devoted exclusively
    to caring for children is separately licensed as a
    hospital by a municipality prior to February 28, 2013;
    (ii) the hospital has been designated by the State as a
    Level III perinatal care facility, has a Medicaid
    Inpatient Utilization rate greater than 55% for the rate
    year 2003 disproportionate share determination, and has
    more than 10,000 qualified children days as defined by the
    Department in rulemaking; (iii) the hospital has been
    designated as a Perinatal Level III center by the State as
    of December 1, 2017, is a Pediatric Critical Care Center
    designated by the State as of December 1, 2017 and has a
    2017 Medicaid inpatient utilization rate equal to or
    greater than 45%; or (iv) the hospital has been designated
    as a Perinatal Level II center by the State as of December
    1, 2017, has a 2017 Medicaid Inpatient Utilization Rate
    greater than 70%, and has at least 10 pediatric beds as
    listed on the IDPH 2015 calendar year hospital profile; or
        (6) A hospital that reopens a previously closed
    hospital facility within 4 3 calendar years of the
    hospital facility's closure, if the previously closed
    hospital facility qualified for payments under paragraph
    (c) at the time of closure, until utilization data for the
    new facility is available for the Medicaid inpatient
    utilization rate calculation. For purposes of this clause,
    a "closed hospital facility" shall include hospitals that
    have been terminated from participation in the medical
    assistance program in accordance with Section 12-4.25 of
    this Code.
    (c) Inpatient adjustment payments. The adjustment payments
required by paragraph (b) shall be calculated based upon the
hospital's Medicaid inpatient utilization rate as follows:
        (1) hospitals with a Medicaid inpatient utilization
    rate below the mean shall receive a per day adjustment
    payment equal to $25;
        (2) hospitals with a Medicaid inpatient utilization
    rate that is equal to or greater than the mean Medicaid
    inpatient utilization rate but less than one standard
    deviation above the mean Medicaid inpatient utilization
    rate shall receive a per day adjustment payment equal to
    the sum of $25 plus $1 for each one percent that the
    hospital's Medicaid inpatient utilization rate exceeds the
    mean Medicaid inpatient utilization rate;
        (3) hospitals with a Medicaid inpatient utilization
    rate that is equal to or greater than one standard
    deviation above the mean Medicaid inpatient utilization
    rate but less than 1.5 standard deviations above the mean
    Medicaid inpatient utilization rate shall receive a per
    day adjustment payment equal to the sum of $40 plus $7 for
    each one percent that the hospital's Medicaid inpatient
    utilization rate exceeds one standard deviation above the
    mean Medicaid inpatient utilization rate;
        (4) hospitals with a Medicaid inpatient utilization
    rate that is equal to or greater than 1.5 standard
    deviations above the mean Medicaid inpatient utilization
    rate shall receive a per day adjustment payment equal to
    the sum of $90 plus $2 for each one percent that the
    hospital's Medicaid inpatient utilization rate exceeds 1.5
    standard deviations above the mean Medicaid inpatient
    utilization rate; and
        (5) hospitals qualifying under clause (6) of paragraph
    (b) shall have the rate assigned to the previously closed
    hospital facility at the date of closure, until
    utilization data for the new facility is available for the
    Medicaid inpatient utilization rate calculation.
    (d) Supplemental adjustment payments. In addition to the
adjustment payments described in paragraph (c), hospitals as
defined in clauses (1) through (6) of paragraph (b), excluding
county hospitals (as defined in subsection (c) of Section 15-1
of this Code) and a hospital organized under the University of
Illinois Hospital Act, shall be paid supplemental inpatient
adjustment payments of $60 per day. For purposes of Title XIX
of the federal Social Security Act, these supplemental
adjustment payments shall not be classified as adjustment
payments to disproportionate share hospitals.
    (e) The inpatient adjustment payments described in
paragraphs (c) and (d) shall be increased on October 1, 1993
and annually thereafter by a percentage equal to the lesser of
(i) the increase in the DRI hospital cost index for the most
recent 12 month period for which data are available, or (ii)
the percentage increase in the statewide average hospital
payment rate over the previous year's statewide average
hospital payment rate. The sum of the inpatient adjustment
payments under paragraphs (c) and (d) to a hospital, other
than a county hospital (as defined in subsection (c) of
Section 15-1 of this Code) or a hospital organized under the
University of Illinois Hospital Act, however, shall not exceed
$275 per day; that limit shall be increased on October 1, 1993
and annually thereafter by a percentage equal to the lesser of
(i) the increase in the DRI hospital cost index for the most
recent 12-month period for which data are available or (ii)
the percentage increase in the statewide average hospital
payment rate over the previous year's statewide average
hospital payment rate.
    (f) Children's hospital inpatient adjustment payments. For
children's hospitals, as defined in clause (5) of paragraph
(b), the adjustment payments required pursuant to paragraphs
(c) and (d) shall be multiplied by 2.0.
    (g) County hospital inpatient adjustment payments. For
county hospitals, as defined in subsection (c) of Section 15-1
of this Code, there shall be an adjustment payment as
determined by rules issued by the Illinois Department.
    (h) For the purposes of this Section the following terms
shall be defined as follows:
        (1) "Medicaid inpatient utilization rate" means a
    fraction, the numerator of which is the number of a
    hospital's inpatient days provided in a given 12-month
    period to patients who, for such days, were eligible for
    Medicaid under Title XIX of the federal Social Security
    Act, and the denominator of which is the total number of
    the hospital's inpatient days in that same period.
        (2) "Mean Medicaid inpatient utilization rate" means
    the total number of Medicaid inpatient days provided by
    all Illinois Medicaid-participating hospitals divided by
    the total number of inpatient days provided by those same
    hospitals.
        (3) "Medicaid obstetrical inpatient utilization rate"
    means the ratio of Medicaid obstetrical inpatient days to
    total Medicaid inpatient days for all Illinois hospitals
    receiving Medicaid payments from the Illinois Department.
    (i) Inpatient adjustment payment limit. In order to meet
the limits of Public Law 102-234 and Public Law 103-66, the
Illinois Department shall by rule adjust disproportionate
share adjustment payments.
    (j) University of Illinois Hospital inpatient adjustment
payments. For hospitals organized under the University of
Illinois Hospital Act, there shall be an adjustment payment as
determined by rules adopted by the Illinois Department.
    (k) The Illinois Department may by rule establish criteria
for and develop methodologies for adjustment payments to
hospitals participating under this Article.
    (l) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any
rate of reimbursement for services or other payments in
accordance with Section 5-5e.
    (m) The Department shall establish a cost-based
reimbursement methodology for determining payments to
hospitals for approved graduate medical education (GME)
programs for dates of service on and after July 1, 2018.
        (1) As used in this subsection, "hospitals" means the
    University of Illinois Hospital as defined in the
    University of Illinois Hospital Act and a county hospital
    in a county of over 3,000,000 inhabitants.
        (2) An amendment to the Illinois Title XIX State Plan
    defining GME shall maximize reimbursement, shall not be
    limited to the education programs or special patient care
    payments allowed under Medicare, and shall include:
            (A) inpatient days;
            (B) outpatient days;
            (C) direct costs;
            (D) indirect costs;
            (E) managed care days;
            (F) all stages of medical training and education
        including students, interns, residents, and fellows
        with no caps on the number of persons who may qualify;
        and
            (G) patient care payments related to the
        complexities of treating Medicaid enrollees including
        clinical and social determinants of health.
        (3) The Department shall make all GME payments
    directly to hospitals including such costs in support of
    clients enrolled in Medicaid managed care entities.
        (4) The Department shall promptly take all actions
    necessary for reimbursement to be effective for dates of
    service on and after July 1, 2018 including publishing all
    appropriate public notices, amendments to the Illinois
    Title XIX State Plan, and adoption of administrative rules
    if necessary.
