There Is a Newer Version of the Illinois Compiled Statutes

2005 Illinois 305 ILCS 5/ Illinois Public Aid Code. Article V-a - Hospital Provider Funding

(305 ILCS 5/Art. V‑A heading)
ARTICLE V‑A.

HOSPITAL PROVIDER FUNDING

(305 ILCS 5/5A‑1)(from Ch. 23, par. 5A‑1)

Sec. 5A‑1. Definitions.

 As used in this Article, unless the context requires
otherwise:

"Adjusted gross hospital revenue" shall be determined separately for inpatient and outpatient services for  each hospital conducted, operated or maintained by a hospital provider, and means the hospital provider's total gross revenues less:  (i)  gross revenue attributable to non‑hospital based services including home dialysis services, durable medical equipment, ambulance services, outpatient clinics and any other non‑hospital based services as determined by the Illinois Department by rule; and (ii)  gross revenues attributable to the routine services provided to persons receiving skilled or intermediate long‑term care services within the meaning of Title XVIII or XIX of the Social Security Act; and (iii) Medicare gross revenue (excluding the Medicare gross revenue attributable to clauses (i) and (ii) of this paragraph and the Medicare gross revenue attributable to the routine services provided to patients in a psychiatric hospital, a rehabilitation hospital, a distinct part psychiatric unit, a distinct part rehabilitation unit, or swing beds).  Adjusted gross hospital revenue shall be determined using the most recent data available from each hospital's 2003 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on December 31, 2004, without regard to any subsequent adjustments or changes to such data.  If a hospital's 2003 Medicare cost report is not contained in the Healthcare Cost Report Information System, the hospital provider shall furnish such cost report or the data necessary to determine its adjusted gross hospital revenue as required by rule by the Illinois Department.

"Fund" means the Hospital Provider Fund.

"Hospital" means an institution, place, building, or agency located in this
State that is subject to licensure by the Illinois Department of Public Health
under the Hospital Licensing Act, whether public or private and whether
organized for profit or not‑for‑profit.

"Hospital provider" means a person licensed by the Department of Public
Health to conduct, operate, or maintain a hospital, regardless of whether the
person is a Medicaid provider.  For purposes of this paragraph, "person" means
any political subdivision of the State, municipal corporation, individual,
firm, partnership, corporation, company, limited liability company,
association, joint stock association, or trust, or a receiver, executor,
trustee, guardian, or other representative appointed by order of any court.

"Occupied bed days" means the sum of the number of days
that each bed was occupied by a patient for all beds during
calendar year 2001.  Occupied bed days shall be computed separately for each
hospital operated or maintained by a hospital provider.

"Proration factor" means a fraction, the numerator of which is 53 and the denominator of which is 365.

(Source: P.A. 93‑659, eff. 2‑3‑04; 93‑1066, eff. 1‑15‑05; 94‑242, eff. 7‑18‑05.)

    (305 ILCS 5/5A‑2)(from Ch. 23, par. 5A‑2)
    (Section scheduled to be repealed on July 1, 2008)
    Sec. 5A‑2.

Assessment; no local authorization to tax.

(a) Subject to Sections 5A‑3 and 5A‑10, an annual assessment on inpatient
services is imposed on
each
hospital
provider in an amount equal to the hospital's occupied bed days multiplied by $84.19 multiplied by the proration factor for State fiscal year 2004 and the hospital's occupied bed days multiplied by $84.19 for State fiscal year 2005.

The
Department of Healthcare and Family Services
						
						shall use the number of occupied bed days as reported
by
each hospital on the Annual Survey of Hospitals conducted by the
Department of Public Health to calculate the hospital's annual assessment.  If
the sum
of a hospital's occupied bed days is not reported on the Annual Survey of
Hospitals or if there are data errors in the reported sum of a hospital's occupied bed days as determined by the Department of Healthcare and Family Services (formerly Department of Public Aid), then the Department of Healthcare and Family Services may obtain the sum of occupied bed
days
from any source available, including, but not limited to, records maintained by
the hospital provider, which may be inspected at all times during business
hours
of the day by the Department of Healthcare and Family Services
						
						or its duly authorized agents and
employees.

Subject to Sections 5A‑3 and 5A‑10, for the privilege of engaging in the occupation of hospital provider, beginning August 1, 2005,  an annual assessment is imposed on each hospital provider for State fiscal years 2006, 2007, and 2008, in an amount equal to 2.5835% of the hospital provider's adjusted gross hospital revenue for inpatient services and 2.5835% of the hospital provider's adjusted gross hospital revenue for outpatient services.  If the hospital provider's adjusted gross hospital revenue is not available, then the Illinois  Department may obtain the hospital provider's adjusted gross hospital revenue from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois  Department or its duly authorized agents and employees.

(b) Nothing in this Article


shall be construed to authorize
any home rule unit or other unit of local government to license for revenue or
to impose a tax or assessment upon hospital providers or the occupation of
hospital provider, or a tax or assessment measured by the income or earnings of
a hospital provider.

(c) As provided in Section 5A‑14, this Section is repealed on July 1,
2008.

(d) Notwithstanding any of the other provisions of this Section, the Department is authorized, during this 94th General Assembly, to adopt rules to reduce the rate of any annual assessment imposed under this Section, as authorized by Section 5‑46.2 of the Illinois Administrative Procedure Act.

(Source: P.A. 93‑659, eff. 2‑3‑04; 93‑841, eff. 7‑30‑04; 93‑1066, eff. 1‑15‑05; 94‑242, eff. 7‑18‑05; 94‑838, eff. 6‑6‑06.)

(305 ILCS 5/5A‑3)(from Ch. 23, par. 5A‑3)

Sec. 5A‑3.

Exemptions.

(a) (Blank).

(b) A hospital provider that is a State agency, a State university, or
a county
with a population of 3,000,000 or more is exempt from the assessment imposed
by Section 5A‑2.

(b‑2) A hospital provider
that is a county with a population of less than 3,000,000 or a
township,
municipality,
hospital district, or any other local governmental unit is exempt from the
assessment
imposed by Section 5A‑2.

