Public Act 90-0588 of the 90th General Assembly
Public Act 90-0588
SB1706 Enrolled LRB9011519MWpc
AN ACT in relation to State government.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be cited as the
FY99 Budget Implementation (Health Related) Act.
Section 5. Purpose. It is the purpose and subject of
this Act to make the changes in State programs that are
necessary to implement the Governor's FY1999 budget
recommendations.
Section 10. The Illinois Administrative Procedure Act is
amended by changing Section 5-45 as follows:
(5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
Sec. 5-45. Emergency rulemaking.
(a) "Emergency" means the existence of any situation
that any agency finds reasonably constitutes a threat to the
public interest, safety, or welfare.
(b) If any agency finds that an emergency exists that
requires adoption of a rule upon fewer days than is required
by Section 5-40 and states in writing its reasons for that
finding, the agency may adopt an emergency rule without prior
notice or hearing upon filing a notice of emergency
rulemaking with the Secretary of State under Section 5-70.
The notice shall include the text of the emergency rule and
shall be published in the Illinois Register. Consent orders
or other court orders adopting settlements negotiated by an
agency may be adopted under this Section. Subject to
applicable constitutional or statutory provisions, an
emergency rule becomes effective immediately upon filing
under Section 5-65 or at a stated date less than 10 days
thereafter. The agency's finding and a statement of the
specific reasons for the finding shall be filed with the
rule. The agency shall take reasonable and appropriate
measures to make emergency rules known to the persons who may
be affected by them.
(c) An emergency rule may be effective for a period of
not longer than 150 days, but the agency's authority to adopt
an identical rule under Section 5-40 is not precluded. No
emergency rule may be adopted more than once in any 24 month
period, except that this limitation on the number of
emergency rules that may be adopted in a 24 month period does
not apply to (i) emergency rules that make additions to and
deletions from the Drug Manual under Section 5-5.16 of the
Illinois Public Aid Code or the generic drug formulary under
Section 3.14 of the Illinois Food, Drug and Cosmetic Act or
(ii) emergency rules adopted by the Pollution Control Board
before July 1, 1997 to implement portions of the Livestock
Management Facilities Act. Two or more emergency rules
having substantially the same purpose and effect shall be
deemed to be a single rule for purposes of this Section.
(d) In order to provide for the expeditious and timely
implementation of the State's fiscal year 1999 1998 budget,
emergency rules to implement any provision of this amendatory
Act of 1998 1997 or any other budget initiative for fiscal
year 1999 1998 may be adopted in accordance with this Section
by the agency charged with administering that provision or
initiative, except that the 24-month limitation on the
adoption of emergency rules and the provisions of Sections
5-115 and 5-125 do not apply to rules adopted under this
subsection (d). The adoption of emergency rules authorized
by this subsection (d) shall be deemed to be necessary for
the public interest, safety, and welfare.
(Source: P.A. 89-714, eff. 2-21-97; 90-9, eff. 7-1-97.)
Section 15. The Illinois Public Aid Code is amended by
changing Sections 5-5.02, 5-5.4, 12-4.34, and 14-8 and adding
Section 12-4.35 as follows:
(305 ILCS 5/5-5.02) (from Ch. 23, par. 5-5.02)
Sec. 5-5.02. Hospital reimbursements.
(a) Reimbursement to Hospitals; July 1, 1992 through
September 30, 1992. Notwithstanding any other provisions of
this Code or the Illinois Department's Rules promulgated
under the Illinois Administrative Procedure Act,
reimbursement to hospitals for services provided during the
period July 1, 1992 through September 30, 1992, shall be as
follows:
(1) For inpatient hospital services rendered, or if
applicable, for inpatient hospital discharges occurring,
on or after July 1, 1992 and on or before September 30,
1992, the Illinois Department shall reimburse hospitals
for inpatient services under the reimbursement
methodologies in effect for each hospital, and at the
inpatient payment rate calculated for each hospital, as
of June 30, 1992. For purposes of this paragraph,
"reimbursement methodologies" means all reimbursement
methodologies that pertain to the provision of inpatient
hospital services, including, but not limited to, any
adjustments for disproportionate share, targeted access,
critical care access and uncompensated care, as defined
by the Illinois Department on June 30, 1992.
