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90_SB1706ham003
LRB9011519EGfgam04
1 AMENDMENT TO SENATE BILL 1706
2 AMENDMENT NO. . Amend Senate Bill 1706 on page 1, by
3 inserting below line 9 the following:
4 "Section 10. The Illinois Administrative Procedure Act
5 is amended by changing Section 5-45 as follows:
6 (5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
7 Sec. 5-45. Emergency rulemaking.
8 (a) "Emergency" means the existence of any situation
9 that any agency finds reasonably constitutes a threat to the
10 public interest, safety, or welfare.
11 (b) If any agency finds that an emergency exists that
12 requires adoption of a rule upon fewer days than is required
13 by Section 5-40 and states in writing its reasons for that
14 finding, the agency may adopt an emergency rule without prior
15 notice or hearing upon filing a notice of emergency
16 rulemaking with the Secretary of State under Section 5-70.
17 The notice shall include the text of the emergency rule and
18 shall be published in the Illinois Register. Consent orders
19 or other court orders adopting settlements negotiated by an
20 agency may be adopted under this Section. Subject to
21 applicable constitutional or statutory provisions, an
22 emergency rule becomes effective immediately upon filing
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1 under Section 5-65 or at a stated date less than 10 days
2 thereafter. The agency's finding and a statement of the
3 specific reasons for the finding shall be filed with the
4 rule. The agency shall take reasonable and appropriate
5 measures to make emergency rules known to the persons who may
6 be affected by them.
7 (c) An emergency rule may be effective for a period of
8 not longer than 150 days, but the agency's authority to adopt
9 an identical rule under Section 5-40 is not precluded. No
10 emergency rule may be adopted more than once in any 24 month
11 period, except that this limitation on the number of
12 emergency rules that may be adopted in a 24 month period does
13 not apply to (i) emergency rules that make additions to and
14 deletions from the Drug Manual under Section 5-5.16 of the
15 Illinois Public Aid Code or the generic drug formulary under
16 Section 3.14 of the Illinois Food, Drug and Cosmetic Act or
17 (ii) emergency rules adopted by the Pollution Control Board
18 before July 1, 1997 to implement portions of the Livestock
19 Management Facilities Act. Two or more emergency rules
20 having substantially the same purpose and effect shall be
21 deemed to be a single rule for purposes of this Section.
22 (d) In order to provide for the expeditious and timely
23 implementation of the State's fiscal year 1999 1998 budget,
24 emergency rules to implement any provision of this amendatory
25 Act of 1998 1997 or any other budget initiative for fiscal
26 year 1999 1998 may be adopted in accordance with this Section
27 by the agency charged with administering that provision or
28 initiative, except that the 24-month limitation on the
29 adoption of emergency rules and the provisions of Sections
30 5-115 and 5-125 do not apply to rules adopted under this
31 subsection (d). The adoption of emergency rules authorized
32 by this subsection (d) shall be deemed to be necessary for
33 the public interest, safety, and welfare.
34 (Source: P.A. 89-714, eff. 2-21-97; 90-9, eff. 7-1-97.)
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1 Section 15. The Illinois Public Aid Code is amended by
2 changing Sections 5-5.02, 5-5.4, 12-4.34, and 14-8 and adding
3 Section 12-4.35 as follows:
4 (305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
5 Sec. 5-5.02. Hospital reimbursements.
6 (a) Reimbursement to Hospitals; July 1, 1992 through
7 September 30, 1992. Notwithstanding any other provisions of
8 this Code or the Illinois Department's Rules promulgated
9 under the Illinois Administrative Procedure Act,
10 reimbursement to hospitals for services provided during the
11 period July 1, 1992 through September 30, 1992, shall be as
12 follows:
13 (1) For inpatient hospital services rendered, or if
14 applicable, for inpatient hospital discharges occurring,
15 on or after July 1, 1992 and on or before September 30,
16 1992, the Illinois Department shall reimburse hospitals
17 for inpatient services under the reimbursement
18 methodologies in effect for each hospital, and at the
19 inpatient payment rate calculated for each hospital, as
20 of June 30, 1992. For purposes of this paragraph,
21 "reimbursement methodologies" means all reimbursement
22 methodologies that pertain to the provision of inpatient
23 hospital services, including, but not limited to, any
24 adjustments for disproportionate share, targeted access,
25 critical care access and uncompensated care, as defined
26 by the Illinois Department on June 30, 1992.
