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Public Act 92-0370
SB873 Enrolled LRB9201523DJgc
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 University of Illinois Act is amended by
changing Section 7 as follows:
(110 ILCS 305/7) (from Ch. 144, par. 28)
Sec. 7. Powers of trustees.
(a) The trustees shall have power to provide for the
requisite buildings, apparatus, and conveniences; to fix the
rates for tuition; to appoint such professors and
instructors, and to establish and provide for the management
of such model farms, model art, and other departments and
professorships, as may be required to teach, in the most
thorough manner, such branches of learning as are related to
agriculture and the mechanic arts, and military tactics,
without excluding other scientific and classical studies. The
trustees shall, upon the written request of an employee
withhold from the compensation of that employee any dues,
payments or contributions payable by such employee to any
labor organization as defined in the Illinois Educational
Labor Relations Act. Under such arrangement, an amount shall
be withheld from each regular payroll period which is equal
to the pro rata share of the annual dues plus any payments or
contributions, and the trustees shall transmit such
withholdings to the specified labor organization within 10
working days from the time of the withholding. They may
accept the endowments and voluntary professorships or
departments in the University, from any person or persons or
corporations who may offer the same, and, at any regular
meeting of the board, may prescribe rules and regulations in
relation to such endowments and declare on what general
principles they may be admitted: Provided, that such special
voluntary endowments or professorships shall not be
incompatible with the true design and scope of the act of
congress, or of this Act: Provided, that no student shall at
any time be allowed to remain in or about the University in
idleness, or without full mental or industrial occupation:
And provided further, that the trustees, in the exercise of
any of the powers conferred by this Act, shall not create any
liability or indebtedness in excess of the funds in the hands
of the treasurer of the University at the time of creating
such liability or indebtedness, and which may be specially
and properly applied to the payment of the same. Any lease to
the trustees of lands, buildings or facilities which will
support scientific research and development in such areas as
high technology, super computing, microelectronics,
biotechnology, robotics, physics and engineering shall be for
a term not to exceed 18 years, and may grant to the trustees
the option to purchase the lands, buildings or facilities.
The lease shall recite that it is subject to termination and
cancellation in any year for which the General Assembly fails
to make an appropriation to pay the rent payable under the
terms of the lease.
Leases for the purposes described herein exceeding 5
years shall have the approval of the Illinois Board of Higher
Education.
The Board of Trustees may, directly or in cooperation
with other institutions of higher education, acquire by
purchase or lease or otherwise, and construct, enlarge,
improve, equip, complete, operate, control and manage medical
research and high technology parks, together with the
necessary lands, buildings, facilities, equipment and
personal property therefor, to encourage and facilitate (a)
the location and development of business and industry in the
State of Illinois, and (b) the increased application and
development of technology and (c) the improvement and
development of the State's economy. The Board of Trustees may
lease to nonprofit corporations all or any part of the land,
buildings, facilities, equipment or other property included
in a medical research and high technology park upon such
terms and conditions as the University of Illinois may deem
advisable and enter into any contract or agreement with such
nonprofit corporations as may be necessary or suitable for
the construction, financing, operation and maintenance and
management of any such park; and may lease to any person,
firm, partnership or corporation, either public or private,
any part or all of the land, building, facilities, equipment
or other property of such park for such purposes and upon
such rentals, terms and conditions as the University may deem
advisable; and may finance all or part of the cost of any
such park, including the purchase, lease, construction,
reconstruction, improvement, remodeling, addition to, and
extension and maintenance of all or part of such high
technology park, and all equipment and furnishings, by
legislative appropriations, government grants, contracts,
private gifts, loans, receipts from the operation of such
high technology park, rentals and similar receipts; and may
make its other facilities and services available to tenants
or other occupants of any such park at rates which are
reasonable and appropriate.
The Trustees shall have power (a) to purchase real
property and easements, and (b) to acquire real property and
easements in the manner provided by law for the exercise of
the right of eminent domain, and in the event negotiations
for the acquisition of real property or easements for making
any improvement which the Trustees are authorized to make
shall have proven unsuccessful and the Trustees shall have by
resolution adopted a schedule or plan of operation for the
execution of the project and therein made a finding that it
is necessary to take such property or easements immediately
or at some specified later date in order to comply with the
schedule, the Trustees may acquire such property or easements
in the same manner provided in Sections 7-103 through 7-112
of the Code of Civil Procedure.
The Board of Trustees also shall have power to agree with
the State's Attorney of the county in which any properties of
the Board are located to pay for services rendered by the
various taxing districts for the years 1944 through 1949 and
to pay annually for services rendered thereafter by such
district such sums as may be determined by the Board upon
properties used solely for income producing purposes, title
to which is held by said Board of Trustees, upon properties
leased to members of the staff of the University of Illinois,
title to which is held in trust for said Board of Trustees
and upon properties leased to for-profit entities the title
to which properties is held by the Board of Trustees. A
certified copy of any such agreement made with the State's
Attorney shall be filed with the County Clerk and such sums
shall be distributed to the respective taxing districts by
the County Collector in such proportions that each taxing
district will receive therefrom such proportion as the tax
rate of such taxing district bears to the total tax rate that
would be levied against such properties if they were not
exempt from taxation under the Property Tax Code.
The Board of Trustees of the University of Illinois,
subject to the applicable civil service law, may appoint
persons to be members of the University of Illinois Police
Department. Members of the Police Department shall be peace
officers and as such have all powers possessed by policemen
in cities, and sheriffs, including the power to make arrests
on view or warrants of violations of state statutes and city
or county ordinances, except that they may exercise such
powers only in counties wherein the University and any of its
branches or properties are located when such is required for
the protection of university properties and interests, and
its students and personnel, and otherwise, within such
counties, when requested by appropriate state or local law
enforcement officials; provided, however, that such officer
shall have no power to serve and execute civil processes.
The Board of Trustees must authorize to each member of
the University of Illinois Police Department and to any other
employee of the University of Illinois exercising the powers
of a peace officer a distinct badge that, on its face, (i)
clearly states that the badge is authorized by the University
of Illinois and (ii) contains a unique identifying number. No
other badge shall be authorized by the University of
Illinois.
The Board of Trustees may own, operate, or govern, by or
through the College of Medicine at Peoria, a managed care
community network established under subsection (b) (r) of
Section 5-11 5-16.3 of the Illinois Public Aid Code.
The powers of the trustees as herein designated are
subject to the provisions of "An Act creating a Board of
Higher Education, defining its powers and duties, making an
appropriation therefor, and repealing an Act herein named",
approved August 22, 1961, as amended.
The Board of Trustees shall have the authority to adopt
all administrative rules which may be necessary for the
effective administration, enforcement and regulation of all
matters for which the Board has jurisdiction or
responsibility.
