Public Act 093-0659
Public Act 93-0659 of the 93rd General Assembly
Public Act 93-0659
HB0701 Enrolled LRB093 05499 MKM 05590 b
AN ACT in relation to public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Finance Act is amended by adding
Sections 5.620, 5.621, and 6z-56 and changing Section 8h as
follows:
(30 ILCS 105/5.620 new)
Sec. 5.620. The Health Care Services Trust Fund.
(30 ILCS 105/5.621 new)
Sec. 5.621. The Health and Human Services Medicaid Trust
Fund.
(30 ILCS 105/6z-56 new)
Sec. 6z-56. The Health Care Services Trust Fund. The
Health Care Services Trust Fund is hereby created as a
special fund in the State treasury.
The Fund shall consist of moneys deposited, transferred,
or appropriated into the Fund from units of local government
other than a county with a population greater than 3,000,000,
from the State, from federal matching funds, or from any
other legal source.
Subject to appropriation, the moneys in the Fund shall be
used by the Department of Public Aid to make payments to
providers of services covered under the Medicaid or State
Children's Health Insurance programs. Payments may be made
out of the Fund only to providers located within the
geographic jurisdiction of units of local government that
make deposits, transfers, or appropriations into the Fund.
The Department of Public Aid shall adopt rules concerning
application for and disbursement of the moneys in the Fund.
(30 ILCS 105/8h)
Sec. 8h. Transfers to General Revenue Fund.
Notwithstanding any other State law to the contrary, the
Director of the Governor's Office of Management and Budget
Bureau of the Budget may from time to time direct the State
Treasurer and Comptroller to transfer a specified sum from
any fund held by the State Treasurer to the General Revenue
Fund in order to help defray the State's operating costs for
the fiscal year. The total transfer under this Section from
any fund in any fiscal year shall not exceed the lesser of 8%
of the revenues to be deposited into the fund during that
year or 25% of the beginning balance in the fund. No
transfer may be made from a fund under this Section that
would have the effect of reducing the available balance in
the fund to an amount less than the amount remaining
unexpended and unreserved from the total appropriation from
that fund for that fiscal year. This Section does not apply
to any funds that are restricted by federal law to a specific
use or to any funds in the Motor Fuel Tax Fund or the
Hospital Provider Fund. Notwithstanding any other provision
of this Section, the total transfer under this Section from
the Road Fund or the State Construction Account Fund shall
not exceed 5% of the revenues to be deposited into the fund
during that year.
In determining the available balance in a fund, the
Director of the Governor's Office of Management and Budget
Bureau of the Budget may include receipts, transfers into the
fund, and other resources anticipated to be available in the
fund in that fiscal year.
The State Treasurer and Comptroller shall transfer the
amounts designated under this Section as soon as may be
practicable after receiving the direction to transfer from
the Director of the Governor's Office of Management and
Budget Bureau of the Budget.
(Source: P.A. 93-32, eff. 6-20-03; revised 8-21-03.)
Section 10. The Illinois Public Aid Code is amended by
changing Sections 5-5.4, 5A-1, 5A-2, 5A-3, 5A-4, 5A-5, 5A-7,
5A-8, 5A-10, and 14-1 and by adding Sections 5A-12, 5A-13,
and 5A-14 as follows:
(305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
Sec. 5-5.4. Standards of Payment - Department of Public
Aid. The Department of Public Aid shall develop standards of
payment of skilled nursing and intermediate care services in
facilities providing such services under this Article which:
(1) Provide for the determination of a facility's
payment for skilled nursing and intermediate care services on
a prospective basis. The amount of the payment rate for all
nursing facilities certified by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities, Long Term Care
for Under Age 22 facilities, Skilled Nursing facilities, or
Intermediate Care facilities under the medical assistance
program shall be prospectively established annually on the
basis of historical, financial, and statistical data
reflecting actual costs from prior years, which shall be
applied to the current rate year and updated for inflation,
except that the capital cost element for newly constructed
facilities shall be based upon projected budgets. The
annually established payment rate shall take effect on July 1
in 1984 and subsequent years. No rate increase and no update
for inflation shall be provided on or after July 1, 1994 and
before July 1, 2004, unless specifically provided for in this
Section.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on July
1, 1998 shall include an increase of 3%. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Skilled Nursing facilities or Intermediate
Care facilities, the rates taking effect on July 1, 1998
shall include an increase of 3% plus $1.10 per resident-day,
as defined by the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on July
1, 1999 shall include an increase of 1.6% plus $3.00 per
resident-day, as defined by the Department. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Skilled Nursing facilities or Intermediate
Care facilities, the rates taking effect on July 1, 1999
shall include an increase of 1.6% and, for services provided
on or after October 1, 1999, shall be increased by $4.00 per
resident-day, as defined by the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on July
1, 2000 shall include an increase of 2.5% per resident-day,
as defined by the Department. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act
as Skilled Nursing facilities or Intermediate Care
facilities, the rates taking effect on July 1, 2000 shall
include an increase of 2.5% per resident-day, as defined by
the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as skilled nursing
facilities or intermediate care facilities, a new payment
methodology must be implemented for the nursing component of
the rate effective July 1, 2003. The Department of Public Aid
shall develop the new payment methodology using the Minimum
Data Set (MDS) as the instrument to collect information
concerning nursing home resident condition necessary to
compute the rate. The Department of Public Aid shall develop
the new payment methodology to meet the unique needs of
Illinois nursing home residents while remaining subject to
the appropriations provided by the General Assembly. A
transition period from the payment methodology in effect on
June 30, 2003 to the payment methodology in effect on July 1,
2003 shall be provided for a period not exceeding 2 years
after implementation of the new payment methodology as
follows:
(A) For a facility that would receive a lower
nursing component rate per patient day under the new
system than the facility received effective on the date
immediately preceding the date that the Department
implements the new payment methodology, the nursing
component rate per patient day for the facility shall be
held at the level in effect on the date immediately
preceding the date that the Department implements the new
payment methodology until a higher nursing component rate
of reimbursement is achieved by that facility.