27 (2) For the purpose of calculating the inpatient
28 payment rate for each hospital eligible to receive
29 quarterly adjustment payments for targeted access and
30 critical care, as defined by the Illinois Department on
31 June 30, 1992, the adjustment payment for the period July
32 1, 1992 through September 30, 1992, shall be 25% of the
33 annual adjustment payments calculated for each eligible
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1 hospital, as of June 30, 1992. The Illinois Department
2 shall determine by rule the adjustment payments for
3 targeted access and critical care beginning October 1,
4 1992.
5 (3) For the purpose of calculating the inpatient
6 payment rate for each hospital eligible to receive
7 quarterly adjustment payments for uncompensated care, as
8 defined by the Illinois Department on June 30, 1992, the
9 adjustment payment for the period August 1, 1992 through
10 September 30, 1992, shall be one-sixth of the total
11 uncompensated care adjustment payments calculated for
12 each eligible hospital for the uncompensated care rate
13 year, as defined by the Illinois Department, ending on
14 July 31, 1992. The Illinois Department shall determine
15 by rule the adjustment payments for uncompensated care
16 beginning October 1, 1992.
17 (b) Inpatient payments. For inpatient services provided
18 on or after October 1, 1993, in addition to rates paid for
19 hospital inpatient services pursuant to the Illinois Health
20 Finance Reform Act, as now or hereafter amended, or the
21 Illinois Department's prospective reimbursement methodology,
22 or any other methodology used by the Illinois Department for
23 inpatient services, the Illinois Department shall make
24 adjustment payments, in an amount calculated pursuant to the
25 methodology described in paragraph (c) of this Section, to
26 hospitals that the Illinois Department determines satisfy any
27 one of the following requirements:
28 (1) Hospitals that are described in Section 1923 of
29 the federal Social Security Act, as now or hereafter
30 amended; or
31 (2) Illinois hospitals that have a Medicaid
32 inpatient utilization rate which is at least one-half a
33 standard deviation above the mean Medicaid inpatient
34 utilization rate for all hospitals in Illinois receiving
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1 Medicaid payments from the Illinois Department; or
2 (3) Illinois hospitals that on July 1, 1991 had a
3 Medicaid inpatient utilization rate, as defined in
4 paragraph (f) of this Section, that was at least the mean
5 Medicaid inpatient utilization rate for all hospitals in
6 Illinois receiving Medicaid payments from the Illinois
7 Department and which were located in a planning area with
8 one-third or fewer excess beds as determined by the
9 Illinois Health Facilities Planning Board, and that, as
10 of June 30, 1992, were located in a federally designated
11 Health Manpower Shortage Area; or
12 (4) Illinois hospitals that:
13 (A) have a Medicaid inpatient utilization rate
14 that is at least equal to the mean Medicaid
15 inpatient utilization rate for all hospitals in
16 Illinois receiving Medicaid payments from the
17 Department; and
18 (B) also have a Medicaid obstetrical inpatient
19 utilization rate that is at least one standard
20 deviation above the mean Medicaid obstetrical
21 inpatient utilization rate for all hospitals in
22 Illinois receiving Medicaid payments from the
23 Department for obstetrical services; or
24 (5) Any children's hospital, which means a hospital
25 devoted exclusively to caring for children. A hospital
26 which includes a facility devoted exclusively to caring
27 for children that is separately licensed as a hospital by
28 a municipality prior to September 30, 1998 shall be
29 considered a children's hospital to the degree that the
30 hospital's Medicaid care is provided to children.