(b‑5) (Blank).

(b‑10) For State fiscal years 2004 and 2005, a hospital provider whose hospital does not
charge for its services is exempt from the assessment imposed
by Section 5A‑2, unless the exemption is adjudged to be unconstitutional or
otherwise invalid, in which case the hospital provider shall pay the assessment
imposed by Section 5A‑2.

(b‑15) For State fiscal years 2004 and 2005, a hospital provider whose hospital is licensed by
the Department of Public Health as a psychiatric hospital is
exempt from the assessment imposed by Section 5A‑2, unless the exemption is
adjudged to be unconstitutional or
otherwise invalid, in which case the hospital provider shall pay the assessment
imposed by Section 5A‑2.

(b‑20) For State fiscal years 2004 and 2005, a hospital provider whose hospital is licensed by the Department of
Public Health as a rehabilitation hospital is exempt from the assessment
imposed by
Section 5A‑2, unless the exemption is
adjudged to be unconstitutional or
otherwise invalid, in which case the hospital provider shall pay the assessment
imposed by Section 5A‑2.

(b‑25) For State fiscal years 2004 and 2005, a hospital provider whose hospital (i) is not a psychiatric hospital,
rehabilitation hospital, or children's hospital and (ii) has an average length
of inpatient
stay greater than 25 days is exempt from the assessment imposed by Section
5A‑2, unless the exemption is
adjudged to be unconstitutional or
otherwise invalid, in which case the hospital provider shall pay the assessment
imposed by Section 5A‑2.

(c) (Blank).

(Source: P.A. 93‑659, eff. 2‑3‑04; 94‑242, eff. 7‑18‑05.)

(305 ILCS 5/5A‑4)(from Ch. 23, par. 5A‑4)
Sec. 5A‑4.

Payment of assessment; penalty.

(a) The annual assessment imposed by Section 5A‑2 for State fiscal year
2004
shall be due
and payable on June 18 of
the
year.
The assessment imposed by Section 5A‑2 for State fiscal year 2005
 shall be
due and payable in quarterly installments, each equalling one‑fourth of the
assessment for the year, on July 19, October 19, January 18, and April 19 of
the year. The assessment imposed by Section 5A‑2 for State fiscal year 2006 and each subsequent State fiscal year shall be due and payable in quarterly installments, each equaling one‑fourth of the assessment for the year, on the fourteenth State business day of September, December, March, and May.
No installment payment of an assessment imposed by Section 5A‑2 shall be due
and
payable, however, until after: (i) the hospital provider
receives written
notice from the Department of Public Aid that the payment methodologies to
hospitals
required under
Section 5A‑12 or Section 5A‑12.1, whichever is applicable for that fiscal year, have been approved by the Centers for Medicare and Medicaid
Services of
the U.S. Department of Health and Human Services and the waiver under 42 CFR
433.68 for the assessment imposed by Section 5A‑2, if necessary, has been granted by the
Centers for Medicare and Medicaid Services of the U.S. Department of Health and
Human Services; and (ii) the hospital
has
received the payments required under Section 5A‑12 or Section 5A‑12.1, whichever is applicable for that fiscal year.
Upon notification to the Department of approval of the payment methodologies required under Section 5A‑12 or Section 5A‑12.1, whichever is applicable for that fiscal year, and the waiver granted under 42 CFR 433.68, all quarterly installments otherwise due under Section 5A‑2 prior to the date of notification shall be due and payable to the Department upon written direction from the Department and receipt of the payments required under Section 5A‑12.1.

(b) The Illinois Department is authorized to establish
delayed payment schedules for hospital providers that are unable
to make installment payments when due under this Section due to
financial difficulties, as determined by the Illinois Department.

(c) If a hospital provider fails to pay the full amount of
an installment when due (including any extensions granted under
subsection (b)), there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5A‑2 a penalty
assessment equal to the lesser of (i) 5% of the amount of the
installment not paid on or before the due date plus 5% of the
portion thereof remaining unpaid on the last day of each 30‑day period

thereafter or (ii) 100% of the installment amount not paid on or
before the due date.  For purposes of this subsection, payments
will be credited first to unpaid installment amounts (rather than
to penalty or interest), beginning with the most delinquent
installments.

(Source: P.A. 93‑659, eff. 2‑3‑04; 93‑841, eff. 7‑30‑04; 93‑1066, eff. 1‑15‑05; 94‑242, eff. 7‑18‑05.)

(305 ILCS 5/5A‑5)(from Ch. 23, par. 5A‑5)
Sec. 5A‑5.

Notice; penalty; maintenance of records.

(a)
The Department of Public Aid shall send a
notice of assessment to every hospital provider subject
to assessment under this Article.  The notice of assessment shall notify the hospital of its assessment and shall be sent after receipt by the Department of notification from the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services that the payment  methodologies required under Section 5A‑12 or Section 5A‑12.1, whichever is applicable for that fiscal year, and, if necessary, the waiver granted under 42 CFR 433.68 have been approved.  The notice

shall be on a form
prepared by the Illinois Department and shall state the following:

(1) The name of the hospital provider.

(2) The address of the hospital provider's principal

place of business from which the provider engages in the occupation of hospital provider in this State, and the name and address of each hospital operated, conducted, or maintained by the provider in this State.

(3) The occupied bed days or adjusted gross hospital

revenue of the hospital provider (whichever is applicable), the amount of assessment imposed under Section 5A‑2 for the State fiscal year for which the notice is sent, and the amount of each quarterly installment to be paid during the State fiscal year.

(4) (Blank).

(5) Other reasonable information as determined by the

Illinois Department.

(b) If a hospital provider conducts, operates, or
maintains more than one hospital licensed by the Illinois
Department of Public Health, the provider shall pay the
assessment for each hospital separately.