(b) To assist in the provision of buildings and
facilities beneficial to, useful for, or supportive of
University purposes, the Board of Trustees of the University
of Illinois may exercise the following powers with regard to
the area located on or adjacent to the University of Illinois
at Chicago campus and bounded as follows: on the West by
Morgan Street; on the North by Roosevelt Road; on the East by
Union Street; and on the South by 16th Street, in the City of
Chicago:
(1) Acquire any interests in land, buildings, or
facilities by purchase, including installments payable
over a period allowed by law, by lease over a term of
such duration as the Board of Trustees shall determine,
or by exercise of the power of eminent domain;
(2) Sub-lease or contract to purchase through
installments all or any portion of buildings or
facilities for such duration and on such terms as the
Board of Trustees shall determine, including a term that
exceeds 5 years, provided that each such lease or
purchase contract shall be and shall recite that it is
subject to termination and cancellation in any year for
which the General Assembly fails to make an appropriation
to pay the rent or purchase installments payable under
the terms of such lease or purchase contract; and
(3) Sell property without compliance with the State
Property Control Act and retain proceeds in the
University Treasury in a special, separate development
fund account which the Auditor General shall examine to
assure compliance with this Act.
Any buildings or facilities to be developed on the land shall
be buildings or facilities that, in the determination of the
Board of Trustees, in whole or in part: (i) are for use by
the University; or (ii) otherwise advance the interests of
the University, including, by way of example, residential
facilities for University staff and students and commercial
facilities which provide services needed by the University
community. Revenues from the development fund account may be
withdrawn by the University for the purpose of demolition and
the processes associated with demolition; routine land and
property acquisition; extension of utilities; streetscape
work; landscape work; surface and structure parking;
sidewalks, recreational paths, and street construction; and
lease and lease purchase arrangements and the professional
services associated with the planning and development of the
area. Moneys from the development fund account used for any
other purpose must be deposited into and appropriated from
the General Revenue Fund. Buildings or facilities leased to
an entity or person other than the University shall not be
subject to any limitations applicable to a State supported
college or university under any law. All development on the
land and all use of any buildings or facilities shall be
subject to the control and approval of the Board of Trustees.
(Source: P.A. 90-730, eff. 8-10-98; 91-883, eff. 1-1-01.)
Section 10. The Southern Illinois University Management
Act is amended by changing Section 8 as follows:
(110 ILCS 520/8) (from Ch. 144, par. 658)
Sec. 8. Powers and Duties of the Board. The Board shall
have power and it shall be its duty:
1. To make rules, regulations and by-laws, not
inconsistent with law, for the government and management
of Southern Illinois University and its branches;
2. To employ, and, for good cause, to remove a
president of Southern Illinois University, and all
necessary deans, professors, associate professors,
assistant professors, instructors, and other educational
and administrative assistants, and all other necessary
employees, and contract with them upon matters relating
to tenure, salaries and retirement benefits in accordance
with the State Universities Civil Service Act; the Board
shall, upon the written request of an employee of
Southern Illinois University, withhold from the
compensation of that employee any dues, payments or
contributions payable by such employee to any labor
organization as defined in the Illinois Educational Labor
Relations Act. Under such arrangement, an amount shall be
withheld from each regular payroll period which is equal
to the pro rata share of the annual dues plus any
payments or contributions, and the Board shall transmit
such withholdings to the specified labor organization
within 10 working days from the time of the withholding.
Whenever the Board establishes a search committee to fill
the position of president of Southern Illinois
University, there shall be minority representation,
including women, on that search committee;
3. To prescribe the course of study to be followed,
and textbooks and apparatus to be used at Southern
Illinois University;
4. To issue upon the recommendation of the faculty,
diplomas to such persons as have satisfactorily completed
the required studies of Southern Illinois University, and
confer such professional and literary degrees as are
usually conferred by other institutions of like character
for similar or equivalent courses of study, or such as
the Board may deem appropriate;
5. To examine into the conditions, management, and
administration of Southern Illinois University, to
provide the requisite buildings, apparatus, equipment and
auxiliary enterprises, and to fix and collect
matriculation fees; tuition fees; fees for student
activities; fees for student facilities such as student
union buildings or field houses or stadium or other
recreational facilities; student welfare fees; laboratory
fees and similar fees for supplies and material;
6. To succeed to and to administer all trusts,
trust property, and gifts now or hereafter belonging or
pertaining to Southern Illinois University;
7. To accept endowments of professorships or
departments in the University from any person who may
proffer them and, at regular meetings, to prescribe rules
and regulations in relation to endowments and declare on
what general principles they may be accepted;
8. To enter into contracts with the Federal
government for providing courses of instruction and other
services at Southern Illinois University for persons
serving in or with the military or naval forces of the
United States, and to provide such courses of instruction
and other services;
9. To provide for the receipt and expenditures of
Federal funds, paid to the Southern Illinois University
by the Federal government for instruction and other
services for persons serving in or with the military or
naval forces of the United States and to provide for
audits of such funds;
10. To appoint, subject to the applicable civil
service law, persons to be members of the Southern
Illinois University Police Department. Members of the
Police Department shall be conservators of the peace and
as such have all powers possessed by policemen in cities,
and sheriffs, including the power to make arrests on view
or warrants of violations of state statutes, university
rules and regulations and city or county ordinances,
except that they may exercise such powers only within
counties wherein the university and any of its branches
or properties are located when such is required for the
protection of university properties and interests, and
its students and personnel, and otherwise, within such
counties, when requested by appropriate State or local
law enforcement officials. However, such officers shall
have no power to serve and execute civil processes.
The Board must authorize to each member of the
Southern Illinois University Police Department and to any
other employee of Southern Illinois University exercising
the powers of a peace officer a distinct badge that, on
its face, (i) clearly states that the badge is authorized
by Southern Illinois University and (ii) contains a
unique identifying number. No other badge shall be
authorized by Southern Illinois University.
11. To administer a plan or plans established by
the clinical faculty of the School of Medicine for the
billing, collection and disbursement of charges made by
individual faculty members for professional services
performed by them in the course of or in support of their
academic responsibilities, provided that such plan has
been first approved by Board action. All such collections
shall be deposited into a special fund or funds
administered by the Board from which disbursements may be
made according to the provisions of said plan. The
reasonable costs incurred, by the University,
administering the billing, collection and disbursement
provisions of a plan shall have first priority for
payment before distribution or disbursement for any other
purpose. Charges established pursuant to this plan must
be itemized in any billing and any amounts collected
which are not used to off-set the cost of operating or
maintaining the activity which generated the funds
collected, must be accounted for separately. This
accounting must clearly show the use and application made
of the funds and the Board shall report such accountings
for the previous fiscal year to the Legislative Audit
Commission annually by December 31 of each fiscal year.
The Board of Trustees may own, operate, or govern,
by or through the School of Medicine, a managed care
community network established under subsection (b) (r) of
Section 5-11 5-16.3 of the Illinois Public Aid Code.