        (5) As used in this subsection, "managed care days"
    means costs associated with services rendered to enrollees
    of Medicaid managed care entities. "Medicaid managed care
    entities" means any entity which contracts with the
    Department to provide services paid for on a capitated
    basis. "Medicaid managed care entities" includes a managed
    care organization and a managed care community network.
        (6) All payments under this Section are contingent
    upon federal approval of changes to the Illinois Title XIX
    State Plan, if that approval is required.
        (7) The Department may adopt rules necessary to
    implement Public Act 100-581 through the use of emergency
    rulemaking in accordance with subsection (aa) of Section
    5-45 of the Illinois Administrative Procedure Act. For
    purposes of that Act, the General Assembly finds that the
    adoption of rules to implement Public Act 100-581 is
    deemed an emergency and necessary for the public interest,
    safety, and welfare.
(Source: P.A. 101-81, eff. 7-12-19; 102-682, eff. 12-10-21.)
 
ARTICLE 30.

 
    Section 30-5. The Illinois Income Tax Act is amended by
changing Section 223 as follows:
 
    (35 ILCS 5/223)
    Sec. 223. Hospital credit.
    (a) For tax years ending on or after December 31, 2012 and
ending on or before December 31, 2027 December 31, 2022, a
taxpayer that is the owner of a hospital licensed under the
Hospital Licensing Act, but not including an organization that
is exempt from federal income taxes under the Internal Revenue
Code, is entitled to a credit against the taxes imposed under
subsections (a) and (b) of Section 201 of this Act in an amount
equal to the lesser of the amount of real property taxes paid
during the tax year on real property used for hospital
purposes during the prior tax year or the cost of free or
discounted services provided during the tax year pursuant to
the hospital's charitable financial assistance policy,
measured at cost.
    (b) If the taxpayer is a partnership or Subchapter S
corporation, the credit is allowed to the partners or
shareholders in accordance with the determination of income
and distributive share of income under Sections 702 and 704
and Subchapter S of the Internal Revenue Code. A transfer of
this credit may be made by the taxpayer earning the credit
within one year after the credit is earned in accordance with
rules adopted by the Department. The Department shall
prescribe rules to enforce and administer provisions of this
Section. If the amount of the credit exceeds the tax liability
for the year, then the excess credit may be carried forward and
applied to the tax liability of the 5 taxable years following
the excess credit year. The credit shall be applied to the
earliest year for which there is a tax liability. If there are
credits from more than one tax year that are available to
offset a liability, the earlier credit shall be applied first.
In no event shall a credit under this Section reduce the
taxpayer's liability to less than zero.
(Source: P.A. 100-587, eff. 6-4-18.)
 
    Section 30-10. The Use Tax Act is amended by changing
Section 3-8 as follows:
 
    (35 ILCS 105/3-8)
    Sec. 3-8. Hospital exemption.
    (a) Until July 1, 2027 2022, tangible personal property
sold to or used by a hospital owner that owns one or more
hospitals licensed under the Hospital Licensing Act or
operated under the University of Illinois Hospital Act, or a
hospital affiliate that is not already exempt under another
provision of this Act and meets the criteria for an exemption
under this Section, is exempt from taxation under this Act.
    (b) A hospital owner or hospital affiliate satisfies the
conditions for an exemption under this Section if the value of
qualified services or activities listed in subsection (c) of
this Section for the hospital year equals or exceeds the
relevant hospital entity's estimated property tax liability,
without regard to any property tax exemption granted under
Section 15-86 of the Property Tax Code, for the calendar year
in which exemption or renewal of exemption is sought. For
purposes of making the calculations required by this
subsection (b), if the relevant hospital entity is a hospital
owner that owns more than one hospital, the value of the
services or activities listed in subsection (c) shall be
calculated on the basis of only those services and activities
relating to the hospital that includes the subject property,
and the relevant hospital entity's estimated property tax
liability shall be calculated only with respect to the
properties comprising that hospital. In the case of a
multi-state hospital system or hospital affiliate, the value
of the services or activities listed in subsection (c) shall
be calculated on the basis of only those services and
activities that occur in Illinois and the relevant hospital
entity's estimated property tax liability shall be calculated
only with respect to its property located in Illinois.
    (c) The following services and activities shall be
considered for purposes of making the calculations required by
subsection (b):
        (1) Charity care. Free or discounted services provided
    pursuant to the relevant hospital entity's financial
    assistance policy, measured at cost, including discounts
    provided under the Hospital Uninsured Patient Discount
    Act.
        (2) Health services to low-income and underserved
    individuals. Other unreimbursed costs of the relevant
    hospital entity for providing without charge, paying for,
    or subsidizing goods, activities, or services for the
    purpose of addressing the health of low-income or
    underserved individuals. Those activities or services may
    include, but are not limited to: financial or in-kind
    support to affiliated or unaffiliated hospitals, hospital
    affiliates, community clinics, or programs that treat
    low-income or underserved individuals; paying for or
    subsidizing health care professionals who care for
    low-income or underserved individuals; providing or
    subsidizing outreach or educational services to low-income
    or underserved individuals for disease management and
    prevention; free or subsidized goods, supplies, or
    services needed by low-income or underserved individuals
    because of their medical condition; and prenatal or
    childbirth outreach to low-income or underserved persons.
        (3) Subsidy of State or local governments. Direct or
    indirect financial or in-kind subsidies of State or local
    governments by the relevant hospital entity that pay for
    or subsidize activities or programs related to health care
    for low-income or underserved individuals.
        (4) Support for State health care programs for
    low-income individuals. At the election of the hospital
    applicant for each applicable year, either (A) 10% of
    payments to the relevant hospital entity and any hospital
    affiliate designated by the relevant hospital entity
    (provided that such hospital affiliate's operations
    provide financial or operational support for or receive
    financial or operational support from the relevant
    hospital entity) under Medicaid or other means-tested
    programs, including, but not limited to, General
    Assistance, the Covering ALL KIDS Health Insurance Act,
    and the State Children's Health Insurance Program or (B)
    the amount of subsidy provided by the relevant hospital
    entity and any hospital affiliate designated by the
    relevant hospital entity (provided that such hospital
    affiliate's operations provide financial or operational
    support for or receive financial or operational support
    from the relevant hospital entity) to State or local
    government in treating Medicaid recipients and recipients
    of means-tested programs, including but not limited to
    General Assistance, the Covering ALL KIDS Health Insurance
    Act, and the State Children's Health Insurance Program.
    The amount of subsidy for purpose of this item (4) is
    calculated in the same manner as unreimbursed costs are
    calculated for Medicaid and other means-tested government
    programs in the Schedule H of IRS Form 990 in effect on the
    effective date of this amendatory Act of the 97th General
    Assembly.
        (5) Dual-eligible subsidy. The amount of subsidy
    provided to government by treating dual-eligible
    Medicare/Medicaid patients. The amount of subsidy for
    purposes of this item (5) is calculated by multiplying the
    relevant hospital entity's unreimbursed costs for
    Medicare, calculated in the same manner as determined in
    the Schedule H of IRS Form 990 in effect on the effective
    date of this amendatory Act of the 97th General Assembly,
    by the relevant hospital entity's ratio of dual-eligible
    patients to total Medicare patients.