(c) Notwithstanding any other provision in this Article, in
the case of a person who ceases to conduct, operate, or maintain a
hospital in respect of which the person is subject to assessment
under this Article as a hospital provider, the assessment for the State
fiscal year in which the cessation occurs shall be adjusted by
multiplying the assessment computed under Section 5A‑2 by a
fraction, the numerator of which is the number of days in the
year during which the provider conducts, operates, or maintains
the hospital and the denominator of which is 365.  Immediately
upon ceasing to conduct, operate, or maintain a hospital, the person
shall pay the assessment
for the year as so adjusted (to the extent not previously paid).

(d) Notwithstanding any other provision in this Article, a
provider who commences conducting, operating, or maintaining a
hospital, upon notice by the Illinois Department,

shall pay the assessment computed under Section 5A‑2 and
subsection (e) in installments on the due dates stated in the
notice and on the regular installment due dates for the State
fiscal year occurring after the due dates of the initial
notice.

(e) Notwithstanding any other provision in this Article, for State fiscal years 2004 and 2005, in
the case of a hospital provider that did not conduct, operate, or
maintain a hospital throughout calendar year 2001, the assessment for that State fiscal year
shall be computed on the basis of hypothetical occupied bed days for the full calendar year as determined by the Illinois Department.
Notwithstanding any other provision in this Article, for State fiscal years after 2005, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in 2003, the assessment for that State fiscal year shall be computed on the basis of hypothetical adjusted gross hospital revenue for the hospital's first full fiscal year as determined by the Illinois Department (which may be based on annualization of the provider's actual revenues for a portion of the year, or revenues of a comparable hospital for the year, including revenues realized by a prior provider of the same hospital during the year).

(f) Every hospital provider subject to assessment under this Article shall keep sufficient records to permit the determination of adjusted gross hospital revenue for the hospital's fiscal year.  All such records shall be kept in the English language and shall, at all times during regular business hours of the day, be subject to inspection by the Illinois Department or its duly authorized agents and employees.

(g) The Illinois Department may, by rule, provide a hospital provider a reasonable opportunity to request a clarification or correction of any clerical or computational errors contained in the calculation of its assessment, but such corrections shall not extend to updating the cost report information used to calculate the assessment.

(h) (Blank).

(Source: P.A. 93‑659, eff. 2‑3‑04; 93‑841, eff. 7‑30‑04; 94‑242, eff. 7‑18‑05.)

(305 ILCS 5/5A‑6) (from Ch. 23, par. 5A‑6)

Sec. 5A‑6.

Disposition of proceeds.

The Illinois Department
shall pay all moneys received from hospital providers under this
Article into the Hospital Provider Fund.  Upon certification by
the Illinois Department to the State Comptroller of its intent to
withhold from a provider under Section 5A‑7(b), the State
Comptroller shall draw a warrant on the treasury or other fund
held by the State Treasurer, as appropriate.  The warrant shall
state the amount for which the provider is entitled to a
warrant, the amount of the deduction, and the reason therefor and
shall direct the State Treasurer to pay the balance to the provider,
all in accordance with Section 10.05 of the State Comptroller Act.
The warrant also shall direct the State Treasurer to transfer the amount of the
deduction so ordered from the treasury or other fund into the
Hospital Provider Fund.

(Source: P.A. 87‑861.)

(305 ILCS 5/5A‑7)(from Ch. 23, par. 5A‑7)

Sec. 5A‑7.

Administration; enforcement provisions.

(a) The Illinois Department shall establish and maintain a listing of all hospital providers appearing in the licensing records of the Illinois Department of Public Health, which shall show each provider's name and principal place of business and the name and address of each hospital operated, conducted, or maintained by the provider in this State.  The Illinois Department shall administer and enforce this Article and collect the assessments and penalty assessments imposed under this Article using procedures employed in its administration of this Code generally.  The Illinois Department, its Director, and every hospital provider subject to assessment under this Article shall have the following powers, duties, and rights:

(1) The Illinois Department may initiate either

administrative or judicial proceedings, or both, to enforce provisions of this Article. Administrative enforcement proceedings initiated hereunder shall be governed by the Illinois Department's administrative rules.  Judicial enforcement proceedings initiated hereunder shall be governed by the rules of procedure applicable in the courts of this State.

(2) No proceedings for collection, refund, credit, or

other adjustment of an assessment amount shall be issued more than 3 years after the due date of the assessment, except in the case of an extended period agreed to in writing by the Illinois Department and the hospital provider before the expiration of this limitation period.

(3) Any unpaid assessment under this Article shall

become a lien upon the assets of the hospital upon which it was assessed.  If any hospital provider, outside the usual course of its business, sells or transfers the major part of any one or more of (A) the real property and improvements, (B) the machinery and equipment, or (C) the furniture or fixtures, of any hospital that is subject to the provisions of this Article, the seller or transferor shall pay the Illinois Department the amount of  any assessment, assessment penalty, and interest (if any) due from it under this Article up to the date of the sale or transfer.  If the seller or transferor fails to pay any assessment, assessment penalty, and interest (if any) due, the purchaser or transferee of such asset shall be liable for the amount of the assessment, penalties, and interest (if any) up to the amount of the reasonable value of the property acquired by the purchaser or transferee. The purchaser or transferee shall continue to be liable until the purchaser or transferee pays the full amount of the assessment, penalties, and interest (if any) up to the amount of the reasonable value of the property acquired by the purchaser or transferee  or until the purchaser or transferee receives from the Illinois Department a certificate showing that such assessment, penalty, and interest have been paid or a certificate from the Illinois Department showing that no assessment, penalty, or interest is due from the seller or transferor under this Article.

(4) Payments under this Article are not subject to

the Illinois Prompt Payment Act. Credits or refunds shall not bear interest.

(b) In addition to any other remedy provided for and

without sending a notice of assessment liability, the Illinois Department may collect an unpaid assessment by withholding, as payment of the assessment, reimbursements or other amounts otherwise payable by the Illinois Department to the hospital provider.

(Source: P.A. 93‑659, eff. 2‑3‑04; 93‑841, eff. 7‑30‑04; 94‑242, eff. 7‑18‑05.)

(305 ILCS 5/5A‑8)(from Ch. 23, par. 5A‑8)

Sec. 5A‑8.

Hospital Provider Fund.

