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91_HB1989
LRB9104707DJcd
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 14-8.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Section 14-8 as follows:
7 (305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
8 Sec. 14-8. Disbursements to Hospitals.
9 (a) For inpatient hospital services rendered on and
10 after September 1, 1991, the Illinois Department shall
11 reimburse hospitals for inpatient services at an inpatient
12 payment rate calculated for each hospital based upon the
13 Medicare Prospective Payment System as set forth in Sections
14 1886(b), (d), (g), and (h) of the federal Social Security
15 Act, and the regulations, policies, and procedures
16 promulgated thereunder, except as modified by this Section.
17 Payment rates for inpatient hospital services rendered on or
18 after September 1, 1991 and on or before September 30, 1992
19 shall be calculated using the Medicare Prospective Payment
20 rates in effect on September 1, 1991. Payment rates for
21 inpatient hospital services rendered on or after October 1,
22 1992 and on or before March 31, 1994 shall be calculated
23 using the Medicare Prospective Payment rates in effect on
24 September 1, 1992. Payment rates for inpatient hospital
25 services rendered on or after April 1, 1994 shall be
26 calculated using the Medicare Prospective Payment rates
27 (including the Medicare grouping methodology and weighting
28 factors as adjusted pursuant to paragraph (1) of this
29 subsection) in effect 90 days prior to the date of
30 admission. For services rendered on or after July 1, 1995,
31 the reimbursement methodology implemented under this
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1 subsection shall not include those costs referred to in
2 Sections 1886(d)(5)(B) and 1886(h) of the Social Security
3 Act. The additional payment amounts required under Section
4 1886(d)(5)(F) of the Social Security Act, for hospitals
5 serving a disproportionate share of low-income or indigent
6 patients, are not required under this Section. For hospital
7 inpatient services rendered on or after July 1, 1995, the
8 Illinois Department shall reimburse hospitals using the
9 relative weighting factors and the base payment rates
10 calculated for each hospital that were in effect on June 30,
11 1995, less the portion of such rates attributed by the
12 Illinois Department to the cost of medical education.
13 (1) The weighting factors established under Section
14 1886(d)(4) of the Social Security Act shall not be used
15 in the reimbursement system established under this
16 Section. Rather, the Illinois Department shall establish
17 by rule Medicaid weighting factors to be used in the
18 reimbursement system established under this Section.
19 (2) The Illinois Department shall define by rule
20 those hospitals or distinct parts of hospitals that shall
21 be exempt from the reimbursement system established under
22 this Section. In defining such hospitals, the Illinois
23 Department shall take into consideration those hospitals
24 exempt from the Medicare Prospective Payment System as of
25 September 1, 1991. For hospitals defined as exempt under
26 this subsection, the Illinois Department shall by rule
27 establish a reimbursement system for payment of inpatient
28 hospital services rendered on and after September 1,
29 1991. For all hospitals that are children's hospitals as
30 defined in Section 5-5.02 of this Code, the reimbursement
31 methodology shall, through June 30, 1992, net of all
32 applicable fees, at least equal each children's hospital
33 1990 ICARE payment rates, indexed to the current year by
34 application of the DRI hospital cost index from 1989 to
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1 the year in which payments are made. Excepting county
2 providers as defined in Article XV of this Code,
3 hospitals licensed under the University of Illinois
4 Hospital Act, and facilities operated by the Department
5 of Mental Health and Developmental Disabilities (or its
6 successor, the Department of Human Services) for hospital
7 inpatient services rendered on or after July 1, 1995, the
8 Illinois Department shall reimburse children's hospitals,
9 as defined in 89 Illinois Administrative Code Section
10 149.50(c)(3), at the rates in effect on June 30, 1995,
11 and shall reimburse all other hospitals at the rates in
12 effect on June 30, 1995, less the portion of such rates
13 attributed by the Illinois Department to the cost of
14 medical education. For inpatient hospital services
15 provided on or after August 1, 1998, the Illinois
16 Department may establish by rule a means of adjusting the
17 rates of children's hospitals, as defined in 89 Illinois
18 Administrative Code Section 149.50(c)(3), that did not
19 meet that definition on June 30, 1995, in order for the
20 inpatient hospital rates of such hospitals to take into
21 account the average inpatient hospital rates of those
22 children's hospitals that did meet the definition of
23 children's hospitals on June 30, 1995.
24 (3) (Blank)
25 (4) Notwithstanding any other provision of this
26 Section, hospitals that on August 31, 1991, have a
27 contract with the Illinois Department under Section 3-4
28 of the Illinois Health Finance Reform Act may elect to
29 continue to be reimbursed at rates stated in such
30 contracts for general and specialty care.
31 (5) In addition to any payments made under this
32 subsection (a), the Illinois Department shall make the
33 adjustment payments required by Section 5-5.02 of this
34 Code; provided, that in the case of any hospital
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1 reimbursed under a per case methodology, the Illinois
2 Department shall add an amount equal to the product of
3 the hospital's average length of stay, less one day,
4 multiplied by 20, for inpatient hospital services
5 rendered on or after September 1, 1991 and on or before
6 September 30, 1992.
7 (b) (Blank)
8 (b-5) Excepting county providers as defined in Article
9 XV of this Code, hospitals licensed under the University of
10 Illinois Hospital Act, and facilities operated by the
11 Illinois Department of Mental Health and Developmental
12 Disabilities (or its successor, the Department of Human
13 Services), for outpatient services rendered on or after July
14 1, 1995 and before July 1, 1998 the Illinois Department shall
15 reimburse children's hospitals, as defined in the Illinois
16 Administrative Code Section 149.50(c)(3), at the rates in
17 effect on June 30, 1995, less that portion of such rates
18 attributed by the Illinois Department to the outpatient
19 indigent volume adjustment and shall reimburse all other
20 hospitals at the rates in effect on June 30, 1995, less the
21 portions of such rates attributed by the Illinois Department
22 to the cost of medical education and attributed by the
23 Illinois Department to the outpatient indigent volume
24 adjustment. For outpatient services provided on or after
25 July 1, 1998, reimbursement rates shall be established by
26 rule.