        (6) Relief of the burden of government related to
    health care. Except to the extent otherwise taken into
    account in this subsection, the portion of unreimbursed
    costs of the relevant hospital entity attributable to
    providing, paying for, or subsidizing goods, activities,
    or services that relieve the burden of government related
    to health care for low-income individuals. Such activities
    or services shall include, but are not limited to,
    providing emergency, trauma, burn, neonatal, psychiatric,
    rehabilitation, or other special services; providing
    medical education; and conducting medical research or
    training of health care professionals. The portion of
    those unreimbursed costs attributable to benefiting
    low-income individuals shall be determined using the ratio
    calculated by adding the relevant hospital entity's costs
    attributable to charity care, Medicaid, other means-tested
    government programs, Medicare patients with disabilities
    under age 65, and dual-eligible Medicare/Medicaid patients
    and dividing that total by the relevant hospital entity's
    total costs. Such costs for the numerator and denominator
    shall be determined by multiplying gross charges by the
    cost to charge ratio taken from the hospital's most
    recently filed Medicare cost report (CMS 2252-10
    Worksheet, Part I). In the case of emergency services, the
    ratio shall be calculated using costs (gross charges
    multiplied by the cost to charge ratio taken from the
    hospital's most recently filed Medicare cost report (CMS
    2252-10 Worksheet, Part I)) of patients treated in the
    relevant hospital entity's emergency department.
        (7) Any other activity by the relevant hospital entity
    that the Department determines relieves the burden of
    government or addresses the health of low-income or
    underserved individuals.
    (d) The hospital applicant shall include information in
its exemption application establishing that it satisfies the
requirements of subsection (b). For purposes of making the
calculations required by subsection (b), the hospital
applicant may for each year elect to use either (1) the value
of the services or activities listed in subsection (e) for the
hospital year or (2) the average value of those services or
activities for the 3 fiscal years ending with the hospital
year. If the relevant hospital entity has been in operation
for less than 3 completed fiscal years, then the latter
calculation, if elected, shall be performed on a pro rata
basis.
    (e) For purposes of making the calculations required by
this Section:
        (1) particular services or activities eligible for
    consideration under any of the paragraphs (1) through (7)
    of subsection (c) may not be counted under more than one of
    those paragraphs; and
        (2) the amount of unreimbursed costs and the amount of
    subsidy shall not be reduced by restricted or unrestricted
    payments received by the relevant hospital entity as
    contributions deductible under Section 170(a) of the
    Internal Revenue Code.
    (f) (Blank).
    (g) Estimation of Exempt Property Tax Liability. The
estimated property tax liability used for the determination in
subsection (b) shall be calculated as follows:
        (1) "Estimated property tax liability" means the
    estimated dollar amount of property tax that would be
    owed, with respect to the exempt portion of each of the
    relevant hospital entity's properties that are already
    fully or partially exempt, or for which an exemption in
    whole or in part is currently being sought, and then
    aggregated as applicable, as if the exempt portion of
    those properties were subject to tax, calculated with
    respect to each such property by multiplying:
            (A) the lesser of (i) the actual assessed value,
        if any, of the portion of the property for which an
        exemption is sought or (ii) an estimated assessed
        value of the exempt portion of such property as
        determined in item (2) of this subsection (g), by
            (B) the applicable State equalization rate
        (yielding the equalized assessed value), by
            (C) the applicable tax rate.
        (2) The estimated assessed value of the exempt portion
    of the property equals the sum of (i) the estimated fair
    market value of buildings on the property, as determined
    in accordance with subparagraphs (A) and (B) of this item
    (2), multiplied by the applicable assessment factor, and
    (ii) the estimated assessed value of the land portion of
    the property, as determined in accordance with
    subparagraph (C).
            (A) The "estimated fair market value of buildings
        on the property" means the replacement value of any
        exempt portion of buildings on the property, minus
        depreciation, determined utilizing the cost
        replacement method whereby the exempt square footage
        of all such buildings is multiplied by the replacement
        cost per square foot for Class A Average building
        found in the most recent edition of the Marshall &
        Swift Valuation Services Manual, adjusted by any
        appropriate current cost and local multipliers.
            (B) Depreciation, for purposes of calculating the
        estimated fair market value of buildings on the
        property, is applied by utilizing a weighted mean life
        for the buildings based on original construction and
        assuming a 40-year life for hospital buildings and the
        applicable life for other types of buildings as
        specified in the American Hospital Association
        publication "Estimated Useful Lives of Depreciable
        Hospital Assets". In the case of hospital buildings,
        the remaining life is divided by 40 and this ratio is
        multiplied by the replacement cost of the buildings to
        obtain an estimated fair market value of buildings. If
        a hospital building is older than 35 years, a
        remaining life of 5 years for residual value is
        assumed; and if a building is less than 8 years old, a
        remaining life of 32 years is assumed.
            (C) The estimated assessed value of the land
        portion of the property shall be determined by
        multiplying (i) the per square foot average of the
        assessed values of three parcels of land (not
        including farm land, and excluding the assessed value
        of the improvements thereon) reasonably comparable to
        the property, by (ii) the number of square feet
        comprising the exempt portion of the property's land
        square footage.
        (3) The assessment factor, State equalization rate,
    and tax rate (including any special factors such as
    Enterprise Zones) used in calculating the estimated
    property tax liability shall be for the most recent year
    that is publicly available from the applicable chief
    county assessment officer or officers at least 90 days
    before the end of the hospital year.
        (4) The method utilized to calculate estimated
    property tax liability for purposes of this Section 15-86
    shall not be utilized for the actual valuation,
    assessment, or taxation of property pursuant to the
    Property Tax Code.
    (h) For the purpose of this Section, the following terms
shall have the meanings set forth below:
        (1) "Hospital" means any institution, place, building,
    buildings on a campus, or other health care facility
    located in Illinois that is licensed under the Hospital
    Licensing Act and has a hospital owner.
        (2) "Hospital owner" means a not-for-profit
    corporation that is the titleholder of a hospital, or the
    owner of the beneficial interest in an Illinois land trust
    that is the titleholder of a hospital.
        (3) "Hospital affiliate" means any corporation,
    partnership, limited partnership, joint venture, limited
    liability company, association or other organization,
    other than a hospital owner, that directly or indirectly
    controls, is controlled by, or is under common control
    with one or more hospital owners and that supports, is
    supported by, or acts in furtherance of the exempt health
    care purposes of at least one of those hospital owners'
    hospitals.
        (4) "Hospital system" means a hospital and one or more
    other hospitals or hospital affiliates related by common
    control or ownership.
        (5) "Control" relating to hospital owners, hospital
    affiliates, or hospital systems means possession, direct
    or indirect, of the power to direct or cause the direction
    of the management and policies of the entity, whether
    through ownership of assets, membership interest, other
    voting or governance rights, by contract or otherwise.
        (6) "Hospital applicant" means a hospital owner or
    hospital affiliate that files an application for an
    exemption or renewal of exemption under this Section.
        (7) "Relevant hospital entity" means (A) the hospital
    owner, in the case of a hospital applicant that is a
    hospital owner, and (B) at the election of a hospital
    applicant that is a hospital affiliate, either (i) the
    hospital affiliate or (ii) the hospital system to which
    the hospital applicant belongs, including any hospitals or
    hospital affiliates that are related by common control or
    ownership.
        (8) "Subject property" means property used for the
    calculation under subsection (b) of this Section.
        (9) "Hospital year" means the fiscal year of the
    relevant hospital entity, or the fiscal year of one of the
    hospital owners in the hospital system if the relevant
    hospital entity is a hospital system with members with
    different fiscal years, that ends in the year for which
    the exemption is sought.
    (i) It is the intent of the General Assembly that any
exemptions taken, granted, or renewed under this Section prior
to the effective date of this amendatory Act of the 100th
General Assembly are hereby validated.
    (j) It is the intent of the General Assembly that the
exemption under this Section applies on a continuous basis. If
this amendatory Act of the 102nd General Assembly takes effect
after July 1, 2022, any exemptions taken, granted, or renewed
under this Section on or after July 1, 2022 and prior to the
effective date of this amendatory Act of the 102nd General
Assembly are hereby validated.
(Source: P.A. 99-143, eff. 7-27-15; 100-1181, eff. 3-8-19.)