(a) There is created in the State Treasury the Hospital Provider Fund.
Interest earned by the Fund shall be credited to the Fund.  The
Fund shall not be used to replace any moneys appropriated to the
Medicaid program by the General Assembly.

(b) The Fund is created for the purpose of receiving moneys
in accordance with Section 5A‑6 and disbursing moneys only for the following
purposes, notwithstanding any other provision of law:

(1) For making payments to hospitals as required

under Articles V, VI, and XIV of this Code and under the Children's Health Insurance Program Act.

(2) For the reimbursement of moneys collected by the

Illinois Department from hospitals or hospital providers through error or mistake in performing the activities authorized under this Article and Article V of this Code.

(3) For payment of administrative expenses incurred

by the Illinois Department or its agent in performing the activities authorized by this Article.

(4) For payments of any amounts which are

reimbursable to the federal government for payments from this Fund which are required to be paid by State warrant.

(5) For making transfers, as those transfers are

authorized in the proceedings authorizing debt under the Short Term Borrowing Act, but transfers made under this paragraph (5) shall not exceed the principal amount of debt issued in anticipation of the receipt by the State of moneys to be deposited into the Fund.

(6) For making transfers to any other fund in the

State treasury, but transfers made under this paragraph (6) shall not exceed the amount transferred previously from that other fund into the Hospital Provider Fund.

(7) For State fiscal years 2004 and 2005 for making

transfers to the Health and Human Services Medicaid Trust Fund, including 20% of the moneys received from hospital providers under Section 5A‑4 and transferred into the Hospital Provider Fund under Section 5A‑6. For State fiscal year 2006 for making transfers to the Health and Human Services Medicaid Trust Fund of up to $130,000,000 per year of the moneys received from hospital providers under Section 5A‑4 and transferred into the Hospital Provider Fund under Section 5A‑6. Transfers under this paragraph shall be made within 7 days after the payments have been received pursuant to the schedule of payments provided in subsection (a) of Section 5A‑4.

(7.5) For State fiscal years 2007 and 2008 for making

    transfers of the moneys received from hospital providers under Section 5A‑4 and transferred into the Hospital Provider Fund under Section 5A‑6 to the designated funds not exceeding the following amounts in any State fiscal year:

    Health and Human Services
     Medicaid Trust Fund.......... $20,000,000
    Long‑Term Care Provider Fund......... $30,000,000
    General Revenue Fund........ $80,000,000.
        Transfers under this paragraph shall be made within 7

days after the payments have been received pursuant to the schedule of payments provided in subsection (a) of Section 5A‑4.

(8) For making refunds to hospital providers pursuant

to Section 5A‑10.

Disbursements from the Fund, other than transfers authorized under
paragraphs (5) and (6) of this subsection, shall be by
warrants drawn by the State Comptroller upon receipt of vouchers
duly executed and certified by the Illinois Department.

(c) The Fund shall consist of the following:

(1) All moneys collected or received by the Illinois

Department from the hospital provider assessment imposed by this Article.

(2) All federal matching funds received by the

Illinois Department as a result of expenditures made by the Illinois Department that are attributable to moneys deposited in the Fund.

(3) Any interest or penalty levied in conjunction

with the administration of this Article.

(4) Moneys transferred from another fund in the State

treasury.

(5) All other moneys received for the Fund from any

other source, including interest earned thereon.

(d) (Blank).

(Source: P.A. 93‑659, eff. 2‑3‑04; 94‑242, eff. 7‑18‑05; 94‑839, eff. 6‑6‑06.)

(305 ILCS 5/5A‑9) (from Ch. 23, par. 5A‑9)

Sec. 5A‑9.

Emergency services audits.

The Illinois Department may
audit hospital claims for payment for emergency services provided to a
recipient who does not require admission as an inpatient.  The Illinois
Department shall adopt rules that describe how the emergency services audit
process will be conducted.  These rules shall include, but need not be
limited to, the following provisions:

(1) The determination that an emergency medical

condition exists shall be based upon the symptoms and condition of the recipient at the time the recipient is initially examined by the hospital emergency department and not upon the final  determination of the recipient's actual medical condition.

(2) The Illinois Department or its authorized

representative shall meet with the chief executive officer of the hospital, or a person designated by the chief executive officer, upon arrival at the hospital to conduct the audit and before leaving the hospital at the conclusion of the audit.  The purpose of the pre‑audit meeting shall be to inform the hospital concerning the scope of the audit.  The purpose of the post‑audit meeting shall be to provide the hospital with the preliminary findings of the audit.

(3) An emergency services audit shall be limited to

a review of records related to services rendered within 3 years of the date of the audit.  The hospital's business and professional records for at least 12 previous calendar months shall be maintained and available for inspection by authorized Illinois Department personnel on the premises of the hospital.  Illinois Department personnel shall make requests in writing to inspect records more than 12 months old at least 2 business days in advance of the date they must be produced.

(4) Where the purpose of the audit is to determine

the appropriateness of the emergency services provided, any final determination that would result in a denial of or reduction in payment to the hospital shall be made by a physician licensed to practice medicine in all of its branches who is board certified in emergency medicine or by the appropriate health care professionals under the supervision of the physician.

(5) The preliminary audit findings shall be provided

to the hospital within 120 days of the date on which the audit conducted on the hospital premises was completed.

(6) The Illinois Department or its designated review

agent shall use statistically valid sampling techniques when conducting audits.

(Source: P.A. 87‑861.)

(305 ILCS 5/5A‑10)(from Ch. 23, par. 5A‑10)

Sec. 5A‑10.

Applicability.

