Bill Text: IL HB0542 | 2009-2010 | 96th General Assembly | Enrolled

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Bill Title: Amends the Illinois Public Aid Code. Provides formulas for Medicaid reimbursement of ambulance service providers for emergency ambulance services, non-emergency ambulance services, mileage, advanced life support services, and specialty care transport services. Provides that the requirement for payment of ground ambulance services by the Illinois Department of Healthcare and Family Services is met if the services are provided pursuant to a request for evaluation, treatment, and transport for an individual with a condition of such a nature that a prudent layperson would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to life or health. Requires the Department to annually update the ambulance fee schedule rates on July 1 of each year. Makes other changes.

Spectrum: Slight Partisan Bill (Democrat 12-4)

Status: (Passed) 2009-11-20 - Public Act . . . . . . . . . 96-0821 [HB0542 Detail]

Download: Illinois-2009-HB0542-Enrolled.html

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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Excellence in Academic Medicine Act is
amended by changing Sections 25, 30, and 35 as follows:
(30 ILCS 775/25)
Sec. 25. Medical research and development challenge
program.
(a) The State shall provide the following financial
incentives to draw private and federal funding for biomedical
research, technology and programmatic development:
(1) Each qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospital shall
receive a percentage of the amount available for
distribution from the National Institutes of Health
Account, equal to that hospital's percentage of the total
contracts and grants from the National Institutes of Health
awarded to qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospitals and
their affiliated medical schools during the preceding
calendar year. These amounts shall be paid from the
National Institutes of Health Account.
(2) Each qualified Chicago Medicare Metropolitan

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Statistical Area academic medical center hospital shall
receive a payment from the State equal to 25% of all funded
grants (other than grants funded by the State of Illinois
or the National Institutes of Health) for biomedical
research, technology, or programmatic development received
by that qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospital during
the preceding calendar year. These amounts shall be paid
from the Philanthropic Medical Research Account.
(3) Each qualified Chicago Medicare Metropolitan
Statistical Area academic medical center hospital that (i)
contributes 40% of the funding for a biomedical research or
technology project or a programmatic development project
and (ii) obtains contributions from the private sector
equal to 40% of the funding for the project shall receive
from the State an amount equal to 20% of the funding for
the project upon submission of documentation demonstrating
those facts to the Comptroller; however, the State shall
not be required to make the payment unless the contribution
of the qualified Chicago Medicare Metropolitan Statistical
Area academic medical center hospital exceeds $100,000.
The documentation must be submitted within 180 days of the
beginning of the fiscal year. These amounts shall be paid
from the Market Medical Research Account.
(b) No hospital under the Medical Research and Development
Challenge Program shall receive more than 20% of the total

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amount appropriated to the Medical Research and Development
Fund.
The amounts received under the Medical Research and
Development Challenge Program by the Southern Illinois
University School of Medicine in Springfield and its affiliated
primary teaching hospitals, considered as a single entity,
shall not exceed an amount equal to one-sixth of the total
amount available for distribution from the Medical Research and
Development Fund, multiplied by a fraction, the numerator of
which is the amount awarded the Southern Illinois University
School of Medicine and its affiliated teaching hospitals in
grants or contracts by the National Institutes of Health and
the denominator of which is $8,000,000.
(c) On or after the 180th day of the fiscal year the
Comptroller may transfer unexpended funds in any account of the
Medical Research and Development Fund to pay appropriate claims
against another account.
(d) The amounts due each qualified Chicago Medicare
Metropolitan Statistical Area academic medical center hospital
under the Medical Research and Development Fund from the
National Institutes of Health Account, the Philanthropic
Medical Research Account, and the Market Medical Research
Account shall be combined and one quarter of the amount payable
to each qualified Chicago Medicare Metropolitan Statistical
Area academic medical center hospital shall be paid on the
fifteenth working day after July 1, October 1, January 1, and

