Public Act 104-0007
 
HB2771 EnrolledLRB104 08638 BDA 18691 b

    AN ACT concerning health.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Administrative Procedure Act is
amended by adding Section 5-45.65 as follows:
 
    (5 ILCS 100/5-45.65 new)
    Sec. 5-45.65. Emergency rulemaking; Medicaid reimbursement
rates for hospital inpatient and outpatient services. To
provide for the expeditious and timely implementation of the
changes made by this amendatory Act of the 104th General
Assembly to Sections 5A-2, 5A-7, 5A-8, 5A-10, and 5A-12.7 of
the Illinois Public Aid Code, emergency rules implementing the
changes made by this amendatory Act of the 104th General
Assembly to Sections 5A-2, 5A-7, 5A-8, 5A-10, and 5A-12.7 of
the Illinois Public Aid Code may be adopted in accordance with
Section 5-45 by the Department of Healthcare and Family
Services. The adoption of emergency rules authorized by
Section 5-45 and this Section is deemed necessary for the
public interest, safety, and welfare.
    This Section is repealed one year after the effective date
of this amendatory Act of the 104th General Assembly.
 
    Section 10. The Illinois Public Aid Code is amended by
changing Sections 5A-2, 5A-5, 5A-7, 5A-8, 5A-10, 5A-12.7,
5A-14, and 12-4.105 as follows:
 
    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
    (Section scheduled to be repealed on December 31, 2026)
    Sec. 5A-2. Assessment.
    (a)(1) Subject to Sections 5A-3 and 5A-10, for State
fiscal years 2009 through 2018, or as long as continued under
Section 5A-16, an annual assessment on inpatient services is
imposed on each hospital provider in an amount equal to
$218.38 multiplied by the difference of the hospital's
occupied bed days less the hospital's Medicare bed days,
provided, however, that the amount of $218.38 shall be
increased by a uniform percentage to generate an amount equal
to 75% of the State share of the payments authorized under
Section 5A-12.5, with such increase only taking effect upon
the date that a State share for such payments is required under
federal law. For the period of April through June 2015, the
amount of $218.38 used to calculate the assessment under this
paragraph shall, by emergency rule under subsection (s) of
Section 5-45 of the Illinois Administrative Procedure Act, be
increased by a uniform percentage to generate $20,250,000 in
the aggregate for that period from all hospitals subject to
the annual assessment under this paragraph.
    (2) In addition to any other assessments imposed under
this Article, effective July 1, 2016 and semi-annually
thereafter through June 2018, or as provided in Section 5A-16,
in addition to any federally required State share as
authorized under paragraph (1), the amount of $218.38 shall be
increased by a uniform percentage to generate an amount equal
to 75% of the ACA Assessment Adjustment, as defined in
subsection (b-6) of this Section.
    For State fiscal years 2009 through 2018, or as provided
in Section 5A-16, a hospital's occupied bed days and Medicare
bed days shall be determined using the most recent data
available from each hospital's 2005 Medicare cost report as
contained in the Healthcare Cost Report Information System
file, for the quarter ending on December 31, 2006, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2005 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Illinois Department may obtain the hospital provider's
occupied bed days and Medicare bed days from any source
available, including, but not limited to, records maintained
by the hospital provider, which may be inspected at all times
during business hours of the day by the Illinois Department or
its duly authorized agents and employees.
    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on inpatient
services is imposed on each hospital provider in an amount
equal to $197.19 multiplied by the difference of the
hospital's occupied bed days less the hospital's Medicare bed
days. For State fiscal years 2019 and 2020, a hospital's
occupied bed days and Medicare bed days shall be determined
using the most recent data available from each hospital's 2015
Medicare cost report as contained in the Healthcare Cost
Report Information System file, for the quarter ending on
March 31, 2017, without regard to any subsequent adjustments
or changes to such data. If a hospital's 2015 Medicare cost
report is not contained in the Healthcare Cost Report
Information System, then the Illinois Department may obtain
the hospital provider's occupied bed days and Medicare bed
days from any source available, including, but not limited to,
records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Illinois Department or its duly authorized agents and
employees. Notwithstanding any other provision in this
Article, for a hospital provider that did not have a 2015
Medicare cost report, but paid an assessment in State fiscal
year 2018 on the basis of hypothetical data, that assessment
amount shall be used for State fiscal years 2019 and 2020.
    (4) Subject to Sections 5A-3 and 5A-10 and to subsection
(b-8), for the period of July 1, 2020 through December 31, 2020
and calendar years 2021 through 2024 2026, an annual
assessment on inpatient services is imposed on each hospital
provider in an amount equal to $221.50 multiplied by the
difference of the hospital's occupied bed days less the
hospital's Medicare bed days, provided however: for the period
of July 1, 2020 through December 31, 2020, (i) the assessment
shall be equal to 50% of the annual amount; and (ii) the amount
of $221.50 shall be retroactively adjusted by a uniform
percentage to generate an amount equal to 50% of the
Assessment Adjustment, as defined in subsection (b-7). For the
period of July 1, 2020 through December 31, 2020 and calendar
years 2021 through 2024 2026, a hospital's occupied bed days
and Medicare bed days shall be determined using the most
recent data available from each hospital's 2015 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Illinois Department may obtain the hospital provider's
occupied bed days and Medicare bed days from any source
available, including, but not limited to, records maintained
by the hospital provider, which may be inspected at all times
during business hours of the day by the Illinois Department or
its duly authorized agents and employees. Should the change in
the assessment methodology for fiscal years 2021 through
December 31, 2022 not be approved on or before June 30, 2020,
the assessment and payments under this Article in effect for
fiscal year 2020 shall remain in place until the new
assessment is approved. If the assessment methodology for July
1, 2020 through December 31, 2022, is approved on or after July
1, 2020, it shall be retroactive to July 1, 2020, subject to
federal approval and provided that the payments authorized
under Section 5A-12.7 have the same effective date as the new
assessment methodology. In giving retroactive effect to the
assessment approved after June 30, 2020, credit toward the new
assessment shall be given for any payments of the previous
assessment for periods after June 30, 2020. Notwithstanding
any other provision of this Article, for a hospital provider
that did not have a 2015 Medicare cost report, but paid an
assessment in State Fiscal Year 2020 on the basis of
hypothetical data, the data that was the basis for the 2020
assessment shall be used to calculate the assessment under
this paragraph until December 31, 2023. Beginning July 1, 2022
and through December 31, 2024, a safety-net hospital that had
a change of ownership in calendar year 2021, and whose
inpatient utilization had decreased by 90% from the prior year
and prior to the change of ownership, may be eligible to pay a
tax based on hypothetical data based on a determination of
financial distress by the Department. Subject to federal
approval, the Department may, by January 1, 2024, develop a
hypothetical tax for a specialty cancer hospital which had a
structural change of ownership during calendar year 2022 from
a for-profit entity to a non-profit entity, and which has
experienced a decline of 60% or greater in inpatient days of
care as compared to the prior owners 2015 Medicare cost
report. This change of ownership may make the hospital
eligible for a hypothetical tax under the new hospital
provision of the assessment defined in this Section. This new
hypothetical tax may be applicable from January 1, 2024
through December 31, 2026.
    (5) Subject to Sections 5A-3 and 5A-10, beginning January
1, 2025, an annual assessment on inpatient services is imposed
on each hospital provider in an amount equal to $362, or any
reduction thereof in accordance with this subsection,
multiplied by the difference of the hospital's occupied bed
days less the hospital's Medicare bed days; however, the rate
shall be $221.50 until the Department receives federal
approval and implements the reimbursement rates in subsection
(r) of Section 5A-12.7. The Department may bill for the
difference between the assessment rate of $362, or any
reduction thereof in accordance with this subsection, and
$221.50 no earlier than 17 calendar days after implementing
the reimbursement rates in subsection (r) of Section 5A-12.7.
        (A) Upon receiving federal approval for the
    reimbursement rates in subsection (r) of Section 5A-12.7,
    the Department shall bill the hospital for the incremental
    difference in total tax due resulting from the increase
    provided in this subsection for the number of months from
    January 1, 2025 through the date of federal approval. The
    amount shall be due and payable no later than December 31,
    2025 and no earlier than 17 calendar days after
    implementing the reimbursement rates in subsection (r) of
    Section 5A-12.7. The Department shall bill hospitals in
    the same proportional rate as the Department has
    implemented the inpatient reimbursement rates in
    subsection (r) of Section 5A-12.7.
        (B) Beginning January 1, 2025, a hospital's occupied
    bed days and Medicare bed days shall be determined using
    the most recent data available from each hospital's 2015
    Medicare cost report as contained in the Healthcare Cost
    Report Information System file, for the quarter ending on
    March 31, 2017, without regard to any subsequent
    adjustments or changes to such data. If a hospital's 2015
    Medicare cost report is not contained in the Healthcare
    Cost Report Information System, then the Department may
    obtain the hospital provider's occupied bed days and
    Medicare bed days from any source available, including,
    but not limited to, records maintained by the hospital
    provider, which may be inspected at all times during
    business hours of the day by the Department or its duly
    authorized agents and employees. If the reimbursement
    rates in subsection (r) of Section 5A-12.7 require
    reduction to comply with federal spending limits, then the
    tax rate of $362 shall be reduced, in accordance with
    subsection (s) of Section 5A-12.7, by the same percentage
    reduction to payments required to comply with federal
    spending limits.
    (b) (Blank).
    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
portion of State fiscal year 2012, beginning June 10, 2012
through June 30, 2012, and for State fiscal years 2013 through
2018, or as provided in Section 5A-16, an annual assessment on
outpatient services is imposed on each hospital provider in an
amount equal to .008766 multiplied by the hospital's
outpatient gross revenue, provided, however, that the amount
of .008766 shall be increased by a uniform percentage to
generate an amount equal to 25% of the State share of the
payments authorized under Section 5A-12.5, with such increase
only taking effect upon the date that a State share for such
payments is required under federal law. For the period
beginning June 10, 2012 through June 30, 2012, the annual
assessment on outpatient services shall be prorated by
multiplying the assessment amount by a fraction, the numerator
of which is 21 days and the denominator of which is 365 days.
For the period of April through June 2015, the amount of
.008766 used to calculate the assessment under this paragraph
shall, by emergency rule under subsection (s) of Section 5-45
of the Illinois Administrative Procedure Act, be increased by
a uniform percentage to generate $6,750,000 in the aggregate
for that period from all hospitals subject to the annual
assessment under this paragraph.
    (2) In addition to any other assessments imposed under
this Article, effective July 1, 2016 and semi-annually
thereafter through June 2018, in addition to any federally
required State share as authorized under paragraph (1), the
amount of .008766 shall be increased by a uniform percentage
to generate an amount equal to 25% of the ACA Assessment
Adjustment, as defined in subsection (b-6) of this Section.
    For the portion of State fiscal year 2012, beginning June
10, 2012 through June 30, 2012, and State fiscal years 2013
through 2018, or as provided in Section 5A-16, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2009 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on June 30, 2011, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2009 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on outpatient
services is imposed on each hospital provider in an amount
equal to .01358 multiplied by the hospital's outpatient gross
revenue. For State fiscal years 2019 and 2020, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2015 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
Notwithstanding any other provision in this Article, for a
hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State fiscal year 2018 on the
basis of hypothetical data, that assessment amount shall be
used for State fiscal years 2019 and 2020.