(B) For a facility that would receive a higher
nursing component rate per patient day under the payment
methodology in effect on July 1, 2003 than the facility
received effective on the date immediately preceding the
date that the Department implements the new payment
methodology, the nursing component rate per patient day
for the facility shall be adjusted.
(C) Notwithstanding paragraphs (A) and (B), the
nursing component rate per patient day for the facility
shall be adjusted subject to appropriations provided by
the General Assembly.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on March
1, 2001 shall include a statewide increase of 7.85%, as
defined by the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on April
1, 2002 shall include a statewide increase of 2.0%, as
defined by the Department. This increase terminates on July
1, 2002; beginning July 1, 2002 these rates are reduced to
the level of the rates in effect on March 31, 2002, as
defined by the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as skilled nursing
facilities or intermediate care facilities, the rates taking
effect on July 1, 2001 shall be computed using the most
recent cost reports on file with the Department of Public Aid
no later than April 1, 2000, updated for inflation to January
1, 2001. For rates effective July 1, 2001 only, rates shall
be the greater of the rate computed for July 1, 2001 or the
rate effective on June 30, 2001.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois Department shall
determine by rule the rates taking effect on July 1, 2002,
which shall be 5.9% less than the rates in effect on June 30,
2002.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois Department shall
determine by rule the rates taking effect on July 1, 2003,
which shall be 3.0% less than the rates in effect on June 30,
2002. This rate shall take effect only upon approval and
implementation of the payment methodologies required under
Section 5A-12.
Rates established effective each July 1 shall govern
payment for services rendered throughout that fiscal year,
except that rates established on July 1, 1996 shall be
increased by 6.8% for services provided on or after January
1, 1997. Such rates will be based upon the rates calculated
for the year beginning July 1, 1990, and for subsequent years
thereafter until June 30, 2001 shall be based on the facility
cost reports for the facility fiscal year ending at any point
in time during the previous calendar year, updated to the
midpoint of the rate year. The cost report shall be on file
with the Department no later than April 1 of the current rate
year. Should the cost report not be on file by April 1, the
Department shall base the rate on the latest cost report
filed by each skilled care facility and intermediate care
facility, updated to the midpoint of the current rate year.
In determining rates for services rendered on and after July
1, 1985, fixed time shall not be computed at less than zero.
The Department shall not make any alterations of regulations
which would reduce any component of the Medicaid rate to a
level below what that component would have been utilizing in
the rate effective on July 1, 1984.
(2) Shall take into account the actual costs incurred by
facilities in providing services for recipients of skilled
nursing and intermediate care services under the medical
assistance program.
(3) Shall take into account the medical and
psycho-social characteristics and needs of the patients.
(4) Shall take into account the actual costs incurred by
facilities in meeting licensing and certification standards
imposed and prescribed by the State of Illinois, any of its
political subdivisions or municipalities and by the U.S.
Department of Health and Human Services pursuant to Title XIX
of the Social Security Act.
The Department of Public Aid shall develop precise
standards for payments to reimburse nursing facilities for
any utilization of appropriate rehabilitative personnel for
the provision of rehabilitative services which is authorized
by federal regulations, including reimbursement for services
provided by qualified therapists or qualified assistants, and
which is in accordance with accepted professional practices.
Reimbursement also may be made for utilization of other
supportive personnel under appropriate supervision.
(Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01;
92-597, eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff.
1-1-03; 93-20, eff. 6-20-03.)
(305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1)
Sec. 5A-1. Definitions. As used in this Article, unless
the context requires otherwise:
"Fund" means the Hospital Provider Fund.
"Hospital" means an institution, place, building, or
agency located in this State that is subject to licensure by
the Illinois Department of Public Health under the Hospital
Licensing Act, whether public or private and whether
organized for profit or not-for-profit.
"Hospital provider" means a person licensed by the
Department of Public Health to conduct, operate, or maintain
a hospital, regardless of whether the person is a Medicaid
provider. For purposes of this paragraph, "person" means any
political subdivision of the State, municipal corporation,
individual, firm, partnership, corporation, company, limited
liability company, association, joint stock association, or
trust, or a receiver, executor, trustee, guardian, or other
representative appointed by order of any court.