(a) The assessment imposed by Section 5A‑2 shall not take effect or shall
cease to be imposed, and
any moneys
remaining in the Fund shall be refunded to hospital providers
in proportion to the amounts paid by them, if:

(1) the sum of the appropriations for State fiscal

years 2004 and 2005 from the General Revenue Fund for hospital payments under the medical assistance program is less than $4,500,000,000 or the appropriation for each of State fiscal years 2006, 2007 and 2008 from the General Revenue Fund for hospital payments under the medical assistance program is less than $2,500,000,000 increased annually to reflect any increase in the number of recipients; or

(2) the Department of Public Aid makes changes in its

rules that reduce the hospital inpatient or outpatient payment rates, including adjustment payment rates, in effect on October 1, 2004, except for hospitals described in subsection (b) of Section 5A‑3 and except for changes in the methodology for calculating outlier payments to hospitals for exceptionally costly stays, so long as those changes do not reduce aggregate expenditures below the amount expended in State fiscal year 2005 for such services; or

(3) the payments to hospitals required under Section

5A‑12 are changed or are not eligible for federal matching funds under Title XIX or XXI of the Social Security Act.

(b) The assessment imposed by Section 5A‑2 shall not take effect or
shall
cease to be imposed if the assessment is determined to be an impermissible
tax under Title XIX
of the Social Security Act.  Moneys in the Hospital Provider Fund derived
from assessments imposed prior thereto shall be
disbursed in accordance with Section 5A‑8 to the extent federal matching is
not reduced due to the impermissibility of the assessments, and any
remaining
moneys shall be
refunded to hospital providers in proportion to the amounts paid by them.

(Source: P.A. 93‑659, eff. 2‑3‑04; 94‑242, eff. 7‑18‑05.)

(305 ILCS 5/5A‑11) (from Ch. 23, par. 5A‑11)

Sec. 5A‑11.

Severability.

If any clause, sentence, Section,
exemption, provision, or part of this Article or the application
thereof to any person or circumstance shall be adjudged to be
unconstitutional or otherwise invalid, the remainder of this
Article or its application to persons or circumstances other than
those to which it is held invalid shall not be affected thereby.
This Article V‑A is intended to be separate from and independent
of Articles V‑B and V‑C, and the application and validity of
this Article V‑A shall not be affected by the invalidity of one or
more of Articles V‑B and V‑C.

(Source: P.A. 87‑861.)

(305 ILCS 5/5A‑12)

Sec. 5A‑12.

(Repealed).

(Source: P.A. 93‑1066, eff. 1‑15‑05. Repealed internally, eff. 7‑1‑05.)

    (305 ILCS 5/5A‑12.1)
    (Section scheduled to be repealed on July 1, 2008)
    Sec. 5A‑12.1. Hospital access improvement payments.

(a) To preserve and improve access to hospital services, for hospital services rendered on or after August 1, 2005, the Department of Public Aid shall make payments to hospitals as set forth in this Section, except for hospitals described in subsection (b) of Section 5A‑3. These payments shall be paid on a quarterly basis. For State fiscal year 2006, once the approval of the payment methodology required under this Section and any waiver required under 42 CFR 433.68 by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services is received, the Department shall pay the total amounts required for fiscal year 2006 under this Section within 100 days of the latest notification. In State fiscal years 2007 and 2008, the total amounts required under this Section shall be paid in 4 equal installments on or before the seventh State business day of September, December, March, and May, except that if the date of notification of the approval of the payment methodologies required under this Section and any waiver required under 42 CFR 433.68 is on or after July 1, 2006, the sum of amounts required under this Section prior to the date of notification shall be paid within 100 days of the date of the last notification. Payments under this Section are not due and payable, however, until (i) the methodologies described in this Section are approved by the federal government in an appropriate State Plan amendment, (ii) the assessment imposed under this Article is determined to be a permissible tax under Title XIX of the Social Security Act, and (iii) the assessment is in effect.

(b) Medicaid eligibility payment.  In addition to amounts paid for inpatient hospital
services, the Department shall pay each Illinois hospital (except for hospitals described in Section 5A‑3) for each inpatient Medicaid admission in State fiscal year 2003, $430 multiplied by the percentage by which the number of Medicaid recipients in the county in which the hospital is located increased from State fiscal year 1998 to State fiscal year 2003.

(c) Medicaid high volume adjustment.
(1) In addition to rates paid for inpatient hospital

services, the Department shall pay to each Illinois hospital (except for hospitals that qualify for Medicaid Percentage Adjustment payments under 89 Ill. Adm. Code 148.122 for the 12‑month period beginning on October 1, 2004) that provided more than 10,000 Medicaid inpatient days of care  (determined using the hospital's fiscal year 2002 Medicaid cost report on file with the Department on July 1, 2004) amounts as follows:

(i) for hospitals that provided more than 10,000

Medicaid inpatient days of care but less than or equal to 14,500 Medicaid inpatient days of care, $90 for each Medicaid inpatient day of care provided during that period; and

(ii) for hospitals that provided more than 14,500

Medicaid inpatient days of care but less than or equal to 18,500 Medicaid inpatient days of care, $135 for each Medicaid inpatient day of care provided during that period; and

(iii) for hospitals that provided more than

18,500 Medicaid inpatient days of care but less than or equal to 20,000 Medicaid inpatient days of care, $225 for each Medicaid inpatient day of care provided during that period; and

(iv) for hospitals that provided more than 20,000

Medicaid inpatient days of care, $900 for each Medicaid inpatient day of care provided during that period.

Provided, however, that no hospital shall receive

more than $19,000,000 per year in such payments under subparagraphs (i), (ii), (iii), and (iv).

(2) In addition to rates paid for inpatient hospital

services, the Department shall pay to each Illinois general acute care hospital that as of October 1, 2004, qualified for Medicaid percentage adjustment payments under 89 Ill. Adm. Code 148.122 and provided more than 21,000 Medicaid inpatient days of care (determined using the hospital's fiscal year 2002 Medicaid cost report on file with the Department on July 1, 2004) $35 for each Medicaid inpatient day of care provided during that period. Provided, however, that no hospital shall receive more than $1,200,000 per year in such payments.

