Public Act 90-0588 of the 90th General Assembly

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Public Act 90-0588

SB1706 Enrolled                                LRB9011519MWpc

    AN ACT in relation to State government.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  1.   Short  title.  This Act may be cited as the
FY99 Budget Implementation (Health Related) Act.

    Section 5.  Purpose.  It is the purpose  and  subject  of
this  Act  to  make  the  changes  in State programs that are
necessary  to  implement   the   Governor's   FY1999   budget
recommendations.

    Section 10.  The Illinois Administrative Procedure Act is
amended by changing Section 5-45 as follows:

    (5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
    Sec. 5-45.  Emergency rulemaking.
    (a)  "Emergency"  means  the  existence  of any situation
that any agency finds reasonably constitutes a threat to  the
public interest, safety, or welfare.
    (b)  If  any  agency  finds that an emergency exists that
requires adoption of a rule upon fewer days than is  required
by  Section  5-40  and states in writing its reasons for that
finding, the agency may adopt an emergency rule without prior
notice  or  hearing  upon  filing  a  notice   of   emergency
rulemaking  with  the  Secretary of State under Section 5-70.
The notice shall include the text of the emergency  rule  and
shall  be published in the Illinois Register.  Consent orders
or other court orders adopting settlements negotiated  by  an
agency  may  be  adopted  under  this  Section.   Subject  to
applicable   constitutional   or   statutory  provisions,  an
emergency rule  becomes  effective  immediately  upon  filing
under  Section  5-65  or  at a stated date less than 10  days
thereafter.  The agency's finding  and  a  statement  of  the
specific  reasons  for  the  finding  shall be filed with the
rule.  The  agency  shall  take  reasonable  and  appropriate
measures to make emergency rules known to the persons who may
be affected by them.
    (c)  An  emergency  rule may be effective for a period of
not longer than 150 days, but the agency's authority to adopt
an identical rule under Section 5-40 is  not  precluded.   No
emergency  rule may be adopted more than once in any 24 month
period,  except  that  this  limitation  on  the  number   of
emergency rules that may be adopted in a 24 month period does
not  apply  to (i) emergency rules that make additions to and
deletions from the Drug Manual under Section  5-5.16  of  the
Illinois  Public Aid Code or the generic drug formulary under
Section 3.14 of the Illinois Food, Drug and Cosmetic  Act  or
(ii)  emergency  rules adopted by the Pollution Control Board
before July 1, 1997 to implement portions  of  the  Livestock
Management  Facilities  Act.   Two  or  more  emergency rules
having substantially the same purpose  and  effect  shall  be
deemed to be a single rule for purposes of this Section.
    (d)  In  order  to provide for the expeditious and timely
implementation of the State's fiscal year 1999  1998  budget,
emergency rules to implement any provision of this amendatory
Act  of  1998  1997 or any other budget initiative for fiscal
year 1999 1998 may be adopted in accordance with this Section
by the agency charged with administering  that  provision  or
initiative,  except  that  the  24-month  limitation  on  the
adoption  of  emergency  rules and the provisions of Sections
5-115 and 5-125 do not apply  to  rules  adopted  under  this
subsection  (d).   The adoption of emergency rules authorized
by this subsection (d) shall be deemed to  be  necessary  for
the public interest, safety, and welfare.
(Source: P.A. 89-714, eff. 2-21-97; 90-9, eff. 7-1-97.)
    Section  15.   The Illinois Public Aid Code is amended by
changing Sections 5-5.02, 5-5.4, 12-4.34, and 14-8 and adding
Section 12-4.35 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; 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 (f) 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
    Illinois  Health  Facilities Planning 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 that is separately licensed as a hospital by
    a municipality prior  to  September  30,  1998  shall  be
    considered  a  children's hospital to the degree that the
    hospital's Medicaid care is provided to children.
    (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; and
         (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.
    (d)  Supplemental adjustment payments.   In  addition  to
the adjustment payments described in paragraph (c), hospitals
as  defined  in  clauses  (1)  through  (5) 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.
(Source: P.A. 88-88; 89-21, eff. 7-1-95.)

    (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)  Provides  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  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.   Rate  increases  shall be
provided annually thereafter on July 1 in 1984  and  on  each
subsequent July 1 in the following years, except that no rate
increase  and no update for inflation shall be provided on or
after  July  1,  1994  and  before  July  1,   1999,   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.  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  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  United
States  Department  of Health, Education and Welfare 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. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96; 90-9,
eff. 7-1-97.)