"Occupied bed days" means the sum of the number of days
that each bed was occupied by a patient for all beds during
calendar year 2001. Occupied bed days shall be computed
separately for each hospital operated or maintained by a
hospital provider.
"Adjusted gross hospital revenue" shall be determined
separately for each hospital conducted, operated, or
maintained by a hospital provider, and means the hospital
provider's total gross patient revenues less Medicare
contractual allowances, but does not include gross patient
revenue (and the portion of any Medicare contractual
allowance related thereto) from skilled or intermediate
long-term care services within the meaning of Title XVIII or
XIX of the Social Security Act.
"Intergovernmental transfer payment" means the payments
established under Section 15-3 of this Code, and includes
without limitation payments payable under that Section for
July, August, and September of 1992.
(Source: P.A. 87-861; 88-88.)
(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
Sec. 5A-2. Assessment; no local authorization to tax.
(a) Subject to Sections 5A-3 and 5A-10, an annual
assessment on inpatient services is imposed on each hospital
provider for State fiscal years 2004 and 2005 in an amount
equal to the hospital's occupied bed days multiplied by
$84.19.
The Department of Public Aid shall use the number of
occupied bed days as reported by each hospital on the Annual
Survey of Hospitals conducted by the Department of Public
Health to calculate the hospital's annual assessment. If the
sum of a hospital's occupied bed days is not reported on the
Annual Survey of Hospitals, then the Department of Public Aid
may obtain the sum of occupied 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 Department of Public
Aid or its duly authorized agents and employees. For the
privilege of engaging in the occupation of hospital provider,
an assessment is imposed upon each hospital provider for the
State fiscal year beginning on July 1, 1993 and ending on
June 30, 1994, in an amount equal to 1.88% of the provider's
adjusted gross hospital revenue for the most recent calendar
year ending before the beginning of that State fiscal year.
Effective July 1, 1994 through June 30, 1996, an annual
assessment is imposed upon each hospital provider in an
amount equal to the provider's adjusted gross hospital
revenue for the most recent calendar year ending before the
beginning of that State fiscal year multiplied by the
Provider's Savings Rate.
Effective July 1, 1996 through March 31, 1997, an
assessment is imposed upon each hospital provider in an
amount equal to three-fourths of the provider's adjusted
gross hospital revenue for calendar year 1995 multiplied by
the Provider's Savings Rate. No assessment shall be imposed
on or after April 1, 1997.
Before July 1, 1995, the Provider's Savings Rate is 1.88%
multiplied by a fraction, the numerator of which is the
Maximum Section 5A-2 Contribution minus the Cigarette Tax
Contribution, and the denominator of which is the Maximum
Section 5A-2 Contribution. Effective July 1, 1995, the
Provider's Savings Rate is 1.25% multiplied by a fraction,
the numerator of which is the Maximum Section 5A-2
Contribution minus the Cigarette Tax Contribution, and the
denominator of which is the Maximum Section 5A-2
Contribution.
The Cigarette Tax Contribution is the sum of the total
amount deposited in the Hospital Provider Fund in the
previous State fiscal year pursuant to Section 2(a) of the
Cigarette Tax Act, plus the total amount deposited in the
Hospital Provider Fund in the previous State fiscal year
pursuant to Section 5A-3(c) of this Code.
The Maximum Section 5A-2 Contribution is the total amount
of tax imposed by this Section in the previous State fiscal
year on providers subject to this Act, multiplied by a
fraction the numerator of which is adjusted gross hospital
revenues reported to the Department by providers subject to
this Act for the previous State fiscal year and the
denominator of which is adjusted gross hospital revenues
reported to the Department by providers subject to this Act
for the State fiscal year immediately preceding the previous
State fiscal year.
The Department shall notify hospital providers of the
Provider's Savings Rate by mailing a notice to each
provider's last known address as reflected by the records of
the Illinois Department.
(b) Nothing in this amendatory Act of the 93rd General
Assembly 1995 shall be construed to authorize any home rule
unit or other unit of local government to license for revenue
or to impose a tax or assessment upon hospital providers or
the occupation of hospital provider, or a tax or assessment
measured by the income or earnings of a hospital provider.
(c) As provided in Section 5A-14, this Section is
repealed on July 1, 2005.
(Source: P.A. 88-88; 89-21, eff. 7-1-95; 89-499, eff.
6-28-96.)
(305 ILCS 5/5A-3) (from Ch. 23, par. 5A-3)
Sec. 5A-3. Exemptions; intergovernmental transfers.
(a) Blank). A hospital provider which is a county with a
population of more than 3,000,000 that makes
intergovernmental transfer payments as provided in Section
15-3 of this Code shall be exempt from the assessment imposed
by Section 5A-2, unless the exemption is adjudged to be
unconstitutional or otherwise invalid, in which case the
county shall pay the assessment imposed by Section 5A-2 for
all assessment periods beginning on or after July 1, 1992,
and the assessment so paid shall be creditable against the
intergovernmental transfer payments.
(b) A hospital provider that is a State agency, a State
university, or a county with a population of 3,000,000 or
more is exempt from the assessment imposed by Section 5A-2. A
hospital organized under the University of Illinois Hospital
Act and exempt from the assessment imposed by Section 5A-2 is
hereby authorized to enter into an interagency agreement with
the Illinois Department to make intergovernmental transfer
payments to the Illinois Department. These payments shall be
deposited into the University of Illinois Hospital Services
Fund or, if that Fund ceases to exist, into the General
Revenue Fund.