(d) Intensive care adjustment. In addition to rates paid

for inpatient services, the Department shall pay an adjustment payment to each Illinois general acute care hospital located in a large urban area that, based on the hospital's fiscal year 2002 Medicaid cost report, had a ratio of Medicaid intensive care unit days to total Medicaid days greater than 19%.  If such ratio for the hospital is less than 30%, the hospital shall be paid an adjustment payment for each Medicaid inpatient day of care provided equal to $1,000 multiplied by the hospital's ratio of Medicaid intensive care days to total Medicaid days.  If such ratio for the hospital is equal to or greater than 30%, the hospital shall be paid an adjustment payment for each Medicaid inpatient day of care provided equal to $2,800 multiplied by the hospital's ratio of Medicaid intensive care days to total Medicaid days.

(e) Trauma center adjustments.
(1) In addition to rates paid for inpatient hospital

services, the Department shall pay to each Illinois general acute care hospital that as of January 1, 2005, was designated as a Level I trauma center and is either located in a large urban area or is located in an other urban area and as of October 1, 2004 qualified for Medicaid percentage adjustment payments under 89 Ill. Adm. Code 148.122, a payment equal to $800 multiplied by the hospital's Medicaid intensive care unit days  (excluding Medicare crossover days).  This payment shall be calculated based on data from the hospital's 2002 cost report on file with the Department on July 1, 2004.  For hospitals located in large urban areas outside of a city with a population in excess of 1,000,000 people, the payment required under this subsection shall be multiplied by 4.5.  For hospitals located in other urban areas, the payment required under this subsection shall be multiplied by 8.5.

(2) In addition to rates paid for inpatient hospital

services, the Department shall pay an additional payment to each Illinois general acute care hospital that as of January 1, 2005, was designated as a Level II trauma center and is located in a county with a population in excess of 3,000,000 people.  The payment shall equal $4,000 per day for the first 500 Medicaid inpatient days, $2,000 per day for the Medicaid inpatient days between 501 and 1,500, and $100 per day for any Medicaid inpatient day in excess of 1,500. This payment shall be calculated based on data from the hospital's 2002 cost report on file with the Department on July 1, 2004.

(3) In addition to rates paid for inpatient hospital

services, the Department shall pay an additional payment to each Illinois general acute care hospital that as of January 1, 2005, was designated as a Level II trauma center, is located in a large urban area outside of a county with a population in excess of 3,000,000 people, and as of January 1, 2005, was designated a Level III perinatal center or  designated a Level II or II+ prenatal center that has a ratio of Medicaid intensive care unit days to total Medicaid days greater than 5%.  The payment shall equal $4,000 per day for the first 500 Medicaid inpatient days, $2,000 per day for the Medicaid inpatient days between 501 and 1,500, and $100 per day for any Medicaid inpatient day in excess of 1,500. This payment shall be calculated based on data from the hospital's 2002 cost report on file with the Department on July 1, 2004.

(4) In addition to rates paid for inpatient hospital

services, the Department shall pay an additional payment to each Illinois children's hospital that as of January 1, 2005, was designated a  Level I pediatric trauma center that had more than 30,000 Medicaid days in State fiscal year 2003 and to each Level I pediatric trauma center located outside of Illinois and that had more than 700 Illinois Medicaid cases in State fiscal year 2003.  The amount of such payment shall equal $325 multiplied by the hospital's Medicaid intensive care unit days, and this payment shall be multiplied by 2.25 for hospitals located outside of Illinois. This payment shall be calculated based on data from the hospital's 2002 cost report on file with the Department on July 1, 2004.

(5) Notwithstanding any other provision of this

subsection, a children's hospital, as defined in 89 Ill. Adm. Code 149.50(c)(3)(B), is not eligible for the payments described in paragraphs (1), (2), and (3) of this subsection.

(f) Psychiatric rate adjustment.
(1) In addition to rates paid for inpatient

psychiatric services, the Department shall pay each Illinois psychiatric hospital and general acute care hospital with a distinct part psychiatric unit, for each Medicaid inpatient psychiatric day of care provided in State fiscal year 2003, an amount equal to $420 less the hospital's per diem rate for Medicaid inpatient psychiatric services as in effect on July 1, 2002. In no event, however, shall that amount be less than zero.

(2) For Illinois psychiatric hospitals and distinct

part psychiatric units of Illinois general acute care hospitals whose inpatient per diem rate as in effect on July 1, 2002 is greater than $420, the Department shall pay, in addition to any other amounts authorized under this Code, $40 for each Medicaid inpatient psychiatric day of care provided in State fiscal year 2003.

(3) In addition to rates paid for inpatient

psychiatric services, for Illinois psychiatric hospitals located in a county with a population in excess of 3,000,000 people that did not qualify for Medicaid percentage adjustment payments under 89 Ill. Adm. Code 148.122 for the 12‑month period beginning on October 1, 2004, the Illinois Department shall make an adjustment payment of $150 for each Medicaid inpatient psychiatric day of care provided by the hospital in State fiscal year 2003. In addition to rates paid for inpatient psychiatric services, for Illinois psychiatric hospitals located in a county with a population in excess of 3,000,000 people, but outside of a city with a population in excess of 1,000,000 people, that did qualify for Medicaid percentage adjustment payments under 89 Ill. Adm. Code 148.122 for the 12‑month period beginning on October 1, 2004, the Illinois Department shall make an adjustment payment of $20 for each Medicaid inpatient psychiatric day of care provided by the hospital in State fiscal year 2003.

(g) Rehabilitation adjustment.
(1) In addition to rates paid for inpatient

rehabilitation services, the Department shall pay each Illinois general acute care hospital with a distinct part rehabilitation unit that had at least 40 beds as reported on the hospital's 2003 Medicaid cost report on file with the Department as of March 31, 2005, for each Medicaid inpatient day of care provided during State fiscal year 2003, an amount equal to $230.

(2) In addition to rates paid for inpatient

rehabilitation services, for Illinois rehabilitation hospitals that did not qualify for Medicaid percentage adjustment payments under 89 Ill. Adm. Code 148.122 for the 12‑month period beginning on October 1, 2004, the Illinois Department shall make an adjustment payment of $200 for each Medicaid inpatient day of care provided during State fiscal year 2003.

