Bill Amendment: IL SB1510 | 2019-2020 | 101st General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: NURSING HOME CARE ACT-VARIOUS

Status: 2021-01-13 - Passed Both Houses [SB1510 Detail]

Download: Illinois-2019-SB1510-House_Amendment_003.html

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Rep. Gregory Harris

Filed: 1/12/2021

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AMENDMENT TO SENATE BILL 1510
AMENDMENT NO. ______. Amend Senate Bill 1510, AS AMENDED,
by replacing everything after the enacting clause with the
following:
"Article 1.
Section 1-5. The Illinois Public Aid Code is amended by
adding Section 5A-2.1 as follows:
(305 ILCS 5/5A-2.1 new)
Sec. 5A-2.1. Continuation of Section 5A-2 of this Code;
validation.
(a) The General Assembly finds and declares that:
(1) Public Act 101-650, which took effect on July 7,
2020, contained provisions that would have changed the
repeal date for Section 5A-2 of this Act from July 1, 2020
to December 31, 2022.

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(2) The Statute on Statutes sets forth general rules on
the repeal of statutes and the construction of multiple
amendments, but Section 1 of that Act also states that
these rules will not be observed when the result would be
"inconsistent with the manifest intent of the General
Assembly or repugnant to the context of the statute".
(3) This amendatory Act of the 101st General Assembly
manifests the intention of the General Assembly to extend
the repeal date for Section 5A-2 of this Code and have
Section 5A-2 of this Code, as amended by Public Act
101-650, continue in effect until December 31, 2022.
(b) Any construction of this Code that results in the
repeal of Section 5A-2 of this Code on July 1, 2020 would be
inconsistent with the manifest intent of the General Assembly
and repugnant to the context of this Code.
(c) It is hereby declared to have been the intent of the
General Assembly that Section 5A-2 of this Code shall not be
subject to repeal on July 1, 2020.
(d) Section 5A-2 of this Code shall be deemed to have been
in continuous effect since July 8, 1992 (the effective date of
Public Act 87-861), and it shall continue to be in effect, as
amended by Public Act 101-650, until it is otherwise lawfully
amended or repealed. All previously enacted amendments to the
Section taking effect on or after July 8, 1992, are hereby
validated.
(e) In order to ensure the continuing effectiveness of

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Section 5A-2 of this Code, that Section is set forth in full
and reenacted by this amendatory Act of the 101st General
Assembly. In this amendatory Act of the 101st General Assembly,
the base text of the reenacted Section is set forth as amended
by Public Act 101-650.
(f) All actions of the Illinois Department or any other
person or entity taken in reliance on or pursuant to Section
5A-2 of this Code are hereby validated.
Section 1-10. The Illinois Public Aid Code is amended by
reenacting Section 5A-2 as follows:
(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
Sec. 5A-2. Assessment.
(a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
years 2009 through 2018, or as long as continued under Section
5A-16, an annual assessment on inpatient services is imposed on
each hospital provider in an amount equal to $218.38 multiplied
by the difference of the hospital's occupied bed days less the
hospital's Medicare bed days, provided, however, that the
amount of $218.38 shall be increased by a uniform percentage to
generate an amount equal to 75% of the State share of the
payments authorized under Section 5A-12.5, with such increase
only taking effect upon the date that a State share for such
payments is required under federal law. For the period of April
through June 2015, the amount of $218.38 used to calculate the

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assessment under this paragraph shall, by emergency rule under
subsection (s) of Section 5-45 of the Illinois Administrative
Procedure Act, be increased by a uniform percentage to generate
$20,250,000 in the aggregate for that period from all hospitals
subject to the annual assessment under this paragraph.
(2) In addition to any other assessments imposed under this
Article, effective July 1, 2016 and semi-annually thereafter
through June 2018, or as provided in Section 5A-16, in addition
to any federally required State share as authorized under
paragraph (1), the amount of $218.38 shall be increased by a
uniform percentage to generate an amount equal to 75% of the
ACA Assessment Adjustment, as defined in subsection (b-6) of
this Section.
For State fiscal years 2009 through 2018, or as provided in
Section 5A-16, a hospital's occupied bed days and Medicare bed
days shall be determined using the most recent data available
from each hospital's 2005 Medicare cost report as contained in
the Healthcare Cost Report Information System file, for the
quarter ending on December 31, 2006, without regard to any
subsequent adjustments or changes to such data. If a hospital's
2005 Medicare cost report is not contained in the Healthcare
Cost Report Information System, then the Illinois Department
may obtain the hospital provider's occupied bed days and
Medicare 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

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by the Illinois Department or its duly authorized agents and
employees.
(3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on inpatient
services is imposed on each hospital provider in an amount
equal to $197.19 multiplied by the difference of the hospital's
occupied bed days less the hospital's Medicare bed days. For
State fiscal years 2019 and 2020, a hospital's occupied bed
days and Medicare bed days shall be determined using the most
recent data available from each hospital's 2015 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Illinois Department may obtain the hospital provider's
occupied bed days and Medicare 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 Illinois Department or
its duly authorized agents and employees. Notwithstanding any
other provision in this Article, for a hospital provider that
did not have a 2015 Medicare cost report, but paid an
assessment in State fiscal year 2018 on the basis of
hypothetical data, that assessment amount shall be used for
State fiscal years 2019 and 2020.

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(4) Subject to Sections 5A-3 and 5A-10, for the period of
July 1, 2020 through December 31, 2020 and calendar years 2021
and 2022, an annual assessment on inpatient services is imposed
on each hospital provider in an amount equal to $221.50
multiplied by the difference of the hospital's occupied bed
days less the hospital's Medicare bed days, provided however:
for the period of July 1, 2020 through December 31, 2020, (i)
the assessment shall be equal to 50% of the annual amount; and
(ii) the amount of $221.50 shall be retroactively adjusted by a
uniform percentage to generate an amount equal to 50% of the
Assessment Adjustment, as defined in subsection (b-7). For the
period of July 1, 2020 through December 31, 2020 and calendar
years 2021 and 2022, a hospital's occupied bed days and
Medicare bed days shall be determined using the most recent
data available from each hospital's 2015 Medicare cost report
as contained in the Healthcare Cost Report Information System
file, for the quarter ending on March 31, 2017, without regard
to any subsequent adjustments or changes to such data. If a
hospital's 2015 Medicare cost report is not contained in the
Healthcare Cost Report Information System, then the Illinois
Department may obtain the hospital provider's occupied bed days
and Medicare 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 Illinois Department or its duly authorized
agents and employees. Should the change in the assessment

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methodology for fiscal years 2021 through December 31, 2022 not
be approved on or before June 30, 2020, the assessment and
payments under this Article in effect for fiscal year 2020
shall remain in place until the new assessment is approved. If
the assessment methodology for July 1, 2020 through December
31, 2022, is approved on or after July 1, 2020, it shall be
retroactive to July 1, 2020, subject to federal approval and
provided that the payments authorized under Section 5A-12.7
have the same effective date as the new assessment methodology.
In giving retroactive effect to the assessment approved after
June 30, 2020, credit toward the new assessment shall be given
for any payments of the previous assessment for periods after
June 30, 2020. Notwithstanding any other provision of this
Article, for a hospital provider that did not have a 2015
Medicare cost report, but paid an assessment in State Fiscal
Year 2020 on the basis of hypothetical data, the data that was
the basis for the 2020 assessment shall be used to calculate
the assessment under this paragraph.
(b) (Blank).
(b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
portion of State fiscal year 2012, beginning June 10, 2012
through June 30, 2012, and for State fiscal years 2013 through
2018, or as provided in Section 5A-16, an annual assessment on
outpatient services is imposed on each hospital provider in an
amount equal to .008766 multiplied by the hospital's outpatient
gross revenue, provided, however, that the amount of .008766