    (4) Subject to Sections 5A-3 and 5A-10 and to subsection
(b-8), for the period of July 1, 2020 through December 31, 2020
and calendar years 2021 through 2024 2026, an annual
assessment on outpatient services is imposed on each hospital
provider in an amount equal to .01525 multiplied by the
hospital's outpatient gross revenue, provided however: (i) for
the period of July 1, 2020 through December 31, 2020, the
assessment shall be equal to 50% of the annual amount; and (ii)
the amount of .01525 shall be retroactively adjusted by a
uniform percentage to generate an amount equal to 50% of the
Assessment Adjustment, as defined in subsection (b-7). For the
period of July 1, 2020 through December 31, 2020 and calendar
years 2021 through 2024 2026, a hospital's outpatient gross
revenue shall be determined using the most recent data
available from each hospital's 2015 Medicare cost report as
contained in the Healthcare Cost Report Information System
file, for the quarter ending on March 31, 2017, without regard
to any subsequent adjustments or changes to such data. If a
hospital's 2015 Medicare cost report is not contained in the
Healthcare Cost Report Information System, then the Illinois
Department may obtain the hospital provider's outpatient
revenue data from any source available, including, but not
limited to, records maintained by the hospital provider, which
may be inspected at all times during business hours of the day
by the Illinois Department or its duly authorized agents and
employees. Should the change in the assessment methodology
above for fiscal years 2021 through calendar year 2022 not be
approved prior to July 1, 2020, the assessment and payments
under this Article in effect for fiscal year 2020 shall remain
in place until the new assessment is approved. If the change in
the assessment methodology above for July 1, 2020 through
December 31, 2022, is approved after June 30, 2020, it shall
have a retroactive effective date of July 1, 2020, subject to
federal approval and provided that the payments authorized
under Section 12A-7 have the same effective date as the new
assessment methodology. In giving retroactive effect to the
assessment approved after June 30, 2020, credit toward the new
assessment shall be given for any payments of the previous
assessment for periods after June 30, 2020. Notwithstanding
any other provision of this Article, for a hospital provider
that did not have a 2015 Medicare cost report, but paid an
assessment in State Fiscal Year 2020 on the basis of
hypothetical data, the data that was the basis for the 2020
assessment shall be used to calculate the assessment under
this paragraph until December 31, 2023. Beginning July 1, 2022
and through December 31, 2024, a safety-net hospital that had
a change of ownership in calendar year 2021, and whose
inpatient utilization had decreased by 90% from the prior year
and prior to the change of ownership, may be eligible to pay a
tax based on hypothetical data based on a determination of
financial distress by the Department.
    (5) Subject to Sections 5A-3 and 5A-10, beginning January
1, 2025, an annual assessment on outpatient services is
imposed on each hospital provider in an amount equal to
.03273, or any reduction thereof in accordance with this
subsection, multiplied by the hospital's outpatient gross
revenue; however the rate shall remain .01525, until the
Department receives federal approval and implements the
reimbursement rates of payment in subsection (r) of Section
5A-12.7. The Department may bill for the difference between
the assessment multiplier of .03273 and .01525 no earlier than
17 calendar days after the first payment based on the
reimbursement rates in subsection (r) of Section 5A-12.7.
        (A) Upon receiving federal approval for the
    reimbursement rates in subsection (r) of Section 5A-12.7,
    the Department shall bill the hospital for the incremental
    difference in total tax due resulting from the increase
    provided in this subsection for the number of months from
    January 1, 2025 through the date of federal approval. The
    amount shall be due and payable no later than December 31,
    2025 and no earlier than 17 calendar days after
    implementing the reimbursement rates in subsection (r) of
    Section 5A-12.7. The Department shall bill hospitals in
    the same proportional rate as the Department has
    implemented the outpatient reimbursement rates in
    subsection (r) of Section 5A-12.7.
        (B) Beginning January 1, 2025, a hospital's outpatient
    gross revenue shall be determined using the most recent
    data available from each hospital's 2015 Medicare cost
    report as contained in the Healthcare Cost Report
    Information System file, for the quarter ending on March
    31, 2017, without regard to any subsequent adjustments or
    changes to such data. If a hospital's 2015 Medicare cost
    report is not contained in the Healthcare Cost Report
    Information System, then the Department may obtain the
    hospital provider's outpatient revenue data from any
    source available, including, but not limited to, records
    maintained by the hospital provider, which may be
    inspected at all times during business hours of the day by
    the Department or its duly authorized agents and
    employees. If the reimbursement rates in subsection (r) of
    Section 5A-12.7 require reduction to comply with federal
    spending limits, then the tax rate of .03273 shall be
    reduced, in accordance with subsection (s) of Section
    5A-12.7, by the same percentage reduction to payments
    required to comply with federal spending limits.
    (b-6)(1) As used in this Section, "ACA Assessment
Adjustment" means:
        (A) For the period of July 1, 2016 through December
    31, 2016, the product of .19125 multiplied by the sum of
    the fee-for-service payments to hospitals as authorized
    under Section 5A-12.5 and the adjustments authorized under
    subsection (t) of Section 5A-12.2 to managed care
    organizations for hospital services due and payable in the
    month of April 2016 multiplied by 6.
        (B) For the period of January 1, 2017 through June 30,
    2017, the product of .19125 multiplied by the sum of the
    fee-for-service payments to hospitals as authorized under
    Section 5A-12.5 and the adjustments authorized under
    subsection (t) of Section 5A-12.2 to managed care
    organizations for hospital services due and payable in the
    month of October 2016 multiplied by 6, except that the
    amount calculated under this subparagraph (B) shall be
    adjusted, either positively or negatively, to account for
    the difference between the actual payments issued under
    Section 5A-12.5 for the period beginning July 1, 2016
    through December 31, 2016 and the estimated payments due
    and payable in the month of April 2016 multiplied by 6 as
    described in subparagraph (A).
        (C) For the period of July 1, 2017 through December
    31, 2017, the product of .19125 multiplied by the sum of
    the fee-for-service payments to hospitals as authorized
    under Section 5A-12.5 and the adjustments authorized under
    subsection (t) of Section 5A-12.2 to managed care
    organizations for hospital services due and payable in the
    month of April 2017 multiplied by 6, except that the
    amount calculated under this subparagraph (C) shall be
    adjusted, either positively or negatively, to account for
    the difference between the actual payments issued under
    Section 5A-12.5 for the period beginning January 1, 2017
    through June 30, 2017 and the estimated payments due and
    payable in the month of October 2016 multiplied by 6 as
    described in subparagraph (B).
        (D) For the period of January 1, 2018 through June 30,
    2018, the product of .19125 multiplied by the sum of the
    fee-for-service payments to hospitals as authorized under
    Section 5A-12.5 and the adjustments authorized under
    subsection (t) of Section 5A-12.2 to managed care
    organizations for hospital services due and payable in the
    month of October 2017 multiplied by 6, except that:
            (i) the amount calculated under this subparagraph
        (D) shall be adjusted, either positively or
        negatively, to account for the difference between the
        actual payments issued under Section 5A-12.5 for the
        period of July 1, 2017 through December 31, 2017 and
        the estimated payments due and payable in the month of
        April 2017 multiplied by 6 as described in
        subparagraph (C); and
            (ii) the amount calculated under this subparagraph
        (D) shall be adjusted to include the product of .19125
        multiplied by the sum of the fee-for-service payments,
        if any, estimated to be paid to hospitals under
        subsection (b) of Section 5A-12.5.
    (2) The Department shall complete and apply a final
reconciliation of the ACA Assessment Adjustment prior to June
30, 2018 to account for:
        (A) any differences between the actual payments issued
    or scheduled to be issued prior to June 30, 2018 as
    authorized in Section 5A-12.5 for the period of January 1,
    2018 through June 30, 2018 and the estimated payments due
    and payable in the month of October 2017 multiplied by 6 as
    described in subparagraph (D); and
        (B) any difference between the estimated
    fee-for-service payments under subsection (b) of Section
    5A-12.5 and the amount of such payments that are actually
    scheduled to be paid.
    The Department shall notify hospitals of any additional
amounts owed or reduction credits to be applied to the June
2018 ACA Assessment Adjustment. This is to be considered the
final reconciliation for the ACA Assessment Adjustment.
    (3) Notwithstanding any other provision of this Section,
if for any reason the scheduled payments under subsection (b)
of Section 5A-12.5 are not issued in full by the final day of
the period authorized under subsection (b) of Section 5A-12.5,
funds collected from each hospital pursuant to subparagraph
(D) of paragraph (1) and pursuant to paragraph (2),
attributable to the scheduled payments authorized under
subsection (b) of Section 5A-12.5 that are not issued in full
by the final day of the period attributable to each payment
authorized under subsection (b) of Section 5A-12.5, shall be
refunded.
    (4) The increases authorized under paragraph (2) of
subsection (a) and paragraph (2) of subsection (b-5) shall be
limited to the federally required State share of the total
payments authorized under Section 5A-12.5 if the sum of such
payments yields an annualized amount equal to or less than
$450,000,000, or if the adjustments authorized under
subsection (t) of Section 5A-12.2 are found not to be
actuarially sound; however, this limitation shall not apply to
the fee-for-service payments described in subsection (b) of
Section 5A-12.5.
    (b-7)(1) As used in this Section, "Assessment Adjustment"
means:
        (A) For the period of July 1, 2020 through December
    31, 2020, the product of .3853 multiplied by the total of
    the actual payments made under subsections (c) through (k)
    of Section 5A-12.7 attributable to the period, less the
    total of the assessment imposed under subsections (a) and
    (b-5) of this Section for the period.
        (B) For each calendar quarter beginning January 1,
    2021 through December 31, 2022, the product of .3853
    multiplied by the total of the actual payments made under
    subsections (c) through (k) of Section 5A-12.7
    attributable to the period, less the total of the
    assessment imposed under subsections (a) and (b-5) of this
    Section for the period.
        (C) Beginning on January 1, 2023, and each subsequent
    July 1 and January 1, the product of .3853 multiplied by
    the total of the actual payments made under subsections
    (c) through (j) and subsection (r) of Section 5A-12.7
    attributable to the 6-month period immediately preceding
    the period to which the adjustment applies, less the total
    of the assessment imposed under subsections (a) and (b-5)
    of this Section for the 6-month period immediately
    preceding the period to which the adjustment applies.
    (2) The Department shall calculate and notify each
hospital of the total Assessment Adjustment and any additional
assessment owed by the hospital or refund owed to the hospital
on either a semi-annual or annual basis. Such notice shall be
issued at least 30 days prior to any period in which the
assessment will be adjusted. Any additional assessment owed by
the hospital or refund owed to the hospital shall be uniformly
applied to the assessment owed by the hospital in monthly
installments for the subsequent semi-annual period or calendar
year. If no assessment is owed in the subsequent year, any
amount owed by the hospital or refund due to the hospital,
shall be paid in a lump sum. If the calculation that is
computed under this Section could result in a decrease in the
Department's federal financial participation percentage for
payments authorized under Section 5A-12.7, then the Department
shall instead apply a uniform percentage reduction to the
payment rates outlined in subsection (r) of Section 5A-12.7
for all classes as defined in subsections (g) and (h) of
Section 5A-12.7 by an amount no more than necessary to
maximize federal reimbursement.
    (3) The Department shall publish all details of the
Assessment Adjustment calculation performed each year on its
website within 30 days of completing the calculation, and also
submit the details of the Assessment Adjustment calculation as
part of the Department's annual report to the General
Assembly.
    (b-8) Notwithstanding any other provision of this Article,
the Department shall reduce the assessments imposed on each
hospital under subsections (a) and (b-5) by the uniform
percentage necessary to reduce the total assessment imposed on
all hospitals by an aggregate amount of $240,000,000, with
such reduction being applied by June 30, 2022. The assessment
reduction required for each hospital under this subsection
shall be forever waived, forgiven, and released by the
Department.