    (305 ILCS 5/12-4.34)
    (Section scheduled to be repealed on August 31, 1998)
    Sec. 12-4.34.  Naturalization and nutrition  Services  to
noncitizens.
    (a)  Subject  to  specific appropriation for this purpose
and notwithstanding Sections 1-11 and 3-1 of this  Code,  the
Department   of  Human  Services  is  authorized  to  provide
naturalization services to legal  immigrants,  including  but
not  limited  to  naturalization  and  nutrition services and
financial assistance.  The nature of these services,  payment
levels,  and  eligibility  conditions  shall be determined by
rule.
    (b)  Subject to specific appropriation for this  purpose,
the  Department  of  Human  Services is authorized to provide
nutrition services to noncitizens who are 65 years of age  or
older,  under  18  years of age, or disabled, and who were in
the United States prior  to  August  22,  1996  and  are  not
eligible  for  the  federal  food  stamp program due to their
noncitizen status.  The payment levels and other  eligibility
conditions for these services shall be determined by rule.
    The  Illinois  Department  is  authorized  to  lower  the
payment levels established under this subsection or take such
other  actions  during  the  fiscal  year as are necessary to
ensure that payments under this subsection do not exceed  the
amounts  appropriated for this purpose.  These changes may be
accomplished by emergency rule  under  Section  5-45  of  the
Illinois   Administrative  Procedure  Act,  except  that  the
limitation on the number  of  emergency  rules  that  may  be
adopted in a 24-month period shall not apply.
    (c)  This Section is repealed on August 31, 1999 1998.
(Source: P.A. 90-564, eff. 12-22-97.)

    (305 ILCS 5/12-4.35 new)
    Sec. 12-4.35. Medical services for certain noncitizens.
    (a)  Subject  to specific appropriation for this purpose,
and notwithstanding Section 1-11  of  this  Code  or  Section
20(a)  of  the  Children's  Health Insurance Program Act, the
Department of Public Aid  may  provide  medical  services  to
noncitizens who have not yet attained 19 years of age and who
are  not  eligible  for medical assistance under Article V of
this Code or under the Children's  Health  Insurance  Program
created by the Children's Health Insurance Program Act due to
their  not  meeting  the  otherwise  applicable provisions of
Section 1-11 of this Code or Section 20(a) of the  Children's
Health   Insurance   Program   Act.    The  medical  services
available, standards for eligibility, and other conditions of
participation under this Section shall be established by rule
by the Department; however, any such rule shall be  at  least
as  restrictive  as  the  rules  for medical assistance under
Article V of this Code or  the  Children's  Health  Insurance
Program  created  by  the Children's Health Insurance Program
Act.
    (b)  The Department is authorized  to  take  any  action,
including   without   limitation   cessation  of  enrollment,
reduction  of  available  medical  services,   and   changing
standards  for  eligibility,  that is deemed necessary by the
Department during a State fiscal year to assure that payments
under this Section do not exceed the amounts appropriated for
this purpose.
    (c)  In the event that the appropriation  in  any  fiscal
year  for  the Children's Health Insurance Program created by
the Children's Health Insurance Program Act is determined  by
the  Department  to be insufficient to continue enrollment of
otherwise eligible children under that  Program  during  that
fiscal  year,  the  Department  is  authorized  to  use funds
appropriated for the purposes of this Section  to  fund  that
Program  and  to  take any other action necessary to continue
the  operation  of  that  Program.   Furthermore,   continued
enrollment of individuals into the program created under this
Section  in  any  fiscal  year  is  contingent upon continued
enrollment  of  individuals  into   the   Children's   Health
Insurance Program during that fiscal year.
    (d)  The  General  Assembly  finds  that  the adoption of
rules to meet the purposes of subsections (a), (b),  and  (c)
is  an  emergency  and  necessary  for  the  public interest,
safety, and welfare.  The Department  may  adopt  such  rules
through  the  use  of emergency rulemaking in accordance with
Section 5-45 of the Illinois  Administrative  Procedure  Act,
except  that  the limitation on the number of emergency rules
that may be adopted in a 24-month period shall not apply.

    (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.
(Source: P.A.  89-21,  eff.  7-1-95;  89-499,  eff.  6-28-96;
89-507, eff. 7-1-97; 90-9, eff. 7-1-97; 90-14, eff. 7-1-97.)

    Section  99.  Effective  date.   This Act takes effect on
July 1, 1998.

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