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shall be increased by a uniform percentage to generate an
amount equal to 25% of the State share of the payments
authorized under Section 5A-12.5, with such increase only
taking effect upon the date that a State share for such
payments is required under federal law. For the period
beginning June 10, 2012 through June 30, 2012, the annual
assessment on outpatient services shall be prorated by
multiplying the assessment amount by a fraction, the numerator
of which is 21 days and the denominator of which is 365 days.
For the period of April through June 2015, the amount of
.008766 used to calculate the assessment under this paragraph
shall, by emergency rule under subsection (s) of Section 5-45
of the Illinois Administrative Procedure Act, be increased by a
uniform percentage to generate $6,750,000 in the aggregate for
that period from all hospitals subject to the annual assessment
under this paragraph.
(2) In addition to any other assessments imposed under this
Article, effective July 1, 2016 and semi-annually thereafter
through June 2018, in addition to any federally required State
share as authorized under paragraph (1), the amount of .008766
shall be increased by a uniform percentage to generate an
amount equal to 25% of the ACA Assessment Adjustment, as
defined in subsection (b-6) of this Section.
For the portion of State fiscal year 2012, beginning June
10, 2012 through June 30, 2012, and State fiscal years 2013
through 2018, or as provided in Section 5A-16, a hospital's

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outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2009 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on June 30, 2011, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2009 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
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
Department or its duly authorized agents and employees.
(3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on outpatient
services is imposed on each hospital provider in an amount
equal to .01358 multiplied by the hospital's outpatient gross
revenue. For State fiscal years 2019 and 2020, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2015 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited

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to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
Notwithstanding any other provision in this Article, for a
hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State fiscal year 2018 on the
basis of hypothetical data, that assessment amount shall be
used for State fiscal years 2019 and 2020.
(4) Subject to Sections 5A-3 and 5A-10, for the period of
July 1, 2020 through December 31, 2020 and calendar years 2021
and 2022, an annual assessment on outpatient services is
imposed on each hospital provider in an amount equal to .01525
multiplied by the hospital's outpatient gross revenue,
provided however: (i) for the period of July 1, 2020 through
December 31, 2020, the assessment shall be equal to 50% of the
annual amount; and (ii) the amount of .01525 shall be
retroactively adjusted by a uniform percentage to generate an
amount equal to 50% of the Assessment Adjustment, as defined in
subsection (b-7). For the period of July 1, 2020 through
December 31, 2020 and calendar years 2021 and 2022, a
hospital's outpatient gross revenue shall be determined using
the most recent data available from each hospital's 2015
Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on March 31,
2017, without regard to any subsequent adjustments or changes
to such data. If a hospital's 2015 Medicare cost report is not

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contained in the Healthcare Cost Report Information System,
then the Illinois Department may obtain the hospital provider's
outpatient revenue data 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. Should the change in the
assessment methodology above for fiscal years 2021 through
calendar year 2022 not be approved prior to July 1, 2020, the
assessment and payments under this Article in effect for fiscal
year 2020 shall remain in place until the new assessment is
approved. If the change in the assessment methodology above for
July 1, 2020 through December 31, 2022, is approved after June
30, 2020, it shall have a retroactive effective date of July 1,
2020, subject to federal approval and provided that the
payments authorized under Section 12A-7 have the same effective
date as the new assessment methodology. In giving retroactive
effect to the assessment approved after June 30, 2020, credit
toward the new assessment shall be given for any payments of
the previous assessment for periods after June 30, 2020.
Notwithstanding any other provision of this Article, for a
hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State Fiscal Year 2020 on the
basis of hypothetical data, the data that was the basis for the
2020 assessment shall be used to calculate the assessment under
this paragraph.

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(b-6)(1) As used in this Section, "ACA Assessment
Adjustment" means:
(A) For the period of July 1, 2016 through December 31,
2016, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of April 2016 multiplied by 6.
(B) For the period of January 1, 2017 through June 30,
2017, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of October 2016 multiplied by 6, except that the
amount calculated under this subparagraph (B) shall be
adjusted, either positively or negatively, to account for
the difference between the actual payments issued under
Section 5A-12.5 for the period beginning July 1, 2016
through December 31, 2016 and the estimated payments due
and payable in the month of April 2016 multiplied by 6 as
described in subparagraph (A).
(C) For the period of July 1, 2017 through December 31,
2017, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under

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Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of April 2017 multiplied by 6, except that the amount
calculated under this subparagraph (C) shall be adjusted,
either positively or negatively, to account for the
difference between the actual payments issued under
Section 5A-12.5 for the period beginning January 1, 2017
through June 30, 2017 and the estimated payments due and
payable in the month of October 2016 multiplied by 6 as
described in subparagraph (B).
(D) For the period of January 1, 2018 through June 30,
2018, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of October 2017 multiplied by 6, except that:
(i) the amount calculated under this subparagraph
(D) shall be adjusted, either positively or
negatively, to account for the difference between the
actual payments issued under Section 5A-12.5 for the
period of July 1, 2017 through December 31, 2017 and
the estimated payments due and payable in the month of
April 2017 multiplied by 6 as described in subparagraph
(C); and

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(ii) the amount calculated under this subparagraph
(D) shall be adjusted to include the product of .19125
multiplied by the sum of the fee-for-service payments,
if any, estimated to be paid to hospitals under
subsection (b) of Section 5A-12.5.
(2) The Department shall complete and apply a final
reconciliation of the ACA Assessment Adjustment prior to June
30, 2018 to account for:
(A) any differences between the actual payments issued
or scheduled to be issued prior to June 30, 2018 as
authorized in Section 5A-12.5 for the period of January 1,
2018 through June 30, 2018 and the estimated payments due
and payable in the month of October 2017 multiplied by 6 as
described in subparagraph (D); and
(B) any difference between the estimated
fee-for-service payments under subsection (b) of Section
5A-12.5 and the amount of such payments that are actually
scheduled to be paid.
The Department shall notify hospitals of any additional
amounts owed or reduction credits to be applied to the June
2018 ACA Assessment Adjustment. This is to be considered the
final reconciliation for the ACA Assessment Adjustment.
(3) Notwithstanding any other provision of this Section, if
for any reason the scheduled payments under subsection (b) of
Section 5A-12.5 are not issued in full by the final day of the
period authorized under subsection (b) of Section 5A-12.5,

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funds collected from each hospital pursuant to subparagraph (D)
of paragraph (1) and pursuant to paragraph (2), attributable to
the scheduled payments authorized under subsection (b) of
Section 5A-12.5 that are not issued in full by the final day of
the period attributable to each payment authorized under
subsection (b) of Section 5A-12.5, shall be refunded.
(4) The increases authorized under paragraph (2) of
subsection (a) and paragraph (2) of subsection (b-5) shall be
limited to the federally required State share of the total
payments authorized under Section 5A-12.5 if the sum of such
payments yields an annualized amount equal to or less than
$450,000,000, or if the adjustments authorized under
subsection (t) of Section 5A-12.2 are found not to be
actuarially sound; however, this limitation shall not apply to
the fee-for-service payments described in subsection (b) of
Section 5A-12.5.
(b-7)(1) As used in this Section, "Assessment Adjustment"
means:
(A) For the period of July 1, 2020 through December 31,
2020, the product of .3853 multiplied by the total of the
actual payments made under subsections (c) through (k) of
Section 5A-12.7 attributable to the period, less the total
of the assessment imposed under subsections (a) and (b-5)
of this Section for the period.
(B) For each calendar quarter beginning on and after
January 1, 2021, the product of .3853 multiplied by the

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total of the actual payments made under subsections (c)
through (k) of Section 5A-12.7 attributable to the period,
less the total of the assessment imposed under subsections
(a) and (b-5) of this Section for the period.
(2) The Department shall calculate and notify each hospital
of the total Assessment Adjustment and any additional
assessment owed by the hospital or refund owed to the hospital
on either a semi-annual or annual basis. Such notice shall be
issued at least 30 days prior to any period in which the
assessment will be adjusted. Any additional assessment owed by
the hospital or refund owed to the hospital shall be uniformly
applied to the assessment owed by the hospital in monthly
installments for the subsequent semi-annual period or calendar
year. If no assessment is owed in the subsequent year, any
amount owed by the hospital or refund due to the hospital,
shall be paid in a lump sum.
(3) The Department shall publish all details of the
Assessment Adjustment calculation performed each year on its
website within 30 days of completing the calculation, and also
submit the details of the Assessment Adjustment calculation as
part of the Department's annual report to the General Assembly.
(c) (Blank).
(d) Notwithstanding any of the other provisions of this
Section, the Department is authorized 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