27 (c) In addition to any other payments under this Code,
28 the Illinois Department shall develop a hospital
29 disproportionate share reimbursement methodology that,
30 effective July 1, 1991, through September 30, 1992, shall
31 reimburse hospitals sufficiently to expend the fee monies
32 described in subsection (b) of Section 14-3 of this Code and
33 the federal matching funds received by the Illinois
34 Department as a result of expenditures made by the Illinois
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1 Department as required by this subsection (c) and Section
2 14-2 that are attributable to fee monies deposited in the
3 Fund, less amounts applied to adjustment payments under
4 Section 5-5.02.
5 (d) Critical Care Access Payments.
6 (1) In addition to any other payments made under
7 this Code, the Illinois Department shall develop a
8 reimbursement methodology that shall reimburse Critical
9 Care Access Hospitals for the specialized services that
10 qualify them as Critical Care Access Hospitals. No
11 adjustment payments shall be made under this subsection
12 on or after July 1, 1995.
13 (2) "Critical Care Access Hospitals" includes, but
14 is not limited to, hospitals that meet at least one of
15 the following criteria:
16 (A) Hospitals located outside of a
17 metropolitan statistical area that are designated as
18 Level II Perinatal Centers and that provide a
19 disproportionate share of perinatal services to
20 recipients; or
21 (B) Hospitals that are designated as Level I
22 Trauma Centers (adult or pediatric) and certain
23 Level II Trauma Centers as determined by the
24 Illinois Department; or
25 (C) Hospitals located outside of a
26 metropolitan statistical area and that provide a
27 disproportionate share of obstetrical services to
28 recipients.
29 (e) Inpatient high volume adjustment. For hospital
30 inpatient services, effective with rate periods beginning on
31 or after October 1, 1993, in addition to rates paid for
32 inpatient services by the Illinois Department, the Illinois
33 Department shall make adjustment payments for inpatient
34 services furnished by Medicaid high volume hospitals. The
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1 Illinois Department shall establish by rule criteria for
2 qualifying as a Medicaid high volume hospital and shall
3 establish by rule a reimbursement methodology for calculating
4 these adjustment payments to Medicaid high volume hospitals.
5 No adjustment payment shall be made under this subsection for
6 services rendered on or after July 1, 1995.
7 (f) The Illinois Department shall modify its current
8 rules governing adjustment payments for targeted access,
9 critical care access, and uncompensated care to classify
10 those adjustment payments as not being payments to
11 disproportionate share hospitals under Title XIX of the
12 federal Social Security Act. Rules adopted under this
13 subsection shall not be effective with respect to services
14 rendered on or after July 1, 1995. The Illinois Department
15 has no obligation to adopt or implement any rules or make any
16 payments under this subsection for services rendered on or
17 after July 1, 1995.
18 (f-5) The State recognizes that adjustment payments to
19 hospitals providing certain services or incurring certain
20 costs may be necessary to assure that recipients of medical
21 assistance have adequate access to necessary medical
22 services. These adjustments include payments for teaching
23 costs and uncompensated care, trauma center payments,
24 rehabilitation hospital payments, perinatal center payments,
25 obstetrical care payments, targeted access payments, Medicaid
26 high volume payments, and outpatient indigent volume
27 payments. On or before April 1, 1995, the Illinois
28 Department shall issue recommendations regarding (i)
29 reimbursement mechanisms or adjustment payments to reflect
30 these costs and services, including methods by which the
31 payments may be calculated and the method by which the
32 payments may be financed, and (ii) reimbursement mechanisms
33 or adjustment payments to reflect costs and services of
34 federally qualified health centers with respect to recipients
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1 of medical assistance.
2 (g) If one or more hospitals file suit in any court
3 challenging any part of this Article XIV, payments to
4 hospitals under this Article XIV shall be made only to the
5 extent that sufficient monies are available in the Fund and
6 only to the extent that any monies in the Fund are not
7 prohibited from disbursement under any order of the court.
8 (h) Payments under the disbursement methodology
9 described in this Section are subject to approval by the
10 federal government in an appropriate State plan amendment.
11 (i) The Illinois Department may by rule establish
12 criteria for and develop methodologies for adjustment
13 payments to hospitals participating under this Article. For
14 hospital services provided after June 30, 1999, the Illinois
15 Department shall by rule establish criteria for and develop
16 methodologies for adjustment payments to hospitals
17 participating under this Article; those rules shall take into
18 account the cost of medical education.
19 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96;
20 89-507, eff. 7-1-97; 90-9, eff. 7-1-97; 90-14, eff. 7-1-97;
21 90-588, eff. 7-1-98.)
22 Section 99. Effective date. This Act takes effect upon
23 becoming law.