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2005 Illinois 305 ILCS 5/      Illinois Public Aid Code. Article XV - County Provider Trust Fund


      (305 ILCS 5/Art. XV heading)
ARTICLE XV
COUNTY PROVIDER TRUST FUND

    (305 ILCS 5/15‑1) (from Ch. 23, par. 15‑1)
    Sec. 15‑1. Definitions. As used in this Article, unless the context requires otherwise:
    (a) "Base amount" means $108,800,000 multiplied by a fraction, the numerator of which is the number of days represented by the payments in question and the denominator of which is 365.
    (a‑5) "County provider" means a health care provider that is, or is operated by, a county with a population greater than 3,000,000.
    (b) "Fund" means the County Provider Trust Fund.
    (c) "Hospital" or "County hospital" means a hospital, as defined in Section 14‑1 of this Code, which is a county hospital located in a county of over 3,000,000 population.
(Source: P.A. 87‑13; 88‑85; 88‑554, eff. 7‑26‑94.)

    (305 ILCS 5/15‑2) (from Ch. 23, par. 15‑2)
    Sec. 15‑2. County Provider Trust Fund.
    (a) There is created in the State Treasury the County Provider Trust Fund. Interest earned by the Fund shall be credited to the Fund. The Fund shall not be used to replace any funds appropriated to the Medicaid program by the General Assembly.
    (b) The Fund is created solely for the purposes of receiving, investing, and distributing monies in accordance with this Article XV. The Fund shall consist of:
        (1) All monies collected or received by the Illinois
    
Department under Section 15‑3 of this Code;
        (2) All federal financial participation monies
    
received by the Illinois Department pursuant to Title XIX of the Social Security Act, 42 U.S.C. 1396(b), attributable to eligible expenditures made by the Illinois Department pursuant to Section 15‑5 of this Code;
        (3) All federal moneys received by the Illinois
    
Department pursuant to Title XXI of the Social Security Act attributable to eligible expenditures made by the Illinois Department pursuant to Section 15‑5 of this Code; and
        (4) All other monies received by the Fund from any
    
source, including interest thereon.
    (c) Disbursements from the Fund shall be by warrants drawn by the State Comptroller upon receipt of vouchers duly executed and certified by the Illinois Department and shall be made only:
        (1) For hospital inpatient care, hospital outpatient
    
care, care provided by other outpatient facilities operated by a county, and disproportionate share hospital payments made under Title XIX of the Social Security Act and Article V of this Code as required by Section 15‑5 of this Code;
        (1.5) For services provided by county providers
    
pursuant to Section 5‑11 of this Code;
        (2) For the reimbursement of administrative expenses
    
incurred by county providers on behalf of the Illinois Department as permitted by Section 15‑4 of this Code;
        (3) For the reimbursement of monies received by the
    
Fund through error or mistake;
        (4) For the payment of administrative expenses
    
necessarily incurred by the Illinois Department or its agent in performing the activities required by this Article XV;
        (5) For the payment of any amounts that are
    
reimbursable to the federal government, attributable solely to the Fund, and required to be paid by State warrant; and
        (6) For hospital inpatient care, hospital outpatient
    
care, care provided by other outpatient facilities operated by a county, and disproportionate share hospital payments made under Title XXI of the Social Security Act, pursuant to Section 15‑5 of this Code.
(Source: P.A. 91‑24, eff. 7‑1‑99; 92‑370, eff. 8‑15‑01.)