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Procedure Act.
(e) Notwithstanding any other provision of this Section,
any plan providing for an assessment on a hospital provider as
a permissible tax under Title XIX of the federal Social
Security Act and Medicaid-eligible payments to hospital
providers from the revenues derived from that assessment shall
be reviewed by the Illinois Department of Healthcare and Family
Services, as the Single State Medicaid Agency required by
federal law, to determine whether those assessments and
hospital provider payments meet federal Medicaid standards. If
the Department determines that the elements of the plan may
meet federal Medicaid standards and a related State Medicaid
Plan Amendment is prepared in a manner and form suitable for
submission, that State Plan Amendment shall be submitted in a
timely manner for review by the Centers for Medicare and
Medicaid Services of the United States Department of Health and
Human Services and subject to approval by the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services. No such plan shall become
effective without approval by the Illinois General Assembly by
the enactment into law of related legislation. Notwithstanding
any other provision of this Section, the Department is
authorized to adopt rules to reduce the rate of any annual
assessment imposed under this Section. Any such rules may be
adopted by the Department under Section 5-50 of the Illinois
Administrative Procedure Act.

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(Source: P.A. 100-581, eff. 3-12-18; 101-10, eff. 6-5-19;
101-650, eff. 7-7-20.)
Article 5.
Section 5-5. The Illinois Public Aid Code is amended by
changing Sections 5-5.07, 5-5e.1, and 14-12 as follows:
(305 ILCS 5/5-5.07)
Sec. 5-5.07. Inpatient psychiatric stay; DCFS per diem
rate. The Department of Children and Family Services shall pay
the DCFS per diem rate for inpatient psychiatric stay at a
free-standing psychiatric hospital effective the 11th day when
a child is in the hospital beyond medical necessity, and the
parent or caregiver has denied the child access to the home and
has refused or failed to make provisions for another living
arrangement for the child or the child's discharge is being
delayed due to a pending inquiry or investigation by the
Department of Children and Family Services. If any portion of a
hospital stay is reimbursed under this Section, the hospital
stay shall not be eligible for payment under the provisions of
Section 14-13 of this Code. This Section is inoperative on and
after July 1, 2021 2020 2019. Notwithstanding the provision of
Public Act 101-209 stating that this Section is inoperative on
and after July 1, 2020, this Section is operative from July 1,
2020 through June 30, 2021.

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(Source: P.A. 100-646, eff. 7-27-18; reenacted by 101-15, eff.
6-14-19; reenacted by 101-209, eff. 8-5-19; revised 9-24-19.)
Article 10.
Section 10-5. The Illinois Public Aid Code is amended by
changing Section 14-12 as follows:
(305 ILCS 5/14-12)
Sec. 14-12. Hospital rate reform payment system. The
hospital payment system pursuant to Section 14-11 of this
Article shall be as follows:
(a) Inpatient hospital services. Effective for discharges
on and after July 1, 2014, reimbursement for inpatient general
acute care services shall utilize the All Patient Refined
Diagnosis Related Grouping (APR-DRG) software, version 30,
distributed by 3MTM Health Information System.
(1) The Department shall establish Medicaid weighting
factors to be used in the reimbursement system established
under this subsection. Initial weighting factors shall be
the weighting factors as published by 3M Health Information
System, associated with Version 30.0 adjusted for the
Illinois experience.
(2) The Department shall establish a
statewide-standardized amount to be used in the inpatient
reimbursement system. The Department shall publish these

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amounts on its website no later than 10 calendar days prior
to their effective date.
(3) In addition to the statewide-standardized amount,
the Department shall develop adjusters to adjust the rate
of reimbursement for critical Medicaid providers or
services for trauma, transplantation services, perinatal
care, and Graduate Medical Education (GME).
(4) The Department shall develop add-on payments to
account for exceptionally costly inpatient stays,
consistent with Medicare outlier principles. Outlier fixed
loss thresholds may be updated to control for excessive
growth in outlier payments no more frequently than on an
annual basis, but at least triennially. Upon updating the
fixed loss thresholds, the Department shall be required to
update base rates within 12 months.
(5) The Department shall define those hospitals or
distinct parts of hospitals that shall be exempt from the
APR-DRG reimbursement system established under this
Section. The Department shall publish these hospitals'
inpatient rates on its website no later than 10 calendar
days prior to their effective date.
(6) Beginning July 1, 2014 and ending on June 30, 2024,
in addition to the statewide-standardized amount, the
Department shall develop an adjustor to adjust the rate of
reimbursement for safety-net hospitals defined in Section
5-5e.1 of this Code excluding pediatric hospitals.

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(7) Beginning July 1, 2014, in addition to the
statewide-standardized amount, the Department shall
develop an adjustor to adjust the rate of reimbursement for
Illinois freestanding inpatient psychiatric hospitals that
are not designated as children's hospitals by the
Department but are primarily treating patients under the
age of 21.
(7.5) (Blank).
(8) Beginning July 1, 2018, in addition to the
statewide-standardized amount, the Department shall adjust
the rate of reimbursement for hospitals designated by the
Department of Public Health as a Perinatal Level II or II+
center by applying the same adjustor that is applied to
Perinatal and Obstetrical care cases for Perinatal Level
III centers, as of December 31, 2017.
(9) Beginning July 1, 2018, in addition to the
statewide-standardized amount, the Department shall apply
the same adjustor that is applied to trauma cases as of
December 31, 2017 to inpatient claims to treat patients
with burns, including, but not limited to, APR-DRGs 841,
842, 843, and 844.
(10) Beginning July 1, 2018, the
statewide-standardized amount for inpatient general acute
care services shall be uniformly increased so that base
claims projected reimbursement is increased by an amount
equal to the funds allocated in paragraph (1) of subsection

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(b) of Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 40%.
(11) Beginning July 1, 2018, the reimbursement for
inpatient rehabilitation services shall be increased by
the addition of a $96 per day add-on.
(b) Outpatient hospital services. Effective for dates of
service on and after July 1, 2014, reimbursement for outpatient
services shall utilize the Enhanced Ambulatory Procedure
Grouping (EAPG) software, version 3.7 distributed by 3MTM
Health Information System.
(1) The Department shall establish Medicaid weighting
factors to be used in the reimbursement system established
under this subsection. The initial weighting factors shall
be the weighting factors as published by 3M Health
Information System, associated with Version 3.7.
(2) The Department shall establish service specific
statewide-standardized amounts to be used in the
reimbursement system.
(A) The initial statewide standardized amounts,
with the labor portion adjusted by the Calendar Year
2013 Medicare Outpatient Prospective Payment System
wage index with reclassifications, shall be published
by the Department on its website no later than 10
calendar days prior to their effective date.
(B) The Department shall establish adjustments to

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the statewide-standardized amounts for each Critical
Access Hospital, as designated by the Department of
Public Health in accordance with 42 CFR 485, Subpart F.
For outpatient services provided on or before June 30,
2018, the EAPG standardized amounts are determined
separately for each critical access hospital such that
simulated EAPG payments using outpatient base period
paid claim data plus payments under Section 5A-12.4 of
this Code net of the associated tax costs are equal to
the estimated costs of outpatient base period claims
data with a rate year cost inflation factor applied.
(3) In addition to the statewide-standardized amounts,
the Department shall develop adjusters to adjust the rate
of reimbursement for critical Medicaid hospital outpatient
providers or services, including outpatient high volume or
safety-net hospitals. Beginning July 1, 2018, the
outpatient high volume adjustor shall be increased to
increase annual expenditures associated with this adjustor
by $79,200,000, based on the State Fiscal Year 2015 base
year data and this adjustor shall apply to public
hospitals, except for large public hospitals, as defined
under 89 Ill. Adm. Code 148.25(a).
(4) Beginning July 1, 2018, in addition to the
statewide standardized amounts, the Department shall make
an add-on payment for outpatient expensive devices and
drugs. This add-on payment shall at least apply to claim