12. The Board of Trustees may, directly or in
cooperation with other institutions of higher education,
acquire by purchase or lease or otherwise, and construct,
enlarge, improve, equip, complete, operate, control and
manage medical research and high technology parks,
together with the necessary lands, buildings, facilities,
equipment, and personal property therefor, to encourage
and facilitate (a) the location and development of
business and industry in the State of Illinois, and (b)
the increased application and development of technology
and (c) the improvement and development of the State's
economy. The Board of Trustees may lease to nonprofit
corporations all or any part of the land, buildings,
facilities, equipment or other property included in a
medical research and high technology park upon such terms
and conditions as the Board of Trustees may deem
advisable and enter into any contract or agreement with
such nonprofit corporations as may be necessary or
suitable for the construction, financing, operation and
maintenance and management of any such park; and may
lease to any person, firm, partnership or corporation,
either public or private, any part or all of the land,
building, facilities, equipment or other property of such
park for such purposes and upon such rentals, terms and
conditions as the Board of Trustees may deem advisable;
and may finance all or part of the cost of any such park,
including the purchase, lease, construction,
reconstruction, improvement, remodeling, addition to, and
extension and maintenance of all or part of such high
technology park, and all equipment and furnishings, by
legislative appropriations, government grants, contracts,
private gifts, loans, receipts from the operation of such
high technology park, rentals and similar receipts; and
may make its other facilities and services available to
tenants or other occupants of any such park at rates
which are reasonable and appropriate.
The powers of the Board as herein designated are subject
to the Board of Higher Education Act.
(Source: P.A. 91-883, eff. 1-1-01.)
Section 15. The Illinois Insurance Code is amended by
changing Section 352 as follows:
(215 ILCS 5/352) (from Ch. 73, par. 964)
Sec. 352. Scope of Article.
(a) Except as provided in subsections (b), (c), (d), and
(e), this Article shall apply to all companies transacting in
this State the kinds of business enumerated in clause (b) of
Class 1 and clause (a) of Class 2 of section 4. Nothing in
this Article shall apply to, or in any way affect policies or
contracts described in clause (a) of Class 1 of Section 4;
however, this Article shall apply to policies and contracts
which contain benefits providing reimbursement for the
expenses of long term health care which are certified or
ordered by a physician including but not limited to
professional nursing care, custodial nursing care, and
non-nursing custodial care provided in a nursing home or at a
residence of the insured.
(b) This Article does not apply to policies of accident
and health insurance issued in compliance with Article XIXB
of this Code.
(c) A policy issued and delivered in this State that
provides coverage under that policy for certificate holders
who are neither residents of nor employed in this State does
not need to provide to those nonresident certificate holders
who are not employed in this State the coverages or services
mandated by this Article.
(d) Stop-loss insurance is exempt from all Sections of
this Article, except this Section and Sections 353a, 354,
357.30, and 370. For purposes of this exemption, stop-loss
insurance is further defined as follows:
(1) The policy must be issued to and insure an
employer, trustee, or other sponsor of the plan, or the
plan itself, but not employees, members, or participants.
(2) Payments by the insurer must be made to the
employer, trustee, or other sponsors of the plan, or the
plan itself, but not to the employees, members,
participants, or health care providers.
(e) A policy issued or delivered in this State to the
Illinois Department of Public Aid and providing coverage,
under clause (b) of Class 1 or clause (a) of Class 2 as
described in Section 4, to persons who are enrolled in the
integrated health care program established under Article V
Section 5-16.3 of the Illinois Public Aid Code or under the
Children's Health Insurance Program Act is exempt from all
restrictions, limitations, standards, rules, or regulations
respecting benefits imposed by or under authority of this
Code, except those specified by subsection (1) of Section
143. Nothing in this subsection, however, affects the total
medical services available to persons eligible for medical
assistance under the Illinois Public Aid Code.
(Source: P.A. 87-435; 87-757; 87-938; 87-956; 88-364; 88-554,
eff. 7-26-94.)
Section 20. The Health Maintenance Organization Act is
amended by changing Sections 1-2, 2-1, and 6-3 as follows:
(215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402)
Sec. 1-2. Definitions. As used in this Act, unless the
context otherwise requires, the following terms shall have
the meanings ascribed to them:
(1) "Advertisement" means any printed or published
material, audiovisual material and descriptive literature of
the health care plan used in direct mail, newspapers,
magazines, radio scripts, television scripts, billboards and
similar displays; and any descriptive literature or sales
aids of all kinds disseminated by a representative of the
health care plan for presentation to the public including,
but not limited to, circulars, leaflets, booklets,
depictions, illustrations, form letters and prepared sales
presentations.
(2) "Director" means the Director of Insurance.
(3) "Basic health care services" means emergency care,
and inpatient hospital and physician care, outpatient medical
services, mental health services and care for alcohol and
drug abuse, including any reasonable deductibles and
co-payments, all of which are subject to such limitations as
are determined by the Director pursuant to rule.
(4) "Enrollee" means an individual who has been enrolled
in a health care plan.
(5) "Evidence of coverage" means any certificate,
agreement, or contract issued to an enrollee setting out the
coverage to which he is entitled in exchange for a per capita
prepaid sum.
(6) "Group contract" means a contract for health care
services which by its terms limits eligibility to members of
a specified group.
(7) "Health care plan" means any arrangement whereby any
organization undertakes to provide or arrange for and pay for
or reimburse the cost of basic health care services from
providers selected by the Health Maintenance Organization and
such arrangement consists of arranging for or the provision
of such health care services, as distinguished from mere
indemnification against the cost of such services, except as
otherwise authorized by Section 2-3 of this Act, on a per
capita prepaid basis, through insurance or otherwise. A
"health care plan" also includes any arrangement whereby an
organization undertakes to provide or arrange for or pay for
or reimburse the cost of any health care service for persons
who are enrolled in the integrated health care program
established under Article V Section 5-16.3 of the Illinois
Public Aid Code or under the Children's Health Insurance
Program Act through providers selected by the organization
and the arrangement consists of making provision for the
delivery of health care services, as distinguished from mere
indemnification. A "health care plan" also includes any
arrangement pursuant to Section 4-17. Nothing in this
definition, however, affects the total medical services
available to persons eligible for medical assistance under
the Illinois Public Aid Code.
(8) "Health care services" means any services included
in the furnishing to any individual of medical or dental
care, or the hospitalization or incident to the furnishing of
such care or hospitalization as well as the furnishing to any
person of any and all other services for the purpose of
preventing, alleviating, curing or healing human illness or
injury.
(9) "Health Maintenance Organization" means any
organization formed under the laws of this or another state
to provide or arrange for one or more health care plans under
a system which causes any part of the risk of health care
delivery to be borne by the organization or its providers.
(10) "Net worth" means admitted assets, as defined in
Section 1-3 of this Act, minus liabilities.
(11) "Organization" means any insurance company, a
nonprofit corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act, or a
corporation organized under the laws of this or another state
for the purpose of operating one or more health care plans
and doing no business other than that of a Health Maintenance
Organization or an insurance company. "Organization" shall
also mean the University of Illinois Hospital as defined in
the University of Illinois Hospital Act.