 
    Section 30-15. The Service Use Tax Act is amended by
changing Section 3-8 as follows:
 
    (35 ILCS 110/3-8)
    Sec. 3-8. Hospital exemption.
    (a) Until July 1, 2027 2022, tangible personal property
sold to or used by a hospital owner that owns one or more
hospitals licensed under the Hospital Licensing Act or
operated under the University of Illinois Hospital Act, or a
hospital affiliate that is not already exempt under another
provision of this Act and meets the criteria for an exemption
under this Section, is exempt from taxation under this Act.
    (b) A hospital owner or hospital affiliate satisfies the
conditions for an exemption under this Section if the value of
qualified services or activities listed in subsection (c) of
this Section for the hospital year equals or exceeds the
relevant hospital entity's estimated property tax liability,
without regard to any property tax exemption granted under
Section 15-86 of the Property Tax Code, for the calendar year
in which exemption or renewal of exemption is sought. For
purposes of making the calculations required by this
subsection (b), if the relevant hospital entity is a hospital
owner that owns more than one hospital, the value of the
services or activities listed in subsection (c) shall be
calculated on the basis of only those services and activities
relating to the hospital that includes the subject property,
and the relevant hospital entity's estimated property tax
liability shall be calculated only with respect to the
properties comprising that hospital. In the case of a
multi-state hospital system or hospital affiliate, the value
of the services or activities listed in subsection (c) shall
be calculated on the basis of only those services and
activities that occur in Illinois and the relevant hospital
entity's estimated property tax liability shall be calculated
only with respect to its property located in Illinois.
    (c) The following services and activities shall be
considered for purposes of making the calculations required by
subsection (b):
        (1) Charity care. Free or discounted services provided
    pursuant to the relevant hospital entity's financial
    assistance policy, measured at cost, including discounts
    provided under the Hospital Uninsured Patient Discount
    Act.
        (2) Health services to low-income and underserved
    individuals. Other unreimbursed costs of the relevant
    hospital entity for providing without charge, paying for,
    or subsidizing goods, activities, or services for the
    purpose of addressing the health of low-income or
    underserved individuals. Those activities or services may
    include, but are not limited to: financial or in-kind
    support to affiliated or unaffiliated hospitals, hospital
    affiliates, community clinics, or programs that treat
    low-income or underserved individuals; paying for or
    subsidizing health care professionals who care for
    low-income or underserved individuals; providing or
    subsidizing outreach or educational services to low-income
    or underserved individuals for disease management and
    prevention; free or subsidized goods, supplies, or
    services needed by low-income or underserved individuals
    because of their medical condition; and prenatal or
    childbirth outreach to low-income or underserved persons.
        (3) Subsidy of State or local governments. Direct or
    indirect financial or in-kind subsidies of State or local
    governments by the relevant hospital entity that pay for
    or subsidize activities or programs related to health care
    for low-income or underserved individuals.
        (4) Support for State health care programs for
    low-income individuals. At the election of the hospital
    applicant for each applicable year, either (A) 10% of
    payments to the relevant hospital entity and any hospital
    affiliate designated by the relevant hospital entity
    (provided that such hospital affiliate's operations
    provide financial or operational support for or receive
    financial or operational support from the relevant
    hospital entity) under Medicaid or other means-tested
    programs, including, but not limited to, General
    Assistance, the Covering ALL KIDS Health Insurance Act,
    and the State Children's Health Insurance Program or (B)
    the amount of subsidy provided by the relevant hospital
    entity and any hospital affiliate designated by the
    relevant hospital entity (provided that such hospital
    affiliate's operations provide financial or operational
    support for or receive financial or operational support
    from the relevant hospital entity) to State or local
    government in treating Medicaid recipients and recipients
    of means-tested programs, including but not limited to
    General Assistance, the Covering ALL KIDS Health Insurance
    Act, and the State Children's Health Insurance Program.
    The amount of subsidy for purposes of this item (4) is
    calculated in the same manner as unreimbursed costs are
    calculated for Medicaid and other means-tested government
    programs in the Schedule H of IRS Form 990 in effect on the
    effective date of this amendatory Act of the 97th General
    Assembly.
        (5) Dual-eligible subsidy. The amount of subsidy
    provided to government by treating dual-eligible
    Medicare/Medicaid patients. The amount of subsidy for
    purposes of this item (5) is calculated by multiplying the
    relevant hospital entity's unreimbursed costs for
    Medicare, calculated in the same manner as determined in
    the Schedule H of IRS Form 990 in effect on the effective
    date of this amendatory Act of the 97th General Assembly,
    by the relevant hospital entity's ratio of dual-eligible
    patients to total Medicare patients.
        (6) Relief of the burden of government related to
    health care. Except to the extent otherwise taken into
    account in this subsection, the portion of unreimbursed
    costs of the relevant hospital entity attributable to
    providing, paying for, or subsidizing goods, activities,
    or services that relieve the burden of government related
    to health care for low-income individuals. Such activities
    or services shall include, but are not limited to,
    providing emergency, trauma, burn, neonatal, psychiatric,
    rehabilitation, or other special services; providing
    medical education; and conducting medical research or
    training of health care professionals. The portion of
    those unreimbursed costs attributable to benefiting
    low-income individuals shall be determined using the ratio
    calculated by adding the relevant hospital entity's costs
    attributable to charity care, Medicaid, other means-tested
    government programs, Medicare patients with disabilities
    under age 65, and dual-eligible Medicare/Medicaid patients
    and dividing that total by the relevant hospital entity's
    total costs. Such costs for the numerator and denominator
    shall be determined by multiplying gross charges by the
    cost to charge ratio taken from the hospital's most
    recently filed Medicare cost report (CMS 2252-10
    Worksheet, Part I). In the case of emergency services, the
    ratio shall be calculated using costs (gross charges
    multiplied by the cost to charge ratio taken from the
    hospital's most recently filed Medicare cost report (CMS
    2252-10 Worksheet, Part I)) of patients treated in the
    relevant hospital entity's emergency department.
        (7) Any other activity by the relevant hospital entity
    that the Department determines relieves the burden of
    government or addresses the health of low-income or
    underserved individuals.
    (d) The hospital applicant shall include information in
its exemption application establishing that it satisfies the
requirements of subsection (b). For purposes of making the
calculations required by subsection (b), the hospital
applicant may for each year elect to use either (1) the value
of the services or activities listed in subsection (e) for the
hospital year or (2) the average value of those services or
activities for the 3 fiscal years ending with the hospital
year. If the relevant hospital entity has been in operation
for less than 3 completed fiscal years, then the latter
calculation, if elected, shall be performed on a pro rata
basis.
    (e) For purposes of making the calculations required by
this Section:
        (1) particular services or activities eligible for
    consideration under any of the paragraphs (1) through (7)
    of subsection (c) may not be counted under more than one of
    those paragraphs; and
        (2) the amount of unreimbursed costs and the amount of
    subsidy shall not be reduced by restricted or unrestricted
    payments received by the relevant hospital entity as
    contributions deductible under Section 170(a) of the
    Internal Revenue Code.
    (f) (Blank).
    (g) Estimation of Exempt Property Tax Liability. The
estimated property tax liability used for the determination in
subsection (b) shall be calculated as follows:
        (1) "Estimated property tax liability" means the
    estimated dollar amount of property tax that would be
    owed, with respect to the exempt portion of each of the
    relevant hospital entity's properties that are already
    fully or partially exempt, or for which an exemption in
    whole or in part is currently being sought, and then
    aggregated as applicable, as if the exempt portion of
    those properties were subject to tax, calculated with
    respect to each such property by multiplying:
            (A) the lesser of (i) the actual assessed value,
        if any, of the portion of the property for which an
        exemption is sought or (ii) an estimated assessed
        value of the exempt portion of such property as
        determined in item (2) of this subsection (g), by
            (B) the applicable State equalization rate
        (yielding the equalized assessed value), by
            (C) the applicable tax rate.