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lines that: (i) are assigned with one of the following
EAPGs: 490, 1001 to 1020, and coded with one of the
following revenue codes: 0274 to 0276, 0278; or (ii) are
assigned with one of the following EAPGs: 430 to 441, 443,
444, 460 to 465, 495, 496, 1090. The add-on payment shall
be calculated as follows: the claim line's covered charges
multiplied by the hospital's total acute cost to charge
ratio, less the claim line's EAPG payment plus $1,000,
multiplied by 0.8.
(5) Beginning July 1, 2018, the statewide-standardized
amounts for outpatient services shall be increased by a
uniform percentage so that base claims projected
reimbursement is increased by an amount equal to no less
than the funds allocated in paragraph (1) of subsection (b)
of Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of subsection (a) and paragraphs (3)
and (4) of this subsection multiplied by 46%.
(6) Effective for dates of service on or after July 1,
2018, the Department shall establish adjustments to the
statewide-standardized amounts for each Critical Access
Hospital, as designated by the Department of Public Health
in accordance with 42 CFR 485, Subpart F, such that each
Critical Access Hospital's standardized amount for
outpatient services shall be increased by the applicable
uniform percentage determined pursuant to paragraph (5) of
this subsection. It is the intent of the General Assembly

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that the adjustments required under this paragraph (6) by
Public Act 100-1181 shall be applied retroactively to
claims for dates of service provided on or after July 1,
2018.
(7) Effective for dates of service on or after March 8,
2019 (the effective date of Public Act 100-1181), the
Department shall recalculate and implement an updated
statewide-standardized amount for outpatient services
provided by hospitals that are not Critical Access
Hospitals to reflect the applicable uniform percentage
determined pursuant to paragraph (5).
(1) Any recalculation to the
statewide-standardized amounts for outpatient services
provided by hospitals that are not Critical Access
Hospitals shall be the amount necessary to achieve the
increase in the statewide-standardized amounts for
outpatient services increased by a uniform percentage,
so that base claims projected reimbursement is
increased by an amount equal to no less than the funds
allocated in paragraph (1) of subsection (b) of Section
5A-12.6, less the amount allocated under paragraphs
(8) and (9) of subsection (a) and paragraphs (3) and
(4) of this subsection, for all hospitals that are not
Critical Access Hospitals, multiplied by 46%.
(2) It is the intent of the General Assembly that
the recalculations required under this paragraph (7)

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by Public Act 100-1181 shall be applied prospectively
to claims for dates of service provided on or after
March 8, 2019 (the effective date of Public Act
100-1181) and that no recoupment or repayment by the
Department or an MCO of payments attributable to
recalculation under this paragraph (7), issued to the
hospital for dates of service on or after July 1, 2018
and before March 8, 2019 (the effective date of Public
Act 100-1181), shall be permitted.
(8) The Department shall ensure that all necessary
adjustments to the managed care organization capitation
base rates necessitated by the adjustments under
subparagraph (6) or (7) of this subsection are completed
and applied retroactively in accordance with Section
5-30.8 of this Code within 90 days of March 8, 2019 (the
effective date of Public Act 100-1181).
(9) Within 60 days after federal approval of the change
made to the assessment in Section 5A-2 by this amendatory
Act of the 101st General Assembly, the Department shall
incorporate into the EAPG system for outpatient services
those services performed by hospitals currently billed
through the Non-Institutional Provider billing system.
(c) In consultation with the hospital community, the
Department is authorized to replace 89 Ill. Admin. Code 152.150
as published in 38 Ill. Reg. 4980 through 4986 within 12 months
of June 16, 2014 (the effective date of Public Act 98-651). If

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the Department does not replace these rules within 12 months of
June 16, 2014 (the effective date of Public Act 98-651), the
rules in effect for 152.150 as published in 38 Ill. Reg. 4980
through 4986 shall remain in effect until modified by rule by
the Department. Nothing in this subsection shall be construed
to mandate that the Department file a replacement rule.
(d) Transition period. There shall be a transition period
to the reimbursement systems authorized under this Section that
shall begin on the effective date of these systems and continue
until June 30, 2018, unless extended by rule by the Department.
To help provide an orderly and predictable transition to the
new reimbursement systems and to preserve and enhance access to
the hospital services during this transition, the Department
shall allocate a transitional hospital access pool of at least
$290,000,000 annually so that transitional hospital access
payments are made to hospitals.
(1) After the transition period, the Department may
begin incorporating the transitional hospital access pool
into the base rate structure; however, the transitional
hospital access payments in effect on June 30, 2018 shall
continue to be paid, if continued under Section 5A-16.
(2) After the transition period, if the Department
reduces payments from the transitional hospital access
pool, it shall increase base rates, develop new adjustors,
adjust current adjustors, develop new hospital access
payments based on updated information, or any combination

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thereof by an amount equal to the decreases proposed in the
transitional hospital access pool payments, ensuring that
the entire transitional hospital access pool amount shall
continue to be used for hospital payments.
(d-5) Hospital and health care transformation program. The
Department shall develop a hospital and health care
transformation program to provide financial assistance to
hospitals in transforming their services and care models to
better align with the needs of the communities they serve. The
payments authorized in this Section shall be subject to
approval by the federal government.
(1) Phase 1. In State fiscal years 2019 through 2020,
the Department shall allocate funds from the transitional
access hospital pool to create a hospital transformation
pool of at least $262,906,870 annually and make hospital
transformation payments to hospitals. Subject to Section
5A-16, in State fiscal years 2019 and 2020, an Illinois
hospital that received either a transitional hospital
access payment under subsection (d) or a supplemental
payment under subsection (f) of this Section in State
fiscal year 2018, shall receive a hospital transformation
payment as follows:
(A) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is equal to or greater than
45%, the hospital transformation payment shall be
equal to 100% of the sum of its transitional hospital

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access payment authorized under subsection (d) and any
supplemental payment authorized under subsection (f).
(B) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is equal to or greater than
25% but less than 45%, the hospital transformation
payment shall be equal to 75% of the sum of its
transitional hospital access payment authorized under
subsection (d) and any supplemental payment authorized
under subsection (f).
(C) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is less than 25%, the
hospital transformation payment shall be equal to 50%
of the sum of its transitional hospital access payment
authorized under subsection (d) and any supplemental
payment authorized under subsection (f).
(2) Phase 2.
(A) The funding amount from phase one shall be
incorporated into directed payment and pass-through
payment methodologies described in Section 5A-12.7.
(B) Because there are communities in Illinois that
experience significant health care disparities due to
systemic racism, as recently emphasized by the
COVID-19 pandemic, aggravated by social determinants
of health and a lack of sufficiently allocated
healthcare resources, particularly community-based
services, preventive care, obstetric care, chronic

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disease management, and specialty care, the Department
shall establish a health care transformation program
that shall be supported by the transformation funding
pool. It is the intention of the General Assembly that
innovative partnerships funded by the pool must be
designed to establish or improve integrated health
care delivery systems that will provide significant
access to the Medicaid and uninsured populations in
their communities, as well as improve health care
equity. It is also the intention of the General
Assembly that partnerships recognize and address the
disparities revealed by the COVID-19 pandemic, as well
as the need for post-COVID care. During State fiscal
years 2021 through 2027, the hospital and health care
transformation program shall be supported by an annual
transformation funding pool of up to $150,000,000,
pending federal matching funds, to be allocated during
the specified fiscal years for the purpose of
facilitating hospital and health care transformation.
No disbursement of moneys for transformation projects
from the transformation funding pool described under
this Section shall be considered an award, a grant, or
an expenditure of grant funds. Funding agreements made
in accordance with the transformation program shall be
considered purchases of care under the Illinois
Procurement Code, and funds shall be expended by the