(12) "Provider" means any physician, hospital facility,
or other person which is licensed or otherwise authorized to
furnish health care services and also includes any other
entity that arranges for the delivery or furnishing of health
care service.
(13) "Producer" means a person directly or indirectly
associated with a health care plan who engages in
solicitation or enrollment.
(14) "Per capita prepaid" means a basis of prepayment by
which a fixed amount of money is prepaid per individual or
any other enrollment unit to the Health Maintenance
Organization or for health care services which are provided
during a definite time period regardless of the frequency or
extent of the services rendered by the Health Maintenance
Organization, except for copayments and deductibles and
except as provided in subsection (f) of Section 5-3 of this
Act.
(15) "Subscriber" means a person who has entered into a
contractual relationship with the Health Maintenance
Organization for the provision of or arrangement of at least
basic health care services to the beneficiaries of such
contract.
(Source: P.A. 89-90, eff. 6-30-95; 90-177, eff. 7-23-97;
90-372, eff. 7-1-98; 90-376, eff. 8-14-97; 90-655, eff.
7-30-98.)
(215 ILCS 125/2-1) (from Ch. 111 1/2, par. 1403)
Sec. 2-1. Certificate of authority - Exception for
corporate employee programs - Applications - Material
modification of operation.
(a) No organization shall establish or operate a Health
Maintenance Organization in this State without obtaining a
certificate of authority under this Act. No person other
than an organization may lawfully establish or operate a
Health Maintenance Organization in this State. This Act
shall not apply to the establishment and operation of a
Health Maintenance Organization exclusively providing or
arranging for health care services to employees of a
corporate affiliate of such Health Maintenance Organization.
This exclusion shall be available only to those Health
Maintenance Organizations which require employee
contributions which equal less than 50% of the total cost of
the health care plan, with the remainder of the cost being
paid by the corporate affiliate which is the employer of the
participants in the plan. This Act shall not apply to the
establishment and operation of a Health Maintenance
Organization exclusively providing or arranging health care
services under contract with the State to persons committed
to the custody of the Illinois Department of Corrections.
This Act does not apply to the establishment and operation of
(i) a managed care community network providing or arranging
health care services under contract with the State
exclusively to persons who are enrolled in the integrated
health care program established under Section 5-16.3 of the
Illinois Public Aid Code or (ii) a managed care community
network owned, operated, or governed by a county provider as
defined in Section 15-1 of that Code.
This Act does not apply to the establishment and
operation of managed care community networks that are
certified as risk-bearing entities under Section 5-11 of the
Illinois Public Aid Code and that contract with the Illinois
Department of Public Aid pursuant to that Section.
(b) Any organization may apply to the Director for and
obtain a certificate of authority to establish and operate a
Health Maintenance Organization in compliance with this Act.
A foreign corporation may qualify under this Act, subject to
its registration to do business in this State as a foreign
corporation.
(c) Each application for a certificate of authority
shall be filed in triplicate and verified by an officer or
authorized representative of the applicant, shall be in a
form prescribed by the Director, and shall set forth, without
limiting what may be required by the Director, the following:
(1) A copy of the organizational document;
(2) A copy of the bylaws, rules and regulations, or
similar document regulating the conduct of the internal
affairs of the applicant, which shall include a mechanism
to afford the enrollees an opportunity to participate in
an advisory capacity in matters of policy and operations;
(3) A list of the names, addresses, and official
positions of the persons who are to be responsible for
the conduct of the affairs of the applicant; including,
but not limited to, all members of the board of
directors, executive committee, the principal officers,
and any person or entity owning or having the right to
acquire 10% or more of the voting securities or
subordinated debt of the applicant;
(4) A statement generally describing the applicant,
geographic area to be served, its facilities, personnel
and the health care services to be offered;
(5) A copy of the form of any contract made or to
be made between the applicant and any providers regarding
the provision of health care services to enrollees;
(6) A copy of the form of any contract made or to
be made between the applicant and any person listed in
paragraph (3) of this subsection;
(7) A copy of the form of any contract made or to
be made between the applicant and any person,
corporation, partnership or other entity for the
performance on the applicant's behalf of any functions
including, but not limited to, marketing, administration,
enrollment, investment management and subcontracting for
the provision of health services to enrollees;
(8) A copy of the form of any group contract which
is to be issued to employers, unions, trustees, or other
organizations and a copy of any form of evidence of
coverage to be issued to any enrollee or subscriber and
any advertising material;
(9) Descriptions of the applicant's procedures for
resolving enrollee grievances which must include
procedures providing for enrollees participation in the
resolution of grievances;
(10) A copy of the applicant's most recent
financial statements audited by an independent certified
public accountant. If the financial affairs of the
applicant's parent company are audited by an independent
certified public accountant but those of the applicant
are not, then a copy of the most recent audited financial
statement of the applicant's parent, attached to which
shall be consolidating financial statements of the parent
including separate unaudited financial statements of the
applicant, unless the Director determines that additional
or more recent financial information is required for the
proper administration of this Act;
(11) A copy of the applicant's financial plan,
including a three-year projection of anticipated
operating results, a statement of the sources of working
capital, and any other sources of funding and provisions
for contingencies;
(12) A description of rate methodology;
(13) A description of the proposed method of
marketing;
(14) A copy of every filing made with the Illinois
Secretary of State which relates to the applicant's
registered agent or registered office;
(15) A description of the complaint procedures to
be established and maintained as required under Section
4-6 of this Act;
(16) A description, in accordance with regulations
promulgated by the Illinois Department of Public Health,
of the quality assessment and utilization review
procedures to be utilized by the applicant;
(17) The fee for filing an application for issuance
of a certificate of authority provided in Section 408 of
the Illinois Insurance Code, as now or hereafter amended;
and
(18) Such other information as the Director may
reasonably require to make the determinations required by
this Act.
(Source: P.A. 90-618, eff. 7-10-98.)
(215 ILCS 125/6-3) (from Ch. 111 1/2, par. 1418.3)
Sec. 6-3. Scope. This Article applies to direct
individual contracts, group contracts and certificates issued
thereunder, or any other evidence of coverage, each of which
provides for coverage under a health care plan, and has been
issued by organizations licensed to transact health
maintenance organization business in this State under the
Health Maintenance Organization Act, but not to any business
of such organization not transacted under its health
maintenance organization certificate of authority. This
Article does not apply to (i) a managed care community
network providing or arranging health care services under
contract with the State exclusively to persons who are
enrolled in the integrated health care program established
under Section 5-16.3 of the Illinois Public Aid Code or (ii)
a managed care community network owned, operated, or governed
by a county provider as defined in Section 15-1 of that Code.
(Source: P.A. 88-554, eff. 7-26-94.)
Section 25. The Health Care Worker Self-Referral Act is
amended by changing Section 20 as follows:
(225 ILCS 47/20)
Sec. 20. Prohibited referrals and claims for payment.