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March 1 or on a schedule determined by the Department of
Healthcare and Family Services by rule that results in a more
expeditious payment of the amounts due.
(e) The Southern Illinois University School of Medicine in
Springfield and its affiliated primary teaching hospitals,
considered as a single entity, shall be deemed to be a
qualified Chicago Medicare Metropolitan Statistical Area
academic medical center hospital for the purposes of this
Section.
(f) In each State fiscal year, beginning in fiscal year
2008, the full amount appropriated for the Medical research and
development challenge program for that fiscal year shall be
distributed as described in this Section.
(Source: P.A. 95-744, eff. 7-18-08.)
(30 ILCS 775/30)
Sec. 30. Post-Tertiary Clinical Services Program. The
State shall provide incentives to develop and enhance
post-tertiary clinical services. Qualified academic medical
center hospitals as defined in Section 15 may receive funding
under the Post-Tertiary Clinical Services Program for up to 3
qualified programs as defined in Section 15 in any given year;
however, qualified academic medical center hospitals may
receive continued funding for previously funded qualified
programs rather than receive funding for a new program so long
as the number of qualified programs receiving funding does not

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exceed 3. Each qualified academic medical center hospital as
defined in Section 15 shall receive an equal percentage of the
Post-Tertiary Clinical Services Fund to be used in the funding
of qualified programs. In each State fiscal year, beginning in
fiscal year 2008, the full amount appropriated for the
Post-Tertiary Clinical Services Program for that fiscal year
shall be distributed as described in this Section. One quarter
of the amount payable to each qualified academic medical center
hospital shall be paid on the fifteenth working day after July
1, October 1, January 1, and March 1 or on a schedule
determined by the Department of Healthcare and Family Services
by rule that results in a more expeditious payment of the
amounts due.
(Source: P.A. 95-744, eff. 7-18-08.)
(30 ILCS 775/35)
Sec. 35. Independent Academic Medical Center Program.
There is created an Independent Academic Medical Center Program
to provide incentives to develop and enhance the independent
academic medical center hospital. In each State fiscal year,
beginning in fiscal year 2002, the independent academic medical
center hospital shall receive funding under the Program, equal
to the full amount appropriated for that purpose for that
fiscal year. In each fiscal year, one quarter of the amount
payable to the independent academic medical center hospital
shall be paid on the fifteenth working day after July 1,

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October 1, January 1, and March 1 or on a schedule determined
by the Department of Healthcare and Family Services by rule
that results in a more expeditious payment of the amounts due.
(Source: P.A. 92-10, eff. 6-11-01.)
Section 10. The Illinois Public Aid Code is amended by
changing Sections 5A-4, 5A-8, 5A-12.2, and 5A-14 and by adding
Section 5A-12.3 as follows:
(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 years 2006
through 2008 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. Except as provided in subsection
(a-5) of this Section, the The assessment imposed by Section
5A-2 for State fiscal year 2009 and each subsequent State
fiscal year shall be due and payable in monthly installments,
each equaling one-twelfth of the assessment for the year, on

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the fourteenth State business day of each month. No installment
payment of an assessment imposed by Section 5A-2 shall be due
and payable, however, until after: (i) the Department notifies
the hospital provider, in writing, that the payment
methodologies to hospitals required under Section 5A-12,
Section 5A-12.1, or Section 5A-12.2, 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
Comptroller has issued the payments required under Section
5A-12, Section 5A-12.1, or Section 5A-12.2, whichever is
applicable for that fiscal year. Upon notification to the
Department of approval of the payment methodologies required
under Section 5A-12, Section 5A-12.1, or Section 5A-12.2,
whichever is applicable for that fiscal year, and the waiver
granted under 42 CFR 433.68, all 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 issuance by the Comptroller of the payments
required under Section 5A-12.1 or Section 5A-12.2, whichever is
applicable for that fiscal year.
(a-5) The Illinois Department may, for the purpose of
maximizing federal revenue, accelerate the schedule upon which

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assessment installments are due and payable by hospitals with a
payment ratio greater than or equal to one. Such acceleration
of due dates for payment of the assessment may be made only in
conjunction with a corresponding acceleration in access
payments identified in Section 5A-12.2 to the same hospitals.
For the purposes of this subsection (a-5), a hospital's payment
ratio is defined as the quotient obtained by dividing the total
payments for the State fiscal year, as authorized under Section
5A-12.2, by the total assessment for the State fiscal year
imposed under Section 5A-2.
(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