31 (c) Inpatient adjustment payments. The adjustment
32 payments required by paragraph (b) shall be calculated based
33 upon the hospital's Medicaid inpatient utilization rate as
34 follows:
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1 (1) hospitals with a Medicaid inpatient utilization
2 rate below the mean shall receive a per day adjustment
3 payment equal to $25;
4 (2) hospitals with a Medicaid inpatient
5 utilization rate that is equal to or greater than the
6 mean Medicaid inpatient utilization rate but less than
7 one standard deviation above the mean Medicaid inpatient
8 utilization rate shall receive a per day adjustment
9 payment equal to the sum of $25 plus $1 for each one
10 percent that the hospital's Medicaid inpatient
11 utilization rate exceeds the mean Medicaid inpatient
12 utilization rate;
13 (3) hospitals with a Medicaid inpatient
14 utilization rate that is equal to or greater than one
15 standard deviation above the mean Medicaid inpatient
16 utilization rate but less than 1.5 standard deviations
17 above the mean Medicaid inpatient utilization rate shall
18 receive a per day adjustment payment equal to the sum of
19 $40 plus $7 for each one percent that the hospital's
20 Medicaid inpatient utilization rate exceeds one standard
21 deviation above the mean Medicaid inpatient utilization
22 rate; and
23 (4) hospitals with a Medicaid inpatient
24 utilization rate that is equal to or greater than 1.5
25 standard deviations above the mean Medicaid inpatient
26 utilization rate shall receive a per day adjustment
27 payment equal to the sum of $90 plus $2 for each one
28 percent that the hospital's Medicaid inpatient
29 utilization rate exceeds 1.5 standard deviations above
30 the mean Medicaid inpatient utilization rate.
31 (d) Supplemental adjustment payments. In addition to
32 the adjustment payments described in paragraph (c), hospitals
33 as defined in clauses (1) through (5) of paragraph (b),
34 excluding county hospitals (as defined in subsection (c) of
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1 Section 15-1 of this Code) and a hospital organized under the
2 University of Illinois Hospital Act, shall be paid
3 supplemental inpatient adjustment payments of $60 per day.
4 For purposes of Title XIX of the federal Social Security Act,
5 these supplemental adjustment payments shall not be
6 classified as adjustment payments to disproportionate share
7 hospitals.
8 (e) The inpatient adjustment payments described in
9 paragraphs (c) and (d) shall be increased on October 1, 1993
10 and annually thereafter by a percentage equal to the lesser
11 of (i) the increase in the DRI hospital cost index for the
12 most recent 12 month period for which data are available, or
13 (ii) the percentage increase in the statewide average
14 hospital payment rate over the previous year's statewide
15 average hospital payment rate. The sum of the inpatient
16 adjustment payments under paragraphs (c) and (d) to a
17 hospital, other than a county hospital (as defined in
18 subsection (c) of Section 15-1 of this Code) or a hospital
19 organized under the University of Illinois Hospital Act,
20 however, shall not exceed $275 per day; that limit shall be
21 increased on October 1, 1993 and annually thereafter by a
22 percentage equal to the lesser of (i) the increase in the DRI
23 hospital cost index for the most recent 12-month period for
24 which data are available or (ii) the percentage increase in
25 the statewide average hospital payment rate over the previous
26 year's statewide average hospital payment rate.
27 (f) Children's hospital inpatient adjustment payments.
28 For children's hospitals, as defined in clause (5) of
29 paragraph (b), the adjustment payments required pursuant to
30 paragraphs (c) and (d) shall be multiplied by 2.0.
31 (g) County hospital inpatient adjustment payments. For
32 county hospitals, as defined in subsection (c) of Section
33 15-1 of this Code, there shall be an adjustment payment as
34 determined by rules issued by the Illinois Department.