(a) A health care worker shall not refer a patient for
health services to an entity outside the health care worker's
office or group practice in which the health care worker is
an investor, unless the health care worker directly provides
health services within the entity and will be personally
involved with the provision of care to the referred patient.
(b) Pursuant to Board determination that the following
exception is applicable, a health care worker may invest in
and refer to an entity, whether or not the health care worker
provides direct services within said entity, if there is a
demonstrated need in the community for the entity and
alternative financing is not available. For purposes of this
subsection (b), "demonstrated need" in the community for the
entity may exist if (1) there is no facility of reasonable
quality that provides medically appropriate service, (2) use
of existing facilities is onerous or creates too great a
hardship for patients, (3) the entity is formed to own or
lease medical equipment which replaces obsolete or otherwise
inadequate equipment in or under the control of a hospital
located in a federally designated health manpower shortage
area, or (4) such other standards as established, by rule, by
the Board. "Community" shall be defined as a metropolitan
area for a city, and a county for a rural area. In addition,
the following provisions must be met to be exempt under this
Section:
(1) Individuals who are not in a position to refer
patients to an entity are given a bona fide opportunity
to also invest in the entity on the same terms as those
offered a referring health care worker; and
(2) No health care worker who invests shall be
required or encouraged to make referrals to the entity or
otherwise generate business as a condition of becoming or
remaining an investor; and
(3) The entity shall market or furnish its services
to referring health care worker investors and other
investors on equal terms; and
(4) The entity shall not loan funds or guarantee
any loans for health care workers who are in a position
to refer to an entity; and
(5) The income on the health care worker's
investment shall be tied to the health care worker's
equity in the facility rather than to the volume of
referrals made; and
(6) Any investment contract between the entity and
the health care worker shall not include any covenant or
non-competition clause that prevents a health care worker
from investing in other entities; and
(7) When making a referral, a health care worker
must disclose his investment interest in an entity to the
patient being referred to such entity. If alternative
facilities are reasonably available, the health care
worker must provide the patient with a list of
alternative facilities. The health care worker shall
inform the patient that they have the option to use an
alternative facility other than one in which the health
care worker has an investment interest and the patient
will not be treated differently by the health care worker
if the patient chooses to use another entity. This shall
be applicable to all health care worker investors,
including those who provide direct care or services for
their patients in entities outside their office
practices; and
(8) If a third party payor requests information
with regard to a health care worker's investment
interest, the same shall be disclosed; and
(9) The entity shall establish an internal
utilization review program to ensure that investing
health care workers provided appropriate or necessary
utilization; and
(10) If a health care worker's financial interest
in an entity is incompatible with a referred patient's
interest, the health care worker shall make alternative
arrangements for the patient's care.
The Board shall make such a determination for a health
care worker within 90 days of a completed written request.
Failure to make such a determination within the 90 day time
frame shall mean that no alternative is practical based upon
the facts set forth in the completed written request.
(c) It shall not be a violation of this Act for a health
care worker to refer a patient for health services to a
publicly traded entity in which he or she has an investment
interest provided that:
(1) the entity is listed for trading on the New
York Stock Exchange or on the American Stock Exchange, or
is a national market system security traded under an
automated inter-dealer quotation system operated by the
National Association of Securities Dealers; and
(2) the entity had, at the end of the corporation's
most recent fiscal year, total net assets of at least
$30,000,000 related to the furnishing of health services;
and
(3) any investment interest obtained after the
effective date of this Act is traded on the exchanges
listed in paragraph 1 of subsection (c) of this Section
after the entity became a publicly traded corporation;
and
(4) the entity markets or furnishes its services to
referring health care worker investors and other health
care workers on equal terms; and
(5) all stock held in such publicly traded
companies, including stock held in the predecessor
privately held company, shall be of one class without
preferential treatment as to status or remuneration; and
(6) the entity does not loan funds or guarantee any
loans for health care workers who are in a position to be
referred to an entity; and
(7) the income on the health care worker's
investment is tied to the health care worker's equity in
the entity rather than to the volume of referrals made;
and
(8) the investment interest does not exceed 1/2 of
1% of the entity's total equity.
(d) Any hospital licensed under the Hospital Licensing
Act shall not discriminate against or otherwise penalize a
health care worker for compliance with this Act.
(e) Any health care worker or other entity shall not
enter into an arrangement or scheme seeking to make referrals
to another health care worker or entity based upon the
condition that the health care worker or entity will make
referrals with an intent to evade the prohibitions of this
Act by inducing patient referrals which would be prohibited
by this Section if the health care worker or entity made the
referral directly.
(f) If compliance with the need and alternative investor
criteria is not practical, the health care worker shall
identify to the patient reasonably available alternative
facilities. The Board shall, by rule, designate when
compliance is "not practical".
(g) Health care workers may request from the Board that
it render an advisory opinion that a referral to an existing
or proposed entity under specified circumstances does or does
not violate the provisions of this Act. The Board's opinion
shall be presumptively correct. Failure to render such an
advisory opinion within 90 days of a completed written
request pursuant to this Section shall create a rebuttable
presumption that a referral described in the completed
written request is not or will not be a violation of this
Act.
(h) Notwithstanding any provision of this Act to the
contrary, a health care worker may refer a patient, who is a
member of a health maintenance organization "HMO" licensed in
this State, for health services to an entity, outside the
health care worker's office or group practice, in which the
health care worker is an investor, provided that any such
referral is made pursuant to a contract with the HMO.
Furthermore, notwithstanding any provision of this Act to the
contrary, a health care worker may refer an enrollee of a
"managed care community network", as defined in subsection
(b) of Section 5-11 5-16.3 of the Illinois Public Aid Code,
for health services to an entity, outside the health care
worker's office or group practice, in which the health care
worker is an investor, provided that any such referral is
made pursuant to a contract with the managed care community
network.
(Source: P.A. 87-1207; 88-554, eff. 7-26-94.)
Section 30. The Illinois Public Aid Code is amended by
changing Sections 5-11, 5-16.9, 5-16.11, 15-2, 15-3, 15-4,
and 15-5 as follows:
(305 ILCS 5/5-11) (from Ch. 23, par. 5-11)
Sec. 5-11. Co-operative arrangements; contracts with
other State agencies, health care and rehabilitation
organizations, and fiscal intermediaries.
(a) The Illinois Department may enter into co-operative
arrangements with State agencies responsible for
administering or supervising the administration of health
services and vocational rehabilitation services to the end
that there may be maximum utilization of such services in the
provision of medical assistance.
The Illinois Department shall, not later than June 30,
1993, enter into one or more co-operative arrangements with
the Department of Mental Health and Developmental
Disabilities providing that the Department of Mental Health
and Developmental Disabilities will be responsible for
administering or supervising all programs for services to
persons in community care facilities for persons with
developmental disabilities, including but not limited to
intermediate care facilities, that are supported by State
funds or by funding under Title XIX of the federal Social
Security Act. The responsibilities of the Department of
Mental Health and Developmental Disabilities under these
agreements are transferred to the Department of Human
Services as provided in the Department of Human Services Act.