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penalty or interest), beginning with the most delinquent
installments.
(d) Any assessment amount that is due and payable to the
Illinois Department more frequently than once per calendar
quarter shall be remitted to the Illinois Department by the
hospital provider by means of electronic funds transfer. The
Illinois Department may provide for remittance by other means
if (i) the amount due is less than $10,000 or (ii) electronic
funds transfer is unavailable for this purpose.
(Source: P.A. 94-242, eff. 7-18-05; 95-331, eff. 8-21-07;
95-859, eff. 8-19-08.)
(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, V-A, VI, and XIV of this Code, under the
Children's Health Insurance Program Act, and under the
Covering ALL KIDS Health Insurance Act, and under the

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Senior Citizens and Disabled Persons Property Tax Relief
and Pharmaceutical Assistance 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.
(6.5) For making transfers to the Healthcare Provider
Relief Fund, except that transfers made under this
paragraph (6.5) shall not exceed $60,000,000 in the
aggregate.

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(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 year 2007 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 that 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.

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(7.8) For State fiscal year 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 that State fiscal year:
Health and Human Services
Medicaid Trust Fund..................$40,000,000
Long-Term Care Provider Fund..............$60,000,000
General Revenue Fund...................$160,000,000.
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.
(7.9) For State fiscal years 2009 through 2013, 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 that 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.
Except as provided under this paragraph, transfers
under this paragraph shall be made within 7 business days
after the payments have been received pursuant to the

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schedule of payments provided in subsection (a) of Section
5A-4. For State fiscal year 2009, transfers to the General
Revenue Fund under this paragraph shall be made on or
before June 30, 2009, as sufficient funds become available
in the Hospital Provider Fund to both make the transfers
and continue hospital payments.
(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

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other source, including interest earned thereon.
(d) (Blank).
(Source: P.A. 95-707, eff. 1-11-08; 95-859, eff. 8-19-08; 96-3,
eff. 2-27-09; 96-45, eff. 7-15-09.)
(305 ILCS 5/5A-12.2)
(Section scheduled to be repealed on July 1, 2013)
Sec. 5A-12.2. Hospital access payments on or after July 1,
2008.
(a) To preserve and improve access to hospital services,
for hospital services rendered on or after July 1, 2008, the
Illinois Department shall, except for hospitals described in
subsection (b) of Section 5A-3, make payments to hospitals as
set forth in this Section. These payments shall be paid in 12
equal installments on or before the seventh State business day
of each month, except that no payment shall be due within 100
days after the later of the date of notification of federal
approval of the payment methodologies required under this
Section or any waiver required under 42 CFR 433.68, at which
time the sum of amounts required under this Section prior to
the date of notification is due and payable. 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 and
(ii) the assessment imposed under this Article is determined to
be a permissible tax under Title XIX of the Social Security

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Act.
(a-5) The Illinois Department may, when practicable,
accelerate the schedule upon which payments authorized under
this Section are made.
(b) Across-the-board inpatient adjustment.
(1) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois general
acute care hospital an amount equal to 40% of the total
base inpatient payments paid to the hospital for services
provided in State fiscal year 2005.
(2) In addition to rates paid for inpatient hospital
services, the Department shall pay to each freestanding
Illinois specialty care hospital as defined in 89 Ill. Adm.
Code 149.50(c)(1), (2), or (4) an amount equal to 60% of
the total base inpatient payments paid to the hospital for
services provided in State fiscal year 2005.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay to each freestanding
Illinois rehabilitation or psychiatric hospital an amount
equal to $1,000 per Medicaid inpatient day multiplied by
the increase in the hospital's Medicaid inpatient
utilization ratio (determined using the positive
percentage change from the rate year 2005 Medicaid
inpatient utilization ratio to the rate year 2007 Medicaid
inpatient utilization ratio, as calculated by the
Department for the disproportionate share determination).