    (c) (Blank).
    (d) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules to reduce
the rate of any annual assessment imposed under this Section,
as authorized by Section 5-46.2 of the Illinois Administrative
Procedure Act.
    (e) Notwithstanding any other provision of this Section,
any plan providing for an assessment on a hospital provider as
a permissible tax under Title XIX of the federal Social
Security Act and Medicaid-eligible payments to hospital
providers from the revenues derived from that assessment shall
be reviewed by the Illinois Department of Healthcare and
Family Services, as the Single State Medicaid Agency required
by federal law, to determine whether those assessments and
hospital provider payments meet federal Medicaid standards. If
the Department determines that the elements of the plan may
meet federal Medicaid standards and a related State Medicaid
Plan Amendment is prepared in a manner and form suitable for
submission, that State Plan Amendment shall be submitted in a
timely manner for review by the Centers for Medicare and
Medicaid Services of the United States Department of Health
and Human Services and subject to approval by the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services. No such plan shall become
effective without approval by the Illinois General Assembly by
the enactment into law of related legislation. Notwithstanding
any other provision of this Section, the Department is
authorized to adopt rules to reduce the rate of any annual
assessment imposed under this Section. Any such rules may be
adopted by the Department under Section 5-50 of the Illinois
Administrative Procedure Act.
    (f) To provide for the expeditious and timely
implementation of the changes made to this Section by this
amendatory Act of the 104th General Assembly, the Department
may adopt emergency rules as authorized by Section 5-45 of the
Illinois Administrative Procedure Act. The adoption of
emergency rules is deemed to be necessary for the public
interest, safety, and welfare.
(Source: P.A. 102-886, eff. 5-17-22; 103-102, eff. 1-1-24.)
 
    (305 ILCS 5/5A-5)  (from Ch. 23, par. 5A-5)
    Sec. 5A-5. Notice; penalty; maintenance of records.
    (a) The Illinois Department shall send a notice of
assessment to every hospital provider subject to assessment
under this Article. The notice of assessment shall notify the
hospital of its assessment and shall be sent after receipt by
the Department of notification from the Centers for Medicare
and Medicaid Services of the U.S. Department of Health and
Human Services that the payment methodologies required under
this Article and, if necessary, the waiver granted under 42
CFR 433.68 have been approved. The notice shall be on a form
prepared by the Illinois Department and shall state the
following:
        (1) The name of the hospital provider.
        (2) The address of the hospital provider's principal
    place of business from which the provider engages in the
    occupation of hospital provider in this State, and the
    name and address of each hospital operated, conducted, or
    maintained by the provider in this State.
        (3) The occupied bed days, occupied bed days less
    Medicare days, adjusted gross hospital revenue, or
    outpatient gross revenue of the hospital provider
    (whichever is applicable), the amount of assessment
    imposed under Section 5A-2 for the State fiscal year for
    which the notice is sent, and the amount of each
    installment to be paid during the State fiscal year.
        (4) (Blank).
        (5) Other reasonable information as determined by the
    Illinois Department.
    (b) If a hospital provider conducts, operates, or
maintains more than one hospital licensed by the Illinois
Department of Public Health, the provider shall pay the
assessment for each hospital separately.
    (c) Notwithstanding any other provision in this Article,
in the case of a person who ceases to conduct, operate, or
maintain a hospital in respect of which the person is subject
to assessment under this Article as a hospital provider, the
assessment for the State fiscal year in which the cessation
occurs shall be adjusted by multiplying the assessment
computed under Section 5A-2 by a fraction, the numerator of
which is the number of days in the year during which the
provider conducts, operates, or maintains the hospital and the
denominator of which is 365. Immediately upon ceasing to
conduct, operate, or maintain a hospital, the person shall pay
the assessment for the year as so adjusted (to the extent not
previously paid).
    (d) Notwithstanding any other provision in this Article, a
provider who commences conducting, operating, or maintaining a
hospital, upon notice by the Illinois Department, shall pay
the assessment computed under Section 5A-2 and subsection (e)
in installments on the due dates stated in the notice and on
the regular installment due dates for the State fiscal year
occurring after the due dates of the initial notice.
    (e) Notwithstanding any other provision in this Article,
for State fiscal years 2009 through 2018, in the case of a
hospital provider that did not conduct, operate, or maintain a
hospital in 2005, the assessment for that State fiscal year
shall be computed on the basis of hypothetical occupied bed
days for the full calendar year as determined by the Illinois
Department. Notwithstanding any other provision in this
Article, for the portion of State fiscal year 2012 beginning
June 10, 2012 through June 30, 2012, and for State fiscal years
2013 through 2018, in the case of a hospital provider that did
not conduct, operate, or maintain a hospital in 2009, the
assessment under subsection (b-5) of Section 5A-2 for that
State fiscal year shall be computed on the basis of
hypothetical gross outpatient revenue for the full calendar
year as determined by the Illinois Department.
    Notwithstanding any other provision in this Article,
beginning July 1, 2018 through December 31, 2026, in the case
of a hospital provider that did not conduct, operate, or
maintain a hospital in the year that is the basis of the
calculation of the assessment under this Article, the
assessment under paragraph (3) of subsection (a) of Section
5A-2 for the State fiscal year shall be computed on the basis
of hypothetical occupied bed days for the full calendar year
as determined by the Illinois Department, except that for a
hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State fiscal year 2018 on the
basis of hypothetical data, that assessment amount shall be
used for State fiscal years 2019 and 2020; however, for State
fiscal year 2020, the assessment amount shall be increased by
the proportion that it represents of the total annual
assessment that is generated from all hospitals in order to
generate $6,250,000 in the aggregate for that period from all
hospitals subject to the annual assessment under this
paragraph.
    Notwithstanding any other provision in this Article,
beginning July 1, 2018 through December 31, 2026, in the case
of a hospital provider that did not conduct, operate, or
maintain a hospital in the year that is the basis of the
calculation of the assessment under this Article, the
assessment under subsection (b-5) of Section 5A-2 for that
State fiscal year shall be computed on the basis of
hypothetical gross outpatient revenue for the full calendar
year as determined by the Illinois Department, except that for
a hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State fiscal year 2018 on the
basis of hypothetical data, that assessment amount shall be
used for State fiscal years 2019 and 2020; however, for State
fiscal year 2020, the assessment amount shall be increased by
the proportion that it represents of the total annual
assessment that is generated from all hospitals in order to
generate $6,250,000 in the aggregate for that period from all
hospitals subject to the annual assessment under this
paragraph.
    (f) Every hospital provider subject to assessment under
this Article shall keep sufficient records to permit the
determination of adjusted gross hospital revenue for the
hospital's fiscal year. All such records shall be kept in the
English language and shall, at all times during regular
business hours of the day, be subject to inspection by the
Illinois Department or its duly authorized agents and
employees.
    (g) The Illinois Department may, by rule, provide a
hospital provider a reasonable opportunity to request a
clarification or correction of any clerical or computational
errors contained in the calculation of its assessment, but
such corrections shall not extend to updating the cost report
information used to calculate the assessment.
    (h) (Blank).
(Source: P.A. 102-886, eff. 5-17-22.)
 
    (305 ILCS 5/5A-7)  (from Ch. 23, par. 5A-7)
    Sec. 5A-7. Administration; enforcement provisions.
    (a) The Illinois Department shall establish and maintain a
listing of all hospital providers appearing in the licensing
records of the Illinois Department of Public Health, which
shall show each provider's name and principal place of
business and the name and address of each hospital operated,
conducted, or maintained by the provider in this State. The
listing shall also include the monthly assessment amounts owed
for each hospital and any unpaid assessment liability greater
than 90 days delinquent. The Illinois Department shall
administer and enforce this Article and collect the
assessments and penalty assessments imposed under this Article
using procedures employed in its administration of this Code
generally. The Illinois Department, its Director, and every
hospital provider subject to assessment under this Article
shall have the following powers, duties, and rights:
        (1) The Illinois Department may initiate either
    administrative or judicial proceedings, or both, to
    enforce provisions of this Article. Administrative
    enforcement proceedings initiated hereunder shall be
    governed by the Illinois Department's administrative
    rules. Judicial enforcement proceedings initiated
    hereunder shall be governed by the rules of procedure
    applicable in the courts of this State.
        (2) (Blank). No proceedings for collection, refund,
    credit, or other adjustment of an assessment amount shall
    be issued more than 3 years after the due date of the
    assessment, except in the case of an extended period
    agreed to in writing by the Illinois Department and the
    hospital provider before the expiration of this limitation
    period.
        (3) Any unpaid assessment under this Article shall
    become a lien upon the assets of the hospital upon which it
    was assessed. If any hospital provider, outside the usual
    course of its business, sells or transfers the major part
    of any one or more of (A) the real property and
    improvements, (B) the machinery and equipment, or (C) the
    furniture or fixtures, of any hospital that is subject to
    the provisions of this Article, the seller or transferor
    shall pay the Illinois Department the amount of any
    assessment, assessment penalty, and interest (if any) due
    from it under this Article up to the date of the sale or
    transfer. The Illinois Department may, in its discretion,
    foreclose on such a lien, but shall do so in a manner that
    is consistent with Section 5e of the Retailers' Occupation
    Tax Act. If the seller or transferor fails to pay any
    assessment, assessment penalty, and interest (if any) due,
    the purchaser or transferee of such asset shall be liable
    for the amount of the assessment, penalties, and interest
    (if any) up to the amount of the reasonable value of the
    property acquired by the purchaser or transferee. The
    purchaser or transferee shall continue to be liable until
    the purchaser or transferee pays the full amount of the
    assessment, penalties, and interest (if any) up to the
    amount of the reasonable value of the property acquired by
    the purchaser or transferee or until the purchaser or
    transferee receives from the Illinois Department a
    certificate showing that such assessment, penalty, and
    interest have been paid or a certificate from the Illinois
    Department showing that no assessment, penalty, or
    interest is due from the seller or transferor under this
    Article.
        (4) Payments under this Article are not subject to the
    Illinois Prompt Payment Act. Credits or refunds shall not
    bear interest.
    (b) In addition to any other remedy provided for and
without sending a notice of assessment liability, the Illinois
Department shall may collect an unpaid assessment by
withholding, as payment of the assessment, reimbursements or
other amounts otherwise payable by the Illinois Department to
the hospital provider, including, but not limited to, payment
amounts otherwise payable from a managed care organization
performing duties under contract with the Illinois Department.
        (1) The requirements of this subsection may be waived
    in instances when a disaster proclamation has been
    declared by the Governor. In such circumstances, a
    hospital must demonstrate temporary financial distress and
    establish an agreement with the Illinois Department
    specifying when repayment in full of all taxes owed will
    occur.
        (2) The requirements of this subsection may be waived
    by the Illinois Department in instances when a hospital
    has entered into and remains in compliance with a
    repayment plan or a tax deferral plan. A repayment plan or
    tax deferral plan must be entered into no later than 30
    days after notice of an unpaid assessment payment. No
    repayment plan may exceed a period of 36 months. No tax
    deferral plan may exceed a period of 6 months, and
    repayment after the end of a tax deferral plan shall not
    exceed 36 months. Failure to remain in compliance with a
    repayment plan or tax deferral plan shall cause immediate
    termination of such plan unless there is prior written
    consent from the Illinois Department for a period of
    non-compliance.