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1 (h) For the purposes of this Section the following
2 terms shall be defined as follows:
3 (1) "Medicaid inpatient utilization rate" means a
4 fraction, the numerator of which is the number of a
5 hospital's inpatient days provided in a given 12-month
6 period to patients who, for such days, were eligible for
7 Medicaid under Title XIX of the federal Social Security
8 Act, and the denominator of which is the total number of
9 the hospital's inpatient days in that same period.
10 (2) "Mean Medicaid inpatient utilization rate"
11 means the total number of Medicaid inpatient days
12 provided by all Illinois Medicaid-participating hospitals
13 divided by the total number of inpatient days provided by
14 those same hospitals.
15 (3) "Medicaid obstetrical inpatient utilization
16 rate" means the ratio of Medicaid obstetrical inpatient
17 days to total Medicaid inpatient days for all Illinois
18 hospitals receiving Medicaid payments from the Illinois
19 Department.
20 (i) Inpatient adjustment payment limit. In order to
21 meet the limits of Public Law 102-234 and Public Law 103-66,
22 the Illinois Department shall by rule adjust disproportionate
23 share adjustment payments.
24 (j) University of Illinois Hospital inpatient adjustment
25 payments. For hospitals organized under the University of
26 Illinois Hospital Act, there shall be an adjustment payment
27 as determined by rules adopted by the Illinois Department.
28 (k) The Illinois Department may by rule establish
29 criteria for and develop methodologies for adjustment
30 payments to hospitals participating under this Article.
31 (Source: P.A. 88-88; 89-21, eff. 7-1-95.)
32 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
33 Sec. 5-5.4. Standards of Payment - Department of Public
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1 Aid. The Department of Public Aid shall develop standards of
2 payment of skilled nursing and intermediate care services in
3 facilities providing such services under this Article which:
4 (1) Provides for the determination of a facility's
5 payment for skilled nursing and intermediate care services on
6 a prospective basis. The amount of the payment rate for all
7 nursing facilities certified under the medical assistance
8 program shall be prospectively established annually on the
9 basis of historical, financial, and statistical data
10 reflecting actual costs from prior years, which shall be
11 applied to the current rate year and updated for inflation,
12 except that the capital cost element for newly constructed
13 facilities shall be based upon projected budgets. The
14 annually established payment rate shall take effect on July 1
15 in 1984 and subsequent years. Rate increases shall be
16 provided annually thereafter on July 1 in 1984 and on each
17 subsequent July 1 in the following years, except that no rate
18 increase and no update for inflation shall be provided on or
19 after July 1, 1994 and before July 1, 1999, unless
20 specifically provided for in this Section. For facilities
21 licensed by the Department of Public Health under the Nursing
22 Home Care Act as Intermediate Care for the Developmentally
23 Disabled facilities or Long Term Care for Under Age 22
24 facilities, the rates taking effect on July 1, 1998 shall
25 include an increase of 3%. For facilities licensed by the
26 Department of Public Health under the Nursing Home Care Act
27 as Skilled Nursing facilities or Intermediate Care
28 facilities, the rates taking effect on July 1, 1998 shall
29 include an increase of 3% plus $1.10 per resident-day, as
30 defined by the Department. Rates established effective each
31 July 1 shall govern payment for services rendered throughout
32 that fiscal year, except that rates established on July 1,
33 1996 shall be increased by 6.8% for services provided on or
34 after January 1, 1997. Such rates will be based upon the
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1 rates calculated for the year beginning July 1, 1990, and for
2 subsequent years thereafter shall be based on the facility
3 cost reports for the facility fiscal year ending at any point
4 in time during the previous calendar year, updated to the
5 midpoint of the rate year. The cost report shall be on file
6 with the Department no later than April 1 of the current rate
7 year. Should the cost report not be on file by April 1, the
8 Department shall base the rate on the latest cost report
9 filed by each skilled care facility and intermediate care
10 facility, updated to the midpoint of the current rate year.
