Public Act 096-1382
 
HB5765 EnrolledLRB096 18857 KTG 36166 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Public Aid Code is amended by
changing Section 14-8 as follows:
 
    (305 ILCS 5/14-8)  (from Ch. 23, par. 14-8)
    Sec. 14-8. Disbursements to Hospitals.
    (a) For inpatient hospital services rendered on and after
September 1, 1991, the Illinois Department shall reimburse
hospitals for inpatient services at an inpatient payment rate
calculated for each hospital based upon the Medicare
Prospective Payment System as set forth in Sections 1886(b),
(d), (g), and (h) of the federal Social Security Act, and the
regulations, policies, and procedures promulgated thereunder,
except as modified by this Section. Payment rates for inpatient
hospital services rendered on or after September 1, 1991 and on
or before September 30, 1992 shall be calculated using the
Medicare Prospective Payment rates in effect on September 1,
1991. Payment rates for inpatient hospital services rendered on
or after October 1, 1992 and on or before March 31, 1994 shall
be calculated using the Medicare Prospective Payment rates in
effect on September 1, 1992. Payment rates for inpatient
hospital services rendered on or after April 1, 1994 shall be
calculated using the Medicare Prospective Payment rates
(including the Medicare grouping methodology and weighting
factors as adjusted pursuant to paragraph (1) of this
subsection) in effect 90 days prior to the date of admission.
For services rendered on or after July 1, 1995, the
reimbursement methodology implemented under this subsection
shall not include those costs referred to in Sections
1886(d)(5)(B) and 1886(h) of the Social Security Act. The
additional payment amounts required under Section
1886(d)(5)(F) of the Social Security Act, for hospitals serving
a disproportionate share of low-income or indigent patients,
are not required under this Section. For hospital inpatient
services rendered on or after July 1, 1995, the Illinois
Department shall reimburse hospitals using the relative
weighting factors and the base payment rates calculated for
each hospital that were in effect on June 30, 1995, less the
portion of such rates attributed by the Illinois Department to
the cost of medical education.
        (1) The weighting factors established under Section
    1886(d)(4) of the Social Security Act shall not be used in
    the reimbursement system established under this Section.
    Rather, the Illinois Department shall establish by rule
    Medicaid weighting factors to be used in the reimbursement
    system established under this Section.
        (2) The Illinois Department shall define by rule those
    hospitals or distinct parts of hospitals that shall be
    exempt from the reimbursement system established under
    this Section. In defining such hospitals, the Illinois
    Department shall take into consideration those hospitals
    exempt from the Medicare Prospective Payment System as of
    September 1, 1991. For hospitals defined as exempt under
    this subsection, the Illinois Department shall by rule
    establish a reimbursement system for payment of inpatient
    hospital services rendered on and after September 1, 1991.
    For all hospitals that are children's hospitals as defined
    in Section 5-5.02 of this Code, the reimbursement
    methodology shall, through June 30, 1992, net of all
    applicable fees, at least equal each children's hospital
    1990 ICARE payment rates, indexed to the current year by
    application of the DRI hospital cost index from 1989 to the
    year in which payments are made. Excepting county providers
    as defined in Article XV of this Code, hospitals licensed
    under the University of Illinois Hospital Act, and
    facilities operated by the Department of Mental Health and
    Developmental Disabilities (or its successor, the
    Department of Human Services) for hospital inpatient
    services rendered on or after July 1, 1995, the Illinois
    Department shall reimburse children's hospitals, as
    defined in 89 Illinois Administrative Code Section
    149.50(c)(3), at the rates in effect on June 30, 1995, and
    shall reimburse all other hospitals at the rates in effect
    on June 30, 1995, less the portion of such rates attributed
    by the Illinois Department to the cost of medical
    education. For inpatient hospital services provided on or
    after August 1, 1998, the Illinois Department may establish
    by rule a means of adjusting the rates of children's
    hospitals, as defined in 89 Illinois Administrative Code
    Section 149.50(c)(3), that did not meet that definition on
    June 30, 1995, in order for the inpatient hospital rates of
    such hospitals to take into account the average inpatient
    hospital rates of those children's hospitals that did meet
    the definition of children's hospitals on June 30, 1995.
        (3) (Blank)
        (4) Notwithstanding any other provision of this
    Section, hospitals that on August 31, 1991, have a contract
    with the Illinois Department under Section 3-4 of the
    Illinois Health Finance Reform Act may elect to continue to
    be reimbursed at rates stated in such contracts for general
    and specialty care.
        (5) In addition to any payments made under this
    subsection (a), the Illinois Department shall make the
    adjustment payments required by Section 5-5.02 of this
    Code; provided, that in the case of any hospital reimbursed
    under a per case methodology, the Illinois Department shall
    add an amount equal to the product of the hospital's
    average length of stay, less one day, multiplied by 20, for
    inpatient hospital services rendered on or after September
    1, 1991 and on or before September 30, 1992.
    (b) (Blank)
    (b-5) Excepting county providers as defined in Article XV
of this Code, hospitals licensed under the University of
Illinois Hospital Act, and facilities operated by the Illinois
Department of Mental Health and Developmental Disabilities (or
its successor, the Department of Human Services), for
outpatient services rendered on or after July 1, 1995 and
before July 1, 1998 the Illinois Department shall reimburse