        (3) Beginning September 1, 2025, the Illinois
    Department shall immediately collect all overdue unpaid
    assessments and penalties through the collection methods
    authorized under this Section, unless a repayment plan or
    tax deferral plan has already been agreed to by September
    1, 2025.
    (c) To provide for the expeditious and timely
implementation of the changes made to this Section by this
amendatory Act of the 104th General Assembly, the Department
may adopt emergency rules as authorized by Section 5-45 of the
Illinois Administrative Procedure Act. The adoption of
emergency rules is deemed to be necessary for the public
interest, safety, and welfare.
(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04;
94-242, eff. 7-18-05.)
 
    (305 ILCS 5/5A-8)  (from Ch. 23, par. 5A-8)
    Sec. 5A-8. Hospital Provider Fund.
    (a) There is created in the State Treasury the Hospital
Provider Fund. Interest earned by the Fund shall be credited
to the Fund. The Fund shall not be used to replace any moneys
appropriated to the Medicaid program by the General Assembly.
    (b) The Fund is created for the purpose of receiving
moneys in accordance with Section 5A-6 and disbursing moneys
only for the following purposes, notwithstanding any other
provision of law:
        (1) For making payments to hospitals as required under
    this Code, under the Children's Health Insurance Program
    Act, under the Covering ALL KIDS Health Insurance Act, and
    under the Long Term Acute Care Hospital Quality
    Improvement Transfer Program Act.
        (2) For the reimbursement of moneys collected by the
    Illinois Department from hospitals or hospital providers
    through error or mistake in performing the activities
    authorized under this Code.
        (3) For payment of administrative expenses incurred by
    the Illinois Department or its agent in performing
    activities under this Code, under the Children's Health
    Insurance Program Act, under the Covering ALL KIDS Health
    Insurance Act, and under the Long Term Acute Care Hospital
    Quality Improvement Transfer Program Act.
        (4) For payments of any amounts which are reimbursable
    to the federal government for payments from this Fund
    which are required to be paid by State warrant.
        (5) For making transfers, as those transfers are
    authorized in the proceedings authorizing debt under the
    Short Term Borrowing Act, but transfers made under this
    paragraph (5) shall not exceed the principal amount of
    debt issued in anticipation of the receipt by the State of
    moneys to be deposited into the Fund.
        (6) For making transfers to any other fund in the
    State treasury, but transfers made under this paragraph
    (6) shall not exceed the amount transferred previously
    from that other fund into the Hospital Provider Fund plus
    any interest that would have been earned by that fund on
    the monies that had been transferred.
        (6.5) For making transfers to the Healthcare Provider
    Relief Fund, except that transfers made under this
    paragraph (6.5) shall not exceed $60,000,000 in the
    aggregate.
        (7) For making transfers not exceeding the following
    amounts, related to State fiscal years 2013 through 2018,
    to the following designated funds:
            Health and Human Services Medicaid Trust
                Fund..............................$20,000,000
            Long-Term Care Provider Fund..........$30,000,000
            General Revenue Fund.................$80,000,000.
    Transfers under this paragraph shall be made within 7 days
    after the payments have been received pursuant to the
    schedule of payments provided in subsection (a) of Section
    5A-4.
        (7.1) (Blank).
        (7.5) (Blank).
        (7.8) (Blank).
        (7.9) (Blank).
        (7.10) For State fiscal year 2014, for making
    transfers of the moneys resulting from the assessment
    under subsection (b-5) of Section 5A-2 and received from
    hospital providers under Section 5A-4 and transferred into
    the Hospital Provider Fund under Section 5A-6 to the
    designated funds not exceeding the following amounts in
    that State fiscal year:
            Healthcare Provider Relief Fund......$100,000,000
        Transfers under this paragraph shall be made within 7
    days after the payments have been received pursuant to the
    schedule of payments provided in subsection (a) of Section
    5A-4.
        The additional amount of transfers in this paragraph
    (7.10), authorized by Public Act 98-651, shall be made
    within 10 State business days after June 16, 2014 (the
    effective date of Public Act 98-651). That authority shall
    remain in effect even if Public Act 98-651 does not become
    law until State fiscal year 2015.
        (7.10a) For State fiscal years 2015 through 2018, for
    making transfers of the moneys resulting from the
    assessment under subsection (b-5) of Section 5A-2 and
    received from hospital providers under Section 5A-4 and
    transferred into the Hospital Provider Fund under Section
    5A-6 to the designated funds not exceeding the following
    amounts related to each State fiscal year:
            Healthcare Provider Relief Fund......$50,000,000
        Transfers under this paragraph shall be made within 7
    days after the payments have been received pursuant to the
    schedule of payments provided in subsection (a) of Section
    5A-4.
        (7.11) (Blank).
        (7.12) For State fiscal year 2013, for increasing by
    21/365ths the transfer of the moneys resulting from the
    assessment under subsection (b-5) of Section 5A-2 and
    received from hospital providers under Section 5A-4 for
    the portion of State fiscal year 2012 beginning June 10,
    2012 through June 30, 2012 and transferred into the
    Hospital Provider Fund under Section 5A-6 to the
    designated funds not exceeding the following amounts in
    that State fiscal year:
            Healthcare Provider Relief Fund.......$2,870,000
        Since the federal Centers for Medicare and Medicaid
    Services approval of the assessment authorized under
    subsection (b-5) of Section 5A-2, received from hospital
    providers under Section 5A-4 and the payment methodologies
    to hospitals required under Section 5A-12.4 was not
    received by the Department until State fiscal year 2014
    and since the Department made retroactive payments during
    State fiscal year 2014 related to the referenced period of
    June 2012, the transfer authority granted in this
    paragraph (7.12) is extended through the date that is 10
    State business days after June 16, 2014 (the effective
    date of Public Act 98-651).
        (7.13) In addition to any other transfers authorized
    under this Section, for State fiscal years 2017 and 2018,
    for making transfers to the Healthcare Provider Relief
    Fund of moneys collected from the ACA Assessment
    Adjustment authorized under subsections (a) and (b-5) of
    Section 5A-2 and paid by hospital providers under Section
    5A-4 into the Hospital Provider Fund under Section 5A-6
    for each State fiscal year. Timing of transfers to the
    Healthcare Provider Relief Fund under this paragraph shall
    be at the discretion of the Department, but no less
    frequently than quarterly.
        (7.14) For making transfers not exceeding the
    following amounts, related to State fiscal years 2019 and
    2020, to the following designated funds:
            Health and Human Services Medicaid Trust
                Fund..............................$20,000,000
            Long-Term Care Provider Fund..........$30,000,000
            Healthcare Provider Relief Fund.....$325,000,000.
        Transfers under this paragraph shall be made within 7
    days after the payments have been received pursuant to the
    schedule of payments provided in subsection (a) of Section
    5A-4.
        (7.15) For making transfers not exceeding the
    following amounts, related to State fiscal years 2023
    through 2024 2026, to the following designated funds:
            Health and Human Services Medicaid Trust
                Fund.............................$20,000,000
            Long-Term Care Provider Fund.........$30,000,000
            Healthcare Provider Relief Fund.....$365,000,000
        (7.16) For making transfers not exceeding the
    following amounts, related to July 1, 2024 2026 to
    December 31, 2024 2026, to the following designated funds:
            Health and Human Services Medicaid Trust
                Fund.............................$10,000,000
            Long-Term Care Provider Fund.........$15,000,000
            Healthcare Provider Relief Fund.....$182,500,000
        (7.17) For making transfers not exceeding the
    following amounts, related to calendar years 2025 and each
    calendar year thereafter, the following designated funds:
            Health and Human Services Medicaid Trust
                Fund..............................$20,000,000
            Long-Term Care Provider Fund..........$30,000,000
            Healthcare Provider Relief Fund....$505,637,082;
        however the amount shall remain $365,000,000 until the
        reimbursement rates described in subsection (r) of Section
        5A-12.7 are fully implemented. If for any reason the
        assessment imposed by subsection (a) or (b-5) of Section 5A-2
        is reduced, the amount of $505,637,082 shall be reduced by the
        same percentage.
    To provide for the expeditious and timely implementation
of the changes made to this subsection by this amendatory Act
of the 104th General Assembly, the Department may adopt
emergency rules as authorized by Section 5-45 of the Illinois
Administrative Procedure Act. The adoption of emergency rules
is deemed to be necessary for the public interest, safety, and
welfare.
        (8) For making refunds to hospital providers pursuant
    to Section 5A-10.
        (9) For making payment to capitated managed care
    organizations as described in subsections (s) and (t) of
    Section 5A-12.2, subsection (r) of Section 5A-12.6, and
    Section 5A-12.7 of this Code.
    Disbursements from the Fund, other than transfers
authorized under paragraphs (5) and (6) of this subsection,
shall be by warrants drawn by the State Comptroller upon
receipt of vouchers duly executed and certified by the
Illinois Department.
    (c) The Fund shall consist of the following:
        (1) All moneys collected or received by the Illinois
    Department from the hospital provider assessment imposed
    by this Article.
        (2) All federal matching funds received by the
    Illinois Department as a result of expenditures made by
    the Illinois Department that are attributable to moneys
    deposited in the Fund.
        (3) Any interest or penalty levied in conjunction with
    the administration of this Article.
        (3.5) As applicable, proceeds from surety bond
    payments payable to the Department as referenced in
    subsection (s) of Section 5A-12.2 of this Code.
        (4) Moneys transferred from another fund in the State
    treasury.
        (5) All other moneys received for the Fund from any
    other source, including interest earned thereon.
    (d) (Blank).
(Source: P.A. 101-650, eff. 7-7-20; 102-886, eff. 5-17-22.)
 
    (305 ILCS 5/5A-10)  (from Ch. 23, par. 5A-10)
    Sec. 5A-10. Applicability.
    (a) The assessment imposed by subsection (a) of Section
5A-2 shall cease to be imposed and the Department's obligation
to make payments shall immediately cease, and any moneys
remaining in the Fund shall be refunded to hospital providers
in proportion to the amounts paid by them, if:
        (1) The payments to hospitals required under this
    Article are not eligible for federal matching funds under
    Title XIX or XXI of the Social Security Act;
        (2) For State fiscal years 2009 through 2018, and as
    provided in Section 5A-16, the Department of Healthcare
    and Family Services adopts any administrative rule change
    to reduce payment rates or alters any payment methodology
    that reduces any payment rates made to operating hospitals
    under the approved Title XIX or Title XXI State plan in
    effect January 1, 2008 except for:
            (A) any changes for hospitals described in
        subsection (b) of Section 5A-3;
            (B) any rates for payments made under this Article
        V-A;
            (C) any changes proposed in State plan amendment
        transmittal numbers 08-01, 08-02, 08-04, 08-06, and
        08-07;
            (D) in relation to any admissions on or after
        January 1, 2011, a modification in the methodology for
        calculating outlier payments to hospitals for
        exceptionally costly stays, for hospitals reimbursed
        under the diagnosis-related grouping methodology in
        effect on July 1, 2011; provided that the Department
        shall be limited to one such modification during the
        36-month period after the effective date of this
        amendatory Act of the 96th General Assembly;
            (E) any changes affecting hospitals authorized by
        Public Act 97-689;
            (F) any changes authorized by Section 14-12 of
        this Code, or for any changes authorized under Section
        5A-15 of this Code; or
            (G) any changes authorized under Section 5-5b.1.
    (b) The assessment imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, and the Department's
obligation to make payments shall immediately cease, if the
assessment is determined to be an impermissible tax under
Title XIX of the Social Security Act. Moneys in the Hospital
Provider Fund derived from assessments imposed prior thereto
shall be disbursed in accordance with Section 5A-8 to the
extent federal financial participation is not reduced due to
the impermissibility of the assessments, and any remaining
moneys shall be refunded to hospital providers in proportion
to the amounts paid by them.