    (305 ILCS 5/15‑3) (from Ch. 23, par. 15‑3)
    Sec. 15‑3. Intergovernmental Transfers.
    (a) Each qualifying county shall make an annual intergovernmental transfer to the Illinois Department in an amount equal to 71.7% of the difference between the total payments made by the Illinois Department to such county provider for hospital services under Titles XIX and XXI of the Social Security Act or pursuant to Section 5‑11 of this Code in each fiscal year ending June 30 (or fraction thereof during the fiscal year ending June 30, 1993) and $108,800,000 (or fraction thereof), except that the annual intergovernmental transfer shall not exceed the total payments made by the Illinois Department to such county provider for hospital services under this Code, less the sum of (i) 50% of payments reimbursable under the Social Security Act at a rate of 50% and (ii) 65% of payments reimbursable under the Social Security Act at a rate of 65%, in each fiscal year ending June 30 (or fraction thereof).
    (b) The payment schedule for the intergovernmental transfer made hereunder shall be established by intergovernmental agreement between the Illinois Department and the applicable county, which agreement shall at a minimum provide:
        (1) For periodic payments no less frequently than
    
monthly to the county provider for inpatient and outpatient approved or adjudicated claims and for disproportionate share payments under Section 5‑5.02 of this Code (in the initial year, for services after July 1, 1991, or such other date as an approved State Medical Assistance Plan shall provide).
        (2) For periodic payments no less frequently than
    
monthly to the county provider for supplemental disproportionate share payments hereunder based on a federally approved State Medical Assistance Plan.
        (3) For calculation of the intergovernmental
    
transfer payment to be made by the county equal to 71.7% of the difference between the amount of the periodic payment and the base amount; provided, however, that if the periodic payment for any period is less than the base amount for such period, the base amount for the succeeding period (and any successive period if necessary) shall be increased by the amount of such shortfall.
        (4) For an intergovernmental transfer methodology
    
which obligates the Illinois Department to notify the county and county provider in writing of each impending periodic payment and the intergovernmental transfer payment attributable thereto and which obligates the Comptroller to release the periodic payment to the county provider within one working day of receipt of the intergovernmental transfer payment from the county.
(Source: P.A. 91‑24, eff. 7‑1‑99; 92‑370, eff. 8‑15‑01.)

    (305 ILCS 5/15‑4) (from Ch. 23, par. 15‑4)
    Sec. 15‑4. Contractual assumption of certain expenses. Hospitals may, at their election, by written agreement between the counties owning and operating the hospitals and the Illinois Department, assume specified expenses of the operation of the Illinois Department associated with the determination of eligibility, direct payment of which expenses by the Illinois Department would qualify as public funds expended by the Illinois Department for the Illinois Medical Assistance Program or other health care programs administered by the Illinois Department. The Illinois Department shall open an adequately staffed special on‑site office or offices at facilities designated by the county for the purpose of assisting the county in ensuring that all eligible individuals are enrolled in the Illinois Medical Assistance Program. Each such agreement, executed in accordance with Section 3 of the Intergovernmental Cooperation Act, shall describe the operational expenses to be assumed in sufficient detail to permit the Illinois Department to certify upon such written obligation or performance thereunder that the hospital's compliance with the terms of the agreement will amount to the commitment of public funds eligible for the federal financial participation or other federal funding called for in Title XIX or Title XXI of the Social Security Act.
(Source: P.A. 91‑24, eff. 7‑1‑99; 92‑370, eff. 8‑15‑01.)

    (305 ILCS 5/15‑5) (from Ch. 23, par. 15‑5)
    Sec. 15‑5. Disbursements from the Fund.
    (a) The monies in the Fund shall be disbursed only as provided in Section 15‑2 of this Code and as follows:
        (1) To pay the county hospitals' inpatient
    
reimbursement rate based on actual costs, trended forward annually by an inflation index and supplemented by teaching, capital, and other direct and indirect costs, according to a State plan approved by the federal government. Effective October 1, 1992, the inpatient reimbursement rate (including any disproportionate or supplemental disproportionate share payments) for hospital services provided by county operated facilities within the County shall be no less than the reimbursement rates in effect on June 1, 1992, except that this minimum shall be adjusted as of July 1, 1992 and each July 1 thereafter through July 1, 2002 by the annual percentage change in the per diem cost of inpatient hospital services as reported in the most recent annual Medicaid cost report. Effective July 1, 2003, the rate for hospital inpatient services provided by county hospitals shall be the rate in effect on January 1, 2003, except that this minimum may be adjusted by the Illinois Department to ensure compliance with aggregate and hospital‑specific federal payment limitations.
        (2) To pay county hospitals and county operated
    