        (2) The estimated assessed value of the exempt portion
    of the property equals the sum of (i) the estimated fair
    market value of buildings on the property, as determined
    in accordance with subparagraphs (A) and (B) of this item
    (2), multiplied by the applicable assessment factor, and
    (ii) the estimated assessed value of the land portion of
    the property, as determined in accordance with
    subparagraph (C).
            (A) The "estimated fair market value of buildings
        on the property" means the replacement value of any
        exempt portion of buildings on the property, minus
        depreciation, determined utilizing the cost
        replacement method whereby the exempt square footage
        of all such buildings is multiplied by the replacement
        cost per square foot for Class A Average building
        found in the most recent edition of the Marshall &
        Swift Valuation Services Manual, adjusted by any
        appropriate current cost and local multipliers.
            (B) Depreciation, for purposes of calculating the
        estimated fair market value of buildings on the
        property, is applied by utilizing a weighted mean life
        for the buildings based on original construction and
        assuming a 40-year life for hospital buildings and the
        applicable life for other types of buildings as
        specified in the American Hospital Association
        publication "Estimated Useful Lives of Depreciable
        Hospital Assets". In the case of hospital buildings,
        the remaining life is divided by 40 and this ratio is
        multiplied by the replacement cost of the buildings to
        obtain an estimated fair market value of buildings. If
        a hospital building is older than 35 years, a
        remaining life of 5 years for residual value is
        assumed; and if a building is less than 8 years old, a
        remaining life of 32 years is assumed.
            (C) The estimated assessed value of the land
        portion of the property shall be determined by
        multiplying (i) the per square foot average of the
        assessed values of three parcels of land (not
        including farm land, and excluding the assessed value
        of the improvements thereon) reasonably comparable to
        the property, by (ii) the number of square feet
        comprising the exempt portion of the property's land
        square footage.
        (3) The assessment factor, State equalization rate,
    and tax rate (including any special factors such as
    Enterprise Zones) used in calculating the estimated
    property tax liability shall be for the most recent year
    that is publicly available from the applicable chief
    county assessment officer or officers at least 90 days
    before the end of the hospital year.
        (4) The method utilized to calculate estimated
    property tax liability for purposes of this Section 15-86
    shall not be utilized for the actual valuation,
    assessment, or taxation of property pursuant to the
    Property Tax Code.
    (h) For the purpose of this Section, the following terms
shall have the meanings set forth below:
        (1) "Hospital" means any institution, place, building,
    buildings on a campus, or other health care facility
    located in Illinois that is licensed under the Hospital
    Licensing Act and has a hospital owner.
        (2) "Hospital owner" means a not-for-profit
    corporation that is the titleholder of a hospital, or the
    owner of the beneficial interest in an Illinois land trust
    that is the titleholder of a hospital.
        (3) "Hospital affiliate" means any corporation,
    partnership, limited partnership, joint venture, limited
    liability company, association or other organization,
    other than a hospital owner, that directly or indirectly
    controls, is controlled by, or is under common control
    with one or more hospital owners and that supports, is
    supported by, or acts in furtherance of the exempt health
    care purposes of at least one of those hospital owners'
    hospitals.
        (4) "Hospital system" means a hospital and one or more
    other hospitals or hospital affiliates related by common
    control or ownership.
        (5) "Control" relating to hospital owners, hospital
    affiliates, or hospital systems means possession, direct
    or indirect, of the power to direct or cause the direction
    of the management and policies of the entity, whether
    through ownership of assets, membership interest, other
    voting or governance rights, by contract or otherwise.
        (6) "Hospital applicant" means a hospital owner or
    hospital affiliate that files an application for an
    exemption or renewal of exemption under this Section.
        (7) "Relevant hospital entity" means (A) the hospital
    owner, in the case of a hospital applicant that is a
    hospital owner, and (B) at the election of a hospital
    applicant that is a hospital affiliate, either (i) the
    hospital affiliate or (ii) the hospital system to which
    the hospital applicant belongs, including any hospitals or
    hospital affiliates that are related by common control or
    ownership.
        (8) "Subject property" means property used for the
    calculation under subsection (b) of this Section.
        (9) "Hospital year" means the fiscal year of the
    relevant hospital entity, or the fiscal year of one of the
    hospital owners in the hospital system if the relevant
    hospital entity is a hospital system with members with
    different fiscal years, that ends in the year for which
    the exemption is sought.
    (i) It is the intent of the General Assembly that any
exemptions taken, granted, or renewed under this Section prior
to the effective date of this amendatory Act of the 100th
General Assembly are hereby validated.
    (j) It is the intent of the General Assembly that the
exemption under this Section applies on a continuous basis. If
this amendatory Act of the 102nd General Assembly takes effect
after July 1, 2022, any exemptions taken, granted, or renewed
under this Section on or after July 1, 2022 and prior to the
effective date of this amendatory Act of the 102nd General
Assembly are hereby validated.
(Source: P.A. 99-143, eff. 7-27-15; 100-1181, eff. 3-8-19.)
 
    Section 30-20. The Service Occupation Tax Act is amended
by changing Section 3-8 as follows:
 
    (35 ILCS 115/3-8)
    Sec. 3-8. Hospital exemption.
    (a) Until July 1, 2027 2022, tangible personal property
sold to or used by a hospital owner that owns one or more
hospitals licensed under the Hospital Licensing Act or
operated under the University of Illinois Hospital Act, or a
hospital affiliate that is not already exempt under another
provision of this Act and meets the criteria for an exemption
under this Section, is exempt from taxation under this Act.
    (b) A hospital owner or hospital affiliate satisfies the
conditions for an exemption under this Section if the value of
qualified services or activities listed in subsection (c) of
this Section for the hospital year equals or exceeds the
relevant hospital entity's estimated property tax liability,
without regard to any property tax exemption granted under
Section 15-86 of the Property Tax Code, for the calendar year
in which exemption or renewal of exemption is sought. For
purposes of making the calculations required by this
subsection (b), if the relevant hospital entity is a hospital
owner that owns more than one hospital, the value of the
services or activities listed in subsection (c) shall be
calculated on the basis of only those services and activities
relating to the hospital that includes the subject property,
and the relevant hospital entity's estimated property tax
liability shall be calculated only with respect to the
properties comprising that hospital. In the case of a
multi-state hospital system or hospital affiliate, the value
of the services or activities listed in subsection (c) shall
be calculated on the basis of only those services and
activities that occur in Illinois and the relevant hospital
entity's estimated property tax liability shall be calculated
only with respect to its property located in Illinois.
    (c) The following services and activities shall be
considered for purposes of making the calculations required by
subsection (b):
        (1) Charity care. Free or discounted services provided
    pursuant to the relevant hospital entity's financial
    assistance policy, measured at cost, including discounts
    provided under the Hospital Uninsured Patient Discount
    Act.
        (2) Health services to low-income and underserved
    individuals. Other unreimbursed costs of the relevant
    hospital entity for providing without charge, paying for,
    or subsidizing goods, activities, or services for the
    purpose of addressing the health of low-income or
    underserved individuals. Those activities or services may
    include, but are not limited to: financial or in-kind
    support to affiliated or unaffiliated hospitals, hospital
    affiliates, community clinics, or programs that treat
    low-income or underserved individuals; paying for or
    subsidizing health care professionals who care for
    low-income or underserved individuals; providing or
    subsidizing outreach or educational services to low-income
    or underserved individuals for disease management and
    prevention; free or subsidized goods, supplies, or
    services needed by low-income or underserved individuals
    because of their medical condition; and prenatal or
    childbirth outreach to low-income or underserved persons.