11 In determining rates for services rendered on and after July
12 1, 1985, fixed time shall not be computed at less than zero.
13 The Department shall not make any alterations of regulations
14 which would reduce any component of the Medicaid rate to a
15 level below what that component would have been utilizing in
16 the rate effective on July 1, 1984.
17 (2) Shall take into account the actual costs incurred by
18 facilities in providing services for recipients of skilled
19 nursing and intermediate care services under the medical
20 assistance program.
21 (3) Shall take into account the medical and
22 psycho-social characteristics and needs of the patients.
23 (4) Shall take into account the actual costs incurred by
24 facilities in meeting, licensing and certification standards
25 imposed and prescribed by the State of Illinois, any of its
26 political subdivisions or municipalities and by the United
27 States Department of Health, Education and Welfare pursuant
28 to Title XIX of the Social Security Act.
29 The Department of Public Aid shall develop precise
30 standards for payments to reimburse nursing facilities for
31 any utilization of appropriate rehabilitative personnel for
32 the provision of rehabilitative services which is authorized
33 by federal regulations, including reimbursement for services
34 provided by qualified therapists or qualified assistants, and
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1 which is in accordance with accepted professional practices.
2 Reimbursement also may be made for utilization of other
3 supportive personnel under appropriate supervision.
4 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96; 90-9,
5 eff. 7-1-97.)
6 (305 ILCS 5/12-4.34)
7 (Section scheduled to be repealed on August 31, 1998)
8 Sec. 12-4.34. Naturalization and nutrition Services to
9 noncitizens.
10 (a) Subject to specific appropriation for this purpose
11 and notwithstanding Sections 1-11 and 3-1 of this Code, the
12 Department of Human Services is authorized to provide
13 naturalization services to legal immigrants, including but
14 not limited to naturalization and nutrition services and
15 financial assistance. The nature of these services, payment
16 levels, and eligibility conditions shall be determined by
17 rule.
18 (b) Subject to specific appropriation for this purpose,
19 the Department of Human Services is authorized to provide
20 nutrition services to noncitizens who are 65 years of age or
21 older, under 18 years of age, or disabled, and who were in
22 the United States prior to August 22, 1996 and are not
23 eligible for the federal food stamp program due to their
24 noncitizen status. The payment levels and other eligibility
25 conditions for these services shall be determined by rule.
26 The Illinois Department is authorized to lower the
27 payment levels established under this subsection or take such
28 other actions during the fiscal year as are necessary to
29 ensure that payments under this subsection do not exceed the
30 amounts appropriated for this purpose. These changes may be
31 accomplished by emergency rule under Section 5-45 of the
32 Illinois Administrative Procedure Act, except that the
33 limitation on the number of emergency rules that may be
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1 adopted in a 24-month period shall not apply.
2 (c) This Section is repealed on August 31, 1999 1998.
3 (Source: P.A. 90-564, eff. 12-22-97.)
4 (305 ILCS 5/12-4.35 new)
5 Sec. 12-4.35. Medical services for certain noncitizens.
6 (a) Subject to specific appropriation for this purpose,
7 and notwithstanding Section 1-11 of this Code or Section
8 20(a) of the Children's Health Insurance Program Act, the
9 Department of Public Aid may provide medical services to
10 noncitizens who have not yet attained 19 years of age and who
11 are not eligible for medical assistance under Article V of
12 this Code or under the Children's Health Insurance Program
13 created by the Children's Health Insurance Program Act due to
14 their not meeting the otherwise applicable provisions of
15 Section 1-11 of this Code or Section 20(a) of the Children's
16 Health Insurance Program Act. The medical services
17 available, standards for eligibility, and other conditions of
18 participation under this Section shall be established by rule
19 by the Department; however, any such rule shall be at least
20 as restrictive as the rules for medical assistance under
21 Article V of this Code or the Children's Health Insurance
22 Program created by the Children's Health Insurance Program
23 Act.
24 (b) The Department is authorized to take any action,
25 including without limitation cessation of enrollment,
26 reduction of available medical services, and changing
27 standards for eligibility, that is deemed necessary by the
28 Department during a State fiscal year to assure that payments
29 under this Section do not exceed the amounts appropriated for
30 this purpose.