outpatient facilities for outpatient services based on a federally approved methodology to cover the maximum allowable costs per patient visit. Effective October 1, 1992, the outpatient reimbursement rate for outpatient services provided by county hospitals and county operated outpatient facilities shall be no less than the reimbursement rates in effect on June 1, 1992, except that this minimum shall be adjusted as of July 1, 1992 and each July 1 thereafter through July 1, 2002 by the annual percentage change in the per diem cost of inpatient hospital services as reported in the most recent annual Medicaid cost report. Effective July 1, 2003, the Illinois Department shall by rule establish rates for outpatient services provided by county hospitals and other county‑operated facilities within the County that are in compliance with aggregate and hospital‑specific federal payment limitations.
        (3) To pay the county hospitals' disproportionate
    
share payments as established by the Illinois Department under Section 5‑5.02 of this Code. Effective October 1, 1992, the disproportionate share payments for hospital services provided by county operated facilities within the County shall be no less than the reimbursement rates in effect on June 1, 1992, except that this minimum shall be adjusted as of July 1, 1992 and each July 1 thereafter through July 1, 2002 by the annual percentage change in the per diem cost of inpatient hospital services as reported in the most recent annual Medicaid cost report. Effective July 1, 2003, the Illinois Department may by rule establish rates for disproportionate share payments to county hospitals that are in compliance with aggregate and hospital‑specific federal payment limitations.
        (3.5) To pay county providers for services provided
    
pursuant to Section 5‑11 of this Code.
        (4) To reimburse the county providers for expenses
    
contractually assumed pursuant to Section 15‑4 of this Code.
        (5) To pay the Illinois Department its necessary
    
administrative expenses relative to the Fund and other amounts agreed to, if any, by the county providers in the agreement provided for in subsection (c).
        (6) To pay the county providers any other amount due
    
according to a federally approved State plan, including but not limited to payments made under the provisions of Section 701(d)(3)(B) of the federal Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000. Intergovernmental transfers supporting payments under this paragraph (6) shall not be subject to the computation described in subsection (a) of Section 15‑3 of this Code, but shall be computed as the difference between the total of such payments made by the Illinois Department to county providers less any amount of federal financial participation due the Illinois Department under Titles XIX and XXI of the Social Security Act as a result of such payments to county providers.
    (b) The Illinois Department shall promptly seek all appropriate amendments to the Illinois State Plan to effect the foregoing payment methodology.
    (c) The Illinois Department shall implement the changes made by Article 3 of this amendatory Act of 1992 beginning October 1, 1992. All terms and conditions of the disbursement of monies from the Fund not set forth expressly in this Article shall be set forth in the agreement executed under the Intergovernmental Cooperation Act so long as those terms and conditions are not inconsistent with this Article or applicable federal law. The Illinois Department shall report in writing to the Hospital Service Procurement Advisory Board and the Health Care Cost Containment Council by October 15, 1992, the terms and conditions of all such initial agreements and, where no such initial agreement has yet been executed with a qualifying county, the Illinois Department's reasons that each such initial agreement has not been executed. Copies and reports of amended agreements following the initial agreements shall likewise be filed by the Illinois Department with the Hospital Service Procurement Advisory Board and the Health Care Cost Containment Council within 30 days following their execution. The foregoing filing obligations of the Illinois Department are informational only, to allow the Board and Council, respectively, to better perform their public roles, except that the Board or Council may, at its discretion, advise the Illinois Department in the case of the failure of the Illinois Department to reach agreement with any qualifying county by the required date.
    (d) The payments provided for herein are intended to cover services rendered on and after July 1, 1991, and any agreement executed between a qualifying county and the Illinois Department pursuant to this Section may relate back to that date, provided the Illinois Department obtains federal approval. Any changes in payment rates resulting from the provisions of Article 3 of this amendatory Act of 1992 are intended to apply to services rendered on or after October 1, 1992, and any agreement executed between a qualifying county and the Illinois Department pursuant to this Section may be effective as of that date.
    (e) If one or more hospitals file suit in any court challenging any part of this Article XV, payments to hospitals from the Fund under this Article XV 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 and may be disbursed under any order of the court.
    (f) All payments under this Section are contingent upon federal approval of changes to the State plan, if that approval is required.
(Source: P.A. 92‑370, eff. 8‑15‑01; 93‑20, eff. 6‑20‑03.)