(b-2) A hospital provider that is a county with a
population of less than 3,000,000 or a township,
municipality, hospital district, or any other local
governmental unit is exempt from the assessment imposed by
Section 5A-2.
(b-5) (Blank). A hospital operated by the Department of
Human Services in the course of performing its mental health
and developmental disabilities functions is exempt from the
assessment imposed by Section 5A-2.
(b-10) A hospital provider whose hospital does not
charge for its services is exempt from the assessment imposed
by Section 5A-2, unless the exemption is adjudged to be
unconstitutional or otherwise invalid, in which case the
hospital provider shall pay the assessment imposed by Section
5A-2.
(b-15) A hospital provider whose hospital is licensed by
the Department of Public Health as a psychiatric hospital is
exempt from the assessment imposed by Section 5A-2, unless
the exemption is adjudged to be unconstitutional or otherwise
invalid, in which case the hospital provider shall pay the
assessment imposed by Section 5A-2.
(b-20) A hospital provider whose hospital is licensed by
the Department of Public Health as a rehabilitation hospital
is exempt from the assessment imposed by Section 5A-2, unless
the exemption is adjudged to be unconstitutional or otherwise
invalid, in which case the hospital provider shall pay the
assessment imposed by Section 5A-2.
(b-25) A hospital provider whose hospital (i) is not a
psychiatric hospital, rehabilitation hospital, or children's
hospital and (ii) has an average length of inpatient stay
greater than 25 days is exempt from the assessment imposed by
Section 5A-2, unless the exemption is adjudged to be
unconstitutional or otherwise invalid, in which case the
hospital provider shall pay the assessment imposed by Section
5A-2.
(c) (Blank). The Illinois Department is hereby
authorized to enter into agreements with publicly owned or
operated hospitals to make intergovernmental transfer
payments to the Illinois Department. These payments shall be
deposited into the Hospital Provider Fund, except that any
payments arising under an agreement with a hospital organized
under the University of Illinois Hospital Act shall be
deposited into the University of Illinois Hospital Services
Fund, if that Fund exists.
(Source: P.A. 88-88; 88-554, eff. 7-26-94; 89-21, eff.
7-1-95; 89-507, eff. 7-1-97.)
(305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4)
Sec. 5A-4. Payment of assessment; penalty.
(a) The annual assessment imposed by Section 5A-2 for
State fiscal year 2004 shall be due and payable on June 18 of
the year. The assessment imposed by Section 5A-2 for a State
fiscal year 2005 shall be due and payable in quarterly
installments, each equalling one-fourth of the assessment for
the year, on July 19, October 19, January 18, and April 19
September 30, December 31, March 31, and May 31 of the year;
except that for the period July 1, 1996 through March 31,
1997, the assessment imposed by Section 5A-2 for that period
shall be due and payable in 3 equal installments on September
30, December 31, and March 31 of that period. No installment
payment of an assessment imposed by Section 5A-2 shall be due
and payable, however, until after: (i) the hospital provider
receives written notice from the Department of Public Aid
that the payment methodologies to hospitals required under
Section 5A-12 have been approved by the Centers for Medicare
and Medicaid Services of the U.S. Department of Health and
Human Services and the waiver under 42 CFR 433.68 for the
assessment imposed by Section 5A-2 has been granted by the
Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services; and (ii) the
hospital has received the payments required under Section
5A-12.
(b) The Illinois Department is authorized to establish
delayed payment schedules for hospital providers that are
unable to make installment payments when due under this
Section due to financial difficulties, as determined by the
Illinois Department.
(c) If a hospital provider fails to pay the full amount
of an installment when due (including any extensions granted
under subsection (b)), there shall, unless waived by the
Illinois Department for reasonable cause, be added to the
assessment imposed by Section 5A-2 a penalty assessment equal
to the lesser of (i) 5% of the amount of the installment 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 month
thereafter or (ii) 100% of the installment amount not paid on
or before the due date. For purposes of this subsection,
payments will be credited first to unpaid installment amounts
(rather than to penalty or interest), beginning with the most
delinquent installments.
(Source: P.A. 88-88; 89-499, eff. 6-28-96.)
(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)
Sec. 5A-5. Notice Reporting; penalty; maintenance of
records.
(a) After December 31 of each year (except as otherwise
provided in this subsection), and on or before March 31 of
the succeeding year, the Department of Public Aid shall send
a notice of assessment to every hospital provider subject to
assessment under this Article shall file a return with the
Illinois Department. The notice of assessment shall notify
the hospital of its return shall report the adjusted gross
hospital revenue from the calendar year just ended and shall
be utilized by the Illinois Department to calculate the
assessment for the State fiscal year commencing on the next
July 1, except that the notice return for the State fiscal
year commencing July 1, 2003 1992 and the report of revenue
for calendar year 1991 shall be sent filed on or before June
1, 2004 September 30, 1992. The notice return 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 adjusted gross hospital
revenue of the hospital provider for the calendar year
just ended, the amount of assessment imposed under
Section 5A-2 for the State fiscal year for which the
notice return is sent filed, and the amount of each
quarterly installment to be paid during the State fiscal
year.