(2) For the purpose of calculating the inpatient
payment rate for each hospital eligible to receive
quarterly adjustment payments for targeted access and
critical care, as defined by the Illinois Department on
June 30, 1992, the adjustment payment for the period July
1, 1992 through September 30, 1992, shall be 25% of the
annual adjustment payments calculated for each eligible
hospital, as of June 30, 1992. The Illinois Department
shall determine by rule the adjustment payments for
targeted access and critical care beginning October 1,
1992.
(3) For the purpose of calculating the inpatient
payment rate for each hospital eligible to receive
quarterly adjustment payments for uncompensated care, as
defined by the Illinois Department on June 30, 1992, the
adjustment payment for the period August 1, 1992 through
September 30, 1992, shall be one-sixth of the total
uncompensated care adjustment payments calculated for
each eligible hospital for the uncompensated care rate
year, as defined by the Illinois Department, ending on
July 31, 1992. The Illinois Department shall determine
by rule the adjustment payments for uncompensated care
beginning October 1, 1992.
(b) Inpatient payments. For inpatient services provided
on or after October 1, 1993, in addition to rates paid for
hospital inpatient services pursuant to the Illinois Health
Finance Reform Act, as now or hereafter amended, or the
Illinois Department's prospective reimbursement methodology,
or any other methodology used by the Illinois Department for
inpatient services, the Illinois Department shall make
adjustment payments, in an amount calculated pursuant to the
methodology described in paragraph (c) of this Section, to
hospitals that the Illinois Department determines satisfy any
one of the following requirements:
(1) Hospitals that are described in Section 1923 of
the federal Social Security Act, as now or hereafter
amended; or
(2) Illinois hospitals that have a Medicaid
inpatient utilization rate which is at least one-half a
standard deviation above the mean Medicaid inpatient
utilization rate for all hospitals in Illinois receiving
Medicaid payments from the Illinois Department; or
(3) Illinois hospitals that on July 1, 1991 had a
Medicaid inpatient utilization rate, as defined in
paragraph (f) of this Section, that was at least the mean
Medicaid inpatient utilization rate for all hospitals in
Illinois receiving Medicaid payments from the Illinois
Department and which were located in a planning area with
one-third or fewer excess beds as determined by the
Illinois Health Facilities Planning Board, and that, as
of June 30, 1992, were located in a federally designated
Health Manpower Shortage Area; or
(4) Illinois hospitals that:
(A) have a Medicaid inpatient utilization rate
that is at least equal to the mean Medicaid
inpatient utilization rate for all hospitals in
Illinois receiving Medicaid payments from the
Department; and
(B) also have a Medicaid obstetrical inpatient
utilization rate that is at least one standard
deviation above the mean Medicaid obstetrical
inpatient utilization rate for all hospitals in
Illinois receiving Medicaid payments from the
Department for obstetrical services; or
(5) Any children's hospital, which means a hospital
devoted exclusively to caring for children. A hospital
which includes a facility devoted exclusively to caring
for children that is separately licensed as a hospital by
a municipality prior to September 30, 1998 shall be
considered a children's hospital to the degree that the
hospital's Medicaid care is provided to children.