The Department may also contract with such State health
and rehabilitation agencies and other public or private
health care and rehabilitation organizations to act for it in
supplying designated medical services to persons eligible
therefor under this Article. Any contracts with health
services or health maintenance organizations shall be
restricted to organizations which have been certified as
being in compliance with standards promulgated pursuant to
the laws of this State governing the establishment and
operation of health services or health maintenance
organizations. The Department may also contract with
insurance companies or other corporate entities serving as
fiscal intermediaries in this State for the Federal
Government in respect to Medicare payments under Title XVIII
of the Federal Social Security Act to act for the Department
in paying medical care suppliers. The provisions of Section
9 of "An Act in relation to State finance", approved June 10,
1919, as amended, notwithstanding, such contracts with State
agencies, other health care and rehabilitation organizations,
or fiscal intermediaries may provide for advance payments.
(b) For purposes of this subsection (b), "managed care
community network" means an entity, other than a health
maintenance organization, that is owned, operated, or
governed by providers of health care services within this
State and that provides or arranges primary, secondary, and
tertiary managed health care services under contract with the
Illinois Department exclusively to persons participating in
programs administered by the Illinois Department.
The Illinois Department may certify managed care
community networks, including managed care community networks
owned, operated, managed, or governed by State-funded medical
schools, as risk-bearing entities eligible to contract with
the Illinois Department as Medicaid managed care
organizations. The Illinois Department may contract with
those managed care community networks to furnish health care
services to or arrange those services for individuals
participating in programs administered by the Illinois
Department. The rates for those provider-sponsored
organizations may be determined on a prepaid, capitated
basis. A managed care community network may choose to
contract with the Illinois Department to provide only
pediatric health care services. The Illinois Department shall
by rule adopt the criteria, standards, and procedures by
which a managed care community network may be permitted to
contract with the Illinois Department and shall consult with
the Department of Insurance in adopting these rules.
A county provider as defined in Section 15-1 of this Code
may contract with the Illinois Department to provide primary,
secondary, or tertiary managed health care services as a
managed care community network without the need to establish
a separate entity and shall be deemed a managed care
community network for purposes of this Code only to the
extent it provides services to participating individuals. A
county provider is entitled to contract with the Illinois
Department with respect to any contracting region located in
whole or in part within the county. A county provider is not
required to accept enrollees who do not reside within the
county.
In order to (i) accelerate and facilitate the development
of integrated health care in contracting areas outside
counties with populations in excess of 3,000,000 and counties
adjacent to those counties and (ii) maintain and sustain the
high quality of education and residency programs coordinated
and associated with local area hospitals, the Illinois
Department may develop and implement a demonstration program
from managed care community networks owned, operated,
managed, or governed by State-funded medical schools. The
Illinois Department shall prescribe by rule the criteria,
standards, and procedures for effecting this demonstration
program.
A managed care community network that contracts with the
Illinois Department to furnish health care services to or
arrange those services for enrollees participating in
programs administered by the Illinois Department shall do all
of the following:
(1) Provide that any provider affiliated with the
managed care community network may also provide services
on a fee-for-service basis to Illinois Department clients
not enrolled in such managed care entities.
(2) Provide client education services as determined
and approved by the Illinois Department, including but
not limited to (i) education regarding appropriate
utilization of health care services in a managed care
system, (ii) written disclosure of treatment policies and
restrictions or limitations on health services,
including, but not limited to, physical services,
clinical laboratory tests, hospital and surgical
procedures, prescription drugs and biologics, and
radiological examinations, and (iii) written notice that
the enrollee may receive from another provider those
covered services that are not provided by the managed
care community network.
(3) Provide that enrollees within the system may
choose the site for provision of services and the panel
of health care providers.
(4) Not discriminate in enrollment or disenrollment
practices among recipients of medical services or
enrollees based on health status.
(5) Provide a quality assurance and utilization
review program that meets the requirements established by
the Illinois Department in rules that incorporate those
standards set forth in the Health Maintenance
Organization Act.
(6) Issue a managed care community network
identification card to each enrollee upon enrollment.
The card must contain all of the following:
(A) The enrollee's health plan.
(B) The name and telephone number of the
enrollee's primary care physician or the site for
receiving primary care services.
(C) A telephone number to be used to confirm
eligibility for benefits and authorization for
services that is available 24 hours per day, 7 days
per week.
(7) Ensure that every primary care physician and
pharmacy in the managed care community network meets the
standards established by the Illinois Department for
accessibility and quality of care. The Illinois
Department shall arrange for and oversee an evaluation of
the standards established under this paragraph (7) and
may recommend any necessary changes to these standards.
(8) Provide a procedure for handling complaints
that meets the requirements established by the Illinois
Department in rules that incorporate those standards set
forth in the Health Maintenance Organization Act.
(9) Maintain, retain, and make available to the
Illinois Department records, data, and information, in a
uniform manner determined by the Illinois Department,
sufficient for the Illinois Department to monitor
utilization, accessibility, and quality of care.
(10) Provide that the pharmacy formulary used by
the managed care community network and its contract
providers be no more restrictive than the Illinois
Department's pharmaceutical program on the effective date
of this amendatory Act of 1998 and as amended after that
date.
The Illinois Department shall contract with an entity or
entities to provide external peer-based quality assurance
review for the managed health care programs administered by
the Illinois Department. The entity shall be representative
of Illinois physicians licensed to practice medicine in all
its branches and have statewide geographic representation in
all specialities of medical care that are provided in managed
health care programs administered by the Illinois Department.
The entity may not be a third party payer and shall maintain
offices in locations around the State in order to provide
service and continuing medical education to physician
participants within those managed health care programs
administered by the Illinois Department. The review process
shall be developed and conducted by Illinois physicians
licensed to practice medicine in all its branches. In
consultation with the entity, the Illinois Department may
contract with other entities for professional peer-based
quality assurance review of individual categories of services
other than services provided, supervised, or coordinated by
physicians licensed to practice medicine in all its branches.
The Illinois Department shall establish, by rule, criteria to
avoid conflicts of interest in the conduct of quality
assurance activities consistent with professional peer-review
standards. All quality assurance activities shall be
coordinated by the Illinois Department.
Each managed care community network must demonstrate its
ability to bear the financial risk of serving individuals
under this program. The Illinois Department shall by rule
adopt standards for assessing the solvency and financial
soundness of each managed care community network. Any
solvency and financial standards adopted for managed care
community networks shall be no more restrictive than the
solvency and financial standards adopted under Section
1856(a) of the Social Security Act for provider-sponsored
organizations under Part C of Title XVIII of the Social
Security Act.