(4) (Blank). The amount of penalty due, if any.
(5) Other reasonable information as determined by
the Illinois Department requires.
(b) If a hospital provider conducts, operates, or
maintains more than one hospital licensed by the Illinois
Department of Public Health, the provider shall may not file
a single return covering all those hospitals, but shall file
a separate return for each hospital and shall compute and 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 months in the year during which
the provider conducts, operates, or maintains the hospital
and the denominator of which is 365 12. Immediately upon
ceasing to conduct, operate, or maintain a hospital, the
person shall pay file a final, amended return with the
Illinois Department not more than 90 days after the cessation
reflecting the adjustment and shall pay with the final return
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 file an initial return for the State fiscal
year in which the commencement occurs within 90 days
thereafter and shall pay the assessment computed under
Section 5A-2 and subsection (e) in equal installments on the
due dates stated in the notice date of the return and on the
regular installment due dates for the State fiscal year
occurring after the due dates date of the initial notice
return.
(e) Notwithstanding any other provision in this Article,
in the case of a hospital provider that did not conduct,
operate, or maintain a hospital throughout the calendar year
2001 preceding a State fiscal year, the assessment for that
State fiscal year shall be computed on the basis of
hypothetical occupied bed days adjusted gross hospital
revenue for the full calendar year as determined by rules
adopted by the Illinois Department (which may be based on
annualization of the provider's actual revenues for a portion
of the calendar year, or revenues of a comparable hospital
for the year, including revenues realized by a prior provider
from the same hospital during the year).
(f) (Blank). In the case of a hospital provider existing
as a corporation or legal entity other than an individual,
the return filed by it shall be signed by its president,
vice-president, secretary, or treasurer or by its properly
authorized agent.
(g) (Blank). If a hospital provider fails to file its
return for a State fiscal year on or before the due date of
the return, there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5A-2 for the State fiscal year a penalty
assessment equal to 25% of the assessment imposed for the
year.
(h) (Blank). Every hospital provider subject to
assessment under this Article shall keep sufficient records
to permit the determination of adjusted gross hospital
revenue on a calendar year basis. All such records shall be
kept in the English language and shall, at all times during
business hours of the day, be subject to inspection by the
Illinois Department or its duly authorized agents and
employees.
(Source: P.A. 87-861.)
(305 ILCS 5/5A-7) (from Ch. 23, par. 5A-7)
Sec. 5A-7. Administration; enforcement provisions.
(a) To the extent practicable, the Illinois Department
shall administer and enforce this Article and collect the
assessments, interest, and penalty assessments imposed under
this Article using procedures employed in its administration
of this Code generally and, as it deems appropriate, in a
manner similar to that in which the Department of Revenue
administers and collects the retailers' occupation tax under
the Retailers' Occupation Tax Act ("ROTA"). Instead of
certificates of registration, the Illinois Department shall
establish and maintain a listing of all hospital providers
appearing in the licensing records of the Department of
Public Health, which shall show each provider's name,
principal place of business, and the name and address of each
hospital operated, conducted, or maintained by the provider
in this State. In addition, the following specified
provisions of the Retailers' Occupation Tax Act are
incorporated by reference into this Section except that the
Illinois Department and its Director (rather than the
Department of Revenue and its Director) and every hospital
provider subject to assessment measured by occupied bed days
adjusted gross hospital revenue and to the return filing
requirements of this Article (rather than persons subject to
retailers' occupation tax measured by gross receipts from the
sale of tangible personal property at retail and to the
return filing requirements of ROTA) shall have the powers,
duties, and rights specified in these ROTA provisions, as
modified in this Section or by the Illinois Department in a
manner consistent with this Article and except as manifestly
inconsistent with the other provisions of this Article:
(1) ROTA, Section 4 (examination of return; notice
of correction; evidence; limitations; protest and
hearing), except that (i) the Illinois Department shall
issue notices of assessment liability (rather than
notices of tax liability as provided in ROTA, Section 4);
(ii) in the case of a fraudulent return or in the case of
an extended period agreed to by the Illinois Department
and the hospital provider before the expiration of the
limitation period, no notice of assessment liability
shall be issued more than 3 years after the later of the
due date of the return required by Section 5A-5 or the
date the return (or an amended return) was filed (rather
within the period stated in ROTA, Section 4); and (iii)
the penalty provisions of ROTA, Section 4 shall not
apply.
(2) ROTA, Sec. 5 (failure to make return; failure
to pay assessment), except that the penalty and interest
provisions of ROTA, Section 5 shall not apply.
(3) ROTA, Section 5a (lien; attachment;
termination; notice; protest; review; release of lien;
status of lien).
(4) ROTA, Section 5b (State lien notices; State
lien index; duties of recorder and registrar of titles).
(5) ROTA, Section 5c (liens; certificate of
release).
(6) ROTA, Section 5d (Department not required to
furnish bond; claim to property attached or levied upon).
(7) ROTA, Section 5e (foreclosure on liens;
enforcement).