(h) Supplemental tertiary care adjustment. In addition

to rates paid for inpatient services, the Department shall pay to each Illinois hospital eligible for tertiary care adjustment payments under 89 Ill. Adm. Code 148.296, as in effect for State fiscal year 2005, a supplemental tertiary care adjustment payment equal to 2.5 multiplied by the tertiary care adjustment payment required under 89 Ill. Adm. Code 148.296, as in effect for State fiscal year 2005.

(i) Crossover percentage adjustment. In addition to

rates paid for inpatient services, the Department shall pay each Illinois general acute care hospital, excluding any hospital defined as a cancer center hospital in rules by the Department, located in an urban area that  provided over 500 days of inpatient care to Medicaid recipients,  that had a ratio of crossover days to total Medicaid days, utilizing information used for the Medicaid percentage adjustment determination  described in 84 Ill. Adm. Code 148.122,  effective October 1, 2004, of greater than 40%, and that does not qualify for Medicaid percentage adjustment payments under 89 Ill. Adm. Code 148.122, on October 1, 2004, an amount as follows:

(1) for hospitals located in an other urban area,

$140 per Medicaid inpatient day (including crossover days);

(2) for hospitals located in a large urban area

whose ratio of crossover days to total Medicaid days is less than 55%, $350 per  Medicaid inpatient day (including crossover days);

(3) for hospitals located in a large urban area

whose ratio of crossover days to total Medicaid days is equal to or greater than 55%, $1,400 per  Medicaid inpatient day (including crossover days).

The term "Medicaid days" in paragraphs  (1), (2), and (3) of this subsection (i) means  the Medicaid days utilized for the Medicaid percentage  adjustment determination described in 89 Ill. Adm. Code 148.122 for the October 1, 2004 determination.

(j) Long term acute care hospital adjustment. In

addition to rates paid for inpatient services, the Department shall pay each Illinois  long term acute care hospital  that, as of October 1, 2004, qualified for a Medicaid percentage adjustment under 89 Ill. Adm. Code 148.122, $125 for each Medicaid inpatient day of care provided in State fiscal year 2003.  In addition to rates paid for inpatient services, the Department shall pay each long term acute care hospital that, as of October 1, 2004,  did not qualify for a Medicaid percentage adjustment under 89 Ill. Adm. Code 148.122, $1,250 for each Medicaid inpatient day of care provided in State fiscal year 2003. For purposes of this subsection, "long term acute care hospital" means a hospital that (i) is not a psychiatric hospital, rehabilitation hospital, or children's hospital and (ii) has an average length of inpatient stay greater than 25 days.

(k) Obstetrical care adjustments.
(1) In addition to rates paid for inpatient services,

the Department shall pay each Illinois hospital an amount equal to $550 multiplied by each Medicaid obstetrical day of care provided by the hospital in State fiscal year 2003.

(2) In addition to rates paid for inpatient services,

the Department shall pay each Illinois hospital that qualified as a Medicaid disproportionate share hospital under 89 Ill. Adm. Code 148.120 as of October 1, 2004, and that had a Medicaid obstetrical percentage greater than 10% and a Medicaid emergency care percentage greater than 40%, an amount equal to $650 multiplied by each Medicaid obstetrical day of care provided by the hospital in State fiscal year 2003.

(3) In addition to rates paid for inpatient services,

the Department shall pay each Illinois hospital that is located in the St. Louis metropolitan statistical area and that provided more than 500 Medicaid obstetrical days of care in State fiscal year 2003, an amount equal to $1,800 multiplied by each Medicaid obstetrical day of care provided by the hospital in State fiscal year 2003.

(4) In addition to rates paid for inpatient services,

the Department shall pay $600 for each Medicaid obstetrical day of care provided in State fiscal year 2003 by each Illinois hospital that (i) is located in a large urban area, (ii) is located in a county whose number of Medicaid recipients increased from State fiscal year 1998 to State fiscal year 2003 by more than 60%, and (iii) that had a Medicaid obstetrical percentage used for the October 1, 2004, Medicaid percentage adjustment determination described in 89 Ill. Adm. Code 148.122 greater than 25%.

(5) In addition to rates paid for inpatient services,

the Department shall pay $400 for each Medicaid obstetrical day of care provided in State fiscal year 2003 by each Illinois rural hospital that (i) was designated a Level II perinatal center as of January 1, 2005, (ii) had a Medicaid inpatient utilization rate greater than 34% in State fiscal year 2002, and (iii) had a Medicaid obstetrical percentage used for the October 1, 2004, Medicaid percentage adjustment determination described in 89 Ill. Adm. Code 148.122 greater than 15%.

(l) Outpatient access payments. In addition to the rates

paid for outpatient hospital services, the Department shall pay each Illinois hospital (except for hospitals described in Section   5A‑3), an amount equal to 2.38 multiplied by the hospital's outpatient ambulatory procedure listing payments for services provided during State fiscal year 2003 multiplied  by the percentage by which the number of Medicaid recipients in the county in which the hospital is located increased from State fiscal year 1998 to State fiscal year 2003.

(m) Outpatient utilization payment.
(1) In addition to the rates paid for outpatient

hospital services, the Department shall pay each Illinois rural hospital, an amount equal to 1.7 multiplied by the hospital's outpatient ambulatory procedure listing payments for services provided during State fiscal year 2003.

(2) In addition to the rates paid for outpatient

hospital services, the Department shall pay each Illinois hospital located in an urban area, an amount equal to 0.45 multiplied by the hospital's outpatient ambulatory procedure listing payments received for services provided during State fiscal year 2003.

(n) Outpatient complexity of care adjustment. In

addition to the rates paid for outpatient hospital services, the Department shall pay each Illinois hospital located in an urban area an amount equal to 2.55 multiplied by the hospital's emergency care percentage multiplied by the hospital's outpatient ambulatory procedure listing payments received for services provided during State fiscal year 2003.  For children's hospitals with an inpatient utilization rate used for the October 1, 2004, Medicaid percentage adjustment determination described in 89 Ill. Adm. Code 148.122  greater than 90%, this adjustment shall be multiplied by 2.  For cancer center hospitals, this adjustment shall be multiplied by 3.