        (3) Subsidy of State or local governments. Direct or
    indirect financial or in-kind subsidies of State or local
    governments by the relevant hospital entity that pay for
    or subsidize activities or programs related to health care
    for low-income or underserved individuals.
        (4) Support for State health care programs for
    low-income individuals. At the election of the hospital
    applicant for each applicable year, either (A) 10% of
    payments to the relevant hospital entity and any hospital
    affiliate designated by the relevant hospital entity
    (provided that such hospital affiliate's operations
    provide financial or operational support for or receive
    financial or operational support from the relevant
    hospital entity) under Medicaid or other means-tested
    programs, including, but not limited to, General
    Assistance, the Covering ALL KIDS Health Insurance Act,
    and the State Children's Health Insurance Program or (B)
    the amount of subsidy provided by the relevant hospital
    entity and any hospital affiliate designated by the
    relevant hospital entity (provided that such hospital
    affiliate's operations provide financial or operational
    support for or receive financial or operational support
    from the relevant hospital entity) to State or local
    government in treating Medicaid recipients and recipients
    of means-tested programs, including but not limited to
    General Assistance, the Covering ALL KIDS Health Insurance
    Act, and the State Children's Health Insurance Program.
    The amount of subsidy for purposes of this item (4) is
    calculated in the same manner as unreimbursed costs are
    calculated for Medicaid and other means-tested government
    programs in the Schedule H of IRS Form 990 in effect on the
    effective date of this amendatory Act of the 97th General
    Assembly.
        (5) Dual-eligible subsidy. The amount of subsidy
    provided to government by treating dual-eligible
    Medicare/Medicaid patients. The amount of subsidy for
    purposes of this item (5) is calculated by multiplying the
    relevant hospital entity's unreimbursed costs for
    Medicare, calculated in the same manner as determined in
    the Schedule H of IRS Form 990 in effect on the effective
    date of this amendatory Act of the 97th General Assembly,
    by the relevant hospital entity's ratio of dual-eligible
    patients to total Medicare patients.
        (6) Relief of the burden of government related to
    health care. Except to the extent otherwise taken into
    account in this subsection, the portion of unreimbursed
    costs of the relevant hospital entity attributable to
    providing, paying for, or subsidizing goods, activities,
    or services that relieve the burden of government related
    to health care for low-income individuals. Such activities
    or services shall include, but are not limited to,
    providing emergency, trauma, burn, neonatal, psychiatric,
    rehabilitation, or other special services; providing
    medical education; and conducting medical research or
    training of health care professionals. The portion of
    those unreimbursed costs attributable to benefiting
    low-income individuals shall be determined using the ratio
    calculated by adding the relevant hospital entity's costs
    attributable to charity care, Medicaid, other means-tested
    government programs, Medicare patients with disabilities
    under age 65, and dual-eligible Medicare/Medicaid patients
    and dividing that total by the relevant hospital entity's
    total costs. Such costs for the numerator and denominator
    shall be determined by multiplying gross charges by the
    cost to charge ratio taken from the hospital's most
    recently filed Medicare cost report (CMS 2252-10
    Worksheet, Part I). In the case of emergency services, the
    ratio shall be calculated using costs (gross charges
    multiplied by the cost to charge ratio taken from the
    hospital's most recently filed Medicare cost report (CMS
    2252-10 Worksheet, Part I)) of patients treated in the
    relevant hospital entity's emergency department.
        (7) Any other activity by the relevant hospital entity
    that the Department determines relieves the burden of
    government or addresses the health of low-income or
    underserved individuals.
    (d) The hospital applicant shall include information in
its exemption application establishing that it satisfies the
requirements of subsection (b). For purposes of making the
calculations required by subsection (b), the hospital
applicant may for each year elect to use either (1) the value
of the services or activities listed in subsection (e) for the
hospital year or (2) the average value of those services or
activities for the 3 fiscal years ending with the hospital
year. If the relevant hospital entity has been in operation
for less than 3 completed fiscal years, then the latter
calculation, if elected, shall be performed on a pro rata
basis.
    (e) For purposes of making the calculations required by
this Section:
        (1) particular services or activities eligible for
    consideration under any of the paragraphs (1) through (7)
    of subsection (c) may not be counted under more than one of
    those paragraphs; and
        (2) the amount of unreimbursed costs and the amount of
    subsidy shall not be reduced by restricted or unrestricted
    payments received by the relevant hospital entity as
    contributions deductible under Section 170(a) of the
    Internal Revenue Code.
    (f) (Blank).
    (g) Estimation of Exempt Property Tax Liability. The
estimated property tax liability used for the determination in
subsection (b) shall be calculated as follows:
        (1) "Estimated property tax liability" means the
    estimated dollar amount of property tax that would be
    owed, with respect to the exempt portion of each of the
    relevant hospital entity's properties that are already
    fully or partially exempt, or for which an exemption in
    whole or in part is currently being sought, and then
    aggregated as applicable, as if the exempt portion of
    those properties were subject to tax, calculated with
    respect to each such property by multiplying:
            (A) the lesser of (i) the actual assessed value,
        if any, of the portion of the property for which an
        exemption is sought or (ii) an estimated assessed
        value of the exempt portion of such property as
        determined in item (2) of this subsection (g), by
            (B) the applicable State equalization rate
        (yielding the equalized assessed value), by
            (C) the applicable tax rate.
        (2) The estimated assessed value of the exempt portion
    of the property equals the sum of (i) the estimated fair
    market value of buildings on the property, as determined
    in accordance with subparagraphs (A) and (B) of this item
    (2), multiplied by the applicable assessment factor, and
    (ii) the estimated assessed value of the land portion of
    the property, as determined in accordance with
    subparagraph (C).
            (A) The "estimated fair market value of buildings
        on the property" means the replacement value of any
        exempt portion of buildings on the property, minus
        depreciation, determined utilizing the cost
        replacement method whereby the exempt square footage
        of all such buildings is multiplied by the replacement
        cost per square foot for Class A Average building
        found in the most recent edition of the Marshall &
        Swift Valuation Services Manual, adjusted by any
        appropriate current cost and local multipliers.
            (B) Depreciation, for purposes of calculating the
        estimated fair market value of buildings on the
        property, is applied by utilizing a weighted mean life
        for the buildings based on original construction and
        assuming a 40-year life for hospital buildings and the
        applicable life for other types of buildings as
        specified in the American Hospital Association
        publication "Estimated Useful Lives of Depreciable
        Hospital Assets". In the case of hospital buildings,
        the remaining life is divided by 40 and this ratio is
        multiplied by the replacement cost of the buildings to
        obtain an estimated fair market value of buildings. If
        a hospital building is older than 35 years, a
        remaining life of 5 years for residual value is
        assumed; and if a building is less than 8 years old, a
        remaining life of 32 years is assumed.
            (C) The estimated assessed value of the land
        portion of the property shall be determined by
        multiplying (i) the per square foot average of the
        assessed values of three parcels of land (not
        including farm land, and excluding the assessed value
        of the improvements thereon) reasonably comparable to
        the property, by (ii) the number of square feet
        comprising the exempt portion of the property's land
        square footage.
        (3) The assessment factor, State equalization rate,
    and tax rate (including any special factors such as
    Enterprise Zones) used in calculating the estimated
    property tax liability shall be for the most recent year
    that is publicly available from the applicable chief
    county assessment officer or officers at least 90 days
    before the end of the hospital year.
        (4) The method utilized to calculate estimated
    property tax liability for purposes of this Section 15-86
    shall not be utilized for the actual valuation,
    assessment, or taxation of property pursuant to the
    Property Tax Code.
    (h) For the purpose of this Section, the following terms
shall have the meanings set forth below:
        (1) "Hospital" means any institution, place, building,
    buildings on a campus, or other health care facility
    located in Illinois that is licensed under the Hospital
    Licensing Act and has a hospital owner.