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Department in a manner that maximizes federal funding
to expend the entire allocated amount.
The Department shall convene, within 30 days after
the effective date of this amendatory Act of the 101st
General Assembly, a workgroup that includes subject
matter experts on healthcare disparities and
stakeholders from distressed communities, which could
be a subcommittee of the Medicaid Advisory Committee,
to review and provide recommendations on how
Department policy, including health care
transformation, can improve health disparities and the
impact on communities disproportionately affected by
COVID-19. The workgroup shall consider and make
recommendations on the following issues: a community
safety-net designation of certain hospitals, racial
equity, and a regional partnership to bring additional
specialty services to communities. Whereas there are
communities in Illinois that suffer from significant
health care disparities aggravated by social
determinants of health and a lack of sufficiently
allocated healthcare resources, particularly
community-based services and preventive care, there is
established a new hospital and health care
transformation program, which shall be supported by a
transformation funding pool. An application for
funding from the hospital and health care

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transformation program may incorporate the campus of a
hospital closed after January 1, 2018 or a hospital
that has provided notice of its intent to close
pursuant to Section 8.7 of the Illinois Health
Facilities Planning Act. During State Fiscal Years
2021 through 2023, the hospital and health care
transformation program shall be supported by an annual
transformation funding pool of at least $150,000,000
to be allocated during the specified fiscal years for
the purpose of facilitating hospital and health care
transformation. The Department shall not allocate
funds associated with the hospital and health care
transformation pool as established in this
subparagraph until the General Assembly has
established in law or resolution, further criteria for
dispersal or allocation of those funds after the
effective date of this amendatory Act of 101st General
Assembly.
(C) As provided in paragraph (9) of Section 3 of
the Illinois Health Facilities Planning Act, any
hospital participating in the transformation program
may be excluded from the requirements of the Illinois
Health Facilities Planning Act for those projects
related to the hospital's transformation. To be
eligible, the hospital must submit to the Health
Facilities and Services Review Board approval from the

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Department that the project is a part of the hospital's
transformation.
(D) As provided in subsection (a-20) of Section
32.5 of the Emergency Medical Services (EMS) Systems
Act, a hospital that received hospital transformation
payments under this Section may convert to a
freestanding emergency center. To be eligible for such
a conversion, the hospital must submit to the
Department of Public Health approval from the
Department that the project is a part of the hospital's
transformation.
(E) Criteria for proposals. To be eligible for
funding under this Section, a transformation proposal
shall meet all of the following criteria:
(i) the proposal shall be designed based on
community needs assessment completed by either a
University partner or other qualified entity with
significant community input;
(ii) the proposal shall be a collaboration
among providers across the care and community
spectrum, including preventative care, primary
care specialty care, hospital services, mental
health and substance abuse services, as well as
community-based entities that address the social
determinants of health;
(iii) the proposal shall be specifically

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designed to improve healthcare outcomes and reduce
healthcare disparities, and improve the
coordination, effectiveness, and efficiency of
care delivery;
(iv) the proposal shall have specific
measurable metrics related to disparities that
will be tracked by the Department and made public
by the Department;
(v) the proposal shall include a commitment to
include Business Enterprise Program certified
vendors or other entities controlled and managed
by minorities or women; and
(vi) the proposal shall specifically increase
access to primary, preventive, or specialty care.
(F) Entities eligible to be funded.
(i) Proposals for funding should come from
collaborations operating in one of the most
distressed communities in Illinois as determined
by the U.S. Centers for Disease Control and
Prevention's Social Vulnerability Index for
Illinois and areas disproportionately impacted by
COVID-19 or from rural areas of Illinois.
(ii) The Department shall prioritize
partnerships from distressed communities, which
include Business Enterprise Program certified
vendors or other entities controlled and managed

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by minorities or women and also include one or more
of the following: safety-net hospitals, critical
access hospitals, the campuses of hospitals that
have closed since January 1, 2018, or other
healthcare providers designed to address specific
healthcare disparities, including the impact of
COVID-19 on individuals and the community and the
need for post-COVID care. All funded proposals
must include specific measurable goals and metrics
related to improved outcomes and reduced
disparities which shall be tracked by the
Department.
(iii) The Department should target the funding
in the following ways: $30,000,000 of
transformation funds to projects that are a
collaboration between a safety-net hospital,
particularly community safety-net hospitals, and
other providers and designed to address specific
healthcare disparities, $20,000,000 of
transformation funds to collaborations between
safety-net hospitals and a larger hospital partner
that increases specialty care in distressed
communities, $30,000,000 of transformation funds
to projects that are a collaboration between
hospitals and other providers in distressed areas
of the State designed to address specific

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healthcare disparities, $15,000,000 to
collaborations between critical access hospitals
and other providers designed to address specific
healthcare disparities, and $15,000,000 to
cross-provider collaborations designed to address
specific healthcare disparities, and $5,000,000 to
collaborations that focus on workforce
development.
(iv) The Department may allocate up to
$5,000,000 for planning, racial equity analysis,
or consulting resources for the Department or
entities without the resources to develop a plan to
meet the criteria of this Section. Any contract for
consulting services issued by the Department under
this subparagraph shall comply with the provisions
of Section 5-45 of the State Officials and
Employees Ethics Act. Based on availability of
federal funding, the Department may directly
procure consulting services or provide funding to
the collaboration. The provision of resources
under this subparagraph is not a guarantee that a
project will be approved.
(v) The Department shall take steps to ensure
that safety-net hospitals operating in
under-resourced communities receive priority
access to hospital and healthcare transformation

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funds, including consulting funds, as provided
under this Section.
(G) Process for submitting and approving projects
for distressed communities. The Department shall issue
a template for application. The Department shall post
any proposal received on the Department's website for
at least 2 weeks for public comment, and any such
public comment shall also be considered in the review
process. Applicants may request that proprietary
financial information be redacted from publicly posted
proposals and the Department in its discretion may
agree. Proposals for each distressed community must
include all of the following:
(i) A detailed description of how the project
intends to affect the goals outlined in this
subsection, describing new interventions, new
technology, new structures, and other changes to
the healthcare delivery system planned.
(ii) A detailed description of the racial and
ethnic makeup of the entities' board and
leadership positions and the salaries of the
executive staff of entities in the partnership
that is seeking to obtain funding under this
Section.
(iii) A complete budget, including an overall
timeline and a detailed pathway to sustainability

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within a 5-year period, specifying other sources
of funding, such as in-kind, cost-sharing, or
private donations, particularly for capital needs.
There is an expectation that parties to the
transformation project dedicate resources to the
extent they are able and that these expectations
are delineated separately for each entity in the
proposal.
(iv) A description of any new entities formed
or other legal relationships between collaborating
entities and how funds will be allocated among
participants.
(v) A timeline showing the evolution of sites
and specific services of the project over a 5-year
period, including services available to the
community by site.
(vi) Clear milestones indicating progress
toward the proposed goals of the proposal as
checkpoints along the way to continue receiving
funding. The Department is authorized to refine
these milestones in agreements, and is authorized
to impose reasonable penalties, including
repayment of funds, for substantial lack of
progress.
(vii) A clear statement of the level of
commitment the project will include for minorities

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and women in contracting opportunities, including
as equity partners where applicable, or as
subcontractors and suppliers in all phases of the
project.
(viii) If the community study utilized is not
the study commissioned and published by the
Department, the applicant must define the
methodology used, including documentation of clear
community participation.
(ix) A description of the process used in
collaborating with all levels of government in the
community served in the development of the
project, including, but not limited to,
legislators and officials of other units of local
government.
(x) Documentation of a community input process
in the community served, including links to
proposal materials on public websites.
(xi) Verifiable project milestones and quality
metrics that will be impacted by transformation.
These project milestones and quality metrics must
be identified with improvement targets that must
be met.
(xii) Data on the number of existing employees
by various job categories and wage levels by the
zip code of the employees' residence and

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benchmarks for the continued maintenance and
improvement of these levels. The proposal must
also describe any retraining or other workforce
development planned for the new project.
(xiii) If a new entity is created by the
project, a description of how the board will be
reflective of the community served by the
proposal.
(xiv) An explanation of how the proposal will
address the existing disparities that exacerbated
the impact of COVID-19 and the need for post-COVID
care in the community, if applicable.
(xv) An explanation of how the proposal is
designed to increase access to care, including
specialty care based upon the community's needs.
(H) The Department shall evaluate proposals for
compliance with the criteria listed under subparagraph
(G). Proposals meeting all of the criteria may be
eligible for funding with the areas of focus
prioritized as described in item (ii) of subparagraph
(F). Based on the funds available, the Department may
negotiate funding agreements with approved applicants
to maximize federal funding. Nothing in this
subsection requires that an approved project be funded
to the level requested. Agreements shall specify the
amount of funding anticipated annually, the