(c) Inpatient adjustment payments. The adjustment
payments required by paragraph (b) shall be calculated based
upon the hospital's Medicaid inpatient utilization rate as
follows:
(1) hospitals with a Medicaid inpatient utilization
rate below the mean shall receive a per day adjustment
payment equal to $25;
(2) hospitals with a Medicaid inpatient
utilization rate that is equal to or greater than the
mean Medicaid inpatient utilization rate but less than
one standard deviation above the mean Medicaid inpatient
utilization rate shall receive a per day adjustment
payment equal to the sum of $25 plus $1 for each one
percent that the hospital's Medicaid inpatient
utilization rate exceeds the mean Medicaid inpatient
utilization rate;
(3) hospitals with a Medicaid inpatient
utilization rate that is equal to or greater than one
standard deviation above the mean Medicaid inpatient
utilization rate but less than 1.5 standard deviations
above the mean Medicaid inpatient utilization rate shall
receive a per day adjustment payment equal to the sum of
$40 plus $7 for each one percent that the hospital's
Medicaid inpatient utilization rate exceeds one standard
deviation above the mean Medicaid inpatient utilization
rate; and
(4) hospitals with a Medicaid inpatient
utilization rate that is equal to or greater than 1.5
standard deviations above the mean Medicaid inpatient
utilization rate shall receive a per day adjustment
payment equal to the sum of $90 plus $2 for each one
percent that the hospital's Medicaid inpatient
utilization rate exceeds 1.5 standard deviations above
the mean Medicaid inpatient utilization rate.
(d) Supplemental adjustment payments. In addition to
the adjustment payments described in paragraph (c), hospitals
as defined in clauses (1) through (5) of paragraph (b),
excluding county hospitals (as defined in subsection (c) of
Section 15-1 of this Code) and a hospital organized under the
University of Illinois Hospital Act, shall be paid
supplemental inpatient adjustment payments of $60 per day.
For purposes of Title XIX of the federal Social Security Act,
these supplemental adjustment payments shall not be
classified as adjustment payments to disproportionate share
hospitals.
(e) The inpatient adjustment payments described in
paragraphs (c) and (d) shall be increased on October 1, 1993
and annually thereafter by a percentage equal to the lesser
of (i) the increase in the DRI hospital cost index for the
most recent 12 month period for which data are available, or
(ii) the percentage increase in the statewide average
hospital payment rate over the previous year's statewide
average hospital payment rate. The sum of the inpatient
adjustment payments under paragraphs (c) and (d) to a
hospital, other than a county hospital (as defined in
subsection (c) of Section 15-1 of this Code) or a hospital
organized under the University of Illinois Hospital Act,
however, shall not exceed $275 per day; that limit shall be
increased on October 1, 1993 and annually thereafter by a
percentage equal to the lesser of (i) the increase in the DRI
hospital cost index for the most recent 12-month period for
which data are available or (ii) the percentage increase in
the statewide average hospital payment rate over the previous
year's statewide average hospital payment rate.
(f) Children's hospital inpatient adjustment payments.
For children's hospitals, as defined in clause (5) of
paragraph (b), the adjustment payments required pursuant to
paragraphs (c) and (d) shall be multiplied by 2.0.
(g) County hospital inpatient adjustment payments. For
county hospitals, as defined in subsection (c) of Section
15-1 of this Code, there shall be an adjustment payment as
determined by rules issued by the Illinois Department.
(h) For the purposes of this Section the following
terms shall be defined as follows:
(1) "Medicaid inpatient utilization rate" means a
fraction, the numerator of which is the number of a
hospital's inpatient days provided in a given 12-month
period to patients who, for such days, were eligible for
Medicaid under Title XIX of the federal Social Security
Act, and the denominator of which is the total number of
the hospital's inpatient days in that same period.
(2) "Mean Medicaid inpatient utilization rate"
means the total number of Medicaid inpatient days
provided by all Illinois Medicaid-participating hospitals
divided by the total number of inpatient days provided by
those same hospitals.
(3) "Medicaid obstetrical inpatient utilization
rate" means the ratio of Medicaid obstetrical inpatient
days to total Medicaid inpatient days for all Illinois
hospitals receiving Medicaid payments from the Illinois
Department.
(i) Inpatient adjustment payment limit. In order to
meet the limits of Public Law 102-234 and Public Law 103-66,
the Illinois Department shall by rule adjust disproportionate
share adjustment payments.
(j) University of Illinois Hospital inpatient adjustment
payments. For hospitals organized under the University of
Illinois Hospital Act, there shall be an adjustment payment
as determined by rules adopted by the Illinois Department.
(k) The Illinois Department may by rule establish
criteria for and develop methodologies for adjustment
payments to hospitals participating under this Article.
(Source: P.A. 88-88; 89-21, eff. 7-1-95.)