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(4) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois
children's hospital an amount equal to 20% of the total
base inpatient payments paid to the hospital for services
provided in State fiscal year 2005 and an additional amount
equal to 20% of the base inpatient payments paid to the
hospital for psychiatric services provided in State fiscal
year 2005.
(5) In addition to rates paid for inpatient hospital
services, the Department shall pay to each Illinois
hospital eligible for a pediatric inpatient adjustment
payment under 89 Ill. Adm. Code 148.298, as in effect for
State fiscal year 2007, a supplemental pediatric inpatient
adjustment payment equal to:
(i) For freestanding children's hospitals as
defined in 89 Ill. Adm. Code 149.50(c)(3)(A), 2.5
multiplied by the hospital's pediatric inpatient
adjustment payment required under 89 Ill. Adm. Code
148.298, as in effect for State fiscal year 2008.
(ii) For hospitals other than freestanding
children's hospitals as defined in 89 Ill. Adm. Code
149.50(c)(3)(B), 1.0 multiplied by the hospital's
pediatric inpatient adjustment payment required under
89 Ill. Adm. Code 148.298, as in effect for State
fiscal year 2008.
(c) Outpatient adjustment.

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(1) In addition to the rates paid for outpatient
hospital services, the Department shall pay each Illinois
hospital an amount equal to 2.2 multiplied by the
hospital's ambulatory procedure listing payments for
categories 1, 2, 3, and 4, as defined in 89 Ill. Adm. Code
148.140(b), for State fiscal year 2005.
(2) In addition to the rates paid for outpatient
hospital services, the Department shall pay each Illinois
freestanding psychiatric hospital an amount equal to 3.25
multiplied by the hospital's ambulatory procedure listing
payments for category 5b, as defined in 89 Ill. Adm. Code
148.140(b)(1)(E), for State fiscal year 2005.
(d) Medicaid high volume adjustment. In addition to rates
paid for inpatient hospital services, the Department shall pay
to each Illinois general acute care hospital that provided more
than 20,500 Medicaid inpatient days of care in State fiscal
year 2005 amounts as follows:
(1) For hospitals with a case mix index equal to or
greater than the 85th percentile of hospital case mix
indices, $350 for each Medicaid inpatient day of care
provided during that period; and
(2) For hospitals with a case mix index less than the
85th percentile of hospital case mix indices, $100 for each
Medicaid inpatient day of care provided during that period.
(e) Capital adjustment. In addition to rates paid for
inpatient hospital services, the Department shall pay an

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additional payment to each Illinois general acute care hospital
that has a Medicaid inpatient utilization rate of at least 10%
(as calculated by the Department for the rate year 2007
disproportionate share determination) amounts as follows:
(1) For each Illinois general acute care hospital that
has a Medicaid inpatient utilization rate of at least 10%
and less than 36.94% and whose capital cost is less than
the 60th percentile of the capital costs of all Illinois
hospitals, the amount of such payment shall equal the
hospital's Medicaid inpatient days multiplied by the
difference between the capital costs at the 60th percentile
of the capital costs of all Illinois hospitals and the
hospital's capital costs.
(2) For each Illinois general acute care hospital that
has a Medicaid inpatient utilization rate of at least
36.94% and whose capital cost is less than the 75th
percentile of the capital costs of all Illinois hospitals,
the amount of such payment shall equal the hospital's
Medicaid inpatient days multiplied by the difference
between the capital costs at the 75th percentile of the
capital costs of all Illinois hospitals and the hospital's
capital costs.
(f) Obstetrical care adjustment.
(1) In addition to rates paid for inpatient hospital
services, the Department shall pay $1,500 for each Medicaid
obstetrical day of care provided in State fiscal year 2005

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by each Illinois rural hospital that had a Medicaid
obstetrical percentage (Medicaid obstetrical days divided
by Medicaid inpatient days) greater than 15% for State
fiscal year 2005.
(2) In addition to rates paid for inpatient hospital
services, the Department shall pay $1,350 for each Medicaid
obstetrical day of care provided in State fiscal year 2005
by each Illinois general acute care hospital that was
designated a level III perinatal center as of December 31,
2006, and that had a case mix index equal to or greater
than the 45th percentile of the case mix indices for all
level III perinatal centers.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay $900 for each Medicaid
obstetrical day of care provided in State fiscal year 2005
by each Illinois general acute care hospital that was
designated a level II or II+ perinatal center as of
December 31, 2006, and that had a case mix index equal to
or greater than the 35th percentile of the case mix indices
for all level II and II+ perinatal centers.
(g) Trauma adjustment.
(1) In addition to rates paid for inpatient hospital
services, the Department shall pay each Illinois general
acute care hospital designated as a trauma center as of
July 1, 2007, a payment equal to 3.75 multiplied by the
hospital's State fiscal year 2005 Medicaid capital