(8) ROTA, Section 5f (demand for payment; levy and
sale of property; limitation).
(9) ROTA, Section 5g (sale of property;
redemption).
(10) ROTA, Section 5j (sales on transfers outside
usual course of business; report; payment of assessment;
rights and duties of purchaser; penalty), except that
notice shall be provided to the Illinois Department as
specified by rule.
(11) ROTA, Section 6 (erroneous payments; credit or
refund), provided that (i) the Illinois Department may
only apply an amount otherwise subject to credit or
refund to a liability arising under this Article; (ii)
except in the case of an extended period agreed to by the
Illinois Department and the hospital provider before the
expiration of this limitation period, a claim for credit
or refund must be filed no more than 3 years after the
due date of the return required by Section 5A-5 (rather
than the time limitation stated in ROTA, Section 6); and
(iii) credits or refunds shall not bear interest.
(12) ROTA, Section 6a (claims for credit or
refund).
(13) ROTA, Section 6b (tentative determination of
claim; notice; hearing; review), provided that a hospital
provider or its representative shall have 60 days (rather
than 20 days) within which to file a protest and request
for hearing in response to a tentative determination of
claim.
(14) ROTA, Section 6c (finality of tentative
determinations).
(15) ROTA, Section 8 (investigations and
hearings).
(16) ROTA, Section 9 (witness; immunity).
(17) ROTA, Section 10 (issuance of subpoenas;
attendance of witnesses; production of books and
records).
(18) ROTA, Section 11 (information confidential;
exceptions).
(19) ROTA, Section 12 (rules and regulations;
hearing; appeals), except that a hospital provider shall
not be required to file a bond or be subject to a lien in
lieu thereof in order to seek court review under the
Administrative Review Law of a final assessment or
revised final assessment or the equivalent thereof issued
by the Illinois Department under this Article.
(b) In addition to any other remedy provided for and
without sending a notice of assessment liability, the
Illinois Department may collect an unpaid assessment by
withholding, as payment of the assessment, reimbursements or
other amounts otherwise payable by the Illinois Department to
the provider.
(Source: P.A. 87-861.)
(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 as follows:
(1) For making payments to hospitals as required
under Articles V, VI, and XIV hospital inpatient care,
hospital ambulatory care, and disproportionate share
hospital distributive expenditures made under Title XIX
of the Social Security Act and Article V of this Code and
under the Children's Health Insurance 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 Article and Article V of
this Code and for making required payments under Section
14-9 of this Code if there are no moneys available for
those payments in the Hospital Services Trust Fund.
(3) For payment of administrative expenses incurred
by the Illinois Department or its agent in performing the
activities authorized by this Article.
(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 to the General Obligation
Bond Retirement and Interest Fund, 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.
(7) For making transfers to the Health and Human
Services Medicaid Trust Fund, including 20% of the moneys
received from hospital providers under Section 5A-4 and
transferred into the Hospital Provider Fund under Section
5A-6. 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.
(8) For making refunds to hospital providers
pursuant to Section 5A-10.
Disbursements from the Fund, other than transfers
authorized under paragraphs (5) and (6) of this subsection to
the General Obligation Bond Retirement and Interest Fund,
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.
(4) Moneys transferred from another fund in the
State treasury. Any balance in the Hospital Services
Trust Fund in the State Treasury. The balance shall be
transferred to the Fund upon certification by the
Illinois Department to the State Comptroller that all of
the disbursements required by Section 14-2(b) of this
Code have been made.
(5) All other moneys received for the Fund from any
other source, including interest earned thereon.
(d) (Blank). The Fund shall cease to exist on October 1,
1999. Any balance in the Fund as of that date shall be
transferred to the General Revenue Fund. Any moneys that
otherwise would be paid into the Fund on or after that date
shall be deposited into the General Revenue Fund. Any
disbursements on or after that date that otherwise would be
made from the Fund may be appropriated by the General
Assembly from the General Revenue Fund.
(Source: P.A. 89-626, eff. 8-9-96; 90-587, eff. 7-1-98.)
(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
Sec. 5A-10. Applicability.
(a) The assessment imposed by Section 5A-2 shall not
take effect or shall cease to be imposed, and any moneys
remaining in the Fund shall be refunded to hospital providers
in proportion to the amounts paid by them, if:
(1) the sum of the appropriations for State fiscal
years 2004 and 2005 from the General Revenue Fund for
hospital payments under the medical assistance program is
less than $4,500,000,000; or
(2) the Department of Public Aid makes changes in
its rules that reduce the hospital inpatient or
outpatient payment rates, including adjustment payment
rates, in effect on October 1, 2003, except for hospitals
described in subsection (b) of Section 5A-3 and except
for changes in outpatient payment rates made to comply
with the federal Health Insurance Portability and
Accountability Act, so long as those changes do not
reduce aggregate expenditures below the amount expended
in State fiscal year 2003 for such services; or
(3) the payments to hospitals required under
Section 5A-12 are changed or are not eligible for federal
matching funds under Title XIX or XXI of the Social
Security Act.