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methodology of payments, the limit on the number of
years such funding may be provided, and the milestones
and quality metrics that must be met by the projects in
order to continue to receive funding during each year
of the program. Agreements shall specify the terms and
conditions under which a health care facility that
receives funds under a purchase of care agreement and
closes in violation of the terms of the agreement must
pay an early closure fee no greater than 50% of the
funds it received under the agreement, prior to the
Health Facilities and Services Review Board
considering an application for closure of the
facility. Any project that is funded shall be required
to provide quarterly written progress reports, in a
form prescribed by the Department, and at a minimum
shall include the progress made in achieving any
milestones or metrics or Business Enterprise Program
commitments in its plan. The Department may reduce or
end payments, as set forth in transformation plans, if
milestones or metrics or Business Enterprise Program
commitments are not achieved. The Department shall
seek to make payments from the transformation fund in a
manner that is eligible for federal matching funds.
In reviewing the proposals, the Department shall
take into account the needs of the community, data from
the study commissioned by the Department from the

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University of Illinois-Chicago if applicable, feedback
from public comment on the Department's website, as
well as how the proposal meets the criteria listed
under subparagraph (G). Alignment with the
Department's overall strategic initiatives shall be an
important factor. To the extent that fiscal year
funding is not adequate to fund all eligible projects
that apply, the Department shall prioritize
applications that most comprehensively and effectively
address the criteria listed under subparagraph (G).
(3) (Blank).
(4) Hospital Transformation Review Committee. There is
created the Hospital Transformation Review Committee. The
Committee shall consist of 14 members. No later than 30
days after March 12, 2018 (the effective date of Public Act
100-581), the 4 legislative leaders shall each appoint 3
members; the Governor shall appoint the Director of
Healthcare and Family Services, or his or her designee, as
a member; and the Director of Healthcare and Family
Services shall appoint one member. Any vacancy shall be
filled by the applicable appointing authority within 15
calendar days. The members of the Committee shall select a
Chair and a Vice-Chair from among its members, provided
that the Chair and Vice-Chair cannot be appointed by the
same appointing authority and must be from different
political parties. The Chair shall have the authority to

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establish a meeting schedule and convene meetings of the
Committee, and the Vice-Chair shall have the authority to
convene meetings in the absence of the Chair. The Committee
may establish its own rules with respect to meeting
schedule, notice of meetings, and the disclosure of
documents; however, the Committee shall not have the power
to subpoena individuals or documents and any rules must be
approved by 9 of the 14 members. The Committee shall
perform the functions described in this Section and advise
and consult with the Director in the administration of this
Section. In addition to reviewing and approving the
policies, procedures, and rules for the hospital and health
care transformation program, the Committee shall consider
and make recommendations related to qualifying criteria
and payment methodologies related to safety-net hospitals
and children's hospitals. Members of the Committee
appointed by the legislative leaders shall be subject to
the jurisdiction of the Legislative Ethics Commission, not
the Executive Ethics Commission, and all requests under the
Freedom of Information Act shall be directed to the
applicable Freedom of Information officer for the General
Assembly. The Department shall provide operational support
to the Committee as necessary. The Committee is dissolved
on April 1, 2019.
(e) Beginning 36 months after initial implementation, the
Department shall update the reimbursement components in

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subsections (a) and (b), including standardized amounts and
weighting factors, and at least triennially and no more
frequently than annually thereafter. The Department shall
publish these updates on its website no later than 30 calendar
days prior to their effective date.
(f) Continuation of supplemental payments. Any
supplemental payments authorized under Illinois Administrative
Code 148 effective January 1, 2014 and that continue during the
period of July 1, 2014 through December 31, 2014 shall remain
in effect as long as the assessment imposed by Section 5A-2
that is in effect on December 31, 2017 remains in effect.
(g) Notwithstanding subsections (a) through (f) of this
Section and notwithstanding the changes authorized under
Section 5-5b.1, any updates to the system shall not result in
any diminishment of the overall effective rates of
reimbursement as of the implementation date of the new system
(July 1, 2014). These updates shall not preclude variations in
any individual component of the system or hospital rate
variations. Nothing in this Section shall prohibit the
Department from increasing the rates of reimbursement or
developing payments to ensure access to hospital services.
Nothing in this Section shall be construed to guarantee a
minimum amount of spending in the aggregate or per hospital as
spending may be impacted by factors, including, but not limited
to, the number of individuals in the medical assistance program
and the severity of illness of the individuals.

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(h) The Department shall have the authority to modify by
rulemaking any changes to the rates or methodologies in this
Section as required by the federal government to obtain federal
financial participation for expenditures made under this
Section.
(i) Except for subsections (g) and (h) of this Section, the
Department shall, pursuant to subsection (c) of Section 5-40 of
the Illinois Administrative Procedure Act, provide for
presentation at the June 2014 hearing of the Joint Committee on
Administrative Rules (JCAR) additional written notice to JCAR
of the following rules in order to commence the second notice
period for the following rules: rules published in the Illinois
Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
(Medical Payment), 4628 (Specialized Health Care Delivery
Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
Grouping (DRG) Prospective Payment System (PPS)), and 4977
(Hospital Reimbursement Changes), and published in the
Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499
(Specialized Health Care Delivery Systems) and 6505 (Hospital
Services).
(j) Out-of-state hospitals. Beginning July 1, 2018, for
purposes of determining for State fiscal years 2019 and 2020
and subsequent fiscal years the hospitals eligible for the
payments authorized under subsections (a) and (b) of this
Section, the Department shall include out-of-state hospitals
that are designated a Level I pediatric trauma center or a

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Level I trauma center by the Department of Public Health as of
December 1, 2017.
(k) The Department shall notify each hospital and managed
care organization, in writing, of the impact of the updates
under this Section at least 30 calendar days prior to their
effective date.
(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
101-81, eff. 7-12-19; 101-650, eff. 7-7-20.)
Article 13.
Section 13-5. The Illinois Public Aid Code is amended by
changing Section 12-4.53 as follows:
(305 ILCS 5/12-4.53)
Sec. 12-4.53. Prospective Payment System (PPS) rates.
Effective January 1, 2021, and subsequent years, based on
specific appropriation, the Prospective Payment System (PPS)
rates for FQHCs shall be increased based on the cost principles
found at 45 Code of Federal Regulations Part 75 or its
successor. Such rates shall be increased by using any of the
following methods: reducing the current minimum productivity
and efficiency standards no lower than 3500 encounters per FTE
physician; increasing the statewide median cost cap from 105%
to 120%, or a one-time re-basing of rates utilizing 2018 FQHC
cost reports, or another alternative payment method acceptable

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to the Centers for Medicare and Medicaid Services and the
FQHCs, including an across the board percentage increase to
existing rates.
(Source: P.A. 101-636, eff. 6-10-20.)
Article 15.
Section 15-1. Short title. This Act may be cited as the
COVID-19 Medically Necessary Diagnostic Testing Act.
Section 15-5. Findings. The General Assembly finds that
COVID-19 has infected hundreds of thousands of Illinois
residents and taken the lives of tens of thousands all within
less than a year's time. Nursing home residents are at
particular risk of the virus due to many factors, and routine
testing among residents and staff is critical to control the
spread within facilities. Nursing facilities are required by
federal and State regulation to conduct COVID-19 routine
testing at specified intervals.
The General Assembly finds that some insurance companies
are denying coverage of routine COVID-19 testing for insured
staff because it is not deemed medically necessary.
The General Assembly also finds that diagnostic testing for
COVID-19 is a medically necessary basic health care service for
nursing home employees, regardless of whether the employee has
symptoms of COVID-19 infection or is asymptomatic, or whether