(305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
Sec. 5-5.4. Standards of Payment - Department of Public
Aid. The Department of Public Aid shall develop standards of
payment of skilled nursing and intermediate care services in
facilities providing such services under this Article which:
(1) Provides for the determination of a facility's
payment for skilled nursing and intermediate care services on
a prospective basis. The amount of the payment rate for all
nursing facilities certified under the medical assistance
program shall be prospectively established annually on the
basis of historical, financial, and statistical data
reflecting actual costs from prior years, which shall be
applied to the current rate year and updated for inflation,
except that the capital cost element for newly constructed
facilities shall be based upon projected budgets. The
annually established payment rate shall take effect on July 1
in 1984 and subsequent years. Rate increases shall be
provided annually thereafter on July 1 in 1984 and on each
subsequent July 1 in the following years, except that no rate
increase and no update for inflation shall be provided on or
after July 1, 1994 and before July 1, 1999, unless
specifically provided for in this Section. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Intermediate Care for the Developmentally
Disabled facilities or Long Term Care for Under Age 22
facilities, the rates taking effect on July 1, 1998 shall
include an increase of 3%. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act
as Skilled Nursing facilities or Intermediate Care
facilities, the rates taking effect on July 1, 1998 shall
include an increase of 3% plus $1.10 per resident-day, as
defined by the Department. Rates established effective each
July 1 shall govern payment for services rendered throughout
that fiscal year, except that rates established on July 1,
1996 shall be increased by 6.8% for services provided on or
after January 1, 1997. Such rates will be based upon the
rates calculated for the year beginning July 1, 1990, and for
subsequent years thereafter shall be based on the facility
cost reports for the facility fiscal year ending at any point
in time during the previous calendar year, updated to the
midpoint of the rate year. The cost report shall be on file
with the Department no later than April 1 of the current rate
year. Should the cost report not be on file by April 1, the
Department shall base the rate on the latest cost report
filed by each skilled care facility and intermediate care
facility, updated to the midpoint of the current rate year.
In determining rates for services rendered on and after July
1, 1985, fixed time shall not be computed at less than zero.
The Department shall not make any alterations of regulations
which would reduce any component of the Medicaid rate to a
level below what that component would have been utilizing in
the rate effective on July 1, 1984.
(2) Shall take into account the actual costs incurred by
facilities in providing services for recipients of skilled
nursing and intermediate care services under the medical
assistance program.
(3) Shall take into account the medical and
psycho-social characteristics and needs of the patients.
(4) Shall take into account the actual costs incurred by
facilities in meeting, licensing and certification standards
imposed and prescribed by the State of Illinois, any of its
political subdivisions or municipalities and by the United
States Department of Health, Education and Welfare pursuant
to Title XIX of the Social Security Act.
The Department of Public Aid shall develop precise
standards for payments to reimburse nursing facilities for
any utilization of appropriate rehabilitative personnel for
the provision of rehabilitative services which is authorized
by federal regulations, including reimbursement for services
provided by qualified therapists or qualified assistants, and
which is in accordance with accepted professional practices.
Reimbursement also may be made for utilization of other
supportive personnel under appropriate supervision.
(Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96; 90-9,
eff. 7-1-97.)
(305 ILCS 5/12-4.34)
(Section scheduled to be repealed on August 31, 1998)
Sec. 12-4.34. Naturalization and nutrition Services to
noncitizens.
(a) Subject to specific appropriation for this purpose
and notwithstanding Sections 1-11 and 3-1 of this Code, the
Department of Human Services is authorized to provide
naturalization services to legal immigrants, including but
not limited to naturalization and nutrition services and
financial assistance. The nature of these services, payment
levels, and eligibility conditions shall be determined by
rule.
(b) Subject to specific appropriation for this purpose,
the Department of Human Services is authorized to provide
nutrition services to noncitizens who are 65 years of age or
older, under 18 years of age, or disabled, and who were in
the United States prior to August 22, 1996 and are not
eligible for the federal food stamp program due to their
noncitizen status. The payment levels and other eligibility
conditions for these services shall be determined by rule.