The Illinois Department may implement the amendatory
changes to this Code made by this amendatory Act of 1998
through the use of emergency rules in accordance with Section
5-45 of the Illinois Administrative Procedure Act. For
purposes of that Act, the adoption of rules to implement
these changes is deemed an emergency and necessary for the
public interest, safety, and welfare.
(c) Not later than June 30, 1996, the Illinois
Department shall enter into one or more cooperative
arrangements with the Department of Public Health for the
purpose of developing a single survey for nursing facilities,
including but not limited to facilities funded under Title
XVIII or Title XIX of the federal Social Security Act or
both, which shall be administered and conducted solely by the
Department of Public Health. The Departments shall test the
single survey process on a pilot basis, with both the
Departments of Public Aid and Public Health represented on
the consolidated survey team. The pilot will sunset June 30,
1997. After June 30, 1997, unless otherwise determined by
the Governor, a single survey shall be implemented by the
Department of Public Health which would not preclude staff
from the Department of Public Aid from going on-site to
nursing facilities to perform necessary audits and reviews
which shall not replicate the single State agency survey
required by this Act. This Section shall not apply to
community or intermediate care facilities for persons with
developmental disabilities.
(d) Nothing in this Code in any way limits or otherwise
impairs the authority or power of the Illinois Department to
enter into a negotiated contract pursuant to this Section
with a managed care community network or a health maintenance
organization, as defined in the Health Maintenance
Organization Act, that provides for termination or nonrenewal
of the contract without cause, upon notice as provided in the
contract, and without a hearing.
(Source: P.A. 89-415, eff. 1-1-96; 89-507, eff. 7-1-97;
90-618, eff. 7-10-98.)
(305 ILCS 5/5-16.9)
Sec. 5-16.9. Woman's health care provider. The medical
assistance program is subject to the provisions of Section
356r of the Illinois Insurance Code. The Illinois Department
shall adopt rules to implement the requirements of Section
356r of the Illinois Insurance Code in the medical assistance
program including managed care components defined in Section
5-16.3.
(Source: P.A. 89-514, eff. 7-17-96.)
(305 ILCS 5/5-16.11)
Sec. 5-16.11. Uniform standards applied to managed care
entities. Any managed care entity providing services under
this Code shall use a pharmacy formulary that is no more
restrictive than the Illinois Department's pharmaceutical
program comply with the criteria, standards, and procedures
imposed on managed care entities under paragraph (14) of
subsection (d) of Section 5-16.3 of this Code.
(Source: P.A. 90-538, eff. 12-1-97.)
(305 ILCS 5/15-2) (from Ch. 23, par. 15-2)
Sec. 15-2. County Provider Trust Fund.
(a) There is created in the State Treasury the County
Provider Trust Fund. Interest earned by the Fund shall be
credited to the Fund. The Fund shall not be used to replace
any funds appropriated to the Medicaid program by the General
Assembly.
(b) The Fund is created solely for the purposes of
receiving, investing, and distributing monies in accordance
with this Article XV. The Fund shall consist of:
(1) All monies collected or received by the
Illinois Department under Section 15-3 of this Code;
(2) All federal financial participation monies
received by the Illinois Department pursuant to Title XIX
of the Social Security Act, 42 U.S.C. 1396(b),
attributable to eligible expenditures made by the
Illinois Department pursuant to Section 15-5 of this
Code;
(3) All federal moneys received by the Illinois
Department pursuant to Title XXI of the Social Security
Act attributable to eligible expenditures made by the
Illinois Department pursuant to Section 15-5 of this
Code; and
(4) All other monies received by the Fund from any
source, including interest thereon.
(c) Disbursements from the Fund shall be by warrants
drawn by the State Comptroller upon receipt of vouchers duly
executed and certified by the Illinois Department and shall
be made only:
(1) For hospital inpatient care, hospital
outpatient care, care provided by other outpatient
facilities operated by a county, and disproportionate
share hospital payments made under Title XIX of the
Social Security Act and Article V of this Code as
required by Section 15-5 of this Code;
(1.5) For services provided by county providers
pursuant to Section 5-11 or 5-16.3 of this Code;
(2) For the reimbursement of administrative
expenses incurred by county providers on behalf of the
Illinois Department as permitted by Section 15-4 of this
Code;
(3) For the reimbursement of monies received by the
Fund through error or mistake;
(4) For the payment of administrative expenses
necessarily incurred by the Illinois Department or its
agent in performing the activities required by this
Article XV;
(5) For the payment of any amounts that are
reimbursable to the federal government, attributable
solely to the Fund, and required to be paid by State
warrant; and
(6) For hospital inpatient care, hospital
outpatient care, care provided by other outpatient
facilities operated by a county, and disproportionate
share hospital payments made under Title XXI of the
Social Security Act, pursuant to Section 15-5 of this
Code.
(Source: P.A. 90-618, eff. 7-10-98; 91-24, eff. 7-1-99.)
(305 ILCS 5/15-3) (from Ch. 23, par. 15-3)
Sec. 15-3. Intergovernmental Transfers.
(a) Each qualifying county shall make an annual
intergovernmental transfer to the Illinois Department in an
amount equal to 71.7% of the difference between the total
payments made by the Illinois Department to such county
provider for hospital services under Titles XIX and XXI of
the Social Security Act or pursuant to Section 5-11 or 5-16.3
of this Code in each fiscal year ending June 30 (or fraction
thereof during the fiscal year ending June 30, 1993) and
$108,800,000 (or fraction thereof), except that the annual
intergovernmental transfer shall not exceed the total
payments made by the Illinois Department to such county
provider for hospital services under this Code or pursuant to
Section 5-16.3 of this Code, less the sum of (i) 50% of
payments reimbursable under the Social Security Act at a rate
of 50% and (ii) 65% of payments reimbursable under the Social
Security Act at a rate of 65%, in each fiscal year ending
June 30 (or fraction thereof).
(b) The payment schedule for the intergovernmental
transfer made hereunder shall be established by
intergovernmental agreement between the Illinois Department
and the applicable county, which agreement shall at a minimum
provide:
(1) For periodic payments no less frequently than
monthly to the county provider for inpatient and
outpatient approved or adjudicated claims and for
disproportionate share payments under Section 5-5.02 of
this Code (in the initial year, for services after July
1, 1991, or such other date as an approved State Medical
Assistance Plan shall provide) and to the county provider
pursuant to Section 5-16.3 of this Code.
(2) For periodic payments no less frequently than
monthly to the county provider for supplemental
disproportionate share payments hereunder based on a
federally approved State Medical Assistance Plan.
(3) For calculation of the intergovernmental
transfer payment to be made by the county equal to 71.7%
of the difference between the amount of the periodic
payment and the base amount; provided, however, that if
the periodic payment for any period is less than the base
amount for such period, the base amount for the
succeeding period (and any successive period if
necessary) shall be increased by the amount of such
shortfall.