(o) Rehabilitation hospital adjustment. In addition to

the rates paid for outpatient hospital services, the Department shall pay each Illinois freestanding rehabilitation hospital that does not qualify for a Medicaid percentage adjustment under 89 Ill. Adm. Code 148.122 as of October 1, 2004, an amount equal to 3 multiplied by the hospital's outpatient ambulatory procedure listing payments for Group 6A services provided during  State fiscal year 2003.

(p) Perinatal outpatient adjustment. In addition to the

rates paid for outpatient hospital services, the Department shall pay an adjustment payment to each large urban general acute care hospital that is designated as a perinatal center as of January 1, 2005, has a Medicaid obstetrical percentage of at least 10% used for the October 1, 2004, Medicaid percentage adjustment determination described in 89 Ill. Adm. Code 148.122, has a Medicaid intensive care unit percentage of at least 3%, and has a ratio of ambulatory procedure listing Level 3 services to total ambulatory procedure listing services of at least 50%.  The amount of the adjustment payment under this subsection shall be $550 multiplied by the hospital's outpatient ambulatory procedure listing Level 3A services provided in State fiscal year 2003.  If the hospital, as of January  1, 2005, was designated a Level III or II+ perinatal center, the adjustment payments required by this subsection shall be multiplied by 4.

(q) Supplemental psychiatric adjustment payments. In

addition to rates paid for inpatient services, the Department shall pay to each Illinois hospital that does not qualify for Medicaid percentage adjustments described in 89 Ill. Adm. Code 148.122 but is eligible for psychiatric adjustment payments under 89 Ill. Adm. Code 148.105 for State fiscal year 2005, a supplemental psychiatric adjustment payment equal to 0.7 multiplied by the psychiatric adjustment payment required under 89 Ill. Adm. Code 148.105, as in effect for State fiscal year 2005.

(r) Outpatient community access adjustment. In addition

to the rates paid for outpatient hospital services, the Department shall pay an adjustment payment to each general acute care hospital that is designated as a perinatal center as of January 1, 2005, that had a Medicaid obstetrical percentage used for the October 1, 2004, Medicaid percentage adjustment determination described in 89 Ill. Adm. Code 148.122 of at least 12.5%, that had a ratio of crossover days to total Medicaid days utilizing information used for the Medicaid percentage adjustment described in 89 Ill. Adm. Code 148.122 determination effective October 1, 2004, of greater than or equal to 25%, and that qualified for the Medicaid percentage adjustment payments under 89 Ill. Adm. Code 148.122 on October 1, 2004, an amount equal to $100 multiplied by the hospital's outpatient ambulatory procedure listing services provided during State fiscal year 2003.

(r‑5) Notwithstanding any of the other provisions of this Section, the Department is authorized, during this 94th General Assembly, to adopt rules that change the hospital access improvement payments specified in this Section, but only to the extent necessary to conform to any federally approved amendment to the Title XIX State plan. Any such rules shall be adopted by the Department, as authorized by Section 5‑46.2 of the Illinois Administrative Procedure Act. Notwithstanding any other provision of law, any changes implemented in relation to Public Act 94‑242 shall be given retroactive effect so that they shall be deemed to have taken effect as of the effective date of that Public Act.

(s) Definitions. Unless the context requires otherwise or unless provided otherwise in this Section, the terms used in this Section for qualifying criteria and payment calculations shall have the same meanings as those terms have been given in the Illinois Department's administrative rules as in effect on May 1, 2005. Other terms shall be defined by the Illinois Department by rule.

As used in this Section, unless the context requires otherwise:

"Emergency care percentage" means a fraction, the numerator of which is the total Group

3 ambulatory procedure listing services provided by the hospital in State fiscal year 2003, and the denominator of which is the total ambulatory procedure listing services provided by the hospital in State fiscal year 2003.

"Large urban area" means an area located within a metropolitan statistical area, as defined by the U.S. Office of Management and Budget in OMB Bulletin 04‑03, dated February 18, 2004, with a population in excess of 1,000,000.

"Medicaid intensive care unit days" means the number of hospital inpatient days during which Medicaid recipients received intensive care services from the hospital, as determined from the hospital's 2002 Medicaid cost report that was on file with the Department as of July 1, 2004.

"Other urban area" means an area located within a metropolitan statistical area, as defined by the U.S. Office of Management and Budget in OMB Bulletin 04‑03, dated February 18, 2004, with a city with a population in excess of 50,000 or a total population in excess of 100,000.

(t) For purposes of this Section, a hospital that enrolled to provide Medicaid services during State fiscal year 2003 shall have its utilization and associated reimbursements annualized prior to the payment calculations being performed under this Section.

(u) For purposes of this Section, the terms "Medicaid days", "ambulatory procedure listing services", and "ambulatory procedure listing payments" do not include any days, charges, or services for which Medicare was liable for payment, except where explicitly stated otherwise in this Section.

(v) As provided in Section 5A‑14, this Section is

repealed on July 1, 2008.

(Source: P.A. 94‑242, eff. 7‑18‑05; 94‑838, eff. 6‑6‑06.)

(305 ILCS 5/5A‑13)

Sec. 5A‑13. Emergency rulemaking.

 The Department of
Public Aid may adopt rules necessary to implement
this amendatory Act of the 94th General Assembly
through the use of emergency rulemaking in accordance with
Section 5‑45 of the Illinois Administrative Procedure Act.
For purposes of that Act, the General Assembly finds that the
adoption of rules to implement this
amendatory Act of the 94th General Assembly is deemed an
emergency and necessary for the public interest, safety, and welfare.

(Source: P.A. 93‑659, eff. 2‑3‑04; 94‑242, eff. 7‑18‑05.)

(305 ILCS 5/5A‑14)

Sec. 5A‑14. Repeal of assessments and disbursements.

(a) Section 5A‑2 is repealed on July 1, 2008.

(b) Section 5A‑12 is repealed on July 1, 2005.

(c) Section 5A‑12.1 is repealed on July 1, 2008.

(Source: P.A. 93‑659, eff. 2‑3‑04; 94‑242, eff. 7‑18‑05.)

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