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the employee has a known or suspected exposure to a person with
COVID-19.
The General Assembly therefore finds and declares that
routine COVID-19 testing of nursing home facility employees, as
mandated by State or federal laws, rules, regulations, or
guidance, is medically necessary and insurance companies must
cover the cost associated with such testing.
Section 15-10. Applicability. This Act applies to
companies as defined in subsection (e) of Section 2 of the
Illinois Insurance Code, which offer insurance policies and
coverage to employees of long-term care facilities as defined
in Section 1-113 of the Nursing Home Care Act.
Section 15-15. Definitions.
"COVID-19" means the disease caused by SARS-CoV-2 or any
further mutation.
"Diagnostic testing" means testing administered for the
purposes of diagnosing COVID-19 or a related virus and the
administration of such tests if the test is:
(1) approved, cleared, or authorized under Section
510(k), 513, 515, or 564 of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 360(k), 360c, 360e, and 360bbb-3);
(2) the subject of a request or intended request for
emergency use authorization under Section 564 of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-3),

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until the emergency use authorization request has been
denied or the developer of the test does not submit a
request within a reasonable timeframe;
(3) developed and authorized by a state that has
notified the Secretary of the United States Department of
Health and Human Services of its intention to review a test
intended to diagnose COVID-19; or
(4) determined by the Secretary of the United States
Department of Health and Human Services or the Director of
the Centers for Disease Control and Prevention as
appropriate for the diagnosis of COVID-19.
"Enrollee" means a nursing home employee who is covered by
a health plan.
"Health plan" means all policies, contracts, and
certificates of health insurance coverage that are or will be
enforced, issued, delivered, amended, or renewed in this State
and subject to the authority of the Director of Insurance under
any insurance law.
"Nursing home employee" means anyone employed by or under
contract with a long-term care facility as defined in Section
1-113 of the Nursing Home Care Act, or under contract with a
third party to provide services within a long-term care
facility.
"Testing provider" means any professional person,
organization, health facility, or other person or institution
licensed or authorized by the State to deliver or furnish

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COVID-19 diagnostic tests. Testing providers include
physicians and other primary care providers; urgent care
centers; State-run or county-run clinics or testing sites;
pharmacies; university laboratories; hospital emergency
departments; skilled nursing facilities; and any other
outpatient provider setting for which the diagnosis of COVID-19
is within the scope of the provider's State licensure or
authorization.
Section 15-20. Diagnostic testing.
(a) A health plan shall not impose utilization management
requirements on COVID-19 diagnostic tests for nursing home
employees.
(b) A health plan may inquire as to whether an enrollee is
a nursing home employee as defined in this Act, but shall
require no further evidence or verification of the enrollee's
nursing home employee status when determining whether the
enrollee is a nursing home employee.
(c) Medically necessary COVID-19 testing is urgent care,
and health plans shall not extend the applicable wait time for
a COVID-19 testing appointment, even if such an extension would
otherwise be permitted.
(d) A health plan shall reimburse the testing provider for
medically necessary COVID-19 testing at the contracted rate if
the health plan has a contract with the testing provider. If
the health plan and the testing provider do not have a contract

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that encompasses COVID-19 testing, the health plan shall
reimburse the provider at the provider's cash price, when
required by federal law. In all other instances, the health
plan shall reimburse the provider for the reasonable and
customary value of the services.
(e) Changes to a contract between a health plan and a
provider delegating financial risk for COVID-19 diagnostic
testing, including related items and services, shall be
considered a material change to the parties' contract. A health
plan shall not delegate the financial risk to a contracted
provider for the cost of the enrollee services provided under
this Section unless the parties have negotiated and agreed upon
a new provision of the parties' contract.
(f) The timeframes specified in the Illinois Insurance Code
apply for the submission and payment of claims for COVID-19
diagnostic testing and related items and services. A health
plan shall not delay or deny payment of a testing provider's
claim for services received by an enrollee in accordance with
this Section.
(g) For purposes of the submission of claims in accordance
with this Section, "provider" includes the State of Illinois,
university laboratories, and State-run or county-run clinics
or other testing sites.
(h) Failure by a health plan to comply with the
requirements of this Act may constitute a basis for
disciplinary action against the health plan. The Director of

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Insurance shall have all the civil, criminal, and
administrative remedies available under the Illinois Insurance
Code.
Article 30.
Section 30-5. The Nursing Home Care Act is amended by
changing Section 3-206 as follows:
(210 ILCS 45/3-206) (from Ch. 111 1/2, par. 4153-206)
Sec. 3-206. The Department shall prescribe a curriculum for
training nursing assistants, habilitation aides, and child
care aides.
(a) No person, except a volunteer who receives no
compensation from a facility and is not included for the
purpose of meeting any staffing requirements set forth by the
Department, shall act as a nursing assistant, habilitation
aide, or child care aide in a facility, nor shall any person,
under any other title, not licensed, certified, or registered
to render medical care by the Department of Financial and
Professional Regulation, assist with the personal, medical, or
nursing care of residents in a facility, unless such person
meets the following requirements:
(1) Be at least 16 years of age, of temperate habits
and good moral character, honest, reliable and
trustworthy.

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(2) Be able to speak and understand the English
language or a language understood by a substantial
percentage of the facility's residents.
(3) Provide evidence of employment or occupation, if
any, and residence for 2 years prior to his present
employment.
(4) Have completed at least 8 years of grade school or
provide proof of equivalent knowledge.
(5) Begin a current course of training for nursing
assistants, habilitation aides, or child care aides,
approved by the Department, within 45 days of initial
employment in the capacity of a nursing assistant,
habilitation aide, or child care aide at any facility. Such
courses of training shall be successfully completed within
120 days of initial employment in the capacity of nursing
assistant, habilitation aide, or child care aide at a
facility. Nursing assistants, habilitation aides, and
child care aides who are enrolled in approved courses in
community colleges or other educational institutions on a
term, semester or trimester basis, shall be exempt from the
120-day completion time limit. The Department shall adopt
rules for such courses of training. These rules shall
include procedures for facilities to carry on an approved
course of training within the facility. The Department
shall allow an individual to satisfy the supervised
clinical experience requirement for placement on the

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Health Care Worker Registry under 77 Ill. Adm. Code 300.663
through supervised clinical experience at an assisted
living establishment licensed under the Assisted Living
and Shared Housing Act. The Department shall adopt rules
requiring that the Health Care Worker Registry include
information identifying where an individual on the Health
Care Worker Registry received his or her clinical training.
The Department may accept comparable training in lieu
of the 120-hour course for student nurses, foreign nurses,
military personnel, or employees of the Department of Human
Services.
The Department shall accept on-the-job experience in
lieu of clinical training from any individual who
participated in the temporary nursing assistant program
during the COVID-19 pandemic before the end date of the
temporary nursing assistant program and left the program in
good standing, and the Department shall notify all approved
certified nurse assistant training programs in the State of
this requirement. The individual shall receive one hour of
credit for every hour employed as a temporary nursing
assistant, up to 40 total hours, and shall be permitted 90
days after the end date of the temporary nursing assistant
program to enroll in an approved certified nursing
assistant training program and 240 days to successfully
complete the certified nursing assistant training program.
Temporary nursing assistants who enroll in a certified

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nursing assistant training program within 90 days of the
end of the temporary nursing assistant program may continue
to work as a nursing assistant for up to 240 days after
enrollment in the certified nursing assistant training
program. As used in this Section, "temporary nursing
assistant program" means the program implemented by the
Department of Public Health by emergency rule, as listed in
44 Ill. Reg. 7936, effective April 21, 2020.
The facility shall develop and implement procedures,
which shall be approved by the Department, for an ongoing
review process, which shall take place within the facility,
for nursing assistants, habilitation aides, and child care
aides.
At the time of each regularly scheduled licensure
survey, or at the time of a complaint investigation, the
Department may require any nursing assistant, habilitation
aide, or child care aide to demonstrate, either through
written examination or action, or both, sufficient
knowledge in all areas of required training. If such
knowledge is inadequate the Department shall require the
nursing assistant, habilitation aide, or child care aide to
complete inservice training and review in the facility
until the nursing assistant, habilitation aide, or child
care aide demonstrates to the Department, either through
written examination or action, or both, sufficient
knowledge in all areas of required training.