(4) For an intergovernmental transfer methodology
which obligates the Illinois Department to notify the
county and county provider in writing of each impending
periodic payment and the intergovernmental transfer
payment attributable thereto and which obligates the
Comptroller to release the periodic payment to the county
provider within one working day of receipt of the
intergovernmental transfer payment from the county.
(Source: P.A. 90-618, eff. 7-10-98; 91-24, eff. 7-1-99.)
(305 ILCS 5/15-4) (from Ch. 23, par. 15-4)
Sec. 15-4. Contractual assumption of certain expenses.
Hospitals may, at their election, by written agreement
between the counties owning and operating the hospitals and
the Illinois Department, assume specified expenses of the
operation of the Illinois Department associated with the
determination of eligibility, direct payment of which
expenses by the Illinois Department would qualify as public
funds expended by the Illinois Department for the Illinois
Medical Assistance Program or other health care programs
administered by the Illinois Department. The Illinois
Department shall open an adequately staffed special on-site
office or offices at facilities designated by the county for
the purpose of assisting the county in ensuring that all
eligible individuals are enrolled in the Illinois Medical
Assistance Program and, to the extent that enrollment into
the integrated health care program established under Section
5-16.3 of this Code is conducted at local public assistance
offices in the county, for the purpose of enrollment of
persons into any managed health care entity operated by the
county. The enrollment process shall meet the requirements
of subsection (e) of Section 5-16.3. Each such agreement,
executed in accordance with Section 3 of the
Intergovernmental Cooperation Act, shall describe the
operational expenses to be assumed in sufficient detail to
permit the Illinois Department to certify upon such written
obligation or performance thereunder that the hospital's
compliance with the terms of the agreement will amount to the
commitment of public funds eligible for the federal financial
participation or other federal funding called for in Title
XIX or Title XXI of the Social Security Act.
(Source: P.A. 91-24, eff. 7-1-99.)
(305 ILCS 5/15-5) (from Ch. 23, par. 15-5)
Sec. 15-5. Disbursements from the Fund.
(a) The monies in the Fund shall be disbursed only as
provided in Section 15-2 of this Code and as follows:
(1) To pay the county hospitals' inpatient
reimbursement rate based on actual costs, trended forward
annually by an inflation index and supplemented by
teaching, capital, and other direct and indirect costs,
according to a State plan approved by the federal
government. Effective October 1, 1992, the inpatient
reimbursement rate (including any disproportionate or
supplemental disproportionate share payments) for
hospital services provided by county operated facilities
within the County shall be no less than the reimbursement
rates in effect on June 1, 1992, except that this minimum
shall be adjusted as of July 1, 1992 and each July 1
thereafter by the annual percentage change in the per
diem cost of inpatient hospital services as reported in
the most recent annual Medicaid cost report.
(2) To pay county hospitals and county operated
outpatient facilities for outpatient services based on a
federally approved methodology to cover the maximum
allowable costs per patient visit. Effective October 1,
1992, the outpatient reimbursement rate for outpatient
services provided by county hospitals and county operated
outpatient facilities shall be no less than the
reimbursement rates in effect on June 1, 1992, except
that this minimum shall be adjusted as of July 1, 1992
and each July 1 thereafter by the annual percentage
change in the per diem cost of inpatient hospital
services as reported in the most recent annual Medicaid
cost report.
(3) To pay the county hospitals' disproportionate
share payments as established by the Illinois Department
under Section 5-5.02 of this Code. Effective October 1,
1992, the disproportionate share payments for hospital
services provided by county operated facilities within
the County shall be no less than the reimbursement rates
in effect on June 1, 1992, except that this minimum shall
be adjusted as of July 1, 1992 and each July 1 thereafter
by the annual percentage change in the per diem cost of
inpatient hospital services as reported in the most
recent annual Medicaid cost report.
(3.5) To pay county providers for services provided
pursuant to Section 5-11 or 5-16.3 of this Code.
(4) To reimburse the county providers for expenses
contractually assumed pursuant to Section 15-4 of this
Code.
(5) To pay the Illinois Department its necessary
administrative expenses relative to the Fund and other
amounts agreed to, if any, by the county providers in the
agreement provided for in subsection (c).
(6) To pay the county hospitals' supplemental
disproportionate share payments, hereby authorized, as
specified in the agreement provided for in subsection (c)
and according to a federally approved State plan.
Effective October 1, 1992, the supplemental
disproportionate share payments for hospital services
provided by county operated facilities within the County
shall be no less than the reimbursement rates in effect
on June 1, 1992, except that this minimum shall be
adjusted as of July 1, 1992 and each July 1 thereafter by
the annual percentage change in the per diem cost of
inpatient hospital services as reported in the most
recent annual Medicaid cost report.
(b) The Illinois Department shall promptly seek all
appropriate amendments to the Illinois State Plan to effect
the foregoing payment methodology.
(c) The Illinois Department shall implement the changes
made by Article 3 of this amendatory Act of 1992 beginning
October 1, 1992. All terms and conditions of the
disbursement of monies from the Fund not set forth expressly
in this Article shall be set forth in the agreement executed
under the Intergovernmental Cooperation Act so long as those
terms and conditions are not inconsistent with this Article
or applicable federal law. The Illinois Department shall
report in writing to the Hospital Service Procurement
Advisory Board and the Health Care Cost Containment Council
by October 15, 1992, the terms and conditions of all such
initial agreements and, where no such initial agreement has
yet been executed with a qualifying county, the Illinois
Department's reasons that each such initial agreement has not
been executed. Copies and reports of amended agreements
following the initial agreements shall likewise be filed by
the Illinois Department with the Hospital Service Procurement
Advisory Board and the Health Care Cost Containment Council
within 30 days following their execution. The foregoing
filing obligations of the Illinois Department are
informational only, to allow the Board and Council,
respectively, to better perform their public roles, except
that the Board or Council may, at its discretion, advise the
Illinois Department in the case of the failure of the
Illinois Department to reach agreement with any qualifying
county by the required date.
(d) The payments provided for herein are intended to
cover services rendered on and after July 1, 1991, and any
agreement executed between a qualifying county and the
Illinois Department pursuant to this Section may relate back
to that date, provided the Illinois Department obtains
federal approval. Any changes in payment rates resulting
from the provisions of Article 3 of this amendatory Act of
1992 are intended to apply to services rendered on or after
October 1, 1992, and any agreement executed between a
qualifying county and the Illinois Department pursuant to
this Section may be effective as of that date.
(e) If one or more hospitals file suit in any court
challenging any part of this Article XV, payments to
hospitals from the Fund under this Article XV 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 and may be disbursed
under any order of the court.
(f) All payments under this Section are contingent upon
federal approval of changes to the State plan, if that
approval is required.
(Source: P.A. 90-618, eff. 7-10-98.)
(305 ILCS 5/5-16.3 rep.)
Section 31. The Illinois Public Aid Code is amended by
repealing Section 5-16.3.
Section 99. Effective date. This Act takes effect upon
becoming law.
Passed in the General Assembly May 23, 2001.
Approved August 15, 2001.
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