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payments.
(2) In addition to rates paid for inpatient hospital
services, the Department shall pay $400 for each Medicaid
acute inpatient day of care provided in State fiscal year
2005 by each Illinois general acute care hospital that was
designated a level II trauma center, as defined in 89 Ill.
Adm. Code 148.295(a)(3) and 148.295(a)(4), as of July 1,
2007.
(3) In addition to rates paid for inpatient hospital
services, the Department shall pay $235 for each Illinois
Medicaid acute inpatient day of care provided in State
fiscal year 2005 by each level I pediatric trauma center
located outside of Illinois that had more than 8,000
Illinois Medicaid inpatient days in State fiscal year 2005.
(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 2007, a supplemental tertiary care adjustment
payment equal to the tertiary care adjustment payment required
under 89 Ill. Adm. Code 148.296, as in effect for State fiscal
year 2007.
(i) Crossover adjustment. In addition to rates paid for
inpatient services, the Department shall pay each Illinois
general acute care hospital that had a ratio of crossover days
to total inpatient days for medical assistance programs

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administered by the Department (utilizing information from
2005 paid claims) greater than 50%, and a case mix index
greater than the 65th percentile of case mix indices for all
Illinois hospitals, a rate of $1,125 for each Medicaid
inpatient day including crossover days.
(j) Magnet hospital adjustment. In addition to rates paid
for inpatient hospital services, the Department shall pay to
each Illinois general acute care hospital and each Illinois
freestanding children's hospital that, as of February 1, 2008,
was recognized as a Magnet hospital by the American Nurses
Credentialing Center and that had a case mix index greater than
the 75th percentile of case mix indices for all Illinois
hospitals amounts as follows:
(1) For hospitals located in a county whose eligibility
growth factor is greater than the mean, $450 multiplied by
the eligibility growth factor for the county in which the
hospital is located for each Medicaid inpatient day of care
provided by the hospital during State fiscal year 2005.
(2) For hospitals located in a county whose eligibility
growth factor is less than or equal to the mean, $225
multiplied by the eligibility growth factor for the county
in which the hospital is located for each Medicaid
inpatient day of care provided by the hospital during State
fiscal year 2005.
For purposes of this subsection, "eligibility growth
factor" means the percentage by which the number of Medicaid

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recipients in the county increased from State fiscal year 1998
to State fiscal year 2005.
(k) For purposes of this Section, a hospital that is
enrolled to provide Medicaid services during State fiscal year
2005 shall have its utilization and associated reimbursements
annualized prior to the payment calculations being performed
under this Section.
(l) 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 or a managed care
organization reimbursed on a capitated basis was liable for
payment, except where explicitly stated otherwise in this
Section.
(m) For purposes of this Section, in determining the
percentile ranking of an Illinois hospital's case mix index or
capital costs, hospitals described in subsection (b) of Section
5A-3 shall be excluded from the ranking.
(n) 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
March 1, 2008. Other terms shall be defined by the Illinois
Department by rule.
As used in this Section, unless the context requires

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otherwise:
"Base inpatient payments" means, for a given hospital, the
sum of base payments for inpatient services made on a per diem
or per admission (DRG) basis, excluding those portions of per
admission payments that are classified as capital payments.
Disproportionate share hospital adjustment payments, Medicaid
Percentage Adjustments, Medicaid High Volume Adjustments, and
outlier payments, as defined by rule by the Department as of
January 1, 2008, are not base payments.
"Capital costs" means, for a given hospital, the total
capital costs determined using the most recent 2005 Medicare
cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on December 31,
2006, divided by the total inpatient days from the same cost
report to calculate a capital cost per day. The resulting
capital cost per day is inflated to the midpoint of State
fiscal year 2009 utilizing the national hospital market price
proxies (DRI) hospital cost index. If a hospital's 2005
Medicare cost report is not contained in the Healthcare Cost
Report Information System, the Department may obtain the data
necessary to compute the hospital's capital costs 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.
"Case mix index" means, for a given hospital, the sum of