    (305 ILCS 5/15‑6) (from Ch. 23, par. 15‑6)
    Sec. 15‑6. Annual audit.
    (a) Within 120 days after the end of each fiscal year of each county hospital, the Illinois Department shall conduct an annual audit of the Fund to determine that amounts received from or paid to county providers were correct. If such an audit identifies amounts that a county provider should not have been required to pay but did pay, a county provider should have been required to pay but did not pay, a county provider should not have received but did receive, or a county provider should have received but did not receive, the Illinois Department shall:
        (1) Make required payments to any such county
    
provider, or
        (2) Take action to recover required amounts from any
    
such county provider, including recoupment from future payments.
    (b) Amounts recovered from a county provider shall be credited to the Fund. A county provider is entitled to recover amounts paid to the Illinois Department into the Fund and to receive refunds and payment from the Illinois Department for payments that should have been paid from the Fund only to the extent that monies are available in the Fund.
(Source: P.A. 87‑13; 88‑554, eff. 7‑26‑94.)

    (305 ILCS 5/15‑7) (from Ch. 23, par. 15‑7)
    Sec. 15‑7. Applicability. The requirements of this Article XV shall apply only as long as federal funds under Title XIX of the Social Security Act are available to match the intergovernmental transfer payments made and disbursed under this Article and only as long as reimbursable expenditures are matched by the federal government at a rate of at least 50%. Whenever the Illinois Department is informed that federal funds are not available for these purposes, or shall be available at a lower percentage, this Article XV shall no longer apply and the Illinois Department shall promptly refund to each county provider the amount of money currently in the Fund that has been paid by the county provider, plus any investment earnings on that amount.
(Source: P.A. 87‑13; 87‑861; 88‑554, eff. 7‑26‑94.)

    (305 ILCS 5/15‑8) (from Ch. 23, par. 15‑8)
    Sec. 15‑8. Federal disallowances. In the event of any federal deferral or disallowance of any federal matching funds obtained through this Article which have been disbursed by the Illinois Department under this Article based upon challenges to reimbursement methodology or disproportionate share methodology, the full faith and credit of the county is pledged for repayment by the county of those amounts deferred or disallowed to the Illinois Department.
(Source: P.A. 87‑13.)

    (305 ILCS 5/15‑9) (from Ch. 23, par. 15‑9)
    Sec. 15‑9. Waiver of appropriation procedures. Notwithstanding the provisions of Sections 6‑24001 and 6‑24008 of the Counties Code, or any comparable provision relating to appropriations, the board of commissioners of qualifying counties may, during each fiscal year, adopt a supplemental appropriation bill or resolution for expenditures by qualifying counties on behalf of or by qualifying county hospitals of any funds received hereunder and the payment of fees to be collected under this Article in an amount not in excess of any such additional revenue available to that county, or estimated to be received by that county, subsequent to the adoption of the annual appropriation bill or resolution for that fiscal year. The supplemental appropriation bill or resolution shall only affect revenue that was not available for appropriation when the annual appropriation bill or resolution was adopted, and the provisions of Section 6‑24004 of the Counties Code or any other comparable provision relating to publication, notice, and public hearing shall not be applicable to such supplemental appropriation bill or resolution or to the budget document forming the basis thereof.
(Source: P.A. 87‑13.)

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