    (c) The assessments imposed by subsection (b-5) of Section
5A-2 shall not take effect or shall cease to be imposed, the
Department's obligation to make payments shall immediately
cease, and any moneys remaining in the Fund shall be refunded
to hospital providers in proportion to the amounts paid by
them, if the payments to hospitals required under Section
5A-12.4 or Section 5A-12.6 are not eligible for federal
matching funds under Title XIX of the Social Security Act.
    (d) The assessments imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, the Department's
obligation to make payments shall immediately cease, and any
moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
        (1) for State fiscal years 2013 through 2018, and as
    provided in Section 5A-16, the Department reduces any
    payment rates to hospitals as in effect on May 1, 2012, or
    alters any payment methodology as in effect on May 1,
    2012, that has the effect of reducing payment rates to
    hospitals, except for any changes affecting hospitals
    authorized in Public Act 97-689 and any changes authorized
    by Section 14-12 of this Code, and except for any changes
    authorized under Section 5A-15, and except for any changes
    authorized under Section 5-5b.1;
        (2) for State fiscal years 2013 through 2018, and as
    provided in Section 5A-16, the Department reduces any
    supplemental payments made to hospitals below the amounts
    paid for services provided in State fiscal year 2011 as
    implemented by administrative rules adopted and in effect
    on or prior to June 30, 2011, except for any changes
    affecting hospitals authorized in Public Act 97-689 and
    any changes authorized by Section 14-12 of this Code, and
    except for any changes authorized under Section 5A-15, and
    except for any changes authorized under Section 5-5b.1; or
        (3) for State fiscal years 2015 through 2018, and as
    provided in Section 5A-16, the Department reduces the
    overall effective rate of reimbursement to hospitals below
    the level authorized under Section 14-12 of this Code,
    except for any changes under Section 14-12 or Section
    5A-15 of this Code, and except for any changes authorized
    under Section 5-5b.1.
    (e) In State fiscal year 2019 through State fiscal year
2020, the assessments imposed under Section 5A-2 shall not
take effect or shall cease to be imposed, the Department's
obligation to make payments shall immediately cease, and any
moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
        (1) the payments to hospitals required under Section
    5A-12.6 are not eligible for federal matching funds under
    Title XIX of the Social Security Act; or
        (2) the Department reduces the overall effective rate
    of reimbursement to hospitals below the level authorized
    under Section 14-12 of this Code, as in effect on December
    31, 2017, except for any changes authorized under Sections
    14-12 or Section 5A-15 of this Code, and except for any
    changes authorized under changes to Sections 5A-12.2,
    5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by Public Act
    100-581.
    (f) Beginning in State Fiscal Year 2021 through December
31, 2024, the assessments imposed under Section 5A-2 shall not
take effect or shall cease to be imposed, the Department's
obligation to make payments shall immediately cease, and any
moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
        (1) the payments to hospitals required under Section
    5A-12.7 are not eligible for federal matching funds under
    Title XIX of the Social Security Act; or
        (2) the Department reduces the overall effective rate
    of reimbursement to hospitals below the level authorized
    under Section 14-12, as in effect on December 31, 2021,
    except for any changes authorized under Sections 14-12 or
    5A-15, and except for any changes authorized under changes
    to Sections 5A-12.7 and 14-12 made by this amendatory Act
    of the 101st General Assembly, and except for any changes
    to Section 5A-12.7 made by this amendatory Act of the
    102nd General Assembly.
    (g) Beginning January 1, 2025, the assessments imposed
under Section 5A-2 shall not take effect or shall cease to be
imposed, if:
        (1) the payments to hospitals required under Section
    5A-12.7 are not eligible for federal matching funds under
    Title XIX of the Social Security Act; or
        (2) the Department reduces the rates of reimbursement
    below the rates in effect December 31, 2024, resulting in
    an aggregate reduction below the levels of reimbursement
    for the 12-month period ending 6 months prior to the
    effective date of the proposed new rates.
    (h) To provide for the expeditious and timely
implementation of the changes made to this Section by this
amendatory Act of the 104th General Assembly, the Department
may adopt emergency rules as authorized by Section 5-45 of the
Illinois Administrative Procedure Act. The adoption of
emergency rules is deemed to be necessary for the public
interest, safety, and welfare.
(Source: P.A. 101-650, eff. 7-7-20; 102-886, eff. 5-17-22.)
 
    (305 ILCS 5/5A-12.7)
    (Section scheduled to be repealed on December 31, 2026)
    Sec. 5A-12.7. Continuation of hospital access payments on
and after July 1, 2020.
    (a) To preserve and improve access to hospital services,
for hospital services rendered on and after July 1, 2020, the
Department shall, except for hospitals described in subsection
(b) of Section 5A-3, make payments to hospitals or require
capitated managed care organizations to make payments as set
forth in this Section. Payments under this Section are not due
and payable, however, until: (i) the methodologies described
in this Section are approved by the federal government in an
appropriate State Plan amendment or directed payment preprint;
and (ii) the assessment imposed under this Article is
determined to be a permissible tax under Title XIX of the
Social Security Act. In determining the hospital access
payments authorized under subsection (g) of this Section, if a
hospital ceases to qualify for payments from the pool, the
payments for all hospitals continuing to qualify for payments
from such pool shall be uniformly adjusted to fully expend the
aggregate net amount of the pool, with such adjustment being
effective on the first day of the second month following the
date the hospital ceases to receive payments from such pool.
    (b) Amounts moved into claims-based rates and distributed
in accordance with Section 14-12 shall remain in those
claims-based rates.
    (c) Graduate medical education.
        (1) The calculation of graduate medical education
    payments shall be based on the hospital's Medicare cost
    report ending in Calendar Year 2018, as reported in the
    Healthcare Cost Report Information System file, release
    date September 30, 2019. An Illinois hospital reporting
    intern and resident cost on its Medicare cost report shall
    be eligible for graduate medical education payments.
        (2) Each hospital's annualized Medicaid Intern
    Resident Cost is calculated using annualized intern and
    resident total costs obtained from Worksheet B Part I,
    Columns 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
    96-98, and 105-112 multiplied by the percentage that the
    hospital's Medicaid days (Worksheet S3 Part I, Column 7,
    Lines 2, 3, 4, 14, 16-18, and 32) comprise of the
    hospital's total days (Worksheet S3 Part I, Column 8,
    Lines 14, 16-18, and 32).
        (3) An annualized Medicaid indirect medical education
    (IME) payment is calculated for each hospital using its
    IME payments (Worksheet E Part A, Line 29, Column 1)
    multiplied by the percentage that its Medicaid days
    (Worksheet S3 Part I, Column 7, Lines 2, 3, 4, 14, 16-18,
    and 32) comprise of its Medicare days (Worksheet S3 Part
    I, Column 6, Lines 2, 3, 4, 14, and 16-18).
        (4) For each hospital, its annualized Medicaid Intern
    Resident Cost and its annualized Medicaid IME payment are
    summed, and, except as capped at 120% of the average cost
    per intern and resident for all qualifying hospitals as
    calculated under this paragraph, is multiplied by the
    applicable reimbursement factor as described in this
    paragraph, to determine the hospital's final graduate
    medical education payment. Each hospital's average cost
    per intern and resident shall be calculated by summing its
    total annualized Medicaid Intern Resident Cost plus its
    annualized Medicaid IME payment and dividing that amount
    by the hospital's total Full Time Equivalent Residents and
    Interns. If the hospital's average per intern and resident
    cost is greater than 120% of the same calculation for all
    qualifying hospitals, the hospital's per intern and
    resident cost shall be capped at 120% of the average cost
    for all qualifying hospitals.
            (A) For the period of July 1, 2020 through
        December 31, 2022, the applicable reimbursement factor
        shall be 22.6%.
            (B) Beginning For the period of January 1, 2023
        through December 31, 2026, the applicable
        reimbursement factor shall be 35% for all qualified
        safety-net hospitals, as defined in Section 5-5e.1 of
        this Code, and all hospitals with 100 or more Full Time
        Equivalent Residents and Interns, as reported on the
        hospital's Medicare cost report ending in Calendar
        Year 2018, and for all other qualified hospitals the
        applicable reimbursement factor shall be 30%.
    (d) Fee-for-service supplemental payments. For the period
of July 1, 2020 through December 31, 2022, each Illinois
hospital shall receive an annual payment equal to the amounts
below, to be paid in 12 equal installments on or before the
seventh State business day of each month, except that no
payment shall be due within 30 days after the later of the date
of notification of federal approval of the payment
methodologies required under this Section or any waiver
required under 42 CFR 433.68, at which time the sum of amounts
required under this Section prior to the date of notification
is due and payable.
        (1) For critical access hospitals, $385 per covered
    inpatient day contained in paid fee-for-service claims and
    $530 per paid fee-for-service outpatient claim for dates
    of service in Calendar Year 2019 in the Department's
    Enterprise Data Warehouse as of May 11, 2020.
        (2) For safety-net hospitals, $960 per covered
    inpatient day contained in paid fee-for-service claims and
    $625 per paid fee-for-service outpatient claim for dates
    of service in Calendar Year 2019 in the Department's
    Enterprise Data Warehouse as of May 11, 2020.
        (3) For long term acute care hospitals, $295 per
    covered inpatient day contained in paid fee-for-service
    claims for dates of service in Calendar Year 2019 in the
    Department's Enterprise Data Warehouse as of May 11, 2020.
        (4) For freestanding psychiatric hospitals, $125 per
    covered inpatient day contained in paid fee-for-service
    claims and $130 per paid fee-for-service outpatient claim
    for dates of service in Calendar Year 2019 in the
    Department's Enterprise Data Warehouse as of May 11, 2020.
        (5) For freestanding rehabilitation hospitals, $355
    per covered inpatient day contained in paid
    fee-for-service claims for dates of service in Calendar
    Year 2019 in the Department's Enterprise Data Warehouse as
    of May 11, 2020.
        (6) For all general acute care hospitals and high
    Medicaid hospitals as defined in subsection (f), $350 per
    covered inpatient day for dates of service in Calendar
    Year 2019 contained in paid fee-for-service claims and
    $620 per paid fee-for-service outpatient claim in the
    Department's Enterprise Data Warehouse as of May 11, 2020.
        (7) Alzheimer's treatment access payment. Each
    Illinois academic medical center or teaching hospital, as
    defined in Section 5-5e.2 of this Code, that is identified
    as the primary hospital affiliate of one of the Regional
    Alzheimer's Disease Assistance Centers, as designated by
    the Alzheimer's Disease Assistance Act and identified in
    the Department of Public Health's Alzheimer's Disease
    State Plan dated December 2016, shall be paid an
    Alzheimer's treatment access payment equal to the product
    of the qualifying hospital's State Fiscal Year 2018 total
    inpatient fee-for-service days multiplied by the
    applicable Alzheimer's treatment rate of $226.30 for
    hospitals located in Cook County and $116.21 for hospitals
    located outside Cook County.
    (d-2) Fee-for-service supplemental payments. Beginning
January 1, 2023, each Illinois hospital shall receive an
annual payment equal to the amounts listed below, to be paid in
12 equal installments on or before the seventh State business
day of each month, except that no payment shall be due within
30 days after the later of the date of notification of federal
approval of the payment methodologies required under this
Section or any waiver required under 42 CFR 433.68, at which
time the sum of amounts required under this Section prior to
the date of notification is due and payable. The Department
may adjust the rates in paragraphs (1) through (7) to comply
with the federal upper payment limits, with such adjustments
being determined so that the total estimated spending by
hospital class, under such adjusted rates, remains
substantially similar to the total estimated spending under
the original rates set forth in this subsection.