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the DRG relative weighting factors in effect on January 1,
2005, for all general acute care admissions for State fiscal
year 2005, excluding Medicare crossover admissions and
transplant admissions reimbursed under 89 Ill. Adm. Code
148.82, divided by the total number of general acute care
admissions for State fiscal year 2005, excluding Medicare
crossover admissions and transplant admissions reimbursed
under 89 Ill. Adm. Code 148.82.
"Medicaid inpatient day" means, for a given hospital, the
sum of days of inpatient hospital days provided to recipients
of medical assistance under Title XIX of the federal Social
Security Act, excluding days for individuals eligible for
Medicare under Title XVIII of that Act (Medicaid/Medicare
crossover days), as tabulated from the Department's paid claims
data for admissions occurring during State fiscal year 2005
that was adjudicated by the Department through March 23, 2007.
"Medicaid obstetrical day" means, for a given hospital, the
sum of days of inpatient hospital days grouped by the
Department to DRGs of 370 through 375 provided to recipients of
medical assistance under Title XIX of the federal Social
Security Act, excluding days for individuals eligible for
Medicare under Title XVIII of that Act (Medicaid/Medicare
crossover days), as tabulated from the Department's paid claims
data for admissions occurring during State fiscal year 2005
that was adjudicated by the Department through March 23, 2007.
"Outpatient ambulatory procedure listing payments" means,

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for a given hospital, the sum of payments for ambulatory
procedure listing services, as described in 89 Ill. Adm. Code
148.140(b), provided to recipients of medical assistance under
Title XIX of the federal Social Security Act, excluding
payments for individuals eligible for Medicare under Title
XVIII of the Act (Medicaid/Medicare crossover days), as
tabulated from the Department's paid claims data for services
occurring in State fiscal year 2005 that were adjudicated by
the Department through March 23, 2007.
(o) The Department may adjust payments made under this
Section 12.2 to comply with federal law or regulations
regarding hospital-specific payment limitations on
government-owned or government-operated hospitals.
(p) Notwithstanding any of the other provisions of this
Section, the Department is authorized 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 5-50 of the Illinois Administrative Procedure Act.
Notwithstanding any other provision of law, any changes
implemented as a result of this subsection (p) shall be given
retroactive effect so that they shall be deemed to have taken
effect as of the effective date of this Section.
(q) For State fiscal years 2012 and 2013, the Department
may make recommendations to the General Assembly regarding the

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use of more recent data for purposes of calculating the
assessment authorized under Section 5A-2 and the payments
authorized under this Section 5A-12.2.
(Source: P.A. 95-859, eff. 8-19-08.)
(305 ILCS 5/5A-12.3 new)
Sec. 5A-12.3. Hospital Medicaid Stimulus Payments.
(a) Supplemental payments. Subject to federal approval and
as soon as practicable after the effective date of this
amendatory Act of the 96th General Assembly, the Department
shall make a one-time Medicaid supplemental payment to
hospitals for inpatient and outpatient Medicaid services. This
payment shall be the sum of the following payment
methodologies:
(1) In addition to the rates paid for outpatient
hospital services, the Department shall pay all rural
hospitals a supplemental outpatient payment in an amount
equal to the hospital's outpatient ambulatory procedure
listing payments for Group 3 as defined in 89 Ill. Adm.
Code 148.140(b)(1)(C), for State fiscal year 2005. For a
hospital qualified as a critical access hospital, as
designated by the Illinois Department of Public Health in
accordance with 42 CFR 485, Subpart F (2001), the payment
amount under this paragraph (1) shall be multiplied by 3.5.
In order to qualify for payments under this Section a
hospital must:

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(A) Be a hospital that is licensed by the
Department of Public Health under the Hospital
Licensing Act, certified by that Department to
participate in the Illinois Medicaid Program, and
enrolled with the Department of Healthcare and Family
Services to participate in the Illinois Medicaid
Program;
(B) Provide services as required under 77 Ill. Adm.
Code 250.710 in an emergency room subject to the
requirements under either 77 Ill. Adm. Code
250.2440(k) or 77 Ill. Adm. Code 250.2630(k); and
(C) Be a rural Illinois hospital, as defined at 89
Ill. Adm. Code 148.25(g)(3).
(2) In addition to the rates paid for inpatient
hospital services, the Department shall pay $175 for each
Medicaid obstetrical day of care by each Illinois general
acute care hospital that was designated a level III
perinatal center as of July 1, 2009 and provided more than
2,000 Medicaid obstetrical days of service.
(3) In addition to the rates paid for inpatient
hospital services, the Department shall pay $22 for each
Medicaid inpatient day to each hospital designated as a
Level I Trauma Center. For the purpose of this Section, a
Level I Trauma Center is a hospital designated by the
Department of Public Health using the criteria under 77
Ill. Adm. Code 515.2030 or 77 Ill. Adm. Code 515.2035 as of

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July 1, 2009. For the purposes of this payment, hospitals
located in the same city that alternate their Level I
Trauma Center designation as defined in 89 Ill. Adm. Code
148.295(a)(2) shall both be eligible to receive this
payment.
(4) In addition to the rates paid for inpatient
hospital services, the Department shall pay $37 for each
Medicaid inpatient day.
(5) In addition to the rates paid for inpatient
hospital services, the Department shall pay an additional
$35 for each Medicaid inpatient day to each hospital
qualifying for a payment in paragraph (4) of this
subsection (a) that also qualifies for payments under 89
Ill. Adm. Code 148.120 or 89 Ill. Adm. Code 148.122 for the
rate period beginning October 1, 2009.
(b) Exclusions from payments under this Section.
(1) A hospital that is operated by a State agency, a
State university, or a county with a population of
3,000,000 or more is not eligible for any payment under
this Section.
(2) A hospital as defined in 89 Ill. Adm. Code
149.50(c)(4) is not eligible for any payment under
paragraph (4) or (5) of subsection (a) of this Section.
(3) A hospital as defined in 89 Ill. Adm. Code
149.50(c)(1) or 89 Ill. Adm. Code 149.50(c)(2) is not
eligible for any payment under paragraph (5) of subsection

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(a) of this Section.
(4) A hospital that ceases operations prior to federal
approval of, and adoption of administrative rules
necessary to effect, payments under this Section is not
eligible for any payment under this Section.
(5) A hospital that has filed for bankruptcy or is
operating under bankruptcy protection under any Chapter of
Title 11 of the United States Code (Bankruptcy) is not
eligible for any payment under this Section.
(c) 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 Department's administrative rules as in effect on March 1,
2008. As used in this Section, unless the context requires
otherwise:
(1) “Medicaid inpatient day” has the same meaning as
defined in subsection (n) of Section 5A-12.2.
(2) “Hospital” means any facility located in Illinois
that is required to submit cost reports as mandated under
89 Ill. Adm. Code 148.210.
(3) “Medicaid obstetrical day” has the same meaning
ascribed to it in subsection (n) of Section 5A-12.2.
(4) "Outpatient ambulatory procedure listing payments"
means, for a given hospital, the sum of payments for
ambulatory procedure listing services, as described in 89

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Ill. Adm. Code 148.140(b)(1)(C), provided to recipients of
medical assistance under Title XIX of the federal Social
Security Act, excluding payments for individuals eligible
for Medicare under Title XVIII of the Act
(Medicaid/Medicare crossover days), as tabulated from the
Department's paid claims data for services occurring in
State fiscal year 2005 that were adjudicated by the
Department through March 23, 2007.
(d) Funding sources. Payments under this Section shall be
made from the Healthcare Provider Relief Fund.
(e) Adjustments. The Department may pay a portion of
payments made under this Section in a subsequent State fiscal
year to comply with federal law or regulations regarding
hospital-specific payment limitations.
(305 ILCS 5/5A-14)
Sec. 5A-14. Repeal of assessments and disbursements.
(a) Section 5A-2 is repealed on July 1, 2013.
(b) Section 5A-12 is repealed on July 1, 2005.
(c) Section 5A-12.1 is repealed on July 1, 2008.
(d) Section 5A-12.2 is repealed on July 1, 2013.
(e) Section 5A-12.3 is repealed on July 1, 2011.
(Source: P.A. 94-242, eff. 7-18-05; 95-859, eff. 8-19-08.)
Section 99. Effective date. This Act takes effect upon