The Illinois Department is authorized to lower the
payment levels established under this subsection or take such
other actions during the fiscal year as are necessary to
ensure that payments under this subsection do not exceed the
amounts appropriated for this purpose. These changes may be
accomplished by emergency rule under Section 5-45 of the
Illinois Administrative Procedure Act, except that the
limitation on the number of emergency rules that may be
adopted in a 24-month period shall not apply.
(c) This Section is repealed on August 31, 1999 1998.
(Source: P.A. 90-564, eff. 12-22-97.)
(305 ILCS 5/12-4.35 new)
Sec. 12-4.35. Medical services for certain noncitizens.
(a) Subject to specific appropriation for this purpose,
and notwithstanding Section 1-11 of this Code or Section
20(a) of the Children's Health Insurance Program Act, the
Department of Public Aid may provide medical services to
noncitizens who have not yet attained 19 years of age and who
are not eligible for medical assistance under Article V of
this Code or under the Children's Health Insurance Program
created by the Children's Health Insurance Program Act due to
their not meeting the otherwise applicable provisions of
Section 1-11 of this Code or Section 20(a) of the Children's
Health Insurance Program Act. The medical services
available, standards for eligibility, and other conditions of
participation under this Section shall be established by rule
by the Department; however, any such rule shall be at least
as restrictive as the rules for medical assistance under
Article V of this Code or the Children's Health Insurance
Program created by the Children's Health Insurance Program
Act.
(b) The Department is authorized to take any action,
including without limitation cessation of enrollment,
reduction of available medical services, and changing
standards for eligibility, that is deemed necessary by the
Department during a State fiscal year to assure that payments
under this Section do not exceed the amounts appropriated for
this purpose.
(c) In the event that the appropriation in any fiscal
year for the Children's Health Insurance Program created by
the Children's Health Insurance Program Act is determined by
the Department to be insufficient to continue enrollment of
otherwise eligible children under that Program during that
fiscal year, the Department is authorized to use funds
appropriated for the purposes of this Section to fund that
Program and to take any other action necessary to continue
the operation of that Program. Furthermore, continued
enrollment of individuals into the program created under this
Section in any fiscal year is contingent upon continued
enrollment of individuals into the Children's Health
Insurance Program during that fiscal year.
(d) The General Assembly finds that the adoption of
rules to meet the purposes of subsections (a), (b), and (c)
is an emergency and necessary for the public interest,
safety, and welfare. The Department may adopt such rules
through the use of emergency rulemaking in accordance with
Section 5-45 of the Illinois Administrative Procedure Act,
except that the limitation on the number of emergency rules
that may be adopted in a 24-month period shall not apply.
(305 ILCS 5/14-8) (from Ch. 23, par. 14-8)
Sec. 14-8. Disbursements to Hospitals.
(a) For inpatient hospital services rendered on and
after September 1, 1991, the Illinois Department shall
reimburse hospitals for inpatient services at an inpatient
payment rate calculated for each hospital based upon the
Medicare Prospective Payment System as set forth in Sections
1886(b), (d), (g), and (h) of the federal Social Security
Act, and the regulations, policies, and procedures
promulgated thereunder, except as modified by this Section.
Payment rates for inpatient hospital services rendered on or
after September 1, 1991 and on or before September 30, 1992
shall be calculated using the Medicare Prospective Payment
rates in effect on September 1, 1991. Payment rates for
inpatient hospital services rendered on or after October 1,
1992 and on or before March 31, 1994 shall be calculated
using the Medicare Prospective Payment rates in effect on
September 1, 1992. Payment rates for inpatient hospital
services rendered on or after April 1, 1994 shall be
calculated using the Medicare Prospective Payment rates
(including the Medicare grouping methodology and weighting
factors as adjusted pursuant to paragraph (1) of this
subsection) in effect 90 days prior to the date of
admission. For services rendered on or after July 1, 1995,
the reimbursement methodology implemented under this
subsection shall not include those costs referred to in
Sections 1886(d)(5)(B) and 1886(h) of the Social Security
Act. The additional payment amounts required under Section
1886(d)(5)(F) of the Social Security Act, for hospitals
serving a disproportionate share of low-income or indigent
patients, are not required under this Section. For hospital
inpatient services rendered on or after July 1, 1995, the
Illinois Department shall reimburse hospitals using the
relative weighting factors and the base payment rates
calculated for each hospital that were in effect on June 30,
1995, less the portion of such rates attributed by the
Illinois Department to the cost of medical education.