(b) The assessment imposed by Section 5A-2 shall not
take effect or shall cease to be imposed if the assessment is
determined to be an impermissible tax amount of matching
federal funds under Title XIX of the Social Security Act is
eliminated or significantly reduced on account of the
assessment. 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 matching
is not reduced due to the impermissibility of by the
assessments, and any remaining moneys assessments shall be
refunded to hospital providers in proportion to the amounts
paid by them.
(Source: P.A. 87-861.)
(305 ILCS 5/5A-12 new)
Sec. 5A-12. Hospital access improvement payments.
(a) To improve access to hospital services, for hospital
services rendered on or after June 1, 2004, the Department of
Public Aid shall make payments to hospitals as set forth in
this Section, except for hospitals described in subsection
(b) of Section 5A-3. These payments shall be paid on a
quarterly basis. For State fiscal year 2004, the Department
shall pay the total amounts required under this Section;
these amounts shall be paid on or before June 15 of the year.
In subsequent State fiscal years, the total amounts required
under this Section shall be paid in 4 equal installments on
or before July 15, October 15, January 14, and April 15 of
the year. 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, (ii) the assessment imposed
under this Article is determined to be a permissible tax
under Title XIX of the Social Security Act, and (iii) the
assessment is in effect.
(b) High volume payment. In addition to rates paid for
inpatient hospital services, the Department of Public Aid
shall pay, to each Illinois hospital that provided more than
20,000 Medicaid inpatient days of care during State fiscal
year 2001 (except for hospitals that qualify for adjustment
payments under Section 5-5.02 for the 12-month period
beginning on October 1, 2002), $190 for each Medicaid
inpatient day of care provided during that fiscal year. A
hospital that provided less than 30,000 Medicaid inpatient
days of care during that period, however, is not entitled to
receive more than $3,500,000 per year in such payments.
(c) Medicaid inpatient utilization rate adjustment. In
addition to rates paid for inpatient hospital services, the
Department of Public Aid shall pay each Illinois hospital
(except for hospitals described in Section 5A-3), for each
Medicaid inpatient day of care provided during State fiscal
year 2001, an amount equal to the product of $57.25
multiplied by the quotient of 1 divided by the greater of
1.6% or the hospital's Medicaid inpatient utilization rate
(as used to determine eligibility for adjustment payments
under Section 5-5.02 for the 12-month period beginning on
October 1, 2002). The total payments under this subsection to
a hospital may not exceed $10,500,000 annually.
(d) Psychiatric base rate adjustment.
(1) In addition to rates paid for inpatient
psychiatric services, the Department of Public Aid shall
pay each Illinois general acute care hospital with a
distinct part-psychiatric unit, for each Medicaid
inpatient psychiatric day of care provided in State
fiscal year 2001, an amount equal to $400 less the
hospital's per-diem rate for Medicaid inpatient
psychiatric services as in effect on October 1, 2003. In
no event, however, shall that amount be less than zero.
(2) For distinct part-psychiatric units of Illinois
general acute care hospitals, except for all hospitals
excluded in Section 5A-3, whose inpatient per-diem rate
as in effect on October 1, 2003 is greater than $400, the
Department shall pay, in addition to any other amounts
authorized under this Code, $25 for each Medicaid
inpatient psychiatric day of care provided in State
fiscal year 2001.
(e) Supplemental tertiary care adjustment. In addition
to rates paid for inpatient services, the Department of
Public Aid shall pay to each Illinois hospital eligible for
tertiary care adjustment payments under 89 Ill. Adm. Code
148.296, as in effect for State fiscal year 2003, a
supplemental tertiary care adjustment payment equal to the
tertiary care adjustment payment required under 89 Ill. Adm.
Code 148.296, as in effect for State fiscal year 2003.
(f) Medicaid outpatient utilization rate adjustment. In
addition to rates paid for outpatient hospital services, the
Department of Public Aid shall pay each Illinois hospital
(except for hospitals described in Section 5A-3), an amount
equal to the product of 2.45% multiplied by the hospital's
Medicaid outpatient charges multiplied by the quotient of 1
divided by the greater of 1.6% or the hospital's Medicaid
outpatient utilization rate. The total payments under this
subsection to a hospital may not exceed $6,750,000 annually.
For purposes of this subsection:
"Medicaid outpatient charges" means the charges for
outpatient services provided to Medicaid patients for State
fiscal year 2001 as submitted by the hospital on the UB-92
billing form or under the ambulatory procedure listing and
adjudicated by the Department of Public Aid on or before
September 12, 2003.
"Medicaid outpatient utilization rate" means a fraction,
the numerator of which is the hospital's Medicaid outpatient
charges and the denominator of which is the total number of
the hospital's charges for outpatient services for the
hospital's fiscal year ending in 2001.
(g) State outpatient service adjustment. In addition to
rates paid for outpatient hospital services, the Department
of Public Aid shall pay each Illinois hospital an amount
equal to the product of 75.5% multiplied by the hospital's
Medicaid outpatient services submitted to the Department on
the UB-92 billing form for State fiscal year 2001 multiplied
by the hospital's outpatient access fraction.
For purposes of this subsection, "outpatient access
fraction" means a fraction, the numerator of which is the
hospital's Medicaid payments for outpatient services for
ambulatory procedure listing services submitted to the
Department on the UB-92 billing form for State fiscal year
2001, and the denominator of which is the hospital's Medicaid
outpatient services submitted to the Department on the UB-92
billing form for State fiscal year 2001.