31 (c) In the event that the appropriation in any fiscal
32 year for the Children's Health Insurance Program created by
33 the Children's Health Insurance Program Act is determined by
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1 the Department to be insufficient to continue enrollment of
2 otherwise eligible children under that Program during that
3 fiscal year, the Department is authorized to use funds
4 appropriated for the purposes of this Section to fund that
5 Program and to take any other action necessary to continue
6 the operation of that Program. Furthermore, continued
7 enrollment of individuals into the program created under this
8 Section in any fiscal year is contingent upon continued
9 enrollment of individuals into the Children's Health
10 Insurance Program during that fiscal year.
11 (d) The General Assembly finds that the adoption of
12 rules to meet the purposes of subsections (a), (b), and (c)
13 is an emergency and necessary for the public interest,
14 safety, and welfare. The Department may adopt such rules
15 through the use of emergency rulemaking in accordance with
16 Section 5-45 of the Illinois Administrative Procedure Act,
17 except that the limitation on the number of emergency rules
18 that may be adopted in a 24-month period shall not apply.
19 (305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
20 Sec. 14-8. Disbursements to Hospitals.
21 (a) For inpatient hospital services rendered on and
22 after September 1, 1991, the Illinois Department shall
23 reimburse hospitals for inpatient services at an inpatient
24 payment rate calculated for each hospital based upon the
25 Medicare Prospective Payment System as set forth in Sections
26 1886(b), (d), (g), and (h) of the federal Social Security
27 Act, and the regulations, policies, and procedures
28 promulgated thereunder, except as modified by this Section.
29 Payment rates for inpatient hospital services rendered on or
30 after September 1, 1991 and on or before September 30, 1992
31 shall be calculated using the Medicare Prospective Payment
32 rates in effect on September 1, 1991. Payment rates for
33 inpatient hospital services rendered on or after October 1,
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1 1992 and on or before March 31, 1994 shall be calculated
2 using the Medicare Prospective Payment rates in effect on
3 September 1, 1992. Payment rates for inpatient hospital
4 services rendered on or after April 1, 1994 shall be
5 calculated using the Medicare Prospective Payment rates
6 (including the Medicare grouping methodology and weighting
7 factors as adjusted pursuant to paragraph (1) of this
8 subsection) in effect 90 days prior to the date of
9 admission. For services rendered on or after July 1, 1995,
10 the reimbursement methodology implemented under this
11 subsection shall not include those costs referred to in
12 Sections 1886(d)(5)(B) and 1886(h) of the Social Security
13 Act. The additional payment amounts required under Section
14 1886(d)(5)(F) of the Social Security Act, for hospitals
15 serving a disproportionate share of low-income or indigent
16 patients, are not required under this Section. For hospital
17 inpatient services rendered on or after July 1, 1995, the
18 Illinois Department shall reimburse hospitals using the
19 relative weighting factors and the base payment rates
20 calculated for each hospital that were in effect on June 30,
21 1995, less the portion of such rates attributed by the
22 Illinois Department to the cost of medical education.
23 (1) The weighting factors established under Section
24 1886(d)(4) of the Social Security Act shall not be used
25 in the reimbursement system established under this
26 Section. Rather, the Illinois Department shall establish
27 by rule Medicaid weighting factors to be used in the
28 reimbursement system established under this Section.