        (2) "Hospital owner" means a not-for-profit
    corporation that is the titleholder of a hospital, or the
    owner of the beneficial interest in an Illinois land trust
    that is the titleholder of a hospital.
        (3) "Hospital affiliate" means any corporation,
    partnership, limited partnership, joint venture, limited
    liability company, association or other organization,
    other than a hospital owner, that directly or indirectly
    controls, is controlled by, or is under common control
    with one or more hospital owners and that supports, is
    supported by, or acts in furtherance of the exempt health
    care purposes of at least one of those hospital owners'
    hospitals.
        (4) "Hospital system" means a hospital and one or more
    other hospitals or hospital affiliates related by common
    control or ownership.
        (5) "Control" relating to hospital owners, hospital
    affiliates, or hospital systems means possession, direct
    or indirect, of the power to direct or cause the direction
    of the management and policies of the entity, whether
    through ownership of assets, membership interest, other
    voting or governance rights, by contract or otherwise.
        (6) "Hospital applicant" means a hospital owner or
    hospital affiliate that files an application for an
    exemption or renewal of exemption under this Section.
        (7) "Relevant hospital entity" means (A) the hospital
    owner, in the case of a hospital applicant that is a
    hospital owner, and (B) at the election of a hospital
    applicant that is a hospital affiliate, either (i) the
    hospital affiliate or (ii) the hospital system to which
    the hospital applicant belongs, including any hospitals or
    hospital affiliates that are related by common control or
    ownership.
        (8) "Subject property" means property used for the
    calculation under subsection (b) of this Section.
        (9) "Hospital year" means the fiscal year of the
    relevant hospital entity, or the fiscal year of one of the
    hospital owners in the hospital system if the relevant
    hospital entity is a hospital system with members with
    different fiscal years, that ends in the year for which
    the exemption is sought.
    (i) It is the intent of the General Assembly that any
exemptions taken, granted, or renewed under this Section prior
to the effective date of this amendatory Act of the 100th
General Assembly are hereby validated.
    (j) It is the intent of the General Assembly that the
exemption under this Section applies on a continuous basis. If
this amendatory Act of the 102nd General Assembly takes effect
after July 1, 2022, any exemptions taken, granted, or renewed
under this Section on or after July 1, 2022 and prior to the
effective date of this amendatory Act of the 102nd General
Assembly are hereby validated.
(Source: P.A. 99-143, eff. 7-27-15; 100-1181, eff. 3-8-19.)
 
    Section 30-25. The Retailers' Occupation Tax Act is
amended by changing Section 2-9 as follows:
 
    (35 ILCS 120/2-9)
    Sec. 2-9. Hospital exemption.
    (a) Until July 1, 2027 2022, tangible personal property
sold to or used by a hospital owner that owns one or more
hospitals licensed under the Hospital Licensing Act or
operated under the University of Illinois Hospital Act, or a
hospital affiliate that is not already exempt under another
provision of this Act and meets the criteria for an exemption
under this Section, is exempt from taxation under this Act.
    (b) A hospital owner or hospital affiliate satisfies the
conditions for an exemption under this Section if the value of
qualified services or activities listed in subsection (c) of
this Section for the hospital year equals or exceeds the
relevant hospital entity's estimated property tax liability,
without regard to any property tax exemption granted under
Section 15-86 of the Property Tax Code, for the calendar year
in which exemption or renewal of exemption is sought. For
purposes of making the calculations required by this
subsection (b), if the relevant hospital entity is a hospital
owner that owns more than one hospital, the value of the
services or activities listed in subsection (c) shall be
calculated on the basis of only those services and activities
relating to the hospital that includes the subject property,
and the relevant hospital entity's estimated property tax
liability shall be calculated only with respect to the
properties comprising that hospital. In the case of a
multi-state hospital system or hospital affiliate, the value
of the services or activities listed in subsection (c) shall
be calculated on the basis of only those services and
activities that occur in Illinois and the relevant hospital
entity's estimated property tax liability shall be calculated
only with respect to its property located in Illinois.
    (c) The following services and activities shall be
considered for purposes of making the calculations required by
subsection (b):
        (1) Charity care. Free or discounted services provided
    pursuant to the relevant hospital entity's financial
    assistance policy, measured at cost, including discounts
    provided under the Hospital Uninsured Patient Discount
    Act.
        (2) Health services to low-income and underserved
    individuals. Other unreimbursed costs of the relevant
    hospital entity for providing without charge, paying for,
    or subsidizing goods, activities, or services for the
    purpose of addressing the health of low-income or
    underserved individuals. Those activities or services may
    include, but are not limited to: financial or in-kind
    support to affiliated or unaffiliated hospitals, hospital
    affiliates, community clinics, or programs that treat
    low-income or underserved individuals; paying for or
    subsidizing health care professionals who care for
    low-income or underserved individuals; providing or
    subsidizing outreach or educational services to low-income
    or underserved individuals for disease management and
    prevention; free or subsidized goods, supplies, or
    services needed by low-income or underserved individuals
    because of their medical condition; and prenatal or
    childbirth outreach to low-income or underserved persons.
        (3) Subsidy of State or local governments. Direct or
    indirect financial or in-kind subsidies of State or local
    governments by the relevant hospital entity that pay for
    or subsidize activities or programs related to health care
    for low-income or underserved individuals.
        (4) Support for State health care programs for
    low-income individuals. At the election of the hospital
    applicant for each applicable year, either (A) 10% of
    payments to the relevant hospital entity and any hospital
    affiliate designated by the relevant hospital entity
    (provided that such hospital affiliate's operations
    provide financial or operational support for or receive
    financial or operational support from the relevant
    hospital entity) under Medicaid or other means-tested
    programs, including, but not limited to, General
    Assistance, the Covering ALL KIDS Health Insurance Act,
    and the State Children's Health Insurance Program or (B)
    the amount of subsidy provided by the relevant hospital
    entity and any hospital affiliate designated by the
    relevant hospital entity (provided that such hospital
    affiliate's operations provide financial or operational
    support for or receive financial or operational support
    from the relevant hospital entity) to State or local
    government in treating Medicaid recipients and recipients
    of means-tested programs, including but not limited to
    General Assistance, the Covering ALL KIDS Health Insurance
    Act, and the State Children's Health Insurance Program.
    The amount of subsidy for purposes of this item (4) is
    calculated in the same manner as unreimbursed costs are
    calculated for Medicaid and other means-tested government
    programs in the Schedule H of IRS Form 990 in effect on the
    effective date of this amendatory Act of the 97th General
    Assembly.
        (5) Dual-eligible subsidy. The amount of subsidy
    provided to government by treating dual-eligible
    Medicare/Medicaid patients. The amount of subsidy for
    purposes of this item (5) is calculated by multiplying the
    relevant hospital entity's unreimbursed costs for
    Medicare, calculated in the same manner as determined in
    the Schedule H of IRS Form 990 in effect on the effective
    date of this amendatory Act of the 97th General Assembly,
    by the relevant hospital entity's ratio of dual-eligible
    patients to total Medicare patients.
