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Public Act 104-0007 | ||||
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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This Section is repealed one year after the effective date | ||||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(Section scheduled to be repealed on December 31, 2026) | ||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. |