        (1) For critical access hospitals, as defined in
    subsection (f), $750 per covered inpatient day contained
    in paid fee-for-service claims and $750 per paid
    fee-for-service outpatient claim for dates of service in
    Calendar Year 2019 in the Department's Enterprise Data
    Warehouse as of August 6, 2021.
        (2) For safety-net hospitals, as described in
    subsection (f), $1,350 per inpatient day contained in paid
    fee-for-service claims and $1,350 per paid fee-for-service
    outpatient claim for dates of service in Calendar Year
    2019 in the Department's Enterprise Data Warehouse as of
    August 6, 2021.
        (3) For long term acute care hospitals, $550 per
    covered inpatient day contained in paid fee-for-service
    claims for dates of service in Calendar Year 2019 in the
    Department's Enterprise Data Warehouse as of August 6,
    2021.
        (4) For freestanding psychiatric hospitals, $200 per
    covered inpatient day contained in paid fee-for-service
    claims and $200 per paid fee-for-service outpatient claim
    for dates of service in Calendar Year 2019 in the
    Department's Enterprise Data Warehouse as of August 6,
    2021.
        (5) For freestanding rehabilitation hospitals, $550
    per covered inpatient day contained in paid
    fee-for-service claims and $125 per paid fee-for-service
    outpatient claim for dates of service in Calendar Year
    2019 in the Department's Enterprise Data Warehouse as of
    August 6, 2021.
        (6) For all general acute care hospitals and high
    Medicaid hospitals as defined in subsection (f), $500 per
    covered inpatient day for dates of service in Calendar
    Year 2019 contained in paid fee-for-service claims and
    $500 per paid fee-for-service outpatient claim in the
    Department's Enterprise Data Warehouse as of August 6,
    2021.
        (7) For public hospitals, as defined in subsection
    (f), $275 per covered inpatient day contained in paid
    fee-for-service claims and $275 per paid fee-for-service
    outpatient claim for dates of service in Calendar Year
    2019 in the Department's Enterprise Data Warehouse as of
    August 6, 2021.
        (8) Alzheimer's treatment access payment. Each
    Illinois academic medical center or teaching hospital, as
    defined in Section 5-5e.2 of this Code, that is identified
    as the primary hospital affiliate of one of the Regional
    Alzheimer's Disease Assistance Centers, as designated by
    the Alzheimer's Disease Assistance Act and identified in
    the Department of Public Health's Alzheimer's Disease
    State Plan dated December 2016, shall be paid an
    Alzheimer's treatment access payment equal to the product
    of the qualifying hospital's Calendar Year 2019 total
    inpatient fee-for-service days, in the Department's
    Enterprise Data Warehouse as of August 6, 2021, multiplied
    by the applicable Alzheimer's treatment rate of $244.37
    for hospitals located in Cook County and $312.03 for
    hospitals located outside Cook County.
    (e) The Department shall require managed care
organizations (MCOs) to make directed payments and
pass-through payments according to this Section. Each calendar
year, the Department shall require MCOs to pay the maximum
amount out of these funds as allowed as pass-through payments
under federal regulations. The Department shall require MCOs
to make such pass-through payments as specified in this
Section. The Department shall require the MCOs to pay the
remaining amounts as directed Payments as specified in this
Section. The Department shall issue payments to the
Comptroller by the seventh business day of each month for all
MCOs that are sufficient for MCOs to make the directed
payments and pass-through payments according to this Section.
The Department shall require the MCOs to make pass-through
payments and directed payments using electronic funds
transfers (EFT), if the hospital provides the information
necessary to process such EFTs, in accordance with directions
provided monthly by the Department, within 7 business days of
the date the funds are paid to the MCOs, as indicated by the
"Paid Date" on the website of the Office of the Comptroller if
the funds are paid by EFT and the MCOs have received directed
payment instructions. If funds are not paid through the
Comptroller by EFT, payment must be made within 7 business
days of the date actually received by the MCO. The MCO will be
considered to have paid the pass-through payments when the
payment remittance number is generated or the date the MCO
sends the check to the hospital, if EFT information is not
supplied. If an MCO is late in paying a pass-through payment or
directed payment as required under this Section (including any
extensions granted by the Department), it shall pay a penalty,
unless waived by the Department for reasonable cause, to the
Department equal to 5% of the amount of the pass-through
payment or directed payment not paid on or before the due date
plus 5% of the portion thereof remaining unpaid on the last day
of each 30-day period thereafter. Payments to MCOs that would
be paid consistent with actuarial certification and enrollment
in the absence of the increased capitation payments under this
Section shall not be reduced as a consequence of payments made
under this subsection. The Department shall publish and
maintain on its website for a period of no less than 8 calendar
quarters, the quarterly calculation of directed payments and
pass-through payments owed to each hospital from each MCO. All
calculations and reports shall be posted no later than the
first day of the quarter for which the payments are to be
issued.
    (f)(1) For purposes of allocating the funds included in
capitation payments to MCOs, Illinois hospitals shall be
divided into the following classes as defined in
administrative rules:
        (A) Beginning July 1, 2020 through December 31, 2022,
    critical access hospitals. Beginning January 1, 2023,
    "critical access hospital" means a hospital designated by
    the Department of Public Health as a critical access
    hospital, excluding any hospital meeting the definition of
    a public hospital in subparagraph (F).
        (B) Safety-net hospitals, except that stand-alone
    children's hospitals that are not specialty children's
    hospitals, safety-net hospitals that elect not to be
    included as provided in item (i), and, for calendar years
    2025 and 2026 only, hospitals with over 9,000 Medicaid
    acute care inpatient admissions per calendar year,
    excluding admissions for Medicare-Medicaid dual eligible
    patients, will not be included. For the calendar year
    beginning January 1, 2023, and each calendar year
    thereafter, assignment to the safety-net class shall be
    based on the annual safety-net rate year beginning 15
    months before the beginning of the first Payout Quarter of
    the calendar year.
            (i) Beginning calendar year 2026, all hospitals
        qualifying as a safety-net hospital under subsection
        (a) of Section 5-5e.1 for rates years beginning on and
        after October 1, 2024 shall be permitted to elect to
        remain in the high Medicaid hospital class as defined
        in subparagraph (G) for purposes of the State directed
        payments described in subsection (r) instead of being
        assigned to the safety-net fixed pool directed
        payments class as described in subsection (g).
            (ii) If a hospital elects assignment in the high
        Medicaid hospital class as defined in subparagraph
        (G), the hospital must remain in the high Medicaid
        hospital class for the entire calendar year.
        (C) Long term acute care hospitals.
        (D) Freestanding psychiatric hospitals.
        (E) Freestanding rehabilitation hospitals.
        (F) Beginning January 1, 2023, "public hospital" means
    a hospital that is owned or operated by an Illinois
    Government body or municipality, excluding a hospital
    provider that is a State agency, a State university, or a
    county with a population of 3,000,000 or more.
        (G) High Medicaid hospitals.
            (i) As used in this Section, "high Medicaid
        hospital" means a general acute care hospital that:
                (I) For the payout periods July 1, 2020
            through December 31, 2022, is not a safety-net
            hospital or critical access hospital and that has
            a Medicaid Inpatient Utilization Rate above 30% or
            a hospital that had over 35,000 inpatient Medicaid
            days during the applicable period. For the period
            July 1, 2020 through December 31, 2020, the
            applicable period for the Medicaid Inpatient
            Utilization Rate (MIUR) is the rate year 2020 MIUR
            and for the number of inpatient days it is State
            fiscal year 2018. Beginning in calendar year 2021,
            the Department shall use the most recently
            determined MIUR, as defined in subsection (h) of
            Section 5-5.02, and for the inpatient day
            threshold, the State fiscal year ending 18 months
            prior to the beginning of the calendar year. For
            purposes of calculating MIUR under this Section,
            children's hospitals and affiliated general acute
            care hospitals shall be considered a single
            hospital.
                (II) For the calendar year beginning January
            1, 2023, and each calendar year thereafter, is not
            a public hospital, safety-net hospital, or
            critical access hospital and that qualifies as a
            regional high volume hospital or is a hospital
            that has a Medicaid Inpatient Utilization Rate
            (MIUR) above 30%. As used in this item, "regional
            high volume hospital" means a hospital which ranks
            in the top 2 quartiles based on total hospital
            services volume, of all eligible general acute
            care hospitals, when ranked in descending order
            based on total hospital services volume, within
            the same Medicaid managed care region, as
            designated by the Department, as of January 1,
            2022. As used in this item, "total hospital
            services volume" means the total of all Medical
            Assistance hospital inpatient admissions plus all
            Medical Assistance hospital outpatient visits. For
            purposes of determining regional high volume
            hospital inpatient admissions and outpatient
            visits, the Department shall use dates of service
            provided during State Fiscal Year 2020 for the
            Payout Quarter beginning January 1, 2023. The
            Department shall use dates of service from the
            State fiscal year ending 18 month before the
            beginning of the first Payout Quarter of the
            subsequent annual determination period.
            (ii) For the calendar year beginning January 1,
        2023, the Department shall use the Rate Year 2022
        Medicaid inpatient utilization rate (MIUR), as defined
        in subsection (h) of Section 5-5.02. For each
        subsequent annual determination, the Department shall
        use the MIUR applicable to the rate year ending
        September 30 of the year preceding the beginning of
        the calendar year.
        (H) General acute care hospitals. As used under this
    Section, "general acute care hospitals" means all other
    Illinois hospitals not identified in subparagraphs (A)
    through (G).
    (2) Hospitals' qualification for each class shall be
assessed prior to the beginning of each calendar year and the
new class designation shall be effective January 1 of the next
year. The Department shall publish by rule the process for
establishing class determination.
    (3) Beginning January 1, 2024, the Department may reassign
hospitals or entire hospital classes as defined above, if
federal limits on the payments to the class to which the
hospitals are assigned based on the criteria in this
subsection prevent the Department from making payments to the
class that would otherwise be due under this Section. The
Department shall publish the criteria and composition of each
new class based on the reassignments, and the projected impact
on payments to each hospital under the new classes on its
website by November 15 of the year before the year in which the
class changes become effective.
    (g) Fixed pool directed payments. Beginning July 1, 2020,
the Department shall issue payments to MCOs which shall be
used to issue directed payments to qualified Illinois
safety-net hospitals and critical access hospitals on a
monthly basis in accordance with this subsection. Prior to the
beginning of each Payout Quarter beginning July 1, 2020, the
Department shall use encounter claims data from the
Determination Quarter, accepted by the Department's Medicaid
Management Information System for inpatient and outpatient
services rendered by safety-net hospitals and critical access
hospitals to determine a quarterly uniform per unit add-on for
each hospital class.
        (1) Inpatient per unit add-on. A quarterly uniform per
    diem add-on shall be derived by dividing the quarterly
    Inpatient Directed Payments Pool amount allocated to the
    applicable hospital class by the total inpatient days
    contained on all encounter claims received during the
    Determination Quarter, for all hospitals in the class.
            (A) Each hospital in the class shall have a
        quarterly inpatient directed payment calculated that
        is equal to the product of the number of inpatient days
        attributable to the hospital used in the calculation
        of the quarterly uniform class per diem add-on,
        multiplied by the calculated applicable quarterly
        uniform class per diem add-on of the hospital class.