(1) The weighting factors established under Section
1886(d)(4) of the Social Security Act shall not be used
in the reimbursement system established under this
Section. Rather, the Illinois Department shall establish
by rule Medicaid weighting factors to be used in the
reimbursement system established under this Section.
(2) The Illinois Department shall define by rule
those hospitals or distinct parts of hospitals that shall
be exempt from the reimbursement system established under
this Section. In defining such hospitals, the Illinois
Department shall take into consideration those hospitals
exempt from the Medicare Prospective Payment System as of
September 1, 1991. For hospitals defined as exempt under
this subsection, the Illinois Department shall by rule
establish a reimbursement system for payment of inpatient
hospital services rendered on and after September 1,
1991. For all hospitals that are children's hospitals as
defined in Section 5-5.02 of this Code, the reimbursement
methodology shall, through June 30, 1992, net of all
applicable fees, at least equal each children's hospital
1990 ICARE payment rates, indexed to the current year by
application of the DRI hospital cost index from 1989 to
the year in which payments are made. Excepting county
providers as defined in Article XV of this Code,
hospitals licensed under the University of Illinois
Hospital Act, and facilities operated by the Department
of Mental Health and Developmental Disabilities (or its
successor, the Department of Human Services) for hospital
inpatient services rendered on or after July 1, 1995, the
Illinois Department shall reimburse children's hospitals,
as defined in 89 Illinois Administrative Code Section
149.50(c)(3), at the rates in effect on June 30, 1995,
and shall reimburse all other hospitals at the rates in
effect on June 30, 1995, less the portion of such rates
attributed by the Illinois Department to the cost of
medical education. For inpatient hospital services
provided on or after August 1, 1998, the Illinois
Department may establish by rule a means of adjusting the
rates of children's hospitals, as defined in 89 Illinois
Administrative Code Section 149.50(c)(3), that did not
meet that definition on June 30, 1995, in order for the
inpatient hospital rates of such hospitals to take into
account the average inpatient hospital rates of those
children's hospitals that did meet the definition of
children's hospitals on June 30, 1995.
(3) (Blank)
(4) Notwithstanding any other provision of this
Section, hospitals that on August 31, 1991, have a
contract with the Illinois Department under Section 3-4
of the Illinois Health Finance Reform Act may elect to
continue to be reimbursed at rates stated in such
contracts for general and specialty care.
(5) In addition to any payments made under this
subsection (a), the Illinois Department shall make the
adjustment payments required by Section 5-5.02 of this
Code; provided, that in the case of any hospital
reimbursed under a per case methodology, the Illinois
Department shall add an amount equal to the product of
the hospital's average length of stay, less one day,
multiplied by 20, for inpatient hospital services
rendered on or after September 1, 1991 and on or before
September 30, 1992.
(b) (Blank)
(b-5) Excepting county providers as defined in Article
XV of this Code, hospitals licensed under the University of
Illinois Hospital Act, and facilities operated by the
Illinois Department of Mental Health and Developmental
Disabilities (or its successor, the Department of Human
Services), for outpatient services rendered on or after July
1, 1995 and before July 1, 1998, the Illinois Department
shall reimburse children's hospitals, as defined in the
Illinois Administrative Code Section 149.50(c)(3), at the
rates in effect on June 30, 1995, less that portion of such
rates attributed by the Illinois Department to the outpatient
indigent volume adjustment and shall reimburse all other
hospitals at the rates in effect on June 30, 1995, less the
portions of such rates attributed by the Illinois Department
to the cost of medical education and attributed by the
Illinois Department to the outpatient indigent volume
adjustment. For outpatient services provided on or after
July 1, 1998, reimbursement rates shall be established by
rule.