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(6) Be familiar with and have general skills related to
resident care.
(a-0.5) An educational entity, other than a secondary
school, conducting a nursing assistant, habilitation aide, or
child care aide training program shall initiate a criminal
history record check in accordance with the Health Care Worker
Background Check Act prior to entry of an individual into the
training program. A secondary school may initiate a criminal
history record check in accordance with the Health Care Worker
Background Check Act at any time during or after a training
program.
(a-1) Nursing assistants, habilitation aides, or child
care aides seeking to be included on the Health Care Worker
Registry under the Health Care Worker Background Check Act on
or after January 1, 1996 must authorize the Department of
Public Health or its designee to request a criminal history
record check in accordance with the Health Care Worker
Background Check Act and submit all necessary information. An
individual may not newly be included on the Health Care Worker
Registry unless a criminal history record check has been
conducted with respect to the individual.
(b) Persons subject to this Section shall perform their
duties under the supervision of a licensed nurse.
(c) It is unlawful for any facility to employ any person in
the capacity of nursing assistant, habilitation aide, or child
care aide, or under any other title, not licensed by the State

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of Illinois to assist in the personal, medical, or nursing care
of residents in such facility unless such person has complied
with this Section.
(d) Proof of compliance by each employee with the
requirements set out in this Section shall be maintained for
each such employee by each facility in the individual personnel
folder of the employee. Proof of training shall be obtained
only from the Health Care Worker Registry.
(e) Each facility shall obtain access to the Health Care
Worker Registry's web application, maintain the employment and
demographic information relating to each employee, and verify
by the category and type of employment that each employee
subject to this Section meets all the requirements of this
Section.
(f) Any facility that is operated under Section 3-803 shall
be exempt from the requirements of this Section.
(g) Each skilled nursing and intermediate care facility
that admits persons who are diagnosed as having Alzheimer's
disease or related dementias shall require all nursing
assistants, habilitation aides, or child care aides, who did
not receive 12 hours of training in the care and treatment of
such residents during the training required under paragraph (5)
of subsection (a), to obtain 12 hours of in-house training in
the care and treatment of such residents. If the facility does
not provide the training in-house, the training shall be
obtained from other facilities, community colleges or other

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educational institutions that have a recognized course for such
training. The Department shall, by rule, establish a recognized
course for such training. The Department's rules shall provide
that such training may be conducted in-house at each facility
subject to the requirements of this subsection, in which case
such training shall be monitored by the Department.
The Department's rules shall also provide for
circumstances and procedures whereby any person who has
received training that meets the requirements of this
subsection shall not be required to undergo additional training
if he or she is transferred to or obtains employment at a
different facility or a facility other than a long-term care
facility but remains continuously employed for pay as a nursing
assistant, habilitation aide, or child care aide. Individuals
who have performed no nursing or nursing-related services for a
period of 24 consecutive months shall be listed as "inactive"
and as such do not meet the requirements of this Section.
Licensed sheltered care facilities shall be exempt from the
requirements of this Section.
An individual employed during the COVID-19 pandemic as a
nursing assistant in accordance with any Executive Orders,
emergency rules, or policy memoranda related to COVID-19 shall
be assumed to meet competency standards and may continue to be
employed as a certified nurse assistant when the pandemic ends
and the Executive Orders or emergency rules lapse. Such
individuals shall be listed on the Department's Health Care

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Worker Registry website as "active".
(Source: P.A. 100-297, eff. 8-24-17; 100-432, eff. 8-25-17;
100-863, eff. 8-14-18.)
Article 40.
Section 40-5. The Nurse Practice Act is amended by changing
Sections 55-35 and 60-40 as follows:
(225 ILCS 65/55-35)
(Section scheduled to be repealed on January 1, 2028)
Sec. 55-35. Continuing education for LPN licensees. The
Department may adopt rules of continuing education for licensed
practical nurses that require 20 hours of continuing education
per 2-year license renewal cycle. The rules shall address
variances in part or in whole for good cause, including without
limitation illness or hardship. The continuing education rules
must ensure that licensees are given the opportunity to
participate in programs sponsored by or through their State or
national professional associations, hospitals, or other
providers of continuing education. The continuing education
rules must allow for a licensee to complete all required hours
of continuing education in an online format. Each licensee is
responsible for maintaining records of completion of
continuing education and shall be prepared to produce the
records when requested by the Department.

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(Source: P.A. 95-639, eff. 10-5-07.)
(225 ILCS 65/60-40)
(Section scheduled to be repealed on January 1, 2028)
Sec. 60-40. Continuing education for RN licensees. The
Department may adopt rules of continuing education for
registered professional nurses licensed under this Act that
require 20 hours of continuing education per 2-year license
renewal cycle. The rules shall address variances in part or in
whole for good cause, including without limitation illness or
hardship. The continuing education rules must ensure that
licensees are given the opportunity to participate in programs
sponsored by or through their State or national professional
associations, hospitals, or other providers of continuing
education. The continuing education rules must allow for a
licensee to complete all required hours of continuing education
in an online format. Each licensee is responsible for
maintaining records of completion of continuing education and
shall be prepared to produce the records when requested by the
Department.
(Source: P.A. 95-639, eff. 10-5-07.)
Section 40-10. The Nursing Home Administrators Licensing
and Disciplinary Act is amended by changing Section 11 as
follows:

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(225 ILCS 70/11) (from Ch. 111, par. 3661)
(Section scheduled to be repealed on January 1, 2028)
Sec. 11. Expiration; renewal; continuing education. The
expiration date and renewal period for each license issued
under this Act shall be set by rule.
Each licensee shall provide proof of having obtained 36
hours of continuing education in the 2 year period preceding
the renewal date of the license as a condition of license
renewal. The continuing education rules must allow for a
licensee to complete all required hours of continuing education
in an online format. The continuing education requirement may
be waived in part or in whole for such good cause as may be
determined by rule.
Any continuing education course for nursing home
administrators approved by the National Continuing Education
Review Service of the National Association of Boards of
Examiners of Nursing Home Administrators will be accepted
toward satisfaction of these requirements.
Any continuing education course for nursing home
administrators sponsored by the Life Services Network of
Illinois, Illinois Council on Long Term Care, County Nursing
Home Association of Illinois, Illinois Health Care
Association, Illinois Chapter of American College of Health
Care Administrators, and the Illinois Nursing Home
Administrators Association will be accepted toward
satisfaction of these requirements.

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Any school, college or university, State agency, or other
entity may apply to the Department for approval as a continuing
education sponsor. Criteria for qualification as a continuing
education sponsor shall be established by rule.
It shall be the responsibility of each continuing education
sponsor to maintain records, as prescribed by rule, to verify
attendance.
The Department shall establish by rule a means for the
verification of completion of the continuing education
required by this Section. This verification may be accomplished
through audits of records maintained by registrants; by
requiring the filing of continuing education certificates with
the Department; or by other means established by the
Department.
Any nursing home administrator who has permitted his or her
license to expire or who has had his or her license on inactive
status may have his or her license restored by making
application to the Department and filing proof acceptable to
the Department, as defined by rule, of his or her fitness to
have his or her license restored and by paying the required
fee. Proof of fitness may include evidence certifying to active
lawful practice in another jurisdiction satisfactory to the
Department and by paying the required restoration fee.
However, any nursing home administrator whose license
expired while he or she was (1) in federal service on active
duty with the Armed Forces of the United States, or the State

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Militia called into service or training, or (2) in training or
education under the supervision of the United States
preliminary to induction into the military services, may have
his or her license renewed or restored without paying any
lapsed renewal fees if within 2 years after honorable
termination of such service, training or education, he or she
furnishes the Department with satisfactory evidence to the
effect that he or she has been so engaged and that his or her
service, training or education has been so terminated.
(Source: P.A. 95-703, eff. 12-31-07.)
Article 99.
Section 99-99. Effective date. This Act takes effect upon
becoming law.".