        (6) Relief of the burden of government related to
    health care. Except to the extent otherwise taken into
    account in this subsection, the portion of unreimbursed
    costs of the relevant hospital entity attributable to
    providing, paying for, or subsidizing goods, activities,
    or services that relieve the burden of government related
    to health care for low-income individuals. Such activities
    or services shall include, but are not limited to,
    providing emergency, trauma, burn, neonatal, psychiatric,
    rehabilitation, or other special services; providing
    medical education; and conducting medical research or
    training of health care professionals. The portion of
    those unreimbursed costs attributable to benefiting
    low-income individuals shall be determined using the ratio
    calculated by adding the relevant hospital entity's costs
    attributable to charity care, Medicaid, other means-tested
    government programs, Medicare patients with disabilities
    under age 65, and dual-eligible Medicare/Medicaid patients
    and dividing that total by the relevant hospital entity's
    total costs. Such costs for the numerator and denominator
    shall be determined by multiplying gross charges by the
    cost to charge ratio taken from the hospital's most
    recently filed Medicare cost report (CMS 2252-10
    Worksheet, Part I). In the case of emergency services, the
    ratio shall be calculated using costs (gross charges
    multiplied by the cost to charge ratio taken from the
    hospital's most recently filed Medicare cost report (CMS
    2252-10 Worksheet, Part I)) of patients treated in the
    relevant hospital entity's emergency department.
        (7) Any other activity by the relevant hospital entity
    that the Department determines relieves the burden of
    government or addresses the health of low-income or
    underserved individuals.
    (d) The hospital applicant shall include information in
its exemption application establishing that it satisfies the
requirements of subsection (b). For purposes of making the
calculations required by subsection (b), the hospital
applicant may for each year elect to use either (1) the value
of the services or activities listed in subsection (e) for the
hospital year or (2) the average value of those services or
activities for the 3 fiscal years ending with the hospital
year. If the relevant hospital entity has been in operation
for less than 3 completed fiscal years, then the latter
calculation, if elected, shall be performed on a pro rata
basis.
    (e) For purposes of making the calculations required by
this Section:
        (1) particular services or activities eligible for
    consideration under any of the paragraphs (1) through (7)
    of subsection (c) may not be counted under more than one of
    those paragraphs; and
        (2) the amount of unreimbursed costs and the amount of
    subsidy shall not be reduced by restricted or unrestricted
    payments received by the relevant hospital entity as
    contributions deductible under Section 170(a) of the
    Internal Revenue Code.
    (f) (Blank).
    (g) Estimation of Exempt Property Tax Liability. The
estimated property tax liability used for the determination in
subsection (b) shall be calculated as follows:
        (1) "Estimated property tax liability" means the
    estimated dollar amount of property tax that would be
    owed, with respect to the exempt portion of each of the
    relevant hospital entity's properties that are already
    fully or partially exempt, or for which an exemption in
    whole or in part is currently being sought, and then
    aggregated as applicable, as if the exempt portion of
    those properties were subject to tax, calculated with
    respect to each such property by multiplying:
            (A) the lesser of (i) the actual assessed value,
        if any, of the portion of the property for which an
        exemption is sought or (ii) an estimated assessed
        value of the exempt portion of such property as
        determined in item (2) of this subsection (g), by
            (B) the applicable State equalization rate
        (yielding the equalized assessed value), by
            (C) the applicable tax rate.
        (2) The estimated assessed value of the exempt portion
    of the property equals the sum of (i) the estimated fair
    market value of buildings on the property, as determined
    in accordance with subparagraphs (A) and (B) of this item
    (2), multiplied by the applicable assessment factor, and
    (ii) the estimated assessed value of the land portion of
    the property, as determined in accordance with
    subparagraph (C).
            (A) The "estimated fair market value of buildings
        on the property" means the replacement value of any
        exempt portion of buildings on the property, minus
        depreciation, determined utilizing the cost
        replacement method whereby the exempt square footage
        of all such buildings is multiplied by the replacement
        cost per square foot for Class A Average building
        found in the most recent edition of the Marshall &
        Swift Valuation Services Manual, adjusted by any
        appropriate current cost and local multipliers.
            (B) Depreciation, for purposes of calculating the
        estimated fair market value of buildings on the
        property, is applied by utilizing a weighted mean life
        for the buildings based on original construction and
        assuming a 40-year life for hospital buildings and the
        applicable life for other types of buildings as
        specified in the American Hospital Association
        publication "Estimated Useful Lives of Depreciable
        Hospital Assets". In the case of hospital buildings,
        the remaining life is divided by 40 and this ratio is
        multiplied by the replacement cost of the buildings to
        obtain an estimated fair market value of buildings. If
        a hospital building is older than 35 years, a
        remaining life of 5 years for residual value is
        assumed; and if a building is less than 8 years old, a
        remaining life of 32 years is assumed.
            (C) The estimated assessed value of the land
        portion of the property shall be determined by
        multiplying (i) the per square foot average of the
        assessed values of three parcels of land (not
        including farm land, and excluding the assessed value
        of the improvements thereon) reasonably comparable to
        the property, by (ii) the number of square feet
        comprising the exempt portion of the property's land
        square footage.
        (3) The assessment factor, State equalization rate,
    and tax rate (including any special factors such as
    Enterprise Zones) used in calculating the estimated
    property tax liability shall be for the most recent year
    that is publicly available from the applicable chief
    county assessment officer or officers at least 90 days
    before the end of the hospital year.
        (4) The method utilized to calculate estimated
    property tax liability for purposes of this Section 15-86
    shall not be utilized for the actual valuation,
    assessment, or taxation of property pursuant to the
    Property Tax Code.
    (h) For the purpose of this Section, the following terms
shall have the meanings set forth below:
        (1) "Hospital" means any institution, place, building,
    buildings on a campus, or other health care facility
    located in Illinois that is licensed under the Hospital
    Licensing Act and has a hospital owner.
        (2) "Hospital owner" means a not-for-profit
    corporation that is the titleholder of a hospital, or the
    owner of the beneficial interest in an Illinois land trust
    that is the titleholder of a hospital.
        (3) "Hospital affiliate" means any corporation,
    partnership, limited partnership, joint venture, limited
    liability company, association or other organization,
    other than a hospital owner, that directly or indirectly
    controls, is controlled by, or is under common control
    with one or more hospital owners and that supports, is
    supported by, or acts in furtherance of the exempt health
    care purposes of at least one of those hospital owners'
    hospitals.
        (4) "Hospital system" means a hospital and one or more
    other hospitals or hospital affiliates related by common
    control or ownership.
        (5) "Control" relating to hospital owners, hospital
    affiliates, or hospital systems means possession, direct
    or indirect, of the power to direct or cause the direction
    of the management and policies of the entity, whether
    through ownership of assets, membership interest, other
    voting or governance rights, by contract or otherwise.
        (6) "Hospital applicant" means a hospital owner or
    hospital affiliate that files an application for an
    exemption or renewal of exemption under this Section.
        (7) "Relevant hospital entity" means (A) the hospital
    owner, in the case of a hospital applicant that is a
    hospital owner, and (B) at the election of a hospital
    applicant that is a hospital affiliate, either (i) the
    hospital affiliate or (ii) the hospital system to which
    the hospital applicant belongs, including any hospitals or
    hospital affiliates that are related by common control or
    ownership.
        (8) "Subject property" means property used for the
    calculation under subsection (b) of this Section.
        (9) "Hospital year" means the fiscal year of the
    relevant hospital entity, or the fiscal year of one of the
    hospital owners in the hospital system if the relevant
    hospital entity is a hospital system with members with
    different fiscal years, that ends in the year for which
    the exemption is sought.
    (i) It is the intent of the General Assembly that any
exemptions taken, granted, or renewed under this Section prior
to the effective date of this amendatory Act of the 100th
General Assembly are hereby validated.
    (j) It is the intent of the General Assembly that the
exemption under this Section applies on a continuous basis. If
this amendatory Act of the 102nd General Assembly takes effect
after July 1, 2022, any exemptions taken, granted, or renewed
under this Section on or after July 1, 2022 and prior to the
effective date of this amendatory Act of the 102nd General
Assembly are hereby validated.
(Source: P.A. 99-143, eff. 7-27-15; 100-1181, eff. 3-8-19.)
 
ARTICLE 999.

 
    Section 999-99. Effective date. This Act takes effect upon
becoming law.