(c) In addition to any other payments under this Code,
the Illinois Department shall develop a hospital
disproportionate share reimbursement methodology that,
effective July 1, 1991, through September 30, 1992, shall
reimburse hospitals sufficiently to expend the fee monies
described in subsection (b) of Section 14-3 of this Code and
the federal matching funds received by the Illinois
Department as a result of expenditures made by the Illinois
Department as required by this subsection (c) and Section
14-2 that are attributable to fee monies deposited in the
Fund, less amounts applied to adjustment payments under
Section 5-5.02.
(d) Critical Care Access Payments.
(1) In addition to any other payments made under
this Code, the Illinois Department shall develop a
reimbursement methodology that shall reimburse Critical
Care Access Hospitals for the specialized services that
qualify them as Critical Care Access Hospitals. No
adjustment payments shall be made under this subsection
on or after July 1, 1995.
(2) "Critical Care Access Hospitals" includes, but
is not limited to, hospitals that meet at least one of
the following criteria:
(A) Hospitals located outside of a
metropolitan statistical area that are designated as
Level II Perinatal Centers and that provide a
disproportionate share of perinatal services to
recipients; or
(B) Hospitals that are designated as Level I
Trauma Centers (adult or pediatric) and certain
Level II Trauma Centers as determined by the
Illinois Department; or
(C) Hospitals located outside of a
metropolitan statistical area and that provide a
disproportionate share of obstetrical services to
recipients.
(e) Inpatient high volume adjustment. For hospital
inpatient services, effective with rate periods beginning on
or after October 1, 1993, in addition to rates paid for
inpatient services by the Illinois Department, the Illinois
Department shall make adjustment payments for inpatient
services furnished by Medicaid high volume hospitals. The
Illinois Department shall establish by rule criteria for
qualifying as a Medicaid high volume hospital and shall
establish by rule a reimbursement methodology for calculating
these adjustment payments to Medicaid high volume hospitals.
No adjustment payment shall be made under this subsection for
services rendered on or after July 1, 1995.
(f) The Illinois Department shall modify its current
rules governing adjustment payments for targeted access,
critical care access, and uncompensated care to classify
those adjustment payments as not being payments to
disproportionate share hospitals under Title XIX of the
federal Social Security Act. Rules adopted under this
subsection shall not be effective with respect to services
rendered on or after July 1, 1995. The Illinois Department
has no obligation to adopt or implement any rules or make any
payments under this subsection for services rendered on or
after July 1, 1995.
(f-5) The State recognizes that adjustment payments to
hospitals providing certain services or incurring certain
costs may be necessary to assure that recipients of medical
assistance have adequate access to necessary medical
services. These adjustments include payments for teaching
costs and uncompensated care, trauma center payments,
rehabilitation hospital payments, perinatal center payments,
obstetrical care payments, targeted access payments, Medicaid
high volume payments, and outpatient indigent volume
payments. On or before April 1, 1995, the Illinois
Department shall issue recommendations regarding (i)
reimbursement mechanisms or adjustment payments to reflect
these costs and services, including methods by which the
payments may be calculated and the method by which the
payments may be financed, and (ii) reimbursement mechanisms
or adjustment payments to reflect costs and services of
federally qualified health centers with respect to recipients
of medical assistance.
(g) If one or more hospitals file suit in any court
challenging any part of this Article XIV, payments to
hospitals under this Article XIV shall be made only to the
extent that sufficient monies are available in the Fund and
only to the extent that any monies in the Fund are not
prohibited from disbursement under any order of the court.
(h) Payments under the disbursement methodology
described in this Section are subject to approval by the
federal government in an appropriate State plan amendment.
(i) The Illinois Department may by rule establish
criteria for and develop methodologies for adjustment
payments to hospitals participating under this Article.
(Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96;
89-507, eff. 7-1-97; 90-9, eff. 7-1-97; 90-14, eff. 7-1-97.)
Section 99. Effective date. This Act takes effect on
July 1, 1998.