29 (2) The Illinois Department shall define by rule
30 those hospitals or distinct parts of hospitals that shall
31 be exempt from the reimbursement system established under
32 this Section. In defining such hospitals, the Illinois
33 Department shall take into consideration those hospitals
34 exempt from the Medicare Prospective Payment System as of
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1 September 1, 1991. For hospitals defined as exempt under
2 this subsection, the Illinois Department shall by rule
3 establish a reimbursement system for payment of inpatient
4 hospital services rendered on and after September 1,
5 1991. For all hospitals that are children's hospitals as
6 defined in Section 5-5.02 of this Code, the reimbursement
7 methodology shall, through June 30, 1992, net of all
8 applicable fees, at least equal each children's hospital
9 1990 ICARE payment rates, indexed to the current year by
10 application of the DRI hospital cost index from 1989 to
11 the year in which payments are made. Excepting county
12 providers as defined in Article XV of this Code,
13 hospitals licensed under the University of Illinois
14 Hospital Act, and facilities operated by the Department
15 of Mental Health and Developmental Disabilities (or its
16 successor, the Department of Human Services) for hospital
17 inpatient services rendered on or after July 1, 1995, the
18 Illinois Department shall reimburse children's hospitals,
19 as defined in 89 Illinois Administrative Code Section
20 149.50(c)(3), at the rates in effect on June 30, 1995,
21 and shall reimburse all other hospitals at the rates in
22 effect on June 30, 1995, less the portion of such rates
23 attributed by the Illinois Department to the cost of
24 medical education. For inpatient hospital services
25 provided on or after August 1, 1998, the Illinois
26 Department may establish by rule a means of adjusting the
27 rates of children's hospitals, as defined in 89 Illinois
28 Administrative Code Section 149.50(c)(3), that did not
29 meet that definition on June 30, 1995, in order for the
30 inpatient hospital rates of such hospitals to take into
31 account the average inpatient hospital rates of those
32 children's hospitals that did meet the definition of
33 children's hospitals on June 30, 1995.
34 (3) (Blank)
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1 (4) Notwithstanding any other provision of this
2 Section, hospitals that on August 31, 1991, have a
3 contract with the Illinois Department under Section 3-4
4 of the Illinois Health Finance Reform Act may elect to
5 continue to be reimbursed at rates stated in such
6 contracts for general and specialty care.
7 (5) In addition to any payments made under this
8 subsection (a), the Illinois Department shall make the
9 adjustment payments required by Section 5-5.02 of this
10 Code; provided, that in the case of any hospital
11 reimbursed under a per case methodology, the Illinois
12 Department shall add an amount equal to the product of
13 the hospital's average length of stay, less one day,
14 multiplied by 20, for inpatient hospital services
15 rendered on or after September 1, 1991 and on or before
16 September 30, 1992.
17 (b) (Blank)
18 (b-5) Excepting county providers as defined in Article
19 XV of this Code, hospitals licensed under the University of
20 Illinois Hospital Act, and facilities operated by the
21 Illinois Department of Mental Health and Developmental
22 Disabilities (or its successor, the Department of Human
23 Services), for outpatient services rendered on or after July
24 1, 1995 and before July 1, 1998, the Illinois Department
25 shall reimburse children's hospitals, as defined in the
26 Illinois Administrative Code Section 149.50(c)(3), at the
27 rates in effect on June 30, 1995, less that portion of such
28 rates attributed by the Illinois Department to the outpatient
29 indigent volume adjustment and shall reimburse all other
30 hospitals at the rates in effect on June 30, 1995, less the
31 portions of such rates attributed by the Illinois Department
32 to the cost of medical education and attributed by the
33 Illinois Department to the outpatient indigent volume
34 adjustment. For outpatient services provided on or after
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1 July 1, 1998, reimbursement rates shall be established by
2 rule.
3 (c) In addition to any other payments under this Code,
4 the Illinois Department shall develop a hospital
5 disproportionate share reimbursement methodology that,
6 effective July 1, 1991, through September 30, 1992, shall
7 reimburse hospitals sufficiently to expend the fee monies
8 described in subsection (b) of Section 14-3 of this Code and
9 the federal matching funds received by the Illinois
10 Department as a result of expenditures made by the Illinois
11 Department as required by this subsection (c) and Section
12 14-2 that are attributable to fee monies deposited in the
13 Fund, less amounts applied to adjustment payments under
14 Section 5-5.02.
15 (d) Critical Care Access Payments.