The total payments under this subsection to a hospital
may not exceed $3,000,000 annually.
(h) Rural hospital outpatient adjustment. In addition to
rates paid for outpatient hospital services, the Department
of Public Aid shall pay each Illinois rural hospital an
amount equal to the product of $14,500,000 multiplied by the
rural hospital outpatient adjustment fraction.
For purposes of this subsection, "rural hospital
outpatient adjustment fraction" means a fraction, the
numerator of which is the hospital's Medicaid visits for
outpatient services for ambulatory procedure listing services
submitted to the Department on the UB-92 billing form for
State fiscal year 2001, and the denominator of which is the
total Medicaid visits for outpatient services for ambulatory
procedure listing services for all Illinois rural hospitals
submitted to the Department on the UB-92 billing form for
State fiscal year 2001.
For purposes of this subsection, "rural hospital" has the
same meaning as in 89 Ill. Adm. Code 148.25, as in effect on
September 30, 2003.
(i) Merged/closed hospital adjustment. If any hospital
files a combined Medicaid cost report with another hospital
after January 1, 2001, and if that hospital subsequently
closes, then except for the payments described in subsection
(e), all payments described in the various subsections of
this Section shall, before the application of the annual
limitation amount specified in each such subsection, be
multiplied by a fraction, the numerator of which is the
number of occupied bed days attributable to the open hospital
and the denominator of which is the sum of the number of
occupied bed days of each open hospital and each closed
hospital. For purposes of this subsection, "occupied bed
days" has the same meaning as the term is defined in
subsection (a) of Section 5A-2.
(j) For purposes of this Section, the terms "Medicaid
days", "Medicaid charges", and "Medicaid services" do not
include any days, charges, or services for which Medicare was
liable for payment.
(k) As provided in Section 5A-14, this Section is
repealed on July 1, 2005.
(305 ILCS 5/5A-13 new)
Sec. 5A-13. Emergency rulemaking. The Department of
Public Aid may adopt rules necessary to implement this
amendatory Act of the 93rd General Assembly through the use
of emergency rulemaking in accordance with 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 this amendatory Act of the 93rd General
Assembly is deemed an emergency and necessary for the public
interest, safety, and welfare.
(305 ILCS 5/5A-14 new)
Sec. 5A-14. Repeal of assessments and disbursements.
(a) Section 5A-2 is repealed on July 1, 2005.
(b) Section 5A-12 is repealed on July 1, 2005.
(305 ILCS 5/14-1) (from Ch. 23, par. 14-1)
Sec. 14-1. Definitions. As used in this Article, unless
the context requires otherwise:
"Fund" means the Hospital Services Trust Fund.
"Estimated Rate Year Utilization" means the hospital's
projected utilization for the State fiscal year in which the
fee is due (for example, fiscal year 1992 for fees imposed in
State fiscal year 1992, fiscal year 1993 for fees imposed in
State fiscal year 1993, and so forth).
"Gross Receipts" means all payments for medical services
delivered under Title XIX of the Social Security Act and
Articles V, VI, and VII of this Code and shall mean any and
all payments made by the Illinois Department, or a Division
thereof, to a Medical Assistance Program provider certified
to participate in the Illinois Medical Assistance Program,
for services rendered eligible for Medical Assistance under
Articles V, VI and VII of this Code, State regulations and
the federal Medicaid Program as defined in Title XIX of the
Social Security Act and federal regulations.
"Hospital" means any institution, place, building, or
agency, public or private, whether organized for profit or
not-for-profit, which is located in the State and is subject
to licensure by the Illinois Department of Public Health
under the Hospital Licensing Act or any institution, place,
building, or agency, public or private, whether organized for
profit or not-for-profit, which meets all comparable
conditions and requirements of the Hospital Licensing Act in
effect for the state in which it is located, and is required
to submit cost reports to the Illinois Department under Title
89, Part 148, of the Illinois Administrative Code, but shall
not include the University of Illinois Hospital as defined in
the University of Illinois Hospital Act or a county hospital
in a county of over 3 million population.
"Total Medicaid Base Year Spending" means the hospital's
State fiscal year 1991 weighted average payment rates, as
defined by rule, excluding payments under Section 5-5.02 of
this Code, reduced by 5% and multiplied by the hospital's
estimated rate year utilization.
(Source: P.A. 87-13.)
(305 ILCS 5/Art. V-D rep.)
(305 ILCS 5/14-2 rep.)
(305 ILCS 5/14-3 rep.)
(305 ILCS 5/14-4 rep.)
(305 ILCS 5/14-5 rep.)
(305 ILCS 5/14-6 rep.)
(305 ILCS 5/14-7 rep.)
(305 ILCS 5/14-9 rep.)
(305 ILCS 5/14-10 rep.)
Section 11. The Illinois Public Aid Code is amended by
repealing Article V-D and Sections 14-2, 14-3, 14-4, 14-5,
14-6, 14-7, 14-9, and 14-10.
Section 99. Effective date. This Act takes effect upon
becoming law.
Effective Date: 02/03/04
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