            (B) Each hospital shall be paid 1/3 of its
        quarterly inpatient directed payment in each of the 3
        months of the Payout Quarter, in accordance with
        directions provided to each MCO by the Department.
        (2) Outpatient per unit add-on. A quarterly uniform
    per claim add-on shall be derived by dividing the
    quarterly Outpatient Directed Payments Pool amount
    allocated to the applicable hospital class by the total
    outpatient encounter claims received during the
    Determination Quarter, for all hospitals in the class.
            (A) Each hospital in the class shall have a
        quarterly outpatient directed payment calculated that
        is equal to the product of the number of outpatient
        encounter claims attributable to the hospital used in
        the calculation of the quarterly uniform class per
        claim add-on, multiplied by the calculated applicable
        quarterly uniform class per claim add-on of the
        hospital class.
            (B) Each hospital shall be paid 1/3 of its
        quarterly outpatient directed payment in each of the 3
        months of the Payout Quarter, in accordance with
        directions provided to each MCO by the Department.
        (3) Each MCO shall pay each hospital the Monthly
    Directed Payment as identified by the Department on its
    quarterly determination report.
        (4) Definitions. As used in this subsection:
            (A) "Payout Quarter" means each 3 month calendar
        quarter, beginning July 1, 2020.
            (B) "Determination Quarter" means each 3 month
        calendar quarter, which ends 3 months prior to the
        first day of each Payout Quarter.
        (5) For the period July 1, 2020 through December 2020,
    the following amounts shall be allocated to the following
    hospital class directed payment pools for the quarterly
    development of a uniform per unit add-on:
            (A) $2,894,500 for hospital inpatient services for
        critical access hospitals.
            (B) $4,294,374 for hospital outpatient services
        for critical access hospitals.
            (C) $29,109,330 for hospital inpatient services
        for safety-net hospitals.
            (D) $35,041,218 for hospital outpatient services
        for safety-net hospitals.
        (6) For the period January 1, 2023 through December
    31, 2023, the Department shall establish the amounts that
    shall be allocated to the hospital class directed payment
    fixed pools identified in this paragraph for the quarterly
    development of a uniform per unit add-on. The Department
    shall establish such amounts so that the total amount of
    payments to each hospital under this Section in calendar
    year 2023 is projected to be substantially similar to the
    total amount of such payments received by the hospital
    under this Section in calendar year 2021, adjusted for
    increased funding provided for fixed pool directed
    payments under subsection (g) in calendar year 2022,
    assuming that the volume and acuity of claims are held
    constant. The Department shall publish the directed
    payment fixed pool amounts to be established under this
    paragraph on its website by November 15, 2022.
            (A) Hospital inpatient services for critical
        access hospitals.
            (B) Hospital outpatient services for critical
        access hospitals.
            (C) Hospital inpatient services for public
        hospitals.
            (D) Hospital outpatient services for public
        hospitals.
            (E) Hospital inpatient services for safety-net
        hospitals.
            (F) Hospital outpatient services for safety-net
        hospitals.
        (7) Semi-annual rate maintenance review. The
    Department shall ensure that hospitals assigned to the
    fixed pools in paragraph (6) are paid no less than 95% of
    the annual initial rate for each 6-month period of each
    annual payout period. For each calendar year, the
    Department shall calculate the annual initial rate per day
    and per visit for each fixed pool hospital class listed in
    paragraph (6), by dividing the total of all applicable
    inpatient or outpatient directed payments issued in the
    preceding calendar year to the hospitals in each fixed
    pool class for the calendar year, plus any increase
    resulting from the annual adjustments described in
    subsection (i), by the actual applicable total service
    units for the preceding calendar year which were the basis
    of the total applicable inpatient or outpatient directed
    payments issued to the hospitals in each fixed pool class
    in the calendar year, except that for calendar year 2023,
    the service units from calendar year 2021 shall be used.
            (A) The Department shall calculate the effective
        rate, per day and per visit, for the payout periods of
        January to June and July to December of each year, for
        each fixed pool listed in paragraph (6), by dividing
        50% of the annual pool by the total applicable
        reported service units for the 2 applicable
        determination quarters.
            (B) If the effective rate calculated in
        subparagraph (A) is less than 95% of the annual
        initial rate assigned to the class for each pool under
        paragraph (6), the Department shall adjust the payment
        for each hospital to a level equal to no less than 95%
        of the annual initial rate, by issuing a retroactive
        adjustment payment for the 6-month period under review
        as identified in subparagraph (A).
    (h) Fixed rate directed payments. Effective July 1, 2020,
the Department shall issue payments to MCOs which shall be
used to issue directed payments to Illinois hospitals not
identified in paragraph (g) on a monthly basis. Prior to the
beginning of each Payout Quarter beginning July 1, 2020, the
Department shall use encounter claims data from the
Determination Quarter, accepted by the Department's Medicaid
Management Information System for inpatient and outpatient
services rendered by hospitals in each hospital class
identified in paragraph (f) and not identified in paragraph
(g). For the period July 1, 2020 through December 2020, the
Department shall direct MCOs to make payments as follows:
        (1) For general acute care hospitals an amount equal
    to $1,750 multiplied by the hospital's category of service
    20 case mix index for the determination quarter multiplied
    by the hospital's total number of inpatient admissions for
    category of service 20 for the determination quarter.
        (2) For general acute care hospitals an amount equal
    to $160 multiplied by the hospital's category of service
    21 case mix index for the determination quarter multiplied
    by the hospital's total number of inpatient admissions for
    category of service 21 for the determination quarter.
        (3) For general acute care hospitals an amount equal
    to $80 multiplied by the hospital's category of service 22
    case mix index for the determination quarter multiplied by
    the hospital's total number of inpatient admissions for
    category of service 22 for the determination quarter.
        (4) For general acute care hospitals an amount equal
    to $375 multiplied by the hospital's category of service
    24 case mix index for the determination quarter multiplied
    by the hospital's total number of category of service 24
    paid EAPG (EAPGs) for the determination quarter.
        (5) For general acute care hospitals an amount equal
    to $240 multiplied by the hospital's category of service
    27 and 28 case mix index for the determination quarter
    multiplied by the hospital's total number of category of
    service 27 and 28 paid EAPGs for the determination
    quarter.
        (6) For general acute care hospitals an amount equal
    to $290 multiplied by the hospital's category of service
    29 case mix index for the determination quarter multiplied
    by the hospital's total number of category of service 29
    paid EAPGs for the determination quarter.
        (7) For high Medicaid hospitals an amount equal to
    $1,800 multiplied by the hospital's category of service 20
    case mix index for the determination quarter multiplied by
    the hospital's total number of inpatient admissions for
    category of service 20 for the determination quarter.
        (8) For high Medicaid hospitals an amount equal to
    $160 multiplied by the hospital's category of service 21
    case mix index for the determination quarter multiplied by
    the hospital's total number of inpatient admissions for
    category of service 21 for the determination quarter.
        (9) For high Medicaid hospitals an amount equal to $80
    multiplied by the hospital's category of service 22 case
    mix index for the determination quarter multiplied by the
    hospital's total number of inpatient admissions for
    category of service 22 for the determination quarter.
        (10) For high Medicaid hospitals an amount equal to
    $400 multiplied by the hospital's category of service 24
    case mix index for the determination quarter multiplied by
    the hospital's total number of category of service 24 paid
    EAPG outpatient claims for the determination quarter.
        (11) For high Medicaid hospitals an amount equal to
    $240 multiplied by the hospital's category of service 27
    and 28 case mix index for the determination quarter
    multiplied by the hospital's total number of category of
    service 27 and 28 paid EAPGs for the determination
    quarter.
        (12) For high Medicaid hospitals an amount equal to
    $290 multiplied by the hospital's category of service 29
    case mix index for the determination quarter multiplied by
    the hospital's total number of category of service 29 paid
    EAPGs for the determination quarter.
        (13) For long term acute care hospitals the amount of
    $495 multiplied by the hospital's total number of
    inpatient days for the determination quarter.
        (14) For psychiatric hospitals the amount of $210
    multiplied by the hospital's total number of inpatient
    days for category of service 21 for the determination
    quarter.
        (15) For psychiatric hospitals the amount of $250
    multiplied by the hospital's total number of outpatient
    claims for category of service 27 and 28 for the
    determination quarter.
        (16) For rehabilitation hospitals the amount of $410
    multiplied by the hospital's total number of inpatient
    days for category of service 22 for the determination
    quarter.
        (17) For rehabilitation hospitals the amount of $100
    multiplied by the hospital's total number of outpatient
    claims for category of service 29 for the determination
    quarter.
        (18) Effective for the Payout Quarter beginning
    January 1, 2023, for the directed payments to hospitals
    required under this subsection, the Department shall
    establish the amounts that shall be used to calculate such
    directed payments using the methodologies specified in
    this paragraph. The Department shall use a single, uniform
    rate, adjusted for acuity as specified in paragraphs (1)
    through (12), for all categories of inpatient services
    provided by each class of hospitals and a single uniform
    rate, adjusted for acuity as specified in paragraphs (1)
    through (12), for all categories of outpatient services
    provided by each class of hospitals. The Department shall
    establish such amounts so that the total amount of
    payments to each hospital under this Section in calendar
    year 2023 is projected to be substantially similar to the
    total amount of such payments received by the hospital
    under this Section in calendar year 2021, adjusted for
    increased funding provided for fixed pool directed
    payments under subsection (g) in calendar year 2022,
    assuming that the volume and acuity of claims are held
    constant. The Department shall publish the directed
    payment amounts to be established under this subsection on
    its website by November 15, 2022.
        (19) Each hospital shall be paid 1/3 of their
    quarterly inpatient and outpatient directed payment in
    each of the 3 months of the Payout Quarter, in accordance
    with directions provided to each MCO by the Department.
        (20) Each MCO shall pay each hospital the Monthly
    Directed Payment amount as identified by the Department on
    its quarterly determination report.
    Notwithstanding any other provision of this subsection, if
the Department determines that the actual total hospital
utilization data that is used to calculate the fixed rate
directed payments is substantially different than anticipated
when the rates in this subsection were initially determined
for unforeseeable circumstances (such as the COVID-19 pandemic
or some other public health emergency), the Department may
adjust the rates specified in this subsection so that the
total directed payments approximate the total spending amount
anticipated when the rates were initially established.
    Definitions. As used in this subsection:
            (A) "Payout Quarter" means each calendar quarter,
        beginning July 1, 2020.
            (B) "Determination Quarter" means each calendar
        quarter which ends 3 months prior to the first day of
        each Payout Quarter.
            (C) "Case mix index" means a hospital specific
        calculation. For inpatient claims the case mix index
        is calculated each quarter by summing the relative
        weight of all inpatient Diagnosis-Related Group (DRG)
        claims for a category of service in the applicable
        Determination Quarter and dividing the sum by the
        number of sum total of all inpatient DRG admissions
        for the category of service for the associated claims.
        The case mix index for outpatient claims is calculated
        each quarter by summing the relative weight of all
        paid EAPGs in the applicable Determination Quarter and
        dividing the sum by the sum total of paid EAPGs for the
        associated claims.
    (i) Beginning January 1, 2021, the rates for directed
payments shall be recalculated in order to spend the
additional funds for directed payments that result from
reduction in the amount of pass-through payments allowed under
federal regulations. The additional funds for directed
payments shall be allocated proportionally to each class of
hospitals based on that class' proportion of services.
