SB1391 104TH GENERAL ASSEMBLY

LRB104 09551 KTG 19614 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB1391

Introduced 1/29/2025, by Sen. Kimberly A. Lightford

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5e.1
305 ILCS 5/14-12.6 new

Amends the Illinois Public Aid Code. In a provision in the Medical Assistance Article concerning safety-net hospitals, provides that, subject to federal approval, reimbursement rates for inpatient hospital services in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10% for safety-net hospitals; and reimbursement rates for outpatient hospital services in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10% for safety-net hospitals. Requires the Department of Healthcare and Family Services to take all actions necessary to ensure the rate increases for safety-net hospitals are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary. In the Hospital Services Trust Fund Article, provides that, subject to federal approval, reimbursement rates for inpatient hospital services in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10%; and reimbursement rates for outpatient hospital services in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10%. Requires the Department of Healthcare and Family Services to take all actions necessary to ensure the rate increases are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary. Effective immediately.

A BILL FOR

AN ACT concerning public aid.

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

Section 5. The Illinois Public Aid Code is amended by adding Sections 5-5e.1 and 14-12.6 as follows:

(305 ILCS 5/5-5e.1)

Sec. 5-5e.1. Safety-Net Hospitals.

(a) A Safety-Net Hospital is an Illinois hospital that:

(1) is licensed by the Department of Public Health as a general acute care or pediatric hospital; and

(2) is a disproportionate share hospital, as described in Section 1923 of the federal Social Security Act, as determined by the Department; and

(3) meets one of the following:

(A) has a MIUR of at least 40% and a charity percent of at least 4%; or

(B) has a MIUR of at least 50%.

(b) Definitions. As used in this Section:

(1) "Charity percent" means the ratio of (i) the hospital's charity charges for services provided to individuals without health insurance or another source of third party coverage to (ii) the Illinois total hospital charges, each as reported on the hospital's OBRA form.

(2) "MIUR" means Medicaid Inpatient Utilization Rate and is defined as a fraction, the numerator of which is the number of a hospital's inpatient days provided in the hospital's fiscal year ending 3 years prior to the rate year, to patients who, for such days, were eligible for Medicaid under Title XIX of the federal Social Security Act, 42 USC 1396a et seq., excluding those persons eligible for medical assistance pursuant to 42 U.S.C. 1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of Section 5-2 of this Article, and the denominator of which is the total number of the hospital's inpatient days in that same period, excluding those persons eligible for medical assistance pursuant to 42 U.S.C. 1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of Section 5-2 of this Article.

(3) "OBRA form" means form HFS-3834, OBRA '93 data collection form, for the rate year.

(4) "Rate year" means the 12-month period beginning on October 1.

(c) Beginning July 1, 2012 and ending on December 31, 2026, a hospital that would have qualified for the rate year beginning October 1, 2011 or October 1, 2012 shall be a Safety-Net Hospital.

(c-5) Beginning July 1, 2020 and ending on December 31, 2026, a hospital that would have qualified for the rate year beginning October 1, 2020 and was designated a federal rural referral center under 42 CFR 412.96 as of October 1, 2020 shall be a Safety-Net Hospital.

(d) No later than August 15 preceding the rate year, each hospital shall submit the OBRA form to the Department. Prior to October 1, the Department shall notify each hospital whether it has qualified as a Safety-Net Hospital.

(e) The Department may promulgate rules in order to implement this Section.

(f) Nothing in this Section shall be construed as limiting the ability of the Department to include the Safety-Net Hospitals in the hospital rate reform mandated by Section 14-11 of this Code and implemented under Section 14-12 of this Code and by administrative rulemaking.

(g) Notwithstanding any other provision of this Code, effective for dates of service on and after January 1, 2026, subject to federal approval, reimbursement rates for safety-net hospitals shall be revised as follows:

(1) For inpatient hospital services, reimbursement rates in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10% for safety-net hospitals.

(2) For outpatient hospital services, reimbursement rates in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10% for safety-net hospitals.

The Department shall take all actions necessary to ensure the rate increases for safety-net hospitals authorized by this amendatory Act of the 104th General Assembly are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary.

(Source: P.A. 101-650, eff. 7-7-20; 101-669, eff. 4-2-21; 102-886, eff. 5-17-22.)

(305 ILCS 5/14-12.6 new)

Sec. 14-12.6. Hospital services; rate increases.

(a) Notwithstanding any other provision of this Code, effective for dates of service on and after January 1, 2026, subject to federal approval, hospital reimbursement rates shall be revised as follows:

(1) For inpatient hospital services, reimbursement rates in effect January 1, 2025 under the All Patient Refined-Diagnosis Related Groups system shall be increased by 10%.

(2) For outpatient hospital services, reimbursement rates in effect January 1, 2025 under the Enhanced Ambulatory Procedure Grouping system shall be increased by 10%.

(b) The Department shall take all actions necessary to ensure the rate increases authorized in this amendatory Act of the 104th General Assembly are in effect for dates of service on and after January 1, 2026, including publishing all appropriate public notices, applying for federal approval of amendments to the Illinois Title XIX State Plan, and adopting administrative rules if necessary.

Section 99. Effective date. This Act takes effect upon becoming law.