children's hospitals, as defined in the Illinois
Administrative Code Section 149.50(c)(3), at the rates in
effect on June 30, 1995, less that portion of such rates
attributed by the Illinois Department to the outpatient
indigent volume adjustment and shall reimburse all other
hospitals at the rates in effect on June 30, 1995, less the
portions of such rates attributed by the Illinois Department to
the cost of medical education and attributed by the Illinois
Department to the outpatient indigent volume adjustment. For
outpatient services provided on or after July 1, 1998,
reimbursement rates shall be established by rule.
    (c) In addition to any other payments under this Code, the
Illinois Department shall develop a hospital disproportionate
share reimbursement methodology that, effective July 1, 1991,
through September 30, 1992, shall reimburse hospitals
sufficiently to expend the fee monies described in subsection
(b) of Section 14-3 of this Code and the federal matching funds
received by the Illinois Department as a result of expenditures
made by the Illinois Department as required by this subsection
(c) and Section 14-2 that are attributable to fee monies
deposited in the Fund, less amounts applied to adjustment
payments under Section 5-5.02.
    (d) Critical Care Access Payments.
        (1) In addition to any other payments made under this
    Code, the Illinois Department shall develop a
    reimbursement methodology that shall reimburse Critical
    Care Access Hospitals for the specialized services that
    qualify them as Critical Care Access Hospitals. No
    adjustment payments shall be made under this subsection on
    or after July 1, 1995.
        (2) "Critical Care Access Hospitals" includes, but is
    not limited to, hospitals that meet at least one of the
    following criteria:
            (A) Hospitals located outside of a metropolitan
        statistical area that are designated as Level II
        Perinatal Centers and that provide a disproportionate
        share of perinatal services to recipients; or
            (B) Hospitals that are designated as Level I Trauma
        Centers (adult or pediatric) and certain Level II
        Trauma Centers as determined by the Illinois
        Department; or
            (C) Hospitals located outside of a metropolitan
        statistical area and that provide a disproportionate
        share of obstetrical services to recipients.
    (e) Inpatient high volume adjustment. For hospital
inpatient services, effective with rate periods beginning on or
after October 1, 1993, in addition to rates paid for inpatient
services by the Illinois Department, the Illinois Department
shall make adjustment payments for inpatient services
furnished by Medicaid high volume hospitals. The Illinois
Department shall establish by rule criteria for qualifying as a
Medicaid high volume hospital and shall establish by rule a
reimbursement methodology for calculating these adjustment
payments to Medicaid high volume hospitals. No adjustment
payment shall be made under this subsection for services
rendered on or after July 1, 1995.
    (f) The Illinois Department shall modify its current rules
governing adjustment payments for targeted access, critical
care access, and uncompensated care to classify those
adjustment payments as not being payments to disproportionate
share hospitals under Title XIX of the federal Social Security
Act. Rules adopted under this subsection shall not be effective
with respect to services rendered on or after July 1, 1995. The
Illinois Department has no obligation to adopt or implement any
rules or make any payments under this subsection for services
rendered on or after July 1, 1995.
    (f-5) The State recognizes that adjustment payments to
hospitals providing certain services or incurring certain
costs may be necessary to assure that recipients of medical
assistance have adequate access to necessary medical services.
These adjustments include payments for teaching costs and
uncompensated care, trauma center payments, rehabilitation
hospital payments, perinatal center payments, obstetrical care
payments, targeted access payments, Medicaid high volume
payments, and outpatient indigent volume payments. On or before
April 1, 1995, the Illinois Department shall issue
recommendations regarding (i) reimbursement mechanisms or
adjustment payments to reflect these costs and services,
including methods by which the payments may be calculated and
the method by which the payments may be financed, and (ii)
reimbursement mechanisms or adjustment payments to reflect
costs and services of federally qualified health centers with
respect to recipients of medical assistance.
    (g) If one or more hospitals file suit in any court
challenging any part of this Article XIV, payments to hospitals
under this Article XIV shall be made only to the extent that
sufficient monies are available in the Fund and only to the
extent that any monies in the Fund are not prohibited from
disbursement under any order of the court.
    (h) Payments under the disbursement methodology described
in this Section are subject to approval by the federal
government in an appropriate State plan amendment.
    (i) The Illinois Department may by rule establish criteria
for and develop methodologies for adjustment payments to
hospitals participating under this Article.
    (j) Hospital Residing Long Term Care Services. In addition
to any other payments made under this Code, the Illinois
Department may by rule establish criteria and develop
methodologies for payments to hospitals for Hospital Residing
Long Term Care Services.
    (k) Critical Access Hospital outpatient payments. In
addition to any other payments authorized under this Code, the
Illinois Department shall reimburse critical access hospitals,
as designated by the Illinois Department of Public Health in
accordance with 42 CFR 485, Subpart F, for outpatient services
at an amount that is no less than the cost of providing such
services, based on Medicare cost principles. Payments under
this subsection shall be subject to appropriation.
(Source: P.A. 93-20, eff. 6-20-03.)

Effective Date: 1/1/2011