        (1) Beginning January 1, 2024, the fixed pool directed
    payment amounts and the associated annual initial rates
    referenced in paragraph (6) of subsection (f) for each
    hospital class shall be uniformly increased by a ratio of
    not less than, the ratio of the total pass-through
    reduction amount pursuant to paragraph (4) of subsection
    (j), for the hospitals comprising the hospital fixed pool
    directed payment class for the next calendar year, to the
    total inpatient and outpatient directed payments for the
    hospitals comprising the hospital fixed pool directed
    payment class paid during the preceding calendar year.
        (2) Beginning January 1, 2024, the fixed rates for the
    directed payments referenced in paragraph (18) of
    subsection (h) for each hospital class shall be uniformly
    increased by a ratio of not less than, the ratio of the
    total pass-through reduction amount pursuant to paragraph
    (4) of subsection (j), for the hospitals comprising the
    hospital directed payment class for the next calendar
    year, to the total inpatient and outpatient directed
    payments for the hospitals comprising the hospital fixed
    rate directed payment class paid during the preceding
    calendar year.
    (j) Pass-through payments.
        (1) For the period July 1, 2020 through December 31,
    2020, the Department shall assign quarterly pass-through
    payments to each class of hospitals equal to one-fourth of
    the following annual allocations:
            (A) $390,487,095 to safety-net hospitals.
            (B) $62,553,886 to critical access hospitals.
            (C) $345,021,438 to high Medicaid hospitals.
            (D) $551,429,071 to general acute care hospitals.
            (E) $27,283,870 to long term acute care hospitals.
            (F) $40,825,444 to freestanding psychiatric
        hospitals.
            (G) $9,652,108 to freestanding rehabilitation
        hospitals.
        (2) For the period of July 1, 2020 through December
    31, 2020, the pass-through payments shall at a minimum
    ensure hospitals receive a total amount of monthly
    payments under this Section as received in calendar year
    2019 in accordance with this Article and paragraph (1) of
    subsection (d-5) of Section 14-12, exclusive of amounts
    received through payments referenced in subsection (b).
        (3) For the calendar year beginning January 1, 2023,
    the Department shall establish the annual pass-through
    allocation to each class of hospitals and the pass-through
    payments to each hospital so that the total amount of
    payments to each hospital under this Section in calendar
    year 2023 is projected to be substantially similar to the
    total amount of such payments received by the hospital
    under this Section in calendar year 2021, adjusted for
    increased funding provided for fixed pool directed
    payments under subsection (g) in calendar year 2022,
    assuming that the volume and acuity of claims are held
    constant. The Department shall publish the pass-through
    allocation to each class and the pass-through payments to
    each hospital to be established under this subsection on
    its website by November 15, 2022.
        (4) For the calendar years beginning January 1, 2021
    and January 1, 2022, each hospital's pass-through payment
    amount shall be reduced proportionally to the reduction of
    all pass-through payments required by federal regulations.
    Beginning January 1, 2024, the Department shall reduce
    total pass-through payments by the minimum amount
    necessary to comply with federal regulations. Pass-through
    payments to safety-net hospitals, as defined in Section
    5-5e.1 of this Code, shall not be reduced until all
    pass-through payments to other hospitals have been
    eliminated. All other hospitals shall have their
    pass-through payments reduced proportionally.
    (k) At least 30 days prior to each calendar year, the
Department shall notify each hospital of changes to the
payment methodologies in this Section, including, but not
limited to, changes in the fixed rate directed payment rates,
the aggregate pass-through payment amount for all hospitals,
and the hospital's pass-through payment amount for the
upcoming calendar year.
    (l) Notwithstanding any other provisions of this Section,
the Department may adopt rules to change the methodology for
directed and pass-through payments as set forth in this
Section, but only to the extent necessary to obtain federal
approval of a necessary State Plan amendment or Directed
Payment Preprint or to otherwise conform to federal law or
federal regulation.
    (m) As used in this subsection, "managed care
organization" or "MCO" means an entity which contracts with
the Department to provide services where payment for medical
services is made on a capitated basis, excluding contracted
entities for dual eligible or Department of Children and
Family Services youth populations.
    (n) In order to address the escalating infant mortality
rates among minority communities in Illinois, the State shall,
subject to appropriation, create a pool of funding of at least
$50,000,000 annually to be disbursed among safety-net
hospitals that maintain perinatal designation from the
Department of Public Health. The funding shall be used to
preserve or enhance OB/GYN services or other specialty
services at the receiving hospital, with the distribution of
funding to be established by rule and with consideration to
perinatal hospitals with safe birthing levels and quality
metrics for healthy mothers and babies.
    (o) In order to address the growing challenges of
providing stable access to healthcare in rural Illinois,
including perinatal services, behavioral healthcare including
substance use disorder services (SUDs) and other specialty
services, and to expand access to telehealth services among
rural communities in Illinois, the Department of Healthcare
and Family Services shall administer a program to provide at
least $10,000,000 in financial support annually to critical
access hospitals for delivery of perinatal and OB/GYN
services, behavioral healthcare including SUDS, other
specialty services and telehealth services. The funding shall
be used to preserve or enhance perinatal and OB/GYN services,
behavioral healthcare including SUDS, other specialty
services, as well as the explanation of telehealth services by
the receiving hospital, with the distribution of funding to be
established by rule.
    (p) For calendar year 2023, the final amounts, rates, and
payments under subsections (c), (d-2), (g), (h), and (j) shall
be established by the Department, so that the sum of the total
estimated annual payments under subsections (c), (d-2), (g),
(h), and (j) for each hospital class for calendar year 2023, is
no less than:
        (1) $858,260,000 to safety-net hospitals.
        (2) $86,200,000 to critical access hospitals.
        (3) $1,765,000,000 to high Medicaid hospitals.
        (4) $673,860,000 to general acute care hospitals.
        (5) $48,330,000 to long term acute care hospitals.
        (6) $89,110,000 to freestanding psychiatric hospitals.
        (7) $24,300,000 to freestanding rehabilitation
    hospitals.
        (8) $32,570,000 to public hospitals.
    (q) Hospital Pandemic Recovery Stabilization Payments. The
Department shall disburse a pool of $460,000,000 in stability
payments to hospitals prior to April 1, 2023. The allocation
of the pool shall be based on the hospital directed payment
classes and directed payments issued, during Calendar Year
2022 with added consideration to safety net hospitals, as
defined in subdivision (f)(1)(B) of this Section, and critical
access hospitals.
    (r) Directed payment update. For calendar year 2025, and
each calendar year thereafter, the final amounts, rates, and
payments for the fixed pool directed payments described in
subsection (g) and the fixed rate directed payments described
in subsection (h) shall be established by the Department at no
less than the following:
        (1) $579,261,585 for inpatient services at safety-net
    hospitals.
        (2) $763,418,138 for outpatient services at safety-net
    hospitals.
        (3) $12,389,160 for inpatient services at critical
    access hospitals.
        (4) $137,437,866 for outpatient services at critical
    access hospitals.
        (5) $5,418 as a base fixed rate per admit prior to
    adjusting for acuity, for inpatient services at high
    Medicaid hospitals.
        (6) $1,512 as a base fixed rate per paid E-APG prior to
    adjusting for acuity, for outpatient services at high
    Medicaid hospitals.
        (7) $3,898 as a base fixed rate per admit prior to
    adjusting for acuity, for inpatient services at other
    acute care hospitals.
        (8) $1,322 as a base fixed rate per E-APG prior to
    adjusting for acuity, for outpatient services at other
    acute hospitals.
        (9) $773 per day for inpatient services at long term
    acute care hospitals.
        (10) $206 per day for inpatient services at
    freestanding psychiatric hospitals.
        (11) $223 per claim for outpatient services at
    freestanding psychiatric hospitals.
        (12) $776 per day for inpatient services at
    freestanding rehabilitation hospitals.
        (13) $252 per claim for outpatient services at
    freestanding rehabilitation hospitals.
        (14) $7,793,812 for inpatient services at public
    hospitals.
        (15) $26,849,592 for outpatient services at public
    hospitals.
    Implementation of the rate increases described in this
subsection (r) shall be contingent on federal approval. The
rates for fixed pool directed payments as described in
subsection (g) and for fixed rate directed payments as
described in subsection (h) shall remain as published by the
Department on November 27, 2024 until the Department receives
federal approval for the updated rates described in this
subsection (r).
    (s) If, in order to secure approval by the Centers for
Medicare and Medicaid Services, the rates under subsection (r)
are reduced, the Department may submit a State Plan amendment
to increase rates in place at the time of the reduction
pertaining to subsection (d-2) to offset the annual amount of
reduction to the rates under subsection (r), in amounts equal
to the required reduction on a class-specific basis to ensure
that funds are not reallocated from one class to another; or
the rates in subsection (r) shall be reduced uniformly to the
amounts necessary to achieve approval and the assessments
imposed by subsection (a) or (b-5) of Section 5A-2 shall be
reduced uniformly to achieve a total annual reduction across
both assessments equal to the product of the total annual
reduction to payments and .3853. In addition, the assessments
shall further be reduced uniformly to achieve a total annual
reduction across both assessments equal to the difference of
subtracting the product calculated in the previous sentence
from the resulting quotient of dividing the product described
in the previous sentence by .92 for a reduction to the
transfers in subsection 7.16 and 7.17 of Section 5A-8.
    (t) To provide for the expeditious and timely
implementation of the changes made to this Section by this
amendatory Act of the 104th General Assembly, the Department
may adopt emergency rules as authorized by Section 5-45 of the
Illinois Administrative Procedure Act. The adoption of
emergency rules is deemed to be necessary for the public
interest, safety, and welfare.
(Source: P.A. 102-4, eff. 4-27-21; 102-16, eff. 6-17-21;
102-886, eff. 5-17-22; 102-1115, eff. 1-9-23; 103-102, eff.
6-16-23; 103-593, eff. 6-7-24; 103-605, eff. 7-1-24.)
 
    (305 ILCS 5/5A-14)
    Sec. 5A-14. Repeal of assessments and disbursements.
    (a) (Blank). Section 5A-2 is repealed on December 31,
2026.
    (b) Section 5A-12 is repealed on July 1, 2005.
    (c) Section 5A-12.1 is repealed on July 1, 2008.
    (d) Section 5A-12.2 and Section 5A-12.4 are repealed on
July 1, 2018, subject to Section 5A-16.
    (e) Section 5A-12.3 is repealed on July 1, 2011.
    (f) Section 5A-12.6 is repealed on July 1, 2020.
    (g) (Blank). Section 5A-12.7 is repealed on December 31,
2026.
(Source: P.A. 101-650, eff. 7-7-20; 102-886, eff. 5-17-22.)
 
    (305 ILCS 5/12-4.105)
    Sec. 12-4.105. Human poison control center; payment
program. Subject to funding availability resulting from
transfers made from the Hospital Provider Fund to the
Healthcare Provider Relief Fund as authorized under this Code,
for State fiscal year 2017 and State fiscal year 2018, and for
each State fiscal year thereafter in which the assessment
under Section 5A-2 is imposed, the Department of Healthcare
and Family Services shall pay to the human poison control
center designated under the Poison Control System Act an
amount of not less than $3,000,000 for each of State fiscal
years 2017 through 2020, and for State fiscal years 2021
through 2023 an amount of not less than $3,750,000 and for
State fiscal year years 2024 through 2026 an amount of not less
than $4,000,000, and for State fiscal year 2025 an amount not
less than $4,500,000, and for State fiscal year 2026, and each
fiscal year thereafter, an amount of not less than $4,750,000
and for the period July 1, 2026 through December 31, 2026 an
amount of not less than $2,000,000, if the human poison
control center is in operation.
(Source: P.A. 102-886, eff. 5-17-22; 103-102, eff. 6-16-23.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.