16 (1) In addition to any other payments made under
17 this Code, the Illinois Department shall develop a
18 reimbursement methodology that shall reimburse Critical
19 Care Access Hospitals for the specialized services that
20 qualify them as Critical Care Access Hospitals. No
21 adjustment payments shall be made under this subsection
22 on or after July 1, 1995.
23 (2) "Critical Care Access Hospitals" includes, but
24 is not limited to, hospitals that meet at least one of
25 the following criteria:
26 (A) Hospitals located outside of a
27 metropolitan statistical area that are designated as
28 Level II Perinatal Centers and that provide a
29 disproportionate share of perinatal services to
30 recipients; or
31 (B) Hospitals that are designated as Level I
32 Trauma Centers (adult or pediatric) and certain
33 Level II Trauma Centers as determined by the
34 Illinois Department; or
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1 (C) Hospitals located outside of a
2 metropolitan statistical area and that provide a
3 disproportionate share of obstetrical services to
4 recipients.
5 (e) Inpatient high volume adjustment. For hospital
6 inpatient services, effective with rate periods beginning on
7 or after October 1, 1993, in addition to rates paid for
8 inpatient services by the Illinois Department, the Illinois
9 Department shall make adjustment payments for inpatient
10 services furnished by Medicaid high volume hospitals. The
11 Illinois Department shall establish by rule criteria for
12 qualifying as a Medicaid high volume hospital and shall
13 establish by rule a reimbursement methodology for calculating
14 these adjustment payments to Medicaid high volume hospitals.
15 No adjustment payment shall be made under this subsection for
16 services rendered on or after July 1, 1995.
17 (f) The Illinois Department shall modify its current
18 rules governing adjustment payments for targeted access,
19 critical care access, and uncompensated care to classify
20 those adjustment payments as not being payments to
21 disproportionate share hospitals under Title XIX of the
22 federal Social Security Act. Rules adopted under this
23 subsection shall not be effective with respect to services
24 rendered on or after July 1, 1995. The Illinois Department
25 has no obligation to adopt or implement any rules or make any
26 payments under this subsection for services rendered on or
27 after July 1, 1995.
28 (f-5) The State recognizes that adjustment payments to
29 hospitals providing certain services or incurring certain
30 costs may be necessary to assure that recipients of medical
31 assistance have adequate access to necessary medical
32 services. These adjustments include payments for teaching
33 costs and uncompensated care, trauma center payments,
34 rehabilitation hospital payments, perinatal center payments,
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1 obstetrical care payments, targeted access payments, Medicaid
2 high volume payments, and outpatient indigent volume
3 payments. On or before April 1, 1995, the Illinois
4 Department shall issue recommendations regarding (i)
5 reimbursement mechanisms or adjustment payments to reflect
6 these costs and services, including methods by which the
7 payments may be calculated and the method by which the
8 payments may be financed, and (ii) reimbursement mechanisms
9 or adjustment payments to reflect costs and services of
10 federally qualified health centers with respect to recipients
11 of medical assistance.
12 (g) If one or more hospitals file suit in any court
13 challenging any part of this Article XIV, payments to
14 hospitals under this Article XIV shall be made only to the
15 extent that sufficient monies are available in the Fund and
16 only to the extent that any monies in the Fund are not
17 prohibited from disbursement under any order of the court.
18 (h) Payments under the disbursement methodology
19 described in this Section are subject to approval by the
20 federal government in an appropriate State plan amendment.
21 (i) The Illinois Department may by rule establish
22 criteria for and develop methodologies for adjustment
23 payments to hospitals participating under this Article.
24 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96;
25 89-507, eff. 7-1-97; 90-9, eff. 7-1-97; 90-14, eff.
26 7-1-97.)".